Nootropics: to drink or not to drink? Neurologist told “Search” about drugs “for the brain”

Everyone is probably familiar with the state when the brain “refuses to work”. Intellectual tasks are solved more difficult and longer, texts are not written, melodies are not composed. In such cases, it is customary to resort to the help of nootropics – drugs that are believed to improve brain function. These drugs are called neurometabolic stimulants, which means they should activate cognitive functions. I took a pill – I think it’s better. What more could you want?

But not everything is so simple. By “boosting” the brain, can’t we harm it? Poisk asked this and other questions to a neurologist, neuropsychologist, doctor of the highest category of the Semeynaya clinic network , Professor Irina Preobrazhenskaya.

– Irina Sergeevna, how do nootropic drugs work?

Nootropics do not improve cognitive function. They raise the level of attention for a short time and activate the person. This effect lasts as long as the patient takes the drug. But the main thing is that they do not contribute to the creation of new connections in the brain, thanks to which you can improve your cognitive functions. A pill from which you can grow wiser, mankind has not yet come up with.

Is  it possible to get addicted to these drugs? 
There is usually no addiction, but a “rollback” after taking it is quite common. The increase in activity and performance while taking nootropics drops sharply when the course of treatment ends. And the patient is forced to take drugs again and again in order to return himself to an active state. It is worth considering and deciding whether it is better to find the cause and treat the disease that led to cognitive impairment, or endlessly stimulate your brain, regardless of the consequences.

“So you shouldn’t take nootropics at all?”

– Not worth it. In Russian practice, doctors often prescribe nootropics for any reason – feeling unwell, decreased activity, increased mental stress, apathy, impaired cognitive functions, recovery after a stroke … This approach to treatment is fundamentally wrong and should be excluded from everyday clinical practice.

All the conditions listed above (decreased activity, etc.) can be symptoms of a variety of diseases. And the main thing in these cases should be the treatment of the disease that led to the onset of symptoms. Therefore, the correct approach is to make a diagnosis, to identify the causes of the development of the disease. They should be eliminated if possible or, if this is not possible, the clinical manifestations should be reduced. Or, if the disease is progressive, slow down its development.

Did the patient develop symptoms as a result of a stroke? We look for cardiovascular diseases and vascular risk factors that led to the disease – we treat them. We carry out physical, cognitive rehabilitation with the help of a physical therapist and a neuropsychologist. We connect a speech therapist, if necessary. Got depression? We select the dose of antidepressants and psychotherapy necessary for the person’s condition. Got Alzheimer’s disease? We treat it with recommended drugs, including monoclonal antibodies, NMDA receptor antagonists, and others. If the treatment is chosen correctly, I assure you that nootropics will not be needed.

Более того – эти препараты могут “смазать” клиническую картину заболеваний, для которых характерны когнитивные расстройства. А эти недуги, как правило, прогрессирующие: болезнь Альцгеймера, лобно-височная дегенерация, деменция с тельцами Леви (DLB). В этих случаях важно как можно раньше поставить диагноз и назначить лечение, замедляющее развитие заболевания. Это даст пациенту несколько дополнительных лет жизни без снижения когнитивных функций или с минимальной прогрессией.

– What to do if you need to activate, but it doesn’t work?  
If you want to increase your activity, normalize sleep, diet, add walks and rest. Start learning something new. And cognitive functions will improve without nootropics. After all, it is as a result of regular cognitive activity in combination with aerobic exercise that neuronal connections are formed in the brain. As long as you practice, the effect will last. This is not possible with nootropics.

– Does foreign medicine use these drugs?

In the West, drugs with unproven effectiveness are not prescribed. There are rather rigid standards for the treatment of diseases, created on the basis of the results of double-blind, randomized, placebo-controlled trials. These standards and clinical guidelines, which are compiled by experts in the field of treatment of certain diseases, are a guide to the doctor’s action. Just like in Russia, by the way. If you read the Russian clinical guidelines for the treatment of cognitive disorders, then nootropics will not be found there. It is precisely because the effectiveness of these drugs in clinical studies of the required level has not been proven.