cognitive enhancement drugs in med school

Discussion in 'Medical Students - MD' started by WellWornLad, Jun 20, 2008.

  1. WellWornLad

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    I was curious whether "cognitive enhancement" (nootropic) drugs are becoming prevalent in med school - specifically, modafinil. I've never tried it but I have been curious for some time if the benefits are really substantial, and going into med school the issue has become rather salient for me.

    That said, I imagine there is some controversy - is it unfair to the rest of the class? I'm not competitive by any stretch of the imagination, and I'd rather drop the matter than make classmates uncomfortable or angry. On a personal level, however, anything that might make me more competent and knowledgeable as a physician would seem to be worth considering.

    So, has anyone tried cognitive enhancers? Were they effective? Does anyone have strong opinions on their use during M1/M2? Has anyone been prescribed monafidil for shift work sleep disorder as an M3 or beyond?
     
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  3. Law2Doc

    Law2Doc 5K+ Member
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    You only want to be on a prescription drug if you have a medical need. ALL meds have side effects. Some less benign than others. And it would be too easy to abuse such a prescription. Don't go down this road. In most cases they are really just a crutch for someone who could walk on their own if they put their mind to it. Sure, some of the original proponents of the 100+ hour work week were coke-heads, but we should learn from their mistakes, not follow their path. you are entering a profession where it is unethical to use these or prescribe these where there is no MEDICAL need. Not a good way to start off your professional career.
     
  4. aiLoveJuh

    aiLoveJuh ai em suh pa!
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    Doesn't everyone wish they had more energy sometimes? I know I do.

    "you are entering a profession where it is unethical to use these or prescribe these where there is no MEDICAL need. Not a good way to start off your professional career."
    Law2Doc, I think you really hit the nail on the head here.:thumbup:
     
  5. ZagDoc

    ZagDoc Ears, Noses, and Throats
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    Seconded. I abuse my GI tract by self-medicating with a $%@#load of caffeine.
     
  6. Gabujabu

    Gabujabu Senior Member
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    I would say the drug that is most commonly used by physicians for this purpose is caffeine, as I know many people who get withdrawal symptoms without it.
     
  7. igotshoe

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    adderall and ritalin are abused in various areas of academia to promote concentration and creativity. most notoriously in field mathematics.
     
  8. VPDcurt

    VPDcurt 2K Member
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    Yes, very notorious indeed.
     
  9. The Angriest Bird

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    Flutamide + Leuprolide

    You'd spend your time with wife/gf or web porn with your syllabus instead.
     
  10. LabMonster

    LabMonster Clinically relevant.
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    Why use drugs when you don't have to? Diet and exercise. When you're too tired to exercise, you should probably just sleep then ;)

    Unfortunately, I also require coffee, but I think that is in stark contrast to using a Rx med to "boost" your brainpower.
     
  11. IHeartNerds

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    ...regardless of the ethics of this, your logic is grossly flawed. Provigil has never been shown to increase any kind of cognitive function you would care about in medical school. Yes, you'll be awake, but your long-term memory won't be thanking you. Air force pilots are doing something they have done for thousands of hours prior, not learning something out of Robbins.
     
  12. Samus Aran

    Physician Moderator Emeritus 15+ Year Member

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    i get energized by three things: sex, exercising and lo-carb monster energy drinks :thumbup:
     
  13. dynx

    dynx Yankee Imperialist
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    Yes
    yes
    and only during Step 1-2 studying for my 250-260 score. Worth it. But I don't generally advertise that I used them
    not monafidil though
     
  14. kdburton

    kdburton Ulnar Deviant
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    What did you take then? Wouldn't you need to be diagnosed with one of the disorders for which these drugs are indicated and approved before you could get your hands on them anyways?
     
  15. HopkinsGrad

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    I advise against using any mind-enhancing drugs. I personally refuse to drink even coffee.
     
  16. Bubblehead-to-MD

    Bubblehead-to-MD Emergency Blow!
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    I substitute coffee for the 3rd one, but the first two are definitely :thumbup:
     
  17. blabbyblab

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    This argument seems flawed in my respectful opinion. You could say the same thing for most psychiatric disorders from ADHD to depression ("you only want to be on a prescription drug if you have a medical need"), which are only considered MEDICAL disorders when a series of criteria are met + causes patient distress. What about the long distance runner who uses NSAIDs for pain? How about cortisone injections? What's the difference between physical pain and psychological pain? Is one worse than the other and should one be treated while ignoring the other? Is it psychologically painful to perform below ones potential? Would taking cognitive enhancers relieve some of the stress of med school? What are the MEDICAL implications of psychological stress?

