Ayahuasca and Psychosis: 7 Human Studies and Everything You Need To Know About Ayahuasca-Induced Psychosis

Ayahuasca and psychosis are often associated with each other because the former could induce the latter. Individuals with psychosis experience hallucinations, delusions and confusion and disturbance of thoughts.

Due to this, people with mental health disorders are discouraged from taking this medicinal plant.

In this blog post, we will explore how closely related ayahuasca consumption is to reports about psychiatric symptoms in experimental and ritual settings.

We will also find out if ayahuasca users experienced psychiatric disorders and if the psychotic episodes induced by ayahuasca and DMT are rare or not.

Contents

How Ayahuasca Affects Mental Health

Due to the lack of effective treatment for psychological, neurological or psychiatric disorders, many have been attracted to trying alternative medical practices like the ritualistic use of ayahuasca.

Many turn to ayahuasca to solve various mental disorders like anxiety, post-traumatic stress disorder (PTSD) and addiction. Others consume ayahuasca to address depressive symptoms.

Why ayahuasca? Because ayahuasca is a psychoactive tea and its effects are similar to taking psychoactive drugs. People take psychoactive drugs for different reasons — fun, excitement, to feel better or counter negative feelings, or to sleep.

Psychoactive drugs alter your brain functions which affect your perceptions, moods, and consciousness. The effects of ayahuasca are similar to that but it came naturally — from plants.

However, there is a mixed opinion about ayahuasca consumption due to potential risks. because those with a personal or family psychiatric history are discouraged from taking it as it could worsen psychosis. But many still want to try ayahuasca to solve psychiatric symptoms despite the lack of experimental and clinical studies.

There are several human studies and clinical investigations examining the effects of ayahuasca on one’s mental health and here are some of them.

Systematic Review 1: Mental Health Of Naive Vs. Long-Term Ayahuasca Users

A 2020 study(1)https://www.nature.com/articles/s41598-020-61169-x published in Scientific Reports weighed in on the effects of ayahuasca consumption on mental health and the quality of life of naive users. It used two sub-studies to investigate the matter.

In the first sub-study, a psychiatric interview and a battery of questionnaires were administered to 40 naive users before their ayahuasca use. Two follow-ups were conducted after one and six months.

In the second sub-study, the same interview and battery questionnaires were given to 23 long-term ayahuasca users.

The results of the clinical trials from the two groups were compared. In the first assessment, nearly half of the naive users meet the diagnostic criteria for a psychiatric disorder.

After the ayahuasca use, more than 80% of the subjects showed clinical improvements that persisted for six months. The questionnaires showed significant reductions in depression and psychopathology.

In the second sub-study, long-term ayahuasca users showed lower depression scores and higher scores for self-transcendence and quality of life compared to the other group.

Systematic Review 2: Rapid Antidepressant Effects Of Ayahuasca In Treatment-Resistant Depression

In 2019, another study examined the rapid antidepressant effects of the psychedelic ayahuasca in treatment-resistant depression. The researchers looked into it after learning from an open-label trial that psychedelics like ayahuasca are promising as fast-onset antidepressants in treatment-resistant depression.

To test the rapid antidepressant effects of ayahuasca, the researchers conducted a parallel-arm, double-blind randomized placebo-controlled trial in 29 patients with treatment-resistant depression. The patients received a single dose of either ayahuasca or placebo and their depression severity was later assessed if there were changes using the Montgomery-Åsberg Depression Rating Scale (MADRS) and the Hamilton Depression Rating Scale at baseline on the first, second and seventh day of dosing.

The results showed significant antidepressant effects of ayahuasca compared with placebo. The MADRS scores of the ayahuasca group were significantly lower compared to the placebo group. The response rate for both groups was high during the first and second days, but significantly higher for the ayahuasca group on the seventh day.

The study was the first controlled clinical trial to test a psychedelic substance in treatment-resistant depression and it brings new evidence supporting the safety and therapeutic value of ayahuasca when dosed within an appropriate setting, to help treat depression.

Systematic Review 3: Acute Effects Of Ayahuasca On Neuropsychological Performance

A systematic review by José Carlos Bouso(2)https://pubmed.ncbi.nlm.nih.gov/?term=Bouso+JC&cauthor_id=23793226 and colleagues investigated the effects of acute ayahuasca intake on neuropsychological performance, specifically on working memory and executive function.

