2000-jasinski.pdf: “An evaluation of the abuse potential of modafinil using methylphenidate as a reference”, Donald R. Jasinski (2000-01-01):
Modafinil is a unique wake-promoting agent. Preclinical studies indicate a mechanism of action which is distinct from that of amphetamine or methylphenidate. To compare the pharmacodynamic profiles of modafinil, methylphenidate, and placebo in humans, a double-blind Latin square crossover study was conducted in 24 male volunteers with a history of polysubstance abuse that included the stimulant cocaine. Each subject was given single oral doses of methylphenidate (45 mg or 90 mg), modafinil (200 mg, 400 mg or 800 mg) and placebo. Measures of subjective, behavioural, and physiological responses were evaluated at fixed intervals during 72h after each dosing occasion. Subjects discriminated both modafinil and methylphenidate from placebo. Subjects liked the effects of both drugs. However, modafinil differed from methylphenidate in its lack of a statistically-significant response on the Amphetamine Scale of the Addiction Research Center Inventory. The profile of physiological effects for modafinil differed from methylphenidate in that it showed greater inhibition of observed and reported sleep, less facilitation of orthostatic tachycardia and less reduction of caloric intake. These findings are consistent with preclinical pharmacological data suggesting that modafinil is not an amphetamine-like agent.
2019-kredlow.pdf: “The Efficacy of Modafinil as a Cognitive Enhancer: A Systematic Review and Meta-Analysis”, M. Alexandra Kredlow, Ani Keshishian, Sarah Oppenheimer, Michael W. Otto (2019-08-19):
Background: Animal models and human studies have identified the potential of modafinil as a cognitive enhancing agent, independent of its effects on promoting wakefulness in sleep-deprived samples. Given that single-dose applications of other putative memory enhancers (eg, D-cycloserine, yohimbine, and methylene blue) have shown success in enhancing clinical outcomes for anxiety-related disorders, we conducted a meta-analytic review examining the potential for single-dose effects for modafinil on cognitive functioning in non-sleep-deprived adults.
Methods: A total of 19 placebo-controlled trials that examined the effects of single-dose modafinil versus placebo on the cognitive domains of attention, executive functioning, memory, or processing speed were identified, allowing for the calculation of 67 cognitive domain-specific effect sizes.
Results: The overall positive effect of modafinil over placebo across all cognitive domains was small and statistically-significant (g = 0.10; 95% confidence interval, 0.05–0.15; p < 0.001). No statistically-significant differences between cognitive domains were found. Likewise, no statistically-significant moderation was found for modafinil dose (100 mg vs 200 mg) or for the populations studied (psychiatric vs nonpsychiatric).
Conclusions: In conclusion, the available evidence indicates only limited potential for modafinil to act as a cognitive enhancer outside sleep-deprived populations.
2019-savarese.pdf: “Excessive sleepiness in shift work disorder: a narrative review of the last 5 years”, Mariantonietta Savarese, Maria Caterina Di Perri (2019-08-30):
Introduction: Shift work sleep disorder (SWSD), also known as shift work disorder (SWD), is a circadian rhythm sleep disorder characterized by insomnia and/
or excessive sleepiness, associated with a recurring work schedule that overlaps the usual time designated for sleeping.
Purpose: This article aims to provide a narrative review of the pharmacological trials conducted on SWD in the last 5 years, to better address safety and health issues inherent to this disorder.
Methods: An electronic literature search was conducted using PubMed. All eligible randomized controlled trials (RCTs) and cross-over RCTs with employees undertaking shift work (including night shifts) were considered, yielding three articles.
Results: All three studies showed the efficacy of armodafinil in improving subjective and objective sleepiness, clinical conditions, and global functioning regardless of shift duration. Both performance and driving simulator performance tests administered during the night shift bore better results following armodafinil administration than after placebo. However, armodafinil only reduced subjective disability in individuals working more than 9 h; furthermore, even after armodafinil, alertness was reduced but not normalized.
