
Modafinil for cognitive neuroenhancement: a systematic review - molecule
http://www.europeanneuropsychopharmacology.com/article/S0924-977X(15)00249-7/abstract
======
scrapcode
I have recently, within the past 2 years, started to realize that I may be
unintentionally self-medicating larger underlying issues and am attempting to
put more trust into medical professionals.

Skipping the story book, I work rapidly changing shift-work and couldn't
sleep, stay awake, or function when i was supposed to. I saw a specialist that
diagnosed me with "shift-work disorder." The solution cocktail includes Ambien
to go to sleep, and Modafinil/Provigil to stay awake. I only use them during
the times when I'm on the odd-ball shifts (not days), and they work great.
I've had no issues.

I have also recently gotten prescribed Adderall after voicing my (and former
teachers) life-long concerns of possible ADHD. Low dosages did nothing, and I
can "kind-of, maybe?" tell some improvements with a higher IR dose. I don't
want to ask for more at risk of looking like a drug seeker, and I don't want
the jitters to increase, but I'm also not really sure what I'm supposed to
"feel."

Until I've recently went back onto one of those odd-ball shifts and took
modafinil again. I can absolutely without a doubt tell that I'm on it. I am
focused and am constantly completing something. This is what I imagined
Adderall was supposed to be. The con is that it has this effect that I don't
notice I'm hyper-focused until many hours later when it wears down a bit, and
it's noticed in retrospect. It's weird enough that I take it as rarely as
possible (I'd rather feel this then constantly falling asleep while at work,
which is extremely dangerous at my job)

~~~
benevol
It's well established that shift work destroys you. Don't do it.

~~~
rattray
Really? Scientific studies are now establishing that this or that "destroys
you"?

I find it rather presumptive that you simply tell this person not to do
something, period. They have more information about their own life and the
trade-offs involved. As a straw man, maybe they earn enough from occasional
shifts to pay for treatment of an otherwise deadly medical condition, or don't
have other economic opportunities.

In addition, many jobs simply need to be done in shifts, and someone's gotta
do it. Servers need monitoring, hospitals need staffing, power plants need
running.

~~~
toomuchtodo
> Really? Scientific studies are now establishing that this or that "destroys
> you"?

I'm not going to go grab links for you, but yes, shift work is terribly
detrimental to your health. Google "shift work health risks".

> In addition, many jobs simply need to be done in shifts, and someone's gotta
> do it. Servers need monitoring, hospitals need staffing, power plants need
> running.

Indeed. They can pay extra for the requirement, while we ensure we have
regulations to keep people who have to do it as healthy as possible.

~~~
Spooky23
If you shift "backwards" doing shift work, you're significantly more likely to
have a heart attack, accident, etc.

Take a few minutes and google it, this has been studied for 100 years or more.

------
synaesthesisx
While "cognitive enhancers" and nootropics can increase performance (caffeine
is my stimulant of choice) I don't think any can really act as a substitute
for proper sleep. Sleep is incredibly important to learning & memory -
stimulants can only really temporarily mask the effects of sleep deprivation
but they rapidly lose effectiveness if one isn't maintaining proper sleep
hygiene.

~~~
bjwbell
I can't agree more. The drug that had the biggest impact on my productivity is
[http://www.gwern.net/Melatonin](http://www.gwern.net/Melatonin), more than
modafinil or anything else.

And yes besides melatonin I follow the recommendations for improved sleep.

~~~
joshcanhelp
Totally agree. And not just from a performance perspective, the positive
affect on mood in general is very important. Melatonin has helped me greatly
in the last year.

------
bmir-alum-007
Interesting. It so happens I took provigil (modafinil) more for this reason
than for sleep deprivation or to cram in more all-nighters in college. The
experience was like caffeine, but without jitters or noticeably increased
BP/heart rate. It was more like "hyperawareness" without hyper-vigilance or
anything unpleasant. ("Limitless lite.")

I tried adderall for concentration at a standard therapeutic dose, but the
jitters and palpitations.

