0:00:16.430,0:00:29.369 3:4 methylenedioxypyrovalerone on drug 0:00:26.310,0:00:32.308 ecstasy but today I want to talk about 0:00:29.369,0:00:34.969 MDMA not as a recreational drug but as a 0:00:32.308,0:00:37.410 potential new treatment in medicine and 0:00:34.969,0:00:39.750 then very important treatment for 0:00:37.410,0:00:41.969 psychiatry because MDMA could offer us 0:00:39.750,0:00:45.079 in psychiatry for the first time the 0:00:41.969,0:00:47.550 opportunity to tackle trauma and 0:00:45.079,0:00:49.289 psychological trauma particularly that 0:00:47.550,0:00:52.829 caused by child abuse and maltreatment 0:00:49.289,0:00:56.190 is at the heart of all or most 0:00:52.829,0:01:00.449 psychiatric disorders due to anxiety and 0:00:56.190,0:01:02.760 addictions psychiatry is in need of this 0:01:00.449,0:01:05.000 innovative approach because current 0:01:02.760,0:01:08.520 treatments are failing patients 0:01:05.000,0:01:10.409 hi my name's Ben sesor I'm a child and 0:01:08.520,0:01:12.390 adolescent psychiatrist now that means I 0:01:10.409,0:01:14.520 trained as a medical doctor then 0:01:12.390,0:01:16.380 specialized in mental health and then 0:01:14.520,0:01:18.479 specialized in child and adolescent 0:01:16.380,0:01:20.220 mental health but for the last five 0:01:18.479,0:01:22.500 years I've been working with adults with 0:01:20.220,0:01:24.930 mental health disorders and addictions 0:01:22.500,0:01:27.509 due to misuse of drugs and that 0:01:24.930,0:01:30.299 developmental pathway of my own from 0:01:27.509,0:01:32.189 working with child abuse into adults 0:01:30.299,0:01:35.009 with mental disorders and addictions has 0:01:32.189,0:01:37.439 brought me to the door of MDMA and I'm 0:01:35.009,0:01:38.939 gonna propose today that MDMA could be 0:01:37.439,0:01:41.729 important for the future as the Kyah 0:01:38.939,0:01:44.299 tree as the discovery of antibiotics was 0:01:41.729,0:01:47.909 for general medicine a hundred years ago 0:01:44.299,0:01:51.090 so when we think about child abuse we 0:01:47.909,0:01:54.090 think about physical abuse mental abuse 0:01:51.090,0:01:57.630 emotional abuse sexual abuse and neglect 0:01:54.090,0:01:59.430 and we think about noxious environments 0:01:57.630,0:02:01.140 we think about parents with mental 0:01:59.430,0:02:03.570 disorder we think about parents who are 0:02:01.140,0:02:06.649 addicted to drugs and social issues like 0:02:03.570,0:02:08.878 poverty and poor housing poor education 0:02:06.649,0:02:10.770 now I'm going to illustrate my talk 0:02:08.877,0:02:12.330 today with a patient and I'm going to 0:02:10.770,0:02:14.550 call her Claire 0:02:12.330,0:02:16.560 now Claire was no single particular 0:02:14.550,0:02:18.600 patient of mine rather she's an 0:02:16.560,0:02:20.790 amalgamation of many different people 0:02:18.600,0:02:24.270 I've met in the last 18 years working as 0:02:20.790,0:02:24.900 a medical doctor she's certainly not the 0:02:24.270,0:02:27.810 worst 0:02:24.900,0:02:30.600 now what was Claire's environment like 0:02:27.810,0:02:32.490 she was growing up well her mother was 0:02:30.600,0:02:34.610 depressed now unfortunately the family 0:02:32.490,0:02:37.140 doctor didn't have time to accurately 0:02:34.610,0:02:38.850 diagnose and treat depression rather 0:02:37.140,0:02:40.410 Claire's mother was put onto one 0:02:38.850,0:02:42.990 antidepressant after another 0:02:40.410,0:02:44.760 never really got therapy Claire's mother 0:02:42.990,0:02:46.830 also had a lot of aches and pains 