Ayahuasca, dimethyltryptamine, and psychosis: a systematic review of human studies

Abstract

Ayahuasca is a hallucinogen brew traditionally used for ritual and therapeutic purposes in Northwestern Amazon. It is rich in the tryptamine hallucinogens dimethyltryptamine (DMT), which acts as a serotonin 5-HT agonist. This mechanism of action is similar to other compounds such as lysergic acid diethylamide (LSD) and psilocybin. The controlled use of LSD and psilocybin in experimental settings is associated with a low incidence of psychotic episodes, and population studies corroborate these findings. Both the controlled use of DMT in experimental settings and the use of ayahuasca in experimental and ritual settings are not usually associated with psychotic episodes, but little is known regarding ayahuasca or DMT use outside these controlled contexts. Thus, we performed a systematic review of the published case reports describing psychotic episodes associated with ayahuasca and DMT intake. We found three case series and two case reports describing psychotic episodes associated with ayahuasca intake, and three case reports describing psychotic episodes associated with DMT. Several reports describe subjects with a personal and possibly a family history of psychosis (including schizophrenia, schizophreniform disorders, psychotic mania, psychotic depression), nonpsychotic mania, or concomitant use of other drugs. However, some cases also described psychotic episodes in subjects without these previous characteristics. Overall, the incidence of such episodes appears to be rare in both the ritual and the recreational/noncontrolled settings. Performance of a psychiatric screening before administration of these drugs, and other hallucinogens, in controlled settings seems to significantly reduce the possibility of adverse reactions with psychotic symptomatology. Individuals with a personal or family history of any psychotic illness or nonpsychotic mania should avoid hallucinogen intake.

Ayahuasca: what mental health professionals need to know

“…The difference between this study and the SPECT study, where visual areas were not activated, may be determined by the task since in the fMRI study subjects were instructed to do tasks related with visual stimulation and/or imagery. 16,18,[20][21][22] Anxiety, panic, and fear Psychotic symptoms (less common) Negative subjective effects (prolonged) 23,59 Psychotic reactions (rare) Physiological effects (acute) 5,14,18,19,21,24 Moderate increases in blood pressure and heart rate Mydriasis Increases in body temperature Increases in prolactin, cortisol, and growth hormone secretion Increases in natural killer cells levels Decreases on CD3 and CD4 lymphocyte levels…”

“…Dysphoric reaction are less frequent and my include anxiety, fear, and psychotomimetic symptoms, but these effects are generally transient and usually do not need medical intervention 16,18,20,21 . Prolonged dysphoric or psychotic reactions in controlled contexts (experimental or ritual) are rare and seem to occur mostly among individuals with a personal or family psychiatric history, although cases where there was no personal of family antecedent have also been reported ( Table 1) 22,23 .…”

“…Thus, these participants may have specific characteristics that could limit the generalization of the results. Moreover, although psychiatric complications such as anxiety and psychotic reactions associated with ritual ayahuasca are rare, they may occur, especially among vulnerable individuals [21][22][23] . In the ritual contexts of ayahuasca use, individuals with a personal or family history of psychotic illness or that are currently with psychotic symptoms are generally not allowed to use ayahuasca or are advised that they should avoid it 23,59 .…”

“…Moreover, although psychiatric complications such as anxiety and psychotic reactions associated with ritual ayahuasca are rare, they may occur, especially among vulnerable individuals [21][22][23] . In the ritual contexts of ayahuasca use, individuals with a personal or family history of psychotic illness or that are currently with psychotic symptoms are generally not allowed to use ayahuasca or are advised that they should avoid it 23,59 . This could explain at least in part the low incidence of psychotic reactions among ritual ayahuasca users, and show that individuals with a personal or family history of psychotic illness or nonpsychotic mania should avoid ayahuasca use 23,59 .…”

“…Its important to highlight that individuals with a personal or family history of psychotic illness or nonpsychotic mania are usually not enrolled in these studies, which could explain the absence of reports of prolonged dysphoric or psychotic reaction in the experimental and clinical settings 5,14,[18][19][20][21]23,24,[27][28][29]32,33,36,[41][42][43]60 . These results are in line with experimental and clinical studies with other serotonergic hallucinogens such as LSD and psilocybin 13,15,30,31,36,[44][45][46][47][50][51][52][53] .…”