Innovation is needed because remission rates for people experiencing depression, using the standard treatments of antidepressants and psychotherapy, are only about 35 per cent effective. The remission rates for post-traumatic stress disorder are even lower than this – current treatments achieve relief from symptoms for only about 20 per cent of sufferers.
Simply doing more of the same, or making only incremental changes to the current system, is not going to solve this problem and relieve the pain for the millions who are suffering. To create positive change, we have to be innovative and broaden the tools available to our medical practitioners and qualified therapists working in this area.
Our charitable organisation, Mind Medicine Australia, was formed with a view to history. In the 1950s and 1960s, psychedelic-assisted psychotherapy was regarded by psychiatrists as the next big breakthrough for treating key mental illnesses. These medicines were used to successfully treat more than 40,000 patients for a variety of conditions.
In the 70s, though, during Richard Nixon's War on Drugs, they were criminalised for political reasons, to suppress the anti-war movement. The study of psychedelics halted, as did their role in tackling very thorny mental health conditions. Professor David Nutt, head of Neuropsychopharmacology at London's Imperial College, describes this as "the worst censorship of research and medical treatment in the history of humanity".
We have lost half a century. But in recent years the early promise of extraordinary outcomes with psychedelic-assisted therapy has been rekindled by some of the world's leading universities and hospitals including Harvard, Yale, John Hopkins, Imperial College and Oxford, and at St Vincent's Hospital in Melbourne. There are more than 119 current and recently completed trials taking place around the world.
It is important to distinguish between recreational use of these drugs, and medicines being used in a medically controlled environment. Around the world, recognising the medical value of these treatments, many countries are drawing this distinction.
In the US, psychedelic-assisted psychotherapies have been granted "Breakthrough Therapy Designation" by the Food and Drug Administration. MDMA-assisted psychotherapy has been approved for use through Special Access Schemes – similar to those used in Australia for medicinal cannabis – in Israel, the US and Switzerland for patients who are resistant to existing forms of treatment.
These medicines never leave the security of the hospital or clinic, and patients can be properly cared for by experienced clinicians. In this environment, all evidence shows them to be safe and not creating a risk of addiction.
As our fellow MMA board director Dr Simon Longstaff, AO, has said: "We also believe that we should not allow the prejudices of the past to deny relief in the present. If these medicines are safe and effective when applied in a clinical environment, as current research suggests, then Australian governments have an obligation to make them available."
In the US and Europe, phase three medical trials are already under way using MDMA-assisted psychotherapy for PTSD. There are also Phase 2(b) trials underway using psilocybin-assisted psychotherapy for depression. In the US, the approval process for both treatments has been fast-tracked because earlier trials showed lasting impact and high remission rates; and because of the urgent need for new treatments.
Phase 2 trials demonstrated remission rates in 60-80 per cent of patients suffering from depression and post-traumatic stress disorder. Other trials using these therapies for substance abuse are also showing great promise. New trials are also underway for the treatment of eating disorders, OCD and dementia.
These early studies suggest both therapies could be orders of magnitude more effective than antidepressants for the treatment of depression.
Remarkably, these results are being achieved in only two to three sessions, in contrast to conventional treatments, which can require, for many people, daily medications and weekly psychotherapy over decades and lifetimes.
In so many areas of health, Australia leads the world. But we are being left behind when it comes to one of the most promising opportunities in mental health – the use of psychedelic-assisted psychotherapies. This is a chance for Australia to practice the innovation that is so often talked about, to step up and expand our treatment options.
If we are serious about solving our deepening mental health crisis, we need to focus on innovation in treatments as an urgent priority.