Modafinil may not be beneficial for PWCs

Discussion in 'Fibromyalgia Main Forum' started by tansy, Nov 5, 2005.

  1. tansy

    tansy New Member

    Journal of Psychopharmacology, Vol. 19, No. 6, 647-660 (2005)
    DOI: 10.1177/0269881105056531
    © 2005 British Association for Psychopharmacology

    Chronic treatment with modafinil may not be beneficial in patients with
    chronic fatigue syndrome

    Delia C. Randall
    Psychopharmacology Research Unit, Centre for Neuroscience Research,
    King’s College London, London, UK and Respiratory Support and Sleep
    Centre, Papworth Hospital, Cambridge, UK

    Fay H. Cafferty
    MRC Biostatistics Unit, Institute of Public Health, Cambridge, UK

    John M. Shneerson
    Respiratory Support and Sleep Centre, Papworth Hospital, Cambridge, UK,

    Ian E. Smith
    Respiratory Support and Sleep Centre, Papworth Hospital, Cambridge, UK

    Meirion B. Llewelyn
    General Medicine/Infectious Diseases, Royal Gwent Hospital, Newport,
    South Wales, UK

    Sandra E. File
    Psychopharmacology Research Unit, Centre for Neuroscience Research,
    King’s College London, London, UK

    Fourteen patients (7 male, 7 female, 22-63 years), classified as having
    chronic fatigue syndrome (CFS), but without concurrent major depression,
    significant sleepiness or use of psychoactive medication, completed a
    double-blind, placebo-controlled, crossover study of the effects of the
    selective wakefulness-promoting agent, modafinil (200 and 400mg/day).

    The treatment periods were each 20 days, with washout periods of 2

    The primary aim was to determine effects on cognition and the
    secondary aim was to determine effects on self-ratings of fatigue,
    quality of life and mood.

    Modafinil had mixed effects in two cognitive
    tasks. In a test of sustained attention, treatment with 200mg reduced
    the latency to correctly detect sequences, but 400mg increased the
    number of missed targets. In a test of spatial planning, the 200mg dose
    resulted in a slower initial thinking time for the easiest part of the
    task, whereas 400mg reduced the initial thinking time for the hardest
    part of the test.

    Lastly, in a test of mental flexibility and one of
    motor speed, patients performed worse whilst on modafinil (400mg),
    compared with the placebo period. No effects were observed on the
    performance of other psychometric tests or on self-ratings of fatigue,
    quality of life or mood, but this may have been due to insufficient
    statistical power.

    It is discussed whether the limited and mixed
    cognitive effects that we observed could have occurred by chance, or
    whether a subgroup of CFS patients with daytime sleepiness would have
    shown greater benefits.[This Message was Edited on 11/05/2005]
  2. TwinMa

    TwinMa New Member

    Interesting post Tansy.

    I have FM, not CFS, but I have tried Provigil. I wanted to see if it helped some of the minor fatigue I have. It didn't seem to help me. Even a 1/4 caplet gives me a headache. No big surprise there--everything gives me a headache! But it didn't even help perk me up. Bummer!

    I've seen lots of posts from people who love Provigil. I'm sure you'll hear from them. Thanks for sharing the info.

  3. hopeful4

    hopeful4 New Member

    Thank you for sharing this info, you find so much relevant research for all of us.

    My Dr. recently recommended Provigil for me. I have been napping daily for 2 hours for a long, long time. Also very brain-foggy. She offered it to me as a trial to see if it would work.

    At first I just didn't want it, as my son pointed out to me that it is a stimulant, so that made me wary. When I asked about it, my Dr. said that it stimulates the dopamine receptors in the frontal lobe...actually, I haven't looked that up yet! I believe the idea was to help with cognitive function, and reduce daytime sleeping.

    I've been using 100 mg. for about 2 weeks. No noticeable side-effects so far. Results: I've almost completely stopped daytime napping, however after 5 pm I'm very tired and can't really accomplish much. Perhaps she'll recommend an increased dose.

    I do not feel "buzzed" like with "uppers" from college days gone by.

    Thanks again for continuing to support us all!

    Sending sunshine your way,
  4. elsa

    elsa New Member

    I'd be interested in a similar study with subjects who did have excessive daytime sleepiness.

    I have used provigil for a couple of years now. It does help me with EDS, but it is not the best medication for helping cognitive problems. (For me anyway.)

    Dr. Charles Lapp theorizes that ADD medications may be beneficial for CFS/FM patients with EDS and "fibro fog".

    I have an rx for adderall and it is quite effective in both categories for me. (I don't have ADHD or ADD, so the fog is definately fibro related.)I have come to the conclusion that Dr. Lapp is onto something.

    Since my tolerance for the bone crushing fatigue symptom of theses illness is extremely low and limited, I appreciate having both medications available to me.

    The whole thought process behind having both rx'es is to keep myself from becoming used to any one EDS medication thus developing a tolerance and losing any effective treatments.

    I'll alternate days between provigil and adderall ... about every couple of days on each one then switch.

    It has helped both to stay effective and I don't miss any days of help with EDS unless of course I don't want the help. LOL ... Planned "recovery days", etc..

    Thank you for posting this. I feel between the two drugs, adderall offers the most benefit at a more reasonable cost. But, like all good things for us, I'm taking serious steps to insure it keeps delivering it's benefits!

    I hope you are doing well. For those of us who are able to tolerate this med, it's always good to learn more things about it.

    It's also great reading about real tests being performed in hopes of solving the mystery behind CFS/FM.

    Take care,