WEBVTT

00:00:16.430 --> 00:00:29.369
3:4 methylenedioxypyrovalerone on drug

00:00:26.310 --> 00:00:32.308
ecstasy but today I want to talk about

00:00:29.369 --> 00:00:34.969
MDMA not as a recreational drug but as a

00:00:32.308 --> 00:00:37.410
potential new treatment in medicine and

00:00:34.969 --> 00:00:39.750
then very important treatment for

00:00:37.410 --> 00:00:41.969
psychiatry because MDMA could offer us

00:00:39.750 --> 00:00:45.079
in psychiatry for the first time the

00:00:41.969 --> 00:00:47.550
opportunity to tackle trauma and

00:00:45.079 --> 00:00:49.289
psychological trauma particularly that

00:00:47.550 --> 00:00:52.829
caused by child abuse and maltreatment

00:00:49.289 --> 00:00:56.190
is at the heart of all or most

00:00:52.829 --> 00:01:00.449
psychiatric disorders due to anxiety and

00:00:56.190 --> 00:01:02.760
addictions psychiatry is in need of this

00:01:00.449 --> 00:01:05.000
innovative approach because current

00:01:02.760 --> 00:01:08.520
treatments are failing patients

00:01:05.000 --> 00:01:10.409
hi my name's Ben sesor I'm a child and

00:01:08.520 --> 00:01:12.390
adolescent psychiatrist now that means I

00:01:10.409 --> 00:01:14.520
trained as a medical doctor then

00:01:12.390 --> 00:01:16.380
specialized in mental health and then

00:01:14.520 --> 00:01:18.479
specialized in child and adolescent

00:01:16.380 --> 00:01:20.220
mental health but for the last five

00:01:18.479 --> 00:01:22.500
years I've been working with adults with

00:01:20.220 --> 00:01:24.930
mental health disorders and addictions

00:01:22.500 --> 00:01:27.509
due to misuse of drugs and that

00:01:24.930 --> 00:01:30.299
developmental pathway of my own from

00:01:27.509 --> 00:01:32.189
working with child abuse into adults

00:01:30.299 --> 00:01:35.009
with mental disorders and addictions has

00:01:32.189 --> 00:01:37.439
brought me to the door of MDMA and I'm

00:01:35.009 --> 00:01:38.939
gonna propose today that MDMA could be

00:01:37.439 --> 00:01:41.729
important for the future as the Kyah

00:01:38.939 --> 00:01:44.299
tree as the discovery of antibiotics was

00:01:41.729 --> 00:01:47.909
for general medicine a hundred years ago

00:01:44.299 --> 00:01:51.090
so when we think about child abuse we

00:01:47.909 --> 00:01:54.090
think about physical abuse mental abuse

00:01:51.090 --> 00:01:57.630
emotional abuse sexual abuse and neglect

00:01:54.090 --> 00:01:59.430
and we think about noxious environments

00:01:57.630 --> 00:02:01.140
we think about parents with mental

00:01:59.430 --> 00:02:03.570
disorder we think about parents who are

00:02:01.140 --> 00:02:06.649
addicted to drugs and social issues like

00:02:03.570 --> 00:02:08.878
poverty and poor housing poor education

00:02:06.649 --> 00:02:10.770
now I'm going to illustrate my talk

00:02:08.877 --> 00:02:12.330
today with a patient and I'm going to

00:02:10.770 --> 00:02:14.550
call her Claire

00:02:12.330 --> 00:02:16.560
now Claire was no single particular

00:02:14.550 --> 00:02:18.600
patient of mine rather she's an

00:02:16.560 --> 00:02:20.790
amalgamation of many different people

00:02:18.600 --> 00:02:24.270
I've met in the last 18 years working as

00:02:20.790 --> 00:02:24.900
a medical doctor she's certainly not the

00:02:24.270 --> 00:02:27.810
worst

00:02:24.900 --> 00:02:30.600
now what was Claire's environment like

00:02:27.810 --> 00:02:32.490
she was growing up well her mother was

00:02:30.600 --> 00:02:34.610
depressed now unfortunately the family

00:02:32.490 --> 00:02:37.140
doctor didn't have time to accurately

00:02:34.610 --> 00:02:38.850
diagnose and treat depression rather

00:02:37.140 --> 00:02:40.410
Claire's mother was put onto one

00:02:38.850 --> 00:02:42.990
antidepressant after another

00:02:40.410 --> 00:02:44.760
never really got therapy Claire's mother

00:02:42.990 --> 00:02:46.830
also had a lot of aches and pains

