"Talks a good game about freedom when out of power, but once he’s in – bam! Everyone's enslaved in the human-flourishing mines."

Brief Cautionary Notes On Branded Combination Nootropics

I.

Taking nootropics is an inherently questionable decision. The risk isn’t zero, and the benefits are usually subtle at best.

On the other hand, mountain-climbing also has risks, and is so devoid of benefit that the only excuse mountaineers can come up with is “because it’s there”. So whatever. If someone wants to do either – well, it’s a free country, and we all have to amuse ourselves somehow.

But even within this context, special caution is warranted for branded combination nootropics.

I wanted to make up a caricatured fake name for these sorts of things, so I could make fun of them without pointing at any company in particular. But all of the caricatured fake names I can think of turn out to be real products. MegaMind? Real. SuperBrain? Real. UltraBrain? Real. Mr. Power Brain? Real, for some reason.

Even the ones that don’t make sense are real. NeuroBrain? Real, even though one hopes that brains are always at least a little neuro. NeuroMind? Real, with its own Indiegogo campaign. The only thing I haven’t been able to find is a nootropic called BrainMind, but it’s only a matter of time.

These usually combine ten or twenty different chemicals with potential nootropic properties, then make outrageous claims about the results. For example, Neuroxium says on its ridiculous webpage that:

Neuroxium is a revolutionary brain supplement formulated to give you ultimate brain power. Known in Scientific Terms as a “NOOTROPIC” or “GENIUS PILL” Neuroxium improves mental functions such as cognition, memory, intelligence, motivation, attention, concentration and therefore happiness and success.

Your first warning sign should have been when they said “genius pill” was a scientific term (or as they call it, Scientific Term). If you needed more warning signs, this is word-for-word the same claim made by several other nootropics like Synagen IQ, Nootrox, and Cerebral X. So either they can’t even be bothered not to plagiarize their ads, or they change their name about once a week to stay ahead of the law.

I was eventually able to find a list of the ingredients in this stuff:

DMAE (dimethylethanolamine bitartrate), GABA (?-Amino-butyric acid), Caffeine anhydrous, Bacopa monnieri leaf extract, NALT (N-acetyl-L-tyrosine), Centrophenoxine HCl, Alpha-GPC (a-glycerophosphocholine, Agmatine sulfate, Gingko biloba leaf extract, Pine (Pinus pinaster) bark extract, Phosphatidylserine, Aniracetam, CDC Choline (Citicoline), Sarcosine (N-methylglycine), Vincamine [Lesser Periwinkle (Vinca minor) aerial extract], L-Theanine (?-glutamylethylamide), NADH (nicotinamide adenine dinucleotide), TAU (triacetyluridine), Noopept, Adrafinil, Tianeptine, Piperine [Black Pepper (Piper nigrum) fruit extract 445mg.

And the weird thing is, a lot of these are decent choices. Everyone knows caffeine is a good stimulant. Adrafinil is the over-the-counter version of modafinil, an FDA-approved medication for sleep disorders; many of my patients have been very happy with it. Bacopa monnieri has been found to improve memory in so many studies I can’t even keep track of all of them. Noopept is an approved medication in Russia. Tianeptine is an approved medication in France. All of these are chemicals with at least some evidence base behind them, which are potentially good for certain people. If some nootropics user were to say they wanted to try adrafinil, or bacopa, or noopept, or any of the other stuff on that list, I would classify them with the mountain climber – doing something risky but not necessarily stupid.

But taking Neuroxium/Synagen/CerebralX is exactly as bad an idea as you would expect from the advertising copy.

For one thing, they don’t list the doses of any of these things – but they have to be getting them terribly wrong. A standard dose of adrafinil is 600 mg. A standard dose of bacopa is 300 mg. A standard dose of Alpha-GPC choline is about 600 mg. So combining standard doses of just these three ingredients means you need a 1.5 g pill. This is probably too big to swallow. The only pills I know of that get that big are those gigantic fish oil pills made of pure fish oil that everybody hates because they’re uncomfortably big. But this is just what you’d need to have three of the 22 ingredients listed in CerebralX at full doses. The pill is already unswallowably large, and you’ve only gotten a seventh of the way through the ingredient list.

I conclude that they’re just putting miniscule, irrelevant doses into this so they can say they’ve got exciting-sounding chemicals.

For another thing, all of these substances have unique profiles which have to be respected on their own terms. For example, lots of studies say bacopa improves memory – but only after you’ve taken it consistently for several months. If you just go “WOOO, CEREBRALX!” and swallow a bunch of pills and hope that you’ll do better on your test tomorrow, all you’re going to get are the short-term effects of bacopa – which include lethargy and amotivation.

Most sources discussing Noopept recommend starting very low – maybe as low as 5 mg – and then gradually increasing to a standard dose of 10 – 40 mg depending on how it works for you. Some people will apparently need higher doses, and some find it works best for them as high as 100 mg. Needless to say, none of this is possible if you’re taking CerebralX. You’ll take whatever dose is in the product – which they don’t tell you, and which is probably so low as to be meaningless – and stay at the same level for however long you’re taking the entire monstrosity.

Tianeptine has a short half-life and is typically dosed three times a day, unlike most of the other things on the list which are dosed once per day. CerebralX says you should take their whole abomination once a day, which means you’re getting the wrong dosing schedule of tianeptine.

GABA, taken orally, doesn’t cross the blood-brain barrier and has no effect. The only way it could possibly make a difference – and even this is debatable – is if you join it to niacin to create the N-nicotinoyl-GABA molecule, which these people did not do. As a result, their GABA will be totally inert. This is probably for the best, because most of the things on their list are stimulants, and GABA is a depressant, so it would probably all just cancel out.

Piperine is a chemical usually used to inhibit normal drug-metabolizing enzymes and enhance the effect of other substances. This is very occasionally a good idea, when you know exactly what drug you’re trying to enhance and you’re not taking anything else concurrently. But I can’t figure out which drug they’re trying to enhance the activity of here, or even whether they’re trying to enhance the activity of anything at all, or if they just heard that piperine could enhance things and thought “Okay, it’s in”. And if I were giving someone a concoction of twenty-one different random psychoactive drugs, which I was dosing wrong and giving at the wrong schedule, the last thing I would want to do is inhibit the body’s normal drug metabolism. The entire reason God gave people drug-metabolizing enzymes is because He knew, in His wisdom, that some of them were going to be idiots who would take a concoction of twenty-one different random psychoactive drugs because a website said it was, in Scientific Terms, a “GENIUS PILL”. Turning them off is a terrible idea and the only saving grace is that the dose of everything in this monstrosity is probably too small for it to do anything anyway.

