Welcome to Hacking Your ADHD. I'm your host, William Curb, and I have ADHD. On this podcast, I dig into the tools, tactics, and best practices to help you work with your ADHD brain. Today, I'm joined by Skye Waterson for our Research Recap series. In this series, we take a look at a single research paper and dive into what the paper says, how it was conducted, and try and find any practical takeaways.
In this episode, we're going to be discussing a paper called "Effects of Psychedelic Microdosing versus Conventional ADHD Medication Use on Emotional Regulation, Empathy, and ADHD Symptoms in Adults with Severe ADHD Symptoms: A Naturalistic Prospective Comparison Study." That is a mouthful.
If you'd life to follow along on the show notes page you can find that at HackingYourADHD.com/322
https://tinyurl.com/56rvt9fr - Unconventional Organisation Affiliate link
https://tinyurl.com/y835cnrk - YouTube
William Curb: Welcome to Hacking Your ADHD. I'm your host, William Curb, and I have ADHD. On this podcast, I dig into the tools, tactics, and best practices to help you work with your ADHD brain. Today, I'm joined by Skye Waterson for our Research Recap series. In this series, we take a look at a single research paper and dive into what the paper says, how it was conducted, and try and find any practical takeaways.
In this episode, we're going to be discussing a paper called "Effects of Psychedelic Microdosing versus Conventional ADHD Medication Use on Emotional Regulation, Empathy, and ADHD Symptoms in Adults with Severe ADHD Symptoms: A Naturalistic Prospective Comparison Study." That is a mouthful.
And yeah, that's right—we're going to be talking about psychedelics today. So before we dive in, a few things to flag. I am not a doctor. Skye, are you a doctor?
Skye Waterson: Not.
William Curb: So keep that in mind while you are listening. This episode isn't medical, psychiatric, or legal advice. We'll be discussing psychedelics, microdosing, and some published research on ADHD and mental health, but research findings—especially early, uncontrolled studies like some of the ones we're covering today—are not the same as clinical guidance for any individual person.
These substances remain illegal in many jurisdictions, and use carries real legal risk that varies by where you live. They can also interact seriously with certain psychiatric medications and mental health conditions. So if that applies to you, this is a conversation that you should be having with your doctor and not something that you're basing off of a podcast. Take everything here as informational and not instructional.
And yes, that all sounds very serious, but I think it's worth saying before we get into this.
Skye Waterson: Yeah, 100%, 100%. And, you know, the qualitative researcher in me also wants to mention our own experiences. We're not talking about our own experiences. This is not a way to describe our own experiences with psychedelics, which are effectively—at least for me—nonexistent. So this is the perspective that I'm bringing to this paper as well.
William Curb: Yeah, I was looking through the questionnaire here where it's like, "What have you experienced with... ayahu—" I don't even know how to say that—DMT, 5-MeO-DMT, LSD... just a list of these things that I'm like, "Oh, I've heard of some of those," and many I have not. So yeah, this is not an area that I'm very experienced in. Let's always take that with a grain of salt while you're listening to this, because we can only bring our own experience to this, and really we're mostly just trying to look at what the research says, not our experience with it or lack thereof.
Skye Waterson: Yeah, 100%. So this paper is from 2024. There are other papers that go up to 2026 where they have done larger studies of studies on psychedelics—because believe it or not, this has been studied quite a few times—that have not found significant results. So when we were looking at it at least, this was kind of the most up-to-date version that found a significant result, and that's why we're talking about it.
But yeah, I just want to keep that in mind. There was later research where they found no significance when doing systematic reviews. But it's not a really fun conversation to be like, "And then they didn't find anything," so we, like everybody, have a bit of a publication bias when it comes to that.
William Curb: Yeah, although I'm sure we'll find some stuff where we're like, "Hey, this is something that a lot of people are talking about and it's not true."
Skye Waterson: Yeah, I think we have done that, actually.
