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Original title: Ibogaine is a banned hallucinogenic drug. Scientists believe it can help veterans overcome PTSD
It seems strange to me to choose ibogaine when Salvia divinorum seems like it has a similar psychological experience without the physical heart risk.
Only veterans?

I wonder about the editorial choice to use veterans rather than, say, women who have PTSD from assaults, which is a much larger group of people. (Approximately 4% of US men and 8% of US women experience PTSD every year across all reasons like accidents, sexual assaults, combat, etc.)

Presumably this treatment would help everyone? Or is it somehow supporting only vets?

The research on ptsd began with US veterans afaik. It’s probably the group that is most studied for it and also receives trials.

The US also spends a large amount of money on each veteran. If they can find a cure for trauma they would benefit hugely from it. The side effect of this is that others would benefit as well.

Way back in something like 2002, I was in college. One day at my then-girlfriend’s apartment east of campus, she got a phone call. An old friend of hers was in town, so she told him to come over. I don’t know his name, but let’s call him J., which is a randomly selected letter.

J. was a traveling Ibogaine ... healer? He went from city to city, summoned by the loved ones of advanced heroin addicts, to attempt one last Hail Mary shot at recovery.

These were situations of absolute desperation, and I can’t overstate the seriousness with which he took his adopted occupation. He described to us in detail his process.

First, he interviewed the person requesting help, seeing what else they had tried and trying to suss out if Ibogaine would be worth the risk. He turned away most callers.

Those who he accepted would be dropped off at his van, inside which was a mobile, DIY ICU of sorts: a bed, food, water and emergency medical supplies. He would administer the ibogaine (I don’t know what form this took), and then, in his words, the patient would undergo a 2 to 3-day continuous hallucination.

During this time, in J.’s observations, the patient was almost always ‘visited’ by dead relatives, who typically admonished the patient for what had become of them, laying into them with real talk about the state of their life.

J. said half of the patients came out of this experience fundamentally changed, and effectively cured of their addiction to heroin. I don’t know if he had any data (anecdotal or otherwise) on recidivism, but the implication was that this was likely to be permanent.

But, he said, the other half went insane, which is why he spent a great deal of effort screening families and informing them of the risks.

I don’t know how much, if any, of this is true. I don’t know what ‘insane’ means, or meant. But I remember vividly how seriously this guy took it, without ever coming off as some kind of self-satisfied guru or medicine man, believing himself to be a god, or anything like that. He never accepted money. He lived somewhat roughly. I wonder whatever happened to that guy.

The war machine is the one funding so the framing makes sense. Not that I like it... I would prefer that the concept of a war veteran was non existent but that is akin to wishing the moon was made out of cheese.
> Presumably...

Presumably isn't how science is done. They did an experiment with veterans who had ptsd and ibogaine so the results are relevant to veterans with ptsd using ibogaine.

One could, presumably, extrapolate that result to an even wider audience and say "hallucinogens could help people who experience trauma" but that'd be unscientific and irresponsible to imply this study showed that.

If this was a study on ptsd in assault survivors you could make the exact same comment asking why they didn’t try it in veterans (and I have no reason to doubt someone would)
I always associated it with treating opioid and alcohol addiction. I suspect there's something to do with funding here. Same with the whole "we could use MDMA to treat veterans" angle when veterans are a tiny percentage of the population worth treating with it.
They are an easy group to recruit or reach and have complete medical histories on file. Remember this is a military study.
If you know anything about the people funding research/lobbying it is not really surprising.
> Only veterans?

Well, anybody who wishes to can get their hands on this medication and treat themselves. People have been doing it for decades.

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While I’m broadly open to research on the therapeutic applications of these drugs, right now the landscape is perilous because of the combination of illegal status and a spike in “wellness” pseudoscience. Outside of the few supervised, IBR-approved studies there is a world of (for lack of a better term) therapeutic cults that prey on some of the most psychologically vulnerable people. (related 2023 article: https://www.wired.com/story/psychedelic-therapy-mess/)
I always wonder why ECT doesn't get more press. It very very often works on depression (and bipolar disorder, catatonia; anything affective-related really), although the effects may wane over time when the treatment is discontinued. Memory loss is one of the side effects, and it could actually be beneficial here.
It's strange how much attention novel psychedelic treatments get compared with older, less glamorous interventions that already help a lot of people
This is nuts. Bringing ECT into the discussion of a novel psychedelic medicine.

Totally different ballparks. Well-established results vs. very little formal research.

