Skip to main contentrtttttt Skip to main content
Integrative Psychiatry

Getting to the Root of it: Ibogaine in Mental Health

By November 20, 2024No Comments

Some psychedelics like MDMA, psilocybin, and LSD have enjoyed much of the spotlight of the psychedelic movement in Western medicine, ibogaine is beginning to emerge as an exciting actor in the mental health field. Derived from the root bark of Tabernanthe iboga, a rainforest shrub native to West Central Africa, ibogaine has been traditionally used by indigenous peoples for spiritual ceremonies and healing rituals. However, its unique pharmacological and psychotropic effects have led researchers to investigate ibogaine’s potential as a therapeutic tool. 

Ibogaine and Addiction

One of the most compelling applications of ibogaine is in treating opioid use disorder (OUD). In particular, ibogaine has a unique ability to reduce withdrawal symptoms and cravings, often in a single session. Limited evidence suggests a similar effect of ibogaine for treatment of cocaine addiction, while the jury is still out on other addictive substances and processes.

When I first heard the claim that ibogaine could help treat addiction, I thought it was an impossible, oversimplified, flashy headline. How could a drug possibly interact with and instantly treat long-standing addiction circuits? At this time, the precise mechanism of action is still rather mysterious. Yet preliminary research suggests that ibogaine interacts with serotonin, NMDA, and opioid receptors to “reset” certain parts of the brain that are involved in addiction. 

Plus, ibogaine does more than simple pharmacology; its psychedelic effects may encourage meaning-making and engagement with life (see our blogs explaining effects of psychedelics on the self or embodied cognition). Without understanding and tending to the unmet need underlying addiction, cessation of one addiction often leads directly into another addiction, for example, trading a substance use disorder for an exercise addiction. Trauma and addiction expert, Gabor Maté, famously says, “The question is never ‘Why the addiction?’ but ‘Why the pain?’” (Maté, 2010, p. 36). Like other psychedelics, ibogaine opens consciousness to make aware that which was not previously aware, including unresolved pain. It can also help facilitate connection with spirituality, including emotions like unity, awe, gratitude, and love. In essence, ibogaine works at two levels: 1) helping stabilize the brain’s neurocircuitry that has been altered in addiction while 2) opening up the psyche in ways that might reduce impulse toward the addiction. 

Therefore, working with ibogaine for addiction does not imply a quick fix. I would think of it as a multifaceted approach combining treatment and counseling, aligning with holistic recovery goals. Unlike methadone or buprenorphine, which require ongoing dosing, ibogaine could potentially offer a one-time intervention that, with continued support and integration, leads to long-term behavioral change. That said, clinical studies on ibogaine’s efficacy for OUD remain limited, and more data is needed to support its widespread use.

Ibogaine for Traumatic Brain Injury (TBI)

Another emerging clinical application of ibogaine is in traumatic brain injury (TBI). Early studies imply that ibogaine may encourage neurogenesis, or the growth of new neurons, and support brain plasticity. In animal studies, ibogaine appears to stimulate the brain-derived neurotrophic factor (BDNF), which is vital for cognitive function and recovery post-injury.

Ibogaine could potentially provide relief from symptoms like depression, anxiety, cognitive impairment, and mood dysregulation, which commonly co-occur with TBI. One recent study in veterans with posttraumatic stress disorder (PTSD) found that a single treatment of ibogaine with magnesium (to reduce potential cardiotoxic effects) reduced disability scores as well as symptoms of PTSD, depression, and anxiety. These effects persisted at least 1-month following the magnesium-ibogaine therapy, exhibiting. The study also showed improvements in many of the neuropsychological tests, including processing speed, executive functions, and accuracy in sustained attention at both post-treatment time points. While the neuroplastic and psychospiritual effects of ibogaine are promising, there is still much to learn about the appropriate dosing and administration methods for individuals with TBI.