Taking any of the ingredients in CerebralX on its own is a potentially risky affair. But if you study up on it and make sure to take it correctly, then maybe it’s a calculated risk, like mountain climbing. Taking everything in CerebralX together is more like trying to mountain-climb in a t-shirt and sandals. You’re not taking a calculated risk as part of a potentially interesting hobby. You’re just being an idiot.

II.

But that’s too easy. I have a larger point here, which is that these sorts of branded combos are bad ideas even if they’re by smart, well-intentioned people who are doing everything right.

Tru-Brain is undeniably in a class above CerebralX. It has a team including neuroscience PhDs. It seems to be a real company that can keep the same name for more than a week. Instead of promising a GENIUS PILL, it makes comparatively modest claims to be able to “perform at your peak” and “stay sharp all day long”.

Correspondingly, its special nootropics combo makes a lot more pharmacological sense. For one thing, it’s a packet rather than a single pill – a concession to the impossibility of combining correct doses of many substances into a single capsule. For another, it limits itself to mostly things that some sane person could conceivably in some universe want to dose on the schedule they recommend. And it’s only got seven ingredients, none of which counteract any of the others or turn off important metabolic systems that God created to protect you from your own stupidity. This is probably about as well-designed a branded nootropics combo as it’s possible to make.

But I would still caution people away from it. Why?

Last year, I surveyed people’s reactions to various nootropics. I got 870 responses total, slightly fewer for each individual substance. Here are the response curves for two of the substances in TruBrain – piracetam and theanine:

These are on a 1-10 scale, where I directed responders to:

Please rate your subjective experience on a scale of 0 to 10. 0 means a substance was totally useless, or had so many side effects you couldn’t continue taking it. 1 – 4 means for subtle effects, maybe placebo but still useful. 5 – 9 means strong effects, definitely not placebo. 10 means life-changing.

Some substances known to be pretty inert averaged scores of around 4. Piracetam and theanine averaged around 5, so maybe a little better than that. But the most dramatic finding was the range. Almost 20% of people rated theanine a two or lower; almost 20% rated it a nine or higher. More than a third placed it in the “probably placebo” range, but 5% found its effects “life-changing”.

The effect of nootropics seems to vary widely among different people. This shouldn’t be surprising: so do the effects of real drugs. Gueorguieva and Mallinckrodt do an unusually thorough job modeling differences in response to the antidepressant duloxetine, and find a clear dichotomy between responders and nonresponders. This matches psychiatric lore – some medications work on some people, other medications work on others. I particularly remember one depressed patient who had no response at all to any SSRI, but whose depression shut off almost like a lightswitch once we tried bupropion. Other people fail bupropion treatment but do well on SSRIs. Probably this has something to do with underlying differences in their condition or metabolism that we just don’t know how to identify at this point (sample simplified toy model: what we call “depression” is actually two diseases with identical symptoms, one of which responds to SSRIs and one of which responds to bupropion).

I think this is why there are no multidrug combo packs. Your psychiatrist never treats your depression with a pill called “MegaMood”, boasting combination doses of Prozac, Wellbutrin, Remeron, and Desyrel. For one thing, either you’re giving an insufficient dose of each drug, or you’re giving full doses of four different drugs – neither is well-tested or advisable. For another, you’re getting four times the side effect risk. For a third thing, if one of the four drugs gives you a side effect, you’ve got to throw out the whole combo. For a fourth, if the combo happens to work, you don’t know whether it’s only one of the four drugs working and the others are just giving you side effects and making you worse. And if it sort of works, you don’t know which of the four drugs to increase, or else you just have to increase all four at once and hope for the best.

All these considerations are even stronger with nootropics. There shouldn’t be universally effective nootropics, for the same reason there’s no chemical you can pour on your computer to double its processing speed: evolution put a lot of work into making your brain as good as possible, and it would be silly if some random molecule could make it much better. Sure, there are exceptions – I think stimulants get a pass because evolution never expected people to have to pay attention to stimuli as boring as the modern world provides us with all the time – but in general the law holds. If you find a drug does significantly help you, it’s probably because your brain is broken in some particular idiosyncratic way (cf. mutational load), the same way you can double a computer’s processing speed with duct tape if one of the processors was broken.

If everyone’s brain is broken in a different way, then not only will no drug be universally effective, but drugs with positive effects for some people are likely to have negative effects for others. If (to oversimplify) your particular brain problem is not having enough serotonin, a serotonin agonist might help you. But by the same token, if you have too much serotonin, a serotonin agonist will make your life worse. Even if you have normal serotonin, maybe the serotonin agonist will push you out of the normal range and screw things up.

Most effective psychiatric drugs hurt some people. I mean, a lot of them hurt the people they’re supposed to be used for – even the psychotic people hate antipsychotics – but once you’ve brushed those aside, there are a lot of others that help a lot of people, but make other people feel worse. There are hordes of people who feel tired on stimulants, or sleepy on caffeine, or suicidal on antidepressants, or any other crazy thing. You rarely hear about these, because usually if someone’s taking a drug and it makes them feel worse, they stop. But psychiatrists hear about it all the time. “That antidepressant you gave me just made me feel awful!” Oh, well, try a different one. “That’s it? Try a different one? Aren’t you embarassed that your so-called antidepressant made me more depressed?” You’re pretty new to this ‘psychopharmacology’ thing, aren’t you?

Thus the tactic used by every good psychiatrist: try a patient on a drug that you think might work, make them report back to you on whether it does. If so, keep it; if not, switch.

If you take a seven-drug combo pack, you lose this opportunity for experiment. Suppose that two of the drugs make you feel +1 unit better, two others have no effect, and three of the drugs make you feel -0.5 units worse, so in the end you feel +0.5 units better. Maybe that seems good to you so you keep taking it. Now you’re taking five more drugs than you need to, including three making you actively worse, and you’re missing the chance to be a full +2 units better by just taking the drugs that are helping and not hurting.

You’re also missing the opportunity to play with the doses or the schedules of things. Maybe if you doubled the dose of one of the drugs making you +1 better, you could be +2 better, but if you double the dose of the other, you start getting side effects and the drug only breaks even. If you experiment, you can figure this out and take twice the dose of the first and the starting dose of the second, for +3 better. Taking them all as part of a combo ruins this: if you try taking twice the dose of the combo, nothing happens.

(And a special word of warning: if some stimulant product combines caffeine with something else, and you feel an effect, your first theory should be that the effect is 100% caffeine – unless the “something else” is amphetamine. There are like a million products which bill themselves as “organic energy cocktails” by combining caffeine with some rare herb from Burma. People drink these and say “Oh, this high feels so much more intense than just drinking caffeine”. Yeah, that’s because it’s much more caffeine. Seriously. Check the doses on those things. I will grudgingly make an exception for some chemicals that are supposed to decrease caffeine jitters, like theanine, which might have a real effect. But the stimulation is from caffeine. Go get an espresso instead.)

