Article by Sam Riches, Growth Op
Having spent more than 30 years as a medical officer and psychiatrist in the Canadian Armed Forces, including deployments in Rwanda and Afghanistan, Dr. Rakesh Jetly has both a personal and professional interest in post-traumatic stress disorder (PTSD).
A chronic condition, PTSD is defined by the Canadian Mental Health Association as a mental illness that “involves exposure to trauma involving death or the threat of death, serious injury, or sexual violence.”
According to Veterans Affairs Canada, it is estimated that up to 10 per cent of war zone veterans — including war-service veterans and peacekeeping forces — will experience PTSD. There is not a clear explanation as to why some people are more affected than others.
The condition can be particularly hard to treat in veterans, Dr. Jetly says.
“There are lots of evidence-based treatments for post-traumatic stress disorder but like many treatments in mental health, they don’t work for everybody,” he says. “So there’s a huge need to think outside the box and think about novel ways in which to help people that are suffering with post-traumatic stress disorder.” In November 2020, Dr. Jetly was named the Chief Medical Officer of Mydecine Innovations Group Inc., which acquired Vancouver-based NeuroPharm Inc., a developer of natural psychedelic-based treatments for mental health disorders in the Canadian and United States veteran communities, earlier in the year.
In his role as CMO, Dr. Jetly — who is also an associate professor of psychiatry at Dalhousie University and at the University of Ottawa — is overseeing international research into the efficacy of psilocybin and psychedelic-assisted psychotherapy to treat veterans and first responders with a PTSD indication. And though the COVID pandemic has interrupted their work, Mydecine announced in November that it was expanding its Phase 2A clinical research to additional sites.
The company is working with researchers and institutions in Canada, including the University of Western Ontario and the University of Alberta, as well as Leiden University Medical Centre in the Netherlands, and is planning to include additional clinical sites in the U.S., Europe, and Australia.
“There seems to be this urgency for us to develop more effective novel treatments and maybe give people more choices if the traditional first-line evidence-based psychotherapy and exposure-based therapies don’t work,” Dr. Jetly says.
He offers a few hypotheses as to why PTSD in veterans can be difficult to treat.
There are often multiple traumatic episodes experienced by vets, rather than a single occurrence, he says, and rates of childhood trauma are often higher among those who join combat forces. Another factor to consider, Dr. Jetly says, is the concept of moral injury, first introduced by U.S. psychiatrist Dr. Jonathan Shay in the 1990s.
Shay offers a three-part definition of moral injury in his 1994 book Achilles in Vietnam: Combat Trauma and the Undoing of Character. “Moral injury is present when (1) there has been a betrayal of what is morally correct; (2) by someone who holds legitimate authority; and (3) in a high-stakes situation,” he writes.
Dr. Jetly explains moral injury as persistent guilt, shame, or anger as a result of transgressing values or highly-held beliefs. He offers the example of a soldier tasked with clearing a mine site, missing a mine, and then witnessing a convoy being killed as they attempt to navigate the area.
According to Dr. Jetly, traditional treatments for PTSD may not be as effective when the predominant problem is guilt and shame and that novel treatments, like psilocybin assisted psychotherapy, could be “better suited to help people to deal with this underlying feeling about themselves.”
“Maybe we can demonstrate through some of our studies, that there’s a fundamental shift in the way the brain and the mind are interpreting their environment, their sense of self, and which makes them more receptive to some of the therapeutic principles that are being performed,” he says.
In traditional treatment options for PTSD, Dr. Jetly says the medications offered, such as antidepressants, are to “quiet the noise” and allow psychotherapy to take place. He stresses that the Mydecine trials are not for a drug but rather a mode of treatment.
“It is not something that I ever really see where it’s ‘Here’s a pill, you’re going to feel better,’ because it really requires working through the trauma,” he says. “This is not a trial of Paxil or a trial of Prozac. This is a medication-assisted psychotherapy trial — this is the substance with psychotherapy, that’s what we’re studying.”
Patients will undergo the psychedelic experience two to three times over a 16-week trial, Dr. Jetly explains.
“We believe that both the psychedelic and the psychotherapy together are the active ingredients that will lead to improved patient outcomes,” he says.
For Josh Bartch, chairman and CEO of Mydecine, he says he’s excited about the opportunity to be involved in something that could potentially be “revolutionary in the way that mental health is treated throughout military constituencies, whether that’s active military or, as in our case, starting with veterans.”
“These people come home from war, after fighting for our freedoms, and are essentially just left,” Bartch says. “There’s really no viable solution to fix this ailment in PTSD. In the United States, 22 veterans a day are committing suicide with PTSD, it’s a staggering number.”
In November, Mydecine announced that its subsidiary NeuroPharm Inc. had filed a provisional patent application in the U.S. for a “psychedelic therapy enhancer for the treatment of certain psychiatric disorders, including enhancements to treatments for PTSD.”
According to the release, the enhancer reduces the enzymatic breakdown of psilocin, the active ingredient in psilocybin that causes psychedelic effects. “This may result in an enhanced psychedelic experience in the treatment of PTSD, whether by extended in time, intensity, intensity per dose, or a combination thereof,” the release states.