How to Deal with A Troubling Psychedelic Experience

Plant medicines and psychedelics, used in thoughtful and intentional ways, can be incredibly life changing and transformative. They offer the potential for profound spiritual experiences and deep healing.

But these experiences can also be very challenging, difficult, dark, or painful. This is especially true when the person is unprepared for the magnitude of what they experience. Even people going through positive transformative journeys with psychedelics can find themselves struggling to come to terms with what happened or return to a balanced state. It is not always a smooth process.

There are a variety of experiences that can be particularly troubling for someone journeying with psychedelics or planet medicines. Based on my experience working with hundreds of people before, during, and after psychedelic and plant medicine journeys, I have identified the following common themes. I would also add that I have personally experienced just about all of these at one point or another:

• The Bad Trip / Dark Night of The Soul

• Tour Through The Hell Realms

• Unexpected Revelations

• Rocky Return

• Spiritual Crisis

• Psychotic Break

The Bad Trip / Dark Night Of The Soul

Some people have really rough, nightmarish experiences. These usually involve a significant amount of fear or terror. The participant can feel persecuted or tormented by what is happening. This almost always occurs at a very high intensity for that person and they experience an intensity that overwhelms their capacity to cope. Frequently they reach a point where the self or the ego begins to dissolve or fragment and is struggling to hold on. The person may feel that they are actually dying or going insane. This can be very terrifying and as a result the person may go into a state of panic.

The irony is that these experiences, by bringing the person to the cusp of total ego dissolution, offer the potential to experience a true mystical experience, total unity with the universe, and the experience of pure consciousness. But to get there, the self has to temporarily go away. These mystical experiences are almost always characterized by an experience of universal love and awe and most people consider them to be one of the if not the most important experiences of their lives.

To get there, however, one has to surrender, and this is usually the sticking point. People experiencing tremendous fear at this point will contract, resist, and try to hold on in any way they can. This creates a tremendous amount of anguish, friction, and turbulence. It is almost the archetypal definition of suffering: there is both holding on and resisting occurring simultaneously.

The best thing to do here is to relax, surrender, and allow oneself to “die.” In many ways, these experiences are good practice for actual death since eventually we all have to give everything in our lives back. The phrase “you can’t take it with you” is true on the deepest of levels: you can’t even take your “self” with you. And the experience can illuminate what your biggest attachments and fears are, which can then become the focus of deep spiritual or personal work.

A Tour Through The Hell Realms

Another type of “bad trip” is what I call the tour through the hell realms. These are very dark experiences where the visions or feelings are characterized by dread, fear, human suffering, and encounters with what feels like evil or evil beings, demons, etc.

While the hellish realms share a very common set of elements, there are many different reasons why these can occur. Sometimes the experience can relate to the current state of suffering or unhappiness that someone is living in. Other times they may relate to the ways in which the person is creating suffering for others. A hell realm experience can also be a result of mixing different substances together (e.g. alcohol and psychedelics) or a poor setting (e.g. a party setting, urban environment, etc.) that creates the conditions for such an encounter.

The best prophylactic for these experiences is being in a positive emotional state, having a positive intention for the experience and having a safe, peaceful and appropriate setting. This is where the concept of “set and setting” came from.

While the experience is often of an absence of love, love is the best antidote to the hell realms. Focusing on the feeling of love, the heart, loved ones, divine love, can result in a significant shift into a better place. No matter what the hellish experience, eventually it ends and there is usually a huge relief of having survived it. In the moment it may feel eternal, but reminding oneself that this is a temporary visit can really help. Relaxing oneself, slowing down, and breathing deeply, if possible, is helpful as well (assuming one is still in touch with their body during the experience.)

Integrating a hellish experience offers particular challenges. Often there is a strong desire to make sense of it, why it happened, and what it means. Exploring this can be helpful. However, one doesn’t always get immediate clarity on what the purpose of that experience was. These are experiences that can take a long time to digest and clarity may not come right away.

In my experience, at a minimum a hellish psychedelic experience offers some increased understanding of our own darkness or shadow-nature (i.e. the capacity for negative intent that we all have within us) and as a result increase empathy and compassion. It can also illuminate the nature of suffering which can be a very meaningful and important life lesson. In addition, it serves as a reminder to treat these substances with reverence and respect as they offer the potential for great highs and great lows.

