Nootropics: indications, effectiveness, list of nootropic drugs

Nootropics are neurometabolic stimulants that have a positive effect on complex psychophysiological processes. The mechanism of their action is associated with the restoration of the bioenergetic and metabolic functions of the neuron, as well as the neurotransmitter systems of the brain. The principle of operation of nootropic drugs, as their name suggests, is aimed at improving the functioning of the parts of the brain that are responsible for learning, memory, attention and other cognitive functions.

Nootropic drugs are drugs containing organic or synthetic active substances, as well as their derivatives, which stimulate the functioning of neurotransmitters. They are grouped into a pharmacotherapeutic group with the ATX code N06BX (“Other psychostimulants and nootropic drugs”).

The term nootropics was coined in 1972 by Romanian chemist, psychologist and Ph.D., Corneliu E. Giurgea, who first synthesized piracetam in 1964. Its therapeutic effect turned out to be the opposite of the chemist's expectations - characteristic of psychostimulants, without the occurrence of non-core actions. This effect still remains a mystery to scientists.

Nootropics used in medicine today are presented in the international drug classification system (Anatomical Therapeutic Chemical, ATC), adopted by the Ministry of Health of the Russian Federation in 2002. Other nootropic drugs are created for use within specific countries and are not introduced into the international market.

Clinical use of nootropics

Psychiatrists and psychotherapists can prescribe nootropic drugs either as monotherapy or in combination with other psychotropic drugs. For example, nootropics are prescribed for the treatment of neuroses, attention deficit hyperactivity disorder (ADHD), depressive disorders and other mood disorders, and schizophrenia.

The purpose of prescribing nootropic drugs is to restore the cognitive functions of the brain responsible for the processes of interaction with received information, in particular:

perception (information, - approx., etc.);
processing;
analysis;
memorization;
storage;
correlations;
conclusions.

Nootropic drugs are also used in other areas of clinical medicine. For example, in pediatrics, where nootropics help restore amino acid deficiency that disrupts protein biosynthesis in the body and metabolic processes in general. In particular, a doctor can prescribe nootropics for children with signs of delayed speech and mental development, mental retardation, and the consequences of perinatal damage to the central nervous system. Doctors of other specializations (speech therapists, neurologists, endocrinologists, gynecologists, urologists, ophthalmologists) can prescribe nootropics depending on the symptoms, including in complex therapy, for various diseases and conditions:

neuroleptic syndrome;
stuttering, logoneurosis;
hyperkinesis, dyskinesia;
urinary disorders;
insomnia and other sleep disorders;
headaches of various etiologies;
dizziness;
seasickness;
open-angle glaucoma;
vascular diseases of the retina;
macular diseases;
diabetic retinopathy;
Alzheimer's disease;
Parkinson's disease;
Huntington's disease;
with the consequences of TBI.

In other words, the range of use of nootropic drugs is wide and is not limited only to mental disorders. The gentle therapeutic mechanism of drugs in this group allows nootropics to be prescribed to newborns and infants, as well as the elderly. It is also important that nootropic drugs are included in the List of vital and essential drugs for medical use.

Without prescriptions

Uncontrolled use of nootropic drugs can lead to serious consequences, so they can only be purchased in online pharmacies with a doctor’s prescription. This group of drugs is not suitable for self-medication, as it requires individual recommendations and the correct dosage.

There are several drugs that can be purchased at pharmacies without a prescription.

For example, L-theanine. This amino acid is present in almost all types of tea, and in Asian countries it is widely used for mental disorders. L-theanine helps with nervous disorders, hyperactivity and sleep disorders. It has a pronounced sedative effect, but does not cause lethargy or drowsiness, and acts gently.

The nootropic helps:

remove anxiety;
improve sleep;
relieve stress;
improve attention.

Gotu Kola is a natural medicine available without a prescription in the form of tablets, capsules, and tinctures. It got its name from the plant that is part of it. Gotu kola works as an antioxidant and brain cognitive enhancer.

The medicine reduces the level of cortisol in the body, reducing attacks of stress, and at the same time increases the amount of serotonin and dopamine. Also helps with stroke and Alzheimer's disease.

Mechanism of action of nootropic drugs

The mechanism of action of nootropics has not been fully studied to date. However, the principle underlying the therapeutic effect, repeatedly confirmed in vivo, is still of interest to researchers in the fields of biochemistry, cytology and pharmacology. In particular, researchers know that the effectiveness of nootropics in clinical medicine is associated with several mechanisms observed at the cellular level in the central nervous system:

enhance the synthesis of ATP and its derivatives;
enhance the process of synaptic transmission in the central nervous system;
enhance the plastic process in the central nervous system by increasing the synthesis of RNA and proteins;
enhance the process of glucose utilization;
have a membrane-stabilizing and antioxidant effect.

Thus, the mechanism of action of nootropic drugs is associated with the restoration of metabolic and bioenergetic processes in the brain, which affect a person’s mood, performance and well-being. A correctly selected nootropic will have the effects necessary for treatment, which manifest themselves over a long period of time, provided that the recommendations of the attending physician are followed (for example, regarding a rational and healthy lifestyle, attending psychotherapy sessions, taking first-line medications).

Rice. 1. Neuron

New generation

In the world of pharmacology, new nootropic drugs are constantly being developed in order to improve their effectiveness and reduce side effects. The main task that pharmacologists set for themselves when creating drugs is to increase the quality and safety of nootropics, as well as to ensure an affordable price.

Modern nootropics differ from earlier developments in many ways. They are less toxic, so new generation drugs have virtually no side effects. You can take them for a long time without taking breaks.

New nootropics are more effective and have a cumulative effect, acting on the problem gradually.

Among the new generation of nootropics, the most popular is Piracetam. It is used in the complex treatment of myocardial infarction, as well as to relieve withdrawal symptoms from alcohol and drug addiction. Doctors often prescribe it for dizziness and dyslexia (impaired reading skills).

There is also an improved version of Piracetam - Aniracetam. This dietary supplement helps improve memory and mental processes of the brain, eliminates anxiety and depression.

