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Some anecdotal and early research evidence suggests that ibogaine, a compound derived from a shrub in western Central African, may help reduce symptoms of drug and alcohol withdrawal, ease cravings, and lower the risk of recurrent use.
Although some expertsTrusted Source acknowledge that ibogaine could be an excellent alternative treatment, the Drug Enforcement Agency (DEA) recognizes it as a Schedule I substance. This classification means that it is illegal and currently has no approved medical use in the United States.
This article explains more about ibogaine, including what the research says so far about using it to treat addiction and the potential risks. It also lists some other psychedelic compounds that may be useful in addiction treatment.
What is ibogaine?
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Ibogaine is a type of compound called an alkaloid. It is the most abundantTrusted Source alkaloid that Tabernanthe iboga, a mid-sized shrub native to western Central Africa, produces.
The Bwiti religion uses different parts of T. iboga for certain healing and religious purposes. For example, as well as having hallucinogenic effects, the roots and root bark of the shrub can be effective in:
- restoring good health
- increasing sexual arousal or behavior
- reducing fever
The leaves of T.iboga also act as an aphrodisiac. In addition, their anesthetic properties mean that they can numb pain.
Research suggests that in small doses, ibogaine usually acts as a mild stimulant. However, larger quantities can cause hallucinations and induce a profound psychedelic state. This state may significantly reduce symptoms of opioid withdrawal and block substance cravings.
In the 1980s, ibogaine became popular in Europe and the U.S. as a nonaddictive treatment option for drug dependency. Since then, some research indicates that ibogaine may also be useful for the treatment of neuropsychiatric conditions, alcohol use disorder, and depression.
Using ibogaine to treat addiction
Despite the classification of ibogaine as a Schedule I drug, researchers renewed their investigations of the substance as a treatment for addiction in the late 1990s.
However, according to a 2020 article in NatureTrusted Source, scientists have not yet tested ibogaine in placebo-controlled, double-blind clinical trials. Instead, they have only looked at ibogaine’s potential benefits in open-label studies, in which all the participants were aware of which form of treatment they were taking.
Anecdotal reports around ibogaine’s medical uses also indicate that it has promise as a treatment, but these reports are usually based on hearsay, observations, or historical accounts, as opposed to scientific research and trials.
Other major issuesTrusted Source may prevent ibogaine from therapeutic use, even if researchers establish its medical properties. For instance, it is hard to gather large quantities of ibogaine because humans have overexploited T. iboga. There are currently only three ways to make synthetic ibogaine, all of which involve numerous steps and produce extremely low yields.
The safety profile of ibogaine is also currently unacceptable. The compound tends to accumulate in fatty tissues and can block potassium channels, causing heart problems. Furthermore, several people have died from ibogaine toxicity. Ibogaine can also cause hallucinations that can be severe and last longer than 24 hoursTrusted Source.
Successes
Researchers around the world continue to explore ibogaine’s potential medical uses — in particular, its use as a treatment for addiction and neuropsychiatric conditions. Thousands of studies have investigated the different properties of ibogaine, its potential uses, and its effectiveness. Currently, Brazil, South Africa, and New Zealand classify ibogaine as a pharmaceutical substance that licensed medical professionals can use.
Some researchTrusted Source suggests that ibogaine somehow changes addiction-related or promoting pathways between nerve cells in the brain. It may also affect signaling in brain regions that play a role in the behavioral effects of drugs that are addictive.
Hallucinogens such as ibogaine may also activateTrusted Source the 5-HT2A serotonin receptor (HTR2A). Serotonin is a brain hormone that helps improve mood, happiness, and feelings of well-being.
In a 2014 study in Brazil, researchers recruited 75 participants who previously used cannabis, cocaine, crack cocaine, or alcohol. The participants who received one ibogaine treatment reported abstaining from drug use for a median of 5.5 months. Those who received multiple ibogaine treatments abstained for a median of 8.4 months.
The Multidisciplinary Association for Psychedelic Studies (MAPS) also helped fund two observational studies in 2017 that supported the use of ibogaine as a treatment for addiction to drugs.
