The long-term ‘lifestyle use’ use of cognitive enhancing drugs by healthy people is potentially harmful and should be further investigated by the government, pharmaceutical industry, and national medical organizations, according to a Personal View paper recently published in The Lancet Psychiatry.
“Cognitive enhancing drugs, such as cholinesterase inhibitors and methylphenidate, are used as treatments for the cognitive symptoms of Alzheimer’s disease and attention deficit hyperactivity disorder,” the researchers wrote. “However, these drugs and others, including modafinil, are being increasingly used by healthy people for enhancement purposes.”
The use of drugs such as Ritalin (methylphenidate, Novartis) and Provigil (modafinil, Cephalon) by healthy individuals to improve concentration, memory and alertness, appears to be on the increase, according to the paper. The long-term consequences of non-medical use of these drugs is not known, according to the researchers.
“We simply do not know enough about how many healthy people are using cognitive-enhancing drugs, in what ways, and why,” said researcher Barbara J. Sahakian, PhD, professor of clinical neuropsychology at the department of psychiatry, University of Cambridge School of Clinical Medicine and Honorary Consultant Clinic Psychologist at Addenbrooke’s Hospital.
According to Sahakian and co-author Sharon Morein-Zamir, PhD, the use of these cognitive-enhancing drugs for nonmedical purposes appears to be related to gaining a “competitive edge” at school, college or work. Those who use these drugs may be attempting to compensate for sleep deprivation, jetlag, or maintaining focus. While most research to date has focused on student use (estimated at between 5% and 35% in this population), the researchers added that there may be a more significant problem involving usage among professional or older demographics.
Various substances are used by patients and healthy individuals to improve mental functioning and alertness, from readily available stimulants such as nicotine and caffeine to psychotropic medications. Many of the medications used for cognitive enhancement, such as modafinil and donepezil (Aricept, Eisai/Pfizer), were created by the pharmaceutical industry to manage cognitive impairment in conditions such as Alzheimer’s disease, attention deficit hyperactivity disorder (ADHD) and schizophrenia.
However, the non-medical use of these drugs causes safety and ethical issues. In particular, the researchers expressed concerns about healthy patients buying cognitive-enhancing drugs from the Internet.
“Present cognitive-enhancing drugs have wide-ranging effects and side effects, and are not predictable,” Morein-Zamir, a research associate at the department of psychology, University of Cambridge, said in the press release. “We also know next to nothing about their long-term effects in healthy people.”
The researchers also discussed the need to address the issue of cognitive enhancers at a policy level. They wrote that frequently, pharmacological cognitive enhancers are treated as a single class, despite their different pharmacological mechanisms, effects, and legal status. According to the researchers, case-by-case discussions of regulation will be needed regarding the potential for dependence and social harms.
“Policy proposals have spanned a broad range of approaches, but should take into account costs, bureaucracy and current regulations,” the researchers wrote. “Although there is great merit in the development of novel, effective, and safe pharmacological cognitive enhancers, use of these drugs is likely to, at least in the near future, stem from off-label expansion and online sales to individuals.”
Disclosure: Dr. Sahakian reports consulting for Cambridge Cognition, Servier, Otsuka and Lundbeck, and holds a grant from Janssen/Johnson & Johnson. He also reports having share options in Cambridge Cognition. Morein-Zamir reports no relevant financial disclosures.