Can ayahuasca help a man with bipolar disorder or can it worsen his condition? What are the odds of the psychedelic brew treating this particular mental disorder?
Ayahuasca is a popular hallucinogenic beverage from the Amazon. Some take ayahuasca for recreational purposes, but many want to try it for healing. Many claimed that the psychedelic brew has helped them with depression and anxiety. Thus, several are wondering if it will deliver the same results to a woman or man with bipolar disorder.
However, several experts strongly discouraged those with bipolar disorder against ayahuasca consumption due to substance-induced mental disorders. The relationship between ayahuasca and bipolar disorder is quite complicated. So, read more to understand it better. We will start by defining the mental health condition that we will be talking about in this article in the next section.
What Is Bipolar Disorder?
Bipolar disorder is a serious mental condition that involves a shift in mood, energy and ability to carry out daily tasks. A man with bipolar disorder experiences periods of intense emotions and changes in a behavior called mood “episodes” that can last for days or weeks.
The mood disorder is also called manic depression because one usually experiences two kinds of extreme and abnormal mood swings which are as follows.
Mania or hypomania — When one feels great energy and happiness. During this period there is great excitement or euphoria, delusions and overactivity.
Depression — When one feels severely sad or low. This mental condition is characterized with intense loneliness and hopelessness. It is usually accompanied by a lack of energy and disturbance of appetite and sleep.
Hypomanic and manic symptoms per Mayo Clinic(1)https://www.mayoclinic.org/diseases-conditions/bipolar-disorder/symptoms-causes/syc-20355955.
• Abnormally upbeat, jumpy or wire
• Increased activity, energy or agitation
• Exaggerated sense of well-being and self-confidence (euphoria)
• Decreased need for sleep
• Unusual talkativeness
• Racing thoughts
• Poor decision-making — for example, going on buying sprees, taking sexual risks or making foolish investments
Major depressive episode needs to include at least five of the following.
• Feelings of sadness, hopelessness or incessant crying
• Abnormal feelings of guilt and worthlessness
• Disinterest or taking no pleasure in engaging in activities
• Significant weight loss or weight gain or changes in appetite
• Inability to sleep or sleeping too much
• Reduced energy levels
• Slower behavior or restlessness
• Difficulty concentrating or indecisiveness
• Suicidal thoughts
The mood swings may happen only once or frequently in a year. And when it hits, it usually takes days or weeks, thus interrupting one’s regular routine.
How serious is the mental disorder?
Bipolar disorder can affect one’s overall health. It can disrupt one’s daily routine or regular activities.
Also, according to the National Institute of Mental Health(2)https://www.nimh.nih.gov/, bipolar disorder can result in a 9.2-year reduction in the expected life span. People diagnosed with bipolar disorder are also at risk of harming or killing themselves with 15% to 17% committing suicide.
Moreover, up to 60% of people suffering from a mental health disorder, including bipolar disorder, develop substance use disorder. Also, they may report co-occurring health conditions like migraine, asthma, high cholesterol, high blood pressure, thyroid disease and osteoarthritis.
3 Types of Bipolar Disorder
According to Anna Hindell(3)https://www.annahindell.com/, LCSW-R, a psychotherapist based in New York, there are three types of bipolar disorder.
Bipolar I — When the manic episodes last at least seven days and may require hospitalization. Usually, the depressive episode that follows can last up to two weeks. If the two symptoms happen simultaneously, one is experiencing a mixed episode.
Bipolar II — Characterized by a pattern of hypomanic and depressive episodes. Hypomania is a mood elevation where one experiences an increase in energy, agitation and pressured speech. Mania is not as intense as bipolar I, but the depressive episode can be severe and may last longer.
Cyclothymic disorder — When one experiences more frequent shifts between mood swings called rapid cycling. The highs are similar to hypomania symptoms and the lows are mild to moderate depression.
“With cyclothymia, the ups and downs are more frequent and can have these swings for a longer period of time, diagnostically two years,” Hindell explained(4)https://www.singlecare.com/blog/news/bipolar-disorder-statistics/.
