Modafinil Is Wall Street’s New Drug of Choice

http://nymag.com/news/intelligencer/modafinil-2013-4/

by whalesalad • 13 years ago

59 69 13 years ago

mathattack• 13 years ago

I am very interested of opinions on these boards for it. My intuition is there is no free lunch - if this were the optimal brain wiring, we'd be there already. Is it the inevitable crash or sleep deprivation? I haven't done any hard research on the topic, so I am interested in first hand observations. We are the target audience of the article, even if the link title doesn't suggest it.

Elgabacho2• 13 years ago

Depression for me. I've used it multiple times in law school and afterwards. I stopped because for a couple days afterwards I would get seriously depressed.

ollysb2• 13 years ago

Were you sleeping less when using the pills?

Afforess4• 13 years ago

That's interesting because modafinil supposedly has mild antidepressant effects.

ollysb2• 13 years ago

It's quite possible the brain isn't optimised for the current availability of nutrients. Judging by the number of overweight people walking around it seems likely that evolution has selected for efficiency rather than performance. Given that our gene pool hasn't changed much in 250,000 years a little chemical nudge in the right direction is probably the way to go.

aaron6952• 13 years ago

Well the no free lunch theory is I think wrong, we are vastly better off with modern medicines. We are already getting free lunches of longer and heather lives.

My experience, obviously not scientific, with modafinil is mild mania, grumpiness/quick to anger (What I think is the tiredness coming through), increase concentration and attentiveness to a task. My intelligence goes down. Mixed with alcohol it can cause blackouts (It has a long half life so this can be a day or so later). Hard to sleep on. Euphoric enough to take recreationally.

Listening to other people they have different effects.

For me I'm not sure it's a effective drug. Because it's said long term you can build up tolerance I've always only done it one pill per week for small projects, so maybe doing it on a regular schedule it might stop some of the above negatives.

manicdee• 13 years ago

The "free lunches of longer and healthier lives" are due mostly to clean water and covered sewers, with the rest of medical science not mattering to the vast majority of people who don't suffer from life-limiting medical problems.

Along with clean water and covered sewers we have improved working conditions (which medical science has contributed to without making everyone take medication), and a range of other quality-of-life changes that have occurred in society.

balloot2• 13 years ago

You're missing his point, which is a reasonable one. If the human body truly functioned better with modafinil, then evolution would have given us humans that naturally produced modafinil. That isn't the case, so the assumption is there is some downside to the drug, and one that actually outweighs the positives. However, the article makes modafinil seems like an obviously positive thing and that taking the pill fixes some bug in natural human behavior.

danneu• 13 years ago

The brain didn't evolve to address the struggles of today. My ancestors weren't trying to stay mentally engaged to a computer screen for eight hours at a time.

roundingerror• 13 years ago

I've had a fair bit of experience (though not every day for months on end). From what I've read many people have a similar time, though some may end up with better results.

If you're tired, you can use it as an alertness aid. If before, you would have fallen asleep at your desk from exhaustion, you will instead be able to continue to work (but still be fairly tired). Modafinil will allow you to continue on from the point of exhaustion and be able to function in some reduced capacity (50-60%). You will experience some periods of higher function (almost like waking up and being a bit tired, and then your mind clears a bit), basically you will alternate between tired and fine for a few hours, each period about an hour in duration. Taking modafinil in this manner isn’t especially recommended, but if you just spent all day / night putting out fires and you need to come in the next day to ensure everything is still running smoothly (but hard work isn’t expected), modafinil will do great here. Alternatively, I would recommend using it at the beginning of a normal day after a full night’s rest. This will result in some periods of clear headedness, and generally make it incredibly easy to focus on a task. I wouldn’t say I’m as ‘quick’ on modafinil, but I can certainly refactor code and slowly improve it for hours without feeling bored or getting distracted. I find that it makes me super calm as well. It definitely hampers creativity / big picture thinking, I wouldn’t do system design on modafinil, or even design for a subcomponent, I wouldn’t be at my best and might miss details or produce a subpar design. Basically, if you are just implementing a chunk of code, and have already figured out the details, modafinil will result in a good experience, you’ll make steady progress, your work will be of high quality, and the day will go by fairly quickly.

