The decision to participate in an ayahuasca ceremony is never simple, but for people living with bipolar disorder, it carries particular weight. Ayahuasca has gained recognition for its potential therapeutic benefits, yet it also poses serious risks for those with mood disorders – risks that aren’t always clearly communicated in the excitement surrounding psychedelic healing.
This article isn’t meant to judge your choices or close doors to healing. Instead, it’s written to give you the complete picture so you can make an informed decision about your mental health and safety. Whether you’re considering ayahuasca for the first time or have already participated in ceremonies, understanding how this powerful medicine interacts with bipolar disorder could be crucial to your well-being.
Key takeaways: the risk of drinking Ayahuasca with Bipolar Disorder
Ayahuasca poses serious psychiatric risks for people with bipolar disorder. The medicine’s effects on brain chemistry can trigger manic episodes, psychosis, or destabilize mood regulation—potentially requiring psychiatric hospitalization.
Full disclosure and professional guidance are essential. Be completely honest with facilitators about your diagnosis, medications, and family history. Never stop psychiatric medications without close supervision from your prescribing physician.
Effective alternatives exist for healing. Trauma-focused therapy, breathwork, meditation, and somatic practices can address the same issues that draw people to plant medicine—often with more sustainable results and without the significant risks.
Table of Contents
What Bipolar Disorder Actually Involves
Bipolar disorder is characterized by significant mood swings that cycle between emotional highs (mania or hypomania) and lows (depression). These aren’t simply good days and bad days – they’re distinct episodes that can last days, weeks, or even months.
During manic episodes, a person might experience elevated mood, increased energy, racing thoughts, impulsivity, decreased need for sleep, and sometimes disconnection from reality. Hypomanic episodes involve similar symptoms but are less severe and don’t include psychotic features. Depressive episodes bring persistent sadness, loss of interest, fatigue, and sometimes suicidal ideation.
The condition exists on a spectrum. Bipolar I involves full manic episodes, while Bipolar II features hypomanic episodes and more severe depression. Cyclothymic disorder involves chronic fluctuating moods that don’t meet full criteria for mania or major depression but still cause significant distress.
What makes bipolar disorder particularly relevant to ayahuasca use is its neurochemical nature. The condition involves dysregulation of neurotransmitters – including serotonin, dopamine, and norepinephrine – the very systems that ayahuasca powerfully affects. The brain of someone with bipolar disorder is already prone to extreme states; introducing a substance that profoundly alters brain chemistry can be like adding accelerant to a smoldering fire.
Why Ayahuasca Can Be Dangerous for Bipolar Disorder
Ayahuasca works primarily through DMT (dimethyltryptamine) and MAO inhibitors (from the Banisteriopsis caapi vine), which dramatically increase serotonin availability in the brain. For most people, this creates the visionary and introspective experience ayahuasca is known for. For someone with bipolar disorder, this neurochemical surge can destabilize a carefully balanced mood regulation system.
The risks include:
Triggering manic episodes: The intense emotional and energetic experience of ayahuasca can precipitate mania in susceptible individuals. What begins as spiritual awakening can escalate into grandiosity, reckless behavior, and loss of reality testing that persists long after the ceremony ends.
Here you can find a published case report of a person with bipolar disorder developing a manic episode after ayahuasca use, reinforcing clinical concerns about mood destabilization in this population (Szmulewicz et al., 2015).
Inducing psychosis: People with bipolar disorder, especially Bipolar I, have an elevated risk of psychotic symptoms. Ayahuasca can trigger or worsen hallucinations, delusions, and severe confusion that may require psychiatric hospitalization.
A systematic review of ayahuasca and DMT-related psychosis found that psychotic and manic episodes, though relatively rare, tend to occur in people with pre-existing vulnerabilities such as mood or psychotic disorders and substance use problems (dos Santos et al., 2017; “Psicosis inducida por ayahuasca,” 2017; dos Santos & Strassman, 2008).
In a detailed article, I talk about if Ayahuasca can cause psychosis.
