It’s Time for Cautious Excitement About Ayahuasca As Depression Treatment

By
Yage ceremony in La Calera, Colombia. Yage, a mixture of the Ayahuasca hallucinogenic liana and a psychoactive bush, attracts people who seek to participate in a traditional indigenous ritual of spiritual and physical healing.Photo: Eitan Abramovich/AFP/Getty Images
Yage ceremony in La Calera, Colombia. Yage, a mixture of the Ayahuasca hallucinogenic liana and a psychoactive bush, attracts people who seek to participate in a traditional indigenous ritual of spiritual and physical healing.Photo: Eitan Abramovich/AFP/Getty Images

Ayahuasca is the new “juice cleanse”; the drug of choice for the “age of kale”; a way to “cry, vomit, and feel amazing.” An Amazonian psychoactive brew, the hallucinogen strikes just the right balance between hipster status symbol (former Fleet Foxes singer-songwriter J. Tillman found his stage name Father John Misty on such a trip) and actual spiritual catalyst (as evidenced by its 5,000 years of indigenous use) that it hits multiple subcultures in the contemporary urban landscape. It’s both a vehicle of self-care for Goop-reading yogis and individuation for Joseph Campbell–loving Buddhists.

The ayahuasca boom coincides with a resurgence in hallucinogen as clinical intervention. LSD is helping cancer patients reckon with death; psilocybin is looking way more effective at helping smokers quit than the best pharmaceutical drugs. The question, then, is how does ayahuasca stack up as not just a journey into the self, but as a treatment?

Brazilian researcher Rafael Guimarães dos Santos summarized the state of the research for a recent post on The Conversation. Santos, a postdoctoral fellow at the University of São Paulo’s medical school, warns that the field is young but promising.

A 2016 review of observational studies of regular users found reductions in dependence and substance use; a preliminary 2015 study for depression treatment found 82 percent reductions in depression scores; and another 2016 review found that short-term use was associated with “improved planning and inhibitory control,” with potential antidepressive and anti-addiction applications. Intriguingly, a 2012 longitudinal study of long-term users found that regular use does not seem “to induce the pattern of addiction-related problems that characterize drugs of abuse.”

The problem with all this research is methodological: The placebo effect is real, especially in regards to depression interventions. If people are signing up for an ayahuasca trial, after all, they’re going to be biased to thinking that it’s going to help them with whatever emotional challenges they’re working through. That’s where Santos comes in: He and his colleagues are in the middle of an 80-person study on ayahuasca as a treatment for social anxiety, he reports, with a “double-blind, placebo-controlled design,” meaning that the results will be way more robust. The methodology is crucial, since less rigorous designs make it easier to do clickbaity, failing to replicate research. Ideally, one would think, the study Santos is co-authoring would have even more patients, making it even more robust.

The promise of a hallucinogenic intervention is that it’s the sort of thing that can change someone’s outlook on life for the better — an epiphany, a conversion, a peak experience. Matthew W. Johnson, the Johns Hopkins psychiatrist doing the smoking-cessation and psilocybin work, told Science of Us that he wasn’t specifically looking for a spiritual outcome, but it’s apparently what makes the difference. “Our data does indicate that stronger mystical experiences are associated with success,” Johnson wrote in an email. “Such experiences tend to reframe life priorities, with pure pleasure-seeking dropping, and other aspects increasing (family, connection, higher principles).” If it works with the active ingredient in mushrooms, the reasoning would go, then it should work with ayahuasca, too.