In the first of these studies, which took place in Mexico, ibogaine use improved symptoms of opioid withdrawal and reduced subsequent drug use in people who had found other treatment options ineffective.
In the other study, researchers in New Zealand concluded that a single treatment with ibogaine reduced symptoms of opioid withdrawal in people dependent on opioids over 12 months. It also helped people stop taking opioids or maintain a reduced use. However, one person in the study died during treatment.
Some researchersTrusted Source are currently trying to modify psychedelic compounds such as ibogaine to make them safer by reducing their ability to cause hallucinations.
In 2012, the National Institute on Drug Abuse pledged $6.5 million to develop a nonpsychoactive version of ibogaine called 18-methoxycoronaridine (18-MC). Currently, researchers have completed a phase 1 human clinical trial of 18-MC, and there are plans for phase 2a clinical trials.
Risks
The DEA classifies ibogaine as a Schedule I controlled substance. According to this classification, ibogaine:
- has no currently accepted medical use
- lacks evidence to show that it is safe for use under medical supervision
- has a high risk of abuse and addiction
- can be a dangerous substance
Furthermore, ibogaine can be toxic, with the potential to cause paralysis, convulsions, and death from respiratory failure or heart failure.
According to MAPS, 30 people have died due to ingesting ibogaine in peer-reviewed scientific works. However, the association claims that researchers could have avoided most of these deaths by taking preventive steps, such as screening properly for medical conditions, monitoring electrolyte levels, and monitoring cardiac health.
Other psychedelics to treat addiction
Open-label studies and anecdotal reports also supportTrusted Source the use of psychedelic drugs for addiction treatment, including lysergic acid diethylamide (LSD) and psilocybin, which contains the active ingredient psilocin.
The psychiatric community has suggested a few other psychedelics as treatments for addiction, including:
- ketamine
- ayahuasca
- peyote (mescaline)
- substituted N-benzyl phenylalkylamines
- N,N-dimethyltryptamine (DMT)
- kratom
- 3,4-methylenedioxymethamphetamine (MDMA)
- salvia
Summary
Ibogaine has shown a lot of promise in early research, but the DEA has classified it as an illegal, dangerous substance in the U.S.
The reason for this classification is that there is not enough large-scale clinical research to support the effectiveness or safety of ibogaine as a treatment and to confirm how to use it therapeutically.
However, ibogaine seems to have a lot of potential, and researchers continue to study its therapeutic uses, with more and more studies emerging.
At present, it is important to note that people should never attempt to purchase ibogaine or use it without the supervision of a licensed healthcare professional. It is illegal and can lead to death.ADVERTISEMENThttps://googleads.g.doubleclick.net/pagead/ads?gdpr=0&us_privacy=1YNY&gdpr_consent=tcunavailable&tcfe=3&client=ca-pub-4771166113579725&output=html&h=262&slotname=6271596127&adk=4186111579&adf=2283288762&pi=t.ma~as.6271596127&w=750&lmt=1639787116&rafmt=12&psa=0&format=750×262&url=https%3A%2F%2Fwww.medicalnewstoday.com%2Farticles%2Fibogaine-for-addicition%23ibogaine-and-addiction&flash=0&wgl=1&dt=1639787116439&bpp=1&bdt=823272&idt=1&shv=r20211207&mjsv=m202112060101&ptt=9&saldr=aa&abxe=1&cookie=ID%3De2e25ba50438bc32-22826dfb09cd0067%3AT%3D1639786293%3AS%3DALNI_MaV96JJfNwa8YaXYFra5I1mpiGq3Q&prev_fmts=0x0%2C728x90&nras=1&correlator=5815299456755&frm=20&pv=1&ga_vid=285273873.1639786294&ga_sid=1639786300&ga_hid=991260350&ga_fc=1&u_tz=60&u_his=1&u_h=900&u_w=1600&u_ah=852&u_aw=1600&u_cd=24&u_sd=1&adx=242&ady=5506&biw=1583&bih=767&scr_x=0&scr_y=5011&eid=31062422%2C31062930&oid=2&pvsid=1091882508564074&pem=928&tmod=693&ref=https%3A%2F%2Fwww.google.com%2F&eae=0&fc=896&brdim=-8%2C-8%2C-8%2C-8%2C1600%2C0%2C1616%2C868%2C1600%2C767&vis=1&rsz=%7C%7CpeE%7C&abl=CS&pfx=0&fu=256&bc=31&ifi=10&uci=a!a&fsb=1&xpc=WgdHUErC1k&p=https%3A//www.medicalnewstoday.com&dtd=5
Last medically reviewed on May 14, 2021
12 sourcescollapsedMedical News Today has strict sourcing guidelines and draws only from peer-reviewed studies, academic research institutions, and medical journals and associations. We avoid using tertiary references. We link primary sources — including studies, scientific references, and statistics — within each article and also list them in the resources section at the bottom of our articles. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.
