Smart drugs' (also known as 'nootropics ' and 'cognitive enhancers' [CEs]) are being used by healthy subjects (i.e. students and workers) typically to improve memory, attention, learning, executive functions and vigilance, hence the reference to a 'pharmaceutical cognitive doping behaviour'. Whilst the efficacy of known CEs in individuals with memory or learning deficits is well known, their effect on non-impaired brains is still to be fully assessed. This paper aims to provide an overview on the prevalence of use; putative neuroenhancement benefits and possible harms relating to the intake of the most popular CEs (e.g. amphetamine-type stimulants, methylphenidate, donepezil, selegiline, modafinil piracetam, benzodiazepine inverse agonists, and unifiram analogues) in healthy individuals. CEs are generally perceived by the users as effective, with related enthusiastic anecdotal reports. However, their efficacy in healthy individuals is uncertain and any reported improvement temporary. Conversely, since most CEs are stimulants, the related modulation of central noradrenaline, glutamate, and dopamine levels may lead to cardiovascular, neurological and psychopathological complications. Furthermore, CEs' use can be associated with paradoxical short-and long-term cognitive decline; decreased potential for plastic learning; and addictive behaviour. Finally, the non-medical use of any potent psychotropic raises serious ethical and legal issues, with nootropics having the potential to become a major public health concern. Further studies investigating CE-associated social, psychological, and biological outcomes are urgently needed to allow firm conclusions to be drawn on the appropriateness of CE use in healthy individuals.
Key points• Cognitive enhancers (CEs) are extensively and increasingly being used by healthy active subjects, with student use having been reported in the range of 1.3-33% across studies, with variations depending on country and definition of cognitive doping. However, their efficacy on non-impaired brains is uncertain and any reported improvement is temporary. • Conversely, since most CEs are stimulants, the modulation of central neurotransmitter pathways could lead to severe complications and can be associated with paradoxical short-and long-term cognitive decline; decreased potential for plastic learning; and addictive behaviour. • Finally, non-medical use of CEs raises serious ethical and legal issues, and CEs have the potential to become a major public health concern