Mania following use of ibogaine: A case series

Introduction

Tabernanthe iboga, a West African shrub, contains the hallucinogenic indole ibogaine. Use of ibogaine has expanded outside indigenous contexts for reasons including treatment of opiate withdrawal and detoxification, often in unregulated clinics in countries such as Mexico and Canada. The extracted text reports survey and ethnographic estimates indicating growing non‑indigenous use (for example, a non‑scientific HuffPost/YouGov poll showed 17% support for legalization, and an ethnographic estimate suggested several thousand people had taken ibogaine outside Africa, with about 53% using it for opioid dependence). Known adverse effects in the literature include cardiac toxicity leading to sudden death (attributed to QT prolongation), seizures, vestibular toxicity, ataxia and vomiting, but prior to this report mania had not been documented as an outcome. This paper presents a case series describing three patients who developed manic syndromes temporally associated with unregulated ibogaine ingestion. The authors aim to document these occurrences, summarise clinical features and course, and discuss implications for clinicians encountering new‑onset mania in the context of ibogaine exposure and opiate treatment histories.