The effectiveness of nootropics

The effectiveness of nootropics, in particular, is explained by the therapeutic effect on the neurotransmitter systems of the brain - monoaminergic, cholinergic and glutamatergic. Nootropics help restore the regulation of the synthesis of phospholipids and proteins in neurons, normalize the structure of cell membranes; reduce the oxygen demand of neurons; suppress the formation of free radicals and lipid peroxidation of cell membranes; increase the protection of neurons to adverse factors affecting their proper functioning.

The results of biochemical blood tests and EEG, as well as laboratory experiments using modern microscopes, allow us to visualize the effectiveness of nootropics. For example, the results of an electroencephalogram can clearly see the effect of using nootropics - increased amplitudes of transcallosal evoked potentials, enhanced power spectrum of the EEG of the cortex and hippocampus, an enlarged dominant peak, smoothed interhemispheric asymmetry.

Rice. 2. Visualization of the effect of nootropics on the electroencephalogram

Monoamine neurotransmitters

Classic monoamines include: histamine, adrenaline, dopamine, norepinephrine, serotonin, melatonin. Monoamine neurotransmitters and neuromodulators act as neurotransmitters in the monoaminergic systems of the central nervous system, which regulate a variety of processes in the body, including:

emotional condition;
cognitive activity;
concentration;
ability to remember information;
excitation processes.

Cholinergic neurotransmitters

Cholinergic neurotransmitters in the central nervous system are responsible for the processes of excitation and inhibition in the body. Neurotransmitters of this central nervous system support the autonomous functioning of internal organs and vital processes associated with the work of innervated organs and participate in the transmission of motor activity impulses. Cholinergic deficiency directly affects the imbalance of the central nervous system structures associated with it and can cause the development of:

neurological symptoms;
emotional-volitional pathology.

Glutamatergic neurotransmitters

Glutamatergic neurotransmitters are involved in CNS processes associated with cognitive function - they help process and store information. In addition, these neurotransmitters are responsible for motor coordination, response to pain, and the body’s immune response; are responsible for the quality of transmission of nerve impulses and the state of the nervous system as a whole.

Rice. 3. Central nervous system

No side effects

Nootropics that do not have side effects include two drugs:

Noopept;
Glycine.

Noopept is a nootropic that has neuroprotective properties, i.e. improves blood circulation and metabolic processes in the brain. It is prescribed to eliminate the consequences of traumatic brain injuries and in case of neuropathologies due to oxygen starvation.

In addition, Noopept has a good effect on the human vegetative-vascular system, helping to relieve headaches and attacks of tachycardia.

It has no withdrawal syndrome, and has virtually no effect on internal organs and blood and urine parameters.

The safest and most affordable medicine is Glycine. It is known to everyone as the most harmless and cheapest remedy for restoring memory, mental clarity and well-being. Many schoolchildren take Glycine to prevent neuroses and fatigue during the educational process. It is also prescribed for:

memory impairment;
stroke;
encephalopathy.

Glycine, in fact, is a purified amino acid, has no side effects and is not capable of causing an overdose.

Nootropics for children, adults and the elderly

Currently, clinical studies of nootropics are being conducted in the USA and Europe to identify therapeutic effects that can be used to treat diseases in various fields of medicine. It should be emphasized that we can talk about nootropics with proven effectiveness only in terms of the positive mechanism of their action, recorded by both researchers and doctors in clinical practice.

For example, on February 12, 2010, data from a clinical study on the use of nootropics in the treatment of CNS pathologies was published in the USA (Malykh A., Sadaie R. “Piracetam and piracetam-like drugs: from basic science to novel clinical applications to CNS disorders”). The study demonstrated the neuroprotective effect of the substance, effectiveness in the treatment of cognitive disorders of cerebrovascular and traumatic etiology, as well as associated depressive states. In particular, the study notes the effectiveness of nootropics as part of complex therapy in the treatment of epilepsy.

Similar and other positive effects of using nootropics are noted in many modern clinical studies, the results of which are published in scientific journals and are publicly available on the Internet. In other words, nootropics with proven effectiveness exist, they are presented on the pharmaceutical market, and are actively prescribed by doctors in various fields of medicine, but the final decoding of the therapeutic mechanism of drugs in this group has yet to be learned.

Nootropics for children

Nootropics are used in the treatment of various diseases associated with central nervous system pathology in children. In the first years of a child’s life, they can be prescribed for the prevention and treatment of delayed psycho-speech-motor development; at a later age - to stimulate the activity of the central nervous system systems responsible for concentration, the learning process, memory, and the ability to reproduce information.

Nootropics for children include drugs with dominant or predominant mnestic effects (“true” nootropics):

racetams;
cholinesterase drugs;
neuropeptides and their analogues;
amino acid activators;
neuroprotectors;
activators of brain metabolism;
cerebral vasodilators;
calcium antagonists;
antioxidants;
GABA activators.

Indications for prescribing nootropics for children are:

delayed speech development;
impaired mental function;
cognitive impairment due to organic brain damage (consequences of neuroinfections, head injury, genetic pathology);
mental retardation;
ADHD;
Parkinson's disease;
neurogenic urination disorders;
neurosis-like conditions;
stuttering, predominantly clonic;
asthenic and anxiety-neurotic conditions;
epilepsy (in complex therapy).

Nootropics for adults

Biological therapy for mild, borderline and severe mental disorders may include nootropic drugs. They are prescribed for the occurrence of pathological conditions associated with cognitive functions, mood and sleep. For example, they have a positive effect on the psycho-emotional state and personal effectiveness as an addition to psychotherapeutic treatment, and accelerate the achievement of the desired result.

Nootropics for adults used in mono- and complex therapy of mental disorders:

pyrrolidone derivatives (Nootropil - note, for example, and further);
cyclic derivatives, GABA (Pantogam, Phenibut, Aminalon);
acetylcholine precursors (Deanol);
pyridoxine derivatives (Pyritinol);
Devincan derivatives (Vincamine, Vinpocetine);
neuropeptides (Vasopressin, Oxytocin, Thyroliberin, Cholecystokinin);
antioxidants (Ionol, Mexidol, Tocopherol).

The above nootropics are prescribed for mental disorders arising from vascular diseases of the brain (F00-F09, “Organic, including symptomatic, mental disorders”):

exogenous-organic mental disorders;
transient psychotic disorders;
persistent mental disorders;
psychoorganic disorders;
vascular dementia.

