Nootropics are a category of medications used by healthy individuals without any systemic conditions for cognitive enhancement. They are referred to as brain boosters because of their action on the CNS to improve or boost the already active brain for further development. The word ‘brain booster’ covers a broad spectrum of naturally occurring and synthetically derived medications. The Nootropic market is one of the fastest-growing global markets and is making many headlines because of its hype.
What do Statistics Say?
The need to enhance productivity for improved results has plummeted the sale of nootropics to sky-high numbers. The global nootropics market size was a staggering 2.17 billion dollars in 2018 and is expected to touch 4.94 billion dollars by 2025 with an annual growth rate of 12.5%. Students and professionals form a significant percentage of nootropic users, with the surge in the vegan population boosting the demand for plant-based nootropics compounds. Additionally, the multi-utility component of nootropics, including antidepressant, energy-boosting, and anxiolytic properties, further adds to their popularity enhancement. The Covid period proving fatal for many businesses has further enhanced the nootropic industry by increasing the number of users looking forward to managing mood and helping manage stress during hard times.
How Do Nootropics actually work?
There are multiple ways in which nootropics work on the human body to produce the desired results. Natural nootropics work by dilating the small arteries and veins of the brain, and this result in increased blood circulation with more nutrients and oxygen reaching the brain. Natural nootropics have also been proved to reduce inflammatory conditions and protect the brain from toxins and aging through their actions. Synthetic nootropics like Modafinil and Waklert work by increasing the neurotransmitter levels responsible for wakefulness and alertness. Additionally, they improve the central cholinergic system by upregulating the Amyloid Precursor Proteins to improve memory and cognitive functions.
Are they Really Effective?
In a study conducted to determine the effectiveness of nootropic medications with cholinergic activity in the treatment of cognitive deficiency, a systematic review was conducted of the data available about medications and cognitive function. Articles and abstracts with the keywords ‘cognitive function’ preceded by the name of the concerned drug were retrieved from the database. Only randomized monitored trials, reviews, and meta-analyses were taken into consideration. Out of 267 selected abstracts, 176 were considered relevant, out of which 26 articles met the criterion of adequacy and representativeness.
Seven of these articles were about Piracetam and cognitive function, out of which four were relevant to the discussion. Piracetam, a medication used for the treatment of dizziness and age-related cognitive impairment, was found to prevent cognitive dysfunction after surgery owing to the effects of general anesthesia.
One of the articles was about Oxiracetam which, when administered for 2-6 months in a population older than 65 years, showed improved cognitive parameters like the speed of reaction time and attentional matrices.
Two articles about Lecithin that were eligible for the inclusion criteria did not give any satisfactory outcome of the research.
Four articles were selected regarding the effects of Citicoline, a medication used in patients who have suffered a stroke. It was found that Citicoline, along with improving heart function, was even effective in brain injury cases. Citicoline was found to reduce the duration of hospitalization in these conditions by improving the recovery of neurological functions and level of consciousness.
Six papers were selected regarding Acetyl-L-Carnitine. The studies proved the role of medication in the development of cognitive functions in hepatic encephalopathy patients.
One article was about Choline Alfoscerate that, when used in around 1570 subjects with dementia, improved their clinical status with regard to memory and attention.
What was the Outcome of the Research?
This study proved that Nootropics could be used in people with impairments but by keeping in mind some underlying factors. The role of Piracetam in the improvement of cognition was established. But side-effects like insomnia, somnolence, and agitation were also recorded. Piracetam showed improvement in heart patients who had undergone surgery but was unable to produce satisfactory results in patients with open-heart surgery. Similarly, the protective effects of Piracetam were not observed in patients with Down’s syndrome with was reversed in cocaine addicts with a withdrawal syndrome. Oxiracetam failed to produce favorable results in Alzheimer’s patients despite its geriatric efficacy. Lecithin needed further studies to arrive at a definite conclusion. Citicoline produced the most favorable results of all to the extent of being suggested in the treatment of Parkinsonism dementia.
