Although not approved by the FDA to treat ADHD, modafinil and its close relative armodafinil have proven helpful for the condition in clinical trials. It is a common practice for doctors to prescribe medications off-label when they are helpful for other conditions, and this is legal.
Modafinil Australia Online was developed as a wakefulness-promoting agent to treat conditions like narcolepsy and shift work sleep disorder. It acts as a eugeroic and enhances cognition by increasing alertness without the jitters and stimulant rush of traditional psychostimulants. It has a low affinity for the central dopamine transporter and does not inhibit dopamine release in rodent brain preparations, nor does it have direct effects on nerve membrane ion channels.
Its unique chemical structure and lack of effects on neurotransmitter systems may account for its ability to improve cognitive functioning in people with ADHD. In one flexible-dose study, Modafinil produced significant improvements in the CPT-IP and Letter-Number Span scales within the treatment group compared to placebo (Cohen’s d > 0.3 for both).
However, there was no difference in the change in the WCST score between groups. This might be due to the small sample size, which was insufficient to detect a statistically significant difference between groups.
In addition to lowering hyperactivity, Modafinil is also effective in enhancing focus and attention, which are core symptoms of ADHD. However, the evidence is less clear regarding whether this drug can also improve inattention and impulsivity in children and adolescents with ADHD.
Another limitation is the lack of long-term studies, which makes it difficult to determine its safety and efficacy in children and adolescents with ADHD over extended periods. This is a major reason why other ADHD medications are approved for use in children and adolescents.
Modafinil, sold as Provigil and other names, is a wakefulness-enhancing psychostimulant. Its pharmacological profile differs from that of the more traditional stimulants (methylphenidate, Ritalin, cocaine). It is less likely to cause the characteristic jitteriness or excess locomotor activity associated with those drugs, and it does not produce the drowsiness and rebound sleep associated with them.
In addition, some studies indicate that modafinil enhances cognitive performance. For example, in medication-free narcoleptic patients undergoing a flexible-dose trial of modafinil (titrated upward over 3 weeks), improvements were observed on the Pauli Test and measures of cognitive flexibility. Moreover, fMRI studies of these patients demonstrated an activation of the anterior cingulate cortex during a working memory task, which was not found in controls.
These findings are consistent with the hypothesis that, in individuals with ADHD, modafinil enhances working memory by inhibiting acetylcholine inhibition. The clinical relevance of this finding, however, is unclear, since the majority of adults with ADHD report normal acetylcholine function.
While it is important to note that modafinil has not been approved by the FDA to treat ADHD, its use as a “lifestyle drug” has become common among entrepreneurs and millennials who are under pressure to outperform their peers at work. Online blogs abound with glowing accounts of unwavering concentration and superhuman levels of focus that allow them to power through 14-hour work days.
Modafinil is known to have multiple actions on central neurotransmitter systems that improve cognitive function. These effects appear to be mediated by its primary stimulant activity, rather than a direct effect on dopamine or noradrenergic systems, as in sympathomimetic stimulants.
In one study, a 4-day course of Modalert 200 mg improved performance on the WCST and Hayling sentence completion test (Walsh et al, 2004), both tests requiring attentional control, as compared to placebo. This improvement was associated with the activation of the dorsolateral prefrontal cortex and anterior cingulate cortical areas, as measured by functional MRI.
Other studies have also shown improvements in various cognitive measures, including the California Verbal Learning Test and Degraded Stimulus Continuous Performance Task. However, a few of these studies were small and showed no significant changes within the modafinil group compared to placebo, indicating that a smaller sample size could have reduced statistical power.
In a larger clinical trial, patients with ADHD who received either 340 mg or 425 mg daily of modafinil based on body weight experienced greater improvements in teacher and parent-rated Conners ADHD Rating Scale-IV School and Home versions, as well as in their symptom severity indices (CGI) than those receiving placebo (Biederman et al, 2006). In addition, modafinil was safe and well tolerated with only minor side effects such as insomnia and headache, which did not result in medication discontinuation.
Modafinil increases working memory capacity, which is essential for attention-deficit/hyperactivity disorder (ADHD) patients. Its effectiveness in this area has been attributed to the fact that the drug boosts histamine levels in the brain and inhibits the release of glucocorticoid hormones (GCDH) from nerve cells. GCDH is involved in the regulation of neurotransmitters such as histamine and glutamate, which play an important role in memory function.
Modafinil also enhances the activity of dopamine receptors in the prefrontal cortex, thereby increasing cortical histamine levels (HA). Studies have shown that modafinil improves performance on digit span, letter-number span, and spatial planning tasks, as well as short-term memory, in both children and adults with ADHD.
It has also been shown to reduce errors on the Wisconsin Card Sort Test (WCST), and in some cases to increase performance on the Hayling Sentence Completion Task. Moreover, fMRI has demonstrated that a single dose of modafinil decreases WCST and digit-symbol-matching errors and that it increases activation of the anterior cingulate cortex in individuals with low initial fMRI activation (Ellis et al 1999).
One double-blind, placebo-controlled study of adults with 85 h of sleep deprivation found that a 4-day course of 400 mg of modafinil reduced errors on the WCST, compared to placebo; and increased performance on the Hayling task and on a version of the digit symbol task that requires cognitive control.
This improvement in cognitive functioning was comparable to that observed after administration of 600 mg caffeine and 20 mg amphetamine. Read More Blog…