Illustration by Mila Tovar
In our series ‘Psychedelics and Mental Health,’ the Lovepost interviews experts in psilocybin, LSD, Ayahuasca, and cannabis, to explore the resurgence of psychedelics in research. We consider how they have been used across the ages to treat mental health conditions, address trauma and enhance one's enjoyment of life and connection to Self and nature. We discuss the impact of the 'war on drugs' on psychedelic research, usage and public perception; while also paying particular attention to the racial and political motivations which have driven this. As the world wakes up to the potential of hallucinogens, we consider a future where these drugs are better understood and positively integrated into mental health care.
Dr Simon Ruffell is a London-based psychiatrist and researcher with an interest in psychedelics. He has studied both psilocybin and ketamine as treatments for depression. Dr Ruffell has been researching Ayahuasca in the Peruvian Amazon since 2016, exploring how this “most complex” psychedelic can be used to enhance mental wellbeing. He will soon be joining the Psychae Institute in Melbourne, a non-profit research centre dedicated to developing new psychedelic therapies. He spoke to The Lovepost on behalf of Onaya Science, the not-for-profit research institute he co-founded. His research is largely based at the Ayahuasca Foundation, which works to preserve Indigenous wisdom and culture while offering Ayahuasca healing retreats and education courses.
As this series is about exploring the impacts of psychedelics on mental health, I'd like to begin by asking about what Ayahuasca is and how it interacts with the mind.
From a reductionist-scientific view, Ayahuasca is a psychedelic brew from the Amazon rainforest. It's been used for hundreds—if not thousands—of years to communicate with the spirit world.
It's always funny when people ask me this question. It's actually quite difficult to answer because Ayahuasca is many different things to many different people. But very simply put, it's a mix of the Banisteriopsis caapi vine, also known as the Ayahuasca vine, and some leaves that contain the potent psychedelic Dimethyltryptamine (DMT). That's usually Psychotria viridis, but you can have different kinds of leaves. I think in New Zealand, the most common one is acacia.
So you have all of these different leaves that contain DMT. And usually, if you were to consume DMT orally, it would get broken down by enzymes in your stomach. But when you mix it with the Banisteriopsis caapi vine (the Ayahuasca vine), the vine contains harmala alkaloids, which are naturally occurring beta-carbolines. These contain enzymes that prevent the breakdown of DMT in the stomach, allowing DMT to get absorbed into the bloodstream [instead]—and [so] you get the powerful psychedelic effects associated with DMT. In a very kind of potted version, that's how Ayahuasca works physiologically.
I'm not sure if there's a better word, but what can someone expect from an Ayahuasca ‘trip’? Are there commonalities or is it different for every person?
I think there definitely are commonalities. Many people describe changes in their sense of perception. They might be able to see or hear things that other people may not be able to see or hear. Or they might experience changes in their cognition, where they have this deep sense of introspection. They may think about things in a different way. So those kinds of things are common.
But then, it is very different for different people. At the moment, one of the things we are addressing in psychedelic research is managing people's expectations. Many people—when they go into an Ayahuasca ceremony or take any kind of psychedelic, especially in clinical trials—expect this life-changing experience. You hear these stories of people revisiting childhood memories and having these incredible insights—which certainly can happen, but it doesn't happen every time. For other people, it can be a lot more subtle, like changes in thought patterns or changes in your thinking—not the typical trip. So there is much variation.
That's one of the things that makes, at least for me, Ayahuasca so interesting and confusing. It's that in the same ceremony, even if you drink the same brew two nights in a row, it can have a completely different effect. Sometimes you can be sky-rocketed into hyperspace, and other times it feels like it hasn't done anything. It's curious. There isn't always a clear dose-response, which is interesting. It's different to most kinds of other drugs.
That's interesting, so it's quite distinct in the way that it reacts?
Yeah. For example, if you take 75 milligrams of Methylenedioxymethamphetamine or ecstasy (MDMA), you probably know what you're going to get. And then, if you take another 50, you have a good idea of what is going to happen. With Ayahuasca, the more you take, the more likely you will have a particular effect—which, of course, is what you'd expect—but you never really know what's going to happen. It's a little bit like throwing dice.
