WEBVTT 00:00:16.804 --> 00:00:22.350 3,4-Methylenedioxymethamphetamine: MDMA. 00:00:22.350 --> 00:00:24.469 Now you've probably heard of this compound 00:00:24.469 --> 00:00:27.719 in the context of the recreational drug Ecstasy. 00:00:27.999 --> 00:00:31.768 But today I want to talk about MDMA, not as a recreational drug, 00:00:31.768 --> 00:00:35.419 but as a potential new treatment in medicine, 00:00:35.619 --> 00:00:37.950 and then a very important treatment for psychiatry NOTE Paragraph 00:00:37.950 --> 00:00:41.749 because MDMA could offer us, in psychiatry, for the first time, 00:00:41.749 --> 00:00:45.079 the opportunity to tackle trauma. 00:00:45.079 --> 00:00:46.769 And psychological trauma, 00:00:46.769 --> 00:00:50.069 particularly that caused by child abuse and maltreatment, 00:00:50.069 --> 00:00:54.704 is at the heart of all or most psychiatric disorders 00:00:54.704 --> 00:00:57.754 due to anxiety and addictions. 00:00:58.269 --> 00:01:02.000 Psychiatry is in need of this innovative approach 00:01:02.000 --> 00:01:04.731 because current treatments are failing patients. 00:01:05.651 --> 00:01:07.820 Hi, my name's Ben Sessa. 00:01:07.820 --> 00:01:09.860 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 00:01:20.220 --> 00:01:24.480 with 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 --> 00:01:31.919 from working with child abuse into adults with mental disorders and addictions 00:01:31.919 --> 00:01:34.039 has brought me to the door of MDMA. 00:01:34.749 --> 00:01:37.919 And I'm going to propose today that MDMA could be [as] important 00:01:37.919 --> 00:01:41.449 for the future of psychiatry as the discovery of antibiotics 00:01:41.449 --> 00:01:44.439 was for general medicine a hundred years ago. 00:01:44.999 --> 00:01:47.770 So when we think about child abuse, 00:01:47.770 --> 00:01:53.070 we think about physical abuse, mental abuse, emotional abuse, 00:01:53.070 --> 00:01:54.920 sexual abuse, and neglect. 00:01:55.250 --> 00:01:57.990 And we think about noxious environments. 00:01:57.990 --> 00:02:00.090 We think about parents with mental disorders, 00:02:00.090 --> 00:02:02.450 we think about parents who are addicted to drugs, 00:02:02.450 --> 00:02:06.709 and social issues like poverty, and poor housing, poor education. 00:02:07.389 --> 00:02:10.257 Now I'm going to illustrate my talk today with a patient, 00:02:10.257 --> 00:02:12.330 and I'm going to call her Claire. 00:02:12.330 --> 00:02:15.920 Now, Claire was no single particular patient of mine. 00:02:15.920 --> 00:02:18.570 Rather, she's an amalgamation of many different people 00:02:18.570 --> 00:02:22.070 I've met in the last 18 years working as a medical doctor. 00:02:23.350 --> 00:02:25.060 She's certainly not the worst. 00:02:25.680 --> 00:02:29.430 Now what was Claire's environment like as she was growing up? 00:02:29.430 --> 00:02:31.310 Well, her mother was depressed. 00:02:31.310 --> 00:02:33.600 Unfortunately, the family doctor didn't have time 00:02:33.600 --> 00:02:36.940 to accurately diagnose and treat depression, 00:02:36.940 --> 00:02:40.480 rather, Claire's mother was put onto one antidepressant after another, 00:02:40.480 --> 00:02:42.630 never really got therapy. 