Psychedelics in the Treatment of Mental Health with Dr. Adrian Lopresti and Professor Jerome Sarris

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Psychedelics in the Treatment of Mental Health with Dr. Adrian Lopresti and Professor Jerome Sarris

Psychedelics are psychoactive plants that produce hallucinogenic or mind-altering effects and represent an emerging treatment protocol in the management of chronic and acute mental health conditions. We are in the midst of a mental health epidemic, and the need for more creative treatments is pressing.  

For years the psychedelic space was left to the ‘psychonauts’ to explore. However, now with recent demand on mental health treatments and increased governmental interest in this area, psychedelics represent an important opportunity to diversify treatment opportunities in the fight for mental health wellbeing.  

Professor Jerome Sarris, Professor of Integrative Mental Health at the NICM Health Research Institute and Co-Director of Psychae Institute talks with our ambassador Dr. Adrian Lopresti about the emerging science and potential therapeutic application of psychedelic use for the treatment of mental health conditions.  

Covered in this episode

[00:39] Welcoming Professor Jerome Sarris
[02:11] What are psychedelics?
[04:24] Similarities and differences of the effects of various psychedelics, and their potential treatment uses
[06:47] Using psychedelics as preventative medicine vs treatment of symptoms
[08:49] Microdosing
[11:01] Dosing of various psychedelics and the importance of providing a psychological support framework 
[14:14] Psychedelics are not a one-size-fits-all treatment
[16:51] Randomised controlled trials on psychedelics underway in Australia
[20:52] How quickly does treatment with psychedelics work? 
[22:49] Psychedelic mechanisms of action
[24:35] Gaining insights into the self
[26:08] Positive effects on alcohol abuse
[27:28] Safety concerns and contraindications
[30:42] Is treatment with psychedelics available in Australia? 
[33:39] Predictions for the future of psychedelics 
[36:46] Thanking Jerome and closing remarks


Key takeaways 

  • Psychedelics are psychotropic plant medicines that provide a hallucinogenic and mind-altering effect. 
  • Psychedelics include psilocybin, LSD, mescaline, peyote cactus and ayahuasca and have been used in traditional cultures and have been tied to religious or cultural ceremony. 
  • Psychedelics work on the 5-HT2A receptor, are 5-HT2A agonists, and provide monoamine effects and are seretonergic.  
  • Research into the therapeutic benefit of psychedelics for the treatment of mental health conditions is underway and showing promise for the treatment of mood, anxiety disorders, depression, trauma, addiction and acute mental health crises when used in combination with psychological support. 
  • Psychedelics may provide support for acute mental health concerns including depression. 
  • Microdosing is the use of psychedelic substances regularly in lower (up to 1/10) doses without the hallucinogenic effect. 
  • Stacking is the combining of a microdose of a psychedelic with another substance, such as cacao, niacin or lion’s mane. 
  • Psychedelic use should be medically supervised in conjunction with psychological scaffolding. 
  • Ayahuasca when used independently in a single dose in Brazil has been shown to have antidepressant effect. 

Resources discussed in this episode

Professor Jerome Sarris
NICM Health Research Institute
Psychae Institute
Study: Psychedelic medicines for mood disorders: current evidence and clinical considerations (Sarris, et al, 2021)
Study: Influence of Context and Setting on the Mental Health and Wellbeing Outcomes of Ayahuasca Drinkers: Results of a Large International Survey (Perkins, et al., 2021)
Study: Associations between ayahuasca consumption in naturalistic settings and current alcohol and drug use: Results of a large international cross-sectional survey (Perkins, et al., 2022)
Dr. Marg Ross's study at St. Vincent's Hospital (ongoing)
Professor Susan Rosell's study at Swinburne University (ongoing)

Transcript

Adrian: Hi, and welcome to FX Medicine, where we bring you the latest in evidence-based integrative, functional, and complementary medicine. I'm Dr. Adrian Lopresti, and joining us on the line today is Jerome Sarris, Professor of Integrative Mental Health at the NICM Health Research Institute, as well as the Co-Director of the not-for-profit Psychae Institute which focuses on botanical psychedelic medicine research. 