Right, so there is an element of unpredictability to it. From what I understand, there has been a large amount of research on Ayahuasca's ability to alleviate depression and anxiety, which you have also contributed to. Where are we at with Ayahuasca research and mental health? Are we able to ascertain the long-term impacts yet?
Basically, the research we do with Ayahuasca is in the Amazon rainforest, and is what we call naturalistic observational trials or studies. This means we have minimal intervention and [we] just observe some of the effects of Ayahuasca retreats on participants. They're not clinical trials. Now, according to Western science, you can't really draw solid conclusions from those kinds of studies. The gold standard is the lab-based trials, which we are actually starting in Melbourne, Australia.
However, so far the rainforest-based research definitely suggests that Ayahuasca can positively affect mental health conditions such as depression and anxiety, and increase things like self-compassion and general wellbeing. But I'd be hesitant to say that we have proven that. It does seem as well, from the research we've done, that the positive changes that are elicited from Ayahuasca in terms of mental health are maintained at the six-month follow-up. I'm not sure about whether or not those changes are maintained longer than that. We tried to do a one-year follow-up, but no one replied [laughs]. So we decided just to drop it.
Anecdotally, I think it can go either way. The typical thing is, you get an afterglow after drinking Ayahuasca. You feel like you're buzzing from the whole thing. That lasts for about two weeks. With other psychedelics—for instance, the effects we've seen from psilocybin begin to diminish after about three or four months. But Ayahuasca, at least from our research, seems to suggest that it lasts a bit longer. The effects begin to diminish but are still there by about six months. Other research into the Ayahuasca churches suggests that it lasts for longer, for about a year—but we can't be sure.
There's a lot of individual variability. Some people drink Ayahuasca once, have this life-changing experience, and never have to drink it again. It will change everything. Other people feel like they need more. They need to drink it often, or they feel like they're back down to baseline.
It will be intriguing to see how the Australian trials turn out. So, we've briefly touched on this, but I'd like to return to talking about the cultural significance of Ayahuasca. Could you talk about the origins of Ayahuasca use and why the ritual side of it is so important?
The origins of Ayahuasca?
Yeah. I don't normally get asked this one, so you caught me slightly off guard by that, which is good! Keeps me on my toes.
So, the origins of Ayahuasca. The jury's out about how old it is and how it specifically came to be. The evidence most people quote, based on Western anthropologists' work, is that it's at least 300 years old. But, that being said, the Indigenous communities who use Ayahuasca say they have been using it for much longer. As I said earlier, it takes two very specific plants to make the Ayahuasca brew. In order to find that combination from—well, we don't have any idea how many different species of plants there are in the Amazon rainforest, but to find that specific combination by trial and error would have taken ages. When we say to the Indigenous communities, 'How do you know how to do that?' they say the spirits in the plants told them how to make the brew.
The invasion of the Spaniards during the early 19th century has heavily influenced the modern use of Ayahuasca. So, a lot of what we see now is this mix of Spanish with Indigenous culture. For instance, most of the shamans in the rainforest speak Spanish, and many of them have Christian influences. It's the same in the Ayahuasca churches around Brazil. So, in answer to your question, it seems that Ayahuasca has been used for longer than 300 years, but maybe not in the same form that we think of it today.
I'd like to talk a little about drug tourism. It's interesting because it sounds like it started with the Spanish arriving. But in more modern times, how do you think this has impacted Indigenous communities in South America? I'd be interested to hear about how The Ayahuasca Foundation centres Indigenous knowledge and experience.
So, the reason we wanted to research with The Ayahuasca Foundation was that they try to maintain and uphold Indigenous traditions as much as possible when they run their retreats. I mean, the actual concept of Ayahuasca retreats is quite foreign to the Indigenous communities. You know, they would never run Ayahuasca retreats. That's really a Western thing. But other than that, they try to stick to the traditions as strictly as possible.
The impacts of drug tourism can be seen as a real, double-edged sword. For the Mishana community, who we work with, there are about 80 Indigenous individuals, and Ayahuasca tourism has brought in a lot of money. For many people in the community, that's seen as a good thing. A lot of the members now have smartphones, and some of them have TVs. But you could also argue that now that there is a research centre in their community and more money—is it changing the community? There can also be this issue when you get larger amounts of money coming in, larger amounts of US dollars: this can destabilise the economy. So you must be very careful and work with the community.
