Antibiotics for the mind?

New centre has bold ambitions for addressing mental illness

In March 2021, after more than two years of investigation, the Royal Commission into Victoria’s Mental Health System delivered its Final Report.

Among many noteworthy and disturbing observations was this simple statement of fact:

There have been no truly novel medicinal breakthroughs in treatments for mental illness or psychological distress over the past 50 years.”

It’s a striking assertion all on its own, but when set alongside the stark facts of mental health in Australia, it becomes even more remarkable.

One in five Australians has suffered from a mood, anxiety, or substance-use disorder in the past 12 months alone. More than eight people die by suicide every day in Australia. More than half of all Australians with chronic mental illness are unemployed. And current medications only lead to remission for just over one third of those with depression and 20 to 30 per cent of those with post-traumatic stress disorder (PTSD).

This, then, is clearly a major public health problem just like cancer, diabetes or dementia. But over the same half century, medicinal breakthroughs for these illnesses have been numerous and momentous.

There was also the matter of the statement’s provenance. It came from a submission to the Royal Commission made by Professor Arthur Christopoulos, Dean of the Monash Faculty of Pharmacy and Pharmaceutical Sciences. It was weighty in part because it was not an exercise in finger-pointing – this was an esteemed member of the pharmaceutical sciences community conceding that it had not had the influence in this area of health that it might have. But if it was a lamentation, it has also become a catalyst.

In late 2021 the Neuromedicines Discovery Centre (NDC) was launched. Its mission: to make certain 50 years without a novel mental health medicine breakthrough does not become 60 or 70. It is an idea conceived and advanced by Professor Christopoulos.

He will also lead it as inaugural Director, while retaining his role as Dean of the Faculty.

The Centre’s explicit objective will be to find what Professor Christopoulos describes as "antibiotics for the mind" – medicines that require minimal dosing, have fewer side-effects and are effective for longer periods than drugs currently used to treat mental illness. Should such drugs be discovered and proven safe, the result would be a dramatic drop in the number of Australians suffering from mental illness with a consequent drop in the cases of suicide.

While the last ten years have witnessed a resurgence of interest in the long-dormant field of psychedelic research, Professor Christopoulos believes the NDC is different because of the comprehensiveness of its approach.

“Piecemeal interventions – a clinical trial here, a new publication there – will likely not yield the kind of transformative change a societal problem of this scale requires. And that’s where the NDC becomes essential,” he said.

The Centre’s researchers will concentrate on three central themes: Better Medicines, Better Minds and Better Futures.

“Under the Better Medicines theme, we will aim to deliver new classes of mental health medications using MDMA, medicinal psilocybin, ketamine and related short-acting psychoactive medicinal candidates as starting points, but it is envisaged that the scope of the centre would become broader as it grows and reflects our strengths in neuroscience and psychopharmacology research. The medicinal work of the centre will be led by the Monash Institute of Pharmaceutical Sciences in close collaboration with the University of Melbourne and the Florey Institute of Neuroscience and Mental Health.

“At the same time, the Better Minds theme will provide clinical validation, workforce training and new clinical guidelines in the treatment of multiple psychiatric diseases, including depression, PTSD, generalised anxiety, obsessive compulsive disorder, substance use and eating disorders. This will be led by Monash’s Department of Psychiatry, the Turner Institute, and the School of Clinical Sciences (Monash Health), in close collaboration with the University of Melbourne’s Department of Psychiatry, the Melbourne Neuropsychiatry Centre and Phoenix Australia Centre for Post-traumatic Mental Health.”

Professor Christopoulos said the third, Better Futures, theme positions the centre as an expert in drug policy and regulation.

“The Better Futures theme is about developing policies, regulatory tools and rollout strategies for new classes of medicines, and to  ensure a supportive social and political environment. This will be led primarily by Monash’s Behaviourworks Australia and the  Monash Sustainable Development Institute.”

This is a major undertaking, not just because the aspirations are so audacious, but because the NDC is by its own description “the world’s first end-to-end research centre” in this space.

We can attack the problem comprehensively, using multiple drugs and regimens evaluated in different mental health disorders across representative patient cohorts. And it will be backed by world-class research into the development of next generation therapeutics and rigorously designed clinical trials.”

Research into psychedelic drugs and their effectiveness in treating mental health conditions is not new, but it lost momentum many decades ago. There has nonetheless been excellent work done over the last several years and decades. And the results, Professor Christopoulos said, are enormously promising.

“Traditional approaches to mental illnesses usually entail a medicine being taken each day for months or years. Or a patient might  need to attend therapy sessions for extended periods.

“The model we’re investigating at the NDC is called Neuromedicines-Assisted Psychotherapy, or 'NMAPs'. With NMAPs, therapeutic effects can be achieved with short-term treatment. Just two or three sessions can produce positive results lasting  longer than six months and we now have powerful evidence to support this with drugs such as ketamine and MDMA.”

Those names on their own and taken out of the clinical context will inevitably lead to raised eyebrows. Indeed, stigma around these drugs is the principal reason that research has stalled for so long. Professor Christopoulos said that part of the centre’s role will be  to shift perceptions.

“When we talk about being an ‘end-to-end’ research centre, we’re not just referring to that classic ‘bench to bedside’ purpose; we  aim to go further. We want to work directly with community members, to seek their point of view on mental health and how it’s  treated.

Our objective is unashamedly bold: we want to provide global leadership to change received wisdom, negative attitudes and public policy around these therapies. Not just for the sake of change, but so that patients can benefit from these drugs. Ultimately, we want to change lives forever.”