To sleep, perchance to….rejuvenate, heal, affect mental, emotional, behavioral, and physical wellbeing…and yes, dream?  Unlocking the mystery of why we sleep and what we suffer when we do not is the mission of Dr. Luis de Lecea and his lab in the Stanford University Psychiatry and Behavioral Sciences.  In this segment of What Makes Up Your Mind, you’ll hear about Dr. de Lecea’s discovery of a pair of neuropeptides in the hypothalamus which influence on sleep, wakefulness, stress, and reward.  Called The Hypocretins, their discovery opened a new path of research into how these messengers signal sleep-related activities to the brain.  

Dr. de Lecea and his team are following this path with vigor, aiming to uncover not only the connection between quality of sleep and wellness, but how manipulation of these specific neuropeptides might result in the treatment of mental and brain related illness. Imagine the implications!  

Researchers already know that insomnia is a symptom of some conditions, and that poor sleep quality can make the symptoms of some illnesses worse.  But, by understanding the exact mechanisms at work when the brain is at rest, or deprived of it, those mechanisms could be utilized to mitigate the impacts of everything from depression and anxiety to addiction, to autism, as well as illnesses like Parkinson’s. 
Some of the questions Dr. de Lecea is working to answer more completely are likely some of the same questions you have about sleep: 
Why do we sleep and why, at times, is it so difficult to get quality sleep?
Do all animals sleep?
Do our sleep patterns and what we need from sleep change as we age?
What do we risk, health-wise, when we don’t get the rest we need?
How can we optimize the sleep we do get?

Dr. de Lecea addresses all of these topics, and more, in this podcast, and shares his excitement about new developments on the horizon, including next generation sleep monitoring and therapeutics.
You’ll also learn why our small mice companions are so critical to Dr. de Lecea’s work and in what way we are very much like them! We owe them our gratitude for helping us understand ourselves better.

Read more on the work of Dr. de Lecea and his lab at: https://med.stanford.edu/delecea/home.html 

For help with sleeping issues:   https://stanfordhealthcare.org/medical-clinics/sleep-medicine-center.html

What Makes Up Your Mind - Of Mice & Men & Sleep, with Dr. Luis de Lecea

In the face of record opioid overdose deaths and cases of addiction, this episode of What Makes Up Your Mind offers hope. 

Our guest is Dr. Keith Humphreys, the Esther Ting Memorial Professor in the Department of Psychiatry and Behavioral Sciences at Stanford University, an internationally recognized expert on addiction, treatment, and public policy. He was part of the Obama administration's team when the Affordable Care Act was crafted and passed and was the architect of policy to allow naloxone, a life-saving antidote to opioid overdose, to be used outside health care facilities so that first responders, and even family members and other caretakers could have it at hand. This strategy has saved untold lives. Among his honors, Dr. Humphreys was recognized in 2022 by Queen Elizabeth II for his addiction-related science and policy work in the United Kingdom by being made an Honorary Officer of the Order of the British Empire.

Currently, and in the years during the worst of the COVID crisis, opioid addictions and overdose deaths have been overwhelmingly driven by illegal fentanyl, a synthetic drug manufactured with raw chemicals from China, illegally processed and smuggled into the United States by criminal organizations, primarily Mexican drug cartels, according to the Federal Drug Enforcement Administration. Besides its addictive properties, fentanyl's extreme potency means vast numbers of deadly doses can be trafficked without detection. Fentanyl pills can be disguised to look like other recreationally used prescription drugs and, in powder form, can be laced with other narcotics. 

A dire situation, to be sure, but experts are working to unlock the brain's susceptibility to these addictions, develop new treatment methods, and expand the efficacy of those we already have.  Dr. Humphreys' specialty is critical to putting these advancements to work, crafting strategies to deliver the help to those who desperately need it, and informing policymakers on science-based, structural solutions to the existing epidemic and ways to stop its spread. In our conversation, you'll hear about a commission chaired by Dr. Humphreys in which experts across North America have been working on this challenge. Recommendations from their work have been put into action in a first-ever policy in California designed to protect one of our most vulnerable populations. 