00:02:42.630 --> 00:02:44.960 Claire's mother also had a lot of aches and pains, 00:02:44.960 --> 00:02:48.110 typical of what we call psychosomatic symptoms in depression, 00:02:48.110 --> 00:02:52.800 and, as a result, the family doctor put her onto opiate based painkillers 00:02:52.800 --> 00:02:55.470 which she promptly became addicted to. 00:02:55.950 --> 00:02:59.730 Claire's father, now he was alcoholic, and he was often not around, 00:02:59.730 --> 00:03:01.210 in and out of prison, 00:03:01.210 --> 00:03:02.290 which is just as well 00:03:02.290 --> 00:03:03.530 because when he was there, 00:03:03.530 --> 00:03:06.640 he was physically abusive to Claire and her mother. 00:03:06.640 --> 00:03:08.190 Okay, so what does this kind 00:03:08.190 --> 00:03:13.640 of chaotic, frightening environment do to the developing child brain? 00:03:13.720 --> 00:03:16.960 I'm going to give you a brief neurophysiology lesson, if I may. 00:03:16.960 --> 00:03:19.430 There's a part of the brain called the amygdala. 00:03:19.430 --> 00:03:22.780 Now the amygdala is a very ancient part of the mammalian brain, 00:03:22.780 --> 00:03:26.440 and many other animals other than humans have an amygdala. 00:03:26.440 --> 00:03:29.249 The amygdala lights up when stimulated 00:03:29.249 --> 00:03:32.630 by fear in the environment, by a frightening stimulus. 00:03:32.630 --> 00:03:36.849 It lights up and it says, "Fight or flight, get out!" 00:03:36.849 --> 00:03:40.170 Now, there's another part of the brain, much more sophisticated part, 00:03:40.170 --> 00:03:41.570 called the prefrontal cortex, 00:03:41.570 --> 00:03:44.510 and it's right here at the front above the eyes. 00:03:44.510 --> 00:03:47.360 Now the prefrontal cortex, only humans have, 00:03:47.360 --> 00:03:52.270 and it's in the prefrontal cortex where we use logic and reasoning 00:03:52.270 --> 00:03:56.240 to rationalize the situation, and we can use our prefrontal cortex 00:03:56.240 --> 00:04:00.880 to overcome that instinctive fear response from the amygdala. 00:04:00.880 --> 00:04:02.720 Now when Claire was growing up, 00:04:02.730 --> 00:04:04.590 she never knew, one moment to the next, 00:04:04.590 --> 00:04:07.780 whether the adult coming into the room was going to give her a kiss, 00:04:07.780 --> 00:04:09.770 or a cuddle, or do a jigsaw with her, 00:04:09.770 --> 00:04:11.960 or were they going to punch her, or kick her, 00:04:11.960 --> 00:04:14.309 or burn her with their cigarette. 00:04:14.309 --> 00:04:16.579 Or were they going to rape her. 00:04:16.579 --> 00:04:20.409 Because, throughout her childhood, Claire was also subjected to sexual abuse. 00:04:21.630 --> 00:04:25.850 Now, there's a group of disorders called the anxiety disorders, 00:04:25.850 --> 00:04:27.949 and one of the most important is what we call 00:04:27.949 --> 00:04:31.599 posttraumatic stress disorder, or PTSD. 00:04:31.929 --> 00:04:34.841 Now PTSD, some of the core features: 00:04:34.841 --> 00:04:38.770 very low mood, anxiety, high levels of anxiety, 00:04:38.770 --> 00:04:41.169 what we call hypervigilance - 00:04:41.169 --> 00:04:43.179 this edginess, this jumpiness. 00:04:43.179 --> 00:04:47.160 Exactly how Claire felt, throughout her childhood and adolescence. 00:04:47.160 --> 00:04:49.730 Never knowing whether the next assailant or assault 00:04:49.730 --> 00:04:51.849 was around the corner. 00:04:51.849 --> 00:04:56.420 Another core feature of PTSD, what we call re-experiencing phenomena. 00:04:56.420 --> 00:04:58.390 Flashbacks, in which the patient 00:04:58.390 --> 00:05:01.590 has sudden remembrances of these painful traumatic memories. 00:05:01.590 --> 00:05:04.520 They could've popped into the head, at any time, 00:05:04.520 --> 00:05:07.150 triggered by some cue in the environment. 