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(applause)

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3,4-Methylenedioxymethamphetamine: MDMA.

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Now you're probably heard 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 very important treatment 
for psychiatry because MDMA could offer us

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in psychiatry for the first time the
opportunity to tackle trauma.

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And psychological trauma 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. 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 with

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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

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with mental disorders and addictions has
brought me to the door of MDMA.

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And I'm gonna propose today 
that MDMA could be

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important for the future of psychiatry
as the discovery of antibiotics was

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for general medicine a hundred years ago.

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So when we think about child abuse we think
about physical abuse, mental abuse,

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emotional abuse, sexual abuse and neglect.

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And we think about noxious environments.

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We think about parents with mental disorder. 


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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 
when she was growing up?

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Well, her mother was depressed.

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Now unfortunately the family
doctor didn't have time to accurately

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diagnose and treat depression, rather,

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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 what we call 
psychosomatic symptoms in depression,

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and as a result the family doctor 
put her on to opiate based painkillers

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which she promptly became addicted to.

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Now Claire's father, now he was alcoholic and he was often

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not around in and out of prison.

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Which is just as well 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

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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 by

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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 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 to

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rationalize the situation and we can use

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our prefrontal cortex to overcome that

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instinctive fear response from the amygdala.

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Now when Claire was growing up

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she never knew from one moment to the next

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whether the adult coming into the room,
were they 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

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is what we call
post-traumatic 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 hyper vigilance:

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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, when the patient has sudden
remembrances of painful traumatic memories.

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They can just pop into the head

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at any time, 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 and this results in

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them freezing or dissociating
to try and block out the pain.

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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 and

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was using street heroin
when Claire was a teenager.

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Because of the way the war on drugs has
set up that reduces access to treatment

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for people with opiate dependence,
she had to pay for her

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heroin using sex work 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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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,
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 for weeks, months, decades.

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They have to keep taking them because
the drugs we use to treat trauma when it's

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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
and this will lower the temperature

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and 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

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again a broad range of these: DBT, CBT,
EMDR, trauma focused psychotherapy,

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CAT, APT... Now all of them have a pretty

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similar approach which actually is an old wives tales which is:

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a problem shared is a problem halved.

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"Let's talk about your trauma.
Claire tell me about your rape."

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Now that's fine for 50% of patients 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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By the time she was 15 Claire had been
removed from the family home and she was

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

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hostels where the abuse continued.

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She was self-harm cutting and
she started drinking and

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

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Sometimes working in psychiatry can feel
pretty desperate, 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 do not get to the

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root cause of the problem, the trauma.

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They paper over the cracks.

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And I think the pharma industry know this
and they queue up and they

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provide us with product after product to
give to our patients that doesn't quite

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cure them 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 where
we were in general medicine 100 years ago.

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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 we discovered the antibiotics.

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Not symptomatic treatment 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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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: 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

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switch 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 who's

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being abused and we throw money at our
television sets on these campaigns to

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improve the lives of these
poor little innocent victims.

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Well, 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 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. You brought this
upon yourself. It's your lifestyle choice."

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And I'm quite shocked and having worked in
pediatrics and seen the developmental

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trajectory that is so inevitable from
early trauma into adolescent and then

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adult mental health and addictions, 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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I would suggest that if you were to invent
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 its receptors
and its subjective psychological effects

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ticks all the right boxes.

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At one level of receptors it causes
a 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 and this
puts the patient into the optimal arousal

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zone where they can engage in psychotherapy.

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But perhaps the most important thing about
MDMA and the most important clinical tool

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is its ability to provide a sense of empathy
and understanding and emotional security.

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It can hold the patient in a place 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 is

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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

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that fear response whilst 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
and 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 and the

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other sessions 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 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
and it is 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.
I can smell the whiskey on his breath and

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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
and she reflects upon it

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

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I've tried everything and now I tried MDMA
and I'm starting to make a breakthrough!"


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Now, anecdotal reports like that are
interesting but they're not science so

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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, 16-week course,

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patient takes MDMA three times
tested against a placebo.

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At the end of that course 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 of
their daily medications.

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They were cured! We don't use the word
"cure" 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 like anxiety or depression

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in your 20s, and the developmental route
of that disorder is severe child abuse,

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

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

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psychiatric clinics in your 60s and 70s.

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Now that is not good enough and

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we're in this position because we're not

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tackling trauma. So, it works but is it

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safe? Well, when we talk about safety of

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clinical MDMA, what we must not do is

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look at the risks of recreational

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ecstasy. I don't even know what ecstasy

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is anymore!

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Ecstasy is over here, what is ecstasy?

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Some dodgy pill bought in some dodgy

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club of some dodgy geezer, that may or

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may not contain MDMA plus or minus

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whatever far more toxic substance. And

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indeed when you hear about the very

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high-profile deaths of people who take

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ecstasy, it invariably is not MDMA. So,

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let's not look at ecstasy as a measure

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of MDMA. Let's look at clinical MDMA. Now,

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when you use clinical MDMA, you take

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it under medical supervision. It is pure.

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The MDMA that I'm using in my studies is

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99.98% pure! Very expensive! 
(laughter)

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We do it under medical supervision with

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a doctor and a nurse and a psychologist.

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And under those conditions the risks are

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reduced to a absolute minimum. Indeed

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after 40 years of MDMA research, there

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has not been a single serious adverse

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drug reaction, not one! And certainly no

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deaths. So, we need to do this research

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and we need to do this research in an

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evidence-based, compassionate way. Looking

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at the data. We need to ignore the

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socio-political agenda that says any

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drug that's being used recreationally

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must also be very bad and dangerous. That

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sort of attitude hampers research. And we

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need scientists to drive this. It works,

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it's safe. And it offers patients like

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Claire for the first time in their life

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an opportunity to break through from

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that trauma and not become a lifelong

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chronic PTSD sufferer. So where were we

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going with MDMA research? Well, we've had

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some studies, we've got more coming here.

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I'm doing a study in Cardiff with

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neuroimaging in which we're going to

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give patients with PTSD MDMA and placebo

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and we're going to look at

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that relationship between the

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amygdala and the prefrontal cortex. We're

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also doing a study here in Bristol

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giving patients with alcohol use

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disorder MDMA, because underlying the

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root of this addiction is trauma. So this

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is an exciting time. Now people say: "This

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is controversial!" And indeed, I was

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introduced as a controversial speaker.

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I'm not controversial, I'm a very boring

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conservative doctor. I like data.

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I like evidence-based data that helps my

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patients. I'll tell you what's

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controversial! What's controversial is

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that more people have died returning

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from Afghanistan and Iraq because

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they've committed suicide because of

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their untreated PTSD then ever died in

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the conflict out there. That is

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controversial and that is unethical! So

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this is a important time for science.

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MDMA could be the antibiotic that

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psychiatry has been waiting for. We owe

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that population of patients who are

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being failed,

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we owe them this research! We owe this

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Claire! Thank you.
(applause)