Microdosing doesn’t seem to have meaningful benefits, and comes with a host of risks.
What is microdosing?
Microdosing is taking very small doses of a drug. This term is typically used to mean taking a dose of a psychedelic such as LSD, psilocybin, or ketamine in a “sub-therapeutic” or “sub-conscious” dose that is not noticeable or is barely noticeable, on a regular or recurrent basis – much as you might take a vitamin or prescription medication, perhaps.
Microdosing ketamine should not be confused with the “sub-anesthetic” doses used in clinical settings for the treatment of depression and other conditions that some clinicians refer to as “low-dose” administration. Microdosing is meant to be much smaller amounts and much more frequent use.
The promise of microdosing ketamine
Ketamine has been a wonder-drug in many respects – rapidly reducing negative symptoms for depression, anxiety, PTSD and other mood disorders and pain conditions for many people. It is especially effective when administered in an appropriate clinical setting by trained professionals by IV infusion. But ketamine can also be taken (if less successfully) through nearly any manner of delivery including oral (swallowed by mouth), sublingual (absorbed under the tongue), intranasal (in the nose), IM (a shot in muscle), transdermal (with a cream or patch through on the skin), or by suppository (through intestine walls, for instance). It is absorbed readily by our bodies and eventually some fraction makes it to the bloodstream where it is distributed and put to work in our nervous systems and brains.
If ketamine can have such profound benefits, and can be administered in any number of ways, why not take it at home all the time orally – like many of our other medications? After all, taking larger, therapeutic doses of psychedelic drugs has its challenges such as the inconvenience of visiting a clinic, the cost and time associated with treatments, and psychedelic side-effects which may include feeling a bit loopy and being nauseous. The promise, or premise, of microdosing is that a little bit of the drug on a regular basis might have beneficial effects while avoiding the downsides of occasional larger doses.
Benefits from microdosing may be limited
There are anecdotal reports of benefits from microdosing with proponents saying that it appears to help with mood, energy and creativity. Unfortunately, the evidence from studies does not currently support meaningful improvement beyond, perhaps, a placebo response and even those reported benefits appear short-lived.
Research and analysis of microdosing is limited, and is especially limited for any one drug (including ketamine). We can look, therefore, for information on microdosing for psychedelics:
Surveys show anecdotal reports of possible benefits from microdosing:
Meta analyses and comprehensive reviews show that research is sparse, and suggest that benefits are occasionally limited and generally inconclusive, and that it is very possible that any reported benefits may be affected by the placebo effect:
- Modern Psychedelic Microdosing Research on Mental Health: A Systematic Review
- Less is more? A review of psilocybin microdosing
- Potential safety, benefits, and influence of the placebo effect in microdosing psychedelic drugs: A systematic review
- Microdosing psychedelics: More questions than answers? An overview and suggestions for future research
- Publications by Dr Robin Murphy
We don’t know precisely why microdosing doesn’t work as well as therapeutic dosing, but the reasons are probably severalfold. Perhaps foremost is that the amounts of active drug used for microdosing are small and taking ketamine orally isn’t as effective as by IV infusion. Other contributing factors may include the importance of set and setting in an effective clinical setting, therapeutic guidance or integration provided by clinicians, adjunct medicines included with the ketamine infusion in a clinical setting, the use of regulated drugs from pharmaceutical sources, and adherence to established protocols in clinical use.
Microdosing ketamine at home comes with real risks
Tolerance appears to go up with frequent use of ketamine – so the amount you take when microdosing will likely increase, leading to large doses that are fundamentally unsafe for home use.
People with ketamine around tend to abuse it and use it as needed (PRN) like Xanax. Because some of the effects of the drug can be felt immediately, and some of the immediate effects may be considered pleasant or useful, people are likely to take it when they feel they need it without sticking to a regular schedule. This is where the generally low addiction potential of ketamine adds up to and can lead to a cycle of abuse.
Ketamine may have negative side effects with daily or very frequent doses. These side effects, seen by abusers of ketamine, may include bladder and liver damage. While the doses and frequency provided in a clinical setting are unlikely to result in these negative side effects, increasingly large doses taken on a regular basis at home might be a problem.
It is easy to miscalculate concentrations or volumes and end up taking too much. Ketamine is a very safe drug in many respects, and it is unlikely that the drug itself would harm you. But a too-high dose has the potential to lead to serious problems.
Differences in bioavailability from different routes of administration complicate the picture. If ketamine is taken sublingually, much less of it eventually makes it into the bloodstream than if it is taken orally, for instance. So the dosing for different administrations can vary widely meaning people may have potentially huge doses one day and very light experiences the next depending on a stuffy nose, or swallowing too quickly or eating beforehand. Once taken by any of these routes, the medication’s effects and intoxication cannot be reversed and it lasts until it wears off on its own.
Having access to a controlled substance in the home has the possibility for many additional complications, including the potential for access concerns, illicit sales, dangers from incorrect dosing, hot tubs, unsafely mixing medications by accident or on purpose, often patients will want to take more because they feel it hasn’t kicked in yet or they feel something really bad happened in their lives or they feel they are in a very bad place with their moods and they just need more, but a skilled provider can help guide them to patience and a safe and effective dose with as few side effects and risks as possible. Eventually, it seems likely that home use will lead to overly-restrictive regulations in an effort to curb these and other issues.
Ketamine in any dose at home
We recommend that you don’t take ketamine in any doses at home. We recommend that you don’t microdose, or take troches, or take sublingual, intranasal, IM, IV or any other kind of dosing at home. It will almost certainly be less effective than it could be, and the potential for misuse and abuse is high. All the risks associated with microdosing apply to larger doses of ketamine at home – except more so!
The best place for administration and journeying with ketamine is a safe quiet place where a caretaker/observer is present and where guaranteed peace is ensured – without intrusions from a delivery person, next door neighbor, or unexpected visitor.
Not everything is better done at home, even if it looks like it might be cheaper or more convenient. Ketamine dosing is absolutely one of those things that’s better to do in a structured setting with a professional who knows what they are doing and who can provide a safe environment and safe dosing and steady guidance if the journey is difficult or challenging.
Ketamine is safe and effective in the right setting
Ketamine is a very safe drug when used appropriately, under the supervision of appropriately-trained professionals, but it is still a very serious drug with potential adverse side-effects. Ketamine works in 70-80% of patients by the 3rd or 4th infusion, but it also works best in a holistic model where discussions and help around sleep and supplements and diet and exercise can contribute to the progress.
Ketamine treatments can be an exceptional treatment option for Depression, Anxiety, PTSD and some other conditions and symptoms when used appropriately. Let’s ensure that these treatments are used appropriately and to maximum effect for the many people who can benefit from their proper use.
About Us
Wells Medicine is a Houston-based practice designed to provide meaningful care for mental health. Providing targeted interventional treatments for Depression, Anxiety, OCD, PTSD and other conditions, with Ketamine Treatments, Stellate Ganglion Blocks, TMS, and Nitrous-Oxide Treatments. Focused on comprehensive care and integration with Psychiatry, Psychology, and Support Services. We are evidence-based, patient-focused and mission-driven.
The content here is for informational purposes and should not be relied upon for medical decisions. For the details of your specific medical conditions and treatments consult your doctors or other qualified healthcare professionals.