Cycle destabilization: Even if you’ve been stable for years, ayahuasca can disrupt that equilibrium, potentially leading to more frequent mood episodes or increased severity of symptoms in the months following use.
Unpredictable reactions: Unlike many other health conditions where risk factors are more straightforward, the interaction between ayahuasca and bipolar disorder can be highly individual and impossible to predict with certainty.
These aren’t theoretical concerns.
Mental health professionals who work with psychedelic communities have documented cases of severe psychiatric crises following ayahuasca use in people with bipolar disorder, some requiring extended hospitalization and fundamentally altering the course of someone’s illness.
A recent retrospective case study of ayahuasca use in a person with bipolar disorder and psychotic features underscores that, even in carefully followed cases, the risk of destabilization remains significant and requires intensive psychiatric oversight (Turkia et al., 2023).
Ayahuasca & Bipolar Disorder
Safety, Risks, and Informed Decisions
Individuals with Bipolar Disorder navigate intense emotional landscapes. Introducing Ayahuasca can act as an accelerant, potentially triggering destabilization or psychosis.
Why the Risk is High
Sleep Deprivation
Ceremonies run late into the night. Sleep loss is a major trigger for manic episodes.
Serotonin Surge
The DMT and MAOIs in the medicine create chemical shifts that a bipolar nervous system may not be able to regulate.
Potential Psychosis
Risk of triggering severe confusion, delusions, or hallucinations that may require psychiatric intervention.
Lack of Specialized Support
Most traditional facilitators aren't trained to handle clinical psychiatric emergencies.
Fast Facts
Can I take a small dose? No. Even micro-amounts can trigger manic cycles in vulnerable brains.
What about my meds? Combining Ayahuasca with SSRIs/SNRIs can lead to fatal Serotonin Syndrome.
Should I hide my diagnosis? Never. Full transparency is essential for your life and the safety of the group.
Safer Roads to Healing
How Ceremonies Can Trigger Mania or Psychosis
The ceremony environment itself – beyond the pharmacology – can contribute to psychiatric destabilization. Understanding these factors can help you assess your risk more accurately.
Ayahuasca ceremonies typically involve:
Sleep deprivation: Many ceremonies run late into the night, and participants often attend multiple ceremonies over consecutive nights. Sleep disruption is one of the most powerful triggers for manic episodes in people with bipolar disorder.
Research consistently shows that sleep loss is one of the most powerful and predictable triggers for manic and hypomanic episodes in bipolar disorder (Colombo et al., 1999), which is especially relevant given that many ayahuasca ceremonies run late into the night or occur on several consecutive nights.
Intense emotional catharsis: While emotional release can be healing, the extreme intensity of ayahuasca experiences – confronting trauma, experiencing ego death, or processing overwhelming emotion – can overtax already vulnerable mood regulation systems.
Sensory overstimulation: Ceremonial songs, darkness punctuated by candles, intense physical sensations, and profound visions create a highly stimulating environment that can be activating for those prone to mania.
Group energy: The collective altered state in ceremony spaces can amplify individual experiences, sometimes making it harder to ground oneself or recognize when one’s experience is shifting from healing to destabilizing.
Lack of psychiatric support: Most ayahuasca facilitators, even experienced ones, aren’t trained to recognize early signs of mania or psychosis, and ceremonies typically occur far from psychiatric emergency services.
A person might leave a ceremony feeling profoundly opened and energized, interpreting this as spiritual awakening, when they’re actually entering the early stages of a manic episode. By the time the mania is obvious – perhaps days or weeks later – significant damage to relationships, finances, or safety may have already occurred.
Misdiagnosis and Hidden Bipolar Conditions
One of the most concerning scenarios is when someone doesn’t know they have bipolar disorder before participating in an ayahuasca ceremony. Bipolar disorder is frequently misdiagnosed, often as unipolar depression, especially in people who seek help primarily during depressive episodes.
Consider these situations:
Previous “good periods” misunderstood: What you thought was just finally feeling better might have been hypomanic episodes that went unrecognized, especially if they were productive and pleasant rather than destructive.
Family history not connected: A parent or sibling diagnosed with depression or anxiety might actually have had bipolar disorder, increasing your own risk significantly.
