The
drug modafinil was recently found to enhance cognition in healthy people.
Should you take it to get a raise?
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ArtFamily /
O.Bellini / Shutterstock / Zak Bickel / The Atlantic
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By Olga Khazan
If
you could take a pill that will make you better at your job, with few or no
negative consequences, would you do it?
In
a meta-analysis recently published in European
Neuropsychopharmacology, researchers from the University of Oxford and
Harvard Medical School concluded that a drug called modafinil, which is
typically used to treat sleep disorders, is a cognitive enhancer. Essentially,
it can help normal people think better.
Out
of all cognitive processes, modafinil was found to improve decision-making and
planning the most in the 24 studies the authors reviewed. Some of the studies
also showed gains in flexible thinking, combining information, or coping with
novelty. The drug didn’t seem to influence creativity either way.
“What
emerged was that the longer and the more complex the task, ... the more
consistently modafinil showed cognitive benefits,” said Anna-Katharine Brem, a
neuropsychologist at Oxford and one of the paper’s authors, in an email.
Surprisingly,
the authors found no safety concerns in the data, though they caution that most
of the studies were done in controlled environments and only looked at the
effects of a single dose.
Modafinil
is one of an arsenal of drugs, which includes Adderall, Ritalin, and Concerta,
that are increasingly used “off-label" by college students and adults
seeking greater productivity. Just 1.5 percent of adults aged 26 to 34 were
taking ADHD medications in 2008, but that number had almost doubled to 2.8
percent in 2013, as FiveThirtyEightpoints out. Though these drugs treat real medical conditions—ADHD, in
Adderall’s case; narcolepsy, in modafinil’s—many of the people who take them
don’t have those conditions.
Adderall
and modafinil are different chemically, but their effects on cognition are
similar, according to some psychiatrists. Adderall, or amphetamine, works by
boosting the brain’s levels of norepinephrine and dopamine, two chemicals that
are responsible for concentration and alertness.
Scientists
are less sure how modafinil works. One pathway is by stimulating the release of
histamine, which produces a sensation of wakefulness. (People with allergies
may be familiar with histamine because many allergy drugs are antihistamines.
Just as Benadryl dampens histamine and puts you to sleep, modafinil boosts it
and wakes you up.) But modafinil also works on other neurotransmitter systems
in the brain, and the resulting effect is one of allowing users to perform
complex cognitive tasks more effectively.
These
drugs can have negative health consequences, especially at large doses. The
number of ER visits associated with the non-medical use of stimulants among
young adults tripled between 2005 and 2011, according
to the Substance Abuse and Mental Health Services Administration. Some
research has shown
that the long-term use of modafinil can affect sleep patterns. In rare cases
and at high doses, stimulants like Adderall have been shown
to induce psychosis.
Still,
some psychiatrists say the health risks of cognitive enhancers are overstated.
Millions of adults take these drugs. Not all of them have ADHD or sleep
disorders. And yet, investment bankers and corporate lawyers aren’t dropping
dead at their desks.
Very
few adults “are going to have a horrible effect from using these medicines,”
James McGough, a clinical psychiatrist at UCLA, told me. “They're safe.”
The
side effects, he says, are no worse than having one too many
coffees—jitteriness and stomach aches. According to him, people taking Adderall
or modafinil at therapeutic doses don’t get addicted, in the sense that stopping
their use doesn’t cause a painful withdrawal.
Adderall
and modafinil are about equal when it comes to both their performance-enhancing
capacity and side effects, McGough told me. Ruairidh Battleday, one of the
authors of the modafinil paper, said the side effects and abuse potential of
amphetamine seem worse to him than those of modafinil.
The
paper hints at a coming debate over the ethics of smart drugs. Currently,
people require psychiatric diagnoses in order to be prescribed any of these
pills. But if these medicines are ultimately found to be safe, and they work
for almost everyone, should anyone be able to take them?
And
if modafinil does become more widespread, where does it end? Will we soon be
locked in a productivity arms race, pumping out late-night memos with one hand
while Googling for the latest smart-drug advancement with the other? Some
sports organizations, for what it’s worth,
already ban the use of these drugs without an ADHD diagnosis for the same
reasons they ban steroids and other performance enhancers. Will employer drug
tests soon screen for off-label modafinil use? Or on the contrary, will CEOs
welcome the rise of extra-sharp workers who never need sleep?
These
are not hypothetical questions. Between technological enhancers like holographic computers
and pharmacological ones like modafinil, more and more products are coming to
market that will give well-heeled, busy consumers the means to become even more
so. As Battleday says, “more agents for neuro-enhancement are undoubtedly on
their way.”
Little
is known about the long-term risks of pharmaceutical nootropics. What’s more,
cognitive enhancement falls beyond the scope of medicine. The FDA doesn’t
prioritize approving drugs for healthy people who want to become superheroes.
Similarly, doctors aren’t allowed to prescribe medication to people who aren’t
sick. “It's cheating, by our current standards,” McGough says.
But
if white-collar workers are pounding spreadsheets for 16 hours a day—as they reportedlyare at companies like Amazon—those standards are bound to be questioned
sooner rather than later.
Originally published in The Atlantic
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