00:05:07.770 --> 00:05:11.000 And when they have those experiences, those daytime flashbacks, 00:05:11.000 --> 00:05:14.050 they relive the trauma in all the sensory modalities, NOTE Paragraph 00:05:14.230 --> 00:05:17.620 and this results in them freezing or dissociating 00:05:17.620 --> 00:05:20.000 to try and block out the pain. 00:05:20.000 --> 00:05:23.410 Now, Claire experienced all of this as she was growing up. 00:05:25.160 --> 00:05:29.450 High levels of self-harm and suicide are associated with PTSD. 00:05:29.450 --> 00:05:32.070 Claire would cut her thighs and her breasts. 00:05:32.820 --> 00:05:37.269 Pretty common form of cutting in children who've been sexually abused. 00:05:37.269 --> 00:05:39.970 She was being sexually abused by clients of her mother 00:05:39.970 --> 00:05:43.559 because her mother had moved on from the addiction to painkillers 00:05:43.559 --> 00:05:46.800 and was using street heroin when Claire was a teenager. 00:05:46.800 --> 00:05:49.650 And because of the way the war on drugs has set up, 00:05:49.650 --> 00:05:53.980 that reduces access to treatment for people with opiate dependence, 00:05:53.980 --> 00:05:56.319 she had to pay for her heroin using sex work, 00:05:56.319 --> 00:05:58.939 and the clients would sexually abuse Claire. 00:06:00.409 --> 00:06:05.289 It's very hard to treat PTSD and it has a high treatment resistance - 00:06:05.289 --> 00:06:09.380 50% of people do not respond to the traditional treatments. 00:06:09.920 --> 00:06:10.960 How do we treat it? 00:06:10.960 --> 00:06:14.949 Well, we can treat it with medications. We can treat it with psychotherapies. 00:06:14.979 --> 00:06:18.850 And the medications we use, there's a broad range of drugs. 00:06:18.940 --> 00:06:21.010 No single drug, and this is very important, 00:06:21.010 --> 00:06:24.340 no single drug cures PTSD. 00:06:24.850 --> 00:06:27.430 Rather, we treat the disorder symptomatically. 00:06:27.430 --> 00:06:30.400 If the patient's depressed, give them an antidepressant. 00:06:30.400 --> 00:06:33.800 If their mood fluctuates, give them a mood stabilizer. 00:06:33.800 --> 00:06:36.540 If they can't sleep, give them a hypnotic. 00:06:36.540 --> 00:06:41.000 And if that edginess and that fear spills over into paranoia and psychosis, 00:06:41.000 --> 00:06:43.750 give the patient an anti-psychotic drug. 00:06:43.880 --> 00:06:46.240 And they have to take these drugs day in, day out, 00:06:46.270 --> 00:06:48.240 for weeks, months, decades. 00:06:48.240 --> 00:06:53.470 They have to keep taking them because the drugs we use to treat trauma, 00:06:53.470 --> 00:06:59.320 when it's due to this level of severity, do not attack the root cause of trauma. 00:06:59.320 --> 00:07:01.470 They paper over the cracks. 00:07:01.470 --> 00:07:07.700 A good analogy would be taking aspirin or ibuprofen when you have a fever. 00:07:07.700 --> 00:07:13.100 Now, a fever is caused by an infection, by a microorganism. 00:07:13.100 --> 00:07:15.900 Sure, you can take paracetamol or ibuprofen, 00:07:15.900 --> 00:07:17.770 and this will lower the temperature, 00:07:17.770 --> 00:07:22.020 make you feel a bit better, but it doesn't attack the root cause. 00:07:22.190 --> 00:07:26.440 And that's what we do when we give these patients these daily SSRI drugs. 00:07:26.440 --> 00:07:27.710 We paper over the cracks. 00:07:27.710 --> 00:07:30.510 We maintain the symptoms at a manageable level. 00:07:32.090 --> 00:07:37.740 We also use psychotherapies to treat PTSD, and there's again a broad range of these: 00:07:37.740 --> 00:07:43.670 DBT, CBT, EMDR, trauma focused psychotherapy, CAT, APT ... 