What Is Ayahuasca? The Brew, the DMT, the Risks, and the Honest Picture
A clinician’s guide to ayahuasca: what the brew is and how it works, what a ceremony involves, the genuine risks including dangerous drug interactions, the psychological dangers, and what the evidence does and does not say about healing.
Clinically reviewed by Dr. Ponlawat Pitsuwan, Physician and Addiction Medicine Specialist, Phuket Island Rehab.
Ayahuasca is a psychoactive brew made from the Banisteriopsis caapi vine combined with a DMT-containing plant such as the leaves of Psychotria viridis, traditionally used in spiritual and healing ceremonies by Indigenous peoples of the Amazon. It works because the vine contains MAOI compounds that allow the powerful psychedelic DMT to be active when drunk, producing several hours of intense altered perception, visions, emotional release, and often vomiting and diarrhoea, known as the purge. Ayahuasca is not physically addictive, but it carries real risks: dangerous interactions with antidepressants and other medications, serious psychological reactions especially in people with a personal or family history of psychosis or bipolar disorder, and rare deaths linked to unregulated retreats. It is being studied for depression, trauma, and addiction, but the research is early. Anyone considering it should understand the medical and psychological risks honestly first.
What ayahuasca is
Ayahuasca is a psychoactive brew, usually a bitter tea, that has been used for centuries in the spiritual and healing ceremonies of Indigenous peoples of the Amazon basin in South America. The name is often used both for the finished brew and for one of its key ingredients, the Banisteriopsis caapi vine. The traditional brew is made by combining this vine with a plant that contains DMT, most commonly the leaves of Psychotria viridis, known as chacruna. Together these plants produce a powerful, long-lasting psychedelic experience that sits at the centre of traditional ceremonies and, increasingly, of a global retreat industry.
In its traditional context, ayahuasca is regarded as a sacred medicine, taken in ceremony under the guidance of an experienced leader, often called a shaman or curandero, for purposes of healing, insight, and spiritual connection. In recent decades it has spread far beyond the Amazon, with retreats in South America and around the world drawing people seeking healing from depression, trauma, addiction, or simply a profound experience. This wider use has brought the brew to people who often know little about what it actually is or what its risks are, which is the gap this guide is meant to fill.
How ayahuasca works
The pharmacology of ayahuasca is genuinely clever and is the key to understanding both its effects and its dangers. The active psychedelic is DMT, a powerful, short-acting compound that on its own is broken down so quickly by an enzyme in the gut and liver, called monoamine oxidase, that it has almost no effect when swallowed. The Banisteriopsis caapi vine contains compounds called beta-carbolines that act as monoamine oxidase inhibitors, or MAOIs. By blocking that enzyme, the vine allows the DMT from the companion plant to survive digestion, enter the bloodstream, and reach the brain, where it produces several hours of intense psychedelic effects.
This combination is what makes ayahuasca work, and it is also what makes it medically risky. The MAOI compounds in the vine do not only protect the DMT; they affect the body’s handling of other substances and certain foods, which is the basis of several dangerous interactions. Understanding that ayahuasca is, in effect, a strong psychedelic plus an MAOI is essential to understanding why it is not a substance to take casually or without knowing what else is in your body.
What a ceremony and the experience involve
An ayahuasca ceremony is usually held at night, in a group, under the guidance of a facilitator, and lasts several hours. Participants drink the brew and then sit or lie quietly as the effects build over the following hour. The experience itself is intense and varies widely between people and between sessions. It commonly includes vivid visual imagery and visions, a powerful sense of emotional release, the surfacing of memories and feelings, altered perception of time and self, and sometimes experiences described as deeply meaningful or spiritual. It can also include fear, confusion, and frightening or distressing content, what is sometimes called a difficult journey.
A near-universal feature of ayahuasca is the purge: most participants vomit, and many also have diarrhoea, during the experience. In the traditional framework this is regarded as a cleansing and a meaningful part of the process rather than a side effect. Physically it reflects the brew’s effect on the gut and the MAOI activity. The intensity, the duration of several hours, the purging, and the emotional depth are why the setting and the experience of the facilitator matter so much, and why ayahuasca is very different from a brief recreational drug experience.