Conclusion: These studies underscore the importance of preventing and/
or minimizing disturbances due to shift work. This may be achieved through various strategies, such as the employer’s commitment to adopt ergonomic criteria in shift design and to implement work-environment interventions like controlled bright light. Health personnel is of pivotal importance to detect potential factors of intolerance to shift work or early symptoms of SWD. Additional and improved studies are needed to further evaluate the effectiveness and safety of both pharmacological and non-pharmacological interventions. [Keywords: shift work disorder, excessive sleepiness, insomnia, performance, alertness, stimulants, armodafinil]
2020-aras.pdf: “Modafinil Induced Spontaneous Ejaculation Without Orgasm: A Case Report”, Neriman Aras (2020-11-27):
Modafinil is used for the treatment of narcolepsy and obstructive sleep apnea syndrome, and as add-on therapy for psychiatric diseases such as attention-deficit/
hyperactivity disorder, schizophrenia, depression, cocaine addiction. The exact mechanism of action is unknown. Modafinil may be helpful for the treatment of erectile dysfunction and premature ejaculation. The addition of modafinil to antidepressant treatment may provide positive effects on sexual dysfunction. However, side effects such as hypersexuality and unwanted orgasm have been reported with modafinil treatment. In this article, a patient who had developed spontaneous ejaculations after the addition of modafinil for the treatment of depression with venlafaxine is discussed. Although venlafaxine treatment continued after the discontinuation of modafinil, spontaneous ejaculation did not continue. It should be kept in mind that agents with dopaminergic and noradrenergic effects, such as modafinil, can cause undesirable sexual side effects.
2020-bajorek.pdf: “Exploring the Economic Benefits of Modafinil for Post-Stroke Fatigue in Australia: A Cost-Effectiveness Evaluation”, Beata Bajorek, Lan Gao, Tom Lillicrap, Andrew Bivard, Carlos Garcia-Esperon, Mark Parsons, Neil Spratt, Elizabeth Holliday, Chris Levi (2020-11-01):
- Modafinil is cost-effective, costing AUD$0.20/day per unit change in fatigue score.
- Treatment to increase stroke-survivors’ productivity saves AUD$467 million annually.
- Treating post-stroke fatigue to reduce unemployment saves $383 billion over 10 years.
- Modafinil use post-stroke derives large cost-savings to health-systems and society.
Background: In stroke survivors, post-stroke fatigue predicts dependency in daily living and failure to return to work. Modafinil shows promise as a pharmacotherapy to reduce post-stroke fatigue and related sequelae, e.g., poorer functional and clinical outcomes.
Aims This study explored the cost-effectiveness of modafinil in treating post-stroke fatigue in the Australian context, by determining its incremental cost-effectiveness ratio (ICER) and by simulating the potential cost-savings on a national scale, through a re-analysis of MIDAS trial data.
Methods: A post hoc cost-effectiveness analysis was undertaken. Part A: patient-level cost and health effect data (Multidimensional Fatigue Inventory (MFI) scores) were derived from the MIDAS trial and analysis undertaken from a health-system perspective. Part B: a secondary analysis simulated the societal impact of modafinil therapy in terms of national productivity costs.
Results: Part A: Mean cost of modafinil treatment was AUD$3.60/day/patient for a minimally clinically important change (10 points) in total MFI fatigue score, i.e., AUD$0.36/day/unit change in fatigue score per patient. For the base case scenario, the ICER of using modafinil (versus placebo) was AUD$131.73 ($90.17—248.15, for minimum and maximum costs, respectively). Part B: The potential productivity cost-savings to society were calculated as nearly AUD$467 million over 1 year, and up to AUD$383,471,991,248 over 10 years, from the widespread use of modafinil treatment in the Australian population of working-age stroke-survivors, representing a substantial societal benefit.
