The hallucinogenic decoction ayahuasca has been used for centuries by indigenous Amazonian peoples.
Its use is expanding worldwide among religious adherents and recreational users.
Ayahuasca could offer therapeutic benefits as an antidepressant and anxiolytic, although more research is needed.
Despite existing on the fringes of American drug culture, ayahuasca is gaining attention in medical circles around the world as a psychoactive substance with potential therapeutic uses, typically related to mental health. This potential, however, must be supported by evidence and considered in light of any potential adverse effects of this drug. To date, such data are limited but emerging.
A closer look
Ayahuasca is a dimethyltryptamine (DMT)-harmala alkaloid–based traditional medicine that has been used by Amazonian cultures for hundreds of years for healing and spiritual purposes.
It is consumed in liquid form, brewed from the ayahuasca vine and the leaves of chacruna or chaliponga. Authors of a review article discuss various aspects of ayahuasca, drawing upon data from the Global Ayahuasca Project (GAP).
The term ayahuasca is derived from the Quechua language and means “vine of the souls.” This highly potent decoction produces changes in consciousness, which is key to its purported therapeutic benefits.
In addition to its use by indigenous tribes of the Amazon, practitioners of various Brazilian syncretic religions use this agent as a religious sacrament. These religious practices have expanded outside of South America to North America, Europe, and Australia to include neo-shamanic ceremonies. Moreover, tourists to South America seek the drug’s therapeutic and spiritual effects.
Brazilian writers publishing in Plants sketch the expanding use of ayahuasca. “Originally, the tribes resorted to this beverage for therapeutic purposes and divine rituals,” they wrote. “It was also used by native healers to cure psychological disorders and stimulate creative thinking and visual creativity."
In addition to more traditional and religious uses, ayahuasca is also being increasingly consumed recreationally worldwide.
GAP research has demonstrated that the most common insights that ayahuasca users achieve when drinking ayahuasca involve personality issues, family relationships, and personal relationships. Such realizations reflect morals, ethics, and self-conduct, as well as life purpose and direction. Ayahuasca can also help unpack childhood events and patterns in romantic relationships, and can lead to an improved appreciation of self-care.
How does it work?
The neurobiological mechanisms underlying the acute and longer-term therapeutic effects of DMT-harmaloid preparations appear to involve shared pathways with other classic psychedelics, such as psilocybin and LSD.
According to the review article authors, these include serotonergic, dopaminergic, and glutamatergic pathways via serotonin 5-HT2A agonism, along with an ability to trigger neurogenesis. DMT may also specifically activate the sigma-1 and the harma alkaloid psychedelic pathways.
Ayahuasca may decrease connectivity in the default mode network (DMN), thus contributing to its therapeutic effects. Increased neurogenesis and neuroplasticity may also play a role in therapeutic action, along with serotonergic and MAOI effects, a decrease in pro-inflammatory cytokines, a decrease in amygdala and insula reactivity, and the modulation of brain regions linked to interoception, emotional processing, and volition.
“This wide range of neurobiological effects is likely to facilitate multifaceted psychotherapeutic processes and provides an underpinning rational[e] for the proposed transdiagnostic application of ayahuasca in the treatment of mood and anxiety disorders, addiction, and trauma,” the review authors wrote.
Although much research still needs to be done, there is some evidence that ayahuasca may help with psychiatric disorders. An article in Scientific Reports cites data from observational studies indicating that DMT may exert anxiolytic properties.
An open-label study demonstrated therapeutic benefits in patients with major depressive disorder following a single dose of the drug, with another randomized, controlled trial demonstrating similar findings. In addition, in a study conducted by the authors among a cohort of naïve ayahuasca users, 45% of whom had a diagnosis of a psychiatric disorder, 80% exhibited clinical improvements after their first ayahuasca use. The improvements included a decrease in depression or psychopathology, which persisted at 6 months.
The International Center for Ethnobotanical Education, Research, and Service (ICEERS) expounds on the distinct experience of taking ayahuasca, which involves “decentering,” or the ability to observe thoughts and emotions from a detached perspective. Ayahuasca also promotes mindfulness, cognitive flexibility, and emotional and grief processing.
ICEERS also cites research indicating that ayahuasca may help with PTSD, eating disorders, and borderline personality disorder. A decrease in levels of suicidal ideation that has been reported may possibly be related to the observed decrease in cortisol levels after ayahuasca administration.
Potential adverse effects
DMT has not been associated with psychopathology or impairments in neuropsychological functioning, according to Scientific Reports.
Physically, however, the authors writing in Plants note that ayahuasca ingestion often results in nausea, diarrhea, and vomiting. Changes in pupil size and body temperature can occur. Psychological effects may involve altered perceptions of time/space and visual/auditory changes. Some users have religious experiences, feeling a connection to mythical entities or gods.
Challenges of taking ayahuasca
ICEERS is forthcoming about certain intense psychological challenges that can occur with ayahuasca. One is when the user ends up confronting “shadow content,” painful memories, personality flaws, or repressed trauma. Such confrontations can be transformative and only rarely lead to long-term repercussions. Nevertheless, it’s a good idea for individuals to take ayahuasca with a responsible and experienced guide or facilitator.
Another aspect of taking ayahuasca is purging. In indigenous Amazonian culture, purging is considered essential to the experience of taking the drug. It helps clean the body (of things like parasites, allegedly) and helps the user process emotional situations. Whatever the case may be, purging is not viewed as an adverse effect by either indigenous or experienced users.
What this means for you
There isn’t enough evidence yet to render a medical consensus on the use of ayahuasca. Physicians should be aware that their patients may be taking this drug for religious or recreational purposes. It appears that ayahuasca doesn’t pose any long-term threat to mental or physical health, although more research on potential risks is needed.