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What Are Nootropics? Brain-Boosters Defined and Explained

By Dr. Ramon Velazquez Ph.D. | |

Nootropics are brain-boosters: Supplements that help to improve cognitive performance and brain wellness. Nootropics enhance memory, focus, attention, motivation, relaxation, mood, alertness, stress resistance and more.

The best nootropics are also good for the brain, helping to promote healthy brain function over time.

In this guide, we discuss the meaning of nootropics in detail: What they are, what they do, and how to find the best ones for various cognitive functions, mental health and more.

While nootropics are sometimes referred to as "smart drugs," this article will focus on nootropic dietary supplements that are available without a prescription. Let's get to it.

The Origin of Nootropics

How are nootropics defined? In general, nootropics are cognitive enhancers. But that's just the beginning of a complex story.

Romanian psychologist and chemist Dr. Corneliu E. Giurgea, the founding father of nootropics, was the first to attempt to define nootropics. He developed six key criteria to qualify substances as true nootropics. Giurgea's criteria:1

  1. Enhancement of memory and learning
  2. Improved cognition under stress
  3. Protection of brain cells (neuroprotective)
  4. Facilitation of cell-to-cell communication
  5. Backed by human research demonstrating brain bioactivity
  6. Absence of usual pharmacological effects of psychotropic drugs

By the strictest definition, only a handful of true nootropics exist. But as science has learned more about the brain and identified more brain-beneficial supplements since the 1960s, the original definition has expanded dramatically.

Modern Definition of Nootropics

Now, if a supplement helps the brain in any way, it may be considered as a "nootropic." This amounts to a long list of nootropic supplementsover 80, in fact – that have been linked to better brain health and cognitive function in some way.

As the list of nootropics has grown, so has appreciation for a healthy brain's capacity to improve all aspects of life in all types of people – broadening the potential of brain-boosting nootropics even further.

What Are Nootropics Used For?

In the early days, before "nootropic" was a popular class of supplements, brain supplements were used primarily by seniors seeking memory support.

Now, nootropics are used by all age groups, for a wide variety of potential benefits. In general, these uses can be divided into performance benefits and health benefits.

Cognitive Function Benefits of Nootropics

Cognitive performance benefits associated with various brain supplements and smart drugs are more numerous and expansive than ever before. The more that science investigates nootropics, the more potential nootropic benefits are uncovered. These include enhancements for:

  • Memory - Traditional one-dimensional long-range memory pills have evolved into dynamic nootropics for short term memory, recall, learning and more.

  • Mental Energy - The brain has high energy demands. When brain energy runs low, mental functions suffer. Nootropic supplements can both fuel the brain and optimize energy metabolism within the brain, helping to naturally rejuvenate cognitive performance.

  • Attention - Nootropics enhance various aspects of attention, focus and concentration; these cognitive function benefits can give users an edge in productivity.

  • Learning - Students of academia and lifelong learners can benefit from nootropics' various enhancements for cognitive learning processes like memory formation, storage, and recall.

  • Mood & Mental Health - Nootropics that help with relaxation, confidence, mood balance, motivation, sociability, anxiety, happiness, and more can optimize cognitive function and improve life performance.

  • Creativity - Brain wave-tuning nootropics can foster relaxed, free-flowing thinking that is conducive to creative thinking, artistic exploration and quiet contemplation.

  • Physical - Although they are brain supplements, nootropics are now in the sports nutrition canon due to their ability to improve motivation, training intensity, and focus in the gym.

  • Stress Resistance - Nootropics, especially the class of herbs known as adaptogens, have well-documented anti-stress benefits. Stress reduction can enhance brain performance of everyone from multitasking professionals to competitive athletes.

What are the best nootropics for ADHD?

Nootropics are increasingly sought by people with attention deficit hyperactivity disorder (ADHD). Some may seek nootropics as an "alternative medicine" option instead of (or in combination with) pharmaceutical smart drugs.

While effective, prescription smart drugs like stimulants may have side effects that compel certain individuals to try natural nootropics as a means of managing ADHD symptoms.

Nootropics that influence brain chemicals, particularly dopamine, are emphasized in ADHD supplements. Cognitive enhancer nootropics may also help to sharpen general mental performance when attention problems are present. Phosphatidylserine (PS) and L-Tyrosine may be two of the most promising nootropics for ADHD.

