Modafinil (Modalert) is a wake-fulness agent. Used to stay awake, be better focused, and to work better, modafinil has also been found to be a very effective cognitive enhancer that improves the power of decision-making. It is thought to work by affecting certain brain chemicals that control the sleep/wake cycle and has been shown to enhance wakefulness, attention capacity and vigilance.
First approved for excessive sleepiness caused by narcolepsy in 1998, the drug is now frequently prescribed off-label for a host of conditions from depression to multiple sclerosis. Some researchers say it might also be used successfully to treat attention deficit hyperactivity disorder (ADHD). Although this has not been proven yet.
Approved by the US Food and Drug Administration (FDA) for treating narcolepsy, it is sold under various brand names, and is classified as a Schedule IV substance. This means it has a relatively low potential for abuse (as opposed to Schedule I, II and III drugs.) Even though researchers are still not certain how modafinil affects the brain, it appears that more and more people are asking their doctors to prescribe the drug to enhance and improve their cognitive performance. This places it firmly in the realm of a contemporary “smart drug,” and its popularity as such is increasing.
In fact in August this year (2015) British researchers published the first overview of the effect of modafinil on non-sleep-deprived people in seven years. They concluded that modafinil could be “the first well-validated pharmaceutical nootropic agent” – making it the first “real example” of a smart drug that can genuinely help with exam preparation and similar tasks.
Effects of Modafinil
Nicknamed “moda,” modafinil has become a smart drug of choice for students who take it to stay awake and focused, and to be able to work better – even though it is not licensed for this use, and is often obtained illegally, without a prescription.
While it is still not totally clear how the drug works in the brain, users and researchers report that it improves attention, executive function, memory and learning, and also creativity. It is often compared to stimulants like Ritalin and Adderall that are both schedule II amphetamines for treating ADHD. Both generally produce a sense of euphoria and are often used by healthy individuals to improve concentration and focus when studying or working on large projects. However, while Ritalin and Adderall are stimulants that increase norepinephrine and dopamine levels in the brain, modafinil seems to slow the brain down by decreasing gamma-aminobutyric acid. Ironically this produces a stimulant effect, but it doesn’t produce any sense of euphoria.
The recent British study mentioned above and below states that modafinil is a “eugeroic” (a drug that improves wakefulness and makes one more alert) that directly increases the cortical levels of catecholamine in the brain and other internal organs. It also indirectly: (1) has the effect of “upregulating” cerebral serotonin, orexin, glutamate, and also histamine levels, and (2) decreases levels of cerebral gamma-amino-butrytic acid.
Titled Modafinil for cognitive neuronhancement in healthy non-sleep-deprived subjects: A systematic review, the study was undertaken by Dr Ruairidh McLennan Battleday and Dr Anna-Katharine Brem of the Department of Experimental Psychology at the British University of Oxford.
Recognizing that it is used widely “off-prescription” for the purpose of cognitive enhancement, the two researchers state that the desire to improve executive function is the primary aim of many users. More specifically, they state that users find they are able to select and manipulate information and use it to exclude irrelevant information and focus on what is required, initiating and constructing complex plans of action.
A growing number of students who need to learn a lot quickly swear by modafinil, saying it gives them the ability to work harder, longer. Various experiences have been shared. A user who takes the drug five days a week when studying says it makes him “feel like a well-oiled machine” for about five hours. Another says she finds she can type a lot faster. One states his brain is at “ninja level.” Others say they take it because their level of focus improves radically and this translates to good exam results.
Research Into the Effects of Modafinil
Since its emergence on the medical market, modafinil has been recognized as a drug that will increase “cognitive performance” in normal, young and healthy people who have been deprived of sleep. This has lead to a substantial number of research studies aiming to learn more about its effects on learning, the acquisition of knowledge, and understanding in general. While findings vary, generally studies do back up the claims that modafinil improves cognitive and meta-cognitive performance.
Early studies showed that modafinil had a similar clinical profile to several conventional stimulants, including methylphenidate, a synthetic drug used to improve mental activity in people suffering from ADHD. This lead to the school of thought that modafinil could also be used to treat ADHD.
An early British study, published in 2002 evaluated this idea using a number of neuropsychological tests on 60 young, healthy men. Participants were required to take 100 mg or 200 mg doses of modafinil before they carried out specific tests aimed at testing memory and attention. The results confirmed earlier study results.
Another early British study had quite different results, and showed that when quite large (300 mg) single doses were given to healthy adults deprived of sleep, they tended to overestimate their cognitive abilities and become over confident. A Canadian research study published in 2004 focused on this finding in their own study, and found that the tendency was not significant. Rather, modafinil improved, not just fatigue levels, but also reaction time, vigilance, and motivation.
A British study published in 2003 reported different findings, stating that rather than affecting cognitive function, modafinil had more impact on mood. Like the Canadian study, these researchers looked at adults who weren’t sleep-deprived, but gave much lower doses of modafinil (100 mg and 200 mg) and also found that mood (including anxiety and aggression) was affected, particularly when smaller doses were given.
Another study also published in 2004 involved middle-aged people (aged 50 to 67 years) who were not sleep-deprived. Interestingly there was not much evidence of increased cognitive performance, suggesting that this is a smart drug that is most effective at a much younger age.
Yet another British study published in 2005 found that the cognitive effects of modafinil could be dependent on the IQ of the user. Researchers did a battery of tests on healthy university student volunteers two to three hours after they had taken the drug, and found that generally sustained attention was improved in terms of both speed and vigilance. However they found that some responses were slower in students who had tested for a “lower” IQ, and that the brighter students benefited most. They also concluded that the fact modafinil prevented sleepiness was an important factor.
