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

Over the past decade there has been renewed interest in psychedelic drugs as potential therapies for mental and substance use disorders, with recent clinical trials investigating medium-to-high doses of psilocybin, ayahuasca, LSD and MDMA for conditions such as treatment-resistant depression, alcohol and nicotine dependence, end-of-life anxiety and PTSD. Concurrently, microdosing—regular ingestion of low to very low doses of psychedelics (commonly described as around 5–10% of a standard dose) on a scheduled basis—has attracted media and community attention as a self-managed practice for mood, cognition and wellbeing. Contemporary empirical research on microdosing is limited: early laboratory and naturalistic studies have reported mixed findings on time perception, vigour and problem solving, and a small body of observational and qualitative work has documented self-reported mood and cognitive benefits alongside some unwanted effects and notable methodological limitations (e.g., non-blinded designs, exclusion of people with mental illness).

Lea and colleagues conducted an international online survey in late 2018 targeting people with experience of microdosing psychedelics. Recruitment used email lists of psychedelic community organisations, posts on online discussion forums, shared social media posts and paid Facebook advertisements. Eligible participants were aged 16 years or older, had used psychedelic drugs for any purpose and could read English. From 2088 respondents who reported ever microdosing, the analysis sample comprised 1,102 respondents after excluding those who primarily microdosed non-psychedelics and those who did not complete the survey. Ethical approval was obtained from the University of Duisburg-Essen, Germany, and a follow-up survey was planned for late 2019.

The analysed sample (n = 1,102) had a mean age of 33 years (SD = 12.1); 73.1% were male, 78.6% identified as heterosexual, 53.3% were in a relationship and 51.6% had a university degree. Geographic distribution was led by the USA (43.6%), followed by Western Europe (20.9%), Eastern Europe (10.5%), the UK (7.9%), Canada (6.9%) and Australia/New Zealand (6.2%). At the time of the survey 36% were currently microdosing, 37.1% were taking a break and 27.0% had stopped. Median age at microdosing commencement was 29 years; 78.5% reported total microdosing duration up to 6 months. Psilocybin (46.4%) and LSD/1P-LSD (45.0%) were the most commonly reported substances. Reported dosing schedules varied: 14% every day, 11.3% every second day, 26.6% every third day, 14.8% every fourth day and 18.2% once a week or less; the median LSD microdose was 11 micrograms (IQR 10–20). Eighty-two percent reported having taken a full psychedelic dose for self-reported therapeutic purposes outside clinical settings, and 89% had used psychedelics recreationally. Over half (56.7%) reported ever having been diagnosed with a mental disorder (most commonly depression 41.2% and anxiety disorders 32.0%). On standard symptom measures at survey time, 17.5% showed at least moderate depression on the PHQ-9 and 12.6% showed at least moderate anxiety on the GAD-7. Thirty-nine percent of respondents reported that their primary motivation to microdose was mental health or substance use therapy (21.3% for depression, 6.9% for anxiety, 8.9% for other mental health issues, 1.7% for substance use cessation/reduction). In multivariate models, primary motivation for therapeutic microdosing was associated with longer microdosing duration, microdosing psilocybin rather than LSD, recent use of full psychedelic doses for therapeutic purposes, a mental disorder diagnosis older than 12 months, psychiatric medication prescription in the past 12 months, prior counselling or psychotherapy, and current mild or severe anxiety; recent attendance at alcohol/drug treatment was associated with lower odds of therapeutic motivation. Regarding changes in use since starting microdosing, among those ever prescribed psychiatric medications 50.6% reported having ceased antidepressants and 39.7% reported ceasing other psychiatric medications. Cessation rates were lower for non-medical substances (tobacco cessation 19.5%, alcohol cessation 15.9%), with larger proportions reporting reduced consumption. Respondents currently microdosing or taking a break were more likely than those who had stopped to report reduced alcohol use (44.6% vs 35.2%), reduced cannabis use (28.1% vs 18.3%) and cessation of antidepressants (55.2% vs 38.5%). On perceived mental health outcomes, 44% of respondents reported their mental health was "much better" and 35.8% "somewhat better" since commencing microdosing; 19% reported no change and 1.5% reported some worsening. Multivariate correlates of reporting "much better" mental health included female gender, lower education compared with a university degree, longer microdosing duration, motivation to microdose for depression, substance use reduction or other mental health issues (excluding anxiety), recent full-dose therapeutic psychedelic use, and higher sense of coherence (SOC-13) scores. Those reporting "much better" were less likely to have stopped microdosing and less likely to have moderate-to-severe depressive or certain anxiety symptoms. Among respondents who primarily microdosed as self-managed therapy, 89.2% rated microdosing as helpful; by comparison, 64.8% rated counselling/psychotherapy helpful, 35.5% rated antidepressants helpful (53.9% unhelpful) and 53.1% rated prescribed anxiolytics helpful (34.5% unhelpful).

Lea and colleagues interpret their findings as indicating that many people who microdose psychedelics do so to manage mental health and that most respondents perceived benefit: 79% reported some improvement in mental health and many reported having reduced or ceased psychiatric medications after starting microdosing. The authors note that cognitive enhancement was less commonly a primary motive than media narratives suggest, though it featured as a secondary motive, possibly because cognitive deficits are common among those with mental disorders. Most participants who microdosed for mental health had prior mental health diagnoses and prior or ongoing engagement with conventional treatments; many reported dissatisfaction with antidepressants and moderate satisfaction with psychotherapy. The authors highlight that a substantial portion of respondents who ceased psychiatric medications had not discussed microdosing with their clinicians, suggesting that self-managed cessation without clinical oversight was occurring. Several important caveats and limitations are acknowledged. The cross-sectional and self-selected online design prevents causal inference: reported improvements may reflect placebo or meaning responses, reductions in other substance use, lifestyle changes, prior or recent full-dose psychedelic experiences, or combinations of these factors. Recruitment through online psychedelic communities and the high prevalence of prior higher-dose psychedelic use suggest the sample may be biased toward motivated users and thus toward perceived benefits. The small number of respondents who primarily microdosed to reduce or cease substance use limits confidence about microdosing's role in treating substance use disorders, and standardised measures of substance use disorder severity were not used. The authors therefore call for double-blind, randomised controlled trials to determine efficacy and for clinical research to consider appropriate delivery models (noting that standard psychedelic therapies typically involve one to a few supervised high-dose sessions integrated with psychotherapy, whereas microdosing—if effective—might be an intermittently administered ongoing therapy). They also recommend monitoring microdosing practices in population surveys and continuing longitudinal social research to inform harm reduction and clinical translation while awaiting trial results. Overall, the investigators position their results as supportive of further clinical and social research rather than as evidence of efficacy, emphasising the need for controlled trials to disentangle placebo effects and prior psychedelic exposure from any true therapeutic effects of microdosing.