00:07:43.670 --> 00:07:46.790 Now all of them have a pretty similar approach 00:07:46.790 --> 00:07:48.550 which actually is an old wives tale 00:07:48.550 --> 00:07:51.390 which is: a problem shared is a problem halved. 00:07:51.390 --> 00:07:53.030 "Let's talk about your trauma. 00:07:53.030 --> 00:07:56.130 Claire, tell me about your rape." 00:07:56.440 --> 00:07:59.840 Now that's fine for 50% of patients, 00:07:59.840 --> 00:08:03.630 but for a significant half, they just cannot do that. 00:08:03.850 --> 00:08:07.530 As soon as Claire is asked to talk about her rape, she freezes, 00:08:07.530 --> 00:08:10.310 she flees, she drops out of treatment. 00:08:10.310 --> 00:08:11.690 Now, by the time she was 15, 00:08:11.690 --> 00:08:13.870 Claire had been removed from the family home, 00:08:13.970 --> 00:08:18.500 and she was brought up in a succession of foster placements and children's houses 00:08:18.500 --> 00:08:21.559 and hostels where the abuse continued. 00:08:22.159 --> 00:08:25.229 She would self-harm cutting, and she started drinking, 00:08:25.229 --> 00:08:29.040 and, by the time she was 18, she was using heroin as well. 00:08:29.260 --> 00:08:32.100 Sometimes working in psychiatry can feel pretty desperate, 00:08:32.100 --> 00:08:34.410 can feel pretty hopeless. 00:08:34.410 --> 00:08:39.090 Sometimes it feels as if psychiatry is a palliative care profession. 00:08:39.090 --> 00:08:41.469 And this is the truth because the treatments we use 00:08:41.469 --> 00:08:44.559 do not get to the root cause of the problem, the trauma, 00:08:44.559 --> 00:08:46.740 and paper over the cracks. 00:08:46.740 --> 00:08:49.660 And I think the pharma industry knows this, and they queue up, 00:08:49.660 --> 00:08:51.800 and they provide us with product after product 00:08:51.800 --> 00:08:54.600 to give to our patients that doesn't quite cure them, 00:08:54.600 --> 00:08:58.380 but it gets them slightly better to function. 00:08:58.380 --> 00:09:00.070 And they have to keep taking them. 00:09:00.070 --> 00:09:02.200 I would say that we're in psychiatry today 00:09:02.200 --> 00:09:04.660 where we were in general medicine 100 years ago. 00:09:04.660 --> 00:09:06.520 Now 100 years ago in general medicine, 00:09:06.520 --> 00:09:10.110 humanity was losing the battle to the infectious diseases. 00:09:10.110 --> 00:09:12.800 Oh, we were very good at classifying and diagnosing them. 00:09:12.800 --> 00:09:14.770 We knew who got smallpox. 00:09:14.770 --> 00:09:17.480 We knew people died of post-operative surgery. 00:09:17.480 --> 00:09:20.770 We knew there were microorganisms, but we didn't have a treatment. 00:09:20.770 --> 00:09:23.380 And then, at the beginning of the 20th century, 00:09:23.380 --> 00:09:25.820 we discovered the antibiotics. 00:09:25.820 --> 00:09:27.220 Not symptomatic treatment, 00:09:27.220 --> 00:09:29.890 but treatment that goes to the core of the cause, 00:09:29.890 --> 00:09:33.460 and we started getting on top of infectious disease. 00:09:33.760 --> 00:09:37.090 Now, psychiatry, today, is in a similar place. 00:09:37.090 --> 00:09:39.550 We're very good at classifying and diagnosing. 00:09:39.550 --> 00:09:41.600 Our epidemiology is superb. 00:09:41.600 --> 00:09:44.000 We write these thick diagnostic manuals. 00:09:44.000 --> 00:09:45.529 We know who gets depression. 00:09:45.529 --> 00:09:47.070 We know who gets anxiety. 00:09:47.070 --> 00:09:48.530 We even know the cause: 00:09:48.530 --> 00:09:53.700 trauma, child abuse, maltreatment, poor social conditions. 00:09:53.700 --> 00:09:56.150 But our treatments are lousy. 