- Brown, T. K., et al. (2017). Treatment of opioid use disorder with ibogaine: Detoxification and drug use outcomes.
https://www.tandfonline.com/doi/full/10.1080/00952990.2017.1320802 - Cameron, L. P., et al. (2020). A non-hallucinogenic psychedelic analogue with therapeutic potential.
https://www.nature.com/articles/s41586-020-3008-z.epdf?sharing_token=_v_aP4m6HpklSLriQ7hNt9RgN0jAjWel9jnR3ZoTv0MTwBsLC3XlYuvLqbxS1c8EyIGuIqdPD5Ybp8IFAe2WvXV12Bh5c6LmJRBQifSwO_uq_FJemy5Yn5qlTzgYtDBCmP1tRwzVN6dOzQsQ1Ol_8lbjXYtGF0Wm7kn2Khzfv4m9lHWt6rNdI9WzgVU1m7bk8USLbqx0hQyj6lDFcPBojg%3D%3D&tracking_referrer=www.npr.org - Drugs of abuse: A DEA resource guide. (2017).
https://www.dea.gov/sites/default/files/drug_of_abuse.pdf - Ibogaine. (2021).
https://pubchem.ncbi.nlm.nih.gov/compound/Ibogaine - Ibogaine therapy. (n.d.).
https://maps.org/research/ibogaine-therapy - Kim, K., et al. (2020). Structure of a hallucinogen-activated Gq-coupled 5-HT2A serotonin receptor.
https://www.cell.com/cell/fulltext/S0092-8674(20)31066-7?_returnURL=https%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS0092867420310667%3Fshowall%3Dtrue - Nigam, K. B., et al. (2021). Do hallucinations have a role in the treatment of addictions? A review of the current literature [Abstract].
https://link.springer.com/article/10.1007/s42399-021-00871-x - Noller, G. E., et al. (2017). Ibogaine treatment outcomes for opioid dependence from a twelve-month follow-up observational study.
https://www.tandfonline.com/doi/full/10.1080/00952990.2017.1310218 - Other psychedelic research. (n.d.).
https://maps.org/research/other-research - Schenberg, E. E. (2014). Treating drug dependence with the aid of ibogaine: A retrospective study [Abstract].
https://journals.sagepub.com/doi/10.1177/0269881114552713?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub++0pubmed& - Tabernanthe iboga — Baill. (n.d.).
https://pfaf.org/user/Plant.aspx?LatinName=Tabernanthe+iboga - Underwood, M. S., et al. (2021). A narrative review of the pharmacological, cultural and psychological literature on ibogaine.
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Medically reviewed by Debra Rose Wilson, Ph.D., MSN, R.N., IBCLC, AHN-BC, CHT — Written by Jennifer Huizen on May 14, 2021
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What to know about ayahuasca
Ayahuasca is a psychoactive tea that originates from the Amazon region. Psychoactive substances affect the brain and cause people to experience changes in their mood, thinking, and behavior.
Traditional healers in several South American countries use the tea for its reported healing properties. It also plays an important role in some types of religious ceremonies.
In recent years, research has highlighted several potential health benefits of ayahuasca. As a result, interest in this substance has been increasing in Western countries. However, much remains unknown.
Keep reading to learn more about the history of ayahuasca and its potential benefits, as well as the risks and side effects of this powerful brew.
What is it?
When a person consumes ayahuasca they may experience feelings of euphoria, hallucinations, and paranoia.