III.

But don’t drugs interact? Instead of viewing these seven drugs as seven different variables, shouldn’t we view them as coming together in a seven-color beautiful rainbow of happiness, or whatever?

Once again, I can only appeal to psychiatry, which is still unsure whether there are any useful interactions between its various super-well-studied drugs which it’s been using for decades and prescribing to millions of people. Take the CO-MED study, which combined the popular SSRI escitalopram with the popular NDRI bupropion. Since depression seems to involve abnormalities in the three major catecholamine systems, and escitalopram hits one of these and bupropion hits the other two, this seems like exactly the sort of synergistic interaction we should expect to work. It doesn’t. CO-MED found that the two antidepressants together didn’t treat depression any better than either one alone, let alone produce some synergy that made them more than the sum of their parts. They did, however, have about twice as many side effects.

Other smaller studies say the opposite, so I’m not saying never try escitalopram and bupropion together. I’m saying we don’t know. These are intensely-studied drugs, the whole power of the existing system has been focused on the question of whether they synergize or antisynergize or what, and we’re still not sure.

Also from psychiatry: we know a lot less about the mechanisms of action of drugs than we like to think. Ketamine has been intensively studied for depression for a decade or so, and we only just learned last year that it probably worked on a different receptor than we thought. SSRIs might be the most carefully studied drug class of all time, and we still don’t really know exactly what’s up with them – it can’t just be serotonin; they increase serotonin within a day of ingestion, but take a month to work.

So when people take these incredibly weird substances that have barely been studied at all, where we have only the faintest clue how they work, and then say from their armchair “And therefore, drug A will enhance the effects of drug B and C” – this is more than a little arrogant. Is it all made up? I can’t say “all” with surety. But it might be.

The best-known and most-discussed interaction in nootropics is piracetam-choline. Piracetam increases levels of acetylcholine, which is formed from choline, so it makes sense that these two substances would go well together. Most sites on piracetam urge you to take them together. TruBrain, which predictably is on top of this kind of stuff, combines them together in its combo pack.

But there’s never been a human study showing that this helps. Examine.com, another group which is usually on top of stuff, summarizes (emphasis carried over from original):

[Choline] may augment the relatively poor memory enhancing effects of Piracetam in otherwise healthy animals, but administration of choline alongside Piracetam is not a prerequisite to its efficacy and has not been tested in humans

I surveyed a bunch of choline users, using a little gimmick. Some of the forms of choline sold these days don’t cross the blood-brain barrier and shouldn’t have an effect, so they provide a sort of placebo control for more active forms of choline. In my survey, people who took piracetam with inactive forms of choline didn’t report any worse an experience than those who took the real thing.

This is the most famous and best-discussed interaction in the entire field of nootropics, and it’s on super-shaky ground. So trust me, the CerebralX people don’t have good evidence about the interactions of all twenty-one of their ridiculous substances.

I have to admit, I’m not confident in this part. Maybe psychiatry is wrong. Sometimes I wonder what would happen if we just throw five different antidepressants with five different mechanisms of action at somebody at once. Realistically, maybe this would involve some supplements: l-methylfolate, SAMe, tryptophan, turmeric, and a traditional SSRI. One day I want to try this on someone I know well enough to let me test things on them, but not so well I don’t mind losing a friend when it all blows up in my face. Until then, keep in mind that anyone who says they bet a certain combination of things will produce a synergistic interaction is engaging in the wildest sort of speculation.

IV.

One more piece of evidence. The 2016 nootropics survey asked people to rate their experiences with 35 different individual substances, plus a branded combo pack (“AlphaBrain”) of pretty good reputation. The AlphaBrain performed worse than any of the individual substances, including substances that were part of AlphaBrain!

This is of course a very weak result – it wasn’t blinded, and maybe the survey responders have the same anti-branded-combo prejudice I do. But it at least suggests knowledgeable people in the nootropics community are really uncomfortable with this stuff.

90% of the people making branded combo nootropics are lying scum. A few, like TruBrain, seem like probably decent people trying to get it right – but are you confident you can tell them apart? And if you do manage to beat the odds and get something that’s not a complete pharmacological mess, aren’t you still just going to end up with an overpriced bundle of black boxes that won’t provide you with useful information, and which, empirically, everyone hates?

If you’re interested in nootropics, consider trying one substance at a time, very carefully, using something like examine.com to learn how to take it and what the possible side effects are. If you can, do what people like Gwern do and try it blind, mixing real pills with placebo pills over the space of a few weeks, so you can make sure it’s a real effect. If you find something that does have a real effect on you, treat that knowledge as a hard-won victory. Then, if you want to go from there, tentatively add a second chemical and test that one in the same way. Do this, and you have some small sliver of a chance of doing more good than harm, at least in the short term.

But if you’re going to order a combination of twenty different things at homeopathic doses from somebody who thinks “GENIUS PILL” is a Scientific Term – well, I hope it works, because you need it.

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93 Responses to Brief Cautionary Notes On Branded Combination Nootropics

  1. c0rw1n says:

    > But if you’re going to order a combination of twenty different things at homeopathic doses from somebody who thinks “GENIUS PILL” is a Scientific Term – well, I hope it works, because you need it.

    heh, this is an incentive for them to not make efficient Genius Pills, then, right?

    • Deiseach says:

      Honestly, that ingredient list sounds like I took the contents of my store cupboard and spice rack and threw them all in a mixing bowl… hmmm… wait a minute…

      *wonders if could get away with calling a new supplement BrainBrain*

  2. rahien.din says:

    Honestly, I could keep coming back here just for the extremely lucid medical reasoning.

  3. I wanted to make up a caricatured fake name for these sorts of things, so I could make fun of them without pointing at any company in particular. But all of the caricatured fake names I can think of turn out to be real products. MegaMind? Real. SuperBrain? Real. UltraBrain? Real. Mr. Power Brain? Real, for some reason.

    Even the ones that don’t make sense are real. NeuroBrain? Real, even though one hopes that brains are always at least a little neuro. NeuroMind? Real, with its own Indiegogo campaign. The only thing I haven’t been able to find is a nootropic called BrainMind, but it’s only a matter of time.

    How could you possibly leave out INTELLIFUCK? /s

    • Nornagest says:

      Just call them Mentats.

    • christhenottopher says:

      That site is a joy to behold.

      Totally sketchy ass lying fuckheads, but goddamn do they (not) know how to make a website!

    • Scott Alexander says:
      • Deiseach says:

        That has reduced me to incoherence.

