Skye
Gould/Tech Insider
There are several things you can do right now to clear up brain
fog that makes it hard to keep up with everything you have to get
done.
You could go for a run or hit the gym –
exercise has been shown to effectively boost cognitive
ability. You could get
a good night’s sleep, something that refreshes energy levels,
is essential for memory, and makes it significantly easier to
focus. You could have a cup of coffee and benefit
from that proven little helper, caffeine.
But sometimes none of that seems like enough. It makes you want
an additional solution, a pill that can boost you for long enough
to get you over that hump.
While students and overworked employees frequently experiment
with substances like Adderall or Ritalin in an attempt to do just
that, it hasn’t been shown that most of these "cognitive
enhancers" actually make anyone’s brain work "better."
But there’s one substance that a
recent review published in the journal European
Neuropsychopharmacology found actually does improve attention,
memory, learning, and other cognitive abilities – modafinil.
Pharmaceutical cognitive enhancement isn’t a new idea. People
have used drugs to try to boost their brainpower for more than
100 years.
Early in his career in the late 1800s, Sigmund Freud
experimented prolifically with cocaine, which he described at the
time as his "most gorgeous excitement." Mathematician Paul Erdős
had such a serious relationship with amphetamines that when he
once stopped taking them for a month to win a $500 bet, he
immediately got back on drugs afterwards. He famously
told the friend he bet: "You’ve set mathematics back a
month."
Those substances, however, come with significant negative side
effects. That’s what makes modafinil so interesting.
In their review of the literature on modafinil, Oxford
researchers Ruairidh Battleday and Anna-Katherine Brem found that
it didn’t seem to have any particularly serious side effects and
didn’t seem likely to cause dependency – though there are still
unanswered questions there.
How modafinil affects your brain
Battleday and Brem reviewed 24 studies that assessed how
modafinil affected healthy non-sleep deprived people’s minds
(they considered 267 studies, but rejected those that weren’t
placebo controlled, used unhealthy subjects, or tested animals
and not people). The fact that subjects were healthy is an
important distinction – many of the ways we look at drugs that
affect thinking ability are designed to assess people with
cognitive deficiencies.
Most studies could be broken down into either "basic" or
"complex" tests of cognitive function, Brem and Battleday tell
Tech Insider.
Basic tests assess just one sub-component of cognition and tend
to be very simple tasks. On these tests, the effects of modafinil
were mixed. It was on complex tests that the authors found
consistent improvement, especially in terms of attention, the
ability to focus on a task and process relevant information;
learning and memory; and executive function, which includes the
ability to take in information and use it to come up with plans
or strategies.
Films where characters
suddenly gain access to new mental powers take the idea to an
extreme, but cognitive enhancement is a real
possibility.
Universal
These complex tasks are much better ways to answer the question
of "does this substance actually improve cognitive ability" than
the basic ones, the authors tell Tech Insider.
"Rarely in life do we spend an entire day using a sole cognitive
sub-domain – attention, for example. Rather, we constantly plan,
predict, and problem solve – all of which involve marshaling
subdomains of cognition and integrating their output – over
varying tasks and difficulties," they wrote in an email. "It is
in this sense that complex tasks can approximate everyday
functioning better than simple."
As for how modafinil works, we still really don’t know. It was
originally designed as a treatment for narcolepsy to keep people
awake. But no one is entirely certain how it affects cognition.
Matt Cardy/Getty
"The best idea we have is that by directly altering the
concentration of a group of chemicals in the brain – called
‘catecholamines’ – modafinil upregulates activity in attention
and executive control networks in the brain," the authors tell
Tech Insider. "These changes are then hypothesized to allow
individuals to perform better on cognitive tasks: particularly
those requiring good focus and problem solving."
Can I take it?
So, will your doctor write you a modafinil
prescription?
The answer for now is no, unless you have narcolepsy. But that
may not always be the case.
When it comes to safety, Brem and Battleday said that the studies
they reviewed didn’t note serious side effects.
Most studies reported a slight boost to positive mood and no
adverse effects. In the studies that found adverse effects, a
small number of participants reported insomnia, headache, stomach
ache or nausea, and dry mouth.
