Psychiatric Medications
Ibogaine and antidepressants
Antidepressant dependence is not an indication for ibogaine. No trial has tested it for this, and this page will not pretend otherwise. But people keep coming to us after ten or twenty years on a medication that was supposed to be temporary, and they deserve a straight answer about what we can and cannot offer.
How ibogaine can help, honestly told
Straight answer first: nobody has run a trial of ibogaine as a way off antidepressants, and anyone who quotes you a success rate for it invented the number. What follows is how we think about it, built from what the research does show and from the people we have actually walked through it.
Most of the people who come to us for this are not in crisis. They are flattened. The medication did what it was designed to do, and somewhere along the way it kept doing it long after the crisis passed, and now the feelings that are missing include the good ones.
The spiritual work comes first
Ibogaine is not a classical psychedelic, and the treatment does not feel like one. For hours you lie inside something closer to a waking dream that walks you back through your own life. In one survey, every person treated reported insights about their personal past, and 85% described relief from guilt.¹¹³ Many compared it to a spiritual transformation.¹¹⁴ An antidepressant turns the volume down on a story. This turns the page toward reading it, start to finish, and deciding for yourself what it means.
Ibogaine is the first step, never the whole answer
We say this on every page and we mean it here most of all: a single treatment does not rebuild a life. In one study, roughly a quarter of people struggled to integrate the experience on their own afterwards.¹²⁴ That is exactly why the treatment sits inside a month on our campus, in a strong, healthy environment with a spiritual, indigenous and philosophical approach to the mind. The medicine opens a door. The weeks around it are how you walk through.
Then, the neurochemistry
The biological story is real but secondary. Ibogaine's long-lived metabolite, noribogaine, slows serotonin reuptake in a way loosely comparable to an SSRI, and the proposed mechanism pairs a fast, ketamine-like reset with a sustained rise in the growth factor GDNF.¹¹¹ ⁸¹ In open-label studies of people treated for other conditions, depression scores fell after a single treatment.⁴² All of this is signal, not proof, and we will keep saying so.
An honest boundary
If your antidepressant is working for you, we are not here to talk you out of it. This page is for the people who have decided, together with their prescriber, that the season of medication is over and who want more support for the exit than a printout and a follow-up in three months.
Why the four weeks are not negotiable
SSRIs and SNRIs interfere with the liver enzyme that clears ibogaine from your body. Fluoxetine and paroxetine in particular inhibit CYP2D6, and ibogaine on top of an uncleared inhibitor means higher exposure and higher cardiac risk.¹²² Clearance of ibogaine varies more than ten-fold with that one enzyme, which is why we treat this seriously.¹²³
There is also the serotonin system itself: ibogaine's metabolite acts on serotonin reuptake directly,¹¹¹ and stacking that on an active antidepressant is not something any responsible provider does.
The taper is planned during screening with your prescriber and the independent licensed Brazilian physicians who oversee every treatment. Never alone, never abruptly, and for long-acting drugs like fluoxetine, sometimes longer than 28 days.¹²²
Antidepressant withdrawal is real: about one in six people stopping these drugs experience symptoms attributable to the medication itself, more after long-term use.¹²⁷ Nothing on this page is medical advice. The plan comes from physicians, not from a website.
What we give your nervous system instead
The medication was standing in for something. Our answer is not to swap it for a different prescription: it is to hand your system, every single day, the things it was asking for in the first place.
Exercise
Daily movement, every day of the program. Not a gym routine bolted onto a schedule: strength, sweat and play built into how the campus lives.
Meditation
Taught, practiced and repeated until it belongs to you. The skill of sitting with a feeling instead of medicating it is the single thing we most want you to leave with.
The jungle
The campus sits inside Atlantic rainforest above Paraty. Green in every window, a river to swim in, and no corridor that smells like a clinic.
Daily walking and hiking
Trails leave from the property. Walking is the oldest antidepressant there is, and we use it every day, rain or shine.
