Neuro-enhancement

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Pharmacological neuro-enhancement is the intake of psychoactive substances of all kinds with the aim of increasing mental performance. Brain doping , a term that is often used as a synonym but not necessarily congruent, describes the improper use of substances that require a prescription or that are illegal.

Performance-enhancing substances

Illegal stimulants

These include amphetamines under the name Speed, Ecstasy, Crystal Meth.

Prescription Stimulants

Psychostimulants

Psychostimulants are amphetamines and amphetamine-like substances, for example methylphenidate (MPH). MPH is contained in the preparation Ritalin , which is used to treat attention deficit / hyperactivity disorder (ADD / ADHD). The basic substance amphetamine is also known as the drug speed .

MPH and amphetamines block presynaptic noradrenaline and dopamine transporters. The prevented re-uptake in the presynapse increases the monoaminergic neurotransmission . Amphetamines also stimulate the vesicular dopamine release, which leads to an increased concentration of dopamine in the synaptic gap and thus increases dopamine activity.

Modafinil

Modafinil is known as an extreme "wake-up" and is used to treat narcolepsy . Chronic shiftworker syndrome and sleep apnea may no longer be treated with Modafinil because of side effects (severe skin reactions and neuropsychiatric disorders). The action profile is not fully understood. It is assumed that dopamine and noradrenaline will be re-uptake into the presynapse and that GABA-ergic and glutamatergic neurotransmitter systems will be modulated. Because of these properties, the active ingredient was initially included in the Narcotics Act. However, the substance's potential for abuse is classified as low, which is why Modafinil was released from the Narcotics Act in 2008.

Prescription Non-Stimulants

Antidementia drugs

There are two subgroups of antidementia drugs : acetylcholinesterase inhibitors and NMDA antagonists such as memantine. Antidementia drugs are used to treat Alzheimer's dementia.

Acetylcholine esterase inhibitors prevent the breakdown of acetylcholine in the synaptic cleft and, through increased acetylcholine concentration, lead to better memory performance.

In addition to inhibiting acetylcholine esterase, galantamine also causes an allosteric modification of the nicotinic acetylcholine receptor . Rivastigmine also inhibits butyrylesterase . Memantine act as a partial antagonist on the glutamatergic NMDA receptor ( N -methyl- D -aspartate receptor).

Antidepressants

Above all, selective serotonin reuptake inhibitors are said to improve both mood and social functioning.

β-blockers

β-blockers have a calming effect as they block the β-adreno receptors. This prevents the adrenaline from having an effect.

Freely available stimulants

caffeine

Caffeine does not require a prescription and is therefore expressly attributed to neuro-enhancement and not doping. It is consumed every day by many in the form of the luxury product coffee and modulates the central nervous system in at least three ways:

  • The nucleotide phosphodiesterase is inhibited and thus an accumulation of cAMP is caused. The adrenaline effect triggered by cAMP lasts longer and the effect is potentiated.
  • Adenosine receptors are blocked mainly in the striatum. This antagonizes the vigilance reduction triggered by adenosine.
  • Intracellular calcium is mobilized.

Energy drinks

The effect of energy drinks is based on the effect of caffeine, which is also reinforced by taurine . Taurine leads to an improved utilization of glucose through an increased insulin level.

Over the counter non-stimulants

Lifestyle preparations

These include, for example, dextrose, vitamins, food supplements, trace elements, omega-3 fatty acids, phytosterols.

Ginkgo biloba

Ginkgo biloba is an over-the-counter product with substances from the Asian ginkgo tree. It mainly contains flavonoids and terpenoids . Antioxidants are said to counteract oxidative stress. In addition, anti-apoptotic properties supposedly lead to neuroprotection.

distribution

According to many media reports, but also relevant specialist publications, neuro-enhancement is widespread and / or increasing. However, this has often been identified and criticized as an error in recent years. Boris Quednow therefore spoke of a phantom debate, Jayne Lucke and colleagues of a neuro-enhancement bladder. Stephan Schleim described in detail that the dissemination theses are based on a wrong interpretation of studies by North American students and that this has also continued in the German media .

