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3:4 methylenedioxypyrovalerone on drug

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ecstasy but today I want to talk about

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MDMA not as a recreational drug but as a

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potential new treatment in medicine and

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then very important treatment for

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psychiatry because MDMA could offer us

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in psychiatry for the first time the

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opportunity to tackle trauma and

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psychological trauma particularly that

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caused by child abuse and maltreatment

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is at the heart of all or most

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psychiatric disorders due to anxiety and

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addictions psychiatry is in need of this

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innovative approach because current

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treatments are failing patients

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hi my name's Ben sesor I'm a child and

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adolescent psychiatrist now that means I

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trained as a medical doctor then

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specialized in mental health and then

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specialized in child and adolescent

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mental health but for the last five

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years I've been working with adults with

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mental health disorders and addictions

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due to misuse of drugs and that

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developmental pathway of my own from

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working with child abuse into adults

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with mental disorders and addictions has

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brought me to the door of MDMA and I'm

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gonna propose today that MDMA could be

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important for the future as the Kyah

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tree as the discovery of antibiotics was

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for general medicine a hundred years ago

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so when we think about child abuse we

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think about physical abuse mental abuse

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emotional abuse sexual abuse and neglect

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and we think about noxious environments

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we think about parents with mental

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disorder we think about parents who are

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addicted to drugs and social issues like

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poverty and poor housing poor education

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now I'm going to illustrate my talk

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today with a patient and I'm going to

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call her Claire

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now Claire was no single particular

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patient of mine rather she's an

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amalgamation of many different people

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I've met in the last 18 years working as

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a medical doctor she's certainly not the

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worst

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now what was Claire's environment like

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she was growing up well her mother was

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depressed now unfortunately the family

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doctor didn't have time to accurately

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diagnose and treat depression rather

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Claire's mother was put onto one

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antidepressant after another

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never really got therapy Claire's mother

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also had a lot of aches and pains

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typical what we call psychosomatic

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symptoms in depression and as a result

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the family doctor put her on to opiate

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based painkillers which she promptly

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became addicted to now Claire's father

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now he was alcoholic and he was often

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not around in and out of prison which is

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just as well because when he was there

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he was physically abusive to Claire and

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her mother okay so what does this kind

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of chaotic frightening environment due

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to the developing child brain I'm going

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to give you a brief neurophysiology

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lesson if I may there's a part of the

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brain called the amygdala now the

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amygdala is a very ancient part of the

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mammalian brain and many other animals

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other than humans have an amygdala the

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amygdala lights up when stimulated by

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fear in the environment by a frightening

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stimulus if lights up and it says

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fight-or-flight get out

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now there's another part of the brain

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much more sophisticated part called the

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prefrontal cortex and it's right here at

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the front above the eyes

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now the prefrontal cortex only humans

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have and it's in the prefrontal cortex

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where we use logic and reasoning to

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rationalize the situation and we can use

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our prefrontal cortex to overcome that

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instinctive fear response from the

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amygdala now when Claire was growing up

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she never knew from one moment to the

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next whether the adult coming into the

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room were they going to give him a kiss

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or a cuddle or do a jigsaw with her over

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they're going to punch her or kick her

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or burn her with their cigarette or were

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they going to rape her because

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throughout her childhood Claire was also

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subjected to sexual abuse now there's a

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lupa disorders called the anxiety

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disorders and one of the most important

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is what we call post-traumatic stress

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disorder or PTSD now PTSD some of the

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core features very low mood anxiety high

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levels of anxiety what we call hyper

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vigilance this edginess this jumpiness

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exactly how claire felt throughout her

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childhood and adolescence never knowing

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whether they next assailant or assault

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was around the corner another core

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feature of PTSD what we call REE

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experiencing phenomena flashbacks in

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which the patient has sudden

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remembrances of these painful traumatic

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memories they can just pop into the head

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at any time triggered by some cue in the

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environment and when they have those

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experiences those daytime flashbacks

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they relive the trauma in all the

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sensory modalities and this results in

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them freezing or dissociating to try and

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block out the pain now Claire

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experienced all of this as she was

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growing up high levels of self-harm and

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suicide are associated with PTSD Claire

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would cut her thighs and her breasts

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pretty common form of cutting in

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children who've been sexually abused she

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was being sexually abused by clients of

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her mother because her mother had moved

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on from the addiction to painkillers and

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was using street heroin when Claire was

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a teenager and because of the way the

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war on drugs has set up that reduces

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access to treatment for people with

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opiate dependence she had to pay for her

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heroin using sex work and the clients

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would sexually abused Claire now it's

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very hard to treat PTSD and it has a

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high treatment resistance 50% of people

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do not respond to the traditional

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treatments how do we treat it well we

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can treat it with medications we can