Excellent food
Cooked on site, mostly from the region, eaten together. Rebuilding a nervous system starts embarrassingly often at the table.
Media detox
The feed stays off. A month without the scroll is its own withdrawal for most people, and one of the most commented-on parts of the program.
And where the transition needs support, plants before prescriptions
When a symptom needs help during a taper, we reach for the plant traditions before the pharmacy: saffron and mulungu from South American practice, ashwagandha and brahmi from Ayurveda, chosen case by case with the medical team. They play a supportive, traditional role in the program. They are not a new prescription, and we will never present them as one.
Come see where the exit actually happens
A taper plan on paper is one thing. A month in a place built for it is another. Walk the gardens, see the rooms, and picture the version of yourself that does this properly.
A medicated society, counted honestly
If you are on an antidepressant, you are not an outlier: one in six US adults filled a psychiatric drug prescription in a single year, and for more than eight in ten of them it was long-term use, not a bridge through a bad season.¹³⁰
The direction of travel is toward more, not less. Visits where a psychiatrist prescribed two or more psychotropic drugs rose from 43% to 60% in a decade, and visits with three or more doubled.¹⁴⁷
Here is the part we find hardest to accept: the system that starts these prescriptions has almost nothing to say about ending them. The entire scientific literature on helping people off long-term antidepressants is thin enough that its own review calls it inconclusive.¹³¹ People are handed an entrance and left to find the exit alone. That, more than anything, is the gap we built this program to stand in.
You were told you were depressed, that your brain chemistry was messed up. That was the first problem: you let someone else tell you how you are.
It is time you learn who you really are, and how your mind works.
Tatiana Aya Tupinambá, Co-Founder, Nekawa
After the medication era
For decades the standard offer for a struggling mind has been a daily molecule, indefinitely. We think the next era treats medication as one tool among many, and treats coming off it as seriously as going on. Ibogaine, honestly framed, is a first step in that direction: a hard reset followed by the real work.
The real work is the part no molecule does: a strong environment, a practice of meditation, movement, food, forest and the spiritual traditions, indigenous and philosophical, that treated the mind as something to be understood rather than corrected. That is what the 28-Day UNprogram is: not a detox with a view, but a month of learning to run your own mind.
The politics are moving too: a 2026 US executive order directed the FDA to prioritise review of psychedelic medicines, naming ibogaine specifically.⁸⁰ The trials this page is honest about lacking are coming. Until they report, you get our candor instead of our promises.
Citations (17)
[42] Cherian K, Keynan J, Anker L, Faerman A, Brown R, Shamma A, Keynan O, Coetzee J, Batail JM, Phillips A, Bassano N, Sahlem G, Inzunza J, Millar T, Dickinson J, Rolle C, Keller J, Adamson M, Kratter I, Williams N (2024). Magnesium-ibogaine therapy in veterans with traumatic brain injuries. Nature Medicine, 30, 373–381. Read the source →
The MISTIC trial. 30 male US Special Operations Forces veterans with predominantly mild traumatic brain injury received intravenous magnesium plus oral ibogaine (mean 12.1 mg/kg); 23 met criteria for PTSD at baseline. One month after treatment the group had moved from mild-to-moderate disability to no disability on the WHODAS-2.0 (30.2 to 5.1, d = 2.20), the study primary outcome. PTSD symptoms fell 88% on average, with a 100% response rate and 86% remission (d = 2.54); depression fell 87% (83% remission) and anxiety 81% (83% remission). Suicidal ideation fell from 47% at baseline to 7% at one month. Participants also gained in processing speed, executive function, verbal fluency and verbal learning, with no cognitive decline on any measure, and there were no serious or unexpected treatment-emergent adverse events. Open-label and uncontrolled, in a highly selected cohort, with magnesium co-administered, so the effect cannot be attributed to ibogaine alone.
