Emerging and Adjunct Treatments for Common Mental Health Conditions Affecting Veterans: A Rapid Evidence Assessment
There has been a lot of interest in emerging treatments for mental health conditions, such as psychedelic-assisted therapy. DVA commissioned Gallipoli Medical Research Foundation (GMRF) to undertake a project examining the latest high-quality research to inform veterans and their families about emerging treatments. It is important to note that evidence-based treatments should always be tried before considering emerging treatments. While there is limited evidence to support emerging treatments, they may be helpful for some individuals who have had little improvement, or have not responded, to evidence-based treatments.
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Overview
DVA commissioned Gallipoli Medical Research Foundation (GMRF) to undertake a rolling Rapid Evidence Assessment (REA) of emerging and adjunct treatments for post-traumatic stress disorder (PTSD) and common mental health conditions affecting veterans. The goal of the REA was to provide an evidence base to develop a flexible, yet robust, decision-making process that allows DVA to assess emerging treatments for veterans who have not responded to evidence-based treatments.
The REA examined four categories of mental health conditions:
- Anxiety disorder/s;
- Mood or depressive disorder/s;
- Substance-related and addictive disorder/s;
- Trauma- and stressor-related disorder/s.
The REA examined five categories of interventions:
- Psychedelic compounds; specifically:
- Ketamine;
- Methylenedioxymethamphetamine (MDMA);
- Lysergic acid diethylamide (LSD);
- Psilocybin;
- Dimethyltryptamine (DMT) including ayahuasca.
- Medicinal cannabis; specifically:
- Cannabidiol (CBD);
- Cannabinol (CBN);
- Tetrahydrocannabinol (THC).
- D-cycloserine (DCS).
- Stellate ganglion block (SGB).
- Transcranial magnetic stimulation (TMS) including theta-burst stimulation (TBS).
The Reports
These reports are available in Research and Studies on the DVA website.
Back to topTranslating the evidence
This video is a guide to understanding the evidence from the rapid review of emerging treatments for PTSD and common mental health conditions affecting veterans.
Transcript of Understanding Emerging Mental Health Treatments
- There has been a lot of interest in emerging treatments for mental health conditions.
- Over a hundred high-quality studies were reviewed and the findings were mixed: some studies showed an effect of the treatment and some studies did not show a treatment effect.
- While there is limited evidence to support most of the treatments, they may still be helpful for some individuals who have had little improvement, or have not responded, to evidence-based treatments.
- In most studies, the treatments were delivered in highly controlled research environments, so providing treatment in less controlled settings may yield different outcomes, or could increase the risks of treatment.
- With any treatment there are risks, and most studies of emerging treatments have reduced these risks by excluding people with a range of medical and psychological issues. This means the study findings may not apply to people with more complex conditions.
Emerging Treatments: Number of studies identified from database searches and then reviewed following screening and eligibility checks
The REA focused on randomised controlled trials (RCTs) because this type of study design is the most suitable for assessing whether an intervention is responsible for any observed change in outcomes (e.g., reductions in mental health symptoms; side effects of treatment). The defining feature of an RCT is that the participants are randomly allocated to the intervention and control conditions for the study (e.g., active treatment vs. inactive treatment). As study group membership is based on chance, the groups should not be systematically different before treatment. Thus, differences between the groups after treatment may be attributed to the effects of the intervention.
Initial (5-year) literature review (Apr 2022)
| Treatment type | Unique studies identified | RCTs included in the review |
|---|---|---|
| Psychedelics | 1211 | 18 |
| Medical Cannabis | 461 | 12 |
| D-cycloserine (DCS) | 76 | 13 |
| Stellate ganglion block (SGB) | 15 | 1 |
| TMS (including TBS) | 1316 | 47 |
| TOTAL | 3079 | 91 |
First (six-month) update to the literature review (Oct 2022)
| Treatment type | Unique studies identified | RCTs included in the review |
|---|---|---|
| Psychedelics | 210 | 0 |
| Medical Cannabis | 82 | 1 |
| D-cycloserine (DCS) | 7 | 1 |
| Stellate ganglion block (SGB) | 2 | 0 |
| TMS (including TBS) | 188 | 11 |
| TOTAL | 489 | 13 |
Second (six-month) update to the literature review (Apr 2023)
| Treatment type | Unique studies identified | RCTs included in the review |
|---|---|---|
| Psychedelics | 321 | 4 |
| Medical Cannabis | 80 | 0 |
| D-cycloserine (DCS) | 9 | 1 |
| Stellate ganglion block (SGB) | 6 | 0 |
| TMS (including TBS) | 293 | 8 |
| TOTAL | 709 | 13 |
Third (six-month) update to the literature review (Oct 2023)
| Treatment type | Unique studies identified | RCTs included in the review |
|---|---|---|
| Psychedelics | 343 | 2 |
| Medical Cannabis | 55 | 0 |
| D-cycloserine (DCS) | 8 | 0 |
| Stellate ganglion block (SGB) | 9 | 1 |
| TMS (including TBS) | 261 | 4 |
| TOTAL | 676 | 7 |
All Reviews (Apr 2022 - Oct 2023)
| Treatment type | Unique studies identified | RCTs included in the review |
|---|---|---|
| GRAND TOTAL - All Reviews | 4953 | 124 |
TGA announcement to reschedule MDMA and psilocybin
- On 3 February 2023, the Therapeutic Goods Administration (TGA) announced that medicines containing the psychedelic substances MDMA and psilocybin may be prescribed by authorised psychiatrists for specific mental health conditions: MDMA for PTSD, and psilocybin for treatment-resistant depression. These changes came into effect on 1 July 2023.
- Prescribing of these substances will be limited to psychiatrists who are approved under the Authorised Prescriber Scheme following approval by a Human Research Ethics Committee (HREC).
- The TGA’s decision acknowledges the current lack of options for patients with specific treatment-resistant mental health conditions. While these medicines are federally approved for use under these limited circumstances, the medicines will still need approval for use in individual states and territories.
- DVA will continue to review the literature as new studies are published in Australia and overseas.
- Providing our community with the most up-to-date information on safe and effective treatments for mental health conditions is our priority.
Information and Resources
- Therapeutic Goods Administration MDMA and psilocybin hub
- The Royal Australian and New Zealand College of Psychiatrists Clinical Memorandum on Therapeutic use of psychedelic substances and Therapeutic use of MDMA for PTSD and psilocybin for treatment resistant depression
- Australian National University College of Health and Medicine Australian Interventional Pharmacotherapy and Psychedelic Assisted Psychotherapy Research Registry
- Australian Government Department of Health and Aged Care Clinical Trials Activity Initiative
- Guide to understanding research evidence Understanding Evidence: A Framework for Guiding the Use of Evidence in Decision Making for Mental Health Interventions including Adjunct Therapies