The study involved 24 ayahuasca users — 11 were long-term experienced users and 13 were occasional users. They were assessed in their habitual settings using the Stroop, Sternberg, and Tower of London tasks prior to and following ayahuasca intake.

The study concluded that acute ayahuasca administration could impair working memory but decrease stimulus-response interference. Interestingly, the detrimental effects on higher cognition were only observed in the occasional ayahuasca users. The long-term ayahuasca users did not experience an increased impairment but reported reduced incapacitation.

Compensatory or neuromodulatory effects associated with long-term ayahuasca intake could underlie preserved executive function in experienced users.

Although the effects of ayahuasca on mental health are promising, considering the positive reviews about it from ayahuasca users who claim that it helped improve their mental condition, it is still worth checking if it will work the same for you.

There are also a number of human studies and clinical trials about adverse reactions from ayahuasca consumption linking ayahuasca use to worsening psychotic disorders, psychiatric symptoms and manic symptoms. However, in most cases, it involves several factors and not just ayahuasca.


Psychosis Symptoms and Causes

Psychosis is a mental health problem that temporarily alters one’s interpretation of the world differently from those around them through delusions or hallucinations. It can also be a combination of symptoms due to an impaired relationship with reality or a symptom of serious mental health disorders.

Psychosis is a symptom of certain mental disorders and not a diagnosis, itself. However, someone who experiences it and leaves it untreated is at a greater risk of developing a psychotic illness like schizophrenia or other psychotic disorders.

Symptoms of Psychosis

Here are some symptoms of psychosis, according to National Institute for Mental Health (NIMH)(3)https://www.nimh.nih.gov/health/publications/understanding-psychosis. I have categorized it per WebMD(4)https://www.webmd.com/schizophrenia/guide/what-is-psychosis.

Warning Signs Before Psychosis

• a sudden change in performance or school work
• trouble thinking clearly
• difficulty concentrating
• feeling paranoid or suspicious of others
• withdrawing from friends and loved ones
• an influx of strange, new feelings, or no feeling at all
• disinterest in personal grooming
• difficulty separating reality from non-reality
• trouble communicating
• shows stronger emotions than situations call for
• show no emotions at all

Signs Of Early Psychosis

• Hear, see or taste things others don’t
• Hang on to unusual beliefs or thoughts, no matter what others say
• Pull away from family and friends
• Stop taking care of oneself
• Cannot think clearly or pay attention

Symptoms Of Psychotic Episodes

When one is experiencing an episode of psychosis, they will likely experience the abovementioned and the following symptoms which are similar to anxiolytic effects.

• hallucinations
• delusions
• disorganized behavior (behavior that does not seem to make sense, or that is impulsive)
• negative symptoms (seemingly having no emotion, lack of interest in activities previously enjoyed, an ungroomed appearance, etc.)
• catatonia(5)https://www.healthline.com/health/depression/catatonic-depression (a “frozen” appearance)

A number of ayahuasca users reported that most, if not all, of the abovementioned, are also effects of ayahuasca because they experienced it after ayahuasca ingestion. People with bipolar disorder also experience the same symptoms.

What Triggers Psychosis?

The cause of psychosis can be different for everyone and it can be triggered by a number of things like genetics, trauma, injuries and illnesses, prescribed medication, alcohol, or recreational drugs. Yes, psychosis can be induced by drugs and may manifest as a side-effect when taking certain medications or overdosing on them.

Drug-induced psychosis happens when one experiences episodes of psychosis such as delusions or hallucinations as a direct result of a substance. It can occur when one either takes too much of a certain drug that it provokes paranoia and psychotic episode or one has an adverse reaction from mixing different substances, withdrawing from a drug, prescribed or otherwise.

What Drugs Bring On Psychosis?

Methamphetamine, amphetamine, scopolamine, ketamine, phencyclidine (PCP), MDMA (ecstasy or molly) and psychedelic drugs such as lysergic acid diethylamide (LSD), NBOMes, psilocybin (magic mushrooms), DMT and ayahuasca can trigger psychosis.


Can Ayahuasca Consumption Induce Psychosis?

Ayahuasca is a natural hallucinogen traditionally used by several indigenous groups from the Northwestern Amazon for ritual and therapeutic purposes. Ayahuasca tea is a combination of Banisteriopsis caapi that contains monoamine oxidase A (MAO-A) inhibitors and Psychotria viridis that is rich in dimethyltryptamine (DMT).

