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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