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Time magazine, Jan 17, 2006
A guide to today's brain-boosting pills and supplements and
what's in the pipeline
By UNMESH KHER
If you haven't already heard the term nootrope, better jot it
down. Chances are you'll hear it a lot in the future. A marriage
of the Greek words noos, for "mind," and tropein, for
"toward," it refers to drugs that enhance mental performance—popularly
known as smart drugs. Nootropes aren't new. Amphetamines, first
synthesized by a German chemist in 1887 and used in over-the-counter
inhalers by the 1920s, were doled out generously during World
War II to Allied and German troops to keep them alert. Military
pilots still take dextroamphetamine, or go pills, to stay in fighting
form on long missions. But in the post-Viagra era, many neurologists
believe—and ethicists fear—that scientific advances
and social changes may have set the stage for a new age of cosmetic
nootropy.
Indeed, some argue that the era is well under way. There's already
a lively market for brain boosters. Herbs and supplements with
names like Focusfactor and Brain Quicken clutter health-store
shelves and the Internet, often with little scientific basis for
their claims. Pill popping in some circles has become as American
as SAT-prep classes. Students and professionals in growing numbers
are taking potentially addictive stimulants like Ritalin to focus
their minds and bolster their memory.
The latest addition to that budding pharmacopoeia is a narcolepsy
drug called modafinil that was approved two years ago to help
shift workers stay alert. And there's a lot more in the pipeline.
Neurologists have made rapid progress unraveling the molecular
underpinnings of memory and attention, and drug companies are
testing dozens of compounds derived from those discoveries to
treat cognitive ailments like Alzheimer's disease and schizophrenia.
Memory Pharmaceuticals in Montvale, N.J., for instance, is developing
drugs that boost the expression of genes essential to shoring
up the connections among neurons—the physical process that
is thought to turn immediate experiences into long-term memories.
Cortex Pharmaceuticals in Irvine, Calif., meanwhile, is testing
compounds that accomplish something similar more indirectly. Those
molecules amplify the response of brain chemicals called AMPA
receptors, among the first players in a long biochemical cascade
that takes place in the neuron as it encodes memory. The first
of those ampakine molecules has been shown in
a recent study to boost the attention and mental performance of
healthy, sleep-deprived men. The more powerful compounds in Cortex's
untested arsenal, says CEO Roger Stoll, may bolster long-term
memory without inducing the jittery side effects of drugs like
Ritalin and caffeine.
Drugs already on the market, notably those that treat Alzheimer's
disease, have been shown in small studies to improve the performance
of healthy brains, though not by much. (Most of the research to
date has been carried out on patients suffering from cognitive
deficits.) "It's not like you start out with an IQ of 100
and get an IQ of 140 after taking these drugs," says Dr.
Anjan Chatterjee, a neurologist at the University of Pennsylvania.
Ritalin-type drugs, which have a broadly stimulating effect on
the nervous system, clearly improve attention and memory. According
to a 2002 study of helicopter pilots operating flight simulators,
so does donepezil, a drug that raises levels of the neurotransmitter
acetylcholine. In another study, men on 200 mg of modafinil did
better at mentally challenging games than subjects taking a placebo.
But those results must be kept in perspective. Research at the
Walter Reed Army Institute of Research in Silver Spring, Md.,
found that neither modafinil nor the military pilots' go pills
were any better than several cups of coffee at restoring the attention
and performance of sleep-deprived people.
If the effects are that mild, what are ethicists so worried about?
Almost everything. "As our society becomes more competitive
and specialized," says Chatterjee, "even the perception
that these medicines provide a slight advantage can drive demand."
If new and more effective drugs have few immediately discernible
side effects, patients will probably pressure doctors to prescribe
them. And as their usage spreads, people may feel forced to take
them just to keep up. Would the means to pay for them determine
who gets them? Would the rich get smarter and the poor fall further
behind? What effects would such drugs have on the personality
and mental health of users in the long run? The tendency to forget
some things, for example, may be a big part of emotional stability
and efficient problem solving.
Those issues don't seem to bother the Americans who pop pills
and snap up supplements touted as brain enhancers. The latter
are often a waste of money. Studies examining the cognitive benefits
of supplements have either proved inconclusive or shown only modest
effects. There's some evidence that the popular herb ginkgo biloba
boosts cerebral blood flow and improves mental functioning, particularly
when taken with ginseng. But there's also evidence that it doesn't.
Some of the most popular brain supplements, including deanol,
are stimulants, but they have not been shown to improve cognition.
"Americans like to have the five-Starbucks-triple-latte effect,"
says complementary-medicine guru Dharma Singh Khalsa, who sells
his own line of "brain longevity" supplements. He recommends
a regimen of antioxidants like vitamins E and C and co-enzyme
Q10 to keep the brain healthy. Beyond that, one of his favorite
nootropic formulations is a combination of ginkgo, phosphatidylserine
(a molecule essential to the health of neural-cell membranes)
and omega-3 fats (found in fish oils). But Khalsa emphasizes that
nine-tenths of the mental boost people seek can be had by eating
well, staying mentally and physically active and keeping stress
at bay.
And if that doesn't help, you can always try a cup of joe.
SCHOOLYARD DRUGS Adderall and Ritalin, two drugs widely used
to treat attention-deficit disorders, can focus healthy minds
as well. These potentially addictive stimulants are increasingly
abused by students and professionals—so much so that the
U.S. government now considers them "drugs of concern"
Provigil, otherwise known as modafinil, was approved to help
narcoleptics and shift workers stay awake. Lately it has joined
the ranks of Ritalin as a popular performance aid. Some recent
studies suggest it may indeed boost attention and mental acuity.
If you haven't already heard the term nootrope, better jot it
down. Chances are you'll hear it a lot in the future. A marriage
of the Greek words noos, for "mind," and tropein, for
"toward," it refers to drugs that enhance mental performance—popularly
known as smart drugs. Nootropes aren't new. Amphetamines, first
synthesized by a German chemist in 1887 and used in over-the-counter
inhalers by the 1920s, were doled out generously during World
War II to Allied and German troops to keep them alert. Military
pilots still take dextroamphetamine, or go pills, to stay in fighting
form on long missions. But in the post-Viagra era, many neurologists
believe—and ethicists fear—that scientific advances
and social changes may have set the stage for a new age of cosmetic
nootropy.
NEW BRAIN BOOSTERS Some drugs for treating Alzheimer's disease
increase the levels of the neurotransmitter acetylcholine, which
plays a key role in attention and memory. One of the drugs, donepezil,
was shown in a study of helicopter pilots to enhance mental performance.
These drugs, however, are not widely abused
MEANWHILE, IN HEALTH STORES... ...the shelves are filled with
herbs and supplements advertised as brain boosters. Few, if any,
clinical trials have assessed their efficacy, but here's what
we know about some of the more popular ingredients in these concoctions
Some studies suggest ginkgo biloba, especially in combination
with panax ginseng, can boost mental performance
Found in plants like the common snowdrop, galantamine is approved
by the FDA as the Alzheimer's drug Razadyne. It's marketed to
healthy people as a memory enhancer, but no reliable studies support
the claim
Derived from a chemical found in the periwinkle, vinpocetine
increases blood circulation in the brain. Will taking it make
you smarter or more attentive? No one really knows
Derived from the Chinese club moss, huperzine A works like donepezil
and galantamine. But there is no evidence it helps young, healthy
brains work better
Many swear by the memory-boosting power of phosphatidylserine,
and studies suggest it may aid those with age-related problems
Bacopa monniera, or brahmi, has not yet been proved to make anyone
any smarter
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Ampakines
Therapeutic Uses