Brian Anderson, especially for Plantando Consciência
(veja versão em português)
This essay is meant to make available to the lay reader some basic information on the topic of ayahuasca and depression. Health decisions should not be made on the basis of this information alone, rather they should be made with the consultation of a trusted health care professional, an experienced folk healer, or a religious leader. Like all substances with medicinal properties, ayahuasca can be harmful if used incorrectly; of course, what consists of the “correct” and healthy use of ayahuasca is debatable.
One health-related question regarding ayahuasca that comes up frequently is whether people taking antidepressant drugs can drink ayahuasca? This question cannot at the moment be answered in a very satisfying manner, but we can make an initial attempt at it.
Depression is a very common illness. Although it is often spoken of as a “mental illness,” depression can consist of physical as well as psychological symptoms, including decreased mood, the inability to experience pleasure, decreased energy, loss of appetite, loss of concentration, sleeping more or less, feelings of guilt, agitation, physical pains, and suicidal thoughts. The use of ayahuasca to treat symptoms like these has likely been around for decades—one well-known book describing such a use of ayahuasca is Marlene Dobkin de Rios’ Visionary Vine. Attempts to use ayahuasca in traditional settings to treat depression has also been documented recently.[i] No biomedical clinical trials using ayahuasca to treat depression have yet been completed, but some scientists do believe that other psychedelics, like psilocybin, may be useful in the treatment of depression.[ii] So, there is a chance that scientific research may shed some more light on if and how ayahuasca use might have beneficial effects on depression.
Before we get to the question of negative medication interactions with ayahuasca, it should be noted that even in people who are not taking psychiatric medications, ayahuasca can have harmful psychological effects (such as inducing psychotic or depressed states), even if these cases are relatively rare. It is thought that psychedelics in general may precipitate psychotic states in people who are predisposed to such reactions.[iii] Other negative reactions may occur when the ayahuasca user lacks the proper social support to help them integrate their experiences after the session.[iv] It is important for their own health that people with a history of psychosis do not drink ayahuasca.[v] And although some depressed people may report feeling better after taking ayahuasca, people who suffer from depression with psychotic symptoms should probably avoid ayahuasca as well.
Much of the concern regarding the use of ayahuasca by people taking antidepressant medications seems to stem from the issue of the “serotonin syndrome” raised by James Callaway and Charles Grob in their 1998 article “Ayahuasca Preparations and Serotonin Reuptake Inhibitors: A Potential Combination for Severe Adverse Interactions.”[vi] The serotonin syndrome is characterized by the signs and symptoms of fever, elevated pulse and blood pressure, confusion and agitation, convulsions, tremor, muscle rigidity, increased joint reflexes, dilated pupils, continuous horizontal eye movements, sweating, vomiting, and diarrhea.[vii] These symptoms usually start within minutes of consuming drugs that excessively increase levels of serotonin, and if left untreated severe cases can result in death. In the case of suspected serotonin syndrome, medical help should be sought immediately; this is complicated though in the case of ayahuasca users because several of these symptoms can be normal short-term effects of ayahuasca use.
The serotonin syndrome is a concern among ayahuasca users because ayahuasca contains harmala alkaloids like harmine and harmaline, which act as monoamine oxidase inhibitors (MOAIs), meaning they stop serotonin from being broken down, and hence increase levels of serotonin in the body. Therefore if a person who is taking antidepressant drugs like MAOIs, or the more frequently used selective serotonin reuptake inhibitors (SSRIs), it is feared that they could raise their serotonin levels too high if they also drank ayahuasca. Interestingly , however, despite the fact that 1000s of people across Brazil and other countries regularly drink ayahuasca, and that many of them are likely to be taking antidepressant medications, not a single case of suspected serotonin syndrome from ayahuasca use has appeared in the scientific literature since Callaway & Grob’s 1998 article. There are several possible reasons for this, only one of which is that such cases truly are very rare or non-existent, but the idea that severe cases of serotonin syndrome rarely occurs, at least in the Brazilian ayahuasca religion União do Vegetal (UDV), is supported by the statement made by the psychiatrist Luis Fernando Tófoli, coordinator of the Mental Health Committee for the UDV, that he has never heard of any reports of such cases occurring in the UDV.[viii] Of course, this lack of evidence of harm should not necessarily be taken as evidence of safety. Furthermore, Tófoli does comment that it is important to avoid using ayahuasca while taking the MAOI tranylcypromine. This is because tranylcypromine is an “irreversible” MAOI, meaning its effects last longer than other “reversible” MAOIs like moclobemide.