We also discuss research underway to make opioids safer because, as Dr. Humphreys points out, in medical uses, they are effective in relieving acute pain; "We don't just have an opioid crisis, we have a crisis of pain with a lot of people not getting the care they need." You'll learn how patients can work with their doctors to use these pain relievers safely, what loved ones can do to help mitigate risk and assist people who are addicted, the challenges of developing an addiction vaccine, and the latest treatment about which Dr. Humphreys is most optimistic. 

What you'll hear most in this installment of What Makes Up Your Mind, is caring and compassion.  

To learn more about Dr. Humphreys  https://med.stanford.edu/profiles/keith-humphreys
For links to addiction assistance, The American Society of Addiction Medicine  https://www.asam.org/
The Stanford-Lancet Commission on the North American Opioid Crisis  https://opioids.stanford.edu/
The Stanford Network on Addiction Policy – Bridging Science and Public Policy  https://addictionpolicy.stanford.edu/
Dr. Humphreys’ book, “Addiction: A Very Short Introduction” https://global.oup.com/academic/product/addiction-a-very-short-introduction-9780199557233?cc=us&lang=en&facet_narrowbybinding_facet=Paperback&type=listing%20script:;tenable_wasscan_xss_in_element_event=0b8dd304-0a47-4fbd-9fb7-b32a65cec313/&facet_narrowbypubdate_facet=Next%203%20months

What Makes Up Your Mind - Fighting the Deadly Fentanyl Epidemic, with Dr. Keith Humphreys

It is a very human thing to, at times, worry, ruminate, to experience self-doubt: “did I lock the door, did I give anyone this darn cold, what if ______” (fill-in the blank with any one of thousands of thoughts)?  In most cases these episodes are infrequent, centered around a specific incident or situation, and our rational minds step in to interrupt the pattern and alleviate the concern.

However, if we are able, for a moment, to put ourselves in the worst possible moments of those fairly typical situations - the brief panic and dread followed by an uncontrollable impulse to immediately take action - and then extend that feeling, and experience it over and over again, we’ll have an idea of the trauma that Obsessive-Compulsive Disorder, OCD, inflicts on those who suffer from it.   It can be utterly debilitating for between two and three million Americans.  

In this episode of What Makes Up Your Mind, you’re going to learn more about OCD, how to tell if you or someone you love may be challenged by it, and where to get help if you do.  But most exciting, you’re going to learn about the ground-breaking research going on to understand how and why disorders like this one manifest in the brain, and some ground-breaking work to develop fast-acting treatments which, in early trials, have offered near miraculous, temporary relief. 

Dr. Carolyn Rodriguez, professor in Stanford University’s Department of Psychiatry and Behavioral Sciences, is spearheading this research as director of the Translational Therapeutics Lab.  Dr. Rodriguez was the first to investigate the use of Ketamine to treat OCD and continues to test its possibilities as well as trials looking at the efficacy of MDMA, and Nitrous Oxide, or as most of us know it in the dental chair, laughing gas. As Dr. Rodriguez also tells us, new technologies give her and others additional treatment options such as Deep Brain Stimulation, and offer ever better insights into how these mental disorders behave in the brain.

Click to listen, and you’ll also find out how you can participate in these studies, bringing better treatments closer to reality.

More Information

For more on Dr. Carolyn Rodriguez, who also serves as Associate Dean in the Office of Academic Affairs, as Consultation-Liaison at the VA Palo Alto Health Care System, and Director of the Stanford Hoarding Disorders Research Program: https://med.stanford.edu/profiles/carolyn-rodriguez

This is also where you’ll find links to her talks and publications including the book she co-authored, “Hoarding Disorder: A Comprehensive Clinical Guide.”

