The primary danger mechanism is the MAOI activity of ayahuasca’s beta-carboline alkaloids. With monoamine oxidase A inhibited, serotonergic medications and tyramine-rich foods can accumulate to dangerous levels. The interactions most associated with serious adverse events are: SSRIs and SNRIs, MAOIs, lithium, MDMA, amphetamines, and dextromethorphan. The second danger mechanism is psychiatric vulnerability: ayahuasca can precipitate or exacerbate psychotic episodes in people with a history of psychosis or bipolar disorder with manic features. The third is the facilitation context: unsupervised or poorly facilitated settings are consistently associated with worse outcomes (Bouso et al., 2022; Malcolm and Thomas, 2018).
