This survey study (n=51) found very large effects on mental health for special forces veterans after ibogaine and 5-MeO-DMT treatment.
Abstract
“Background U.S. Special Operations Forces Veterans are at increased risk for a variety of mental health problems and cognitive impairment associated with military service. Current treatments are lacking in effectiveness and adherence. Therefore, this study examined psychedelic treatment with ibogaine and 5-methoxy-N,N-dimethyltryptamine for trauma-related psychological and cognitive impairment among U.S. Special Operations Forces Veterans.
Method We conducted a survey of Veterans who completed a specific psychedelic clinical program in Mexico between 2017 and 2019. Questions probed retrospective reports of mental health and cognitive functioning during the 30 days before and 30 days after treatment. A total of 65 people completed treatment during this time frame and were eligible for contact. Of these, 51 (78%) completed the survey and were included in data analyses (mean age = 40; male = 96%; married = 55%; Caucasian/White = 92%; Operation Enduring Freedom/Operation Iraqi Freedom Service = 96%).
Results Results indicated significant and very large reductions in retrospective report of suicidal ideation (p < .001; d = −1.9), cognitive impairment (p < .001; d = −2.8), and symptoms of posttraumatic stress disorder (p < .001; d = −3.6), depression (p < .001; d = −3.7), and anxiety (p < .001; d = −3.1). Results also showed a significant and large increase in retrospective report of psychological flexibility (p < .001; d = 2.9) from before-to-after the psychedelic treatment. Increases in the retrospective report of psychological flexibility were strongly associated with retrospective report of reductions in cognitive impairment, and symptoms of posttraumatic stress disorder, depression, and anxiety (rs range −0.61 to −0.75; p < .001). Additionally, most participants rated the psychedelic experiences as one of the top five personally meaningful (84%), spiritually significant (88%), and psychologically insightful (86%) experiences of their lives.
Limitations: Several limitations should be considered including the retrospective, self-report, survey design of the study, and the lack of randomization and blinding, thus making these finding preliminary.
Conclusion U.S. Special Operations Forces Veterans may have unique treatment needs because of the sequela of problems associated with repeated trauma exposure and the nature of the exposure. Psychedelic-assisted therapy with these under-researched psychedelics may hold unique promise for this population. However, controlled studies are needed to determine whether this treatment is efficacious in relieving mental health and cognitive impairment among U.S. Special Operations Forces Veterans.”
Authors: Alan K. Davis, Lynnette A. Averill, Nathan D. Sepeda, Joseph P. Barsuglia & Timothy Amoroso
Notes
Also reported on PsyPost.
As mentioned in the limitations, care should be taken in interpreting the results as the treatment was between one month and two years earlier.
During the treatment, they were constantly monitored. On the first day, they were given a “single oral dose (10 mg/kg) of ibogaine hydrochloride (99% purity)”. On the third day, they were given “at least three doses: 5 mg, 15 mg, and 30 mg for a total of 50 mg of inhaled 5-MeO-DMT” and up to 45mg in a fifth dose if no peak experience was achieved before that.
“Preliminary results from our study suggest that ibogaine and 5-MeO-DMT treatments may offer a novel, rapid-acting and potentially costeffective treatment for people suffering from PTSD.”
This is in response to the lack of available (effective) methods and the long-lasting effects of these three days of treatment. The authors also specifically mention the psychological flexibility as a mediator for the positive outcomes.
Expectancy effects and the lack of a placebo in this study are two big limitations. Ones that future studies may help overcome.
Summary
U.S. Special Operations Forces Veterans are at increased risk for mental health problems.
Introduction
Special Operations Forces personnel are among the most elite members of the military, but are often exposed to more deployments and intense combat which are associated with increased prevalence of posttraumatic stress disorder (PTSD).
Combat Veterans with PTSD frequently demonstrate a complex spectrum of co-morbid psychological and neuropsychiatric symptoms, including traumatic brain injury (TBI), depression, anxiety, cognitive impairment, and suicidal behaviors.
Currently available treatments for PTSD in SOF members and Veterans demonstrate limited efficacy, have unwanted side effects, and require long-term use. It is essential to develop novel, potentially curative treatment approaches that can address the underlying etiology and spectrum of symptoms in the Veteran population.
Psychedelic drugs have potential as transdiagnostic treatment approaches for Veterans with PTSD and other psychiatric conditions. Ibogaine and 5-MeO-DMT are lesser researched psychedelic drugs that may be of particular relevance for addressing the symptom clusters experienced by SOF Veterans.
Ibogaine
Ibogaine is a psychoactive indole alkaloid that is extracted from the Tabernanthe iboga rainforest shrub. It is used in Central Africa for initiatory rituals and is reported to alleviate a spectrum of mood and anxiety symptoms and improve cognitive functioning in individuals with substance use disorders.
