Q: My wife, who is in her late forties, has suffered from depression for years. She has not responded well to the regular antidepressant drugs that she has been given by her psychiatrist such as Luvox or Prosac. Recently a friend, who also has relatives with depression, suggested a new drug called Modafinil. Is this safe and effective? Is it available in Canada?
A: Modafinil, trade name Provigil, has been around for some time for the treatment of narcolepsy, although its close relative, adrafinil, has been tested more extensively. Narcolepsy is a condition where the sufferer falls asleep all the time during the day. These attacks can occur quite suddenly, even in the middle of a conversation, and can be embarrassing or even dangerous.
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Previously, narcolepsy was treated with stimulant medications such as cocaine, Ritalin or other amphetamines. These are quite addictive, so Modafinil is thought to be a safer alternative. It is less likely to cause tremulousness, nervousness or anxiety than the others.
These drugs are well tolerated because they act on more specific regions of the brain – the anterior and lateral hypothalamus. These are the parts of the brain responsible for the sleep-wake mechanism. Modafinil causes wakefulness and alertness by directly stimulating the alpha1-adrenergic receptors in this area.
Modafinil has been used in research projects to treat Alzheimer’s, attention-deficit disorder and myotonic dystrophy, as well as depression. It is one of the so-called “smart drugs” that some people use illegally to enhance memory and IQ.
Although at this point there is no evidence to show that this drug is addictive, it may yet prove to be so. Many addictive drugs were thought to be quite safe at one time. Even the antidepressants that your wife is taking can be quite difficult to stop, and cause distressing withdrawal effects if suddenly discontinued. As Modafinil can lead to sleep deprivation, caution should be used if it is taken for any length of time. Sleep loss can affect the immune system, causing a predisposition to viral and bacterial infections.
Dr. M.A Menza and others in the department of psychiatry at New Jersey Robert Wood Medical School performed some research on this drug, using it to augment the effect of the more traditional antidepressants when the patient did not respond to treatment. They used doses of 100-200 milligrams a day. Although they only tested seven patients, all seven achieved a full or partial remission, generally within one or two weeks. They concluded that Modafinil appeared to be a promising drug when used in combination with other antidepressants.
I do not know of any research where the drug has been tested alone for the treatment of depression.
Clare Rowson is a medical doctor with a practice near Belleville, Ont. Her columns are intended for general information only. Individuals are encouraged to also seek the advice of their own doctor regarding medical questions and treatments.