Substance use masking symptoms: If you’ve used cannabis, alcohol, or other substances regularly, they may have been inadvertently mood-stabilizing or may have masked the true pattern of your mood cycles.
Young age: Bipolar disorder often first emerges in late teens or twenties. Someone seeking ayahuasca for depression at age 22 might be on the cusp of their first manic episode, which ayahuasca could precipitate.
Misattributed past experiences: Previous episodes of unusual euphoria, decreased sleep need, intense creativity, or impulsive behavior that you attributed to life circumstances might have been mood episodes.
If you’re considering ayahuasca and have been diagnosed with depression or anxiety but not fully evaluated for bipolar disorder – particularly if you have concerning family history or some of the patterns above – it may be worth seeking a comprehensive psychiatric evaluation before proceeding. This is especially important if you’ve noticed that antidepressants have made you feel “too good,” irritable, or agitated, as this can be a sign of underlying bipolar vulnerability.
The Importance of Full Disclosure
When you fill out intake forms or speak with ayahuasca facilitators, complete honesty about your mental health history could literally save your life – or at minimum prevent a psychiatric crisis that derails your healing journey.
Ethical retreat centers will screen for bipolar disorder and other contraindications, but this system only works if you provide accurate information. Some people minimize their diagnosis or medication use because they fear being turned away from an experience they desperately want. Others simply don’t think it’s relevant or worry about being judged.
Be completely transparent about:
Any psychiatric diagnoses, even if you received them years ago or disagreed with them. Include depression, anxiety disorders, PTSD, and personality disorders, as these can sometimes overlap with or mask bipolar disorder.
All medications you’re taking, including mood stabilizers, antipsychotics, antidepressants, anti-anxiety medications, and any other psychiatric drugs. Don’t omit medications you’ve recently stopped or plan to stop for the ceremony.
In a separate article, I go in depth about the risks of Ayahuasca and SSRIs.
Family psychiatric history, particularly mood disorders, psychosis, schizophrenia, or suicide. Genetic vulnerability matters significantly.
Past unusual experiences such as periods of very high energy, racing thoughts, impulsive behavior, paranoid thinking, or hallucinations, even if they weren’t formally diagnosed.
Substance use history, including any past problems with drugs or alcohol that might relate to mood regulation.
Previous reactions to psychedelics or cannabis, especially if you’ve had paranoid, manic, or prolonged difficult experiences.
Remember that experienced facilitators have likely worked with many people with complex mental health histories. Your honesty allows them to make educated decisions about your safety. If they determine ayahuasca isn’t appropriate for you right now, that’s not a rejection – it’s a responsible act of care.
How Ethical Retreat Centers Make Safety Decisions
Reputable ayahuasca centers take mental health screening seriously, though approaches and standards vary. Understanding what responsible facilitators consider can help you evaluate whether a center is prioritizing safety.
Ethical centers typically:
Require detailed medical and psychiatric questionnaires that ask specifically about mood disorders, psychotic disorders, and family history. They review these carefully rather than as a formality.
Conduct phone or video interviews to discuss your mental health history in depth, asking clarifying questions and assessing your current stability and understanding of risks.
Consult with medical or psychiatric advisors when participants have complex histories, rather than making decisions based solely on ceremonial experience.
Have clear exclusion criteria that typically include active bipolar disorder, schizophrenia, recent psychotic episodes, and current use of certain medications. Some may work with people with stable, well-managed bipolar disorder under specific conditions, but this requires extensive discussion.
Maintain appropriate boundaries by not presenting ayahuasca as a cure or replacement for psychiatric treatment, and by encouraging people to work with mental health professionals rather than abandoning conventional care.
Provide integration support and have plans for psychiatric emergencies, including knowing where the nearest psychiatric facility is located.
If a center asks minimal health questions, seems dismissive of your concerns about your diagnosis, encourages you to stop medications without consulting your prescriber, or makes guarantees about healing, these are serious red flags. Centers that prioritize filling ceremonies over safety screening put participants at risk.
