Brain medication being used to ‘gain an edge’ at school and work

Drugs typically used to treat Alzheimer’s disease and attention deficit hyperactivity disorder are being increasingly used by healthy people to gain a competitive edge at school, university and work.

Wed, 01 Apr, 2015 - 01:00

Catherine Shanahan

The claims are made by experts writing in The Lancet Psychiatry journal.

The growing “lifestyle use” of brain-enhancing drugs —such as methylphenidate (marketed as Ritalin, used to treat ADHD) and modafinil (marketed as Provigil, used to improve wakefulness in adults with sleep disorders) — is against a backdrop of very little being known about the long-term effects of non-medical use, according to the authors, neuroscientists Barbara Sahakian and Sharon Morein-Zamir from the University of Cambridge in the UK.

Most brain enhancers, such as modafinil and donepezil, have been developed by the pharmaceutical industry to treat the effects of impaired cognition in conditions such as Alzheimer’s disease, attention deficit hyperactivity disorder, and schizophrenia.

However the neuroscientists say a wide range of pharmaceutical substances — from psychotropic medications to nicotine and caffeine — are used by patients and healthy individuals to alter, improve, and enhance mental functioning.

According to HSE figures, more than 136,000 prescriptions for donepezil (to treat Alzheimer’s) were written in 2012 for medical card holders, while 2,213 prescriptions were written for methylphenidate under the Long-Term Illness Scheme, and 935 were written for modafinil.

Non-medical use raises a host of safety and ethical concerns including side effects and potential abuse, particularly from sourcing on the internet, the authors say.

“We also know next to nothing about their long-terms effects in healthy people,” Dr Morein-Zamir said.

The authors say evidence suggests that healthy individuals use cognitive-enhancing drugs to gain a competitive edge at school, university, or work, and for maintaining attention and performance when sleep derived or jet lagged. Research on student use in the US estimates usage at between 5% and 35%.

However the authors feel this may be the tip of the iceberg and is unlikely to be representative of usage in professional or older populations.

A German study (Andreas G Franke, 2013) looking at use of illicit and prescription drugs for cognitive or mood enhancement among surgeons found it was “an underestimated phenomenon among surgeons,” which is “generally attributable to high workload, perceived workload, and private stress”.

The authors believe that the use and number of cognitive-enhancing drugs is likely to grow substantially and they call on funders and policy-makers to prioritise research into the potential advantages and dangers of their use in healthy individuals with a view to setting out clear regulatory guidelines.

However, consultant psychiatrist Dr Siobhán Barry, clinical director at Cluain Mhuire mental health clinic in Dublin, said “getting healthy volunteers who would take cognitive enhancers for years and then agree to long-term follow up would be the challenge”.

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