DMT is a hallucinogenic tryptamine drug and produces similar effects to psychedelics like LSD (lysergic acid diethylamide) and magic mushrooms. DMT is the main active ingredient in ayahuasca that may induce psychosis.

Ayahausca has many psychopharmacological that’s why it is used to treat different diseases. However, one of its side effects is ayahuasca-induced psychosis. So, yes — ayahuasca can induce psychosis.

Also, as I mentioned earlier, ayahuasca is similar to psychoactive drugs. So, after ayahuasca ingestion, your neuropsychological functioning may change. You will experience the effects of ayahuasca which may include prolonged psychotic reactions.

Symptoms Of Ayahuasca-Induced Psychosis

In this section, we will concentrate on the psychotic depression or psychotic episode one experiences in both the controlled use and ritual ayahuasca intake.

The ritual ayahuasca users or those who first used the psychedelic ayahuasca for healing benefits or religious ceremonies did not experience adverse reactions except for manic symptoms that did not last long or anxiolytic effects that were not serious. The effects of ayahuasca consumption on them were mostly positive.

Given the current popularity of ayahuasca — from the boom of ayahuasca tourism in Peru to having ayahuasca retreat centers in developed cities, it is very important to understand the effects of ayahuasca consumption. One should be aware of the potential risks.

Again, one of the side-effects of psychedelic ayahuasca intake is ayahuasca intoxication which may lead to prolonged psychotic episodes enduring for hours or days. Some were given antipsychotic medication after developing psychiatric symptoms following an ayahuasca intake.

These are symptoms of ayahuasca-induced psychosis, that those who attended ayahuasca retreats or ceremonies reported. Usually, the initial effects begin around half an hour after ayahuasca intake.

• Anxiety
• Reveries
• Paranoia
• Delusions
• Confusion
• Panic Attacks
• Colored imageries
• Dissociative states
• Visual hallucinations
• Auditory hallucinations
• Altered thought processes
• Intensification of emotions


How Ayahuasca Induce Psychosis

Ayahuasca works like psychoactive drugs and induces psychosis because of its main ingredient and because it targets the nervous central system.

DMT – Main Ingredient of Ayahuasca

Ayahuasca’s main ingredient, DMT, affects the human consciousness. It significantly alters the brain’s electrical activity with some researchers likening its powerful effects to “dreaming while awake.” DMT is what makes one hallucinates after taking an ayahuasca brew and it’s what makes ayahuasca similar to psychoactive drugs.

In a 2019 study(6)https://www.sciencedaily.com/releases/2019/11/191119075305.htm, researchers from Centre for Psychedelic Research at Imperial College London observed 13 healthy participants who were given an intravenous infusion of DMT at the National Institute for Health Research (NIHR) Imperial Clinical Research

Facility in controlled settings. The volunteers were fitted with caps with electrodes to measure their brain’s electrical activity.

The researchers noticed that DMT altered the brain’s electrical activity significantly. There was a drop off in alpha waves, which is the dominant electrical rhythm when one is awake. There was a short-lived increase in theta waves, the brainwaves associated with dreaming.

The brain’s activity tends to be more chaotic and less predictable. Lead author Christopher Timmermann, from the Centre for Psychedelic Research, noticed an emergent rhythm when the participant is at the most intense part of the experience.

He described the overall experience after ayahuasca consumption as “like daydreaming only far more vivid and immersive, it’s like dreaming but with your eyes open” or a “near-death experience.”

Interacts With Glutamate And Dopamine

What part of the brain does ayahuasca affect? The answer to this question is key to understanding why ayahuasca could induce psychosis.

Ayahuasca does not just alter brain activities, it targets the neurotransmitters that regulate our sleep, memory and emotional well-being. For that reason, the effects of ayahuasca include psychiatric symptoms. Ayahuasca-induced psychosis is due to the interaction between the serotonin and dopamine system.

Again, ayahuasca is a combination of Banisteriopsis caapi vine and leaves of Psychotria viridis. B.caapi contains several alkaloids that act as monoamine oxidates inhibitors (MAOI) to make the DMT from the P. Viridis orally active so that it can act on the central nervous system (CNS).

Ayahuasca produces bioelectrical, neurochemical and metabolic changes in the CNS. Its main target is the serotonergic system and it also interacts with Dopamine, Glutamate, and Noradrenalin receptors.

There are two brain chemicals involved in the development of psychotic disorders — glutamate and dopamine.

