From the Editor

He had struggled for years with mood and ADHD. While we discussed different medication options, my patient was very focused on psychedelics; he explained that his friends had found microdosing to be helpful, especially for their attentional problems.

Psychedelics have entered the mainstream: research is active; patients seem increasingly interested; and, yes, investors offer up billions in the rush to find potential treatments (and profit). But is there evidence for psychedelics for those with ADHD?  Dr. Lorenz Mueller (of the University of Basel) and his colleagues attempt to answer that question with a new paper, just published in JAMA Psychiatry. They describe the first double-blind, placebo-controlled phase 2A randomized clinical trial. 52 participants received repeated doses of LSD (twice weekly) or placebo over six weeks. “In this randomized clinical trial, repeated low-dose LSD administration was safe in an outpatient setting, but it was not more efficacious than placebo in reducing ADHD symptoms.” We consider the paper and its implications.

The molecular structure of LSD – pretty but useful for ADHD?

In the second selection, Vasileia Karasavva (of the University of British Columbia) and her co-authors look at ADHD and social media in a new paper for PLOS One. In a two-part study, they analyzed 100 popular videos on ADHD, finding many views but uneven quality. While they note the “democratizing” of mental health information, they warn: “TikTok’s anecdotal content could lead some viewers to misattribute normal behaviors or those better explained by other conditions to be signs of ADHD…”

In the third selection, Dr. Zilin Cui (of Boston University) writes about ADHD – as a provider and also as a patient. In a personal Psychiatric Services paper, the physician discloses long-standing problems and a diagnosis. She also writes about cultural considerations. “Instead of continuing to dwell on what I cannot do, I now have different tools and strategies to chart my path forward. Now, I can finally tell myself that I am enough.”

DG


Selection 1: “Safety and Efficacy of Repeated Low-Dose LSD for ADHD Treatment in Adults: A Randomized Clinical Trial”

Lorenz Mueller, Joyce Santos de Jesus, Yasmin Schmid, et al.

JAMA Psychiatry, 19 March 2025  Online First

Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder characterized by symptoms of inattention and/or hyperactivity-impulsivity, with an estimated global prevalence of 2.6% among adults. Adults with ADHD often experience substantial impairment in various aspects of their lives and have a high frequency of psychiatric comorbidities. ADHD is typically treated with stimulants (e.g., methylphenidate and amphetamines) and nonstimulants (e.g., atomoxetine). These medications are generally effective, particularly in the short term, but approximately 20% to 40% of patients do not achieve an adequate response…

In recent years, the microdosing of psychedelics has gained considerable attention. It involves the repeated use of low doses of psychedelics, such as lysergic acid diethylamide (LSD) or psilocybin, with the aim of enhancing well-being, cognitive functions, and emotional processes. Surveys and naturalistic studies have reported that individuals also use microdosing to self-treat various disorders, including ADHD, with findings indicating a positive impact on symptoms. A microdose is generally considered to be one-tenth to one-twentieth of a recreational dose, an amount that does not induce significant acute perceptual changes or interfere with daily activities. Microdoses or low doses of LSD typically range from of 5 to 20 μg, with a common practice of taking the psychedelic once every 3 days over several weeks. However, clinical evidence from controlled studies in patients is lacking.

So begins a paper by Mueller et al.

Here’s what they did:

  • They conducted a multicenter, double-blind, placebo-controlled randomized clinical trial.
  • Recruitment included advertising.
  • Two centres were involved: University Hospital in Basel (Switzerland) and Maastricht University (the Netherlands).
  • Inclusion criteria: Adults with a prior ADHD diagnosis who presented with moderate to severe symptoms (Adult Investigator Symptom Rating Scale [AISRS] score ≥26 and Clinical Global Impression Severity score ≥4).
  • Exclusion criteria included the use of potentially interacting medications – which included any ADHD medications.
  • “Participants received either LSD (20 μg) or placebo twice weekly for 6 weeks (total of 12 doses).” All doses were administered on-site and with supervision.
  • Main outcome: “the change in ADHD symptoms from baseline to week 6, assessed by the AISRS and analyzed with a mixed-effects model for repeated measures.”

