Drug counters sleepiness from antidepressants

Some people taking the newer class of antidepressants experience excessive sleepiness and fatigue, but this can be prevented with a drug that's used to treat narcolepsy, according to a new report.

Antidepressants like Prozac or Zoloft are classified as selective serotonin reuptake inhibitors, or SSRIs. Even though they have less of a sedative effect than previous types of antidepressants, some people are still affected.

Dr. Thomas L. Schwartz and colleagues at the New York Upstate Medical University in Syracuse, New York, wondered if Provigil (modafinil) - a drug approved for treating excessive sleepiness in truck drivers and shift workers, as well as patients with narcolepsy - might help patients taking SSRIs.

To investigate, the team enrolled 20 adults in a 3-week study to determine the effect of modafinil, given once daily, on sedation related to serotonergic drugs. All the participants had major depressive disorder, but all reported that sedation, fatigue, and low energy had developed only after they began to take SSRIs.

In the 16 patients who completed the study, the addition of modafinil "significantly improved overall depressive symptoms," the researchers report in the Journal of Clinical Psychiatry. Also, modafinil therapy was associated with improved subjective impressions of wakefulness and reduced fatigue.

By their final study visit, the study participants showed improvements in their overall health status and health-related quality of life.

"Generalization of these findings is limited by the open-label nature of (the study), exclusion of a control group, and selective entry criteria for study participants," Schwartz's team acknowledges. Still, they conclude, "These positive findings ... warrant further systematic study."

SOURCE: Journal of Clinical Psychiatry, September 2004.