aaron695 mentioned dose – 2-3 pills a week is fine. Alternating entire weeks on and off is fine. I would only take at most one pill a day, but some people take two and are fine. Tolerance builds up about as quickly as it does for Adderall IR. Definitely don’t go drinking on the drug, but if you typically have a drink with dinner you’ll be fine - just don’t expect to feel any of the effects from the alcohol. I’ve felt the beginnings of depression on other nootropics (specifically piracetam - I generally have a poor diet though, so that may have been my fault) – but haven’t had a problem with modafinil after an extended period of time. It will be difficult to sleep if you take it too late in the day, definitely dose in the morning.

Essentially it’s a stronger, better version of caffeine (increased alertness, focus, can be used to increase performance with acute use, but with regular use tolerance builds and productivity decreases).

icelancer2• 13 years ago

>if this were the optimal brain wiring, we'd be there already

Evolution isn't an "optimal" process. It is very random. And very slow.

thomasbk• 13 years ago

Gwern has an amazing writeup of Modafinil, including his own (DIY "double" blind-trial) experience, effects, etc:

http://www.gwern.net/Modafinil

Highly recommended for anyone even slightly interested in the workings of Modafinil. His own experiences are described in the most detail on this page:

http://www.gwern.net/Nootropics#modafinil

jcomis• 13 years ago

There goes my night. That site is like a black hole.

codemac• 13 years ago

It's not just a black hole, it's a well researched and cited black hole.

Gwern seems to be an awesomely motivated person. It really inspired me to take what I consider to be "interests" more fully.

anon4atruestory3• 13 years ago

When drugs are used illegally, reporting on their adverse effects is generally shoddier than for on-label prescription usage, for a variety of reasons. In my personal experience, Provigil is an extremely effective and powerful tool, and like any power tool, should be treated with the proper respect or you're likely to get hurt. See my other comment a few threads below for more information and context, but I wanted to reply quickly to this (admittedly excellent) resource because it didn't seem to have a whole lot to say about the potential dangers, and as I've personally experienced them (and still find Modafanil to be a drug worth taking on occasion) I thought I'd try and make sure that others like me can learn from my mistakes without the need for their permanent consequences. The long and short - If you choose to use Modafanil, drink plenty of water, try not to use it as a sleep replacement (48-72 hours without sleep) more than once or twice a month, and fortify and replenish your body with quality food before, during, and after. If you are reckless, the lack of sleep combined with a histamine agonist can have effects that are roughly the opposite of benadryl, including an increased propensity for immune response (including allergies), that depending on your misfortune may become a permanent part of your life.

the_cat_kittles• 13 years ago

For me, it was a pretty euphoric high and short term memory boost the first time. With repeated use, the effects diminished alot. I am much more effective/productive/clever/creative without it, though the drug makes it feel like im better at all those thing. (I was prescribed it long ago)

MacsHeadroom2• 13 years ago

That is very odd. I have never heard of somebody having euphoria from Modafinil in any of the medical literature or on any of the nootropic/drug forums.

http://www.gwern.net/Modafinil list off 10 different citations for the line "But what does medicine say? It seems to report no euphoria, tolerance, or withdrawal/dependency."

bquarant• 13 years ago

Congratulations HN for upvoting Big Pharma propaganda nonsense.

Afforess4• 13 years ago

As opposed to vitriolic opinions?

sdoowpilihp• 13 years ago

As I read this, I can't help but be reminded of the old adage, "There ain't no such thing as a free lunch".

tapp• 13 years ago

Slightly OT:

I am surprised to hear this sentiment on HN as often as I do. It seems to imply a somewhat Luddite-like fear of technological advancement, versus the generally positive interest I would expect from hackers. Am I off base?

I'm not talking about modafinil specifically (no opinion there) but more generally.

duaneb• 13 years ago

I think it's more about caution when dealing with your body than actually believing some law about having a bad side.

rayiner2• 13 years ago

Engineers have (rightly) a strong "don't fix what ain't broken" streak.

balloot2• 13 years ago

Your problem is you are confusing skepticism for fear.

