How Effective Is Provigil For ADHD Really?
Is Provigil (modafinil) an effective treatment for ADHD? Good question! At one time in my life I was wondering the same thing myself.
Before delving into these studies let's back up for a moment. Why might we expect that modafinil could be useful for ADHD? Also, why should we care? There are plenty of medications available to ADHDers already.
As you'll find out, modafinil has advantages over traditional psychostimulants like Ritalin (methylphenidate).
Why Modafinil Treats ADHD
If you suffer from ADHD, you know firsthand that staying focused can be a constant challenge.
People who don't suffer from ADHD have a sense of urgency about finishing their homework and paying their taxes. But if you have ADHD you lack this sense of urgency; mundane tasks are a struggle.
Neurobiologically, ADHD is probably caused by alterations in dopamine and norepinephrine. These are neurotransmitters that regulate psychological, reward, arousal, fear, and attention.
The neurobiological profile of people with ADHD is the reason modafinil can help.
Modafinil affects a lot of pathways:
- gap junctions
But modafinil's key mechanism still remains poorly understood. It's still debated3 whether modafinil's effect on dopamine plays a role in its benefits for patients with ADHD. The concensus is that modafinil's affinity for the dopamine transporter (DAT) is too weak to be clinically meaningful.
Whatever modafinil's mechanism may be, we know its effects from behavioral studies in humans and animal. Modafinil tends to improve concentration, arousal, executive function, and wakefulness.
A Closer Look At The Evidence
Showdown: Provigil vs Dextroamphetamine
Dr. Taylor2 compared the efficacy of modafinil to dextroamphetamine for the treatment of ADHD. Note that dextroamphetamine (an ingredient in Adderall) is essentially the gold standard of ADHD treatments.
To test his hypothesis, Taylor conducted a randomized, double-blind, placebo-controlled crossover study in 21 adults with ADHD.
Taylor used the DSM-IV checklist to compare the effects of modafinil, dextroamphetamine, and placebo in patients with ADHD. Here are the results:
The authors concluded that:
The magnitude of improvement in ADHD symptoms after modafinil treatment was comparable to the magnitude of improvement following treatment with d-amphetamine.
These results are promising, but the study suffered from some important limitations:
- Taylor's study was underpowered - more than 21 participants would have been better
- Another limitation was the study's short duration (2 weeks)
Provigil For ADHD - Metanalyses
Wang et. al.1 published a metanalysis on the efficacy of Provigil (modafinil) for ADHD.
Wang aimed to assess the safety and the effectiveness of modafinil in the treatment of teenagers and kids with ADHD. The study authors found 5 randomized clinical trials. Their meta-analysis showed statistically superior efficacy of modafinil compared with placebo for treating adolescents and kids with ADHD.
Other takeaways from the study:
- In terms of primary efficacy measures, mean change in ADHD-RS-IV Home and School, the difference between placebo and modafinil were moderate and very close to large (SMD = -0.77 for ADHD-RS-IV Home and SMD = -0.71 for ADHD-RS-IV School).
- The effect sizes in the present study were comparable to those from previous meta-analysis investigating multiple drugs, where the effects sizes were found to be varied 0.6 through 0.8 indicating a robust medication effects in the treatment of ADHD despite of methodological and medication bias factors.
- In terms of tolerability and safety, modafinil was generally well tolerated.
- Interestingly, the total dropout rate of modafinil was significantly lower than that of placebo. The dorpout rate is the rate at which study participants exit the study due to intolerable side effects.
- Previous meta-analyses of modafinil in other conditions, suggested that modafinil’s dropout rate due to all cause and adverse event is either comparable to or worse than placebo.
FDA Approval of Provigil For ADHD
As we've seen, there's strong evidence for the benefits of Provigil (modafinil) in patients with ADHD. Yet modafinil lacks FDA approval for this indication. Even so, modafinil is increasingly being prescribed off-label for ADHD by psychiatrists.
Modafinil's lack of FDA approval for ADHD is probably motivated by economics. As of this writing, all of Cephalon's patents on modafinil have expired. Thus there is little incentive for Cephalon to pursue FDA approval of modafinil for ADHD.
Provigil's FDA-Approved Uses
Provigil is currently approved for the following indications:
- Obstructive Sleep Apnea
- Shift Work Disorder
The common theme in all these conditions in excessive daytime sleepiness. As a wakefulness enhancer, modafinil combats fatigue and the urge to sleep.
Advantages of Modafinil Over Traditional Psychostimulants
What's a "traditional psychostimulant"? The classic psychostimulants are drugs like Adderall (mixed amphetamine salts) and Ritalin (methylphenidate).
Traditional psychostimulants all work by boosting catecholamines (dopamine, in particular). A big downside of Ritalin and Adderall is the potential for neurotoxicity. In contrast, modafinil may be neuroprotective.
However, modafinil is no magic bullet and is not without side effects.
Modafinil Experiences on Reddit
Reddit is a great place to look for experience reports.
NewlyOCD's report was particularly noteable:
Look at me, I think I'm interesting enough for an AMA!
About 6 months ago I started taking Modafinil to see how it would affect my ADHD. After the first month of taking it semi-regularly I decided that I had decided that I was going to perpetually self-medicate.
Since then I've lost 35 pounds, and quit drinking (5 months now).
I read books now, one every week or two, and I could never keep focused long enough to do that before. I now start AND FINISH projects! I just finished stripping, sanding, and painting my bicycle with a custom frame.
It's like it turns "I should" into "I am currently doing". Many more changes I'm sure will come out in the answers to your questions.
You can read the questions and responses here
Wang SM, Han C, Lee SJ, et al. Modafinil for the treatment of attention-deficit/hyperactivity disorder: A meta-analysis. J Psychiatr Res. 2017;84:292-300. ↩ ↩2
Taylor FB, Russo J. Efficacy of modafinil compared to dextroamphetamine for the treatment of attention deficit hyperactivity disorder in adults. J Child Adolesc Psychopharmacol. 2000;10(4):311-20. ↩ ↩2
Wisor JP, Eriksson KS. Dopaminergic-adrenergic interactions in the wake promoting mechanism of modafinil. Neuroscience. 2005;132(4):1027-34. ↩