That reaction could very much be dose dependent. I think those in most need of the effect start out very hypersensitive to it and that reaction could easily obscure any benefits.

I use Modafinil and Amitryptiline as a rather unorthodox method for treating dysautonomia which seems to be an intrinsic precursor to ME/CFS, at least in my case where I have hEDS from a number of TNXB variants.

My overall theory is that a combination of anxiety disorders (genetic inability to ameliorate stress) pushes me into a Sympathetic state and keeps me there to the point that cytokines (or some undiscovered small molecule) are created by the immune system to knock me out of that state as a backup to other mechanisms that have stopped working. So I studied some psychopharmacology to design a drug combo that wouldn’t override the autonomic state so I could both work with my natural rhythms (using weaker ligands) and increase the magnitude of the swings so that I could spend enough time in the Parasympathetic state to obviate the need for the immune system backup. I take a lower dose of Modafinil (100mg started and stayed at this dose no apparent tolerance build) and am genetically very sensitive to caffeine so that and one coffee is enough to get me amped for the entire day, but I need amitryptiline to bring me back down to sleep (started as 25mg and many years later I’m at 125mg due to increasing tolerance). I do want to bring down my reliance on amitryptiline but I’m working crazy hours and figure I can wait to titrate down my dose later. I’ve been at this same dose for a year now so it’s at least not getting any worse).