Abnormal levels of neurotransmitter glutamate lead to changes in the levels of another neurotransmitter — dopamine — causing the transition into psychosis. The abnormal glutamate-dopamine interaction is what leads one to experience psychosis, according to a 2013 study(7)https://www.livescience.com/35009-brain-chemicals-cooperate-to-cause-psychosis-study-suggests.html.


7 Systematic Review of Humans Studies About Ayahuasca and Psychosis

As mentioned, ayahuasca could induce psychosis. However, this rarely happens and when it does, other factors are usually at play and DMT (ayahuasca’s main ingredient) only exacerbates the condition.

Here are some systematic review of human studies and clinical trials when people take ayahuasca or DMT and psychotic events occurred after. Some cases are in controlled contexts others are not. The various reports describe subjects in different settings — both the ritual and unsupervised ingestion, with different psychiatric histories, and exposure to psychoactive drugs or hallucinogens while taking ayahuasca.

Case 1: Taking Ayahuasca In Controlled Settings Vs. Doing It At Home Alone

A case study(8)http://www.scielo.org.co/scielo.php?script=sci_arttext&pid=S0034-74502021000100043 reported about a 41-year-old male who consumed ayahuasca in a controlled therapeutic setting to treat cocaine addiction when he was 25 years. Between ages 27 and 30, he had continuously used ayahuasca at home in rituals organized by himself in an attempt to address chronic depressive symptoms.

During his solo sessions at home, the effects of ayahuasca include psychotic phenomena, and behavioral changes like auditory hallucinations, high anxiety, a sensation of losing the limits or control of his body, and fragmentation of body parts. However, the psychotic-like symptoms didn’t last and usually disappeared after each ayahuasca use. He experienced similar symptoms when he was intoxicated with cocaine in the past.

The patient quit ayahuasca when he turned 30 until the month preceding his current episode. He started to use ayahuasca again once a week for a month at home without supervision in an attempt to address his emotional distress due to a relationship.

However, he experiences restlessness, unspecified fears, delusions, severe mood fluctuations (from loneliness, uncontrolled crying to irritability), sensory-perceptive distortions, and somaesthetic and auditory hallucinations. Ten days later, he was admitted into the emergency room.

His blood panel, EKG or CT scan were all fine. He also tested negative for cannabis, cocaine, opiates, methadone, methamphetamine and alcohol. But after a Mental State Examination, he was admitted into a psychiatric inpatient unit.

While in the hospital, the medical staff noticed severe anxiety, social isolation, hyper-familiarity, and frequent oscillations. There were also subjective “peaceful” episodes. The patient’s discourse was mainly about spiritual healing through ayahuasca use and mystical thinking. He also talked about astral projections and personal regeneration as a consequence of ayahuasca consumption.

Antipsychotic medication was prescribed to treat his symptoms, with increasing dosage of olanzapine PO up to 30 mg daily. He experienced fewer Sensory-perceptive distortions and delusional thoughts. However, they eventually substitute Olanzapine with Paliperidone at 9 mg daily.

Upon remission of his psychotic symptoms, he was discharged with follow-up care in a SUD outpatient unit. He was also prescribed antipsychotic medication, palmitate Paliperidone 100 mg/monthly and quetiapine 200 mg/night after he was discharged.

Case 2: Combining DMT and Cannabis

A 19-year-old North American male experienced dramatic psychotic symptoms after consuming DMT and cannabis. He had no personal or family history of psychotic symptoms but had been using cannabis for three years and “rarely and irregularly” in the last 1.5 years

His mom thought his psychotic episodes were due to his happiness returning home after living with his dad for 3 months. The subject experienced episodes of psychotic mania characterized by continuous swearing, delusional ideas (thinking he was a king), increased speech, excessive money spending, inappropriate dressing and behavior (dancing in public streets or being too friendly to people he doesn’t know before).

The family didn’t seek any treatment. It was later learned that a friend offered the subject a DMT/cannabis solution and after taking the combination, he experienced intense psychotic symptoms such as feeling like being directed by an unknown force, seeing musical sounds in the sky, communicating with extraterrestrial creatures and believing that he could read one’s mind.

The dramatic symptoms got his mom worried, so she seek help. Cannabis metabolites were detected in his urine 20 days after DMT consumption.
He received an unspecified prescription from a private hospital but did not use it. He was brought to another hospital three days later and received a 12-day inpatient antipsychotic medication.

After being discharged, he continued to take his medications (risperidone) regularly and was followed for approximately 2.5 months, and the psychotic symptoms gradually remitted.

