Health

Methylphenidate and Cognitive Performance Improvement

It is unfortunately very difficult to get unbiased information on seemingly anything in today’s society. Everybody has an agenda. Of course, sometimes there is also a lot of incompetence at play. A good example is the discussion surrounding methylphenidate (MPH), not just in society but also in science. A fair amount of college students use this drug in order to gain an edge over their competition. Some openly admit it, while others keep their usage private. It is not always clear how these people get their drugs if they do not have an ADHD diagnosis, but I am hearing that having a family member who is diagnosed with ADHD, or, even better, having a strong personal connection to a medical doctor helps a lot.

Obviously, there are widespread delusions. Robert Malone spoke of “mass formation psychosis” in the context of the vaxx, i.e. people believing incredible nonsense as a result of relentless brainwashing via mass media. This is not happening with MPH, however. Instead, it is a drug people use and normally do not talk about. Quite certainly, these people would not keep using it if it had no effect. However, as MPH usage is apparently more common among students who are among the most competitive anyway, they may not have much of an incentive to promote their little secret. There are also people who use cocaine in order to be able to pull all-nighters in politics or banking, and these people also do not draw attention to it.

My impression is that there is a lot of dishonesty around MPH. Supposedly it does not really help, yet a lot of people use it. Some psychiatrists may even claim that this drug does not really help all that much. I came across articles written by psychiatrists which stated that you should get proper sleep and study regularly, and if you do that then MPH will not have any effect. This reminds me of steroids. Supposedly absolutely nobody is using them and even if, they are technically superfluous. Even people who show all the side-effects of roiding are claimed to be “naturals”. There are also absurd claims about known roiders themselves that they do not need to take steroids at all, and that their physique is attainable even without it. Even effing Dwayne “The Rock” Johnson, the most obvious roider in all of Hollywood, apparently got his physique because of hard work and eating copious amounts of chicken-breast fillets, and not because of gear. This is nothing but nonsense. Steroids work, and MPH also works.

The other day, I came across an incredibly dishonest scientific study on MPH. It claims that this drug does not enhance cognitive performance in healthy, young people. Feel free to have a look at the study first before you continue with my article. (I will wait.) As you may have noticed, the definition of “cognitive performance” the authors use is highly misleading. They used two IQ test, WAIS-R and Raven. These are excellent IQ test. However, I do not think that people claim that MPH makes them smarter. Instead, it increases their ability to focus. You can perhaps call it intellectual endurance. Have you ever experienced getting so engrossed in a book, a game, or some research, that you forgot everything around yourself, and hours just went by? If this is too abstract, think back spending time with a woman you were really into! In such situations, you do not notice anything else around you. On MPH, doing your taxes is as captivating as the best movie you have ever watched or a 10/10 chick you have crush on who is sitting on your bed naked, with her legs spread.

IQ test hardly stress endurance. You go through a sequence of brief exercise, e.g. ten times ten sets of questions, and each set of questions may take no longer than 90 seconds or two minutes. Even longer tests, like Raven’s Advanced Progressive Matrices, do not allot a lot of time to each single question. In terms of endurance, these are not taxing tests. They are designed to quickly get your to your cognitive limit but not keep you there. In contrast, a four-hour exam in a proof-based mathematics course is an entirely different beast, putting a much higher demand on your ability to focus, at least if you are not so far ahead of the level that was taught that you can solve the problems with ease.

MPH does not make you smarter, but it enables you to perform at a consistently high level. If you get distracted easily, then there is the cost of task switching, and you may find it difficult to get a lot done. In contrast, if you pop an MPH pill, you can go for four hours straight at peak performance. Tasks that used to take me two hours I can do in 45 minutes. Here, I should add that my baseline is already very high. My output without MPH is at a level not many people can match and this surely includes less intelligent people on MPH. With MPH, my days are effectively a few hours longer.

To go back to the study mentioned above: if the researchers really wanted to measure the impact of MPH, they should have come up with an IQ test similar to Raven’s that takes two or three hours. Even a simpler test, like going through twenty densely printed pages full of t’s and (very few) i’s, with the task of circling all i’s, should probably suffice to demonstrate the difference in performance. This is a simple task but it requires to maintain your attention for an extended amount of time. Probably anybody will hit their limit sooner without MPH, no matter what their baseline performance may be, and exceed that limit with MPH.

3 thoughts on “Methylphenidate and Cognitive Performance Improvement

    1. Adderall is an amphetamine, so this article is not a complete match. Despite the perhaps alarmist title of this article, the risks are low to nonexistent. Look at the summary:

      My impression is that the risks of proper, medically supervised Adderall use are the following:

      1. High risk of minor short-term side effects that might make you want to stop taking the medication with no long-term issues
      2. Extremely low risk of serious medical side effects like stroke or heart attack, except maybe in a few very vulnerable populations
      3. Maybe one percent risk, but not literally zero risk, of addiction if patients are well-targeted by their doctors and use the medication responsibly.
      4. Perhaps one in five hundred risk, but not literally zero risk, of psychosis. Some anecdotal evidence suggests it is more common than this. Most of these cases will be mild and resolve quickly. Some people find a very small number of cases of stimulant-induced psychosis may be permanent, though I still find this hard to believe.
      5. Some evidence for tolerance after several years, though most patients will continue to believe it is helping them. No sign of supertolerance where it actually makes the condition worse.
      6. Plausibly 60% increased relative risk (+~1% absolute risk) for Parkinson’s disease with long-term use.
      7. Unknown unknowns.

  1. I skimmed the Methods section, and noticed one major, and a couple of minor, defects.

    Firstly, they had a very small group of subjects (with significant numbers of drop-outs). Secondly, they instructed participants to get a good night’s sleep and eat a light meal, but had no protocols to ensure this actually happened.

    Those are pretty minor quibbles, though, and not unusual in studies like this.

    However, the major issue I saw was the third one, which was the random assignment of doses, and only of methylphenidate.

    It’s well known among researchers and clinicians in the field that titration is critical for this kind of medication. It’s very rare that the first does tried is optimal for the patient. A rare few get so lucky that they get it right immediately, but they’re in the minority.

    There are also variations among how well the drugs work for different patients. Some get excellent results on methylphenidate, but poor results on dextroamphetamine. Some are the other way around. Some only do well on Adderall (dextro/levoamphetamine mix). Some only get good results with Vyvanse (lisdexamfetamine – yes, ‘f’, not ‘ph’).

    As far as I know, the researchers are not quite sure why there is such a big individual difference when it comes to which medicines are efficacious. It’s been around a decade since I studied the topic, though, and I have only made minor efforts at keeping up with the developments in the field. They may have more understanding now.

    To sum it up, the study shows that if you take random people and throw them a random dose of methylphenidate, and don’t try any other medications, then the chances of getting it right and finding an efficacious dose for a person who responds well to methylphenidate are not significant. Which would surprise nobody with knowledge of the field, I believe. 🙂

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