This brings us to another point—the effects of some drugs, including antidepressants, will last longer than those of other drugs after one stops taking them. The effects of the SSRI Prozac (fluoxetine), for example, can last for weeks after the last dose; so even if someone were to stop taking an antidepressant in order to avoid having a negative interaction with ayahuasca, such an interaction may still be possible for days after the medication was stopped. Also, quickly stopping a medication is not always a benign process—besides the potential of leading to a worsening of mental health, stopping a psychiatric medication suddenly can sometimes lead to physical symptoms, such as gastrointestinal cramps in people who have used an SSRI for a long time.
This has been a quick review of what is known within the academic sciences on the topic of ayahuasca and depression, and has attempted to address concerns around the possibility of the potentially lethal serotonin syndrome occurring in people who are taking antidepressant medications while they drink ayahuasca. It should be noted that not only antidepressant drugs are thought to be associated with the serotonin syndrome, but so are pain medications like meperidine, the antibiotic Linezolid, the cough-suppressant and sometimes recreational drug dextromethorphan, and several other drugs.[ix] How these medications may interact with ayahuasca is unknown, especially given the many different methods that exist for preparing ayahuasca. In summary, ayahuasca is a truly complex substance, and the experiences people have, and the relationships they can develop, with the brew are even more complex. Far more is unknown than is currently known about how ayahuasca affects mental health. And beyond the substance itself, the contexts and ways in which ayahuasca is used can be quite important, thus compounding the complexity of ayahuasca’s effects on mental health. As with the use of most drugs as mental health therapies, context and concomitant interpersonal support are crucial for cultivating the drug’s optimal effects—this fact should not be ignored.
[i] Palladino, L. 2010. Vine of the Soul: A Phenomenological Study of Ayahuasca and its Effects on Depression. Ph.D. dissertation, Program in Clinical Psychology, Pacifica Graduate Institute.
[ii] Grob, C. S., A. L. Danforth, G. S. Chopra, M. Hagerty, C. R. McKay, A. L. Halberstadt and G. R. Greer. 2011. Pilot Study of Psilocybin Treatment for Anxiety in Patients with Advanced-Stage Cancer. Archives of General Psychiatry 68(1):71-8.
Vollenweider, F. X., and M. Kometer. 2010. The Neurobiology of Psychedelic Drugs: Implications for the Treatment of Mood Disorders. Nature Reviews Neuroscience 11:642-51.
[iii] Strassman, R. J. 1984. Adverse Reactions to Psychedelic Drugs: A Review of the Literature. The Journal of Nervous and Mental Disease 172(10):577-95.
[iv]Lewis, S. E. 2008. Ayahuasca and Spiritual Crisis: Liminality as Space for Personal Growth. Anthropology of Consciousness 19(2):109-33.
[v]Santos, R. G., and Strassman, R. J. 2008. Ayahuasca and psychosis. British Journal of Psychiatry (online). 2008.
[vi] Callaway, J. C., and C. S. Grob. 1998. Ayahuasca Preparations and Serotonin Reuptake Inhibitors: A Potential Combination for Severe Adverse Interactions. Journal of Psychoactive Drugs 30(4):367-9.
[vii] Boyer, E. W., and M. Shannon. 2005. The Serotonin Syndrome. New England Journal of Medicine 352:1112-20.
[viii] Almeida, C. 2010. Pesquisas testam potencial benefício da ayahuasca contra depressão e dependência. Bol Notícias. http://noticias.bol.uol.com.br/ciencia/2010/04/26/pesquisadores-testam-beneficios-da-ayahuasca-contra-a-depressao.jhtm Accessed 26 April.
[ix] Boyer, E. W., and M. Shannon. 2005. The Serotonin Syndrome. New England Journal of Medicine 352:1112-20.
MD candidate, Stanford University School of Medicine
MSc candidate, BIOS Centre, London School of Economics
Researcher, Núcleo de Estudos Interdisciplinares sobre Psicoativos