The real risks of ayahuasca
The most important medical risk of ayahuasca comes from its MAOI content interacting with other substances. Combining ayahuasca with many antidepressants, particularly SSRIs and the older MAOI antidepressants, can cause serotonin syndrome, a dangerous and potentially fatal reaction with agitation, high temperature, muscle rigidity, and a racing heart. The MAOI activity can also cause dangerous spikes in blood pressure when combined with certain foods and medications, including some cold and allergy remedies and stimulants. Anyone on antidepressants or other regular medication faces a serious and underappreciated risk, and people frequently arrive at retreats without understanding this.
The second major risk is psychological. A powerful psychedelic can trigger or worsen serious mental illness, and ayahuasca can precipitate prolonged anxiety, psychosis, or mania, particularly in people with a personal or family history of schizophrenia, psychosis, or bipolar disorder, for whom it is generally considered unsafe. Even in people without that history, a frightening experience can be destabilising, and lasting psychological distress sometimes follows. There are also physical risks: the strain on the heart and blood pressure can be dangerous for people with cardiovascular conditions, and a number of deaths have been linked to ayahuasca retreats, sometimes involving undisclosed health conditions, drug interactions, other substances given alongside, or inadequate screening and supervision at unregulated retreats.
Is ayahuasca addictive?
Ayahuasca is not physically addictive in the way that alcohol, opioids, or benzodiazepines are. It does not produce physical dependence or a withdrawal syndrome, people do not generally develop tolerance that drives escalating use, and the demanding, purging, hours-long nature of the experience does not lend itself to compulsive repeated use. In this narrow sense it is not a drug of dependence, and classic addiction to ayahuasca itself is uncommon.
That does not make it free of risk of misuse. Some people come to rely on repeated ceremonies in an unhealthy way, using them to avoid dealing with life rather than to support genuine change, and the retreat culture can encourage a search for one more breakthrough that becomes its own kind of escape. People with substance use disorders sometimes turn to ayahuasca hoping for a cure and instead destabilise their recovery, especially if other substances are involved. So while ayahuasca is not addictive in the physical sense, it is not a harmless or consequence-free practice, and it is not a substitute for evidence-based treatment of addiction or mental illness.
What the evidence says about healing
There is real and growing scientific interest in ayahuasca and its components for conditions such as depression, post-traumatic stress, and addiction, alongside the wider research into psychedelics. Some early studies and observational reports suggest possible benefits for mood and for processing trauma, and the experience can be genuinely meaningful for participants. But the research is still early, much of it is small or uncontrolled, and it is conducted in carefully screened and supervised settings that look nothing like an unregulated retreat. It is honest to say that the evidence is promising in places and far from settled, and that the gap between the scientific picture and the marketing of retreats is large.
For someone struggling with depression, trauma, or addiction, the responsible position is that ayahuasca is not an established treatment, carries real risks, and is no substitute for proven care. If the underlying problem is a substance use disorder or a mental health condition, the safest and most effective path remains evidence-based treatment, and anyone drawn to ayahuasca for healing would be wise to address those conditions properly first and to be honest with a doctor about any medications and history before considering a psychedelic of any kind.
When substance use has become more than occasional
People are often drawn to ayahuasca precisely because they are struggling, with low mood, with trauma, or with their drinking or drug use, and are looking for something that conventional approaches have not given them. That impulse is understandable, but a psychedelic brew with the risks described here is a poor and sometimes dangerous substitute for treatment, particularly when alcohol or other drugs are part of the picture. Alcohol use disorder and other addictions respond to structured, evidence-based care, and the urge to seek a single transformative experience is itself sometimes a sign of how much pain a person is in.
If you or someone you love is drinking heavily, using drugs, or struggling with mental health to the point of looking for a dramatic fix, it is worth seeking proper help. Addiction and depression are treatable, and the steady work of detox where needed, therapy, and support does what people hope a single ceremony will do, more reliably and far more safely. Anyone who is physically dependent on alcohol or benzodiazepines should not stop suddenly, because withdrawal can cause seizures, and should seek medical support. Real help exists, and it works.
