Nootropics (pronounced “NO-eh-TRO-piks”) encompass a variety of prescription drugs, nonprescription supplements, and other substances that are designed to improve cognitive performance in healthy individuals by targeting metabolic or nutritional aspects of brain function.1 By doing so, cognitive abilities, such as concentration, alertness, and memory, are greatly improved.

And who would deny wanting to experience all that in the face of a work deadline, final exam, or athletic contest? 

Indeed, many of Silicon Valley’s trailblazers are leading the charge toward these performance enhancers. For example, Ray Kurzweil, scientist, inventor, author, and Google’s director of engineering, who has been described as the “ultimate thinking machine,” is an open advocate for nootropics.2 

With overachievers such as Kurzweil on board, it is not surprising that many average Joes wonder what these drugs or supplements can do for them. The intrigue, however, is also leading to questions and concerns. Therefore, health care professionals need to be up to speed on the nootropics craze and understand the benefits and risks associated with these substances. Furthermore, health care professionals must determine how to best work with patients who come knocking on their door looking for that extra edge. 

Supple-mental

Nootropics promise to increase cognitive performance in three distinct ways, says James Giordano, PhD, professor in the departments of neurology and biochemistry, Georgetown University Medical Center, Washington, D.C.:
  • Increase attentiveness
  • Deepen and extend engagement in a task
  • Promote wakefulness

“So, if you put all those together, that’s a basic recipe for the possibility that there will be some improvement in certain types of cognitive performance,” says Dr. Giordano.

Many patients are prescribed nootropics to treat specific conditions, but some consumers seek to obtain prescriptions and use them off-label to enhance cognitive performance. While these drugs have been shown to improve, for example, working and episodic memory in patients who have been diagnosed with attention deficit disorder (ADD), their efficacy with the average consumer is less clear, according to Dr. Giordano. 

Also, nootropics are sold directly to healthy consumers as supplements designed to improve cognitive performance, rather than remedy a disease or condition. In fact, these products, according to Geoffrey Woo, cofounder and CEO at Nootrobox, a supplement company based in San Francisco, appeal to “the fundamental human instinct to want to improve oneself.” Nootrobox is one of a variety of companies that offers nootropic supplements. 

Another think comin’

With the self-improvement goal in mind, many companies in this space are taking a biohacking approach to product development. The idea is to take an engineering or computer science methodology to achieve constant improvement of human performance. 

 

“We take the approach that the human body is a system, just like a computer system, with a set of inputs and outputs. So the notion of biohacking is applying these engineering concepts to the human body to improve and optimize it,” explains Woo. 

Even though many supplement companies research, develop, and manufacture nootropics with state-of-the-art manufacturing techniques and use components the U.S. Food and Drug Administration (FDA) considers generally recognized as safe (GRAS), these dietary supplements are not required to meet the same safety and effectiveness requirements as FDA-approved drugs.3 

However, Woo points out that these supplements have been proven to bring about some intended benefits. For example, a study published in Biological Psychology4 showed that 90 minutes after ingestion of 250 milligrams of L-theanine (an amino acid shown to increase serotonin and dopamine levels2) and 150 milligrams of caffeine, participants showed a 9.3 percent increase in simple reaction time, a 13.9 percent increase in a sustained-attention task, and a 19.5 percent increase in self-reported alertness compared with a placebo.4 

Second thoughts

While such studies appear promising, health care professionals need to approach the nootropics trend with some caution. In the summer of 2016, the American Medical Association (AMA) adopted a policy discouraging the nonmedical use of prescription drugs for cognitive enhancement in healthy individuals.5 

 

Prescription drugs that are FDA-approved to treat attention deficit hyperactivity disorder (ADHD) or narcolepsy are commonly associated with off-label use by individuals looking to boost various aspects of cognition.5 Such use, however, often elicits patterns of substance misuse or leads to adverse conditions, such as the following6

  • Psychosis 
  • Paranoia 
  • Self-injurious behavior 
  • Agitation 
  • Hypomania
“As temptation grows to use prescription drugs for a competitive advantage at work and school, the nonmedical use of these drugs should be discouraged, given the potential for substance misuse and other adverse consequences,” says AMA member Maya A. Babu, MD. “The AMA believes physicians can support this goal by not prescribing any drug for the purpose of cognitive enhancement in otherwise healthy individuals.”5

 

The AMA has warned against the use of nootropic supplements as well. The AMA policy recognizes there is a gap in available information and calls for more research into the use of dietary supplements for cognitive enhancement.5

Brainteaser

Even though such concerns are valid, health care professionals cannot simply close the door on patients seeking to improve their cognitive performance. Indeed, health care providers will need to deal with healthy patients looking to obtain such prescriptions. For example, having heard of the positive effects of stimulants, many patients might be apt to describe symptoms in line with ADD or other cognitive impairments. 

In these situations, even if the care provider does not believe that the patient is presenting a true representation of symptoms, he or she should not necessarily just write off the request for a performance-enhancing drug, Dr. Giordano says. 

“The clinician could recognize that even if they don’t provide a prescription, one way or another some patients are going to go ahead and obtain a nootropic agent,” he notes and adds an opinion counter to the AMA’s stance: “So, the care provider might realize that it would be better to actually prescribe the medication in a low dose and continue to manage such patients. As a result, you could exercise a level of clinical control that is in the patients’ best interests.” 

In fact, if clinicians do not provide some type of nootropic prescription, they might be putting their patients in harm’s way. 

“A patient might turn to the gray or black market and obtain and use a controlled substance that could be harmful. Other patients might turn to the Internet and fall victim to a variety of scams,” says Dr. Giordano. “At least by keeping the patient under their care, clinicians can prevent them from falling between the cracks.”

In the final analysis, health care providers need to become more aware of the growing popularity of nootropics, as well as their benefits and risks. As such, they can then work with patients to lead them to make the best choices.