We live in an age of self-medication, says Sally Brown, but what pills – prescription, over-the-counter or herbal – are your fellow travellers taking to stay well and perform better?

Remember your last hangover at work, when you felt like your IQ had dropped 20 points overnight? Or the time you nearly nodded off in a meeting because you were jet-lagged? Wouldn’t it be great if you could take a pill and instantly click back to your normal eight-hours-a-night self?

Well, now you can. Modafinil – known as Provigil in the US – is one of a new breed of “smart” pills that boosts concentration and eliminates jet lag with no jittery side effects, and it’s available to buy with just a few clicks of your mouse.

“Recently I casually mentioned to a colleague that I was jet-lagged and had a big presentation to give,” says Barbara Sahakian, professor of clinical neuropsychology at the University of Cambridge. “The response was immediate: ‘Do you want some Modafinil?’ They were surprised I hadn’t already taken it.”

Thanks to online access to medical knowledge, we’re becoming a nation of amateur pharmacologists. Want to feel calmer, smarter or more focused? There’s a pill that can help. According to Social Science and Medicine journal, Brits are twice as likely to turn to medicine today as 20 years ago. In a knowledge-based economy, “cosmetic neurology” – or the desire to improve the brain power you were born with – is set to be a health buzzword in the next few years, according to trend-spotters at consultancy the Futures Company.

A recent survey of UK readers of scientific journal Nature found that 20 per cent had already taken a so-called “smart” drug to help their concentration. And according to a report by the British Medical Association (bma.org.uk), they’ll soon be as “common as coffee”.

But it’s not just about boosting brain power – savvy self-medicators know the right drugs to fight jet lag, get some sleep on an economy flight, and even feel calmer and more confident. Self-medication is the fastest way to self-improvement, they believe, and there’s a word-of-mouth buzz that certain prescription drugs, licensed for use to treat anxiety or sleep disorders, have bonus benefits when taken by healthy users.

The fact that the drugs have gone through the stringent testing process required of any licensed medicine means there’s an in-built element of safety. Atholl Johnston, professor of clinical pharmacology at Queen Mary, University of London, says: “Occasional self-medication is highly unlikely to be dangerous.”

Even so, the Royal Pharmaceutical Society (rpsgb.org.uk) urges caution. “These are potent medicines and they’re prescription-only for a reason,” says Neal Patel, spokesperson and pharmacist at the society. “If they were risk-free, they’d be available over the counter.”

According to Cephalon, the manufacturer of Modafinil, the list of possible side-effects in use among narcoleptics includes psychosis, and it’s not recommended for anyone with a history of depression. Half of the regular users in the Nature survey reported side effects including headaches, jitteriness, anxiety and insomnia.

“There’s a risk/benefit equation with any drug,” Patel says. “Your doctor will prescribe a drug if they think the benefits outweigh the potential side effects. If you’re self-medicating, you need to weigh that up yourself. And don’t forget that drugs react with each other, so people on long-term medication or with an existing health condition such as high blood pressure need to be particularly cautious.”

Taking drugs off-licence is unlikely to get you into trouble with the law. Although it’s illegal to sell licensed drugs without a prescription, it’s not illegal to buy them, or to take what you need for personal use through customs. “Unless a drug is controlled, like Ritalin, the police are unlikely to get involved,” Johnston says. And a sympathetic GP can prescribe any drug “off-licence” if they feel there is a clinical need. “So you could, in theory, ask your doctor for Modafinil for jet lag,” he says, “although most people think it’s easier to buy from the internet.”

Unsurprisingly, counterfeit medication is an issue. “In research, we find that 50 per cent of drugs ordered from internet sites are fake,” Johnston says. In the UK, legitimate internet pharmacies must be an offshoot of an existing bricks-and-mortar pharmacy.

