Microdosing - Tiny doses with even tinier amounts of evidence
Disclaimer: This blog is by no means an endorsement, nor is it advocating, illegal activities. It is purely a discussion about a trend of drug-use which is growing in popularity and could have potential implications for novel treatment approaches in mental health. It should be noticed that microdosing recreational drugs is, under law, a criminal activity.
If you’re anything like me, you may have seen the concept of ‘microdosing’ popping up here, there and everywhere recently. Well, before our lives were rightly overtaken by news of COVID-19, that is.
It’s a key theme running through six-time bestselling author Liane Moriaty’s hit, ‘Nine Perfect Strangers’. We are introduced to a group of strangers as they arrive at a wellness retreat hoping to resolve various invidual issues. But, there is a twist — the retreat turns out to be an unconventional one (spoiler alert — skip to the next paragraph if you’re planning on delving into this novel). As the transformational methods start to be questioned by the guests, we find out that they have been unknowingly drugged with microdoses of illegal substances as a form of ‘therapy’.
It is also commonly mentioned as a new trend in Silicon Valley amongst technology circles. I’m sure we’ve all heard stories about the relationship between the valley and psychedelic drug use, but now there’s a different spin and that is to microdose these drugs.
And it has gathered momentum in the media — only a few months ago my Grandad, who wonderfully points me in the direction of any psychology related articles he finds in the newspaper (thank you to him!), showed me an article from The Telegraph about a 34 year olds man and his personal experience. And it was at this point I thought to myself, yes, but what actually is microdosing?
Being a clinical trial manager myself, I am well versed in knowing how drugs go through rigorous testing before they can be licensed and rolled out into clinical care (you can read more about this in my last blog), however this phenomenon was something very new to me.
I wanted to know more about the world of unregulated drug use in the mental health disorders I research, and how this drug use has gained so much popularity despite its lacking evidence. So, here is what I have learnt. Microdosing
The phenomenon has been described as “consuming crumb-sized amounts of psychedelics — not to feel high but to feel more focused and creative and present”. Microdosing usually consists of taking small amounts of a psychedelic drug — usually one tenth to one twentieth of a standard recreational dose — it really is tiny doses in comparison to its full dose counterpart.
The most frequent drugs to be microdosed are LSD, psilobilin, or ‘magic’ mushrooms; however, any drug with psychedelic properties are used, including cannabis, ayahuasca and ketamine, amongst others.
Each drug can be microdosed for different effects to be achieved. An article in The Cut even provides a breakdown: microdosing LSD and mushrooms can result in a new found energy and focus; cannabis for pain, nausea and inflammation; heightened sensitivity and reduced boundaries can be the effects of ayahuasca; and microdoses of ketamine can reportedly be used for reducing stress and symptoms of depression. While the dose only stays in the body’s system for a couple of hours, reportedly the effects can last for some days.
But what we know about this comes from individuals’ experiences only, and not everyone achieves these effects. There are only tiny amounts of actual scientific evidence when it comes to these tiny doses: it seems that in the case of microdosing, people have been taking things into their own hands. There is even a Reddit forum for microdosing users who compare notes and methods with some 24,000 users.
So what do people use it for and why?
I mentioned technology circles in Silicon Valley, and this is really where microdosing first gathered its popularity although, supposedly indigenous groups have been using the sub-perceptual doses for centuries. Young professionals working in the bustling hub of technology and innovation have insisted that taking these microdoses helps them perform at work by enhancing their creativity and focus.
One individual describes the first time they experimented with microdosing after not having used psychedelics before: “I stared at a blank wall every now and then just to make sure I didn’t see any hallucinations, but there was nothing. Weirdly, it’s not until the next day, in retrospect where you look back, that you realise you handled things, or reacted to things differently. It’s so subtle it’s easy to miss. But it definitely worked”. Essentially, the act may provide some level of benefit, minus the hallucinogenic affect that psychedelics are known for.
Creativity and focus aside, others have reported a significant benefit on their mood — many people microdose for mood balancing and management. In a piece on microdosing written in The Guardian, a woman spoke of how after taking 15 micrograms of an LSD tab (in comparison to a whole tab which is typically 100mg) she saw a positive change in her mental health — “It lifted me out of a pretty deep depression […] I’m able to be more mindful of my emotions. If I’m feeling sad, that’s ok. I don’t obsess anymore. I don’t dwell on it. I don’t get worked up about it.”
Could there be implications for novel treatments for mental health?
Microdosing for mental health
With concerning proportions of those using antidepressant medication not finding any/significant improvement in their depressive treatment (‘treatment resistant’), it’s no wonder so many people are taking things into their own hands.
An emerging body of research makes a case for using psychedelic drugs such as LSD and Psilobilin to treat mental disorders including depression. The effects of Psilobilin particularly hint at a potential benefit for treatment-resistant depressed patients and a first controlled trial of psychedelics using ayahuasca, in a controlled environment, indicates similar potential. And with evidence as such, which proposes the beneficial effect of full doses of psychedelic drugs in treating depression, it makes sense that people consider microdosing.
In theory, could these small doses retain these beneficial effects without the consequence of distortions from psychedelic experiences?
But when it comes to microdosing, a review published in 2019 identified only 4 scientific papers exploring the concept. Scientifically, this doesn’t amount to much evidence at all.
These studies mainly recruited existing microdosing users to examine their experiences, and identified positive effects for depression and anxiety, and cognitive performance. When compared to those who were naive to the practice, microdosers reported much more improvement in their mood with depression symptoms lessening considerably. Despite showing benefit for mental health disorders such as depression, this research doesn’t seem to use clinical samples such as groups of people with a clinical diagnosis of depression yet. Is this the next step?
It’s not just mood disorders which could be implicated here either. Psychedelic researcher from Imperial College London, Carhart-Harris, has suggested that people who suffer from mental health disorders such as obsessive compulsive disorder and addiction could benefit as small doses of drugs could help to interfere with the rigid patters of thinking and behaviour that are key in these disorders.
Evidence is lacking because this is a relatively new phenomenon. Although research into the implications of microdosing on mental health is beginning to build momentum, what is missing is plain and simple scientific evidence from clinical trials, and this may largely due to the bureaucracy and regulations surrounding use of recreational drugs — aka it is very hard to run a trial using something that is illegal. But, there is promise with one or two pre-registered trials on the horizon.
What is next for microdosing?
Until we know more, and by more, I mean a significant body of real hard-hitting scientific evidence, microdosing isn’t something that should be taken lightly, as the lack of evidence also means that we do not yet know what exactly microdosing does to the brain over time.
While accounts of personal experience show that it may potentially have a positive effect in the short-term, we don’t know if there are detrimental effects to health and brain function later in life; not to mention that taking any regular doses of substances as such can lead to development of addiction.
Until we can predict this better, it is better not to experiment yourself — not only is this unsafe, but also all the most commonly microdosed substances are illegal for use in the UK and in most other countries, and therefore any possession or use of these drugs is, by law, a criminal offence. However for now, what we know about microdosing is that we mostly don’t know.
We are very much at the beginning of a new brink of research in mental health, and whether it’s psychedelics, microdosing, or another new treatment method, we can all hope that things will advance soon enough, so that we will have more effective treatments for those who need them.