[80] The White House (2026). Fact sheet: President Donald J. Trump is accelerating medical treatments for serious mental illness. whitehouse.gov, 18 April 2026. Read the source →
The April 2026 executive order directing the FDA to prioritise review of psychedelic medicines, naming ibogaine, easing DEA research restrictions, and funding the effort with $50 million.
[81] He DY, Ron D (2006). Autoregulation of glial cell line-derived neurotrophic factor expression: implications for the long-lasting actions of ibogaine. The FASEB Journal, 20(13), 2420–2422. Read the source →
Shows ibogaine triggers a sustained, self-sustaining upregulation of GDNF in reward-related brain regions — a mechanism for effects that outlast the drug itself.
[111] Mash DC (2023). IUPHAR invited review — Ibogaine: A legacy within the current renaissance of psychedelic therapy. Pharmacological Research, 190, 106620. Read the source →
Mechanism synthesis: ibogaine inhibits the serotonin transporter noncompetitively, its long-lived metabolite noribogaine slows serotonin reuptake and acts as a G-protein-biased kappa-opioid agonist, and rapid antidepressant-like effects are thought to involve ketamine-like NMDA receptor blockade. All framed as proposed mechanisms under investigation, not demonstrated clinical effects.
[113] Heink A, Katsikas S, Lange-Altman T (2017). Examination of the phenomenology of the ibogaine treatment experience: role of altered states of consciousness and psychedelic experiences. Journal of Psychoactive Drugs, 49(3), 201–208. Read the source →
Survey of 27 people who underwent ibogaine treatment: all reported insights about their personal past, 97% experienced visions, 77% saw content drawn from their own childhood, and 85% reported subjective relief from guilt. Large majorities reported insights about the meaning of life, death, and creation. A small, self-selected online survey, reported as phenomenology rather than outcome evidence.
[114] Brown TK, Noller GE, Denenberg JO (2019). Ibogaine and subjective experience: transformative states and psychopharmacotherapy in the treatment of opioid use disorder. Journal of Psychoactive Drugs, 51(2), 155–165. Read the source →
In 44 opioid-dependent people undergoing ibogaine treatment, 43% met criteria for a complete mystical experience. Participants described cyclic visual content leading to confronting realisations involving remorse and regret toward others, subjective release from guilt and worthlessness, and many compared the significance of the experience to a spiritual transformation.
[122] Litjens RPW, Brunt TM (2016). How toxic is ibogaine?. Clinical Toxicology, 54(4), 297–302. Read the source →
Review of ibogaine's toxicity and interactions. Medications that inhibit the CYP2D6 enzyme, including SSRIs such as fluoxetine and paroxetine and the antidepressant bupropion, impair ibogaine metabolism and should be discontinued before treatment, with washout periods matched to the half-life of the drug and its active metabolites. Fluoxetine's long-lived metabolite can warrant several weeks.
[123] Knuijver T, Ter Heine R, Schellekens AFA, Heydari P, Lucas L, Westra S, Belgers M, Van Oosteren T, Verkes RJ, Kramers C (2024). The pharmacokinetics and pharmacodynamics of ibogaine in opioid use disorder patients. Journal of Psychopharmacology, 38(5), 481–488. Read the source →
PK/PD study in opioid use disorder patients: ibogaine clearance varies more than ten-fold with CYP2D6 enzyme activity, and QTc prolongation tracks drug exposure. The quantitative basis for strict cardiac screening and for clearing CYP2D6-inhibiting medications before treatment.
[124] Davis AK, Renn E, Windham-Herman AM, Polanco M, Barsuglia JP (2018). A mixed-method analysis of persisting effects associated with positive outcomes following ibogaine detoxification. Journal of Psychoactive Drugs, 50(4), 287–297. Read the source →
In a retrospective study of 73 people treated with ibogaine for opioid use disorder, roughly 23% reported difficulty integrating the experience into daily life afterwards. The evidence that ibogaine is a beginning that needs a structured program around it, not a standalone treatment.
