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How Ketamine Therapy Differs from "Microdosing"

Of those exploring ketamine therapy options, “Is this microdosing?” is a common question —and for good reason.

The concept of “microdosing” has gained steam as a conversation topic amongst friends and colleagues, and boosted by the media. For many, it’s their introduction to psychedelic therapy as a mental health treatment option.

Simply stated, ketamine therapy isn’t the same as microdosing. Instead ketamine therapy uses sub-anesthetic doses of ketamine.

More on that difference below. Let's begin by explaining what microdosing actually is.

What is microdosing? 

Microdosing is when a lower dosage of any medicine or compound is administered, without the full pharmacological effect applied, often producing imperceptible-to-mild effects or benefits.

As of 2019, the most recent international guideline for a microdose of any medicine or compound is “a dose of drug that is 1% of the pharmacologically active dose, up to a maximum of 100 [micrograms].”

Microdosing is typically referred to in the context of psychedelic therapy. However, it is not limited to psychedelic applications.

Microdosing and psychedelics

An increasing amount of research suggests that psychedelics may have an impact on mood disorders like depression, anxiety disorders, and other mental health or behavioral conditions. 

Anecdotal reports from those who have microdosed mention higher energy levels, better regulation of emotions, or improved cognitive function. However, recent studies have indicated that any improvement may be attributed to a placebo effect.

There are a few common psychedelics that are administered in microdosing studies or personal experiences: 

  • Psilocybin (the psychoactive compound found in psychedelic mushrooms)
  • MDMA
  • LSD

A 2011 study of LSD suggests psychedelic microdosing of LSD specifically would be “5–10% of a usual psychoactive dose and lie between a full pharmacological dose (100%) and a ‘pharmacological microdose.’” [1]

Challenges of Psychedelic Microdosing

While self or group-administered microdosing may be done with medical or therapeutic intent, it's often done without clinical oversight. Outside of controlled studies, there are no formal medical guidelines to administer or survey microdosed experiences. This leads to a number of potential challenges.

Unknown dosages

Microdosing psychedelics can present challenges when it comes to exact dosing. For example, the concentration of psilocybin differs between species of mushrooms (e.g. psilocybe cubensis), and even batches of the same species. 

This may add potential for undesirable outcomes, such as the experience being stronger than expected.

Outside of clinical or research settings, it’s difficult to know the exact psychedelic dosage that’s being administered. The only way to determine the concentration of a microdose is through a lab test.

Legal considerations

Those who choose to self-administer psychedelic microdoses often do so in local, and/or federal jurisdictions where the compounds are illegal to distribute or possess.

Additionally, those who microdose could be subject to repercussions from employers, based on the workplace policies or potential liabilities.

Unmonitored administration

There are often no licensed clinicians or therapists involved in monitoring or advising a person who is microdosing recreationally. In fact, many people who microdose may choose to do so by themselves.

A potential lack of awareness of psychedelics’ therapeutic benefits by the general population, and even in some medical communities, could make finding and receiving appropriate care more difficult.

This means that if an undesired or adverse event occurs, there is often no care team available to immediately assist.

Intentional integration of the experience

Tremendous progress has been made in providing therapeutic containers for those choosing clinical psychedelic therapy options, as well as for those microdosing.

However, those who microdose seeking positive mental health outcomes often do so without proper integrative structure or intent. 

Psychedelic integration is a key component of helping to create lasting behavioral change, which extends beyond the initial insights of the felt experience, or neuroscientific benefits psychedelics may provide. 

How ketamine therapy differs from microdosing

Microdosing psychedelics recreationally differs greatly from clinical ketamine treatment. Here are a few key differences.

Ketamine therapy uses sub-anesthetic doses

As mentioned in our intro, ketamine therapy uses sub-anesthetic doses of ketamine, not “microdoses.”

These doses are much lower than the amount of ketamine required for anesthesia during surgical or medical procedures. Sub-anesthetic doses are administered through various methods such as dissolvable tablet or intravenous injection (IV).

Ketamine therapy involves licensed clinical professionals

Ketamine therapy is prescribed and monitored by a licensed medical professional. This clinician often has psychiatric clinician who considers the patient’s medical history and potential contraindications, and then administers a calculated sub-anesthetic dose of the medicine in subsequent sessions

Clinical ketamine treatment has proven efficacy, along with science-backed research that underlines the positive results that can come about with this type of therapy.

Ketamine therapy is designed to provide a perceptible psychedelic and dissociative experience

Kristin Arden, PMHNP-BC and Lead Clinician at Mindbloom, says that ketamine clinics and therapeutic platforms like Mindbloom don’t administer a dose of the medicine below that which would elicit a subjective response or experience. Instead, patients are administered a dose that allows them to disassociate.

“We’re looking for something that’s felt at least to a mild or moderate degree, so that having that disassociate experience makes it very therapeutic,” she explains. “The whole idea or thought behind microdosing is that you’re taking sub-psychedelic dosing. It’s something being taken every day, and they don’t know if it’s a microdose or non-psychoactive day.”

