A recent study published in the New England Journal of Medicine has found that psilocybin, alongside therapy, can help relieve symptoms of treatment-resistant depression. Scott Aaronson, MD, one of the study’s lead authors, is chief science officer of the Institute for Advanced Diagnostics and Therapeutics at Sheppard Pratt. The institute opened its doors in May of 2022 and is already a leading site worldwide for psilocybin research and treatment.
Participants in the New England Journal of Medicine study reported significant improvement in as little as three weeks. Research like this stands to revolutionize care for individuals with difficult-to-treat illnesses. It is an advancement made possible by the institute, a place where research and experimental clinical trials are housed together with other cutting-edge treatments including transcranial magnetic stimulation (TMS) and electroconvulsive therapy (ECT). The institute was designed to include a specific range of care options under one roof to unleash the ability to offer people the best care possible. Having such a variety of psychiatric experts in one program allows the renowned experts leading the institute to explore every option.
“You can send someone to an ECT program, or a TMS clinic, or an esketamine clinic. But there aren’t many places to send patients for an unbiased opinion about which of those interventions might be best for them,” says Aaronson.
Through Sheppard Pratt’s Institute for Advanced Diagnostics and Therapeutics, he hopes to provide just such a place. “We want to create an environment where patients are evaluated by expert psychiatrists who consider all the facets of a patient’s illness and treatment history, to recommend advanced therapeutics that offer the best chance at improvement,” Aaronson says.
Launched in 2022, Sheppard Pratt’s Institute for Advanced Diagnostics and Therapeutics combines clinical expertise in difficult-to-treat mental illnesses with research on cutting-edge interventions, including:
- Vagus nerve stimulation
- Psychedelic therapies (provided only within research protocols)
The institute also houses a second opinion clinic, where physicians across the country can bring their most difficult cases for consultation. The patients brought to the institute via the second opinion clinic will benefit from varied perspectives and deep clinical insight while continuing to advance research in the field.
Sheppard Pratt has a long history of studying advanced therapeutic interventions. Bringing them together under one roof better serves patients and accelerates the research, says Aaronson. “We’re moving toward more interventional psychiatry, and I believe the next five years will be transformational for the field.”
Psilocybin and Psychedelics Research and Treatment
A centerpiece of the new institute is the Center for Excellence for Psilocybin Research and Treatment. Developed in partnership with the company COMPASS Pathways, the center will be a hub for investigating psilocybin therapy for psychiatric illnesses. As the first site designated a center of excellence, Sheppard Pratt will be the first in the world to enroll patients for a phase III clinical trial of psilocybin for treatment-resistant depression.
Experts at the center are also studying psilocybin treatment in bipolar type II depression, chronic suicidal ideation, and anorexia. “These are illnesses for which there are very few treatment options,” Aaronson says. “Could psychedelics help ease that burden?”
He and his colleagues are also investigating other leading-edge medications, including esketamine. A derivative of the anesthetic ketamine, esketamine was approved by the FDA in 2019 for treatment-resistant depression. Though it’s not technically a psychedelic at the receptor level, it can trigger brief perceptual changes and is often discussed in the same category as psilocybin and other psychedelic compounds.
With funding from SAMHSA, the institute is launching an esketamine clinic to provide this treatment to patients and conduct additional research on its use.
Integrating Psychotherapy and Pharmacotherapy
When undergoing psilocybin or esketamine treatment, patients also receive therapy before and after the dosing to help them prepare for and then integrate the experience. Aaronson and his colleagues at Sheppard Pratt plan to investigate how various forms of therapy might improve outcomes.
“One of the most interesting things about psychedelics research is that it’s the remarriage of psychotherapy and pharmacotherapy,” Aaronson says. “These interventions make the brain more plastic. We’re creating new treatments that may be able to help people change their thinking process.”
Advances in Neuromodulation
Sheppard Pratt has a long history of providing neurostimulation, and it was one of the first sites in the nation to provide TMS to patients with major depressive disorder. The new institute now serves as a home for the established TMS and ECT programs. Both options are available to people with hard-to-treat depression.
ECT may also be used to treat other conditions, including:
- Postpartum psychosis
- Self-injurious behaviors
- Severe obsessive-compulsive behavior complicated by depression
Institute researchers are a lead site for a Medicare-funded study investigating vagus nerve stimulation in patients with bipolar and unipolar depression who have not responded to multiple antidepressants. Positive results will lead to third-party support for routine availability of this technology.
While such new psychiatric treatments hold great promise, there is an element of skill in determining when, how, and to whom they should be offered. “A big problem in psychiatry is that we often don’t have randomized trials that clearly show which treatment is best for which patient,” Aaronson says. “But at Sheppard Pratt, we have a lot of clinical experience to point us toward the right paths.”
In addition to providing clinical services and conducting research on advanced diagnostic and therapeutic tools, Aaronson says the institute will educate other providers about advances in interventional psychiatry. “Increasingly, we’re going to be talking about interventional psychiatry. This field is no longer just dispensing medications and talking to people — we’re offering new interventions and other somatic treatments,” Aaronson says.
“I’ve been a clinician in this area for 40 years, and I can honestly say there are more interesting things going on now than at any time in my career.”
Chief Science Officer, Institute for Advanced Diagnostics and Therapeutics; Psychiatrist, The Retreat at Sheppard PrattSpecialties:Adult Psychiatry, Biological Psychiatry, Depression, Medication Management, Mood Disorders, Psychopharmacology, Transcranial Magnetic Stimulation (TMS), Treatment-resistant Depression
The Institute for Advanced Diagnostics and Therapeutics brings expert clinical care of difficult-to-treat illnesses together with a center of research developing brand new treatment modalities.