According to David Ezell(5)https://darienwellness.com/david-ezell-m-a-m-s-l-p-c-l-m-h-c/, LMHC, the CEO and founder of Darien Wellness, when they are in the manic stage, the experience can be exhausting because they have excessive energy. However, when they are depressed they also tend to do nothing.
“They tend to have endless energy, set a vast number of goals, and have beliefs about themselves that aren’t true or are even impossible for humans to achieve” in a manic stage, Ezell explained. “Conversely, when they are experiencing the depressive side of their mood they essentially become the opposite with regard to mood. They don’t want to do anything, they tend to disengage from people and become fairly lifeless. As a result, people withdraw from them.”
How Common Is Bipolar Disorder?
Based on the World in Data in 2018, 46 million people around the world have bipolar disorder. Therapeutic Advances in Psychopharmacology surveyed 11 countries and learned that the lifetime prevalence of bipolar disorder was 2.4%. The United States alone had a 1% prevalence of bipolar type I.
In 2007, a study from Harvard Medical School revealed that 2.8% of U.S. adults had a bipolar disorder diagnosis.
People age 18 to 29 years old had the highest rates of bipolar disorder (4.7%) followed by those between 30 to 44 years old (3.5%). Meanwhile, people 60 and older had the lowest rates of bipolar disorder (0.7%).
Is there a treatment for bipolar disorder? The condition is left untreated in half of the people diagnosed with the health condition because there is no cure. While it is a life-long condition, it can be managed with smart treatment plans.
According to Ezell, there are optimal treatment plans for bipolar disorder which usually is a combination of medication (mood stabilizers and antipsychotics) and cognitive-behavioral therapy (counseling).
“The medication allows the client to experience a more stable mood and see things more clearly,” Ezell explained. “When they are able to have a more stable emotional experience they are more open to starting and sticking with therapy. The therapy helps them understand their thoughts and begin to differentiate between accurate thoughts as opposed to thoughts that are generated by their condition.”
Mood stabilizers and anti-depressants can help people with bipolar type 2 to be highly functional, according to Hindell. In fact, many people with a bipolar diagnosis have regular jobs. Several are parents, have been successful in their careers and are enjoying normal lives.
Hindell stressed the importance of the medication to control mood dysregulation. She added that psychotherapy is needed to gain insight into their patterns and moods. It will also be helpful for awareness when they become asymptomatic.
Can Ayahuasca Help People Diagnosed With Bipolar Disorder?
There is a consensus among experts and those in the psychedelic science community that those with bipolar disorder should avoid psychedelics, including ayahuasca, as they could aggravate their conditions.
Apparently, psychedelics are believed to be not safe for them. However, many have a hard time accepting this especially after learning the therapeutic potential of ayahuasca to almost any health condition.
Ayahuasca, a brew made from Banisteriopsis caapi and Psychotria Viridis, has been used for decades for spiritual and religious purposes in the Amazon. Many tribes and religious communities in Brazil, Peru, and North America, including Santo Daime, consider it a sacred beverage for healing.
Psychotria Viridis contains N,N-dimethyltryptamine (DMT), a psychedelic substance that occurs naturally in the plant. DMT is a powerful hallucinogenic chemical that is rapidly broken down by enzymes called monoamine oxidase MAO in the liver and gastrointestinal tract.
Meanwhile, Banisteriopsis caapi contains potent MAOIs (monoamine oxidase inhibitors) called β-carbolines — harmine and tetrahydroharmine — which also have psychoactive effects of their own.
DMT is orally inactive due to intestinal monoamine oxidase MAO-A metabolism. However, when it is combined with a peripheral MAO-A inhibitor (like harmine), its oral biodisponsibility increases and the interaction is the base of the ayahuasca psychotropic effect (McKenna 2004)(6)https://journalbipolardisorders.springeropen.com/articles/10.1186/s40345-014-0020-y#ref-CR11.
DMT and MAOIs (monoamine oxidase inhibitors) are the main components of ayahuasca and when the two are combined, it results in a powerful psychedelic brew that affects the nervous system and could alter one’s state of consciousness. Those who take ayahuasca usually experience hallucinations, euphoria, depression, out-of-body experiences and more. Thus, people with bipolar disorder are discouraged from taking it because they might switch to mania or experience manic episodes after an ayahuasca consumption.
