Experimental Neuropsychopharmacology, Federal Institute for Drugs and Medical Devices (Bundesinstitut für Arzneimittel und Medizinprodukte, BfArM), Kurt-Georg-Kiesinger-Allee 3, 53175 Bonn, Germany.
Institute of Neurophysiology, University of Cologne, Faculty of Medicine, Robert-Koch-Str. 39, 50931 Cologne, Germany.
Neural Plast. 2021 Jan 13;2021:8823383. doi: 10.1155/2021/8823383. eCollection 2021.
Recent pharmacoepidemiologic studies suggest that pharmacological neuroenhancement (pNE) and mood enhancement are globally expanding phenomena with distinctly different regional characteristics. Sociocultural and regulatory aspects, as well as health policies, play a central role in addition to medical care and prescription practices. The users mainly display self-involved motivations related to cognitive enhancement, emotional stability, and adaptivity. Natural stimulants, as well as drugs, represent substance abuse groups. The latter comprise purines, methylxanthines, phenylethylamines, modafinil, nootropics, antidepressants but also benzodiazepines, -adrenoceptor antagonists, and cannabis. Predominant pharmacodynamic target structures of these substances are the noradrenergic/dopaminergic and cholinergic receptor/transporter systems. Further targets comprise adenosine, serotonin, and glutamate receptors. Meta-analyses of randomized-controlled studies in healthy individuals show no or very limited verifiability of positive effects of pNE on attention, vigilance, learning, and memory. Only some members of the substance abuse groups, i.e., phenylethylamines and modafinil, display positive effects on attention and vigilance that are comparable to caffeinated drinks. However, the development of new antidementia drugs will increase the availability and the potential abuse of pNE. Social education, restrictive regulatory measures, and consistent medical prescription practices are essential to restrict the phenomenon of neuroenhancement with its social, medical, and ethical implications. This review provides a comprehensive overview of the highly dynamic field of pharmacological neuroenhancement and elaborates the dramatic challenges for the medical, sociocultural, and ethical fundaments of society.
最近的药物流行病学研究表明，药理学神经增强（pNE）和情绪增强是全球范围内不断扩大的现象，具有明显不同的区域特征。除了医疗保健和处方实践外，社会文化和监管方面以及卫生政策也起着核心作用。使用者主要表现出自恋相关的认知增强、情绪稳定和适应性动机。天然兴奋剂和药物都代表着物质滥用群体。后者包括嘌呤、甲基黄嘌呤、苯乙胺、莫达非尼、益智药、抗抑郁药，还有苯二氮䓬类、β-肾上腺素受体拮抗剂和大麻。这些物质的主要药效学靶结构包括去甲肾上腺素/多巴胺能和胆碱能受体/转运体系统。其他靶标包括腺苷、血清素和谷氨酸受体。对健康个体的随机对照研究的荟萃分析表明，pNE 对注意力、警觉性、学习和记忆的积极影响没有或非常有限。只有一些物质滥用群体的成员，即苯乙胺和莫达非尼，对注意力和警觉性有积极影响，与含咖啡因的饮料相当。然而，新的抗痴呆药物的开发将增加 pNE 的可用性和潜在滥用。社会教育、限制性监管措施和一致的医疗处方实践对于限制神经增强现象及其对社会、医学和伦理的影响至关重要。本综述全面概述了药理学神经增强这一高度动态的领域，并详细阐述了医学、社会文化和伦理基础面临的巨大挑战。