Why Medication and Ayahuasca Often Cannot Mix
Many psychiatric medications contraindicate with ayahuasca, creating risks ranging from uncomfortable to life-threatening. The MAO inhibitors in ayahuasca are the primary culprit, as they interact dangerously with various substances.
Antidepressants (SSRIs, SNRIs): These combined with ayahuasca’s MAO inhibitors can cause serotonin syndrome—a potentially fatal condition involving confusion, rapid heart rate, high blood pressure, dilated pupils, muscle rigidity, and hyperthermia. Even if you’ve stopped your antidepressant, it may take weeks to fully clear your system.
Mood stabilizers (lithium, lamotrigine, valproate): Interactions aren’t as well documented as with antidepressants, but stopping mood stabilizers to do ayahuasca creates its own serious risk of mood destabilization and potentially triggering severe episodes.
Antipsychotics: These can reduce the effects of ayahuasca or create unpredictable interactions. More concerning, stopping antipsychotics for ceremony could precipitate psychosis.
Benzodiazepines: These may dampen the ayahuasca experience, and chronic use creates its own set of risks including potentially dangerous withdrawal if stopped abruptly.
The timing problem is significant. Psychiatric medications can’t simply be skipped for a few days before ceremony. Most require weeks or even months to fully leave your system, and abruptly discontinuing them – particularly mood stabilizers or antipsychotics – can itself trigger psychiatric emergencies.
Never stop psychiatric medications for ayahuasca without close supervision from your prescribing physician. A responsible psychiatrist might, in rare cases, work with a stable patient to create a safe tapering plan, but this would involve careful monitoring and likely wouldn’t be recommended for someone with significant bipolar disorder. Any facilitator who encourages you to stop medications on your own isn’t prioritizing your safety.
Because the vine component of ayahuasca acts as an MAOI, combining ayahuasca with SSRIs, SNRIs or other serotonergic antidepressants carries a known risk of serotonin syndrome, a potentially life-threatening condition; clinical guidelines state that MAOIs should never be combined with these drugs and require washout periods of weeks ( 2019; clinical interaction guidance; Cleveland Clinic, 2024).
Alternatives for Healing Without Psychedelics
If ayahuasca isn’t safe for you, that doesn’t mean your healing journey ends. Numerous effective alternatives exist, many of which address the same underlying issues that draw people to plant medicine.
Trauma-focused psychotherapy: Approaches like EMDR (Eye Movement Desensitization and Reprocessing), somatic experiencing, internal family systems, and sensorimotor psychotherapy can facilitate profound healing from trauma without destabilizing mood.
Breathwork: Practices like conscious connected breathing, transformational breath, or other breathwork techniques can facilitate altered states and emotional release. While these should still be approached cautiously with bipolar disorder, they may be safer than ayahuasca for some people and can provide transformative experiences. It really depends on the type of breathwork you are working with. Box breathing, 4 – 7 – 8 breathing are beneficial in regulating one’s nervous system
Meditation and contemplative practices: Regular mindfulness meditation, loving-kindness practice, or other contemplative traditions can create significant psychological and spiritual shifts over time. Many people find the gradual transformation through practice to be more sustainable than dramatic psychedelic experiences.
Nature-based healing: Extended time in wilderness, whether through vision quests (without substances), backpacking, or simply regular immersion in nature, provides many people with the perspective shifts and connection they seek.
Bodywork and somatic therapies: Practices like trauma-sensitive yoga, Feldenkrais, Hakomi, or other body-based approaches can help release stored trauma and shift consciousness in gentler ways.
Creative expression: Art therapy, music therapy, movement/dance therapy, or personal creative practice can access unconscious material and facilitate integration of difficult experiences without the risks of psychedelics.
Community and connection: Sometimes what we’re truly seeking through ayahuasca is a sense of belonging, purpose, and authentic connection. Therapeutic communities, men’s or women’s circles, spiritual communities, or support groups can provide this.
Psychedelic integration therapy—without the psychedelics: Working with a therapist trained in psychedelic integration can help you explore the same types of questions and experiences that people process after ceremonies, using imagination, memory, and therapeutic relationship.