That may not sound great, but in context, those effects aren’t
such a big deal. That’s essentially like having an extra cup of
coffee that you didn’t need, UCLA clinical
psychiatrist James
McGough told The Atlantic’s Olga Khazan.
Only one study assessed the potential for abuse, and reported
that it was low.
Substances
like Adderall have a higher risk of abuse.
Alex
Dodd/flickr
But none of these studies tested long term use, so we don’t know
if it’s safe for someone to take modafinil over an extended
period of time. As the authors point out, most of these studies
only tested one single dose, which comes nowhere close to
assessing risks of regular use.
Funding is scarce for drugs that help healthy
people
Interestingly, Battleday and Brem point out that there isn’t much
research on cognitive enhancement for healthy people and that
there’s a lack of funding and perhaps even a bit of a taboo on
studying the topic.
"It appears that funding for drug-based studies on healthy
individuals fails to attract typically medical-oriented grants
and awards," they say.
That’s why they say it was hard to find good complex tests of
cognitive enhancement, and they hope that perhaps their work will
encourage researchers to further investigate the topic.
If that does happen, there may be surprises out there – perhaps
some of the other drugs used for cognitive improvement, things
like Adderall, work better for healthy people than we think they
do despite their potential dependency risks.
But even if modafinil were to be proven safe long term and its
cognitive boosting ability affirmed by further studies, there are
still reasons why – for now – doctors aren’t going to start
prescribing it to healthy people.
At the recent annual meeting of the American Medical Association,
the
group decided to adopt a policy "discouraging the nonmedical
use of prescription drugs for cognitive enhancement in healthy
individuals."
There’s little evidence so
far that tells us how effective many other nootropics are or are
not.
Dylan Love
Of prescription stimulants, they say that the cognitive effects
appear limited for healthy people. Of other supplements and
"smart drugs," known as nootropics, they say that there’s limited
research right now and that more analysis is needed before anyone
can conclude that they are safe.
So don’t expect a modafinil prescription soon. Not that that
stops many users. There are healthy internet communities dedicated to nootropics,
and plenty of user
reports on modafinil specifically.
Most of those users order it off the internet from somewhat-shady
pharmacies, a practice strongly
discouraged by law enforcement, since it’s illegal and
potentially dangerous.
Will you someday be able to take the smart pill?
Let’s say it turns out that multiple studies show that it’s safe
to take modafinil occasionally over long periods of time – for
the rest of your life, even. Let’s say that there are no
additional negative side effects that come with that use.
If that’s the case, should you be able to use the drug?
"That is a very interesting question, and one society must
properly address in the near future; not just for modafinil, but
for all potential neuroenhancement agents," say Battleday and
Brem. But they point out that even if something proves to be safe
for an individual, that doesn’t answer all questions about how
its use affects the rest of society.
A number of other devices
might be able to stimulate the brain as well.
REUTERS/ Morris MacMatzen
Some people fear that if we permit any use of cognitive enhancing
drugs for individuals, it will eventually lead to people being
required to use those substances, even if they don’t want to.
That could be due to internal pressure that comes from a fear of
keeping up – if my co-workers are taking this brain-boosting drug
and I’m not, will I be judged as not working hard enough?
There’s even a concern that people in certain professions might
be compelled to use brain-enhancing substances. Could we get to
the point that it’s considered unsafe for pilots to fly or
surgeons to operate without using focus- and attention-boosting
drugs?
In
The Conversation, researchers Emma Jane and Nicole Vincent
describe how the use of beta-blockers became widespread among
classical musicians. While some people first used these drugs to
get over performance anxiety, they were so effective and had
minimal enough side effects that other musicians felt they were
losing out by not using beta-blockers as well.
"Just as the use of beta blockers has become widespread in the
classical music scene, so too cognitive enhancement threatens to
become a new ‘normal’, a de facto standard that pressures
everyone to bio-hack their brains to keep up," they write.
And the ethical questions don’t stop there. There are questions
about justice – if wealthy people can easily afford cognitive
enhancement but no one else can, that’s likely to create an even
more unequal society.
Cognitive enhancing substances are already out there and
more are likely to become available in the near future. These
questions about how to use them or how to regulate them are
important.
"This is not a future but already a present scenario," say Brem
and Battleday.
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