The authors concluded that DMT exacerbated the psychotic symptoms of a previous cannabis-induced psychotic mania.

Case 3: DMT Use With Personal Or Family History Of Psychotic Disorder And Other Drugs

Warren and colleagues reported a case of a 24-year-old man from rural South Australia. He was admitted to the hospital after experiencing a psychotic episode associated with continuous use of a smokable powder made of DMT-containing plants.

A friend introduced him to DMT and encouraged him to check it out. So, the subject collected the leaves, bark and seeds from two DMT-rich plants, dried and ground them to produce a DMT powder. He added the powder to a pipe where he regularly used tobacco and cannabis.

The subject developed a “complex delusional spiritual belief system and was pursuing enlightenment.” The pattern of increased use and delusional thinking led the subject to hospital admission since he was already presenting positive symptoms of schizophrenia.

Interestingly, the man had a family history of psychotic disorder, which he did not specify. In addition, prior to taking DMT, he had prior experience with tobacco, cannabis, and methamphetamines.

Since many factors were at play, it was difficult to assess the possible role of DMT in the subject’s psychiatric disorders.

Case 4: Man Who Experienced 2 Psychotic Episodes After Joining Ayahuasca Rituals On 2 Separate Occasions

Dos Santos and Strassman reported a case about a 21-year-old Brazilian man who experienced two consecutive psychotic episodes after participating in ayahuasca rituals and both episodes happened during the ceremony. It endured for several days or weeks that followed.

The subject had no personal or family history of psychosis. However, he had use other hallucinogens like LSD (lysergic acid diethylamide) and psilocybin on several occasions and did not experience any adverse effects.

The man is also a cannabis user for six years before his first psychotic episode with no significant adverse effects associated with the use of cannabis. And before his first psychotic episode, he admitted that he had already used ayahuasca “more or less twice per month, for about 2 years” without incident.

During one particular ayahuasca ritual, he consumed ayahuasca and combined it with cannabis. When the effects of ayahuasca kicked in, he experienced very intense paranoia and had suicidal thoughts. He even cut himself with a sharp-edged item during the ceremony.

The psychotic and paranoid symptoms lasted for two to three weeks and only subsided after a year of taking antipsychotic medication (risperidone). During that year, he quit ayahuasca, cannabis or other drugs and remained symptom-free.

However, a year after the treatment, the subject wished to resume participating in ayahuasca rituals. He consumed ayahuasca in three separate ceremonies without cannabis anymore.

There were no adverse reactions in the first two rituals. However, during his third ayahuasca ingestion, he experienced the same paranoid and suicidal thoughts. The symptoms lasted for 2-3 weeks again and it took another year of antipsychotic treatment.

The researchers had difficulty establishing the role of ayahuasca in the first episode of psychosis because of the subject’s history of previous use of other hallucinogens and concomitant use of cannabis.

The second psychotic episode, it happened a year later and there was no concomitant use of cannabis, so the researchers believed that the subject might have developed a sensibility or predisposition to psychotic experiences after his first episode.

They checked the subject again in 2016 after he completed the treatment for his second episode. At the time, the subject resumed the use of cannabis daily and occasionally used other hallucinogenic like LSD (lysergic acid diethylamide), psilocybin, ketamine, 2, 5-dimethoxy-4-iodophenethylamine (2C-I) and nonhallucenogenic drugs (MDMA, γ-hydroxybutyric acid (GHB), alcohol, tobacco, amphetamines, cocaine, heroin). However, he quit ayahuasca.

A year after the second treatment he also experimented with MDMA on four occasions separated by 3-4 months. He experienced another paranoid/psychotic episode the fourth time he did it. It took another year of successful risperidone treatment for him to completely recover.

He waited a few months after his third treatment and experimented with phenethylamine 2C-I. He experienced another paranoid episode and took a year of risperidone treatment again.

His last psychotic episode occurred just months after his last treatment and it was associated with excessive alcohol intake. He went through another year of risperidone treatment to recover.

After the last treatment, the subject quit taking any psychoactive drugs or hallucinogens and did not have another psychotic symptom afterward. But he continued the use of cannabis daily until 2016, including during all his antipsychotic treatments without an increase in psychotic symptoms.

Case 5: Man With A Family History Of Bipolar Disorder And Experienced Psychotic Symptoms Before Ayahuasca Use

​​Szmulewicz and colleagues reported a case of a 30-year-old Argentinian man who reported a manic episode after joining a 4-day ayahuasca retreat. The man traveled to Brazil for 3 months to learn about the South American tribes.