Additional educational videos by Dr. Rodriguez in both English and Spanish via the Stanford Center for Health Education:
OCD: Signs and Symptoms (English) https://www.youtube.com/watch?v=-Zg6PEJHRoo  (35K views)
Trastorno obsesivo compulsivo (TOC) (Spanish) https://www.youtube.com/watch?v=Mf_mRF6M_Jk&t=83s 
OCD Treatment (English) https://www.youtube.com/watch?v=i4SGc64BwLM&t=2s (10K views)

The Rodriguez Lab/ Translational Lab: https://med.stanford.edu/rodriguezlab.html

To learn more and volunteer for clinical trials in Dr. Rodriguez’s lab: 
https://med.stanford.edu/rodriguezlab/research/healthy-volunteers.html   ocdresearch@stanford.edu, 650-723-4095

For more on Stanford Psychiatry’s Obsessive-Compulsive Disorders Program   https://med.stanford.edu/ocd.html

For clinical care at the Obsessive-Compulsive Disorder Clinic at Stanford  https://med.stanford.edu/psychiatry/patient_care/ocd.html

Additional Recovery and Support: International OCD Foundation: https://iocdf.org/

Conquering OCD With Dr. Carolyn Rodriguez

Our topic on this episode of What Makes Up Your Mind takes us deep into the human brain where stimulation treatments show great promise for relieving psychiatric illnesses.  Already used to treat neural conditions affecting motor skills like epilepsy and movement disorders such as Parkinson’s disease, Deep Brain Stimulation (DBS) has also been beneficial in the treatment of severe Obsessive-Compulsive Disorder (OCD) and is being tested for treatment-resistant severe depression.  Our guest, Dr. Mahendra Bhati, says DBS has the potential to treat many mental illnesses.

Dr. Bhati, Clinical Professor of Psychiatry and Behavioral Sciences and Clinical Professor of Neurosurgery at Stanford, was an investigator in the first controlled clinical trials of DBS for depression, and remains at the forefront of neuromodulation therapy research, including ongoing work with neurosurgeons to employ Deep Brain Stimulation.  He’s also part of the team at the Stanford Interventional Psychiatry Clinic and Brain Stimulation Lab offering these specialized device-based interventions in clinical and research settings:
Transcranial Magnetic Stimulation (TMS)
Electro-convulsive Therapy (ECT)
Vagus Nerve Stimulation (VNS)

As we focus on Deep Brain Stimulation (DBS) in this conversation, the Stanford Interventional Psychiatry Clinic describes it this way:  DBS is an FDA-approved treatment for conditions including Parkinson’s disease, tremor, and obsessive-compulsive disorder. It is an invasive procedure involving neurosurgical implantation of brain electrodes connected to a pulse generator to directly modulate brain circuits and activity. Despite its invasive nature, DBS is considered reversible and associated with few side effects.

In our podcast, you’ll hear Dr. Bhati give an in-depth description of the DBS procedure itself, the results he’s seen, and his process for evaluating candidates for the procedure.  He explains the criteria for using DBS to treat OCD is severe treatment resistance, while using DBS for severe treatment-resistant depression is currently only available through a research study.

In terms of documented efficacy for depression, Dr. Bhati says past studies done as “open label” investigations in which both researchers and participants are aware of the treatment being given showed positive results from DBS.  Later controlled studies did not show greater positive results than so-called “sham treatments” in which the doctor simply goes through the motions without performing the treatment, not unlike using a placebo in a blind study for a pharmaceutical.  However, according to Dr. Bhati, on-going studies continue, using advanced tools like neuroimaging to better characterize patients and neural circuits, as well as investigations of longer duration, to seek better outcomes.

While extremely optimistic and excited about the possibilities DBS holds for alleviating the suffering of psychiatric patients, Dr. Bhati is concerned about how accessible this and other developing treatments will be, and currently are, for those who need them.  One impediment is the shortage of mental health care providers in this arena, so Dr. Bhati directs a clinical fellowship in interventional psychiatry to encourage more young psychiatrists to engage in these new treatment options.  