The meta-analysis by Steve Sussmann and colleagues has shown that instead of the frequently mentioned 16% or even 25% in the USA, 4% (annual prevalence) of older teenagers and young adults resort to pharmacological study aids. The more recent meta-analysis by Elizabeth Smith and Martha Farah discusses 14 studies on the prevalence, which vary on average between 0.3 and 35.3%. It is noticeable, however, that the larger, representative surveys of several thousand to ten thousand people without exception report a prevalence in the single-digit percentage range. Smaller, non-representative surveys, on the other hand, sometimes report numbers above ten percent. It should be noted, however, that some of the studies examined very different constructs: Most asked their participants about non-medical consumption of prescription stimulants, which included use as an appetite suppressant or party drug as well as use as a study aid in the sense of neuro-enhancement. A striking example of misunderstanding is the study of Babcock & Byrne in 2000: For this, only 283 students of colleges were asked whether they ever using amphetamine , cocaine or methylphenidate (the active ingredient in the drug Ritalin ) for recreational purposes (English . recreational use). For methylphenidate, 16.6% of those questioned answered in the affirmative. Nevertheless, this figure, which is neither representative nor refers to neuro-enhancement at all, was often quoted as evidence for the thesis of high or increasing prevalence.

Several studies from Germany agree that neuro-enhancement is not yet a mass phenomenon: According to the DAK health report 2009 with the focus on doping in the workplace, around one to two percent of those in work between the ages of 20 and 50 use in Germany potent active ingredients for increasing mental performance or improving mood without medical necessity. A study among university lecturers in Germany shows a similarly low prevalence. 0.9% of the respondents stated that they had already taken enhancers, but willingness to take them was significantly higher at over 10%. Another study among more than 6,000 people in employment in Germany also found that 10.45% of those questioned were willing to take income, while the lifetime prevalence was significantly lower at 2.96%. A study carried out in 2010, which is based on a random sample of students from several German universities, showed that 1.2% of the almost 5,000 respondents took prescription drugs to increase cognitive performance within 30 days without there being any medical need , about 2.3% reported such use within the last 6 months, 3.2% within the last year. The lifetime prevalence determined in this study is 4.6%. Of those who used such substances within the last 6 months, 39.4% said they had done it once, 24.2% twice, 12.1% three times and 24.2% more than three times. It could be shown that people who have already used Neuro-Enhancers in the past are much more willing to do so in the future. The non-representative study of schoolchildren in three German cities and students of medicine, pharmacy and business administration in Mainz by Andreas Franke and colleagues showed that 1.6% of the schoolchildren and 0.8% of the students used a prescription stimulant at least once in their life Used for neuro-enhancement purposes. For drugs illegal in Germany, the lifetime prevalence was 2.4% and 2.9%, respectively. In the KOLIBRI study by the Robert Koch Institute in 2010, people across Germany were asked about the consumption of performance-influencing agents in everyday life and leisure. Overall, 1.5% stated that they had used drugs or illegal substances for neuroenhancement once in the past 12 months. In 2012, HIS GmbH published the results of a representative survey of around 8,000 students in Germany on the prevalence and patterns of brain doping and drug abuse. Here, 5% indicated the consumption of prescription drugs, pain relievers, sedatives, psychostimulants or stimulants. However, almost half of them used these drugs only rarely, only 17% (or 0.9% of the total sample) did so regularly. However, this contradicts a new study by the University of Mainz, which asked 2569 students about their use of performance-enhancing drugs. Here, 20% of those questioned said that drugs or illegal drugs such as B. to take amphetamines or cocaine only for the purpose of increasing mental performance. The authors suspect that the direct questioning methods used in previous studies led to an underestimation of the prevalence figures, and recommend the introduction of preventive measures to counter drug abuse at universities. However, a large part of the high prevalence could also be traced back to the users of caffeine tablets.

