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Modafinil Therapy for Apathy in an Elderly Patient

Staff Psychiatrist, Omaha Veterans Affairs Medical Center; Assistant Professor, Department of Psychiatry, University of Nebraska Medical Center, Omaha, NE

William J Burke, MD

Vice Chair for Research, Department of Psychiatry, University of Nebraska Medical Center

Subhash C Bhatia, MD

Chief, Mental Health and Behavioral Sciences Department, Omaha Veterans Affairs Medical Center

Reprints: Dr. Padala, University of Nebraska Medical Center, 4101 Woolworth Ave., Omaha, NE 68105, fax 402/943-5543, ppadala{at}unmc.edu

OBJECTIVE: To present a case of successful treatment of apathy syndrome with modafinil.

CASE SUMMARY: A 78-year-old man with dementia and depression was also experiencing apathy that did not respond to antidepressants including escitalopram, a selective serotonin-reuptake inhibitor (SSRI). Escitalopram was discontinued and modafinil, a novel vigilance-promoting agent pharmacologically distinct from stimulants, was used to successfully treat the apathy. The dosage regimen was initiated at 50 mg and titrated to 200 mg/day over 4 weeks. Apathy was assessed using the Apathy Evaluation Scale developed specifically to identify apathy and also to differentiate this from depression.

DISCUSSION: Apathy, a common behavioral problem, is often mistaken for depression; however, apathy differs from depression in symptomatology, clinical presentation, and treatment options. SSRIs, a common treatment for depression, are known to cause or increase apathy. Deficits in the dopamine receptor system are involved in the etiology of apathy; modafinil's increased dopaminergic transmission is thought to help alleviate apathy. Due to its relative lack of drug interactions, modafinil is a good alternative for elderly patients, who often receive multiple medications. Apathy improved significantly after treatment with modafinil in this patient. To the best of our knowledge, as of January 22, 2007, this is the first report of modafinil treatment of apathy syndrome.

CONCLUSIONS: Modafinil may be useful in treating apathy syndrome. Its role in the treatment of apathy requires further testing in clinical trials.

Key Words: apathy, modafinil

Published Online, January 30, 2007. www.theannals.com, DOI 10.1345/aph.1H302

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