Nootropics for older people

Neuroprotective nootropic therapy for older people is prescribed for Alzheimer's disease, Pick's disease, as well as syndromes including confusion, instability of attention, confusion, disorientation in space and time, memory problems, fragmented thinking, emotional imbalance, fear, anxiety, motor agitation or lethargy, deceptions of perception, sleep disturbances.

Rice. 4. Structure of the nervous system

Side effects

Nootropics have a number of side effects, including:

headache;
insomnia;
dizziness;
skin allergic reactions;
irritability, etc.

Most often, these conditions are associated with nootropic drug withdrawal syndrome. It can be easily avoided if you do not end the course of treatment abruptly, but gradually reduce the dosage.

List of nootropic drugs

Nootropic drugs for the brain can be found in the international Anatomical-Therapeutic-Chemical Classification of Medicines. The list of nootropics in the subsection “Other psychostimulants and nootropic drugs” (N06BX), which is included in the section “Psychostimulants, drugs used for attention deficit hyperactivity disorder, and nootropic drugs” (N06B), contains:

Meclofenoxate;
Pyritinol;
Piracetam;
Deanol;
Fipexide;
Citicoline;
Oxiracetam;
Pirisudanol;
Linopyrdine;
Nisophenone;
Aniracetam;
Acetylcarnitine;
Idebenone;
Prolintane;
Pipradrol;
Pramiracetam;
Adrafinil;
Vinpocetine;
Mebicar;
Phenibut.

The list of nootropics does not end with the names above. On the domestic pharmaceutical markets there are other derivatives, synthetic analogues and drugs that have the properties of nootropics, but are not such. It should be noted that recently there has been a fashion for precisely these “latest generation nootropics” - dietary supplements that can be purchased without a prescription. As a rule, they are complexes of vitamins and substances of plant origin.

In the strict sense of the word, it is not possible to talk about the latest generation of nootropics. It should be understood here that the first nootropic, by definition, was piracetam. Racetams, which have variations in formula and therapeutic effect, and drugs with nootropic properties are still being developed by pharmaceutical companies. Some of them are prohibited in the United States and, in particular, are classified as new psychoactive substances (NPS) in several European countries.

To restore intelligence and memory

Since nootropics have a beneficial effect on cerebral circulation, they are most interesting as an effective means for preserving and restoring intelligence and memory, especially in old age.

Let's briefly look at two natural preparations:

1. 5-HTP is a dietary supplement based on tryptophan, a processed amino acid, that can be purchased without a prescription. It has been proven that a lack of tryptophan in the body negatively affects a person’s emotional state, causes insomnia and nightmares, and also reduces libido and causes sexual disorders.

The 5-NTR nootropic normalizes the level of serotonin, the “hormone of joy,” helping to eliminate all negative conditions caused by its deficiency.

2. Alpha GPC is a fatty acid that the body produces in small quantities. Present in some protein foods. Taking the drug helps:

Preserve and develop brain cells.
Produce growth hormone and improve physical strength.
Increase your focus and maintain a clear mind.
Recovery for patients who have suffered an ischemic stroke.

List of used literature

1. Klitochenko G.V., Malyuzhinskaya N.V. "The use of nootropic drugs in pediatrics."

2. Pichikov A.A., Popov Yu.V. "Anorexia nervosa in adolescent girls: course options, relapse factors and suicidal risk in the early stages of treatment."

3. Davydova O.N., Boldyrev A.A. "Glutamate receptors in cells of the nervous and immune systems."

4. Vostrikov V.V. "The place of piracetam in modern practical medicine."

5. Shabalov N.P., Skoromets A.A., Shumilina A.P. “Nootropic and neuroprotective drugs in pediatric neurological practice.”

6. Malykh A., Sadaie R. “Piracetam and piracetam-like drugs: from basic science to novel clinical applications to CNS disorders.”

7. Calliauw L., Marchau M. “Clinical trial of piracetam in disorders of consciousness due to head injury.”

8. Rybak V.A., Matokhina N.V. “Nootropic drugs in the clinical practice of a neurologist.”

What effects do nootropics have?

The drugs are prescribed for:

improving cerebral circulation;
increasing the energy potential of cells - stimulating the work of mitochondria, activating the synthesis of DNA and RNA, structural proteins;
normalization of carbohydrate metabolism, glucose utilization;
preventing damage to neurons by free radicals.

Taking medications from this group allows you to achieve the following improvements:

memory – patients note improvement in short-term memory, easier memorization;
learning ability - neural connections are formed more easily and are stronger. A person learns new information more easily, it moves faster from short-term to long-term memory;
concentration, attentiveness - it is easier for the patient to concentrate on completing a task, he is less likely to be distracted, and procrastinates less;
thinking, speech - the patient shows signs of sound, critical thinking, expresses thoughts better and easier orally, speaks more clearly, intelligibly;
sleep – insomnia is eliminated or becomes less pronounced, the deep sleep phase is lengthened, awakening is easy and quick;
adaptogenic properties and immunity - the patient is more resistant to the effects of environmental factors, he is less painful, demonstrates good resistance to ARVI, bacterial pathogenic agents;
psychological state - the drugs have a mild sedative, antidepressant effect, eliminate emotional lability, and increase stress resistance.

In addition, hormonal imbalances are indirectly eliminated, metabolism is normalized, and some overweight patients experience moderate weight loss before achieving a normal BMI.

Cost of treatment in our clinic

Service	Price
Ambulatory treatment
Psychiatrist consultation	4 500 ₽
Consultation with a psychotherapist	4 500 ₽
Psychodiagnostics extended	7 000 ₽
Consultation with a psychiatrist at home	6 000 ₽
Treatment in hospital
Delivery to hospital	For free
Standard room	7 700 ₽
3-bed superior room	10 600 ₽
2-bed superior room	13 700 ₽
1 local VIP chamber	19 000 ₽
Doctor's appointment 2 weeks after discharge	For free

Contraindications to taking nootropics

Drugs in this group are considered among the safest. Even with long-term use, longer than 3 months, patients do not experience significant side effects. Dyspeptic disorders and allergic reactions may occur, which resolve on their own after discontinuation of the drug. However, nootropics are prescribed with caution in cases of severe liver and kidney failure, blood clotting disorders, and exacerbation of mental illness. Medicines are not used for the treatment of pregnant and lactating women, and are not prescribed to children under 5 years of age.

