Microdosing Psychedelics: Hope or Hype?
The term ‘microdosing’ refers to taking tiny amounts of psychedelics, well below the dose required for a typical psychedelic experience. It has become very common, and hundreds of thousands of individuals use these each year. By far the commonest drugs used are LSD and ‘magic’ mushrooms containing psilocybin.
Reported benefits of microdosing include improvements in overall sense of wellbeing, greater ability to focus, increased energy level, improved mood, less anxiety, and increased creativity. With potential benefits like those it is not a surprise that many are using them. Despite this use, to date only a few controlled studies have taken place. And the findings of these don’t seem to line up with the positive user experiences reported. A negative view is also consistent with some of the small, but carefully controlled, placebo studies which suggest most if not all of the effect is due to expectancy effects. So what’s going on? Is this simply a placebo effect?
The only way to separate the science from the hype is to take a closer look at the clinical studies that have been done, which I dive into in my book, The Promise of Psychedelics. Very recent peer-reviewed publications have also helped clarify this issue.
Reasons for Hope
There have been several large studies based upon users self-reporting. However, when considering results from these a high level of caution is required. They are self-selected groups, often microdosing with a high level of expectation, and the results don’t have a placebo-control group to compare with. All of these things tend to make results more positive in general, and also less useful for us to give advice.
Nonetheless, even recognizing these limitations there are a lot of positive studies. For example, a 2018 study reported that nearly half the more than 1,100 microdose users self-reported improvements in symptoms of anxiety and depression, cognition, and creativity. Another study from 2019 reported from 410 individuals clinically diagnosed with a mental health disorder, and participants in this study reported better results from microdosing with psychedelics than with conventional treatments. A larger study from 2020, with over 6,570 participants, concluded that the benefits of microdosing outweigh the risks.
There have been 3 recent studies which help shed light on this issue. Perhaps the most useful is a recent study from researchers in Canada and the Netherlands, published in June 2022 (Rootman et al), in which the authors followed 953 psilocybin microdose users for 30 days and compared them to 180 non-microdosing controls. They found some mild-moderate improvements in both mood and mental health. While not a true placebo-controlled study, this was prospective and controlled so we can give some weight to the findings.
This approach is also supported by a recent review published in May 2022 (Polito and Liknaitzky) which systematically reviewed over 65 years of research on low dose psychedelics, including both laboratory and placebo-controlled studies and they “argue that claims that microdosing effects are largely due to expectancy are premature and possibly wrong”.
Another recent study, published in June 2022 (Sanz et al) suggested that one of the issues is that microdosing studies use measures that are better suited for much higher dose. Subtle changes may not be picked up, which is what they found in their study. It was a small study (only 34 individuals) but well controlled using placebo and measuring natural speech. They concluded that there are real changes in speech, and that it is not all placebo.
Scientific Reasons for Hope
There is also an increasing knowledge base of scientific evidence to support possible benefits. This is mostly the impact of psilocybin and other similar psychedelics on activity in the default mode network of the brain, brain changes in key areas (‘neuronal plasticity’), impacts on nerve growth (‘neurogenesis’), increase in connections between nerves (‘synaptogenesis’), and better understanding of the receptors involved (5HT2A, glutamate, etc).
Reasons for Caution
So there are reasons for hope, but many issues remain. There is still not much convincing evidence about when microdosing is best, the best drug to use (although it is likely to be psilocybin based on existing knowledge), the best dose, how frequently it should be used, and if this is a short-term and/or longer-term benefit.
In line with these hesitations a placebo-controlled study of low dose LSD from March 2022 (de Wit et al) did not find any meaningful benefits on mood or task performance in healthy volunteers. Similar negative findings in volunteers were reported in a placebo-controlled study with psilocybin in January 2022 (Marschall et al).
Additionally, caution is also required in terms of the potential underlying changes found in the neuroscience research since the effect of either short-term or longer-term psychedelic use remains uncertain, or how this may change with different doses.
A final note of caution is that psychedelics are more effective when combined with appropriate therapy, using the so-called psychedelic assisted psychotherapy approach, but the role of therapy in microdosing is uncertain.
Microdosing and The Treatment of Mental Health
So what is the takeaway? Overall, the balance of evidence suggests that microdosing may have mild-moderate benefits for patients with some disorders. However, the level of uncertainty at this time is such that they cannot be clinically recommended, although with more research this may change over the next few years and it may become an accepted an treatment for certain conditions.
You can learn more about those risks, as well as the benefits, in my book: The Promise of Psychedelics, Science-Based Hope for Better Mental Health.
Copyright 2022: The Promise of Psychedelics: Science-Based Hope for Better Mental Health