Smart pills: More focus or hocus-pocus?

They’re all the buzz, and more of my patients seem to be asking for them: Drugs that can improve attention span and memory and help them be more productive at work. That may explain why the demand for neuroenhancement medication seems to be gaining steam. Prescriptions for the 18-year-old-and-older age group have been steadily rising, with 3.2 million recorded between November 2006 and October 2007. In one survey conducted in 2008 by the scientific journal Nature, 20 percent of respondents admitted to using neurocognitive-enhancing drugs, mostly to improve concentration.

Examples include stimulants such as Ritalin (methylphenidate) and Adderall (amphetamine/dextroamphetamine combination)—the drugs used for children with attention deficit hyperactivity disorder (ADHD)—to improve performance on academic tests and to learn new skills, and cholinesterase inhibitors like Aricept (donepezil), the Alzheimer’s medication, to treat normal age-related memory changes. They also include Provigil (modafinil), the drug used off-label to keep pilots alert and approved to treat narcolepsy and sleep apnea.

Some say that they’re better than a double-espresso, but do they work? According to new guidance by the American Academy of Neurology (AAN):

"Medications currently used for neuroenhancement do not appear to act uniformly to improve executive function or memory across age groups (e.g. elderly/young), populations (high/low IQ), or tasks (novel/repetitive), and in some cases may make cognitive function worse. Thus, the idea of simply "making people smarter" by prescribing these medications ignores the complex nature of cognitive function. In addition, the risks of the long-term use of off-label medications for neuroenhancement in normal patients without a medical or mental health condition are not known and may not be known for many years." The AAN statement goes on to advise neurologists like me to exercise our clinical and ethical judgment to decide whether to prescribe medications for neuroenhancement. But proponents argue that if we don’t get on the bandwagon, we’ll be at a competitive disadvantage, not only as individuals but as a nation in this global economy.

Without data on the long-term side effects, are you tempted to take the risk?

—Orly Avitzur, Consumer Reports medical adviser

Photo courtesy of hipsxxhearts

Comments

[Lyle S.]

I took Provigil for three years after battling excessive exhausting which I and my GP thought was narcolepsy. The drug was amazing: 18 hours of alertness with no perceived side effects. It really helped me turn around my academic career - I would fall asleep in nearly every class prior to use. After three years I needed to get a refill and it was recommended by a new GP to get a complete sleep study done to confirm my preliminary narcolepsy diagnosis (and now my insurance covered most of it). The sleep study revealed that I didn't have narcolepsy and that the provigil was possibly treating some mild anxiety/depression i was suffering. Accordingly, I didn't get a new refill for it. It didn't take long to return to normal, no withdrawal, but now knee deep in dental school I wish I had that stuff lying around. I sometimes wonder if it wouldn't be better than all the caffeine I'm drinking now. Provigil was a godsend for me, but I think that long term question mark has kept me from going back for an Rx.