Have you had ECT, or do you know anyone who has? It's a last resort for horrible depression and not much else. It has huge risks, and while it does often make these people's lives manageable, it shouldn't be in the same discussion as a medication that's been out of discussion for political reasons.

shivers at the thought of ECT

I had a friend who just went through ECT. It did nothing for their depression and I left them with severe memory loss, and cognitive decline.

You’d be surprised to read the statistics about how poorly ECT works, and how little they understand about how to use it a treatment.

Anecdotal, but I had a friend who had ECT for their depressive symptoms.

They ended their life a few years afterwards.

So no, ”very often works on depression” is not a characterization I would use.

Does it really help or are they just too dissociated after taking it
This is, I am assuming from the context, not opporating under the assumption PTSD often is rooted in brain damage from exposure to shockwaves.
PTSD doesn't have anything to do with brain damage.

PTSD is a trauma response.

Are you thinking of TBI? TBI is a cumulative impact of small and large head trauma.

Would the treatment be any different? It's my understanding that were have no way of accelerating repair from neurological damage and instead focus on therapies to regain ability.
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no one thinks "shell shocked" is real anymore, and afaik it wasn't ever supported by task science. it's just super intense trauma response
Ibogaine may or may not work. Iocane powder usually effects a complete cure.
Iocaine powder is a fictional, odorless, and tasteless poison from The Princess Bride.
Another very interesting possible benefit of ibogaine not mentioned in the article is potential for treating TBI.

from https://pubmed.ncbi.nlm.nih.gov/41883580/:

>Longitudinal analyses assessed cortical thickness, subcortical volume, and predicted brain age (pBA), estimated from T1 scans. pBA was significantly reduced at 1 month relative to baseline (-1.3 years). Cortical thickness analysis revealed post-treatment increases in 11 regions. Subcortical analyses revealed significant volumetric expansion in 8 regions. Magnesium-ibogaine therapy was associated with increased cortical thickness, subcortical expansion, and reduced pBA at 1 month.

Open-label study, no control group, and ibogaine was not the only compound administered.

Any study like this is nearly useless without a control group, unfortunately. There is no way to tell if the treatment caused the changes or if they naturally occurred over the study period.

It feels promising, but also exactly the kind of treatment that should move through careful clinical trials
The article acts like ibogaine is a newly discovered drug. This is an old hallucinagenix drug that has helped thousands of people get over ptsd. The only thing holding this back is government bureaucracy and red tape. I’m happy that people will get there chance to benefit from this after decades of stupid government policy.
An important warning: Ibogaine has been associated with a considerable number of deaths. Some of the deaths even occurred within the context of clinical trials, under medical supervision. Ibogaine has some chemical properties that are highly undesirable for medication because it directly interacts with the cardiac system as a side effect.

It is actually an old drug with a long history of being tried for different conditions and was once even marketed commercially in some countries. It goes through cycles where news stories are written about how it might be a treatment for problems which inspires some people to seek it out, but I strongly caution people not to do this. If you try one of the ibogaine clinics you may not even been given real ibogaine, and if you do you’re playing a dangerous game.

Anecdotally: I’ve known a couple acquaintances and their friends who tried ibogaine for different reasons. Among them, there was a 100% rate of feeling convinced it solved their problems in the weeks following their experience. There was a 0% rate of actual improvement in the problems after weeks to months. I think it’s good that this is being researched, but the claimed curative powers of the drug have also become enhanced through the mythology and mystery around it.

I’m sorry, but people really need to understand how these drugs “treat addiction“. ibogaine acts on an opioid receptor. So all you’re doing is changing one opiate for another.

It acts on the KOR receptors instead of the MOR receptor, which most openly act on. But it’s not like you’re going to be cured from opioid addiction. You’re just replacing one opioid with another that doesn’t affect the respiratory system.

Roe Jogan, senior pharma correspondent at the BBC
We are close to treating PTSD of people who we sent to massacre other people, and we justified their massacre as heroic act. Great achievement for humanity!
> Some research suggests that chemistry is all that is needed – that the intense psychedelic experiences may not even be necessary for ibogaine's healing effects.

> [...] Building on such research, some startups are working on drugs that mimic therapeutic effects without the hallucinations.

I understand not everyone wants the hallucinations, but man, scientists are just no fun sometimes.

This recent focus on ibogaine is annoying when we have previous promising success with what I understand to be low risk side effects in a controlled environment using substances like ketamine and MDMA.

I've never seen something in other well known psychedelics to compare to the health issues I've seen associated with ibogaine, so who is benefitting from us putting all this attention on it now?