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