Nootropics are not the first choice drugs for the treatment of vascular disorders or neurodegenerative disorders. But if the attending physician recommends taking a medicine from this group, then you need to follow its instructions and not stop taking the medicine at your own discretion or based on the opinions of people around you who are not specialists.

Motivation

The best nootropics for motivation, focus, and alertness target dopamine and sometimes norepinephrine (4). Let's look at one popular Western rating of nootropics based on a sample of 325 people.

So what do we see?

For attention and motivation, compounds banned in Russia are displayed in the tops: Adderall or amphetamine, methylphenidate, modafinil and armodafinil. In the USA they are available by prescription, so they are taken into account here. There is an immediate plus for Ukraine - Modafinil is legal. This smart drug has a good safety profile and it is not clear why it is banned in Russia (5).

Some studies clearly state that the side effects of modafinil are similar to placebo, and the effectiveness in some respects is higher than that of amphetamine (6).

So for Western countries and Ukraine we can immediately name the top nootropic specifically for focus and motivation - Modafinil.

But look what comes next - Phenylpiracetam and Caffeine. This is already legal in Russia! If you trust this rating, then according to people’s reviews, the effects are not far from prohibited. Which is weird by the way! We have a popular opinion that nootropics are dummies. This means that the percentage of efficiency should be the same, judging by logic. Throw a die 1000 times and each side will land approximately the same number of times. If everything is equally useless, then all smartdrags will score an equal number of points. But we see a clear gradation, where supposedly empty Semax and Oxiracetam are surrounded by microdoses of LSD, and Phenylpiracetam, formerly known as Phenotropil, is breathing down the back of Amphetamine.

Summary: Top – Modafinil, if legal in your country. If not, then pay attention to phenylpiracetam, caffeine, oxiracetam and Semax.

Here's a fresh meta-analysis, not a survey of nootropics lovers, that says modafinil may be useful for healthy people, not just those with abnormalities (7). And in Italy a couple of months ago they became concerned about the ethics of using methylphenidate and modafinil, since these things improve working memory and concentration in healthy people (8). Perhaps our biohacker from Silicon Valley, Sergei Fage, was right when he said that the country that first starts distributing Modafinil to its population for free will receive a competitive advantage in the economy. Let me remind you that it is prohibited in Russia.

