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3,4-Methylenedioxymethamphetamine: MDMA.

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Now you've probably heard

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of this compound in the context
of the recreational drug Ecstasy.

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But today I want to talk about MDMA,
not as a recreational drug,

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but as a potential
new treatment in medicine,

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and then a very important
treatment for psychiatry

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because MDMA could offer us,
in psychiatry, for the first time,

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the opportunity to tackle trauma.

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And psychological trauma,

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particularly that caused
by child abuse and maltreatment,

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is at the heart of all or most psychiatric
disorders due to anxiety and addictions.

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Psychiatry is in need
of this innovative approach

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because current treatments 
are failing patients.

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Hi, my name's Ben Sessa.

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I'm a child and adolescent psychiatrist.

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Now that means
I trained as a medical doctor,

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then specialized in mental health,

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and then specialized
in child and adolescent mental health.

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But for the last five years,
I've been working with adults

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with mental health disorders
and addictions due to misuse of drugs.

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And that developmental
pathway of my own,

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from working with child abuse into adults
with mental disorders and addictions

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has brought me to the door of MDMA.

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And I'm going to propose today 
that MDMA could be [as] important

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for the future of psychiatry
as the discovery of antibiotics

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was for general medicine
a hundred years ago.

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So when we think about child abuse,

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we think about physical abuse,
mental abuse, emotional abuse,

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sexual abuse, and neglect.

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And we think about noxious environments.

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We think about parents
with mental disorders,

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we think about parents
who are addicted to drugs,

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and social issues like poverty and
poor housing, poor education.

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Now I'm going to illustrate
my talk today with a patient,

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and I'm going to call her Claire.

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Now, Claire was no single
particular patient of mine.

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Rather, she's an amalgamation
of many different people

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I've met in the last 18 years working
as a medical doctor.

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She's certainly not the worst.

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Now what was Claire's environment like 
as she was growing up?

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Well, her mother was depressed.

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Unfortunately, the family doctor
didn't have time

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to accurately diagnose
and treat depression,

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rather, Claire's mother was put
onto one antidepressant after another,

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never really got therapy.

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Claire's mother also had a lot
of aches and pains,

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typical of what we call 
psychosomatic symptoms in depression,

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and, as a result, the family doctor 
put her onto opiate based painkillers

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which she promptly became addicted to.

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Claire's father, now he was alcoholic,
and he was often not around,

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in and out of prison,

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which is just as well

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because when he was there,
he was physically abusive

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to Claire and her mother.

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Okay, so what does this kind

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of chaotic, frightening environment
do to the developing child brain?

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I'm going to give you a brief
neurophysiology lesson, if I may.

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There's a part of the brain
called the amygdala.

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Now the amygdala is a very ancient part
of the mammalian brain,

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and many other animals
other than humans have an amygdala.

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The amygdala lights up when stimulated

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by fear in the environment,
by a frightening stimulus.

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It lights up and it says,
"Fight or flight, get out!"

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Now, there's another part of the brain,
much more sophisticated part,

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called the prefrontal cortex,

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and it's right here
at the front above the eyes.

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Now the prefrontal cortex,
only humans have,

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and it's in the prefrontal cortex
where we use logic and reasoning

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to rationalize the situation,
and we can use our prefrontal cortex

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to overcome that instinctive fear response
from the amygdala.

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Now when Claire was growing up,

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she never knew,
one moment to the next,

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whether the adult coming into the room
was going to give her a kiss,

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or a cuddle, or do a jigsaw with her,

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or were they going
to punch her, or kick her,

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or burn her with their cigarette.

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Or were they going to rape her.

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Because, throughout her childhood,
Claire was also subjected to sexual abuse.

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Now, there's a group of disorders
called the anxiety disorders,

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and one of the most important
is what we call

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posttraumatic stress disorder, or PTSD.

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Now PTSD, some of the core features:

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very low mood, anxiety,
high levels of anxiety,

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what we call hypervigilance -

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this edginess, this jumpiness.

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Exactly how Claire felt,
throughout her childhood and adolescence.

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Never knowing whether
the next assailant or assault

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was around the corner.

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Another core feature of PTSD,
what we call re-experiencing phenomena.

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Flashbacks, in which the patient

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has sudden remembrances
of painful traumatic memories.

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They could've popped
into the head, at any time,

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triggered by some cue in the environment.

