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

This survey (n=1102) study found positive effects after microdosing psychedelics (44% reported ‘much better’ mental health), but was limited to self-reports.

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.”

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

Notes

  • 37% of participants used microdosing for mental health (2% for substance use)
  • 80% of participants reported some (36%) or much better (44%) mental health
  • Most respondents did use a high/full dose of psychedelics in the last 12 months

The survey study is a good sign for microdosing, especially if you just consider the effect it has on the people surveyed. Other placebo-controlled studies have difficulty finding effects beyond a placebo effect. And one also has to take into account effects like regression to the mean. But at a low dose and costs that are also very low, there may be made a case for trying microdosing for mental health.

“Respondents who had been microdosing for a longer duration were also more likely to be motivated to microdose for mental health. This may suggest that microdosing is working for these people, and that they are continuing to microdose as an ongoing therapy to replace or supplement psychiatric medications, some with the knowledge of their doctor and/or psychotherapist.”

Summary

The regular consumption of very small doses of psychedelic drugs to improve mental health or to cease or reduce substance use has been a source of growing media and community attention in recent years.

Introduction

Over the past decade, there has been a renewed interest in psychedelic drugs as potential therapies for mental and substance use disorders. These drugs have shown promising results in clinical trials for treatment-resistant depression, alcohol dependence, nicotine dependence, and end-of-life anxiety in terminally ill patients.

People are using psychedelics to manage mental health and substance use issues outside of approved clinical and research settings, and some are seeking out shamanic healers and underground therapists.

Microdosing has gained considerable media attention in recent years, and has been characterised as a workplace trend among technology professionals in Silicon Valley to enhance productivity, focus and creativity, as well as a self-managed treatment for depression, anxiety and other mental disorders.

Research on small doses of LSD is in its infancy, but two recent randomised controlled trials have shown increases in ratings of “vigour”.

A small number of studies have assessed different aspects of microdosing, including performance enhancement, mood enhancement, and symptom relief. Most studies found that microdosing was more effective than conventional therapies for depression, anxiety, and substance use disorders, but less effective than full psychedelic doses for substance use disorders.

A small number of qualitative studies have also been conducted, including an online interview study with 21 men and a semi-structured interview study with 30 people who had microdosed. Both studies reported perceived improvements in symptoms of depression and anxiety, as well as enhanced energy and cognition.

Most quantitative microdosing studies have excluded people with a history of mental illness, have not reported microdosing motivations, and have not examined sociodemographic and other correlates of microdosing.

Sample and recruitment

An international online survey was conducted with 2088 respondents who reported having ever microdosed psychedelics. 1102 respondents who primarily microdosed psychedelics completed the survey (60.2% completion rate).

Baseline recruitment was conducted via email lists of psychedelic community and non-profit organisations, shared Facebook posts, and paid Facebook advertisements in late 2018. People aged 16 years or older were eligible to participate.

Respondents were asked about mental health diagnoses, treatments, and medications, including psychotherapy, psychiatric medications, and alcohol and other drug use treatment. They were also asked how helpful they found these treatments.

The Patient Health Questionnaire (PHQ-9) measured depressive symptoms and the Generalised Anxiety Disorder 7-item scale measured anxiety symptoms. The Sense of Coherence 13-item scale measured successful coping with internal and external stressors.

Microdosing and other psychedelic use were examined, and respondents’ motivations for microdosing were elicited. A composite measure was generated from these items for overall perceived helpfulness of microdosing among respondents who were motivated to microdose to improve their mental health.

Respondents were asked if they had taken psychedelics for therapeutic purposes or recreational purposes ever and in the past 12 months.

Perceived outcomes of microdosing were measured by asking participants how their use of alcohol, tobacco, cannabis, other recreational drugs, pain medication, antidepressants and other prescription mental health medications had changed since starting microdosing.

Statistical analyses

Analyses were conducted with Stata Version 16.0 and statistical significance was set at p 0.05. Logistic regression models were used to examine covariates of motivation and self-perceived mental health.

