Microdosing with psychedelics to self-medicate for ADHD symptoms in adults: A prospective naturalistic study

This excellent free full-text paper from the psychedelic research team at Maastricht is a very helpful step forward in exploring the possible value of microdosing for ADHD. The authors write: "This online prospective naturalistic survey study aimed to assess changes in ADHD symptoms, well-being, and time perception using validated questionnaires and a time reproduction task in individuals with an ADHD diagnosis or severe ADHD complaints, who started MD on their own initiative. The primary hypothesis that MD would reduce ADHD symptoms was confirmed, as findings showed decreased (self-report) ADHD symptoms after two weeks of MD, with additional decrements two weeks later. Using conventional ADHD medication seemed to delay the decrease in ADHD symptoms after MD. In line with expectations, increased well-being was reported at two and four weeks after MD. Additionally, MD-related changes in well-being and ADHD symptoms were negatively associated. Using conventional medication alongside MD, or having comorbidities alongside ADHD, did not change the effect of MD on ADHD symptoms and well-being after four weeks of MD in the current study. Lastly, time perception seemed to be altered after MD for individuals using conventional medication, illustrated by an over-reproduction of the shortest (1000 ms) time interval used in a time reproduction task. The results do not find support for the hypothesis that performance on a time perception task would be improved after MD in individuals with an ADHD diagnosis or severe ADHD complaints.  The decrease in ADHD symptoms after MD was in line with earlier findings showing that MD as self-medication used by people diagnosed with ADHD was rated as being more effective than conventional treatments and increasing their quality of life (Hutten et al., 2019a). Also, the findings were in line with anecdotes of individuals who microdosed to self-treat their ADHD (Andersson and Kjellgren, 2019). The strength of the present study over retrospective reports is that the current design allows causal inferences to be made about MD and the observed and self-rated effects. Based on this, it can be said with more certainty that MD could be beneficial and of therapeutic value for individuals diagnosed with ADHD or having severe ADHD complaints, even in addition to first-line pharmacological interventions. After four weeks of MD, mean CAARS-S:SV t-scores were below the used cut-off of 65 for three out of four subscales. The current study sample showed similar changes in the CAARS-S:SV DSM-IV total symptoms scores compared to studies investigating the effects of several weeks of mindfulness-based cognitive therapy (Hepark et al., 2019; Janssen et al., 2019) and treatment with methylphenidate (Takahashi et al., 2014) in adults diagnosed with ADHD. Almost twenty percent of the sample at the four-week time point did not show improvements in ADHD symptoms. This lack of improvement did not seem related to using conventional medication alongside MD or having comorbidities alongside ADHD. Other aspects most likely underlay the lack of improvement in the non-responding participants. A potential explanation might be that individuals had difficulties determining the right dose, a question that future controlled dose-titration studies could investigate … To conclude, the present study provides the first evidence that MD may have therapeutic value in adults diagnosed with ADHD or experiencing severe ADHD complaints. Given the limitations of the current study design, studies including placebo-treated and/or other control groups could confirm the magnitude of the therapeutic effect of MD in ADHD."

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