00:09:57.810 --> 00:10:01.650 And I'm quite shocked the way the empathy switch 00:10:01.650 --> 00:10:05.380 and our understanding of these patients seems to be switched off. 00:10:05.550 --> 00:10:09.520 We have lots of gushing sentimentality for the little five and six year old 00:10:09.520 --> 00:10:14.630 who's being abused, and we throw money at our television sets on these campaigns 00:10:14.630 --> 00:10:17.850 to improve the lives of these poor little innocent victims. 00:10:17.850 --> 00:10:21.040 But let me tell you what happens to that little five or six year-old 00:10:21.040 --> 00:10:23.570 when they're 11 or 12. 00:10:23.570 --> 00:10:26.800 On goes the hood, start smoking weed. 00:10:26.800 --> 00:10:29.420 When they're 16, they're buying and selling amphetamine, 00:10:29.420 --> 00:10:31.890 by the time they're Claire's age, in their mid 20s, 00:10:31.900 --> 00:10:33.760 they're addicted to heroin and alcohol. 00:10:33.760 --> 00:10:36.580 And, suddenly, we have lost our empathy. 00:10:36.580 --> 00:10:39.450 These people are public enemy number one. 00:10:39.450 --> 00:10:40.890 "It's your fault, Claire. 00:10:40.890 --> 00:10:42.770 You brought this upon yourself. 00:10:42.770 --> 00:10:45.160 It's your lifestyle choice." 00:10:45.160 --> 00:10:48.060 And I'm quite shocked, and having worked in pediatrics 00:10:48.060 --> 00:10:52.410 and seeing the developmental trajectory that is so inevitable, 00:10:52.410 --> 00:10:55.290 from early trauma into adolescent, 00:10:55.290 --> 00:10:57.510 and then adult mental health and addictions. 00:10:57.510 --> 00:10:59.799 We have to hold on to that sense of compassion 00:10:59.799 --> 00:11:04.470 and evidence-based understanding about the developmental trajectory there. 00:11:05.720 --> 00:11:08.720 So it does sound desperate, but all is not lost. 00:11:09.910 --> 00:11:13.960 MDMA. MDMA has some fascinating qualities. 00:11:13.960 --> 00:11:17.330 Indeed, I would suggest that if you were to invent 00:11:17.330 --> 00:11:19.410 a hypothetical drug to treat trauma, 00:11:19.410 --> 00:11:21.900 it would be MDMA. 00:11:21.900 --> 00:11:23.850 The way it works, in terms of receptors 00:11:23.850 --> 00:11:25.610 and subjective psychological effects, 00:11:25.610 --> 00:11:27.550 ticks all the right boxes. 00:11:27.550 --> 00:11:31.420 At one level of receptors, it causes an increased positive mood. 00:11:31.420 --> 00:11:34.200 Lowering of depression, lowering of anxiety. 00:11:34.200 --> 00:11:37.160 At another group of receptors, it speeds the patient up, 00:11:37.160 --> 00:11:41.570 mild stimulation which motivates them to engage in therapy. 00:11:41.570 --> 00:11:45.140 At another level, it relaxes the patient, paradoxically, 00:11:45.140 --> 00:11:47.470 at the same time as the stimulation, 00:11:47.470 --> 00:11:51.180 and this puts the patient into the optimal arousal zone 00:11:51.180 --> 00:11:53.730 where they can engage in psychotherapy. 00:11:53.730 --> 00:11:56.070 But perhaps the most important thing about MDMA, 00:11:56.070 --> 00:11:58.390 and the most important clinical tool, 00:11:58.390 --> 00:12:01.310 is its ability to provide a sense 00:12:01.310 --> 00:12:05.740 of empathy, and understanding, and emotional security. 00:12:07.170 --> 00:12:09.400 It can hold the patient in a place 00:12:09.400 --> 00:12:12.230 where they can think about and access their trauma, 00:12:12.230 --> 00:12:15.310 like they've never been able to do before. 