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And when they have those experiences,
those daytime flashbacks,

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they relive the trauma in all the
sensory modalities,

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and this results in them
freezing or dissociating

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to try and block out the pain.

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Now, Claire experienced all of this
as she was growing up.

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High levels of self-harm and suicide
are associated with PTSD.

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Claire would cut her thighs
and her breasts.

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Pretty common form of cutting
in children who've been sexually abused.

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She was being sexually abused
by her mother's clients

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because her mother had moved on
from the addiction to painkillers

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and was using street heroin
when Claire was a teenager.

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And because of the way
the war on drugs has set up,

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that reduces access to treatment
for people with opiate dependence,

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she had to pay for her heroin
using sex work,

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and the clients
would sexually abuse Claire.

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It's very hard to treat PTSD
and it has a high treatment resistance -

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50% of people do not respond
to the traditional treatments.

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How do we treat it?

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Well, we can treat it with medications.

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We can treat it with psychotherapies.

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And the medications we use,
there's a broad range of drugs.

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No single drug,
and this is very important,

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no single drug cures PTSD.

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Rather, we treat
the disorder symptomatically.

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If the patient's depressed,
give them an antidepressant.

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If their mood fluctuates,
give them a mood stabilizer.

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If they can't sleep, give them a hypnotic.

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And if that edginess and that fear 
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, day out,

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for weeks, months, decades.

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They have to keep taking them
because the drugs we use to treat trauma,

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when it's due to this level of severity,
do not attack the root cause of trauma.

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They paper over the cracks.

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A good analogy would be taking aspirin
or ibuprofen when you have a fever.

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A fever is caused by an infection,
by a microorganism.

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Sure, you can take
paracetamol or ibuprofen,

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and this will lower the temperature,

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make you feel a bit better,
but it doesn't attack the root cause.

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And that's what we do when we give
these patients these daily SSRI drugs.

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We paper over the cracks.

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We maintain the symptoms
at a manageable level.

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We also use psychotherapies to treat PTSD,
and there's again a broad range of these:

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DBT, CBT, EMDR, trauma focused
psychotherapy, CAT, APT ...

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Now all of them have
a pretty similar approach

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which actually is an old wives tale

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which is: a problem shared
is a problem halved.

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"Let's talk about your trauma.

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Claire, tell me about your rape."

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Now that's fine for 50% of patients,

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but for a significant half,
they just cannot do that.

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As soon as Claire is asked to talk
about her rape, she freezes,

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she flees, she drops out of treatment.

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Now, by the time she was 15,

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Claire had been removed
from the family home,

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and she was brought up in a succession
of foster placements and children's houses

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and hostels where the abuse continued.

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She would self-harm, cutting, and
she started drinking,

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and, by the time she was 18,
she was using heroin as well.

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Sometimes working in psychiatry
can feel pretty desperate,

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can feel pretty hopeless.

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Sometimes it feels as if psychiatry
is a palliative care profession.

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And this is the truth
because the treatments we use

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do not get to the root cause
of the problem, the trauma,

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and paper over the cracks.

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And I think the pharma industry
knows this, and they queue up,

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and they provide us
with product after product

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to give to our patients
that doesn't quite cure them,

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but it gets them
slightly better to function.

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And they have to keep taking them.

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I would say that we're in psychiatry today

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where we were in general
medicine 100 years ago.

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Now 100 years ago in general medicine,

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humanity was losing the battle
to the infectious diseases.

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Oh, we were very good
at classifying and diagnosing them.

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We knew who got smallpox.

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We knew people died
of post-operative surgery.

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We knew there were microorganisms,
but we didn't have a treatment.

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And then, at the beginning
of the 20th century,

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we discovered the antibiotics.

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Not symptomatic treatment,

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but treatment that goes
to the core of the cause,

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and we started getting
on top of infectious disease.

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Now, psychiatry, today,
is in a similar place.

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We're very good
at classifying and diagnosing.

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Our epidemiology is superb.

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We write these thick diagnostic manuals.

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We know who gets depression.

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We know who gets anxiety.

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We even know the cause:

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trauma, child abuse, maltreatment,
poor social conditions.

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But our treatments are lousy.

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And I'm quite shocked
the way the empathy switch

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and our understanding of these patients
seems to be switched off.

