Does Modafinil 200 mg Aid in Mood Enhancement?

Modafinil is a wakefulness-promoting drug that acts somewhat like amphetamine and has similar effects on neurotransmitter systems. It causes dose-dependent decreases in GABA activity in the cortex, medial preoptic area and posterior hypothalamus, striatum and globus pallidus, and hippocampus and nucleus accumbens.

It is not known whether modafinil passes into breast milk or could harm a nursing baby. Talk to your doctor before breastfeeding.

Mood Disorders

Modafinil 200 Australia has been shown to be a wake-promoting agent and improve cognitive functioning in healthy subjects. In addition, it has been shown to be a powerful stimulant in ADHD, and had a moderate-to-large effect size in six controlled trials (Lowenthal R et al, Eur Neuropsychopharmacol 2017). Modafinil appears to have fewer adverse effects than amphetamines such as tachycardia and hypertension. It also does not seem to lead to tolerance or dependence.

In a pilot study, Katherine Burdick and colleagues examined the effects of modafinil in stable bipolar depression patients with sleep disturbance. They found that a combination of modafinil and antidepressants significantly improved the fatigue and cognition of these patients. This was a small investigator-initiated study, and larger studies are often needed to confirm these findings.

However, it should be noted that the participants in this trial were receiving traditional antidepressants before being randomized to modafinil or placebo. This may have impacted the depression outcome measures. However, the primary measure of improvement in fatigue and sleepiness was significant for both groups.

The researchers also looked at a number of other prefrontal-dependent functions. They found that modafinil improved another cognitive function associated with BD, Stroop interference. Modafinil has been show to be effective in improving sleepiness and mood in other clinical trials, including narcolepsy, obstructive sleep apnea, and shift-work disorder.

Sleep Disorders

Excessive sleepiness can result from a variety of conditions such as narcolepsy. Shift work disorder (SWD), and obstructive sleep apnea (OSA). In addition, certain medications may also cause this condition, including the popular stimulant Modvigil 200 mg. Identification of underlying causes and appropriate therapy is key in managing this condition.

In double-blind placebo-controlled studies of patients with narcolepsy, modafinil significantly improved objectively determined wakefulness using the MSLT and the MWT, as well as subjectively assessed sleepiness levels using the ESS. The drug also significantly reduced lapses in attention during nighttime testing on the Psychomotor Vigilance Test and the number of accidents and near-accidents reported by the participants in the studies (PVT, MWT).

A newer study of SWD patients found that modafinil decreased daytime sleepiness and improved performance on a series of cognitive tests. The study used a double-blind, placebo controlled design with 12-weeks of follow up. The participants were emergency department residents who received either 200 mg of modafinil or a placebo daily. 1 hour before their night shift began. The drug significantly increase their ability to stay awake during the night shift and was associate with a reduction in the frequency of post-shift somnolence. In addition, the participants reported that the drug increased their overall ability to function during the night shift and improved their mood during the study.

Fatigue

Modafinil is a unique wake-promoting agent that is chemically distinct from other psychostimulants. It increases dopamine in the nucleus accumbens, but also has noradrenergic, GABAergic, and glutamatergic effects. It also has orexin and histamine actions, which explain its ability to improve fatigue in MS and other neurological disorders.

One study using fMRI showed that modafinil reduces the amygdala response to emotionally salient stimuli. It also decreases the reactivity of prefrontal cortex and anterior cingulate during two executive cognition tasks (WM task and VAC task). Although not statistically significant, modafinil also reduces reactivity during these tasks in subjects who are not sleep-deprive. These results are consistent with behavioral studies showing that modafinil improves performance on both WM and attentional tasks in non-sleep-deprived subjects.

Five RCTs have evaluated the effect of modafinil on depression associated with neurological diseases. Using the Beck Depression Inventory in three, Hamilton Depression Scale in another, and Center for Epidemiological Studies-Depression scale in one, the pooled standardized mean difference of modafinil compared to placebo was 0.19 (95% CI 0.03-0.26, p=0.04).

In one randomized, placebo-controlled trial, PD patients who took 200 mg of modafinil twice a day reported less fatigue and were better able to attend post-nightshift didactic classroom sessions compared to those taking placebo. It is important to take modafinil as directed to avoid side effects such as euphoria, nausea and confusion.

Depression

In addition to its efficacy in treating excessive daytime sleepiness. Modafinil has been show to improve mood in some people and reduce depression symptoms. It also appears to have a less-potent antidepressant effect than most other stimulants and a lower liability for abuse. Which makes it a potentially more attractive drug in this area.

In one study, participants were randomiz to receive either 200 mg of modafinil or placebo. They were match on age, gender, premorbid IQ, and depressive symptoms and fatigue severity. They completed visual analogue scales of feelings and neurocognitive test scores from the Cambridge Neuropsychological Test Automated Battery at baseline.

The results showed that the modafinil group had a significant reduction in the four-item fatigue and energy subset of the IDS. And a medium effect on the CGI-BP depression score compared to placebo. The effect was not influence by concomitant medications. Although 58% of the participants were receiving antidepressant therapy at the time of the trial.

The exact mechanism of action of modafinil is not fully understood. However, it is believe to increase wakefulness by inhibiting reuptake of the neurotransmitter dopamine at adrenergic receptors. It also acts as an indirect NMDA receptor antagonist. Unlike most stimulants, modafinil has little effect on extracellular levels of the monoamines glutamate and GABA. Which may contribute to its lower liability for addiction and abuse. Read More Blog…

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