Conclusions: Modafinil is a highly cost-effective treatment for post-stroke fatigue, offering substantial productivity gains and potential cost-savings to society from the widespread use of modafinil treatment in the Australian population of working-age stroke-survivors. [Keywords: modafinil, stroke, fatigue, cost analysis, cost-effectiveness]
2020-blumberg.pdf: “Procognitive Effects of Antidepressants and Other Therapeutic Agents in Major Depressive Disorder: A Systematic Review”, Michelle J. Blumberg, Sophie R. Vaccarino, Shane J. McInerney (2020-07-21):
Objective: To review the efficacy of antidepressants and other therapeutic agents for the treatment of cognitive impairment in adults with major depressive disorder (MDD).
Data Sources: We conducted a database search of MEDLINE, PsycINFO, and Embase through Ovid on May 7, 2019. The year of publication was not restricted. The search terms “Major Depressive Disorder,” “depress*,” “cognit*,” and “therapeutics” were used.
Study Selection: The studies included in this review were clinical trials of antidepressants and other therapeutic agents in MDD populations. Participants were aged between 18 and 65 years and had a DSM-III, -IV, or -5 diagnosis of MDD. In total, 2,045 research papers were screened, 53 full-text articles were assessed, and 26 articles were eligible to be included in this systematic review.
Data Extraction: The data and quality of research papers were assessed and screened by 2 independent reviewers. Discrepancies were resolved through a third reviewer.
Results: Overall, studies demonstrated that tricyclic antidepressants do not have procognitive effects, while vortioxetine and bupropion have demonstrated procognitive effects in MDD populations relative to selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors. Several non-antidepressant agents, such as modafinil, amphetamines, and erythropoietin, have also demonstrated statistically-significant positive effects on cognition in depression.
Conclusions: Present-day antidepressants and other agents have demonstrated procognitive effects in MDD, but the findings between various agents are mixed. Further research looking at objective measures of cognitive performance would be helpful to obtain more definitive results regarding the efficacy of therapeutics for cognitive impairment in MDD.
2020-cesta.pdf: “Incidence of Malformations After Early Pregnancy Exposure to Modafinil in Sweden and Norway”, Carolyn E. Cesta, Anders Engeland, Pär Karlsson, Helle Kieler, Johan Reutfors, Kari Furu (2020-09-01):
Modafinil is used to improve wakefulness in adults with excessive sleepiness due to narcolepsy, for fatigue related to multiple sclerosis, and for the treatment of attention-deficit/
hyperactivity disorder. In 2018, an interim report from a manufacturer-established pregnancy registry reported a prevalence of 15% for major malformation in infants exposed to modafinil during pregnancy, spurring regulatory bodies to amend product information.1–3 Recently, a Danish study reported a major malformation rate of 12% (n = 6) among 49 infants exposed to modafinil during early pregnancy compared with 3.9% (n = 32 466) among 828 644 unexposed to modafinil (adjusted odd ratio, 2.7; 95% CI, 1.1–6.9).4 To add to the emerging evidence, we investigated if modafinil use during early pregnancy was associated with major malformations in Norway and Sweden.
…Compared with pregnant women who had not taken modafinil, pregnant women who had taken modafinil were more often overweight or obese and had higher rates of smoking and diagnoses of narcolepsy, multiple sclerosis, and attention-deficit/
hyperactivity disorder (Table).
Overall, the rate of major malformations in the unexposed group was 2.1% (n = 40 697). There were 3 modafinil-exposed infants diagnosed as having a major malformation, resulting in a prevalence rate of 2.6% and a crude risk ratio of 1.06 (95% CI, 0.35–3.26). When restricted to only filled prescriptions during the first trimester, 75 pregnancies were exposed and 1 modafinil-exposed infant was diagnosed as having a major malformation(risk ratio, 0.44; 95% CI, 0.06–3.10).
Discussion: In this study, modafinil use during early pregnancy was not statistically-significantly associated with increased risk of major malformations. The combined Norwegian and Swed-ish study population had a similar proportion of modafinil-exposed pregnancies compared with the Danish study, allowing for more than double the number of exposed infants to be followed up. However, the 95% CIs estimated in this study overlap with those from the Danish study and allow for the possibility of a greater than 3-fold risk as previously reported.4
2020-flavell.pdf: “Modafinil-induced psychosis in a patient with attention deficit hyperactivity disorder”, Joshua Flavell (2020-07-26):
Modafinil is a wakefulness-promoting agent that is known to be used off-label as a cognitive enhancer and for the treatment of attention deficit hyperactivity disorder (ADHD).1 There are increasing case reports of Modafinil-induced psychosis; however, this is the first to report a patient with ADHD to develop psychosis from Modafinil use.
