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13 Jun 2024, by Amy Sarcevic
A new clinical program is shedding light on how medicinal psychedelics can be optimised in the treatment of depression and post-traumatic stress disorder (PTSD).
The ‘approved prescriber pathway scheme’, which administers psilocybin and methylenedioxymethamphetamine (MDMA) as part of a comprehensive psychotherapy program, has so far demonstrated strong patient outcomes, and is giving psychiatrists increased hope over this new treatment option.
Dr Ted Cassidy, psychiatrist and co-founder of Monarch Mental Health Group, says the program, which treats people who have not had a clinically meaningful improvement in their symptoms from other therapies, is also revealing how psychedelics work in real clinical settings.
“There is lots of literature underpinning medicinal psychedelics, but much of it has been held back by methodological limitations. For example, in studies based on compassionate use programs, it is more common than not for people to have multiple medical morbidities, which can make it hard to generalise the findings.
“Our program is treating people with more traditional mental health presentations and in a real life clinical context. So, it is giving us a better insight into how this treatment works in practice,” he said ahead of the Medicinal Psychedelics Conference.
Surprising findings
The types of people seeking support via the MMHG program has been a surprise to Dr Cassidy.
“What we are finding is that around two thirds of the patients are primarily presenting with PTSD and interested in MDMA assisted therapy, with the balance presenting with depression. I had thought it might be more of a 50/50 balance, or even weighted towards depression, which I understood to be more common in the general population.
“Also, within the PTSD group, it does seem that the majority of patients are with trauma relating to domestic violence and sexual assault. I had thought first responders would make up the bulk of participants, given the level of advocacy within that community, but again this hasn’t been the case.”
The program has also shed light on patient preferences, with MDMA a clear favourite among people with both PTSD and depression.
“With psilocybin, patients have quite an internal experience, whereas MDMA assisted therapy is not like that at all.”
In terms of the treatment’s efficacy, a further revelation from the program is that access to a support person, who can accompany patients to and from the dosing sessions, may have important implications.
“Social support is important to people safely completing this therapy and we would not recommend people engage in this intensive therapy without having a level of psychosocial support and stability.”
While these observations may be important, Dr Cassidy notes that it is still “early days” and things may change as the program progresses.
“Currently, the cost of participation is prohibitive for many, so the findings may look different as funding support comes on board.”
Research outline
Alongside the approved prescriber scheme, Dr Cassidy is involved with a series of research studies. The first is investigating the effect of a single administration of psilocybin and MDMA in psychedelic therapists in a group setting.
The second is exploring the therapeutic efficacy of psilocybin- and MDMA-assisted psychotherapy for participants with treatment resistant OCD.
The third is reviewing the safety and efficacy of these therapies for people diagnosed with treatment resistant major depressive disorder (TRD).
Dr Cassidy says this research is vital for understanding the mechanism of action for each therapy, in a climate where more people are turning to psychedelics for psychiatric treatment.
“They will improve our understanding of these drugs and how to apply them, as they transition towards broad scale implementation as therapies for psychiatric conditions.”
Progress
So far, Dr Cassidy and his colleague have only treated four patients via the MMHG program – two with MDMA- and two with psilocybin-assisted therapy. But, they are already in the process of scaling up the program.
“We have got a new facility with three dosing rooms and a number of other clinicians and therapists that are joining us. We are going to be treating multiple patients at a time going forward. This is in addition to our research site for clinical trials.”
Dr Cassidy notes that progress for this therapy in Australia will require clinicians throughout Australia engaging in a national register. One has recently been established through Australian National University.
“As we build more clinical programs, if we actually want to get meaningful national data – given that we’re the first jurisdiction in the world to do this treatment – we probably do need to think about rallying around a National Register, so that we can start to get good data.”
Sharing more views about the progression of medicinal psychedelics research, Dr Cassidy will present at the upcoming Medicinal Psychedelics Conference.
This year’s event will be held 25 July at the Crown Promenade Melbourne, and is co-located with the Mental Health Models & Facilities Forum.
About Dr Ted Cassidy
Dr Ted Cassidy is a psychiatrist and co-founder of Monarch Mental health group which provides innovative next step treatments for people suffering from Depression, PTSD and anxiety.
Monarch mental health is Australia’s first outpatient clinic offering psychedelic assisted therapy and Australia’s largest provider of outpatient magnetic stimulation therapy. It also offers a range of other next step treatments, including ketamine, portable direct current stimulation telepsychology and telepsychiatry
From 2004 to 2015 Dr Ted Cassidy was co-founder and Chief Psychiatrist of The Hills Clinic Hospital and medical centres which treated over 10,000 patients during Ted’s involvement.
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