Adverse Events

As with many powerful plant medicines, ibogaine comes with significant risks that do not make it accessible for everyone, especially those with specific preexisting conditions. The most dangerous and well-documented contraindications for ibogaine therapy are cardiac-related. Ibogaine is well known to cause a specific change in the electrical firing pattern of the heart, as measured by electrocardiogram. This effect, in vulnerable people, can lead to an irregular heart rhythm and even death. To evaluate and minimize this risk, it seems obvious to propose that an evaluation of risk by a qualified physician such as a cardiologist prior to undergoing ibogaine treatment. The vomiting that often accompanies the ibogaine journey may amplify this risk via loss of potassium, as low potassium levels are another risk factor for the heart. Given its psychedelic nature, ibogaine can cause other physical (i.e., gastrointestinal distress) and psychological effects (i.e., changes in mood, sleep, hallucinations) that some patients find challenging, particularly if unprepared for the extraordinary length of an ibogaine journey, typically lasting up to 72 hours. 

Conclusion

While ibogaine offers exciting potential in the realms of addiction treatment and TBI recovery, it is by no means a “cure-all.” It is a powerful medicine that must be honored with respect. Working with ibogaine requires carefully balancing an understanding of a person’s medical condition  and psychological profile, to assess possible pharmacological risks. In risk assessment, it’s also worth considering what alternatives (have less risky treatments been exhausted?) and what the risks are of not treating an OUD, which itself is often a lethal disease, to say nothing of the damage to family members of unresolved addictions. Nevertheless, ibogaine is making its way to the stage as an option worth exploring for holistic recovery and wellness.

Citation

Maté, G. (2010). In the realm of hungry ghosts: Close encounters with addiction. North Atlantic Books.

Sara Reed, MS, LMFT

Sara Reed is a Licensed Marriage and Family Therapist and CEO of Mind’s iHealth Solutions, a digital health company that provides evidence based and culturally responsible mental health services for underserved groups. As a mental health futurist and clinical researcher, Sara examines the ways culture informs the way we diagnose and treat mental illness. Sara’s prior research work includes participation as a study therapist in psychedelic therapy research at Yale University and the University of Connecticut’s Health Center. Sara was the first Black therapist to provide MDMA-assisted psychotherapy in a clinical trial and continues to engage in ongoing advocacy work around health equity in psychedelic medicine.

https://psychiatryinstitute.com/wp-content/uploads/2019/11/Jeffrey-Guss.png

Jeffrey Guss, MD is a psychiatrist, psychoanalyst, and researcher with specializations in psychoanalytic therapy and the treatment of substance use disorders. He was Co-Principal Investigator and Director of Psychedelic Therapy Training for the NYU School of Medicine’s study on psychedelic-assisted psychotherapy in the treatment of cancer-related existential distress, which was published in Journal of Psychopharmacology, 2016. He currently is a study therapist in the NYU study on Psychedelic-Assisted therapy in the treatment of Alcoholism, a collaborator with Yale University’s study on psychedelic-assisted therapy for Major Depressive Disorder and a study therapist with the MAPS (Multidisciplinary Association for Psychedelic Studies) study on treatment of Post Traumatic Stress Disorder with Psychedelic-Assisted Psychotherapy. 

Dr. Guss is interested in the integration of psychedelic therapies with contemporary psychoanalytic theory and has published in Studies in Gender and Sexuality and Psychoanalysis, Culture and Society. He has published (with Elizabeth Nielson, PhD) a paper on “the influence of therapists’ first had experience with psychedelics on psychedelic-assisted psychotherapy research and therapist training” in The Journal of Psychedelic Studies, August, 2018. He is an Instructor and Mentor with the California Institute of Integral Studies’ Center for Psychedelic Therapies and Supervisor in NYU’s Fellowship in Addiction Psychiatry. 

Dr. Guss maintains a private practice in New York City.

Will Van Derveer, MD

Will Van Derveer, MD is Co-Founder of Integrative Psychiatry Institute and Integrative Psychiatry Centers. Dr. Van Derveer was co-investigator on a phase 2 MAPS study of Psychedelic-assisted psychotherapy for treatment-resistant PTSD, and co-authored the publication of this study in 2018. He has also provided Psychedelic-assisted psychotherapy in two MAPS training studies. An active provider of KAP at his clinic in Boulder, CO, he has been teaching others KAP therapy for several years. Dr. Van Derveer contributed a chapter on mescaline in the 2021 "Handbook of Medical Hallucinogens" (edited by Charles Grob and Jim Grigsby). He is co-host of the Higher Practice Podcast.

