Modafinil and Psychosis

[Pharmavixen]

I don't want her to find this.

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[zelman]

I haven't heard of it, but I'm no expert. Is she taking any other medications? Just looking for alternate explanations.

 

[Pharmavixen]

Just OCs and mirtazepine, though there's the possibility that in the lead-up to this episode, she took ciprofloxacin and fluconazole, both inhibitors of CYP 3A4, of which modafinil is a minor substrate.

 

[TheThorn]

This is a great question... for a psychiatrist. No offense, but you're not qualified to address this. When you're a hammer, everything looks like a nail. Since you're a pharmacist, you think it may be a medication side effect. If you were a DEA agent, you'd think she was secretly using meth. If you were a chemist, you'd think she was exposed to some harmful chemicals at work. And so on. Only a psychiatrist is qualified enough to truly assess her.

 

[zelman]

Just OCs and mirtazepine, though there's the possibility that in the lead-up to this episode, she took ciprofloxacin and fluconazole, both inhibitors of CYP 3A4, of which modafinil is a minor substrate.

Psychosis from OC induced cerebral blood clot is about as likely as modafinil causing psychosis after several years of use. TheThorn is right, they need a more in-depth workup, but pharmaceuticals aren't the worst place to start.

-- zelman

 

[Pharmavixen]

This is a great question... for a psychiatrist.

Well, obviously. The struggle here is getting a highly paranoid person into treatment. Who thinks she needs the drug to maintain a high level of vigilance in order to ensure her safety. Her psychiatrist has seen her since I first posted this, but the Mental Health Act is specific about when you can force someone into treatment.

No offense, but you're not qualified to address this.

Again, duh. As medical folks, we know that prompt admission to hospital and a complete workup is essential and possibly life-saving.
For late-onset psychosis, an organic cause is probable, but getting her into treatment is the whole problem.

 

[farmadiazepine]

She sounds sick. She needs to have a psychiatrist see her. That's obvious mental illness right there.

 

[knight on horse]

Modafinil = dopamine = psychosis

Lots of dopamine is always good until you hit that threshold. Different for each person

 

[Aznfarmerboi]

This is a great question... for a psychiatrist. No offense, but you're not qualified to address this. When you're a hammer, everything looks like a nail. Since you're a pharmacist, you think it may be a medication side effect. If you were a DEA agent, you'd think she was secretly using meth. If you were a chemist, you'd think she was exposed to some harmful chemicals at work. And so on. Only a psychiatrist is qualified enough to truly assess her.

No offense to you either buddy.. and none taken, but we as professionals know what we are qualified and not qualified to do. That is why we are professionals.

 

[rxlea]

I've seen two patients experience psychosis while on modafinil. One stopped taking her mood stabilizer, but continued the modafinil and SSRI.

The other took twice the amount to stay awake for a week because of supposed nightmares (also experiencing delusions/paranoia). That one had stopped taking it because of bruxism but started again a couple months later on the double dose (400mg).

Pharmacologically it makes sense it could contribute to psychosis, but I'd be hard pressed to conclude it directly causes psychosis alone, especially if she's been on it awhile. I mean, I guess it could happen

Has she ever stopped it and started it again?

 

[rxlea]

The second patient had an underlying psychiatric disorder as well.

 

[Pharmavixen]

I've seen two patients experience psychosis while on modafinil. One stopped taking her mood stabilizer, but continued the modafinil and SSRI.

The other took twice the amount to stay awake for a week because of supposed nightmares (also experiencing delusions/paranoia). That one had stopped taking it because of bruxism but started again a couple months later on the double dose (400mg).

Pharmacologically it makes sense it could contribute to psychosis, but I'd be hard pressed to conclude it directly causes psychosis alone, especially if she's been on it awhile. I mean, I guess it could happen

I also found some anecdotes on Erowid where they report bruxism.

Has she ever stopped it and started it again?

Unknown. I thought modafinil was ok; less dopaminergic than amphetamines. But it does inhibit the dopamine transporter in the CNS in the same areas of the brain as cocaine (much more weakly, of course).

 

[rxlea]

Interesting. Could be an good case study. The staying up all night to research or do other things seems fairly common- at least that's what my patients in the medication groups told me. Mostly they complained about bruxism and xerostomia and liked the alertness sans the tachycardia, which the amphetamines gave them.

I'd say it is possible since you can pretty much isolate it to starting the drug in her case. Despite the less dopaminergic effects, as you know, some people are just more sensitive. I saw plenty of patients that complained of OCD tendencies while on Abilify.