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  • Writer's pictureRyan Sheridan, NP

Exploring Psilocybin Microdosing: An Integrative Approach in Washington DC.


Psilocybin mushroom

The practice of microdosing psychedelics—taking sub-impairing doses of substances every few days—has gained significant attention for its potential mental health benefits.


My goal with this blog is to explore the research and the use of microdosing from the perspective of integrative psychiatry, microdosing efficacy, research, and legal status in Washington, DC.


Note: this article discusses microdoses of psilocybin. I do NOT offer prescriptions or supply psilocybin.


 

TL;DR: I can be a resource for you on your microdosing journey. Scroll to the bottom for more.

 

An Overview of Microdosing


Microdosing involves the regular, controlled intake of small doses of psychedelics, typically just a small fraction a recreational dose. This practice is thought to enhance mental wellbeing, increase mood, reduce anxiety, even improve focus and creativity.


Microdoses are NOT intended to induce the intense sensory experiences that full doses of these substances might cause – meaning the intention and outcome is not getting high, tripping, or otherwise.


Variability and Effects


The effects of microdosing are often very subtle and highly individualized. Just like a medication, for example, each person responds differently. Individual biology and environmental factors contribute to the variability including other medications, supplements, lifestyle factors, and body chemistry.


This variability is also due in part to the unregulated nature of these substances, which leads to inconsistencies in dosage, purity, and composition.


Additionally, individual differences in psychological state, and even expectations can influence the outcomes of microdosing.


Scientific Studies and Findings


Lots of recent studies have begun to examine the claims of microdosing systematically. Preliminary studies have suggested significant potential improvements in mental health, including reduced symptoms of depression, anxiety, and even ADHD.


I have to mention these are preliminary studies that often rely on self-reporting, which can impact the validity of the data. More rigorous scientific studies are needed to better understand the pharmacological effects and long-term, wide-spread potential therapeutic benefits of microdosing psychedelics.


Microdosing shows promise in the preliminary research and warrants consideration as treatment, especially for resistant diagnoses.


Integrative Psychiatry and Microdosing


Plant with roots

I'm sure you've heard me go on and on about integrative psychiatry. Psychedelics fit beautifully within the framework of integrative psychiatry.


Integrative psychiatry represents a holistic approach to mental health that combines traditional medical treatments with alternative therapeutic options. This field often embraces new and innovative treatments, among which microdosing of psychedelics is gaining interest as a potential tool for enhancing mental wellness.


Philosophy and Practice


The philosophy of integrative psychiatry is grounded in treating the whole person—addressing physical, emotional, mental, social, and environmental influences that affect health.


In this context, microdosing might be considered for its ability to integrate with and potentially enhance traditional mental health treatments.


Microdosing could complement existing treatments for depression and anxiety by potentially moderating mood and enhancing cognitive function, thus providing a different avenue for alleviation of psychiatric symptoms.


The low dosage aims to minimize traditional psychedelic experiences, focusing instead on subtle shifts in perception that might boost mood, creativity, and overall well-being without disrupting daily functioning.


It is important to remember that any substance used medicinally should be done from a comprehensive perspective that explores lifestyle and emotional factors that may be contributing to any mental unwellness. This is why I always start with ensuring a strong basis with the Pillars of Health.


Microdosing fits within the framework for integrative psychiatry by looking outside the box of tradition to off individualized care based on the latest evidence.


Medication Interactions and Microdosing


Understanding the interactions between microdosed psychedelics and other psychiatric medications is critical. Psychedelics, even at low doses, can influence neurotransmitter systems in ways that might interact with conventional medications, particularly those affecting serotonin levels such as selective serotonin reuptake inhibitors (SSRIs).


Medication

Psychedelics are thought to affect the serotonin system, which is also the target of many antidepressants, especially SSRIs. These medications work by increasing serotonin levels in the brain, and adding a psychedelic could potentially disrupt this balance, either by enhancing the effects leading to symptoms of serotonin syndrome or by blunting the intended effects of the medication.


One of the most significant risks of combining SSRIs and psychedelics is serotonin syndrome, a potentially life-threatening condition characterized by an excess of serotonin in the brain. Symptoms may include confusion, agitation, rapid heart rate, dilated pupils, muscle rigidity, and in severe cases, seizures or unconsciousness.


More common, however, is the risk that a concurrently prescribed SSRI or antidepressant may reduce the efficacy or impact of the microdose. Therefore, it discontinuation of medication should be considered before microdosing. Discontinuing any medication should always be done under the supervision of a trained psychiatric provider.


Given these risks, we must carefully manage patients interested in exploring microdosing. This includes:


  • Thoroughly reviewing the patient's current medication regimen.

