Methylphenidate in the Treatment of Medication Induced Excessive Daytime Sleepiness: A Unique Case Report and Review of Literature

Background: Excessive daytime sleepiness (EDS) is defined as an inability to remain alert and maintain wakefulness for a majority of wakeful periods during the day. It commonly presents as subjective complaints of excessive daytime drowsiness, fatigue, or low energy occurring at inappropriate times, almost every day for at least three months. Medication-induced EDS is one of the very common encounters in psychiatric practice.

Case Presentation: We present a case of a 56-year old male with a long history of bipolar I and anxiety disorders finally stabilized after multiple medications trials with a combination of different psychotropic medications, including mood stabilizers and benzodiazepine. The patient developed severe EDS which significantly interfered his functioning and did not improve with trials of behavioral modifications and adjustment of the medications. Interestingly, the addition of low dose methylphenidate not only resulted in successful resolution of EDS without changing the only effective regimen but also, improved concentration and distractibility.

Conclusion: To the best of our knowledge, this is the first case reported in the literature suggesting possible benefits of the judicious use of methylphenidate in selected patients with medicationinduced EDS. However, clinical judgment should be made on a case-by-case basis for clinical utility and larger research studies are recommended for more conclusive results. Nonetheless, behavioral modification, sleep hygiene education, medication switch, and dose/timing adjustment should always be the first line strategies in the management of EDS induced by the medication.