    I think it would be wise to ask some of these questions before summarily discouraging the use of cognitive enhancement or pronouncing them "unethical".
     
  18. mjl1717

    mjl1717 Senior Member
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    IN defense of L2D.. You really dont want to be on any meds...By definition medicine is conservative by nature.. Although Ive heard some elderly folks claiming that B vitamins may help memory.. (didnt read any literature about it)
    But at least its water soluble without toxicity..
     
  19. mjl1717

    mjl1717 Senior Member
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    1) In this competitive field could see this topic coming up....

    2)As far a more "knowledgeable as a physician" --Ask any veteran on this forum, the only way to do this is to "properly burn the midnight oil" [study hard]
     
  20. TerpMD

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    No classmate will be angry if you are being treated for a medical condition (read: someone besides yourself diagnosed it). If you truly have a problem that is entirely different than 'I want to get better scores.' No offense but you are premed so until you know how you will handle med school, I would wait to see if you even feel like you need to go talk to someone about concentration probs. Maybe you can elaborate for us what you are specifically worried about.

    Completely agree.


    Sorry, but people who use these when they aren't prescribed should be ashamed of themselves. You are going to be doctors. If you think you need them go talk to someone who is trained to know if you need them or not.
     
  21. parrotsmuggler

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    You could always look into non-prescription nootropics, including the following:

    - The racetams: piracetam, aniracetam, oxiracetam
    - ACh precursors: CDP choline, alpha GPC,
    - Acetylcholinesterase inhibitors: huperzine
    - Miscellaneous: Acetyl l carnitine, vinpocetine, idebenone, sulbutiamine, DMAE, centrophenoxine, bacopa.
     
  22. Reimat

    Reimat Friend of talking skulls
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    I'm a little confused by this post. I think you're comparing a runner taking NSAIDs for joint pain to a medical student taking stimulants to relieve the stress of medical school? In both cases there are legal drugs available - NSAIDs for the runner, caffeine for the med student.

    If you're suggesting it's ethical for a medical student w/o documented medical need to take amphetamines, I would disagree. That would be like saying a runner should be allowed to take steroids/EPO injections because the stress of running is too great and those drugs will help relieve the stress. If a med student is really psychologically struggling, they need anti-depressants or anti-anxiety meds, not stimulants.
     
  23. WellWornLad

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    Well, I see this thread still has life. I forgot about it after L2D slapped my wrist, but some interesting comments have come down the pipe.

    Why should I take offense? I'm curious about nootropics because I think it's topical, not because I'm looking for someone to talk me down from some ledge I haven't climbed onto. In any case, the idea is cognitive enhancement, not cognitive normalcy, so concentration problems are besides this particular point.

    Geez, I'm asking about people's experiences or impressions, not formulating my Grand Nootropic Theory Of Cognition.

    In any case, modafinil has been found to improve mood, alertness, and working memory, which could be advantageous. Or you can insert your nootropic of choice, it's more of an abstract discussion on cognitive enhancement than a comparison of efficacy.

    You, sir, get a gold star for honesty. You're probably out of the running for the silver star of ethics, however.

    This question is what I find most interesting: Has anyone been prescribed monafidil (or other nootropic/stimulant) for shift work sleep disorder as an M3 or beyond? The ethical implications are a little more obscure here...
     
    #22 WellWornLad, Jun 26, 2008
    Last edited: Jun 26, 2008
  24. OncoCaP

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    Eh, you're not talking about eating your vegetables or doing yoga. You're talking about meds in a manner that weightlifters might talk about anabolic steroids. Yes, there are people that do these things and get the results they are looking for, but such use will attract criticism, and that's appropriate given the risk / benefit tradeoff. You may not get the results you're looking for. The folks who do unusually well don't seem to need these crutches. I can't go into details, but let's just say that the other day I met a patient not much different from your typical medical student with a brain hemorrhage the size of a peach thanks to a little too much cognitive enhancement. The consequences are not theoretical and the benefits are generally not carefully studied (frequently unproven). You might want to start with the proven and time-tested basics of doing well in medical school before you worry too much about enhancing your performance with medications. You may find that you can do fine without taking additional medications.
     
