Medical Editor: Dr. Benjamin Malcolm, PharmD, MPH, BCPP
From tribal ceremonies in Africa to the treatment of opioid use disorder in the West, people are using ibogaine, but can it treat depression?
Ibogaine is notorious for potent anti-addictive effects and works differently from other psychedelics, although has higher medical risks and is not well studied in depression.. Despite ibogaine’s risks, in select persons, it could be worth considering, particularly if depression occurs alongside or is associated with an opioid use disorder or other addiction.
What Is Ibogaine?
Ibogaine is an alkaloid derived most commonly from the root bark of the Tabernanthe iboga shrub, although also found in other plant species (e.g. voacanga). Ibogaine is classified as a psychedelic and hallucinogen, although is perhaps most accurately described as an oneiric (producing a lucid dream-like state) substance. It targets different receptors and neurotransmitters than psychedelics like psilocybin or MDMA. For example, ibogaine seems to primarily work on opioid, glutamate, and dopamine neurotransmitter systems, while psilocybin and MDMA work primarily on serotonin. Ibogaine is long-acting and is metabolized to another compound, noribogaine, that has an even longer duration of action.
Due to the endangered status of the iboga shrub, most ibogaine providers are currently working with voacanga derived ibogaine hydrochloride, a sustainable alternative to iboga-derived ibogaine. However, when we talk about ibogaine, we are usually talking about what we know from experience with iboga extracts. The Pygmy tribes of equatorial west Africa have been using iboga for millennia as a rite of passage, a tool to connect to ancestral roots, and as a method for medicinal healing.
French explorers noticed and set their eye on the practice of using iboga root bark in tribal ceremonies in the 19th century, in particular, the naval physician Gabon Marie-Théophile Griffon du Bellay. The psychedelic made it’s way back to France, where it was first isolated from T. iboga in 1901 using T. iboga samples from Gabon. It was sold in France as Lambarène, as a stimulant and a mental and physical performance enhancement drug, during the 1930s to 1960s, and even taken by World War II athletes before it became illegal in 1966.
In the United States, ibogaine was first lauded for its anti-addictive properties in 1962 by Howard Lotsof, when he broke his heroin addiction with a single dose. He went on to found the Global Ibogaine Therapy Alliance (GITA) and patented ibogaine as an ‘interrupter of narcotic addiction’. Most published ibogaine research focuses on addiction. Research, studies, and even anecdotal reports indicate that ibogaine is anti-addictive for many substances, such as opioids, alcohol, nicotine, and cocaine. In addition, ibogaine is unique in that it appears to almost completely eliminate the withdrawal effects of opioids.
It is still used around the world today, both therapeutically and ceremonially. Due to barriers to access, the potential for adverse effects, long duration of action, and reputation for not being the most pleasant experience, there is little to no recreational value in ibogaine. Many people travel to countries with legal grey areas where the substance is ‘unregulated or ‘unscheduled’, such as Mexico, South Africa, and Canada. There are also treatment centers in Costa Rica, the Bahamas, and other clandestine locations.
Ibogaine can cause fatality from arrhythmias or cardiopulmonary arrest. While many more persons die on a daily basis of opioid overdoses in the US than have ever been reported to die from use of ibogaine, these risks argue the case that ibogaine should only be taken under medical supervision with monitoring and emergency medical support available.
Can Ibogaine Treat Depression?
There is little evidence from studies that ibogaine is able to treat depression. his is perhaps because the limited research has focused on the potent anti-addictive effects. It stands to reason that if ibogaine can effectively help a person recover from heavy addictions to substances like heroin and cocaine, that person’s mood could significantly improve as a result. Similarly, if ibogaine can eliminate withdrawal symptoms, it may plausibly help post-acute withdrawal symptoms such as depression. Many psychedelic-assisted therapies appear to have ‘transdiagnostic’ potential, meaning they can treat a number of mental illnesses. This flexibility is perhaps due to the rewiring of core traumas that underlie negative emotional states and substance use disorders. Specifically, ibogaine promotes neurogenesis and neuroplasticity due to its mechanism of action with neurotrophic factors GDNF and BDNF that may explain how it resets addiction neurocircuitry or targets the lack of motivation or interest in pleasurable activities that accompanies depression (e.g. anhedonia). Given other psychedelics such as ketamine and psilocybin have much more data supporting their benefits in depression and much lower medical risks than ibogaine, it may be more reasonable to try other psychedelic therapies before considering ibogaine unless opioid use disorder or another serious addiction is present for depression.
What Can I Expect From an Ibogaine Experience?
As with all psychedelics, dose, set, and setting factor into the quality of experience. Persons should undergo medical screening that measures electrolytes, liver function, and their heart (EKG) as well as avoid any contraindicated medications (including antidepressants, many psychiatric medications, and even some OTC medications).
The experience lasts intensely for 12-18 hours and could last 24 hours or more total. Nausea and vomiting can occur and participants may feel off-balance or dizzy if they try standing up. Expect to be in bed or lying down for at least the first 12-18 hours of your trip.
In general, ibogaine trips can be summarized into three parts:
- Visionary phase: The visionary (or acute) phase starts one to three hours after consumption and usually lasts for four to eight hours, some individuals report longer. People describe it as an awake but dreamlike state (oneiric). There are intense hallucinations, such as visits from otherworldly beings, ancestors, and past life or repressed memories. Unlike visuals on LSD, whereas the person experiences hallucinations immediately around them, an ibogaine trip is more an introspective review, akin to a lucid dream, of one’s self as the ego takes a backseat.
- Introspection phase: The introspection (or evaluative) stage is where the healing takes place. It begins about four to eight hours after taking ibogaine and can last eight to 20 hours. While still psychoactive, this phase usually has fewer visions or memories and more thoughts and inner dialogues often related to processing trauma and the intentions or reasons for seeking out ibogaine. Some people report they are able to process the revelations they experienced in the visionary stage and others describe life-changing epiphanies.
- Residual stimulation phase: The residual stimulation phase begins 12 to 24 hours after taking ibogaine and can last 24 to 72 hours or more. This is the phase where the person begins to integrate their ibogaine experience into everyday life. There is usually a day after ibogaine that is emotionally challenging that is sometimes referred to as a “grey day”. The“ibogaine glow” many speak of usually begins once someone sleeps after their grey day.
While this acts as a loose guide to the ibogaine experience, it varies from individual to individual.
Though ibogaine shows tremendous potential in addiction medicine, due to the intensity and duration of the experience, potential adverse effects, and access limitations, it’s worth looking into other psychedelics such as ketamine- or psilocybin-assisted therapies for depression first.
