Despite the relative lack of controlled data, psychostimulant drugs are frequently used as augmenting therapy for refractory depression. Modafinil is a nonamphetamine stimulant approved for narcolepsy often prescribed for off-label indications. While its mechanism of action is not yet fully understood it is known to be a well tolerated drug with high selectivity for the central nervous system. It also appears to have a lower abuse potential than other stimulants.

It will be presented a case report of a refractory depression that achieved symptom remission following augmentation with modafinil.

Review of clinical record and interview with the patient.

A 60 year old patient suffering from Major Depression has been highly resistant to several first-line pharmacological treatment as well as several conventional augmentation strategies and psychotherapy. The clinical picture was characterized mainly by anergy, excessive sleepiness and fatigue. Along the course of the disease the patient has been admitted to the psychiatric ward several times. During the last admission 50 mg/day of modafinil were added to the antidepressive treatment. The patient improved throughout the followup and full remission was achieved, currently being asymptomatic with modafinil monotherapy.

Modafinil proved to be an useful pharmacological option for augmentation of antidepressive therapy specially regarding symptoms of sleepiness and and fatigue. Its prescription has been increasing mostly due to off-label indications. As concerns have been raised about hypersensitivity reactions and neuropsychiatric adverse effects, further studies are needed to increase the safety of its use in this specific group of patients.