Microdosing psychedelics is more than just a trend. What began as a homegrown experiment is now, for some, a form of daily medication; for others (such as in Silicon Valley), a tool for creativity and productivity; and increasingly, a subject of serious scientific research. Anecdotally, countless people say taking substances like LSD and psilocybin mushrooms at “subthreshold” doses (that is, not enough to properly trip or “feel it”) has vastly improved their mental health, energy levels, and outlook on life. You’ll find many of them on /r/microdosing, a subreddit with 230,000 followers, which features crowd-sourced content like a “starter’s guide,” dosing advice, and an FAQ. In partnership with MUD/WTR, DoubleBlind even offers a course on microdosing.
Yet there remains some debate over the efficacy of microdosing, a question which merited an investigation by the New York Times. Not much scientific evidence supports the claims of micro-dosers: Is the effect just a placebo? (All the same, placebos can be very effective!) Renowned mycologist Paul Stamets contributed research to a study published last year—and one the year before—that supported the benefits of microdosing psilocybin mushrooms while also discussing the difficulties of disproving a possible placebo effect.
But can all psychedelics be microdosed? Some ketamine consumers claim an antidepressant effect from taking small bumps of the drug daily—but this can be dangerously addictive, and ketamine’s antidepressant effect has only been scientifically observed in controlled sessions spaced weeks or months apart. On the other hand, researchers have found benefits to microdosing substances like caffeine and kanna, a succulent native to South Africa long used both ceremonially and medicinally by local Indigenous communities.
One substance we don’t hear about as much in a microdosing context is MDMA. Why is that? Does microdosing MDMA work? Could it have unintended consequences? DoubleBlind consulted the experts to get you the answers.
Can You Microdose MDMA?
MDMA, known on the street as “molly,” “mandy,” or (when pressed with other drugs into tablet form) “ecstasy,” is an empathogen. That means that effects include increased emotional openness and feelings of profound connection in addition to euphoria and a light stimulant effect. This won’t surprise anyone familiar with dance music culture; Peace, Love, Unity, Respect is a time-honored ethos at raves, where MDMA has been a staple for decades.
READ: MDMA: What is Molly?
Though MDMA is best known as a recreational drug, the last ten years have seen renewed interest in its therapeutic potential, particularly in treating addiction and PTSD. Importantly, studies demonstrating its efficacy have used pure, “unadulterated” MDMA whose “potency is known,” says Betty Aldworth, spokesperson for the Multidisciplinary Association for Psychedelic Studies (MAPS), an organization at the forefront of MDMA research. “Drugs [obtained] through the unregulated market may be adulterated, and their potency is unknown.” (A 2017 study that tested 529 samples discovered that only 60 percent of pills sold as MDMA actually contained the empathogen.)
All that said, pure MDMA can work wonders when taken in the right context. Dr. Ben Sessa, a UK-based psychiatrist who’s researched psychedelics for over a decade, has administered MDMA to psychotherapy patients as part of research trials, finding that it “allows patients to address significant emotional challenges, including trauma-based disorders,” he says. In general, he is not a fan of microdosing psychedelics due to a lack of scientific evidence that it works. And while there are tens of thousands of anecdotal reports from people who claim benefit from taking small doses of LSD and psilocybin, hardly anyone—neither scientists nor users of online communities like Erowid or Reddit—endorses microdosing MDMA.
It’s simply not effective, and MDMA can produce a “heavier toll on the body” compared to LSD or psilocybin, says Dr. Sessa. In fact, anyone who asks about MDMA on /r/microdosing is met with an automated response that begins “Do not microdose MDMA” (in bold) and thoroughly explains why it’s a bad idea, touching on tolerance issues, dysregulation of motivation centers in the brain, and the possibility of losing access to the drug’s effects forever. In short, MDMA is not a great drug to microdose: It hasn’t shown much benefit and could cause harm.
How Much is a Microdose of MDMA?
A microdose is any “sub-threshold” quantity of a drug—lower than what it takes to produce tangible effects. Dr. Sessa believes this fact is often lost in discussions of microdosing; people may be taking threshold doses without realizing it. “If you have a buzz, you’re not on a microdose; you’re tripping,” he says. And if you’re tripping multiple days a week, Dr. Sessa believes you could be at risk for developing psychosis or other complications.
Under Dr. Sessa’s protocols, most MDMA-assisted psychotherapy patients receive an initial threshold dose of 120 milligrams, followed two hours later by a 60-milligram booster dose. At a second therapy session two to three weeks later, they receive the same dosing. Dr. Sessa pegs the threshold for MDMA at around 25 to 35 milligrams, where the user might start to feel a gentle tingling effect but wouldn’t experience the “full switching-off the amygdala,” which is where the full therapeutic power of MDMA lies. The amygdala is a part of the brain that processes fear.
