Ayahuasca, or "vine of the soul", is a psychedelic brew made by mixing the bark of a vine (Banisteriopsis caapi) with the leaves of the chacruna plant (Psychotria viridis). It has been used for centuries by indigenous Amazonian tribes to cure illnesses and for spiritual reasons. Some religious groups also use it as a sacrament.

The concoction contains N,N-dimethyltryptamine (DMT) which is the main psychoactive substance. It is chemically similar to the neurotransmitter serotonin. This is what is responsible for the psychedelic effect. Users report feeling euphoric and in an altered state of consciousness; many say they feel more at peace with themselves and more accepting of their life situation.

However, there are side effects as well. Users often get diarrhoea and vomiting. Some people experience "bad trips", wherein they have terrifying visions or an overwhelming sense of loss, and a small fraction can even have psychotic breaks. While adverse reactions have not been reported in lab settings, there have been some cases of people dying after ingesting the drug. However, the cause of death remains unclear—it is possible that the drug was administered in unsafe settings and was mixed with other substances. 

Ayahuasca has shown promise in the treatment of many mental health disorders such as depression, PTSD (post-traumatic stress disorder) and alcohol addiction. Psychedelic-assisted therapy maybe indeed become reality in the future—there are many studies underway to see if cognitive behavioural therapy along with psychoactive substances can be used for medical purposes.

Researchers are also looking into the potential of DMT to treat cancer and multiple sclerosis.

Traditionally, ayahuasca is administered by a shaman, or a spiritual leader, who guides the psychedelic journey. Unlike other psychedelics such as LSD, those under the influence of ayahuasca are keenly aware that they are in an altered state of consciousness so they are better able to unpack their experiences. The concept of "setting" is very important. This means that the drug should be administered in surroundings that amplify the effect of the drug without making the user feel overwhelmed or worried for their safety. It is the job of the shaman or the leader to ensure that the environment is safe and conducive to a good "trip".

Studies so far have not shown adverse long-term effects, and those who regularly take the drug do not develop a tolerance. This means that the dosage does not need to be increased to feel the effects of the drug. However, the drug is not recommended for those who have mental illnesses such as bipolar disorder or schizophrenia since it can amplify symptoms. The drug should not be mixed with alcohol or certain drugs such as antidepressants. There is a chance of adverse reactions especially in the latter.

Though the US has clearly marked ayahuasca a schedule 1 or banned drug, its legal status in India is uncertain—it is definitely not something you can easily buy at a chemist or paan shop. That said, the point of this article is not to recommend the use of ayahuasca, but to simply weigh what science has to say about the potential health benefits and side effects of the psychedelic substance that is increasingly piquing people's curiosity in India.

  1. How does ayahuasca work?
  2. Health benefits of ayahuasca
  3. Ayahuasca side effects

The chacruna leaves contain DMT. However, when these are ingested alone, they have no effect on the body as they are rapidly broken down in the gut by an enzyme called monoamine oxidase. This is where the vines come into play—B. caapi has potent monoamine oxidase inhibitors called beta-carbolines. These allow the DMT to be absorbed by the blood and eventually cross the blood-brain barrier; DMT is one of the very few substances that can breach the blood-brain barrier.

fMRI and EEG studies on those under the influence of ayahuasca have shown that the drug lowers activity in the default mode network (DMN) of the brain. The DMN is a complex and relatively novel concept that involves the prefrontal cortex, posterior cingulate cortex, and the inferior parietal lobule. The DMN is active when we are mentally at rest, meaning when we are in a relaxed state and not thinking about anything in particular or engaged in a mental task. When we are paying attention to a particular task, signals within the DMN dampen, but when we are daydreaming, passively thinking about memories and the future and about other people, DMN activity increases. 

Higher DMN activity has been linked with mental health disorders like depression, anxiety, social phobias and schizophrenia. Negative, repetitive thoughts and rumination are some of the symptoms of depression, so it makes sense that higher DMN or baseline brain activity contributes to depressive states. (Read more: Social anxiety

Other than reducing activity in the DMN, ayahuasca also increases activity in the visual cortex and the limbic system, which is responsible for processing memories and emotions. This altered activity explains "trips" to a degree. The mind becomes more self-aware, but due to the decrease in activity, it is purportedly able to operate in an unencumbered manner and see the bigger picture—both in the user's personal situations and the world at large.

Users begin to feel the effects of the drug within half an hour and the whole experience can last about five hours.

