Pills for the mind (2)
What would you like to eat to get smarter? Part IIDenis Yatsutko, XXII CENTURY
Let's continue our conversation about "smart pills". Let me remind you that in the first part we talked about the so-called racetams, as well as about B vitamins and substances close to them (pyritinol, inositol). Today we will consider some more medications that can (or supposedly can) improve what is commonly called cognitive functions: memory, attention, mental performance, and so on.
To begin with, however, I would like to make a small digression and speculate, what do we expect from drugs claiming to be called nootropics? Above, we seem to have already answered this question: improving cognitive functions. Moreover, when it comes to, in fact, nootropics, it means improving the cognitive functions of a healthy body. But can any of us be sure that we are healthy? Perhaps I won't lie if I say that the situation with smart pills is somewhat similar to the situation with geroprotectors: just as every drug that stops or slows down degenerative processes of one kind or another in any organ or tissue and thereby slows down the onset of old age and, possibly, delays death, is to some extent a geroprotector, so every drug that improves well-being and already, by virtue of this, facilitates the thought process, is to some extent a geroprotector.that is, a nootropic. And in obvious cases of fever or hypertensive crisis, the cognitive functions of a person experiencing these symptoms may well be improved by banal aspirin or kapoten. If your teeth or knees hurt, the pain will undoubtedly interfere with focusing on solving the problem, and then ketanov or diclofenac will claim to be assistants to your cognitive abilities.
But the human body is a delicate thing. It's not always so obvious. And even if nothing hurts, there is no cough, fever and other obvious symptoms, but the memory is slightly failing, there is not enough will to make bold decisions, or just even fresh interesting ideas began to come not as often as before, it can still mean that you are unwell. Physically unwell, of course. Because there is no other way: a person is physiology, everything that was once considered the movements of the soul is actually the movement of dopamine, serotonin, norepinephrine, testosterone, oxytocin, and so on. You are a very complex system. And that's why the "smart pill", which remarkably helps to increase the level of attention, the ability to memorize and generally improve the work of the mind of one person, may not help you. Because there is something wrong in your body specifically. Something else. And as a "smart pill" you may need a medicine that usually does not appear as such. So, do not be surprised, but before continuing the conversation about the actual "smart pills", we will mention several drugs and groups of drugs of a different kind.
Metformin If you read about metformin, listen to the reviews of those who take it, it seems that this drug is just a damn miracle, it does so many wonderful things.
It was discovered back in 1922, when it was noticed that it could reduce sugar in rabbits. Opened – and forgot. Then they came back to him in the 1940s, in the 1950s, in the 1970s, confirmed that he remarkably lowers blood sugar levels, including in humans, and also knows many other techniques: works as an antiviral, in some cases as an antipyretic, recently it turned out that he can it helps in the treatment of fatty hepatosis and influenza, facilitates the course of polycystic ovary syndrome and even slows down the process of normal aging. The latter is still being tested, but the fact that metformin reduces sugar and reduces the number of low–density lipoproteins ("bad cholesterol") in the blood has long been known facts. Nevertheless, this drug (trade names: "Formetin", "Gliformin", "Glucophage", "Siofor", etc.) has received really wide application only in recent years. But what a wide one! You will be surprised, but psychiatrists prescribe metformin to their patients, perhaps, only a little less often than endocrinologists, gastroenterologists and nutritionists. Testimony? Decreased mental activity, memory impairment, rapid fatigue (including during mental work, yes). One caveat: all this is in overweight and obese patients. Why? Because excess body weight, and excess not due to heroic muscles, but due to fat, is, in general, a prediabetic condition, a decrease in glucose tolerance, this is, of course, excess cholesterol and low testosterone. And hence the decline in cognitive abilities.
By reducing glucose levels and "bad cholesterol", metformin will relieve fatigue, as well as stabilize weight or even push it down. As a result, this should lead to a significant improvement in the state of mind. At the same time, you should feel some improvement almost immediately.
A simple logic works here: people with obesity, prediabetes and type II diabetes almost inevitably have some cognitive deficits (this, unfortunately, is a scientific fact, so many employers do not want to hire fat people), as well as mood disorders (depression, apathetic syndrome, etc.). Improving their metabolic functions with the help of metformin, it should also lead to an improvement in cognitive functions.