Modern view of nootropic therapy

The extreme importance of drugs with nootropic effects is evidenced by data on the widespread use of them: according to WHO statistics, a third of the adult population in Europe and Japan takes nootropics, and they can rightfully be classified as vital drugs [1]. The word “nootropic” comes from the Greek “noos” - thinking, mind; “tropos” – direction, change. The first nootropic, piracetam, was synthesized in Belgium in 1963. Based on the fact that piracetam is a cyclic analogue of the main inhibitory neurotransmitter of the nervous system, GABA, it was assumed that it would have antikinetic properties. However, subsequent studies conducted by Cornelia Giurgea in 1972 found that piracetam improves cognitive function and memory [2]. The history of the use of nootropic drugs began with the discovery of piracetam, which was a fundamentally new stage in the development of psychopharmacotherapy and led to the formation of the nootropic concept. After the successful introduction of piracetam into medical practice, other drugs of the pyrrolidone series began to appear. The study of piracetam not only enriched the clinic with a new effective drug, but also gave impetus to the search and creation of other highly active psychotropic compounds with a similar type of action, both among pyrrolidone derivatives and among other chemical structures [3]. Research is still ongoing in various countries around the world and many pharmaceutical companies are searching for new nootropic drugs. The family of pyrrolidone nootropics includes more than 10 original drugs, of which the best known are piracetam, oxiracetam, aniracetam, etiracetam and pramiracetam. Due to their common chemical structure, these nootropics are called racetams. Following them, other families of nootropic drugs appeared, including cholinergic, GABAergic, peptidergic and other substances, which significantly expanded the understanding of nootropics. But despite this, piracetam remains the reference drug for the entire group of these drugs. In addition, components of many medicinal plants - ginseng, Eleutherococcus, Schisandra, etc. - have a nootropic effect. [1]. With the advent of nootropics, for the first time, the possibility of targeted pharmacological effects on cognitive functions and manifestations of mental and neurological deficits that develop as a result of organic brain damage became possible. The main characteristic of nootropics is their activating specific effect on the higher integrative functions of the brain and the restoration of disorders of higher nervous activity. Thus, nootropic drugs lead to improved memory, attention, thinking, orientation, expansion of the scope of perception, increased ability to analyze and assess the situation, and make decisions. The effect of drugs is determined by their ability to facilitate learning processes, promote the assimilation of new information and its analysis, improve the quality of memorization, as well as increase the brain’s resistance to damaging factors in the event of stressful situations (extreme physical activity, hypoxia). In addition, the main manifestations of the nootropic effect are increased motivation and improved switching from one type of activity to another [4]. Nootropics increase cortico-subcortical control and improve information exchange in the brain, have a positive effect on the formation and reproduction of a memory trace, facilitate the restoration of brain tissue in case of damage of various origins, and stimulate intellectual activity. Nootropics facilitate the transmission of excitation through the corpus callosum both between the superficial and between the deep layers of the cerebral cortex, activate cortical apical dendrites, which leads to functional synaptic facilitation (underlies learning and memory). Apparently, under the influence of nootropics, a shift occurs towards the optimal ratio and balance of the processes of excitation and inhibition in the central nervous system, the organization of the basic rhythmic activity of the brain improves, and the level of wakefulness increases [5]. Nootropic drugs can improve cognitive (cognitive) functions both in healthy people and, in particular, those impaired by various diseases. The ability to improve cognitive functions has given rise to calling nootropic drugs “cognitive stimulants.” In general, the spectrum of clinical activity of nootropics is diverse and is represented by the following main effects [6,7]: 1) the nootropic effect itself, i.e. improvement of intellectual abilities (impact on impaired higher cortical functions, level of judgment); 2) mnemotropic effect (improving memory, increasing learning success); 3) increasing the level of wakefulness, clarity of consciousness (impact on the state of depressed and darkened consciousness); 4) adaptogenic effect (increasing tolerance to various exogenous and psychogenic adverse effects, including medications, increasing the body’s overall resistance to extreme factors); 5) anti-asthenic effect (reduction of the phenomena of weakness, lethargy, exhaustion, phenomena of mental and physical asthenia); 6) psychostimulating effect (influence on apathy, physical inactivity, hypobulia, aspontaneity, poverty of motives, mental inertia, motor and intellectual retardation); 7) anxiolytic (tranquilizing) effect (reducing feelings of anxiety, emotional tension); sedative effect, reduction of irritability and emotional excitability; 9) antidepressant effect; 10) vegetative effect (effect on headache, dizziness, cerebrasthenic syndrome); 11) antikinetic effect; 12) antiparkinsonian effect; 13) antiepileptic effect, influence on epileptic paroxysmal activity. For different drugs in the nootropic group, the combination and degree of severity of the components of the therapeutic effect are not the same. Of the above properties, some are inherent in all nootropic drugs, others are selective. In recent years, much new data has been obtained on the mechanisms of action and clinical effects of nootropic drugs. Their therapeutic action is based on several mechanisms [2,4,8,9,10,11,12,13]: – improving the energy state of neurons, enhancing the synthesis and turnover of ATP (due to activation of adenylate cyclase, which catalyzes the conversion of ADP to ATP); – accelerating the penetration of glucose through the blood-brain barrier and increasing its absorption by brain cells, especially in the cerebral cortex; – stimulation of redox processes; – improving the exchange of nucleic acids in nerve cells, enhancing protein synthesis (activation of plastic processes in the central nervous system); – strengthening of synaptic transmission processes in the central nervous system, normalization of neurotransmitter disorders (the effect of a number of nootropic drugs is mediated through the neurotransmitter systems of the brain, among which the most important are monoaminergic, cholinergic, glutamatergic, GABAergic); – membrane-stabilizing effect (regulation of the synthesis of phospholipids and proteins in nerve cells and erythrocytes, stabilization and normalization of the fluid properties of cell membranes, increased membrane fluidity during aging, normalization of the quantitative ratio of individual phospholipid fractions, stabilization of the functional activity of membrane-bound enzymes); – antioxidant, protection of cell membranes (removal of free radicals, inhibition of lipid peroxidation of cell membranes, inhibition of lysosomal enzymes); – antihypoxic (reducing the oxygen demand of neurons under conditions of hypoxia, adapting the effect on brain structures in conditions of deficiency in the formation of macroergs and ensuring the preservation of neuronal functions); – neuroprotective effect (increasing the resistance of nerve cells to the effects of adverse factors of various origins); – improvement of reparative processes in case of brain damage of various origins; – improvement of microcirculation in the brain by improving the deformability of erythrocytes, optimizing the passage of erythrocytes through the vessels of the microvasculature and inhibiting platelet aggregation; – blocking pathological bioelectrical impulses, stopping foci of epileptic and pathological neuronal activity, which manifests itself incl. antikinetic effect. Nootropics, thus, have multiple points of application, involving a large number of anatomical and functional systems in the mechanism of their action - cell metabolism, neurotransmitter, vascular, rheological, etc. [14]. The most important thing in the mechanism of their action is the influence on metabolic and bioenergetic processes in the nerve cell. In recent years, the mechanisms of action of nootropic drugs have been intensively studied at the neurophysiological level. The influence of nootropics on late components (400–800 ms) of evoked potentials in people when solving problems has been shown, which is considered as direct confirmation of the effect of nootropics on cognitive processes [5]. It is known that the mechanism of action of nootropic drugs has a pronounced cortical component [15]. The most characteristic pharmacoelectroencephalographic effects of nootropics, both in healthy volunteers and in patients, are an increase in the power of the ?-rhythm with increased regularity and duration, an increase in ?-activity (in some cases), a decrease in the power of ?- and ?-rhythms, as well as some increase in the average EEG frequency and ?