[125] Brody DJ, Gu Q (2020). Antidepressant use among adults: United States, 2015–2018. NCHS Data Brief No. 377, CDC National Center for Health Statistics. Read the source →
In 2015–2018, 13.2% of US adults had used an antidepressant in the past 30 days: 17.7% of women and 8.4% of men, rising to 24.3% among women over 60. A self-report survey covering all antidepressant classes, some prescribed for conditions other than depression.
[126] Pratt LA, Brody DJ, Gu Q (2017). Antidepressant use among persons aged 12 and over: United States, 2011–2014. NCHS Data Brief No. 283, CDC National Center for Health Statistics. Read the source →
A quarter of past-month antidepressant users (25.3%) had been taking them for ten years or more, nearly double the share of a decade earlier, and the median duration of use exceeded five years. Self-reported survey data from 2011–2014.
[127] Henssler J, Schmidt Y, Schmidt U, Schwarzer G, Bschor T, Baethge C (2024). Incidence of antidepressant discontinuation symptoms: a systematic review and meta-analysis. The Lancet Psychiatry, 11(7), 526–535. Read the source →
The largest meta-analysis of antidepressant discontinuation to date (79 studies, 21,002 people): symptoms occurred in about 31% of people stopping an antidepressant versus 17% stopping placebo, putting the drug-attributable rate at roughly one in six to seven, with severe symptoms in about 3%. Based largely on short-duration trials, which critics argue understates withdrawal after years of use.
[128] Davies J, Read J (2019). A systematic review into the incidence, severity and duration of antidepressant withdrawal effects: are guidelines evidence-based?. Addictive Behaviors, 97, 111–121. Read the source →
Reported that 56% of people stopping antidepressants experience withdrawal symptoms, nearly half of them severe. A disputed figure: it leans on self-selected surveys of long-term users and was criticised on those grounds (Jauhar & Hayes, 2019), while the trial-based estimate is closer to one in six. The honest range runs from roughly 15% to over 50% depending on how long people have taken the drug.
[129] Eveleigh R, Muskens E, Lucassen P, Verhaak P, Spijker J, van Weel C, Oude Voshaar R, Speckens A (2018). Withdrawal of unnecessary antidepressant medication: a randomised controlled trial in primary care. BJGP Open, 2(4), bjgpopen18X101663. Read the source →
In a Dutch primary-care trial of long-term antidepressant users with no remaining medical indication, only 51% were willing to attempt tapering when advised to, and just 6% actually managed to stop. A single trial of 146 people, but the clearest measure of how hard discontinuation is without real support.
[130] Moore TJ, Mattison DR (2017). Adult utilization of psychiatric drugs and differences by sex, age, and race. JAMA Internal Medicine, 177(2), 274–275. Read the source →
One in six US adults (16.7%) filled at least one psychiatric drug prescription in 2013: 12.0% antidepressants, 8.3% anxiolytics, sedatives and hypnotics, 1.6% antipsychotics. Most use was long-term, with 84.3% of users refilling repeatedly or continuing a drug started years earlier. Prescription-fill data, which undercounts relative to surveys.
[131] Van Leeuwen E, van Driel ML, Horowitz MA, Kendrick T, Donald M, De Sutter AI, Robertson L, Christiaens T (2021). Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults. Cochrane Database of Systematic Reviews, 4, CD013495. Read the source →
The Cochrane review of how to stop long-term antidepressants found only 33 usable trials, most tapering over four weeks or less or stopping abruptly, and could draw no firm conclusions about the safety or effectiveness of any approach. Evidence that structured support for coming off these medications has barely been studied.
[147] Mojtabai R, Olfson M (2010). National trends in psychotropic medication polypharmacy in office-based psychiatry. Archives of General Psychiatry, 67(1), 26–36. Read the source →
The share of US psychiatrist visits where two or more psychotropic medications were prescribed rose from 42.6% to 59.8% in a decade, and visits with three or more medications doubled to 33.2%. Historical trend data ending in 2006, documenting the drift toward medication stacking.
Let’s connect.
No pressure. Tell us a little about what you’re going through.