Evolution has given us a brain that is so complex that we still have very little understanding of how it actually functions. So do I believe that a drug company came up with a way to improve upon evolution and make the brain better? No, I do not. And I think that's a pretty reasonable initial stance to take given the facts at hand.

bluetooth2• 13 years ago

In this case, you end up paying for the tolerance that builds up extremely quickly when you take Modafinil multiple times.

Afforess4• 13 years ago

It's interesting that tolerance is always mentioned when modafinil is brought up, because no research studies have found any evidence of the reported tolerance, and users of said drug have no incentive to hurt the modafinils image.

I wonder if repeated use simply makes the user feel that the changes are normal, when in effect, they are in a high functioning state.

Afforess4• 13 years ago

There are however, extremely cheap lunches, which the savvy will take advantage of. From my personal experience, this is one such case.

malandrew5• 13 years ago

Yup. I agree that for those that want the benefits, modafinil does fall into the free lunch category if you follow the one rule I posted about not taking it within 12 hours of your intended sleep time. ref: https://news.ycombinator.com/item?id=5478020

anon4atruestory3• 13 years ago

[I meant for this to be a short post, but it's grown entirely too long. TL;DR - Modafanil is in many ways a wonder drug, but it is absolutely not free of side effects. You need to know (and monitor) your own body, and not ignore physiological imbalance, even if it seems trivial. Drink a lot of water, eat lots of nutritious food while taking it, and for the love of god, do not stay up more than 2 or 3 nights in a row without sleep. It's not worth it. Read on below if you want context]

I wanted to provide a personal story to counter a lot of the enthusiasm and carelessness around modafanil. I'm a software engineer, and I've dabbled on and off with modafanil for a little less than a decade now, including several one-week runs of hardcore usage, without sleep, during contracting gigs in my early-mid twenties.

I'll start by saying that I still think modafanil can be extremely useful as a tool, and that, until I recently ran out, I would still take 100-200mg of modafanil if it were no more than once a week (with an effort to make it not more than twice a month), so I still feel the risks and unknowns can be worth the tradeoff. But make no mistake - modafanil is an effective medication, and like all effective medications, it has side effects, (light) mental habituation, and potentially life threatening side effects if used improperly.

At the end of one particularly rough 9 days or so of straight usage during a major release for a contract, averaging 3 hours of sleep once every two to three nights (and the rest solidly awake), I settled with the team at a 24-hour diner right before release, and had an all-potato breakfast. My stomach had been steadily gaining in acidity over the week, but I had ignored it. A couple of hours later, I threw up and accidentally inhaled a small amount of the most corrosive stomach acid I've ever felt. When I coughed it out I tasted blood, and shortly after found it harder to breath. The bleeding was so profuse that I found it necessary to handstand over a hotel bathroom sink to let it all drain out without choking me. Luckily the person who had dropped me off was nearby - I phoned him and he took me straight to the hospital. I never had experienced that level of lung trauma before, and I've had a lot of hospitalization events related to some pretty severe asthma in my life, and it was this moment more than any other in my life that I seriously considered that I might die. In the end, I made it out with a light lung infection, and was treated at the hospital for an allergic reaction. I've never been able to eat potatoes since without experiencing an allergic reaction.

I can't seem to find a citation for this right now, but I remember reading at one point that modafanil is an agonist in the histamine receptor family. I am not a neurologist, and I know that the histamine receptor family can have very contradictory effects due to them being a modulator of the release levels of neurotransmitters dopaminergic and serotonergic pathways, and is also more publicly famous as being the target of the antagonist, Benadryl. I generally think about the vigilance instilled by Provigil as the same kind of vigilance you may have experienced during the beginning stages of an infection. The immune system revs up, you get warmer, you don't want to move around as much (as opposed to amphetamine based stimulants that seem to give you physical energy you want to burn off), and you slip into a more introspective and determinedly focused state. But vigilance comes at a price, and if you keep burning carelessly through your internal resources without replenishing them, eventually you'll start burning the wick (you) too. Something will fail. Sometimes catastrophically.

od2m• 13 years ago

This is nonsense.

rayiner2• 13 years ago

The "meritocracy" article on the front page is relevant in context of this one.

woah2• 13 years ago

I use modafinil regularly. I have (had?) some variant of ADD, and while it does not trouble me as much as it did when I was younger, it can still be frustrating, mostly if I am trying to focus on work I don't particularly enjoy.