William Curb: Yeah. So what is really interesting about this paper is it's actually looking at two studies they did. They did a first study, and then they were like, "Okay, we need to [do another one] for final results," because the control on the first one was nonexistent, and that did have an effect on the results.
Skye Waterson: Yeah. I did find it really interesting they included the first study, because sometimes people just won't. I also found it interesting they didn't have a control group in general. But yeah, with this first study, it was an online prospective naturalistic study.
They were recruiting people online who had the intention to microdose on their own initiative, and it had no experimental manipulations. It just collected data during participants' self-initiated microdosing practices. So in some ways, I imagine this was potentially a study that they did just to see what was even out there in terms of microdosing.
William Curb: Yeah, because it's something that I see a lot of talk about online, but there is so much where people are just like, "Oh yeah, this is how this works." And it's like, okay, but what are the mechanisms underneath? What are people actually doing? Should we even be doing more research with it? And I think that was really the point of their first study.
Skye Waterson: Yeah, 100%. So they had people who were diagnosed with ADHD and those who didn't have a diagnosis but experienced severe symptoms, which, to be fair, a lot of papers do. For people who didn't have a diagnosis, if they had T-scores that were too low on a general ADHD symptom scale, they were not included. So they did have a cutoff, which I thought was interesting, because I actually haven't seen that explicitly stated in other papers.
William Curb: Yeah, and I guess it's also a responsible thing for them to do in this research, because people with more extreme symptoms are more likely to be reaching out for these substances. If we want to have a better sense of whether they're working or not, you want to have more of the mean of what people are at, rather than on either extreme end of the findings here. Most people that have low symptoms are not going to be trying to reach out for microdosing because... I don't know, personally, that would not be my first go-to.
Skye Waterson: Yeah. I know people who wouldn't agree with you there, so I do feel like—
William Curb: That is true, yeah.
Skye Waterson: But yeah, so in terms of the diagnosis questionnaire, they did the CAARS-S:SV to assess ADHD symptom severity. They also did an emotional regulation questionnaire as well as looking at empathy, and that was kind of their focus. They wanted to look at emotional regulation specifically.
William Curb: Yeah, which is also an interesting thing to choose to look for, because most ADHD medication is not focused on the emotional regulation side of things, because that's not a priority in the medical field.
Skye Waterson: Yeah, and they pointed to that as a reason to do this study in the first place. I think anybody who prescribes SSRIs is probably waving their hand like, "Hello! We do some stuff." But in terms of specifically ADHD medication, yeah, there is a gap.
William Curb: Yeah. They were definitely looking at the ability for people to take different people's perspectives, their empathetic concerns, and this... One of the interesting things was they had the fantasy rating, and I was like, "What is that?" It's basically the same thing as empathy, but with fictional characters, where you can put yourself in someone else's shoes, kind of thing. And then also this layer of personal distress and how you're feeling about yourself.
Skye Waterson: Yeah, exactly. So in terms of the results that they found with that, they did find results. But like they said, there was no control group, so this is more of just a naturalistic study rather than something you could determine significance with in any real way.
William Curb: Yeah. And I guess another thing with the naturalistic study to note is that what people were taking was less standardized than you would have in a randomized control study or something.
Skye Waterson: Yes, yeah. They had a whole list of different things that people were taking, like you said: ayahuasca, LSD, psilocybin mushrooms, truffles, things like that.
William Curb: Yeah, and I even saw the note where they were like, "Even with that, we weren't controlling for whether the mushrooms were dried or not." And I'm like, that must have some effect, and I don't know which way it goes.
Skye Waterson: Yeah, 100%. And I am curious—they didn't really talk about it here that I saw, so I'm curious about your take. When I've seen these studies done before, they're done with a university group that has access to a specific kind of mushroom or LSD medication and is microdosing it for the participant, versus this one, which felt very much like, "This isn't legal, but we're asking you to tell us about it anyway."
William Curb: Yeah.
Skye Waterson: Yeah.
