case report

Modafinil-Associated Weight Loss in a Clozapine-Treated Schizoaffective Disorder Patient

David C. Henderson, MD*, ^{1, 2}, Pearl M. Louie, MD^{1, 2}, Pamposh Koul, BS³, Leah Namey, BS³, Tara B. Daley, MPH¹ and Dana D. Nguyen, PhD¹

¹Massachusetts General Hospital Schizophrenia Program, Freedom Trail Clinic, Boston, MA, USA.

²Harvard Medical School, Boston, MA, USA.

³Northeastern University, Boston, MA, USA.

*Correspondence: Dr. Henderson, Freedom Trail Clinic, 25 Staniford Street, Boston, MA 02114. E-mail: dchenderson@partners.org

Abstract

Background. We report a case of weight loss associated with modafinil-initiation in a clozapine-treated man with schizoaffective disorder.

Methods. To report the impact of modafinil, a wake promoting agent that lacks the unwanted side affects brought on by many psychostimulants, on weight in a clozapine-treated patient.

Results. Modafinil was initiated, and over the course of 1 year, Mr. B. experienced a weight loss of 40 lbs (from 280 lbs to 240 lbs) and a reduction in body mass index (BMI) of 5.08 Kg/m² (from 35.52 Kg/m² to 30.44 Kg/m²). After 3 years on the combination of clozapine and modafinil, his weight stabilized at 230 lbs (BMI = 29.59 Kg/m²). A 30-lb weight gain over a 6-month period occurred following discontinuation of modafinil. Reinstitution of modafinil resulted in a 10-lb. weight loss over a 6-week period.

Conclusions. Modafinil treatment resulted in a significant weight loss in this patient, possibly due to reducing clozapine-associated fatigue. Randomized placebo-controlled trials are necessary to evaluate the safety and efficacy of modafinil for clozapine-associated weight gain.

Keywords   Modafinil; sedation; schizoaffective; clozapine; weight-gain; weight-loss.