        Since when has “Extra even more ALKALOIDS in this!!!” become a selling point? Possibly I am prejudiced since I am only familiar with alkaloids as in “what poisoned the victim in a murder mystery*” so maybe I am simply behind the times, but this really does remind me of the raw apricot kernels with the cyanide warning on them – don’t worry, if you only eat 3 a day you probably won’t kill yourself.

        Are these things some kind of social experiment to weed out everyone who, back in the good old hunter-gatherer days, would have died via eating the wrong kinds of berries?

        *

        Holmes is a little too scientific for my tastes — it approaches to cold-bloodedness. I could imagine his giving a friend a little pinch of the latest vegetable alkaloid, not out of malevolence, you understand, but simply out of a spirit of inquiry in order to have an accurate idea of the effects. To do him justice, I think that he would take it himself with the same readiness. He appears to have a passion for definite and exact knowledge

    • CatCube says:

      The gif on that website is going to haunt my dreams.

  4. metacelsus says:

    Regarding choline:

    A large fraction of dietary choline is broken down by intestinal bacteria before it has a chance to be absorbed. This fraction differs in different people, depending on the composition of the intestinal microbiota. (Source.) In people who consume more choline, there are more choline-degrading bacteria.

    So, dietary supplementation of choline may not be very effective in some people. Also, excess dietary choline may contribute to heart disease, via the same bacterial pathway (indirectly).

  5. rpenm says:

    Off-topic, but since you mentioned it: mountaineering clearly has social status benefits. There is also just the pleasure that comes from developing a skill. And of course the mind-altering high that comes from extreme exertion and going to places that expose us to the sublime immensity of the universe.

    • alchemy29 says:

      I’m less understanding than you. Personally I found that quip extremely annoying. Scott seems to enjoy defending fringe beliefs/practices by deflecting and making fun of something higher status thus asserting that other people do worthless things as well*. Mountain climbing is a sport – it’s a physically demanding (and yes dangerous) form of leisure with a social aspect. Nootropics claim to do something (enhance some aspect of cognitive abilities), and are often snake oil. Scrutinizing them is just as sensible as scrutinizing companies that lie about what is in their food, or crystal healers who profit off of stupid people. Maybe some work, but it’s a terrible argument to say that it’s okay if they don’t because other people waste their money too.

      *Other examples include making fun of researchers studying pronoun disambiguation to defend friendly AI, and making fun of people who spend money on online farming games to defend … also friendly AI. The form of argument [other people get to waste their money so it’s okay to spend money on X] just doesn’t work logically, rhetorically or otherwise.

  6. rlms says:

    “This matches psychiatric lore – some medications work on some people, other medications work on others.”
    Are there any interesting studies in this area that look for ways in which e.g people who respond to SSRIs and not by propionate differ from the converse?

    • JShots says:

      I am curious about this as well (did you mean to say Bupropion? maybe what you said and Bupropion are interchangeable terms, I don’t know enough about the topic, just making a comparison to the article). But I was literally waiting in the doctors office this morning reading a Time magazine article about Ketamine and the article described depression as being caused by “several different maladies” or something to that effect and discussed why some medications work for some people but not for others. I’m curious, are there marked or subtle differences in how people describe their depression symptoms (or combination of) that may lead your psychiatrist to prescribe one medication over the other? (i.e. Person Y has indicated they have A & B symptoms mostly, so I’ll prescribe an SSRI to start, but person Z has B & C symptoms, so I’ll prescribe Bupropion to start, etc) I’m sure if I spent enough time googling, I could find out, but thought someone here might have direct knowledge.

      • christmansm says:

        Sort of. Tailoring antidepressants to symptoms has been a goal of psychiatry for a long time. There was evidence in the old days that major depressive patients with a fairly specific cluster of symptoms–sleeping too much, feeling like their limbs were heavy, temporary mood improvement to positive events but intense sensitivity to interpersonal rejection–responded markedly better to MAOIs than to tricyclic antidepressants. It’s known as “atypical depression,” and suggests that the umbrella of “major depression” covers more than one distinct thing. In terms of current treatment, however, SSRIs seem comparable to MAOIs for atypical depression (and most prescribers are scared of MAOIs) so it doesn’t come up much. There’s generally not strong evidence for prescribing one first-line drug over another based on certain depressive symptoms, leading to the general approach of “try one and switch if it doesn’t work.”

        Instead, guidelines and clinical experience suggest a sort of low-grade tailoring based largely on side effects and other patient characteristics. Bupropion tends to be more stimulating and can cause insomnia but is weight-neutral, so one might favor it for patients who are sleeping 20 hours a day with significant weight gain. On the flip side, mirtazapine is pretty sedating and stimulates appetite, so it’s more popular for the can’t-sleep-can’t-eat patient. Both bupropion and mirtazapine have fewer sexual side effects than SSRIs/SNRIs if that’s a sticking point for a patient. Of the SSRIs, citalopram and escitalopram have few interactions with other drugs, so they can be handy if the patient is already on lots of other medications. If the patient has another problem that could be treated with a certain drug (SSRIs for obsessive-compulsive disorder, SNRIs for certain types of chronic pain, bupropion for quitting smoking) then you might try to kill two birds with one stone.

        So, while there’s a sort of practical logic, we’re still trying to find characteristics that would suggest better response to certain drugs in advance.

  7. Nornagest says:

    There are like a million products which bill themselves as “organic energy cocktails” by combining caffeine with some rare herb from Burma. People drink these and say “Oh, this high feels so much more intense than just drinking caffeine”. Yeah, that’s because it’s much more caffeine. Seriously. Check the doses on those things.

    I did that for energy drinks like Red Bull once, and found that they were usually good for about what you’d get in a large (12oz) cup of coffee. Less than that if we’re talking a Starbucks venti. I think the residual effect is coming from sugar and B vitamins, though, not rare herbs from Burma.

    • Fossegrimen says:

      Don’t remember if RedBull is one, but many energy drinks contain caffeine and guarana which is a way of saying “caffeine and MORE CAFFEINE” so the extra jolt may be from the caffeine differently labeled

      • Nornagest says:

        I wasn’t looking at marketing material, I was looking at tested caffeine levels. That should be picking up the caffeine in guarana extract along with the pure stuff that gets added during the manufacturing process; they’re the same chemical.

  8. Douglas Knight says:

    no multidrug combo packs

    Maybe not in psychiatry, but they are becoming popular. For example, most new diabetes drugs are available in combination with metformin. But just 2 drug combos.

  9. Nancy Lebovitz says:

    Is it possible we have an intelligence test here? Or possibly a wisdom test?

    Lately, I’ve been wondering what makes some people susceptible to multi-level marketing and others not. Note that there are people with substantial education (like doctors) who do MLM.