0:02:44.760,0:02:48.990 typical what we call psychosomatic 0:02:46.830,0:02:51.690 symptoms in depression and as a result 0:02:48.990,0:02:53.430 the family doctor put her on to opiate 0:02:51.690,0:02:56.580 based painkillers which she promptly 0:02:53.430,0:02:59.070 became addicted to now Claire's father 0:02:56.580,0:03:01.620 now he was alcoholic and he was often 0:02:59.070,0:03:03.120 not around in and out of prison which is 0:03:01.620,0:03:04.950 just as well because when he was there 0:03:03.120,0:03:08.130 he was physically abusive to Claire and 0:03:04.950,0:03:10.920 her mother okay so what does this kind 0:03:08.130,0:03:13.920 of chaotic frightening environment due 0:03:10.920,0:03:15.510 to the developing child brain I'm going 0:03:13.920,0:03:17.670 to give you a brief neurophysiology 0:03:15.510,0:03:19.620 lesson if I may there's a part of the 0:03:17.670,0:03:22.050 brain called the amygdala now the 0:03:19.620,0:03:23.880 amygdala is a very ancient part of the 0:03:22.050,0:03:26.580 mammalian brain and many other animals 0:03:23.880,0:03:29.489 other than humans have an amygdala the 0:03:26.580,0:03:31.560 amygdala lights up when stimulated by 0:03:29.489,0:03:34.230 fear in the environment by a frightening 0:03:31.560,0:03:35.989 stimulus if lights up and it says 0:03:34.230,0:03:38.130 fight-or-flight get out 0:03:35.989,0:03:40.440 now there's another part of the brain 0:03:38.130,0:03:42.209 much more sophisticated part called the 0:03:40.440,0:03:43.770 prefrontal cortex and it's right here at 0:03:42.209,0:03:46.560 the front above the eyes 0:03:43.770,0:03:48.650 now the prefrontal cortex only humans 0:03:46.560,0:03:52.500 have and it's in the prefrontal cortex 0:03:48.650,0:03:55.050 where we use logic and reasoning to 0:03:52.500,0:03:57.540 rationalize the situation and we can use 0:03:55.050,0:03:59.430 our prefrontal cortex to overcome that 0:03:57.540,0:04:02.190 instinctive fear response from the 0:03:59.430,0:04:04.440 amygdala now when Claire was growing up 0:04:02.190,0:04:06.060 she never knew from one moment to the 0:04:04.440,0:04:07.470 next whether the adult coming into the 0:04:06.060,0:04:09.870 room were they going to give him a kiss 0:04:07.470,0:04:11.640 or a cuddle or do a jigsaw with her over 0:04:09.870,0:04:14.489 they're going to punch her or kick her 0:04:11.640,0:04:16.829 or burn her with their cigarette or were 0:04:14.489,0:04:18.329 they going to rape her because 0:04:16.829,0:04:23.590 throughout her childhood Claire was also 0:04:18.329,0:04:25.600 subjected to sexual abuse now there's a 0:04:23.590,0:04:27.100 lupa disorders called the anxiety 0:04:25.600,0:04:29.139 disorders and one of the most important 0:04:27.100,0:04:33.760 is what we call post-traumatic stress 0:04:29.139,0:04:37.150 disorder or PTSD now PTSD some of the 0:04:33.760,0:04:39.729 core features very low mood anxiety high 0:04:37.150,0:04:42.729 levels of anxiety what we call hyper 0:04:39.729,0:04:45.580 vigilance this edginess this jumpiness 0:04:42.729,0:04:47.800 exactly how claire felt throughout her 0:04:45.580,0:04:49.810 childhood and adolescence never knowing 0:04:47.800,0:04:52.389 whether they next assailant or assault 0:04:49.810,0:04:54.520 was around the corner another core 0:04:52.389,0:04:57.280 feature of PTSD what we call REE 0:04:54.520,0:04:59.020 experiencing phenomena flashbacks in 0:04:57.280,0:05:00.729 which the patient has sudden 0:04:59.020,0:05:02.860 remembrances of these painful traumatic 0:05:00.729,0:05:05.860 