Safety issues Regarding Nootropics
There have been very few and unsatisfactory studies about the use of nootropics or brain boosters in healthy people. Long-term safety evidence of nootropics is also unavailable for nootropics. Physicians are required to prescribe nootropics only to people with impairments and not to healthy people. The growing use of nootropics in students is a matter of serious worry to health practitioners because of the risk of dependence, cardiovascular problems, and psychosis. A medication is declared safe for use on the basis of its FDA approval. The FDA conducts a series of research on any medications before deciding whether it is safe for use, i.e., whether the goods associated with the medication outweigh the complications. The FDA, as of now, has not approved any nootropic for use in healthy individuals. The risks of dependence, tolerance and cardiovascular problems associated with long-term use or misuse of the medications are the main reasons for this overall verdict. Ethics are another reason for their unpopularity.
In a number of countries, prescriptions are provided through a public-funded health care system. Using essential medications for off-label purposes on healthy individuals comes with the risk of depriving needy people of the required medications.
The good and the bad
The growing use of nootropics has brought both positive and negative impacts in its trial. The Care Quality Commissioner reported in 2015 that there had been an increase in the dispensing and use of Methylphenidate, a scheduled medication. Methylphenidate or Ritalin is a medication for ADHD; the good news was that there had been a supposed increase in the awareness about and diagnosis of ADHD. But the bad news was the possibility of its overuse and misuse owing to its purported Nootropic effects. A survey of around 2000 students in 2016 showed that every 1 out of 10 students had used nootropics to improve focus and productivity for study purposes. None of them had a prescription for these meds or had a definite idea about the dosage of these meds.
Unfortunately, the growing need for cognitive enhancement has led to a lot of illegal drugs being passed off in the market with fancy names labeled as ‘brain boosters. The use of these boosters or novel psychoactive substances has led to a sharp spike in their production and subsequent illegal marketing. In 2015, 100 new brands of brain boosters were introduced to the pharma market, with a total of 644 novel psychoactive substances reported by 102 countries the year after.
What is the actual problem?
A lot of these purported brain boosters have shady ingredients listed on their covers. Some of these brain boosters or psychoactive substances are designed to mimic the effects of classic drugs like heroin, cocaine, LSD and even Methamphetamine, a scheduled medication. But being synthetic derivatives or generic components, these medications evade the drug legislations required to set the safety parameters of use of them.
The use of brain boosters can be implemented for study purposes in students and for pulling all-nighters in university students and professionals requiring prolonged focus and attention. It can also be used by party goers, drug addicts and self-proclaimed psychonauts for pleasure and increased enjoyment. Of late, there has been an increase in the incidence of casualties following use of nootropics. A study in 1500 German primary school and university students proved that students with bad grades were more likely to use nootropics for increased performance. Even the natural nootropics like caffeine and ginseng, if used more than the safe limit, can lead to increased blood pressure and insomnia with gastric troubles and general feelings of agitation.
In a study conducted by Trinity College, nootropics like Provigil and Ritalin were said to improve the motivation of the students to perform academic tasks. There was also an increase in spatial working memory but no improvement in attention. In contrast, there was an obstruction in the performance of familiar tasks on medication use. The study also proved that the same amount of brain boosters work differently on different people. For some people, the same strength of Provigil may be enough to improve cognitive function, while in others; a stronger dose might be needed for the desired effects. The studies led to one common finding. The amount of research material available was not enough to reach a common verdict about the use of brain boosters for prolonged periods in healthy people.
Facts and proofs are the building blocks of every verdict and decision regarding scientific research. It has been proved that Nootropics are effective in a number of conditions like excessive sleep disorder, traumatic or surgical cognitive impairment, and any systemic condition-induced cognitive impairment. But their use in healthy individuals for prolonged periods is debatable. Media hype and false propaganda have led to a surge in their increase, resulting in illegal manufacturing and spurious production. The growing incidence of casualties pertaining to their misuse has further added to the problem. Further research is needed to understand their use in healthy individuals. The government needs to spread more awareness regarding them to better understand their usability among the public. A common parameter needs to be reached for deciding their dose in healthy individuals to avoid any risk or ensuing complication after using them.