From MDMA to magic mushrooms, Northern Beaches psychiatrist Ranil Gunewardene is taking psychedelic therapy global.
Associate Professor Dr Ranil Gunewardene is the psychiatrist making global headlines for his world-first research in the emerging field of psychedelic therapy.
In 2023, Australia made history as the first country in the world to legalise the medical use of MDMA and psilocybin for people with trauma, PTSD, and treatment-resistant depression.
It uses a measured dose of the drugs to induce a heightened state of consciousness to disrupt rigid, negative cognitive patterns, with counselling to accelerate emotional healing.
Dr Gunewardene is Australia’s most experienced authorised prescriber of psychedelic therapies under the Therapeutic Goods Administration (TGA) , and was the first in NSW to do so.
Under the TGA framework, MDMA can only be prescribed for people with post-traumatic stress disorder (PTSD), while psilocybin is limited to treatment-resistant depression.
“I thought I’d seen it all – but this service is like a lightning rod for some of the most severe trauma stories I’ve ever heard,” says Dr Gunewardene. “For me, it’s thrown into sharp focus the way psychiatry works and turned the psychiatric diagnostic classifications on their head.
“I haven’t seen much innovation in decades of practice and could see the limitations of the existing treatments in conventional psychiatry.”
He’s established NSW’s first psychedelic-assisted therapy and research service, Evolution Enhanced Therapy in Sydney, and delivers it at Hirondelle Private Hospital in Chatswood.
Dr Gunewardene presented world-first research at the UK’s Psychiatry Congress in June and is collaborating with Professor David Nutt and Imperial College London.
“He’s a true pioneer in the field of psychedelic research,” says Dr Gunewardene. “It was a privilege to share the stage and spend some quality time with him.”
As Australia continues to build evidence around the treatments, the findings from patients who have exhausted conventional treatments have been submitted to a scientific journal.
Dr Gunewardene is also Clinical Director of Mental Health Services at Northern Beaches Hospital, and Director of Mindlife Clinic Frenchs Forest – previously, Mosman Private Hospital.
Diagnoses are generally based on how patients present with symptoms.
“If someone has severe anxiety, they might be diagnosed with generalised anxiety or panic disorder, or OCD, major depression, a substance disorder or PTSD,” Dr Gunewardene says.
“But what has become apparent is that many of those end syndromes are driven by a long-term process of severe trauma and suffering.
“Having worked in mental health for around 30 years, I believe it’s important to try and find new treatments for people who have been suffering for decades.”
Hirondelle Private Hospital, Chatswood
Interestingly, most of his patients seeking psychedelic therapy are women in midlife.
Unlike recreational drugs taken for fun, capsules of MDMA and psylocibin are administered over three sessions – bringing to the surface the previous traumas and adverse life events.
“There’s nothing fun or euphoric about it, which is often misunderstood. We often get patients really revisiting very horrible experiences,” says Dr Gunewardene. “It could be re-experiencing their violent, alcoholic father or being raped or neglected.”
Patients undergo an intensive three-month program beginning with at least three 90-minute preparation sessions and complete three treatment cycles.
Each medicine session lasts around eight hours under the supervision of two therapists, followed by three integration sessions designed to help patients process their experiences.
Patients can wear an eye mask and headphones with a psychedelic soundtrack to remove the conscious mind, which then revisits various experiences.
“What’s most interesting is that the emotional system is still stuck in the past because it got overwhelmed with that experience. It creates unhelpful beliefs such as ‘I’m not lovable’ or ‘the world is not a safe place,’” explains Dr Gunewardene.
“MDMA switches off the amygdala, the fear centre of the brain, and releases a cocktail of emotionally protective neurotransmitters – dopamine, serotonin, noradrenaline, oxytocin.
Dr David Nutt and Dr Gunewardene
“It’s like a lightning rod for some of the most severe trauma stories I’ve ever heard.”
Dr Ranil Gunewardene
“Rather than being overwhelmed, in this setting it’s within their control – we call it a ‘window of tolerance’, and they’re able to reprocess the experience at that emotional level.
That’s the really hard thing about conventional treatment. Healing has to happen at that emotional level,” adds Dr Gunewardene.
Jess Yugovich underwent MDMA-assisted psychotherapy for PTSD after unexpectedly losing her three-year-old daughter.
“I genuinely believe if I hadn’t had MDMA therapy, I wouldn’t be here. It was almost like having a bird’s-eye view of my entire life to see every part of what’s actually going on,” Jess says. “I was able to connect with myself in a way I haven’t ever been able to do my entire life.”
Jess Yugovich turned to MDMA therapy after losing her daughter (pictured in frame)
Evolution MET’s three-cycle program is $25,000 – others can range up to $40,000 – and health insurers like Medibank Private have started funding patients.
Medibank chief medical officer, psychiatrist Andrew Wilson, says current care is not working and creating more problems for our stretched health system.
“Unless treated effectively, mental ill-health is a major cause of premature death and disability,” says Dr Wilson.
Dr Gunewardene has presented at the British College of Psychiatry and MAPS Psychedelic Science Congress, the world’s biggest psychedelic conference in Denver, Colorado.
Despite the international excitement, he says expectations must remain realistic and it’s not for everyone.
“You can’t just take these medications and have a life-changing experience,” says Dr Gunewardene. “You really have to do the therapy work with the heart and mind open for meaningful changes.”
“I genuinely believe if I hadn’t had MDMA therapy, I wouldn’t be here.”
Jess Yugovich
He recommends How to Change Your Mind on Netflix and Stepping into the Unknown on SBS on Demand as excellent resources for those considering psychedelic therapy.
Public servant Lara Stevens tells her story: “I was abused as a child and felt such shame and deep despair.
“Despite decades of treatment, counselling and medication, nothing worked until I tried plant medicines in Peru. The shift was incredible.
“If more Australians can access these treatments, it will save many lives.”
A TGA spokesperson confirms around 164 patients have received MDMA-assisted therapy and 74 patients received psilocybin therapy outside of clinical trials.
As Australia continues its world-first research, the next challenge is determining how to make the treatments more affordable for the Australians who need them.