Unexpected Revelations

These occur when people are shown things they didn’t want to see or know. Often time there is a painful realization that something in their life isn’t working. This could be a relationship, a job, or something very important to them.

Other times repressed issues and themes can surface, including inner conflicts and old traumas that the person may have buried. These can be very challenging to deal with especially as they seem to come out of nowhere.

No matter what the revelation, it is unsettling and destabilizes the person’s homeostasis. This leads to both turbulence and volatility after the psychedelic experience but also leaves the person sitting with a dilemma or an open question that needs to be answered or resolved.

What is typically needed here is patient reflection and examination on what was illuminated. If some deep wound was revealed, there may be a need for healing or therapeutic work. If some unsustainable life situation or pattern was highlighted, the person may need to examine what about this pattern isn’t working, how they got into it in the first place, and what the options are to change it.

In none of these cases is the person served by impulsive or reactionary action. Often something does need to be done to address the situation but that doesn’t need to be done immediately and in fact they won’t be in a good place to do something about it until they have truly digested and integrated the revelation or insight. This takes time and work.

The Rocky Return

A rocky return occurs when someone’s consciousness is still flying high and their energy still quite open even after the effects of the psychedelic or plant medicine have worn off. This occurs even if they’ve had a very positive experience. In fact, the biggest predictor of this occurring isn’t whether it was a “good” or “bad” trip, it is the intensity of the experience they went through. They may feel “high” walking on a cloud, or conversely may feel caught in darkness, for days after. Often times the person may be quite emotional or labile, with a rapid succession of alternating feelings and racing thoughts. Or they may feel tuned into spirits, higher levels of consciousness, or find that they are easily accessing non-ordinary awareness.

What is needed here is grounding and balancing of their energy. The person’s mind, body, and overall energy needs to be grounded back to earth. Grounding exercises can be helpful for this. So can physical self soothing, such as a nice comforting heavy meal or a gentle massage. Anything that helps anchor the person back in their body can be helpful. I find that spending time in nature, especially in the mountains, by the ocean, or in a forest can really help to ground someone and balance their energy.

Talking to someone about the experience and what they are going through and processing can also be very helpful here, as long as it is someone who will listen non-judgmentally and be supportive.

It is important that the person not open up their energy or consciousness any further until they have truly come back and integrated the experience. This means no psychedelics or other altered state work (hypnosis, shamanic journeys, trances, etc.) Even regular meditation can be too much for some people, although a gentle guided visualization focused on grounding can be of help. The point is the direction of attention should be back into the body, back to the earth, and back to the present until the person has stabilized and fully integrated what they experienced.

The Spiritual Crisis

Sometimes people can experience such a powerful spiritual opening or awakening that they are left not only fundamentally altered but stunned or shocked as well. Their entire understanding of reality has fundamentally shifted and they struggle to fit this new understanding into their existing cosmology or worldview. Frequently it doesn’t fit, and integrating the experience involves expanding their cosmology to incorporate the new experiences and understandings.

They may return to their regular life but feel very differently about it. Life may take on an unreal quality. Similar to the Rocky Return scenario, they may have trouble coming back and grounding into their new reality. They may be dazed or in a state of semi-shock for days or weeks after.

The person may also be dealing with deep questions about who they are, the meaning of life, what life is about and other existential issues. As a result, every day activities may seem unimportant and meaningless.

The combination of all of these aspects (i.e. the change in worldview, existential dilemmas, and the ungroundedness) make the Spiritual Crisis very challenging territory to navigate and frequently help is needed. More often than not what is helpful here is working through the new understandings and the questions it has brought up in a spiritual framework.

Working with a spiritual teacher or psycho-spiritual guide is usually a better fit than seeing a traditional psychotherapist. Regardless of the approach taken, the difference aspects that have shown up will all need to be addressed, including grounding practices, exploration of the experience, and fitting the new understandings into a coherent worldview. The end-result of this kind of work is often significant changes in terms of how the person is living their life, what their life compass is, and how they relate to the experience of life. As such the spiritual crisis, when worked-with purposefully can lead to major positive life transformation.