His primary area of research is a therapeutic potential of psychotropic plant medicines for mental health and particularly mood and anxiety disorders, which is what we're going to be discussing today. 

So welcome to FX Medicine, Jerome. Thanks for being with us today.

Jerome: Great to be with you.

Adrian: Now, I know that you've done lots of research on herbs and nutrients. So how did you get into psychedelics?

Jerome: Well, it's a good question. I guess, look, I've always been passionate about plant-based medicine, and I would say probably preferentially anything involving psychoactive plants back when I was a teenager, very interested, and not obviously saying that just from an experiential perspective, but even just from a research perspective back then. 

About three decades ago, I was very much enjoying studying, learning about them. And then throughout my career, progressed an interest in kava, in medicinal cannabis, and then, gosh, probably in a more formalised way over the last seven years in psychedelic medicines.

Adrian: Wow. So what are psychedelics?

Jerome: Well, psychedelics, broadly speaking, are agents which will impart a hallucinogenic effect. And when we say hallucinations…when we talk about, I should say psychedelics, it's not just confined to having a hallucinogenic effect. 

These are substances which work primarily on the 5-HT2A receptor. They have a range of monoamine effects, but in principle, they're very strongly serotonergic. And they can elicit, aside from hallucinations, a range of mind-altering effects. People may have distortions about time, regarding their present reality. 

But this can be actually harnessed in a therapeutic way that people can gain quite profound insights about themselves, about mental health issues, the experiences which they have if used within a therapeutic model can actually be quite beneficial to their health, and especially their mental health.

Adrian: Okay, and what are some examples of the psychedelics that you're talking about?

Jerome: Well, I'm sure listeners would have heard of LSD, obviously very much popularised in the 1960s before prohibition. There's also magic mushrooms which contain psilocybin, as well as other plant-based compounds such as mescaline, which is derived from the peyote cactus. And also something which we are quite interested at Psychae Institute in studying and furthering research which is ayahuasca, which is primarily a two-plant combination consisting of a DMT-containing plant, in many cases Psychotria, as well as a plant, or a vine, I should say, which contains harmala alkaloids, which are monoamine oxidase inhibitor. These are known as harmala alkaloids. And they actually prolong the effect and sustain the effect of DMT, which is a serotonin-based psychedelic.

Adrian: Okay. And so do they have similar effects in terms of their hallucinogenic effects and their acute effects, or they're different when you take them?

Jerome: Yeah, it's a great question. What we do know is that, yes, they are all considered to be classical psychedelics, that is, psychedelics which do operate via the serotonin pathway. So they're 5-HT2A agonists. But look, they do have differential effects as well. 

And I think something which is going to be really interesting as research evolves is to tease out which of these particular agents may be preferentially more beneficial to certain individuals and also certain psychiatric disorders. And our sense is based off an early read of the data. There's not a lot out there in terms of being able to make comparisons. But certainly, what we can see is, for example, your psilocybin, based on the data and also anecdotal reports, it being of benefit for depression, for example. 

When it comes to an agent such as LSD, it's longer-acting. So potentially through the therapeutic process, it's being reported clinically that people may be able to, I guess you'd say sort of have a deeper dive into what's going on with their mental health. And potentially, it may have a more preference role for treatment of trauma, and addiction, and, for example, alcohol or substance use disorders. 

So, we're still diving into it. Ayahuasca is quite interesting as well because the data which we have through Associate Professor Daniel Perkins at Psychae Institute who did a collaborative project which is originally based out of Melbourne University showed really compelling results that people who use ayahuasca may actually have reduced depression, anxiety, beneficial effects on trauma, and also reporting decreased use in alcohol as well as substances. So, that may be the case also, we may find across those broad range of conditions with LSD and psilocybin, but the research really has to catch that up.

