This case report describes the clinical profile of a man from Argentina with a family history of bipolar disorder who participated in a four-day Ayahuasca ceremony that led to the eruption of a hypomanic episode two days after, consisting of mystical and paranoid delusional ideas, auditory hallucinations, racing thoughts, disorganized behavior, elevated energy, and manic euphoria. Given that the remission of psychotic symptoms was immediately followed by an onset of depressive symptoms, the authors theorize that antidepressant effects of harmine may have occasioned the manic shift of his bipolar disorder.

Abstract

“Background: There is an increasing use of ayahuasca for recreational purposes. Furthermore, there is a growing evidence for the antidepressant properties of its components. However, there are no reports on the effects of this substance in the psychiatric setting. Harmaline, one of the main components of ayahuasca, is a selective and reversible MAO-A inhibitor and a serotonin reuptake inhibitor.

Case report: We present the case of a man with bipolar disorder who had a manic episode after an ayahuasca consumption ritual. This patient had had at least one hypomanic episode in the past and is currently depressed. We discuss the diagnostic repercussion of this manic episode.

Conclusion: There is lack of specificity in the diagnosis of substance-induced mental disorder. The knowledge of the pharmacodynamic properties of ayahuasca consumption allows a more physiopathological approach to the diagnosis of the patient.”

Authors: Alejandro G. Szmulewicz, Marina P. Valerio & Jose M. Smith

Summary

Ayahuasca is used for recreational purposes and has antidepressant properties. However, there are no reports on its effects in the psychiatric setting.

A man with bipolar disorder had a manic episode after an ayahuasca.

This patient had a consumption ritual.

We discuss the diagnostic repercussions of this manic episode.

Conclusion: The diagnosis of substance-induced mental disorder is lacking in specificity.

Ayahuasca and bipolar disorder

Background

Ayahuasca is a psychotropic beverage, composed of a mixture of Amazonian plants, which contains DMT, a tryptamine, and a 5HT 2A agonist. DMT is orally inactive due to intestinal MAO-A metabolism, but becomes active when combined with harmine, a peripheral MAO-A inhibitor.

Case presentation

A 30-year-old Argentinian man was admitted to our emergency room after being discharged from a hospital in Brazil.

The patient had traveled to Brazil to learn about South American tribes, and had taken part in an ayahuasca consumption ritual. Two days after the last consumption, he began having psychotic symptoms and was taken to a psychiatric hospital where he received medication.

The patient, who was born eutocic, developed asthma, enuresis, and night terrors when he was 6 years old. He graduated from high school and started a course of business management.

Two weeks before the journey to Brazil, the patient presented with increased energy, goal-directed activity, sleep disorder, pressured speech, increased self-esteem, and running thoughts. His affect was depressed, and he showed marked anhedonia, apathy, and clinophilia.

Discussion

Ayahuasca-induced psychotic disorders are diagnosed when the characteristic symptoms of the disorder appear during or up to 1 month after the consumption of a substance, if there is no data to justify a primary disorder.

We believe that this patient had an antidepressant-induced mania due to excessively prolonged use of a substance with antidepressant properties and his bipolar disorder.

Conclusions

In our patient, the antidepressant effect of the substance and his bipolar disorder diagnosis caused manic symptoms. This case illustrates the lack of specificity in the diagnosis of a substance-induced psychotic episode.