Patel says: “It’s simple – any site that allows you to buy prescription drugs without a prescription isn’t a pharmacy. And once you’ve stepped outside the normal supply chain, you have no way of knowing what you are taking. Counterfeiting is sophisticated and the look of the drugs and packaging can be exact copies. But you have no way of knowing what’s in a drug, whether it’s a harmless sugar pill or something more sinister.”

Patel recommends you do a risk/benefit analysis before popping any pill. “Ask yourself: ‘Am I prepared to take a risk for what are unproven benefits?’” he says. And keep an eye on how often you use them. “If you have to rely on pharmacology to live your life, you may have a problem,” Johnston says. “And it’s easy to develop a tolerance so you start taking more to get the same effect. With any drug there is a tendency to think: one is good, so half a dozen must be even better.”

Cautions aside, here’s what the guy sitting next to you on the plane could be on…
 

Modafinil

ALSO KNOWN AS Provigil
Officially prescribed to keep narcoleptics awake during the day, it makes healthy users process information more effectively, and multitask without getting stressed, according to a University of Cambridge study. It’s the “first real smart drug”, according to the university’s Barbara Sahakian, and will be licensed for general cognitive enhancement in the future.
PROS It helps you to deal with tiredness without affecting concentration or interfering with natural sleep patterns. Some find it reduces appetite and aids weight loss.
CONS The effect has been described as so mild that you don’t notice it. “It didn’t seem to make me any more productive than usual, but it did give me a headache,” says one user.
PRICE About £4 a pill
WHERE TO BUY UK pharmacies with a prescription; internet without a prescription

Pregabalin

ALSO KNOWN AS Lyrica
Licensed in Europe for generalised anxiety disorder and in the US as an anti-convulsive drug, Pregabalin calms nerve activity in the brain – ideal for pre-presentation jitters.
Pros It’s like Valium minus the addiction, as you are not as likely to build up dependence to it. Plus, it treats neuropathic pain so it could sort out your sciatica.
CONS Possible side effects include dizziness, drowsiness and slurred speech – never a particularly impressive look at work.
PRICE £1.50 a pill
WHERE TO BUy UK pharmacies with a prescription; internet without

Ritalin

ALSO KNOWN AS Kiddie Coke
It’s the new Pro-Plus – without the caffeine jitters. Although licensed to treat attention deficit hyperactivity disorder (ADHD) in children, Ritalin is easily available over the internet for those looking for a mental edge. Studies show it improves some cognitive functions, including planning.
PROS An end to unproductive “hangover” days – it focuses the mind even when it’s frazzled.
CONS Ritalin is a controlled drug so it’s technically illegal to take it off-licence. “It could get you into trouble with customs,” clinical pharmacologist Johnston warns. It’s also an amphetamine-type compound, so you could get hooked.
PRICE £8 for 30 pills
WHERE TO BUY UK pharmacies with a prescription; internet without

Melatonin

ALSO KNOWN AS Circadin
The best-known jet lag “cure”, melatonin is a hormone made by the pineal gland, a structure in the brain, and it regulates the body’s circadian rhythm. It was banned from sale in health food shops in the UK in 1995, when it was classified as a medicine rather than a food supplement.
PROS A “natural” supplement that’s also a powerful antioxidant, and said to stave off ageing.
CONS Can cause restlessness and irritation – so you’ll be awake, but nasty. “Plus, there’s little convincing evidence that it works,” Johnston says.
PRICE About £8-10 for 60 tablets
WHERE TO BUY Health food stores in the US, internet pharmacies

Beta-blockers

ALSO KNOWN AS Sectral, Propranolol
Beta-blockers are prescribed for hypertension but have been hijacked as instant tranquillisers. By blocking the effect of the stress hormones norepinephrine and epinephrine, beta-blockers will reduce the physical symptoms of anxiety such as palpitations. “Snooker players like them because they also steady the hands,” Johnston says.
PROS They could reduce your blood pressure and the risk of heart attack.
CONS Can cause health issues for asthma and angina sufferers. “They can also cause impotence with long-term use,” Johnston says.
PRICE About 10p a pill with a prescription, and £2 without
WHERE TO BUy UK pharmacies with a prescription; internet without