Of course, I would like it not to be limited to just logic, that is, that it should be confirmed by scientific research. Unfortunately, the authors of the post–review of studies of the effect of metformin on mental functions and mood disorders published in the journal CNS & Neurological Disorders – Drug Targets from 1990 to 2014 write that "clinical data are ambiguous" - cognitive abilities often improve as a result of the use of metformin, however, the heterogeneity of the conditions under which the studies were conducted does not make it possible to state with absolute certainty: it always works. However, the authors also did not label metformin as an unsuitable agent for the treatment of cognitive disorders, noting that research should be continued.
Unfortunately, metformin has contraindications. With impaired kidney and liver functions, with chronic alcoholism, with regular heavy physical exertion, it can not be taken because of the risk of lactic acidosis (lactic acid coma). This is a very dangerous condition with the highest percentage of mortality.
So, if you are going to take metformin, consult your doctor.
I will add from myself that it is also not worth being too afraid. I know many people who have been taking this drug for years, not to say that they were all completely healthy, but lactic acidosis has not happened to any of them yet. A nutritionist at a very respected scientific and medical institution once told me: "We have all patients with various liver disorders. We prescribe metformin to many people. There have been no cases of lactic acidosis yet."
But still, do not take risks on your own. Or at least understand that there is a risk.
Antidepressants Thousands of them.
Or maybe hundreds. Different. But why are we talking about them at all? Because the English spleen and the Russian melancholy, that is, in modern terms, depression, has a chemical-physiological nature. Most often, the reason lies in the same biogenic amines-neurotransmitters, which we have already mentioned here above: dopamine, serotonin, norepinephrine, melatonin and the like.
You may not realize that you are depressed. Because in the culture there is an idea that depression is when everything is gloomy, when hopelessness and hands themselves reach for hemp rope and soap. And you just feel distracted, you're bored, you can't finish a simple job, or, having finished it, you don't feel joy and don't see any motives to take on a new one, you think that just the work is uninteresting and everything will get better if you find a more timely and lively task (but, as luck would have it, it turns up to hand one thing is completely disgusting). And you just need to take a walk in the fresh air, pull yourself together and force your brain to concentrate. And this is exactly what depression can be. And a vicious circle: you are trying to make a poorly functioning brain work better with the help of that very poorly functioning brain.
The way out in this situation is seen as external assistance that certain medications can provide to the brain. And here it may be a mistake to start taking some antidepressant (or racetam: as I wrote in the first part, many of them may have an antidepressant effect), do not feel any effect, immediately become disappointed in all antidepressants in a crowd and give up trying. And although in a state of depression, this approach will suggest itself – it is wrong.
The fact is that it is not always possible to find the right antidepressant for this particular person right away. For example, if fluoxetine (known as "Prozac") helped someone, it does not mean that it will help you.
The problem lies in the heterogeneous etiology of depression. Therefore, the selection of a suitable antidepressant occurs as follows.
First you need to determine what kind of depression you have. Traditionally, they are divided by "target symptoms" into two main types: the first is characterized by apathy and inhibition, the second by anxiety and agitation (although there is a complete set of all this). Based on this, prescribe drugs that either have a psychostimulating effect or sedative. Plus, your additional indications are taken into account, for example, headaches, heart and vascular diseases, alcoholism. Based on this, the first antidepressant is prescribed (well, or chosen by you yourself, if you are a Google guru and are inclined to experiment on yourself). Most often in practice it is some kind of selective serotonin reuptake inhibitor.
This complex classification name means that drugs of this type prevent the reuptake of the neurotransmitter serotonin by its secreting neurons and thus increase its amount in the synaptic cleft. This improves the transmission of nerve impulses from neuron to neuron and, thus, relieves depression, improves mood and actually – what we are interested in – adjusts cognitive functions well.
A classic among serotonin reuptake inhibitors is fluoxetine (prozac). The most fashionable and effective: sertalin, mirtazapine, escitalopram (cipralex) and venlafaxine (velaxine, efevelone). They are not fashionable from scratch: in 2009, a meta-analysis was conducted (published in the Lancet journal) of one hundred and seventeen randomized placebo-controlled trials of twelve new-generation antidepressants, which recognized the above four as the best.
But neither the classics nor the fashion based on good science in such a delicate matter guarantee results. Therefore, after two or three weeks of taking it, if there is no result or if the result is negative (that is, if it has become even worse, as well as if undesirable side effects have been detected), you may change the dosage, you may be prescribed an additional drug or offered another, possibly with a different mechanism of action. This time it may be a norepinephrine reuptake inhibitor. For example, atomoxetine (strattera) or venlafaxine (it was already mentioned above because it is a double-acting antidepressant: it blocks the reuptake of both serotonin and norepinephrine).
