Review of "Smart Drug" Shows Modafinil Does Enhance Cognition

Modafinil was developed to combat narcolepsy (excessive sleepiness), but it is widely used off-label as a "smart drug" to promote cognitive enhancement, where qualities like alertness and focus are desired to assist, for example, in exam preparation. Past studies on sleep-deprived individuals showed a strong positive effect of modafinil on these functions, but there has been less attention and scientific consensus on the drug’s overall effectiveness as a cognitive enhancer in non-sleep-deprived individuals—likely the majority of its users. Now, a new systematic review, published online in the peer-reviewed journal European Neuropsychopharmacology, shows that modafinil does provide significant cognitive benefits in this group, at least for a specific subset of tasks.

Dr. Ruairidh Battleday and Dr. Anna-Katharine Brem from the University of Oxford and Harvard Medical School evaluated all research papers on cognitive enhancement with modafinil from January 1990 to December 2014. They found 24 studies addressing various benefits associated with taking modafinil, including planning and decision-making, flexibility, learning and memory, and creativity.

Unsurprisingly, they found that modafinil’s ability to enhance performance varied depending on the task. It was determined that the longer and more complex the test task, the more consistently modafinil provided cognitive benefits.

Modafinil did not affect working memory or cognitive flexibility but improved decision-making and planning processes. Highly encouraging is that 70% of studies examining modafinil’s effects on mood and side effects showed a very weak overall effect, although a couple reported insomnia, headache, stomach pain, or nausea (which were also reported in the placebo group).

Ruairidh McLennan Battleday said:

“This is the first review of modafinil’s actions in non-sleep-deprived individuals since 2008, and so 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 used the simplest cognitive tests designed for individuals with neurological impairments. By contrast, more recent studies have typically used more complex tests: when these are used, it turns out that modafinil more reliably enhances cognition: specifically, ‘higher’ brain functions that rely on the contribution of multiple simple cognitive processes.”

Anna-Katharine Brem, a researcher from the University of Oxford and Harvard Medical School, said:

“In conclusion, we reached two main findings: first, that despite a negligible number of side effects in these controlled environments, modafinil can be considered a cognitive enhancer; and second, we need to find better ways to reliably test normal or even above-normal cognition. However, we would like to emphasize that with any method used to enhance cognition, ethical considerations must always be taken into account: this is an important avenue for future research.”

Professor Guy Goodwin, President of the European College of Neuropsychopharmacology (ECNP), commented:

“This review suggests that, based on current data, modafinil enhances cognition independent of its known effects in sleep-disordered populations. Thus, the authors state that ‘modafinil may well deserve the title of the first well-validated pharmaceutical nootropic agent.’ In other words, it is the first real example of a ‘smart drug’ that can genuinely help, for instance, with exam preparation. Previous ethical discussions about such agents often assumed extravagant effects before it was clear what they were.”

Modafinil for cognitive neuroenhancement in healthy non-sleep-deprived subjects: a systematic review is published in European Neuropsychopharmacology doi: 10.1016/j.euroneuro.2015.07.028