memories they can just pop into the head 0:05:02.860,0:05:08.590 at any time triggered by some cue in the 0:05:05.860,0:05:10.600 environment and when they have those 0:05:08.590,0:05:13.090 experiences those daytime flashbacks 0:05:10.600,0:05:15.100 they relive the trauma in all the 0:05:13.090,0:05:18.160 sensory modalities and this results in 0:05:15.100,0:05:20.530 them freezing or dissociating to try and 0:05:18.160,0:05:22.150 block out the pain now Claire 0:05:20.530,0:05:26.590 experienced all of this as she was 0:05:22.150,0:05:29.710 growing up high levels of self-harm and 0:05:26.590,0:05:32.130 suicide are associated with PTSD Claire 0:05:29.710,0:05:34.570 would cut her thighs and her breasts 0:05:32.130,0:05:37.389 pretty common form of cutting in 0:05:34.570,0:05:39.250 children who've been sexually abused she 0:05:37.389,0:05:41.139 was being sexually abused by clients of 0:05:39.250,0:05:43.630 her mother because her mother had moved 0:05:41.139,0:05:45.370 on from the addiction to painkillers and 0:05:43.630,0:05:47.800 was using street heroin when Claire was 0:05:45.370,0:05:50.380 a teenager and because of the way the 0:05:47.800,0:05:52.030 war on drugs has set up that reduces 0:05:50.380,0:05:54.849 access to treatment for people with 0:05:52.030,0:05:57.039 opiate dependence she had to pay for her 0:05:54.849,0:06:00.849 heroin using sex work and the clients 0:05:57.039,0:06:03.849 would sexually abused Claire now it's 0:06:00.849,0:06:06.669 very hard to treat PTSD and it has a 0:06:03.849,0:06:08.440 high treatment resistance 50% of people 0:06:06.669,0:06:11.380 do not respond to the traditional 0:06:08.440,0:06:12.700 treatments how do we treat it well we 0:06:11.380,0:06:15.639 can treat it with medications we can 0:06:12.700,0:06:17.860 treat it with psychotherapies and the 0:06:15.639,0:06:20.620 medications we use there's a broad range 0:06:17.860,0:06:24.120 of drugs no single drug and this is very 0:06:20.620,0:06:26.289 important no single drug cures PTSD 0:06:24.120,0:06:28.210 rather we treat the disorder 0:06:26.289,0:06:30.250 symptomatically if the patient's 0:06:28.210,0:06:32.800 depressed give them an antidepressant if 0:06:30.250,0:06:34.599 their mood fluctuates give them a mood 0:06:32.800,0:06:36.250 stabilizer if they can't sleep 0:06:34.599,0:06:38.350 give them a hypnotic 0:06:36.250,0:06:40.660 and if that edginess and that fear 0:06:38.350,0:06:43.240 spills over into paranoia and psychosis 0:06:40.660,0:06:45.820 give the patient an anti-psychotic drug 0:06:43.240,0:06:48.340 and they have to take these drugs day in 0:06:45.820,0:06:50.980 day out for weeks months decades they 0:06:48.340,0:06:53.710 have to keep taking them because the 0:06:50.980,0:06:56.350 drugs we use to treat trauma when it's 0:06:53.710,0:06:59.440 due to this level of severity do not 0:06:56.350,0:07:02.170 attack the root cause of trauma they 0:06:59.440,0:07:05.580 paper over the cracks a good analogy 0:07:02.170,0:07:08.620 would be taking aspirin or ibuprofen 0:07:05.580,0:07:11.220 when you have a fever now a fever is 0:07:08.620,0:07:14.320 caused by an infection by an ant by a 0:07:11.220,0:07:17.050 microorganism sure you can take powerset 0:07:14.320,0:07:18.490 amal or ibuprofen and this will lower 0:07:17.050,0:07:20.560 the temperature and make you feel a bit 0:07:18.490,0:07:23.470 better but it doesn't attack the root 0:07:20.560,0:07:26.560 cause and that's what we do when we give 0:07:23.470,0:07:28.540 these patients these daily