What Is It?

Science fiction is abound with neuro-enhancement technologies and medications.  The Bradley Cooper film Limitless is just one example, in which characters discover a street drug that allows them to unleash 100% of their brain power, becoming not just more productive but more charming, cleaner, and more energetic.  But could such a drug ever exist?  Perhaps.  Whilst not on the same level as the drug in Limitless, Modafinil is tipped to be the first true neuro-enhancement drug suitable for healthy people. 

The FDA approved drug, which is marketed as Provigil in the US and the UK is a schedule IV drug, meaning that you must have a doctor’s prescription in order to legally buy it or possess it [1] , although there are plenty of off-label versions of the drug being sold on illegal, overseas websites.  At its base, it’s a stimulant that is prescribed to people suffering from sleep disorders such as narcolepsy and is used to increase the cognitive functions of people with neuropsychiatric disorders and shift-work related sleep deprivation [2] .  It has later become a nootropic, or ‘smart drug’, taken by healthy people to increase concentration, memory, alertness, energy, and motor skill as well as reducing sleepiness [3] . 

Doctor Peter Morgan from Yale University explains that it is effective because it acts on several different neurotransmitters at once.  It affects your dopamine levels, making you more alert and more interested in things.  It affects your norepinephrine, again improving alertness and focus.  It affects histamine too, which keeps you awake.  It is also believed to enhance short-term memory by as much as ten per cent by influencing the neurotransmitter glutamate [4] .  It could affect other transmitters too, meaning that the reaction is different for different people. 

That’s a lot of cognitive improvement from one little pill, and the list of people taking it is impressive.  It’s prescribed to surgeons who need the boost to get them through long surgical procedures whilst maintaining a steady hand.  It’s prescribed to long-haul airline pilots and shift workers.  There are also many famous people who reportedly take it to help with day-to-day living.  Tim Ferriss, author of The 4-Hour Workweek is one, comedian and actor Joe Rogan is another.  Even President Obama is rumored to have taken it [5] .  For those not so famous, the internet is littered with case studies and personal proclamations regarding the greatness of this drug and its potential for the future of neuro-enhancement.  All this though, makes it easy to wonder: is it just too good to be true?

 The Good

The anecdotal evidence in favor of this drug is everywhere, with MS sufferers extolling the virtues of the drug that takes away their sluggishness and lack of drive [6] , to students using it to get them through highly pressured exam times [7] .  “It’s like time slows down only for me”, one user claims, explaining that the drug makes him more aware of what is going on around him and means that he can work for hours on end without getting distracted [8] .  It’s even suggested it can help with weight loss, as the drug suppresses your appetite and leaves you so focused on the task at hand that you forget to eat. 

It’s not all anecdotal though, although clinical research of Modafinil on healthy people is still in its infancy.  Researchers Battleday and Brem recently looked at all 24 studies of Modafinil from the last fifteen years and have concluded that as a smart-pill, the drug can indeed improve cognitive performance in healthy people [9] .  Their research shows that modafinil intake does improve higher cognitive functions such as problem solving and planning, although results were different for each test and each participant.  They also revealed that they found little or no side effects reported, which is not surprising given that, as an FDA approved product, the drug will have been subjected to clinical trials over long periods of time to ensure it is safe for human consumption (albeit in sufferers of neuro-psychiatric disorders).  So, they say, the drug is not only effective but it’s safe too.  With all this going for it, it’s easy to wonder why Modafinil hasn’t become a staple in so many more people’s lives. 

 The Bad

Except, of course, if it seems too good to be true, then usually it is.  Even Battleday and Brem, who on the surface seem so keen to see Modafinil used more openly, admit that more research needs to be done, research using better techniques with a wider range of participants.  Not much research has been carried out on healthy people, they claim, and the testing processes generally used are a little inappropriate because they are the same tests given to sufferers of neurological disorders – tests that healthy people should score higher in anyway [10] .  There are side effects too, albeit usually minor ones.  They can include urine that smells worse than usual, oily skin, headaches, and stomach upsets.  Some people have also had a serious skin reaction to the drug, although admittedly those people are few and far between [11] . 