00:02:44.760 --> 00:02:48.990
typical what we call psychosomatic

00:02:46.830 --> 00:02:51.690
symptoms in depression and as a result

00:02:48.990 --> 00:02:53.430
the family doctor put her on to opiate

00:02:51.690 --> 00:02:56.580
based painkillers which she promptly

00:02:53.430 --> 00:02:59.070
became addicted to now Claire's father

00:02:56.580 --> 00:03:01.620
now he was alcoholic and he was often

00:02:59.070 --> 00:03:03.120
not around in and out of prison which is

00:03:01.620 --> 00:03:04.950
just as well because when he was there

00:03:03.120 --> 00:03:08.130
he was physically abusive to Claire and

00:03:04.950 --> 00:03:10.920
her mother okay so what does this kind

00:03:08.130 --> 00:03:13.920
of chaotic frightening environment due

00:03:10.920 --> 00:03:15.510
to the developing child brain I'm going

00:03:13.920 --> 00:03:17.670
to give you a brief neurophysiology

00:03:15.510 --> 00:03:19.620
lesson if I may there's a part of the

00:03:17.670 --> 00:03:22.050
brain called the amygdala now the

00:03:19.620 --> 00:03:23.880
amygdala is a very ancient part of the

00:03:22.050 --> 00:03:26.580
mammalian brain and many other animals

00:03:23.880 --> 00:03:29.489
other than humans have an amygdala the

00:03:26.580 --> 00:03:31.560
amygdala lights up when stimulated by

00:03:29.489 --> 00:03:34.230
fear in the environment by a frightening

00:03:31.560 --> 00:03:35.989
stimulus if lights up and it says

00:03:34.230 --> 00:03:38.130
fight-or-flight get out

00:03:35.989 --> 00:03:40.440
now there's another part of the brain

00:03:38.130 --> 00:03:42.209
much more sophisticated part called the

00:03:40.440 --> 00:03:43.770
prefrontal cortex and it's right here at

00:03:42.209 --> 00:03:46.560
the front above the eyes

00:03:43.770 --> 00:03:48.650
now the prefrontal cortex only humans

00:03:46.560 --> 00:03:52.500
have and it's in the prefrontal cortex

00:03:48.650 --> 00:03:55.050
where we use logic and reasoning to

00:03:52.500 --> 00:03:57.540
rationalize the situation and we can use

00:03:55.050 --> 00:03:59.430
our prefrontal cortex to overcome that

00:03:57.540 --> 00:04:02.190
instinctive fear response from the

00:03:59.430 --> 00:04:04.440
amygdala now when Claire was growing up

00:04:02.190 --> 00:04:06.060
she never knew from one moment to the

00:04:04.440 --> 00:04:07.470
next whether the adult coming into the

00:04:06.060 --> 00:04:09.870
room were they going to give him a kiss

00:04:07.470 --> 00:04:11.640
or a cuddle or do a jigsaw with her over

00:04:09.870 --> 00:04:14.489
they're going to punch her or kick her

00:04:11.640 --> 00:04:16.829
or burn her with their cigarette or were

00:04:14.489 --> 00:04:18.329
they going to rape her because

00:04:16.829 --> 00:04:23.590
throughout her childhood Claire was also

00:04:18.329 --> 00:04:25.600
subjected to sexual abuse now there's a

00:04:23.590 --> 00:04:27.100
lupa disorders called the anxiety

00:04:25.600 --> 00:04:29.139
disorders and one of the most important

00:04:27.100 --> 00:04:33.760
is what we call post-traumatic stress

00:04:29.139 --> 00:04:37.150
disorder or PTSD now PTSD some of the

00:04:33.760 --> 00:04:39.729
core features very low mood anxiety high

00:04:37.150 --> 00:04:42.729
levels of anxiety what we call hyper

00:04:39.729 --> 00:04:45.580
vigilance this edginess this jumpiness

00:04:42.729 --> 00:04:47.800
exactly how claire felt throughout her

00:04:45.580 --> 00:04:49.810
childhood and adolescence never knowing

00:04:47.800 --> 00:04:52.389
whether they next assailant or assault

00:04:49.810 --> 00:04:54.520
was around the corner another core

00:04:52.389 --> 00:04:57.280
feature of PTSD what we call REE

00:04:54.520 --> 00:04:59.020
experiencing phenomena flashbacks in

00:04:57.280 --> 00:05:00.729
which the patient has sudden

00:04:59.020 --> 00:05:02.860
remembrances of these painful traumatic

00:05:00.729 --> 00:05:05.860
