Need to stay up all night to finish that presentation? Want to be able to focus your attention like a laser beam on those tax forms? Got the jitters about a big speech?

There’s a pill for that.

More and more people are reaching for prescription drugs, despite the potential side effects, to get an edge on the competition. In a society bent on getting ahead and determined to cram more activities into schedules that are already bursting at the seams, the caution of experts and ethicists about the wisdom of relying on these drugs is often ignored.

It’s no longer only college students popping stimulants like Ritalin and Adderall to push through exams. Adults in the corporate world, stressed-out parents trying to juggle overly demanding schedules and musicians preparing for auditions are all looking to pills to improve their performance. And the pills deliver.

“They are performance enhancers,” said Michael Manos, section head of Behavioral Medicine in the division of Pediatrics at the Cleveland Clinic. “The truth of the matter is that these medicines would help any of us.”

Drugs like Adderall and Ritalin, stimulants that have helped millions of people with attention deficit disorders, have been available for decades. One of the oldest of the class of drugs known as beta blockers, Inderal, is commonly prescribed as a cure for stage fright and to calm nerves before big presentations.

A newer drug like Provigil, which was approved by the FDA in 1998 to treat the sleep disorder narcolepsy, is commonly prescribed outside of its intended purpose to promote alertness.

And these drugs are only our first stabs at mental performance enhancers. Most weren’t even designed with that purpose in mind. A new generation of lifestyle drugs – drugs that give us the choice of when to sleep and how much, improve memory and offer emotional control, all without the messy side effects of current drugs – may be just around the corner.

Paul Phillips, 35, has credited Adderall and Provigil with helping him earn more than $2.3 million as a poker player. Phillips started using Adderall after he had attention deficit hyperactivity disorder diagnosed five years ago and later obtained a prescription for Provigil to further improve his focus.

There are plenty of these drugs around. Prescription-drug spending has been one of the fastest-growing components of national health-care spending in the past 10 years, according to a report published in May by the Kaiser Family Foundation. From 1994 to 2005, the number of prescriptions purchased increased by 71 percent, while population increased by only 9 percent.

Total sales for Adderall XR and Concerta, the most widely prescribed medications for ADHD, topped out at more than $1 billion last year, according to company records.

The explosion of stimulant use and abuse among high school and college students is old news on campus, where the drugs are often referred to by nicknames like “Diet Coke.” Students who abuse the little blue Adderall pills by crushing and snorting them are known as “blue noses.”

A 2005 report by the Partnership for a Drug Free America ranked diverted prescription medicines – those that were sold or given away by teens who legally obtained them from a doctor – at the middle of the teen drug-use continuum, between marijuana and cough medicine. Nearly 30 percent of teens reported having friends who abused prescription stimulants.

Are adults also turning to stimulants to get through the work day? Manos of the Cleveland Clinic suspects so.

“What occurs on college campuses is likely to occur in the adult working world,” Manos said. He has seen parents in his practice misusing their children’s prescription stimulants, he said.

Another drug increasingly used as a performance enhancer is modafinil, marketed as Provigil by Cephalon, a Pennsylvania-based biopharmaceutical company.

Provigil promotes alertness like other stimulants but seems to have fewer cardiac side effects, said Dr. Reena Mehra, clinical director of the Adult Sleep Laboratory at University Hospitals of Cleveland. Mehra said she prescribes the drug primarily for patients who are sleepy during the day because of sleep apnea.

The Air Force began studying the drug in 2004 as an alternative to the stimulant dextroamphetamine, which had the typical side effects including jitteriness, withdrawal symptoms and headache. Initial testing in sleep-deprived fighter pilots found that flight performance deteriorated less when taking Provigil.

Several studies of cognitive function in normal people taking Provigil have found improvements in some tasks while taking the drug.

“I think it would be very easy to indiscriminately prescribe this medication,” Mehra said, adding that people who are sleep-deprived should be getting more sleep, not popping a pill.

“Even if you take these alerting agents, maybe they will allow you to stay awake, but your cognitive performance is not going to be enhanced by these medications,” she said.

Modafinil was even added to the World Anti-Doping Agency’s list of prohibited drugs in 2004 to discourage its use among athletes. It is not clear if it improves athletic performance.

Classical musicians have for years turned to beta blockers like Inderal, which were first developed to treat heart arrhythmias, as a way to calm the nerves before auditions and performances.

These drugs block adrenaline receptors, which helps to control the heart-pounding, jittery, nauseated feelings that result from excess adrenaline.

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“Adrenaline is in the same category as caffeine,” said Dr. James Fang, clinical director of cardiovascular medicine at UH. “If you drink too much coffee, your hands are shaking and you can’t concentrate.”

A 2005 study at Ohio State University found that healthy people who took a low dose of Inderal before a stressful situation like public speaking were better able to perform cognitive tasks afterward.

Inderal is commonly prescribed for episodic phobias like stage fright or fear of public speaking, said UH psychologist Jeffrey Janata.

Despite the long safety record of the drug, Janata does not recommend its continued use for the same phobia, because other non-pharmaceutical methods for dealing with the fears are just as effective.

“If you have a public-speaking problem and you’re up in front of a class of students every day, that’s a whole different problem,” Janata said. “I wouldn’t even go in the direction of a pill – I would learn to manage the anxiety.”

But putting in the work is difficult – to conquer a fear, plan for a time-consuming task, or just cut out overly taxing commitments – and the temptation to swallow a pill to be able to do it all is a seductive fix.

With a bevy of memory drugs in various stages of clinical development, the years ahead will only bring more options for increasing brain power and optimizing performance.

CM END ZELTNER

(Brie Zeltner is a staff writer for The Plain Dealer of Cleveland and can be contacted at bzeltner(at)plaind.com.)

2007-12-28-MORE-PILLS

AP-NY-12-28-07 1208EST

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