Zolpidem

ALSO KNOWN AS Ambien
The world’s favourite sleeping pill is licensed for treatment of ongoing insomnia, but is popular for one-off use (overnight flight in economy, anyone?). It works by enhancing the effect of the neurotransmitter GABA at receptor sites in the brain, easing you into sleep.
PROS “Zolpidem is one of a class of drugs called non-benzodiazepine that have a short duration of action – you can take it, sleep for six hours and you won’t feel groggy when you wake up,” Johnston says.
CONS It’s also used as a date-rape drug so could take some explaining if you’re found with some in a bar. It doesn’t mix well with alcohol, and makes some people hallucinate and sleepwalk, which never goes down well with fellow passengers. (Put “Ambien” into You Tube’s search engine for classic examples.)
PRICE About £12 for 30 pills
WHERE TO BUY UK pharmacies with a prescription; internet without

Prozac

ALSO KNOWN AS Fluoxetine
Those in the know don’t pop Prozac for its antidepressant qualities but because it helps to focus the mind, dull the appetite and improve athletic performance.
PROS It can make sex last longer.
CONS It is prescription-only so you will need to convince your doctor you’re depressed. It can also kill your sex drive altogether, and the positive effects can stop working after a few weeks, which is known as “Prozac-poop-out”.
PRICE About 60p a pill
WHERE TO BUY UK pharmacies with a prescription; internet without

Topamax

ALSO KNOWN AS Topiramate
An anti-epileptic drug also used to treat migraines, it has the unexpected side effect of making you stop craving things that are bad for you. It enhances the activity of the neurotransmitter GABA in the brain, which acts as a natural calming agent.
PROS Could be a painless way to cut out all that boozing and binge-eating.
CONS Can play havoc with your temperature control, inducing a menopause-style hot flush without any warning.
PRICE About 80p a pill
WHERE TO BUY UK pharmacies with a prescription; internet without

Natural boosters

Need to feel on top of your game? Get a boost without the side-effects by trying these natural alternatives…

Vitano is a licensed herbal medicine made from rhodiola rosea root extract that has been traditionally used to treat stress, fatigue and mild anxiety. (Manufactured by Schwabe Pharma, £13 for 30 pills from pharmacies, health food stores and schwabepharma.co.uk.)

St John’s wort is back in favour – a recent review of all the studies on St John’s wort by the respected Cochrane Collaboration (cochrane.org) found the herbal remedy was as effective as Prozac in treating mild to moderate depression (£25.50 for 90 tablets from Boots, boots.com).

If you need to improve your concentration, early research suggests that extracts of the tree ginkgo biloba can improve short-term memory, probably because it dilates blood vessels and reduces blood’s stickiness, boosting circulation to the brain (Actimind, £10 for 30 from pharmacies).

Take a B complex supplement – at least ten different B vitamins can affect the neurotransmitters in your brain and several clinical trials are under way to further investigate preliminary research that suggests B vitamin supplements improve cognitive function. Take a B complex if you’re under pressure or drink regularly (stress and alcohol both use up B vitamins). Try Boots’ Sustained Release Vitamin B Complex (£6.50 for 90).

Fish has been known as “brain food” for centuries and two of the polyunsaturated fatty acids in fish oils, EPA and DHA, are involved in chemical messaging in the brain. The jury is still out on whether taking fish oils really does boost brain power, but if you don’t eat fish, a supplement is good health insurance. Try Seven Seas Pulse Pure Fish Oil capsules, £9 for 120 from pharmacies.

For energy, Mikei Red Reishi Essence is a mushroom extract traditionally used in Chinese medicine – it’s gaining such a reputation that even Cancer Research UK wants to see clinical trials on its use in cancer patients (£40 for 30 from haeon.com).