Two weeks before his trip, he experienced a 10-day period of hypomanic episodes — increased energy, self-esteem, and goal-directed activity, sleep disorder, pressured speech, and running thoughts. He had no previous diagnosis of manic or depressive episodes but stated that he kind of experienced the same feelings several times before.

The subject’s father was diagnosed with bipolar affective disorder type I. According to his mother, he did not have any manic symptoms before the ritual ayahuasca intake.

Two days after his last ayahuasca use, he experienced mystical and paranoid delusional ideas, auditory hallucinations, disorganized behavior and racing thoughts. The effects of ayahuasca on him also included elevated energy and euphoria.

He was admitted to a psychiatric hospital in Brazil and received antipsychotic/benzodiazepine treatment (risperidone and clonazepam) for a month. After that, he was symptom-free and was discharged with the same medication when he traveled back to Argentina to continue his treatment.

However, when he arrived in his home country, the subject experienced a depressive episode characterized by significant anhedonia, hopelessness, apathy, ideas of ruin, and clinophilia (when one spends more time in bed without necessarily sleeping).

According to the author, the condition was not a case of ayahuasca-induced psychosis or mania, but an “antidepressant-induced mania due to excessively prolonged use of a substance with antidepressant properties” in a man with a personal history of hypomania and a family history of bipolar disorder.

However, the authors stated that the substance with antidepressant properties was “harmine,” which is among the main ayahuasca components. Banisteriopsis caapi one of the basic ingredients of ayahuasca tea has three main alkaloids — harmine, tetrahydroharmine and harmaline.

Thus, it wasn’t clear why the authors suggested that ayahuasca had nothing to do with the symptoms when the “substance with antidepressant properties” they were talking about was present in hallucinogenic tea.

Case 6: Woman Experienced Psychoactive Symptoms After Taking Ayahuasca For The Second Time

Another case was that of a 40-year-old woman who suffered a psychotic episode after attending an ayahuasca retreat. She decided to try it for self-improvement purposes after a friend recommended how ayahuasca could help her face generalized anxiety disorder.

She had no personal or family history of mental disorders. However, she had history of occasional cannabis use in small quantities. She also experimented with MDMA in a house setting with her partner and recalled having a positive experience with it.

She consumed ayahuasca on two occasions — on Friday night and Saturday evening. She was in a normal state before her first ceremony and did not experience any adverse reactions.

She was also in a normal state when she took ayahuasca for the second time on Saturday. However, in her second session, the hallucinogenic effects of ayahuasca kicked in after 10 to 15 minutes. She recalled that before the psychoactive effects began, she developed paranoid ideas, delusional thoughts and aberrant behavior.

She started to manifest an incoherent discourse, according to her friend who also attended the same retreat. Her speech was related to personal events in her life and some aspects of her relatives and close friends, including possible traumatic experiences she didn’t remember until such a moment

The effects of ayahuasca persisted as she remained in that state for 24 hours and didn’t sleep Sunday night. She stayed awake, talking endlessly in constant and incoherent monologue. They also noticed evidence of suffering and uncontrolled movements.

A psychologist attending the ceremony suggested the guides to administer an antipsychotic medication (2 mg of risperidone). Just less than half an hour after taking risperidone, her symptoms disappeared.

She couldn’t recall what happened to her in the last session and had to ask the others. However, she slowly remembered the session after a few hours and fell asleep after being awake for almost 48 hours in a psychotic state

After sleeping for 7 hours, she woke up in a psychotic state which lasted for 2 days. She was eventually taken to a hospital where she received antipsychotic treatment (haloperidol). It ended her psychotic state.

She maintained the antipsychotic treatment for a few months and did not experience any psychotic symptoms anymore. The researchers were able to contact her a year later and according to her, the psychotic symptoms never came back.

Case 7: Man With Cannabis History, Experienced Psychotic Episodes After Smoking DMT

​​Patterson presented a case of a 42-year-old man from North America who suffered a psychotic episode after repeatedly smoking DMT. The subject had no personal psychiatric history but admitted to extensive history of multiple substance use disorders, including alcohol, tobacco, cannabis, 3, 4-methylenedioxymethamphetamine (MDMA, ecstasy), hydrocodone.