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treat it with psychotherapies and the

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medications we use there's a broad range

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of drugs no single drug and this is very

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important no single drug cures PTSD

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rather we treat the disorder

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symptomatically if the patient's

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depressed give them an antidepressant if

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their mood fluctuates give them a mood

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stabilizer if they can't sleep

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give them a hypnotic

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and if that edginess and that fear

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spills over into paranoia and psychosis

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give the patient an anti-psychotic drug

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and they have to take these drugs day in

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day out for weeks months decades they

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have to keep taking them because the

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drugs we use to treat trauma when it's

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due to this level of severity do not

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attack the root cause of trauma they

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paper over the cracks a good analogy

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would be taking aspirin or ibuprofen

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when you have a fever now a fever is

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caused by an infection by an ant by a

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microorganism sure you can take powerset

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amal or ibuprofen and this will lower

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the temperature and make you feel a bit

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better but it doesn't attack the root

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cause and that's what we do when we give

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these patients these daily SSRI drugs we

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paper over the cracks we maintain the

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symptoms at a manageable level we also

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use psycho therapies to treat PTSD

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unless again a broad range of these DBT

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CBT EMDR trauma focused psychotherapy

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cata PT now all of them have a pretty

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similar approach which actually is an

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old wives tales which is a problem

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shared is a problem halved let's talk

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about your trauma Claire tell me about

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your rape now that's fine for 50% of

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patients but for a significant half they

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just cannot do that as soon as Claire is

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asked to talk about her rape she freezes

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she flees she drops out of treatment now

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by the time she was 15 Claire had been

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removed from the family home and she was

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brought up in a succession of foster

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placements and children's houses and

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hostels where the abuse continued and

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she was self-harm cutting and she

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started drinking and by the time she was

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18 she was using heroin as well

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sometimes working in Skytree can feel

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pretty desperate can feel pretty

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hopeless sometimes it feels as if

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psychiatry is a palliative care

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profession and this is the truth because

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the treatments we use do not get to the

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root cause of the problem the trauma

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they paper over the cracks and I think

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the pharma industry know this and they

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queue up and they

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provide us with product after product to

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give to our patients that doesn't quite

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cure them but it gets them slightly

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better to function and they have to keep

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taking them indeed I would say that we

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are in psychiatry today where we were in

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general medicine 100 years ago now 100

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years ago in general medicine humanity

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was losing the battle to the infectious

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diseases oh we were very good at

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classifying and diagnosing them we knew

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who got smallpox we knew people died of

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post-operative surgery we knew there

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were microorganisms but we didn't have a

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treatment and then at the beginning of

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the 20th century we discovered the

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antibiotics not symptomatic treatment

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but treatment that goes to the core of

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the cause and we started getting on top

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of infectious disease now psychiatry

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today is in a similar place we're very

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good at classifying and diagnosing our

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epidemiology is superb we write these

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thick diagnostic manuals we know who

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gets depression we know who gets anxiety

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we even know the cause trauma child

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abuse maltreatment poor social

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conditions but our treatments are lousy

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and I'm quite shocked away the empathy

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switch and our understanding of these

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patients seems to be switched off we

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have lots of gushing sentimentality for

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the little five and six year old who's

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being abused and we throw money at our

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television sets on these campaigns to

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improve the lives of these poor little

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innocent victims well let me tell you

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what happens to that little five or six

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year old when they're 11 or 12 on goes

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the hood start smoking weed by the time

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they're 16 they're buying and selling

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amphetamine and by the time they're

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Claire's age in their mid-20s they're

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addicted to heroin and alcohol and

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suddenly we have lost our empathy these

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people are public enemy number one it's

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your fault Claire you brought this upon

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yourself it's your lifestyle choice and

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I'm quite shocked and having worked in

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Pediatrics and seen the developmental

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trajectory that is so inevitable from

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early trauma into adolescent and then

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adult mental health and addictions we

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have to hold on to that sense of

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compassion and evidence-based

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understanding

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about the developmental trajectory there

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so it does sound desperate but all is

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not lost

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MDMA MDMA has some fascinating qualities

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indeed I would suggest that if you were

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to invent a hypothetical drug to treat

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chorma it would be MDMA the way it works

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in terms of its receptors and it's

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subjective psychological effects ticks

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all the right boxes at one level of

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receptors it causes a increased positive

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mood lowering of depression lowering of

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anxiety at another group of receptors it

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speeds the patient up mild stimulation

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which motivates them to engage in

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therapy at another level it would Laxus

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the patient paradoxically at the same

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time as the stimulation and this puts

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the patient into the optimal arousal

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zone where they can engage in

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psychotherapy but perhaps the most

284
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important thing about MDMA and the most

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important clinical tool is its ability

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to provide a sense of empathy and

