Q: What are nootropic drugs, and do they really boost brainpower?

A: Cognition-enhancing drugs known as nootropics some prescription, some over-the-counter, others available on a worldwide gray market of private sellers are said to improve memory, attention, creativity and motivation.

The word "nootropic" was coined in 1972 by a Romanian scientist, Corneliu Giurgea, who combined the Greek words for "mind" and "bending." Caffeine and nicotine can be considered mild nootropics, while prescription Ritalin, Adderall and Provigil (modafinil, a drug for treating narcolepsy) lie at the far end of the spectrum when prescribed off-label as cognitive enhancers. Even microdosing of LSD is increasingly viewed as a means to greater productivity.

But when aficionados talk about nootropics, they usually refer to substances that have supposedly few side effects and low toxicity. Most often they mean piracetam, which Giurgea first synthesized in 1964 and which is approved for therapeutic use in dozens of countries for use in adults and the elderly. Not so in the United States, however, where officially it can be sold only for research purposes.

Piracetam is well studied and is credited by its users with boosting their memory, sharpening their focus, heightening their immune system, even bettering their personalities. But it's only one of many formulations in the racetam drug family. Newer ones include aniracetam, phenylpiracetam and oxiracetam. All are available online, where their efficacy and safety are debated and reviewed on message boards and in podcasts.

A number of companies now market nootropic "stacks," or formulas, some of which include piracetam, herbal remedies, amino acids and citicoline, a naturally occurring brain chemical that can be taken orally as a supplement, intravenously or as a shot.

Because they are sold as nutritional supplements and natural products that refrain from making health claims, they avoid close government scrutiny.

"Who doesn't want to maximize their cognitive ability?" asks Murali Doraiswamy, who has led several trials of cognitive enhancers at Duke University Health System and has been an adviser to pharmaceutical and supplement manufacturers as well as the Food and Drug Administration. He attributes the demand to an increasingly knowledge-based society that values mental quickness and agility above all else.

But while some studies have found short-term benefits, Doraiswamy says there is no evidence that what are commonly known as smart drugs of any type improve thinking or productivity over the long run.

"There's a sizable demand, but the hype around efficacy far exceeds available evidence," notes Doraiswamy, adding that, for healthy young people such as Silicon Valley go-getters, "it's a zero-sum game. That's because when you up one circuit in the brain, you're probably impairing another system."

Although piracetam has a history of "relatively few side effects," it has fallen far short of its initial promise for treating any of the illnesses associated with cognitive decline, according to Lon Schneider, a professor of psychiatry and behavioral sciences at the Keck School of Medicine at the University of Southern California. "We don't use it at all and never have."

As for newer nootropic drugs, there are unknown risks.

"Piracetam has been studied for decades," says cognitive neuroscientist Andrew Hill, the founder of a neurofeedback company in Los Angeles called Peak Brain Institute. But some of the newer compounds "are things that some random editor found in a scientific article, copied the formula down and sent it to China and had a bulk powder developed three months later that they're selling. Please don't take it, people!"

Sara Solovitch, The Washington Post

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Medical Q&A: So-called smart drugs can turn out to be a dumb idea - Sarasota Herald-Tribune