00:12:15.950 --> 00:12:17.770 One of the ways in which MDMA works 00:12:17.770 --> 00:12:21.650 is it increases the release of a hormone called oxytocin. 00:12:21.650 --> 00:12:25.600 Now, oxytocin is released from the brains of breastfeeding mothers. 00:12:25.600 --> 00:12:28.760 It's a hormone that engenders a sense of attachment and bonding, 00:12:28.760 --> 00:12:32.220 and that's what's happening in the patient who takes MDMA. 00:12:32.910 --> 00:12:35.920 And, also, it acts directly on the amygdala 00:12:35.920 --> 00:12:37.790 to reduce that fear response 00:12:37.790 --> 00:12:41.440 while, at the same time, boosting the prefrontal response, 00:12:41.470 --> 00:12:44.240 allowing the patient to see things in a new light. 00:12:44.240 --> 00:12:46.130 A positive light. 00:12:46.130 --> 00:12:48.140 So let's go back to Claire. 00:12:48.550 --> 00:12:50.340 She's 40 now. 00:12:50.340 --> 00:12:52.780 She's been in and out of psychiatric hospitals, 00:12:52.780 --> 00:12:55.210 having tried to take her own life in the inception. 00:12:55.210 --> 00:12:58.830 She's been on all the antipsychotic and antidepressant mood stabilizer drugs. 00:12:58.830 --> 00:13:01.790 She's tried all the psychotherapies, but she cannot engage 00:13:01.790 --> 00:13:05.340 because she will not talk about her feelings. 00:13:06.320 --> 00:13:11.710 So she comes into a course of MDMA-assisted psychotherapy. 00:13:11.860 --> 00:13:13.529 What does it look like? 00:13:13.529 --> 00:13:17.809 It's weekly sessions, maybe eight, ten, twelve weeks long. 00:13:17.809 --> 00:13:21.079 There're two therapists, male-female pair. 00:13:21.079 --> 00:13:25.359 You do not take MDMA everyday, you do not take it every week. 00:13:25.359 --> 00:13:28.939 Over that course of 12 sessions, you'll take the MDMA three times, 00:13:28.939 --> 00:13:30.370 and the other sessions, 00:13:30.370 --> 00:13:35.010 you talk about the material that's released on the MDMA session. 00:13:35.410 --> 00:13:39.549 So what does Claire actually feel when she takes this MDMA? 00:13:40.529 --> 00:13:42.999 What she feels is a sense of warmth, NOTE Paragraph 00:13:42.999 --> 00:13:46.419 and understanding, and a sense of containment, 00:13:46.419 --> 00:13:50.519 within that relationship she's having with the therapist. 00:13:51.099 --> 00:13:55.550 MDMA is like a lifejacket, like a bulletproof vest 00:13:55.550 --> 00:13:58.870 to wear to go into battle with your trauma. 00:13:58.870 --> 00:14:00.999 This is not ecstasy! 00:14:01.169 --> 00:14:06.310 She's not enjoying some raver's euphoric ecstasy delight. 00:14:06.310 --> 00:14:08.490 This is still trauma-focused psychotherapy, 00:14:08.490 --> 00:14:11.120 and it's still hard and distressing for her, 00:14:11.120 --> 00:14:14.929 but she can just about do it with MDMA on board. 00:14:14.929 --> 00:14:19.559 So when the therapist says, "Claire, tell me about your rape." 00:14:19.559 --> 00:14:22.320 In the past, just the word rape, and she'd be out the door, 00:14:22.320 --> 00:14:26.619 but on MDMA she says, "Yeah, I can talk about that! 00:14:26.619 --> 00:14:29.429 I can see him now coming into the room, 00:14:29.429 --> 00:14:31.899 I can smell the whiskey on his breath, 00:14:31.899 --> 00:14:35.829 and I can feel the stubble on his face as he's raping me." 00:14:35.829 --> 00:14:38.260 And she talks about it, and she explores it, NOTE Paragraph 00:14:38.260 --> 00:14:42.989 and she reflects upon it, and she can begin the process of healing. 00:14:42.989 --> 00:14:45.639 And from here, she can start her journey. 00:14:45.639 --> 00:14:49.119 She can attack the root cause of her problems. 