2020-kandasamy.pdf: “Hyponatraemia and cerebral oedema due to a modafinil overdose”, Rohan Oliver Kandasamy, Viktorija Kaminskaite (2020-07-05):
Modafinil is a non-amphetamine stimulant that is prescribed for narcolepsy-associated sleepiness as well as reported off-licence uses among university students looking to improve wakefulness and focus. There is limited information in the medical literature about supratherapeutic modafinil dosage, symptomatology and management of overdose. We report a case of a healthy 32-year-old man who was found unconscious, having vomited, with an empty modafinil blister strip. At the emergency department, he presented with reduced Glasgow Coma Scale and prolonged episodes of vomiting. This acute presentation was conservatively managed in the intensive care unit. Antibiotics were also given for a suspected aspiration pneumonia. CT of the head showed cerebral oedema and biochemistry investigations revealed hyponatraemia. Result aetiology was unclear, however, it has been theorised to be secondary to a sizeable modafinil overdose.
2020-mereu.pdf: “Modafinil potentiates cocaine self-administration by a dopamine-independent mechanism: possible involvement of gap junctions”, Maddalena Mereu, Takato Hiranita, Chloe J. Jordan, Lauren E. Chun, Jessica P. Lopez, Mark A. Coggiano, Juliana C. Quarterman, Guo-Hua Bi, Jacqueline D. Keighron, Zheng-Xiong Xi, Amy Hauck Newman, Jonathan L. Katz, Gianluigi Tanda (2020-04-27):
Modafinil and methylphenidate are medications that inhibit the neuronal reuptake of dopamine, a mechanism shared with cocaine. Their use as “smart drugs” by healthy subjects poses health concerns and requires investigation. We show that methylphenidate, but not modafinil, maintained intravenous self-administration in Sprague-Dawley rats similar to cocaine. Both modafinil and methylphenidate pretreatments potentiated cocaine self-administration. Cocaine, at self-administered doses, stimulated mesolimbic dopamine levels. This effect was potentiated by methylphenidate, but not by modafinil pretreatments, indicating dopamine-dependent actions for methylphenidate, but not modafinil. Modafinil is known to facilitate electrotonic neuronal coupling by actions on gap junctions. Carbenoxolone, a gap junction inhibitor, antagonized modafinil, but not methylphenidate potentiation of cocaine self-administration. Our results indicate that modafinil shares mechanisms with cocaine and methylphenidate but has a unique pharmacological profile that includes facilitation of electrotonic coupling and lower abuse liability, which may be exploited in future therapeutic drug design for cocaine use disorder.
2020-roberts.pdf: “How effective are pharmaceuticals for cognitive enhancement in healthy adults? A series of meta-analyses of cognitive performance during acute administration of modafinil, methylphenidate and D-amphetamine”, Carl A. Roberts, Andrew Jones, Harry Sumnall, Suzanne H. Gage, Catharine Montgomery (2020-07-21):
Modafinil, methylphenidate (MPH) and d-amphetamine (d-amph) are putative cognitive enhancers. However, efficacy of cognitive enhancement has yet to be fully established. We examined cognitive performance in healthy non-sleep-deprived adults following modafinil, MPH, or d-amph vs placebo in 3 meta-analyses, using subgroup analysis by cognitive domain; executive functions (updating, switching, inhibitory control, access to semantic/
long term memory), spatial working memory, recall, selective attention, and sustained attention. We adhered to PRISMA. We identified k = 47 studies for analysis; k = 14 studies (64 effect sizes) for modafinil, k = 24 studies (47 effect sizes) for Methylphenidate, and k = 10 (27 effect sizes) for d-amph. There was an overall effect of modafinil (SMD = 0.12, p = 0.01). Modafinil improved memory updating (SMD = 0.28, p = 0.03). There was an overall effect of MPH (SMD = 0.21, p = 0.0004) driven by improvements in recall (SMD = 0.43, p = 0.0002), sustained attention (SMD = 0.42, p = 0.0004), and inhibitory control (SMD = 0.27, p = 0.03). There were no effects for d-amph. MPH and modafinil show enhancing effects in specific sub-domains of cognition. However, data with these stimulants is far from positive if we consider that effects are small, in experiments that do not accurately reflect their actual use in the wider population. There is a user perception that these drugs are effective cognitive enhancers, but this is not supported by the evidence so far.
