Acute Psychological Adverse Reactions in First-Time Ritual Ayahuasca Users

Abstract

Background In recent decades, ritualistic use of ayahuasca has spread throughout the world. Retrospective studies have suggested a good psychological safety profile, but prospective studies involving ceremony ayahuasca-naive participants are lacking. Methods We conducted the study using a subsample from a previous study, for which first-time ceremony ayahuasca participants were recruited. The subsample consisted of 7 subjects who experienced acute and challenging psychological reactions. The semistructured Mini-International Neuropsychiatric Interview and psychometric questionnaires were administered before participants attended the ayahuasca ceremony and at 1 and 6 months after exposure. Subjective experiences were also recorded. Results Seven subjects from a sample of 40 reported having experienced intense challenging psychological effects during the ayahuasca ceremony. Four of those 7 subjects met the diagnostic criteria for 1 or more psychiatric disorder before the ayahuasca ceremony. One month after the ceremony, 2 of those subjects no longer showed psychiatric symptoms, whereas the symptoms of the other 2 were reduced considerably. Those results persisted at the 6-month follow-up. Inappropriate setting/context (poor guiding skills and screening) contributed to some of the challenging reactions. Most of the participants (6 of 7) did not take ayahuasca again during the study period. Conclusions Based on the cases reported here, we suggest that although it is possible that participating in ayahuasca ceremonies may entail acute psychological negative reactions, those challenging experiences can also have positive long-term effects. Prospective research on the safety profile of ayahuasca and how it is affected by the context of different practices and safety strategies is therefore necessary.

Adverse Effects After Ayahuasca Administration in the Clinical Setting

“…Despite not detailing how the cases were handled, the authors suggested that inappropriate setting/context (poor guiding skills and screening) contributed to some of the challenging reactions. Interestingly, despite their emergence, these experiences were also perceived as positive by the subjects 13 …”

“…No medical interventions or drug use was required, suggesting that even severe psychological effects can be handled with nondrug interventions. 11 In the specific case of ayahuasca, common adverse effects observed both in the experimental [4][5][6][7][8] and ritual [12][13][14] contexts include nausea, gastrointestinal discomfort, vomiting, diarrhea, headache, and transient increases in blood pressure and heart rate. A descriptive systematic review reported 3 case series and 2 case reports describing psychotic episodes associated with ayahuasca ingestion and 3 case reports describing psychotic episodes associated with smoking DMT.…”

“…Nevertheless, the participants from the studies reviewed had a personal and family history of psychotic disorders and/or concomitant use of other drugs. A recent report described seven cases of acute and challenging difficult psychological experiences after using ayahuasca in ritual settings 13 . The subsample was selected from a study that prospectively followed 40 subjects in the first ceremonial use of ayahuasca to assess safety and tolerability 14 .…”

“…A recent report described seven cases of acute and challenging difficult psychological experiences after using ayahuasca in ritual settings. 13 The subsample was selected from a study that prospectively followed 40 subjects in the first ceremonial use of ayahuasca to assess safety and tolerability. 14 Four of those 7 subjects met the diagnostic criteria for 1 or more psychiatric disorder before the ayahuasca ceremony.…”

“…Interestingly, despite their emergence, these experiences were also perceived as positive by the subjects. 13 Among controlled studies, there is only one report of a PAR. This case involved a brief but intense moment of disorientation and anxiety, which was resolved with verbal management.…”