It is assumed that in the end "your" antidepressant will be found and the symptoms that prevent your mind from working to the fullest will be eliminated.
An important point: most antidepressants do not work on healthy people. That is, if you do not have clinical depression, if there are enough neurotransmitters in your synaptic slits, no prozac and others like it will improve neither your mood, nor the joy of mental work, nor memory. And if you are sick, it is better not to experiment, but still contact the doctors: they were specially taught, they, at least, can save you time and money and warn you against taking what you do not need.
The older we are, the more experience and knowledge we have, the smarter we seem to be.
So, a study was recently conducted (the results were published in November of this year in CNS & Neurological Disorders – Drug Targets), during which 44 elderly male patients were divided into two groups, one received testosterone for 24 weeks, and then, after a four-week break, for the same time, that is another 24 weeks - placebo, the other – on the contrary – first placebo, 4 weeks break, then testosterone. In the first group, a significant improvement in cognitive abilities was observed during testosterone treatment, which persisted during the placebo period. The second group showed no improvement during placebo and during the break, but showed improvements during testosterone treatment.
By the way, in the West it is generally fashionable to take testosterone now, starting from about 40 years old (the other day we published a large translated article about this fashion).
We are accustomed to perceive testosterone as something related primarily to libido and muscle mass, but if you are over forty or fifty years old and your testosterone is at the lower limit of the norm or even lower (it is easy to determine this by donating blood for an appropriate analysis in any commercial laboratory), it is safe to say that the drugs testosterone can improve your memory, your attention, and your state of mind in general.
But testosterone is not a panacea either.
Firstly, taking testosterone medications can cause unpleasant side effects. So, external testosterone suppresses the production of its own. And, if you are not going, like some of the heroes of the above article, to take it all your life, then in order to restore the production of your own hormone, you will have to take injections of chorionic gonadotropin (well, yes, hormone therapy in general is not an easy thing).
Secondly, the result of taking testosterone may be an increase in the prostate gland.
Finally, thirdly, an overdose of testosterone can cause gynecomastia, that is, breast enlargement in men of the female type. The latter is due to the fact that among the metabolic products of testosterone preparations in the body there are estrogens, female hormones.
So, if you are suddenly going to clear your brains with testosterone, contact an endocrinologist first. At least because since 2014, almost all testosterone preparations have been included in a special list of quantitative accounting and they will not be sold to you in a pharmacy just like that. I need a recipe. And to get a prescription, you need a doctor. Who, by the way, may, after examining you, decide that you do not need testosterone at all. For example, if you have depression, there will most likely be no improvement in cognitive abilities from testosterone: everything will result in irritability and aggression. And if there is significant obesity, there will be nothing at all: adipose tissue has the property of "absorbing" testosterone. Therefore, with depression and/or obesity, it may make sense to start with the same antidepressants or metformin.
Choline and nicotine Among other receptors of our nervous system, the so-called cholinergic or acetylcholine receptors are distinguished (we already mentioned them in the first part of the article in connection with pramiracetam).
They are so called because they are excited by the substance acetylcholine. Their functions are diverse: they are partly responsible for memory, partly control smooth muscles, are related to emotions and thinking. Their main neurotransmitter, acetylcholine, is a substance of very short–term action, is formed directly in the body from choline and is rapidly destroyed with the participation of acetylcholinesterase with the formation of choline and acetic acid.
Preparations of acetylcholine and acetylcholine chloride directly are used in clinical studies and in complex operations (for example, on the lens and retina of the eye), but its predecessor choline is produced as a dietary supplement and is presented by sellers as an indispensable substance, useful, among other things, for improving memory. At the same time, I failed to find any serious recommendations for taking choline by healthy people in order to improve memory. Yes, with its lack, deterioration of nervous activity is apparently inevitable, but it is present in sufficient quantities in ordinary everyday foods, so it hardly makes sense to take it also as an additive.
In fairness, I will mention a study that showed that the use of choline as a dietary supplement showed some cognitive improvements in children of alcoholics born with various kinds of brain disorders.
In principle, the additive is on sale. If there is a desire, no one bothers to try.
And here we come to an interesting point: among the cholinergic receptors there are those that, in addition to acetylcholine, react to nicotine. That's why they are called nicotine. By acting on nicotine acetylcholine receptors, nicotine leads to the release of adrenaline and norepinephrine, briefly improves neurotransmission and quickens the heartbeat. That is, when someone says that he needs to smoke in order to concentrate better, these are not empty words, it can actually work.
