Is the promise of nootropics too good to be true? Nootropics consists of a wide range of supplements and medications that people think or suspect may improve the brain's cognitive functioning — including thinking, memory, executive function, creativity and motivation. The concept of such a simple way to boost brainpower to become more productive, focused and intelligent is undoubtedly enticing. But this long held-dream of the perfect brain boosting smart drug, or nootropic, is still just that: a dream. Other names for nootropics include smart drugs, brain boosters and cognitive enhancers. They can include everything from vitamins and minerals, "natural" chemicals obtained from plants, prescription medications to novel "designer drug" compounds. As anyone on antidepressants or other medications for psychological conditions can tell you, adjusting your brain chemistry isn't as easy as popping a pill. While psychotropic medications can be hugely important to improving mental health, there are a lot of downsides to these medications. And when healthy people start experimenting with brain-altering drugs like nootropics, things can go south pretty quickly. What are nootropics? The word nootropic (pronounced new-tropic) was first used by Corneliu Giurgea, a Romanian neuroscientist, in 1972. He thought that smart pills should be developed and freely available, used to boost the brains of the general population and increase human intelligence. "Nootropics work on improving cognition, memory, alertness, concentration, creativity and attention," Amira Guirguis, a senior lecturer in Pharmacy at Swansea University in Wales, U.K., said. "They became known as cognitive enhancers, compounds that amplify how the different cognitive functions in the brain work and how we process information." Today, ethical questions abound about nootropics, and scientists and product developers are still searching for drugs that boost the brain in ways that are helpful, sustainable and safe. The nootropics we have today are either questionably effective, hold the potential for abuse and addiction or have negative side effects. Brain booster supplements Many companies have taken advantage of people's desire to perform better and have tried selling solutions by packaging up supplements marketed as brain boosters for healthy people. These are typically sold as "natural" combinations of vitamins, minerals and plant-based compounds or extracts. These naturally occurring compounds are sometimes called "nutraceuticals," "neuroceuticals" or "micronutrient" compounds. They're typically sold as supplement mixes available over the counter at your local drug store or available for purchase online from a wide variety of retailers. A report from Grand View research pegged the value of the brain booster supplement industry at $7.21 billion in 2020, expanding to $13.38 billion by 2028. According to the report, popular ingredients in these natural or herbal brain booster supplement combinations include: B complex (12 and 6) vitamins, omega-3 fatty acids, acetyl-L-carnitine, huperzine-A, citicoline and alpha glycerylphosphorylcholine. Herbs and food products such as ginkgo biloba, ginseng, lion's mane, curcumin, echinacea, bacopa monnieri, L-theanine from green tea, turmeric, guarana (a plant extract that includes caffeine) and bilberry extract are also commonly included in these formulations. Caffeine is perhaps the most commonly used nootropic, found in many food products like coffee, tea and chocolate. "When we say natural, we also include nicotine and caffeine," Guirguis told Live Science. "These two are kind of 'acceptable' cognitive enhancers — we use them because they're going to improve our memory, productivity and alertness, and ability to do things." Prescription 'smart drugs' One of the most common classes of nootropics that people talk about, especially in relation to students and professionals, are the "smart" prescription drugs like stimulants that are thought to increase attention for hours of focused studying or working. According to a review of cognitive enhancers published by Guirguis in the journal Brain Science, the most common prescriptions used as smart drugs include methylphenidate (Ritalin and Concerta) and amphetamine-salt based stimulants like Adderall and Mydayis. "These prescription medicines are used by people who have cognitive deficits, like ADHD, and some psychiatric disorders as well such as schizophrenia," Guirguis said. But healthy people sometimes abuse them to focus on work or school. There is also a class of sleep disorder medications that are very effective stimulants. Modafinil (Provigil) is one of the most commonly abused drugs that is typically prescribed for narcolepsy and some other sleep disorders, such as those caused by shift work. These drugs tend to keep people awake for long periods of time — even multiple days at a time in healthy people. Other classes of prescription drugs that are sometimes thought of as nootropics include those typically prescribed for patients with Alzheimers' disease, Parkinsons' disease, and dementia. These include the drug donepezil (Aricept), which acts to improve memory and the Parkinson's drug selegiline (Zelapar), which acts as an antidepressant. Like selegiline, other antidepressants and anti-anxiety drugs are also sometimes thought of as smart drugs. "Because these drugs work on increasing the levels of dopamine and noradrenaline, they will improve cognition," Guirguis said. "However, if you think about it, if I use a lot of that, in order to enhance my cognition, the levels of these neurotransmitters increase massively in my brain … potentially causing cognitive decline." That's because the brain gets used to the higher levels of these transmitters, and has trouble adjusting when they're suddenly gone. GABAergic drugs, which modify the brain's levels of or reaction to the neurotransmitter GABA — usually to achieve a more relaxed state. These drugs include, Diazepam (Valium) and lorazepam (Ativan) and are sometimes used as brain boosters, though they have a more relaxing effect that some also claim increases cognition, Guirguis said. Who takes nootropics and why are they popular? Many people may wish for a better brain at some point in life, and many people resort to using cognitive enhancers and nootropics to get there. A large study, published in 2017 in the International Journal of Drug Policy study found that nearly 30% of Americans admitted to using prescription stimulants as cognitive enhancers at least once in the previous year — up from 20% in 2015. The popularity of nootropic drugs may in some part be due to popular culture, like the movie and TV show 'Limitless'. The movie, which debuted in 2011, was an unexpected box office hit starring Bradley Cooper as a man who stumbled upon a new smart drug that propelled him into a super-productive life. The