memories they can just pop into the head

00:05:02.860 --> 00:05:08.590
at any time triggered by some cue in the

00:05:05.860 --> 00:05:10.600
environment and when they have those

00:05:08.590 --> 00:05:13.090
experiences those daytime flashbacks

00:05:10.600 --> 00:05:15.100
they relive the trauma in all the

00:05:13.090 --> 00:05:18.160
sensory modalities and this results in

00:05:15.100 --> 00:05:20.530
them freezing or dissociating to try and

00:05:18.160 --> 00:05:22.150
block out the pain now Claire

00:05:20.530 --> 00:05:26.590
experienced all of this as she was

00:05:22.150 --> 00:05:29.710
growing up high levels of self-harm and

00:05:26.590 --> 00:05:32.130
suicide are associated with PTSD Claire

00:05:29.710 --> 00:05:34.570
would cut her thighs and her breasts

00:05:32.130 --> 00:05:37.389
pretty common form of cutting in

00:05:34.570 --> 00:05:39.250
children who've been sexually abused she

00:05:37.389 --> 00:05:41.139
was being sexually abused by clients of

00:05:39.250 --> 00:05:43.630
her mother because her mother had moved

00:05:41.139 --> 00:05:45.370
on from the addiction to painkillers and

00:05:43.630 --> 00:05:47.800
was using street heroin when Claire was

00:05:45.370 --> 00:05:50.380
a teenager and because of the way the

00:05:47.800 --> 00:05:52.030
war on drugs has set up that reduces

00:05:50.380 --> 00:05:54.849
access to treatment for people with

00:05:52.030 --> 00:05:57.039
opiate dependence she had to pay for her

00:05:54.849 --> 00:06:00.849
heroin using sex work and the clients

00:05:57.039 --> 00:06:03.849
would sexually abused Claire now it's

00:06:00.849 --> 00:06:06.669
very hard to treat PTSD and it has a

00:06:03.849 --> 00:06:08.440
high treatment resistance 50% of people

00:06:06.669 --> 00:06:11.380
do not respond to the traditional

00:06:08.440 --> 00:06:12.700
treatments how do we treat it well we

00:06:11.380 --> 00:06:15.639
can treat it with medications we can

00:06:12.700 --> 00:06:17.860
treat it with psychotherapies and the

00:06:15.639 --> 00:06:20.620
medications we use there's a broad range

00:06:17.860 --> 00:06:24.120
of drugs no single drug and this is very

00:06:20.620 --> 00:06:26.289
important no single drug cures PTSD

00:06:24.120 --> 00:06:28.210
rather we treat the disorder

00:06:26.289 --> 00:06:30.250
symptomatically if the patient's

00:06:28.210 --> 00:06:32.800
depressed give them an antidepressant if

00:06:30.250 --> 00:06:34.599
their mood fluctuates give them a mood

00:06:32.800 --> 00:06:36.250
stabilizer if they can't sleep

00:06:34.599 --> 00:06:38.350
give them a hypnotic

00:06:36.250 --> 00:06:40.660
and if that edginess and that fear

00:06:38.350 --> 00:06:43.240
spills over into paranoia and psychosis

00:06:40.660 --> 00:06:45.820
give the patient an anti-psychotic drug

00:06:43.240 --> 00:06:48.340
and they have to take these drugs day in

00:06:45.820 --> 00:06:50.980
day out for weeks months decades they

00:06:48.340 --> 00:06:53.710
have to keep taking them because the

00:06:50.980 --> 00:06:56.350
drugs we use to treat trauma when it's

00:06:53.710 --> 00:06:59.440
due to this level of severity do not

00:06:56.350 --> 00:07:02.170
attack the root cause of trauma they

00:06:59.440 --> 00:07:05.580
paper over the cracks a good analogy

00:07:02.170 --> 00:07:08.620
would be taking aspirin or ibuprofen

00:07:05.580 --> 00:07:11.220
when you have a fever now a fever is

00:07:08.620 --> 00:07:14.320
caused by an infection by an ant by a

00:07:11.220 --> 00:07:17.050
microorganism sure you can take powerset

00:07:14.320 --> 00:07:18.490
amal or ibuprofen and this will lower

00:07:17.050 --> 00:07:20.560
the temperature and make you feel a bit

00:07:18.490 --> 00:07:23.470
better but it doesn't attack the root

00:07:20.560 --> 00:07:26.560
cause and that's what we do when we give

00:07:23.470 --> 00:07:28.540
these patients these daily SSRI drugs we

