Use of methylphenidate analogues as cognitive enhancers: the prelude to cosmetic neurology and an ethical issue

Drugs involved in the treatment of Alzheimer’s disease and other cognitive deficits such as attention deficit hyperactivity disorder (ADHD), strokes, schizophrenia, and aging are medically defined as cognitive enhancers (1). Amphetamines were the first drugs used to stimulate memory consolidation and improve concentration, and were followed by non-amphetaminic central nervous system (CNS) stimulants modafinil and armodafinil, which are largely prescribed for the treatment of narcolepsy and ADHD, although their mechanism of action is not entirely understood. Atomoxetine, a selective nor-adrenaline reuptake inhibitor, has been used in children with medication-resistant ADHD or undergoing side effects related to other drugs, while donepezil, a second-generation acetylcholinesterase inhibitor, has been employed for the treatment of mild-tomoderately-severe symptoms of Alzheimer-related dementia (2). Nevertheless, methylphenidate is undoubtedly the most prescribed cognitive enhancer. It is also the most misused. Indeed, the non-medical use of methylphenidate and cognitive enhancers in an attempt to improve memory, increase mental concentration, control anxiety, and stimulate motivation and creativity is a rising worldwide phenomenon (2, 3). Due to methylphenidate being a prescription drug with medical restrictions in several countries, many illegal analogues have emerged on the internet and darknet drug markets during the last few years (3). The misuse of cognitive enhancers in adults and young healthy individuals with the aim of increasing neurological functions is part of a phenomenon defined as “cosmetic neurology” (2). In addition, psychedelic microdosing using small doses of psychedelic substances, such as LSD and psilocybin is becoming more common (4). However, this cognitive enhancement comes with mental and ethical costs.