I use it between a few times a week and a few times a month (my desire to take it at all fluctuates quite a bit). I'll take 10-25mg in the morning and get on with my day. I generally don't really notice it, but looking back in the evening, realize I was a bit more productive.

For me, it's less euphoric than coffee. I'll feel happy and energized after a cup of coffee, but after taking modafinil, just a bit more alert.

What it does seem to do is raise overall energy levels during the day, and increases short term memory (useful for programming).

I think many news stories about it, like this one, blow it vastly out of proportion. Cumulatively, it could make the difference that pushes your work to the next level, but sleep and exercise are a way bigger factor. Still, I am very happy to have it.

For those worried about giving money to big pharma, buy it online from one of the many sites that import from India.

jimrandomh• 13 years ago

Sanity check fail: 10mg is an implausibly small dose, so small you'd have to grind the pills and measure tiny quantities of powder. Are you sure you're not thinking of a different drug, or off an order of magnitude?

woah2• 13 years ago

It comes in 100mg pills, and I take between 1/4 and 1/6 of one. Higher doses don't seem to have much more of the beneficial effects on concentration and memory, just make me more jittery.

veemjeem• 13 years ago

not true. I took ritalin in high school, and when I took a whole pill, it made me feel like a zombie. I was able to scale back to 1/5th of a pill and still be able to focus. Those pills were already pretty small, so I'd just smash it and dump approximately 1/5th of the powder in my orange juice.

wpietri2• 13 years ago

A tablet isn't pure active ingredient. "PROVIGIL tablets contain 100 mg or 200 mg of modafinil and the following inactive ingredients: lactose, microcrystalline cellulose, pregelatinized starch, croscarmellose sodium, povidone, and magnesium stearate." [1]

The 100 mg pill is a 13 mm oval. [2]

So it seems entirely plausible to me to use a pill cutter to cut it into 8 or 10 roughly equal parts.

[1] http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=14770 [2] http://pillbox.nlm.nih.gov/pillimage/search_results.php?geti...

DigitalSea2• 13 years ago

Well if this isn't a somewhat glowing endorsement of a pill that is being abused, I don't know what is. As someone who is close friends with someone suffering from narcolepsy who actually needs this pill to function normally, I find it worrying people are abusing a pill that can have some serious side-effects.

Good job publicly endorsing a pharmaceutical drug NY Mag. I have a feeling as word spreads, the abuse will make it harder for legitimate suffers of narcolepsy (and other cases treated by Modafinil) to get access to the pills.

malandrew5• 13 years ago

Diagnosed narcoleptic here with an MSLT score of about ~2min.

I've been taking Modafinil @ 200-400mg/day off and on since 2003, with probably a total of 4 years of usage in that time span, together with Xyrem for about a year in 2004 and punctuated by ritalin for a year or so around 2008-09. I personally only take it when I have to and try to avoid taking it on days on which I think I can manage without it.

Yes, it can be habit forming, but only psychologically and only weekly. I can totally see it being habit forming when "taken together with" a demanding worklife. If you aren't working lots of hours where you need to stay focused the entire time, there is little motivation to take modafinil. It's not any "fun" and the "high" you get is not from the drug itself, but the ego boost from getting a lot of shit done. People don't get "addicted" to the drug but to the feeling of productivity.

On top of that, it has little to no side effects. It might have exacerbated my bruxism slightly but that's about it.

