Introduction to Medication-Assisted Psychotherapy

As noted on the home page, information about Schedule 8 drugs is heavily regulated. As such, the following information should be seen as very rudimentary introductory information that can be utilised to initiate your exploration of medication-assisted psychotherapy. There is a lot more specific information in the password-protected Patient Portal.

Medication-assisted psychotherapy (MAP) is an innovative approach that combines psychotherapy with medications to enhance treatment outcomes for individuals struggling with treatment-resistant mental health disorders. At the moment, a psychiatrist can apply to be an Authorised Prescriber of these unapproved medications to be used in a psychotherapeutic process that has been approved by a Human Research Ethics Committee and the Therapeutic Goods Administration.

Medication-assisted psychotherapy (MAP) is a form of psychotherapy that utilises medications to assist the process. The medications may assist via diminishing the activity of the fear centre of the brain (the amygdala), lowering of defence mechanisms or other mechanisms that are yet understood, such as through the provocation of so-called mystical experiences.

The eligibility criteria for medication-assisted psychotherapy are strict. First and foremost, the individual must meet diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition for:

1. Posttraumatic Stress Disorder; or

2. Major Depressive Disorder / Persistent Depressive Disorder.

Moreover, the individual must be considered to have a treatment-resistant disorder, which is defined as a failure to respond to:

1. trials of at least two anti-depressant medications; and

2. a course of evidence-based psychotherapy.

Dr Bench has had protocols approved by the ACT Health Human Research adn Ethics Committe to successfully be appointed an Authorised Prescriber by the Therapeutic Goods Administration. The protocols outline the indications, contraindications, potential side-effects, and the expected course of treatment. The treatment programme involves up to three dosing sessions and a course of some fifteen or more sessions of psychotherapy.

Financial Eligibility

A course of medication-assisted psychotherapy is costly. It is not covered by Medicare. A lot of individuals will not be able to afford to pay for such treatment privately. As such, patients may rely upon otehr third-party payers, such as workers compensation insurers, compulsory third party insurers or the Department of Veterans Affairs. The eligibility requirements of the insurer or governmental department responsible for paying for the treatment may have much stricter requirements.  For example, some insurers may require the individual to have exhausted a far more comprehensive range of treatments, including repetitive trans-cranial stimulation or combinations of medications. 

At the moment, the Department of Veterans Affairs are requiring all patients who are investigating the possibility of treatment with medication-assisted psychotherapy to undergo a second opinion by another Authorised Prescriber. 

One worker’s compensation insurer has informed us that at the moment, all patients being considered for medication-assisted psychotherapy will have to undergo an Independent Medical Examination.

Exclusion Criteria:

Patients with a history of the following are not currently eligible to participate in medication-assisted psychotherapy:

·      psychotic disorders

·      Bipolar I disorder

·      uncontrolled hypertension

·      significant cardiovascular disease

·      pregnancy or breast-feeding

·      active substance use disorder

Medications

The medications used are synthetic in nature. They have been synthesised by an Australian company, Natural MedTech to GMP standards. However, they remain unapproved medicines and thus can only be prescribed by Authorised Prescribers according to a protocol approved by a Human Resdearch Ethics Committee and the Therapeutic Goods Administration.

Recording of the Sessions

Dr Bench's protocol requires that all dosing sessions are filmed. There are numerous for reasons such. Medication-assisted psychotherapy is a nascent treatment. Filming of sessions will provide a greater level of safety and security. The therapeutic dyad will have the capacity to review the dosing sessions for clinical purposes and / or supervision. The recordindgs will not generally be made available to the patients, unless considered to be therapeutically advantageous. The recordings will not be used for any other purpose but the treatment of the patient.

Therapeutic Dyad

Currently, all medication-assisted psychotherapy protocols, including Dr Bench, require a therapeutic dyad. This will consist of Dr Bench as the Authorised Prescriber and a psychologist. Depending on the ciricumstances, the therapeutic dyad might be made up of Dr Bench and a patient's long-term psychologist, or alternatively a psychologist with more expertise in medication-assisted psychotherapy. The therapeutic dyad is typically a male and female in order to amplify transferential reactions with the medicines.

Trauma-Informed Care

Dr Bench attempts to follow the principles of trauma-informed care, especially honouring one's autonomy and choices around treatment. However, a diagnosis is required for consideration of this treatment. At the present time, Dr Bench is only offering this treatment where he is a part of the therapeutic dyad. If an individual would prefer two female therapists, I am unable to accomodate such. Similarly, my protocol requires all dosing sessions to be recorded with audio and video.

For more information on Medication-Assisted Psychotherapy, visit It's Ineffable.