2020-rohde.pdf: “The use of stimulants in depression: Results from a self-controlled register study”, Christopher Rohde, Philip Brink, Søren D. Østergaard, Jimmi Nielsen (2020-05-23):
Objective: To investigate the effectiveness of stimulants in patients with depression, by using naturalistic outcome measures, such as psychiatric admissions, psychiatric bed-days and incidents of intentional self-harm or suicide attempts.
Methods: Via linkage of the Danish nationwide health registers, we identified all patients with a diagnosis of depression initiating stimulants, including methylphenidate, modafinil, amphetamine, dexamphetamine or lisdexamphetamine, from 1995 to 2012. We used a mirror-image model to test whether redemption of a stimulant prescription was associated with a reduction in psychiatric admissions, inpatient days and incidents of intentional self-harm or suicide attempts. Specifically, the number of these outcomes in the 2 years leading up to redemption of a stimulant prescription was compared to the two subsequent years. Similar outcomes were used in a reverse mirror-image model to investigate the effect of stimulant termination.
Results: A total of 3354, 935 and 105 patients diagnosed with depression redeemed prescriptions for methylphenidate, modafinil or amphetamine/
dexamphetamine/ lisdexamphetamine, respectively. Initiation of methylphenidate was not associated with a statistically-significant change in psychiatric admissions (mean: −0.02 admissions, p = 0.11) or inpatient days (mean: 0.13 days, p = 0.74). Similar findings were made for modafinil and the amphetamines. In addition, no clinically relevant change in psychiatric admissions or inpatient days was found after termination of a stimulant. After initiation of methylphenidate, the incidents of self-harm or suicide attempts were reduced by 54%, from 68 to 31 events (p = 0.004). No statistically-significant change in incidents of self-harm or suicide attempts were found for modafinil or the amphetamines.
Conclusion: This nationwide study, using naturalistic outcomes, does not support the use of stimulants in patients with depression. However, the use of methylphenidate was associated with a 54% reduction in incidents of self-harm or suicide attempts, indicating that methylphenidate may potentially be useful in patients with depression with suicidal or self-harming behaviour. However, further studies are needed, before any firm conclusions can be made. [Keywords: Depression, methylphenidate, modafinil, amphetamines, self-injurious behaviour]
2020-rubinkahana.pdf: “Cognitive enhancement drug use among resident physicians: Prevalence and motivations for use—results from a survey”, Dafna Sara Rubin-Kahana, Ziv Rubin-Kahana, Maya Kuperberg, Rafael Stryjer, Dorit Yodashkin-Porat (2020-04-16):
Background: Non-medical use of prescription drugs for the enhancement of cognitive functioning has gained popularity in recent years, especially among young educated adults. To our knowledge, no previous study investigated this phenomenon among resident physicians.
Objective: To analyze cognitive enhancement drugs use motivations and patterns among resident physicians.
Methods: A survey and statistical analysis regarding the use of drugs traditionally prescribed for the treatment of Attention Deficit Hyperactivity Disorder: stimulants, amphetamines and modafinil.
Participants: 1,453 residents who took their written residency exam in the summer of 2017. The response rate was 32.3%.
Results: 28.1% of responders reported past use, with 73.67% of them reporting use without a related medical diagnosis. Almost half of the users (47.1%) acquired the drug with a prescription, but without a diagnosis of a related medical disorder. The first use was predominantly during residency (54.3%), with 45% reporting it as related to the residency exam.