Adrian: So you're talking about people who use them, they are preventative towards developing those conditions, or once they've had those conditions, it treats the symptoms?

Jerome: That's a great question. And what we can say is certain substances, for example, ayahuasca are used traditionally in some Christian churches incidentally in South America. They actually use this as part of their sacraments, part of their religious conduct. And some people will use it hundreds and thousands of times, so they're using it in a sustained manner. And the data does show, yes, in that context it can be certainly preventative for mental illness. Of course, you've got other confounding factors you have to control for such as the community support, and the effect, and we should say the protective effect of religions and spirituality. 

But that being said, there's also data using it acutely as a treatment for depression. And while they're small samples, that is also encouraging, showing an antidepressant effect which can be used as a treatment. Now other agents, we don't really have, I don't think to my knowledge anyway, data supporting a preventative use. What we can say is that, based on our gap data, which was a study conducted at the University of Melbourne via Associate Professor Daniel Perkins, is that this particular data showed that people who did use ayahuasca consistently did report, and it was a dose-dependent effect, even outside of a religious context, it did actually have a protective effect towards less instance of depression, anxiety, substance alcohol use, and trauma. So there is a potential role.

Another thing which is interesting is that I think there's certainly been reported quite widely a spike in people's interest using these agents in microdoses. So there's a potential to use these as a regular occurrence in lower amounts. Now, of course, we're not advocating for people to do that. And we really do need to catch up the data and there needs to, of course, be...the regulatory systems in place as well as obviously the need for psychological and medical support if needed. So we're certainly not advising people to go off and do it willy-nilly, but there is a bit of preliminary evidence that it may have effects on people's mental health using the microdosing and perhaps in future, when or if data supports this, it could be used in some form of a preventative role.

Adrian: So when you mean microdosing, it's obviously using tiny amounts and they're not getting necessarily that hallucinogenic effect?

Jerome: That's correct, yeah. So that's one-tenth of the dose.

Adrian: Oh, okay.

Jerome: Usually, typically people would use LSD or psilocybin. Now once again, cautioning everybody, to my mind, that is fairly dangerous unless you know exactly what you're getting. Aside from, of course, all the legal elements as well which people need to consider, there are safety issues and, of course, we need to be medically quite vigilant to make sure that, yeah, people's safety is paramount.

Adrian: And also read in one of those papers when they talked about microdosing, they're also stacking it with substances like chocolate and niacin. Is that how sometimes it was used?

Jerome: Oh, there's all sorts of activities which I guess you'd say which are advanced by psychonauts. So I don't know if the listeners have heard of psychonauts, but these are people who delve into their consciousness rather than going out externally into space, in a sense they're going internally into space through their experience with psychedelics. And there's all sorts of combinations used. And that's usually to prime the serotonin system.

Adrian: So when it's used, it's more traditional form, I suppose. What is that? Is that one dose that's given, or do you give multiple doses? How is it being looked at?

Jerome: It really does depend on the agent. If you take ayahuasca, for example, we're looking at multiple doses. And the same can be said also of psilocybin. Though ayahuasca is traditionally used, let's just say if people are taking a traditional setting, they might go to Peru for an ayahuasca experience with a shaman, that these retreats, they'll do 2, 3, 4 sessions over the space of 10 days. So it's more of an intensive experience.

Adrian: Oh, okay.

Jerome: But that being said, in the context of a modern clinical use, we can actually have a system set up whereby, yes, they get their two or three doses of this psychedelic. But you've got proprietary psychotherapy. Obviously, you've got the doses which are medically supervised and facilitated by a clinical psychologist, which occur. Then you've got integration sessions which occur afterwards. 

