In this episode of Huberman Lab Essentials, my guest is Dr. Karl Deisseroth, M.D., Ph.D., a clinical psychiatrist and professor of bioengineering and of psychiatry and behavioral sciences at Stanford University. We discuss his experiences as a clinician treating complex psychiatric conditions and his lab’s pioneering work in developing transformative therapies for mental illness. He explains the complexities of mental illness and how emerging technologies—such as optogenetics and brain-machine interfaces—could revolutionize care. We also explore promising new therapies, including psychedelics and MDMA, for conditions like depression and PTSD. Read the episode show notes at hubermanlab.com. Huberman Lab Essentials are short episodes focused on essential science and protocol takeaways from past full-length Huberman Lab episodes. Watch or listen to the full-length episode at hubermanlab.com. Thank you to our sponsors AG1: https://drinkag1.com/huberman David: https://davidprotein.com/huberman Eight Sleep: https://eightsleep.com/huberman Timestamps 00:00:00 Karl Deisseroth; Neurology vs Psychiatry 00:01:36 Speech; Blood Test?; Seeking Help 00:04:20 Feelings, Jargon; Psychiatric Treatment 00:09:40 Sponsor: David 00:10:55 Future Treatment; Vagus Nerve Stimulation, Depression, Optogenetics 00:19:40 Brain-Machine Interfaces 00:20:53 Sponsor: Eight Sleep 00:23:00 ADHD Symptoms, Lifestyle, Technology 00:29:34 Psychedelics, Depression Treatment, Risks 00:35:43 Sponsor: AG1 00:37:30 MDMA (Ecstasy), Trauma & Post-Traumatic Stress Disorder (PTSD) Treatment 00:40:33 Projections: A Story of Human Emotions Book, Optimism Disclaimer & Disclosures Learn more about your ad choices. Visit megaphone.fm/adchoices
Chapter 1: What is the difference between neurology and psychiatry?
So for people that might not be so familiar with the fields of neuroscience, et cetera, what is the difference between neurology and psychiatry?
Chapter 2: Why is diagnosing mental illness challenging without physical tests?
Psychiatry focuses on disorders where we can't see something that's physically wrong, where we don't have a measurable, where there's no blood test that makes the diagnosis. There's no brain scan that tells us this is schizophrenia, this is depression for an individual patient. And so psychiatry is much more mysterious. And the only tools we have are words. Neurologists are fantastic physicians.
They see the stroke on brain scans. They see the seizure and the pre-seizure activity with an EEG. And they can measure and treat based on those measurables. In psychiatry, we have a harder job. We use words. We have rating scales for symptoms. We can measure depression and autism with rating scales, but those are words still. And ultimately, that's what psychiatry is built around.
It's an odd situation because we've got the most complex, beautiful, mysterious, incredibly engineered object in the universe, and yet all we have are words to find our way in.
Chapter 3: How does speech affect psychiatric diagnosis?
So do you find that if a patient is very verbal or hyperverbal, that you have an easier time diagnosing them as opposed to somebody who's more quiet and reserved, or it's, I can imagine the opposite might be true as well.
Well, because we only have words, you've put your finger on a key point. If they don't speak that much in principle, it's harder. The lack of speech can be a symptom. We can see that in depression. We can see that in the negative symptoms of schizophrenia. We can see that in autism. Sometimes by itself, that is a symptom of reduced speech. But ultimately, you do need something.
You need some words to help guide you. And that, in fact, there's challenges that I can tell you about where patients with depression who are so depressed they can't speak, That makes it a bit of a challenge to distinguish depression from some of the other reasons they might not be speaking. And this is sort of the art and the science of psychiatry.
Do you think we will ever have a blood test for depression or schizophrenia or autism? And would that be a good or a bad thing?
I think ultimately there will be quantitative tests. Already efforts are being made to look at certain rhythms in the brain using external EEGs to look at brain waves effectively. But ultimately what's going on in the brain in psychiatric disease is physical and it's due to the circuits and the connections and the projections in the brain that are not working as they would in a typical situation.
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Chapter 4: Will we ever have a blood test for mental illnesses like depression or schizophrenia?
And I do think we'll have those measurables at some point. Could it be abused or misused? Certainly, but that's, I think, true for all of medicine.
I want to know, and I'm sure there are several, but what do you see as the biggest challenge facing psychiatry and the treatment of mental illness today?
Chapter 5: What are the biggest challenges in treating mental illness today?
I think we're making progress on what the biggest challenge is, which I think there's still such a strong stigma for psychiatric disease that patients often don't come to us and they feel that they should be able to handle this on their own. And that can slow treatment. It can lead to worsening symptoms.
We know, for example, patients who have untreated anxiety issues, if you go for a year or more with a serious untreated anxiety issue, that can convert to depression. You can add another problem on top of the anxiety. And so it would be, you know, why do people not come for treatment?
They feel like this is something they should be able to master on their own, which can be true, but usually some help is a good thing.
That raises a question related to something I heard you say many years ago at a lecture, which was that this was a scientific lecture and you said, you know, we don't know how other people feel. Most of the time, we don't even really know how we feel. Maybe you could elaborate on that a little bit. And the dearth of ways that we have to talk about feelings. I mean, there's so many words.
I don't know how many, but I'm guessing there are more than a dozen words to describe the state that I call sadness. But as far as I understand, we don't have any way of comparing that in a relationship. in a real objective sense. So how, as a psychiatrist, when your job is to use words to diagnose, words of the patient to diagnose, do you maneuver around that?
