Switch to mania after ayahuasca consumption in a man with bipolar disorder : a case report
Alejandro G Szmulewicz, Marina P Valerio and Jose M Smith
International Journal of Bipolar Disorders, 2015, 3, (4), 1-3.
Background : There is an increasing use of ayahuasca for recreational purposes. Furthermore, there is a growing evidence for the antidepressant properties of its components. However, there are no reports on the effects of this substance in the psychiatric setting. Harmaline, one of the main components of ayahuasca, is a selective and reversible MAO-A inhibitor and a serotonin reuptake inhibitor.
Case report : We present the case of a man with bipolar disorder who had a manic episode after an ayahuasca consumption ritual. This patient had had at least one hypomanic episode in the past and is currently depressed. We discuss the diagnostic repercussion of this manic episode.
Conclusion : There is lack of specificity in the diagnosis of substance-induced mental disorder. The knowledge of the pharmacodynamic properties of ayahuasca consumption allows a more physiopathological approach to the diagnosis of the patient.
Keywords : Ayahuasca; Bipolar disorder; DSM 5; Switch to mania; MAO inhibitors
Ayahuasca is a psychotropic, hallucinogenic beverage, composed of a mixture of Amazonian plants. It is usually consumed as an infusion with Banisteriopsis caapi and Psychotria viridis (Guimaraes dos Santos 2010). The main components of B. caapi are β-carbolines – harmine and tetrahydroharmine – and to a lesser extent harmaline, harmol, and harmalol, while P. viridis contains a tryptamine, N,N dimethyl-tryptamine (DMT), and a 5-HT2A agonist (Guimaraes dos Santos 2010; Callaway et al. 2005; McKenna et al. 1998). DMT, from P. viridis species, is the psychoactive substance of ayahuasca (Guimaraes dos Santos 2010). DMT is orally inactive due to intestinal MAO-A metabolism. Harmine, harmaline, and tetrahydroharmine are reversible, competitive, selective inhibitors of MAO-A (Guimaraes dos Santos 2010), with almost no effect on MAO-B (Herraiz 2010). When DMT is orally administered, it is peripherally inactivated by MAO-A (Riba et al. 2012). Nevertheless, when it is combined with a peripheral MAO-A inhibitor (like harmine), its oral biodisponibility increases, this interaction being the base of ayahuasca psychotropic effect (McKenna 2004).