Modafinil is a medication prescribed to treat a few rare sleep-related conditions, including narcolepsy, obstructive sleep apnea, or shift work sleep disorder. It was approved by the U.S. Food and Drug Administration (FDA) in 1998 specifically to treat narcolepsy, but it has been prescribed for other issues around daytime sleepiness for off-label use. It was approved to treat tiredness from obstructive sleep apnea in 2003.
Modafinil is the generic name for the active ingredient in this drug. It is most commonly found prescribed as Provigil, but there are now some other brand names available. Modafinil medications are currently listed as Schedule IV, according to the U.S. Drug Enforcement Administration (DEA), so they are not regulated as tightly as medications in Schedules II or III; however, they still require a prescription to obtain legally.
The drug enhances short-term memory, which allows users to stay awake for longer periods. In people who have specific sleep disorders, this is a useful approach to managing daytime exhaustion while still allowing for regular sleep during the night. However, many people have recently started to abuse modafinil as a “smart drug,” meaning it enhances memory so it must, in some sense, enhance intelligence, too. This has led to many people abusing the drug without a prescription and without a specific medical need for the substance.
While many researchers do not think modafinil is addictive, many are unsure exactly how the drug affects the brain. It is unclear if it may lead to compulsive behaviors, tolerance, dependence, and withdrawal symptoms that are associated with addiction.
Modafinil is one drug in a new class of medications called eugeroics, which are novel psychostimulants. They do not have the common side effects, from restlessness to addiction, that are associated with other psychostimulants, including drugs like caffeine, nicotine, and amphetamines.
Small studies have shown that modafinil is relatively safe for participants. Study subjects had improved overall short-term memory, better planning skills, better reaction time, and better working memory. They also had better spatial planning and better visual pattern recognition. Since the drug appears not to work through the same dopamine-releasing pathways as other drugs, like Ritalin or Adderall which offer similar effects, modafinil appears not to impact users’ mood.
A study dating from 2006 suggested that people who had affective disorders like unipolar depression or bipolar disorder could take modafinil to alleviate symptoms of depression, particularly fatigue and sleepiness, without risking substance abuse symptoms or tolerance to the medication.
In general, tolerance occurs when a substance is used repeatedly. People who drink coffee every day feel less potent stimulating effects from the drink over time. People who drink a glass or two of alcohol every day feel less intoxicated on one serving over time, and people who take prescription opioid painkillers develop a tolerance for the analgesic and psychotropic effects, and may need higher doses of the drug to avoid pain.
Modafinil is a new enough drug that it is hard to know if it triggers addiction, tolerance, or dependence. Many studies indicate that it does not, but anecdotal evidence is beginning to show otherwise.
Young people, like adolescents or young adults, who abuse modafinil put themselves at risk of losing brain plasticity early in life. Long-term use of this drug has been associated with reduced memory ability in young people, which may be a sign of tolerance for the drug’s effects. This side effect typically appears after months or years of excessive modafinil consumption without a need or medical oversight.
An examination of many surveys from 1990 to 2014 found that a study’s methods greatly changed the outcomes. For example, studies involving simple tasks did not show many effects from taking modafinil, while studies involving more complex tasks like playing chess showed that modafinil improved performance. The drug may offer some benefits, but they may not last. Taking the drug repeatedly to enhance mental performance or acuity is a form of substance abuse.
Additionally, modafinil does have some side effects. They include:
If you receive a prescription for modafinil from your doctor, it is important to let them know if you have any history of substance abuse or mental health struggles. Modafinil can impact these conditions, along with other health issues, in various ways. While few studies suggest physical dependence or compulsive behaviors are associated with modafinil, people who take it without a prescription do tend to take it for a long time.
It is also important to note that, in all the small studies conducted so far, modafinil addiction patterns have not been studied directly. The drug appears to still have some effect on dopamine in the brain, so it may be associated with cravings and a sense of euphoria that can lead to compulsive behaviors around drugs, indicating addiction.
A case study from 2015 reported that a 44-year-old individual was found to have signs of physical dependence on modafinil and had indications that he had developed a tolerance to the substance over a six-month period. He began with a prescribed dose of 100 mg (milligrams) every three to four hours, which helped him during shift work that lasted for 12 hours at a time.
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However, by the time he reported to medical professionals for additional help after this prescription, he reported taking as much as 100 mg every hour, for a full day’s dose at 1,200 mg. A tapering approach with the medication was used to overcome his physical dependence on the drug, so he could also end his tolerance to it, which often feeds into cravings and dependence.
If you have received a prescription for modafinil and find that you are beginning to feel tired again during the day despite taking the prescription amount, you may be developing a tolerance for the substance. Speak with your doctor about your options. It may be worthwhile to stop taking it for a week or so, with your prescriber’s supervision so that you can receive benefits from the prescribed dose again.
People who take modafinil without medical supervision are abusing the drug. They need evidence-based treatment through a detox and rehabilitation program to help them quit use of the drug.
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