From Messi’s brain to modern medicine: Where stimulants and psychedelics converge in the performance conversation
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Stimulants mainly increase dopamine and norepinephrine signaling, which can improve wakefulness, task initiation, and behavioral control when used appropriately.
—Rab Nawaz, MD, internal medicine physician
Elite footballers are living, breathing examples of how our brain’s natural high-level performance depends on attention, prediction, reward, timing, motor control, error correction, and learning. These players see the field, filter noise, select an action, and update the next move within seconds.
Researchers are studying how the brain changes with training, injury, therapy, and medication, with a goal to understand how attention, learning, and neuroplasticity are modified—and how those mechanisms might improve clinical care.
Related: 'Neuroplasticity' could transform dementia treatmentStimulants and the attention system
CNS stimulants are already established in ADHD care. Methylphenidate- and amphetamine-based agents remain the best-known and most widely used ADHD medications and are FDA-approved for children as young as age 6. []
Internal medicine physician Rab Nawaz, MD explains, “Stimulants mainly increase dopamine and norepinephrine signaling, which can improve wakefulness, task initiation, and behavioral control when used appropriately.” A pharmacology review notes that amphetamine and methylphenidate increase central dopamine and norepinephrine activity, which affects executive function, motivation, effort, and behavioral control. []
But prescription stimulants appear to act mainly on reward and wakefulness networks, rather than classic attention circuitry, according to Washington University researchers. [] Their study used resting-state fMRI data from 5,795 children aged 8 to 11 in the Adolescent Brain Cognitive Development cohort, then validated findings in a small methylphenidate imaging experiment in healthy adults without ADHD.
Psychedelics and neuroplasticity
Classic psychedelics such as psilocybin, LSD, and DMT are being studied because of their effects on serotonergic signaling, especially 5-HT2A receptor pathways, and their possible influence on neuroplasticity. []
A Biomolecules review on psychedelics and neuroplasticity described molecular, structural, and functional changes seen across preclinical and early clinical studies. The authors also noted the limits of translating animal and imaging findings into clinical practice. []
But these findings are not a treatment recommendation. They are just a mechanistic clue. Dr. Nawaz adds, “Psychedelics act very differently, primarily through serotonin systems, and can alter perception, emotion, and large-scale brain networks, so they should not be described as simple attention enhancers.”
Stimulants are not the same as psychedelics
However, as the topic of neuroplasticity is becoming more popular, patient-facing discussions are increasingly placing stimulants, psychedelics, nootropics, cognition, and neuroplasticity in the same brain-optimization bucket.
One Reddit user wrote, “Hypothetically, if a 15-17 year old male (5'9 125-130lbs) during puberty who takes adderall (10mg) for ADHD were to start taking nootropics (specifically cerebrolysin) as well as neuroplasticity enhancers (such as microdosing LSD or Ket) what would the effects be? Would the person involved see any change? Would anybody recommend any alternative nootropics/neuroplasticity enhancers in this situation?” []
Rostislav Ignatov, MD, Chief Medical Officer at The Haven Detox Group, says, “Both stimulants and psychedelics should not be placed within the same clinical framework. Stimulants have been prescribed for their effects on alertness, reward, and executive functions during daily activities. Research concerning psychedelics has focused on whether a therapeutic session using a monitored psychoactive substance combined with therapy could create a ‘window’ through which symptomatology becomes more manageable.”
Neuroplasticity with rehabilitation
Physical therapy, motor learning, task-specific practice, aerobic exercise, visual-motor training, feedback, and dual-task training all work through experience-dependent adaptation. []According to Dr. Khan, “These tools can be useful as targeted rehabilitation aids, especially when a patient has a specific visual, attention, or reaction-time deficit.”
Exercise is also being studied as a neuroplasticity intervention. A 2024 Frontiers in Molecular Neuroscience review described exercise-induced neuroplasticity as a rehabilitation target, with effects on central nervous system adaptation, pain, cognition, and recovery. []