“Performance-enhancing drugs” is a phrase we’re used to hearing in the context of sport. But what if the drugs in question were aimed at improving our mental ability? Smart drugs, or ‘nootropics’, have been widely hailed as the steroids of the academic world. However, like steroids, concerns are now being raised over healthy students using prescription drugs to enhance their concentration and memory, thus gaining an advantage over their peers. Commentators argue that this advantage is unfair, since it is only available to students who can afford and are willing to risk side-effects of such drugs.

However, beyond the exam hall, there may be a legitimate market for these ‘smart’ drugs. Perhaps improving concentration in shift workers or anyone with a stressful or demanding job. But what ‘smart’ drugs are currently available, how do they work and are they safe for long term use?

Piracetam

A little internet research (and there are some quite alarming websites devoted to the subject!) brings up Piracetam as the original and perhaps most popular ‘smart’ drug. Piracetam has a wide range of clinical applications, stretching from treatment of epilepsy and movement disorders to use as a cognitive enhancer (mainly in elderly people suffering from memory disorders). Aside from its regular clinical applications, it has also been found to improve reading in dyslexics and to protect the brain against the damaging effects of alcoholism. Despite its application as a cognitive enhancer in elderly patients, there are few controlled studies investigating the drug’s ability to enhance mental performance in young healthy adults. The evidence which does exist, mostly points towards a modest improvement in memory and attention across a range of tasks. But how does it work?

Piracetam affects the membrane which surrounds our cells, both in the brain and the rest of the body. This membrane is not static, instead it acts like a fluid allowing proteins within the membrane to ‘float’ around. In neurones, the main job of these proteins is to transmit and receive chemical signals. As we age, the fluidity of our cell membranes is lost therefore affecting the proteins’ ability to communicate. Piracetam is thought to restore membrane fluidity, thus restoring neural communication. Indeed, Piracetam has been found to increase transmission of information in the hippocampus (a part of the brain essential for learning and memory). Studies have also found that it increases the amount of oxygen available to brain cells, this is thought to be the mechanism by which it protects neurones from alcohol-induced damage.

Some users of Piracetam also report increased creative drive. Writers, musicians and other creative people have reported that Piracetam improved their work and encouraged experimentation; however it cannot be ruled out that this is merely a placebo effect. Some people believe that the “light bulb” moment of creativity, when a stunningly original idea hits you (not something this writer is particularly familiar with…) could occur at times when there is greater connectivity between the two hemispheres of the brain. Piracetam is thought to increase transmission of signals moving between hemispheres across the Corpus Callusom (the nerve bundle that links the two hemispheres) so, in theory, this could increase creative output.

Although side effects of Piracetam are thought to be mild, the drug has yet to be studied for long term side effects in healthy adults. Therefore, the use of Piracetam as a nootropic agent may represent an unwarranted risk for a relatively small reward.

Ritalin

Another drug commonly used by students is the ADHD drug Methylphenidate, commonly known as Ritalin. This drug is usually prescribed to children diagnosed with ADHD to improve their concentration and motivation. However, it works just as well in healthy individuals, leading to its use among students as a ‘brain-booster’. It is estimated that in some American universities around 25% of students take Ritalin to improve their concentration. The ethicist John Harris has argued that if the drug is safe enough to be given to children for a non-life-threatening condition, it is safe enough to be used by adults to improve concentration. Although this argument may be sound, there is still much controversy over the very widespread prescription of Ritalin. Indeed, it can have side effects on the cardiovascular system which, in a small number of cases, resulted in sudden death. It has also been linked with psychosis, depression and anxiety. Therefore, although the drug is considered relatively safe for short-term use (as it is currently prescribed) chronic use may prove unsafe.

Methylphenidate is a stimulant that works in the same way as cocaine; however, it has a much slower method of action and if taken as prescribed, it does not generate the same feeling of euphoria as cocaine. The drug blocks transporters on neurons which would usually remove excess dopamine, meaning that brain dopamine levels increase. Dopamine is a neurotransmitter with an important role in the brain’s reward and motivation system, indeed it is by manipulating this system that Ritalin is thought to work. However, due to its parallels with cocaine and associated scope for abuse, Ritalin is a class B drug in the UK; meaning that possession without prescription can carry a maximum five year prison sentence.

These drugs certainly have an important role to play in improving the lives of patients and treating the illnesses they were developed to treat. However, to consider these as ‘smart’ drugs for the healthy seems a little crass. It is likely that as nootropics become more refined and perhaps marketed toward healthy individuals, we will see their use become more widespread, but for now the risk to long-term health probably outweigh the rewards. So, I believe that in this case the old adage, “if it ain’t broke don’t fix it” holds true.

Post by: Claire Scofield