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3,4-Methylenedioxymethamphetamine: MDMA.

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Now you've probably heard
of this compound

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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

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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,

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he was physically abusive
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 these 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 clients of her mother

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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.
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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Now, 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,

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and children's houses,
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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When they're 16, they're
buying and selling amphetamine,

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

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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.

242
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She's 40 now.

243
00:12:50,340 --> 00:12:52,780
She's been in and out
of psychiatric hospitals,

244
00:12:52,780 --> 00:12:55,210
having tried to take
her own life in the inception.

245
00:12:55,210 --> 00:12:58,830
She's been on all the antipsychotic
and antidepressant mood stabilizer drugs.

246
00:12:58,830 --> 00:13:01,790
She's tried all the psychotherapies,
but she cannot engage

247
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because she will not talk
about her feelings.

248
00:13:06,320 --> 00:13:11,710
So she comes into a course
of MDMA-assisted psychotherapy.

249
00:13:11,860 --> 00:13:13,529
What does it look like?

250
00:13:13,529 --> 00:13:17,809
It's weekly sessions,
maybe eight, ten, twelve weeks long.

251
00:13:17,809 --> 00:13:21,079
There're two therapists, male-female pair.

252
00:13:21,079 --> 00:13:25,359
You do not take MDMA everyday,
you do not take it every week.

253
00:13:25,359 --> 00:13:28,939
Over that course of 12 sessions,
you'll take the MDMA three times,

254
00:13:28,939 --> 00:13:30,370
and the other sessions,

255
00:13:30,370 --> 00:13:35,010
you talk about the material
that's released on the MDMA session.

256
00:13:35,410 --> 00:13:39,549
So what does Claire actually feel
when she takes this MDMA?

257
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What she feels is a sense of warmth,

258
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and understanding,
and a sense of containment,

259
00:13:46,419 --> 00:13:50,519
within that relationship
she's having with the therapist.

260
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MDMA is like a lifejacket,
like a bulletproof vest

261
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to wear to go into battle
with your trauma.

262
00:13:58,870 --> 00:14:00,999
This is not ecstasy!

263
00:14:01,169 --> 00:14:06,310
She's not enjoying some
raver's euphoric ecstasy delight.

264
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This is still trauma-focused
psychotherapy,

265
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and it's still hard
and distressing for her,

266
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but she can just about do it
with MDMA on board.

267
00:14:14,929 --> 00:14:19,559
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,

269
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but on MDMA she says,
"Yeah, I can talk about that!

270
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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,

272
00:14:31,899 --> 00:14:35,829
and I can feel the stubble on his face
as he's raping me."

273
00:14:35,829 --> 00:14:38,260
And she talks about it,
and she explores it,

274
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and she reflects upon it,
and she can begin the process of healing.

275
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And from here, she can start her journey.

276
00:14:45,639 --> 00:14:49,119
She can attack the root cause
of her problems.

277
00:14:49,119 --> 00:14:52,729
Not just maintain the symptoms at a level.

278
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So, does it work?

279
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Well, we've known about MDMA
for a very long time,

280
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and, indeed, we've used MDMA
in underground therapy for 30 or 40 years.

281
00:15:04,790 --> 00:15:07,409
and there are thousands
of positive anecdotal cases.

282
00:15:07,409 --> 00:15:10,149
I get five emails a week
from all over the world,

283
00:15:10,149 --> 00:15:12,729
"Dr. Sessa, I've had PTSD for years.

284
00:15:12,729 --> 00:15:15,209
I've tried everything,
and now I tried MDMA,

285
00:15:15,209 --> 00:15:17,629
and I'm starting to make a breakthrough!"

286
00:15:17,629 --> 00:15:20,009
Now, anecdotal reports
like that are interesting,

287
00:15:20,009 --> 00:15:22,940
but they're not science,
so we've done the science

288
00:15:22,940 --> 00:15:25,799
and some important studies
in recent years.

