As many young adults begin to think about their return to college and the need to get studying again, the topic of medications to improve performance will likely return to the radar screen for students and healthcare professionals alike. Over recent years, there has been a well-documented increase in the use of stimulant medications, such as methylphenidate (Ritalin) or mixed salts amphetamines (Adderall), that are used to treat Attention Deficit Hyperactivity Disorder (ADHD), among college students who don’t meet criteria for the diagnosis.
While some of this use may be described as more “recreational,” a sizable number of people take these medications not to get high but to improve their studying stamina and effectiveness. People who take these medications can certainly feel more alert and on top of their game, but there is some doubt about whether or not these agents actually improve neurocognitive performance for people who do not struggle with ADHD in the first place (there is better evidence that it helps some cognitive parameters for people with ADHD). After all, antidepressants are not happy pills for non-depressed individuals. Moreover, when it comes to stimulants, there is some possibility that these medications induce a kind of placebo effect in which people perceive that they are thinking more efficiently without actually doing so.
A small study recently attempted to look at both actual and perceived cognitive performance. A total of 13 healthy college students who did not meet the criteria for ADHD underwent a battery of neurocognitive tests during two different sessions, one after taking 30mg of Adderall and one after taking placebo. The differences between the two sessions were compared. The tests assessed things like working memory (using a test that is also included in many IQ assessments), language, executive functioning, reading proficiency, and, of course, attention. Subjects were also asked about whether or how well they thought they were doing and their emotional state.
The results overall were quite underwhelming when it came to actual performance. In most areas like language and reading recall, there was no difference between drug and placebo. Perhaps not surprisingly, some improvements related to Adderall were found on some of the measures of attention. However, one of the working memory tasks, in which subjects were asked to remember a sequence of numbers, showed better scores with placebo.
On an emotional level, subjects generally noticed when they were taking the Adderall and felt positively activated with peak effects around 90 minutes after administration. Somewhat unexpectedly, subjects generally didn’t believe that the medication had enhanced their cognitive performance, although the numbers suggest that people gave quite a range of responses on this question after subjects took Adderall.
Overall, then, the authors concluded that, for people without an ADHD diagnosis, taking Adderall might result in their subjectively feeling better but that this does not translate into globally improved cognitive performance. In some areas, stimulants may even degrade ability.
One interesting aspect of this study was that it received a fair amount of media attention despite it being published in a more obscure journal. The latter was likely due to its quite small sample size and high numbers of people who did not complete the testing sessions. The study also did not really replicate what many college students are actually doing when taking medications, namely studying for tests and writing papers. Nevertheless, this study adds to a growing literature that demonstrates that when it comes to “smart pills,” the hype doesn’t match the data.
Weyandt LL, White TL, et al. Neurocognitive, Autonomic, and Mood Effects of Adderall: A Pilot Study of Healthy College Students. Pharmacy 2018; 6(3):58