Psychotic Break

In very rare cases, certain people can begin experience psychotic symptoms where there was no history of this before. These include easily getting lost in thought and appearing “spaced out”, odd thinking, difficulty relating to others, persistent audio or visual hallucinations, delusions of all kinds, and increasing mental disorganization preventing them from navigating basic activities. Often, but not always, there is a family history of psychosis, schizophrenia or bipolar disorder.

These are very serious cases and someone going through this absolutely needs to stop doing psychedelics, even though they often feel pulled to do more. Similar to the Rocky Return, they should refrain from all kinds of altered states (including mindfulness) until more grounded. And they should really consult a psychotherapist or psychiatrist as soon as possible. Depending on how far out the person is, psychiatric medication may be needed.

These situations, while very rare, are very serious and need to be treated as such. Psychotic-spectrum experiences from a one-time use of psychedelics, if handled skillfully by a professional, can often be resolved. However, if the person continues to work with psychedelics and experiences or shows increasing psychosis symptoms, it becomes much harder to help them stabilize, which is why refraining from further psychedelics is a key step.

Getting Help

No matter what type of troubling psychedelic experience one may have, getting help with it is important. Depending on the nature of the experience, different kinds of help may be needed. Sometimes a professional psychotherapist is needed, other times a spiritual teacher or guide may be more helpful. In general, it is important that the person be familiar with and understand psychedelics and the territory of altered states of consciousness. With the right help, even these troubling experiences with psychedelics can become springboards for healing and personal transformation. More often than not, I find that people who proactively engage with their difficult psychedelic experience and work with what it brought-up end up benefiting greatly on psychological, emotional, and spiritual levels.

Can Ayahuasca Really Cure Depression?

There has been a lot of attention on the Amazonian plant medicine Ayahuasca over the last few years, especially for its therapeutic potential. But, frankly, there has also been a lot of hype. Statements such as “its 10 years of therapy in 1 night” get bandied about regularly. And the psychedelic press makes big proclamations like “A Single Session Of Ayahuasca Defeats Depression” when new research is released. Meanwhile, the mainstream press relishes in the ayahuasca tragedy stories or overly sensational stories about the visions or the purging. In the end it creates a cloud of misinformation and confusion about what ayahuasca is and what it can do. The truth is that while rigorous clinical trials scientifically studying the effects on humans is scant, there is a lot of evidence, anecdotally, clinically, and neurochemically, in favor of ayahuasca as an anti-depressive agent.

Working with Ayahuasca: Anecdotal Observations

Based on my own professional experience working in Peru full-time as an ayahuasca retreat facilitator, guide, and apprentice shaman for the past 2 years I can unequivocally say that I know that ayahuasca *can* cure depression. During that time, I’ve worked with and met countless people who specifically sought-out ayahuasca to treat their depression. Part of the reason is journalist Kyra Sylak's 2006 National Geographic article on her experience attending an ayahuasca retreat in the Peruvian Amazon. In it, she chronicled her dramatic recovery from depression and PTSD. That article was one of the most viewed National Geographic articles of all time and led to a lot of publicity around ayahuasca as a miracle cure for depression. Many people suffering from life-long and treatment-resistant depression came down to Peru in search of that miracle.

What I saw was that ayahuasca can indeed cure depression in some people, but it is not a panacea for everything or everyone. I worked with several guests who reported complete remission of their depression, not to mention major changes in their outlook on life and the healing of life-long traumas and emotional wounds. I also met several people who had attended their first ayahuasca retreat many years ago and reported that it literally saved their life. They were back now to work on different things or because they really enjoyed the experience. One guest told me that she was literally about to commit suicide several years ago when someone gave her the National Geographic article and it gave her enough hope to try one last remedy. These kinds of stories are not uncommon.

