I’m Yoram Youvel. I’m a psychiatrist and neuroscientist at the Hebrew of Jerusalem. And when I was 14 years old, my father died. I was sitting in when my mother and my grandfather knocked on the door asked me out to the corridor.
“Your father’s very sick,” my mother said. “Your father is dead.” And I felt it. A crushing pain in my chest. I can still feel a glimpse of it whenever I think of my father.
He a doctor, a scientist, a paratrooper. He was a young, strong, happy, man. He was my hero. And his death broke my heart.
Do you remember the you felt when someone broke your heart? When your best or your mother died? Or the man you loved told you that he doesn’t love you anymore. You probably do.
But why do we feel mental pain at all? And what’s the between physical and mental pain? And most importantly, how can we make mental better? Together with many scientists and physicians, I spent years searching for to these questions.
Now, growing up, I never heard the words, “We want you to be doctor and a brain scientist like your father.” But somehow that’s happened. Twelve years after my father died, I was a graduate student at Dr. Eric Kandel’s lab at Columbia University. Eric, won the Nobel Prize for his work on the molecular basis of memory, was the mentor. Passionate, energetic and inspiring.
Under his guidance, I studied a receptor. It’s protein that’s part of a synapse. And synapses are structures through which nerve cells communicate with each other. that receptor was a GPCR. That’s a G protein coupled receptor. I’ll what this means in a minute and then you’ll understand what stack of markers is doing here.
And when I that, I didn’t really realize that work on that receptor, which seemed completely unrelated to my future work as a clinical psychiatrist, one day help us in our search for better for physical and mental pain.
Now a big step along that was the work of Jaak Panksepp, my other great scientific mentor. In a classical experiment, Panksepp separated from their mothers for 15 minutes. Never more than that because he loved animals. When puppies lose their mothers, they make sound which is called the separation distress cry. And it goes like this.
(Imitates wailing)
Puppies do it, kittens do it, babies do it. All young mammals do it when they’re in pain or when they miss their mothers. And we all know how this cry makes us feel inside.
Panksepp and his colleagues then traced the brain circuits produce these cries in guinea pigs, and they made a startling discovery. That these are the very same circuits that are active humans feel sad and when they experience depression. And circuits are also part of the brain’s pain matrix that mediates our sensations of physical and mental pain.
But why are we born this terrible gift hardwired into our brains? Well, probably like any pain, mental pain is an alarm system. Its task is to prevent damage. When babies lose their mothers, they hurt they cry. Which brings their mothers back, and it also makes them seek their mothers. the wild, this is life-saving. Puppies and babies cannot survive without their mothers.
So now we know why we mental pain. It is the glue that keeps us together in couples, in families communities. And when someone we love goes away or taken away from us, it’s this pain which draws back together. And once we realize this, then we answer an age-old question that poets and philosophers have been asking for thousands of years.
Does love always hurt? do you think? Does love always hurt? Yes, love hurts, of course. Because that’s what it’s supposed to do. Mental is simply the high price, the very high price, we pay for our ability to love. And personally, and, you know, I’ve been the block a couple of times, personally, I think it’s worth it.
But we’re not entirely defenseless against pain because our brains produce endorphins or endogenous opioids, very own feel-good molecules, the natural remedy for both physical and mental pain. Endorphins are released in the brain aerobic exercise or when we’re close to someone we love, and immediately severe injuries.
And we now know what endorphins do, they attach special receptors in the brain, and the most important them are mu opioid receptors. And just like the receptor I on in Kandel’s lab, mu opioid receptors are GPCR.
Here’s how work. Like all GPCRs, mu opioid receptors are made of seven spirals or loops are stacked together, sticking through both sides of the cell membrane. Like this, OK.
And when attach to mu opioid receptors from the outside, they cause them to their shape. Like this, OK? And this triggers a series of inside the neurons which eventually ease the pain.
Now, the molecules for a second. When you hug someone you love who is suffering severe physical or mental pain, you actually cause her brain to release endorphins. They attach mu opioid receptors in her synapses and turn them on, they soothe her pain.