Case 1: Argentina Man With Bipolar Disorder History
A 30-year-old Argentinian man(7)https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4338113/ who is single and unemployed was admitted to an emergency room after being discharged from a hospital in Brazil where he was admitted due to a psychotic episode after joining a 4-day ritual of ayahuasca consumption.
He was reportedly offered to take part in an ayahuasca ceremony and two days after the last consumption, he began having mystical and paranoid delusional ideas, auditory hallucinations, racing thoughts, disorganized behavior, elevated energy and euphoria. His psychotic symptoms were consistent with his euphoric mood.
He was taken to a psychiatric hospital where he received risperidone 2 mg/day and clonazepam 2 mg/day. After a month of treatment, he was asymptomatic and was discharged with the same medication as he traveled back to his home country.
According to his mother, he didn’t have any manic symptoms the day before the consumption or use of ayahuasca. In fact, his speech was coherent and he slept 8 hours a day.
The patient had developed asthma, enuresis and night terrors when he was enrolled in primary school at 6 years old. He was social and had no records of substance abuse disorder. He also graduated from high school and started a course in business management. He was actually doing well. But it was learned that his father suffered from bipolar disorder type I.
Also, two weeks before his trip to Brazil, he experienced a period of increased energy and goal-oriented directed activity, sleep disorder, pressured speech, increased self-esteem and running thoughts for 10 days which are compatible with a hypomanic episode. He admitted that he had experienced this kind of episode several times in the past, but he had no previous history of manic or depressive episodes.
After an actual mental state examination, his amount and speed of speech diminished. He was depressed and presented ideas of hopelessness, anhedonia, apathy and clinophilia. However, his sleep and appetite were normal and he had no delusions or hallucinations. His depressive episodes started after the remission of the psychotic episode.
According to the study, considering the patient’s previous history of hypomanic episodes and first-degree family history of bipolar disorder, he developed a manic episode with psychotic features after joining an ayahuasca consumption ritual.
Substance-induced mental disorder is diagnosed according to DSM 5 when the characteristic symptoms of the disorder appear during or up to 1 month after the consumption of a substance. The study also learned that the clinical features of the ayahuasca-induced psychotic disorder have these symptoms — perception disturbances, elevated body temperature, cardiovascular events, psychomotor agitation, ataxia, tremors and vomiting.
The study noted that the patient’s history (pre-existing hypomanic episodes and family history of bipolar disorder and the absence of associated neurovegetative symptoms do not support a diagnosis of either psychotic or bipolar disorder induced by ayahuasca nor ayahuasca intoxication. Also, Robert S. Gable and his colleagues made a revision noting that substance-induced mental disorder from ayahuasca consumption is rare, only under 1%, and usually resolves spontaneously in a few hours.
However, the data postulating the antidepressant action of one component of ayahuasca, harmine, began to appear. The component may have inhibitory actions or serotonin reuptake and agonism of the serotonin 1A receptor which also acts as a reversible MAO-A inhibitor enzyme.
The study concluded that the patient instead had an antidepressant-induced mania due to his excessive and prolonged use of substances with antidepressant properties and his bipolar disorder. There are studies suggesting a 4.58% to 15% risk of switching to mania among bipolar patients treated with MAO inhibitors.
Case 2: União do Vegetal (UDV) Members
Rafael G. dos Santos and his colleagues documented how ayahuasca has been used traditionally for ritual and therapeutic purposes in Northwestern Amazon. The hallucinogenic drink has also been used in religious ceremonies like in Santo Daime and União do Vegetal (UDV). A study(8)https://journals.sagepub.com/doi/pdf/10.1177/2045125316689030 by Lima and colleagues checked the incidence of psychiatric occurrences from data collected in the institutional study of UDV, a Brazilian syncretic religion that regularly uses ayahuasca in a ritual setting twice monthly or several times per week.
Lima and his colleagues reported seven cases of psychotic disorders in the UDV context — two of them did not present any relations with ayahuasca, in three cases ayahuasca increased symptoms of previous psychotic episodes and only one case presented immediate temporal relation with ayahuasca without psychotic antecedents.
According to the researchers, the incidence of psychotic disorders is similar to that of the general population although they did not inform the sample size of the study nor how they calculated the incidence.
