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Ther Adv Psychopharmacol. 2017 Apr;7(4):141-157. doi: 10.1177/2045125316689030. Epub 2017 Feb 23.

Ayahuasca, dimethyltryptamine, and psychosis: a systematic review of human studies.

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1
Department of Neurosciences and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil; National Institute for Translational Medicine (INCT-TM), CNPq, Ribeirão Preto, Brazil; International Center for Ethnobotanical Education, Research and Service, ICEERS, Barcelona, Spain.
2
International Center for Ethnobotanical Education, Research and Service, ICEERS, Barcelona, Spain.
3
Department of Neurosciences and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil; National Institute for Translational Medicine (INCT-TM), CNPq, Ribeirão Preto, Brazil.

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-HT2A agonist. 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.

KEYWORDS:

ayahuasca; dimethyltryptamine; hallucinogens; psychosis

Conflict of interest statement

Conflict of interest statement: RGS is Fellow of the Programa Nacional de Pós-Doutorado, Brazil (PNPD/CAPES). JECH receives a CNPq (Brazil) Productivity Fellowship Award. Sponsors had no role in study design, data analysis, data interpretation, or writing of the report. All authors had full access to all the data and had final responsibility for the decision to submit for publication.

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