Ketamine therapy’s stronger felt experience helps to “quiet the noise,” which proves to be valuable for patients challenged with conditions like depression with treatment resistance, and anxiety.

Arden says that microdosing is totally different from that, since the effect is meant to be nuanced.

“[With microdosing] you’re aiming to avoid any psychedelic experience at all,” she says. 

Ketamine’s experience and benefits are typically felt rapidly

Ketamine is known as a rapid acting antidepressant (RAADS), which means the effects are felt quickly. With ketamine treatment, patients are often back to their baseline self in one to three hours.

At Mindbloom, it’s suggested that clients block off up to three hours for the treatment. The experience itself lasts around an hour, and the remaining time is used for integration exercises like journaling, or processing of surfaced thoughts, feelings, or emotions.

“After treatment someone will be feeling happier, and usually with less anxiety in the days that follow,” says Arden.

Ketamine therapy often promotes set and setting

Ketamine treatment promotes the importance of set and setting: how your surroundings and mood going into the experience will impact it.

Mindbloom’s Guides and Clinicians emphasize the importance of the client finding a comfortable place where they feel emotionally and physically safe. At-home ketamine treatment options like Mindbloom make set and setting easier to achieve, given the client’s familiar surroundings, which may benefit treatment.

In-person ketamine clinics can be a bit different in this regard, as they’re often more sterile and unfamiliar settings.

When it comes to microdosing, set and setting aren’t considered an integral part of the experience. It can be received at any time, and often involves continuing one’s day-to-day routine.

Takeaways

While microdosing and ketamine therapy may both be considered progressive methods of treating mental health conditions using psychedelics, they are quite different in their application and research-backed results.

Microdosing focuses on lower doses with relatively imperceptible effects. Microdoses are often administered without clinical guidance, and taken at the patient’s leisure. 

Ketamine therapy clinicians administer the medicine as a controlled sub-anesthetic dose, which includes potentially higher IV or intramuscular (IM) doses. It’s also received in a clinical environment or context. Its felt effects are meant to be perceptible, with meaningful insights to be gained from the dissociative psychedelic experience. 

When it comes to therapeutic options that address serious mental health challenges like depression, anxiety, and their symptoms, ketamine clinics and platforms like Mindbloom are likely the better and safer option.

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Sources

Disclaimer

This article is for informational purposes only and is not intended to be a substitute for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment. If you are in a life-threatening situation, call the National Suicide Prevention Line at +1 (800) 273-8255, call 911, or go to the nearest emergency room.

Important FDA Safety Information

Ketamine is not FDA-approved for the treatment of depression or anxiety. Learn more about off-label uses here.

Side effects of ketamine treatment may include: altered sense of time, anxiety, blurred vision, diminished ability to see/hear/feel, dry mouth, elevated blood pressure or heart rate, elevated intraocular or intracranial pressure, excitability, loss of appetite, mental confusion, nausea/vomiting, nystagmus (rapid eye movements), restlessness, slurred speech, synesthesia (a mingling of the senses).

Do not proceed with ketamine treatment if any of the following apply to you:

  • Allergic to ketamine
  • Symptoms of psychosis or mania
  • Uncontrolled high blood pressure
  • CHF or other serious heart problem
  • Severe breathing problem
  • History of elevated intraocular or intracranial pressure
  • History of hyperthyroidism
  • Other serious medical illness
  • Pregnant, nursing, or trying to become pregnant

Ketamine has been reported to produce issues including, but not limited to, those listed below. However, lasting adverse side-effects are rare when medical protocols are carefully followed.

While ketamine has not been shown to be physically addictive, it has been shown to cause moderate psychological dependency in some recreational users.

  • In rare cases, frequent, heavy users have reported increased frequency of urination, urinary incontinence, pain urinating, passing blood in the urine, or reduced bladder size
  • Ketamine may worsen problems in people with schizophrenia, severe personality disorders, or other serious mental disorders.
  • Users with a personal or family history of psychosis should be cautious using any psychoactive substance, including ketamine, and discuss potential risks with your MindBloom clinician before proceeding with treatment.
  • The dissociative effects of ketamine may increase patient vulnerability and the risk of accidents.

To promote positive outcomes and ensure safety, follow these ketamine treatment guidelines:

  • Do not operate a vehicle (e.g., car, motorcycle, bicycle) or heavy machinery following treatment until you’ve had a full night of sleep
  • Refrain from taking benzodiazepines or stimulants for 24 hours prior to treatment
  • Continue to take antihypertensive medication as prescribed
  • Avoid hangovers or alcohol intake
  • Refrain from consuming solid foods within 3 hours prior to treatment and liquids within 1 hour prior to treatment
  • Ketamine treatment should never be conducted without a monitor present to ensure your safety

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How Ketamine Therapy Differs from "Microdosing"