January 30, 2016, by tvu

Smart drug research – an interview by Instituto Humanitas Unisinos On-line Magazine (IHU)

Dr Ahmed Dahir Mohamed, School of Psychology, was interviewed by a Brazilian magazine called IHU on his smart drug research. He is a registered chartered psychologist in the United Kingdom and an associate fellow of the British Psychological Society. He is currently a post-doctoral fellow and adjunct lecturer in Psychology (Cognitive and Affective Developmental Neuroscience) at the School of Psychology in the University of Nottingham Malaysia Campus. Details of the interview can be found here. The details of the interview (as translated from Portuguese) are as follows:

What are smart drugs? There are no such things called “Smart Drugs” because they do not exist. What people have been calling “smart drugs” have been drugs that are medically regulated to treat clinical problems such as Narcolepsy, Attention Deficit Hyperactive Disorder (ADHD) and so on. When people use these medically regulated drugs for other purposes such as by trying to stay awake longer or trying to party longer, the media and the uninformed public as well as researchers, who have an agenda, have labelled these medically regulated drugs as “smart drugs”. An example of this is the drug called Modafinil. This is a drug that I have done extensive research on. It is a medically regulated drug and it is licensed for the treatment of Narcolepsy. A lot of people think it is a smart drug because they reason that if it is making the person with narcolepsy awake, it will help me keep alert and focused as a healthy person. They then label this drug and others like them “Smart drugs” but they are actually not “smart drugs”, they are just controlled medications that have existed for a long time. These medications might help people with clinical problems which is a smart thing that they are intended to do but they do not do “smart” things for or to the healthy person. So to answer your questions, I do not know what “Smart drugs” are within the context of you are asking me to describe it such as enhancing cognition in healthy people, simply because they do not exist.

What kind of research has been done on this topic? Research have been carried out to investigate whether medical substances that are licensed for clinical disorders can in fact improve or enhance cognition and emotion in healthy individuals. This research is done as double blind placebo controlled trials. However, most of this research, if not all of it, is done as a single dose trial so participants take an active substance once and then the researchers evaluate their performances on a range of tasks. It is important to know that the research findings-when evaluated objectively-show that these drugs do not enhance cognition and emotion in healthy individuals. The research also shows that the studies that are conducted are underpowered. This means that the studies themselves are not big enough to generate results that are meaningful in the real world and that the results cannot be relied on. Even when you look at these studies, the results are not promising. These drugs do not help healthy individuals, let alone make them “smart”. These findings are hardly surprising because these drugs are made for clinical disorders, not for the healthy individual who want to get “smart”.

According to this research, what are the medicines that are most used as smart drugs? Among healthy individuals, most popular drugs that people report to be taking include methylphenidate (Ritalin) and dextroamphetamine (or Adderall), which are both controlled medications licensed for the treatment of ADHD, and Modafinil (or Provigil), which is also a controlled medication licensed for narcolepsy.

What makes people use smart drugs? Well, first of all, the problem is that people are using the word “smart drugs” in the media and in the literature. As a Journalist, you know that language is important so we have to be careful in using the wrong words to describe a phenomenon. As I said previously, “Smart drugs” do not exist. What exists are controlled medical substances that are regulated and are licensed for particular clinical and/or medical problems.

To answer your question as to why [healthy] people take them is that they want to get an edge-this means that they want to perform better at a certain task. For instance, there is a strong evidence to suggest that healthy young people who are not performing well in high school or at university take these drugs because they think taking these drugs will make them perform better academically. Others are taking these medications because they want to party longer and they feel that they will get a boost in energy. There are all sorts of reasons why people take these drugs but when you look at the evidence, it is not the case that they are taking these drugs because they want to be “smart” or “get smarter”. It has been the case throughout history that sections of the population take drugs recreationally and this has not changed. Society and human nature has not suddenly changed so that people are thinking that they will get smarter by “popping pills”. It is highly likely that people are taking these medications to get “high”. This is the evidence that is currently available from US surveys. The evidence that healthy people who are performing well already want to take these drugs to get “smarter” is just not there.

What are the actual effects of drugs against narcolepsy, such as Modafinil? Modafinil is a controlled medical drug that is licensed for the treatment of narcolepsy but how it works in the brain and the body is not very clear. Several studies indicate that modafinil increases several neurotransmitters in the brain including dopamine, noradrenaline, Serotonin, and glutamate in several regions of the brain, including the prefrontal cortex, hippocampus, hypothalamus, and striatum. These are large areas in the brain that are associated with a lot of functions including increased attention and vigilance, reward, pleasure  and other several complex actions. It is likely that this drug is improving some deficits in the narcoleptic patients by improving some brain functions that are already not functioning well in these patients. We currently do not know how it affects the healthy person.

