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Brain Performance Drugs

By cortex on December 19, 2008.

Last week, Nature published an editorial arguing for the mainstream acceptance of "cognitive enhancing drugs":

Today, on university campuses around the world, students are striking deals to buy and sell prescription drugs such as Adderall and Ritalin -- not to get high, but to get higher grades, to provide an edge over their fellow students or to increase in some measurable way their capacity for learning. These transactions are crimes in the United States, punishable by prison.

Many people see such penalties as appropriate, and consider the use of such drugs to be cheating, unnatural or dangerous. Yet one survey estimated that almost 7% of students in US universities have used prescription stimulants in this way, and that on some campuses, up to 25% of students had used them in the past year. These students are early adopters of a trend that is likely to grow, and indications suggest that they're not alone.

While I agree, in general, with the stance of the editorial - "enhancement" shouldn't be a dirty word - I think there are two important qualifiers. The first is that every "enhancement" comes with unintended side-effects. The brain is a precisely equilibrated machine. In the case of the ADHD drugs cited in the editorial, the tradeoff might involve creativity. Some of my friends who relied on crushed Ritalin during college used to joke about how the drugs were great for late-night cramming sessions, but that they seemed to suppress any kind of originality. In other words, increased focus came at the expense of the imagination.

It makes perfect sense that such a cognitive trade-off would exist. Paying attention to a particular task - like writing a term paper, or cramming for an organic chemistry test - requires the brain to ignore all sorts of seemingly unrelated thoughts and stimuli bubbling up from below. (The unconscious brain is full of potential distractions.) However, the same thoughts that can be such annoying interruptions are also the engine of creativity, since they allow us to come up with new connections between previously unrelated ideas. (This might be why schizotypal subjects score higher on tests of creativity. They are less able to ignore those distracting thoughts, which largely arise from the right hemisphere.) Here's what I wrote in my New Yorker article on the anatomy of the insight moment:

While it's commonly assumed that the best way to solve a difficult problem is to focus, minimize distractions, and pay attention only to the relevant details, this clenched state of mind may inhibit the sort of creative connections that lead to sudden breakthroughs. We suppress the very type of brain activity that we should be encouraging. Jonathan Schooler has recently demonstrated that making people focus on the details of a visual scene, as opposed to the big picture, can significantly disrupt the insight process. "It doesn't take much to shift the brain into left-hemisphere mode," he said. "That's when you stop paying attention to those more holistic associations coming in from the right-hemisphere."

The second caveat is that modern neuroscience actually has a surprisingly mediocre record of coming up with effective drugs. Although we've learned an astonishing amount about how the brain works in recent decades, this basic research has rarely lead to therapeutic breakthroughs. Prozac, after all, was first invented as a treatment for high blood- pressure. (It worked in animals, but not humans.) And even though Prozac and other SSRI's are prescribed in dizzying numbers, we still don't know how they really work. (The over-simplified serotonin hypothesis has been largely discredited, as I explain here.) Or look at addiction, one of the most devastating mental illnesses. In recent decades, neuroscience has learned a tremendous amount about the substrate of addiction, with much of the work focusing on the dopamine reward pathway. And yet we're still giving people methadone, which was invented in 1937. Neuroscience knows a lot about the pathways of long-term memory, having identified plenty of pertinent kinase enzymes (CREB, PKC, etc.) and yet where are the memory enhancing drugs?

The pharmacological failures of neuroscience are entirely understandable. The brain is the most complicated machine in the universe, which means that it's very hard to fix, and even harder to enhance. Pop those pills at your own risk.

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It make sense that stimulants suppress that sort of associative creativity you are fond of writing about. The modern educational system, though, just doesn't seem to require or even value much of that creativity in the first place. The fact that creative insight is blocked by the drugs that legitimately do boost academic performance is a pretty good indication that academic performance isn't a measure of creativity. Getting into a good college these days requires a 4.0 GPA and dozens of "leadership" activities. The same is true of getting into a top grad school or med school. Perhaps the very best of the best can mix creative ability with the single-minded focus necessary to get there, but most don't. Pre-med especially seems to filter out anyone who would take the time to step back and wait for some insight. Which is too bad, because the world could use some more creative doctors.

