The Impact of Ayahuasca on Suicidality : Results From a Randomized Controlled Trial
Richard J. Zeifman, Fernanda Palhano-Fontes, Jaime Hallak, Emerson Arcoverde,
João Paulo Maia-Oliveira, Draulio B. Araujo
Frontiers in Pharmacology, 2019, Volume 10, Article 1325, 1-10.
doi : 10.3389/fphar.2019.01325
Suicide is a major public health problem. Given increasing suicide rates and limitations surrounding current interventions, there is an urgent need for innovative interventions for suicidality. Although ayahuasca has been shown to target mental health concerns associated with suicidality (i.e., depression and hopelessness), research has not yet explored the impact of ayahuasca on suicidality. Therefore, we conducted secondary analyses of a randomized placebo-controlled trial in which individuals with treatment-resistant depression were administered one dose of ayahuasca (n = 14) or placebo (n = 15). Suicidality was assessed by a trained psychiatrist at baseline, as well as 1 day, 2 days, and 7 days after the intervention. A fixed-effects linear mixed model, as well as between and within-groups Cohen’s d effect sizes were used to examine changes in suicidality. Controlling for baseline suicidality, we found a significant effect for time (p < .05). The effect of the intervention (i.e., ayahuasca vs. placebo) trended toward significance (p = .088). At all time points, we found medium between-group effect sizes (i.e., ayahuasca vs. placebo; day 1 Cohen’s d = 0.58; day 2 d = 0.56; day 7 d = 0.67), as well as large within-group (ayahuasca; day 1 Cohen’s d = 1.33; day 2 d = 1.42; day 7 d = 1.19) effect sizes, for decreases in suicidality.
Conclusions : This research is the first to explore the impact of ayahuasca on suicidality. The findings suggest that ayahuasca may show potential as an intervention for suicidality. We highlight important limitations of the study, potential mechanisms, and future directions for research on ayahuasca as an intervention for suicidality.
Clinical Trial Registration : www.ClinicalTrials.gov, identifier NCT02914769.
Keywords : suicidality, ayahuasca, psychedelics, randomized controlled trial, novel intervention
Suicide is a public health issue of major concern: it is a leading cause of premature death, accounting for nearly one million deaths annually (World Health Organization, 2014). For every completed suicide, it is estimated that 20–30 suicide attempts occur (Wasserman, 2001). Furthermore, suicide rates have been increasing within the United States (Curtin et al., 2016).
Suicide occurs most commonly among individuals with major depressive disorder (MDD) (Cavanagh et al., 2003; World Health Organization, 2014) and individuals with comorbid MDD and borderline personality disorder (BPD) exhibit especially heightened levels of suicidality (Soloff et al., 2000; Galione and Zimmerman, 2010; Perugi et al., 2013; Zeng et al., 2015). Given the drastic consequences of suicide and suicide attempts, effective suicide interventions are of great importance.
A number of interventions are effective for treating suicidality (i.e., suicide attempts, suicide planning, and suicidal ideation; for a review, see Zalsman et al., 2016), including electroconvulsive therapy, psychotherapy (e.g., cognitive behavior therapy, dialectical behavior therapy), and pharmacological interventions (e.g., antidepressants, lithium, clozapine). However, there remain a number of important limitations surrounding current interventions for suicidality, including (a) non-immediate effects (e.g., weeks to months; Griffiths et al., 2014), (b) limited treatment availability (Bateman, 2012), (c) negative side-effects (e.g., increased suicidality with antidepressant use among adolescents; Vitiello and Ordóñez, 2016), (d) the need for ongoing administration (Kellner et al., 2005), and (e) high rates of non-responsiveness (Stone et al., 2009; Pompili et al., 2010). Individuals who do not respond to conventional interventions (i.e., individuals with treatment-resistant depression) show especially heightened levels of suicidality (Nelsen and Dunner, 1995; Malhi et al., 2005; Souery et al., 2007) and are, therefore, especially in need of novel interventions for suicidality.