However, he had a family history of alcoholism, bipolar disorder, and obsessive-compulsive disorder. When he was 39, he successfully completed a drug-treatment program but resume

At 42, he began smoking DMT later saying that he did it not more than 10 times. Three weeks before he was hospitalized, he admitted that he had several stressors due to personal problems. He was unemployed, evicted from his apartment, his mom passed away.

He was brought to an emergency department by the police because he was presenting psychiatric disorders symptoms like being agitated, bizarre and disinhibited behavior. Other symptoms include time disorientation, disorganized thoughts and delusions (being navigated by stars).

Due to his agitation, he was given emergency medication (benzodiazepines) and was admitted to an inpatient psychiatry unit. For almost two weeks, he was hyperverbal and intrusive. He also presented paranoid and grandiose delusions believing that he could read minds, communicate with aliens and control distant events and people by adopting their specific body postures.

The subject performed the body postures for several days after his admission and was possible due to the transiently elevated creatinine kinase level which was observed upon his admission.

For 12 days, he received multiple drugs like quetiapine, olanzapine, risperidone for antipsychotics, divalproex sodium to control his impulsivity, gabapentin for anxiety, and hydroxyzine to improve his sleep pattern.

On the 14th day, he showed improved judgment. He was discharged on day 21 to a residential drug-treatment program with no psychotic symptoms.

Six months after he was discharged, he remained treatment compliant and started to reduce his antipsychotic treatment (quetiapine). He was drug and symptom-free.

The authors noted, however, that the subject said he was a long-term cannabis user and a recent cannabis use could have contributed to his psychotic episode. But his urine toxicology, performed 3 days after his admission, was negative for cannabinoids.

Since cannabinoids persist in the urine of chronic users for several days and the result was negative, the subject probably had a lower level of cannabis use or was not using cannabis weeks before the psychotic episode.

The authors concluded that the negative results of cannabinoids suggest DMT was the main drug associated with the patient’s psychotic symptoms.


What Are The Dangers Of Ayahuasca?

I mentioned several systematic review of human studies above to show how ayahuasca consumption is often associated with psychosis and psychotic episodes. While many say that it is generally safe it is still very important to be aware of the risks.

In most human studies and clinical investigations mentioned above, it’s not really ayahuasca or DMT that causes the subject’s psychosis, but it triggers or somewhat contributes something to lead the subject to the state of psychosis. Beyond that are several factors at play — psychiatric history, exposure to psychoactive drugs or hallucinogens, problems with alcohol or substance abuse, taking medications that may interact with DMT and more.

Ayahuasca users who experience psychosis have to seek medical treatment before the symptoms affect their relationship, work, or school performance. Also, leaving symptoms of psychosis untreated could develop into psychiatric disorders.

Who Is Most At Risk Of Psychosis After Ingesting Ayahuasca?

According to PsyPost(9)https://www.psypost.org/2017/04/risk-psychosis-ingesting-ayahuasca-dmt-48634, psychotic episodes associated with ayahuasca and DMT is a rare phenomenon. However, individuals diagnosed or with a family history of mental problems have an increased risk of suffering psychotic episodes.

Ayahuasca brew has been traditionally used in healing and religious ceremonies of indigenous Amazon tribes. It contains the psychedelic drug dimethyltryptamine (DMT) which can be smoked or drank to experience a powerful but relatively short-lasting trip.

However, eight scientific reports of psychotic episodes associated with the intake of ritual ayahuasca and recreational DMT showed that people with a personal or family history of psychosis and bipolar disorder are at higher risk of experiencing it.

Some of the cases, who experienced psychosis, involved mixing ayahuasca or DMT with other drugs like sedatives, amphetamines, opioids, and cocaine. Others combine ayahuasca/DMT with hallucinogens like LSD (lysergic acid diethylamide), mescaline, psilocybin, PCP, cannabis, ecstasy, ketamine, salvia

In two cases the psychosis was linked with an increase in the frequency of DMT intake.

“These data suggest that performance of a psychiatric and drug use history before ayahuasca or DMT administration in controlled settings may reduce the occurrence of psychotic experiences,” the authors of the study said.

“Regarding noncontrolled/recreational use, individuals with a personal or family history of schizophrenia or schizophreniform disorders, psychotic depression or mania, or with ongoing manic or psychotic symptomatology, should avoid ayahuasca/DMT intake.”

Is Ayahuasca Safe Even If It Can Induce Psychosis?

