Stage one: Awareness
Over the next 10 to 20 years, we will witness ever-increasing societal awareness of mental health conditions as a group of disorders treatable with psychedelic therapies. This awareness is critical to close the growing mental health treatment gap, defined as the difference in the proportion of people who have a disorder and those individuals who receive care, which exceeds 50% globally, approaching almost 90% in the least resourced countries. Ongoing clinical research and societal education will drive this awareness by generating more data on the effectiveness and safety of psychedelics, particularly for patients who do not respond to current treatments. Our analysis suggests that upwards of six psychedelic assets are likely to come through the pipeline in the next 10 years, offering more therapeutic options for those in need.
The digital medicine revolution will play a pivotal role in improving awareness of mental health conditions and psychedelic therapies by disseminating evidence-based information through digital platforms, campaigns and media. Mood tracking apps, wearables and platforms in the metaverse will further raise mental health awareness. Increased awareness in at-risk populations will lower the barrier for patients to seek counsel from healthcare professionals (HCPs).
Both mental health disorders and psychedelics will gradually lose any residual stigma that exists today, though the newest evidence thankfully suggests that there has already been a significant reduction in stigma around mental illness through the COVID-19 pandemic.
Stage two: Prevention/screening
By 2040, R&D efforts will have advanced sufficiently to lead to a better understanding of the underlying causes of mental health conditions, allowing for better segmentation of patients and more active personalised or targeted ‘wellness’ (rather than treatment) plans.
Clinically approved artificial intelligence (AI)-driven screening tools have surged ahead, making their way into both homes and clinical environments. Regulated digital medicine in the form of wearables with evidence-based platforms may identify early warning signs of mental health conditions based on behavioural patterns and suggest prevention strategies to minimise the risks of worsening symptoms. If symptoms do worsen, these apps feature interactive questionnaires for at-home screening, enabling patients to assess risk of mental health disorders and receive guidance on next steps before symptoms exacerbate.
Use of digital medicine technologies streamlines the initial triaging process by supporting HCPs in assessing potential patients eligible for psychedelic therapy. As AI becomes a trusted ally for HCPs, we can expect the tools to be fine-tuned to minimise false positives. Patients identified as suitable candidates will receive automated referrals to HCPs for a comprehensive evaluation.
Stage three: Diagnosis
Through 2040, digital medicine technologies will continue to revolutionise formal diagnosis in healthcare practices. They will support HCP diagnosis by managing patient volume and interpreting clinical data, addressing today’s capacity constraints of face-to-face consultations.
Diagnostic tools leveraging digital biomarkers become mainstream, providing valuable insights into patients’ conditions. Digital platforms consolidate pre-filled patient screening and clinical data, shortlisting treatment options and offering personalised treatment recommendations that consider efficacy and risk statistics. These digital tools reduce HCP decision-making time and streamline the assessment process for a seamless patient experience.
Enhanced understanding of disease mechanisms will refine patient population segmentation, leading to significant advancements in developing a more detailed or unified Diagnostic and Statistical Manual of Mental Disorders.
Stage four: Treatment
On a 20-year time horizon, traditional selective serotonin reuptake inhibitors (SSRIs) and other established therapies (e.g. SNRIs, TCAs) will likely no longer be the first line of therapy for most patients with depression. When SSRIs are displaced by other better treatments earlier in the disease course, patients will benefit from early disease modification that will ultimately lead to better outcomes and cost savings. Instigating rapid remission for first episode or first presentation will be the primary treatment aim.
Psychedelic therapy emerges as a promising option to achieve this goal — brought forward in the treatment paradigm driven by the limited options for durable effective treatments of SSRI-resistant depression and corresponding significant side effects. Advances have been made in determining which of the many available psychedelic therapies is best suited for each patient under specific circumstances. Additionally, we will better understand drug dosing requirements at an individual level, as well as have better clarity around what kind of, and how much, pre-dose preparation and post-dose support psychotherapies are required (if at all).
With advancements in psychedelic research, a wider range of psychedelic compounds may become accessible. Some of these may be second-generation with modifications to improve efficacy or minimise hallucinogenic effects. This may expand the eligible patient population to patients who previously did not want to undertake psychedelic therapy and could even facilitate at-home treatment protocols.
As psychedelic therapy requires careful monitoring by HCPs, first-round therapy takes place in clinics; subsequent rounds could occur via teleconsultation or group therapies to minimise capacity constraints. Psychedelic therapy is complemented by digital tools, including immersive virtual reality (VR) packages, which simulate psychedelic-like states through sounds and visuals to help prepare the patient for therapy; patient companion apps to track treatment progress; and clinical tools that predict patient outcomes and deliver personalised treatment programmes (see Table 1). Digital therapeutics delivering post-dose psychotherapeutic programmes could be either validated clinical-grade or wellness-oriented products. These digital programmes aim to extend remission or increase the duration of the treatment’s effects by assisting patients in integrating their psychedelic experiences and capitalising on the neuroplastic state.
“Tackling the challenges currently faced in treatment of mental health will require the introduction of highly effective novel therapies supported by therapeutic frameworks for personalisation. At GH Research, we are striving to maximise the clinical benefit for each patient by developing novel ultra-rapid and durable mental health treatments with individualised dosing, aiming to deliver exactly what they need on their personal path to recovery.”
— Theis Terwey, PD Dr med, CEO and co-founder GH Research
