Microdosing — taking a tiny amount of mood-altering LSD or magic mushrooms — is seemingly on the increase. Should we be worried, asks Helen O’Callaghan.
Ayelet Waldman woke one morning, took a little blue bottle out of her fridge and deposited two drops of diluted LSD under her tongue.
The former lawyer and New York Times bestselling author, who describes herself as a “middle-aged, middle-class mother of four”, had never taken LSD or any other psychedelic drug before.
California-based Waldman — who’s married to writer Michael Chabon — told a Science and Nonduality audience last year: “Psychedelics always terrified me. I accepted all the mythology — like that if you use LSD more than eight times you become insane.”
But she had a debilitating mood disorder, and medicines that had previously kept her mood stable weren’t working anymore.
Suicidal and with “intolerable” depression, Waldman picked up The Psychedelic Explorer’s Guide, James Fadiman’s 2011-published book.
A psychedelic researcher since the 1960s, Fadiman is regarded by followers as an ‘authority on psychedelics’ (powerful psychoactive substances that alter perception and mood and affect numerous cognitive processes).
Waldman opened the chapter on microdosing — the practice of ingesting tiny doses of psychedelic substances, usually at three- to five-day intervals.
Doses are typically between one-tenth and one-twentiethth the recreational dose. The effects of microdosing are ‘sub-perceptual’ — Fadiman says that “a dose that feels as if you’re right at the edge of a psychedelic experience is too high”.
After talking with Fadiman (“I felt I could trust his expertise”), Waldman grew more comfortable about microdosing with LSD — and finally the morning came when she did.
“I was very scared after taking it. I waited for the colours — for that bad trip. Nothing happened! I got my laptop and started working.
"At some point, I lifted my head and looked out the window. A dogwood tree had gone into blossom. [I thought] look how beautiful those blossoms are.
"I had been so devoid of capacity to experience beauty and suddenly I felt it. It was really that dramatic and that instant.
"I went from being suicidally depressed, unable to experience joy, to looking out the window and finding myself exhilarated by beauty.”
For that month Waldman microdosed every three days (“the second day, most people feel an even more enhanced sense of wellbeing”).
In total, she took 10 doses. LSD “allows different parts of the brain to communicate in unusual ways”, she says.
It was a tool, allowing her to be “receptive to therapies and ways of thinking”, so she could experience her moods without being “buffeted” by them.
In that month, she wrote a book – A Really Good Day: How Microdosing Made a Mega Difference in My Mood, My Marriage, and My Life.
David Erritzoe, psychiatrist and academic clinical lecturer at Imperial College London, says no solid statistics exist on the extent of microdosing among “ordinary people on the street”.
But anecdotally, he says there’s a sense that microdosing is “an increasingly popular phenomenon”.
He believes Waldman’s 2016-published book gave it momentum.
“I’d speculate microdosing is gaining popularity because some [people] are a bit critical of established pharmaceutical treatments as a way forward for them.
“As with many other alternative treatments, they’re looking to stuff that has been used in other cultures and that comes from nature and that has a spiritual component, as psychedelics do.”
Swiss chemist Albert Hofmann accidentally invented LSD in 1938 while looking for a blood circulation drug. It had its heyday in the 1960s, becoming the drug of choice for the flower-power generation, but a swift countermovement followed and it was outlawed, as was psilocybin (the active ingredient in ‘magic’ mushrooms).
More recently psychedelics are enjoying resurgent interest among researchers.
“Compared to other substances, psychedelics have very low addictive potential and are among the least harmful substances,” says Dr John Kelly, lecturer in clinical psychiatry at Trinity College, whose team in Tallaght Hospital — headed up by Professor Veronica O’Keane — was the first worldwide, as part of the COMPASS clinical trial, to assist a participant through the psilocybin experience.
In Ireland, it’s a criminal offence to possess LSD. Psilocybin mushrooms are also banned. Psychoactive substances are covered under the Criminal Justice (Psychoactive Substances) Act 2010. (After a complicated process over many months, the Health Products Regulatory Authority granted licences so the Tallaght team could use psilocybin in their trial.)
But are growing numbers microdosing here?
Ciara Sherlock of the Psychedelic Society of Ireland says many “definitely” microdose these days.
“Most [do] to enhance creativity or improve concentration. Others microdose to prevent seasonal depression. LSD and psilocybin mushrooms are mostly used.
A systematic study of microdosing psychedelics conducted by researchers at Sydney’s Macquarie University and published this year found, longer term, microdosing led to improved mental health, reduced mind-wandering, and increased mental absorption.
“This suggests microdosing may lead to more subtle changes — improvements in mental stability, capacity to sustain attention, and increased ability to become engaged in intense imaginative experiences,” say the researchers.
But neuroticism also appeared to increase, highlighting that not everyone has a positive experience.
