Microdosing refers to the practice of consuming very small, sub-perceptual amounts of psychedelics, such as psilocybin, the active compound in magic mushrooms. The idea is to take doses so small that they don’t produce the hallucinogenic effects typically associated with psychedelics but are enough to potentially boost mood, creativity, and cognitive function.

The most common microdosing protocols involve taking a microdose every third day or following a “four days on, three days off” cycle. This approach is designed to allow the body to process the psilocybin while preventing the development of tolerance. Proponents of microdosing report benefits such as enhanced focus, increased energy, emotional balance, and improved overall well-being.

However, microdosing is not without its risks. There are several common mistakes and potential pitfalls that can undermine the benefits and even cause harm. These include inconsistent dosing, lack of integration practices, and misunderstanding the importance of taking breaks. For instance, continual use without taking regular days off can lead to tolerance, reducing the efficacy of the microdoses and potentially leading to negative side effects such as anxiety and emotional instability.

In my work, I frequently encounter clients who have been advised to pursue psilocybin microdosing to enhance cognitive and emotional well-being. However, my extensive experience and research have taught me that this approach, while promising for some, can harm others, particularly those with an elevated Hypothalamic-Pituitary-Adrenal (HPA) axis. The widespread, sometimes indiscriminate recommendation of psilocybin microdosing by guides and psychotherapists without a deep understanding of the client’s physiological and psychological state, especially HPA axis activation, has become a source of significant concern for me. Rather than treating psychedelics with the necessary consideration and respect, it’s becoming akin to popping an over-the-counter plain white pill with little consideration of the potential consequences.

One of my recent clients, Sarah, came to me after following advice from a well-meaning therapist to try psilocybin microdosing to alleviate her anxiety and enhance her creativity. Sarah had been dealing with chronic stress and anxiety for years, and her symptoms all pointed to an elevated HPA axis. Despite her enthusiasm for a new potential solution, she soon found that her anxiety was worsening, and she was experiencing increased episodes of paranoia and emotional volatility.

The HPA axis is the central stress response system, involving interactions between the hypothalamus, pituitary gland, and adrenal glands. When triggered by stress, it releases cortisol, a hormone that helps the body manage stress. Chronic activation of this system can result in dysregulation, causing various psychological and physiological issues such as anxiety, depression, and cognitive impairments.

Psilocybin microdosing, while beneficial for some, can be dangerous for individuals like Sarah, with an already overactive HPA axis. The potential risks are significant:

1. Increased Anxiety and Paranoia: Psilocybin can heighten anxiety symptoms, particularly in those with a hyperactive HPA axis. The altered perceptions and heightened emotional responses induced by psilocybin can exacerbate stress-related symptoms, leading to increased anxiety and paranoia. Sarah experienced this firsthand, her anxiety spiralling out of control.
2. Dysregulated Emotional Responses: Psilocybin’s impact on the serotonin system can lead to unpredictable emotional responses. For clients with elevated HPA axis activity, this can mean heightened emotional volatility, including intensified negative emotions and mood swings. Sarah’s emotional responses became more erratic and difficult to manage.
3. Potential for Unwanted Cognitive Patterns: While psilocybin enhances neuroplasticity, it can also reinforce negative thinking patterns and behaviours, especially in individuals predisposed to anxiety and rumination. The interplay between a hyperactive HPA axis and psilocybin could solidify maladaptive cognitive processes. In Sarah’s case, her negative thought patterns became more entrenched rather than alleviated.
4. Risk of Psychotic Symptoms: Elevated HPA axis activity is linked to increased vulnerability to psychosis. Psilocybin, even at microdoses, can trigger psychotic symptoms in susceptible individuals, including hallucinations and delusions. Thankfully, Sarah did not experience psychosis, but her increased anxiety and paranoia were alarming.

At Mind Matters, we work with our clients to design targeted therapeutic pathways that allow them to make progress quickly and make it visible. This approach enables clients to experience small and visible victories even after only a few weeks, fostering a deeper sense of accomplishment and motivation for continued growth and healing.

One of the key tools we use in this process is the Personal Resilience Indicator (PRI), a precision-engineered, cutting-edge instrument to guide and accelerate personal development. The PRI provides a comprehensive snapshot of an individual’s current level of resilience, crafting a holistic resilience profile across six domains (Health, Purpose, Problem-Solving, Perseverance, Composure, and Relationships) and twelve drivers (two per domain). This comprehensive breakdown offers individuals a granular view of their strengths and highlights areas for growth within the specific facets of resilience. As such, it offers unique insights into their go-to coping mechanisms and provides a solid foundation for personalised and targeted strategies to enhance resilience and facilitate healing.