00:07:26.560 --> 00:07:32.410
paper over the cracks we maintain the

00:07:28.540 --> 00:07:34.660
symptoms at a manageable level we also

00:07:32.410 --> 00:07:38.290
use psycho therapies to treat PTSD

00:07:34.660 --> 00:07:41.800
unless again a broad range of these DBT

00:07:38.290 --> 00:07:45.010
CBT EMDR trauma focused psychotherapy

00:07:41.800 --> 00:07:47.590
cata PT now all of them have a pretty

00:07:45.010 --> 00:07:49.570
similar approach which actually is an

00:07:47.590 --> 00:07:52.030
old wives tales which is a problem

00:07:49.570 --> 00:07:54.940
shared is a problem halved let's talk

00:07:52.030 --> 00:07:58.570
about your trauma Claire tell me about

00:07:54.940 --> 00:08:01.690
your rape now that's fine for 50% of

00:07:58.570 --> 00:08:04.690
patients but for a significant half they

00:08:01.690 --> 00:08:06.820
just cannot do that as soon as Claire is

00:08:04.690 --> 00:08:10.360
asked to talk about her rape she freezes

00:08:06.820 --> 00:08:12.100
she flees she drops out of treatment now

00:08:10.360 --> 00:08:14.410
by the time she was 15 Claire had been

00:08:12.100 --> 00:08:16.000
removed from the family home and she was

00:08:14.410 --> 00:08:18.790
brought up in a succession of foster

00:08:16.000 --> 00:08:21.479
placements and children's houses and

00:08:18.790 --> 00:08:23.919
hostels where the abuse continued and

00:08:21.479 --> 00:08:26.110
she was self-harm cutting and she

00:08:23.919 --> 00:08:28.740
started drinking and by the time she was

00:08:26.110 --> 00:08:31.210
18 she was using heroin as well

00:08:28.740 --> 00:08:32.530
sometimes working in Skytree can feel

00:08:31.210 --> 00:08:35.469
pretty desperate can feel pretty

00:08:32.530 --> 00:08:37.260
hopeless sometimes it feels as if

00:08:35.469 --> 00:08:40.089
psychiatry is a palliative care

00:08:37.260 --> 00:08:42.159
profession and this is the truth because

00:08:40.089 --> 00:08:44.320
the treatments we use do not get to the

00:08:42.159 --> 00:08:47.260
root cause of the problem the trauma

00:08:44.320 --> 00:08:48.790
they paper over the cracks and I think

00:08:47.260 --> 00:08:49.930
the pharma industry know this and they

00:08:48.790 --> 00:08:51.970
queue up and they

00:08:49.930 --> 00:08:53.560
provide us with product after product to

00:08:51.970 --> 00:08:55.720
give to our patients that doesn't quite

00:08:53.560 --> 00:08:59.110
cure them but it gets them slightly

00:08:55.720 --> 00:09:01.000
better to function and they have to keep

00:08:59.110 --> 00:09:02.920
taking them indeed I would say that we

00:09:01.000 --> 00:09:05.200
are in psychiatry today where we were in

00:09:02.920 --> 00:09:06.970
general medicine 100 years ago now 100

00:09:05.200 --> 00:09:08.920
years ago in general medicine humanity

00:09:06.970 --> 00:09:11.140
was losing the battle to the infectious

00:09:08.920 --> 00:09:13.240
diseases oh we were very good at

00:09:11.140 --> 00:09:15.850
classifying and diagnosing them we knew

00:09:13.240 --> 00:09:18.040
who got smallpox we knew people died of

00:09:15.850 --> 00:09:20.020
post-operative surgery we knew there

00:09:18.040 --> 00:09:22.360
were microorganisms but we didn't have a

00:09:20.020 --> 00:09:24.070
treatment and then at the beginning of

00:09:22.360 --> 00:09:27.070
the 20th century we discovered the

00:09:24.070 --> 00:09:28.810
antibiotics not symptomatic treatment

00:09:27.070 --> 00:09:31.540
but treatment that goes to the core of

00:09:28.810 --> 00:09:34.870
the cause and we started getting on top

00:09:31.540 --> 00:09:37.690
of infectious disease now psychiatry

00:09:34.870 --> 00:09:39.670
today is in a similar place we're very

00:09:37.690 --> 00:09:42.220
good at classifying and diagnosing our

00:09:39.670 --> 00:09:44.709
epidemiology is superb we write these

00:09:42.220 --> 00:09:46.510
thick diagnostic manuals we know who

