BMJ 2015;351:h4573 doi: 10.1136/bmj.
h4573 (Published 21 August 2015)
News
Modafinil does enhance cognition, review finds
Nigel Hawkes
London
A drug developed to treat narcolepsy may be the world’s first
safe “smart drug,” say researchers from Oxford and Harvard
Universities who have carried out a systematic review of the
evidence.1
Modafinil has had a long under-the-counter career among
students and academics who claim that it can increase their
mental sharpness. As long ago as 2008 the journal Nature invited
its readers to own up if they had used cognition enhancing drugs,
and one fifth said that they had. Modafinil had been used by
44% of these, who cited improving concentration as the most
popular reason.2
The new review, published in European
Neuropsychopharmacology,1 showed that they may have been
right. Ruairidh Battleday and Anna-Katharine Brem found 24
randomised controlled trials published from 1990 to 2014 that
measured the benefits of taking modafinil, including planning
and decision making, flexibility, learning and memory, and
creativity. Previous studies have shown positive effects in sleep
deprived people, but the two scientists included only studies
that looked at people with normal sleep patterns.
They reported that the drug made no difference to working
memory or flexibility of thought but that it did improve decision
making and planning. No real effect on mood was found, and
other side effects were slight, but a few people had reported
insomnia, headache, stomach ache, or nausea. Patients on
placebo also reported the same side effects.
“So we ended up having two main conclusions,” said Brem.
“First, that in the face of vanishingly few side effects in these
controlled environments, modafinil can be considered a
cognitive enhancer; and, second, that we need to figure out
better ways of testing normal or even supra-normal cognition
in a reliable manner.
“However, we would like to stress the point that, with any
method used to enhance cognition, ethical considerations always
have to be taken into account: this is an important avenue for
future work to explore.”
Battleday commented, “This is the first overview of modafinil’s
actions in non-sleep-deprived individuals since 2008, and so
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we were able to include a lot of recent data. Interestingly, we
found that the type of test used to assess modafinil’s cognitive
benefits has changed over the last few decades.
“In the past, people were using very basic tests of cognition,
developed for neurologically impaired individuals. In contrast,
more recent studies have, in general, used more complex tests:
when these are used, it appears that modafinil more reliably
enhances cognition: in particular, ‘higher’ brain functions that
rely on contribution from multiple simple cognitive processes.”
The findings raised ethical issues, said Guy Goodwin, president
of the European College of Neuropsychopharmacology, who
was not involved in the study. “Previous ethical discussion of
such agents has tended to assume extravagant effects before it
was clear that there were any,” he said. “If correct, the present
update means the ethical debate is real: how should we classify,
condone or condemn a drug that improves human performance
in the absence of pre-existing cognitive impairment?”
Goodwin added, “As the authors point out, modafinil is not
licensed for this use, and it will not be because it would be
outside the current terms of reference of regulatory bodies. The
non-medical use of mind altering drugs has hitherto broadly
conflicted with the work ethic of many societies [and] has been
very popular but leads to a range of demonstrable harms.
“Regulation has been and remains problematic. We cannot know
either if demand for modafinil in the same societies will actually
be significant, whether society will be more accepting [or] how
regulation will then be framed.”
Modafinil was originally developed in France and was approved
in the United Kingdom in 2002. It is now out of patent and
produced by a number of generic companies as Provigil.
1 Battleday R, Brem AK. Modafinil for cognitive neuroenhancement in healthy
non-sleep-deprived subjects: a systematic review. Eur Neuropsychopharmacol 2015,
doi:10.1016/j.euroneuro.2015.07.028.
2 Maher B. Poll results: look who’s doping. Nature 2008;452:674-5.
Cite this as: BMJ 2015;351:h4573
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