More on the Best Nootropics for ADHD

Brain Health Benefits of Nootropics

Nootropics are primarily known as cognitive enhancers that can help your brain perform better in day-to-day life. That's part of why nootropics are associated with students, driven professionals, Silicon Valley minds, and athletes. The cognitive benefits we just discussed can be considered short-range performance effects you can feel.

But the best nootropics also nourish the brain for long-range benefits. Some of the areas where nootropics may help with long-range brain health include:

  • Brain aging - Certain nootropics help to protect the brain from unstable molecules called free radicals. Researchers suggest that free radicals bombard neurons in the brain (and cells throughout the body), causing damage that actually accelerates aging. Healthy individuals may help protect and maintain their youthful brain structure with antioxidant nootropics that neutralize marauding free radicals.

  • Cognitive decline - Mild mental processing issues are considered normal as we grow older. In fact, these challenges are known by names like Age-Associated Cognitive Decline, Age-Related Mental Decline, and Age-Associated Memory Impairment. Some nootropics help to slow this natural decline and help people stay sharper, longer.

  • Mild cognitive impairment - Cognitive impairment is another brain health concern, manifesting as brain fog and sluggish mental processing. Nootropics may help in several ways, supporting healthy brain structure and mental function over time.

  • Brain structure changes - Some brain health problems are caused by irregularities in the brain's structure. Nootropics may help to maintain normal brain structure in healthy individuals. For example, Vitamin B12 helps to maintain the myelin fatty sheaths that surround brain cells and neurons.

Learn more about the many Benefits of Nootropics

What Can Nootropics Do?

Nootropics are believed to work by boosting multiple biological pathways in ways that support sharp cognition. Typically, nootropics and stack supplements are designed to target one or more (ideally, all) of the six following brain function pathways:

  1. Increase Brain Energy - The brain consumes about 20% of the body's total energy, qualifying as the body's most demanding organ.2 Nootropics may support energy metabolism by enhancing mitochondrial efficiency, delivering raw fuel material, and more.

  2. Support Brain Chemicals - Neurotransmitters facilitate neuron-to-neuron communication, essentially regulating all cognitive and memory functions. Increasing neurotransmitter production, sharpening receptor sensitivity, inhibiting brain chemical breakdown, etc. contribute to a more fully optimized neurotransmitter status.

  3. Boost Bloodflow to the brain - Whether affected by injury or age, impaired cerebral circulation can diminish cerebral function.3 Supporting blood vessel integrity and nitric oxide levels may help increase delivery of oxygen and nutrients to the brain.

  4. Tune Brain Waves - Different brainwave frequencies – in order from highest to lowest: gamma, beta, alpha, theta, delta – correspond to different mental states. Some nootropics can help raise certain frequencies to stimulate desired cognitive effects.

  5. Protect the Brain - Antioxidant reduction in free radical damage. Adaptogenic resistance to stress. Healthy brain structure maintenance. Nootropic neuroprotectors may assist the brain's natural defenses against unhealthy changes via several adaptive processes.

  6. Promote Brain Regeneration & Renewal - Neurogenesis is the process by which the brain regenerates and renews via brain cell repair, maintenance, and plasticity. Some nootropics find potential neurogenesis success in supplying raw nutritional building blocks and signaling growth factor synthesis and release.4 Lion's mane mushroom is known for this.

Smart, skilled nootropic users have a keen eye for nootropic combinations and stacks that boost these brain biopathways simultaneously and safely.

More on How Nootropics Work

What Are the Different Types of Nootropics?

In the long run, enhanced brain wellness ultimately results in elevated and sustained mental performance. Contrary to the mass focus on certain synthetic “smart pills," many of the best nootropic supplements sold today are either all natural or extracted from natural sources, and come in various forms:

Essential Nutrients

Vitamins and minerals encompass a wide range of dietary compounds that, depending on your diet, may require supplementation to achieve healthy levels. Healthy brain chemistry status, brain energy and cerebral circulation, for example, rely heavily on nootropic B-Vitamins: B6, B9 and B12. Vitamins D3, K2 and mineral magnesium are also suggested to contribute to normal brain function.

Herbs & Mushrooms

Many of the most popular nootropic ingredients are botanical, ranging from chewed, brewed, and steeped roots and leaves to herbal extracts standardized to precise levels of their active ingredients.

