Using psychedelics for pre-menstrual dysphoric disorder?

Roberta Jean is a critically acclaimed choreographer whose most recent performance, Ways of Being (Thursday, 9th, and Friday, 10th of November, at Sadler’s Wells Lilian Baylis Studio, London) incorporates suffering related to premenstrual disorder (PMDD) and healing through psychedelics. In this piece we explore the evidence of microdosing to soothe this painful and life-disrupting disorder.

From ‘Ways of Being.’ Photo by Emli Bendixen

Roberta Jean is one of the 3-9% of women who experience debilitating emotional and physical symptoms in the lead-up to menstruation, known as PMDD. Women with PMDD commonly experience severe depression, intense mood swings, and extreme discomfort in the luteal phase of their menstrual cycle, one to two weeks before bleeding. 

Though often overlooked medically, the magnitude of PMDD can be enormous. The estimated suicide rate for those with PMDD is seven times that of the average, and symptoms can substantially impair work and social life. “It’s a very unique and hellish experience,” Roberta described. “The Buddha said life is suffering. But I can intuit he didn’t mean this much suffering.”

An array of talk therapies and medications–such as birth control pills and antidepressants–are available for PMDD individuals. Yet, these treatments don’t cut it for everyone and often have their own set of obstacles. “I took Prozac for three years for it [PMDD], but it made me feel numb, like zombie and not like myself,” described one woman. For those who exhaust all medical options, chemical menopause or surgery to remove one’s ovaries altogether becomes a last resort. However, microdosing psychedelics may be a promising alternative solution. 

A regime of using psychedelics, at one-tenth of a dose every three days, was initially coined by psychologist James Fadiman in his 2011 book A Psychedelic Explorer’s Guide. The trend initially took off in Silicon Valley among tech entrepreneurs looking to boost their productivity but has since been employed by various medical communities. 

In “A Really Good Day,” published in 2016, novelist Ayalet Waldman narrates how microdosing LSD helped manage her PMDD. She writes, “[when microdosing LSD] when I think about my husband and my children, I feel a gentle sense of love and security. I am not anxious for them or annoyed with them. When I think of my work, I feel optimistic, brimming with ideas, yet not spilling over.”

Roberta said microdosing has become a “global thing since Ayalet Walman’s book came out,” and a popular subject among PMDD communities on Reddit and Facebook.

“I think it’s out of desperation when people run out of options and people turn to psychedelics,” she said. 

Experiences similar to Walman’s are frequently reported on these forums, with many users describing that microdosing helps ease and shift negative thinking.

“It feels as though my neural pathways are changing, and I’m able to make different decisions for my care in the moment than I would have been able to do before,” described one woman on Reddit. 

“I’ll just microdose every other day until my period…I call it sparkling. Everything radiates a little bit more. I don’t know much about the exact science, but I still have a pep in my step the day after as well,” another woman wrote. 

On a visit to the Netherlands, where psilocybin truffles are legal, Roberta herself explored microdosing. She also found psilocybin hugely useful during her pre-menstrual symptoms, stating it significantly helped relax her mind. 

Researchers don’t fully understand why psychedelics may be so useful for PMDD, but Roberta speculates their ability to “quiet the ego” could be useful. Highlighting this theory, numerous studies show psychedelics decrease activity in the default mode network (DMN) –a brain network associated with the ego and negative ruminating thoughts. The DMN has also been associated with symptoms of pre-menstrual disorder, a milder form of PMDD. 

On a molecular level, blocking the 5-HT2A receptor–the main target for classical psychedelics–has been found to inhibit the release of LHRH, a messenger molecule that regulates ovulation. Psychedelics also interact with the body’s stress response, which plays an important role in the menstrual cycle. However, the interaction between psilocybin and women’s biology still remains relatively unexplored. 

Hystelica is a female-focused research group addressing this knowledge gap. Their mission includes the identification of potential female-specific therapeutic applications for psychedelics, such as psychedelic treatments for PMDD. The team has recently launched a survey to understand the psychedelic experiences of women with PMDD and other menstrual issues. 

The biotech company FelicityPharma is also aiming to develop psychedelic medicines for PMDD. They plan to run the first psychedelics for PMDD clinical trial, which will use a large psilocybin formula dose, followed by maintenance microdoses. 

Despite the excitement, Roberta believes psychedelics aren’t suited for everyone, and there may be instances where psychedelics could, in fact, be harmful to women with PMDD. For instance, psychosis and anxiety are frequent co-morbidities in PMDD, and psychedelics could amplify these psychological symptoms. She also noted that although psychedelics can help, they’re not a standalone cure for PMDD, and other therapies, such as pain relief and talk therapy, would likely still be necessary if psychedelic treatments were to become legal.

“There’s no cure for PMDD, and there’s not likely to be anytime soon. It takes a holistic, very focused management of symptoms you have to attack it from a lot of different angles,” she said. 

Nevertheless, Roberta is passionate about the potential for psychedelics in PMDD and raising awareness about unconventional treatment modalities. Ways of Being is greatly influenced by Roberta’s experience with PMDD but choreographed more broadly as a reflective space for all those who have experienced severe mental health challenges.

“This particular work is a love letter to those who have had experience of depression and suicidal thoughts,” said Roberta. “The work isn’t exclusively about PMDD. It’s made, from my perspective, and a great deal of that reflects on suffering and healing fairly broadly.”

Ways of Being is being performed on Thursday, 9th, and Friday, 10th of November, at Sadler’s Wells Lilian Baylis Studio, London. You can find tickets for the performance here and learn more about Roberta and her work by checking out her website here.