We support various charities. One example is Rain, a re-forestation charity. They use the money in the way they think is best. So, yeah, is it a good thing? Is it a bad thing? It could be viewed as both.
Another thing with Ayahuasca tourism is how it also changes the tradition. The Western perception of Ayahuasca is that it's all about love, light and healing, which is traditionally true. But there is also another side of Ayahuasca, at least in the Shipibo traditional tribal use. For the Shipibo, Ayahuasca was heavily used for things like warfare, witchcraft and for hunting. Now, witchcraft does not fit into the Western ideal of what Ayahuasca should be. So it means that a lot of the shamans aren't really training in that anymore. Because most of the clients only want love and healing, this other side of Ayahuasca is largely being ignored. Some people might say, ‘You know that's good, that we're not having people training in witchcraft anymore.’ But traditionally, it was about balance. So the actual tradition is changing, and that's something to be aware of as well. The impacts that Ayahuasca tourism is having [should be understood] not just on the actual people in terms of economically, but also on the tradition itself.
That is fascinating and leads into my next question: was mental health an aspect of Ayahuasca use before? Or is it hard to know? Do you think it's becoming more common, now that it's being a bit Westernised?
Yeah, I think it definitely was [an aspect of its use]. Because it's a completely different paradigm of healing, people wouldn't necessarily speak about it in terms that we, in the Western sense, would relate to. I mean, I've heard shamans refer to people having a sadness or a lack of energy—things which could roughly equate to depression. So, for example in addiction, instead of saying, 'You are addicted to meth’ for instance, they may use other terms to conceptualise it.
I've heard a lot of shamans speak about having a 'being' or a 'little demon' stuck to you that makes you have these cravings and won't leave you alone. And that being, I guess, roughly equates to the spirit of meth. And so it's a different way of describing it. Even though now we are coming in and saying we are treating mental health problems, Ayahuasca ceremonies have been treating mental health problems for a long time. They just have different ways of viewing it, thinking about it and treating it as well.
The concept of the ‘little beings’ really helps to create a fuller picture of addiction. With your experience as a psychiatrist and your awareness of the cultural importance of Ayahuasca, what would you say are the most essential things to consider when taking Ayahuasca? I've also heard of an Ayahuasca diet. Does this fit into the essential business of it all?
The Ayahuasca diet is another interesting one. The diet begins roughly about two weeks before drinking Ayahuasca. You need to change your diet so that you're reducing things like salt and sugar, and avoiding certain foods like some kinds of cheeses and fortified wines. The reason you do that is to prevent interactions with Ayahuasca, which can lead to hypertensive crises and potentially fatal reactions if you have too much of a chemical called tyramine. You have to come off medications as well, which can increase serotonin, to avoid something called serotonin syndrome because that can occur when you drink Ayahuasca. It can cause fatally high levels of the chemical serotonin.
But, that being said, the Ayahuasca diet is a Western thing. That's not a traditional thing. Western people really have made that up so that other Western people, with their weird diets and processed foods, wouldn't have negative interactions when drinking Ayahuasca. However, preparation in terms of the body is critical.
There are definitely practical things that you can do as well, [such as] making sure that you go to a good centre and go somewhere reputable. Those are big issues at the moment, because Ayahuasca on its own isn't regulated [in South America]. It's not like in the UK or New Zealand, where you go somewhere and know it's legit because they have accreditation. You just have these people saying, 'I'm a shaman,' and they have no qualifications because there aren't any. But to be a shaman is very like being a medic. It takes roughly five years to get some basic training, but there's no cut-off point. It's all quite vague. And then, if you've been a shaman for 20 years, you're going to have a good understanding of the work you do. However, there are charlatans, and issues of psychological and physical damage and sexual exploitation. Unfortunately, it's not rare anymore.