  • Considering the pharmacodynamic properties of both the psychedelic and the existing medications.

  • Closely monitoring the patient for any adverse effects or unusual responses.

Providers must establish clear monitoring guidelines to detect early signs of adverse interactions. This must include regular check-ins, mood assessments, and potentially adjusting the dosage of either the microdose or the other medications.


Treating Depression with Microdoses


The exploration of microdosing psychedelics as a treatment for depression represents a promising frontier in mental health research. Emerging studies suggest that these low doses may have significant effects on mood regulation, potentially offering a novel approach to managing symptoms of depression.


Neurobiological Effects


Microdosing may facilitate a "reset" effect in neural circuits that have become rigidly patterned in ways that underlie depressive symptoms. This could explain the improvements in mood and emotional stability reported by some participants in these studies. Research is ongoing to determine the exact mechanisms by which these subtle changes in brain function could help alleviate depression.


Research Findings


Recent studies, while still limited and often relying on self-reported data, indicate that some individuals experience reduced symptoms of depression when microdosing. These benefits include better emotional regulation, decreased feelings of despair, and a heightened sense of connection to others and one's surroundings.


Considerations for Use


If microdosing is to be considered a viable treatment option for depression, it must be integrated carefully and thoughtfully, with attention to individual patient needs, potential medication interactions, and the legal landscape.


Providers should have detailed discussions with patients about the potential risks and benefits, and any treatment plan should include regular monitoring for adverse effects and changes in symptomatology.


Anxiety and Microdosing


Similar to using microdoses for depression, anecdotal reports and some early research suggest that microdosing may help alleviate symptoms of anxiety.


Potential Mechanisms


Psychedelics, even in microdoses, are thought to affect the brain's serotonin receptors, similar to how many anti-anxiety medications work.


Again, these substances are thought to promote neural plasticity—essentially making the brain more adaptable and capable of forming new connections—which could underlie reductions in anxiety.


The theory suggests that microdosing could help "rewire" thought patterns that contribute to anxiety, potentially leading to more resilient mental states.


Emerging Research


While much of the evidence supporting microdosing's effects on anxiety and depression comes from anecdotal sources, there are a growing number of scientific studies investigating this relationship.


Preliminary results have shown promise, with some individuals reporting a decrease in anxiety and depression symptoms and an improved ability to manage stress and emotional responses.


However, these studies often involve small sample sizes and lack control groups, which can affect the reliability of the outcomes.


Note: In clinical practice, I have seen very real and very meaningful results from the use of microdoses.


Clinical Considerations for Microdosing


For those considering microdosing as a method to manage depression or anxiety, several factors should be considered carefully:


  • Dosing and Frequency: Determining the optimal dose and frequency for microdosing to treat anxiety requires professional oversight to avoid potential negative effects.

  • Individual Differences: The effectiveness of microdosing can vary widely between individuals, influenced by factors like underlying health conditions, concurrent medication use, and personal biochemistry.

  • Legal and Ethical Issues: The legal status of psychedelic substances remains a significant barrier to widespread adoption and formal research, particularly in regions where these substances are not decriminalized.


Legality in Washington, DC


Washington Monument

The legal landscape regarding the use of psychedelics for microdosing in Washington, DC is complicated. Local and federal regulations are somewhat contradictory.


In 2020, DC passed Initiative 81, which declared that police should treat the non-commercial cultivation, distribution, possession, and use of entheogenic plants and fungi as among the lowest law enforcement priorities.


This initiative reflects a significant step towards the decriminalization of psychedelics. However, it's important to note that these substances remain illegal under federal law, and the use or possession of psychedelics on federal property in DC would still be subject to federal penalties.


To be clear, psilocybin is NOT legal in DC. Decriminalization ≠ legal. Navigating this presents challenges for patients and providers.


Navigating the Legal Landscape in DC


For health care providers and residents, staying informed about these laws is essential. The evolving nature of psychedelic legislation at the local level versus the static, restrictive federal stance creates a complex legal environment.


Practitioners in particular must navigate these waters carefully, balancing patient interest in emerging therapies with strict adherence to legal restrictions. Continuous education on the status of both local and federal laws is crucial for those considering the integration of psychedelics into therapeutic practices.


Guidance for Microdoses in Washington DC


So you're interested in microdosing? I can help. My integrative psychiatry practice in Washington DC offers patients resources to manage their depression, anxiety, and ADHD with microdoses of psilocybin.


Resources ≠ prescriptions. I'll repeat: I do NOT offer prescriptions or supply psilocybin.

Ryan Sheridan, N

I will help you navigate your care in a safe, effective, holistic way that considers the legal, medical, and emotional aspects of microdosing psilocybin. Book a free 15-minute intro with me today!


Cheers!

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