After 50 years of stagnation in the development of novel, safe and effective treatments for targeted mental health disorders, Monash launched an end-to-end, cross-disciplinary centre to drive novel psychiatric drug discovery, as well as new approaches to neuromedicine-assisted psychotherapies for their treatment.

The Neuromedicines Discovery Centre (NDC), led by Monash’s Professor Arthur Christopoulos, will bring together the combined expertise and resources of world-leading researchers from Monash University and collaborators from the University of Melbourne and The Florey Institute of Neuroscience and Mental Health, to propel new treatments for mental ill health spanning the entire medicines development pipeline, from drug discovery and optimisation, to clinical trials, new healthcare guidelines and into the public policy arena.

Asked about his vision for the centre, Professor Christopoulos told Neos Kosmos that he hopes to “establish the world’s first end-to-end neuromedicine discovery centre that can cover drug discovery, drug development, formulation, manufacturing and the ability to supply such medicines to clinicians wanting to do clinical trials to improve the current crisis in mental health”.

“Although our initial focus will be on psychedelic-assisted psychotherapies, the depth and critical mass of cross-disciplinary expertise assembled under the Centre’s banner – together with our network of collaborators – has the potential to rapidly expand the pharmacological repertoire of totally new classes of safer and more effective psychiatric medicines,” he said.

“We also want to develop new therapy models and train the next generation of clinical scientists with experience in this type of therapy. We also want to work with patients, carers and regulatory agencies to develop policies and guidelines for how best to roll out these types of therapies, and make them available and affordable to those most in need. This is a huge undertaking, and no one University or Institute can do it alone. There have been quite a few Centres established in this space around the world in recent years, but none of them are operating at the scale that we are proposing to do.”

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Mr Christopoulos said that he has “always been passionate about improving mental ill-health, and [has] remained dismayed that most of the current psychiatric medicines on the market are based on science that is at leas 50-70 years old. It really is time that we tried something different! This could completely transform the way we approach mental illness treatment and, if we get it right, can even cure previously intractable psychiatric diseases,” he said.

The NDC’s research is focused on finding better treatments for common psychiatric illnesses, including depression, post-traumatic stress disorder, obsessive compulsive disorder, anxiety, and substance use disorders.

Psychedelic-assisted psychotherapies

NDC Deputy Director Professor Chris Langmead said, “Although our initial focus will be on psychedelic-assisted psychotherapies, the depth and critical mass of cross-disciplinary expertise assembled under the Centre’s banner – together with our network of collaborators – has the potential to rapidly expand the pharmacological repertoire of totally new classes of safer and more effective psychiatric medicines.”

Mr Christopoulos points out that “psychedelic-assisted therapies are a completely different treatment paradigm relative to current medicines used to treat psychiatric illnesses. In contrast to current prescription psychiatric medicines (which need to be taken for a long time, are only effective in 30-50 per cent of sufferers, and have significant issues with side-effects and addiction liability), psychedelic-assisted therapies offer a very different treatment approach”.

“First, these medicines are only ever used under clinical supervision in the presence of trained therapists; you are not going to be going to a GP, getting a prescription, and then going to the pharmacy and take the medicine on your own! No way,” he said.

“Second, they are immediate-acting (hence the need to only take them under clinical supervision) and alter patient’s consciousness such that they are able to reflect on their psychological issues, but from a perspective of ease and calm. This is in contrast to most existing psychiatric medicines, especially for depression, where you need to take them for a long time before the effect kicks in.

“Third, psychedelic-assisted therapies appear to require only a very few sessions, eg two to three, for the patient to experience a significant beneficial effect that can last for a very long time (months or more) without them needing to take any other medicine.

“Each session typically involves a preparatory meeting with your therapist(s), then a day of therapy with the actual medicine under clinical supervision, then a few days after that with no medicine, but only supportive psychological therapy to help you integrate your experience. You would then repeat this a few weeks/months after the first session and, if need be, one more time. So, essentially, these therapies offer the potential for minimal dosing, yet with extended periods (months of longer) of drug-free remission – if they work.

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“This also means that the likelihood of side effects or addiction is very very low, because you are not taking any medicine for prolonged periods of time. It is a completely different approach to treating mental illnesses that are resistant to current medications, e.g. treatment-resistance depression, PTSD, substance use disorder and severe generalised anxiety, just to name a few. Please note, however, that there is a lot of work to be done to understand how they work, who they work for, and what is the ideal clinical setting in which to undergo the therapy. Nonetheless, the clinical studies in this area over the last decade have shown some remarkable potential, which is why we need to look at this seriously, at depth and at scale using a multi-disciplinary approach and modern scientific rigour.”

Synergies and collaborations

The new Centre is a collaboration between Monash’s Institute of Pharmaceutical Sciences, which is located in Professor Christopoulos’ Faculty, Monash’s Turner Institute for Brain and Mental Health, Monash’s Department of Psychiatry, Monash’s Behaviour Works Australia and the Monash Sustainable Development Institute “so that means we have a lot of researchers that span the gamut from pharmacology, medicinal chemistry, drug delivery all the way through to brain imaging, clinical trials, psychology, policy and regulation development,” Professor Christopoulos said.

“In addition, we are collaborating with the University of Melbourne’s Department of Psychiatry, the Melbourne Neuropsychiatry Centre, Phoenix Australia Centre for Post-traumatic Mental Health, and the Florey Institute of Neuroscience and Mental Health. So, that is a huge network, and something that has never been attempted before anywhere in the world to my knowledge. Recruitment of patients for clinical trials has only recently begun, and it is a very detailed and intricate process (given the subject matter), but if you look at the diseases I mentioned above – you will get an indication of the types of patients that these therapies may eventually be shown to benefit. But we have a lot of science to do first!”

Despite optimism, this “is not a panacea; it is not a magic bullet; it is not going to work for everyone and everything,” he said, “but early studies are showing very exciting potential, and so we owe it to ourselves and our society to bring together all the key experts and do this properly. At the very least, it is a completely different way of treating psychiatric diseases than the current model of chronic dosing with suboptimal medicines.”

Monash University President and Vice-Chancellor Professor Margaret Gardner AC said: “By combining the capabilities from across Monash and our expert collaborators, the NDC offers a globally unprecedented end-to-end capability, from bench to bedside (and back), and into the community.”Our world-leading researchers across psychiatry, psychology, pharmacology, medicinal chemistry, drug discovery and policy development are working to stimulate innovation in treatments for mental illness, bringing hope to those for whom current treatments are only partially effective or don’t work at all.”