    #23 OncoCaP, Jun 26, 2008
    Last edited: Jun 26, 2008
  25. blabbyblab

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    So if an olympic runner has documented EPO deficiency then they should be allowed therapy? They are obviously a good runner despite decreased erythropoesis. Or say that a medical student feels down but does NOT have documented depression (DSM-IVR criteria). Should they be denied antidepressants? What if he/she IS given antidepressants for mood and that student has a subsequent cognitive boost (i.e. better grades). Is this unethical? Should meds NEVER be given without an objective clinical indication determined by RCT and set forth by the APA, ACOG, USPSTF, etc...? Is this not cookbook medicine?

    I'm not saying I'm for handing out amphetamines to all medical students who want to try them, I'm merely saying I'm wary of those who see the issue in a concrete black/white, ethical/unethical, good med student/bad med student dichotomy.
     
  26. joe6102

    joe6102 by the power of grayskull
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    So what about over the counter "supplements"? These can be just as harmful. I don't know half the stuff in these energy drinks like Monster or Rockstar. Also aspirin, alcohol, and cigarettes are probably more dangerous than modafinil. Is it unethical to use these without a "medical need"?
     
  27. IHeartNerds

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    1) I think most of us would relish being able to better regulate otc 'supplements'. Also, Rx drugs are a wee bit more powerful than what you'll find at the local grocery store.

    2) our society has declared alcohol and tobacco as legal drugs. so no, within the context, it is not unethical to use them without 'medical need' (especially seeing as there isn't much of any need for them). Not so for Rxs. Yes, alcohol has killed a lot more people than modafinil. But that's the world we live in...

    To everyone in the thread suggestion use of performance enhancers, dude, get off sdn and study harder. it'll work a hell of a lot better.
     
  28. joe6102

    joe6102 by the power of grayskull
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    I disagree. The points I was trying to make are 1. Many unethical things are also legal and 2. A medical need is often defined by what the patient wants. Hence millions of dollars spent on commercials telling you to "ask you doctor about...". Most of us could walk into a doctor's office and ask for a modafinil and probably get it. So you have a prescription and a "medical need" assessed by a licensed physician, it must be ethical.
    My personal view is as long as it doesn't endanger your patients, it's fine with me. Some of them may be harmful but we can't protect people with poor judgement from themselves.
     
  29. blabbyblab

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    Are you saying the days of paternalism and complete trust in the all-knowing physician are over? :D
     
  30. DrKitty

    DrKitty Senior Member
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    :laugh::thumbup:
     
  31. Messerschmitts

    Messerschmitts Mythic Dawn acolyte
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    I've semi-overdosed on caffeine pills pulling all-nighters for exams. Damn I was so nauseous.
     
  32. spart39

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    I'll insert some experiential knowledge that is lacking in this discussion. I do have a sleep disorder that I take modafinil (Provigil) for. I used to have to take caffiene pills to combat my symptoms before I was prescribed modafinil and I can say unequivocally that modafinil is a more benign drug than caffeine is and has fewer side effects. I always got by pretty well in school before I had modafinil but it was pretty upsetting when I would fall asleep even at the parts of lectures I found interesting. I don't take the medicine for most daily activities, but class and long drives usually require it. I can say now that I am a much better student for taking modafinil.

    It may be reasonable to demonize people for taking potentially harmful stimulants like ritalin for medical school, but its ridiculous to make blanket statements about using medications to help studying or alertness. If the drug is appropriate and has few side effects, then there should be no problem in taking it. Medical school is not a competition against others (or at least should not be), its about preparing yourself as best you can to take care of patients.
     
  33. dynx

    dynx Yankee Imperialist
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    Hmmmmm. Never really considered it an ethical problem. I was doing great in my classes anyway so its not like I was potentially hurting future patients by "cheating" and passing w/o the required knowledge to safely practice. I have 6 figure debt and a shrinking period of time to accumulate wealth. I'm going to not give myself every opportunity to do well in my chosen field?

    Its like baseball players and steroids. I can have a million dollar lifestyle and superstar status w/ roids (in this case not even that) or live out my life with whatever job my HS education could get (in this case not so severe) and talk about my balling days w/o roids. The choice is obvious. People make a great display about how thier against roids but the long ball is still what puts thier asses in the seats. And don't even bring up the health aspects. When the dean or program director starts really caring that I don't get sleep deprived and wreck my car on the drive home he can talk to me about what I MIGHT be doing to my health for a better grade. They sacrafice our health and well being as a matter of routine and no one bats an eye. I want to give myself a competative edge (which worked out to my benefit) and suddenly its an ethical conundrum?