However there is one risk with it and that is sleep deprivation. My number one advice to anyone that takes it is to never take it after about 11am in the morning (or less than 12 hours before the time you intend to sleep). If you follow that one rule, I can't foresee people having any issues with it long term. The problem with taking it less than 12 hours before bedtime is that it has a half-life of about 6-8 hours meaning that it's mostly worn off by 12 hours and sleep "no longer feels optional at that point. This approach lets your feel awake, alert, productive and focused during your daylight hours when you plan to be working.

If however someone does break that rule, it's easy to lapse into a messed up sleep cycle and that itself can lead to someone feeling more and more tired the longer it goes on leading to trying to fix the problem with more modafinil.

The side effects cited from Internal Medicine (“hypersensitivity reactions and neuropsychiatric adverse effects”) aren't a product of modafinil per se, but a constant accumulated lack of sleep. Add to that the fact that the symptoms of sleep deprivation are pretty much indistinguishable from schizophrenia and you have an explanation from those side effects.

I doubt that abuse of this drug would do anything to impact my ability to get this medicine even if such abuse was widespread. It's not a trivial thing for someone to fake a diagnoses with narcolepsy, like you can do with ADD/ADHD or anxiety disorders. A bona fide diagnosis requires a polysomnogram and MSLT if you don't show any serious signs of apnea. If one were to try to fake it, they probably need advice from an actual narcoleptic like myself to know what to say and do to fake one or both of those tests.

Plus, modafinil isn't even the most restricted narcolepsy drug. Xyrem is, which is basically pharmaceutical grade GHB. That drug only comes from one pharmacy in the country and is overnighted in massive boxes so that it can't be trivially stolen. The boxes are huge for two tiny bottles. TBH the only thing that prevents narcoleptics from getting access to a drug they need like xyrem (a necessity if you have cataplexy) are drug costs. If you don't have group insurance or if narcolepsy/cataplexy are pre-existing conditions for your insurance, then Xyrem will set you back around $50k to $80k a year last time I checked. I don't know street prices for drugs, but I imagine that they are 100-200x more expensive than a legitimate prescription. The reason for the cost is the fact that it's an orphan drug, meaning that the costs of bringing it to market are spread across a very small potential target market. Even that's kind of absurd since it's sleep benefits were known from back in the 80s when GNC sold it OTC well before any clinical trials. FWIW Faking cataplexy is largely impossible if your doctor performs the blood test available to diagnose it.

argonaut5• 13 years ago

Correction: its half-life is actually something around 12 hours.

malandrew5• 13 years ago

Another correction: While it's obvious what I meant, I wanted to write that the prescription drugs are 100-200x more expensive, not the other way around.

RobertHoudin• 13 years ago

"a pill that can have some serious side-effects"

Such as?

anon4atruestory3• 13 years ago

Increased immune response (including heightened sensitivity to existing allergens, and potentially developing new ones), raised body temperature, general dehydration, and erratic pulse, especially if used as a sleep replacement instead of as a waking-hours enhancement.

DigitalSea2• 13 years ago

This link seems to detail all of the possible side-effects: http://www.nlm.nih.gov/medlineplus/druginfo/meds/a602016.htm... — I think many would agree some of the side-effects which include; difficulty breathing or swallowing, swelling of the face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs, anxiety, depression are definitely serious. And I would also argue that even though some of the other side-effects like skin peeling, rashes and whatnot aren't as serious, they're still pretty bad side-effects.

It's rare that most drugs these days don't have a potential side-effect or two, but if you don't need to take these pills I think there's no point in potentially risking some serious health issues like depression as a result of taking something you don't need.

tomsthumb• 13 years ago

http://www.ncbi.nlm.nih.gov/pubmed/21567182

pg• 13 years ago

"It was like walking around on a winter day when it just snowed."

Reading that made me want to move back to the East Coast. Not take Modafinil, which is probably a good sign.

hristov2• 13 years ago

Yes, those couple of hours right after it snows can be quite beautiful in a big city. If you want to cure yourself of your nostalgia you can just imagine the couple of hours after that. When the snow starts melting and everything turns into grey/black mush. I guess this is what it must feel like to stop taking Modafinil.

tptacek• 13 years ago

The lack of distinctive seasons was far and away the #1 reason I got out of California. Maybe you're not wrong about wanting to move back. :)

runarb• 13 years ago

So a few months ago, Borden ordered a three-week supply by mail. (“It was a piece of cake,” he says.)

