Microdose ketamine: breakthrough or scam?

Ketamine is widely accepted as having potentially powerful antidepressant, anti-anxiety, and other beneficial effects for mental health when used responsibly under medical supervision. Building on this evidence, there are new practices with ketamine, and psychedelics more broadly, known as "microdosing." What is the ketamine microdose? Does it actually help? Here are the motivations behind the latest headlines around ketamine microdosing.

What does it mean to Microdose?

Microdosing is a vague term describing a low-dose of a substances, medication, or supplement for potential health or performance improvements. Doses vary considerably but may involve taking 1/10 to 1/20 of a "normal" dose of the substance, and taking it more frequently than the "normal" dose. There are 3 components to microdosing any substance:

1. A dose low enough that doesn't cause changes in perception ("subperceptual") and doesn't impair "normal" functioning.
2. Using a lower does more frequently than the higher "normal" dose.
3. Using this low dose/higher frequency approach for performance gains with supposedly fewer side effects.

Microdosing for Safety?

Many advocate microdosing because they believe it is safer to take low doses of substances or medications compared to higher doses. While it is generally preferable to take medications at the lowest effective dose, a microdose of ketamine or psychedelic does not imply safety. In fact, a recent article even demonstrated that microdosing mushrooms for psilocybin content led to cognitive impairment without appreciable offsetting benefits.

Furthermore, given the legal status of many psychedelics, it's often impossible to know the true dose you are receiving in a pill or strip.

Finally, like most medications, tolerance develops to psychedelics like LSD and psylocibin.

What Does it Mean to Microdose Ketamine?

Ketamine has many powerful effects at therapeutic doses, such as weekly intravenous infusions. Microdosing ketamine is intended to:

• Bring about similar benefits to traditional ketamine, but with
• Small, sub-threshold doses, with
• More frequent dosing, without
• Side effects and perceptual changes, and
• Without the hassle of intravenous infusions at a doctor's office

Microdosing evangelists make this idea sound great... but has microdosing ketamine actually been studied?

Marketing this idea has become very popular, especially with mail-order ketamine providers. However, is this actually true and helpful to patients?

Can Ketamine Microdosing Actually Help?

Unfortunately, there is virtually no high-quality evidence on microdosing oral ketamine. The vast majority of studies include intravenous ketamine or intranasal esketamine. This raises a serious red flag when I consult patients. The rationale for microdosing ketamine is taken from a few studies that have shown modest benefits from microdosing psilocybin, the active component of "magic mushrooms." While some of these psilocybin microdosing studies have shown benefit, others have not.

The few studies available on ketamine microdosing are studies in rats in mazes and assessments of depression in rats. While this early data is promising, we don't believe it's appropriate to forego evidence-based intravenous ketamine therapy in this vulnerable population.

Foregoing evidence-based intravenous therapy for unproven ketamine microdosing can be harmful to this vulnerable population struggling to heal from depression and pain

Who is Pushing Ketamine Microdosing? The Unfortunate Agenda

Responsible psychedelic therapy or ketamine therapy requires a holistic healing plan. It is an unfortunate misconception that ketamine is a silver bullet that cures mental health conditions. Here are powerful reasons why microdosing culture is so powerfully advertised:

• Sending ketamine pills in the mail is cheap
• Mail order ketamine pills doesn't require a significant time investment (it's advertised as a "quick fix")
• Responsible ketamine infusion therapy requires time and effort to address the root cause of our health conditions
• Even if low dose ketamine pills aren't effective in curing mental health conditions, they may be relatively safe
• Because low dose ketamine pills can be safe (if ineffective) it's low risk for companies to send these pills out
• Marketing cheap pills to a vulnerable population suffering from serious depression, anxiety, PTSD, or chronic pain has proven financially rewarding

Unfortunately, we have treated patients who have had poor experiences with such mail-order ketamine treatments. There are consistent themes from these treatments:

• Lack of guidance
• Abandonment
• Unrealistic expectations
• "Waste of time" over weeks of treatments
• Feeling hopeless

Healing with Ketamine is Possible with Holistic Ketamine Therapy (not scams)

Intravenous (IV) infusion ketamine therapy is powerful for treating depression, anxiety, chronic pain, PTSD, and other debilitating mental health conditions. However, the key benefit from ketamine therapy is from the holistic approach that fosters persistent changes in self representation. This holistic model must include intentional and mindful preparation and integration as part of the ketamine therapy. Otherwise, marketing ketamine as a "quick fix" is rarely ever the solution to the complex struggles that we are trying to heal from.