Australia Leads the Way in Psychedelic Therapy for PTSD
In a groundbreaking development, Australia has become the first country to allow psychiatrists to prescribe psychedelics as a treatment option for patients suffering from depression or Post Traumatic Stress Disorder (PTSD).
Starting from July 1, Australian physicians have the authority to prescribe MDMA, commonly known as ecstasy, to people with PTSD. Additionally, psilocybin, the active compound found in “magic” mushrooms, can now be prescribed to patients struggling with hard-to-treat depression. These two substances have been officially recognized as approved medicines by the Therapeutic Goods Administration, the country’s regulatory body.
While this development is a significant leap forward, it’s important to note that the use of psychedelics in mental health treatment is still a subject of debate. Medical experts from the United States, Australia, and other countries have cautioned that further research is needed to determine the efficacy and potential risks of psychedelics.
Despite the ongoing debate and concerns surrounding psychedelic therapy, Australia’s decision to allow psychiatrists to prescribe these substances for mental health conditions represents a significant milestone. This progressive approach could potentially open new avenues for treatment and bring hope to individuals who have been struggling with PTSD.
What is MDMA?
MDMA, also known as 3,4-methylenedioxymethamphetamine, is a drug classified as an ’empathogen’. It is known to enhance feelings of empathy, kindness, social acceptance, and connection to others.
Initially developed in the early 1900s to control bleeding, MDMA gained popularity in the 1970s and early 1980s when some psychiatrists began using it to treat Post Traumatic Stress Disorder (PTSD). Simultaneously, it also gained traction as a recreational drug within the party and rave scene and so by the mid-1980s, the United States made MDMA illegal, halting research into its potential as a therapeutic drug, despite objections from researchers and health professionals.
However, in 2010, clinical research on MDMA regained momentum with the publication of a groundbreaking study. Promising results from subsequent clinical trials showcased significant improvements in symptoms of PTSD. As a result, in 2017, the US recognised MDMA as a breakthrough therapy.
Today, clinical trials involving MDMA are underway across the world including 15 locations across the US, along with two sites in Canada and three in Israel. In the UK, the Multidisciplinary Association for Psychedelic Studies (MAPS) was granted the Innovation Passport for MDMA as an adjunct to therapy for PTSD in 2022 and researchers at King’s College London are currently recruiting for a study regarding ‘The Safety And Tolerability Of Comp360 (Psilocybin) In Participants With Post-Traumatic Stress Disorder‘.
These trials hold great promise for unlocking the therapeutic potential of MDMA and revolutionising the treatment of PTSD.
How can MDMA help people with PTSD?
While it’s essential to understand that MDMA is not a standalone treatment for PTSD and does not claim to be a “cure,” the research shows it can play a valuable role in the process of psychotherapy.
MDMA is known to trigger the release of serotonin (a neurotransmitter in the brain) and affects brain pathways associated with oxytocin (a hormone involved in fostering connection and empathy towards others). These combined effects help facilitate emotional openness, empathy, and enhanced social connection in individuals under the influence of MDMA during a psychotherapy session.
MDMA can facilitate psychotherapy by reducing defensiveness and anxiety, promoting relaxation, and enhancing mood. Additionally, it has the potential to strengthen the therapeutic bond between the patient and therapist.
This unique combination of effects can allow individuals to revisit traumatic memories and navigate their emotions without the risk of re-traumatisation or overwhelming anxiety and fear.
By diminishing anxiety associated with recalling traumatic experiences, MDMA can also aid in increasing insight and memory recollection. Negative memories may become less intimidating, enabling therapists and patients to engage in sessions without the patient experiencing excessive anxiety.
Findings from a Phase III clinical trial conducted in the United States, Canada, and Israel revealed that a remarkable 88% of participants who received MDMA experienced a clinically significant reduction in symptoms. Even more promising, 67% of participants no longer met the criteria for a PTSD diagnosis.
It’s important to recognise that MDMA serves as an adjunct to psychotherapy, enhancing the therapeutic process rather than acting as a standalone solution. Through this integrated approach, individuals can find support in addressing their PTSD and working towards healing and recovery.
Clinical MDMA vs recreational MDMA
When MDMA is used clinically, it undergoes the same pharmaceutical standards as any other medication. Its purity and dosage strength are precisely known, and it is administered within a controlled and safe environment by a trained healthcare professional during therapy sessions.
On the contrary, illicit forms of MDMA, such as ecstasy pills, powders, or crystals, lack regulation, and their purity and dosage strength remain uncertain. These substances are often misrepresented as MDMA when they may contain only a small amount or no MDMA at all. Instead, they may be adulterated with other drugs or fillers, making their effects unpredictable and increasing the risk of negative reactions.
It is crucial to distinguish between the clinical use of MDMA, where strict protocols ensure safety and effectiveness, and the illicit forms of MDMA, which pose greater risks due to unknown composition and lack of regulation.
Strict Guidelines for Prescribing Psychedelics in Australia
In Australia, the prescription of psychedelics for the treatment of PTSD or treatment-resistant depression is limited to psychiatrists who have obtained pre-approval through the Therapeutic Goods Administration’s (TGA) authorised prescriber scheme. To prescribe these substances, psychiatrists must provide a clinical justification for why they deem them suitable for the specific patient group they are treating.
It is important to note that patients can only access these medications in supervised clinical settings. There are no provisions for home use or self-administration. This approach ensures that the administration and monitoring of psychedelics are conducted under controlled and professional conditions, maximising safety and efficacy during the treatment process.
Scientists and Clinicians Urge Cautious Approach to Psychedelic Therapies
It’s worth noting that many scientists remain cautious of the use of psychedelics regarding their safety and effectiveness. Although research conducted so far has shown promising results, further investigation is needed to establish a clear understanding of their benefits and potential risks.
The AMA and RANZCP urge a cautious and informed approach, highlighting the potential for psychedelic substances to evoke fear, panic, and re-traumatisation in vulnerable individuals. They emphasise that the current understanding of potential risks and long-term side effects of psychedelic-assisted therapy is still in its early stages and that more knowledge is required before widespread implementation can be considered.
In addition to the scientific concerns, some clinicians express apprehension regarding the regulatory framework surrounding access to these drugs. They worry that the current regulations may not provide adequate oversight or guidance for their use in clinical settings.
Addressing these concerns and ensuring the safety and efficacy of psychedelic-assisted therapies will require continued research, rigorous evaluation, and robust regulatory measures. By taking a cautious yet thorough approach, we can strive to strike a balance between offering new treatment options and maintaining high standards of patient care.
While the use of MDMA and psilocybin for therapeutic purposes is currently not authorised in the UK, psychiatrists in the country will be closely monitoring the developments in Australia. As of now, there are no specific plans to introduce these treatments in the UK, but the experiences and outcomes in Australia will be valuable in shaping future discussions and potential authorisations. By closely observing the Australian approach, UK psychiatrists can gain insights that may inform decisions regarding the use of MDMA and psilocybin for PTSD in the future.
Mitchell, J.M., Bogenschutz, M., Lilienstein, A. et al. MDMA-assisted therapy for severe PTSD: a randomized, double-blind, placebo-controlled phase 3 study. Nat Med 27, 1025–1033 (2021). https://doi.org/10.1038/s41591-021-01336-3
Photo by Adrian Frentescu
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