'Study drug’ Modafinil is safe to use short-term, claim researchers


A comprehensive review of the evidence into the use of Modafinil has found that it "offers significant cognitive benefits" among some people, leading to ethical concerns about its use during examinations.

The so-called 'study drug', prescribed in the UK under brand name Provigil,  is a eugeroic, or wakefulness-inducing agent, developed to treat narcolepsy, a condition where sufferers find it extremely difficult to stay awake. Until now, there has been little scientific investigation into its application among those who are not battling sleep-deprivation.

Oxford University’s Dr Ruairidh Battleday and Dr Anna-Katharine Brem from Harvard Medical School analysed 25 year’s-worth of research relating to Modafinil’s effect on cognitive enhancement, and identified 24 separate studies which looked at the benefits of the drug.

The review, published in the peer-reviewed journal European Neuropsychopharmacology, found that while the drug does not increase intelligence per se, it was found to temporarily enhance some existing cognitive functions in particular those relating to planning and decision-making, but also some benefits to learning and creativity.

Available to purchase online without prescription via a loophole which allows the import of the medicine for personal use, concerns have previously been raised about the safety and efficacy of the drug among those not suffering from narcolepsy or sleep-deprivation.

It is, according to a survey run by the Oxford University newspaper The Tab, used by 26% of its students to help them stay alert during revision for and during exams. Reportedly, the US Air Force have also used it in the past to help pilots stay alert during long flights.

Depending on the dose, effects can typically last for around 24 hours but many regular users have reported sleep disturbances, headaches, nausea and irritability, leading to questions among some users around the negative benefits outweighing the positive in the longer-term.

Researchers found that performance varied according to the task, with use prior to undertaking longer, more complex tasks offering the most consistent benefits. In addition, one study appeared to suggest that using the drug made usually mundane tasks more pleasureable.

With depression cited as a possible side effect, 70% of the studies analysed considered the effects of the drug on mood and other side effects and found very little evidence overall, although both test and placebo groups reported side effects including insomnia, nausea, headaches and stomach ache.

Oxford University's Dr Ruairidh Battleday says of the findings: "Interestingly, we found that the type of test used to assess modafinil’s cognitive benefits has changed over the last few decades. In the past, people were using very basic tests of cognition, developed for neurologically-impaired individuals. In contrast, more recent studies have, in general, used more complex tests: when these are used, it appears that modafinil more reliably enhances cognition: in particular ‘higher’ brain functions that rely on contribution from multiple simple cognitive processes."

Dr Anna-Katharine Brem, University of Oxford and Harvard Medical School, says they drew two primary conclusions: "First, that, in the face of vanishingly few side effects in these controlled environments, modafinil can be considered a cognitive enhancer; and, second that we need to figure out better ways of testing normal or even supra-normal cognition in a reliable manner. However, we would like to stress the point that with any method used to enhance cognition, ethical considerations always have to be taken into account: this is an important avenue for future work to explore."

Professor Guy Goodwin, President of the European College of Neuropsychopharmacology (ECNP), who described the findings as "the first real example of a smart drug", added: "Previous ethical discussion of such agents has tended to assume extravagant effects before it was clear that there were any. If correct, the present update means the ethical debate is real: how should we classify, condone or condemn a drug that improves human performance in the absence of pre-existing cognitive impairment?"

Side effects

According to medicines information firm Datapharm, Modafinil, brand name Provigil, has a number of commonly reported side effects and contraindications or possible interactions with other medicines.

Common (1 in 100) side-effects include anxiety or worsening of existing anxiety, depression, insomnia and increased heart rate. The drug may also interact with a number of other medicines, including selective serotonin re-uptake inhibitors (SSRI’s), propranolol and buspirone – medicines commonly prescribed to treat stress, anxiety and depression. It also decreases the effectiveness of some contraceptives.

This means there may be hidden health implications for those who are regularly taking the drug and, unbeknownst to their GP, seek treatment for the above conditions – likely to be relatively common among students experiencing stressful revision and exam periods.

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