F.A.S. Lima and Luis Fernando Tofoli stated that there were 151 cases of psychiatric occurrences among UDV members between 1994 to 2007 and 29 of which were psychotic disorders — 9 were schizophrenia, 4 were acute and transient psychotic disorders, 2 were unspecified nonorganic, 4 were severe depressive episode with psychotic symptoms, 6 were substance-induced psychosis, and 4 were bipolar affective disorder with a psychotic manic episode.
The detailed evaluation showed that in 19 of the 29 cases, ayahuasca seemed to be the main contributing factor. In the other 10 cases, there was no immediate temporal relation between ayahuasca intake and psychotic episodes suggesting that ayahuasca might not have significantly contributed to the development of the case.
Among the cases related to ayahuasca intake, four cases had an immediate temporal relation between ayahuasca consumption and psychotic episode and the subjects had no psychiatric history; five cases had an immediate temporal relation between ayahuasca intake and the psychotic episode but subjects had a psychiatric history with or without active symptomatology.
In 10 cases, there was no immediate temporal relation between ayahuasca consumption and the psychotic episode but ayahuasca may have contributed to other factors for the development of the case. According to the authors, even in the cases where ayahuasca may have produced a psychotic episode on subjects without a psychiatric history, the detailed examination of the cases suggested the presence of traces of premorbid personality factors that could also influence the occurrence of a psychotic episode.
Meanwhile, Robert Gable reports on the effects of ayahuasca among the UDV members between 2000 to 2005 and said the UDV documented between 13 and 24 cases where ayahuasca might have been a contributing factor in a psychotic incident.
On the other hand, the documents from the Supreme Court of the United States claim that ayahuasca has caused 24 psychotic incidents in Brazil but only 8-13 psychotic incidents were documented. The incidents occurred from an estimated total of 25,000 servings of ayahuasca. However, the document from the Supreme Court of the United States informed the total of 250,000 servings.
Case 3: Brazilian Man Who Takes Ayahuasca With Cannabis And Experience Manic Episode
Another case in SagePub journals(9)https://journals.sagepub.com/doi/pdf/10.1177/2045125316689030 involved a 21-year-old Brazilian man who experienced two consecutive psychotic episodes after participating in ayahuasca rituals. The episodes happened a year apart and occurred during the rituals and endured several days and weeks afterward.
The subject had used other hallucinogens (LCD and psilocybin) on several occasions but did not report any adverse effects associated with these experiences. Before his first psychotic episode, the subject had already used ayahuasca more or less twice per month for about two years without incident.
Sometimes he used cannabis concurrently without incident. However, during a particular ayahuasca ritual, the subject consumed ayahuasca and combined it with cannabis and sometimes later he experienced very intense paranoid and suicidal ideas.
The psychotic and paranoid symptoms persisted for 2-3 weeks and were only resolved after a year of antipsychotic treatment. The subject didn’t use ayahuasca, cannabis, or drugs and had remained symptom-free during the treatment.
After the treatment, the subject wished to continue his participation in ayahuasca rituals. He participated in the ayahuasca ritual in three separate ceremonies without mixing it with cannabis anymore. There were no adverse reactions in the first two rituals, but during the third one, he experienced paranoia and suicidal ideation again.
The symptoms persisted for 2-3 weeks and were resolved after another year of risperidone treatment. The subject’s history of using hallucinogens and cannabis and lack of history of psychotic disorder makes it difficult to establish the exact role of ayahuasca in such a case. In the second one, although it happened a year later and there was no concomitant use of cannabis, the subject might have developed a sensibility or predisposition to psychotic experiences after the first episode.
They made a follow-up on the subject until 2016 and learned that he had continued to use cannabis daily and occasionally used other hallucinogenic (LSD, psilocybin, ketamine, 5-dimethoxy-4-iodophenethylamine) and non-hallucinogenic drugs (MDMA, y-hydroxybutyric acid (GHB), alcohol, tobacco, amphetamines, cocaine and heroin). However, he did not use ayahuasca anymore.
The subject experimented with MDMA on four occasions separated by 3-4 months after his second treatment. However, he experienced another round of paranoid/psychotic episodes on the fourth occasion. He underwent another successful risperidone treatment.