So this is part of, for example, an 8 to 12-week program. And it's important to realise that these agents, certainly where we come from in our research at Psychae Institute, is to make sure that they're scaffolded with proper psychological care and medical supervision as well. Because it's very important to make sure that the psychology, that the psychotherapy is a mainstay of what's being provided. So it's not just the psychedelic medicine, it's also the psychological scaffolding, which is critical.

Adrian: Oh, okay, okay. So it's not just you give it to somebody, you administer it once, and say goodbye, and they come back hopefully feeling better or...it's used often in conjunction with psychotherapy.

Jerome: Yes, absolutely. And that being said, we have been involved with research with some colleagues over in Brazil with ayahuasca. Once again just to remind the listeners, that's the DMT focused medicine. And what's interesting is that even using it acutely, one dose, without psychotherapy in an austere hospital setting still appears for people with major depressive disorder to have an antidepressant effect. 

So, it's good that we know that, that yes, the substance by itself can have an antidepressant effect and therapeutic effects. However, really, from an ethical position, you want to make sure that the person still does have proper pre-care and aftercare. We also want to acknowledge the importance of the psychological therapy around it. And quite frankly, the data also supports the fact that for some people who do not have the integration help, the psychological care, it's a very small percentage, but it still can have harmful effects. So ethically, it's important that they are supported within that model.

Adrian: Okay, all right, all right. Yeah, so I wasn't quite sure of how it was kind of administered. So you could potentially, it's really you're looking at using it as an adjunct or combination to psychedelic, I suppose, assisted psychotherapy that then treats the depression or anxiety. And you mentioned even substance abuse it can be used for.

Jerome: And yes, look, it makes sense if we look, for example, at depression through a pharmacological lens. We know we want to target certain serotonin receptors, and we get an antidepressant effect, and so on. However, what we do know is with conditions, for example, such as trauma, be it childhood-based trauma, PTSD, also substance and alcohol use is that these are conditions which one has to, I think, really delve into what are the triggers? Where does the tumescence of these particular disorders spring from? And that ultimately does take a therapeutic journey, it's a process. It's not just a case of giving a substance and you cure it. So we do recognise strongly that that is incredibly critical in treating those disorders.

Adrian: And when you think about where it kind of fits in, are you seeing it is potentially a treatment for anybody with, say, depression, or is it more with people who've experienced a trauma or treatment-resistant depression? Where do you see it fitting in?

Jerome: Well, I think all of the above. But look, what we should know is that just like everything in life, there's not a case of one treatment will be perfect for everybody. And psychedelics for certain people will not be a good fit. And one thing we were looking at is developing data which we can get a firmer sense of...for which people actually will suit psychotherapy-assisted psychedelic treatment, and which people, it may not be a good fit. So, I think we have to recognise that. 

There are ways which we can, of course, tailor treatment to people. A thing which is also important is the setting. So making sure people are in a therapeutic space, very comfortable, nice music, eyeshades, nice lighting, not being distracted by noise. So there are certain things which we can do to support people as well as having a good therapeutic relationship with the people that we're treating then. But it's not a case of one-size-fits-all. And I think we have to be fairly understanding of that.

Adrian: If we look at the evidence and the research that's been done so far, what's the evidence so far? Are you doing any particular studies at the moment? What's going on there from that field?

Jerome: Yeah, look, we are involved in a few studies. One particular one I can highlight, we were fortunate enough to get an MRFF, so an NHMRC-based grant to study ayahuasca. Be that specifically a DMT harmala alkaloid combination in people with major depressive disorders and also alcohol use disorder. And we may also do some work on trauma. And that's quadruple-blinded RCT. And we're looking at that starting up later on in the year.

Adrian: How do you do blinding when you've got the hallucinogenic effects? How does that work?

Jerome: Well, yeah, it's a good question. In this case, what we're doing is we're prescribing what as our placebo, of course, will be randomised, an antihistamine and also zinc. So it's going to be a combination. The antihistamine will elicit a sedating effect, which will potentially have some cognitive altering experiences apparent as well as the zinc which can give a slightly hermetic nauseating effect. 