Some herbal nootropics have been used in folk wellness practices for centuries, suggesting a long track record of safety and efficacy. Some examples:

Lion's Mane Mushroom - This brain-booster that associated with traditional Eastern herbalism and cuisine. It is suggested to raise brain levels of nerve growth factor (NGF).5 Lion's Mane is associated with support for positive mood, mild age-related cognitive problems and overall brain health.6, 7

Ginkgo biloba - One of the more historic herbs used to boost brain performance, ginkgo biloba is associated with memory and has been used in traditional Eastern alternative medicine for hundreds, if not thousands, of years.

Adaptogens

Originally classified by Soviet scientists, adaptogens are a sub-category of herbal cognitive enhancers that may naturally help bolster the brain and body against the negative effects of stress – be it emotional, physical, chemical, cognitive, etc. Essentially, adaptogens strengthen the body's adaptive resistance to stress, enhancing focus, clarity, emotional stability and overall cognitive ability during stressful conditions.8

Bacopa Monnieri - a classic Ayurvedic herb associated with knowledge, it has research-backed benefits for memory and learning.9 With its combined with its memory benefits and anti-stress effects, Bacopa monnieri an especially effective adaptogen nootropic for students' distinct needs.

Rhodiola Rosea is among the best adaptogen nootropics. Its golden root has been used for centuries in Russia to enhance mental energy, inner drive and mental resilience under challenging and stressful conditions.10, 11 Russian athletes, professionals and laborers have all benefited from Rhodiola rosea's adaptogenic properties.

Brain-Healthy Fats

The brain is about 60% fat. So it's no surprise that consuming healthy fats can benefit the brain. Especially in maintaining healthy brain structure, forming new neural connections (plasticity) and supplying raw materials that are used in various brain regeneration processes.

Phospholipids: Sourced from fish, sunflower, soy, egg yolks, and animal organs, phospholipids are a particular type of fat that play important structural roles in brain cell growth, genesis, and repair. As we age, brain phospholipid levels decline. Research has shown that this concern may be helped by phospholipid supplementation.12 Phosphatidylserine (PS) is the top-ranked phospholipid nootropic, with evidence suggesting it helps improve memory and mental health. It may also help with some aspects of age-related cognitive impairment.13

Omega-3 fatty acids: DHA is the Omega-3 that is often associated with brain health. It is present in mother's milk, and plays a key role in brain development (as well as eye and nervous system development) through our early years. Researchers have linked high Omega-3 intake (especially DHA) and blood levels to cognitive performance metrics like processing speed and attention; nutritional support for fighting cognitive decline, as well as to robust overall brain health.14 While Omega-3s have historically been associated with fish oil, new plant-based Omega-3 supplements -- sourced from algae and flaxseed -- are increasingly popular.

Medium-chain triglycerides (MCT): Commonly taken as MCT oil (although powder supplements are also available), these healthy fats serve as fast-acting brain fuel. Specifically, they are converted into ketones and travel quickly to the brain, where they help to energize cells' mitochondria powerplants.15

Choline Sources

Choline is a natural nootropic used by the body to make and use fats. The brain is itself 60% fat. Therefore, Choline is an important nootropic for supporting brain structure; invaluable for brain repair, regeneration and plasticity. It also helps form the brain chemical acetylcholine.

Nootropic choline sources either provide choline, or help to raise brain choline significantly via indirect pathways. Choline nootropics work well with phospholipids, and are associated with enhancements to memory, mood and mental energy. Examples of choline nootropics include:

Lecithin (phosphatidylcholine): The form that is found in foods we eat, it is estimated to be about 13% total choline. Phosphatidylcholine is the form of choline that is primarily found in our tissues.16

Choline: This is the popular source found in supplements. It is more highly concentrated than Lecithin, so a little goes a long way. The body must then convert it into the phosphatidylcholine form that is used to form and maintain cell membranes.

Citicoline (CDP-choline): This form is the best nootropic choline source to look for in brain supplements. It features unique multi-tasking nootropic activity – including an ability to efficiently raise brain phosphatidylcholine levels.17

Antioxidant Nootropics

Antioxidants help to protect the brain against free radicals: Unstable molecules that smash against brain cells, damage their membranes and accelerate aging. There are many antioxidants that can neutralize free radicals. But not all can naturally cross the blood-brain barrier to reach the brain.