-rhythm (typical for some pathological conditions). Smoothing of interhemispheric asymmetry indicates facilitation of the irradiation of excitation within and between the hemispheres of the brain. Under the influence of nootropics, a restructuring of the EEG power spectra occurs, corresponding to an increase in the level of spatial synchronization of brain biopotentials, which is a necessary component and condition for the formation of conditioned reflexes [5,16]. These data suggest that under the influence of nootropic drugs, changes occur on the EEG corresponding to an increase in the level of wakefulness, and also that the nootropic effect is associated with an improvement in the organization of the rhythmic activity of the brain [16]. Among specialists involved in research in the field of nootropic drugs, there is still no consensus on which group of drugs they should be classified into. For example, in France, nootropics are classified as psychotropic drugs, in Japan - as central nervous system stimulants, in Italy - as analeptics [17]. In addition, within the group of nootropics itself there is also no unified classification, which is due to the heterogeneity of this group of substances both in chemical structure and mechanism of action. As noted by T.A. Voronina, S.B. Seredenin (1998), a serious problem has arisen that for many substances classified as nootropic drugs, memory improvement is not always the dominant component of the spectrum of pharmacological activity [11]. The nootropic effect of a drug can be primary - due to its direct effect on the nerve cell. However, it is known that it is possible to improve the higher integrative functions of the brain and the metabolism of neurons, and reduce the influence of damaging factors on the nervous system indirectly (for example, by improving cerebral circulation and microcirculation, antiplatelet, antihypoxic effects, changing the metabolism of a number of neurotransmitters, etc.). In this case, it is more correct to talk about the “nootropic effect” rather than the “nootropic effect” of drugs [2]. In connection with the above, a number of scientists propose to distinguish a group of “true” nootropic drugs, for which the ability to improve mnestic functions is the main, and sometimes the only effect, and a group of nootropic drugs of mixed action (“untrue” nootropic drugs), in which the mnestic effect is complemented by and often overlaps with other, no less significant manifestations of action [11]. The multicomponent nature of the action of these drugs is reflected in the many synonyms for their designation - “neuroprotectors”, neurodynamic, neuroregulatory, neurotrophic, neuroanabolic or eutotrophic agents, “neurometabolic cerebroprotectors”, cerebroactivators. The terms “metabolic brain protection” and “neurotropic therapy” are also used. These definitions reflect the general property of drugs - the ability to stimulate metabolic processes in nervous tissue (especially in various disorders), optimizing the level of metabolism. The most complete modern classification of substances with nootropic effects was proposed by T.A. Voronina, S.B. Seredenin [11], in which all drugs are divided into two large groups. Classification of substances with nootropic effects (1998): 1. Nootropic drugs with a dominant mnestic effect. 1.1. Pyrrolidone nootropic drugs (racetams), predominantly of metabolic action (piracetam, oxiracetam, aniracetam, etiracetam, isocetam, etc.). 1.2. Cholinesterase drugs. 1.2.1. Strengthening the synthesis of acetylcholine and its release (choline chloride, phosphotidyl-serine, lecithin, acetyl-L-carnitine, etc.). 1.2.2. Agonists of cholinergic receptors (oxotremorine, bethanechol, spiropiperidines, etc.). 1.2.3. Acetylcholinesterase inhibitors (physostigmine, tacrine, amiridine, galantamine, ertastigmine, etc.). 1.2.4. Substances with a mixed mechanism of action (demanol, aceglutamate, nerve growth factor, bifemalan, etc.). 1.3. Neuropeptides and their analogs (ACTH, ebiratide, somatostatin, vasopressin, thyrotropin-releasing hormone, substance P, angiotensin II, cholecystokinin 8, peptide analogues of piracetam, etc.). 1.4. Substances that affect the system of stimulating amino acids (glutamic acid, milacemide, glycine, D-cycloserine, nooglutyl). 2. Nootropic drugs of mixed action with a wide range of effects (“neuroprotectors”). 2.1. Activators of brain metabolism (actovegin, instenon, acetyl-L-carnitine, phosphatidylserine, homopantothenic acid esters, xanthine derivatives, etc.). 2.2. Cerebral vasodilators (vinpocetine, oxybral, nicergoline, vinconate, etc.). 2.3. Calcium antagonists (nimodipine, cinnarizine, flunarizine, etc.). 2.4. Antioxidants (mexidol, exiphon, pyritinol, atherovit, meclofenoxate, tocopherol). 2.5. Substances affecting the GABA system (gammalon, pantogam, picamilon, ligam, nicotinamide, phenibut, phenotropil, sodium hydroxybutyrate, neurobutal, etc.). 2.6. Substances from different groups (ethimizole, orotic acid, methyl glucoorotate, oxymetacyl, beglimin, cerebrocrast, ginseng, instenon, gingko biloba extract, lemongrass, etc.). Despite the variety of drugs presented, they all have a positive effect on memory. Initially, nootropics were used primarily in the treatment of brain dysfunction in elderly patients with organic brain syndrome. In recent years, they have become widely used in various fields of medicine, including geriatric and pediatric practice, neurology, psychiatry and narcology [2,3,7,11,18]. Considering that nootropic drugs are characterized by a wide range of pharmacological properties, relatively low toxicity, and do not have pronounced side effects, the indications for their use have a clear tendency to expand. The main area of application of nootropics in healthy people is the prevention of stressful conditions and maintaining performance in critical situations, with natural aging, with a decrease in the general level of human activity that occurs under conditions such as intoxication, overwork, sleep deprivation, pain syndromes, stress, as an adaptogenic actions under increased physical and intellectual stress. Many nootropic drugs are used for “cover therapy” to relieve severe “withdrawal syndrome”, as well as as anti-alcohol drugs that accelerate recovery from delirium and improve the course of the post-delirium state. Thus, a feature of the use of nootropic drugs is the possibility of their use equally for both sick and healthy people. In pediatrics, indications for prescribing nootropics are delayed mental, motor and speech development, mental retardation of various etiologies, neurocirculatory dysfunction on a residual organic background, the consequences of perinatal encephalopathy and encephalopathies of various origins (posthypoxic, post-traumatic, somatogenic), cerebral palsy, difficulties in learning in children with minimal brain dysfunction (absent-mindedness, mental fatigue, attention deficit hyperactivity disorder, dyslexia). Nootropic drugs can be used in patients with various pathologies of the central nervous system. The list of conditions for which there are violations of basic cognitive functions and for which nootropics are used (mainly as a component of complex therapy) is very wide: - vascular diseases of the brain, both acute (stroke) and chronic cerebrovascular insufficiency (dyscirculatory encephalopathy and one of its the most severe manifestations are vascular dementia); - traumatic damage to the brain (acute stage and consequences of cranial -brain injury); - lesions of the brain of a neurodegenerative nature, dementia in Alzheimer's disease; - impaired brain functions in alcoholism, including with abstinance and psychoorganic syndrome of alcohol genesis; - coma states of vascular, traumatic or toxic genesis; - acute neuroinfections and the rehabilitation period after the infectious and inflammatory diseases of the brain. In addition to organic brain diseases, these drugs are also used for functional disorders, such as vegetative dystonia, asthenic syndrome (decrease in concentration of attention, emotional lability and other manifestations of asthenic syndrome of various genesis), cephalgia (migraine, head pain), chronic chronic syndrome fatigue ”, neurotic and neurosis -like disorder, astheno -depressive and depressive syndrome, as well as to improve mental performance in intellectual -mnestic disorders (impaired memory, concentration, thinking). Some nootropes are used to correct extrapyramidal disorders for antipsychotic syndrome, stuttering, hyperkinesis, urination disorders, sleep disturbances, dizziness of various genesis, for the prevention of motion sickness. The rate of onset of nootropic effects differs in the treatment of urgent conditions and in the treatment of chronic diseases. In acute states, nootropics give a quick positive effect (for example, a way out of a state of impaired consciousness). In a situation of chronic disorders, a long -term intake of nootropic drugs is required. Usually they are prescribed courses lasting up to 3-4 months. The effectiveness of the drug can only be judged at the end of the full course. In clinical practice, nootropics rarely cause any side effects. However, with an overdose, despite their low toxicity, symptoms such as sleep disturbance, fluctuations in blood pressure, irritability, anxiety, headache, nausea, and the revival of psychopathological symptoms may appear. However, these manifestations quickly disappear with a decrease in the dosage. Also, when side effects appear, it is proposed to change this drug to a nootropic of a different class. With insufficient effectiveness of the drug, but it is possible to use a combination of two nootropic agents with different action mechanisms with good tolerance. When prescribing the drug, preference is given to medium dosages, while nootropics with a psychostimulating effect (piracetam, pyrithinol, Meklofenoksat, etc.) are desirable to prescribe in the morning. It should also be noted that the effectiveness of therapy depends on the age of the patient: the younger he is, the better the