New Mothers and Smart Drugs

Smart Drugs

Kids are different today, I hear every mother say,

Mother needs something today to calm her down,

And though she’s not really ill, there’s a little yellow pill,

She goes running for the shelter of a mother’s little helper,

And it helps her on her way, gets her through her busy day….

So begins Mother’s Little Helper, a hit by the Rolling Stones. The song sored to the number 8 spot in the United States, soon after its release in 1966. Supposedly, the little yellow pill that the Stones had in mind was meprobamate, an old anti-anxiety drug, but today it’s mothers who are different. These days, the trend is not to be calmed, but stimulated.

Stimulated with medications that are reputed to enhance concentration, memory, and learning, or even to make you work faster.  I’m referring to nootropics, also known as “smart drugs”, which have been popular with Wall Street investors, Silicon Valley tech gurus, and very ambitious college students. Earlier this decade, news came out that a growing number of mothers could be added to the list of people addicted to stimulants that are prescribed for attention deficit disorder (ADHD) and narcolepsy (a condition in which a person frequently falls asleep with little warning).

Using stimulants merely to boost your concentration when you do not have ADHD is not considered harmful when the stimulant is coffee, where the drug at center stage is caffeine. A cup of typical brew coffee contains about 100 milligrams of caffeine (an espresso shot contains less), while dosage of the largest, most caffeine-packed drinks at Starbucks comes out just under 500 mg. Consuming this much caffeine in a drink can give you side-effects, like nervousness and jitters, and could keep you awake all night when you want to sleep, but it does not qualify as what doctors call toxicity. Other sources of caffeine, however, can be extremely dangerous, even deadly, as we’ll see below, but let’s focus on prescription medications for now.

There has been a surge in adults, including high-paced mothers, seeking, and receiving, diagnoses for ADHD, and subsequently prescriptions for ADHD medication. This is partly because awareness of the condition has increased while the requirements (features and symptoms) for the diagnosis as an adult are easier as compared with children. But there are also a good number of people who just want the medications, and often they’ll dish out advice to others on how to do that. On a simple Internet search, for instance, you can find advise on how to “convince your shrink that you have ADHD” and thus “fool the system” into supplying you with amphetamine/dextroamphetamine (Adderall) or methylphenidate (Ritalin).

Well-studied stimulants amount to one category of nootropics, but there are people, known as “brain hackers”, who experiment regularly with different drugs and combinations of ingredients. There also are some drugs that are utilized more often as nootropics than for approved medical uses, because they haven’t panned out for the latter, but are available in pharmacies in certain countries, because they have been approved to treat certain conditions. One such drug is piracetam, which is approved in the United Kingdom as a treatment for certain seizure disorders. Unlike the ADHD drugs, piracetam is not a stimulant, yet it affects cognition, so it is a popular nootropic. A more expensive drug, a stimulant that has a standard medical use in narcolepsy, is modafinil. It is very trendy in Silicon Valley, because it is reputed to boost memory and learning and keeps you awake, yet has low addiction potential compared with the typical ADHD stimulants.

All of this is merely the tip of the iceberg as the list of nootropics is very long, and growing, but you may be wondering about something that isn’t always at center of the radar screen among business brain hackers, and that is safety. There is no problem with having a cup of coffee or two or three per day while you are pregnant or nursing. Although caffeine enters breast-milk from the mother’s blood, it does so only in very small amounts, so the current thinking about caffeine is that it is overly restricted among new mothers. They are avoiding coffee and tea unnecessarily.

When it comes to the strong, prescription stimulants and other nootropics, the recommendation is to avoid them while pregnant, except when they are necessary because of some legitimate medical need. If you’re a narcoleptic for instance, you may really need it, even when you are pregnant.

Drug guidelines also warn against using these drugs while lactating, so they say don’t take them if you are breast-feeding, or don’t breast-feed if you are taking them. The reason is that the safety to the baby is not certain, but not that the drugs are known to do harm. In many cases, a drug has been found to cross through the placenta from the mother to fetus in a laboratory animal study, but it’s not certain whether this happens in humans. And so, caution is recommended due to a lack of certainty that the drugs are safe during pregnancy and lactation, as opposed to something like smoking, where the danger to a fetus or a nursing infant is well-established.

That said, nootropics may not be all that good for you. We talked about side effects of caffeine, like nervousness –these can hit you after a few cups of coffee, or even one, if you are very sensitive– but people have been acquiring highly concentrated forms of caffeine, where the danger is much more serious. In particular, caffeine powder has been in the news the past couple of years, because it has killed people, sometimes very health-conscious people who purchase it online for nootropic use, and tragically misjudge the caffeine dose. Prescription stimulants like methylphenidate carry significant danger of abuse, because they are highly addictive. And so the benefit of taking them, if you do not really have ADHD or narcolepsy, is trumped by the risk. And yes, the risks of off-label use of piracetam, modafinil, and some others may be somewhat less, but there’s a huge amount of uncertainty, which also warrants caution.

David Warmflash
Dr. David Warmflash is a science communicator and physician with a research background in astrobiology and space medicine. He has completed research fellowships at NASA Johnson Space Center, the University of Pennsylvania, and Brandeis University. Since 2002, he has been collaborating with The Planetary Society on experiments helping us to understand the effects of deep space radiation on life forms, and since 2011 has worked nearly full time in medical writing and science journalism. His focus area includes the emergence of new biotechnologies and their impact on biomedicine, public health, and society.

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