Smart Pills: Do they really exist?
28 January 2020
A smart drug is generally a prescribed medication or off-label drug used primarily to treat some kind of mental or cognitive disorder.
The most common are drugs such as Adderall (dextroamphetamine) or Ritalin (methylphenidate) in the stimulant class used to treat symptoms related to ADHD – although legal and illegal off-label use is rampant. And while they may promote focus and energy in some people, others have dramatic side effect, to body and brain. Smart drugs in the stimulant class also tend to be reinforcing, producing spikes in dopamine and norepinephrine.
This leads to tolerance and habit formation, including adverse effects on appetite, mood stability, cardiac function, stress levels and possibly many other unwanted effects – especially on younger brains such as teens and young adults. Irritability and mood swings, anxiety, sleep issues, and other forms of emotional or cognitive regulation problems can crop up over time with stimulant use, as well.
A popular atypical stimulant “smart drug” includes the narcolepsy agents Modafinil / Adrafinil, although their effects on cognition beyond wakefulness are unproven, and side effects – while rare – can be life threatening. If attention problems are already present the side effect risk appears to be significant increased, as well. In contrast to a smart drug, a nootropic is generally a non-prescribed compound, including vitamins, herb, other supplements, natural or synthetic compound that may increase or protect cognition in some way. The preponderance of research in the past 40 years shows some effects on focus, attention, effects on aging, and possibly cellular metabolism.
To paraphrase the definition of “nootropic” it is something that improves cognition without appreciable side effects, or provides from protection to the brain. In a modern context we think of nootropics as something used not to treat any mental condition or pathology directly, but instead to provide support to peak function, protect against long term risk, and provide daily boost. Across the field, true nootropic ingredients and full blends can now be found largely sourced from natural ingredients. Nootropic blends are designed to leverage synergy effects suggested in the research and subjective experiences. The goals with nootropics should always be to allow for greater and more consistent cognitive effort and flow, without the side effects of a stimulant or other harsh substance.
We’ve come a long way since we accepted that the theory behind the Earth being the center of the universe was wrong. We understand that new research may overturn old knowledge. So how can we truly know the risks and benefits of long term use of nootropics or smart drugs?
A red flag in understanding the harm of a substance is the body’s ability to handle an overabundance of this substance. Small amounts of toxic substances may be beneficial in the short term, but the magic happens when we look at what is happening in the body when we get too much. Something as simple as a cup of coffee may seem harmless, but caffeine in high amounts can cause dizziness, anxiety, and even cardiac arrest or death. Caffeine mimics the action of the neuromodulator adenosine in the body. This leads to higher adrenaline and cortisol levels.
Even in typical doses caffeine can deeply affect our sleep and cause heart arrhythmias for some people. Alcohol has even worse short and long term toxicity symptoms at non-moderate doses, and some people struggle to keep their dosing moderate. In better doses –
perhaps a couple cups of coffee a day (without sugar) and a drink or so per day on average, these substance are actively health promoting, and reduce risk for many brain and cardiac diseases. When you are picking substances and compounds, dosing should be cautious at first.
Smart drugs such as Adderall can cause dangerous lows, psychosis with extreme use, rebound fatigue, and depression, even at lower use levels. As an amphetamine, Adderall can act as a reuptake inhibitor, meaning that it can compete with other neurotransmitters for reuptake.
Specifically it is thought to block the uptake of dopamine and norepinephrine, which are associated with reward behaviors and our nervous system functions, respectively. This causes a flood of these neurotransmitters onto multiple receptors, causing neurotransmitter depletion and overexcited receiving neurons. This large “signal” is the reason for the focus, but also responsible for some of the side effects that go along with this class of prescription drugs. Existing research is also a bit weak on any improvement that Adderall or other stimulants may have on short term memory or cognitive function, and some actually may impair function.
Modafinil, also known as Provigil, is an example of a smart drug that has been used like a nootropic. Modafinil is prescribed to treat sleep disorders, but when combined with a normal functioning brain, can potentially cause increases in cognition and awareness.
Just like Adderall, the use of these drugs outside the medical field does not make them a nootropic. Modafinil is also a reuptake inhibitor for dopamine, causing the same type of neurotransmitter flood as Adderall. However, Modafinil may also affect the histaminergic pathway, which deals with wakefulness and the delicate immune response of the body. Histaminergic neurons in the brain are more active during wakefulness and slow their firing pattern as we rest or sleep.
Modafinil’s “beneficial” side effects may come from this heightened histaminergic neuronal activation, but too much activation can cause apoptosis, or cell death. In addition, this has been shown to cause adverse skin reactions that required hospitalization since the histamine pathway also deals with our immune system. Modafinil may increase your intelligence, but can be extremely dangerous to the health of your brain and body.