Improving access to novel treatments for treatment-resistant depression: The potential role of specialist clinics in Australia

Novel treatments for treatment-resistant depression, such as ketamine, esketamine, transcranial magnetic stimulation, and psilocybin-assisted therapy, are available in Australia but mostly through commercial clinics that require out-of-pocket payment, leaving many patients without access. The authors identify barriers including difficulty diagnosing treatment-resistant depression, lack of clinician training, and regulatory and economic hurdles. They propose establishing specialist treatment-resistant depression clinics, particularly in the public sector, to improve access and build expertise.

Study at a glance

Abstract

Treatment-resistant depression is a condition with significant morbidity, despite the current standard of treatment, including traditional pharmacotherapy, psychotherapy, augmentation strategies and electroconvulsive therapy. While novel therapies have emerged, such as ketamine/esketamine, transcranial magnetic stimulation and psilocybin-assisted therapy, the uptake of these treatments is relatively low, particularly within public mental health services. Commercial clinics across Australia offer these treatments, but can only be accessed by those able to pay, leaving those unable to pay with limited or no access. We compare novel treatments for treatment-resistant depression and examine barriers to their implementation within the Australian mental health system. We also propose specialist treatment-resistant depression clinics as a potential model to improve access and build clinical expertise. We identified challenges in identifying treatment-resistant depression, lack of training and expertise, and regulatory and economic barriers. We propose that the lack of public access to these novel treatments be initially addressed by the establishment of specialist treatment-resistant depression clinics in Australia, including in the public sector, which will drive training and the development of expertise within public mental health.