movie helped make mainstream the bio- and brain-hacking world that had once been confined to the tech world's Silicon Valley. Just a few years earlier, in 2008, TechCrunch hailed the anti-sleepiness drug modafinil (Provigil) as the entrepreneur's drug of choice. "Modafinil may stop you from sleeping for three to four days," Guirguis said. "It may be perceived as a very good option for high achievers," who want to increase productivity and replace sleep with time to work or study. These high achievers that seem to use smart drugs at higher rates include students at prestigious universities, medical professionals like surgeons and other high-pressure careers, such as pilots, Guirguis said. The military has experimented with smart drugs on soldiers, giving them modafinil and amphetamines to help stay alert while on missions, according to the Brain Science review. According to a 2021 review published in the journal Frontiers in Bioscience-Landmark, students specifically use smart drugs to improve their concentration, enhance their brain power, reduce their stress, optimize their time, stay awake longer, have more free time and just because they're curious. These drugs are popular probably in part because they're easy to get online or from friends with prescriptions, Guirguis said. But the real question is, do they work? Are nootropics effective? Some drugs definitely can improve brain functioning in people with certain conditions. Stimulants are definitely helpful for people with attention disorders and drugs like modafinil are important treatment options for people with sleep disorders. But it's unclear if they actually improve cognition in people without those disorders. "There is a lot of placebo effect," Guirguis said. But in many people, she said, prescription stimulants do seem to improve attention, arousal, wakefulness, learning and remembering, and intellectual performance. The 2021 review published in Frontiers in Bioscience-Landmark found the research into prescription stimulant efficacy in healthy adults split. Some studies seem to indicate moderate improvements in attention and sleepiness, as well as giving their users increased confidence. But others seem to suggest that these are more likely to be placebo effects. Another analysis of "smart drugs" published in 2011 in the Psychological Bulletin journal seems to suggest that stimulants like amphetamines increase the ability to learn and retain information even a week after use during a study session. These drugs have the ability to "enhance learning in ways that may be useful in the real world," the study authors write. On the other hand, supplements and over-the-counter brain boosters are less likely to be effective, Guirguis said. "The evidence of their efficacy, effectiveness and safety is very limited. And that's why there is no sufficient evidence to prescribe them." A 2015 review of the effect of nutrients, dietary supplements and vitamins on cognition, published in the Canadian Geriatrics Journal, found that most of the ingredients in various dietary supplements, including Omega-3 fatty acids, B vitamins and vitamin E, didn't improve cognition in healthy middle-aged or older adults. Other supplements may show some effect in small studies, but still need more substantial evidence. Compounds like caffeine and nicotine are effective at increasing wakefulness, but they're also addictive and even caffeine can sometimes backfire, leaving users feeling more tired. Safety and risk factors of nootropics While it's possible that prescription stimulants or other drugs can give you a boost when you need to study or focus on a big project at work, it can be dangerous to do so. "If you just take a prescription medicine without any instructions and monitoring from a healthcare professional, and you just start taking it the way you want, it's gonna cause some harm," Guirguis said. For stimulants, specifically, "there is a very high risk of dependence," Guirguis said. "If you don't take the drug you will feel terrible, you would want to go back and take it again, you would want to take more of it, so there is an element of addiction as well." Many who regularly take these drugs may risk permanently altering their brains. It's possible that repeated use can really add up, Guirguis said, especially if these drugs are used while the brain is still developing, like in students. "I don't want to call it brain damage, because brain damage is a big word, but I would say there is a potential for loss of brain plasticity," Guirguis said. "If you give these drugs to healthy growing brains — during adolescence, to young people — they can lose that plasticity, which can affect learning, impair brain functions affecting behaviours and lead to addictive behaviors." Additionally, the side effects of these medications when used illegally in healthy populations are not well known. The Frontiers in Bioscience-Landmark review suggested that side effects can include increased risk of suicide, psychiatric disorders, and cardiovascular disease. Even the most frequently used nootropics have side effects and can lead to dependence and withdrawal symptoms. Many rely on caffeine to kick start our mornings or perk up our afternoon but for some caffeine causes jitteriness or anxiety. Nicotine has real stimulant properties, but is problematic because it shrinks blood vessels and raises the heart rate, potentially leading to cardiovascular issues and issues during pregnancy. While a vitamin and mineral mix over the counter will likely not pose too much risk, it's wise to make sure the product is created by a reputable company. Supplements themselves are not well regulated and can potentially interfere with other drugs or cause toxicity, according to a 2018 review in the journal Annual Review of Pharmacology and Toxicology. "Most herbs include hundreds and hundreds of phytochemicals — substances that can influence our body so they can change our own physiological functions. And are they tested? No," Guirguis said. These phytochemicals can have unwanted effects, including interacting with prescription drugs, affecting how they are handled by our bodies. "If somebody is taking regular medicines, for any chronic condition, they can interact with it and cause toxicity" If you're thinking of taking any of these brain booster supplements, make sure to take a close look at the ingredients and ask your doctor or pharmacist for their advice on the active ingredients. "When we say a brain booster, if you think about it — if you change the balance of those neurotransmitters in the brain, you're actually doing something to your brain. And if you enhance it so much beyond the baseline, you're actually causing some imbalance," Guirguis said. "The best thing to do is always ask a pharmacist or ask your doctor. But don't think that because it's herbal or natural, it's safe." Source