SSRI drugs we 0:07:26.560,0:07:32.410 paper over the cracks we maintain the 0:07:28.540,0:07:34.660 symptoms at a manageable level we also 0:07:32.410,0:07:38.290 use psycho therapies to treat PTSD 0:07:34.660,0:07:41.800 unless again a broad range of these DBT 0:07:38.290,0:07:45.010 CBT EMDR trauma focused psychotherapy 0:07:41.800,0:07:47.590 cata PT now all of them have a pretty 0:07:45.010,0:07:49.570 similar approach which actually is an 0:07:47.590,0:07:52.030 old wives tales which is a problem 0:07:49.570,0:07:54.940 shared is a problem halved let's talk 0:07:52.030,0:07:58.570 about your trauma Claire tell me about 0:07:54.940,0:08:01.690 your rape now that's fine for 50% of 0:07:58.570,0:08:04.690 patients but for a significant half they 0:08:01.690,0:08:06.820 just cannot do that as soon as Claire is 0:08:04.690,0:08:10.360 asked to talk about her rape she freezes 0:08:06.820,0:08:12.100 she flees she drops out of treatment now 0:08:10.360,0:08:14.410 by the time she was 15 Claire had been 0:08:12.100,0:08:16.000 removed from the family home and she was 0:08:14.410,0:08:18.790 brought up in a succession of foster 0:08:16.000,0:08:21.479 placements and children's houses and 0:08:18.790,0:08:23.919 hostels where the abuse continued and 0:08:21.479,0:08:26.110 she was self-harm cutting and she 0:08:23.919,0:08:28.740 started drinking and by the time she was 0:08:26.110,0:08:31.210 18 she was using heroin as well 0:08:28.740,0:08:32.530 sometimes working in Skytree can feel 0:08:31.210,0:08:35.469 pretty desperate can feel pretty 0:08:32.530,0:08:37.260 hopeless sometimes it feels as if 0:08:35.469,0:08:40.089 psychiatry is a palliative care 0:08:37.260,0:08:42.159 profession and this is the truth because 0:08:40.089,0:08:44.320 the treatments we use do not get to the 0:08:42.159,0:08:47.260 root cause of the problem the trauma 0:08:44.320,0:08:48.790 they paper over the cracks and I think 0:08:47.260,0:08:49.930 the pharma industry know this and they 0:08:48.790,0:08:51.970 queue up and they 0:08:49.930,0:08:53.560 provide us with product after product to 0:08:51.970,0:08:55.720 give to our patients that doesn't quite 0:08:53.560,0:08:59.110 cure them but it gets them slightly 0:08:55.720,0:09:01.000 better to function and they have to keep 0:08:59.110,0:09:02.920 taking them indeed I would say that we 0:09:01.000,0:09:05.200 are in psychiatry today where we were in 0:09:02.920,0:09:06.970 general medicine 100 years ago now 100 0:09:05.200,0:09:08.920 years ago in general medicine humanity 0:09:06.970,0:09:11.140 was losing the battle to the infectious 0:09:08.920,0:09:13.240 diseases oh we were very good at 0:09:11.140,0:09:15.850 classifying and diagnosing them we knew 0:09:13.240,0:09:18.040 who got smallpox we knew people died of 0:09:15.850,0:09:20.020 post-operative surgery we knew there 0:09:18.040,0:09:22.360 were microorganisms but we didn't have a 0:09:20.020,0:09:24.070 treatment and then at the beginning of 0:09:22.360,0:09:27.070 the 20th century we discovered the 0:09:24.070,0:09:28.810 antibiotics not symptomatic treatment 0:09:27.070,0:09:31.540 but treatment that goes to the core of 0:09:28.810,0:09:34.870 the cause and we started getting on top 0:09:31.540,0:09:37.690 of infectious disease now psychiatry 0:09:34.870,0:09:39.670 today is in a similar place we're very 0:09:37.690,0:09:42.220 good at classifying and diagnosing our 0:09:39.670,0:09:44.709 epidemiology is superb we write these 0:09:42.220,0:09:46.510 thick diagnostic manuals we know