Microdosing: What we know so far

By Denise Lin, MD

As a psychiatrist with certification in psychedelic-assisted psychotherapy,  I’ve become very interested in microdosing as a potential therapeutic modality.

Microdosing is the practice of regularly taking small, sub-hallucinogenic doses of psychedelic medicines, such as psilocybin or LSD and then typically going about one's normal activities.

My training in psychedelic therapy – while excellent in many ways -- did not really address microdosing so I am left with multiple questions. Can microdosing actually benefit people suffering from depression, cognitive issues, anxiety or existential angst? If it is beneficial then what are the best microdosing protocols?

Let me be quick to say I don’t endorse the use of illegal drugs, but as some jurisdictions decriminalize psychedelics and researchers advance the case for more therapeutic applications, this is an emerging area of interest.

The internet is full of reports of beneficial effects of microdosing on mood, creativity, focus and personal enrichment. Colleagues have also reported good things. However, the scientific literature is sparse.

Thus, I was interested to read this article, published this month in Addiction Biology. While it was nicely designed as a controlled experiment, comparing LSD microdoses to a placebo, it was small, with only 56 “healthy” participants. In my opinion, the big flaw of this study was that they only enrolled people who were NOT suffering from mood, anxiety or cognitive disorders. Their findings (unsurprisingly) were that the people who got small LSD doses did not show improvements in mood or cognition compared to those who got the placebo. It seems to me that if they wanted to look for an effect on mood or cognition they should have enrolled people with mood or cognition issues starting out!

While that study didn’t help answer my questions, I found a 2019 survey of 278 microdosers of LSD or psilocybin which I found interesting. In this group, 26.6% reported improved mood and 14.8% reported improved focus. They were also asked about challenges related to microdosing of which illegality was the most common challenge (29.5%). Some people (6-7%) did report impaired energy, mood or an increase in anxiety.

Anderson, T., Petranker, R., Christopher, A. et al. Psychedelic microdosing benefits and challenges: an empirical codebook. Harm Reduct J 16, 43 (2019)

What I gleaned from this paper was that there are clearly benefits for some people for some symptoms. Otherwise, honestly, why would microdosing be popular? There also appears to be some important potential side effects, so moving ahead cautiously is going to be important.  Stay tuned for more updates!

References:

1.  de Wit H, Molla HM, Bershad A, Bremmer M, Lee R. Repeated low doses of LSD in healthy adults: A placebo-controlled, dose-response study. Addict Biol. 2022 Feb 1
   
2. Anderson, T., Petranker, R., Christopher, A. et al. Psychedelic microdosing benefits and challenges: an empirical codebook. Harm Reduct J 16, 43 (2019)
   
   

Here are a few additional papers if you’re interested in reading more on psychedelic microdosing:

• Kuypers KPC. The therapeutic potential of microdosing psychedelics in depression. Therapeutic Advances in Psychopharmacology. January 2020
• Prochazkova, L, Lippelt, DP, Colzato, LS, et al. Exploring the effect of microdosing psychedelics on creativity in an open-label natural setting. Psychopharmacology (Berl) 2018; 235: 3401–3413.
• Yanakieva, S, Polychroni, N, Family, N, et al. The effects of microdose LSD on time perception: a randomised, double-blind, placebo-controlled trial. Psychopharmacology (Berl) 2019; 236: 1159–1170.
• Greiner, T, Burch, NR, Edelberg, R. Psychopathology and psychophysiology of minimal LSD-25 dosage; a preliminary dosage-response spectrum. AMA Arch Neurol Psychiatry 1958; 79: 208–210.

Denise Lin, MD

Psychiatrist, Psychedelic-Assisted Psychotherapy practitioner, Physician-Nutrition Specialist