Kelly points to a new University of Chicago study — the first controlled study to investigate acute subjective and behavioural effects of microdoses of LSD in healthy volunteers.
“There were no improvements in mood or cognition. In fact, there was a tendency towards increased anxiety and there was a decrease in positivity ratings of images with positive emotional content. This study was not exactly a ringing endorsement for microdosing,” says Kelly, adding that the Sydney study reported “no changes in mindfulness, mystical experiences, positive personality traits, creativity, sense of agency or overall quality of life”.
Kelly believes the practice of microdosing has “outpaced the evidence” — the evidence “simply isn’t there to support the role of microdosing in improving wellbeing and mood”.
This new interest in researching psychedelics reportedly began with US-based investigators using doses of psilocybin to help dying patients cope with fear of death.
UCLA researchers enlisted 12 terminal cancer patients between 2004 and 2006, each suffering from anxiety.
All took a “moderate” dose of psilocybin (far exceeding microdosing amounts) to see if they’d get relief from their fear of death/disease. Most enjoyed “significant” reduction in end-of-life anxiety one to three months post-treatment.
Depression also eased and this continued even six months later.
The researchers suggest psychedelic drugs like psilocybin “may help ease the existential anxiety and despair that modern medicine has largely found no other way to treat”.
Kelly points to “good quality research” of psilocybin-assisted psychotherapy at Johns Hopkins University.
“The ego dissolution evoked by psilocybin commonly resulted in experiences of substantial personal meaning and spiritual significance,” says Kelly.
Double blind placebo controlled trial of LSD micro-dosing in healthy young adults (n=20)...properly conducted, but no actual benefits (as far as I can see)....https://t.co/lnS1lVqPhU— John Kelly (@johnrkelly) June 9, 2019
“People tend to experience markedly different perspectives on the interaction between the self and the environment, including [feeling] interconnected with the environment and with others.
"For [most], these effects were sustained at six-month follow-up,” says Kelly, adding that other researchers have shown the altered perspective induced by psilocybin-assisted psychotherapy can help overcome addiction (tobacco/alcohol).
Meanwhile, he says the first trial of psilocybin in treatment-resistant depression by Carhart Harris and colleagues showed “remarkable results”.
Kelly says studies indicate a 25mg dose of psilocybin may be required for optimal therapeutic effects.
He believes psilocybin-assisted psychotherapy can serve as a powerful therapeutic tool with potential to benefit many people — provided “it progresses in a safe, scientific and evidence-based manner”.
Which begs the question: While it might be tempting under stress to reach for an instant happy fix, are those who microdose — albeit with tiny amounts but without professional supervision or input — playing with fire?
Sherlock says psychedelics are ‘non-specific amplifiers’ — wherever you are, whatever you’re doing, however you’re feeling becomes more intense under their influence.
“So if you’re around people you don’t know, at a loud party or already in a bad mood, these things would be amplified and could potentially lead to a challenging experience.”
Sherlock, a lead facilitator for the psychedelic ‘Experience Retreats’ — group retreats using psilocybin in the Netherlands, where it’s legal — urges great care in choosing the setting for taking a psychedelic.
“Many people experiment at festivals, but these can be very hectic environments and it may turn out to be an unpleasant experience.
"Irish festivals have no welfare areas, unlike Kosmicare at [Portugal’s] Boom Festival or Zendo at Burning Man [Nevada].”
So who comes on Experience retreats?
“We usually have at least six different nationalities within a group. Out of 16, one or two might be Irish. Their backgrounds vary — students, parents, retired people. Usually each decade’s represented, from 20s to 70s.
“We’ve had barristers, ex-police, professors, scientists, lawyers, schoolteachers, creatives. Some have taken psychedelics before — some have never touched a drug.
"People come for different reasons. They’re all interested in deepening their relationship with themselves and hoping to understand what a potential spiritual experience feels like.”
Kelly’s Tallaght Hospital team are actively recruiting participants for the psilocybin session, but candidates must have treatment-resistant depression — clinical depression that hasn’t responded to at least two medications.
People with history of psychotic disorder, bipolar disorder, some personality disorders and those with active substance abuse or dependency disorders are excluded.
Kelly recommends the same groups shouldn’t microdose. And he warns: while microdosing involves sub-threshold doses, most people don’t know precisely what dose they’re taking. (Regarding psilocybin mushrooms, Sherlock says: “The difference of one gram can make a huge difference in the strength of an experience.”)
Fadiman “specifically” recommends people with colour-blindness, psychotic disorders, or those diagnosed along the autism spectrum shouldn’t microdose.
“People with colour-blindness report lasting visual distortions. People with psychotic disorders may be harmed by psychedelics.
"People along the autism spectrum seem to require dosages far [exceeding] what’s traditionally considered microdosing.”