The PRI does not provide a single score but offers valuable context by positioning domain and driver scores relative to the broader population. This feature allows individuals to understand precisely where they stand compared to others, offering insights into how their resilience measures up in real-world terms. It allows us to measure incremental progress over time, which may not be apparent to the clients because they are living that experience. Establishing a holistic baseline is an absolute necessity when starting preparation for a psychedelic journey. The PRI enables me to pinpoint which areas need the most urgent and immediate attention to facilitate the preparation process for psychedelic healing.

In working with Sarah, the first step was to “get her out of her head and into her body” to start reconnecting her with herself, focusing extensively on the Composure domain. This process involves emotionally intense and painful work, bringing past traumas into the present moment in a safe container where Sarah feels emotionally, psychologically, and spiritually held. This approach helps her bring the pain from the past into the present moment and release it somatically.

After six weeks of preparation, Sarah’s interim PRI results showed tremendous progress. She started to develop intrinsic motivation towards the ceremony and reconnection with herself, improved sleep hygiene, and made conscious lifestyle choices. Her emotional resilience and cognitive patterns were showing positive shifts, indicating readiness for the next steps in her therapeutic journey.

Given these complexities and risks, I adopt a cautious approach when considering psilocybin microdosing for my clients, especially if they have no prior experience with using psychedelics in a therapeutic setting. I only recommend microdosing if I am sure the client has returned to a normal baseline function of the HPA axis. This requires thorough assessment and monitoring of their stress levels, cortisol production, and overall psychological state.

Before recommending microdosing to clients, I carefully consider a range of factors beyond underlying medical conditions and potential drug-drug interactions with prescription drugs the client is taking:

1. Baseline HPA Axis Function: I ensure that the client’s stress levels and cortisol production have stabilised to avoid exacerbating pre-existing anxiety or stress-related symptoms.
2. Psychological State: It is crucial to comprehensively assess the client’s mental health history, including any predispositions to anxiety disorders or psychotic episodes. Understanding their current emotional resilience and cognitive patterns helps predict their response to psilocybin. This is where the Personal Resilience Indicator (PRI) and the awareness it generates become invaluable (discussed in more detail in subsequent sections).
3. Informed Consent and Education: I thoroughly educate clients about the potential risks and benefits of psilocybin microdosing. Informed consent ensures clients understand what to expect and are prepared for the experience.

Through my practice, I have seen firsthand the transformative power of combining careful consideration with holistic preparation techniques like holotropic breathwork and thorough monitoring of HPA axis function. This approach ensures that the benefits of psilocybin microdosing can be harnessed while minimising potential risks.

My cautious approach to psilocybin microdosing within the broader context of psychedelic therapy highlights the importance of personalised assessment and readiness before recommending this practice to clients. As discussed in “Brain Plasticity and Psychedelic Therapy: What You Need to Know“, psychedelics can induce significant structural changes in the brain. However, these changes must be managed correctly to ensure they are beneficial rather than detrimental.

Understanding the phases of neuroplasticity, as detailed in “Harnessing Neuroplasticity: How Psychedelics Transform Your Brain“, is crucial. This knowledge helps align therapeutic interventions with periods of highest neuroplastic potential, ensuring that new neural pathways formed during and after psychedelic therapy lead to positive and lasting changes.

Moreover, preparation and integration, as described in “Effective Strategies for Enhancing Neuroplasticity in Psychedelic-Assisted Therapy“, are essential to make the most of psychedelic-assisted therapy. This involves a thorough understanding of the client’s physiological and psychological state and structured, ongoing support to integrate the insights gained from the psychedelic experience into their daily life.

My experience with clients like Sarah underscores the importance of a tailored approach, considering each individual’s unique psychological and physiological makeup. By doing so, we can harness the potential benefits of psychedelics while minimising the risks, ensuring a safer and more effective therapeutic journey.

Disclaimer:

The content provided in this article series by Mind Matters is for informational and educational purposes only and does not substitute professional medical advice or consultation with healthcare professionals. If you are seeking medical advice, diagnoses, or treatment, we advise you to consult a licensed medical professional or healthcare provider. Psychedelic-assisted therapy is not legalised in Malta; therefore, our services in Malta focus solely on preparation and integration. We do facilitate psychedelic-assisted therapy in collaboration with licensed therapists in jurisdictions where it is legal. We do not provide or facilitate the use of illegal substances. Please check the legal status of psychedelic substances in your jurisdiction, as legal frameworks are continuously evolving.