“Hypersexuality Associated With Modafinil Use”, Muhammet Sancaktar, Bahadır Demir, Abdurrahman Altındag2023 (modafinil)⁠:

…A 24-year-old single male patient with a bachelor’s degree is currently unemployed and preparing for exams. The patient has complaints of unhappiness, malaise, lack of taste for life, attention deficit, increased appetite, daytime sleepiness and sexual reluctance, which started due to not being employed for about two years. The patient was diagnosed with major depressive disorder with these complaints. The patient had previously used escitalopram, fluoxetine and venlafaxine but did not benefit. The patient was also started on methylphenidate for attention deficit because he was studying for an exam but could not tolerate it. Then he started to use sertraline 200 mg and modafinil 200 mg, from which he did not benefit from sertraline as well. He’s only been on modafinil for the last 2 months. When he presented to our clinic, he was only on modafinil 400 mg/day. The patient’s complaint at presentation to our clinic was increased sexual drive after the modafinil dose adjustment from 200 mg to 400 mg. The patient, suffering from sexual reluctance and inability to orgasm for the last two years, had increased sexual desire, dissatisfaction despite masturbation 6× a day, incapability to study for exams due to these reasons, and deterioration in functionality in life after 400 mg/day modafinil dose adjustment.

…Due to ongoing major depressive disorder and concentration problems, we started bupropion 150 mg/day and discontinued modafinil treatment. After 2 weeks he called for a follow-up. At the follow-up, sexual desire and urges returned to standard, and there was a decrease in depressive complaints. On subsequent follow-up visits, we achieved remission with bupropion 300mg/day treatment.

…Two cases of modafinil-related hypersexuality have been reported in the literature (Bulut et al 2015; Swapnajeet et al 2016). The case published by Swapnajeet et al 2016 is a case of hypersexuality resulting from increasing the dose of modafinil to 1000mg/day in a patient diagnosed with bipolar disorder. Unlike our case, hypersexuality, in this case, may be due to the underlying excess sexual desire related to the manic phase of bipolar disorder. Our patient was a patient with major depressive disorder with complaints of sexual anorexia. The case published by Bulut et al 2015 is a case of hypersexuality developing upon initiation of 200 mg/day modafinil in a patient diagnosed with narcolepsy. In this case, hypersexuality developed with a lower dose of modafinil and this adverse effect disappeared after the modafinil dose was reduced to 50mg/day. In our case, the development of higher doses may be the reason for the diagnosis of depression. In addition to hypersexuality, there are cases of spontaneous orgasm (Uca & Altaş 2014) and spontaneous ejaculation (Aras2021) associated with modafinil use.