Neuroenhancement - Blessing or Curse?

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Author: Vanessa Huebner Edited by: Chandan Seth

Have you ever had a cup of coffee sitting next to your computer while checking the newly released survey results of your company’s product or analysing the data from your last experiments? Do you take breaks when you are stuck with a tricky work problem that needs to be solved in time - and in these breaks, chat with your colleagues about your next vacation plans, eat a piece of chocolate or just quietly draw on your cigarette?

If the answer is ‘yes’ then there is science that can explain the ‘why’ behind it. These mechanisms to drive concentration, attention, vigilance and thus, the productivity at work, are commonly used among all age groups and all social classes. In fact, they are socially accepted ‘neuroenhancers’ - even though society does not actually calls them as such. When thinking of neuroenhancers, people have heavily coked investment bankers or overstrained college students in mind - not themselves or close ones. Now, how would you react if your colleague threw in a little white pill after lunch while explaining to you that it helps him to concentrate? Would you take one?

 

What are ‘neuroenhancers’?  

Neuroenhancers are means that aim to increase a person’s cognitive performance. In other words, they intend to boost attention, motivation, concentration, memory, vigilance, decision-making, mood and stress perception. In the wider sense, coffee, nicotine, small distracting breaks, healthy diet, sports, power naps and such activities fall under this definition. These agents and strategies are socially accepted, oftentimes not harmful (except for smoking). In the narrow sense, neuroenhancers are usually illegal or prescription psychoactive substances and brain stimulation techniques used by healthy individuals. To date, brain stimulation by transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS) or deep brain stimulation only play a subordinate role due to the lack of easy access, high costs and low handiness for individuals. However, several studies have shown that brain stimulation does induce changes in brain behaviour, suggesting a beneficial intervention in an individual’s cognition - especially in patients. The easier access, the lower costs and the handiness of illegal or prescription drugs explains their presumably increasing use by healthy individuals. Scientific studies and polls on the actual prevalence of these psychoactive drugs by healthy people vary heavily between 3-22%.

Psychoactive drugs are prescribed to patients diagnosed with Alzheimer’s disease, narcolepsy, brain injuries, attention deficit hyperactivity disorder (ADHD) and other neuropsychiatric disorders. The aim in these cases is to intervene in the disease-related brain functions to enable a normal, physiological brain metabolism.

Some of the neuroenhancement products are abused; prescription drugs such as  amphetamines (e.g. Adderall®) or amphetamine derivates, such as methylphenidate (e.g. Ritalin®), which are used in the treatment of patients with ADHD, fall into this group. These drugs interact with noradrenaline and dopamine transporters in neurons, increasing the release of these neurotransmitters and simultaneously inhibiting their re-uptake. These mechanisms lead to enhanced attention and vigilance as well as to euphoria and impulsivity in ADHD patients. At the same time, these drugs have off-target effects such as increased blood pressure and heart rate. It is noteworthy that the chronic use of amphetamines can lead to addiction, psychosis and hallucinations. In children, the long-term drug treatment can cause reduced growth rates and should always be monitored by medical experts.

Also, use of modafinil as a neuroenhancer by healthy individuals (e.g. Vigil® or Provigil®) is on the rise and is usually indicated for patients with narcolepsy. The stimulant presumably interacts with a number of neurotransmitter transporters (dopamine, noradrenaline, GABA, glutamate, serotonin, histamine and orexin), promoting wakefulness and activity in patients. In comparison to amphetamines, modafinil carries a lower risk of adverse effects and addiction. Consequently, it is tested as a less harmful alternative to the stimulants used in the treatment of various psychiatric and medical disorders.

Other prescription drugs, such as ß-blockers, acetylcholinesterase inhibitors and memantine - regularly used in the treatment of coronary heart disease and Alzheimer’s disease - are also misused for non-essential pharmacological neuroenhancement. Furthermore, some people enhance their cognition with the ‘classical’ drugs, such as cannabis, ecstasy, cocaine or LSD, or the so-called ‘new psychoactive substances’ (NPS). NPS cause the same ‘high’ feeling but often bypass narcotics laws due to their dissimilar chemical structure to the listed drugs.

 

What are the effects of prescription psychoactive drugs in healthy individuals?

Apart from the evidently severe health conditions individuals can have when taking illegal drugs and NPS, the long-term effects and adverse reactions of prescription psychoactive drugs in healthy individuals are often unknown. At the same time, the media hypes them enthusiastically as ‘smart pills’, exaggerating their actual effects while understating their potential risks. To be clear, ‘smart pills’ is a misleading euphemism: prescription psychoactive drugs do not make a person smarter, but can enhance parts of cognitive performance of a person to the optimum level.

As for methylphenidates, different meta-analyses of a wide range of study results found an enhanced spatial working memory but inconsistent effects on attention and higher cognitive functions, demonstrating the scientific uncertainty about the mechanism of action and effects of methylphenidates in healthy individuals.. These positive effects however are greater in children and can be accompanied by addiction. Modafinil improves attention in healthy individuals and is even more enhanced in sleep-deprived subjects by promoting wakefulness and working memory. Although modafinil is globally well-tolerated and shows rather little adverse effects, it leads to overconfidence in cognitive performance tasks. Nonetheless, it is intensely discussed as a safe and potent neuroenhancer.

In addition to the rather moderate effects of prescription psychoactive drugs in healthy individuals, accessing them without a medical indication is illegal. Therefore, people buy them anonymously over the internet, not knowing if the composition of these substances comply with the official regulatory standards for manufacture and storage. Furthermore, apart from side effects, self-medication of prescription drugs can always cause severe risks for one’s health due to contraindications and drug-drug-interactions.

But why do we feel the need to improve ourselves with neuroenhancing stimulants? Why are we okay with putting our health at risk with the gain of performing better at work or for coping better with stress? Why do we prefer these ways of pharmacological cognitive enhancement, to finding time-consuming but longer lasting strategies to achieve the same outcome? On the other hand, if there was a cognitive enhancer drug with no side effects, why should we not try to get the best out of our performance in order to achieve the best possible results from our work and the technological progress? Why should we hinder scientific advancement benefitting the human condition? With the avoidance of errors due to one’s tiredness or inattentiveness and with a longer time spent being concentrated at work to increase one’s productivity, an individual’s achievements, success and motivation would be reinforced. Further, with the effect of accelerating scientific findings and technological solutions for the benefit of a longer life expectancy and cures for presently incurable diseases, cognitive enhancer drugs have the potential to increase the quality of life for the individual and the society. However to date, pharmacological neuroenhancers with strong influence on cognitive performance and without side effects are not available.. Thus, this emphasises the need for studies on long-term usage, effects and risks of prescription drugs in healthy individuals. Let’s say it is much less harmful and more fun to come back to your coffee next to your computer, or to the little chat between your colleagues, or a yoga class after work than opting for illegal or unhealthy means.