May 23, 2024

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Microdosing mushrooms: What does science say about it?

Some people microdose for better mental health, or personal and spiritual growth. Scientific evidence for microdosing, though, is scarce and has been mixed.

(Maria Jesus Contreras for The Washington Post)

During the initial, pre-vaccine days of the pandemic, Diane, a primary care provider in the D.C. area, saw dozens of her patients die.

She started having nightmares, and as the months went on, she developed post-traumatic stress disorder, she said. She tried taking care of herself by eating well, exercising and meditating, but she was working nearly every day — and knew she needed some time to regroup.

Diane had taken psilocybin — also known as magic mushrooms — before, and the substance had made her feel safe, calm and euphoric. “I experienced an incredible warmth and felt light and goodness,” she said.

After reading about promising clinical trial results from studies using psychedelics to treat mental health, she decided to travel to Jamaica for a week-long psilocybin retreat. There she took the psychedelic drug under the guidance and supervision of therapists. After three psilocybin sessions, she felt the weight of her problems lift.

When she returned to the United States, she didn’t want the progress she’d made to wear off. She began researching how to microdose psilocybin — taking the substance in amounts small enough to avoid impairment. “I found it incredibly helpful,” Diane said. “I felt like it really, really helped my anxiety after coming back from the retreat.”

Diane, who spoke on the condition that her last name not be used for privacy reasons, is among many people who microdose or have tried microdosing psychedelic drugs to self-medicate for anxiety, depression, PTSD and other mental health concerns, or for personal and spiritual growth.

Scientific evidence for microdosing, though, is scarce and has been mixed on its efficacy. Research on microdosing is still “in its infancy and poorly developed,” said Harriet de Wit, professor of psychiatry and behavioral neuroscience at the University of Chicago. “There are very few controlled studies that have been able to study the phenomenon.”

Researchers say the drugs are relatively safe in small doses; however, microdosing carries some risk.

Microdosing for mental health

Microdosing is not new — reports of microdosing date to at least the 1500s, and modern Western microdosing practices began in the 1960s. After the United States prohibited psychedelics in the 1960s and ’70s, their use moved underground. For decades, the use of psychedelics was stigmatized.

People microdose a variety of psychedelics — most commonly LSD and psilocybin — and experiment with dosages. A typical microdosing regimen involves taking a drug multiple times a week, sometimes as frequently as every other day.

Frequent microdosers say the practice helps them manage symptoms of PTSD, anxiety, depression, attention-deficit/hyperactivity disorder, or chronic pain. Others microdose to optimize their quality of life; they say it boosts their creativity or mood.

The popularity of psychedelics has skyrocketed as recent clinical trials have suggested that psychedelic-assisted therapy may help treat mental health issues. But microdosing is different from dosing participants with moderate to large amounts of psychedelics and pairing it with therapy, which is the subject of those headline-grabbing studies.

A microdose is typically no more than a tenth of the size of a dose used in clinical trials — and unlike participants in clinical trials, microdosers are largely self-medicating without the support of therapists or facilitators.

In 2020, 2.6 percent of people age 12 and older in the United States (or 7.1 million people) said they used hallucinogens in the past year, according to the 2020 National Survey on Drug Use and Health. Most surveys tend not to distinguish between the use of small and larger amounts of psychedelics, making it difficult to know how many people microdose or have tried microdosing psychedelics.

Why microdosing is hard to study

Microdosing studies are logistically complicated to execute and challenging to design.

Many psychedelics are controlled substances, and researchers need special permissions to study their effects, which includes monitoring participants over the course of a multiweek study. Many microdosing studies rely on survey data instead; researchers find people who are already microdosing and ask them to fill out questionnaires about their mood or stress levels.

In survey studies, participants have reported feeling better on the days they microdose, but researchers say it’s hard to draw conclusions from self-reported data alone.

“Those studies are biased toward the people that are having or at least believe that they’re having good effects from microdosing,” said Vince Polito, a cognitive scientist at Macquarie University in Sydney who studies the effects of microdosing. People’s beliefs about psychedelics — for instance, that the drugs will help with anxiety or increase creativity — can shape study outcomes. Researchers call this bias the expectancy effect.

