Anxiety, panic, and hopelessness during and after ritual ayahuasca intake in a woman with generalized anxiety disorder: A case report

Introduction

Ayahuasca is a traditional botanical hallucinogenic brew composed of Banisteriopsis caapi and Psychotria viridis, containing DMT and β-carbolines that together permit oral DMT to become systemically active. Earlier human and animal studies suggest anxiolytic and antidepressant effects of ayahuasca, and controlled administrations in healthy volunteers are generally well tolerated; the acute psychoactive window typically begins within 30–40 minutes, peaks around 1.5–2 hours, and resolves by 4–6 hours. While transient dysphoric reactions such as anxiety or paranoia can occur during the acute effects, prolonged or subacute anxiety-related adverse events have not been commonly reported in controlled settings, and long-term ritual users generally do not show increased psychopathology in observational studies, although selection biases may limit those findings. Santos and colleagues report a single-case description to document what they consider an uncommon prolonged anxiety-like reaction following ritual ayahuasca ingestion in a young woman with a prior diagnosis of generalized anxiety disorder (GAD). The report aims to characterise the clinical course, contextual factors, and possible mechanisms of the event, and to highlight implications for the use of ayahuasca in people with anxiety histories. This case is presented as, to the authors’ knowledge, the first scientific description of a subacute/prolonged anxiety reaction temporally associated with ayahuasca intake.