Erritzoe says psychedelic drugs in full doses — 10/20 times higher than microdosing amounts — are safe and don’t tend to create addiction, but he cautions they “can be psychologically very challenging” for many.
“And microdosing is repeated dosing, which isn’t the same as a one-off dose. For a person vulnerable to developing mania, paranoia or other psychotic features, we don’t know whether it could push those kinds of symptoms in a negative direction.”
And if someone microdoses three times weekly for a long sustained period, who knows whether that might pose problems for the heart valve, says Erritzoe.
“Other compounds also stimulating the serotonin 2B receptor have been associated with such problems,” he warns.
Erritzoe is heading up the self-blinding microdose study at Imperial College London.
It’s investigating whether benefits reported by microdosers are due to the drug’s pharmacological effects or simply because the person expected to feel better — placebo effect.
With 150 people on board, researchers aim to recruit another 50. They aren’t encouraging microdosing.
“People sign on their own initiative. We’re recruiting people who already microdose or who are planning to.”
The study’s just one among many seeking to add to the knowledge pool surrounding psychedelics, substances with a story full of twists and turns.
And most definitely, the final chapter has not been written yet on their potential for human health and wellbeing.
Dublin-based company CEO Tom*, 34, did an Experience retreat after reading Michael Pollan’s How to Change Your Mind.
A New York Times ‘Best Book of 2018’, it investigates the current medical and scientific revolution around psychedelic drugs — and tells about Pollan’s own life-changing psychedelic experiences.
“It gave me a different perspective on psychedelics,” says Tom.
“I was curious about what kind of experience I’d have. Modern life’s so busy, there’s so much technology. Meditation helps a bit, but I still have anxiety at work.
"I was keen to create the space to come back to myself. The fact it’s legal in Holland was very important to me.”
Before taking the psychedelic truffle on day two of the four-day retreat, Tom was nervous.
“I’d never taken any kind of drug before. There’s a letting go of control. It’s a very internal experience — for me, it hit pretty quickly.
"It was a very positive experience — beautiful imagery, colours. I felt very connected to the world around me, to nature, to myself.
“I had some insights about myself, stuff I’d missed in therapy. I saw a vision of my eight-year-old self at what was a lonely time for me.
"I was able to feel the loneliness of that child and reach out, hug and comfort him. It was the most profound, meaningful aspect of the experience.
“Since then it’s been subtle changes — it doesn’t fix all your problems. I’m a little bit calmer. I have the desire to meditate and stay in that spiritual space a bit more.”
David*, a 40-year-old software technician, also Dublin-based, did an Experience retreat last winter. He too had read Pollan’s book and thought it might be a way to explore his own issues.
"It felt like I was back at the stage of being a baby who didn’t really know what was going on around him.
"I did get some insights — it told me something about how I feel sometimes, this vague anxiety but not being able to put my finger on what it is.
"Now I’m more accepting of that — it’s OK to feel that way and not have the words for it.”
The Tallaght Hospital team is headed up by Professor Veronica O’Keane, with sub-investigator Dr John Kelly, psychiatrist Dr Lauren Alexander, study coordinator Annie Baker, and therapists Lisa Burke and Christine Brennan.
Three participants have received a psilocybin dose — one has fully completed the trial.
The aim is to recruit 216 people with treatment-resistant depression (there are also trial sites across Europe and the US).
Participants arrive at 8am. Kelly meets them and they receive the dose in the psilocybin room at 9am.
Participants have 33% chance of receiving either a once-off 25mg, 10mg or 1mg dose. Most important predictor of response is dose.
“The 33% chance of receiving the sub-threshold 1mg dose is the main risk of this study. Expectations run high. There’ll be unavoidable disappointment for some,” says Kelly.
At preparation stage, therapists build a trusting relationship with participant and build his/her capacity to navigate distressing experiences and to engage in experiential processing.
During the psilocybin experience, the primary therapist minimises verbal guiding, allowing the process to unfold naturally.
Participants are encouraged to stay connected to/focus on their experience in the present moment — to go “in and through” the full range of the experiences, even if challenging.
Only if challenging experience becomes prolonged/extremely uncomfortable, or leads to physical safety concerns, is it necessary to guide participant actively out of such an experience — using simple reassurance, physical contact (hand/arm holding), guided imagery, or breathing exercises.
“We meet participants after the psilocybin experience. We go through the ‘Five-Dimensional Altered States of Consciousness’ scale. I get a very good picture of what type of experience the participants had after we complete this,” says Kelly.
Participants are escorted home by family/friend, with follow-up call to ensure they got home safely.
“We review participants next day. The therapist begins the integration process — encouragement to acknowledge/connect with the range of emotional, cognitive, and physical experiences of the psilocybin session and relate them to current experiences and their life situation.”