William Curb: And yeah, they did not have the best attrition rate. It was fine, but you had quite a few people drop out over the course. I'm missing my numbers here—I thought I put them right here, but I didn't. But it is something to note that with that attrition rate, you do see people who would have seen a positive result staying in the study longer because they're getting their own medication.
Skye Waterson: Yeah, exactly. Exactly. And so we move on to Study 2, where they included a control group and an ADHD symptom severity measure for a more comprehensive understanding of the effects.
Clearly they took this study—I don't know this for sure, but usually what happens is they'll take it to somebody, they'll show it to a professor or a mentor, and that person will say, "Look, this is great, but you're not going to publish this as is. You're going to need to go and do a second study." And that's exactly what they did.
William Curb: Yeah, and they did see a reduction in most of the results from the first study, with the exception of perspective-taking, which had higher throughput, but took longer for that to take effect. So it's interesting to be like, "Oh yeah, that one outside effect was actually greater. That's weird." But yeah, the microdosing saw a reduction compared to the—I always forget what TAU...
Skye Waterson: Treatment as usual. Yeah, so for Study 2, they had baseline measurements, two-week, four-week, and like they said, they had a control group. To get my numbers right: they started with 50 in the microdosing group and 37 in the TAU group.
William Curb: And then the attrition rate at the end: they had 38 in the microdosing group and 28 in the TAU group.
Skye Waterson: Yeah. And they were really careful: if somebody used a psychedelic substance during the study and they weren't in that group, then they were not included. So you had to only use medication in one group and only use psychedelics in the other group, and that's what they were checking for. So they did find significant shifts, but the results were lower.
William Curb: Yeah, and the core thing that they were looking for, which was the emotional side of things, almost entirely fell out. They weren't able to replicate those results.
Skye Waterson: Which was interesting, because they were like, "We want to do this because of the effect that it's going to have on emotional regulation." That wasn't the case, but the effect that it had on inattention, hyperactivity, and general ADHD symptoms did remain in this second study.
William Curb: Yeah. So it's definitely worth looking at, especially considering that this study wasn't blinded at all, to say this definitely shows that it's worth looking at this more.
Skye Waterson: Yeah. Especially because—and I think this came up—a lot of the people (and this is a very specific subset of people who want to take different forms of medication) said they used to take medication, but didn't anymore. 84 people said they used to take a medication for ADHD, but they didn't anymore, and the biggest reason for discontinuing it by far was the psychological side effects and the physical side effects.
So there is a world where somebody has side effects from traditional ADHD medication and is searching for an alternative. That, I think, is probably one of the groups of people that really want this research to continue.
William Curb: Yeah, I think especially finding effective non-stimulant medications for people, because there are so many people that have some sort of adverse effect with their stimulants. And also, just to be clear for people, stimulants do work fine. I take stimulants. It's just that there is a subset of people that need something different, and this is definitely a path that we can start exploring. Again, don't do this on your own. Talk to your doctor.
Skye Waterson: Yep, all the things. But an interesting conversation, and yeah, I'll be curious to see. The later research that came out didn't find a significant effect, so this might be a path that people went down and found it doesn't have the effect when you really do the randomized control trials on it.
Maybe if you liked this episode and you want us to look at the other papers that didn't have a significant effect, we could definitely do that and continue this conversation.
William Curb: Yeah, I'd definitely be happy to look at more of these. I also did fall down a rabbit hole looking at how they try to blind psychedelic studies, because they do have such a high effect on people, even with a microdose. And one of the interesting findings I found was that one of the placebo drugs they give people is methylphenidate.
Skye Waterson: Okay. Huh.
William Curb: Because purely from an "Oh, I feel something happening" standpoint, with that kind of stimulant, they're like, "I have an elevated heart rate, I'm more alert, I have this mild stimulation." And that's often how people have that tell when they're taking a psychedelic, because they're like, "Oh, I feel alive." And that's often what people who don't have ADHD feel from something like methylphenidate.
Skye Waterson: Huh, fascinating.