And the reason is because a certain percentage of people with ayahuasca will have a little bit of nausea. And in some cases, they may actually have a purging experience. And interestingly, that purging experience for some people is incredibly cathartic and therapeutic. And then afterwards, it's perceived as a real release both psychologically and also physiologically of something which is really impeding them with their mental health.

Adrian: So how hard was this to get through ethics, and get approval, and funding, and all that?

Jerome: Well, look, we've been quite blessed. There was a government call put out for 15 million AUD, and myself and colleagues across Australia had seven of these projects funded. So that's quite exciting in Australia now that we're doing that. 

And we've also had other colleagues such as Dr. Marg Ross have ethics approval and has conducted fantastic psilocybin research at St Vincent's. Also have Professor Susan Rossell with psilocybin and depression over at Swinburne. They've got ethics clearance. And there's also some work going on at Monash. So, certainly, we don't expect any issues regarding ongoing ethics clearance.

Adrian: And are they studies that are ongoing or they actually have completed the studies and published the trials?

Jerome: Still ongoing, still ongoing. As you can imagine, it really is quite resource-intensive to run these studies, and in many cases quite costly. And also, look, let's be frank, COVID has not really assisted...

Adrian: No.

Jerome: ...in terms of being a researcher in Australia. But, look, things are heating back up, and there are some fantastic projects which are cooking away during 2022.

Adrian: Wow, wow. Okay, all right. So you've got all these... So the research is looking specifically at the psilocybin, and how do I say it again? The ayahuasca?

Jerome: Ayahuasca, yeah.

Adrian: Ayahuasca, okay. They're the two psychedelics that are being more researched at the moment, is that correct? Or are there other psychedelics that are getting more and more attention?

Jerome: Yeah, there's related compounds, for example, ketamine where there's been a fair bit of work done in Australia. MDMA, so there was a couple of MDMA studies which were funded, and while they're not classical psychedelics, they're still broadly within the field. So they've been funded as part of the government grant as well and they'll be underway later this year.

Adrian: Okay. And so when these are administered, do they have like rapid antidepressant, anxiolytic effects? Is that potentially part of their benefit because they can work really quickly?

Jerome: They certainly can. And I think that was, well, I don't want to use the word popularised, but advanced with really rigorous science. One of the leaders, Professor Colleen Loo, up at UNSW, has done some great work with ketamine. And that has shown to have quite a marked, declarative effect in reducing depression. But we've seen some similar effects with psilocybin and also with ayahuasca. 

So all these agents, yes, can actually elicit quite a strong antidepressant effect. And I think the real proof in the pudding, and where we really have to just delve deeper in terms of the science and generate more data, and that is in respect to the longer-term effects. So we need to understand how many doses the person needs. Do they need a booster? What sort of psychological scaffolding is best to treat this comprehensively? 
I don't think it's a case of it's a miracle drug, give them one treatment, and they're cured for life. I think we need to be realistic about that. But it is incredibly encouraging, because as we know with antidepressants, you do not get that acute antidepressant effect. And that's very important, especially when people are suicidal.

Adrian: So you're talking about acute effects, what, within hours that they're experiencing mood improvements? It's that rapid?

Jerome: Yeah, sure. But then you've got to understand a person's undergoing quite a strong psychological experience. So it knocks them around for that particular day. And then yeah, hopefully, a good night's sleep, and then they're on the mend and have got a sustained mood improvement over the space of days and weeks after.

Adrian: And you mentioned that they're working on the serotonergic function. Is it dopamine, glutamate, where it’s potentially working from those monoamines?

