Disorder to go: Tackling the deadliest psychological illnesses no one is talking about

News.com.au

3 days ago

Eating disorders are among the deadliest mental health disorders
Prevalence among kids 10-19 has almost doubled in last decade
Eating disorders cost Australia $67 billion every year in economic and wellbeing losses
We've all had those thoughts.
Maybe I should cut down on the beers.
I guess I should go for walk. I should probably eat better.
Maybe I could stand to lose a little extra weight here and there.
Body dissatisfaction is a pretty universal experience, but for many it's a temporary thought, a passing moment of discomfort quickly forgotten.
For too many people, especially young people, those uncomfortable, niggling thoughts have become a daily mantra they can't ignore – and it's almost certainly killing them.
A matter of life and death
Eating disorders are widely acknowledged as the deadliest psychological issues a person can be diagnosed with.
That fact is further complicated by comorbidity; a startling 90% of people with eating disorders also have depression, with two thirds simultaneously suffering from an anxiety disorder.
While that combination is deadly on its own – someone with Anorexia Nervosa is 18-times more likely to die by suicide, and those with Bulimia Nervosa seven-times more likely – the leading cause of death among people with severe eating disorders is cardiovascular damage.
The compulsions that come with eating disorders starve the body of nutrients and energy, damaging everything from the heart and bones to the digestive and immune systems.
Even worse, the growing epidemic of eating disorders is becoming entrenched in schools and on social media, affecting younger and younger people during vulnerable periods of social and physical growth.
'Eating disorders among children and young people aged 10-19 has almost doubled in the last decade,' said Dr Jim Hungerford, CEO of eating disorder not-for-profit Butterfly.
'Every month 100 people die from, and 10,000 develop, an eating disorder, and it is critical that the government invest to stop this emerging crisis in eating disorders.'
A national crisis
Deloitte's report, Paying the Price, underscores the heavy toll eating disorders take not just on individuals and families, but on our wider society, too.
Eating disorders cost Australia $67 billion every year in economic and wellbeing losses.
In February, Minister for Health Mark Butler called eating disorders 'a national crisis' – the federal government has earmarked $70 million in grants for programs to research and treat them.
At the moment, treatment for eating disorders is almost entirely based on psychological interventions like cognitive behavioural therapy, family therapy, or more structured and specialised treatments like the Maudsley model of anorexia treatment for adults (MANTRA).
These treatments often have good outcomes; some 60% of anorexia nervosa patients receiving enhanced CBT treatments recover to a healthy weight.
Unfortunately, there are few alternatives for the 40% of patients that don't respond well to psychological intervention.
There are currently no approved pharmacological treatment options at all, although some doctors treat their patients off-label with drugs approved for other mental health conditions.
More direct types of intervention are quite recent – researchers are exploring everything from deep brain stimulation to hormone therapies and psychedelics like ketamine or psilocybin.
It's a new frontier of medicine, led almost entirely by a handful of intrepid pioneers scattered across the globe.
Hitting reset on neural pathways
Interest in psychedelic compounds as a basis for psychological treatment has gained a lot of attention in recent years.
Medicinal compounds based on marijuana, MDMA, ketamine and psilocybin or psilocin from magic mushrooms have been touted as miracle drugs set to revolutionise the treatment of mental health disorders.
While we haven't obtained those lofty goals just yet, psychedelic compounds are already showing an incredible amount of promise in mental health disorders resistant to traditional psychological or medical intervention.
The research is still thin on the ground, but it's thought these compounds have a 'resetting' effect on neurological pathways, disrupting habitual ingrained behaviours and encouraging new connections between different regions of the brain.
You can imagine them a bit like a cleansing flood, washing away the old, worn and rutted pathways of the brain and offering a chance to forge new ones in their place.
Companies such as Tryptamine Therapeutics (ASX:TYP) are working to transform these powerful compounds – once the realm of medicine men and shamans – into something the TGA or FDA can get behind.
