Unless you’ve been living under a rock, you’re likely well aware that stimulants
such as Adderall or Ritalin have been increasingly used in recent years by students who are eager
to get better grades.
In this video, we'll go over the science behind stimulants and whether or not they actually
help students in school.
What's going on guys! Dr. Jubbal, MedSchoolInsiders.com.
Let’s get a couple important items out of
the way.
First, for those of you who are wondering, I have never taken any drugs or substances
to help me study or be productive, other than the occasional coffee once every few months.
Second, I am not your doctor and I am not providing medical advice in any capacity.
Third, this video and the content here are primarily targeted to individuals who are
using these substances as cognitive enhancers, without a diagnosis of ADHD, narcolepsy, or
other conditions that warrant their prescription.
Please speak to your physician prior to starting, stopping, or changing any medications.
Now, Methylphenidate such as Ritalin or Amphetamine such as Adderall are the two prescription
stimulants most commonly used by students seeking to improve their attention, concentration,
and ultimately their grades.
These are schedule II substances in the US, placing them in the same category as cocaine,
oxycodone, and PCP.
That’s some serious stuff.
Now, while these stimulants are effective with professional supervision for treating
ADHD, their utility as a study or concentration aid has not been thoroughly validated.
And while the prescribed use and supervision by your physician is relatively safe, misuse
or abuse of any stimulant can have adverse effects.
A sizable portion of college students use these substances as cognitive enhancers, under
the belief that these drugs will improve their grades.
To answer the question of whether or not they actually do, let’s first start with how
the substances work.
The cognitive-enhancing effects of stimulants are due to the preferential effect of catecholamines
in the prefrontal cortex and activation of the Norepinephrine αlfa 2 and Dopamine D1
receptors.
Catecholamines are a group of neurotransmitters including norepinephrine, epinephrine, and
dopamine.
At low clinically relevant doses that a doctor may prescribe, the PFC-dependent function
is enhanced, which contributes to the stimulants use in ADHD.
But at larger doses, the PFC-dependent attentional processes are improved at the expense of other
processes, like working memory or response inhibition.
Methylphenidate or Ritalin and Amphetamine or Adderall both increase extracellular levels
of Norepinephrine and Dopamine throughout the brain, largely by blocking Norepinephrine
and Dopamine reuptake.
Amphetamine additionally stimulates the release of Dopamine through the Dopamine transporter.
And while amphetamines at higher doses block serotonin reuptake, methylphenidate only blocks
Norepi and Dopamine reuptake.
Now, let's move to the cognitive effects.
The cognitive enhancement properties of stimulants have been studied in the following four categories.
First, inhibitory control, which is linked to focus and avoiding distraction.
Number two, working memory.
Number three, short-term episodic memory, referring to memory and recall within 30 minutes
of learning.
And lastly, delayed episodic memory, referring to longer intervals, such as one hour to one
week between learning and testing.
In a systematic review of the literature, Ilieva et al demonstrated that there is a small but
significant degree of enhancement of inhibitory control and short-term episodic memory.
The effects on working memory are inconclusive, as one statistical analysis demonstrated a
small but statistically significant improvement, and the other demonstrated no statistical
significance.
Delayed episodic memory was the cognitive factor that demonstrated the largest effect.
Now, because stimulants had stronger effects on delayed episodic memory over the short-term
episodic memory, this data suggest that stimulants may more potently affect a memory consolidation
in comparison with encoding or retrieval.
Now, this is interesting, there is evidence that stimulants can actually impair performance
in normal individuals who are especially high performing.
In short, this means that individual variations account for a significant degree of the benefit
or detriment in seeing effects.
In 2017, Arria et al. published a prospective cohort study examining close to 900 college
students without ADHD.
Their conclusion, non-prescribed prescription stimulants did not demonstrate any statistically
significant effect on university GPA scores.
Now, there are multiple other factors that have been linked with stronger cognitive enhancement
and improvements in grades.
Mindfulness meditation, for example, has demonstrated stronger effects on inhibitory control, which
ultimately helps you focus on the task at hand.
The cognitive enhancement from stimulants is smaller and more comparable to the cognitive
benefits you see with physical exercise.
Ultimately, the most important thing that you care about is your GPA and your test scores,
right, and stimulants have not been shown to improve student GPAs.
However, when speaking about broader cognitive benefits, it's important to note that there
are several limitations with the current literature.
Notably, sustained attention and processing speed were not adequately studied.
Current studies also do not examine performance under fatigue, sleep deprivation, or distraction.
And while these possible cognitive benefits are often emphasized, it's important we do
not overlook the adverse effects of using these medications.
Short term side-effects may include GI problems, blurred vision, irritability, insomnia, increased
body temperature, blood pressure, heart rate, and many others.
Long term adverse effects include hallucinations, psychosis, cardiac arrest, and death.
Don’t forget the risk of addiction, headache, panic attacks, aggressive behavior, and a
link to suicidal and homicidal tendencies.
I've gone over the science and current literature on stimulants used by students for cognitive
enhancement and I was as objective as possible, keeping my opinion out of it until now.
There are a few points I’d like to raise.
Again, keep in mind that these points are for those who do not have a medically valid
prescription for these substances.
If you are on these medications for a medical condition, this does not apply to you.
First, the moral and ethical implications.
If you believe that taking stimulants is in fact benefiting you, which again the literature
is inconclusive then what is the fairness to those students you are competing with who
are not taking the drugs?
This opens up a whole other debate that is similar yet distinct from performance-enhancing
drugs in sports, food for thought.
Number two, let's talk about the long-term consequences.
The potential upside is limited based on the data we have, and yet there are significant
health risks, from cardiovascular complications to addiction and other significant detrimental
effects on your health and well-being.
The legal implications of using these substances without a prescription are also substantial.
From a cost-benefit analysis perspective, using stimulants does not appear wise.
Lastly, understand that by using stimulants to help you study, you’re using a shortcut,
a crutch and that crutch overall makes you a weaker student.
Relying on stimulants to help you concentrate or focus diminishes your ability to rely on
your own habits, your own willpower, and your own systems to provide the results that you
want.
You may be thinking right now, so what?
But let’s take a moment to think about how this actually pans out long term.
If you’re in college right now and you rely on stimulants, you’ll find it harder and
harder to perform without them.
You simply won’t be building the habits and strategies to make you an effective student
and when you start medical school, your study habits and strategies will be so weak that
you’ll again be dependent on stimulants, unable to be an effective student without
them.
If the idea of being dependent on a prescription medication with significant medical adverse
effects and legal repercussions doesn’t bother you, understand that you will be drug
tested in the medical profession.
And that can be the end of your medical career.
By taking this shortcut, you’re cheating yourself out of the necessary growth and development
that you need as a student and as an effective and competent future physician.
Now, I’m not here to say what is morally right or wrong.
However, in my opinion, it simply doesn’t make sense for students to use stimulants
without a prescription as cognitive enhancers.
You don’t need them.
I never touched them, and yet I still crushed undergrad, aced the MCAT, beast in medical
school, and matched into plastic surgery.
I did much better than the students who were taking the stimulants and yet I did it the
old fashion way.
Hone your habits, adjust your study strategies and continue to practice.
The hard work pays off, trust me.
The content on this channel is a good place to start, but if you do wanna take your productivity,
study strategies, and overall effectiveness to the next level, check out MedSchooIInsiders.com.
Thanks for watching and good luck.