Since there are risks of psychosis during ayahuasca use, many are wondering if it is still worth trying the medicinal brew. Scientific literature suggests that ayahuasca administration to healthy volunteers has a good safety profile. Long-term ayahuasca consumption is also not associated with cognitive or psychiatric problems.

Moreover, the incidence of psychotic episodes associated with ayahuasca or DMT is a rare phenomenon. In fact, over 20,000 people worldwide are members of the Brazilian ayahuasca religions Santo Daime, UDV, and Barquinha who regularly consume ayahuasca as part of their religious ceremony.

Ayahuasca Contraindications

The rare incidence of psychotic episodes is associated with previous premorbid characteristics of the individuals who either suffered from drug abuse or take ayahuasca in an unsupervised setting.

One’s psychiatric and drug use history before ayahuasca administration should also be considered. Taking DMT or ayahuasca in controlled settings may also reduce the risks of psychosis.

Those who underwent therapy with ayahuasca to address depression and substance use disorder in controlled settings did not encounter serious problems. However, some developed abusive and uncontrolled use of ayahuasca when they started to self-medicate to address depressive symptoms which led to psychotic episodes.

Several authors suggest that ayahuasca is safe when taken in a supervised and controlled setting because there is a low incidence of ayahuasca-induced psychosis compared to the total number of ayahuasca users.

So for safety reasons, one with personal or family history of mental disorder should not take ayahuasca as it can worsen the psychotic episode. It is also not wise to mix ayahuasca or DMT with other hallucinogens like cannabis, LCD, mescaline, psilocybin and ketamine to name a few.

If you have alcohol use disorder or substance use disorder, it’s also not safe to take ayahuasca or DMT. Those who are taking certain medications like antidepressants should also avoid ayahuasca the interaction between the potent monoamine oxidase-inhibiting harmala alkaloids in ayahuasca and the selective serotonin reuptake inhibitor (SSRI) class of antidepressants may induce serotonin syndrome, which can be fatal.


Conclusion

Ayahuasca can induce psychosis but in most cases, it is only temporary and harmless. Regular ayahuasca users, especially those who use it traditionally experience no adverse reactions and only reported positive changes in their mental health.

Most cases of reported psychotic episodes after ayahuasca use are due to the person’s mental health condition and history of substance abuse.

A person with a family history of mental disorders like schizophrenia or bipolar should avoid this medicinal plant as it contains DMT, a natural hallucinogenic drug, that could exacerbate their condition. Individuals who have a history of substance use disorder or alcohol use abuse or were taking other hallucinogens, psychoactive drugs or medications that may adversely interact with DMT, should also avoid ayahuasca.

There is a low incidence of ayahuasca-induced psychosis that’s why many still recommend ayahuasca use. However, one should only consume ayahuasca in a controlled and supervised setting and one should avoid taking it alone at home as it might do more harm than good.

 

If you wish to learn more about ayahuasca, check our ayahuasca homepage.

 

Reference

  • nature.com/articles/s41598-020-61169-x
  • psypost.org/2017/04/risk-psychosis-ingesting-ayahuasca-dmt-48634
  • ncbi.nlm.nih.gov/pmc/articles/PMC5433617/
  • psypost.org/2017/04/risk-psychosis-ingesting-ayahuasca-dmt-48634
  • journalbipolardisorders.springeropen.com/articles/10.1186/s40345-014-0020-y
  • scielo.org.co/scielo.php?script=sci_arttext&pid=S0034-74502021000100043
  • livescience.com/35009-brain-chemicals-cooperate-to-cause-psychosis-study-suggests.html
  • sciencedaily.com/releases/2019/11/191119075305.htm
  • priorygroup.com/mental-health/drug-induced-psychosis

References

References
1 https://www.nature.com/articles/s41598-020-61169-x
2 https://pubmed.ncbi.nlm.nih.gov/?term=Bouso+JC&cauthor_id=23793226
3 https://www.nimh.nih.gov/health/publications/understanding-psychosis
4 https://www.webmd.com/schizophrenia/guide/what-is-psychosis
5 https://www.healthline.com/health/depression/catatonic-depression
6 https://www.sciencedaily.com/releases/2019/11/191119075305.htm
7 https://www.livescience.com/35009-brain-chemicals-cooperate-to-cause-psychosis-study-suggests.html
8 http://www.scielo.org.co/scielo.php?script=sci_arttext&pid=S0034-74502021000100043
9 https://www.psypost.org/2017/04/risk-psychosis-ingesting-ayahuasca-dmt-48634

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