Ayahuasca is a psychoactive brew that people make using the leaves of the Psychotria viridis plant and the stalks of the Banisteriopsis caapi vine. It may also contain other ingredients.
The name “ayahuasca” originates from the Quechua language, where aya means soul or ancestors, and wasca (huasca) means vine or rope. Most people translate this as “vine of the soul.”
The brew has been popular in regions of the Amazon for millennia, for both medical and spiritual reasons. It inducesTrusted Source an “introspective dream-like experience” that includes visions and memories.
Today, people from all over the world travel to these places to participate in ayahuasca rituals.
How does it work?
Both plant ingredients in ayahuasca tea have hallucinogenic properties. The leaves of the P. viridis plant contain N,N-dimethyltryptamine (DMT), which is a strong psychedelic compound.
The B. caapi vine contains MAO inhibitors (MAOIs) called beta-carbolines. MAOIs stop the body from breaking down DMT, which allows the psychedelic effects to materialize. ADVERTISEMENTTry a top-rated app for meditation and sleep
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History, traditions, and uses
Neuroimaging tests reportTrusted Source that ayahuasca increases blood flow to areas of the brain that help regulate emotions and memory, including the medial temporal lobe, amygdala, and hippocampus.
People in Ecuador, Colombia, Peru, and Brazil have used ayahuasca as a healing medicine or as part of religious ceremonies or tribal rituals for thousands of years.
They use it to treat physical issues and mental problems, as well as to deal with spiritual crises. Some people believe that it can provide insight or emotional healing, encourage personal growth, and even foster contact with deities and spirits.
A shaman or curandero, who is a type of healer, will boil the P. viridis leaves and crushed B. caapi stalks in water.
Once the mixture reduces, the shaman will remove the water and add more plant material to form a very concentrated tea. They will then allow the tea to cool before straining it.
Ayahuasca ceremonies typically take place at night. Participants will notice the tea’s psychedelic effects within 1 hourTrusted Source, and these effects can last for up to 6 hours. Ceremonies often continue long after the effects wear off.
The effects of ayahuasca include:
- feelings of euphoria
- hallucinations
- fear
- paranoia
- gastrointestinal symptoms.
During a ceremony, people typically consume one or two drinksTrusted Source. Ceremonies may repeat several nights in a row. Pre-ceremony and postceremony rituals are an important part of the practice.
Modern-day ayahuasca churches include the Santo Daime and the União do Vegetal (UDV), which has members all over the world.
Although DMT is a schedule I controlled substance in the United States, the Supreme Court have upheldTrusted Source the right for members of the UDV to drink the substance under the Religious Freedom Restoration Act.
What are the health benefits?
Research indicates that ayahuasca may offer several potential health benefits, especially for brain health and emotional well-being. However, more studies are necessary to confirm these findings. Potential benefits include:
Brain health
Both DMT and beta-carbolines, the main psychoactive ingredients in ayahuasca, may protect and restore parts of the brain.
ResearchTrusted Source indicates that ingesting DMT can lead to a higher production of antistress and antioxidant proteins.
The findings of a 2017 studyTrusted Source in mice suggest that harmine, the primary beta-carboline in ayahuasca, may have neuroprotective and cognitive-enhancing effects because it reduces inflammation and oxidative stress. However, there is a need for studies to confirm these results in humans.
This research also links harmine with increased levels of brain-derived neurotrophic factor (BDNF), a protein that aids the survival of nerve cells, or neurons, and plays a role in maintaining connections between them.
Laboratory researchTrusted Source reports that harmine and other substances in B. caapi stimulate adult neurogenesis, the generation of neurons.
Mindfulness
According to some studies, ayahuasca may increase a person’s ability to be in a mindful state.
A small studyTrusted Source demonstrated that taking ayahuasca once a week for 4 weeks proved as effective as an 8 week mindfulness-based stress reduction (MBSR) course, in terms of increasing a person’s “acceptance.”
In this case, acceptance refers to nonjudgmental attitudes and behaviors, which the researchers measured using a “mindfulness score.”
However, the researchers advise that more studies with larger sample sizes are necessary to confirm these findings.
Other studiesTrusted Source also support the use of ayahuasca to improve mindfulness.
