Touted as a nootropic (smart drug) with few side effects, modafinil (Provigil) appears to be the answer to every overworked executive's or stressed-out student's problems. But is it?

Stimulating But Not Like Stimulants

Modafinil (Provigil) helps to keep people awake. First approved by the FDA in 1998 to treat narcolepsy, modafinil is also used to treat excessive daytime sleepiness caused by obstructive sleep apnea (OSA) or shift work sleep disorder (SWSD).

Off-label it has been used to help people with Parkinson's Disease, ADHD, chronic fatigue syndrome, and Multiple Sclerosis stay alert, and it has been favored by students, executives, and the military as a way to combat sleep deprivation and fatigue. Some articles even refer to it as the world's first safe smart drug or nootropic. But is it really?

Worryingly, even the experts can't tell you exactly how it works, although they have elucidated that it enhances several chemicals and neurotransmitters in the brain including dopamine, serotonin, histamine, glutamate, and GABA. Studies have shown modafinil's wake-promoting effects match stimulants such as amphetamine and methylphenidate, although its structure is unique and not comparable to those drugs. But just like stimulants, it affects the mind, causing feelings of alertness, enhanced thinking, and perception. As most pharmacists and doctors will tell you, ANY drug with these effects reinforces drug taking and carries a potential risk for addiction and dependence.

Side Effects Comparatively Mild

Over one-third of people who take modafinil report headache as a side effect, with nausea being the next most common complaint (11% of people taking modafinil). Other side effects such as rhinitis, nervousness and anxiety, back pain, insomnia, and gastrointestinal complaints (such as diarrhea, and indigestion) were reported by less than 10% of clinical trial participants.
Modafinil can reduce the effectiveness of hormonal contraceptives by interfering with the enzymes that convert these hormones into their active form.

Rarely, life-threatening rashes have occurred with modafinil, including Stevens-Johnson Syndrome (SJS) and drug-induced hypersensitivity syndrome (DRESS). Most reactions are probably allergy related. Seek urgent treatment if you develop any signs of a rash or other allergic-type reactions (such as facial swelling, or difficulty breathing).

Although modafinil has been around for over 20 years, experts are not sure how long-term use affects the brain. Some are concerned about chronic sleep deprivation, future ability to sleep, increased antisocial tendencies, and suppression of emotions, as well as problems coming off the drug.

Modafinil With Coffee: The Choice of Wall Street?

The pressure to outperform others in today's competitive business world is immense. So it's not surprising that some of the biggest users of modafinil are entrepreneurs and millennials. Online blogs glow about unwavering focus, superhuman levels of concentration, and powering through 14-hour work days. At the opposite end of the spectrum, there are also reports of blackouts that occur when modafinil is mixed with alcohol and the anxiety experienced when coming off the drug.

Despite being a Schedule IV controlled substance, many white-collar employees illegally obtain modafinil, or its close relative, armodafinil, off the internet without a prescription, which is risky. Both these drugs have side effects and clandestine manufacturers do not follow the same quality control measures that ensure tablets contain the proper dose or even the proper ingredient.

Does Modafinil Really Have Cognitive Enhancing Effects?

Only a few small trials have investigated Modafinil's effects on cognition, with mixed results.

Participants reported feeling more alert, attentive, and energetic on the drug, in one 2003 trial, and some improvements in certain memory tasks - such as digit span and visual recognition - were reported. In addition, there was a decrease in impulsivity. A 2014 trial also showed improvements in impulsive decision-making, but no difference in the accuracy of performance.

A 2017 study comparing the effects of modafinil, methylphenidate, and caffeine in chess players found both modafinil and methylphenidate enhanced performance; however, it was at the expense of time (both made the games last longer because the time spent reflecting on each move was increased).

A review of 19 placebo-controlled trials concluded that modafinil works best for sleep-deprived populations and only has a limited effect in other populations with regards to improving attention, executive functioning, memory, or processing speed.

When used as an add-on treatment for people with schizophrenia, modafinil or armodafinil (a similar substance) had a mild effect on reducing negative symptoms of schizophrenia in people who were not chronically ill or with a high negative symptom burden to start with.

Does Modafinil Help Decision Fatigue?

We all know how draining it can be to have to make one decision, after another, after another. The term "Decision Fatigue" describes how our decision-making skills get worse the more decisions we have had to make previously. Judges are less likely to grant parole in cases heard later on in the day. Consumers are more likely to come home with something they didn't need after a long day of shopping. When our mental energy gets low we are more likely to act recklessly or impulsively. Or, do nothing at all.

In a review of 24 studies that investigated the use of modafinil in healthy, non-sleep-deprived individuals, researchers concluded that modafinil is more likely to help improve attention and learning for more complex thought processes rather than basic tasks. Although it made no difference to working memory, or understanding different points of view, it did improve decision-making and planning. In a few studies, modafinil negatively affected creativity, although generally side effects were mild and included insomnia, nausea, and headache.

So although modafinil may enhance your focus and allow you to keep on making decisions up until the early hours of the morning, there is no guarantee that these will always be the right decisions.

And bear in mind that few studies have looked at the long-term consequences of using modafinil.

Modafinil as a Performance-Enhancing Drug

Modafinil and its derivative armodafinil are prohibited in competition by the World Anti-Doping Agency (WADA) unless an athlete has been diagnosed with narcolepsy and has obtained a therapeutic use exemption (TUE) before the event. Although WADA has always considered modafinil "related to stimulants", it sat in a bit of a grey area until it was added to the list of banned substances in 2004.

Numerous athletes have used modafinil to improve their concentration, focus, and recovery time. In 2003, American Kelli White won both the 100m and 200m at the World Track and Field

Championships - a rare sprint double achievement. However, her glory at winning barely lasted a few hours when soon after she tested positive for modafinil. Unfortunately for her, U.S.A Track and Field didn't buy her "I have narcolepsy" story, and she was subsequently stripped of both her medals.

Enhancing Combat Awareness

Although everybody needs a good eight hours of sleep a night, sometimes that's unrealistic when there is other stuff going on... like war... or a space mission.

Modafinil replaced dexamphetamine as the military's "go-pill" in 2012. Modafinil is used to maintain alertness, improve judgment, and increase risk perception in sleep-deprived pilots and soldiers during lengthy missions.

Side effects in one study of six helicopter pilots included vertigo, nausea, and dizziness. Effects of modafinil were rated as most significant between 0330 and 1130 hours when sleep loss was combined with the natural circadian rhythm trough.

Modafinil is also used to optimize performance in fatigued astronauts on the International Space Station, improving circadian rhythm disruptions and compensating for reduced quality of sleep.

Is Modafinil For You?

Modafinil does enhance alertness in people who are sleep-deprived, although it is unlikely to make you smarter. Think carefully before you take it for any unapproved indication, such as a study aid or to help you meet that deadline, especially if it has not been prescribed by a doctor.

Although it has minimal side effects compared to some stimulants, modafinil still carries a risk of dependence. Instead of relying on a pill to prop you up, make a few changes to your lifestyle so that you get enough sleep and can function with a clear head at work. If work pressures are getting to you, talk to your boss about how much you can realistically achieve. Modafinil may help you meet that deadline, but likely at the expense of your general health. Is any job worth having to take a pill for?