Acute Psychological Adverse Reactions in First-Time Ritual Ayahuasca Users
In a prospective subsample of 40 ayahuasca‑naive ceremony participants, 7 experienced acute, challenging psychological reactions—often linked to inadequate setting and preexisting psychiatric disorders—but several of those participants showed substantial symptom reduction or remission at 1‑ and 6‑month follow‑up. The findings indicate that while ritual ayahuasca can provoke short‑term adverse reactions, these may coexist with positive longer‑term outcomes and warrant further prospective safety research focusing on context and screening.
Authors
- Jamie Hallak
- Rafael dos Santos
- Gonzalo Ona
Published
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.
Research Summary of 'Acute Psychological Adverse Reactions in First-Time Ritual Ayahuasca Users'
Introduction
Ayahuasca is a botanical decoction containing Banisteriopsis caapi (β-carbolines such as harmine) combined with plants that supply N,N-dimethyltryptamine (DMT). The β-carbolines inhibit peripheral monoamine oxidase A (MAO-A), permitting orally ingested DMT to exert central psychedelic effects. In Amazonian cultures ayahuasca has longstanding spiritual and therapeutic roles, and in recent decades ceremonial use has spread globally. Previous retrospective and controlled studies have generally reported acceptable tolerability, potential therapeutic benefits (for example in depression and substance use), and few enduring neuropsychiatric harms, yet prospective research that uses clinical interviews and follows ayahuasca‑naive ceremony participants over time remains limited. Gómez-Sousa and colleagues sought to address this gap by analysing a subsample drawn from a previously published prospective cohort of 40 first‑time ayahuasca ceremony participants. The present paper describes seven cases from that cohort who experienced acute, distressing psychological reactions during ceremonies, and reports clinical and psychometric outcomes assessed before exposure and at 1 and 6 months afterwards. The primary aim was to characterise the content, short‑term and longer‑term course of these challenging experiences and to explore contextual factors that might have contributed to adverse reactions.
Expert Research Summaries
Go Pro to access AI-powered section-by-section summaries, editorial takes, and the full research toolkit.
Full Text PDF
Full Paper PDF
Create a free account to open full-text PDFs.
Study Details
- Study Typeindividual
- Journal
- Compound
- Topics
- Authors
- APA Citation
Gómez-Sousa, M., Jiménez-Garrido, D. F., Ona, G., dos Santos, R. G., Hallak, J. E. C., Alcázar-Córcoles, M. Á., & Bouso, J. C. (2021). Acute Psychological Adverse Reactions in First-Time Ritual Ayahuasca Users. Journal of Clinical Psychopharmacology, 41(2), 163-171. https://doi.org/10.1097/JCP.0000000000001343
References (21)
Papers cited by this study that are also in Blossom
Riba, J., Mcilhenny, E. H., Valle, M. et al. · Drug Testing and Analysis (2012)
McKenna, D., Towers, G. H., Abbott, F. · Journal of Ethnopharmacology (1984)
Dos Santos, R. G., Hallak, J. E., Bouso, J. C. · Therapeutic Advances in Psychopharmacology (2017)
Riba, J., Valle, M., Urbano, G. et al. · Journal of Pharmacology and Experimental Therapeutics (2003)
Riba, J., Urbano, G., Morte, A. et al. · Psychopharmacology (2001)
Ona, G., Kohek, M., Massaguer, T. et al. · Journal of Psychoactive Drugs (2019)
Thomas, G., Lucas, P., Rielle Capler, N. et al. · Current Drug Abuse Reviews (2013)
Domínguez-Clavé, E., Soler, J., Pascual, J. C. et al. · Psychopharmacology (2018)
Osório, F. L., Sanches, R. F., Macedo, L. et al. · brazilian Journal of Psychiatry (2015)
Sanches, R. F., Osório, F. L., Dos Santos, R. G. et al. · Journal of Clinical Psychopharmacology (2016)
Show all 21 referencesShow fewer
Palhano-Fontes, F., Barreto, D., Onias, H. et al. · Psychological Medicine (2018)
Jiménez-Garrido, D. F., Gómez-Sousa, M., Ona, G. et al. · Scientific Reports (2020)
De Araujo, D. B., Ribeiro, S., Cecchi, G. A. et al. · Human Brain Mapping (2011)
Dos Santos, R. G., Osório, F. L., Crippa, J. A. et al. · Journal of Psychedelic Studies (2017)
Gable, R. S. · Addiction (2006)
Carbonaro, T. M., Bradstreet, M. P., Barrett, F. S. et al. · Journal of Psychopharmacology (2016)
Szmulewicz, A. G., Valerio, M. P., Smith, J. M. · International Journal of Bipolar Disorders (2015)
Watts, R., Luoma, J. B. · Journal of Contextual Behavioral Science (2020)
Gasser, P., Holstein, D., Michel, Y. et al. · Journal of Nervous and Mental Disease (2014)
Mithoefer, A. T., Mithoefer, M. C., Feduccia, A. A. et al. · Lancet Psychiatry (2018)
Studerus, E., Kometer, M., Hasler, F. et al. · Journal of Psychopharmacology (2010)
Cited By (4)
Papers in Blossom that reference this study
Soto-Angona, Ó., Fortea, A., Fortea, L. et al. · European Neuropsychopharmacology (2024)
Williams, M., Miller, A. K., Lafrance, A. · Eating Disorders - The Journal of Treatment & Prevention (2023)
Evans, J., Robinson, O., Ketzitzidou-Argyri, E. et al. · PLOS ONE (2023)
Bouso, J. C., Andión, O., Sarris, J. et al. · PLOS Global Public Health (2022)
Your Personal Research Library
Go Pro to save papers, add notes, rate studies, and organize your research into custom shelves.