He experienced another psychotic episode months after the treatment associated with excessive alcohol intake. It was successfully treated with risperidone and after that, the subject did not use any hallucinogen anymore. He continued to use cannabis daily even during antipsychotic treatments and there was no increase in psychotic symptoms.
It’s true that ayahuasca may aggravate one’s bipolar disorder, so those with bipolar disorder history should be careful. Some also switch to mania even if to their knowledge they have no history of bipolar disorder. In general, people with bipolar disorder are advised that it’s best to keep themselves away from ayahuasca.
People With Bipolar Disorder Have A Future With Ayahuasca Consumption?
If you check with the professionals and experts, most, if not all, will advise people with bipolar disorder against taking ayahuasca due to the risk of manic, depression, or mood swings getting worse. However, Benjamin Mudge(10)https://icpr2020.net/poster-presenters/benjamin-mudge/, a Ph.D. candidate and Director of the Bipolar Disorder CIC has a different take on the matter.
Mudge was also diagnosed with bipolar disorder, but he was convinced about the therapeutic potential of ayahuasca to people with bipolar disorder. According to him, the DMT from P Viridis and inhibitor and serotonin reuptake inhibitor in banisteriopsis caapi that made up the hallucinogenic brew worked and has stabilized his mental disorder.
Mudge first consumed ayahuasca over a decade ago. Prior to that, his life was marred by episodes of mania with long bouts of depression. There were also moments when he was suicidal.
During Mudge’s speech at the 2019 World Ayahuasca Conference(11)https://www.youtube.com/watch?v=d-gMAK9ZnRs, he addressed the controversial topic about ayahuasca’s role for people with bipolar disorder. In his speech, he pointed out that the statistical correlation of bipolar to creativity and suicide. He admitted that finding a treatment for bipolar disorder is not easy, but ayahuasca has potential.
“The difficulties of treating bipolar disorder is that the currently available [medication] from a suitable antidepressant like Prozac, they either do not work at all or if they do anything, they overstimulate the bipolar brain and escalate bipolar people into a manic episode,” he said. “So, it’s very difficult to treat from a chemical basis and while there are some currently available pharmaceutical drugs like lithium, those notoriously ruin the things most important for bipolar personalities.”
He noted that some bipolar people respond well to those medications and that’s fine. However, he is interested in helping people with bipolar disorder who do not want to take the pharmaceutical pills because the effects of this substance could ruin things like their emotional sensitivity, libido creativity and spiritual awareness that’s why he pushed to study ayahuasca for people with bipolar disorder.
Prof. Draulio Barros de Araujo and his colleagues did clinical trials with ayahuasca and the results strongly suggested that ayahuasca is an effective antidepressant. The next question Mudge wants to answer is — could ayahuasca be an antidepressant that works for bipolar people without over stimulating them into a manic episode?
Again, the experts’ answer will be an automatic “No.” This is the reason people with bipolar disorder are discouraged from joining an ayahuasca ceremony. If they are honest enough in the form, they will be excluded from the ayahuasca consumption ritual to prevent them from experiencing a potential manic episode.
Several ayahuasca retreat centers used to welcome people with bipolar disorder, but witnessed how the ceremony triggered them to experience manic episodes so, they have to stop it and exclude them. However, Mudge said that it’s somewhat dogmatic and not based on any scientific research.
“Bipolar people are not only excluded from using what I consider to be the best antidepressant in the world but also excluded from even any research in the entire field of psychedelic science,” Mudge said.
He believed that it was due to the 5-HT2, a receptor which is the sockets in the brain where the classic hallucinogens plug. LS and mescaline cause mania in bipolar people and Mudge agreed with that because that’s well-documented. Psilocybin, to a lesser extent, also can cause mania and bipolar people serotonin if you have too much.
For example, if you’re taking Prozac you can go manic. So the extrapolation is that DMT will also cause one to switch to mania because it is plugged into the same socket. However, Mudge said the assumption is “wrong.”
“I have bipolar disorder. I’ve had quite severe and treatment-resistant case. I’m also a creative personality. These are self-portraits of how I used to feel before I discovered ayahuasca,” he said while pointing to the distorted images shown on screen.