Dr. Van Derveer regards unresolved emotional trauma as the most significant under-recognized root cause of psychiatric symptoms in integrative psychiatry practice, along with gut issues, hormone imbalances, inflammation, mitochondrial dysfunction, and other functional medicine challenges. He is trained in Somatic Experiencing, EMDR, Internal Family Systems, and other psychotherapy techniques. His current clinical passion is psychedelic-assisted psychotherapy, which he mentors interested doctors in providing. An avid meditator, he has been a meditation instructor since 2004.

For the past several years Dr. Van Derveer has taught psychiatrists and other psychiatric providers integrative psychiatry in a number of settings, including course directing the CU psychiatry residents’ course as well as with Scott Shannon and Janet Settle at the Psychiatry MasterClass.


Scott has been a student of consciousness since his honors thesis on that topic at the University of Arizona in the 1970s under the tutelage of Dr. Andrew Weil. Following medical school, Scott studied Jungian therapy and acupuncture while working as a primary care physician in a rural area for four years. Psychedelic-assisted psychotherapy became a facet of his practice before this medicine was scheduled in 1985. He then completed a psychiatry residency at Columbia program in New York. Scott studied cross-cultural psychiatry and completed a child/adolescent psychiatry fellowship at the University of New Mexico.

In 2010 he founded Wholeness Center in Fort Collins. This innovative clinic provides cross-disciplinary evaluation and care for all mental health concerns. Scott serves as a site Principal Investigator and therapist for the Phase III trial of psychedelic-assisted psychotherapy for PTSD sponsored by (MAPS). He has also published numerous articles about his research on (CBD) in mental health. Currently, Scott works extensively with psychedelic-assisted-psychotherapy. He lectures all over the world to professional groups interested in a deeper look at mental health issues, safer tools, and a paradigm-shifting perspective about transformative care.

Will Van Derveer, MD is co-founder of Integrative Psychiatry Institute (IPI), along with friend and colleague Keith Kurlander, MA. He co-created IPI as an expression of what he stands for. First, that anyone can heal, and second that we medical providers must embrace our own healing journeys in order to fully command our potency as healers.

Dr. Van Derveer spent the last 20 years innovating and testing a comprehensive approach to addressing psychiatric challenges which transcends the conventional model he learned in medical school at Vanderbilt University and residency at University of Colorado, while deeply engaging his own healing path.

He founded the Integrative Psychiatric Healing Center in in 2001 in Boulder, CO, where he currently practices. Dr. Van Derveer regards unresolved emotional trauma as the most significant root cause of psychiatric symptoms in integrative psychiatry practice, along with gut issues, hormone imbalances, inflammation, mitochondrial dysfunction, and other functional medicine challenges. He is trained in Somatic Experiencing, EMDR, Internal Family Systems, and other psychotherapy techniques. His current clinical passion is psychedelic-assisted psychotherapy, which he mentors interested doctors in providing. An avid meditator, he has been a meditation instructor since 2004.

For the past several years Dr. Van Derveer has taught psychiatrists and other psychiatric providers integrative psychiatry in a number of settings, including course directing the CU psychiatry residents’ course as well as with Scott Shannon and Janet Settle at the Psychiatry MasterClass. In addition to his clinical work and teaching, he was co-investigator in 2016 a Phase II randomized clinical trial, sponsored by the Multidisciplinary Association for Psychedelic Studies (MAPS). He continues to support this protocol, now in a Phase III clinical trial under break-through designation by FDA.

Dr. Van Derveer is a diplomate of the American Board of Integrative and Holistic Medicine (ABoIHM) since 2013, and he was board certified in the first wave of diplomates of the new American Board of Integrative Medicine (ABIM) in 2016.