Perceived outcomes of psychedelic microdosing as self-managed therapies for mental and substance use disorders

Toby Lea & Nicole Amada & Henrik Jungaberle & Henrike Schecke & Norbert Scherbaum & Michael Klein

Psychopharmacology, 2020.

Di : 10.1007/s00213-020-05477-0

 

Abstract

Rationale : The regular consumption of very small doses of psychedelic drugs (known as microdosing) has been a source of growing media and community attention in recent years. However, there is currently limited clinical and social research evidence on the potential role of microdosing as therapies for mental and substance use disorders.

Objectives : This paper examined subjective experiences of microdosing psychedelics to improve mental health or to cease or reduce substance use, and examined sociodemographic and other covariates of perceived improvements in mental health that individuals attributed to microdosing.

Methods : An international online survey was conducted in 2018 and examined people’s experiences of using psychedelics for self-reported therapeutic or enhancement purposes. This paper focuses on 1102 respondents who reported current or past experience of psychedelic microdosing.

Results : Twenty-one percent of respondents reported primarily microdosing as a therapy for depression, 7% for anxiety, 9% for other mental disorders and 2% for substance use cessation or reduction. Forty-four percent of respondents perceived that their mental health was “much better” as a consequence of microdosing. In a multivariate analysis, perceived improvements in mental health from microdosing were associated with a range of variables including gender, education, microdosing duration and motivations, and recent use of larger psychedelic doses.

Conclusions : Given the promising findings of clinical trials of standard psychedelic doses as mental health therapies, clinical microdosing research is needed to determine its potential role in psychiatric treatment, and ongoing social research to better understand the use of microdosing as self-managed mental health and substance use therapies.

Keywords : LSD . Psilocybin . Mental health . Alcohol . Drugs . Self-treatment . Microdose

 

Introduction

Over the past decade, there has been a renewed interest in psychedelic drugs as potential therapies for mental and substance use disorders (Sessa 2018). Clinical trials have investigated psilocybin and ayahuasca for treatment-resistant depression (Carhart-Harris et al. 2018; Palhano-Fontes et al. 2019), psilocybin for alcohol dependence (Bogenschutz et al. 2015) and nicotine dependence (Johnson et al. 2017), and psilocybin and lysergic acid diethylamide (LSD) for end-of-life anxiety in terminally ill patients (Gasser et al. 2014; Griffiths et al. 2016). While not technically a psychedelic, 3,4- methylenedioxymethamphetamine (MDMA) has resulted in improved outcomes for people with post traumatic stress disorder (PTSD) (Mithoefer et al. 2019) and is being investigated as a treatment for alcohol use disorder (Sessa et al. 2019).

These studies have shown promising results, and have been driven in part by the limited effectiveness of many conventional treatments for mental health and substance use disorders, low rates of treatment engagement and high rates of attrition (Hoskins et al. 2015; Moncrieff 2018; Pampallona et al. 2002). For example, one-third of depressed patients do not respond to currently available psychiatric medications (Conway et al. 2017), and treatment engagement and adherence for mental and substance use disorders is typically well below 50% (Cipriani et al. 2018; Milward et al. 2014; Whiteford et al. 2014).

Psychedelics are also being used by individuals to manage mental health and substance use issues outside of approved clinical and research settings. In a recent survey of psychedelic users, 62% of those who had been diagnosed with a mental disorder had used psychedelics as a self-administered adjunct or replacement therapy to prescribed medication or psychotherapy, although it was unclear whether participants had discussed this with a clinician (Mason and Kuypers 2018).