00:14:49.119 --> 00:14:52.729 Not just maintain the symptoms at a level. 00:14:54.989 --> 00:14:56.649 So, does it work? 00:14:56.649 --> 00:14:59.179 Well, we've known about MDMA for a very long time, 00:14:59.179 --> 00:15:04.790 and, indeed, we've used MDMA in underground therapy for 30 or 40 years. 00:15:04.790 --> 00:15:07.409 and there are thousands of positive anecdotal cases. 00:15:07.409 --> 00:15:10.149 I get five emails a week from all over the world, 00:15:10.149 --> 00:15:12.729 "Dr. Sessa, I've had PTSD for years. 00:15:12.729 --> 00:15:15.209 I've tried everything, and now I tried MDMA, 00:15:15.209 --> 00:15:17.629 and I'm starting to make a breakthrough!" 00:15:17.629 --> 00:15:20.009 Now, anecdotal reports like that are interesting, 00:15:20.009 --> 00:15:22.940 but they're not science, so we've done the science 00:15:22.940 --> 00:15:25.799 and some important studies in recent years. 00:15:26.219 --> 00:15:30.899 Big study in the States showed that a single course of MDMA therapy, 00:15:30.899 --> 00:15:36.309 16-week course, patient takes MDMA three times, tested against the placebo. 00:15:36.459 --> 00:15:37.839 At the end of that course, 00:15:37.839 --> 00:15:44.129 85% of the people no longer met the diagnostic criteria for PTSD. 00:15:44.129 --> 00:15:48.640 Not just a relief of symptoms, they didn't have PTSD! 00:15:48.820 --> 00:15:54.010 Now that cohort were then followed up three years later, the same - no PTSD. 00:15:54.010 --> 00:15:58.179 Many of those people had come off their daily medications. 00:15:58.179 --> 00:15:59.950 They were cured! 00:15:59.950 --> 00:16:03.010 We don't use the "cure" word in psychiatry. 00:16:03.190 --> 00:16:08.340 We've become learned helplessness position of ... this is the truth! 00:16:08.350 --> 00:16:10.729 If you're diagnosed with a severe mental disorder, 00:16:10.729 --> 00:16:13.049 like anxiety or depression, in your 20s, 00:16:13.049 --> 00:16:16.650 and the developmental route of that disorder is severe child abuse, 00:16:16.650 --> 00:16:19.379 there's a pretty good chance, and I'm sorry to say this, 00:16:19.379 --> 00:16:21.859 there's a pretty good chance, you will still be going 00:16:21.859 --> 00:16:24.449 to psychiatric clinics in your 60s and 70s. 00:16:24.449 --> 00:16:27.079 Now that is not good enough, 00:16:27.079 --> 00:16:30.989 and we're in this position because we're not tackling trauma. 00:16:31.749 --> 00:16:34.130 So, it works, but is it safe? 00:16:35.130 --> 00:16:39.599 When we talk about safety of clinical MDMA, what we must not do 00:16:39.599 --> 00:16:43.659 is look at the risks of recreational ecstasy. 00:16:44.179 --> 00:16:47.000 I don't even know what ecstasy is anymore! 00:16:47.000 --> 00:16:49.370 Ecstasy is over here, what is ecstasy? 00:16:49.370 --> 00:16:53.340 Some dodgy pill, bought in some dodgy club, off some dodgy geezer, 00:16:53.340 --> 00:16:55.924 that may or may not contain MDMA, 00:16:55.924 --> 00:16:59.964 plus or minus, whatever far more toxic substance. 00:17:00.970 --> 00:17:02.319 And indeed, when you hear 00:17:02.319 --> 00:17:05.969 about the very high-profile deaths of people who take ecstasy, 00:17:05.969 --> 00:17:08.818 it invariably is not MDMA. 00:17:10.078 --> 00:17:13.400 So, let's not look at ecstasy as a measure of MDMA. 00:17:13.420 --> 00:17:15.600 Let's look at clinical MDMA. 00:17:15.600 --> 00:17:20.029 When you use clinical MDMA, you take it under medical supervision. 