Factors found to positively impact non-medical use include: declaring undiagnosed Attention Deficit Hyperactivity Disorder, fear of failing the exam, a belief that more than 30% of other examinees take cognitive enhancements drugs, and a learning disability diagnosis. Self-reports of being a competitive person and being a parent, were negatively correlated with non-medical use.
Conclusions: The use of drugs that are taken traditionally for the treatment of Attention Deficit Hyperactivity Disorder is common among resident physicians, both with and without related medical indication. Interestingly, factors associated with the fear of being “left behind” increase non-medical use and not the desire to succeed. [Keywords: substance misuse, cognitive enhancement, physicians, prescription stimulants, residents]
2020-sholtes.pdf: “Optimising sleep and performance during night float: A systematic review of evidence and implications for graduate medical education trainees”, David Sholtes, Howard M. Kravitz, Aniruddha Deka, Jennifer Westrick, Louis F. Fogg (2020-10-15):
Graduate medical education (GME) training commonly requires residents and fellows to engage in night float shift work. This review aims to assess the effectiveness of interventions for trainees when preparing for, completing, and recovering from working night float shifts. We reviewed all available studies published prior to September 2019 using PubMed, Scopus, CINAHL, the Cochrane library, PsycINFO, and Google Scholar databases. We included all original, primary research articles assessing either non-pharmacological or pharmacological interventions on the chronobiological and physiological effects of night float shift work among GME trainees. Five studies (n = 179 patients) met inclusion criteria. Interventions included melatonin in the morning before sleep after night float shifts, napping during night float shifts, modafinil after a night of sleep deprivation, and caffeinated energy drinks after 6 consecutive night float shifts. Melatonin improved one measure of attention. A 2-hr nap was associated with improved speed related to task switching. Modafinil improved performance in tests of cognition. Caffeinated energy drinks led to improvement in select driving performance variables and reaction time. Effect sizes for outcome variables were calculated. Heterogeneity among the studies precluded combining the data in a meta-analysis. According to GRADE criteria, the quality of the evidence in these studies was low or very low. Our findings suggest GME trainees may benefit from utilising a limited number of interventions when preparing for or recovering from night float shift work. More investigation is needed to identify interventions that could help GME trainees adapt to and recover from working night float shifts.
- Modafinil is a psychostimulant drug approved for the treatment of sleep disorders.
- Recent preclinical findings point to a immunomodulatory property of modafinil.
- Modafinil impairs immune cells infiltration and glial activation during neuroinflammation.
- Modafinil decreases neuroinflammation in models of neurodegenerative diseases.
- Modafinil may be useful as adjuvant treatment for neurodegenerative diseases.
Abstract: Modafinil is a psychostimulant drug approved by the FDA primarily for the treatment of sleep disorders such as narcolepsy, excessive daytime sleepiness and sleep apnea. Several documented but not yet approved uses for modafinil have been described over the last 30 years, including alleviating fatigue in neurological and neurodegenerative disorders. Recent evidence has suggested that modafinil may have an immunomodulatory effect. Here, we review the different effects of modafinil treatment in animal models of brain inflammation and peripheral immune function. We conclude that there is unequivocal evidence of an anti-inflammatory effect of modafinil in experimental animal models of brain inflammation and neurodegenerative disorders, including systemic inflammation and methamphetamine-induced neuroinflammation, Parkinson’s disease, brain ischemia, and multiple sclerosis. Modafinil acts on resident glial cells and infiltrating immune cells, negatively affecting both innate and adaptive immune responses in the brain. We also review the outcomes of modafinil treatment on peripheral immune function. The results of studies on this subject are still controversial and far from conclusive, but point to a new avenue of research in relation to peripheral inflammation. The data reviewed here raise the possibility of modafinil being used as adjuvant treatment for neurological disorders in which inflammation plays an important role. [Keywords: modafinil, immunity, inflammation, dopamine, microglia, T cells, macrophages]
2021-eggink.pdf: “Prescription medication use by emergency department doctors to improve work and academic performance, and to manage stress and anxiety”, Karin M. Eggink, Simone E. Taylor, Simon Judkins, David McD. Taylor (2021-02-02):
Objective: To determine medications used by ED doctors to improve work and academic performance, and to manage stress and anxiety.
