Modafinil reduces microsleep during partial sleep deprivation in depressed patients

Objective: Sleep deprivation (SD) can induce a prompt decrease in depressive symptoms within 24 h. Following the recovery night, however, a relapse into depression occurs in most patients. Recovery sleep, naps and even very short episodes of sleep (microsleep; MS) during SD have been shown to provoke a rapid relapse into depression. This study tested the hypothesis that modafinil reduces MS during SD and stabilizes the treatment response to PSD compared to placebo. Methods: A total of 28 patients (13 men, 15 women; age 45.1 +/- 12.1 years) with a major depressive episode and a cumulative daytime microsleep of five or more minutes were investigated using a doubleblind placebo-controlled study design. All patients were treated with a stable mirtazapine monotherapy. A partial SD (PSD) was performed after one week. Additional morning treatment with modafinil vs. placebo started during PSD and was maintained over two weeks. Sleep-EEG and MS episodes were recorded with a portable EEG. Depression severity was assessed using the Hamilton Depression Rating Scale before, during and after PSD and at follow-ups after one and two weeks. Results: Patients treated with modafinil showed significantly reduced microsleep during PSD (11.63 +/- 15.99 min) compared to the placebo group (47.77 +/- 65.31 min). This suppression of MS was not associated with the antidepressive effect of PSD. Conclusions: Compared to placebo, modafinil was efficient in reducing daytime microsleep following partial sleep deprivation but did not enhance the antidepressive effects of PSD and did not stabilize antidepressive effects over two weeks. C) 2010 Elsevier Ltd. All rights reserved.