answer to treatment [11]. In addition, nootropes are characterized by good compatibility with drugs of other pharmacological groups. A wide range of nootropic drugs and a proven positive clinical effect of their use allows that these drugs are a necessary component of modern pathogenetic medicinal therapy of a wide variety of conditions. Considering that the need for nootropics in clinical practice is great, obtaining and introducing into practice new highly effective nootropic drugs is an important and urgent task. Recently, in connection with the decoding of the human genome, the peptide direction in drugs began to develop rapidly [19]. In addition, peptide medicines are interesting as potential nootropists, since neuropeptides play the main role in the regulation of cognitive functions and in most cases peptide preparations are more effective than drugs of other chemical groups [20.11, 10]. Among the analogues of piracetam in the Research Institute of Pharmacology of the RAMS, the most active compound was created, which is a derivative of amino acid - Noopepte (ethyl ether N - phenilecetyl - l - prolillycin). Noopept has significant advantages over existing nootropes: it shows a pronounced mnestic and anti -amnestic activity in significantly smaller doses (1000 times less than for piracetam) is a small toxic compound and has no side effects [21]. Unlike the applied peptides, only 2 amino acids are included in the structure of Noopept. In this regard, such peptides are more resistant to enzymes, more bioavailable [19, 21]. The experiment shows that Noopepte favorably affects all phases of the memory process (in contrast to piracetam, which affects mainly the phase of information input) [21]. He showed anti -amnestic activity on a wide set of models of cognitive deficiency, a distinct anxiolytic effect [21], an increase in the resistance of the body during trauma and ischemia of the brain, hypoxia and aging [11], the absence of the “cancellation syndrome”, he discovered, along with nootropic, a number of useful additional properties , such as neuroprotective, antioxidant [22,21], antitrombotic, did not show any side effects and, finally, demonstrated extremely low toxicity [23]. In addition, the anti -inflammatory properties of Noopepte were shown on the models of acute non -immune and chronic immune inflammation, which is probably due to its antioxidant effect and impact on the system of pro -inflammatory cytokines [22, 24]. According to pharmacokinetic studies, noocopept, when administered orally, is quickly absorbed and enters into a systemic bloodstream unchanged, and then penetrates the brain. At the same time, the content of its active metabolite in the brain of the cyclo -propriet, which has anti -amnestic activity significantly exceeds those in plasma [21]. This indicates the tropiness of the drug to brain tissue and a fairly high specific bioavailability (99%) [23,21]. When studying the mechanism of action of the substance, it was found that Noopept realizes its effects through holino- and glutamatergic mediator systems of the brain [21,15,3]. The indicated set of properties of Noopepte served as the basis for creating its dosage form - tablets (10 mg with a notch, which allows the drug to also be used at a dose of 5 mg). In clinical studies, the drug showed its safety, good tolerance and effectiveness as a means of correction of cognitive disorders in young and elderly patients in organic diseases of the brain of cerebral -vascular and traumatic genesis [25,26]. The effect of Noopeptic is manifested in improving functions such as thinking, attention and short -term memory, in a combination of “soft” stimulating, anxiolytic effect and vegetostabilizing effects, it does not cause sleep disturbance [26]. Data on the potential efficiency of Noopepte was obtained in case of violations of neurodegenerative genesis, taking into account its anti -inflammatory and immunomodulating properties [24]. With a single use, Noopept showed a statistically significant improvement in the integral indicator of the success of operator activities [26]. The analysis of the dynamics of the EEG showed that the action of Noopept corresponds to an increase in the power of the A -rhythm and the weakening of the frequencies of the D -rhythm. On the EEG -profile of the drug, an increase in the power of the B --ritma in the frontal sections is noted. Thus, according to the main EEG -indicators, Noopept has nootropic effects [26]. The drug is taken inside, after eating. The initial dose is 20 mg, divided into 2 doses during the day (in the morning and day). With insufficient efficiency and good tolerance, the dose is increased to 30 mg, divided into 3 doses during the day. You should not take the drug later than 18 hours. Recommended treatment course 1.5-3 months. If necessary, it is possible to conduct a second course after 1 month. The given data indicate that Noopept is an undoubted achievement of modern pharmacology, and thanks to the unique structure, high efficiency and multilateral action, it is advisable to recommend it as a promising means of pathogenetic therapy of diseases requiring the prescription of nootropics. Literature 1. Akhankina V.I., Voronina T.A. The spectrum of pharmacological effects of phenotropil. // Farmatek, 2005, No. 13 [108], p. 19–25. 2. Shabalov N.P., Skoromotets A.A., Shumilina A.P., Platonova T.N., Seredov Yu.V., Fedorov O.A. Nootropic and neuroprotective drugs in children's neurological practice. // Bulletin of the Russian Military Medical Academy, 2001, No. 1 (5), pp. 24–29. 3. Boyko S.S., Vitskova G.Yu., Zherdev V.P. Pharmacokinetics of nootropic drugs. // Experimental and clinical pharmacology, 1997, Volume 60, No. 6, pp. 60–70. 4. Voronina T.A. Hypoxia and memory. Features of the effects and use of nootropic drugs. // Bulletin of the Russian AMN, 2000, No. 9, p. 27–34. 5. Krapivin S.V. Neurophysiological mechanisms of the action of nootropic drugs. // Journal of Neurology and Psychiatry named after S.S. Korsakova, 1993, T.93, No. 4, p. 104–107. 6. Kirichik L.T., Samardakova G.A. Clinical pharmacology and use of nootropics and psychostimulants. // Kharkov Medical Journal, 1996, No. 4, p. 33–35. 7. Davydova I.A. Clinical and pharmacological patterns of therapeutic effect of drugs with nootropic properties. // Diss. Ph.D. honey. Sciences., Moscow, 2001, 167 p. 8. Voronina T.A., Seredenin SB Nootropic drugs, achievements and new problems. // Experimental and clinical pharmacology, 1998, t.61, No. 4, p. 3–9. 9. Voronina T.A. Modern problems of the pharmacology of nootropics: condition and prospects. // Pharmacology and toxicology, 1991, T.54, No. 2, p. 6–11. 10. Krestyun V.I., Rozhkovsky Y.V. The molecular -biochemical mechanisms of the action of nootropic agents. // Bulletin of experimental biology and medicine, 1990, t.110, No. 7, p. 58–60. 11. Nurmukhametov R. Nootropic drugs in modern neurology. // Russian Medical Journal, 1999, No. 2, p. 7. 12. Semina I.G., Semina I.I., Azancheev N.M., Shilovskaya E.V., Tarasova R.I., Pavlov V.A., Ilyasov A.V., Fedotov V.D. On the issue of membrane mechanisms of the action of nootropic drugs. // Biological membranes, 2001, T.18, No. 5, p. 363–369. 13. Windisch M. Cognition - Enhancing (Nootropic) Drugs. // Brain Mechanisms and Psychotropic Drugs. - Ny et al. : CRC Press, 1996. - P. 239–257. 14. Avedisova A.S., Akhapkin R.V., Akhakina V.I., Verigo N.N. Analysis of foreign studies of nootropic drugs (for example piracetam). // Russian Psychiatric Journal, 2001, No. 1, P.46–54. 15. Yasnetsov V.V., Pravdivtsev V.A., Krylova I.N., Kozlov S.B., Korornova N.A., Ivanov Yu.V., Vik.V. Yasnnetsov. The influence of nootropics on the impulse activity of the neurons of the cerebral cortex.// Experimental and clinical pharmacology, 2001, Volume 64, No. 6, p. 3–6. 16. Voronina T.A., Krapivin S.V. New aspects of the neurophysiological mechanism of the action of nootropic drugs. // Pharmacology and toxicology, 1986, No. 5, p. 721–724. 17. Nakubullina N.M. Modern achievements in the development of neurotropic tools. // Kazan Medical Journal, 2000, T.81, No. 2, p.141–143. 18. Croisile B., Trillet M., Fondarai J. et. al. Neurology. --1993. --vol.43. - 2.p.301–305. 19. Gorpinchenko N.V. Studies in the field of pharmaceutical analysis of the new nootropic drug of the peptide structure. Diss. Ph.D. honey. Sci. Moscow, 2001, 157 p. 20. Korotkov S.A. Experimental study of pharmacokintetics and biotransformation of the new dipeptide nootropic noopepate. Author's abstract. dis. for the job application scientist step. Ph.D. biol. Sci. Moscow, 2003, 26 p. 21. Ostrovskaya R.U., Gudasheva T.A., Voronina T.A., Seredenin SB Original nootropic and neuroprotective drug Noopept. // Experimental and clinical pharmacology, 2002, volume 65, No. 5, p. 66–72. 22. Kovalenko L.P., MiMedova M.G., Alekseeva S.V., Gudasheva T.A., Ostrovskaya R. U., Seredenin S. B. The anti -inflammatory properties of Noopept (dipeptide nootropic GVS --111). // Experimental and clinical pharmacology, 2002, No. 2, p.53–55. 23. Mirzoev T.Kh. Pharmacodynamic characteristics of the drug Noopept (GVS -111). Abstract dissens. On SOSK. uch. Art. Ph.D. honey. Sci. Moscow, 2001, 22 p. 24. Arsenyeva K.E. Nootropic drugs in the treatment of cerebrovascular diseases. // Russian Medical Journal, 2007, No. 4, p. 225. 25. Avedisova A.S., Yastrebov D.V. Comparative efficiency of noopept and piracetam in the treatment of asthenic disorders and disorders of organic genesis. // Russian Medical Journal, 2007, No. 5, P.434. 26. Itnumov G.G., Teleshova E.S., Synyakov S.A., Bochkarev V.K., Davydova I.A. The results of the clinical study of the new peptide drug Noopept in patients with psycho -organic disorders. // Psychiatry and psychopharmacotherapy, 2007, t.9, No. 2.

