Trial PaperAnxiety DisordersDepressive DisordersSuicidalityMajor Depressive Disorder (MDD)Public Health, Prevention & Behaviour ChangeAyahuasca

Rapid and sustained decreases in suicidality following a single dose of ayahuasca among individuals with recurrent major depressive disorder: results from an open-label trial

This analysis of an earlier open-label study (n=15) on Ayahuasca, found significant (Hedges' g = 1.75) and sustained decreases in suicidality in people with depression (MDD).

Authors

  • Richard Zeifman
  • Jamie Hallak
  • Rafael dos Santos

Published

Psychopharmacology
individual Study

Abstract

Rationale

Suicidality is a major public health concern with limited treatment options. Accordingly, there is a need for innovative interventions for suicidality. Preliminary evidence indicates that treatment with the psychedelic ayahuasca may lead to decreases in depressive symptoms among individuals with major depressive disorder (MDD). However, there remains limited understanding of whether ayahuasca also leads to reductions in suicidality.

Objective

To examine the acute and post-acute effect of ayahuasca on suicidality among individuals with MDD.

Methods

We conducted a secondary analysis of an open-label trial in which individuals with recurrent MDD received a single dose of ayahuasca (N = 17). Suicidality was assessed at baseline; during the intervention; and 1, 7, 14, and 21 days after the intervention.

Results

Among individuals with suicidality at baseline (n = 15), there were significant acute (i.e., 40, 80, 140, and 180 min after administration) and post-acute (1, 7, 14, and 21 days after administration) decreases in suicidality following administration of ayahuasca. Post-acute effect sizes for decreases in suicidality were large (Hedges' g = 1.31-1.75), with the largest effect size 21 days after the intervention (g = 1.75).

Conclusions

When administered in the appropriate context, ayahuasca may lead to rapid and sustained reductions in suicidality among individuals with MDD. Randomized, double-blind studies with larger sample sizes are needed to confirm this early finding.

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Research Summary of 'Rapid and sustained decreases in suicidality following a single dose of ayahuasca among individuals with recurrent major depressive disorder: results from an open-label trial'

Introduction

Suicide is a leading cause of death worldwide and often occurs in the context of major depressive disorder (MDD). Earlier research indicates that standard first-line treatments for MDD, such as selective serotonin reuptake inhibitors (SSRIs) and cognitive behavioural therapy (CBT), produce limited or delayed reductions in suicidality, and some interventions may even worsen suicidal thoughts in specific subgroups. Rapid-acting pharmacological options such as ketamine have shown promise for anti‑suicidal effects but raise questions about long-term efficacy and safety, leaving a need for additional rapid-acting interventions that target both depressive symptoms and suicidality. Ayahuasca, a traditional psychoactive brew containing DMT and β-carbolines (e.g. harmine), has been reported in preliminary studies to reduce depressive symptoms and may have potential to reduce suicidality when administered in a supportive context. The present study therefore examined whether a single dose of ayahuasca produces rapid (acute) and sustained (post-acute) reductions in suicidality among individuals with recurrent MDD. The authors conducted a secondary analysis of an open‑label clinical trial to test two hypotheses: that suicidality would decrease acutely after ayahuasca administration, and that decreases would be sustained up to 21 days post‑treatment. A single-dose, inpatient setting with repeated suicidality assessments allowed investigation of both immediate and short‑term outcomes.

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Study Details

Related Clinical Trial

Completed

Antidepressant Effects of a Single Dose of Ayahuasca in Patients With Recurrent Depression: An Open-Label SPECT Neuroimaging Study

Open-label inpatient pilot study (Brazil; collaborating institutions include Universidade de São Paulo–Ribeirão Preto and Universidade Federal do Rio Grande do Norte) of a single oral dose of ayahuasca in 17 adults with recurrent MDD (14 women; mean age 42.7 ± 12.11 years) who had an inadequate response to their current antidepressant and were undergoing a planned medication change. Three participants had a mild current episode, 13 moderate, and one severe. After a 2-week washout, participants underwent medical screening (clinical examination, laboratory tests, ECG) and a structured diagnostic interview (SCID-IV). Exclusion criteria: bipolar or psychotic disorder, active psychotic symptoms, pregnancy, history of antidepressant- or substance-induced mania/hypomania. Primary objective: characterise changes in regional cerebral blood flow using single-photon emission computed tomography (SPECT) neuroimaging. Secondary outcomes: Hamilton Depression Rating Scale (HDRS) and Montgomery-Åsberg Depression Rating Scale (MADRS) assessed at baseline and multiple post-dosing time points including 80 minutes, 24 hours, 48 hours, 72 hours, and 21 days. Study preceded the randomized placebo-controlled RCT by the same group (NCT02914769, UFRN, n=35, started 2014), which cites this open-label pilot as background. Approved by a local ethics committee. No trial registration number reported; study pre-dates routine REBEC registration requirements for open-label pilot work and was classified as a single-arm neuroimaging study.

Started
Type
interventional
Randomized
No
Registry ID
SANCHES-2016-JCP-AYAHUASCA-SPECT

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