289
00:15:26,219 --> 00:15:30,899
Big study in the States showed
that a single course of MDMA therapy,

290
00:15:30,899 --> 00:15:36,309
16-week course, patient takes MDMA
three times, tested against the placebo.

291
00:15:36,459 --> 00:15:37,839
At the end of that course,

292
00:15:37,839 --> 00:15:44,129
85% of the people no longer met
the diagnostic criteria for PTSD.

293
00:15:44,129 --> 00:15:48,640
Not just a relief of symptoms,
they didn't have PTSD!

294
00:15:48,820 --> 00:15:54,010
Now that cohort were then followed up
three years later, the same - no PTSD.

295
00:15:54,010 --> 00:15:58,179
Many of those people had come
off their daily medications.

296
00:15:58,179 --> 00:15:59,950
They were cured!

297
00:15:59,950 --> 00:16:03,010
We don't use the "cure"
word in psychiatry.

298
00:16:03,190 --> 00:16:08,340
We've become learned helplessness
position of ... this is the truth!

299
00:16:08,350 --> 00:16:10,729
If you're diagnosed
with a severe mental disorder,

300
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like anxiety or depression, in your 20s,

301
00:16:13,049 --> 00:16:16,650
and the developmental route
of that disorder is severe child abuse,

302
00:16:16,650 --> 00:16:19,379
there's a pretty good chance,
and I'm sorry to say this,

303
00:16:19,379 --> 00:16:21,859
there's a pretty good chance,
you will still be going

304
00:16:21,859 --> 00:16:24,449
to psychiatric clinics
in your 60s and 70s.

305
00:16:24,449 --> 00:16:27,079
Now that is not good enough,

306
00:16:27,079 --> 00:16:30,989
and we're in this position
because we're not tackling trauma.

307
00:16:31,749 --> 00:16:34,130
So, it works, but is it safe?

308
00:16:35,130 --> 00:16:39,599
When we talk about safety
of clinical MDMA, what we must not do

309
00:16:39,599 --> 00:16:43,659
is look at the risks
of recreational ecstasy.

310
00:16:44,179 --> 00:16:47,000
I don't even know what ecstasy is anymore!

311
00:16:47,000 --> 00:16:49,370
Ecstasy is over here, what is ecstasy?

312
00:16:49,370 --> 00:16:53,340
Some dodgy pill, bought in some
dodgy club, off some dodgy geezer,

313
00:16:53,340 --> 00:16:55,924
that may or may not contain MDMA,

314
00:16:55,924 --> 00:16:59,964
plus or minus, whatever
far more toxic substance.

315
00:17:00,970 --> 00:17:02,319
And indeed, when you hear

316
00:17:02,319 --> 00:17:05,969
about the very high-profile deaths
of people who take ecstasy,

317
00:17:05,969 --> 00:17:08,818
it invariably is not MDMA.

318
00:17:10,078 --> 00:17:13,400
So, let's not look at ecstasy
as a measure of MDMA.

319
00:17:13,420 --> 00:17:15,600
Let's look at clinical MDMA.

320
00:17:15,600 --> 00:17:20,029
When you use clinical MDMA,
you take it under medical supervision.

321
00:17:20,029 --> 00:17:21,229
It is pure.

322
00:17:21,229 --> 00:17:25,720
The MDMA that I'm using
in my studies is 99.98% pure!

323
00:17:27,400 --> 00:17:29,129
Very expensive!

324
00:17:29,129 --> 00:17:31,029
(Laughter)

325
00:17:31,029 --> 00:17:32,680
We do it under medical supervision

326
00:17:32,680 --> 00:17:35,150
with a doctor, and a nurse,
and a psychologist.

327
00:17:35,150 --> 00:17:40,340
And under those conditions, the risks 
are reduced to an absolute minimum.