For some people with bipolar disorder, microdosing psilocybin has been explored under careful medical supervision as a potentially safer alternative to full ceremonial doses of ayahuasca, though research is still emerging and risks remain. This should only be considered with psychiatric oversight.
It’s not worth the risk..
I understand you feel that your situation is different. That you really need this medicine. And Ayahuasca is a safe medicine, yet there are certain conditions that can make Ayahausca unsafe in these situations and Bipolar disorder is one of them.
It is good to know that there are many other modalities out there that can help you with your condition, and choosing an extreme one like Ayahausca can put you, the other participants and the retreat center tremendously at risk.
Consider starting with other modalities first like breathwork or therapeutic work to assess how you respond to altered states and emotional intensity.
Consider whether you’re drawn to ayahuasca specifically or whether you’re seeking healing that could come through other means. Sometimes the allure is about the medicine itself; sometimes it’s about desperation or hope that could be directed toward safer modalities.
Accept that this may not be your path, at least not right now. There’s no shame in choosing safety and stability. The work you need to do can happen through other means.
Conclusion
Ayahuasca holds profound potential for healing, but that potential must be weighed against real risks – risks that are significantly elevated for people with bipolar disorder. The intense serotonergic effects, the ceremonial environment, medication interactions, and the unpredictable nature of mood disorders create a confluence of factors that make this path genuinely dangerous for many people with this condition.
This isn’t about judgment or limiting your autonomy. It’s about making sure you have complete information so your choices are truly informed. The spiritual and healing communities sometimes operate with understandable optimism about alternative and traditional medicines, but that optimism shouldn’t override basic safety considerations, particularly for vulnerable populations.
Your healing matters. Your safety matters. And for many people with bipolar disorder, the wisest path forward may be one that doesn’t include ayahuasca, at least not without extensive professional support and extraordinary caution.
If you’re feeling disappointed by this reality, that’s completely understandable. Allow yourself to grieve the path you thought might be available to you. Then turn your energy toward the many other roads to healing that do exist—roads that can ultimately be just as transformative and far more sustainable.
Whatever you decide, make your choice with eyes wide open, support surrounding you, and commitment to your long-term wellbeing above any single experience or intervention. You deserve healing that doesn’t come at the cost of your stability or safety.
Frequently Asked Questions around the risks of Ayahuasca and Bipolar Disorder
Can someone with bipolar disorder safely drink Ayahuasca?
No, Ayahuasca strongly affects mood regulation and neurotransmitters. For people with bipolar disorder—diagnosed or undiagnosed—these shifts can lead to emotional instability, mania, psychosis, or rapid cycling. Most responsible retreat centers will not accept someone with bipolar disorder for safety reasons.
Why is Ayahuasca risky for bipolar disorder?
Ayahuasca increases serotonergic activity and dramatically opens emotional material. For individuals with bipolar disorder, this can destabilize mood, trigger mania, or intensify depressive states. The preparation and post-ceremony phases can also create drastic fluctuations that the nervous system may not be able to regulate.
Can Ayahuasca trigger a manic or psychotic episode?
Yes. Even people who haven’t had episodes for years can experience sudden mania or psychosis after drinking Ayahuasca. The risk is significantly higher for anyone with a personal or family history of bipolar disorder, schizophrenia, or other mood disorders.
What happens if I don't disclose my diagnosis to the retreat center?
Withholding this information can be dangerous. Even high-functioning individuals with stable medication routines can destabilize quickly in an Ayahuasca ceremony. Not informing facilitators means they cannot protect you or react properly if something happens. It also places the entire group at risk.
Does attending an ayahuasca retreat contribute to exploitation?
It depends entirely on where you go. Ethical retreat centers cultivate their own plants or source from traditional families who do. When run transparently and responsibly, retreats bring income into rural areas without extracting natural resources, supporting both people and the forest.
Can I start with a smaller does of Ayahuasca?
At some retreat centers it is possible to start with a lower dose of Ayahausca. Yet, it is not recommended. Even a smaller dose of Ayahuasca can trigger a manic episode.