A sensitivity analysis was conducted to compare the sociodemographic characteristics of respondents with those who had microdosed psychedelics but did not complete the survey.

Sample characteristics

The mean age of the 1102 respondents was 33 years, and most were male. Most were heterosexual, in a relationship, and had completed a university degree.

Thirty-six percent of respondents reported microdosing at the time of the survey, 37.1% were taking a break, and 27.0% had stopped microdosing. Most respondents had been microdosing for up to 6 months in total, and primarily microdosed psilocybin or LSD/1P-LSD.

Eighty-two percent of respondents had taken psychedelics for self-reported “therapeutic purposes” outside of approved clinical settings, and 89 percent had used them recreationally. Fourteen percent had sought conventional treatments for alcohol or other drug use.

Over half of respondents had ever been diagnosed with a mental disorder, and forty-four percent had been prescribed psychiatric medications. Sixty-five percent had ever seen a counsellor or psychotherapist for their mental health.

Microdosing motivations

Thirty-nine percent of respondents reported microdosing for mental health or substance use therapies, while thirty percent reported microdosing for personal development and general wellbeing, cognitive enhancement, physical health issues, and curiosity.

Among respondents primarily microdosing as a mental health therapy, 75.3% had ever been diagnosed with a mental disorder, 62.6% had ever been prescribed psychiatric medications, and 39.% had seen a counsellor or psychotherapist in the past 12 months.

A multivariate analysis found that being motivated to microdose for mental health or substance use cessation or reduction was significantly associated with longer duration of microdosing, and taking psilocybin rather than LSD.

Changes in medication and substance use

Respondents reported a variety of changes in medication use and non-medical substance use since commencing microdosing, including cessation of antidepressants, reduced alcohol use, reduced cannabis use, and cessation of pain medications.

Perceived improvements in mental health

Nineteen percent of respondents perceived no changes to their mental health, 1.3% reported some changes, and two respondents reported much worse changes.

Respondents who perceived that their mental health was much better due to microdosing were more likely to be female, have lower levels of education, have microdosed for a longer duration, and have a higher sense of coherence score.

Perceived helpfulness of microdosing and conventional mental health therapies

Figure 2 shows how helpful respondents found microdosing for mental health and conventional mental health therapies, among those who reported experience of each therapy.

Discussion

In this online survey, almost 40% of respondents reported that improving their mental health was their main reason for microdosing psychedelics. Many respondents reported having ceased psychiatric medications since commencing microdosing.

Contrary to media coverage, less than one in six respondents reported microdosing for cognitive enhancement. However, cognitive deficits are common among people with mental disorders.

Most people who microdosed for mental health had been diagnosed with a mental disorder, received counselling and were prescribed psychiatric medications. Most of them stopped these medications without clinical support, and most had not discussed microdosing with their doctor.

People who microdose with psilocybin rather than LSD are more likely to be motivated to microdose to improve their mental health, and those who microdose for a longer duration are also more motivated to microdose to improve their mental health.

Clinical trials are needed to determine if microdosing psychedelics is an effective therapy for mental disorders, and some are currently underway. If found to be effective, microdosing may be more beneficial as an ongoing, intermittently administered therapy.

Most respondents had used psychedelics at higher doses for self-treatment in the 12 months preceding the survey, which may confound the mental health benefits that respondents attributed to microdosing. This may also have implications for clinical research on microdosing.

The prevalence of microdosing cannot currently be estimated, but national population surveys could consider including questions about psychedelic use for therapy or enhancement.

We cannot make confident inferences about the potential role of microdosing as novel treatments for alcohol and other substance use disorders, but the results support the findings of other research that has reported reductions in alcohol, tobacco and other drugs that study participants attributed to microdosing.

This study suggests that microdosing may play a role in improving mental health, but more research is needed to determine whether it is actually due to microdosing and not due to a placebo effect/meaning response, reductions in alcohol and other drug use, other lifestyle changes, or a combination of these factors.

Psychedelics could be important new therapies in the management of mental and substance use disorders, particularly for conditions that do not respond well to current treatments. Microdosing may be beneficial to some people’s mental health.

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