A recent modafinil study conducted in May 2017 has shown that modafinil reduces fatigue in patients who have suffered a stroke. The double blind placebo controlled study used 232 stroke survivors and tested them against the multidimensional fatigue inventory; secondary outcomes included the Montreal cognitive assessment, the Depression, Anxiety, and Stress Scale (DASS), and the Stroke-Specific Quality of Life (SSQoL) scale.

This is interesting as the secondary outcome actually looked at the effect of modafinil on depression and anxiety. Intuitively you could assume that someone who suffers from lethargic and heavy depression could feel better by taking modafinil to have some more energy. There is a type of depression treatment, used by the NHS in the UK with good results, called behavioral activation which follows the premise that a mildly depressed person will feel better if they can do more of the things which give them pleasure. In my opinion a really stupid treatment since if the depressed person was able to do more fun things they wouldn’t be seeking help for depression, would they? Anyway, this is not the point as with some modafinil in the mix maybe the depressed person finds that they can do more fun stuff.

Unfortunately this study shows no significant improvement on the DASS scale, blowing my little theory straight out of the water. The patients taking modafinil did report significant improvements in quality of life and they found they were less tired (obviously!! haha).

As a side note, the patients were given 200mg daily for six weeks. This modafinil dosage does seem a little high, we suggest starting with 100mg initially.

Modafinil Study Abstract

BACKGROUND AND PURPOSE:

This study aimed to assess the efficacy of modafinil, a wakefulness-promoting agent in alleviating post-stroke fatigue ≥3 months after stroke. We hypothesized that 200 mg of modafinil daily for 6 weeks would result in reduced symptoms of fatigue compared with placebo.

METHODS:

This single-center phase 2 trial used a randomized, double-blind, placebo-controlled, crossover design. The key inclusion criterion was a multidimensional fatigue inventory score of ≥60. Patients were randomized to either modafinil or placebo for 6 weeks of therapy, then after a 1 week washout period swapped treatment arms for a second 6 weeks of therapy. The primary outcome was the multidimensional fatigue inventory; secondary outcomes included the Montreal cognitive assessment, the Depression, Anxiety, and Stress Scale (DASS), and the Stroke-Specific Quality of Life (SSQoL) scale. The multidimensional fatigue inventory is a self-administered questionnaire with a range of 0 to 100. Treatment efficacy was assessed using linear regression by estimating within-person, baseline-adjusted differences in mean outcomes after therapy. This trial was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12615000350527).

RESULTS:

A total of 232 stroke survivors were screened and 36 were randomized. Participants receiving modafinil reported a significant decrease in fatigue (multidimensional fatigue inventory, -7.38; 95% CI, -21.76 to -2.99; P<0.001) and improved quality of life (SSQoL, 11.81; 95% CI, 2.31 to 21.31; P=0.0148) compared with placebo. Montreal cognitive assessment and DASS were not significantly improved with modafinil therapy during the study period (P>0.05).

CONCLUSIONS:

Stroke survivors with nonresolving fatigue reported reduced fatigue and improved quality of life after taking 200 mg daily treatment with modafinil.

https://www.ncbi.nlm.nih.gov/pubmed/28404841

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