Can drugs make us smarter?

20 November 2018

Interview with

Barbara Sahakian, Cambridge University

We all modify ourselves with drugs to some extent: caffeine gives us super shakes and wakefulness; alcohol makes us chatty and other people look more attractive; and anabolic steroids are used by some to bulk up. But they can also make us more intelligent. Chris Smith and Georgia Mills found out more from Cambridge University's Barbara Sahakian.

Barbara - So human enhancement is something that people have strived for for a long time in different forms, as you pointed out. But cognitive enhancement is something that's really quite topical now and seems to be on the increase. So people are taking smart drugs or cognitive enhancing drugs to do better at work, get into better universities, and just improve themselves.

Chris - What are the drugs in question?

Barbara - So two of the most common ones are Methylphenidate, also known as Ritalin, which of course is a common treatment for attention deficit hyperactivity disorder. That acts by boosting noradrenaline chemicals in the brain - noradrenaline and dopamine which kind of fine tune our cognition. Things such as attention, problem solving, planning, learning, and memory - all those sorts of different forms of cognition. And then there's also Modafinil, which seems to act similarly to increase our noradrenaline and dopamine in the brain, but also probably other chemicals through the balance of GABA and glutamate. So it acts on glutamate as well.

Chris - So as you say, we're tweaking brain neurochemistry to enable us to do certain things that we want to do a bit better. Therefore if we can improve the way our brains work at certain tasks, why hasn't nature done that for us?

Barbara - In a way, many times we wake up and we just feel great. We've got a good night's sleep and we get down to work and we feel energized. Our motivation is good - maybe we're doing a task we're really looking forward to. And so we're kind of then at what we might call our optimal level of performance. But many times, of course, we’re suffering from jetlag - I know you got back from Australia recently. Some people have small children who wake them up in the middle of the night. So we're travelling around the world; and a lot of people are also under stress which impairs your cognitive performance. So even as a healthy person you can often be performing lower then you should. But these drugs will actually improve performance, including people who, for instance, are Cambridge undergraduates. So you can get improved performance in people who are not sleep deprived and who are actually of very high intelligence.

Chris - All the things you've described are symptoms of an overbusy lifestyle, a burning-the-candle-at-both-ends approach to life. Are we not just giving ourselves another crutch to lean on?

Barbara - I couldn’t agree with you more. I mean, we really have to think of this as a society where we will all be pill poppers in the future just so that we can get in a bit more work, stay awake and alert for longer, and be competitive with somebody else who's working alongside us - and so forth. I mean, there are really great ways, such as exercise, to enhance your cognition. That really boosts your cognition - it improves your mood and it's very good for your physical health. So really we should be doing things like taking exercise, maybe doing a lifelong learning course, or something else interesting like that.

Chris - What I’m uneasy about is that we may find ourselves in a situation with almost a two tier society, where you've got people who are chemically enhanced and they'll turn up for their exams at university having pulled all nighters for three weeks beforehand and they'll be at the top of their game - because they're popping pills, quite legitimately. Whereas someone who takes the same approach to exams that the athletics and doping association take to sport, which is that you should not chemically dope your body and were going to ban you if you do, those people who turn up with a clean sheet - they haven't done any of this sort of thing. You're going to perform less well, not because they're less able, but they've got fewer drugs on board.

Barbara - Well that's a really good point. I mean sometimes when I’m lecturing to students about these issues students will come up afterwards and say, you know, I don’t want to take these drugs but I feel pressure put upon me. The sort of coercion to take these drugs, because I can see other people passing them around in the library and I feel I’ll be at a disadvantage if I don’t take them. And we know that even a small 10 percent improvement in a memory score could lead to a higher A level, or greater degree class. So we have to think about it very carefully.

Georgia - It sounds like these drugs can have quite a big impact on how well someone does, but where might it go in future with with scientific improvements? Like the films Limitless and Lucy, I think they pop one pill and become super Einsteins straightaway. Will that ever be possible do you think?

Barbara - Well already the effects are what we call mild to moderate, so a moderate effect is really very good for a healthy person to get up to that level of improvement - sometimes a 10 to 40 percent improvement. So that’s really very good for these drugs that we already have, like Ritalin Methylphenidate and Modafinill. But other people are looking at sort of enhancing creativity, and they are looking at micro-dosing with LSD. This is going on in Silicon Valley and places and that’s another drug that’s affecting the brain in different ways as well. So there are new experiments going on but unfortunately not with pharmaceutical companies - they’re not developing too many of these new cognitive enhancing drugs. Which is a shame because really my research has to do with trying to improve cognition for people with psychiatric disorders, and Alzheimer’s disease, and brain injury.

Georgia - And thinking of jobs - like being a pilot, being a doctor. Do you think, in the future, it would just be like a matter of course for these people to just take something that makes them more efficient at their jobs?

Barbara - Well we first need the long term safety and efficacy studies in healthy people, because we don’t have those. But if a drug is shown to be safe and effective for a healthy person to take it may be better than caffeine. So I did a study with Lord Ara Darzi at Imperial College, and he wanted to look at sleep deprived doctors because a lot of his doctors have to operate at night. They take a lot of coffee to get the caffeine - we heard about caffeine as a booster. But the trouble is then they get a hand tremors because that’s a very common side effect of caffeine. So Modafinil may be a better cognitive enhancing drug, and awake-alerting agent for doctors to use - but we really need those studies first. I’m really quite concerned about some of the very young people, you know people under 24-25 years of age, who are using these drugs because we know our brains are still in development then. So it’s one thing to use these drugs as an adult where your brain is fully developed, but if you’ve still got this essentially adolescent brain which is in development, what are the effects of putting a drug into a healthy normal developing brain?

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