Another published the same year (2005) was inconclusive, with results displayed by the 60 healthy students aged between 19 and 22 years ranging from insignificantly effective to performance enabling.
US researchers studying a smaller group of healthy adults administered modafinil to some participants and d-amphetamine to others. They assessed subjective effects and cognitive performance before and 30 minutes after the drugs had been administered, and then every hour for five hours. In the study report published in 2007, both drugs had a similar effect and were found to increase performance in healthy adults who were not deprived of sleep.
The 2015 Battleday and Brem study specifically reviewed the use of modafinil for “cognitive neuroenhancement” in people who were healthy and not deprived of sleep. Researchers considered as many studies as they could locate (24 in total) stretching over a 15-year period (January 1990 until December 2014). They found that of the studies that used basic testing models (which most of the older studies did):
- Most indicated that modafinil enhances “executive function.”
- Half showed improvements in attention, learning and memory.
- A few reported impaired “divergent creative thinking.”
In recent years studies have been using more complex tests, and when these were used, they found that modafinil consistently produced an improvement in attention, executive function, and learning. Additionally, these later studies did not indicate any significant evidence of side effects (see below).
Why Modafinil Is Gaining in Popularity
Nootropics (smart drugs) in general are gaining popularity, particular among younger people who need to focus, concentrate and improve their knowledge as quickly as possible. There are many different types, from nootropic peptides then there is modafinil, recently labeled the first real example of a genuine smart drug! One of the benefits of modafinil is that it isn’t a conventional stimulant, and reported side effects are minimal.
According to the federal Substance Abuse and Mental Health Services Administration, about 137,000 US college students abuse prescription stimulants every year. Ultimately, modafinil is a better bet than taking these, even though none of them is intended for use as a smart drug.
The recommended dose of Modafinil or Modalert is 200 mg given once a day.
Doses up to 400 mg/day, given as a single dose, have been well tolerated, but there is no consistent evidence that a higher dose delivers additional benefit beyond that of the 200 mg dose. Modafinil is non-addictive and the elimination half-life is 12 – 15 hours.
Take Modafinil by mouth with or without food, usually once daily in the morning or the afternoon. If you are using Modafinil for shift work sleep disorder, take it 1 hour before you start your work shift.
It is still not reliably known whether Modafinil has any side effects. A common argument is that since it has been used since the 1970s, and no serious side effects have been reported, that there probably aren’t any to be concerned about.
The recent University of Oxford study indicates that there are minimal side effects or changes in mood. Of the 24 studies Drs Battleday and Brem reviewed, 70 percent assessed the effect of modafinil on mood, and most reported that there was zero change. One of the studies reported the possibility of increased anxiety and another one reported decreased contentedness.
Only nine (37.5 percent) of the 24 studies reported on the possibility of side effects. Of these, only two of the studies found that participants had experienced any form of side effect. These were in the form of insomnia, headaches, nausea, stomach aches, and a dry mouth, but they were also reported in the placebo group! Only one of the studies assessed the potential for modafinil to be abused, finding that the possibility was very low.
Ultimately Battleday and Brem concluded that, “It appears that modafinil exerts minimal effects on mood – if anything improving it – and only rarely causes minor adverse effects.”
However, of course, consult a doctor immediately if any of these rare but serious side effects occur: mental/mood changes (e.g., agitation, confusion, depression, abnormal thoughts, hallucinations).
Seek immediate medical attention if any of these rare but very serious side effects occur: chest pain, fast/pounding/irregular heartbeat, signs of infection (e.g., fever, persistent sore throat).
A very serious allergic reaction to this cognitive enhancing drug are rare. However, stop taking this medication and seek immediate medical attention if you notice any of the following symptoms of a serious allergic reaction: rash, itching/swelling (especially of face/tongue/throat), skin blisters/peeling, severe dizziness, trouble breathing.
Contraindications and warnings
It is important to consult with your physician before using Modafinil, particularly for those with:
– Hypersensitivity to the drug or other constituents of the tablets (wheat gluten),
– Previous cardiovascular problems, particularly while using other stimulants,
– Cardiac conditions, particularly: Left ventricular hypertrophy and Mitral valve prolapse.
Before using Modafinil, tell your doctor or pharmacist of all prescription and nonprescription/herbal products you may use, especially of medications for high blood pressure. For example beta blockers such as: Atenolol or metoprolol, guanabenz, clonidine, methyldopa, prazosin, “blood thinners” (e.g. warfarin), street drugs (e.g. methamphetamine, MDMA-“ecstasy”), medications that affect liver enzymes that remove Modafinil from the body (e.g., azole antifungals such as itraconazole/ketoconazole, rifamycins such as rifabutin/rifampin, anti-seizure medications such as carbamazepine/phenobarbital).
Modafinil can speed up or slow down the removal of other medications from your body by affecting certain liver enzymes. These affected medications may include certain antidepressants (e.g. TCAs such as clomipramine or desipramine, SSRIs such as fluoxetine, fluvoxamine), cyclosporine, diazepam, phenytoin, propranolol, theophylline, triazolam.
Avoid taking MAO inhibitors (e.g., furazolidone, isocarboxazid, linezolid, moclobemide, phenelzine, procarbazine, selegiline, tranylcypromine) within 2 weeks before, during, and after treatment with Modafinil. In some cases a serious (possibly fatal) drug interaction may occur.