Who should not drink Ayahuasca? Understanding the Contraindications

Ayahuasca can be a powerful tool for healing and transformation, but it’s not for everyone. There are important safety considerations that must be taken seriously to avoid serious risks. If you're considering working with this sacred medicine, it's crucial to understand who should not drink Ayahuasca.

1. Medication Interactions: The Biochemistry Behind the Risk

Ayahuasca is a traditional Amazonian brew typically made from two plants: Banisteriopsis caapi (which contains harmala alkaloids like harmine and harmaline) and Psychotria viridis (which contains N,N-DMT). The harmala alkaloids are monoamine oxidase inhibitors (MAOIs)—specifically reversible inhibitors of monoamine oxidase A (RIMAs).

Why MAOIs Matter:

In the body, the enzyme monoamine oxidase A (MAO-A) breaks down neurotransmitters like serotonin, dopamine, and norepinephrine, as well as DMT itself. When MAO-A is inhibited by the harmala alkaloids, DMT becomes orally active, and neurotransmitters like serotonin linger longer in the synaptic cleft.

The Danger of Serotonin Syndrome:

If a person is taking medications that increase serotonin levels (like SSRIs or SNRIs), and then consumes an MAOI like in Ayahuasca, the brain can become flooded with serotonin. This can lead to serotonin syndrome—a potentially fatal condition characterized by high blood pressure, confusion, tremors, fever, and even seizures or death.

Medications that are contraindicated include:

• SSRIs, SNRIs (e.g., Prozac, Zoloft, Effexor) – These increase serotonin availability, and combining them with an MAOI can dangerously amplify this effect.

• MAOIs (prescription types) – Combining different MAOIs can be fatal.

• Tricyclic antidepressants – These affect serotonin and norepinephrine and have a narrow safety margin.

• Benzodiazepines (e.g., Xanax, Valium) – While not serotonergic, they may blunt the Ayahuasca experience and complicate withdrawal.

• Stimulants (e.g., Adderall, Ritalin) – These affect dopamine and norepinephrine and can lead to hypertensive crises when combined with MAOIs.

• Opioids (especially tramadol, fentanyl, or morphine) – Can dangerously increase serotonin or suppress respiration.

• Mood stabilizers (e.g., Lithium) – May increase risk of seizures or neurological side effects.

• Certain herbal supplements – Especially St. John’s Wort, which also increases serotonin.

It’s essential to taper off any contraindicated medications slowly and under the supervision of a qualified medical professional. For SSRIs, this often requires several weeks or even months to allow the body and brain chemistry to return to a baseline.

2. Mental Health Conditions: A Delicate Balance

Ayahuasca is known for amplifying inner psychological content—bringing unconscious material to the surface. This can lead to breakthroughs, but also to destabilization in vulnerable individuals.

Psychosis and Schizophrenia:

People with schizophrenia or a family history of psychosis are at elevated risk. This is because DMT (the active ingredient in Ayahuasca) is a serotonergic psychedelic that primarily acts on 5-HT2A receptors in the brain—similar to LSD or psilocybin.

For individuals predisposed to psychosis, overstimulation of these receptors can trigger hallucinations, paranoia, and delusional thinking—even outside of the ceremonial context—and may lead to long-term psychiatric episodes.

Bipolar Disorder:

Bipolar individuals, especially those with Type I, may be destabilized into manic or hypomanic episodes due to the intense emotional stimulation of Ayahuasca. Mania can include impulsivity, delusions of grandeur, and risky behavior—potentially worsened by the ceremonial environment.

Borderline Personality Disorder (BPD) and Trauma:

While not an absolute contraindication, people with complex trauma or BPD may have difficulty regulating the intense emotional catharsis that Ayahuasca can evoke. Proper preparation, screening, and integration support are essential.

Depression and PTSD:

Many people with these conditions have benefited from Ayahuasca—but only under safe, supportive, and well-guided conditions. Combining Ayahuasca with antidepressants (especially SSRIs) is dangerous and must be avoided.

3. Heart Conditions: The Cardiovascular Load

Ayahuasca activates the sympathetic nervous system, leading to temporary increases in heart rate and blood pressure. For individuals with:

• Arrhythmias

• High blood pressure (hypertension)

• Heart disease

• History of stroke or aneurysm

...this could be risky or even fatal. Even in healthy individuals, it’s not uncommon to experience strong palpitations, chest pressure, or blood pressure spikes during intense parts of the journey.