But there are also people who after 1 terrifying ceremony, decide that this is not for them and leave in a hurry. And there are also people who feel and look great when they finish their retreat only to return 6 months or a year later reporting a significant backslide. Most often this is due to them returning to the same depressogenic environment and not being able to make the structural life changes needed. Sometimes this is because these changes seemed too painful, daunting or traumatic to undertake (eg getting out of a relationship, quitting a job, moving, setting limits with family members, etc.) and over time the effects of, say, living in a toxic relationship, took their toll. For others, ayahuasca will clear the depression cloud that has been hanging over them but they’re going to need to do their part in terms of lifestyle changes when they get home to really liberate themselves permanently from depression. The people who, from what I’ve seen, get the most out of their ayahuasca experience do just this, using it as a springboard to make some major life changes (quitting drinking/smoking, begin meditating, improve nutrition, career changes, etc.)

But perhaps most importantly, I’ve seen ayahuasca help heal the root issues at the core of people’s depressions. Things like childhood trauma, old negative beliefs and patterns of thinking, and pervasive feelings of alienation and meaninglessness. And these are things that can take a long time to heal in traditional psychotherapy. This to me is more impressive because we are talking about more than just depression, but about changing the fundamental way people relate to themselves and their world. This is where the power in ayahuasca medicine lies and, in my opinion, the relief from depression is simply a reflection of the profound transformation occurring underneath.

What Does The Research Show?

While there are mountains of anecdotal evidence, there have only been two serious clinical studies that have been conducted examining the effects of ayahuasca on depression. In both studies depressed subjects were recruited, provided ayahuasca in a controlled setting, and followed-up with afterwards.

The first was a a small study conducted in Brazil in 2016 that examined the effects of ayahuasca on people with recurrent Major Depressive Disorder. In the study, subjects were given a one-time administration of ayahuasca in a hospital setting while seated quietly in a dimly-lit room. The study showed that the average depression score for subjects dropped from 19.2 on the HAM-D scale, a standard depression measurement questionnaire, to 7.5 at 21 days of follow-up. That is the equivalent of going from a moderate depression to full remission, so these results are pretty dramatic. However, this study only had 17 subjects and was neither blind nor placebo-controlled. It also followed subjects for only 21 days so who knows how they were doing 6 months or 1 year later. It was a promising preliminary study but definitely not the final word on ayahuasca and depression.

The same Brazilian team of researchers followed up a year later with a more thorough double-blind placebo controlled study of 29 subjects with treatment-resistant depression (14 in the ayahuasca and 15 in the control). This study is a big deal because it is the first double-blind placebo controlled study conducted on ayahuasca. They also showed that average HAM-D scores of the subjects administered a single dose of ayahuasca dropped from 21.8 to below 10. At the 1-week follow-up, 36% of the ayahuasca-drinking subjects were in full remission while only 8% of the control group was in remission. Again, very promising. However, clinically speaking these groups are too small to draw any definitive conclusions from. Furthermore, due to high drop-out rates, the team wasn’t able to continue the study beyond 1 week. That is a serious limitation as treatment-resistant depression is a long-term condition.

But these 2 clinical studies confirm the results of previous exploratory studies that administered ayahuasca to small groups of clinically depressant research participants. They also showed similar 50-60% declines in HAM-D scores up to 28 days later.

For comparison, the average drop in HAM-D scores in clinical trials for all FDA-approved SSRI-based anti-depressants was approximately 40%. And these were achieved with trials that explicitly excluded the very difficult treatment-resistant clients which where the focus of the ayahuasca studies. So the ayahuasca results, while preliminary are definitely promising, especially since this was after only a one-time administration of ayahuasca while current pharmaceutical treatments require weeks to build up in the body and then must be taken daily on an ongoing basis.

The Hoasca Project

Other researchers have taken the approach of studying the psychological health of long-term ayahuasca drinkers. The most famous of these non-clinical studies on ayahuasca, is the Hoasca Project, also conducted in Brazil, which administered psychological, biochemical, and physiological tests to long-term members of the Uniao do Vegetal Church in Manaus, who drink ayahuasca regularly in a religious context as a sacrament. These subjects had been drinking ayahuasca for many years, in some cases hundreds of times. Researchers compared the results of their psychological and biological tests with the results from a control group of age- and gender-matched subjects from the community. Now this was also a small study with only 30 total subjects, 15 of which were in the control. But the results revealed that most members of the UDV group had battled with alcoholism, addiction and depression prior to their participation in the ayahuasca church but none of the members currently met the criteria for a psychiatric or substance abuse diagnosis. The UDV members had experienced remission in all their psychiatric conditions, including depression, over the course of their participation with the ayahuasca church. This compares with the control group where 2 members had active psychiatric diagnosis. Other similar retrospective studies have showed essentially the same thing: long-term drinkers of ayahuasca appear to be psychologically healthier than their age/gender-matched community counter-parts and have significantly lower levels of addiction and psychiatric conditions.