Here’s what they found:

  • 503 individuals were contacted about participation; the majority didn’t respond. Some were ineligible. 53 participants were randomized to LSD (n = 27) or placebo (n = 26).
  • Demographics. Mean participant age was 37 years; most participants were male (58%).
  • Change. “The LSD group presented a mean AISRS improvement of −7.1 points… The placebo group presented a mean AISRS improvement of −8.9 points… with no difference between groups.” (!!)
  • Adverse events. “No serious AEs and no deaths were recorded during the study. The 5 most common treatment-related AEs were headache, nausea, fatigue, insomnia, and visual alterations.”

A few thoughts:

1. This is a good and relevant study published in a major journal.

2. The main finding in six words: LSD wasn’t more efficacious than placebo.

3. There is much to like here: a placebo-controlled design, the supervised dosing, and the comprehensive assessments of safety, to name a few things.

4. Perspective: only 52 people were involved. “The trial was powered to find a rather large effect size, while very small effects may have been missed.” Still, the main finding is the main finding…

The full JAMA Psych paper can be found here:

https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2831639



Selection 2: “A double-edged hashtag: Evaluation of #ADHD-related TikTok content and its associations with perceptions of ADHD”

Vasileia Karasavva, Caroline Miller, Nicole Groves, et al.

PLOS One, 19 March 2025

Owing to social media, it is easier than ever to access information about mental health concerns like attention-deficit/hyperactivity disorder (ADHD), a condition marked by inattention, hyperactivity, and impulsivity that affects approximately 3 – 7% of adults. Unlike more traditional psychoeducational sources, social media centers the perspectives of those with lived experience, meaning the first-hand experience of a psychological disorder. Consequently, social media can be a powerful tool for showcasing popular information about mental health, reducing stigma, and helping people connect with a community. Nonetheless, the lack of vetting, quality control, and moderation of user-generated mental health content on social media may raise concerns.

So begins a paper by Karasavva et al.

Here’s what they did:

  • They conducted a study evaluating the ADHD-related content on TikTok.
  • In the first part: “Two clinical psychologists with expertise in ADHD evaluated the claims (accuracy, nuance, overall quality as psychoeducation material) made in the top 100 #ADHD TikTok videos.” 
  • They did this by opening a TikTok account and searching for videos with “#ADHD.” Research assistants then looked at distinct claims per video and classified them as symptoms or treatment. Two psychologists independently assessed the claims, including giving each a global score.
  • In the second part: “undergraduate students were asked about their typical frequency of viewing #ADHD content on TikTok and their perceptions of ADHD and were shown the top 5 and bottom 5 psychologist-rated videos.”
  • The undergraduate students were offered partial course credit at a university. They were divided into those who had been diagnosed with ADHD, those who self-diagnosed with ADHD, and those without a diagnosis. They were then asked about the top 5 and bottom 5 videos.

Here’s what they found:

  • Part 1. “Of the 98 videos meeting inclusion criteria, the view count of eight videos was missing in the screen recordings.” They focused on 90 videos.
  • Views. These videos had 495 729 000 views, averaging 5 470 322 views per video. 
  • Length and credentials. Videos were 38.20 seconds long and contained 2.99 claims about ADHD In 93.9% of videos, the content creator did not refer to any source for their claims. Only 20.4% of creators shared their credentials in the video and 36.7% listed them on their TikTok profile.
  • Claims. “Fewer than 50% of the claims about ADHD symptoms were judged to align with the Diagnostic and Statistical Manual of Mental Disorders.”
  • Part 2. There were 843 participants.
  • Demographics. Most participants were women (79.4%), and the most common ethnic identity was Asian (54.3%).
  • Recommendations. “A greater typical frequency of watching ADHD-related TikToks was linked to a greater willingness to recommend both the top and bottom-rated videos… after controlling for demographics and ADHD diagnostic status. It was also linked to estimating a higher prevalence of ADHD in the general population and greater challenges faced by those with ADHD.”
  • Comparison. “Compared to the psychologist raters, young adults in our sample had a more favorable view of the bottom 5 (large effect size) and a less favorable view of the top 5 psychologist-rated ADHD-TikTok videos (small effect size). At the same time, young adults’ ratings for the top 5 videos were higher than those for the bottom 5 videos.”