Can one really just order prescription medicine through the mail or internet like that?

I thought most of thus online pharmacy was just a scam. I guess there would be no way of telling if the pills one got was the real deal or some fake ones containing possibly poisonous ingredients...

boon• 13 years ago

If you were going to run a site that made money from selling "illegal" drugs to people over the internet, would you want to poison your customers? Aside from losing money in the long term, you're going to draw quite the ire when it's discovered you supplied the lethal dose.

This is the largest fallacy in the "we must regulate" side of drugs.

phil• 13 years ago

Skip a dose, and there would be hell to pay. “I really would feel it. It was sort of like being thrust into dirty, messy reality, as opposed to a clean, neatly organized place. It was like crashing, and I actually found what would happen is the anxiety that got dialed down on the way in, when you were coming off it, all of a sudden you went through the reverse. So I got incredibly anxious. Eventually that concerned me.”

Wow, this sounds amazing! Sign me up!

lake993• 13 years ago

Don't worry. To me, it sounds like the author was tripping on his own silly mind.

hristov2• 13 years ago

I don't know why people would experiment with pills like that. I used to pull all nighters when I worked for a big law firm. Sometimes I would pull worse -- I would spend forty hours in a row in the office. I did not take any pills.

Let me tell you its no fun. Even if this pill solves the depression and inevitable mental issues, I doubt it helps the rest of your body handle the lack of sleep.

Your body just tends to fall apart. You start spraining random muscles (even ones you did not know you had), you gain weight very quickly, etc. This is just not worth it. Just do us all a favor and get some sleep.

argonaut5• 13 years ago

1. Modafinil also suppresses appetite.

2. It's easy to argue against the extremes. But nothing about using modafinil precludes sleeping 8 hours a day. The effects usually last anywhere between 12 to 16 hours. So, for example, you can take it with breakfast and go to bed normally in the evening.

malandrew5• 13 years ago

It's appetite suppressing properties are one of the first things to wear off with long term use.

lake993• 13 years ago

> “Not fuzzy-headed,” he says, “but crisp. A crisp softness to it.” Soon he was experiencing a level of concentration he’d never imagined. “My senses sort of shifted to the visual, and my auditory sense went down. Sounds didn’t even register. It was like walking around on a winter day when it just snowed. It was very easy to stay visually focused.”

Placebo effect? I understand that drugs have slightly different effects on each person, but I have never felt any of that stuff.

I experimented with 100mg tablets of Modafinil for a few years because I can't concentrate. It did nothing for my concentration, nothing I could discern, at any rate. Modafinil did help to get rid of my sleepiness: if the task/meetings/lectures dragged a bit, I'd actually nod off. Modafinil fixed that.

Write-ups such as this one on nymag make Modafinil sound like something to trip on. Very misleading.

> At the very least, doctors have warned that modafinil can bring about sleep deprivation

I call BS.

argonaut5• 13 years ago

I completely disagree.

1. The effect is extremely noticeable, as noticeable as a headache is (whatever the opposite of a headache would be).

2. I did read a study which found evidence that a particular genotype affects whether someone finds modafinil effective. I happen to have that genotype correlated with modafinil effectiveness.

lake993• 13 years ago

What dosage have you tried? I have always been very careful to not abuse it. So, I'd take just 100mg as soon as I woke up. Perhaps upping my dosage will bring out those effects.

ScottWhigham• 13 years ago

I file this under, "Something I'd love to try/experiment with for myself, but I can't because, if I convince a doctor to prescribe it to me, I'll be forever labeled as 'someone who needs to pay higher insurance premiums because he has sleep issues'." Oh well. I don't feel comfortable buying unregulated medicines from outside of the US/Canada and I don't want to pay higher insurance premiums (already at $15,000/yr for a family of four w/ no medical issues). I don't need the insurance companies to have yet another reason to charge me more.

Modafinil Is Wall Street’s New Drug of Choice

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