The Therapeutic Goods Administration (TGA) in Australia recently made a groundbreaking decision to reschedule two drugs as treatments for certain mental health conditions. Psilocybin is now approved for treatment-resistant depression, while MDMA is approved for post-traumatic stress disorder (PTSD).
Prof David Nutt (Edmond J. Safra Professor of Neuropsychopharmacology at Imperial College London, and Founder and Chief Scientific Officer of Drug Science), Prof Ilana Crome (Professor of Addiction Psychiatry at Keele University and Trustee of Drug Science) and Prof Allan Young (Chair of Mood Disorders and is Director of the Centre for Affective Disorders at King’s College London) explore the reasons for these developments, the opportunities and challenges they provide to psychiatry communities and how along with health systems these communities might respond to these developments in a feature in the British Journal of Psychiatry.
Access full article open access below.
We summarise the key points below:
Why the Rescheduling in Australia?
Lack of New Psychiatric Medicines
Mental health treatment has seen little innovation over the past 50 years. Most current medications are variations of drugs from the 1950s, with limited effectiveness for many patients. There is a need for new and more effective treatments.
Positive Research Findings
Recent studies have shown that psychedelics like psilocybin and MDMA can be highly effective in treating conditions where other treatments have failed. These drugs have demonstrated significant benefits in clinical trials for depression and PTSD, prompting a re-evaluation of their regulation in Australia.
Growing Support and Demand
There is increasing support from medical professionals and patients for the use of psychedelics with therapy. The potential for these drugs to offer relief where other treatments have not, combined with the lack of new psychiatric medications, has driven this change.
Opportunities and Challenges
Opportunities
New Treatment Options: Psychedelics offer promising new avenues for treating various mental health conditions. Brain imaging evidence reveals that psychedelics work through very different brain pathways than conventional antidepressant medicines and may work where these have failed.
Invigorate Psychiatry: Introducing these therapies can rejuvenate the field of psychiatry and attract new professionals who may have been disillusioned by the lack of progress in psychiatric treatments over the past decades.
Challenges
Regulatory Oversight: Ensuring these treatments are used safely and ethically requires robust regulatory frameworks.
Training: Psychiatrists need to be supported in the implementation of this treatment by boosting capacity and enriching capability. Psychiatrists need comprehensive training to confidently and effectively administer these therapies.
Moving Forward
The psychiatry community and health systems must adapt by:
Creating Training Programs: Integrating psychedelic therapy training into psychiatric education.
Regulatory Controls: Developing strong regulatory and oversight mechanisms, such as a register of practitioners and supervised data collection for efficacy and adverse effects, as being set up in Australia. This could be conducted by the Royal College of Psychiatrists in a similar manner to how it oversees electroconvulsive therapy (ECT) treatment centres.
Encouraging Collaboration: Collaboration and communication between clinical specialists, educators and managers is critical. Learning from international practices, such as Australia, and fostering interdisciplinary cooperation.
UK Working Group: The authors believe the UK Royal College of Psychiatrists should convene a working group comprising, for example, adult general, old age and addiction psychiatrists, to begin considering ways we could implement this therapy.
Conclusion
The rescheduling of psilocybin and MDMA in Australia could revolutionise mental health treatment, offering hope to those with conditions that have not responded to traditional therapies. The UK psychiatry community has a unique opportunity to advocate for similar changes, develop training programs, and engage in collaborative research to ensure that these innovative treatments become a safe and effective part of mental health care. Drug Science will continue to advocate for a rational approach to psychedelic research, education, and clinical treatment, ensuring we are ready for a change in the law.