Editing Modafinil (section)

====Bipolar disorder====
{{See also|Bipolar disorder}}
Modafinil is used off-label as an [[adjunctive treatment]] (i.e., in combination therapy) for the acute depressive phase in bipolar disorder.<ref name=retz-2022>{{cite book|chapter=Efficacy of Amphetamines, Methylphenidate, and Modafinil in the Treatment of Mental Disorders|doi=10.1007/978-3-030-62059-2_319|vauthors=Retz W|title=NeuroPsychopharmacotherapy |date=2022 |pages=2465–2486 |isbn=978-3-030-62058-5 }}</ref><ref name="pmid22717304">{{cite journal |vauthors=Dell'Osso B, Ketter TA |title=Use of adjunctive stimulants in adult bipolar depression |journal=Int J Neuropsychopharmacol |volume=16 |issue=1 |pages=55–68 |date=February 2013 |pmid=22717304 |doi=10.1017/S1461145712000326 |hdl=2434/265768 |hdl-access=free }}</ref><ref name="pmid28144880"/><ref name="pmid30069121">{{cite journal |vauthors=Shen YC |title=Treatment of acute bipolar depression |journal=Ci Ji Yi Xue Za Zhi |volume=30 |issue=3 |pages=141–147 |date=2018 |pmid=30069121 |pmc=6047324 |doi=10.4103/tcmj.tcmj_71_18 |doi-access=free }}</ref> The depressive phase of [[bipolar disorder]] may feature excessive sleepiness and fatigue. Adjunctive treatment with modafinil can be used as an augmentation for the main treatment to increase its effect and is safe and effective, especially for people who do not respond well to standard antidepressants.<ref name="pmid31643130">{{cite journal | vauthors = Nunez NA, Singh B, Romo-Nava F, Joseph B, Veldic M, Cuellar-Barboza A, Cabello Arreola A, Vande Voort JL, Croarkin P, Moore KM, Biernacka J, McElroy SL, Frye MA | title = Efficacy and tolerability of adjunctive modafinil/armodafinil in bipolar depression: A meta-analysis of randomized controlled trials | journal = Bipolar Disorders | volume = 22 | issue = 2 | pages = 109–120 | date = March 2020 | pmid = 31643130 | doi = 10.1111/bdi.12859 | doi-access = free | title-link = doi }}</ref><ref name="pmid36561896">{{cite journal | vauthors = Elsayed OH, Ercis M, Pahwa M, Singh B | title = Treatment-Resistant Bipolar Depression: Therapeutic Trends, Challenges and Future Directions | journal = Neuropsychiatric Disease and Treatment | volume = 18 | pages = 2927–2943 | date = 2022 | pmid = 36561896 | pmc = 9767030 | doi = 10.2147/NDT.S273503 | doi-access = free | title-link = doi }}</ref><ref name="pmid38433530"/> Modafinil does not significantly increase the risk of mood switch to mania or suicide attempts in people with bipolar disorder.<ref name="r2">{{cite web | url=https://www.proquest.com/openview/017f800499b0259521ea4ef8ccf503a8/1?pq-origsite=gscholar&cbl=5540454 | title=Modafinil in the treatment of selected mental disorders | website=[[ProQuest]] | access-date=February 14, 2024 | archive-date=February 14, 2024 | archive-url=https://web.archive.org/web/20240214153327/https://www.proquest.com/openview/017f800499b0259521ea4ef8ccf503a8/1?pq-origsite=gscholar&cbl=5540454 | url-status=live }}</ref><ref name="pmid31643130"/> Modafinil may also have cognitive benefits in people with bipolar disorder who are in a remission state.<ref name="pmid31951804">{{cite journal |vauthors=Sousa A, Dinis-Oliveira RJ |date=2020 |title=Article commentary: Pharmacokinetic and pharmacodynamic of the cognitive enhancer modafinil: Relevant clinical and forensic aspects |journal=Substance Abuse |volume=41 |issue=2 |pages=155–173 |doi=10.1080/08897077.2019.1700584 |pmid=31951804 |bibcode=2020JPkR...41..155S |s2cid=210709160}}</ref><ref name="r4">{{cite journal | doi=10.4088/JCP.19r12767 | title=The Potential Procognitive Effects of Modafinil in Major Depressive Disorder | date=2019 | journal=The Journal of Clinical Psychiatry | volume=80 | issue=6 | pmid=31599501 | s2cid=204028869 | vauthors=Vaccarino SR, McInerney SJ, Kennedy SH, Bhat V }}</ref><ref name="pmid38433530"/>

Whereas modafinil and armodafinil are approved for narcolepsy, they have been repurposed as [[adjunct therapy|adjunctive treatments]] to alleviate symptoms of acute depressive phase in people with bipolar disorder.<ref name="pmid34509090">{{cite journal | vauthors = Bartoli F, Cavaleri D, Bachi B, Moretti F, Riboldi I, Crocamo C, Carrà G | title = Repurposed drugs as adjunctive treatments for mania and bipolar depression: A meta-review and critical appraisal of meta-analyses of randomized placebo-controlled trials | journal = Journal of Psychiatric Research | volume = 143 | pages = 230–238 | date = November 2021 | pmid = 34509090 | doi = 10.1016/j.jpsychires.2021.09.018 | s2cid = 237485915 }}</ref> Drug repurposing in psychiatry is a strategy for discovering new uses for drugs that have already been approved or tested in clinical trials for other illnesses. As such, drug repurposing is a rapid, cost-effective, and reduced-risk strategy for the development of new treatment options for psychiatric disorders.<ref name="pmid34509090"/> 2021 [[meta-analysis]] concluded that add-on modafinil and armodafinil were more effective than placebo on response to treatment, clinical remission, and reduction in depressive symptoms, with only minor side effects, but the effect sizes are small and the quality of evidence is therefore low, limiting the clinical relevance of the evidence.<ref name="pmid34509090"/><ref name="r6">{{cite journal | doi=10.1080/14656566.2023.2194488 | title=An update on potential pharmacotherapies for cognitive impairment in bipolar disorder | date=2023 | journal=Expert Opinion on Pharmacotherapy | volume=24 | issue=5 | pages=641–654 | pmid=36946229 | s2cid=257665446 | vauthors=Johnson DE, McIntyre RS, Mansur RB, Rosenblat JD }}</ref> Very low rates of mood swing (a change in mood from one extreme to another)<ref name="r2"/><ref name="pmid20492846">{{cite journal | vauthors = Salvadore G, Quiroz JA, Machado-Vieira R, Henter ID, Manji HK, Zarate CA | title = The neurobiology of the switch process in bipolar disorder: a review | journal = The Journal of Clinical Psychiatry | volume = 71 | issue = 11 | pages = 1488–1501 | date = November 2010 | pmid = 20492846 | pmc = 3000635 | doi = 10.4088/JCP.09r05259gre }}</ref> have been observed with modafinil and armodafinil in depressive phase of bipolar disorder.<ref name="pmid28144880">{{cite journal | vauthors = Perugi G, Vannucchi G, Bedani F, Favaretto E | title = Use of Stimulants in Bipolar Disorder | journal = Current Psychiatry Reports | volume = 19 | issue = 1 | pages = 7 | date = January 2017 | pmid = 28144880 | doi = 10.1007/s11920-017-0758-x | s2cid = 2932701 }}</ref><ref name="pmid25295426" />