Maritime Pine Bark Extract is one of the best natural nootropics for brain protection due to its powerful antioxidant complex. These antioxidants are capable of crossing the blood-brain barrier, where they can exert their cell-protective activity to maximum effect. Maritime Pine Bark also promotes Brain-Derived Neurotrophic Factor (BDNF) that supports brain regeneration. In addition, Maritime Pine Bark Extract is known for its ability to naturally raise nitric oxide (NO) levels.18 NO is a vasodilator: It relaxes blood vessels, which in turn enhances blood flow. This means that, similar to Ginkgo biloba, Maritime Pine Bark Extract may support blood flow to the brain.

Coenzyme Q-10 is a vitamin-like nootropic that delivers high antioxidant activity and crucial cell energy support. CoQ10 is highly concentrated in the body's high-energy organs, especially the heart and brain. Here, CoQ10 helps to spark high energy levels while protecting against the cell-damaging effects of toxic free radicals.19

Pyrroloquinoline Quinone (PQQ) is a super-antioxidant suggested to have up to 5000X the antioxidant activity of vitamin C. Beyond its formidable antioxidant power, PQQ helps to protect and multiply the mitochondria powerplants that are crucial for peak brain energy.20

Amino Acid Nootropics

Perhaps the most multi-functional resource of nootropics, amino acids include a set of organic compounds that may benefit cognition by alleviating brain burnout (L-tyrosine),8 promoting alpha brainwave concentration (L-theanine), or improving mitochondrial energy output (L-carnitine). Bodybuilders and intermittent fasters also share interest in amino acid nootropics for their metabolic benefits. Examples of nootropic amino acids:

N-Acetyl L-Tyrosine is one of the most significant cognitive enhancers because it serves as a precursor to brain chemicals that are required for sharp mental processing. Stress and multitasking tend to deplete these brain chemicals. Tyrosine helps replenish them. It has been shown to improve brain function under stressful, distracting conditions.21, 22

L-Theanine is one of the best nootropic amino acid supplements, with complementary anti-stress, pro-relaxation, clarity sharpening brain benefits. Known for its presence in green tea, L-Theanine is commonly taken with caffeine because it helps enhance stimulant benefits while reducing jitters and other side effects.23

Are Nootropics Safe?

By definition nootropics must be safe. Regardless, there are so many nootropics, combinations and products that side effects, adverse events and health risks are possible. Further, even nootropic ingredients with a good safety profiles can be rendered unsafe by low-quality sources, ill-advised formulation strategies and suboptimal manufacturing practices. For these reasons, it is advisable to seek out industry-leading nootropic stack supplements that emphasize quality and have a strong track record of safety and minimal side effects reported.

Nootropic Supplements vs. Nootropic Drugs

Many natural nootropics are available on the market. But some nootropics are also synthetic or semi-synthetic in origin. This can create some confusion. Further muddying the waters, nootropics are sometimes called "smart drugs." But it's important to remember:

Nootropic supplements are not the same as prescription drugs.

As dietary supplements, nootropics can be purchased in many retail locations, and are intended to maintain cognitive functions in healthy people. Nootropic supplements can boost brain function in many ways. Supplements can claim to improve memory and improve cognitive function in healthy people.

But when it comes to certain brain diseases, such as with Alzheimer's disease patients, only prescription medications (as smart drugs) taken under the direction of a healthcare professional can make claims about prevention and treatment. Further, while nootropic supplements are not regulated by the FDA and do not require pre-market approval, prescription smart drug nootropics must undergo extensive clinical research and review before reaching the market.

Individual Nootropics vs. Nootropic Stacks

Nootropic supplements categorize into standalone ingredients and multi-ingredient stacks, and the latter category subdivides into homemade stacks and pre-made stacks.

Depending on any number of personal, cognitive, or health factors, you may be drawn to any of the main methods of nootropic supplementation.

What Are Individual Nootropic Supplements?

Single ingredient supplements often supplied for specialized purposes – e.g., L-Tyrosine for stress relief – or cheaply bought in bulk and in conjunction with other standalone bulk ingredients to craft specially enhanced nootropic stack supplements for each individual person.

What Are Nootropic Stack Supplements?