But here, too, there are several problems, and very significant ones. So, the most traditional way of nicotine consumption – smoking – is extremely harmful: there is not so much nicotine in tobacco smoke as a variety of resins and other substances that greatly harm the lungs. It has long been proven that tobacco smoking is the most common cause of lung cancer.
Today, of course, there are electronic cigarettes (vaporizers) that allow nicotine to be delivered to the body without harmful gorenje products, but, firstly, liquids for them may also contain dangerous substances (see http://22century.ru/med-n-health/20227 ), and, secondly, nicotine itself is also not quite white and fluffy: in high doses (which, however, it is difficult to get when smoking tobacco or "vaping" vaporizer), it blocks nicotine acetylcholine receptors, which can lead to severe poisoning, but most importantly, it is addictive, reducing the body's response to other positive stimuli (see the article "Smokers' Paradise Lost" about this). At the same time, its short-term effect on cognitive functions is not always the same: it can be an improvement in concentration, increased activity, but to the same extent relaxation or apathy.
A separate danger is the consumption of nicotine in childhood and adolescence, when there is a formation and reorganization of brain structures necessary in the future for mature cognitive activity, emotional regulation and motivated behavior. Physiologists (for example, the authors of a study published in August in The Journal of Physiology) believe that the effect of nicotine on acetylcholine receptors during this period can cause adverse neurochemical changes in the brain, form a habit of a special kind of external encouragement of the physiological reward system and, in particular, create a reserve for future abuse of other psychoactive substances.
To summarize: nicotine may or may not work as a short-term quasi-psychotropic, but its use carries certain risks, most of which have been studied and are serious.
GABA On some sites that recommend nootropics, you may come across, among other tips, a desire to use a medicine called "Aminalon", GABA or GABA as a "smart pill".
Under all these names appear preparations of gamma-aminobutyric acid. It is one of the important endogenous neurotransmitters of our central nervous system, but this neurotransmitter is inhibitory. The Internet is full of claims that GABA drugs positively regulate the process of glucose utilization by the brain, improve memory, and so on. But on serious medical resources, it is mentioned mainly as a cure for epilepsy and ADHD, less often for schizophrenia, even less often for depression. Its main action, after all, is retarding. It is not recommended to take it when it is necessary to carry out any kind of active activity. In addition, it penetrates the blood-brain barrier very poorly and requires sufficiently long courses of application for any effect. I think I will not be mistaken if I say that all this is not what we expect from a smart tablet.
Cortexin and cerebrolysinDon't eat it! And don't prick. Or whatever it is proposed to do with it. Don't do anything. Cortexin is an extract from the brains of cows and pigs. It was developed at the St. Petersburg Institute of Bioregulation and Gerontology of the Russian Academy of Medical Sciences. And is called a polypeptide regulator with biological activity and a nootropic. It is assumed that peptides from animal brains that have got into the blood should somehow help our brain recover and even restore DNA.
Cerebrolysin is about the same, only cortexin is a new invention, and cerebrolysin has been pulled from pig brains since the 1970s.
Everything that manufacturers write about them is not confirmed by any decent research. It seems like studies have shown that they are safe, but no more.
I heard about cortexin from a nurse serving a regional administration. "Everyone in our government is stabbing him." Well, let them prick, the government is not sorry. And you don't prick. All articles about cortexin are exclusively in Russian, that is, the international medical community is not interested in it. Neither cortexin nor cerebrolysin are registered by the FDA. Even the exact chemical composition of these hoods is practically impossible to determine. A post–review of the studies conducted on these drugs indicates that cerebrolysin seems to be effective for dementia (but when you and I have dementia, we will no longer decide what to inject, but for now I would not), as for cortexin - there is solid bad science, unsubstantiated statements, a small sample etc .
In general, if you are not a member of any government, it is better to avoid.
Ginkgo biloba, rhodiola rosea and clitoris troichata ya
We talked about meat products, now about herbs.
Another big fashion of the last decades is preparations of the ginkgo tree (ginkgo biloba, ginkgo biloba, tanakan). It is also recommended everywhere as a "smart medicine". I will not list the arguments of those who are in favor, simply because in 2001 there was the first systematic review that questioned these arguments, and an updated and supplemented review published in 2007 in Human Psychopharmacology: Clinical & Experimental put an end to this issue: "Ginkgo biloba is not a smart drug". Fifteen randomized studies have shown the absence of a reliable positive effect of the preparations of this tree on the cognitive activity of healthy people. In general, we cross out.