who 0:09:44.709,0:09:49.570 gets depression we know who gets anxiety 0:09:46.510,0:09:52.600 we even know the cause trauma child 0:09:49.570,0:09:55.230 abuse maltreatment poor social 0:09:52.600,0:10:00.940 conditions but our treatments are lousy 0:09:55.230,0:10:02.830 and I'm quite shocked away the empathy 0:10:00.940,0:10:05.650 switch and our understanding of these 0:10:02.830,0:10:08.200 patients seems to be switched off we 0:10:05.650,0:10:09.580 have lots of gushing sentimentality for 0:10:08.200,0:10:12.190 the little five and six year old who's 0:10:09.580,0:10:14.740 being abused and we throw money at our 0:10:12.190,0:10:16.810 television sets on these campaigns to 0:10:14.740,0:10:18.580 improve the lives of these poor little 0:10:16.810,0:10:20.500 innocent victims well let me tell you 0:10:18.580,0:10:24.100 what happens to that little five or six 0:10:20.500,0:10:27.310 year old when they're 11 or 12 on goes 0:10:24.100,0:10:28.540 the hood start smoking weed by the time 0:10:27.310,0:10:29.980 they're 16 they're buying and selling 0:10:28.540,0:10:32.050 amphetamine and by the time they're 0:10:29.980,0:10:33.640 Claire's age in their mid-20s they're 0:10:32.050,0:10:36.730 addicted to heroin and alcohol and 0:10:33.640,0:10:39.670 suddenly we have lost our empathy these 0:10:36.730,0:10:41.560 people are public enemy number one it's 0:10:39.670,0:10:45.010 your fault Claire you brought this upon 0:10:41.560,0:10:47.040 yourself it's your lifestyle choice and 0:10:45.010,0:10:50.560 I'm quite shocked and having worked in 0:10:47.040,0:10:52.720 Pediatrics and seen the developmental 0:10:50.560,0:10:55.600 trajectory that is so inevitable from 0:10:52.720,0:10:57.670 early trauma into adolescent and then 0:10:55.600,0:10:59.079 adult mental health and addictions we 0:10:57.670,0:11:00.570 have to hold on to that sense of 0:10:59.079,0:11:01.830 compassion and evidence-based 0:11:00.570,0:11:04.940 understanding 0:11:01.830,0:11:07.500 about the developmental trajectory there 0:11:04.940,0:11:09.770 so it does sound desperate but all is 0:11:07.500,0:11:09.770 not lost 0:11:09.980,0:11:16.590 MDMA MDMA has some fascinating qualities 0:11:13.620,0:11:18.780 indeed I would suggest that if you were 0:11:16.590,0:11:22.410 to invent a hypothetical drug to treat 0:11:18.780,0:11:24.090 chorma it would be MDMA the way it works 0:11:22.410,0:11:25.770 in terms of its receptors and it's 0:11:24.090,0:11:28.260 subjective psychological effects ticks 0:11:25.770,0:11:30.540 all the right boxes at one level of 0:11:28.260,0:11:32.940 receptors it causes a increased positive 0:11:30.540,0:11:35.550 mood lowering of depression lowering of 0:11:32.940,0:11:38.280 anxiety at another group of receptors it 0:11:35.550,0:11:40.110 speeds the patient up mild stimulation 0:11:38.280,0:11:43.920 which motivates them to engage in 0:11:40.110,0:11:45.750 therapy at another level it would Laxus 0:11:43.920,0:11:48.120 the patient paradoxically at the same 0:11:45.750,0:11:49.800 time as the stimulation and this puts 0:11:48.120,0:11:52.230 the patient into the optimal arousal 0:11:49.800,0:11:54.300 zone where they can engage in 0:11:52.230,0:11:56.550 psychotherapy but perhaps the most 0:11:54.300,0:11:59.400 important thing about MDMA and the most 0:11:56.550,0:12:02.460 important clinical tool is its ability 0:11:59.400,0:12:07.350 to provide a sense of empathy and 0:12:02.460,0:12:09.630 understanding and emotional security it 0:12:07.350,0:12:11.670 can hold the patient in a