In addition, there are increasing reports of people seeking out shamanic healers (e.g., ayahuasca ceremonies), and “underground” therapists (i.e., providing psychedelic-assisted therapy illegally via word of mouth) (Kavenská and Simonová 2015; Noorani 2019). Coinciding with the resurgence of clinical psychedelic research, “microdosing” has gained considerable media attention in recent years. Microdosing refers to the ingestion of low to very low doses of psychedelic drugs (typically between 5 and 10% of a standard dose) on a routine schedule (e.g., every third day) without the intention of experiencing effects typically experienced at higher psychedelic doses (e.g., visual distortions, mystical experiences) (Fadiman 2011; Kuypers et al. 2019; Liechti 2019). Although a recent randomised controlled trial reported 13 mcg of LSD as a threshold microdose above which psychedelic effects may be experienced (Bershad et al. 2019), there is currently no scientific consensus about what dose ranges constitute LSD and psilocybin microdoses (Kuypers et al. 2019; Passie 2019). Microdosing has been characterised in the news and popular media as a workplace trend that started among technology professionals in Silicon Valley to enhance productivity, focus and creativity (Dean 2017; Glatter 2015). There has also been some focus on people microdosing as a self-managed treatment for depression, anxiety and other mental disorders, both in traditional media outlets and online platforms such as YouTube and Reddit (Hupli et al. 2019; Lea et al. 2019; Waldman 2017; Williams 2017). While some research on small LSD doses was conducted before psychedelics were banned in the USA in 1970 (Passie 2019), contemporary research on microdosing is in its infancy.

Two recent randomised controlled trials of LSD microdosing have shown changes in time perception following LSD administration (Yanakieva et al. 2019), and dose-related increases in ratings of “vigour” (Bershad et al. 2019). A naturalistic experimental study found improved performance on problem-solving tasks after taking a non-blinded microdose of psilocybin truffles (Prochazkova et al. 2018).
An observational online study followed respondents microdosing over a 6-week period, and reported reductions in symptoms of depression and stress, but no significant change in symptoms of anxiety (Politi and Stevenson 2019).

A small number of online cross-sectional surveys have also assessed different aspects of microdosing. One of few studies to examine motivations to microdose found that performance enhancement was the most commonly reported motivation (37% of the sample), followed by mood enhancement (29%) and “symptom relief” (14%) (Hutten et al. 2019a). While their respondents rated microdosing as more effective than conventional therapies for depression, anxiety and substance use disorders, they rated microdosing as less effective than full psychedelic doses for depression and anxiety, with no significant
differences between ratings of full doses and microdoses as therapies for substance use disorders (Hutten et al. 2019b).

Another study reported that people who had microdosed scored higher on measures of open-mindedness and creativity, and lower on measures of dysfunctional attitudes and negative emotionality compared with people without microdosing experience (Anderson et al. 2019b). From the same study, respondents
most commonly reported improved mood (27%), focus (15%) and creativity (13%) as benefits of microdosing, and physiological discomfort (18%), impaired focus (9%), impaired mood (7%) and increased anxiety (7%) as unwanted effects (Anderson et al. 2019a).

A small number of qualitative studies have also been conducted. An online interview study with 21 men reported perceived improvements from microdosing in symptoms of depression and anxiety, as well as enhanced energy and cognition, with few adverse effects aside from inadvertently taking too high a dose (Johnstad 2018). Another study comprised semi-structured interviews with 30 people who had microdosed and found that interviewees rationalised microdosing as a functional form of drug use akin to taking a supplement, in order to be “the best possible version of themselves” (Webb et al. 2019, p. 35). A content analysis of microdosing discussions on the online forum Reddit found that posters were primarily motivated tomicrodose to improve mental health and wellbeing, and to enhance cognitive performance (Lea et al. 2019). While many reported that microdosing had met or exceeded their expectations, particularly in providing relief from depression and anxiety and fostering improved health practices and habits, some posters reported no discernible improvements and some reported increased
anxiety while microdosing (Lea et al. 2019).

To date, most quantitative microdosing studies have excluded people with a history of mental illness, have not reported microdosing motivations, and no study has examined the sociodemographic and other correlates of microdosing as mental health and substance use therapies, nor the sociodemographic and other correlates of perceived improvements in mental health that people attribute to microdosing. This paper aimed to address these research gaps using findings from an international online survey.

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