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understanding and emotional security it

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can hold the patient in a place where

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they can think about and access their

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trauma like they've never been able to

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do before one of the ways in which MDMA

292
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works is it increases the release of a

293
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hormone called oxytocin now oxytocin is

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released from the brains of

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breastfeeding mothers it's a hormone

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that engenders a sense of attachment and

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bonding and that's what's happening in

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the patient who takes MDMA and also it

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acts directly on the amygdala to reduce

300
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that fear response whilst at the same

301
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time boosting the prefrontal response

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allowing the patient to see things in a

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new light a positive light so let's go

304
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back to Claire she's 40 now she's been

305
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in and out of psychiatric hospitals

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having tried to take her own life and

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the inception she's been on all the

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antipsychotic antidepressant mood

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stabiliser drugs she's tried all the

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psychotherapies but she cannot engage

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because she will not talk about her

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feelings so she comes into a course of

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mdma-assisted psychotherapy

314
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what does it look like well

315
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it's weekly sessions maybe eight ten

316
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twelve weeks long the two therapists

317
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male-female pair you do not take MDMA

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everyday you do not take it every every

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week over that course of 12 sessions

320
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you'll take the MDMA three times and the

321
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other sessions you talk about the

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material that's released on the MDMA

323
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session so what does Claire actually

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feel when she takes this MDMA what she

325
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feels is a sense of warmth and

326
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understanding and a sense of containment

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within that relationship she's having

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with the therapist MDMA is like it's

329
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like a lifejacket like a bulletproof

330
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vest to wear to go into battle with your

331
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trauma this is not ecstasy she's not

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enjoying some ravers euphoric ecstasy

333
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delight this is still trauma focused

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psychotherapy and it is still hard and

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distressing for her but she can just

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about do it with MDMA on board so when

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the therapist says Claire tell me about

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your rape now in the past just the word

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rape and she'd be out the door but on

340
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MDMA she says yeah I can talk about that

341
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I can see him now coming into the room I

342
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can smell the whiskey on his breath and

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I can feel the stubble on his face as

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he's raping me and she talks about it

345
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and she explores it and she reflects

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upon it and she can begin the process of

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healing and from here she can start her

348
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journey she can attack the root cause of

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her problems not just maintain the

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symptoms at a level so does it work well

351
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we've known about MDMA for very long

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time and indeed we've used MDMA in

353
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underground therapy for 30 or 40 years

354
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and there are thousands of positive

355
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anecdotal cases I get five emails a week

356
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from all over the world dr. sesor I've

357
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had PTSD for years I've tried everything

358
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and now I tried MDMA and I'm starting to

359
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make a breakthrough

360
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now anecdotal reports like that are

361
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interesting but they're not science so

362
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we've done the science and some

363
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important studies in recent years big

364
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study in the state

365
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showed that a single course of MDMA

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therapy 16-week quarks patient takes

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MDMA three times tested against a

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placebo at the end of that course 85% of

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the people no longer met the diagnostic

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criteria for PTSD not just a relief of

371
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symptoms they didn't have PTSD

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now that cohort were then followed up

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three years later the same no PTSD many

374
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of those people had come off their daily

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medications they were cured we don't use

376
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the Cure word in psychiatry we've become

377
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learned helplessness position of this is

378
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the truth if you're diagnosed with a

379
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severe mental disorder like anxiety or

380
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depression in your 20s and the

381
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developmental route of that disorder is

382
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severe child abuse there's a pretty good

383
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chance and I'm sorry to say this there's

384
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a pretty good chance you will still be

385
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going to psychiatric clinics in your 60s

386
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and 70s now that is not good enough and

387
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we're in this position because we're not

388
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tackling trauma so it works but is it

389
00:16:33,370 --> 00:16:39,610
safe well we're anything about safety of

390
00:16:36,819 --> 00:16:42,639
clinical MDMA what we must not do is

391
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look at the risks of recreational

392
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ecstasy I don't even know what ecstasy

393
00:16:45,790 --> 00:16:48,790
is anymore

394
00:16:46,720 --> 00:16:51,550
ecstasy is over here what is ecstasy

395
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some dodgy pill bought in some dodgy

396
00:16:51,550 --> 00:16:56,889
club or some dodgy geezer that may or

397
00:16:54,100 --> 00:17:00,480
may not contain MDMA plus or minus

398
00:16:56,889 --> 00:17:03,040
whatever far more toxic substance and

399
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indeed when you hear about the very