In studies designed to control for expectancy effects, researchers have found little evidence that microdosing has any long-term positive effects. A 2021 study found that participants reported greater well-being while microdosing and while taking a placebo pill; there was no significant difference between their ratings, suggesting that believing you’re microdosing could be as powerful as the actual act.

Controlled lab studies aren’t perfect, either. “Any time you get a negative effect, there are a million reasons why that could be,” de Wit said. It’s possible that the microdoses used in controlled lab studies are too small to show statistically significant effects, she said. Microdosing might also show greater effects in people struggling with mental health, de Wit suggests, as most microdosing research has studied healthy participants.

Neuroimaging to study microdosing

De Wit is using another method to study microdosing: neuroimaging. Her lab has been using electroencephalogram (EEG) recordings to examine whether a microdose of LSD affects participants’ brain signals. De Wit and her colleagues look at the brain’s response to reward, which is typically dampened in people with depression.

“To our surprise, the low dose of LSD increased the brain signal,” said de Wit, suggesting that an LSD microdose could have an antidepressant effect and that small doses may still cause measurable effects. “It’s promising that a dose that doesn’t produce strong subjective effects can produce this neural effect.”

De Wit, however, wants to be clear that LSD is not a panacea.

Claims about the benefits of microdosing psychedelics have been “suspiciously widespread,” she said, including that they can treat anxiety, depression and postmenopausal symptoms; improve creativity and athletic performance; and do much more. “It seems to me unlikely that any one drug does all these things,” de Wit said.

Potential harms of microdosing

Microdosing psychedelics, however, is not for everyone.

In one recent study, microdosing actually increased anxiety in some participants, leading them to drop out of the study.

Psychopharmacologist Kelan Thomas says there also are other risks, such as the potential for developing valvular heart disease (VHD), a condition resulting from damage to heart valves.

Psychedelics such as psilocybin and MDMA act on the body’s serotonin system, and over time, repeated stimulation of serotonin receptors can lead to an overgrowth of heart valve tissue. Other serotonergic drugs, such as the weight-loss drug Fen-Phen and Parkinson’s medication pergolide, have also been linked to an increased risk of valvular heart disease and have been taken off the market.

These drugs “consistently show VHD in about 25 percent of those exposed, which is an outrageously high incidence rate for a potentially irreversible valvular heart disease that may require surgery or cause death compared to other drugs with long-term adverse effects,” said Thomas, who also is an associate professor in pharmacy at Touro University California.

To reduce risk, Thomas advises taking breaks in microdosing regimens. Constant stimulation of serotonin receptors is what causes additional tissue growth, so a break of a couple weeks should be enough, he said.

Thomas compares it to lifting weights: “If you lift weights every day, you’re going to continue to build muscle mass, but if you stop for a month, you’re going to lose it pretty quickly,” he said. “It’s about that constant stimulation; if you microdose continuously, the risk continues to elevate.”

Sourcing drugs can also be dangerous; psychedelics such as MDMA or LSD could be tainted with other drugs such as fentanyl.

Microdosing without supervision may also lead to distress or impairment, especially for microdosers new to psychedelic substances and their dosages.

Diane said she learned to grow her own mushrooms to avoid potential adulteration of her supply, and she has carefully self-experimented to figure out the dosage that works for her.

As a medical professional, she’s also concerned about microdosing “coaches” and others with questionable credentials charging steep prices for microdosing courses and resources. Thomas, too, advises people to be skeptical; it’s worth considering who stands to make money from microdosing, he said.

Diane microdosed for three months and said it was incredibly helpful in controlling her anxiety. “I have no idea if it was placebo or not,” she said. “I think there’s something there, but I think it’s irresponsible to say this is backed by science. It’s too early to say that.”

De Wit agreed. “I’m optimistic there’s something here, but it’s been very difficult to demonstrate,” she said.

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