The question of morality is an important one too.  Does taking brain enhancing drugs constitute cheating, in much the same way that steroids to in sporting events?  If a high number of students take performance enhancing drugs, perhaps those who choose to abstain are at a disadvantage.  However, one thing that the research has shown is that Modafinil can’t make you smarter, it can only enhance what is already there.  Besides which, there are already cognitive enhancers out there that people choose or choose not to take on a regular basis, such as caffeine and nicotine.  However, the potential for manipulation, unfair practice, and moral obscurity is high. 

 The Potentially Ugly

It gets worse, too.  Whilst the short-term side effects are seemingly insignificant, the potential long-term effects are huge.  As a drug that promotes wakefulness, it’s argued that long-term use can have a seriously damaging effect on your sleep behavior.  Dr. Peter Morgan suggests that “if someone takes Modafinil long-term, they may develop some of the same deficits in slow-wave sleep as cocaine users” [12] .  Slow-wave sleep occurs early in the sleep pattern but the drug, which forces the brain into a wakeful state, disrupts that part of the cycle, meaning that when the user wakes up, they do not feel they are fully rested – which in turn can result in taking more of the drug.  This effect has already been seen, as Morgan describes regular users who feel permanently trapped somewhere between sleep and wakefulness. 

It’s also potentially addictive – and not just for the reasons above.  Dr. Nora Volkow argues that doses of 400mg or more are known to affect areas of the brain that are involved in substance abuse and dependence.  The process of releasing dopamine, the ‘reward chemical’, is similar to the process that occurs when taking known addictive substances such as cocaine or Ritalin [13] . 

What we can tell so far, then, is that Modafinil is effective and potentially safe to use.  We also know that research into chemical and technical neuro-enhancement is going to continue – be it for good or bad.  We know, too, that we have already embraced some more basic neuro-enhancers such as caffeine and nicotine.  What we know most of all, though, is that what evidence is available so far is mostly anecdotal and far more research is needed, particularly into the long-term effects of regular use.  So for now, maybe it’s best to focus on some of the more natural (and for that matter, cheapest) forms of neuro-enhancement: a good diet and regular exercise – both of which will increase dopamine levels and improve cognitive function without the potentially devastating side-effects. 

[1] Nootriment, 2015, Is Modafinil Legal in the USA? [online], Available at: http://nootriment.com/modafinil-usa/, [accessed 09.13.2015]

[2] Ruairidh McLennan Battleday and Anna-Katharine Brem, 2015, Modafinil: the Future of Neuroenhancement? [online], Available at: http://www.independent.co.uk/life-style/health-and-families/modafinil-the-future-of-neuroenhancement-10474438.html, [accessed 09.13.2015]

[3] Alex Fortin, 2015, Case Study: Why I Buy Modafinil Online [online], Available at: http://www.alexfortin.com/buy-modafinil-online-personal-experience/, [accessed 09.13.2015]

[4] Cited by David Cox, 2013, Is Modafinil Safe in the Long Term? [online], Available at: http://www.theguardian.com/education/mortarboard/2013/may/31/is-modafinil-safe-in-long-term, [accessed 09.13.2015]

[5] Modafizone, 2015, Who Takes It? [online], Available at: https://www.modafizone.co/uk/, [accessed 09.13.2015]

[6] MJ Hyland, 2013, The Drugs Do Work: My Life on Brain Enhancers [online], Available at: http://www.theguardian.com/lifeandstyle/2013/may/03/brain-enhancing-drugs-mj-hyland, [accessed 09.13.2015]

[7] Carole Cadwalladr, 2015, Students Used tp Take Drugs to Get High.  Now They Take Them To Get Higher Grades [online], Available at: http://www.theguardian.com/society/2015/feb/15/students-smart-drugs-higher-grades-adderall-modafinil, [accessed 09.13.2015]

[8] Alex Fontin, op. cit.

[9] Battleday and Brem, op. cit.

[10] Ibid.

[11] Carole Cadwalladr, op. cit.

[12] Cited by David Cox, op. cit.

[13] Ibid.