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