These days, I just use mirtazapine (depression) and flonase (sleep apnea) and
occasional caffeine, and all is sweetness and light.

EDIT: If anyone can add peer-reviewed, reasonably-safe, well-studied
neuroenhancement lifestyle choices (food, supplements, pharma, etc.) that
aren't just spam/gimmicks, that would be interesting.

~~~
zo1
I'm a little bit confused as to how you're gaining access to some of that
medication. Are they not controlled? I.e. you need a prescription from a
doctor to get them.

~~~
circuiter
I don't know how he got adderall, but modafinal and the other drugs he
mentioned are either schedule IV to Rx Only, so if you ask a pharmacist nicely
they can give it to you. (That's how I got modafinil when I was in college)

~~~
copperx
> if you ask a pharmacist nicely they can give it to you.

In the US?

~~~
circuiter
Yes. There is some minor paperwork involved for them, which is why you should
ask nicely, and YMMV.

~~~
datasink
Can you elaborate? I worked as a pharmacy tech when I was younger and never
saw drugs dispensed without a prescription from a doctor. I also can't find
anything on the web about this being possible in the U.S.

~~~
throwaway2048
the term you are looking for is "over the counter" or OTC

~~~
datasink
Modafinil is classed as a Schedule 4 narcotic. It's definitely not an OTC
medication. Examples of other Schedule 4 medications: Xanax and Valium.

~~~
circuiter
Actually modafinil is a schedule 4 stimulant (which matters in some states).
And Pharm.D.s can get into an agreement with Physicians to dispense medication
on their behalf as they see fit, it's called Collaborative drug therapy
management.

------
codecamper
modafinil at a very low dose might help you stay on task. But be sure not to
get stuck on some random useless task. I've found that I get super focused on
the details of something. But I don't think that is really the right mindset
for writing good code.

~~~
kjs3
Spot on. I found that Vyvance (sp? basically long release Adderall) was great
for helping me stay on task far longer than I normally could, but in no way
helped me pick the right task to stay on. :-)

It's no magic bullet; I still need to self discipline to pick the right things
to work on. FWIW, I pretty heavily rely on todo lists for this.

~~~
jacques_chester
I've had a similar experience using ritalin. If I have a clear task, I will
feel a pressing need to execute that task.

If I don't have a clear task, I will procrastinate even harder.

------
VonGuard
I have completely unscientific evidence from watching two friends on this for
a year. One took it in bursts when code was due, usually no more than 2 weeks
at a time. The other took it every damn day and basically didn't sleep all
year. Friend 1 is fine and now has a majorly well paying job. Dood 2 is gone,
vanished in a fog of paranoia, never to be seen again by his friends.

------
modathrowaway
I started taking Modafinil 3 months ago because I had to start a job which
would be new & kind of difficult for me, and my prior "normal" routine
involved getting really sleepy in the afternoon (yes, I was getting proper 7-8
hrs at night) and taking a nap, which wouldn't be possible at the new job.

In short, it works. I have been taking 200mg doses. I don't notice any
focusing effect. I just don't get sleepy, at all, during the day. Only other
effect, for me, is caffeine sensitivity -- as other posters have noted,
modafinil will not make you feel wired, but add half a cup of coffee and there
you go, if that's your thing.

------
ShirsenduK
I had tried it and it had increased the amount of focussed hours I could have
in a day. Sleep deprivation wasn't an issue as I used to sleep well. I gave up
as it affected my eating patterns. Good that research is being done.

------
neverminder
Well, personally I'm not aware of anything else that can make me as productive
after a bad night's sleep. I'm one of those people that are very susceptible
to sleep deprivation. Cognitive enhancement issue aside - it does what it's
supposed to and that's providing consistent alertness throughout the day. You
can't do much if you're in a yawn-semi-coma state.

------
replete
I've spent a lot of time investigating nootropics over a couple of years, and
I really don't think Modafinil does much.

It is great for feeling a little more awake when you're really sleep-deprived,
but the tunnel-vision effect on high doses isn't always useful.

