Emerging treatments for common mental health conditions affecting Veterans: Psychedelic interventions

Abstract: There are a number of treatments that have an emerging evidence base and could be considered in the management of common mental health conditions affecting veterans. Emerging and adjunct treatments are typically considered when an individual’s adherence or response to accepted or conventional treatment/s is poor (i.e., chronic, treatment-resistant, or treatment-refractory mental health conditions). The aim of the rapid evidence assessment (REA) was to identify and critically evaluate the current evidence on emerging and adjunct treatments for posttraumatic stress disorder (PTSD) and common mental health conditions affecting veterans. From the four (4) databases that were searched, 51 studies met the inclusion criteria; including 35 secondary sources: 21 systematic reviews (SRs) and 14 SRs with accompanying MAs. The studies within these secondary sources (i.e., those contained within SRs and MAs) were extracted to a database containing the primary sources (i.e., randomised controlled trials, RCTs). From this collated set of articles (538 in total), all studies that did not meet the inclusion criteria were excluded (e.g., cohort and case-control studies), and all duplicate studies were removed (i.e., often the same RCT would appear in multiple SRs and MAs, as well as being directly retrieved by the search strategy). The final set of articles included 18 RCTs. The findings from these studies were narratively synthesised, and risk of bias assessments were conducted for each RCT. Six (6) articles contained additional analyses of one or more of the 18 RCTs included in the REA. The references to these articles are listed within the summary of findings table for each corresponding RCT. Strengths of the REA include the focus on peer-reviewed Level I and Level II evidence (NHMRC, 2009) from scientific journals in the fields of health, medicine, psychiatry, and psychology (including a specialist database developed by the US Department of Veterans’ Affairs focusing on literature relevant to veterans with PTSD). Limitations of the REA include the exclusion of potentially relevant papers that were published prior to 2017 and the exclusion of non-English language papers. Based on the literature reviewed in this report, there is insufficient high-quality evidence to support direct policy and practice recommendations in relation to the use of psychedelic compounds as standalone or combined interventions for common mental health conditions affecting veterans (i.e., anxiety disorders, mood/depressive disorders, substance-related and addictive disorders, and trauma and stressor-related disorders). The one exception may be the FDA-approved use of esketamine nasal spray (in combination with an oral antidepressant) for treatment-resistant Major Depressive Disorder.

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