WEBVTT 00:00:11.200 --> 00:00:16.804 (applause) 00:00:16.804 --> 00:00:22.070 3,4-Methylenedioxymethamphetamine: MDMA. 00:00:22.070 --> 00:00:27.489 Now you're probably heard of this compound in the context of the recreational drug Ecstasy. 00:00:27.489 --> 00:00:31.768 But today I want to talk about MDMA not as a recreational drug, 00:00:31.768 --> 00:00:35.629 but as a potential new treatment in medicine. 00:00:35.629 --> 00:00:39.750 And then very important treatment for psychiatry because MDMA could offer us 00:00:39.750 --> 00:00:44.609 in psychiatry for the first time the opportunity to tackle trauma. 00:00:45.079 --> 00:00:49.289 And psychological trauma particularly that caused by child abuse and maltreatment 00:00:49.289 --> 00:00:57.139 is at the heart of all or most psychiatric disorders due to anxiety and addictions. 00:00:57.759 --> 00:01:02.069 Psychiatry is in need of this innovative approach, 00:01:00.900 --> 00:01:04.731 because current treatments are failing patients. 00:01:06.051 --> 00:01:09.860 Hi, my name's Ben Sessa. I'm a child and adolescent psychiatrist. 00:01:09.860 --> 00:01:12.349 Now that means I trained as a medical doctor, 00:01:12.349 --> 00:01:14.440 then specialized in mental health 00:01:14.440 --> 00:01:17.400 and then specialized in child and adolescent mental health. 00:01:17.400 --> 00:01:20.220 But for the last five years I've been working with adults with 00:01:20.220 --> 00:01:24.480 mental health disorders and addictions due to misuse of drugs. 00:01:24.480 --> 00:01:27.509 And that developmental pathway of my own, 00:01:27.509 --> 00:01:30.299 from working with child abuse into adults 00:01:30.299 --> 00:01:34.069 with mental disorders and addictions has brought me to the door of MDMA. 00:01:34.829 --> 00:01:37.299 And I'm gonna propose today that MDMA could be 00:01:37.299 --> 00:01:41.699 important for the future of psychiatry as the discovery of antibiotics was 00:01:41.699 --> 00:01:44.499 for general medicine a hundred years ago. 00:01:44.999 --> 00:01:51.090 So when we think about child abuse we think about physical abuse, mental abuse, 00:01:51.090 --> 00:01:54.430 emotional abuse, sexual abuse and neglect. 00:01:55.370 --> 00:01:58.180 And we think about noxious environments. 00:01:58.180 --> 00:02:00.550 We think about parents with mental disorder. 00:02:01.100 --> 00:02:06.649 We think about parents who are addicted to drugs. 00:02:03.570 --> 00:02:08.878 And social issues like 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 do 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. It 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 her a kiss 00:04:07.470 --> 00:04:11.640 or a cuddle or do a jigsaw with her, or 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 group of 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 00:04:54.520 --> 00:04:59.020 re-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. 00:05:37.389 --> 00:05:41.139 She 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 abuse 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 a 00:07:11.220 --> 00:07:17.050 microorganism. Sure you can take paracetamol 00:07:14.320 --> 00:07:18.490 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 psychotherapies to treat PTSD, and there's 00:07:34.660 --> 00:07:41.800 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 CAT, APT... 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 psychiatry 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 the way 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 trauma, it would be MDMA. The way it works 00:11:22.410 --> 00:11:25.770 in terms of its receptors and its 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 relaxes 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 and 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 Wwhat 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 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 raver's 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. Sessa, 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. 00:15:26.439 --> 00:15:29.949 Big study in the States 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 course, 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 00:15:50.438 --> 00:15:56.709 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 word "cure" 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, when we talk 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 of 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 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! (laughter) 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 00:18:43.320 --> 00:18:47.730 that 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, I 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 00:19:50.220 --> 00:19:53.750 Claire! Thank you. (applause)