Drugs to make you smart

For as long as it has existed, the human race has strived to make itself better, to improve upon its natural ability and to push its boundaries. The Olympic games display impressive feats of human physical endurance, strength and skill. The Guinness book of world records celebrates some of the more ‘niche’ (yet no less impressive) human abilities, such as holding 43 snails on a face at once and squirting milk over impressive distances from an eyeball. These may not be particularly useful skills to have, but the collection of records in the Guinness book is still a demonstration of how we endeavour for success, to improve, and to be the best.

So what about our brains? Can we make them better, faster, smarter?

There are a group of drugs known as ‘Nootropics,’ or ‘Cognitive Enhancers’ that are used for just this purpose. These drugs act by changing the regulation of signalling systems within the brain – that is, they alter how brain cells communicate with each other, thereby subtly altering brain function. A cognitive enhancer aims to improve cognition – this is the brain’s ability to think, make decisions, learn, remember and solve problems. All are essential abilities for living independently, holding down a job, and succeeding at school.

Various cognitive enhancers have been around for decades, and new ones are being developed all the time. However, these drugs are created with an aim to treating psychiatric and neurological problems, where poor cognition is a symptom or a side effect of the illness.  But do they work on healthy brains? Can we use drugs to push our cognitive abilities above and beyond our usual boundaries?

Can we make ourselves cleverer – *ahem* – I mean, more clever?

Well, it may be possible, although it’s not all that clear, and definitely not that simple. The use of cognitive enhancers in a healthy population is a relatively new consideration, so research into the effect of these drugs is very much in its early stages, and there is almost no data on the long-term effects of regularly taking such enhancers.

It’s also important to bear in mind that there is not one ‘wonder pill’ that can make someone smarter. Rather, there are many many different drugs that affect slightly different, and overlapping systems in the brain. Each one may therefore improve different and particular elements of cognition, which in turn means an individual is more able to learn, and as a result will be smarter. For example, different drugs will improve attention, others will affect memory, and others will increase alertness. By taking a cognitive enhancer, you will not suddenly be able to answer all of the questions on University Challenge.

So here is a summary of some of the most common cognitive enhancers currently being used:

ATTENTION (Ritalin/Atomexitine)

One of the illnesses that is most commonly treated with cognitive enhancers is ADHD (attention deficit hyperactivity disorder), which is characterised by a short attention span, hyperactivity and impulsiveness. Therefore cognitive enhancing drugs are thought to be a useful treatment. Two of the most common drugs used for ADHD are Ritalin (Methyphenidate) and Atomexitine.

Ritalin and Atomoxetine both increase noradrenaline and dopamine in the brain. Noradrenaline and dopamine are chemicals that send signals between brain cells, and are therefore known as ‘neurotransmitters.’ In ADHD, there is a reduction of both of these neurotransmitters, suggesting that communication within the brain is not efficient. By increasing the level of these neurotransmitters, Ritalin and Atomoxetine improve communication between brain cells, resulting in better alertness and attention.

So what about in a healthy individual without ADHD? Can these drugs further enhance cognition above and beyond what can be achieved with hard work alone? Many people believe so – ADHD-associated drugs are commonly found on university campuses, particularly in the USA when they have been illegally purchased by desperate students trying to improve their exam performance. But does it work?

The answer isn’t exactly clear. Several studies have indicated that taking Ritalin and Atomexitine can be beneficial in healthy adults – they can increase accuracy and performance on various cognitive-dependent tasks that require good attention and memory to perform well. But the size of the effect seems to be fairly modest, and seems to depend on the individual’s natural ability in the first place – those who had poor attention and memory to begin with saw an improvement in their performance after taking Ritalin, but there was no benefit for those who already performed well. Another dopamine enhancer, Bromocriptine (used for the treatment of Parkinson’s disease) actually lowered the performance of individuals who had initially performed well.

 

MEMORY (Aricept)

Cognitive enhancing drugs are also commonly used in those suffering from neurodegenerative diseases, such as Alzheimer’s or Parkinson’s disease. Both affect cognition and memory, and while there is no cure for either condition, cognitive enhancing drugs may delay or slow down the progression of the cognitive symptoms. Aricept (Donepezil) is commonly used for Alzheimer’s disease. It increases the levels of another neurotransmitter – acetylcholine – by stopping it being broken down and recycled in the brain

The majority of people experience and complain of a bad memory as they get older, so a memory-enhancing drug such as Aricept is going to be of interest to many people, not just those suffering with dementia. As such, research has begun to investigate how Aricept may affect healthy individuals. It has been found to enhance pilot performance after flight simulation training, although a review of multiple studies looking at Aricept found that evidence for its ability to enhance memory was unconvincing, with several studies finding no effect or even an impairment on cognitive ability following treatment.

ALERTNESS (Modafinil)

Modafinil (Provafil) is a treatment for narcolepsy and sleep apnea, and enhances cognition by increasing alertness and wakefulness. Apparently it is commonly used by some individuals in high-stress professions, or those that require long hours and shift work to help them stay awake,  such as doctors, military personnel, and academics. A study of British universities indicated that its use is pretty high among the undergraduate population too, and in 2013 described it as the ‘drug du jour’ to aid studying, despite being a prescription-only medication. The exact way that Modafinil affects the brain isn’t fully understood – it is thought that it may alter similar systems as Ritalin and Atomexitine, but it has also been associated with multiple other neurotransmitters and systems.

Modafinil has been shown to improve cognitive function in male volunteers by enhancing alertness and attention paid to the tasks they were given, and by inhibiting quick, impulsive responses. The volunteers also reported feeling more alert and energetic after taking the drug. However, other studies have found that similar to the ADHD drugs, Modafinil has a greater effect on those with a poor initial performance, and may be of limited use to those with a high cognitive ability.

Overall, there is some tentative evidence that cognitive enhancing drugs typically used for neurological problems could have some benefit in the healthy population. So what should stop you from grabbing a big ol’ box of pills to improve your performance at school or work? Well, lots of things, actually – here’s just a few:

• A big deal is that no one knows the long term effects of taking any of these substances – the majority of studies investigate the effects of a single dose or treatment over just a few weeks.
• It is important to also bear in mind that these drugs are likely to have undesirable side effects. When they are used in people with a neurological disease, it has been thought that the therapeutic effect of the drug outweighs the discomfort of the side effects. As the current evidence points to very modest effects in healthy people, the balance between the benefit and the risks may no longer be favourable.
• It isn’t really understood how they work in healthy people, and it is different for everyone. Most of the studies I came across while researching this post pointed out that the effects of cognitive enhancers were very variable between different people. This may be down to an individual’s brain chemistry, gender or their genetics, but currently it isn’t possible to predict how or if a cognitive enhancer will work in any one person.
• There’s a big ethical debate about whether the use of cognitive enhancers is ok. Is it cheating? How different is it to using caffeine? Would people feel coerced or pressured to take them in order to ‘keep up?’ Does it undermine the value of hard work?

I don’t know the answers to the ethical questions, and the argument is strong for both sides. Nevertheless, the use of cognitive enhancers is an interesting and divisive debate, and looks to be a growing field of research. However, the current consensus appears to be that these may be useful tools in the future for healthy individuals, but at the moment their benefits and effects are questionable.

Personally, I’m happy to continue to celebrate if/when I manage to answer just a single question on that darn University Challenge.

The Biocheminist.