Methods: We undertook an online, voluntary, anonymous survey of ACEM fellows and trainees.
Results: 139 (46.5%) respondents used a medication under examination. Sleep aids included melatonin (19.1% of respondents) and benzodiazepines (8.7%). Medications to improve performance included modafinil (4.7%), pseudoephedrine (2.0%), melatonin (2.0%) and beta blockers (1.3%). Some medications were taken prior to shifts. Medications to manage stress and anxiety included benzodiazepines (3.0%) and beta blockers (2.0%).
Conclusion: Medication use is common and support for some doctors may be required.
2021-garg.pdf: “Recovery from refractory chronic fatigue syndrome with CBT and modafinil”, Himanshu Garg, Maggie Douglas, Gordon Douglas Turkington, Douglas Turkington (2021-03-22):
Many patients with chronic fatigue syndrome (CFS) fail to derive benefit from evidence-based treatments such as cognitive–behavioural therapy (CBT) and graded exercise therapy leading to permanent disability. To discover whether a repeat prescription of modafinil might potentiate the benefits of CBT leading to social recovery as defined by 2 or more point improvement in energy and muscular pain/
concentration and return to work or full-time training. Three patients with treatment-resistant CFS (mean duration 17.66 years) treated with modafinil and CBT in a Liaison Psychiatry clinic were retrospectively reviewed. Progress was reviewed at baseline, 4–6 months and 10–24 months. Patients rated their fatigue, pain and concentration using 10-point Likert scales. 2⁄3 achieved clinically meaningful improvements in energy and pain/ concentration and 3/ 3 achieved social recovery. Modafinil, when prescribed over the medium term, would appear to be a potentially useful potentiating agent when added to CBT.
2021-haney.pdf: “Modafinil reduces smoked cocaine self-administration in humans: effects vary as a function of cocaine ‘priming’ and cost”, Margaret Haney, Eric Rubin, Rebecca K. Denson, Richard W. Foltin (2021-04):
- Modafinil has had mixed efficacy for treating cocaine use disorder.
- This study tested modafinil’s effects on cocaine self-administration under a range of conditions.
- Modafinil robustly reduced self-administration when cocaine was costly and no cocaine was ‘on board.’
- Modafinil had little effect if cocaine was recently used or could be self-administered at low cost.
- Modafinil may be most effective for preventing relapse rather than initiating abstinence.
Background: The absence of an FDA-approved medication for the treatment of cocaine use disorder (CUD) may, in part, reflect the varying conditions present when the decision to use cocaine is made, with one medication unlikely to work under all conditions. The objective of this double-blind, placebo-controlled, human laboratory study was to test the effects of modafinil, a medication with mixed efficacy for the treatment of CUD, using a novel self-administration procedure designed to model distinct clinical scenarios.
Methods: During modafinil maintenance (0, 300 mg/
day), participants chose to self-administer up to 7 doses of smoked cocaine (25 mg) under 9 conditions: immediately after exposure to: (a) cues associated with cocaine and a non-contingent cocaine administration, i.e. ‘prime’ (25 mg), (b) only cocaine cues, and (c) neither cues nor cocaine. Each condition was tested when self-administered cocaine cost $5, $10 and $15/ dose.
Results: Nontreatment-seeking cocaine smokers (3 F,13 M), spending $388 ± $218/
week on cocaine and with no history of alcohol use disorder, completed the study. Relative to placebo, modafinil robustly attenuated self-administration when cocaine was expensive ($10 or $15/ dose) and when there was no ‘prime.’ Modafinil had no effect on self-administration when cocaine was inexpensive ($5/ dose) or when participants received a ‘prime.’
