A Pill to Stretch Your Day: Modafinil (marketed under the name Provigil, short for prolonged vigilance) is a medication approved for narcolepsy (a disorder in which the regulation of alertness falls victim to sudden ‘sleep attacks’) but which, as the name implies, promotes vigilance and combats sleepiness under any circumstances. It is inherently different from caffeine, amphetamines and other psychostimulants which ‘jazz up’ the entire nervous system (whose effectiveness is accompanied by side effects such as jitteriness and muscle tension, a ‘crash’ as their effect wears off, and addictiveness). Modafinil seemingly restricts its actions to the reticular activating system, the part of the brain which keeps us awake and alert, and there does not appear to be ‘rebound’ fatigue or sleepiness when a dose wears off or withdrawal if a user is deprived of it after a period of consistent use.

Its maker is seeking approval for treatment of fatigue and somnolence caused by other medical conditions. The military is, predictably, quite interested in this drug for personnel on longhaul missions where sustained alertness and cognitive efficiency for long periods of time is required. Because somnolence or fatigue is a common side effect of medications used to treat severe psychiatric illnesses, and often limits patient acceptance of necessary medications, many psychiatrists are investigating its potential as a counteractive. Of course, the buzz is about using it in intentional sleep deprivation. I’ve seen a number of webloggers only semi-facetiously avowing, “That’s for me!” in pointing to this LA Times piece. If you thought the ‘cosmetic psychopharmacology’ revolution of ‘Prozac Nation’ was profound, wait until you see what impact this and similar medications coming down the pike might have!

But (as is the rule when you read about newly-developed psychoactive medications), you’ll soon enough find statements to the effect that “nobody really knows how this works” or what the long term consequences — of the medication per se, or of the prolonged sleep deprivation it may be used to facilitate — are. And the effects of the drug in unbalancing an essentially ‘normal’ brain (with regard to somnolence and alertness) may be inherently different from its effects in bringing an ‘unbalanced’ brain back into balance e.g. in narcolepsy, just as (I have long maintained) the effects of stimulants in rebalancing attentional processes in the unbalanced brain of a patient with ADHD are inherently different from their effects in unbalancing a ‘normal’ brain when used recreationally. I’m reminded of a prophetic science fiction story I read what must have been forty years ago in which a man submits to an experiment with a machine that eliminates his need to sleep. Predictably, it is not as pleasant as he had expected and, when he pleads with the investigator to terminate the experiment, things come to a horrific crash. [Does this description ring any bells with anyone?]

I’ve also seen some of the same webloggers who are clamoring for modafinil hoping they can use the recently-publicized ‘magnetic thinking caps’ to expand their cognitive skills to savant-like levels. But scroll back several days in FmH to read my comments on transcranial magnetic stimulation (TMS) for some hints as to the price one has to pay…