    And its not like I bought the stuff on a corner...it was all legal.
     
  34. LabMonster

    LabMonster Clinically relevant.
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    Actually, while studying for the boards, I used 5-hour energy drinks. Of course they're very expensive (didn't drink caffeine with them - additional caffeine.) They work great for me, then I'm not sure of any randomized data ;)

    They're expensive, so my max was about 1-2 q12' -> and the 2nd one just helpds with getting through workout time. I only used these off and on for 3 weeks because of the cost - probably why I studied hardcore for 3 weeks and screwed off the other.

    On the other hand - it's legal, OTC, c/no data, BUT they worked for me. I"ll take placebo effect over no effect anyday.
     
  35. Law2Doc

    Law2Doc 5K+ Member
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    Like Reimat above, I am confused by your post, and don't really agree with your arguments or conclusions. A lot of it is because of strained semantics. I would consider folks with psychiatric disorders or suffering from inflammatory pain to have medical needs, and would have no problem with them getting a prescription from a physician if warranted. In terms of "psychological pain", it depends what you are talking about -- if someone is going to "feel bad" because they don't do well on a test or don't get enough study time in, I dismiss that as your (or the patient's) trying to create a semantic medical need where none exists. Everyone faces various psychological stresses every single day and most deal with them quite well without use of drugs. However if their psychological stress rises to the level of psychiatric issues or physical manifestations (hypertension, rashes, etc), then sure, maybe there is a medical need. But we aren't talking about this here. I do have a problem with someone taking supplements for no medical need other than the hope it will let them stay up longer or concentrate better on tests. This is, for lack of a better term, "recreational use" of a prescription drug, and since ALL drugs have side effects, it is a both unethical to go down this road yourself or to prescribe to folks who want to go down this road. I don't see as much gray area as your semantic argument tries to suggest. NSAIDS and caffeine are not prescription drugs and so it takes the ethics of prescribing out of the loop. And while I wouldn't say it's a good idea to abuse these drugs either, our society has deemed it acceptable and so that largely takes the ethics out of using them; it is a cultural thing. Just like it isn't unethical for a physician to smoke, but is unquestionably foolish from a health standpoint.
     
  36. Monica Lewinsky

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    Celecoxib :confused:
     
  37. Law2Doc

    Law2Doc 5K+ Member
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    Sorry. SOME NSAIDS are nonprescription and in such cases there is no prescription ethics issue. There still are side effects even with OTC stuff so self medication for other than medicinal need is ill advised.
     
  38. Bushido416

    Bushido416 Tired of basic research
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    Wow didn't know there were so many people anxious to go back to old school tactics of getting ahead. Amphetamines have been used a lot by physicians back in the 70's and 80's mostly the attendings prescribed it for their residents to keep up with the hours and patient load. Anyhow this is pretty ridiculous to say that if you want to study longer or harder you should get prescriptions medication. In the context of use described this is a performance enhancing drug. When used in the context of professional school settings this amounts to cheating the same way the guy who just got his yellow jersey stripped away for hormone use in the Tour De France. When a prescription drug is used solely to boost one's performance in a competitive event however long (like school) or short (race) the duration of the event the intent and outcome results to out right cheating. It means that by using it you really don't deserve the awards and titles attributed to your achievements. Even if you're not caught it cheapens your position because look at all those other people who made it on their own without the drugs they are more qualified than you because you could not do it without the drugs....or could you? You'll never know at the point after the use. Anyway especially in the case of the amphetamines I know physicians who had to go to rehab years after their residency for amphetamine dependence one also attempted suicide when he couldn't kick the habit.
     
  39. blabbyblab

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    I think many practicing doctors would disagree strongly with you. The key thing you are hung up on is an "indication" as determined by the medical community at large in order for it to be "ethical" to prescribe. Sorry in advance for not putting together a better argument (studying for boards).

    Not all patients read the textbook to know if what they are experiencing is true pathology, and certainly not all medications are used for what they are indicated in practice, particularly as the ideas around health optimization continue to grow. The goals are to treat pathology and do no harm. The definitions of what is pathology are forever changing (is an LDL of 82 pathology? are crying spells and listlessness pathology?) and I (respectfully) feel that your opinion in this matter is overly dogmatic.
     
  40. WellWornLad

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    But the raison d'etre of sports is competition. The point of medical school is to learn the material - competition is just a byproduct of putting a bunch of neurotic overachievers in the same room.