    • James Miller says:

      I remember learning in law school that doctors and dentists are very susceptible to financial fraud because they greatly overestimate their financial competence.

      • TCW says:

        Working on the financial services industry, this has been my experience. Anecdotally, medical professionals and teachers/educators are convinced they won’t benefit from financial advice, making them very difficult clients to acquire.

      • crh says:

        I’ve heard it said that lawyers make the worst patients, and doctors make the worst (legal) clients, for pretty much that same reason.

      • vV_Vv says:

        Very susceptible compared to whom?

    • vV_Vv says:

      Note that there are people with substantial education (like doctors) who do MLM.

      You need to have money to do get into these fraudulent or borderline-fraudulent schemes. Probably you also need to be stupid to get into these schemes.

      Doctors have money. Most doctors are not stupid, but some fraction of them are and they still have money. These are the ones who get into these schemes.

      • Deiseach says:

        I really do think that successful people make the best patsies. Poor people tend to be wary because if this thing blows up, they’ve lost everything, and experience has generally taught them that if something looks too good to be true, it is. Better off people have the idea that “hard work and intelligence got me where I am, and I can tell a scam when I see one”, so if you dress it up a bit fancier than “this is literally promising you something for nothing, are you that dumb you’ll fall for it?”, then they do, because then you’re playing on “ha ha, I’m shrewd enough to recognise an opportunity and seize it before the masses get in on it!”

        Flatter their acumen, and you can get them to fork over the dosh.

        • Cliff says:

          Some people know that often there really IS something for nothing. But I don’t know if these people fall for MLM. I doubt it.

          • Deiseach says:

            Some people know that often there really IS something for nothing.

            Which is exactly what the con artists are playing on here; hey, you’re smart, you’ve been around, you know that the honest guys not gaming the system are rubes, that smart cookies can get something for nothing. Well, here’s a chance for you to be a smart cookie!

            A smart cookie gets something for nothing out of these schemes, right enough, but it’s not the pigeon with the dough who thinks he can double or triple it for no effort.

        • Ian Bruene says:

          I’m gonna miss this place. Rapture was a candy store for a guy like me. Guys who thought they knew it all. Dames who thought they’d SEEN it all. Give me a smart mark over a dumb one every time.

          — Frank Fontaine

      • Nancy Lebovitz says:

        Please read the comments at the Metafilter link. People who are close to the edge financially buy into MLMs. Sometimes the MLM pushes them over the edge, but they keep buying as long as they can.

        It’s possible that people who are repelled by MLMs aren’t just numberate, they’re reflexively numerate.

        • Deiseach says:

          I think there are two types who buy into schemes like these; the MLM “you can make money by selling our tat and, more importantly, by recruiting people to sell our tat as you get a slice of commission on them” are the ones on the edge, people in precarious financial positions who don’t have a chance to earn a $15 per hour* wage or more, and they can’t borrow money from banks or get money elsewhere. These pyramid schemes seem more legit, more like ‘working for your money’; it’s the same mechanism at work as buying lottery tickets because it’s random so maybe your numbers could come up, it could happen, and if they do then the gains are going to literally change your life. These schemes appeal to desperation.

          The more sophisticated scams (relatively speaking) are the ones that appeal to greed and superiority. You’re smart, worldly, and got where you are by being ahead of the rest. You made your money by a combination of hard work and good decisions. You also know that “rules are for the little people” because you move in the circles where getting the inside scoop first means picking all the ripe fruit and leaving the scraps for the suckers. So here’s an opportunity to get in on the ground floor on one of these behind the scenes deals where you can be amongst those picking the bounty first.

          *That would be me, by the way; I converted my hourly pay rate into dollars and it’s under $15 per hour. So I am rather amused by the minimum wage threads on here that (a) well I’m just not worth paying $15 per hour and (b) if I were paid this, it would completely trash the economy and fling hundreds of thousands into unemployment. Goodness, who knew I had such power? 🙂

          And yes, I’ve had MLM type scams peddled to me, and no, I’ve never taken one up because I do firmly believe “there is never something for nothing, there is always a catch” and “there is no such thing as a free lunch”.

          • Nancy Lebovitz says:

            So in your case, you were protected by a very broad heuristic more than by seeing that an MLM would very rapidly run out of people?

          • adder says:

            I’ve found the MLMs that sell products pretty interesting. They don’t really bubble out and blow up as others do. Cutco is one that comes to mind. I know plenty of people with cutco knives and they say they’re perfectly good. Are they any better than what they could get at Walmart for half the price? /shrug. Having a product to sell coupled with the MLM strategy does provide a termination point, allowing these organizations to sustain regular income. Rather than people having to keep recruiting others down an ever-growing tree until it explodes, I think there are many more ending nodes. There are several levels of recruitment before someone says “shit, I bought all these knives that people don’t really want” and just eats that cost or sells off their stock to friends and family that want to be supportive.

          • Deiseach says:

            So in your case, you were protected by a very broad heuristic more than by seeing that an MLM would very rapidly run out of people?

            Oh, I did see one that would do exactly that. Back in one of our recessions (the 80s-90s were not great until the Celtic Tiger kicked in towards the end of the 90s) there was one of these going around – people were so desperate for work, and our state organisations were so clueless/lacking in options that this was even being recommended by the national employment training agency as a work opportunity – about “send in money for details of how to earn £££££ starting your own home business EDIT: collecting and sending on responses”. I’ve just remembered the exact details, it was so long ago.

            If you did answer (and I was desperate enough at that point to go “What the hell, it’s only a tenner, I don’t believe this is anything but a scam but just in case it’s legit”, so I did reply), what you got back was a generic “here are ideas for selling things door-to-door/offering repairs and maintenance services/etc” leaflet as the kind of ‘response’ you’d in turn send out to others but the kicker was “and of course by placing an advert in your local paper with the same wording as our original advert; when people send you money, you post them on this same flyer, send the money on to us and we pay you a cut of the proceeds” – the idea being, of course, that as soon as your recruits started getting “here’s my £10, how do I set up my sure-fire home business?” you’d pass on the same advice to them, keeping a cut of the money yourself while sending the remainder back to head office and so on ad infinitum. Plainly, though, the supply of desperate people would soon run out but the originators of the scheme would have made a tidy sum in the mean time. Anyone could see this was what would happen, so I shrugged my shoulders and gave my tenner up for lost.

            Once I was aware of this, I looked out for it, and sure enough I saw several of these ads in local and national papers, obviously placed by people who were trying to get their money back after falling for the “send in your £10 for a sure-fire employment opportunity” and it was fairly quickly revealed as a scam, but not before, as I said, even the state-sponsored employment agency had put these ads up with the rest of the “situations vacant” in their offices around the country (it was worded vaguely or carefully enough that it sounded like one of the ‘make money delivering flyers door-to-door’ type of job offers).

