Psychedelic Therapy: A Primer for Primary Care Clinicians—Ibogaine

Author:

Cherian Kirsten1,Shinozuka Kenneth23ORCID,Tabaac Burton J.45,Arenas Alejandro6,Beutler Bryce D.7,Evans Viviana D.8,Fasano Chelsey9,Muir Owen S.1011

Affiliation:

1. Department of Psychiatry & Behavioral Sciences, Stanford University, Palo Alto, CA;

2. Centre for Eudaimonia and Human Flourishing, University of Oxford, Oxford, United Kingdom;

3. Department of Psychiatry, University of Oxford, Oxford, United Kingdom;

4. University of Nevada, Reno School of Medicine, Reno, NV;

5. Department of Neurology, Carson Tahoe Health, Carson City, NV;

6. Department of Anesthesiology, University of Washington School of Medicine, Seattle, WA;

7. Keck School of Medicine, University of Southern California, Los Angeles, CA;

8. Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY;

9. Teachers College, Columbia University, New York, NY;

10. Fermata Health, Brooklyn, NY; and

11. Acacia Clinics, Sunnyvale, CA.

Abstract

Background: Ibogaine is a plant-derived alkaloid that has been used for thousands of years in rites of passage and spiritual ceremonies in West-Central Africa. In the West, it has primarily been used and studied for its anti-addictive properties and more recently for other neuropsychiatric indications, including post-traumatic stress disorder, depression, anxiety, and traumatic brain injury. Areas of Uncertainty: Ibogaine requires careful patient screening and monitoring because of significant safety issues. There is potential for cardiotoxicity (prolonged QT interval); without rigorous screening, fatal arrhythmias may occur. However, preliminary research suggests that co-administration of ibogaine with magnesium may mitigate cardiotoxicity. Additionally, ibogaine may have dangerous interactions with opiates, so patients who receive ibogaine treatment for opioid use disorder must withdraw from long-acting opioids. Other potential concerning effects of ibogaine include rare incidences of mania or psychosis. Anticipated transient effects during ibogaine treatment can include ataxia, tremors, and gastrointestinal symptoms. Therapeutic Advances: Robust effects after a single treatment with ibogaine have been reported. In open-label and randomized controlled trials (RCTs), ibogaine reduces heroin and opioid cravings by upwards of 50%, up to 24 weeks after the treatment. An observational study of 30 Special Operations Forces veterans with mild traumatic brain injury reported that 86% were in remission from post-traumatic stress disorder, 83% from depression, and 83% from anxiety, one month after a single-dose ibogaine treatment. Limitations: Although there are several observational and open-label studies, there is only a single double-blind, placebo-controlled RCT on ibogaine. More RCTs with large sample sizes must be conducted to support ibogaine's safety and efficacy. Conclusions: Given the promising preliminary findings, ibogaine could potentially fill a much-needed gap in treatments for challenging conditions, including opioid dependence. Ibogaine's remarkable effects in traditionally treatment-resistant, combat-exposed individuals hints at its potential in broader populations with physical and psychological trauma.

Publisher

Ovid Technologies (Wolters Kluwer Health)

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