328
00:17:40,340 --> 00:17:42,850
Indeed, after 40 years of MDMA research,

329
00:17:42,850 --> 00:17:47,870
there has not been a single serious
adverse drug reaction, not one!

330
00:17:47,870 --> 00:17:51,090
And certainly no deaths.

331
00:17:51,090 --> 00:17:53,700
So, we need to do this research,

332
00:17:53,700 --> 00:17:59,580
and we need to do this research
in an evidence-based, compassionate way,

333
00:17:59,580 --> 00:18:02,070
looking at the data.

334
00:18:02,070 --> 00:18:05,749
We need to ignore the socio-political
agenda that says any drug

335
00:18:05,749 --> 00:18:10,780
that's being used recreationally
must also be very bad and dangerous.

336
00:18:11,370 --> 00:18:14,270
That sort of attitude hampers research.

337
00:18:15,490 --> 00:18:18,120
And we need scientists to drive this.

338
00:18:18,900 --> 00:18:20,520
It works, it's safe,

339
00:18:20,520 --> 00:18:22,210
and it offers patients like Claire,

340
00:18:22,210 --> 00:18:25,540
for the first time in their life,
an opportunity to break through

341
00:18:25,540 --> 00:18:30,220
from that trauma and not become
a lifelong chronic PTSD sufferer.

342
00:18:30,440 --> 00:18:32,440
So, where are we going with MDMA research?

343
00:18:32,440 --> 00:18:35,630
Well, we've had some studies,
we've got more coming here.

344
00:18:35,630 --> 00:18:38,119
I'm doing a study
in Cardiff with neuroimaging,

345
00:18:38,119 --> 00:18:40,759
in which we're going
to give patients with PTSD,

346
00:18:40,759 --> 00:18:44,270
MDMA and placebo, and we're going
to look at that relationship

347
00:18:44,270 --> 00:18:47,470
between the amygdala
and the prefrontal cortex.

348
00:18:47,470 --> 00:18:49,789
We're also doing a study here in Bristol

349
00:18:49,789 --> 00:18:53,739
giving patients with alcohol
use disorder, MDMA.

350
00:18:53,739 --> 00:18:57,800
because underlying the root
of this addiction is trauma.

351
00:18:57,800 --> 00:18:59,790
So, this is an exciting time.

352
00:18:59,790 --> 00:19:01,849
Now people say, "This is controversial!"

353
00:19:01,849 --> 00:19:04,470
And indeed, I was introduced
as a controversial speaker.

354
00:19:04,470 --> 00:19:05,520
I'm not controversial.

355
00:19:05,520 --> 00:19:07,530
I'm a very boring conservative doctor.

356
00:19:07,530 --> 00:19:09,870
I like data.

357
00:19:09,870 --> 00:19:13,870
I like evidence-based data
that helps my patients.

358
00:19:13,870 --> 00:19:15,819
I'll tell you what's controversial!

359
00:19:15,819 --> 00:19:18,370
What's controversial
is that more people have died

360
00:19:18,370 --> 00:19:20,770
returning from Afghanistan and Iraq

361
00:19:20,770 --> 00:19:24,190
because they've committed suicide
because of their untreated PTSD

362
00:19:24,190 --> 00:19:26,980
than ever died in the conflict out there.

363
00:19:26,980 --> 00:19:30,590
That is controversial,
and that is unethical!

364
00:19:32,370 --> 00:19:35,510
So, this is an important time for science.

365
00:19:35,510 --> 00:19:40,140
MDMA could be the antibiotic
that psychiatry has been waiting for.

366
00:19:40,140 --> 00:19:43,749
We owe that population
of patients who are being failed.

367
00:19:43,749 --> 00:19:46,040
We owe them this research!

368
00:19:46,040 --> 00:19:47,808
We owe this to Claire!

369
00:19:47,808 --> 00:19:49,179
Thank you.

370
00:19:49,219 --> 00:19:53,759
(Applause)