            So yeah, both the broad heuristic and seeing for myself what one of these scams was – and that is basically what they are, if it’s not a legitimate ‘real products which you can sell as an accredited agent of a company’ business – help to protect me, as well as a general people ain’t no good (and that includes me) attitude 🙂

    • Anthony says:

      My experience with MLM is that if you have some small niche where you can sell your products, you can make a nice little side income – one place I worked, one of the field guys was in Amway, and he supplied all our janitorial supplies. It probably netted him the equivalent of about two hours overtime a month, or enough to pay the union dues, but wouldn’t take two hours a month of work.

      But many many pitches, even within Amway, were obvious pyramid schemes, where the point was to recruit more people rather than move product. I never signed up because I’m *not* a salesman, and I’ve never had a nice like my former coworker which was big enough to be worth the trouble. If you have some natural (or learned) sales talent and find an Amway chain that is more about moving product, it might be worth the effort. Otherwise, not so much.

  10. Deiseach says:

    Realistically, maybe this would involve some supplements: l-methylfolate, SAMe, tryptophan, turmeric, and a traditional SSRI.

    Or you know the way medication sometimes says “Take with or after food”? For your tryptophan and turmeric, have them take the combo before/after eating a turkey curry; if it doesn’t work, at least they got a delicious meal out of it 🙂

  11. Janet says:

    OK, somebody has to do it, so I will: come up with your best caricatured fake name for a nootropic, and post it here. Scott has already claimed “MegaMood”. And “Intellifuck” is for REALZ, yo! We only want fake ones!

    • Nornagest says:

      It’s a shame “Smarties” is taken. Would “Smartiez” be enough to make it legally distinct? Probably not.

      • cuke says:

        Smartierz?

      • Janet says:

        When he was learning to talk, my nephew always called Smarties, “Farties”. I’ve never been able to look at them the same way again.

        Trivia fact: Smarties are made with dextrose (= pure glucose = blood sugar), whereas most candy is made with sucrose (= 50% glucose, 50% fructose) or high-fructose corn syrup (42-65% fructose, the rest glucose). Fructose has to be metabolized in the liver, in humans, and it may be a driver in the metabolic syndrome that has become common in Western society. Some people can’t absorb fructose easily through the gut, and if they eat it they get bowel symptoms, including… you guessed it: lots of farties.

        So, in that case, Smarties are actually anti-Farties. People who have the condition, often figure out on their own that Smarties are the only candy they can eat without, er, repercussions.

        • Deiseach says:

          US Smarties look like what over here we’d call Refreshers (I see the company has gone out of business/brand has been taken over by a different one since I used to eat these as a kid). Irish/British Smarties are these, something along the same lines as chocolate M&Ms.

    • grifmoney says:

      IntelligenX
      Smart Squared
      Turbosmart (automotive part, not a supplement)
      Caffeine N’ Shit

    • toastengineer says:

      Brainagra. Or Cerebralis?

      • cuke says:

        +1 for Brainagra. How about Cereballs?

        Seems like something spinning off of the mindfulness craze would be good too. Mindfuleze?

    • Roxolan says:

      Einsteinium. (To protect yourself from legal issues, add actual depleted Es, diluted into non-existence, to the mix.)

      • Nornagest says:

        Depleted einsteinium basically doesn’t exist. There is an isotope with a half-life of a bit more than a year, but it’s hard to make by the already-hard standards of the transuranics, and even that is way more radioactive than any common isotope of uranium. Its most common isotope has a half-life of about three weeks.

    • Montfort says:

      The Mindblower.

    • ManyCookies says:

      MindMender

    • Hyzenthlay says:

      ThoughtTwizzlers
      Vulcan Logic Pills
      BrainRockets
      Sapios
      SkullBursters

    • Error says:

      I’m late, but: “Kerbal Mind Program”

  12. alexsloat says:

    Bacopa monnieri has been found to improve memory in so many studies I can’t even keep track of all of them.

    I’m not sure if this was intended as comedy or not.

  13. Alex Zavoluk says:

    Taking everything in CerebralX together is more like trying to mountain-climb in a t-shirt and sandals.

    Well, at least that explains why there are so many of these things. There’s clearly tremendous demand!

  14. MrBubu says:

    Scott, you write “[…] so many studies I can’t even keep track of all of them”, so I was wondering, how DO you keep track of studies?
    And also did you just happen to know this stuff about the nootropics in the pack? Or did you have to look up the specifics?

  15. Reasoner says:

    Somewhat off topic, but does anyone know of good heuristics for determining whether two drugs are likely to interact?

    • Spinner says:

      Are they chemically very similar (e.g. an extra methyl group; this is not foolproof)? Do they affect the same receptors? Are they metabolized by the same enzyme? Is significant interaction reported in the scientific literature? Does your doctor say “no” when you suggest taking them together?

  16. Spinner says:

    I was diagnosed with depression a few months ago. I tried out different supplements and medications, trying to stay on the “safe” side. Because I check the scientific literature about interactions, actually am a scientist with lots of lab experience and a certificate that says I know a bit about legal issues and pharmacology (specifically, toxicity), I hope I will be okay.

    I needed to wait 3 months before a specialist appointment, and because I don’t want to risk doing something extremely stupid to get rid of my problem, I am currently doing something slightly less stupid to get rid of my problem: I started taking several supplements that might or might not help. I started several supplements at once, checked to see if something would improve or if side effects would happen, and then remove things with strong unpleasant side effects and add new things. I typically take things at doses where they are supposed to definitely do something. Yes, this means swallowing more than 10 large capsules per day, and I sometimes wonder whether the choking hazard is still small enough to be worth it. I also do mini-experiments where I sometimes take more of one thing and none of another, but those things tend to be difficult with things that don’t work on a short notice.

    I started off with melatonin for sleep (works wonders, even after I reduced the dosage), fish oil (no effect either way), vitamin D3 (no effect either way), caffeine plus L-theanine (little effect due to prior caffeine abuse), and opipramol, an antidepressant that my doc prescribed (no effect).

    Then I added citalopram (as per my doc, no effect), folic acid (supposedly good alongside citalopram; side effect: flatulence which went away when I reduced the dosage), and physical exercise (good positive effect). I also tried curcumin but since many sources say it’s just confusing other results, stopped taking it.

    Next, my doc substituted mirtazapine for opipramol and citalopram and I added L-tyrosine and creatine. This total combo still has little overall effect on my mood. I am now trying lithium (10x less than a typical clinical dose, 10x more than a typical nootropic dose; I am aware can be toxic, trust me, I know what I am doing on the chemical/toxicity side of things) and will be starting 5-HTP as well as cobalamin soon. I think this shotgun approach to depression is better than the other possible shotgun approach to depression, so I will stick with it for now.

