Who is most at risk of psychosis after ingesting ayahuasca or DMT?

Psychotic episodes associated with ayahuasca and DMT appear to be a rare phenomenon. But new research published in Therapeutic Advances in Psychopharmacology suggests that individuals with a history of mental problems could face an increased risk.

Ayahuasca is a hallucinogenic brew that has traditionally been used in the healing ceremonies of indigenous Amazon tribes. The brew contains the psychedelic drug dimethyltryptamine (DMT), which can also be smoked on its own to induce a powerful but relatively short-lasting trip.

A systematic review of previous research failed to find any published reports of prolonged psychotic reactions associated with the use of ayahuasca or DMT in controlled clinical settings.

However, the review did examine 8 scientific reports of psychotic episodes associated with ritual ayahuasca intake and recreational DMT intake. Many of these cases involved people with a personal or family history of psychosis or bipolar disorder. Some cases involved mixing ayahuasca or DMT with other drugs like marijuana. In two cases, the psychosis was linked with an increase in the frequency of DMT intake.

“These data suggest that performance of a psychiatric and drug use history before ayahuasca or DMT administration in controlled settings may reduce the occurrence of psychotic experiences,” the authors of the study concluded.

“Regarding noncontrolled/recreational use, individuals with personal or family history of schizophrenia or schizophreniform disorders, psychotic depression or mania, or with ongoing manic or psychotic symptomatology, should avoid ayahuasca/DMT intake.”

PsyPost interviewed the study’s corresponding author, Rafael G. dos Santos of the University of São Paulo. Read his responses below:

PsyPost: Why were you interested in this topic?

Dos Santos: The possible occurrence of prolonged psychotic episodes associated with psychedelic/hallucinogen use is an important but poorly investigated topic. It seems to be rare, especially in controlled (ritual or experimental) settings, but the fact is that isolated cases do occur. Most of the research has focused on LSD and psilocybin, so we wanted to know if in the context of ayahuasca use it was also present and to what extent.

What should the average person take away from your review?

It seems that people with a family or personal history of psychotic symptoms and disorders are more vulnerable to experience psychotic episodes after ayahuasca (or other psychedelic/hallucinogen such as LSD and psilocybin) intake. These people should avoid using these substances, and the people offering them should avoid giving them to people with these characteristics.

Are there any major caveats? What questions still need to be addressed?

There are only a few case reports published and some observational studies. Prolonged psychotic episodes do not seem to occur in experimental or clinical settings, so we think that screening people with a family or personal history of psychotic symptoms and disorders is crucial. We need to better understand who is more vulnerable to these adverse effects.

Is there anything else you would like to add?

People should avoid approaching substances such as ayahuasca as a “cure-for-all troubles”. Most people apparently benefit from taking this substance, but there are some that may be harmed by them. Caution should be taken when using these compounds in vulnerable individuals.

The article, “Ayahuasca dimethyltryptamine, and psychosis: a systematic review of human studies“, was also co-authored by José Carlos Bouso and Jaime E. C. Hallak. It was published February 23, 2017.