Exercise , healthy eating, and mindfulness will yield more benefits than any
smart drug.

~~~
neverminder
I have spent a lot of time researching nootropics too. Modafinil provides
alertness/wakefulness and that is already a lot to some people. You can then
add a racetam, anxiolytic or whatever else is needed. Even l-theanine is known
to smooth out some negative effects of modafinil. You can use all the
cognitive enhancers under the sun, but they're not gonna do squat if you're
yawning your head off.

And just for the record - I work out every day, take cold showers, medidate,
my diet is impeccable (macro nutrient balanced) and all that combined still
doesn't give me the same level as nootropics do.

~~~
Artistry121
Could you point me to a good resource on nootropics?

~~~
forloop
1\. LongeCity: [http://www.longecity.org/forum/forum/169-brain-
health/](http://www.longecity.org/forum/forum/169-brain-health/)

2\. /r/nootropics

From there you should be able to find other resources; but they're the best.

------
andy_ppp
For me Modafinil does not help me to concentrate at all, instead making me
feel non-jittery-jitteriness is the only way I can describe it.

If you are looking for cognitive enhancement and focus improvements nothing
will help more than yoga and meditation.

~~~
aalhour
Modafinil has always made my mind feel like a jet engine out of control! And I
have never managed to avoid having headaches the next morning.

~~~
astrange
Supposedly you can fix that by eating more choline beforehand.

------
throwthrow22
I know this is about Modafinil, but since many of you are commenting on
Adderall and the various amphetamine salt mixes out there, I wanted to
comment:

20mg of instant release Adderall daily (or worse, twice daily) is not a
trivial amount to be taking. The long-term effects of the increased heart-rate
and sudden spikes you will get from Adderall are not yet well studied or well
understood in the medical community.

Stress, arterial stress, vasoconstriction[1], increased heart rate, and high
blood pressure are all just a few of the things that happen when you take
amphetamine salts. It's not just the jitters.

While these side-effects are okay from time to time, the body is not used to
being treated this way on a daily basis, for years and years.

If you are in a place in your life where you don't think you need to be taking
it, consider not taking it. Take a break on weekends, or a week at a time.

1: This is part of why many of you get "short" or "agitated" on these drugs...
drink more water to at least help.

~~~
joshcanhelp
Curious to know how the effects of "stress, arterial stress, vasoconstriction,
increased heart rate, and high blood pressure" from Adderall (which I don't
take) compare to caffeine and/or nicotine (current and former). Are the
problems similar or the same for a daily coffee drinker/smoker or reduced?

------
Phlow
I have thought about trying Modafinil and Adderall for those times when I just
can't seem to stay on task. The results and speculation are interesting,
particularly the idea that "modafinil stimulates improved performance in the
range of tasks reported herein mainly as a downstream effect of enhancement of
‘top-down’ cognitive control processes." The brain is a complex beast. I think
the real test, ignoring the safety concerns with altering brain chemistry, is
whether you can personally observe a benefit when you take it.

~~~
Synaesthesia
Yes I'm interested in Modafinil, Amphetamines can help but they have can also
be detrimental as they have all kinds of side like emotional problems. The
positive effects stop working if you take too much, or too frequently and
they're very addictive. Modafinil sounds milder and less harmful.

------
danneu
Main problem I see with Modafinil is that it's instant release.

Whenever I hear that someone takes Adderall IR, I ask them if they've tried XR
or Vyvanse since the latter are superior in most ways. Mainly, IRs produce
tolerance too fast and the curve is too steep.

I don't think Modafinil has an XR solution. Though, Modafinil feels like a
sugar pill compared to a low dose of amphetamine.

------
benevol
Reminder: Sleep cleans your brain.

www.npr.org/sections/health-shots/2013/10/18/236211811/brains-sweep-
themselves-clean-of-toxins-during-sleep

------
fastball
Off-topic but that domain name is ridiculously long!

------
ommunist
Here is report of one life ruined by modafinil
[https://www.erowid.org/experiences/exp.php?ID=92932](https://www.erowid.org/experiences/exp.php?ID=92932)

~~~
kjs3
If you have an agenda, you can find a report of one life ruined by most
anything. This is a particularly egregious example of "I did basically
everything wrong, but the outcome isn't my fault, it's the terrible, dangerous
drug".

~~~
ommunist
Well, citing my friend professional toxicologist, who spent some time working
for big pharma in Swiss, and delivered relevant course at Bristol Uni,
"Modafinil is not even nootropic, you can only compare it to ladasten". This
guy considers piracetam useful and buys it in Russia, where it is dirty cheap.