place where 0:12:09.630,0:12:13.590 they can think about and access their 0:12:11.670,0:12:17.370 trauma like they've never been able to 0:12:13.590,0:12:19.770 do before one of the ways in which MDMA 0:12:17.370,0:12:22.740 works is it increases the release of a 0:12:19.770,0:12:23.940 hormone called oxytocin now oxytocin is 0:12:22.740,0:12:26.190 released from the brains of 0:12:23.940,0:12:28.320 breastfeeding mothers it's a hormone 0:12:26.190,0:12:29.910 that engenders a sense of attachment and 0:12:28.320,0:12:33.690 bonding and that's what's happening in 0:12:29.910,0:12:36.450 the patient who takes MDMA and also it 0:12:33.690,0:12:38.580 acts directly on the amygdala to reduce 0:12:36.450,0:12:41.070 that fear response whilst at the same 0:12:38.580,0:12:43.080 time boosting the prefrontal response 0:12:41.070,0:12:46.590 allowing the patient to see things in a 0:12:43.080,0:12:50.640 new light a positive light so let's go 0:12:46.590,0:12:52.320 back to Claire she's 40 now she's been 0:12:50.640,0:12:54.390 in and out of psychiatric hospitals 0:12:52.320,0:12:56.040 having tried to take her own life and 0:12:54.390,0:12:57.780 the inception she's been on all the 0:12:56.040,0:12:59.760 antipsychotic antidepressant mood 0:12:57.780,0:13:01.560 stabiliser drugs she's tried all the 0:12:59.760,0:13:04.290 psychotherapies but she cannot engage 0:13:01.560,0:13:08.750 because she will not talk about her 0:13:04.290,0:13:11.160 feelings so she comes into a course of 0:13:08.750,0:13:13.779 mdma-assisted psychotherapy 0:13:11.160,0:13:16.389 what does it look like well 0:13:13.779,0:13:18.699 it's weekly sessions maybe eight ten 0:13:16.389,0:13:22.569 twelve weeks long the two therapists 0:13:18.699,0:13:24.759 male-female pair you do not take MDMA 0:13:22.569,0:13:26.589 everyday you do not take it every every 0:13:24.759,0:13:29.259 week over that course of 12 sessions 0:13:26.589,0:13:31.329 you'll take the MDMA three times and the 0:13:29.259,0:13:33.730 other sessions you talk about the 0:13:31.329,0:13:37.089 material that's released on the MDMA 0:13:33.730,0:13:40.839 session so what does Claire actually 0:13:37.089,0:13:43.029 feel when she takes this MDMA what she 0:13:40.839,0:13:45.839 feels is a sense of warmth and 0:13:43.029,0:13:48.519 understanding and a sense of containment 0:13:45.839,0:13:52.269 within that relationship she's having 0:13:48.519,0:13:54.550 with the therapist MDMA is like it's 0:13:52.269,0:13:57.730 like a lifejacket like a bulletproof 0:13:54.550,0:14:01.829 vest to wear to go into battle with your 0:13:57.730,0:14:05.470 trauma this is not ecstasy she's not 0:14:01.829,0:14:07.389 enjoying some ravers euphoric ecstasy 0:14:05.470,0:14:09.790 delight this is still trauma focused 0:14:07.389,0:14:11.949 psychotherapy and it is still hard and 0:14:09.790,0:14:15.339 distressing for her but she can just 0:14:11.949,0:14:18.009 about do it with MDMA on board so when 0:14:15.339,0:14:20.920 the therapist says Claire tell me about 0:14:18.009,0:14:22.629 your rape now in the past just the word 0:14:20.920,0:14:25.689 rape and she'd be out the door but on 0:14:22.629,0:14:28.899 MDMA she says yeah I can talk about that 0:14:25.689,0:14:31.990 I can see him now coming into the room I 0:14:28.899,0:14:34.329 can smell the whiskey on his breath and 0:14:31.990,0:14:37.089 I can feel the stubble on his face as 0:14:34.329,0:14:39.040 he's raping me and she talks about it 0:14:37.089,0:14:42.069 and she explores it and she reflects 