Sleepless in Mumbai, with smart pills

A 31-year-old school-teacher approaches a doctor to prescribe her ‘smart drugs’. She is perfectly healthy but does not get enough sleep as her one-year-old keeps her busy at night and hopes that these drugs will keep her alert. The doctor refuses to give a prescription without an ailment, but the teacher goes ahead and purchases the pills on her own.

For the uninitiated, it’s a brave new world where working, studying or even partying takes precedence over getting the eight hours of sleep that a person needs. They pop pills to stay up late and then more pills to get over their grogginess the next day. 

“I get requests for prescriptions from people who are looking for drugs that keep them awake all the time,” says Dr Fabian Almeida, a psychiatrist.

A popular choice is Modafinil, a drug prescribed by doctors for narcolepsy, a rare sleep disorder that can make a person fall asleep anytime anywhere. Besides keeping the user awake for long hours, it has yet another interesting side-effect, it enhances human cognition.

Modafinil, or just ‘Mod’ as it is popularly known, is among a number of ‘smart pills’ that have found growing acceptance among students and researchers in the US and UK. In India too, the drug has a serious following among students preparing for entrance examinations,  MBA and engineering students. There is an ongoing debate about the off label usage of such drugs as cognition enhancers, but some new studies have come out in support of their use (See box).

Doctors believe that there is not enough awareness of the harm that can be caused by prolonged use of drugs like Modafinil without supervision. Last month, a corporate worker approached Dr Anoop Misra, head of diabetics and metabolism at Fortis Hospital, requesting him for a prescription for Modalert.

“He claimed he had to work long hours and wanted to cut down on his sleep, ,” says Dr Misra.

Dr Rajesh Sagar, associate professor of psychiatry at AIIMS in New Delhi also says he regularly gets patients who demand the drug.

“We turn away these people, as this drug can have serious side-effects.”

He also admits the drug is often abused by medical students at AIIMS, for extended study sessions.

“We issue regular warnings to students about the harm of sleep deprivation,” he says.

Another class of smart drugs doing the rounds includes Atomexatine and Ritalin which are prescribed to patients suffering from Attention Deficit Hyperactivity Disorder. These help a person focus their attention on the task at hand. Although doctors will generally dissuade people from consuming these drugs in a routine way, there are occasions when they do prescribe them even to people who don not suffer from ADHD.

Dr Almeida says students come to his psychiatry clinic complaining of depression and anxiety linked to impending board examinations. He refuses to give prescriptions to students looking for a magic remedy, but  there are cases where the student really  needs to have drugs that will help him concentrate.

"One needs to understand the cause of the anxiety and depression to decide if medical intervention is necessary. Sometimes if a student is immobilised by anxiety, I give medication that will helps her focus attention," Dr Almeida says. 

But self-medication should be avoided. While each drug has its own set of side-effects, they all generally cause nausea, stomach problems, insomnia and headaches besides a constant streak of irritability caused by lack of sleep.