To add to our fascinating discussion, Dr. Bhati shares his interest in the role of consciousness in mental illness and healing.  Click through to listen, and check the links below for more on Dr. Bhati’s work and where DBS patient trials may be available, including at the Stanford Brain Stimulation Lab.
	
Dr. Mahendra Bhati:   https://med.stanford.edu/profiles/mahendra-bhati
Stanford Interventional Psychiatry Clinic:   https://med.stanford.edu/psychiatry/patient_care/intvpsych.html    
Stanford Brain Stimulation Lab:    https://bsl.stanford.edu/
To search for research trials:  https://clinicaltrials.gov

What Makes Up Your Mind: Deep Brain Stimulation - with Dr. Mahendra Bhati

The mortality rate of eating disorders is the highest of all psychological illnesses, but if you thought they were incurable our expert on this episode of What Makes Up Your Mind has heartening news.  Dr. James Lock is Professor of Child and Adolescent Psychiatry and Pediatrics in the Stanford Department of Psychiatry and Behavioral Sciences. A global expert on eating disorders, Dr. Lock also directs the Stanford Eating Disorder Program for Children and Adolescents.  

As he explains in this episode, eating disorders gradually and sneakily take hold mostly in youth, disrupting physical and emotional development.  Left unchecked serious and debilitating conditions can develop, some with fatal outcomes, including suicide.  But Dr. Lock is having great success treating and curing Anorexia Nervosa and Bulimia Nervosa with Family Based Treatment (FBT) which is exactly the opposite of traditional treatment which isolated the patient and blamed parents for the condition.  He is now researching whether FBT will be as effective against Avoidant Restrictive Food Intake Disorder (ARFID) that often begins in very young children, characterized by profoundly picky eating, appetite struggles, and fears of illness after eating.

As efficacious as FBT has proven to be, access to eating disorder treatment is severely limited so a great focus of Dr. Lock’s work at this time is expanding access as well as training for medical providers.  
Click LISTEN to hear Dr. Lock on the latest science and encouraging news on beating eating disorders and use the links below for additional information and resources.

Dr. James Lock Biography, Research, Publications
https://med.stanford.edu/profiles/James_Lock

“Help Your Teenager Beat An Eating Disorder”  by James Lock, MD, PHD  and Daniel La Grange, PHD
https://www.guilford.com/books/Help-Your-Teenager-Beat-an-Eating-Disorder/Lock-Grange/9781462517480

Stanford Department of Child & Adolescent Psychiatry Eating Disorders Research Program
https://med.stanford.edu/edresearch.html 

Stanford Eating Disorder Program for Children and Adolescents
https://med.stanford.edu/childpsychiatry/clinical/eating_disorders.html

Stanford Child and Adolescent Outpatient Eating Disorders Clinic
https://med.stanford.edu/psychiatry/patient_care/ed.html

Stanford Children’s Health Comprehensive Eating Disorders Program (Family Based Treatment (FTB) Inpatient & Outpatient care through Packard Children’s Hospital)
https://www.stanfordchildrens.org/en/service/eating-disorders-program
https://www.stanfordchildrens.org/en/service/eating-disorders/outpatient-clinic

Stanford Adult Eating Disorders Program
https://med.stanford.edu/psychiatry/patient_care/adulted.html

What Makes Up Your Mind: Beating Eating Disorders, with Dr. James Lock

The Stanford University School of Medicine's Department of Psychiatry and Behavioral Sciences has a great tradition of fundamental science, translational and clinical research, subspecialty expertise, multidisciplinary education, and influential leadership. We invite you to follow our podcast: "WHAT MAKES UP YOUR MIND: Updates from the frontiers of neuroscience, wellbeing, and mental health" hosted by Jane McMillan, broadcast journalist and member of the communications team of the Stanford Department of Psychiatry and Behavioral Sciences. RSSVERIFY

Conquering OCD With Dr. Carolyn Rodriguez

Department of Psychiatry and Behavioral Sciences

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