Understanding & Healing the Mind


Key Takeaways

  • Psychiatry is built around diseases diagnosed with words that don’t appear on scans or neuroimaging – unlike cardiology. We still have a long way to go in our understanding of the brain

  • Treatments in psychiatry can come with frustrations because the drugs and therapies with the best results are non-specific and often have the greatest side effects

  • The hope of optogenetics is to arm physicians with a true causal understanding of circuit underlying certain conditions of mental health disease and inform targeted treatments from there

  • The specificity of optogenetics is only useful if you have an understanding of how to use that information

  • There is a risk with all treatment, but it doesn’t appear that the risks in psychedelics exceed risks tolerated in other branches of medicine

  • “There’s a central cord of optimism that where we’re headed is not only possible but likely.” – Dr. Andrew Huberman

The Art And Science Of Psychiatry

  • Neurologists use imaging to diagnose stroke, Alzheimer’s, brain damage, etc.

  • Psychiatry is built around diseases diagnosed with words that don’t appear on scans or neuroimaging

  • Future of mental health diagnoses: efforts are being made to look at brain waves and imaging but still has ways to go

  • What happens in the brain and psychiatric diseases is physical and measurables will likely be developed

  • Barriers to psychiatry: the stigma of mental health disorders prevents people from seeking treatment

  • Nuances in psychiatry: there is a difference between colloquial use of words and medical use of terminology

  • “You never really know what’s going on in the mind of another person.” – Dr. Karl Deisseroth

  • Sometimes other people observing someone is the best gauge of what’s happening in a person – e.g., husband may see that wife is sleeping more, eating less, and could be heading into depression

  • We actually know very little about the microcircuitry of the human brain

Successes In Psychiatric Treatments

  • Cognitive-behavioral therapy is extremely beneficial in treating panic disorder

  • Successful medications: anti-psychotic medications for schizophrenia – and many medications used for the treatment of various mental health conditions

  • Electroconvulsive therapy is extremely effective in severe depression as long as administered safely and in a controlled environment

  • The most frustrating thing about electroconvulsive therapy is the lack of specificity – you’re causing a brain-wide seizure – but it works

  • Frustration in treatment: some of the most anti-psychotic drugs, therapies, and medications are the least specific and have the greatest side effects but have the best results

  • Vagus nerve stimulation: a way to get into the brain without going directly into the brain

  • FDA approved for depression but is dose-limited because it stimulates everything nearby in the neck

  • Physicians can turn up the intensity in real-time remotely or in-person


  • Some psychiatrists sample small doses of drugs to understand what patients feel and side effects

What Will Move The Needle In Psychiatric Treatment?

  • Frustrations: (1) psychiatrists don’t have the level of understanding that other fields of medicine have – it isn’t like cardiology with a clear understanding of biology and physiology; (2) symptoms vary across people

  • Need clearer understanding: most psychiatric treatments have been discovered serendipitously

  • Anti-depression drugs were first created to cure tuberculosis


  • Need to identify circuits and patterns of activity driving activity in “healthy” state versus “non-healthy” state – to allow treatment along the path in a targeted manner

Defining Channelrhodopsins & Optogenetics

  • In plants channelrhodopsins function as light-gated ion channels – when a light particle hits them, ions rush in the pore

  • The movement of ions across the membrane is how the human brain and neural code for on and off

  • Mechanism of channelrhodopsins spurred the new field of optogenetics

  • Optogenetics: control neurons with algae protons (channelrhodopsins) using light – used to understand and manipulate sensation, cognition, action

  • Protocol of gene injection: channel rhodopsinsare are put into a vector (adeno-associated virus (AAV)) packaged with DNA and injected into a specific part of the body depending on the desired outcome

  • Protocol of light delivery: inject ½ mm light-emitting photon under the skin

Future Of Channelrhodopsins And Optogenetics

  • Early barriers to overcome: channelrhodopsins don’t move many ions because they have a small current so have to pack a lot in without damaging cells

  • 2007 put channelrhodopsins in mice to control actions in mice

  • 2021 put channelrhodopsins in the eyes of human beings and made a blind person see

  • The broader significance of optogenetics is understanding because once you know how circuitry works and what matters, treatment options become more grounded

  • In principle, channelrhodopsins will enable treatments to turn on or off specific regions of the brain which lead to depression, anxiety, etc.

  • Optogenetics would allow for more precise stimulation methods without affecting other parts of the body

  • The specificity of optogenetics is only useful if you have an understanding of how to use that information

Using And Understanding Cues From The Body

  • The eyes are rich in information – eye contact can be intense, mistimed, avoided, absent

  • The pairing of what’s going on in eyes with body language, verbal cues provides additional information

  • Psychiatrists learn to hone in on whatever data stream is given and can detect changes in tone of voice, eyes, etc. to inform diagnoses

Brain-Machine Interface

  • Brain-machine interface: devices that will stimulate patterns of activity of neurons

  • Using electrodes to gather information from neurons will allow us to understand what’s going on in the brain but still has risks

  • Could allow information collection and stimulation only when needed and with greater specificity

  • Identify patterns to target psychiatric interventions and timepoints

ADHD

  • ADHD: symptoms of hyperactive or inattentive states; the key thing is that it’s present across different domains of life and isn’t specific to one setting

  • There is debate about what percentage of the population with symptoms should be treated with medicine

  • Working on quantitative EEG diagnosis

  • It’s debatable whether behaviors and interactions with the sensory world could induce or activate ADD or ADHD – it must be disrupting social or occupational functioning in non-adaptive ways

Psychedelic Medicine

  • Psychedelics create both an opportunity for therapeutic benefit and a risk

  • This is not the first time there has been a movement of psychedelics for medicinal purpose

  • Psychedelics alter the experience of reality in precise ways and there is an opportunity

  • There is a risk with all treatment, but it doesn’t appear the risks in psychedelics exceed the risks tolerated in other branches of medicine

  • Patients with depression are often stuck and can’t look to the future so they discount the value of their own action – psychedelics may improve this symptom by opening new paths or representations of seeing future or altered state

  • MDMA increases brain levels of dopamine and serotonin modulator which can be useful for the treatment of trauma

  • The brain learns from the experiences of psychedelics: psychedelics elicit experience at the moment and lasting impact after

Tips For Stress Mitigation And Improved Focus

  • Carve out protected time to just think – can even be while driving – any time to sit still

  • Make time for yourself without a phone, checking email, notifications, etc.

  • Learn to be physically still

  • Embrace that different stages of life come with unique needs


 

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