Ibogaine, a naturally occurring hallucinogen used illegally for addiction treatment, can trigger manic episodes even in people with no prior bipolar diagnosis. This case series reports three patients who developed mania after using unregulated ibogaine—two for self-treating addictions and one for psycho-spiritual purposes. No previous reports of ibogaine-induced mania exist in the literature. Clinicians encountering new-onset mania should inquire about substance use, especially ibogaine, given its growing popularity among vulnerable populations seeking addiction treatment. The authors advise discussing the lack of safety and efficacy data with patients considering ibogaine.
Intravenous ketamine is a fast-acting treatment for treatment-resistant depression in both unipolar and bipolar forms. Its benefits last days, longer in unipolar depression, and it may reduce suicidality, though data are limited. Strategies to extend effects—multiple doses, maintenance, or additional medications—have shown mixed results. Alternative routes (intramuscular, intranasal, oral) show promise but lack sufficient data. Adverse effects are mainly mild, transient dissociative and sympathomimetic symptoms, indicating good tolerability. Ketamine's unique properties could shift depression treatment paradigms.