Perhaps the most intriguing finding of the Hoasca Project was that the long-term ayahuasca drinkers showed significant increases in serotonin (5HT) transporters levels. Serotonin transporters are intimately related to the regulation of serotonin levels in the brain and are the target site for SSRI-based anti-depressants, so this finding showed one potential pathway by which ayahuasca can treat depression.

Ayahuasca: A complex brew

Ayahuasca is not one individual plant but a combination of plants cooked together to create a drinkable brew. The two primary ingredients are the vine ayahuasca (Banisterias Caapi) and the leaves of the chacruna plant (Psychotria Viridis), although ayahuasqueros will often include many other medicinal plants in their cook or use analogs in lieu of chacruna. Each of these two primary ingredients has their own antidepressant compounds. For example, the ayahuasca vine contains a variety of psychoactive alkaloids known as beta-harmalines that are inhibitors of the Monoamine Oxidase (MAO) enzyme. MAO inhibitors were the first anti-depressants ever developed and the Harmine in ayahuasca is a powerful one. Studies of rats administered with Harmine show a variety of anti-depressant and anti-anxiety like effects and increases in BDNF, which is a protein that supports the growth and function of neurons. 

The chacruna plant contains significant quantities of Dimethyltryptamine (DMT), which is the compound responsible for the visual and visionary experience associated with ayahuasca. DMT strongly affects a variety of Serotonin receptors in the brain as they are very close cousins. One of the serotonin receptors that DMT activates is known as 5HT-2A. This is an important receptor for a lot of psychedelics/entheogens and is considered by some to be a primary neurochemical pathway for psychedelic/visionary experiences. And studies show that harmine also binds to the 5HT-2A receptor, so ayahuasca may be delivering a double dose of serotonin activation at the 2A receptor. 

Recent studies show that some of the very medications psychiatrists prescribe to supplement traditional anti-depressants when they aren’t effective are major 5HT-2A receptor agonists. So we know that targeting 5HT-2A receptors can have anti-depressant properties, especially for those with intractable treatment-resistant depression.  

Powerful anti-depressant compounds, but what else?

At a minimum, ayahuasca contains two very powerful psychoactive compound that have anti-depressant effects. But how can they lessen depression in one session while traditional anti-depressant medications targeting the same neurochemistry take weeks? This is still a mystery. But even the reductionist scientific understanding of ayahuasca shows that there may be more going on than serotonin receptor activation. For example, there is neuro-imaging evidence showing that ayahuasca causes marked reductions in activity and disruptions in connectivity in a network in the brain that is known to be over-active in people with depression.

My personal opinion is that the scientific understanding barely scratches the surface. A ceremonial ayahuasca experience includes a variety of ingredients (the individual, the setting, the peers and community, the shaman/facilitator, the specific constituents of the brew, the beliefs and understandings of how it works by the user, the spiritual nature of the experience for many, the physical purging that is a big part of the experience, etc.) and almost none of them have been examined scientifically. For example, only relatively recently have researchers discovered that psychedelic-caused mystical experiences can themselves have beneficial effects on mood, outlook, and personality.

Frankly, the scientific method does not lend itself well to examining such subjective experiences but that doesn’t mean that we can’t learn from the fruits of of that framework. However, it does mean that in many ways the scientific understanding is way behind the traditional Amazonian knowledge and wisdom that has been accumulated over hundreds of years and passed down from teacher to student. These traditions don’t have a western scientific theory for how Ayahuasca works, but they have tremendous practical knowledge and wisdom on how to wield ayahuasca effectively for maximum benefit.