400
00:17:03,040 --> 00:17:10,359
high-profile deaths of people who take

401
00:17:05,108 --> 00:17:12,219
ecstasy it invariably is not MDMA so

402
00:17:10,358 --> 00:17:15,219
let's not look at ecstasy as a measure

403
00:17:12,220 --> 00:17:18,398
of MDMA let's look at clinical MDMA now

404
00:17:15,220 --> 00:17:20,709
when will you use clinical MDMA you take

405
00:17:18,397 --> 00:17:23,279
it under medical supervision it is pure

406
00:17:20,709 --> 00:17:30,289
the MDMA that I'm using in my studies is

407
00:17:23,280 --> 00:17:32,850
99.98% pure very expensive

408
00:17:30,289 --> 00:17:34,470
we do it under medical supervision with

409
00:17:32,850 --> 00:17:37,950
a doctor and a nurse and a psychologist

410
00:17:34,470 --> 00:17:40,740
and under those conditions the risks are

411
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reduced to a absolute minimum indeed

412
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after 40 years of MDMA research there

413
00:17:42,990 --> 00:17:48,630
has not been a single serious adverse

414
00:17:45,690 --> 00:17:53,580
drug reaction not one and certainly no

415
00:17:48,630 --> 00:17:55,500
deaths so we need to do this research

416
00:17:53,580 --> 00:17:59,880
and we need to do this research in an

417
00:17:55,500 --> 00:18:02,970
evidence-based compassionate way looking

418
00:17:59,880 --> 00:18:05,159
at the data we need to ignore the

419
00:18:02,970 --> 00:18:06,630
socio-political agenda that says any

420
00:18:05,159 --> 00:18:11,610
drug that's being used recreationally

421
00:18:06,630 --> 00:18:15,780
must also be very bad and dangerous that

422
00:18:11,610 --> 00:18:19,320
sort of attitude hampers research and we

423
00:18:15,780 --> 00:18:21,720
need scientists to drive this it works

424
00:18:19,320 --> 00:18:23,760
it's safe and it offers patients like

425
00:18:21,720 --> 00:18:25,590
Claire for the first time in their life

426
00:18:23,760 --> 00:18:27,840
an opportunity to break through from

427
00:18:25,590 --> 00:18:31,110
that trauma and not become a lifelong

428
00:18:27,840 --> 00:18:33,179
chronic PTSD sufferer so where were we

429
00:18:31,110 --> 00:18:35,190
going with MDMA research well we've had

430
00:18:33,179 --> 00:18:37,049
some studies we've got more coming here

431
00:18:35,190 --> 00:18:38,669
I'm doing a study in Cardiff with

432
00:18:37,049 --> 00:18:41,940
neuroimaging in which we're going to

433
00:18:38,669 --> 00:18:43,320
give patients with PTSD MDMA and placebo

434
00:18:41,940 --> 00:18:44,700
and we're going to look at that Plus

435
00:18:43,320 --> 00:18:47,730
that the relationship between the

436
00:18:44,700 --> 00:18:49,159
amygdala and the prefrontal cortex we're

437
00:18:47,730 --> 00:18:51,419
also doing a study here in Bristol

438
00:18:49,159 --> 00:18:54,840
giving patients with alcohol use

439
00:18:51,419 --> 00:18:58,230
disorder MDMA because underlying the

440
00:18:54,840 --> 00:19:00,809
root of this addiction is trauma so this

441
00:18:58,230 --> 00:19:02,460
is an exciting time now people say this

442
00:19:00,809 --> 00:19:04,320
is controversial and indeed that was

443
00:19:02,460 --> 00:19:06,270
introduced as a controversial speaker

444
00:19:04,320 --> 00:19:08,880
I'm not controversial I'm a very boring

445
00:19:06,270 --> 00:19:11,880
conservative doctor I like data

446
00:19:08,880 --> 00:19:14,429
I like evidence-based data that helps my

447
00:19:11,880 --> 00:19:16,860
patients I'll tell you what's

448
00:19:14,429 --> 00:19:19,110
controversial what's controversial is

449
00:19:16,860 --> 00:19:21,179
that more people have died returning

450
00:19:19,110 --> 00:19:22,590
from Afghanistan and Iraq because

451
00:19:21,179 --> 00:19:25,500
they've committed suicide because of

452
00:19:22,590 --> 00:19:27,510
their untreated PTSD then ever died in

453
00:19:25,500 --> 00:19:32,760
the conflict out there that is

454
00:19:27,510 --> 00:19:35,150
controversial and that is unethical so

455
00:19:32,760 --> 00:19:38,340
this is a important time for science

456
00:19:35,150 --> 00:19:40,620
MDMA could be the antibiotic that

457
00:19:38,340 --> 00:19:42,419
psychiatry has been waiting for we owe

458
00:19:40,620 --> 00:19:43,630
that population of patients who are

459
00:19:42,419 --> 00:19:46,690
being failed

460
00:19:43,630 --> 00:19:50,220
we owe them this research we owe this

461
00:19:46,690 --> 00:19:50,220
declare thank you