Stacking is the process of combining diverse nootropics into a formula with the goal of compounding and synergizing individual ingredient bioactivities for greater brain-boosting effects. The two types of stacks are called:

  • Homemade Stacks - The DIY biohacker route to enhanced cognition, often tied to the online forum Reddit, in which efficacy and safety are contingent upon the creator's discretion.

  • Pre-made Stacks - Manufactured multi-ingredient supplements, ideally subjected to safety and quality testing.

Whereas the former type of stack allows nootropic enthusiasts to freely customize a virtually limitless combination of formulas, the latter stack provides a more reliable standard of effects – although, the value of these supplements and their "effects" are heavily dependent on the manufacturer's competence and credibility.

Do nootropics work?

Some nootropics work. There are at least 80 nootropics you can buy in supplement form. Many, but not all, of those nootropics are backed by clinical human research demonstrating their effectiveness. Some other nootropics may have promising evidence, such as from animal studies, but not enough to claim that they work. And then, of course, there are nootropics that just don't work; they are studied, but fail to demonstrate any benefit or even show promise.

In between are the countless anecdotal reports of individuals who are taking nootropics. Some nootropics may work for healthy people, but fail for others. Some must hit a certain dosage to be effective, and may "not work" due to user error.

Ultimately, the answer to "Do nootropics work" is determined by science. Individual nootropics and nootropic combinations must show benefits in human research to claim that they "work." Further, for a nootropic to work, the human research backing it must be well designed: Randomized, double-blind, and placebo controlled. For best results, match the nootropic form and dosage that was shown to be effective in the best research studies.

What is the Best Nootropic Supplement?

Mind Lab Pro® is the best nootropic supplement. Just as the definition of nootropic specifies, Mind Lab Pro® enhances learning, improves memory and more. In fact, with its innovative Universal Nootropic™ stack strategy, Mind Lab Pro® optimizes the whole brain to enhance all types of thinking and cognitive abilities.

Sharp mental performance and healthy brain function go hand in hand. In addition to boosting brain power, Mind Lab Pro® 's holistic Universal Nootropic™ approach optimizes brain health in many ways to best support long-range mental clarity.

All 11 ingredients in Mind Lab Pro® are safe and well-tolerated. But that’s just part of the story. All Mind Lab Pro® ingredients are presented in upgraded, enhanced-potency forms that are easier for the body to absorb and utilize. This includes NutriGenesis® vitamins, which are clean-cultured in a state-of-the-art lab.

Mind Lab Pro® is also the cleanest nootropic supplement ever developed: No artificial colors, no preservatives, no GMO, no gluten, no caffeine and no additives. Even the capsules are clean: Premium vegan NutriCaps®.

Mind Lab Pro®'s innovative formula design and superior quality standards produce a true nootropic supplement that meets and exceeds the nootropic definition originally set forth by Dr. Giurgea.

Mind Lab Pro® meets and exceeds the true definition of nootropic with 11 effective brain-boosters in a safe, clean and premium-quality formula.

Mind Lab Pro® is Backed by Science.

Most importantly, Mind Lab Pro works. How do we know? It has sold over one million bottles, with most customers returning to purchase the formula again and again. It is made with research-backed nootropics in carefully calibrated combinations and dosages.

But most importantly, Mind Lab Pro has been proven effective in well-designed human clinical research. Making it one of the only pre-made stack supplements in the world that backs up its claims with real science.

Conclusion

When we ask the question, "What are nootropics?" We are really asking, "What's in it for me?" That is why the common answers relate to nootropics' ability to improve and enhance short term memory, long range memory, attention, mental processing and other aspects of cognitive performance.

But to really know what nootropics are, we must look deeper – to the original definition of nootropics, and its specific criteria for extremely good safety profiles, human research-backed bioactivities, outstanding tolerability, and brain-protective properties.

In other words, a true nootropic can't just boost brain power – it must nourish the brain and improve brain health while doing absolutely no harm to the user.

And, to be real, an individual nootropic or nootropic stack supplement must be effective. This means it must be backed by high-quality, well-designed human clinical research that demonstrates its claimed benefits.

Mind Lab Pro® is the most advanced nootropic you can buy – clinically proven to enhance cognition while adhering to the safe, brain-healthy and holistic philosophies that exemplify the true meaning of "nootropic."