And what is this landscape that we call feelings or emotions?
This is really interesting. People, here we have, there's a tension between the words that we've built up in the clinic that mean something to the physicians. And then there's the colloquial use of words that may not be the same. And so that's the first level we have to sort out when someone says, you know, I'm depressed. What exactly do they mean by that?
That may be different from what we're talking about in terms of depression. So part of psychiatry is to get beyond that word and to get into how they're actually feeling, get, get rid of the jargon and get to real world examples of, of how they're feeling. So, you know, how do you, what, how much do you look forward into the future? How much hope do you have?
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Chapter 6: How do psychiatrists interpret and understand patients' feelings and emotions?
How much planning are you doing for the future? So these here, now you're getting into actual things you can talk about that are unambiguous. If someone says, yeah, I can't even, I can't even think about tomorrow. I don't see how I'm gonna get to tomorrow. That's a nice, precise thing that, you know, it's sad, it's tragic, but it's also, that means something. And we know what that means.
That's the hopelessness symptom of depression. And that is what I try to do when I do a psychiatric interview. I try to get past the jargon and get to what's actually happening in the patient's life and in their mind. But as you say, ultimately, you know, this shows up across, I address this issue every day in my life, whether it's in the lab where we're looking at animals.
whether fish or mice or rats and studying their behavior or when I'm in a conversation with just a friend or a colleague or when I'm talking to a patient. I never really know what's going on inside the mind of the other person. I get some feedback, I get words, I get behaviors, I get actions, but I never really know.
Are there any very good treatments for psychiatric disease? Meaning, are there currently any pills, potions, forms of communication that reliably work every time? or work in most patients. And could you give a couple of examples of great successes of psychiatry if they exist? Yes.
And psychiatry, despite the depths of our, the mystery we struggle with, many of our treatments are actually, you know, we may be doing better than some other specialties in terms of actually causing, you know, therapeutic benefit for patients.
We do help patients, you know, patients who suffer from, by the way, both medications and talk therapy have been shown to be extremely effective in many cases. For example, People with panic disorder, cognitive behavioral therapy, just working with words, helping people identify the early signs of when they're starting to move toward a panic attack. What are the cognitions that are happening?
You can train people to derail that and you can very potently treat panic disorder that way. There are many psychiatric medications that are very effective for the conditions that they're treating patients. anti-psychotic medications. They have side effects, but boy, do they work. They really can clear up auditory hallucinations, the paranoia.
And then, you know, this is a frustrating and yet heartening aspect of psychiatry. There are treatments like electroconvulsive therapy, which is where, you know, it's extremely effective for depression. We have patients who nothing else works for them, or they can't tolerate medications. And You can administer under a very safe, controlled condition where the patient's body is not moving.
They're put into a very safe situation where the body doesn't move or seize. It's just an internal process that's triggered in the brain. This is an extraordinarily effective treatment for treatment-resistant depression. At the same time, I find it as heartening as it is to see patients respond to this who have severe depression. I'm also frustrated by it.
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Chapter 7: What effective treatments currently exist for psychiatric diseases?
how it's working or not working in terms of that frame. It's clearly a pump. We don't really have that level of what is the circuit really there for in psychiatry.
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I would imagine there are several elements and bins here, understanding the natural biology, understanding what the activity patterns are, how to modify those. Maybe you could just tell us what you think, what is the bento box of the perfect cure?
I think the first thing we need is understanding. What is the element in the brain that's analogous to the pumping heart? When we think about the symptoms of depression, we think about motivation and dopamine neurons. And so then that turns our attention as neuroscientists. We think, okay, let's think about the parts of the brain that are involved in dealing with depression.
merging complex data streams that are very high in bit rate that need to be fused together into a unitary concept and that starts to guide us and maybe we can and we know other animals are social in their own way and we can study those animals and so that there's that's how i think about it there's hope for the future thinking about the symptoms as an engineer might
and trying to identify the circuits that are likely working to make this typical behavior happen and that will help us understand how it becomes atypical.
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Chapter 8: How might optogenetics and vagus nerve stimulation revolutionize mental health treatment?
Yeah. So starting with the body is a good example because it highlights the opportunity and how far we have to go. So let's take this example of vagus nerve stimulation. So the vagus nerve, it's the 10th cranial nerve. It comes from the brain. It goes down. It innervates the heart, innervates the gut.
By innervate, I mean it sends little connections down to help guide what happens in these organs in the abdomen and chest. it also collects information back. And there's information coming back from all those organs that also go through this vagus nerve, the 10th cranial nerve, back to the brain. And so this is somewhat of a superhighway to the brain then, was the idea.
And maybe the idea is maybe we could put a little cuff, a little electrical device around the vagus nerve itself, so a way of getting into the brain without putting something physical into the brain.
And why the vagus? I mean, it's there and it's accessible. That's the reason. That's the reason?
That's the reason, yes. Really?
Yeah. You're not kidding. I'm not kidding. So stimulating the vagus to treat depression simply because it's accessible.
It started as actually as an epilepsy treatment and it can help with epilepsy, but the vagus nerve lands on a particular spot on the brain called the solitary tract nucleus, which is just one synapse away from the serotonin and dopamine and the norepinephrine.
So there's a link to chemical systems in the brain that make it a rational choice.
Yes, it's not irrational, but I can tell you that even if that were not true, the same thing would have been tried. You got you would have done it anyway. Because it's accessible.
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