Psychoactive drink has healing power - but not for everyone

The Amazonian brew ayahuasca is attracting ever-greater scientific attention for its apparent ability to relieve depression, anxiety, and other forms of psychological distress. Yet, testimonials from users also include nights of terror, overwhelming sadness, or lingering feelings of isolation.

A large new analysis reveals that the effects of the psychoactive drink depend heavily on who is consuming it, where they drink, and how their experience is supported. These factors play a major role in determining whether the long-term outcome is healing or harmful.

The new study is led by Óscar Andión of Research Sherpas together with colleagues at the International Center for Ethnobotanical Education, Research and Services (ICEERS) and other institutions.

The research applies both classic statistics and machine-learning algorithms to tease apart patterns that link immediate psychological reactions to longer-term wellbeing.

Who’s drinking ayahuasca and why

The paper draws on data from the Global Ayahuasca Survey, an online questionnaire that reached more than 10,000 consumers on six continents.

Earlier data showed over half of participants experienced adverse mental states after using the psychoactive drink. These difficulties were linked to a history of mental illness and using the drug in non-traditional settings.

In this study, of the original 10,836 respondents, 5,400 supplied complete information and were included in the final models. Among those participants, 14 percent reported a prior diagnosis of anxiety disorder and nearly 20 percent a history of depressive disorder.

The investigators acknowledge that the survey’s voluntary, retrospective design introduces selection and recall biases. People with strong experiences are more likely to respond, and delayed recall can lead to inaccurate or distorted memories. Still, it’s the largest sample yet, spanning Amazonian rituals, Western retreats, and informal underground psychedelic circles.

When ayahuasca helps or hurts

The analyses confirmed that participants with pre-existing anxiety or depression were more likely to report challenging emotional states. This was especially true for those who consumed the psychoactive drink outside traditional or well-structured ceremonial settings.

Experiences such as visual distortions, though often labeled “adverse,” actually predicted better mental health scores at the time of survey. In contrast, lingering feelings like being down, disconnected, or energetically attacked were linked to poorer mental health later on.

Curiously, the machine-learning models suggested that not all difficult experiences should be dismissed as negative. Some initially unpleasant states were linked to improved mental health months later. This suggests that acute psychological struggle may lead to long-term benefits – but only under certain conditions.

What protects against bad outcomes

Environmental and psychosocial variables emerged as powerful moderators. Participants who consumed the psychoactive drink in group ceremonies led by experienced facilitators were less likely to suffer harmful after-effects. Preparation and integration practices further enhanced the benefits, making adverse effects even less likely.

Age also played a role, with older users reporting fewer persisting problems. The authors interpret these findings to mean that a supportive “set and setting,” combined with life experience, may buffer vulnerable individuals from potentially destabilizing reactions.

Spiritual framing likewise appeared beneficial. Survey items that measured the importance of ceremonial symbolism, prayer, or ritual structure correlated with lower probabilities of post-session anxiety, depression, and social withdrawal.

“Our research also highlights that the spiritual significance of ayahuasca ceremonies plays a protective role, reducing adverse emotional states like anxiety, depression, and disconnection, thus contributing to overall mental health improvement,” the authors wrote.

What this means for treatment

Clinical enthusiasm for psychedelics has spurred efforts to translate ayahuasca – traditionally brewed from Banisteriopsis caapi vine and Psychotria viridis leaves – into standardized pharmaceutical formats. The new study cautions against overlooking the communal and cultural matrix that appears to scaffold positive outcomes.

“What stood out most to us was the significant difference in mental health outcomes between users who had supportive environments [during their use] and those who didn’t. This emphasizes the importance of a responsible and well-prepared setting for those seeking healing through ayahuasca,” explained corresponding author José Carlos Bouso, a scientist at ICEERS.

The authors therefore advocate supervised consumption of the ayahuasca, especially for people with mood-disorder histories. They urge future research to study real-world communal ceremonies, not just controlled lab settings, where most drinking happens.

“Ayahuasca use, when experienced in safe, supportive environments, may offer therapeutic benefits, particularly for individuals with a history of mood disorders, highlighting the importance of the ceremony’s setting and the role of facilitators,” they observed.

Redefining difficult experiences

One of the paper’s striking conclusions is that common checklists for psychedelic side-effects may oversimplify complex emotional processes. Medical trials may label certain states as undesirable, while shamanic practice views them as essential stages of purging or insight.

“Our study reveals that the post-ayahuasca mental states, traditionally seen as adverse, can contribute to improved mental health, especially in individuals with previous anxiety and depressive disorders. This suggests the need for a more nuanced understanding of these states as potentially beneficial experiences,” the authors wrote.

Future of psychedelic healing

Despite limitations, the findings add clarity and detail to the debate on how to regulate and deliver psychedelic therapies. They underscore the interplay between personal history, ceremony design, and the subjective meaning of challenging experiences.

“The insights gathered from the Global Ayahuasca Survey (GAS) provided a deeper understanding of the complex relationship between ayahuasca use and mental health outcomes. It was particularly interesting to see how the setting, preparation, and integration practices play a pivotal role in shaping the overall experience,” Bouso explained.

Interest in psychedelic healing is outpacing the evidence base. Context-sensitive studies help maximize benefits and reduce potential harms. Practitioners are reminded that the brew’s power lies not just in its chemistry, but in the communal setting that holds the experience.

The study is published in the journal PLOS Mental Health.