Mood and emotions
Ayahuasca may improve the regulation of mood and emotions, and it could also reduce stress and depression.
According to one studyTrusted Source, B. caapi preparations demonstrate antidepressant activity, possibly due to the presence of harmine and other substances that contribute to neurogenesis. Neurogenesis is the production of neurons.
Further to this, a 2018 studyTrusted Source that involved people who took part in ayahuasca ceremonies found that ratings of depression and stress significantly decreased following the ceremony. These lower levels of depression persisted for 4 weeks after the ceremony.
Other researchTrusted Source supports this evidence, suggesting that a single dose of ayahuasca may produce a rapid antidepressant effect in people with treatment-resistant depression. This antidepressant effect persists for several weeks.
Ayahuasca may also help treat anxiety and mood disorders, according to a reviewTrusted Source of six studies.
Post-traumatic stress disorder (PTSD)
A 2018 research paperTrusted Source suggests that ayahuasca may be beneficial for people with PTSD. It helps with the retrieval of repressed memories, which paves the way for the brain to reprogram or extinguish the associated fear response.
However, more research in this area is necessary to establish the safety and effectiveness of ayahuasca for people experiencing PTSD.
Addiction
Ayahuasca may also be beneficial for people with substance use disorders, according to several studies.
A small studyTrusted Source involving 12 people with psychological and behavioral issues arising from substance misuse took part in two ayahuasca ceremonies as part of a 4 day treatment program.
After 6 months, the participants continued to report positive and lasting changes. They also showed improvements in their overall quality-of-life scores, mindfulness, and sense of empowerment and hope.
The participants also reported a significant reduction in their use of alcohol, tobacco, and cocaine, but the use of cannabis and opiates did not change.
Supporting this idea, further evidenceTrusted Source also suggests that there are beneficial effects of ayahuasca for those with tobacco and alcohol dependence. Nonetheless, the reviewers call for further research into this area.
Suicidal ideation
A 2019 studyTrusted Source suggests that lifetime psychedelic use can lower levels of suicidal ideation. The study reports that ayahuasca shows promise as a form of treatment for a wide range of mental health issues that may contribute to suicidal ideation.
Ayahuasca might, therefore, have potential in suicide intervention, but more research is necessary to confirm this.
Risks and side effects
While some research highlights the potential benefits of ayahuasca, it is important to note that most of these studies were small scale, and some took place in animals or test tubes.
Researchers also carefully prepare and control the brews of ayahuasca that they use, but this is not always the case outside of clinical trials.
There are some serious side effects of ayahuasca use, including death. People may experience temporary symptoms shortly after drinking the brew, including:
- anxiety
- diarrhea
- nausea
- panic
- paranoia
- vomiting
Ayahuasca can also interact with several medications, herbs, and medical conditions, and these effects can sometimes be severe. People should not use ayahuasca if they are taking:
- antidepressants, including serotonin-norepinephrine reuptake inhibitors (SNRIs) and tricyclic antidepressants
- cough medications, such as dextromethorphan
- lithium or other psychiatric drugs
- medications for Parkinson’s disease
- methadone
- St. John’s wort
- weight loss pills
People with schizophrenia or other mental health disorders should also avoid taking ayahuasca.
The brew may increase heart rate and blood pressure, which could be problematic for individuals with heart problems.
In some casesTrusted Source, drinking ayahuasca has resulted in death. Often, this has been because the drink contained other substances. If an untrained person prepares the brew, this may increase the risk of serious adverse outcomes.
It is important that people with mental health disorders seek treatment only from a qualified medical professional.
Ayahuasca vs. magic mushrooms
While both ayahuasca and magic mushrooms have hallucinogenic properties, there are differences between the two substances.
Perhaps most crucially, the psychoactive ingredients are different. Magic mushrooms contain psilocybin rather than the DMT and beta-carbolines in ayahuasca brews.
Many people describe the effects of both substances as similar but not the same. Each person will react differently, however.
In one surveyTrusted Source, users indicated that ayahuasca had a stronger effect than magic mushrooms but also that its negative effects were higher. However, users rated the comedown of ayahuasca as less than that of magic mushrooms. Ayahuasca users also reported less of an urge for repeat use in comparison with magic mushroom users.
