Ayahuasca dimethyltryptamine, and psychosis: a systematic review of human studies
This systematic review of case reports found that psychotic episodes following ayahuasca or DMT use are rare but have been documented in both ritual and recreational/non‑controlled settings. Most reported cases involved a personal or family history of psychosis, bipolar/manic disorders or concomitant substance use, supporting psychiatric screening before administration and avoidance of hallucinogens in those with such histories.
Authors
- Jamie Hallak
- Rafael dos Santos
- José Carlos Bouso
Published
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-HT2Aagonist. 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.
Research Summary of 'Ayahuasca dimethyltryptamine, and psychosis: a systematic review of human studies'
Introduction
Ayahuasca is a traditional Amazonian hallucinogenic brew made from Banisteriopsis caapi (containing reversible monoamine oxidase A inhibitors such as harmine, harmaline and tetrahydroharmine) and Psychotria viridis (containing the serotonin receptor agonist N,N-dimethyltryptamine, DMT). Because the β-carbolines inhibit peripheral MAO-A, orally ingested DMT becomes psychoactive, acting at cortical 5-HT2A receptors in paralimbic and frontal regions including the default mode network. This pharmacology is shared in part with classic serotonergic hallucinogens such as LSD and psilocybin. Controlled experimental studies of single doses in healthy volunteers report transient perceptual and introspective effects and acceptable tolerability, with nausea and vomiting being common adverse reactions, and long-term ritual use has not been linked to increased cognitive deficits or psychopathology in the studies cited by the authors. Dos Santos and colleagues set out to systematically review published human reports of psychotic episodes that lasted longer than the expected acute effects of ayahuasca or DMT. The review aims to characterise the clinical circumstances, temporal relationships, personal and family psychiatric histories, and concurrent substance use in cases where prolonged psychosis was reported, and to consider implications for screening and safer use in both controlled and noncontrolled settings.
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dos Santos, R. G., Bouso, J. C., & Hallak, J. E. C. (2017). Ayahuasca dimethyltryptamine, and psychosis: a systematic review of human studies. Therapeutic Advances in Psychopharmacology, 7(4), 141-157. https://doi.org/10.1177/2045125316689030
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