Drug Improves Wakefulness on the Night Shift

From MedPage Today:

Night shift workers experiencing excessive sleepiness felt more awake throughout their shift when treated with armodafinil (Nuvigil), according to research.

In contrast, workers given the older, shorter-acting drug modafinil (Provigil) felt more awake only during the first half of the night shift, Kenneth P. Wright, PhD, of the University of Colorado in Boulder, and colleagues reported at the Associated Professional Sleep Societies meeting.

Armodafinil is the R isomer of modafinil, and both drugs are approved to treat excessive sleepiness in shift workers.

The most common adverse event associated with both treatments was headache, which was seen in 26% of patients receiving modafinil and in 12% of armodafinil patients.

"What we have shown in this research is that armodafinil is able to improve both objective and subjective measures of alertness in these patients. They are not as alert as daytime workers, but they had an improvement in their wakefulness," Wright said.

Posted: 6/11/2010 3:02:00 PM

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Turning to Drugs to Stop Addiction

From Drug Discovery & Development:

Could a once-a-month alcoholism shot keep some of the highest-risk heroin addicts from relapse? A drug that wakes up narcoleptics treat cocaine addiction? An old antidepressant fight methamphetamine?

This is the next frontier in substance abuse: Better understanding of how addiction overlaps with other brain diseases is sparking a hunt to see if a treatment for one might also help another.

We're not talking about attempts just to temporarily block an addict's high. Today's goal is to change the underlying brain circuitry that leaves substance abusers prone to relapse.

It's "a different way of looking at mental illnesses, including substance abuse disorders," says National Institute on Drug Abuse Director Dr. Nora Volkow, who on Monday urged researchers at the American Psychiatric Association's annual meeting to get more creative in the quest for brain-changing therapies for addiction.

Rather than a problem in a single brain region, scientists increasingly believe that psychiatric diseases are a result of dysfunctioning circuits spread over multiple regions, leaving them unable to properly communicate and work together. That disrupts, for example, the balance between impulsivity and self-control that plays a crucial role in addiction.

These networks of circuits overlap, explaining why so many mental disorders share common symptoms, such as mood problems. It's also a reason that addictions - to nicotine, alcohol or various types of legal or illegal drugs - often go hand-in-hand with post-traumatic stress disorder, depression, schizophrenia and other mental illnesses.

So NIDA, part of the National Institutes of Health, is calling for more research into treatments that could target circuits involved with cognitive control, better decision-making and resistance to impulses. Under way:

-Manufacturer Alkermes Inc. recently asked the Food and Drug Administration to approve its once-a-month naltrexone shot - already sold to treat alcoholism - to help people kick addiction to heroin and related drugs known as opioids.

-Studies at several hospitals around the country suggest modafinil, used to fend off the sudden sleep attacks of narcolepsy, also can help cocaine users abstain.

-An old antidepressant, bupropion, that's already used for smoking cessation now is being tested for methamphetamine addiction, based on early-stage research suggesting it somehow blunts the high.

Medication isn't the only option. Biofeedback teaches people with high blood pressure to control their heart rate. O'Brien's colleagues at Penn are preparing to test if putting addicts into MRI machines for real-time brain scans could do something similar, teaching them how to control their impulses to take drugs.