Manic switch in a patient with treatment-resistant bipolar depression treated with modafinil.

Sir: A number of prospective open-label studies and case reports and 1 placebo-controlled study (showing a significant effect vs. placebo on the Clinical Global ImpressionsImprovement scale and positive trends in affective rating scales) suggest that the novel psychostimulant modafinil might be a useful augmentation treatment for depressive patients who are partially responsive or nonresponsive to antidepressants. This finding applies mainly to the unipolar subtype; however, a few cases of bipolar depression are reported. No switch into mania to our knowledge has been reported yet with modafinil, in contrast to other antidepressants and psychostimulants. Only 1 case of a narcoleptic adolescent who developed a manic episode under treatment with modafinil has been described so far. Here we report the case of a woman with treatment-resistant bipolar depression who developed a manic syndrome after addition of modafinil.