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The psychological and psychosocial benefits of ayahuasca are the best documented. One of the first studies on the psychological benefits of ayahuasca was undertaken in 1996. Fifteen men who had taken the drug regularly for a decade were compared with a control group. It turned out that those who had been on ayahuasca long term had elevated levels of serotonin reuptake transporters. Elevated levels of serotonin transporters is what antidepressants target—according to the study, the consumption of the drug increased the baseline of this indicator. Those who suffer from depression have low levels of the indicator. Further, this indicator is also lowered in a type of alcoholism that involves addiction. The study showed that ayahuasca could, therefore, assist with mental health and addiction disorders. 

Two decades later, a similar study with 32 participants confirmed these findings. 

Other studies have shown that the drug increases assertiveness, liveliness, reduces anxiety and increases optimism and confidence. 

Another recurring theme with ayahuasca experiences is the resurrection of forceful memories and their therapeutic effects. This provides an opportunity for self-reflection that can alter maladaptive habits. Some academicians have compared the spiritual effects of the drug to intense psychotherapy and meditation since it involves confronting the self and using these insights to bring changes in the personal sphere. 

Various longitudinal studies have shown that ritualistic treatments with ayahuasca reduced reliance on illicit drugs and helped overcome addictive thoughts about alcohol and smoking. More studies need to be done on this, however. (Read more: Drug addiction)

In an encouraging development, studies on DMT have shown that the substance may also have physiological—not just pathological—benefits. Preliminary research has shown chemicals very similar to DMT that can increase neuronal survival against oxidative stress and can regulate immune responses. Further studies have shown that DMT has broader applications in cellular growth and protective mechanisms. 

Human clinical studies have shown that ayahuasca can reconfigure immune cells that can increase antiviral and anti-tumour responses. There is also some evidence that ayahuasca can increase the number of natural killer cells with time, making it a candidate for cancer therapy as well. (DMT is not currently administered to cancer patients as an approved therapy.)

While these are incredibly interesting developments, bear in mind that studies are in preliminary stages and it will be a long time before they yield therapeutic benefits. The evidence is largely conjectural at this point. 

In any case, our understanding of psychedelics is improving and the hope is that in time it will bring both psychological and physiological benefits to humankind.

The initial effects of the substance are felt within 30 minutes of administration. Often these are accompanied by fear, confusion and paranoia. Traumatic memories can be resurrected and depress the user. Also, there is a chance of severe vomiting and diarrhoea. According to the literature, the experience is divided into phases and the spiritual phase is often reached after vomiting aggressively. The drink is highly acidic and the interactions involving serotonin receptors also activate the vomiting reflex. 

Aside from this, there is also an increase in systolic and diastolic blood pressure (high blood pressure) and pupil dilation. Cardiovascular and endocrine problems, abnormal lipid metabolism, glaucoma, and fever have been associated with ayahuasca consumption but are rare.

Drug interactions with SSRIs (selective serotonin reuptake inhibitors), MAO inhibitors (monoamine oxidase inhibitors), and ginseng can be severe. This can lead to serotonin syndrome which includes high fever, tremors, shivering, hyperthermia, palpitations, convulsions and even death. 

While the probability is low, those with a family or personal history of mental illness such as schizophrenia can have a psychotic episode and lose touch with reality for an extended period of time. 

Bad trips can be very frightening episodes for some people and can cause mental trauma at times. This likelihood is reduced if the drug is administered by a professional and is not mixed with other substances. Bad experiences and severe side effects have risen with unscrupulous "shamans" misleading tourists and administering dangerous substances.

Studies have shown no indication of dependence or addiction.

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  1. NJ Broers, et al. Sub-acute and long-term effects of ayahuasca on affect and cognitive thinking style and their association with ego dissolution Psychopharmacology (Berl). 2018; 235(10): 2979–2989. PMID: 30105399
  2. Petra Bokor, et al. The Therapeutic Potentials of Ayahuasca: Possible Effects against Various Diseases of Civilization Front. Pharmacol., 02 March 2016.
  3. Garrido, et al. Effects of ayahuasca on mental health and quality of life in naïve users: A longitudinal and cross-sectional study combination Scientific Reports volume 10, Article number: 4075 (2020).
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  5. Genis Ona, et al. Ayahuasca and Public Health: Health Status, Psychosocial Well-Being, Lifestyle, and Coping Strategies in a Large Sample of Ritual Ayahuasca Users Journal of Psychoactive Drugs, Volume 51, 2019 - Issue 2, 07 Feb 2019.
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