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We have lots of gushing sentimentality
for the little five and six year old

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who's being abused, and we throw money
at our television sets on these campaigns

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to improve the lives
of these poor little innocent victims.

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But let me tell you what happens
to that little five or six year-old,

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when they're 11 or 12.

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On goes the hood, start smoking weed.

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By the time they're 16, they're
buying and selling amphetamine,

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and, by the time they're Claire's age,

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in their mid 20s,

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they're addicted to heroin and alcohol.

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And, suddenly, we have lost our empathy.

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These people are public enemy number one.

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"It's your fault, Claire.

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You brought this upon yourself.

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It's your lifestyle choice."

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And I'm quite shocked
and having worked in pediatrics

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and seeing the developmental trajectory
that is so inevitable,

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from early trauma into adolescent,

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and then adult mental
health and addictions.

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We have to hold on
to that sense of compassion

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and evidence-based understanding
about the developmental trajectory there.

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So it does sound desperate,
but all is not lost.

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MDMA. MDMA has some fascinating qualities.

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Indeed, I would suggest
that if you were to invent


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a hypothetical drug to treat trauma,

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it would be MDMA.

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The way it works,
in terms of receptors

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and subjective psychological effects,

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ticks all the right boxes.

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At one level of receptors,it causes
an increased positive mood.

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Lowering of depression,
lowering of anxiety.

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At another group of receptors,
it speeds the patient up,

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mild stimulation which motivates
them to engage in therapy.

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At another level, it relaxes
the patient paradoxically,

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at the same time as the stimulation,

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and this puts the patient
into the optimal arousal zone

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where they can engage in psychotherapy.

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But perhaps the most
important thing about MDMA,

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and the most important clinical tool,

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is its ability to provide a sense


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of empathy and understanding
and emotional security.

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It can hold the patient in a place

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where they can think about
and access their trauma

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like they've never been able to do before.

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One of the ways in which MDMA works

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is it increases the release
of a hormone called oxytocin.

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Oxytocin is released from the brains
of breastfeeding mothers.

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It's a hormone that engenders
a sense of attachment and bonding,

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and that's what's happening
in the patient who takes MDMA.

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And, also, it acts directly on the amygdala
to reduce that fear response

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while ,at the same time,
boosting the prefrontal response,

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allowing the patient
to see things in a new light.

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A positive light.

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So let's go back to Claire.

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She's 40 now.

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She's been in and out
of psychiatric hospitals,

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having tried to take
her own life in the inception.

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She's been on all the antipsychotic
and antidepressant mood stabiliser drugs.

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She's tried all the psychotherapies,
but she cannot engage

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because she will not talk about her feelings.

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So she comes into a course
of MDMA-assisted psychotherapy.

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What does it look like?

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It's weekly sessions,
maybe eight, ten, twelve weeks long.

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There're two therapists, male-female pair.

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You do not take MDMA everyday,
you do not take it every week.

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Over that course of 12 sessions,
you'll take the MDMA three times,

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and the other sessions,

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you talk about the material
that's released on the MDMA session.

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So what does Claire actually feel
when she takes this MDMA?

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What she feels is a sense of warmth.

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and understanding, and a sense of containment,


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within that relationship
she's having with the therapist.

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MDMA is like a lifejacket,
like a bulletproof vest

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to wear to go into battle
with your trauma.

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This is not ecstasy!

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She's not enjoying some
raver's euphoric ecstasy delight.

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This is still trauma-focused
psychotherapy,

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and it's still hard
and distressing for her,

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but she can just about do it
with MDMA on board.

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So when the therapist says,
"Claire, tell me about your rape."

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In the past, just the word rape,
and she'd be out the door,

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but on MDMA she says,
"Yeah, I can talk about that!

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I can see him now coming into the room,

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I can smell the whiskey on his breath,

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and I can feel the stubble on his face
as he's raping me."

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And she talks about it,
and she explores it


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and she reflects upon it,
and she can begin the process of healing.

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And from here she can start her journey.

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She can attack the root cause
of her problems.

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Not just maintain the symptoms at a level.

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So, does it work?

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Well, we've known about MDMA
for a very long time,

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and, indeed, we've used MDMA
in underground therapy for 30 or 40 years.

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and there are thousands
of positive anecdotal cases.

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I get five emails a week
from all over the world,

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"Dr. Sessa, I've had PTSD for years.