It follows that, according to the best available study results, there is probably only a small group of students in North America and Germany who are already doing neuro-enhancement. Especially when it comes to regular consumption, the numbers are in the lower single-digit percentage range or even below 1%. Neuro-enhancement is neither a mass phenomenon nor is it new, because long before that, small groups of people had experimented with the possibilities of drugs and drugs to improve performance.

Substance-based reconsolidation and reprocessing

Psychoactive substances have an effect on human experience, creating an affective state of mind that corresponds to the perception of the presence or the accessibility of life resources. In many cases, the affective experience corresponds to a pretense of the respective state, but it is real for the individual and acts as a factor that serves to create new learning content.

Psychoactive substances act as a "motor" for many learning processes, since information is more easily learned, remembered or changed if it occurs in connection with an emotional stimulus (e.g. cocaine has a direct effect on dopaminergic signal transmission and is therefore in the Able to create strong associations very quickly). This knowledge of the stimulating properties of psychoactive substances on learning processes is helpful when it comes to understanding the use of these substances in the context of substance-based psychotherapy.

Also in the adult brain, especially in the hippocampus, new nerve cells grow again (neurogenesis), which is apparently necessary for the storage of new information. In this context, some psychoactive substances, such as B. psilocybin, ketamine and the SSRI antidepressants have a positive effect on hippocampal neurogenesis.

The fact that a substance slows down brain processes or changes them in any other way can also be advantageous. For example, in animal experiments, a single administration of MDMA before learning to fear extinction led to a significantly increased, permanent and even generalized decrease in conditioned fear reflexes. This is because MDMA has a certain functional toxicity, which causes slowing and impairment of working memory. Before the therapeutic use of psychoactive substances, however, the cellular organic toxicity of some of these substances is in the foreground when weighing the advantages and risks of their use.

However, the effectiveness of many psychoactive substances on elementary learning processes has still not been fully explored in animal models. Some substances have already been pharmacologically tested for their properties that show an effect on reconsolidation and reprocessing. Nevertheless, these pharmacological approaches as a whole, as promising as they may appear, are currently still far from clinical application.

Effectiveness and ethical discussion

It remains to be seen whether the mood or the mental performance of healthy people can be increased in the long term and without any major risk by taking (sometimes prescription) drugs or other substances. Dimitris Repantis and colleagues recently investigated this for both antidepressants and modafinil and methylphenidate . They found that there was insufficient evidence of positive emotional or performance-enhancing effects from taking either antidepressants or methylphenidate. They found modafinil to have a positive effect on alertness and counteract the effects of sleep deprivation. There is little evidence that amphetamines increase cognitive abilities, as many studies have not shown a significant effect.

Whether these users gain an unfair advantage and indirectly force other people to also take these preparations in order not to be left behind is the subject of ethical discussion . There is also a lot of debate as to whether the sometimes extreme side effects are in an acceptable relationship to the benefits of these substances. A study among students and lecturers shows that both side effects and expected benefits are relevant when it comes to taking decisions. Severe side effects discourage potential users from taking it, while an expected increase in performance increases willingness to take it. However, the moral evaluation (which also includes fairness evaluations) of such substances plays an essential role for ingestion. Moral concerns significantly reduce the willingness to take income. To raise the public awareness of the ethical discussion about neuro-enhancers, seven researchers have published a memorandum on neuro-enhancement. In this memorandum, the authors advocate an open and unbiased discussion. Even those who advocate neuro-enhancement do not claim that the products currently on the market are suitable for this purpose, but assume that effective enhancement products may be available in the future. The controversies surrounding human enhancement are less focused on existing enhancement technologies than on hypothetical future possibilities.

