“Atypical psychedelic” ibogaine shows promise as a treatment for chronic disability following TBI
By Conor Gormally. This article was initially published in the 3/7/24 edition of our Concussion Update newsletter; please consider subscribing.
A landmark study published in Nature Medicine found that ibogaine, an “atypical psychedelic” derived from the root bark of an African shrub, showed highly beneficial effects on emotional well-being and cognition in a group of Special Operations Forces (SOF) veterans with chronic illness relating to their military careers and history of traumatic brain injury (TBI), primarily mild TBIs. Authors Kirsten N. Cherian et al. note that this study is potentially the first to “report evidence for a single treatment with a drug that can improve chronic disability related to repeated TBI from combat/blast exposures.”
Thirty SOF veterans, all male and averaging almost eight years since military discharge, participated in the study, which consisted of comprehensive assessments before and after independently scheduled treatment at a clinic in Mexico. Working in collaboration, Stanford University and Veterans Exploring Treatment Solutions (VETS, Inc.) supported the veterans’ travel and treatment. VETS is a non-profit organization that helps veterans access safe, clinically guided psychedelic therapy. Before treatment, 15 of the 30 participants met clinical criteria for major depressive disorder, 14 met criteria for an anxiety disorder, 23 of 30 met criteria for PTSD, and 15 met criteria for alcohol use disorder. The vast majority of participants (28 of 30) had only experienced mild TBIs, with one participant each experiencing a moderate and a severe TBI.
According to a press release from Stanford Medicine News Center, “At the beginning of the study, participants were experiencing clinically significant levels of disability as measured by the World Health Organization Disability Assessment Scale 2.0 [WHODAS], which assesses disability in six functional domains, including cognition, mobility, self-care, getting along, life activities and community participation.” After treatment, participants’ average scores decreased from “mild-to-moderate disability” to “borderline-no-to-mild disability,” and these scores continued to decrease over time; at the one-month follow-up evaluation, participants’ average scores had decreased from 30.2 (out of 100) to 5.1, which the WHODAS scale defines as “no disability.” Further, the Stanford article notes that “participants experienced average reductions of 88% in PTSD symptoms, 87% in depression symptoms, and 81% in anxiety symptoms” at one month after treatment. Perhaps most critically, the proportion of participants who scored at least one point on a measure of suicidal ideation decreased from 47% to 0% after treatment and 7% at one-month post-treatment.
Ibogaine’s effects were not limited to participants’ emotional well-being; they also had significant, positive gains in several functional cognitive domains. Researchers administered a neuropsychological testing battery at all three time points (pre-, post-, and 1-month). They found significant improvements in processing speed, “executive functioning (including inhibition, cognitive flexibility, problem-solving, phonemic fluency, and working memory),” learning and memory, and sustained attention. Specifically, the improved “sustained attention metrics” were “consistent with prioritization of accuracy over speed,” showing that the veterans had “reduced impulsivity.”
Ibogaine is considered an “atypical psychedelic” due to its interaction with multiple neurotransmitter systems, including serotonin and dopamine transporters and brain-derived neurotrophic factor (BDNF)––which is involved in neuroplasticity and neuron growth (neurogenesis), playing a vital role in learning, memory, and neuron growth and survival. Consumption of ibogaine “has been associated with instances of fatal cardiac arrhythmia,” but researchers have found that taking magnesium during dosage mitigated and protected the body from heart issues during treatment.
Participants experienced no adverse effects during treatment, and the researchers noted that ibogaine had apparent “anti-addictive” properties that may mitigate the drug’s risk for abuse. Despite these positive findings, the authors note several limitations and a need for further research.