A 36-year-old immigrant woman from South America began using ayahuasca daily as part of rituals performed by a community in Europe. Over time, she became socially isolated and developed delusional and mystical religious ideas, persecutory delusions, and auditory hallucinations in which Archangels spoke to her about creating music. She was involuntarily admitted to a mental health unit and treated with risperidone, which gradually resolved the hallucinations. After discharge, she continued outpatient treatment with injectable risperidone. The case highlights the need for clinicians to understand culturally unfamiliar substances like ayahuasca, which is undetectable in standard urine or blood tests.
In a six-month naturalistic study of 62 patients with treatment-resistant depression and high suicide risk, those receiving intranasal esketamine showed faster and greater reductions in suicidal thoughts and depressive symptoms compared to those receiving alternative pharmacological treatments. The number needed to treat to prevent one case of high suicide risk was 1.35. Functional improvement was similar between groups. The findings support esketamine as a rapid-acting option in real-world, closely monitored care.