Thursday, April 29, 2010

Do smart drugs really work? by Jerry Brainum

While most of the adverse publicity related to "doping" has to do with the illicit use of various anabolic drugs, such as anabolic steroids, growth hormone, and others, there is another kind of doping that is becoming increasingly prevalent. Those who engage in what is called pharmacological neuroenhancement, are not interested in building a world-class physique, or setting world athletic records, although in some cases, these uses do overlap. Instead, users of smart drugs, as they are often called, are seeking to maximize brain power. This could involve an increase in memory, learning, and attention, along with an increased level of concentration and focus. Such possible benefits are attractive to all whose activities involve intensive use of their brains.While these drugs are popular among students, academics, and even many scientists, the salient question is: do smart drugs really work?
      Various smart drugs have been touted for their alleged brain-boosting activities for years. Most of these drugs are not approved for medical use in the United States, but are often approved for use in treating various brain disorders in European countries. Their efficacy in the treatment of clear-cut neurological deficits, as exemplified by such disorders are Alzheimer's disease and other forms of dementia, had led to the belief that they could also enhance the cognition or thinking ability of healthy people. But the problem here is that those with brain disease usually have deficits in the production and release of brain neurotransmitters and other chemicals that doesn't exist in normal brains. The drugs work by promoting an increased synthesis and release of various brain chemicals in those with brain pathology who aren't releasing these vital brain chemicals. But in those whose brains are normal and releasing sufficient amounts of neurotransmitters and other brain substances, using the various smart drugs does little or nothing. The fact that countless healthy people have reported definite positive effects from these drugs only underscores the power of positive belief. In short, if you think something will work, it just might, but not from any intrinsic activity of the drug.
      Among the most popular of the more recent smart drugs are modafinil and methylphenidate. Modafinil is sold under the trade name Provigil, while methyphenidate is sold as Ritalin and other names. Ritalin has been a controversial drug for years, used mainly in the treatment of attention deficit disorder in children.Ritalin is similar in structure to amphetamines, or "speed," although its actions in the brain more resemble that of cocaine. In fact, it provides all the brain stimulation effects of cocaine minus the well-known euphoria associated with cocaine usage. Similarly to cocaine, Ritalin works by incresing brain levels of dopamine and norepinephrine. Ritalin was initially synthesized in 1944, and found to have stimulant effects in the brain ten years later. Among the effects associated with Ritalin use are increased attention, decrease in mental fatigue, and increased alertness, Considering these properties, it's not hard to understand why it's so popular among students cramming for exams.
      Provigil first came to the attention of the public when it was disclosed that it was used extensively by the military, particularly fighter pilots, who used it to stay awake and alert during extended missions.The actual medical indication of Provigil is to treat narcolepsy, or a sudden onset of sleep, and also to treat excessive daytime sleepiness.Similarly to Ritalin, Provigil also increases brain levels of dopamine and norepinephrine. But Provigil goes a few steps furthur that does Ritalin. For example, Provigil increases levels of histamine in the hypothalamus structure of the brain, in an area that controls alertness.It also interacts with brain chemicals called orexins or hypocretins, that are related to wakefulness.Some studies suggest that Provigil promotes the release of brain-stimulating neurotransmitters, such as glutamate, while blunting those related to brain sedation, such as GABA. Thus, when you consider how both Ritalin and Provigil work in the brain, it appears that there must be some legitmate science behind the use of both drugs for purposes of neuroenhancement--or is there?
     A recent study analyzed several past studies that examined the brain effects in regard to enhancement  of Provigil and Ritalin in healthy people.The study found no neuroenhancement effect for Ritalin, except for a positive effect on memory.There was no effect on increased attention, and the study authors think that the popularity of Ritalin relates more to just getting high than any true brain enhancement effects.For Provigil, brain enhancement effects were found, but mainly for those who were sleep deprived. In such people, Provigil effectively increased attention.No effect, however, was found for any inmprovements in memory,mood, or motivation.Another effect noted with Provigil was a tendency to be overconfident in relation to cognitive ability. This means that in those who use Provigil, there is a tendency to think that they are smarter than they really are. Other studies show that Provigil appears to work better in terms of brain enhancement in those who with lower IQs. It has also been used by athletes, which led to its being banned by the World Antidoping Agency in 2003. This was mainly done because it was thought to provide an amphetamine-like action in athletes.
      As for safety, Ritalin can cause a few serious heart problems, including disorders of normal heart rhythm. Provigil has been linked to some serious skin condition syndromes, although it's officially listed as a schedule-4 drug, meaning that it has a low potential for abuse. But the study that analyzed the use of both drugs by healthy people for purposes of brain enhancement concluded that Ritalin was ineffective, and there wasn't enough convincing evidence to suggest that Provigil would work well in this regard, either.For those who want to increase brain power, but avoid using drugs, consider a few natural brain nutrients. These include acetyl L-carnitine, ginkgo herb, vinpocetin, and others. These nutrients don't work as rapidly as drugs, but they not only promote brain activity, but also offer brain protection through various mechanisms, including antioxidant effects.

Repantis D,et al. Modafinil and methylphenidate for neuroenhancement in healthy individuals: A systematic review.Pharm Res 2010: In press.

©,2012 Jerry Brainum. Any reprinting in any type of media, including electronic and foreign is expressly prohibited

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