SSRIs and Ayahuasca — The Tapering Conversation Nobody Wants to Have

More than half of the people who first contact our retreat are on, recently off, or have a history with SSRIs. This is the most important medication conversation we have, and most websites either gloss it or scare-monger about it. Here's what we actually tell our participants — and what your prescriber probably will not.

What's actually happening pharmacologically

Ayahuasca contains two active components. The vine (Banisteriopsis caapi) contains harmala alkaloids, which are MAO inhibitors — they suppress an enzyme called monoamine oxidase. The leaf (Psychotria viridis) contains DMT, the visionary alkaloid that wouldn't normally survive your gut without the MAOI's protection.

SSRIs (selective serotonin reuptake inhibitors — Prozac, Zoloft, Lexapro, Celexa, Paxil) work by preventing serotonin from being reabsorbed back into nerve cells, raising the available serotonin in the synapse. Combine an MAOI with high serotonin and you can get serotonin syndrome — a dangerous, sometimes fatal condition characterized by high fever, racing heart, seizures, and rigid muscles.

What 'tapered enough' actually means

Different SSRIs leave the body at very different rates. Half-life is the rough indicator. Plan accordingly:

• Fluoxetine (Prozac) — long half-life, requires the longest washout. We recommend at least 6 weeks off before ceremony.
• Sertraline (Zoloft) — 4 to 5 weeks off
• Citalopram (Celexa) and Escitalopram (Lexapro) — 3 to 4 weeks off
• Paroxetine (Paxil) — 3 to 4 weeks off, but notorious for difficult withdrawal — must be tapered very slowly
• Venlafaxine (Effexor, SNRI) — 3 to 4 weeks off, also difficult to taper
• Duloxetine (Cymbalta, SNRI) — 3 to 4 weeks off
• MAOIs (Nardil, Parnate) — at least 6 weeks off, longer for some practitioners
• Tricyclics (Elavil, Tofranil) — 4 to 5 weeks off

These are minimum windows for the safety risk. They are not necessarily the right windows for you mentally. If you have been on an SSRI for years, coming off in 6 weeks may be too fast for your nervous system. Plan with your prescriber.

How to actually have the conversation with your prescriber

Most prescribers in the US, UK, and Europe have not been trained in plant-medicine pharmacology and may default to one of two unhelpful responses: 'absolutely not' or 'sure, just stop a few days before.' Both are wrong. Here's a more useful approach:

1. Don't ask permission to do Ayahuasca. Ask permission to come off your SSRI.
2. Frame the request as 'I'd like to plan a careful taper off my medication over the next 8 to 12 weeks. Can you support me through that?' Most prescribers will say yes to this.
3. If they ask why, you can be honest or you can say you want to evaluate whether you still need it. Either is valid. Tapering is a routine part of psychiatric care.
4. Ask them for a written taper schedule — typically reducing the dose by 10 to 25% every 2 to 4 weeks. Some medications (Paxil, Effexor, Cymbalta) require even slower steps.
5. Schedule check-ins every 2 to 3 weeks during the taper.

What if I can't come off?

Some people genuinely cannot safely come off their medication right now. Severe major depression with suicidal history, bipolar with stabilizer medications, certain anxiety disorders that require ongoing pharmacological management — for these people, this is not the right time for Ayahuasca. We say this clearly and we say it gently:

We have other options for participants in this position. Sacred Mushrooms are not a hard contraindication with most SSRIs (still requires careful conversation, but the risk profile is different). San Pedro is also generally safer with SSRIs in our experience, though we always confirm with each individual case. Kambo is a separate question — debated, generally OK, but we screen carefully. We can also offer non-medicinal modalities: temazcal sweat lodge, breathwork, somatic therapy with John Hasan Khadiyev, family constellations with Ana Karina, individual integration sessions.

After ceremony — when can I go back on?

If you tapered off for ceremony and you and your prescriber agreed you'd resume afterward, the conventional safety window is 2 weeks after your last dose of Ayahuasca. The MAOIs in the medicine clear in much less time than this, but caution beats coincidence.

Many participants find — to their own surprise — that they don't want to resume. Some return to a much lower maintenance dose. Some restart at full dose without changes. Some make a careful decision with their therapist to remain off. None of these are right or wrong. They are conversations, with the people who know you and your history.

What we do

Every participant fills out a detailed medical and psychiatric intake before we accept their booking. We have an MD in Quito on call who consults with us on borderline cases. If your taper plan is unclear, we will ask for a letter from your prescriber confirming you are off the medication and the dates of your last dose. We have, on more than one occasion, declined a participant 48 hours before their flight because their tapering had not been done correctly. We would always rather have that conversation than the one that happens when something goes wrong.

◦ patience now. wisdom later. ◦

Write to us early if you are on medication. The earlier we know, the more we can help you plan.