0:14:39.040,0:14:44.559 upon it and she can begin the process of 0:14:42.069,0:14:47.649 healing and from here she can start her 0:14:44.559,0:14:50.709 journey she can attack the root cause of 0:14:47.649,0:14:56.769 her problems not just maintain the 0:14:50.709,0:14:58.959 symptoms at a level so does it work well 0:14:56.769,0:15:00.970 we've known about MDMA for very long 0:14:58.959,0:15:03.910 time and indeed we've used MDMA in 0:15:00.970,0:15:06.189 underground therapy for 30 or 40 years 0:15:03.910,0:15:09.309 and there are thousands of positive 0:15:06.189,0:15:11.679 anecdotal cases I get five emails a week 0:15:09.309,0:15:13.509 from all over the world dr. sesor I've 0:15:11.679,0:15:16.209 had PTSD for years I've tried everything 0:15:13.509,0:15:16.929 and now I tried MDMA and I'm starting to 0:15:16.209,0:15:19.689 make a breakthrough 0:15:16.929,0:15:21.850 now anecdotal reports like that are 0:15:19.689,0:15:23.230 interesting but they're not science so 0:15:21.850,0:15:26.439 we've done the science and some 0:15:23.230,0:15:27.310 important studies in recent years big 0:15:26.439,0:15:29.949 study in the state 0:15:27.310,0:15:33.100 showed that a single course of MDMA 0:15:29.949,0:15:35.439 therapy 16-week quarks patient takes 0:15:33.100,0:15:39.129 MDMA three times tested against a 0:15:35.439,0:15:41.949 placebo at the end of that course 85% of 0:15:39.129,0:15:45.129 the people no longer met the diagnostic 0:15:41.949,0:15:47.980 criteria for PTSD not just a relief of 0:15:45.129,0:15:50.410 symptoms they didn't have PTSD 0:15:47.980,0:15:54.339 now that cohort were then followed up 0:15:50.410,0:15:56.709 three years later the same no PTSD many 0:15:54.339,0:16:00.610 of those people had come off their daily 0:15:56.709,0:16:03.790 medications they were cured we don't use 0:16:00.610,0:16:07.930 the Cure word in psychiatry we've become 0:16:03.790,0:16:09.579 learned helplessness position of this is 0:16:07.930,0:16:11.559 the truth if you're diagnosed with a 0:16:09.579,0:16:13.300 severe mental disorder like anxiety or 0:16:11.559,0:16:15.220 depression in your 20s and the 0:16:13.300,0:16:17.740 developmental route of that disorder is 0:16:15.220,0:16:19.569 severe child abuse there's a pretty good 0:16:17.740,0:16:21.639 chance and I'm sorry to say this there's 0:16:19.569,0:16:23.589 a pretty good chance you will still be 0:16:21.639,0:16:26.589 going to psychiatric clinics in your 60s 0:16:23.589,0:16:28.809 and 70s now that is not good enough and 0:16:26.589,0:16:33.370 we're in this position because we're not 0:16:28.809,0:16:36.819 tackling trauma so it works but is it 0:16:33.370,0:16:39.610 safe well we're anything about safety of 0:16:36.819,0:16:42.639 clinical MDMA what we must not do is 0:16:39.610,0:16:45.790 look at the risks of recreational 0:16:42.639,0:16:46.720 ecstasy I don't even know what ecstasy 0:16:45.790,0:16:48.790 is anymore 0:16:46.720,0:16:51.550 ecstasy is over here what is ecstasy 0:16:48.790,0:16:54.100 some dodgy pill bought in some dodgy 0:16:51.550,0:16:56.889 club or some dodgy geezer that may or 0:16:54.100,0:17:00.480 may not contain MDMA plus or minus 0:16:56.889,0:17:03.040 whatever far more toxic substance and 0:17:00.480,0:17:05.109 indeed when you hear about the very 0:17:03.040,0:17:10.359 high-profile deaths of people who take 0:17:05.108,0:17:12.219 ecstasy it invariably is not MDMA so 0:17:10.358,0:17:15.219 let's not look at ecstasy as a measure 0:17:12.220,0:17:18.398 of MDMA let's look at clinical MDMA