It is important to note that the potential health benefits of ayahuasca result from the effects of its active ingredients. As mushrooms have a different active ingredient, they may not have the same outcomes in terms of brain health and well-being.
You can read more about the effects of magic mushrooms here.Medical News Today NewsletterKnowledge is power. Get our free daily newsletter.
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Summary
Ayahuasca is a psychedelic brew that originated in the Amazon regions. In recent years, interest in the potential benefits of ayahuasca has grown in Western counties.
Research is in its early stages, but so far, studies suggest that ayahuasca may have several neurological and psychological health benefits.
However, individuals should be aware that the control of ayahuasca use outside of clinical trials is less stringent. There is also the potential to have negative and unsafe experiences with ayahuasca, and in some cases, taking this substance has resulted in death.
Ayahuasca can interact with several medications, and it is not suitable for people with certain health conditions. ADVERTISEMENTTraditional therapy – done online
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Last medically reviewed on January 31, 2020
- Alcohol / Addiction / Illegal Drugs
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- Complementary Medicine / Alternative Medicine
14 sourcescollapsedMedical News Today has strict sourcing guidelines and draws only from peer-reviewed studies, academic research institutions, and medical journals and associations. We avoid using tertiary references. We link primary sources — including studies, scientific references, and statistics — within each article and also list them in the resources section at the bottom of our articles. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.
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https://www.ncbi.nlm.nih.gov/pubmed/27918874 - Dos Santos, R. G., et al. (2016). Antidepressive, anxiolytic, and antiaddictive effects of ayahuasca, psilocybin and lysergic acid diethylamide (LSD): A systematic review of clinical trials published in the last 25 years.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4910400/ - Frecska, E., et al. (2016). The therapeutic potentials of ayahuasca: Possible effects against various diseases of civilization.
https://www.frontiersin.org/articles/10.3389/fphar.2016.00035/full - Graziano, S., et al. (2017). Herbal highs: Review on psychoactive effects and neuropharmacology.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5771051/ - Inserra, A., et al. (2018). Hypothesis: The psychedelic ayahuasca heals traumatic memories via a sigma 1 receptor-mediated epigenetic-mnemonic process.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5895707/ - Lawn, W., et al. (2017). Well-being, problematic alcohol consumption and acute subjective drug effects in past-year ayahuasca users: A large, international, self-selecting online survey.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5680239/ - Malcolm, B. J., et al. (2017). Ayahuasca: An ancient sacrament for treatment of contemporary psychiatric illness?
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6007657/ - Morales-García, J. A., et al. (2017). The alkaloids of Banisteriopsis caapi, the plant source of the Amazonian hallucinogen Ayahuasca, stimulate adult neurogenesis in vitro.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5509699/ - Soler, J., et al. (2016). Exploring the therapeutic potential of Ayahuasca: Acute intake increases mindfulness-related capacities [Abstract].
https://www.ncbi.nlm.nih.gov/pubmed/26612618 - Soler, J., et al. (2018). Four weekly ayahuasca sessions lead to increases in “acceptance” capacities: A comparison study with a standard 8-week mindfulness training program.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5869920/ - Szabo, A., et al. (2016). The endogenous hallucinogen and trace amine N,N-Dimethyltryptamine (DMT) displays potent protective effects against hypoxia via sigma-1 receptor activation in human primary iPSC-derived cortical neurons and microglia-like immune cells.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5021697/ - Thomas, G., et al. (2013). Ayahuasca-assisted therapy for addiction: Results from a preliminary observational study in Canada [Abstract].
https://www.ncbi.nlm.nih.gov/pubmed/23627784 - Uthaug, M. V., et al. (2018). Sub-acute and long-term effects of ayahuasca on affect and cognitive thinking style and their association with ego dissolution.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6182612/ - Zeifman, R. J., et al. (2019). The impact of ayahuasca on suicidality: Results from a randomized controlled trial.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6878725/
Medically reviewed by Kathy W. Warwick, R.D., CDE, Nutrition — Written by Jayne Leonard on January 31, 2020
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