Dr Paul Liknaitzky: The kinds of experiences
that people have
in these high-dose psychedelic trials
are usually unprecedented in their lives.
These drugs are not a walk in the park,
they are powerful substances that occasion
powerful experiences.
Sarah Pant: I think it's really important to have
specialist trained therapists
working with psychedelics,
because it is quite a unique field.
When you're working with people that have really
profound mental health symptoms,
safety is just paramount.
Prof Suresh Sundram: The clinical trials
that are being done overseas
have attracted a huge amount of scientific
medical and community interest.
There is still a huge amount of work to do
before we can start advocating for these
agents to be used more generally
in the community
as treatments for disorders
such as major depression.
Ass Prof Adeel Razi: We know quite a bit
with quite a high confidence
about how these compounds
work in the brain at the molecular level.
What we actually don't know much,
and that's what we are trying to do in our lab
and in a way experiments, is to understand how
they work at the level of brain regions
and brain networks.
Dr Paul Liknaitzky: I'm the head
of Clinical Psychedelic Research at Monash.
I'm initially leading two groundbreaking trials.
The first one is
psilocybin assisted psychotherapy
in the treatment of
generalised anxiety disorder.
Psilocybin is the active ingredient
in magic mushrooms.
Prof Suresh Sundram: This will be
a world-first study.
No-one's looked at psilocybin
in generalised anxiety disorder before.
This is a major debilitating psychiatric
illness for which we have really relatively
ineffective treatments for a large
proportion of the population.
Dr Paul Liknaitzky: The psilocybin trial
at Monash is by far
the largest trial in Australia.
And indeed it is among the large trials
in the modern era globally.
We're also testing MDMA assisted psychotherapy
in the treatment of
post-traumatic stress disorder.
MDMA is commonly known as ecstasy.
This trial is in partnership
with our colleagues,
the Multidisciplinary Association
for Psychedelic Studies in the United States,
and MAPS is an organisation
that is leading the charge globally
with respect to MDMA treatment.
Another motivation for this trial is that we have
recruited a large group of experienced
and qualified mental health care workers,
from psychiatrists through to psychologists
and psychotherapists.
And this group of professionals has received
training from MAPS in the United States.
And indeed, they will receive clinical
supervision from MAPS
through the duration of the trial.
After that process, they can be accredited by MAPS.
This is significant because MAPS is set to be
the first organisation in the world
to take a psychedelic drug to market.
Prof Suresh Sundram: For us then to undertake
clinical trials at Monash using these agents
we have an extraordinarily rigorous
and robust process through which we select patients.
And then we screen and screen again,
and screen again before people can be enrolled.
Sarah Pant: Creating the right conditions
for somebody to have a psychedelic experience
can really impact the journey that somebody
goes on in a dosing session.
Sean O'Carroll: When someone
takes one of these substances,
they move into a state that can be initially
quite anxiety provoking.
In that space, a sense of safety
is profoundly important.
We have two therapists
working with a participant,
people who have spent firstly
a long time training to be able to do this,
but secondly,
a long time with this particular participant,
getting to know them, getting to know
their particular anxieties, building a deep
sense of trust and safety with that person.
Ass Prof Adeel Razi: We had
very vigorous protocols around safety.
I'm leading a trial in which healthy participants
will be given psilocybin.
There will be two facilitators
who are experienced and who have been trained.
They will be supporting the participant
through the experiment.
Once the psilocybin is ingested,
after 60 minutes,
they will be having a peak experience,
psychedelic experience.
At that point they will be moved to the MRI scanner.
This will allow us to look into the brain
in real time.
After the MRI session,
they will be moved into an EEG room.
EEG is again looking into the brain,
but at faster timescales.
Dr Martin Williams: Both of those enable us
essentially to study
the networks of brain connectivity.
And so we'll be looking at the effects of psilocybin,
we'll be scanning people's brains before
and then during the psilocybin experience.
This is a groundbreaking trial
because it is now applying the administration
of psilocybin to healthy volunteers
and correlating the psychological effects
with the neurological effects.
Ass Prof Adeel Razi: There has been evidence
that the context and the mindset,
they help with better psychedelic experience
which results in better therapeutic outcomes.
And this is why we are combining
brain imaging with meditation and music.
Dr Martin Williams: The aim of this study
really is a form
of preventative medicine to establish
whether the administration of a psychedelic
such as psilocybin might assist people to avoid
some of the negative mental health conditions
that appear to develop
just in the course of life.
We would generally be looking at trying
to avoid depression, anxiety, some of the rigid
sort of patterns of thought that might
contribute to obsessive compulsive disorder,
eating disorders, and so on and so forth.
I'm really hoping that through this trial,
we will be able to make an Australian
contribution to the global research effort, as well
as improving the quality of life of Australians.
We feel that the collective state of mind
may benefit dramatically from our research and its
careful application in the future.
Dr Paul Liknaitzky: We're attempting
to help our patients to have greater access
to the sources of their distress, and then to work
with them and to process them in healthier ways
and to understand themselves better.
What's happening is that a person is
getting in touch with their behaviour,
with their memories in a way that they haven't
been in touch with that before
or for a very long time,
they've avoided it in order to survive.
After just a few hours of these kinds of profound
experiences of contact,
people experience lasting changes in their lives.
Ass Prof Adeel Razi: People talk about that
they felt the inside has been synced
with the outside world.
Not everyone will have
those positive experiences.
For some people,
there could be more confronting experience.
However, the evidence is that it doesn't matter.
The health outcomes are largely similar.
Dr Martin Williams: It seems that
a lot of people in our society
are feeling more and more alienated,
they feel less and less in control of their lives,
they feel more isolated.
And so there seems to be the potential
for psychedelic-assisted therapies to re-establish
some of the connectedness among people
within society.
There's still a lot of people
who remain unconvinced
and it has to be said that there are some sceptics
of psychedelic assisted therapies
and their efficacy.
On the other hand, of course,
there are plenty of mental health practitioners
and professionals who are very interested
in exploring the potential,
primarily because they are frustrated
by the inadequacy
of the approaches that we've been using to date.
Prof Suresh Sundram: Psychiatric disorders
have inadequate, substandard treatments
currently.
People suffer under the burden of the illness
from inadequate response
to current treatments,
from high side-effect burdens
of current treatment.
Prof Chris Langmead: One of the big differentiators
is that really a treatment regimen with a psychedelic
medicine, you may only require two or three
doses in a clinically controlled setting,
and the beneficial effects,
they can last for months and even years.
If you contrast that with how we're currently
treating mental health issues from a therapeutic
context, you might be prescribed
an antidepressant.
And then you might be on that drug for many months,
years, indeed for the rest of your life.
Dr Paul Liknaitzky: We are still
trying to understand clearly
what the safety and efficacy profiles are
and who it works for and how to do it well,
but it does look very promising.
And MDMA for PTSD looks very likely to become
a legal treatment in the US and other jurisdictions
including Australia, in 2023.
And psilocybin assisted therapies for depression
look like they're perhaps
three or so years behind that.
Sarah Pant: I think with that
we need to be careful not to dress this up
as a miracle cure or something that is
going to work for everybody.
My hope is that people can experience this treatment
and go on to lead really healthy lives
and not have to be in the throes
of a chronic mental illness.
Prof Suresh Sundram: If we were able
to have new treatments
that modified the course of the disease,
which worked more quickly,
which had longer durations of effect,
which had less in the way of side effects,
this would be truly transformative.
This would not be transformative
just at a local level, or a national level.
This would be an internationally important
set of discoveries,
which could potentially help
tens of millions of people around the world.