This image, from a 2007 article in Time magazine, accompanied a short piece about Provigil, the so-called genius pill. Time put the pill on its list of scariest moments in science.
The up-all-night drug has certainly caught on among students and professionals who want to sharpen their thinking or spend a few additional hours working. I know of colleagues who have used it to handle overseas assignments in distant time zones, to no apparent ill effect.
Now, a small study cautions that the drug could prove addictive. Researchers writing in the Journal of the American Medical Association found that the drug, developed 10 years ago by Cephalon, increases the level of dopamine in the region of the brain involved in feelings of pleasure and reward. Ten healthy volunteers took the drug, then submitted to a PET scan that showed brain activity.
The increase of dopamine is “the signature for drugs that have the potential for producing addiction,” said Nora Volkow, lead author of the study and director of the National Institute on Drug Abuse, told Bloomberg News reporter Marilyn Chases.
Physicians prescribing Provigil should “be alert to the possibility that it could produce addiction,” Volkow said, and the drug “may have more abuse potential than originally believed.”
How is this relevant to our ongoing examination of chemobrain? Provigil, or modafinil, is sometimes prescribed for patients suffering chemobrain symptoms. In interviews, some patients said it helped them function at work. One researcher at Mayo Clinic in Rochester, Minnesota, is optimistic that modafinil can help patients cope with chemobrain. Dr. Sadhna Kohli, a PhD-MPH who was an assistant professor in Rochester, NY, before she went to Mayo, analyzed surveys of 595 patients with various kinds of cancers who were treated in 2001 and 2002. She found that 82 percent of patients who were receiving chemotherapy for cancer experienced symptoms such as forgetfulness, an inability to concentrate or complete thoughts, or had a sense of fogginess that impaired their ability to reason and remember.
Kohli also tested the effects of modafinil in 68 breast cancer survivors over an eight-week period. During the first four weeks of the clinical trial, all 68 women took the drug. For the next four weeks, half continued taking modafinil, and the other half took a placebo pill. Kohli found a significant difference between the two groups. Although the study began as an examination of fatigue, Kohli and her colleagues at the James P. Wilmot Cancer Center in Rochester, NY, did a secondary sweep to look at cognitive function. She found that breast cancer survivors taking modafinil reported improved memory, concentration, and ability to learn.
Does she believe chemobrain is real? “If you talk to patients in the clinic,” she told me in a telephone interview for “ChemoBrain,” “then definitely, I do. Before, they were not being taken seriously. It used to be so subtle in terms of memory and concentration, that physicians didn’t know exactly what it was. But more and more women were complaining of it. We’re going to step back [and look at] what causes chemobrain. We need to know what is going on in the brain.”
She reports that one patient was willing to pay $750 a month out of pocket to get modafinil off label. The pill changed her life, she said.
But any off-label drug use needs to be approached carefully. One physician I talked to said it can be hard for patients to find doctors willing to prescribe stimulants like Focalin and modafinil off label. He viewed off-label prescription as something more apt to be done by an older, more experienced physician.
Cephalon, based in Pennsylvania, also revealed that it is developing a longer-acting version of Provigil for release in late 2009. The new drug, known as Nuvigil, or armodafinil, improved the depressive cycle in bipolar disorder when combined with other drugs, according to a study done by Cephalon.
And, for its part, Cephalon begged to differ with the study results obtained by the drug abuse institute. The chief scientific officer, Jeffry Vaught, told Bloomberg that Provigil’s effect on dopamine is “weak,” and that it is “very different from amphetamines and its abuse potential is very low.”