    I should definitely get bloodwork done, even though the last one only showed a slight inflammation (sounds familiar). Maybe you (@Scott) have some other ideas for things one could hypothetically try which are not on that list?

    • crh says:

      Scott wrote a post a few years back on Things That Sometimes Help if You’re Depressed. He discusses supplements in section IV, including a few you didn’t mention.

      • Spinner says:

        Thanks! S-adenosyl methionine is pretty expensive over here, as opposed to methionine itself, which appears to be a prodrug and is pretty cheap. I will definitely try that – and also saffron.

        • metacelsus says:

          Biochemically speaking, betaine is important for regenerating S-adenosyl methionine in vivo. Make sure you’re getting enough of it.

          • Spinner says:

            I think I’ll just stick to dietary sources for that one. Cobalamine seems to be useful to homocysteine recycling as well, so I guess I’m fine with that.

    • carvenvisage says:

      I started off with melatonin for sleep (works wonders, even after I reduced the dosage)

      Iirc a couple of years ago the recommended dose was way lower than the typical tablet size it was sold in. (like, ballpark comparison, 0.1mg vs 10mg). If I’m not remembering wrong that might still be the case.

      • Spinner says:

        Thanks for the hint. I quarter my tablets down from 2 mg. Even less might still work, but 500 µg is in line with e.g. gwern’s notes on the topic.

  17. sparktherevolt says:

    “That antidepressant you gave me just made me feel awful!” Oh, well, try a different one

    This has definitely been my experience with psych meds. Often feel like a guinea pig with tapering, cross-tapering, etc. from old to new meds simply hoping something will work. It’s a frustrating ordeal to say the least.

    As far as the combo meds go, what about something like the so-called California Rocket Fuel combo of Mirtazapine and Venlafaxine? That’s a combo reported to have a strong effect, despite working on somewhat similar mechanisms (I am vaguely aware Remeron is not a reuptake inhibitor like the Effexor)?

  18. Deiseach says:

    Listening to the wireless and they are currently playing this song, which seems appropriate to the topic: Who Put The Benzedrine In Mrs Murphy’s Ovaltine?

  19. But what about California Rocket Fuel :P? That seems like a crazy combo. (Although I’m just joking, as that’s a well studied exception from what I understand)

    https://en.wikipedia.org/wiki/Mirtazapine#Interactions

    >Mirtazapine in combination with an SSRI, SNRI, or TCA as an augmentation strategy is considered to be relatively safe and is often employed therapeutically,[42][61][62][63][64] with a combination of venlafaxine and mirtazapine, sometimes referred to as “California rocket fuel”.[65][66]

    • christmansm says:

      The assumption is that for initial treatment of the typical major depressive patient, venlafaxine+mirtazapine is no better than venlafaxine alone or mirtazapine alone. (We’re talking from a medical perspective, where even if you could prove that one gets 47% remission and one gets 43% remission, no one would care.) On the flip side, certain drugs have evidence for augmentation. That is, in patients with a partial response to drug A, adding B to A is better than adding placebo. I’m not entirely clear on how to reconcile those two points.

  20. eyeballfrog says:

    >(sample simplified toy model: what we call “depression” is actually two diseases with identical symptoms, one of which responds to SSRIs and one of which responds to bupropion)

    How close do you think this is to being literally true?

    • Hyzenthlay says:

      How close do you think this is to being literally true?

      I’m not a professional, but personally I’d liken depression to a headache: it’s less a root cause and more a descriptor of a condition that’s probably caused by a wide variety of things, and the cause will differ depending on the person. It’s pretty tautological as a diagnosis.

      “Doctor, my head hurts, what’s wrong with me?” “Clearly you have a headache. Try these drugs.”

      “Doctor, I feel depressed all the time, what’s wrong with me?” “Clearly you have depression. Try these drugs.”

      I’m not knocking psych meds because they are still one of the more useful tools in the arsenal, but it does seem to be more about treating the symptoms in the way that Advil treats pain. Which often works, because depression is a self-feeding loop. I think Scott wrote a post about that once, the gist of which was, “what if it is just a cluster of symptoms with no single underlying thing that causes it?” I think the answer is probably yes.

  21. P. George Stewart says:

    It’s always puzzled me why people take these things that have such namby-pamby “is it real or isn’t it?” effects when you’ve got drugs like marijuana, acid, cocaine, mushrooms, etc., that have really NOTICEABLE effects.

    Or to put it another way, there doesn’t seem to be a reason to take any of these piffling “enhancement” drugs until and unless their effect is as big and bold as those traditional, recreational drugs. If I’m going to take a drug that supposedly makes me smart, I want a big fucking lightbulb to go BING! over my head when I take it. Until then, I’ll leave it out, thank you very much.

    (Actually, I’ve found Modafinil is one of the few of these sorts of things I’ve taken that has a noticeable cognitive enhancement effect – one seems to be able to thread one’s way through complex thoughts or actions in a calm, laser-like fashion. Pretty cool. Also, I think there’s a narrow window when marijuana is quite a powerful cognitive enhancer: if you haven’t taken any for months, so it’s out of your system, you’ve been working away at some artistic or intellectual problem, and you suddenly take some, make sure you have a notebook or dictation equipment to hand, because you’re pretty much guaranteed to get some great insights for a day or so – and then it all turns to pot pretty soon after that, if you keep taking the stuff, when you enter a permanently fugged, confuzzled state. It seems like, for that short period of inspiration, it helps you make connections between things, and then after a while the “making connections” machinery just starts to freewheel uselessly.)

    • John Schilling says:

      It’s always puzzled me why people take these things that have such namby-pamby “is it real or isn’t it?” effects when you’ve got drugs like marijuana, acid, cocaine, mushrooms, etc., that have really NOTICEABLE effects.

      Why do people take drugs that might make them a little bit smarter, when they’ve got drugs that certainly make them a whole lot stupider? A puzzler indeed.

      But if it’s just the biggest and boldest effect you’re after, it’s going to be hard to beat good old fashioned cyanide.

      • P. George Stewart says:

        Sorry, I didn’t make my point clear.

        What I’m saying is that I think people are understandably waiting, holding off, until we have “nootropics” that have a similar level of big, bold effect to the recreational drugs we’re familiar with, and that that’s quite sensible in view of what Scott’s saying (it’s not really worth messing with your system in unknown ways for a trifling, dubious effect).

        Or: we have an example from the recreational drugs of what a “proper” drug effect should be like in terms of strength and noticeable change in the psyche, and until we get that magnitude of effect from nootropics, people are, quite rationally, not going to be interested in messing around with things that have unknown ramifications, for such piffling results.