Jerome: Yeah, primarily the serotonergic pathway, as I was saying the 5-HT2A receptor agonism is where we get these effects. But there's also quite interestingly growth promotant, or I should say, neurogenesis-promotant effects as well as dampening what's known as the default mode network. And so in cases such as depression, you have an overly active default mode network, so the circuitry in the brain which, in a sense, if you imagine a car, it's idling away and it's ruminating. And we just want to dampen that background noise, that is what psychedelics have quite compellingly shown. But there's also other effects such as having quite strong anti-inflammatory effects. So, the mystery's being unravelled and it's quite interesting to show a range of these pathways which are affected by psychedelics.

Adrian: So we've got some of the obviously similar mechanisms to some of the traditional antidepressants, but obviously, there's this immediate effect that traditional antidepressants don't have. Obviously, you've got to use it more chronically with regards to antidepressants. But obviously, antidepressants target the serotonergic function. And there's obviously some research around its ability to increase neurotrophic factors and things like that. But this also kind of impacts on those mechanisms too.

Jerome: Yeah, absolutely.

Adrian: Now, also, there's also psychotherapeutic mechanisms like I've read gaining insights into the inner self and altered sense of perception, and increased feelings of connectedness, that's also happening too, isn't it?

Jerome: Oh, look, exactly. And that's the problem is that sometimes we can get sidetracked looking at the biological mechanisms and we forget about the actual human experience. And it's exactly what you said, it really is ultimately, apart from those neuroplastic changes, the individual, the person gaining insights into themselves, but also their mental illness, if used in that way. 

There's also experiences such as ego dissolution. So a person having a sense of... How do I put this? For example, with depression, people are very much myopically focused on themselves. They're ruminating often, they're negatively thinking. Everything's turned inwards. But when that's, in a sense, dissolved, when that noise is just quietened and people feel more connected to people around them, to nature, they feel a part of something greater than themselves, that has a profound therapeutic effect. And then you layer that on top of people having genuinely strong insights as to where the problems are occurring in their life, how they got there, how to make changes in their life, it really can have a very profound therapeutic effect.

Adrian: Wow, that's amazing. So the potential for this obviously, and that's why the interest from different researchers like yourself in the potential of these psychedelics to improve mental health and also the substance abuse. So does alcohol and... Has a positive effect on alcohol abuse and things like that too. Is that what some of the research has indicated?

Jerome: It absolutely is. And look, it makes sense. Look, we have to, of course, consider the comorbidity which is very common. You have people with depression, often there might be increased alcohol use as a coping mechanism, for example. You may also have a background of trauma as well. So, everything is very much interrelated. 

I think the challenge we have with the general scientific model is let's just focus on one cookie-cutter condition. I think really the strength of psychedelic research going forward will be to look at actually treating the person, improving their lives, creating a transformation, addressing across a myriad of conditions. I guess having a transdiagnostic approach. I think that's the real strength.

Adrian: Now, you touched on earlier a bit about safety. So what's the safety of these psychedelics?

Jerome: Well, it's very important we do consider the safety. I think by and large, and, of course, these are small studies presently, but the safety data is pretty good regarding classical psychedelics. Certainly, if you look at across broader populations, if you look at the data concerning, for example, the negative societal effects, health effects of psilocybin versus alcohol or nicotine, we can see obviously it's incredibly minor in comparison. 
But nevertheless, we, of course, have to be very conscious of safety. And that's why, of course, we advocate if any use is happening, that it is within a psychotherapeutic framework with some medical supervision just to make sure that the safety mechanisms are in place.

Adrian: And so what about with people who have comorbid medical conditions, let's factor, for example, cardiovascular disorder or there's a history of psychotic disorders, are they appropriate for those individuals?

Jerome: And, yeah, that's exactly right. We need to be very careful about... We can only comment at the moment, of course, from a research perspective, but who we're including in our studies. And that's why there is a fairly rigorous inclusion-exclusion criteria. One of which you have brought up is the predisposition. It could be familial or an actual diagnosis of a psychotic disorder. That's important to exclude for, as well as a range of major medical conditions. 