Can we say that the “advantages” that Modafinil users ascribe to the drug are placebo effects? Perhaps, though I am not certain about that. What I know from my research is that modafinil is another form of a psychostimulant and that because it increases dopamine-which is a reward producing neurotransmitter-modafinil  might be having a psychostimulant effect and might feel rewarding for healthy individuals to take even though it is not actually making them better in performing objective laboratory tasks. This is what we have shown in our research studies.

What is the chemical-cerebral functioning of this kind of medicine? As I said, several studies indicate that these drugs increase several neurotransmitters in the brain including dopamine, noradrenaline, Serotonin, and glutamate in several regions of the brain. There is evidence that these drugs also have an effect on the body and as there is always a body and mind connection, it is unclear how these drugs have an effect on the body.

What kinds of side effects can be attributed to the use of this kind of drug? Experimental studies have reported that modafinil, for example, may cause serious side-effects that include a rash and allergic reactions. These side-effects include dry mouth, appetite restriction, gastro-intestinal disturbances, including nausea, diarrhoea, constipation, and dyspepsia, abdominal pain; tachycardia, vasodilatation, chest pain, palpitation; headache including migraine, anxiety, sleep disturbances, dizziness, drowsiness, depression, confusion, paraesthesia, asthenia, visual disturbances, Stevens-Johnson syndrome, and toxic epidermal necrolysis.

Contraindications of these drugs include heart problems and hepatic impairments. Additionally, if one is taking other medications there might be drug–drug interactions, which could be dangerous in some cases. It is important to note that Ritalin, for instance, has been associated with stunted growth and impotence in males. Please refer to the British National Formulary and the leaflets provided by the manufacturers. They will tell you what these potential side effects are.

To what extent can medicines such as Ritalin, directed at the various kinds of attention deficit, also be considered smart drugs? I already answered your question. These drugs are medical substances, they are not in my opinion “smart drugs”. They are controlled medical drugs that can only be accessed through a medical doctor who has the authority to prescribe them.

Is it the people or the hegemonic model of society that ultimately needs medicines? I am not sure if I understand your question but if you are asking whether it is the individual or society that is driving this new phenomena, then I would say that it more to do with both. There is also considerable potential for indirect coercion resulting from a highly demanding ‘24/7 society’ where healthy individuals feel compelled to take these medications in order to meet social or workplace demands. For instance, we are working longer hours. We have children to raise and we want to get a lot of things done. Therefore, healthy individuals may resort to self-medication for inadequate sleep or overexertion at work. For example, 33% of respondents of a recent poll by the prestigious science journal Nature indicated that they would feel pressure to give medications to their children if other children at school were taking them. There might still be social pressures to use medical drugs, particularly in young people. A recent survey that was conducted in the USA revealed that US college students are more likely to take medications if such drugs were effective, and were framed as non-threatening to their individuality; they would take them if it would make them more competitive and would give them an advantage. Therefore, this raises the ethical issue that arises from the use of medications because of indirect social pressure from society that demands us to constantly perform well at all tasks in all areas of our lives. However, the individual still has the choice to participate or not to participate in this culture.

Is there anything you would like to add? At the University of Cambridge, we conducted several adequately powered, and effect-sized randomised placebo controlled clinical trials to investigate the effects of modafinil on executive functions, working memory, creativity and motivation in healthy ‘normal’ individuals. Our findings from these trials suggest that modafinil does not enhance cognition in this cohort but it makes them respond slower to tasks that measure executive functions [i.e. planning and problem-solving tasks] and motivational reinforcement learning. Furthermore, taking modafinil seems reduces creativity or thinking outside the box in healthy people who are normally creative while boosting creativity in those who are less creative. Taken together, our results suggest that modafinil might benefit people who have cognitive deficits but it might impair complex psychological functioning in those who are already able. Since these findings are from a single dose modafinil trials, as a psychostimulant medication, the addictive potential of modafinil in healthy people are unknown and need to be thoroughly investigated.

It is important to note that we used some of the most sophisticated and challenging cognitive and creativity tasks available in neuroscience. Our results show that, these tasks, which are highly valid and reliable, have not been boosted by modafinil administration in healthy “normal” individuals. In fact, our results show the opposite; that modafinil is impairing cognition and creativity in normal young healthy adults. It is also important to note that modafinil is being used as substitute medication for patients with cocaine addiction, because the drug activates similar brain areas as cocaine and has similar properties to cocaine. Therefore, healthy individuals need to be careful and consider their safety before taking it. Given this and on top of our negative results, I would not recommend this medication to healthy people and I would not label it as a “smart drug”.

 

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