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Modafinil in Poststroke Depression

To the Editor: Steven G. Sugden, M.D., and James A. Bourgeois, O.D., M.D.,¹ reported on the apparently successful treatment of "an elderly woman" (age unspecified) who supposedly developed depression subsequent to a ruptured berry aneurysm, resulting in a right frontal hematoma and frontal lobe hydrocephalus later treated with a ventriculostomy.

It should be noted that the criteria for major depression were never established and that the patient, in fact, was described as "apathetic and lethargic." The patient, who had been taking lithium before the hematoma, continued to take lithium subsequent to the bleed, but no lithium level was provided at any point in the patient’s course. She was described as initially "unable to complete any components of the Folstein Mini-Mental Status Examination (MMSE)." The trial of modafinil was started the same day that lithium was discontinued. After 3 days of modafinil and no lithium, the patient was described as "more alert and spontaneously engaged in conversation." After 10 days of modafinil and no lithium, her MMSE score was 21.

This case report, as presented, leaves the reader confused as to whether the symptoms represented true depression or stroke-induced apathy and whether the presence of lithium in an elderly patient who had suffered brain damage could be responsible for some of the reported symptoms.

REFERENCES

1. Sugden SG, Bourgeois JA: Modafinil monotherapy in poststroke depression. Psychosomatics 2004; 45:80–81[Free Full Text]

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