References

 

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  2. Magistretti PJ, Allaman I. A cellular perspective on brain energy metabolism and functional imaging. Neuron. 2015 May 20; 86(4): 883-901.
  3. Miyazaki , M. Correlation between cerebral circulation and intellectual impairment in patients with “Aging Brain”, and the effect of vinpocetine on cerebral circulation. Drug. Dev. Res, 14:199-204 (1988).
  4. Dyer AH, et al. The role of Insulin-Like Growth Factor 1 (IGF-1) in brain development, maturation and neuroplasticity. Neuroscience. 2016 Jun 14;325:89-99.
  5. Mori K, et al. Nerve growth factor-inducing activity of Hericium erinaceus in 1321N1 human astrocytoma cells. Biol Pharm Bull. 2008 Sep;31(9):1727-32.
  6. Mori K, et al. Improving effects of the mushroom Yamabushitake (Hericium erinaceus) on mild cognitive impairment.Phytother Res. 2009 Mar;23(3):367-72.
  7. Mayumi N, et al, Reduction of depression and anxiety by 4 weeks Hericium erinaceus intake. Biomedical Research. 2010, 31(4): 231-237.
  8. Panossian A, Wagner H. Stimulating effect of adaptogens: an overview with particular reference to their efficacy following single dose administration. Phytother Res. 2005;19(10):819–38.
  9. Roodenrys S, et al. Chronic effects of Brahmi (Bacopa Monnieri) on human memory. Neuropsychopharmacology. 2002 Aug;27(2):279-81
  10. Hung SK, Perry R, Ernst E. The effectiveness and efficacy of Rhodiola rosea L.: a systematic review of randomized clinical trials. Phytomedicine. 2011 Feb 15;18(4):235-44. doi: 10.1016/j.phymed.2010.08.014. Epub 2010 Oct 30.
  11. Darbinyan V, Kteyan A, Panossian A, et al. Rhodiola rosea in stress induced fatigue – a double blind cross-over study of a standardized extract SHR-5 with a repeated low-dose regimen on the mental performance of healthy physicians during night duty. Phytomedicine 2000;7:365-371.
  12. Crook TH, et al. Effects of phosphatidylserine in age-associated memory impairment. Neurology. 1991 May;41(5):644-9.
  13. Glade MJ, Smith K. Phosphatidylserine and the human brain. Nutrition. 2015 Jun;31(6):781-786.
  14. Weiser W, et al. Docosahexaenoic Acid and Cognition throughout the Lifespan. Nutrients, 2016 Feb; 8(2): 99.
  15. Vandenberghe C, et al. Medium Chain Triglycerides Modulate the Ketogenic Effect of a Metabolic Switch. Front Nutr. 2020; 7: 3.
  16. https://lpi.oregonstate.edu/mic/other-nutrients/choline
  17. Synoradzki , Grieb P. Citicoline: A Superior Form of Choline? Nutrients. 2019 Jul; 11(7): 1569.
  18. Schmitt CA, Dirsch VM. Modulation of endothelial nitric oxide by plant-derived products. Nitric Oxide. 2009 Sep;21(2):77-91.
  19. Bhagavan HN, Chopra RK. Coenzyme Q10: Absorption, tissue uptake, metabolism and pharmokinetics. Free Radic Res. 2006 May;40(05):445-53.
  20. Chowanadisai W, et al. Pyrroloquinoline Quinone Stimulates Mitochondrial Biogenesis through cAMP Response Element-binding Protein Phosphorylation and Increased PGC-1α Expression. J Biol Chem. 2010 Jan 1; 285(1): 142–152.
  21. Mahoney CR, et al. Tyrosine supplementation mitigates working memory decrements during cold exposure. Physiol Behav. 2007 Nov 23;92(4):575-82. Epub 2007 May 22. 
  22. Thomas JR, et al. Tyrosine improves working memory in a multitasking environment. Pharmacol Biochem Behav. 1999 Nov;64(3):495-500. 
  23. Rogers PJ, Smith JE, Heatherley SV and Pleydell-Pearce CW, 2008. Time for tea: mood, blood pressure and cognitive performance effects of caffeine and theanine administered alone and together. Psychopharmacology, 195, 569-577.

These statements have not been approved by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease.

This article is an opinion and explanation of current research given by the author. It is not an expression of a medical diagnosis or treatment and should not be relied on as such.

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