    • Deiseach says:

      I think you answered your own question, e.g. the effects of marijuana which, if taken once clean, have an initial huge creative burst, but if continued, degenerates into “wow, man, everything is, like, connected, y’know?”

      Things which have that initial huge AHA! effect all too often taper off into tolerance (necessitating larger and larger doses) or lose efficacy.

      Something small, slow and steady works better over the long run. Taking magnesium supplements when I have muscle cramps don’t make me go “Hey, I could run a marathon now!” but I don’t wake up at 3 in the morning needing to jump out of bed to stop my foot bending into a U-shape. Taking it every day doesn’t give me an appreciably different feeling, but if I stop taking them, boy do I notice it one morning at 3 a.m. when I am woken up by my foot trying to turn itself upside-down.

    • esraymond says:

      What counts as a lightbulb going off?

      I can take modafinal/armodafinil legally because my GP has prescribed it for the improvement of my cerebral-palsy-impaired motor control. Sometimes I take it for the nootropic effect.

      Is it a lightbulb going off that I can more or less feel it when the dose reaches by brain, because my relationship to my palsied limbs changes? (So does my mental state, in ways that are subtle but hard to mistake once experienced.) Does a chemically induced state of concentrated flow that lasts all night when I’d normally be sleeping count as a lightbulb going off?

      I find the drug worth the risks. (Yes, I researched them first.) I’ve never judged that to be true about any of the common recreational drugs.

  22. Sam Reuben says:

    There’s a fascinating book that I got my hands on a while back, called “The Substance of Civilization.” (ISBN 1611454018) The topic was, basically, a somewhat loose run-through of human technological history from the perspective of a materials scientist. There was a chapter on clay, one on copper, one on glass, one on iron… you get the idea. The author would run through the basic chemistry of what was going on with each substance, and then describe how traditional practices caused that chemistry to take place.

    What I found so interesting about it was that the people creating these traditional methods had absolutely no way of knowing what on earth was going on, lacking the critical theory such as the periodic table, and were basically experimenting blind and then tabulating results as best they could. And despite that, those ancient craftspeople figured out how to make compounds as finnicky as steel two thousand years ago, using rather pathetic tools, and got some pretty fine results, too.

    The reason I bring this up is that I feel we might be in a somewhat similar place with medicine. In a lot of places, and most especially with psychiatry, it feels like we might just lack the necessary physical and theoretical tools to understand what on earth our medicine is doing. As you say yourself, the methodology with prescription is something like “these things are known to work, let’s try them one after another until one does the trick.” That’s not an exact science, but a craft built upon by experience that takes a lot of messing about before it gets the results it’s looking for. Psychiatry is capital-H HARD.

    But something I do vaguely see in the random nootropic pills and other such pseudoscientific nonsense is the kind of mystical practice that’s found in the really old crafts. Think of metallurgic fluxes, quenching, tempering, and all the other weirdness that goes on in traditional blacksmithing: a lot of it seems more like magic and alchemy than anything based on scientific rigor.

    To bring a story into it, a family friend was feeling a little faint, and decided to try out a traditional Chinese doctor to avoid the steep costs of Western medicine. He brought her in, took her pulse, and without asking about why she came in, told her that she “had no pulse” and that she ought to “eat black foods.” So she went home, looked up some of the black foods (various naturally dark-colored plants), and found that what they had in common was a lot of iron. So she went and bought some iron supplements, and sure enough, symptoms cleared: the doctor had diagnosed her correctly, using an older and more mystical system of knowledge.

    So what I feel like these drug-makers are trying to do is, roughly speaking, the blind experimentation phase of an incomplete science. They don’t know what works, so they’re throwing everything together to try and make a “cure.” Of course, I think you’ve provided an excellent takedown of why they’re unlikely to succeed, and I’ll add one reason of my own into the mix: they aren’t personally connected to nor accountable for the results of their product. There’s little ability to fine-tune the material and see if maybe some mixture of chemicals has a result greater than the sum of its parts, which is presumably what they’re trying to accomplish. (Gunpowder and gasoline are both good analogies for this.) As such, rather than being brave experimentation, these combo-mixes are a bit more on the quackery and snake-oil side.

    All the same, the fact that these folks exist ought to be a little bit humbling. We don’t get quack car-manufacturers, after all.

    • Nornagest says:

      Think of metallurgic fluxes, quenching, tempering, and all the other weirdness that goes on in traditional blacksmithing: a lot of it seems more like magic and alchemy than anything based on scientific rigor.

      A lot of cultures have assigned a short of shamanistic role to blacksmiths, or a talismanic role to their products. Including ours: think of horseshoes hung over barn doors, or iron fences around churchyards.

      The same, of course, is true for medicine.

  23. shakeddown says:

    Taking everything in CerebralX together is more like trying to mountain-climb in a t-shirt and sandals.

    Paul Pedzlot (the first guy to climb grand Teton) apparently did it in a t-shirt and sandals.
    On the other hand, he was also apparently kind of crazy, and later got semi-fired for buying a horse farm with most of his company’s money without approval from his investors. So, uh, take off that what you will.

  24. rationaldebt says:

    I don’t know if it’s appropriate to mention placeboproof here. I think it is. (Disclaimer: am investor) link text

    Personalised nootropics.

  25. Slava Bernat says:

    In the figure for theanine:
    3.7% + 5.6% + 7.4% = 16.7%
    3.9% + 4.8% = 8.7%
    I think ‘almost 20%’ is quite an exaggeration, at least in the second case.

  26. neverargreat says:

    This is obviously some strange usage of the word “brief” that I hadn’t previously been aware of.

    -Arthur Dent, probably.

  27. Happily says:

    …evolution put a lot of work into making your brain as good as possible, and it would be silly if some random molecule could make it much better.

    Evolution had to worry a lot more about calories than we do nowadays. I imagine some molecule combination might increase glucose uptake and brain metabolism. Such a chemical probably isn’t found in ginko leaves.

  28. Anthony says:

    “Neuroxium” seems a poor choice from the “marketing” “department”. When I read past it a little carelessly, it read “neurotoxin”.

  29. The Obsolete Man says:

    Thanks for posting this. I especially like your medical posts.

    I just wanted to throw a shout out to SAM-e. I’ve got seasonal affective disorder and I started taking just 400mg of that in the winter a couple of years ago and it’s been my magic pill. Amazing results. Better than the light box.

    Aniracetam

    I also have had lifelong problems with specific phobia (insects). I was experimentally treated with Keppra (levetiracetam) for this several years ago and had a great response to it (better than a benzo). But, it made me horrifically temperamental and hostile and I had to stop. I’m headed to the health food store this afternoon to see if I can find some aniracetam to see if it might work without side effects. Likely not, but who knows?