There are two forms of bipolar disorder: type I affects around 2% of individuals, and type II affects approximately 4% of people globally. Even with treatment, over one-third of patients experience a recurrence after one year, and two-thirds of patients experience a relapse after two years. In addition, after the onset of the disease, patients continue to experience symptoms of depression for up to one-third of their remaining weeks on earth.
It is believed that depression, not mania, is the phase of bipolar disorder (BD) that causes the most prominent issues and is most likely to result in long-term disability. This is because depression tends to last longer than mania does.
Furthermore, it would appear that bipolar depression is a chronic mental disorder that, if left untreated, can result in psychotic symptoms, impaired functioning, a decrease in quality of life, and social stigma.
Most people who have bipolar disorder have a neurocognitive impairment, as demonstrated by a significant number of research.
Some of these neurocognitive abnormalities appear to be present not only in the early stages of the illness but also in the premorbid phases before the beginning of the illness.
This means that they were present before the onset of the illness. According to the most recent studies, the areas most significantly influenced include executive functions, language acquisition, memory, and attention. The premorbid IQ, on the other hand, appears to have been unaffected.
Bipolar Disorder Treatment:
Treatment for bipolar disorders has a well-earned reputation for being difficult for the attending physician. Each guideline provides a variety of therapy options for those diagnosed with acute bipolar depression, some of which are more narrowly focused than others. A little more than one-third of those diagnosed with bipolar depression will never have a clinical remission, and treatment-resistant bipolar depression is a widespread occurrence.
Anecdotally, psychostimulants are among the drugs used to complement the treatment of bipolar depression. Despite the fact that none of these medications have a license for this usage, psychostimulants are among the medicines that are utilized. Psychostimulants now prescribed include methylphenidate (MPH) and amphetamines, including the prodrug lisdexamfetamine (LDX), which is metabolized in vivo to the active form of dextroamphetamine. Methylphenidate (MPH) is also used.
Two wakefulness-promoting agents, Modafinil and Armodafinil, are used to treat drowsiness brought on by narcolepsy, shift work sleep disorder, or obstructive sleep apnea. They can also be used as an alternate treatment for this Disorder. These conditions can cause an individual to experience excessive daytime sleepiness. They are most commonly used off-label, or without a license, for treating attention deficit hyperactivity disorder (ADHD) and bipolar disorder. Both of these conditions are mental illnesses.
It is possible to prescribe modafinil with armodafinil as a third-line treatment for bipolar disorder and acute depression in combination with a mood stabilizer. Both of these treatments are effective. A study discovered that there was no evidence to suggest that using modafinil, armodafinil, pramipexole, MPH, or amphetamines increased the likelihood of experiencing mood swings.
This suggests that these medications might be an effective alternative for treating bipolar depression. However, it also indicated that the psychostimulants had not been sufficiently examined to arrive at a definitive conclusion on their function in bipolar depression. This conclusion could not be reached because of this statement’s implication.
Mechanism of Modafinil and Armodafinil :
Both modafinil and armodafinil appear to exert most of their effects on the amygdala and the suprachiasmatic nucleus of the hypothalamus, which are the two areas of the brain that are principally responsible for wakefulness. So, it is thought that their effect on the nucleus accumbens is less critical than that of amphetamines, making them less likely to be addictive.
Both modafinil and armodafinil, modafinil’s R-enantiomer, are drugs with stimulant-like properties that promote DA- and NE-related transmission. In addition, modafinil boosts noradrenergic transmission, lowers the amount of gamma-aminobutyric acid (GABA) released, and raises the amount of glutamate released in different parts of the brain. There is no evidence that armodafinil acts as a direct or indirect DA receptor agonist.
Even though they are not very effective in treating depressive episodes, modafinil is beneficial in treating tiredness, cognitive performance, and general functioning. These benefits are observable in clinical settings and are supported by research on various illnesses, including mental disorders. For instance, armodafinil was shown to increase functioning even though it was unsuccessful in treating bipolar depression in an extensive study.
Effects on Cognitive Function :
Roughly one in three persons diagnosed with bipolar disorder experience cognitive deficits long after their manic or depressive episodes. There is not much information available regarding how to cure cognitive deficits, although modafinil may offer some potential. They are effective in treating ADHD with a moderate to significant effect size.
Although modafinil was very close to receiving FDA clearance for the treatment of ADHD, FDA halted the approval procedure after a young patient suffered from Stevens-Johnson syndrome while using it. Studies conducted on healthy individuals, people with sleep apnea, alcoholics, and people with schizophrenia found that modafinil increased short-term recollection, set-shifting, working memory, and impulsivity. This provides evidence for the cognitive advantages of modafinil.
Side Effects:
Regarding their adverse effects, modafinil and armodafinil displayed an acceptable tolerance level when given at doses of 174.2 and 150 mg/d, respectively.
The adverse effects of taking these medications to treat Bipolar Disorder are the same as the harmful effects of using these medications to treat narcolepsy and shift work sleep disorder. However, new research has shown a decreased risk of weight gain and an increased likelihood of experiencing nausea and dry mouth.
The most frequent adverse effects are headaches, nausea, feelings of anxiety, and a loss of weight. In patients diagnosed with these disorders, taking these supplements resulted in a little reduction in pressure, which the GABAergic effects of the supplements may have caused. They do not reduce sleep quality as typical stimulants do, but they can produce initial insomnia exacerbated by armodafinil because of its longer-acting effects.
There was no evidence of mania, psychosis, or addiction in studies with many thousand participants focused on mood disorders, schizophrenia, or addiction. Patients with manic episodes may benefit from taking modafinil or armodafinil because it stabilizes their sleep-wake cycle and makes it easier for them to stay awake during the day. Rarely, patients may experience severe allergic responses and moderate increases in blood pressure and pulse rate, although there is no QTc prolongation associated with these side effects.
It showed that supplementary therapy with modafinil or armodafinil for bipolar depression was related to considerably higher therapeutic response rates. There was no indication of mood switch or suicide attempts.
It is recommended that either a mood stabilizer or an atypical antipsychotic be used concurrently with any of these medications.
In periods of depression, their effects are seen gradually over the course of one to two weeks, but in most cases, they are effective immediately and may be used as needed to treat them. Most patients like armodafinil, but if they have sleeplessness while taking it, you might want to try switching them to a modest dose of modafinil instead.
Both Modafinil and Armodafinil are beneficial for treating particular symptoms of fatigue and cognitive impairment, as well as a few frequent comorbidities in people with bipolar disorder. However, both medications will seldom bring complete remission to bipolar depression.