What Happens Chemically:

Ayahuasca raises levels of norepinephrine and epinephrine, stress hormones that activate the "fight or flight" response. This can strain an already compromised cardiovascular system. Medical clearance is strongly recommended for anyone with a known heart condition.

4. Pregnancy and Breastfeeding

There is very little research on the safety of Ayahuasca during pregnancy or lactation. The pharmacological impact on a fetus or nursing infant is not well understood. Both DMT and harmala alkaloids cross the blood-brain barrier and could, in theory, cross the placenta or be excreted in breast milk.

Given the unknowns—and the emotional intensity of the experience—it is best to avoid Ayahuasca during pregnancy and while breastfeeding.

5. Other Substances and Purity of Body

A clean system is critical for safe and deep work with Ayahuasca. Using other substances—like alcohol, cannabis, cocaine, MDMA, or even caffeine—in the days or weeks before can either dull or dangerously amplify the medicine’s effects.

Some substances:

• Compete with serotonin receptors

• Stress the liver or kidneys

• Alter neurotransmitter levels

• Impair your emotional processing

Many traditions recommend a “dieta” not just for energetic alignment, but for biochemical safety and spiritual clarity.

6. Tapering Off Medications: A Dangerous Shortcut

In recent years, some individuals—eager to experience the transformative potential of Ayahuasca—have chosen to stop taking their psychiatric medications in order to participate in ceremonies. While the desire for healing is valid, the method can be extremely risky and even life-threatening if done improperly.

Discontinuing psychiatric medication should never be done without medical supervision. This includes SSRIs, antipsychotics, mood stabilizers, and other medications that affect brain chemistry. The dosage, duration of use, and individual sensitivity all play a role in determining how long it takes for these substances to clear the system safely.

Even if the medication itself is no longer in your body, this does not automatically mean you are ready for Ayahuasca. Why?

Because stopping psychiatric medication can trigger:

• Emotional destabilization

• Rebound depression or anxiety

• Withdrawal syndromes

• Increased risk of psychosis or mania

Mental and emotional readiness is just as important as biochemical compatibility. It’s not enough to be “off meds”—you must also be grounded, supported, and stable enough to face the intense psychological, emotional, and sometimes spiritual material that Ayahuasca can surface.

Without proper preparation and post-ceremony integration, the experience can become disorienting or retraumatizing, rather than healing. The potential of Ayahuasca is not in the visuals or catharsis of a single night, but in how we process, apply, and integrate what we’ve been shown into our lives.

7. A Traditional Alternative: Participating Without Drinking

In modern ceremonies, it has become common practice for all participants to drink Ayahuasca. However, this is a modern adaptation, not a requirement. Traditionally, in many Amazonian lineages, only the healer (curandero or shaman) drinks the brew, while singing healing songs (icaros) for the participants.

There is another way to participate that honors the ceremony while respecting your personal health limitations: topical application.

In certain cases, a small amount of Ayahuasca can be applied to the skin (e.g., forehead, chest, or wrists) as a symbolic and energetic gesture of participation. Some facilitators also offer floral water or other plant preparations for cleansing and energetic connection.

You can also join the ceremony through meditation and presence, sitting or lying in the ceremonial space (maloka), and allowing the icaros and energetic field to do their work.

Many participants who have chosen not to drink—or who were advised against it for medical reasons—report:

• Deep emotional insights

• Feelings of release or connection

• Clarity and inner peace

• A sense of belonging and spiritual nourishment

Healing does not depend solely on drinking Ayahuasca. The ceremonial space itself is a field of transformation, and your willingness to be present, open, and honest can be just as powerful as ingesting the medicine.

Final Thoughts

Ayahuasca is not a casual experience—it’s a potent medicine that demands respect, honesty, and careful preparation. Understanding your mental health, physical condition, and medication use is essential to ensuring a safe and beneficial journey.

If you’re unsure whether it’s safe for you, speak openly with facilitators, a knowledgeable medical professional, or an integrative psychotherapist. With the right foundation, Ayahuasca can offer profound healing. But without it, the risks may outweigh the benefits.