Who are the drugs indicated for?

Now nootropics are prescribed to adults and children, because the range of their use is very wide. Medicines increase physical activity and endurance, therefore they are indicated for athletes and people involved in physical labor. They will help an elderly person correct age-related changes in memory, intelligence, and impairments due to dementia.

Schoolchildren and students will find medications useful for better assimilation of information during intense workloads and exams.

Nootropics are most often recommended for children for mental retardation, as well as for various disorders of the nervous system.

What other indications exist for taking medications? This:

chronic vascular insufficiency;
suffered a stroke and head injury;
neuroses, neurotic disorders;
vegetative-vascular dystonia;
stressful conditions, depression;
organic brain diseases;
alcoholism, drug addiction;
insomnia;
mental illness.

Even with urinary disorders that are caused by nervous disorders, nootropics can help. They are also prescribed for anemia, diseases of the eyes and spine.

Anxiety

Here we move into the territory of Phenibut, Ashwagandha and Selank.

Adherents of evidence-based medicine are no longer too zealous in criticizing Phenibut, as there are more and more reports that this substance has narcotic potential, when taken long-term in large doses, in addition to a pronounced sedative and nootropic effect (9, 10). The substance is a dummy, obviously cannot do that. Ashwagandha gets it, it’s strange why. Here is an Indian review of this supplement that talks about nootropic neuroprotective effects (11). India is the largest supplier of this additive, there may be a conflict of interest. Then here you go Spain, less than a month ago, increasing the volume of maximum oxygen consumption is useful not only in sports (12). Or here's an Iranian report from last month that ashwagandha is a good support to primary therapy for generalized anxiety disorder (13). There was a release on Evidence-Based Medicine and Nootropics in January.

Okay, what about that anxiety survey?

In general, again there are no equal scores for all substances, again a distribution that excludes a random effect. And the leader is phenibut, not far from it is kava (the additive is prohibited in Russia), then CBD oil is a component from marijuana (also prohibited in Russia).

Thus, for anxious individuals, good smart drugs would be: phenibut, Selank, ashwagandha, l-theanine.