00:09:44.709 --> 00:09:49.570
gets depression we know who gets anxiety

00:09:46.510 --> 00:09:52.600
we even know the cause trauma child

00:09:49.570 --> 00:09:55.230
abuse maltreatment poor social

00:09:52.600 --> 00:10:00.940
conditions but our treatments are lousy

00:09:55.230 --> 00:10:02.830
and I'm quite shocked away the empathy

00:10:00.940 --> 00:10:05.650
switch and our understanding of these

00:10:02.830 --> 00:10:08.200
patients seems to be switched off we

00:10:05.650 --> 00:10:09.580
have lots of gushing sentimentality for

00:10:08.200 --> 00:10:12.190
the little five and six year old who's

00:10:09.580 --> 00:10:14.740
being abused and we throw money at our

00:10:12.190 --> 00:10:16.810
television sets on these campaigns to

00:10:14.740 --> 00:10:18.580
improve the lives of these poor little

00:10:16.810 --> 00:10:20.500
innocent victims well let me tell you

00:10:18.580 --> 00:10:24.100
what happens to that little five or six

00:10:20.500 --> 00:10:27.310
year old when they're 11 or 12 on goes

00:10:24.100 --> 00:10:28.540
the hood start smoking weed by the time

00:10:27.310 --> 00:10:29.980
they're 16 they're buying and selling

00:10:28.540 --> 00:10:32.050
amphetamine and by the time they're

00:10:29.980 --> 00:10:33.640
Claire's age in their mid-20s they're

00:10:32.050 --> 00:10:36.730
addicted to heroin and alcohol and

00:10:33.640 --> 00:10:39.670
suddenly we have lost our empathy these

00:10:36.730 --> 00:10:41.560
people are public enemy number one it's

00:10:39.670 --> 00:10:45.010
your fault Claire you brought this upon

00:10:41.560 --> 00:10:47.040
yourself it's your lifestyle choice and

00:10:45.010 --> 00:10:50.560
I'm quite shocked and having worked in

00:10:47.040 --> 00:10:52.720
Pediatrics and seen the developmental

00:10:50.560 --> 00:10:55.600
trajectory that is so inevitable from

00:10:52.720 --> 00:10:57.670
early trauma into adolescent and then

00:10:55.600 --> 00:10:59.079
adult mental health and addictions we

00:10:57.670 --> 00:11:00.570
have to hold on to that sense of

00:10:59.079 --> 00:11:01.830
compassion and evidence-based

00:11:00.570 --> 00:11:04.940
understanding

00:11:01.830 --> 00:11:07.500
about the developmental trajectory there

00:11:04.940 --> 00:11:09.770
so it does sound desperate but all is

00:11:07.500 --> 00:11:09.770
not lost

00:11:09.980 --> 00:11:16.590
MDMA MDMA has some fascinating qualities

00:11:13.620 --> 00:11:18.780
indeed I would suggest that if you were

00:11:16.590 --> 00:11:22.410
to invent a hypothetical drug to treat

00:11:18.780 --> 00:11:24.090
chorma it would be MDMA the way it works

00:11:22.410 --> 00:11:25.770
in terms of its receptors and it's

00:11:24.090 --> 00:11:28.260
subjective psychological effects ticks

00:11:25.770 --> 00:11:30.540
all the right boxes at one level of

00:11:28.260 --> 00:11:32.940
receptors it causes a increased positive

00:11:30.540 --> 00:11:35.550
mood lowering of depression lowering of

00:11:32.940 --> 00:11:38.280
anxiety at another group of receptors it

00:11:35.550 --> 00:11:40.110
speeds the patient up mild stimulation

00:11:38.280 --> 00:11:43.920
which motivates them to engage in

00:11:40.110 --> 00:11:45.750
therapy at another level it would Laxus

00:11:43.920 --> 00:11:48.120
the patient paradoxically at the same

00:11:45.750 --> 00:11:49.800
time as the stimulation and this puts

00:11:48.120 --> 00:11:52.230
the patient into the optimal arousal

00:11:49.800 --> 00:11:54.300
zone where they can engage in

00:11:52.230 --> 00:11:56.550
psychotherapy but perhaps the most

00:11:54.300 --> 00:11:59.400
important thing about MDMA and the most

00:11:56.550 --> 00:12:02.460
important clinical tool is its ability

00:11:59.400 --> 00:12:07.350
to provide a sense of empathy and

00:12:02.460 --> 00:12:09.630
understanding and emotional security it

00:12:07.350 --> 00:12:11.670
can hold the patient in a place where