Conclusions: Modafinil’s effects on cocaine-taking varied substantially as a function of recent cocaine exposure and cost, which may help explain the mixed clinical findings. Modafinil may be most effective for preventing relapse in abstinent patients, particularly under conditions in which cocaine is costly, rather than initiating abstinence for those continuing to use cocaine. [Keywords: cocaine use disorder, smoked cocaine, modafinil self-administration, relapse prevention, medications development]
2021-inoue.pdf: “Efficacy and safety of modafinil in patients with idiopathic hypersomnia without long sleep time: a multicenter, randomized, double-blind, placebo-controlled, parallel-group comparison study”, Yuichi Inoue, Toshiyuki Tabata, Naoji Tsukimori (2021-04):
- The efficacy and safety of modafinil was assessed for idiopathic hypersomnia.
- Excessive daytime sleepiness was evaluated both objectively and subjectively.
- Mean sleep latency was prolonged in patients treated with modafinil vs. placebo.
- No clinically-significant adverse events occurred with modafinil or placebo.
- Modafinil was safe and effective in Japanese patients with idiopathic hypersomnia.
Background: Few treatments are available for patients with idiopathic hypersomnia (IH). Modafinil, an established treatment for narcolepsy, was tested for efficacy and safety in Japanese patients with IH without long sleep time.
Methods: This multicenter, randomized, double-blind, placebo-controlled, parallel-group comparison study was conducted at 20 institutions in Japan. Patients who met the diagnostic criteria of IH in the International Classification of Sleep Disorders (second edition) were included. The study comprised a ≥17-day observation period and a 3-week treatment period during which modafinil (200 mg) or placebo was administered orally once daily (in the morning). The primary efficacy endpoint was change in mean sleep latency on the Maintenance of Wakefulness Test (MWT). Adverse events (AEs) were also recorded to evaluate safety.
Results: In total, 123 patients were screened and 71 were randomized to receive modafinil (n = 34) or placebo (n = 37). Patients treated with modafinil experienced a statistically-significantly prolonged mean sleep latency on the MWT at the end of the study compared with placebo (5.02 min, 95% confidence interval: 3.26–6.77 min; p < 0.001). AEs occurred in 58.8% (20⁄34) and 27.0% (10⁄37) of patients in the modafinil and placebo groups, respectively. Frequent AEs in the modafinil group were headache (n = 6), dry mouth (n = 3), and nausea (n = 3); no clinically-significant AEs occurred.
Conclusion: Modafinil was shown to be an effective and safe treatment for excessive daytime sleepiness in patients with IH without long sleep time.
Clinical Trial Registration: JapicCTI; 142539. [Keywords: modafinil, idiopathic hypersomnia without long sleep time, randomized controlled trial, maintenance of wakefulness test, Japanese version of the Epworth Sleepiness Scale]
2021-robble.pdf: “Concordant neurophysiological signatures of cognitive control in humans and rats”, Mykel A. Robble (2021-03-21):
Progress towards understanding neural mechanisms in humans relevant to psychiatric conditions has been hindered by a lack of translationally-relevant cognitive tasks for laboratory animals. Accordingly, there is a critical need to develop parallel neurophysiological assessments of domains of cognition, such as cognitive control, in humans and laboratory animals.
To address this, we developed a touchscreen-based cognitive (Eriksen Flanker) task in rats and used its key characteristics to construct a novel human version, with similar testing parameters and endpoints across species. We obtained continuous electroencephalogram (EEG) recordings, including local field potentials in rats, and compared electrophysiological signatures locked to stimulus onset and responses across species. We also assessed whether behavioral or physiological task effects were modulated by modafinil, which enhances aspects of cognitive function in humans. In both species, the task elicited expected flanker interference effects (reduced accuracy) during high-conflict trials.
Across homologous neuroanatomical loci, stimulus-locked increases in theta power during high-conflict trials as well as error-related negative potentials were observed. These endpoints were not affected by modafinil in either species. Despite some species-specific patterns, our findings demonstrate the feasibility of a rat Flanker task as well as cross-species behavioral and neurophysiological similarities, which may enable novel insights into the neural correlates of healthy and aberrant behavior and provide mechanistic insights relevant to treatment.