So I think that practically, [you should make] sure you go somewhere, firstly, that's actually serving Ayahuasca. Because Ayahuasca—as long as you've been properly screened and you don't have any complications like predisposition to psychosis—is very safe. Pretty much all of the adverse reactions that have been documented in the literature are when people give you stuff that isn't Ayahuasca. So, people claiming to be shamans that haven't been trained [might] just administer random psychoactive plants that make you trip balls—but also make you psychotic or, in the worst cases, die. So you need to ensure you are actually drinking Ayahuasca. So that's super important.
And then, I find I'm probably biased because I am a psychiatrist, but the psychological preparation is super important [before] going into the ceremonies. I think it's easier, almost, to watch what you eat and ensure you're in good physical shape before going into the ceremonies. But the more important thing is preparing the mind. When you take a potent psychedelic like Ayahuasca, it's easy to 'lose it' or be scattered with your thoughts. So I think having a really good meditation practice; spending a lot of time, if possible, reflecting by yourself in nature; thinking about why you're going into the ceremony [helps]. What do you want to get out of it?
And then, also, watching how you spend your time for those couple of weeks before the ceremony. So, if you're watching horror movies, porn or stuff like that; that stuff might come up. It's in your mind. So I think [that] trying to clean yourself out and just prepare yourself physiologically and psychologically, and research where you're going [helps]. I [would] say those are the most important things.
That's good advice, especially the emphasis on psychological preparation. Final question: with the renewed interest in psychedelics in medicine, do you see Ayahuasca treatment becoming more commonplace? Is it already happening? Do you see it making its way into clinical practice? And what use would you imagine or want to see?
This is an exciting one because this is leading on from the work I'm going to do in Melbourne. So yeah, how can we see Ayahuasca being used in a Western setting? Firstly, there are a lot of barriers to that, so we need to think about [whether this is] cultural appropriation. Would we be appropriating Indigenous culture? We'd have to think about reciprocity—so, working with Indigenous communities, giving back. And that can be extremely complex.
Then, how would we see Ayahuasca being used in a Western setting? Well, I think there are two different ways of that going. [One], we can see retreat centres like the ones we have in the Amazon just springing up all over the world. So, following a kind of a traditional framework [for Ayahuasca use]. So that's neo-shamanism, which is when you are practicing shamanism outside of the source—outside of the rainforest. So you can see these neo-shamanic retreat centres just springing up everywhere.
Or, we might see something more like the work we're doing in Melbourne, which is where you have an Ayahuasca-inspired product. So we use plants that aren't necessarily the same Ayahuasca plants. [We’re] using a source of DMT, a source of harmala alkaloids, and [we’re] mixing them together much in the same way that Ayahuasca would be. So in the Melbourne study, we are using plants that are from Australia. So, is it Ayahuasca? No, it's not, but it's definitely taking inspiration from Ayahuasca. So, I would argue that's not actually Ayahuasca, you know. Ayahuasca is, well, first you have to have the specific plants.
But also, one of the things that's the most useful and exciting about [real] Ayahuasca for me is that it sits at this intersection between science and spirituality, music, art, history and all these disciplines. So if you just have some chemicals, I would argue that's not Ayahuasca. For it to be Ayahuasca you have to have the ceremony, the chanting, the shaman; all of it.
So I think that we'll probably see something reminiscent of Ayahuasca that could potentially work its way into the medical system. This will hopefully give some relief and treatment to people who feel let down by Western medicine and, for whatever reason, [it's] not their thing to go to the rainforest to drink Ayahuasca with a shaman.
So, do you think there's something in it for mental health?
Yeah, for sure. I think psychiatry [has] visibly stagnated, compared to the rest of the specialties in medicine. So, if you look at other specialties like oncology or anything, new drugs are being developed all the time. For psychiatry, we haven't really developed any real, major new drugs for ages. In fact, barely any new drugs have been developed since the turn of the millennium. Most of the new drugs that we do have are just pre-existing versions of old drugs. And so I think we desperately need new treatments, and psychedelics provide an option for that. They provide the potential for treating mental health problems.
And of the psychedelics, I think that Ayahuasca is the most complex and probably the most complicated to look at. But it also has the strongest historical ties, in terms of living Indigenous people who still use it. So I think you can learn a lot from the people who work with it—who are the real experts when we're trying to learn medicine from a different paradigm. For it to work successfully, we would really need to listen to them and work in partnership.