He was prescribed 17 different medications, which according to Mudge, didn’t help at all but only worsened his condition. In fact, for him, it wasn’t worth it because the side effects outweighed the benefits. The prescribed medications did not heal him, instead, they robbed him of his creativity, sensitivity and spiritual awareness. However, he had a different experience after his first ayahuasca consumption.
“Thirteen years ago, I discovered ayahuasca and I’ve been able to live without any need of pharmaceuticals ever since. Generally speaking, whether I’m in an indigenous ceremony or Santo Daime ceremony, I experienced what I call ‘humble happiness’ which is an antidepressant benefit without [the] inflated ego, without a manic episode,” he said.
“I’ve been healing profoundly on this journey. I wouldn’t say it’s been 100% successful [but] there have been some very difficult situations and I’ve been investigating those. I discussed this with the psychiatry department and they gave me the scholarship to research whether this could help other bipolar people.”
Mudge found over 62 other bipolar people who have drunk ayahuasca and 38 of them have a positive experience with it, 14 negative and the other 10 are variable.
By positive experience, they notice improved manic-depressive symptoms and psychotherapeutic benefits. Those who have negative experiences noticed that their manic-depressive symptoms have worsened. And those with variable experience noticed positive experiences sometimes with negative experiences in a different context or with a different brew.
Mudge argued with the result and believed that there are false negatives pointing out that something might have gone wrong at the ceremony and it’s not ayahuasca’s fault. He also pointed out that ayahuasca is not always the same. For instance, first, there are fermented ayahuasca brews that contain alcohol. People with bipolar disorder who drink fermented ayahuasca will likely encounter a problem.
Second, ayahuasca is not consistent either. There is a massive variation in its four ingredients —DMT, harmine harmaline and tetrahydroharmine. Harmaline, one of the main components of ayahuasca is a selective and reversible MAO. The quality of ayahuasca may depend on how it is cooked and the ratio of the four ingredients is highly variable.
Also, the plant materials used to make ayahuasca are variable too. You can use different plants, subspecies of different species which are chemically different and may deliver different results when used. This is an issue because the DMT and harmala alkaloids will have different effects on the different neurotransmitter systems in the brain so harmine and harmaline may push and amplify noradrenaline, dopamine and serotonin in the brain whereas tetrahydroharmine is only serotonergic.
So, if you have tetrahydroharmine, you’re basically up the noradrenaline system too much which is a real problem for bipolar people.
Moreover, when you cook the brew for a long time, the tetrahydroharmine oxidizes and becomes harmine, so the ratio between the serotonin content and noradrenaline content changes the longer you cook it.
Meanwhile, DMT is almost identical to serotonin, arguably an endogenous substance. There is anecdotal evidence from 10 bipolar people who have experienced DMT on its own that without MAOIs, it certainly doesn’t cause manic episodes. If anything, it only got an antidepressant effect and basically a calming down effect with Mudge considering it a mood stabilizer.
Mudge aims to develop an ideal cooking technique for making particular medical ayahuasca customized for bipolar people with a specific ideal ratio of harmine, harmaline, tetrahydroharmine, and DMT.
He is hoping o use the ideal medical ayahuasca customize and collaborate between psychiatry and the spiritual traditions of ayahuasca and have a sacred ayahuasca healing ceremony protocol that can be tested in a clinical trial and hopefully help other people with bipolar disorder
In general, experts would suggest people with bipolar disorder to distance themselves from ayahuasca because the psychedelic brew might only aggravate their condition. There are several stories about people switching to mania after taking the hallucinogenic brew from the Amazon.
However, Benjamin Mudge, who was diagnosed with bipolar disorder, had a different experience after taking ayahuasca. According to him, the brew stabilized his mood and he has been doing well and has not used pharmaceutical medication to deal with his mental condition.
Mudge is focusing his energy on developing an ideal cooking technique to produce medical ayahuasca for people with bipolar disorder. He hopes to collaborate with the department of psychiatry and incorporate it into the sacred ayahuasca healing ceremony protocol and have it tested in a clinical trial. It might still take years but Mudge is positive that ayahuasca has the potential in helping bipolar people especially because it is the “best antidepressant in the world.” Order ayahuasca kit here
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