And yet, sometimes mental pain gets so that no amount of love can soothe it. But medicine has powerful drugs that can ease any physical pain. These the narcotics or opioids like morphine. Narcotics work mainly by activating opioid receptors.
footnote
But if so, can narcotics also treat the pain of separation? was Jaak Panksepp who found the answer. Panksepp gave puppies in a separation experiment tiny, tiny doses of morphine, lower the lowest doses that are used to treat physical pain, and his immediately stopped crying and started playing with each other as if they no longer miss their mothers.
Let’s go humans now. When mental pain in humans becomes too intense to bear people, some people, do anything to stop it, even try to kill themselves. Indeed, I’m saying this as a clinical psychiatrist, unbearable mental pain is a huge risk factor for suicide.
footnote
But if treat physical pain, and if they can soothe the mental of separation, can they also help suicidal people become less suicidal? A few years ago, together with Panksepp and other colleagues, my research team conducted a clinical trial. We gave people were severely suicidal very low doses of a narcotic drug, called buprenorphine, for four weeks.
We discovered that tiny, tiny doses of buprenorphine, which are low to treat physical pain, helped many of them become less suicidal. But narcotics are extremely dangerous drugs. They may addiction, and they’re lethal in overdose. In contrast, endorphins are not lethal in overdose, and they’re much less likely to cause addiction. So and endorphins probably activate mu opioid receptors in different ways.
Now, if we could find drugs that activate mu opioid receptors in way that resembles how endorphins activate them, we might be able to treat physical and mental without some of the dangerous side effects of narcotics. And when my research came to this conclusion, I suddenly remembered what I had learned in Kandel’s lab many, many years ago.
footnote
Some GPCRs be activated by two different drugs at the same time. And when this happens, the may be different from what happens when they’re activated by just one drug. So our team then used molecular computing technologies to create a detailed virtual model of the human mu opioid receptor. And then, with the help of known as molecular docking algorithms, we screened thousands of existing drugs on a model of the receptor.
Eventually, we found a way to teach an old dog, that’s the human mu opioid receptor, some tricks. We found two drugs that are not narcotics, and they work together in very, small doses to activate the human mu opioid receptor.
I’m not telling you their names, because we still have run many tests and clinical trials before we can certain that their combination does exactly what we think it does. But of these drugs have been around for many, many years, and they’ve been used by millions people. So we know that they’re safe for humans.
Here’s our bottom line. Let’s summarize what we’ve seen. First and foremost, mental pain is real. It’s hardwired into our brains. And mental pain an essential part of mourning and depression and sadness. And when it gets severe enough, it can make people suicidal. Endorphins are brain’s natural remedy for physical and mental pain, and they work mainly, not exclusively, but mainly by activating mu opioid receptors.
Now, narcotics also activate mu opioid receptors, but in a that causes addiction and can lead to death. And this is why are so dangerous. New computational technologies have helped us two existing drugs that together may treat physical and mental pain without of the severe side effects of narcotics. However, this is still a work in progress. It would be few years before it may become an approved treatment.
But, and this is last thing I’m going to say, regardless of drugs, you have the ability to help and friends who are in severe physical or mental pain.
Thank you very much.
(Applause)
Footnotes
note
“Panksepp gave his puppies, in separation experiment, tiny, tiny doses of morphine – lower the lowest doses that are used to treat physical pain. And his puppies immediately stopped crying and started playing with each other as if they longer miss their mothers.”
According to results from this 1978 study, morphine-treated puppies were alert and moved about normally while isolated from their mothers.
note
“Unbearable mental pain is a huge factor for suicide.”
For more information about why mental is a significant risk factor for suicide, see here.
note
“A few years ago, with Panksepp and other colleagues, my research team conducted a clinical trial. We gave people who were severely suicidal, very low doses of a narcotic drug, buprenorphine car for four weeks. We discovered that tiny, tiny doses buprenorphine, which are too low to treat physical pain, help many of them less suicidal.”
For more information about these study results, see here.
note
“Some GPCRs can be activated by two different drugs the same time. And when this happens, the result may be different for what happens they’re activated by just one drug.”
For more information about how GPCRs may be activated by different drugs at the same time, see here.