00:12:09.630 --> 00:12:13.590
they can think about and access their

00:12:11.670 --> 00:12:17.370
trauma like they've never been able to

00:12:13.590 --> 00:12:19.770
do before one of the ways in which MDMA

00:12:17.370 --> 00:12:22.740
works is it increases the release of a

00:12:19.770 --> 00:12:23.940
hormone called oxytocin now oxytocin is

00:12:22.740 --> 00:12:26.190
released from the brains of

00:12:23.940 --> 00:12:28.320
breastfeeding mothers it's a hormone

00:12:26.190 --> 00:12:29.910
that engenders a sense of attachment and

00:12:28.320 --> 00:12:33.690
bonding and that's what's happening in

00:12:29.910 --> 00:12:36.450
the patient who takes MDMA and also it

00:12:33.690 --> 00:12:38.580
acts directly on the amygdala to reduce

00:12:36.450 --> 00:12:41.070
that fear response whilst at the same

00:12:38.580 --> 00:12:43.080
time boosting the prefrontal response

00:12:41.070 --> 00:12:46.590
allowing the patient to see things in a

00:12:43.080 --> 00:12:50.640
new light a positive light so let's go

00:12:46.590 --> 00:12:52.320
back to Claire she's 40 now she's been

00:12:50.640 --> 00:12:54.390
in and out of psychiatric hospitals

00:12:52.320 --> 00:12:56.040
having tried to take her own life and

00:12:54.390 --> 00:12:57.780
the inception she's been on all the

00:12:56.040 --> 00:12:59.760
antipsychotic antidepressant mood

00:12:57.780 --> 00:13:01.560
stabiliser drugs she's tried all the

00:12:59.760 --> 00:13:04.290
psychotherapies but she cannot engage

00:13:01.560 --> 00:13:08.750
because she will not talk about her

00:13:04.290 --> 00:13:11.160
feelings so she comes into a course of

00:13:08.750 --> 00:13:13.779
mdma-assisted psychotherapy

00:13:11.160 --> 00:13:16.389
what does it look like well

00:13:13.779 --> 00:13:18.699
it's weekly sessions maybe eight ten

00:13:16.389 --> 00:13:22.569
twelve weeks long the two therapists

00:13:18.699 --> 00:13:24.759
male-female pair you do not take MDMA

00:13:22.569 --> 00:13:26.589
everyday you do not take it every every

00:13:24.759 --> 00:13:29.259
week over that course of 12 sessions

00:13:26.589 --> 00:13:31.329
you'll take the MDMA three times and the

00:13:29.259 --> 00:13:33.730
other sessions you talk about the

00:13:31.329 --> 00:13:37.089
material that's released on the MDMA

00:13:33.730 --> 00:13:40.839
session so what does Claire actually

00:13:37.089 --> 00:13:43.029
feel when she takes this MDMA what she

00:13:40.839 --> 00:13:45.839
feels is a sense of warmth and

00:13:43.029 --> 00:13:48.519
understanding and a sense of containment

00:13:45.839 --> 00:13:52.269
within that relationship she's having

00:13:48.519 --> 00:13:54.550
with the therapist MDMA is like it's

00:13:52.269 --> 00:13:57.730
like a lifejacket like a bulletproof

00:13:54.550 --> 00:14:01.829
vest to wear to go into battle with your

00:13:57.730 --> 00:14:05.470
trauma this is not ecstasy she's not

00:14:01.829 --> 00:14:07.389
enjoying some ravers euphoric ecstasy

00:14:05.470 --> 00:14:09.790
delight this is still trauma focused

00:14:07.389 --> 00:14:11.949
psychotherapy and it is still hard and

00:14:09.790 --> 00:14:15.339
distressing for her but she can just

00:14:11.949 --> 00:14:18.009
about do it with MDMA on board so when

00:14:15.339 --> 00:14:20.920
the therapist says Claire tell me about

00:14:18.009 --> 00:14:22.629
your rape now in the past just the word

00:14:20.920 --> 00:14:25.689
rape and she'd be out the door but on

00:14:22.629 --> 00:14:28.899
MDMA she says yeah I can talk about that

00:14:25.689 --> 00:14:31.990
I can see him now coming into the room I

00:14:28.899 --> 00:14:34.329
can smell the whiskey on his breath and

00:14:31.990 --> 00:14:37.089
I can feel the stubble on his face as

00:14:34.329 --> 00:14:39.040
he's raping me and she talks about it

00:14:37.089 --> 00:14:42.069
and she explores it and she reflects