Taking an occasional microdose is different from microdosing as a part of a protocol. Microdosing protocols involve taking a drug regularly, though not every day. Tolerance to psychedelics builds quickly, so microdosers need to “reset.” MDMA would be similar: because it begets acute physical tolerance, it would likely stop working after a day or two of consecutive use. Yet there’s really no suitable microdose routine for MDMA. Taking it multiple times a week could have dangerous effects on your serotonin levels.
Dr. Sessa advises against attempting to microdose MDMA but says that someone seeking to do so properly would likely start with three milligrams, “the tiniest crumb,” then work their way up in three-milligram increments each day that they dose. On the day they feel “the tiniest of tingles,” they should drop down two increments. “That would be your microdose sweet spot [because] you can’t feel it,” he says.
What Does Microdosing MDMA Do?
Rick Doblin, founder and executive director of MAPS, believes that microdosing MDMA is unlikely to be a pleasant experience. “When you take off for a flight, you can get turbulence on the altitude climb, but once you get above the clouds, it’s generally smooth sailing,” he says. “Low-dose MDMA has been likened to taking off but never getting above the clouds—you end up stuck in the turbulent phase.”
No study has yet focused on the effects of microdosing MDMA, and few people online admit to trying it, so most of what we can say is speculation. MAPS has sponsored dose-response trials in which some participants living with PTSD were given MDMA at low, but not necessarily sub-threshold doses (25, 30, and 40 milligrams) in two sessions spaced three to five weeks apart. Patients who received lower doses reported adverse reactions, such as anxiety and difficulty concentrating, at rates similar to those who took a “full dose” of 100 to 150 milligrams. Patients at the lower dose were more likely to experience fatigue (52 percent) and headaches (67 percent) compared to their high-dose counterparts (42 and 45 percent, respectively).
These trials focused on adverse effects and did not account for possible positive ones. This data is also an imperfect analog for people microdosing at home. “It’s really difficult to map reactions in a clinical setting among people with severe, chronic PTSD to real-world settings among people without a debilitating mental health condition,” says Aldworth, the MAPS spokesperson. However, the findings align with Doblin’s characterization and others’ anecdotal reports.
Are There Any Benefits?
There is not much reason to believe that microdosing MDMA would be helpful. According to Dr. Sessa, “what you would be hoping to see is an antidepressant effect or enhancement of energy and imagination—all the things people say they experience with classic psychedelics.” But there is little anecdotal or scientific evidence to say that this actually happens. “I’m guessing people have tried it, and it didn’t work,” he says.
Even if it did, the drug’s positive effects would likely be limited to the first one or two days. When dosing regularly, risks are incurred, such as physical toxicity, neurological dysregulation, and perhaps insomnia (see more below). Dr. Sessa wants to debunk the idea that MDMA is responsible for causing the debilitating hangovers that people often feel after taking molly or ecstasy when partying; in a paper called “Debunking The Myth of ‘Blue Mondays’,” he and other researchers noted that clinical MDMA does not show this “comedown” effect. It is more likely related to lack of sleep, extreme exercise, impure drugs, dehydration, and combining with other substances, they say. Still, that doesn’t mean microdosing MDMA, even if it’s pure, would have benefits.
What Are the Risks and Side Effects?
There is reason to believe that microdosing MDMA would have serious risks and side effects, though we don’t have hard evidence. The MAPS data mentioned previously showed more than half of the subjects who took low-dose MDMA experienced fatigue and/or headache, and more than one-third reported anxiety. Dr. Sessa says MDMA can generally raise one’s blood pressure and body temperature, effects that could become more extreme with constant usage. He also speculates that the drug’s stimulant effect could lead to insomnia if taken regularly.
There is a reason MDMA-assisted psychotherapy uses threshold doses, which have easily observable and palpable biological effects. At too low a dose—anything under 75 milligrams—MDMA could loosen a patient’s inhibition and open them emotionally without inhibiting parts of the brain that prevent painful feelings of trauma recall. In other words, someone expecting to get emotional benefit from microdosing MDMA could find that they get the challenges without the benefits.
Some have speculated about more serious risks. Aldworth says that while psilocybin and LSD produce their effects (such as those sought by microdosers) by mimicking serotonin, MDMA causes the brain to release large amounts of its own serotonin, causing depleted levels and reduced efficacy in the days following. A 2014 study suggested that regular use of any amphetamine (such as MDMA) can dysregulate an individual’s “reward processing,” by altering dopamine-sensitive neural circuitry.
Because of all these risks, some ravers and MDMA aficionados aim to wait at least three months in between doses. They were perhaps inspired by Ann Shulgin, the widow of chemist Alexander Shulgin (who introduced the drug to psychologists in the 1970s). As she put it, “I would advise anyone who wants to use MDMA not to take it more than four times a year if you want to continue to get the best effects from it; otherwise, you risk losing its effects entirely and permanently.”