literature

Individual evidence

  1. ↑ Volker Faust : Mental Health 150: Neuroenhancement. Liebenau Foundation, Mensch - Medizin - Wirtschaft, Meckenbeuren-Liebenau, 2019. (Brain stimulation through drugs, prescription stimulants, dietary supplements).
  2. ↑ Volker Faust : Mental Health 150: Neuroenhancement. Liebenau Foundation, Mensch - Medizin - Wirtschaft, Meckenbeuren-Liebenau, 2019. (Brain stimulation through drugs, prescription stimulants, dietary supplements).
  3. ↑ see e.g. B. the meta-analysis: BJ Partridge, SK Bell, JC Lucke and others: Smart Drugs As 'Common As Coffee': Media Hype about Neuroenhancement. In: PLOS ONE . 6 (11), 2011, p. E28416, doi: 10.1371 / journal.pone.0028416 .
  4. ^ H. Greely, B. Sahakian, J. Harris et al .: Towards responsible use of cognitive-enhancing drugs by the healthy. In: Nature . 456, 2008, pp. 702-705.
  5. ^ AD Mohamed, BJ Sahakian: The ethics of elective psychopharmacology. In: International Journal of Neuropsychopharmacology . 15, 2012, pp. 559-571.
  6. ↑ a b c J. C. Lucke, S. Bell, B. Partridge, W. Hall: Deflating the Neuroenhancement Bubble. In: American Journal of Bioethics - Neuroscience. 2 (4), 2011, pp. 38-43.
  7. ↑ a b c B. B. Quednow: Ethics of neuroenhancement: A phantom debate. In: BioSocieties. 5 (1), 2010, pp. 153-156.
  8. ↑ a b c S. Schleim: Cognitive Enhancement - Six Reasons Against. In: H. Fink, R. Rosenzweig (Ed.): Artificial senses, doped brain. 2010, pp. 179-208.
  9. ^ S. Schleim : Second thoughts on the prevalence of enhancement. In: BioSocieties. 5 (4), 2010, pp. 484-485.
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  11. ↑ a b M. E. Smith, MJ Farah: Are Prescription Stimulants 'Smart Pills'? The Epidemiology and Cognitive Neuroscience of Prescription Stimulant Use by Normal Healthy Individuals. In: Psychological Bulletin. 137 (5), 2011, pp. 717-741.
  12. ^ Q. Babcock, T. Byrne: Student perceptions of methylphenidate abuse at a public liberal arts college. In: Journal of American College Health. 49 (3), 2000, pp. 143-145.
  13. ↑ DAK Health Report 2009. P. 60; see also the DAK press release ( Memento from June 16, 2013 in the Internet Archive )
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  19. ↑ R. Schilling, J. Hoebel, S. Müters, C. Lange: Pharmakologisches Neuroenhancement . Ed. Robert Koch Institute Berlin , In: GBE compact. (3) 3, 2012. rki.de
  20. ↑ HISBUS survey on the distribution and patterns of brain doping and drug abuse: forms of stress compensation and performance enhancement among students
  21. ↑ P. Dietz, H. Striegel, AG Franke, K. Lieb, P. Simon, R. Ulrich: Randomized response estimates for the 12-month prevalence of cognitive-enhancing drug use in university students. In: Pharmacotherapy . 33 (1), 2013, pp. 44-50.
  22. ↑ a b Rougemont-Bücking, A. (2018). The role of psychoactive substances in learning and adaptation processes. In Handbook Psychoactive Substances (pp. 437–451). Springer, Berlin, Heidelberg.
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  28. ↑ Elaine A. More: The amphetamine debate: the use of Adderall, Ritalin and related drugs for behavior modification, neuroenhencement and anti-aging purposes. McFarland & Co., Jefferson, NC 2011, ISBN 978-0-7864-5873-8 .
  29. ↑ Federal Agency for Civic Education: Enhancement. In: bpb.de. Retrieved July 13, 2016 .
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