Rhodiola rosea extract is also often presented as a cure for everything and for everything, including for the mind. It is even prescribed by doctors – to improve cognitive functions, fatigue, to reduce drug addiction, for the devil and from the devil. There is an interesting substance in the composition of rhodiola – salidroside. It is being actively researched, and it seems to be really useful for something. For example, it inhibits the growth of breast cancer cells. In any case, this is supported by some experiments on animal models. But as for cognitive functions, the rhodiola effect is not confirmed by studies. Tests on eighty "mildly anxious" volunteers showed a decrease in anxiety, stress, even self-esteem, as well as an overall improvement in mood. In the results of cognitive tests, there were no significant differences between the group taking rhodiola and the control group taking nothing. That is, rhodiola is not exactly crossed out, but if the root of your cognitive problems is not anxiety, stress or overestimated self-esteem, it probably won't help you.
The clitoris is threefold – it seems to be another matter. At least until the skeptical analysts have buried it. Of course, all the Ayurvedic nonsense around this plant can scare away, but, as we know, sometimes something worthwhile also comes from ancient medical traditions (for example, artemisinin, a drug for malaria). It is possible to hope (and try): a study on rats showed that the extract of the clitoris actually has an antiamnetic effect on them. Moreover, it is even clear how exactly – by increasing the content of acetylcholine in the brain. In addition, it contains flavonols and anthocyanins, which researchers pin their hopes on in terms of their various useful medical uses (see also about anthocyanins – "Cherry juice against gout").
Mexidol and succinic acid Sometimes orotic acid is mentioned in the same row, the nootropic function of which consists mainly in the fact that it participates in the synthesis of cyanocobalamin (vitamin B₁₂; see about it in the first part of the article) and in the utilization of glucose.
However, as with most vitamins and vitamin-like substances (previously it was called vitamin B₁₃), the absolute majority of people are fine with it and do not need to take it additionally: firstly, it is enough in food, and secondly, it is synthesized by the microbiota of our intestines.
With succinic acid and, especially, mexidol, the situation is interesting. The first, as you know, is part of various kinds of "anti-pokhmelins", and in its pure form is sold at the pharmacy for mere pennies. It is also included in the composition of various soft drinks, including those whose advertising slogans urge to "collect yourself" – with a hangover, lack of sleep, with a cold, etc. At the same time, correct me if I'm wrong, but it seems that the world scientific community is not particularly interested in this compound. That is, it is known that it participates in the cycle of energy metabolism of almost all organisms, in the processes of cellular respiration, but its supposedly nootropic functions are often mentioned only in Russian. With mexidol, which is ethylmethylhydroxypyridine succinate, that is, a compound related to succinic acid, everything is very similar – there are very few publications, only under Russian surnames, and there are a lot of doubts that this drug is related to evidence-based medicine.
Personally, I've tried both. Succinic acid, according to my feelings, invigorates, and mexidol, as it seemed to me, improves both attention and efficiency in mental work. But I admit that it was autosuggestion: none of the friends to whom I recommended mexidol appreciated it, every single one says that they did not feel anything at all. And one doctor I respected, when I asked him about this drug, waved his hands in general and asked "not to mention this nonsense in front of him anymore." When I noticed that I felt more cheerful and collected after mexidol than usual, I replied that I would certainly feel the same way after, for example, a glass of tomato pickle. Well, I won't even argue here: tomato pickle is really invigorating, and even tasty at the same time.
In short, I do not have reliable scientific data on the use of these drugs as "smart pills", and I will not dare to recommend them based on subjective experience.
In any case, succinic acid is safe and is used in the food industry around the world as an acidity regulator.
Glycine It is also called aminoacetic acid.
The simplest amino acid involved in many processes of the body, including, for example, in the synthesis of creatine. It is believed to have a "mild sedative effect". In any case, the rats seem to be "less scared of him when they get into an unfamiliar environment." The nootropic effect of glycine is extremely weak, and as a "smart pill" it is most often prescribed in combination with something else (in the first part we mentioned a study according to which glycine supposedly enhances the effect of nefiracetam, which itself is not very clear to doctors yet). Glycine in general is often prescribed "in addition" to something else. If you have a nervous tic, it may be prescribed in addition to phenazepam. If hypertension – to captopril. And most likely you will not feel the difference when taking the main drug with or without glycine. So, if you need to restore sleep, you can try to drink glycine at night, but if you need a "pill for the mind", that is, something that mobilizes thought processes, glycine is clearly not for you.
