The drug modafinil was developed to treat narcolepsy (excessive sleepiness), but is widely used without a license as a ‘smart drug’ to promote mental development, where qualities such as alertness and concentration are needed to help a person, for example, test preparation. Previous research on people who have lost sleep has shown a positive effect of modafinil on these activities, but there has been little attention and scientific consensus on the full effectiveness of the drug as a cognitive enhancer in insomnia - probably most people take. Now, a new systematic review, published online in the peer-reviewed journal European Neuropsychopharmacology, shows that modafinil offers significant cognitive benefits in this group, at least in a specific subset of activities.
Dr. Ruairidh Battleday and Dr. Anna-Katharine Brem from the University of Oxford and Harvard Medical School reviewed all research papers on modafinil improvement from January 1990 to December 2014. They found 24 studies on the various benefits associated with taking modafinil, including between planning and decision-making, flexibility, learning and remembering, and art.
Surprisingly, they found that the potency of modafinil varied according to activity. What has emerged is that when work is long-term and complex, continuous modafinil offers cognitive benefits.
Modafinil did not make a difference in working memory, or in mood swings, but improved decision-making and planning. Most encouragingly, 70% of studies looking at modafinil effects on mood and side effects showed very little overall effect, whether the couple reported insomnia, headache, abdominal pain or nausea (also reported in the placebo group).
Ruairidh McLennan Battleday said: 'This is the first review of modafinil's actions in insomnia since 2008, so we have been able to include a lot of the latest information. Interestingly, we found that the type of experiment used to assess the cognitive benefits of modafinil has changed in the last few decades. In the past, people used basic cognitive tests, designed for people with physical disabilities. In contrast, recent studies have, in general, used more complex tests: when used, modafinil appears to improve cognitive function: especially 'higher' brain functions that rely on a contribution from many simple cognitive processes. '
Anna-Katharine Brem, a researcher at the University of Oxford and Harvard Medical School, said: 'We have come to have two main conclusions: first, that, when faced with several adverse effects in these controlled areas, modafinil can be considered a cognitive enhancer; and, secondly, we need to find better ways to test common or uncommon understanding in a reliable way. However, we would like to emphasize the point that in any way used to develop comprehension, ethical considerations must be considered: this is an important aspect of future work that you can explore. '
Professor Guy Goodwin, President of the European College of Neuropsychopharmacology (ECNP) commented: Therefore, the authors argue that ‘modafinil may be suitable for the title of the first certified nootropic drug agent’. In other words, it is the first real example of a ‘smart medicine’, which can honestly help, for example, by preparing for an exam. Preliminary discussions of the behavior of such agents tend to take dramatic results before it becomes clear that they exist. If so, the current revision means that the moral dilemma is real: how should we distinguish, allow or criticize a drug that improves human performance in the absence of existing mental disabilities?
'As the authors point out, modafinil is not licensed for this use, nor will it because it will not be without the current regulatory terms of the regulatory bodies. Non-therapeutic mind-altering drug use so far is in stark contrast to the behavior of many communities, it is very popular but has led to serious harm. Regulation has always been and always has a problem. We do not know whether the need for modafinil in the same communities will actually be significant, whether the community will be more receptive and how the law will still be drafted. '
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