Mania following use of ibogaine: A case series

This case report (n=3) examines patients who developed manic symptoms and diagnosed with Bipolar-I disorder in response to ibogaine use. None of the patients had a prior diagnosis or family history of bipolar disorder, but all of them were poly-drug users or recovering from addiction. Manic symptoms which often included grand delusions that lasted up to two weeks after using ibogaine.

Abstract

“Background: Ibogaine is a naturally occurring hallucinogen with postulated anti‐addictive qualities. While illegal domestically, a growing number of individuals have sought it out for treatment of opiate dependence, primarily in poorly regulated overseas clinics. Existing serious adverse events include cardiac and vestibular toxicity, though ours is the first report of mania stemming from its use.

Objectives: To report on a case series of psychiatric emergency room patients whose unregulated use of ibogaine resulted in mania in three patients with no prior diagnosis of bipolar illness.

Methods: Review and summarize charts of three cases. Relevant literature was also reviewed for discussion.

Results: Two cases of reported ibogaine ingestion for self‐treatment of addictions, and one for psycho‐spiritual experimentation resulted in symptoms consistent with mania. No prior reports of mania were found in the literature, and the literature suggests growing popularity of ibogaine’s use.

Conclusions: The three cases presented demonstrate a temporal association between ibogaine ingestion and subsequent development of mania.”

Authors: Cole J. Marta, Wesley C. Ryan, Alex Kopelowicz & Ralph J. Koek

Summary

Introduction

Ibogaine, a hallucinogenic indole found in Tabernanthe iboga, is being increasingly utilized for treatment of opiate withdrawal and detoxification, among other reasons, though less so domestically due to controlled status in the U.S.

Ibogaine is legal in Mexico and Canada, but can cause serious side effects. Here we report three cases of mania caused by ibogaine use.

Case Presentations

A 36-year old Caucasian man with a history of ADHD and polysubstance dependence presented to the ED via police escort with prominent manic symptoms. He had taken ibogaine two months prior, and had stopped all medications and left against medical advice.

Mr. A, who used opiates, cocaine, and alcohol, received methadone until a recent relapse, and was then treated with divalproex ER, quetiapine, risperidone, and atomoxetine. He was discharged having achieved marked improvement in mania symptoms after a 13 day hospitalization.

A woman with opiate dependence, in full sustained remission, presented to the psychiatric ED, escorted by police, after self-discontinuing her medication regimen and decompensating. She was admitted to a nearby hospital and stabilized on a combination of quetiapine, risperidone, and olanzapine (doses unknown). A woman was admitted with methadone use and was titrated up to a therapeutic dose of olanzapine. She was discharged home with partial symptom response. One week later, she presented to the ED again, this time with persecutory delusions. She was diagnosed with bipolar I disorder and administered methadone and opiates.

Mr. C, a 40 year old Caucasian male with no known psychiatric history, self-presented to the psychiatric ED after describing a 2-week history of worsening distractibility, irritability, grandiosity, emotional lability, decreased need for sleep, racing thoughts, and suicidal ideation. He was diagnosed with bipolar I disorder but refused treatment.

Discussion/Conclusions

The three cases presented demonstrate a temporal association between ibogaine ingestion and subsequent development of mania. The onset of symptoms was noted at hours to days after ingestion each time, and each patient was independently diagnosed with bipolar I disorder, current episode mania, by multiple physicians.

There are limitations to the study: collaborative history was unavailable, psilocybin and heavy marijuana use were potential confounds, and toxicology testing was not possible.

Clinicians should be prepared to discuss ibogaine use with patients with new onset mania, given the paucity of good data regarding its use.