By the way, despite the above, science has a constant interest in glycine: it is tested in a variety of situations and sometimes gets interesting results. So, a recent article in Nature tells about a study in which the addition of glycine for 10 days to the culture medium of a 97-year-old fibroblast cell line contributed to the restoration of cellular respiration in them. So, perhaps glycine has some, if not nootropic, then geroprotective potential, and if the doctor advises you to drink it to something in the load - do not neglect the advice.
Creatine Suddenly, Karl. Yes, creatine (2-methylguanidino-ethanoic acid) is widely known among bodybuilders and other gym regulars.
It is used to increase muscle mass, muscle quality and short-term anaerobic endurance. And, it would seem, where are the rocking chairs, and where are the cognitive functions? Oh, it turned out that it was quite close. In 2003, a double-blind placebo-controlled study of the effect of oral creatine supplements on 45 adult young vegetarian volunteers was conducted. The result was unequivocal – creatine significantly improves both memory and intelligence. At least – with vegetarians (that's the devil knows, to be honest, why they were tested only on them).
So if you're a vegetarian, creatine from a regular sports nutrition store can help you get smarter. If not, it is unclear.
Here is a champion. And a celebrity.
In fact, everyone has known about modafinil for a long time. Students have been eating it for years during sessions (according to surveys, every fourth British student accepts it), information about it has been hanging on transhumanist websites since time immemorial. In English–speaking countries, he became known as the "corporate pill" - because of the fashion for him among young careerists who try to sleep as little as possible and work as efficiently as possible. But he became the hero of thousands of publications in August of this year – after the publication in the journal European Neuropsychopatology of a systematic review of 24 studies conducted by scientists at the University of Oxford and Harvard Medical School – Ruairidh McLennan Battleday and Anna-Katharine Brem. The review showed that modafinil really improves cognitive functions, especially when solving long complex tasks, it also improves memory, attention, positive manifestations of planning and decision-making skills and creative activity. At the same time, according to the researchers, it does not have any special negative cognitive, emotional and physical side effects on the body. Unless, of course, it is considered a side effect of what this drug was originally developed for: being conceived and implemented as a drug for narcolepsy for US Air Force pilots, it deprives sleep for a long time.
However, for most of those who need a "smart pill", this is only to their advantage: the Internet is full of stories of young people bragging about how they, having taken a modafinil tablet, did not sleep day and night preparing for exams, then passed the exam perfectly, then solved some issues with documents, showing miracles resourcefulness, and after another day they lit up on some holiday, gathering the attention of the whole company. And all this without a minute of sleep.
Professor Guy Goodwin, president of the European College of Neuropsychopharmacology (ECNP), comments on the results of the inspiring review: "This is the first real example of a "smart drug" that can really help, for example, with exam preparation."
To summarize: the drug for narcolepsy, which has been used for a long time as a nootropic, so to speak, "on a voluntary basis", received a "start in life" from scientists. Now humanity has an "official" smart pill. However, its insomniac effect, combined with the knowledge of the growing fashion for it among the "corporates", makes us recall the futuristic dystopian comic book Power Nap, in which people do not sleep at all and constantly work. Those who, for one reason or another, cannot take pills to ensure such a lifestyle are viewed as inferior creatures. Just look at it, and we'll come to it.
But, we'll wait and see. Modafinil does not yet allow you to do completely without sleep. Tests on pilots of helicopters and F-117 attack aircraft have shown that it is absolutely effective in performing tasks of varying degrees of complexity with short-term sleep deprivation (37-40 hours). A study of 88-hour sleep deprivation in conditions close to combat showed that a dose of 400 mg (standard pharmacy doses of 100 and 200 mg) helps to keep pilots on alert all this time, but it turns out to be insufficient to fully compensate for the negative effects of lack of sleep. That is, not sleeping with modafinil can be easier and longer than without it, but not constantly. And after a long labor feat "on pills", you still have to sleep.
Unfortunately, in the Russian Federation, since May 18, 2012, modafinil has for some reason been included in the List of narcotic drugs and psychotropic substances, the turnover of which is limited on the territory of our country and in respect of which control measures are being established, and now you can't just buy it in a pharmacy.
This, of course, is not a comprehensive review of drugs claiming to be "smart pills". So, the continuation, perhaps, should…
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