Modafinil has emerged as the reigning champion of the smart drugs, a seductive group of cognitive enhancers that promise enhanced memory, motivation and an unrelenting focus.
In the absence of long-term data, the media response to smart drugs has tended towards relaxed, especially in regard to the potential side effects. The Oxford Tab, for example, dismissed any issues with an article titled “Who Cares?”.
This muted response may be linked to the reason many people take these drugs; often, the benefits gained outweigh the risk of negative side effects. Novelist MJ Hyland suffers from multiple sclerosis, and sees these drugs as highly beneficial, having recently wrote an article in The Guardian, praising these brain-enhancing drugs.
However, it is still in question whether young healthy students, stressed but otherwise healthy, and tempted by this quick fix, should be concerned about the potential long term effects of Modafinil on the brain.
Professor Barbara Sahakian has been researching Modafinil at the University of Cambridge as a possible clinical treatment for the cognitive problems associated with psychosis. Her fascination with the consequences when healthy people take Modafinil has led to her recently co-authoring a book on the subject.
“Some people just want an advantage when competing, like with university exams. Then there is another group of people who want to function to their maximum potential all of the time. However, people have also told me that they’ve used these drugs to assist with uninteresting tasks they may have been reluctant to complete.”
“I believe Modafinil is a drug with multiple actions,” Sahakian says. “This is because it acts on multiple different neurotransmitter systems within the brain. I suspect that because it has these multiple actions, a number of different functions improve, but not all for the same reasons.”
Neurotransmitters are chemicals which transmit signals between cells in the brain; Dr Peter Morgan from Yale University says that Modafinil affects three of these in particular. “Modafinil definitely affects the dopamine system and dopamine makes you more alert and interested,” he says. “It affects norepinephrine which can again make you more alert and better able to focus, while also stimulating histamine which keeps you awake.”
However, the improvement of working memory is the particular effect that especially interests many. Modafinil is believed to enhance short-term memory by up to ten percent through influencing the neurotransmitter glutamate. This desire to increase short-term memory function exists mostly in students, who often engage in large amounts of intense, rushed revision and last-minute cramming.
Sahakian urges caution: “A lot of people, students and young people in particular, are getting drugs from the internet and the drugs they are buying could really be anything. If the drugs aren’t from a reputable source, they could be contaminated and are never certainly safe to take.”
Effects of the drug can vary greatly and are highly dependent on the dose administered. Dr Nora Volkow and colleagues recently conducted a study, based on PET scans, which suggested that doses of 400mg had effects in areas of the brain known to be involved in substance abuse and dependence.
As well as this increased risk of abuse or dependence, Sahakian’s research also suggests that prolific use of Modafinil for a prolonged period could damage sleep architecture.
“Some professionals tend to use it on specific occasions – when they’re jetlagged or when they’ve had a particularly poor quality sleep,” she says. “They don’t use it every day or in multiple doses. Whereas, if you question students, they often take one dose and then, when they feel the effects waning, take another. Of course, this affects their sleep pattern, because when they should be sleeping, excess drug remains in their system, exerting its wake-promoting effects. This is counter-productive to learning, as we consolidate our memories during sleep.”
I spoke to students who used Modafinil during exam periods and they revealed that after several weeks, they had the sensation of permanently being trapped in a twilight zone, neither asleep nor awake.
Morgan researches treatments for cocaine addicts with severe sleep disorders and has a possible explanation for this feeling. “If somebody takes Modafinil long-term, they may develop some of the same deficits in slow-wave sleep as cocaine users,” he says. “Slow-wave sleep is the deep sleep that we tend to get early in the night. Taking a stimulant that forces the body to be awake, more than it would otherwise, disrupts the ability of the body to regulate the amount and quality of sleep it should have so the user never feels completely refreshed.”
He believes that long-term use could damage the memory. This is a general side effect “Look at nicotine,” he says. “Nicotine is an amazing cognitive enhancer from a lab perspective. But chronic users of nicotine present a decline in baseline cognitive function, which taking nicotine then may be returning to normal. So, in chronic users, nicotine is no longer a cognitive enhancer but a cognitive normaliser. Chronic use of any drug causes the brain to adapt, so that without it, you are performing at a lower level and there is no reason to assume that Modafinil would cause any different effects.”
But, regardless of the risks presented, it is likely that the demand for smart drugs will continue to grow. “Psychiatrists at an American Psychiatric Association Meeting in the US approached me to comment that they are frequently put under pressure to give a diagnosis of ADHD to a child even though the psychiatrist feels the symptoms are not sufficiently severe to do so,” Professor Sahakian tells me.
“The psychiatrists believe the parents do this to gain potential cognitive enhancing effects that Ritalin provides for their child. In my lectures, I try to point out that our brains are still in development up until late adolescence and through to young adulthood, o for healthy normal children, the effects of manipulating neurotransmitters while the brain is still developing us unknown.”
“We simply don’t know how chronic drug treatment will affect ‘healthy’ brain function in future years.”