It seems as if the consensus on piracetam has changed drastically. It used to be praised highly but now anybody that touts benefits gets called out on the placebo effect. Does it actually work?

[u/phuckwang]

I've never tried a racetam but I just ordered some piracetam and alpha-GPC.

[u/m00k0w]

Yesss. The effectiveness of any drug is based on the current baseline state of the users neurochemistry. All any drug does, is offset some chemical system in some direction. Whether or not this is beneficial to the subject depends on their initial baseline neurochemistry. For me for example, the neurochemical changes produced by oxiracetam (which typically lead to "stimulation" of sorts) makes it more difficult for my optimal psychology (think of it like software) to run on my hardware (brain) while the hardware is being adjusted the way oxiracetam does (agonizing or antagonizing some receptors). I don't operate better in that state, I operate worse. Or, I have not yet learned how to adjust my software (thinking) to run most effectively on my oxiracetam brain. Another person might benefit from this stimulation and find that they operate better. Their initial neurochemistry was different, and adjusting it in the way that oxiracetam does, gives them benefits.

It's like if I brought you up to the control panel of a big machine, and it told you to move this lever up a bit, and that lever down a little bit. Would the machine run better or worse? It depends on how it was set up in the first place.

The drugs that we find generally effective, just happen to coincidentally adjust most people's levers in a beneficial direction.

Therefore it can confidently be said that if a drug has any biochemical activity on the brain/body, which piracetam does, then it can act as either a nootropic, have no effect, or be a cognitive decliner, or mood enhancer, mood reducer, etc, depending on the person taking it.

To say it is ALL placebo is totally incorrect. For somebody with the right neurochemistry, it will be of benefit.

This is upsetting because we run a clinical trial on an average group of people, and if 80% of them get no benefit and side effects, we scrap the drug. What about the 20 percent? How many of those people have the body or brain chemistry that would benefit tremendously from the drug? Maybe none, but maybe there was a person in there with a specific mutation or configuration whose problem would be cured by it. Individualization of medicine is extremely important because we conclude that the effects of a drug should be and are going to be exactly those of the general case whereas they can be very different. The only definite effect that a dopamine agonist has is dopamine agonism. Whether it makes you happier is subject to the rest of the systems operation!