It is clear that psychedelics like MDMA and psilocybin are effective for treating post-traumatic stress, depression, and substance abuse disorders. Used as adjuncts to psychotherapy, these psychedelic medicines work when standard therapies have not. They work faster and they require fewer doses of the medicine compared to antidepressants for the same purpose. One of the issues dealt with in research studies is how much of a psychedelic is necessary for treatment.
Dose of Psilocybin Needed to Treat Depression
A single dose study for psilocybin published last November in The New England Journal Medicine tested doses of 25 mg, 10 mg, and 1 mg (as a control) in a one dose treatment regime for depression over three weeks. What the study showed was a significant difference between the 25 mg and 1 mg groups at three weeks. Depression scores were significantly better for the high dose group but so were side effects like headache, nausea, and dizziness. This kind of study shows that psilocybin can help with treating depression and that there is a dose to response relationship with this psychedelic medicine. It does not tell us how little psilocybin one can get by with in treating depression or how often small doses could be used. For this we need to look at what is called microdosing.
What Is Psilocybin Microdosing?
The idea of using repeated small doses of psychedelics like psilocybin to treat mental illness arose because of a couple of reasons. Not everyone wants to experience hallucinations or other side effects of psychedelics. And not everyone wants to undergo or can afford to pay for a long series of psychological therapy sessions. The rationale of microdosing a medicine like psilocybin is that patients will not suffer from side effects and may not need the usual long course of psychotherapy. We know that psychedelics cause beneficial physical effects within the brain. The question to be answered is if these changes are therapeutic in and of themselves without a lot of therapy sessions. And a good question is if one can arrive at the same physical effects on brain neurons without hallucinating, having other side effects, and not even undergoing hours and hours of therapy.
Microdosing Study of Psilocybin
A double-blind study of 34 people who micro dosed psilocybin gives us a hint of how well this might or might not work. The dose medicine given in the study if psilocybin was 0.5mg given in capsules or a placebo given in identical capsules. Some subjects were able to correctly identify that they got psilocybin and others were not. Those who recognized they were taking a psychedelic also had EEG changes while others did not. At the dose used for this study, even those who received psilocybin did not see any measurable effects on cognitive function, sense of well-being, or creativity. All participants went through a week of microdosing, a week off, and a week of microdosing. Thus everyone got both psilocybin and a placebo but were not supposed to know which. Some guessed or were sufficiently sensitive to low doses that they recognized the difference. Only these folks showed any objective signs on their EEGs. Nobody showed any clinical changes at these low doses.
Not So Micro Dosing Study
Another study of microdosing used 1.5 mg of psilocybin. They looked to see if people experienced feelings of awe under controlled experimental conditions. They did see a difference between those who received psilocybin and those who did not. Thus it is apparent that there is a level at which microdosing becomes effective and below which it does not make a difference. Unlike the study in which only EEG changes were noted, this time a real world effect of psychedelics was noted.
Microdosing Studies Need to Be for Longer
After reviewing published literature about microdosing with psilocybin and other psychedelics we noticed that all of the studies were short term, days or weeks. If you are going to try to help someone with depression or PTSD and not give them unwanted sided effects it seems to us that you need to persist in your efforts for a couple of months or more to see if you get any benefits. As such we are still waiting to see if psychedelic microdosing is of any practical value in treating depression, PTSD, and other mental health conditions. Likewise, we do not yet know if this approach is of any value in reducing the rate of suicide in veterans.