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I've tried everything and now I tried MDMA,

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and I'm starting to make a breakthrough!"

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Now, anecdotal reports like that
are interesting,

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but they're not science,
so we've done the science

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and some important studies
in recent years.

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Big study in the States showed
that a single course of MDMA therapy,

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16-week course, patient takes MDMA
three times, tested against the placebo.

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At the end of that course,

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85% of the people no longer met
the diagnostic criteria for PTSD.

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Not just a relief of symptoms,
they didn't have PTSD!

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Now that cohort were then followed up
three years later, the same - no PTSD.

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Many of those people had come off
their daily medications.

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They were cured!

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We don't use the "cure"
word in psychiatry.

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We've become learned helplessness
position of ... this is the truth!

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If you're diagnosed
with a severe mental disorder,

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like anxiety or depression, in your 20s,

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and the developmental route
of that disorder is severe child abuse,

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there's a pretty good chance,
and I'm sorry to say this,

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there's a pretty good chance,
you will still be going

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to psychiatric clinics
in your 60s and 70s.

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Now that is not good enough,

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and we're in this position
because we're not tackling trauma.

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So, it works, but is it safe?

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When we talk about safety
of clinical MDMA, what we must not do

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is look at the risks
of recreational ecstasy.

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I don't even know what ecstasy is anymore!

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Ecstasy is over here, what is ecstasy?

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Some dodgy pill, bought in some
dodgy club, off some dodgy geezer,

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that may or may not contain MDMA, plus or
minus whatever far more toxic substance.

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And indeed, when you hear

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about the very high-profile deaths
of people who take ecstasy,

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it invariably is not MDMA.

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So, let's not look at ecstasy
as a measure of MDMA.

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Let's look at clinical MDMA.

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When you use clinical MDMA, you take it
under medical supervision.

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It is pure.

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The MDMA that I'm using
in my studies is 99.98% pure!

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Very expensive!

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(Laughter)

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We do it under medical supervision

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with a doctor and a nurse
and a psychologist.

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And under those conditions, the risks 
are reduced to an absolute minimum.

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Indeed, after 40 years of MDMA research,

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there has not been a single serious
adverse drug reaction, not one!

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And certainly no deaths.

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So, we need to do this research

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and we need to do this research
in an evidence-based, compassionate way,

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looking at the data.

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We need to ignore the socio-political
agenda that says any drug

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that's being used recreationally
must also be very bad and dangerous.

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That sort of attitude hampers research.

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And we need scientists to drive this.

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It works, it's safe,

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and it offers patients like Claire,

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for the first time in their life,
an opportunity to break through

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from that trauma and not become
a lifelong chronic PTSD sufferer.

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So, where are we going with MDMA research?

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Well, we've had some studies,
we've got more coming here.

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I'm doing a study
in Cardiff with neuroimaging,

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in which we're going
to give patients with PTSD,

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MDMA and placebo and we're going
to look at that relationship

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between the amygdala
and the prefrontal cortex.

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We're also doing a study here in Bristol

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00:18:49,789 --> 00:18:53,739
giving patients with alcohol
use disorder, MDMA.

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because underlying the root
of this addiction is trauma.

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So, this is an exciting time.

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Now people say, "This is controversial!"

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And indeed, I was introduced
as a controversial speaker.

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00:19:04,470 --> 00:19:05,520
I'm not controversial.

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00:19:05,520 --> 00:19:07,530
I'm a very boring conservative doctor.

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00:19:07,530 --> 00:19:09,870
I like data.

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00:19:09,870 --> 00:19:13,870
I like evidence-based data
that helps my patients.

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00:19:13,870 --> 00:19:15,819
I'll tell you what's controversial!

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What's controversial
is that more people have died

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returning from Afghanistan and Iraq

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because they've committed suicide
because of their untreated PTSD

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than ever died in the conflict out there.

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That is controversial,
and that is unethical!

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00:19:32,370 --> 00:19:35,510
So, this is an important time for science.

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MDMA could be the antibiotic
that psychiatry has been waiting for.

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00:19:40,140 --> 00:19:43,749
We owe that population
of patients who are being failed.

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00:19:43,749 --> 00:19:46,040
We owe them this research!

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00:19:46,040 --> 00:19:47,808
We owe this to Claire!

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00:19:47,808 --> 00:19:49,179
Thank you.

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(Applause)