00:14:39.040 --> 00:14:44.559
upon it and she can begin the process of

00:14:42.069 --> 00:14:47.649
healing and from here she can start her

00:14:44.559 --> 00:14:50.709
journey she can attack the root cause of

00:14:47.649 --> 00:14:56.769
her problems not just maintain the

00:14:50.709 --> 00:14:58.959
symptoms at a level so does it work well

00:14:56.769 --> 00:15:00.970
we've known about MDMA for very long

00:14:58.959 --> 00:15:03.910
time and indeed we've used MDMA in

00:15:00.970 --> 00:15:06.189
underground therapy for 30 or 40 years

00:15:03.910 --> 00:15:09.309
and there are thousands of positive

00:15:06.189 --> 00:15:11.679
anecdotal cases I get five emails a week

00:15:09.309 --> 00:15:13.509
from all over the world dr. sesor I've

00:15:11.679 --> 00:15:16.209
had PTSD for years I've tried everything

00:15:13.509 --> 00:15:16.929
and now I tried MDMA and I'm starting to

00:15:16.209 --> 00:15:19.689
make a breakthrough

00:15:16.929 --> 00:15:21.850
now anecdotal reports like that are

00:15:19.689 --> 00:15:23.230
interesting but they're not science so

00:15:21.850 --> 00:15:26.439
we've done the science and some

00:15:23.230 --> 00:15:27.310
important studies in recent years big

00:15:26.439 --> 00:15:29.949
study in the state

00:15:27.310 --> 00:15:33.100
showed that a single course of MDMA

00:15:29.949 --> 00:15:35.439
therapy 16-week quarks patient takes

00:15:33.100 --> 00:15:39.129
MDMA three times tested against a

00:15:35.439 --> 00:15:41.949
placebo at the end of that course 85% of

00:15:39.129 --> 00:15:45.129
the people no longer met the diagnostic

00:15:41.949 --> 00:15:47.980
criteria for PTSD not just a relief of

00:15:45.129 --> 00:15:50.410
symptoms they didn't have PTSD

00:15:47.980 --> 00:15:54.339
now that cohort were then followed up

00:15:50.410 --> 00:15:56.709
three years later the same no PTSD many

00:15:54.339 --> 00:16:00.610
of those people had come off their daily

00:15:56.709 --> 00:16:03.790
medications they were cured we don't use

00:16:00.610 --> 00:16:07.930
the Cure word in psychiatry we've become

00:16:03.790 --> 00:16:09.579
learned helplessness position of this is

00:16:07.930 --> 00:16:11.559
the truth if you're diagnosed with a

00:16:09.579 --> 00:16:13.300
severe mental disorder like anxiety or

00:16:11.559 --> 00:16:15.220
depression in your 20s and the

00:16:13.300 --> 00:16:17.740
developmental route of that disorder is

00:16:15.220 --> 00:16:19.569
severe child abuse there's a pretty good

00:16:17.740 --> 00:16:21.639
chance and I'm sorry to say this there's

00:16:19.569 --> 00:16:23.589
a pretty good chance you will still be

00:16:21.639 --> 00:16:26.589
going to psychiatric clinics in your 60s

00:16:23.589 --> 00:16:28.809
and 70s now that is not good enough and

00:16:26.589 --> 00:16:33.370
we're in this position because we're not

00:16:28.809 --> 00:16:36.819
tackling trauma so it works but is it

00:16:33.370 --> 00:16:39.610
safe well we're anything about safety of

00:16:36.819 --> 00:16:42.639
clinical MDMA what we must not do is

00:16:39.610 --> 00:16:45.790
look at the risks of recreational

00:16:42.639 --> 00:16:46.720
ecstasy I don't even know what ecstasy

00:16:45.790 --> 00:16:48.790
is anymore

00:16:46.720 --> 00:16:51.550
ecstasy is over here what is ecstasy

00:16:48.790 --> 00:16:54.100
some dodgy pill bought in some dodgy

00:16:51.550 --> 00:16:56.889
club or some dodgy geezer that may or

00:16:54.100 --> 00:17:00.480
may not contain MDMA plus or minus

00:16:56.889 --> 00:17:03.040
whatever far more toxic substance and

00:17:00.480 --> 00:17:05.109
indeed when you hear about the very

00:17:03.040 --> 00:17:10.359
high-profile deaths of people who take

00:17:05.108 --> 00:17:12.219
ecstasy it invariably is not MDMA so

00:17:10.358 --> 00:17:15.219
let's not look at ecstasy as a measure

00:17:12.220 --> 00:17:18.398
of MDMA let's look at clinical MDMA now