TYP is developing two such medicines; an intravenous (IV) infused synthetic psilocin compound, and an oral synthetic psilocybin compound, both designed to offer precise dosing options without adverse effects.
The company's main focuses are binge eating disorder (BED) and illnesses that induce chronic pain like fibromyalgia and irritable bowel syndrome.
BED is the most common eating disorder in the US and the second most common in Australia, representing a high unmet need.
Tryptamine is at the clinical assessment stage with its TRP-8803 IV infusion, currently engaged in a safety and efficacy trial in partnership with Swinburne University of Technology in Melbourne.
The company is dosing 12 adult patients suffering from BED with its TRP treatment alongside simultaneous psychotherapy sessions.
The oral version of the drug has already shown promise in treating BED, reducing daily binge eating episodes by an average of 80.4% in a phase II trial with the University of Florida.
All patients experienced a reduction in episodes of at least 60% from baseline, with improvements in anxiety and depression scores as well.
While the open-label study had a limited patient population with only five participants, it's nonetheless a very promising start.
Overcoming psychedelic adverse effects
One of the challenges in bringing psychedelic medicines to market is also a strength: the altered cognitive state they induce in patients.
Both Tryptamine Therapeutics and its Israeli brethren Shortwave Life Sciences are working to unlock the therapeutic benefits of psychedelics while side-stepping the more intense adverse effects they can illicit in people.
They're attempting to take the guesswork out of dosage and adverse impact by producing synthetic versions of psilocin and psilocybin compounds that are highly controlled, offering more predictable outcomes.
Shortwave is focused mostly on Anorexia Nervosa, one of the deadliest eating disorders.
The company is developing an oral drug combining psilocybin with a beta carboline, a type of tryptamine compound associated with neurotransmitters like serotonin and norepinephrine that directly influence mood.
Shortwave is still in the pre-clinical stages with its drug combination, but early studies are indicating a good safety profile and active metabolisation.
The company has partnered with the Sheba Medical Centre, considered a leading medical institution and eating disorder centre in Israel, to conduct an investigator-initiated, open-label, phase II study.
The trial will investigate the safety and feasibility of psilocybin-assisted psychotherapy for the treatment of anorexia nervosa, the first of its kind in Israel.
Taking a molecular approach
Not all pharmacological interventions being developed for eating disorders are based on psychedelics, but they share a distinct emphasis on resetting or rewiring disordered neurological pathways.
Courage Therapeutics, a spinout of the University of Michigan, has just secured US$7.8 million to advance two drug development programs designed to tackle obesity and restrictive eating disorders.
Head researcher Roger Cone identified two proteins thought to play a part in regulating energy balance and food intake – melanocortin 3 receptor and melanocortin 4 receptor (MC3R and MC4R).
Courage Therapeutics is focusing on leveraging these proteins to directly hack into neurological circuits in the hypothalamus.
Also at the pre-clinical stage, animal studies in mammals have shown great promise in influencing feeding behaviours and weight management.
A rat animal model using CRISPR technology to induce MC3R deficiency showed a significant reduction in both body weight and decreased food intake, while those with an MC4R deficiency increased food intake and gained body weight compared to the control group.
A long path ahead
While research into pharmacological interventions for eating disorders is still in very early stages, the results so far have been incredibly encouraging.
The science seems sound, but proving these treatments are not only effective but safe and predictable will take years of clinical trials and testing.
The Butterfly Foundation is calling for urgent investment in eating disorder research as the number of people suffering from them rises year by year.
'We were incredibly disappointed that there was zero new funding for eating disorder prevention or treatment in the Australian government's 2025-26 budget announcement on March 25,' Dr Hungerford said, 'nor in the budget response from the Coalition.'
'It is clear from latest research that people in Australia want to know why. Without government investment in prevention, the consequences will be catastrophic.
'The time for talk is over, the time for action for the more than 1 million people living with an eating disorder is now.'
At Stockhead, we tell it like it is. While Tryptamine Therapeutics is a Stockhead advertiser, it did not sponsor this article.