00:17:20.029 --> 00:17:21.229 It is pure. 00:17:21.229 --> 00:17:25.720 The MDMA that I'm using in my studies is 99.98% pure! 00:17:27.400 --> 00:17:29.129 Very expensive! 00:17:29.129 --> 00:17:31.029 (Laughter) 00:17:31.029 --> 00:17:32.680 We do it under medical supervision 00:17:32.680 --> 00:17:35.150 with a doctor, and a nurse, and a psychologist. 00:17:35.150 --> 00:17:40.340 And under those conditions, the risks are reduced to an absolute minimum. 00:17:40.340 --> 00:17:42.850 Indeed, after 40 years of MDMA research, 00:17:42.850 --> 00:17:47.870 there has not been a single serious adverse drug reaction, not one! 00:17:47.870 --> 00:17:51.090 And certainly no deaths. 00:17:51.090 --> 00:17:53.700 So, we need to do this research, 00:17:53.700 --> 00:17:59.580 and we need to do this research in an evidence-based, compassionate way, 00:17:59.580 --> 00:18:02.070 looking at the data. 00:18:02.070 --> 00:18:05.749 We need to ignore the socio-political agenda that says any drug 00:18:05.749 --> 00:18:10.780 that's being used recreationally must also be very bad and dangerous. 00:18:11.370 --> 00:18:14.270 That sort of attitude hampers research. 00:18:15.490 --> 00:18:18.120 And we need scientists to drive this. 00:18:18.900 --> 00:18:20.520 It works, it's safe, 00:18:20.520 --> 00:18:22.210 and it offers patients like Claire, 00:18:22.210 --> 00:18:25.540 for the first time in their life, an opportunity to break through 00:18:25.540 --> 00:18:30.220 from that trauma and not become a lifelong chronic PTSD sufferer. 00:18:30.440 --> 00:18:32.440 So, where are we going with MDMA research? 00:18:32.440 --> 00:18:35.630 Well, we've had some studies, we've got more coming here. 00:18:35.630 --> 00:18:38.119 I'm doing a study in Cardiff with neuroimaging, 00:18:38.119 --> 00:18:40.759 in which we're going to give patients with PTSD, 00:18:40.759 --> 00:18:44.270 MDMA and placebo, and we're going to look at that relationship 00:18:44.270 --> 00:18:47.470 between the amygdala and the prefrontal cortex. 00:18:47.470 --> 00:18:49.789 We're also doing a study here in Bristol 00:18:49.789 --> 00:18:53.739 giving patients with alcohol use disorder, MDMA. 00:18:53.739 --> 00:18:57.800 because underlying the root of this addiction is trauma. 00:18:57.800 --> 00:18:59.790 So, this is an exciting time. 00:18:59.790 --> 00:19:01.849 Now people say, "This is controversial!" 00:19:01.849 --> 00:19:04.470 And indeed, I was introduced as a controversial speaker. 00:19:04.470 --> 00:19:05.520 I'm not controversial. 00:19:05.520 --> 00:19:07.530 I'm a very boring conservative doctor. 00:19:07.530 --> 00:19:09.870 I like data. 00:19:09.870 --> 00:19:13.870 I like evidence-based data that helps my patients. 00:19:13.870 --> 00:19:15.819 I'll tell you what's controversial! 00:19:15.819 --> 00:19:18.370 What's controversial is that more people have died 00:19:18.370 --> 00:19:20.770 returning from Afghanistan and Iraq 00:19:20.770 --> 00:19:24.190 because they've committed suicide because of their untreated PTSD 00:19:24.190 --> 00:19:26.980 than ever died in the conflict out there. 00:19:26.980 --> 00:19:30.590 That is controversial, and that is unethical! 00:19:32.370 --> 00:19:35.510 So, this is an important time for science. 00:19:35.510 --> 00:19:40.140 MDMA could be the antibiotic that psychiatry has been waiting for. 00:19:40.140 --> 00:19:43.749 We owe that population of patients who are being failed. 00:19:43.749 --> 00:19:46.040 We owe them this research! 00:19:46.040 --> 00:19:47.808 We owe this to Claire! 00:19:47.808 --> 00:19:49.179 Thank you. 00:19:49.219 --> 00:19:53.759 (Applause)