    To use a bad analogy, it would be cheating to catch a ride during a marathon, but just bad form to eschew an ambulance and run to medical emergencies instead.
     
  41. Law2Doc

    Law2Doc 5K+ Member
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    I think the "do no harm" part is what gets you in trouble with this. ALL MEDS have side effects. So if you are prescribing something without a medical need, but rather a vocational one, then you are not treating pathology and are putting your patient (or yourself) at unnecessary risk. Sure you can make a semantic argument that by not being able to stay up and study a person has "psychological stress" which is what you are really treating. But that's a stretch. You can't define a pathology to allow yourself to "get around" unethical conduct. I agree that some physicians like to play Dr Feelgood and take this leap -- but the fact that other people are doing it is never a good argument that it is ethical. Just because everyone else is jumping off a bridge doesn't mean you should too.:)
     
  42. kdburton

    kdburton Ulnar Deviant
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    .
     
    #41 kdburton, Jul 1, 2008
    Last edited: Jul 31, 2008
  43. Bravofriendly

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    http://www.slate.com/id/2195466/?GT1=38001

    Interesting report on the military's investigation into cognitive enhancement drugs for the purpose of reducing causalties and improving soldier performance under conditions of sleep deprivation.
     
  44. MONKEYBOY

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    http://en.wikipedia.org/wiki/Modafinil

    Provigil (Modinafil) and Ritalin (methylphenidate) definitely have cognitive-enhancement properties.

    Read some jounral articles, the mice do better than the unmedicated mice every time.
     
  45. kdburton

    kdburton Ulnar Deviant
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    I'm not going to disagree with you, but wikipedia is a horrible source for convincing information. Furthermore, reading a couple journal articles about mice does not allow you to extrapolate findings to humans. If there were enough convincing arguments for those drugs to be USED AS cognitive enhancement drugs then they would most likely be indicated for such use (or at least under clinical trials for such use).
     
  46. OncoCaP

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    I would downplay the relevance of that to medicine. If the military does it for their soldiers it must be good for our performance as medical students also? I would check it out carefully first.

    Our military is pretty good at what they do, but they are far from foolproof nor are their methods necessarily applicable to civilian life. Due to the nature of their work, the military will use something that keeps a decent percentage of their soldiers from getting shot or injuried even if it causes permanent disability in a significant number of cases. You need only look at the veterans coming back with PTSD to see a good example of why military methods might only be best when there is no real alternative and be far from optimal in less dangerous circumstances.

    Performance on medical school exams should not be a life and death matter when it comes to performance; even when things go quite badly, it shouldn't result in one or more deaths or traumatic injuries and not require much performance enhancement beyond maybe caffeine. If we had some kind of hurricane / nuclear / bio / chemical attack and our physicians and medical students had to treat huge numbers of seriously ill people in difficulty, time-sensitive circumstances, then ok, crack open the amphetamines and modafinil under the supervision of someone who understands the ethical tradeoffs of possibily injuring a bunch of physicians and can implement this with appropriate tradeoffs and safeguards. This would be a very extreme situation, hopefully. If it's just a series of exams, then coffee should do the trick. Maybe once we understand more about safe use of such medications for performance enhancement by civilians we could expand the use of these drugs to things like studying for an exam.
     
  47. alfonzarel

    alfonzarel howlin, growlin, prowlin.
    Physician 10+ Year Member

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    some people dis ginkgo biloba, but i've been taking it for almost 10 years (2-4 times a week and before every exam). some people cite a lack of evidence for cognitive enhancement, which i won't deny. but anecdotally, i notice a marked improvement in concentration when i take ginkgo. i don't believe that it is a magic feather, but do admit that it doesn't work for everyone. really, none of that matters, since it make a difference for me.

    in any case, i think it's worth giving a try.

    it's fairly cheap and might help you concentrate more better.
     
  48. alfonzarel

    alfonzarel howlin, growlin, prowlin.
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    oh yeah

    coffee + ginkgo is my recipe for a 6 hour study marathon
     
  49. DPT2MD

    2+ Year Member

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    How much ginko do you take?
     
  50. alfonzarel

    alfonzarel howlin, growlin, prowlin.
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    1-2 tablets

    i think they are ~60-100 mg each
     
  51. DPT2MD

    2+ Year Member

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    I think I have 120mg tablets and usually take one every morning with my multivitamin. I believe I read somewhere you need/can take up to 250mg daily and get some good results.
     

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