00:17:15.220 --> 00:17:20.709
when will you use clinical MDMA you take

00:17:18.397 --> 00:17:23.279
it under medical supervision it is pure

00:17:20.709 --> 00:17:30.289
the MDMA that I'm using in my studies is

00:17:23.280 --> 00:17:32.850
99.98% pure very expensive

00:17:30.289 --> 00:17:34.470
we do it under medical supervision with

00:17:32.850 --> 00:17:37.950
a doctor and a nurse and a psychologist

00:17:34.470 --> 00:17:40.740
and under those conditions the risks are

00:17:37.950 --> 00:17:42.990
reduced to a absolute minimum indeed

00:17:40.740 --> 00:17:45.690
after 40 years of MDMA research there

00:17:42.990 --> 00:17:48.630
has not been a single serious adverse

00:17:45.690 --> 00:17:53.580
drug reaction not one and certainly no

00:17:48.630 --> 00:17:55.500
deaths so we need to do this research

00:17:53.580 --> 00:17:59.880
and we need to do this research in an

00:17:55.500 --> 00:18:02.970
evidence-based compassionate way looking

00:17:59.880 --> 00:18:05.159
at the data we need to ignore the

00:18:02.970 --> 00:18:06.630
socio-political agenda that says any

00:18:05.159 --> 00:18:11.610
drug that's being used recreationally

00:18:06.630 --> 00:18:15.780
must also be very bad and dangerous that

00:18:11.610 --> 00:18:19.320
sort of attitude hampers research and we

00:18:15.780 --> 00:18:21.720
need scientists to drive this it works

00:18:19.320 --> 00:18:23.760
it's safe and it offers patients like

00:18:21.720 --> 00:18:25.590
Claire for the first time in their life

00:18:23.760 --> 00:18:27.840
an opportunity to break through from

00:18:25.590 --> 00:18:31.110
that trauma and not become a lifelong

00:18:27.840 --> 00:18:33.179
chronic PTSD sufferer so where were we

00:18:31.110 --> 00:18:35.190
going with MDMA research well we've had

00:18:33.179 --> 00:18:37.049
some studies we've got more coming here

00:18:35.190 --> 00:18:38.669
I'm doing a study in Cardiff with

00:18:37.049 --> 00:18:41.940
neuroimaging in which we're going to

00:18:38.669 --> 00:18:43.320
give patients with PTSD MDMA and placebo

00:18:41.940 --> 00:18:44.700
and we're going to look at that Plus

00:18:43.320 --> 00:18:47.730
that the relationship between the

00:18:44.700 --> 00:18:49.159
amygdala and the prefrontal cortex we're

00:18:47.730 --> 00:18:51.419
also doing a study here in Bristol

00:18:49.159 --> 00:18:54.840
giving patients with alcohol use

00:18:51.419 --> 00:18:58.230
disorder MDMA because underlying the

00:18:54.840 --> 00:19:00.809
root of this addiction is trauma so this

00:18:58.230 --> 00:19:02.460
is an exciting time now people say this

00:19:00.809 --> 00:19:04.320
is controversial and indeed that was

00:19:02.460 --> 00:19:06.270
introduced as a controversial speaker

00:19:04.320 --> 00:19:08.880
I'm not controversial I'm a very boring

00:19:06.270 --> 00:19:11.880
conservative doctor I like data

00:19:08.880 --> 00:19:14.429
I like evidence-based data that helps my

00:19:11.880 --> 00:19:16.860
patients I'll tell you what's

00:19:14.429 --> 00:19:19.110
controversial what's controversial is

00:19:16.860 --> 00:19:21.179
that more people have died returning

00:19:19.110 --> 00:19:22.590
from Afghanistan and Iraq because

00:19:21.179 --> 00:19:25.500
they've committed suicide because of

00:19:22.590 --> 00:19:27.510
their untreated PTSD then ever died in

00:19:25.500 --> 00:19:32.760
the conflict out there that is

00:19:27.510 --> 00:19:35.150
controversial and that is unethical so

00:19:32.760 --> 00:19:38.340
this is a important time for science

00:19:35.150 --> 00:19:40.620
MDMA could be the antibiotic that

00:19:38.340 --> 00:19:42.419
psychiatry has been waiting for we owe

00:19:40.620 --> 00:19:43.630
that population of patients who are

00:19:42.419 --> 00:19:46.690
being failed

00:19:43.630 --> 00:19:50.220
we owe them this research we owe this

00:19:46.690 --> 00:19:50.220
declare thank you