Summary
Ayahuasca is a psychoactive brew made from the Banisteriopsis caapi vine combined with a DMT-containing plant, traditionally used in Amazonian spiritual and healing ceremonies. It works because MAOI compounds in the vine allow the powerful psychedelic DMT to be active when drunk, producing several hours of intense visions, emotional release, and usually purging. It is not physically addictive, but it carries real risks: dangerous interactions with antidepressants and other medications through its MAOI activity, serious psychological reactions especially in people prone to psychosis or bipolar disorder, cardiovascular strain, and deaths linked to unregulated retreats. It is being studied for depression, trauma, and addiction, but the research is early and is no substitute for proven treatment. Anyone considering it should understand the medical and psychological risks honestly first.
As Dr. Ponlawat Pitsuwan, addiction medicine specialist at Phuket Island Rehab, puts it, “People often picture ayahuasca as a gentle plant medicine, but pharmacologically it is a strong psychedelic combined with an MAOI, and that combination can interact dangerously with antidepressants and with a vulnerable mind. I am not here to romanticise it or to demonise it. I am here to say that if you are in enough pain to be seeking it out, there is safer, proven help, and it is worth trying that first.”
Frequently asked questions
What is ayahuasca made of?
Ayahuasca is a brew made from the Banisteriopsis caapi vine combined with a DMT-containing plant, most often the leaves of Psychotria viridis, known as chacruna. The vine provides MAOI compounds that allow the DMT to be active when drunk, and the companion plant provides the DMT itself. Together they create the psychoactive tea used in Amazonian ceremonies.
Is ayahuasca a drug?
Yes, ayahuasca is a psychoactive drug. Its active ingredient, DMT, is a powerful psychedelic, and the brew is illegal in many countries, although it has protected legal status for traditional and religious use in some places. Calling it a plant medicine reflects its traditional role but does not change the fact that it is a potent psychoactive substance with real pharmacological effects and risks.
Is ayahuasca addictive?
Ayahuasca is not physically addictive. It does not cause physical dependence or withdrawal, and its demanding, hours-long, purging nature does not lend itself to compulsive use. However, some people come to rely on repeated ceremonies in an unhealthy way as a form of avoidance, and people with addictions sometimes turn to it hoping for a cure and destabilise their recovery. It is not a substitute for evidence-based treatment.
What are the dangers of ayahuasca?
The main dangers are dangerous interactions with antidepressants and other medications through the brew’s MAOI content, which can cause serotonin syndrome and blood pressure spikes, serious psychological reactions including prolonged anxiety, psychosis, or mania especially in people prone to them, cardiovascular strain, and the variable safety of unregulated retreats, several of which have been linked to deaths. Proper medical screening and disclosure of medications and health history are essential, and many retreats do not provide them.
Why do people vomit during ayahuasca?
Vomiting and diarrhoea, known as the purge, are an almost universal part of the ayahuasca experience, caused by the brew’s effects on the gut and its MAOI activity. In the traditional framework the purge is regarded as a cleansing and a meaningful part of the process rather than a side effect. It is one of the reasons the experience is physically demanding and very different from a brief recreational drug experience.
Can ayahuasca treat depression or addiction?
There is genuine scientific interest in ayahuasca for depression, trauma, and addiction, and some early studies and reports suggest possible benefits, but the research is still small, early, and conducted in carefully screened and supervised settings unlike most retreats. It is not an established treatment, it carries real risks, and it is no substitute for proven care. Anyone struggling with depression or addiction should pursue evidence-based treatment and be honest with a doctor about medications and history first.
Sources
National Institute on Drug Abuse (NIDA). Hallucinogens DrugFacts. https://nida.nih.gov/publications/drugfacts/hallucinogens
Substance Abuse and Mental Health Services Administration (SAMHSA). Mental Health and Substance Use. https://www.samhsa.gov/
National Institutes of Health (NIH). Research on Psychedelics and Mental Health. https://www.nih.gov/
National Health Service (NHS). Serotonin Syndrome. https://www.nhs.uk/conditions/serotonin-syndrome/
World Health Organization (WHO). Mental Health and Substance Use. https://www.who.int/health-topics/mental-health
National Institute on Drug Abuse (NIDA). DMT. https://nida.nih.gov/research-topics/hallucinogens
What is ayahuasca — key entities and related terms
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