now 0:17:15.220,0:17:20.709 when will you use clinical MDMA you take 0:17:18.397,0:17:23.279 it under medical supervision it is pure 0:17:20.709,0:17:30.289 the MDMA that I'm using in my studies is 0:17:23.280,0:17:32.850 99.98% pure very expensive 0:17:30.289,0:17:34.470 we do it under medical supervision with 0:17:32.850,0:17:37.950 a doctor and a nurse and a psychologist 0:17:34.470,0:17:40.740 and under those conditions the risks are 0:17:37.950,0:17:42.990 reduced to a absolute minimum indeed 0:17:40.740,0:17:45.690 after 40 years of MDMA research there 0:17:42.990,0:17:48.630 has not been a single serious adverse 0:17:45.690,0:17:53.580 drug reaction not one and certainly no 0:17:48.630,0:17:55.500 deaths so we need to do this research 0:17:53.580,0:17:59.880 and we need to do this research in an 0:17:55.500,0:18:02.970 evidence-based compassionate way looking 0:17:59.880,0:18:05.159 at the data we need to ignore the 0:18:02.970,0:18:06.630 socio-political agenda that says any 0:18:05.159,0:18:11.610 drug that's being used recreationally 0:18:06.630,0:18:15.780 must also be very bad and dangerous that 0:18:11.610,0:18:19.320 sort of attitude hampers research and we 0:18:15.780,0:18:21.720 need scientists to drive this it works 0:18:19.320,0:18:23.760 it's safe and it offers patients like 0:18:21.720,0:18:25.590 Claire for the first time in their life 0:18:23.760,0:18:27.840 an opportunity to break through from 0:18:25.590,0:18:31.110 that trauma and not become a lifelong 0:18:27.840,0:18:33.179 chronic PTSD sufferer so where were we 0:18:31.110,0:18:35.190 going with MDMA research well we've had 0:18:33.179,0:18:37.049 some studies we've got more coming here 0:18:35.190,0:18:38.669 I'm doing a study in Cardiff with 0:18:37.049,0:18:41.940 neuroimaging in which we're going to 0:18:38.669,0:18:43.320 give patients with PTSD MDMA and placebo 0:18:41.940,0:18:44.700 and we're going to look at that Plus 0:18:43.320,0:18:47.730 that the relationship between the 0:18:44.700,0:18:49.159 amygdala and the prefrontal cortex we're 0:18:47.730,0:18:51.419 also doing a study here in Bristol 0:18:49.159,0:18:54.840 giving patients with alcohol use 0:18:51.419,0:18:58.230 disorder MDMA because underlying the 0:18:54.840,0:19:00.809 root of this addiction is trauma so this 0:18:58.230,0:19:02.460 is an exciting time now people say this 0:19:00.809,0:19:04.320 is controversial and indeed that was 0:19:02.460,0:19:06.270 introduced as a controversial speaker 0:19:04.320,0:19:08.880 I'm not controversial I'm a very boring 0:19:06.270,0:19:11.880 conservative doctor I like data 0:19:08.880,0:19:14.429 I like evidence-based data that helps my 0:19:11.880,0:19:16.860 patients I'll tell you what's 0:19:14.429,0:19:19.110 controversial what's controversial is 0:19:16.860,0:19:21.179 that more people have died returning 0:19:19.110,0:19:22.590 from Afghanistan and Iraq because 0:19:21.179,0:19:25.500 they've committed suicide because of 0:19:22.590,0:19:27.510 their untreated PTSD then ever died in 0:19:25.500,0:19:32.760 the conflict out there that is 0:19:27.510,0:19:35.150 controversial and that is unethical so 0:19:32.760,0:19:38.340 this is a important time for science 0:19:35.150,0:19:40.620 MDMA could be the antibiotic that 0:19:38.340,0:19:42.419 psychiatry has been waiting for we owe 0:19:40.620,0:19:43.630 that population of patients who are 0:19:42.419,0:19:46.690 being failed 0:19:43.630,0:19:50.220 we owe them this research we owe this 0:19:46.690,0:19:50.220 declare thank you