Jonah, I think you've hit a really important point that some people are starting to formalize into testable theories. Sharon Thompson-Schill recently gave a talk that seems inspired by the same idea, and she made direct reference to the work of Farah and the other neuroethicists there at penn. The problem is that most evidence that directly supports this hypothesis is anecdotal, and I definitely get the feeling there's a mad rush to really prove it...

Jonah, I think you've hit a really important point that some people are starting to formalize into testable theories. Sharon Thompson-Schill recently gave a talk that seems inspired by the same idea, and she made direct reference to the work of Farah and the other neuroethicists there at penn. The problem is that most evidence that directly supports this hypothesis (that focus/control is counterproductive to some forms of learning) is almost exclusively anecdotal. Enough people are saying it's true - without data to support their claim - that there must be a mad rush to really prove it...

I dunno about the creativity thing. Amphetamines seem to have worked fine for Erdős. And Stephen King. And Bernard-Henri Lévy. And Jean-Paul Sartre. Probably for many others, too.

If we are seeing a trend towards using psychiatric medications as cognitive performance enhancers, then why spend lots of time making diagnoses of ADHD, depression, etc? Why don't doctors just give out the pills to anyone who wants them? Why not just have a farmer's market where the latest drugs are sold? As a clinical psychologist, this encouragement to make using psychiatric medications a mainstream activity is disturbing. If this trend takes hold, many human beings will forget what it is like to be in a natural state. If a large part of the population buys in to this medicalization of the human psyche,being "natural" without drugs will be taboo and frowned upon. This sounds like the making of a great movie. I hope that we reverse this trend and only use these powerful medications for the individuals who have significant struggles and need help maintaining a fairly normal life.

I'm a software developer who was diagnosed with ADHD at the age of 25 and the creativity observation is true to an extent. Most of my work related tasks fall under either design or implementation. Implementation involves mostly taking my models and translating them into code, which can be pretty boring (especially for someone with ADHD!).

The difference that being on Ritalin has made for me is that implementation tasks fly by. It used to be hard to focus solely on making it run while engineering concepts crept in and out of my thoughts. This is no longer a problem.

As far as the creative side, I've found that my ability to analyze thoughts as they pop up has been greatly enhanced. This has led to much quicker design and the ability to capture more thoughts. I don't feel that I'm any less creative, I'm just creative in a more organized way and this has really helped ideas come to fruition. After all, that's what's important, isn't it?

By Dan Abbamont (not verified) on 20 Dec 2008 #permalink

I used ephedrine through college. Now it's two pots of coffee. These have helped me with motivation more than focus per se. I'm a perfectionist/procrastinator so I need a starter.

I for one am prescribed a cocktail of 'enhancing' medications such as methylphenidate for enhancing my concentration and ability to function perfectly with less of a rest period, a small dose of an anti anxiety medication to keep me calm in a stressful and busy work environment,a low-ish dosage of an SSNRI and a moderate amount of pure caffeine.

I haven't experienced any negative side affects to my health or creativity, in fact, I have been enabled to do more in a well thought out manner then I would have been able to otherwise.

I, personally, don't think that cognitive enhancers are a moral issue or one of fairness. I'm not 'competing' with anyone, I just can do more then my natural state would have ever been able to do. I consider that a good thing, that benefits more then just myself.

- satat

One's own ability to focus and concentrate can be limited to genetics. In addition genetics can be a cause of death, i.e. cancer. Thus, drugs can stop cancer, drugs can also increase focus and concentration.

Are you suggesting it was the US that broke Iraq? That would imply the conditions before OIF were good. Let me see.dissenting cabinet members taken into the room adjacent to the meeting and shot in the head by the president; women kidnapped, raped and killed; children being shot and shoved into mass graves while still clutching their stuffed toys; oil revenues being spent on personal comfort of the president of the country and his family and loyal party members; the dissenting tribes being subjected to nerve agents; next door neighbor invaded when the Government is overthrownthe list goes on. I stand in awe of anyone who would equate that sort of leadership and environment as somehow better. Better than what? Hell? On the other hand, reading some blogs, there are some people (using their 1st Amendment rights to say) that this country is worse than that. Yep, call me maybe dumbfounded, not amazed. Sorry, I mis-spoke.