~~~
kjs3
Your appeal to authority does nothing to refute my point.

------
getdavidhiggins
Good for mindset, but bad for soulset. A lot of people live in their heads
with Modafinil, and don't take guidance from the subtle cues in nature, which
they're going to have to at some point. Michael Tsarion brings this up in his
talks: The War on Conciousness
[https://www.youtube.com/watch?v=knwyZawRse8](https://www.youtube.com/watch?v=knwyZawRse8)
We have a deep fear of Nature because it's the 'final boss' we have to deal
with at some point. Be this death, grief, or getting old. Any number of things
are competing for your attention in Nature. Rushkoff talks about how our minds
increasingly live inside a computer program and are out of sync with Nature.
The internal clock is ignored and we live in a constant state of panic when
checking our email and trying to game the stock market:
[https://www.youtube.com/watch?v=ZQHubIMP-
as](https://www.youtube.com/watch?v=ZQHubIMP-as) Alongside time being out of
whack, we experience different hormones and endorphins at different times of
the year. So summer might be dopamine, winter might be adrenalin filled, and
autumn is some sort of smart drug like Modafinil which allows for high
performance.

~~~
kingmanaz
>Good for mindset, but bad for soulset.

Exactly. From the linked article: Modafinil "indirectly upregulates cerebral
serotonin" ...a concern for those focusing on quality of life rather than
quantity of output.

"To give you some perspective: the type of behavior displayed by upper classes
of society; the elegance, the subtlety, the higher levels of intelligence and
conscience, most likely reflect low serotonin levels (or rather, a lower ratio
of serotonin to other neurotransmitters). Now take the opposite, high
serotonin, say in combination with a poor immune system, low metabolic rate,
chronic inflammation, and what will you have? Well, a serf/thrall."

Further discussion here:

[http://www.longecity.org/forum/topic/73104-natural-
serotonin...](http://www.longecity.org/forum/topic/73104-natural-serotonin-
antagonists/) [http://www.longecity.org/forum/topic/78451-symptoms-signs-
of...](http://www.longecity.org/forum/topic/78451-symptoms-signs-of-too-much-
serotonin-excess-serotonin-specifics-easy-to-read-cited/)

------
seiji
Anybody interested in an ebook about how to dose yourself (or your entire
company) for optimal startup performance?

I've thought about putting one together by interviewing people about their
non-amphetamine-based get-shit-done regimen (timings, dosages, ± side effects,
results). It'll be like an Internet bad-broscience guide, but with a slant
towards combining wider anecdotal evidence with results and performance
benefits/drawbacks across everybody.

email me if you're interested. If there's enough seed interest, I'll make it
happen.

~~~
Bjartr
I'm interested in you not creating such a book. While I support the idea of
seeking your own improvement and taking advantage of what works for you as an
individual, the view such a book espouses is not one of improving quality of
life, it's one of More. Just More. Which in my mind is a really dangerous way
to go about lifestyle choices. You might as well title it "How to Burn Out in
22 Hours a Day"

~~~
seiji
_is not one of improving quality of life, it 's one of More. Just More._

Have you seen which website you're on? More-More-More for Me-Me-Me is pretty
much the MO around here.

~~~
Bjartr
Yup, and while in the context of business value itself I more or less agree
with you, I do observe generally a more balanced view on quality of life and
avoiding burnout around here than a raw selfish drive. Which is exactly why I
hold a disapproving opinion of your idea, it sends that balance out the
window.