A few thoughts:

1. This is a good, relevant study on social media.

2. The main finding in a sentence: the videos were popular but were of uneven quality.

3. The reach of social media is amazing. To repeat: they averaged 5 470 322 views per video.

4. The authors are walking on a familiar path. Past work has shown that social media isn’t a great source of reliable medical information. Drawing on the opinions of young adults was a nice touch.

5. Clinical implications? “Mental health professionals may experience patients seeking an ADHD diagnosis or who are self-diagnosed based on information from TikTok. It may be important for professionals to listen to patients’ experiences with ADHD information on social media and to hear about what patients have found valuable in this information.”

6. Like all studies, there are limitations and the authors note several, including in the selection of the most popular videos (which excluded those with ads and deleted videos).

The full PLOS One paper can be found here:

https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0319335



Selection 3: “Never Enough”

Zilin Cui

Psychiatric Services, 12 November 2024

Attention-deficit hyperactivity disorder (ADHD) is a neurodevelopmental condition that is most often diagnosed among children… I received an ADHD diagnosis during my intern year of psychiatry residency at the age of 27. I had mixed feelings about this label. On the one hand, I was relieved to finally have an explanation for how I think and experience the world. On the other hand, I wondered whether I was truly ‘dysfunctional enough.’ Every DSM diagnosis ends with the same phrase: ‘must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.’ Was I not just another lazy procrastinator who needed to work harder?

So begins an essay by Dr. Ciu.

She notes that she was functional enough to get into medical school – but there were problems. “Pressure and anxiety motivated me to study just enough to pass, which in my preclinical years could mean getting a 76 when the passing score was 75 (a popular saying among my classmates was P=MD, or a passing score makes one a doctor). My attention was drawn elsewhere: I committed myself to far too many student organizations, and I would start five different projects and then feel like a failure when I struggled to finish any of them. A few months before step 1 of the United States Medical Licensing Examination, everything finally caught up to me. Failing my first practice test was my wake-up call that perhaps my lack of focus was not all about discipline and willpower.”

She discusses her background. “I think one reason it took me so long to consider a diagnosis of ADHD, let alone seek treatment, was my background as a Chinese American woman. During my childhood, neither my mother nor I suspected that I might have ADHD, which is frequently underdiagnosed and undertreated among Asian American and Pacific Islander (AAPI) children and adults. ADHD treatment guidelines are not standardized in Asian countries; guidelines do not even exist in China and Taiwan. Furthermore, studies on ADHD overwhelmingly focus on cisgender boys, a pattern that is only exaggerated in the literature on Asian children. There is not enough consideration of gender norms and socialization.”

“If I did not appear dysfunctional, then perhaps I was (and still am) compensating. For example, I organized obsessively, maintained a regimented sleep schedule, and deleted social media apps from my phone. There were social consequences with these strategies: going to bed early on the weekends limited my time with family and loved ones, while staying connected with friends became harder without social media. I scripted and prepared for not only presentations and meetings but also everyday conversations. I have alarms, reminders, calendars, and lists to keep track of my life.” She notes the burden of these strategies. “I can take hours to write an e-mail or fill out a form because of the need to triple-check my work. Is my name spelled right? Is my address correct? My notes can accidentally turn into long essays. I am always the last one to leave the hospital.”

She decides to share the diagnosis with her mother. “When I disclosed my diagnosis to my mother, she was surprised, but she did not reject it like I had anticipated. Instead, we had a conversation about what ADHD looks like in women and common misconceptions about it.”

She mulls the impact of her experience on her clinical work. “As a provider, I am grateful for this experience because it has taught me more about ADHD and neurodivergence than anything in my formal education so far. When I see patients now, I almost always ask questions about neurodivergence, especially with girls, women, and gender-diverse individuals. I also do not rely solely on DSM criteria when screening for ADHD; instead, I ask detailed questions about hobbies, workflow, and factors that support or hinder focus (e.g., interest, stress, and competition).”

“Even now, I am still trying to finish all those projects I started in medical school.”

A few thoughts:

1. This is a well-written essay.

2. The comments on being a Chinese American woman and research biases are interesting and important.

3. It’s nice to see how her lived experience influences her work as a clinician.

The full Psych Services paper can be found here: https://psychiatryonline.org/doi/10.1176/appi.ps.20240414


Reading of the Week. Every week I pick articles and papers from the world of Psychiatry.