That being said, the question which we always get is that that sounds great from a scientific perspective and certainly from an ethics committee perspective. But then, what are we saying? A lot of people with chronic mental health, of course, have got comorbid in many cases, physical ailments. What are we doing? That can never be treated. So, but, look, at the moment we need to collect the data as safely as we can. And then, of course, as that advances, I would like to think that we're going to be looking at making this potential therapy more generalisable to most of the population, safety considerations notwithstanding, or withstanding, I should say. Something's standing, anyway.

Adrian: Something's standing, yes, absolutely. All right. So it sounds like then that the research, like any trial with any new drug or new treatment, the trials are recruiting people who, yeah, there's quite strict eligibility criteria, there's a lot of exclusion criteria, but obviously you need to do your assessments on those individuals first and then potentially look at expanding it in the future if you find some positive results and some positive safety profile too.

Jerome: I think so, yes.

Adrian: Okay, so at the moment though, can I be treated?

Jerome: Well, sadly, the present situation, what we've got is that the TGA, thankfully, they're allowing for some SAS Cat B applications to be approved, so that's in special cases if the psychiatrist says, "Yes, you're a good candidate," for example, "for psilocybin, for depression." They'll get an approval and TGA will say, "Yep, okay, this is fine based on the evidence in your particular case and medical judgment." Then it goes through to the states for state-based approval. And they don't want a bar of it, they won't touch it. 

So it's incredibly disappointing. And if you put yourself in the shoes of the patients, it's very upsetting for that, especially when they've tried many, many other treatments and they're considered to be treatment-resistant. And their doctor decides that's the best treatment. I think it should be respected. But, there's always politics involved in these situations and all we can do is just hope that sanity prevails and that some people who really are needing to have another option can do so in a safe, medical manner.

Adrian: So in reality, at the moment, there's not really an option for people. It sounds like it's very difficult for them to be able to be treated and get approval.

Jerome: Yeah. Well, it's 2022 from memory, so, yes, hopefully, who knows? If somebody listens to the podcast months down the track, years down the track as well, things might have changed. And I hope they would have. 

And look, the other consideration is that people are, some people, they're going overseas when they can, obviously been difficult over the last couple of years, to South America to undergo ayahuasca ceremonies. And we're not going to judge it one way or the other. That's up to the individual. But there's also clandestine ayahuasca ceremonies taking place in Australia. A lot of reports we've had is that they're incredibly beneficial for people. 

And that's not to say, however, that in some cases, people may not have an adverse reaction, that they may not need medical support or psychological support. So, the problem is when you push things underground, you have all sorts of issues. So, to me, it makes sense. If people are really wanting to do it, it would be advantageous from a health policy perspective surely and then making sure that they're being treated appropriately by a clinical psychologist and psychiatrist. 

And they also know what they're getting. There's a standardised medicine. So they actually know what they're taking. To me, that would be a sensible approach. And I guess we'll just have to wait to see how policy changes.

Adrian: Yeah. Unfortunately, the sensible approach is not often the most common approach. But yeah, you're absolutely right. 

Now, okay, so let's say the research is positive, we're looking at some beneficial effects, where do you see this fitting in? Like who's going to be prescribing it? Where would it be? Any ideas around that?

Jerome: Well, we're casting our mind, of course, into the future. We need firmer data. We cannot say on a mass level that these agents should be prescribed yet. But we're getting there. We need a bit more data and we certainly need a bit more understanding around the therapeutic model and the safety elements as well. 

But look, I think all things being equal, the data looks very, very promising. If that gets replicated and we start getting, for example, Phase 3 study data coming through, then realistically, that’s not to say within a certain amount of time there can't be psychedelic-based clinics which are set up across the states. People go in there for treatment. They're assessed, first of all, of course, rigorously for inclusion. And if the criteria, and if they're fine to go, if it's appropriate for them as determined medically, then yes, they undergo psychological preparation sessions, the treatment. Maybe they need one, two, three, four treatments, it depends on the agent and the condition. And they do it in a very comfortable setting getting very good therapy. 

