Drug companies are great at creating new diseases or problems that many people never knew existed. Several years ago we learned about “social anxiety disorder.” Not surprisingly, there was a drug to treat this problem. Back when we were kids, people called this shyness and didn’t think it required medication.
Ad agencies for the pharmaceutical industry have catastrophized ordinary experiences to make them seem like serious maladies that require powerful treatments. There’s premenstrual dysphoric disorder (PMDD), which sounds really grave. It medicalizes the mood swings that can be associated with menstrual periods.
Overactive bladder (OAB), needing to pee frequently, is another uncomfortable situation that is now featured in TV ads for heavy-duty drugs.
The latest condition haunting millions of Americans is “ES.” That stands for excessive sleepiness caused by “SWD,” which is an abbreviation for shift work disorder. The treatment for ES is a medication called Nuvigil (armodafinil).
Ads aimed at shift workers have run on the radio and appeared in newspapers. People are encouraged to ask their doctors for a prescription. There is even an enticement to get the first prescription for free. A month’s supply can cost over $400.
The predecessor of this drug, modafinil (sold under the brand name Provigil), was originally approved for treating narcolepsy. This is a condition in which patients can suddenly fall asleep while eating, in mid-sentence or while crossing the street.
Narcolepsy is relatively rare, though, whereas excessive sleepiness during the workday is quite common. No wonder the company worked to get FDA approval for Provigil to treat ES caused by SWD.
Although the pitch for Nuvigil is aimed at shift workers, lots of other people suffer from sleepiness during the day. That’s why so many of us drink coffee to get a caffeine jolt and improve our alertness. Fortunately, caffeine comes with relatively few side effects.
That’s not true of armodafinil. Side effects can be serious. They include a potentially life-threatening skin reaction called Stevens-Johnson Syndrome. Other possible problems are dangerous allergic reactions, headache, dizziness, nausea, diarrhea, dry mouth, depression, anxiety and insomnia.
Having trouble getting to sleep could be a distinct disadvantage for shift workers. Psychological reactions are also disconcerting: hallucinations, mania, aggressive behavior or suicidal thoughts.
Chest pain, abnormal heart rhythms or trouble breathing might signal cardiac complications.
Assessing the benefits of alertness against the risks of serious side effects can be challenging. We all want our doctors, pilots, police, firemen and other emergency responders to be alert, but we don’t want them pushing their limits too far. Provigil and Nuvigil can’t take the place of a good night’s sleep.
Naming a condition like excessive sleepiness with an abbreviation like ES makes it sound like something that needs a pill. But before asking a doctor for a prescription, people should consider whether there might be less costly and safer ways to deal with daytime drowsiness. That may also hold for many other everyday problems.
