Background

Suicidality is a growing epidemic and current treatment options are limited. One previous, positive study explored the effects of ayahuasca on suicidality in major depressive disorder (MDD), although this study had significant limitations with only 7 days of follow-up and high levels of psychiatric comorbidity (1). Further research into the efficacy of ayahuasca to treat suicidality is warranted.

Methods

We conducted a secondary analysis of an open-label trial in which individuals with recurrent MDD received a single dose of ayahuasca (n=17). The primary outcomes were remission from suicidality as indexed by the suicide items on the Hamilton Rating Scale for Depression (HRSD) and the Montgomery-Asberg Depression Rating Scale (MADRS). Suicidality was assessed at baseline, during the acute effects of the ayahuasca and 1, 7, 14, and 21 days after the intervention.

Results

Of patients with baseline suicidality present, as indexed by the HRSD suicide item (n=12), 83% achieved full and sustained remission of their suicidality. The result was very similar on the MADRS suicide item (80% remission for n=15). Effect sizes at day 21 of follow-up were large and significant, according to paired t-tests (Cohen’s d=2.4, p<0.001 for HRSD suicide item; d=1.9, p<0.001 for MADRS suicide item).

Conclusion

These results provide support for the role of ayahuasca as an intervention for suicidality in patients with recurrent MDD. Limitations of this study include the open-label design and small sample size. Future studies should investigate ayahuasca in a randomized-controlled trial with a larger sample size in patients with MDD.