5-MeO-DMT is a psychedelic tryptamine found in plant species and notably in the venomous secretions of the Sonoran Desert/Colorado River toad. It has been shown to have therapeutic potential across a variety of psychiatric symptoms, including depression and anxiety, as well as increased life satisfaction and mindfulness-related capacities.
Current Study
The current study examined the outcomes of a multi-modal clinical psychedelic program on mental health functioning among U.S. SOF Veterans. The participants reported reductions in symptom severity across multiple mental health domains and reported acute and enduring positive effects of these treatment experiences.
Clinical Program
All participants were English-speaking U.S. SOF Veterans that received treatment at a clinical psychedelic program in Mexico between 2017 and 2019. They underwent medical screening, psychological intake, and laboratory tests before being accepted into the program.
The clinical program occurred in a residential setting in Mexico over a period of three days. Participants were administered ibogaine hydrochloride (10 mg/kg) in a group setting with four to five participants and received continuous cardiac monitoring, intravenous fluids, and medical monitoring throughout the ibogaine session. Participants were administered 5 mg, 15 mg, and 30 mg of inhaled 5-MeO-DMT one at a time on Day 3, and were invited to integrate their experience both individually and via group activities.
Recruitment Procedure for Retrospective Survey
A survey was sent to individuals who previously participated in the clinical program from April 2019 to September 2019. No personally identifying information was collected in the survey. To participate in the study, participants had to be between the ages of 18 and 64, able to read, write, and understand the English language, and have participated in the clinical psychedelic program. They completed a battery of measures that assessed PTSD, substance use, depression, anxiety, cognitive problems, and suicidal thoughts.
Measures
The PTSD checklist assesses 21 symptoms of PTSD and asks how bothersome each symptom was one month before and one month after treatment.
The Patient Health Questionnaire-2 is used to assess depression symptoms. Scores higher than three points are suggestive of major depressive disorder.
Anxiety symptoms are assessed using the Generalized Anxiety Disorder 2-item, and a score of three points is used to identify further diagnostic evaluation for generalized anxiety disorder.
A brief screening tool for suicidal ideation was used to compare responses one month before and one month after treatment.
The Medical Outcomes Study – Cognitive Functioning (MOS-CF) subscale was utilized to assess cognitive functioning in participants before and after participation in the treatment program.
Psychological flexibility was measured by asking respondents to rate each item on a seven-point scale. Lower scores were indicative of higher levels of psychological flexibility.
The treatment history measure is an eight-item measure developed to assess the clinical psychedelic program. Participants provide information on their conditions, past treatments, and evaluation of the clinical psychedelic program.
Analysis
Descriptive analyses were conducted on demographic, background, and treatment history variables, and t-tests were performed to examine changes in mental health symptoms, cognitive functioning, suicidal ideation, and psychological flexibility from before-to-after the psychedelic treatment. A correlation analysis was then conducted to examine the relationship between psychological flexibility and mental health symptoms.
Respondent Characteristics
The sample was comprised of adult, Caucasian/White, non-Hispanic men. Over three-quarters reported having sustained head injuries during a military deployment, with 57% reporting between 1 and 10 head injuries total, and 18% reporting between 1 and 20 blast exposures.
Treatment Satisfaction
Participants reported a high degree of satisfaction with the clinical psychedelic program, and were almost unanimous in their opinion that it was “much better” than prior treatment.
Enduring Effects
Participants reported that the clinical psychedelic treatment program was one of the top five most personally meaningful, spiritually significant, psychologically insightful, and psychologically challenging experiences of their entire lives.
Discussion
In this study, participants who used ibogaine and 5-MeO-DMT reported increased psychological flexibility, and this increased psychological flexibility was strongly associated with decreases in cognitive impairment, and symptoms of PTSD, depression, and anxiety.
Limitations
Ibogaine and 5-MeO-DMT are currently Schedule I substances, which makes it difficult to study their effects. Our study used a quasi-experimental one-group pretest/posttest design, which has several limitations, including recall bias and the present state effect.
We relied on perceived changes in mental health and cognitive functioning to assess ibogaine and 5-MeO-DMT’s effects on PTSD in U.S. SOF Veterans. However, this study is limited in its design and execution.
Conclusions
This study suggests that ibogaine and 5-MeO-DMT may offer a rapid and robust treatment option for SOF Veterans suffering from psychiatric and cognitive impairment. However, further research is needed to support this preliminary evidence.
Given the significant number of Veterans suffering from PTSD and other psychiatric problems, investigation into novel pharmacotherapies such as ibogaine and 5-MeO-DMT is needed. Furthermore, MDMA-assisted psychotherapy may be able to increase adherence and outcomes for Veterans suffering from PTSD.