And hopefully they will have a transformative effect and you'll get a flow-on effect through society that people are functioning better, they're living healthier lives, happier lives. They're contributing. And in a sense they’re… I don't know how else to say it, but spreading the happiness/societal productivity, which I know is probably more of a political sentiment, but maybe that's how it's viewed. I don't know. But yeah, hopefully, that's how the future does evolve and we'll just have to wait and see.

Adrian: Yeah, obviously. And obviously, your work and the work of your colleagues is going to guide us in terms of firstly efficacy, and then safety, and then obviously looking at how to administer it most appropriately. Is it one dose? Is it two doses? Obviously, it's with what type of supports and all those things. So that sounds like there's lots of questions to be answered before we proceed further with regards to psychedelics.

Jerome: Absolutely. Look, on a mass level, I think that is absolutely the case. I still think...look, there are some clinicians who have undergone training in regards to administering psychedelics and they have the psychological training around that as well. And I think they should be afforded the opportunity via the SAS Cat B scheme to regulations to prescribe these agents. But yeah, certainly when it comes to a larger rollout, we need to see how the data evolves.

Adrian: Yeah, absolutely. All right, well, thank you, Jerome, for being with us today to discuss the use of psychedelics in mental health. You've certainly given us a better understanding of what these compounds can do and cleared up some of the myths and, I suppose, stigma surrounding them. We know that right now we're experiencing a mental health epidemic and there are a lot of practitioners out there who are looking at other options, and obviously, this potentially could fulfil one of those gaps. But obviously, we'll see how that progresses over time. So thank you again, Jerome, for taking us through all of this.

Jerome: You're very welcome. Great to be with you.

Adrian: Thank you, everyone, for listening today. Don't forget that you can find all the show notes, transcripts, and other resources from today's episode on the FX Medicine website. I'm Dr. Adrian Lopresti, and thank you for joining us. We'll see you next time.


About Jerome Sarris

Jerome Sarris is Professor of Integrative Mental Health at NICM Health Research Institute at Westmead, Western Sydney University. He is the Co-Director of the not-for-profit Psychae Institute (focusing on botanical psychedelic medicine research), also holding a Visiting Scientist appointment at the Florey Institute of Neuroscience and Mental Health, Melbourne University. Jerome has a particular interest in mood and anxiety disorder research pertaining to psychotropic plant medicines (in particular on Kava, medicinal cannabis, and psychedelics), and Lifestyle Medicine. Prof Sarris has around 220 academic publications (cited over 10,000 times), including journal articles featured in The American Journal of Psychiatry, Lancet Psychiatry, JAMA Psychiatry, and World Psychiatry. He has conducted many RCTs in the field, including several NHMRC and MRFF funded projects. Jerome Chairs the Taskforce on Integrative and Complementary Medicine for the World Federation of Societies for Biological Psychiatry & the Canadian Network for Mood and Anxiety Treatments.


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Dr Adrian Lopresti

Dr. Adrian Lopresti is a Clinical Psychologist in private practice and senior researcher at Murdoch University, Western Australia. He has over 20 years of clinical experience working with children and adults suffering from a range of mental health conditions.

Dr. Lopresti has experience in a range of psychological therapies and has received extensive training in nutritional and lifestyle treatments for mental-health disorders. Dr. Lopresti regularly publishes in peer-reviewed and high-impact journals on the effects of diet, nutraceuticals, sleep, and exercise for the treatment and prevention of depression, anxiety, attention deficit hyperactivity disorder (ADHD), and bipolar disorder. He has completed several clinical trials investigating the effects of curcumin, saffron, and ashwagandha for the treatment of anxiety and depression in children and adults. Dr. Lopresti is also the founder of Personalised Integrative Therapy, and regularly conducts educational workshops both nationally and internationally.