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Miswiring and neuroplasticity

Try out the back seat.

Check out Andrew Huberman’s Episode #AMA 16 – a question and answer episode. The segment on OCD is a great explanation and summary of where OCD is at now – in terms of being understood so we can hopefully hack the crap out of it.  I’m sure this content isn’t supposed to be shared since it’s behind a paywall. But I would love AH to come after me. I hope he does. : )

Seriously, as usual, Mr. Huberman has the most down-to-earth, understandable grouping of words ever in all I have heard and read on OCD. So he would want me to share this with you, I am sure.

This bit is at (00:26:58) Getting Closer to Unraveling OCD

QUESTION:  Are we any closer to finding the cause of OCD?

Well, I think we know what causes OCD. I think it’s pretty clear that OCD is some form of miswiring in the basal ganglia. The structures of the brain that are involved in go action and no go, withholding, action type behaviors.

And some malwiring of those structures to the dopamine reward system because here’s what’s interesting about OCD. OCD involves obsessions obviously. That’s the O in OCD. Compulsions, the actions. That’s the C in OCD. But in a kind of weird twist of the neurology, OCD is a situation where the compulsion does not remove the obsession. Rather, it exacerbates it, OK? The compulsion does not remove the obsession. It exacerbates it.

So unlike an itch that you scratch, with OCD, the scratching of the itch makes it worse, which is actually what we experience when we have a mosquito bite, which by the way, I absolutely loathe mosquito bites. It’s one of my least favorite things in life. I have about 3,600 and counting pet peeves. That’s definitely high on the list of those.

The obsessive compulsive disorder is one that really needs to be treated, frankly, neurologically. It’s one for which there are behavioral interventions, but it’s clear that adjusting the pharmacology of the neural circuits involved in OCD really can help. Again, there are behavioral treatments. But for severe cases of OCD, it’s just very, very clear that interventions, which include SSRIs, which have been demonized. A lot of people say, oh, selective serotonin reuptake inhibitors are terrible. Blah, blah, blah, blah. You know, the serotonin hypothesis of depression isn’t true.

Well, listen, the reality is this that all treatments for depression that are effective, which include SSRIs, in some cases, cognitive behavioral treatments, all of these sorts of things, which are shown efficacy, are all about what? They’re not about serotonin. They’re about neuroplasticity.

That’s why some antidepressants center on dopamine and norepinephrine. Others center on serotonin. They’re about neuroplasticity. They’re about changing neural networks. They’re not about neurochemical per se. But the neuromodulators such as serotonin allow an access point. They are a wedge into the neuroplasticity process.

Now with OCD, in order to overcome these malwirings, it’s very important to get plasticity. How do you get plasticity? Well, in my belief, you work with an excellent psychiatrist who can prescribe the appropriate dose of drug to release the appropriate amount of neuromodulator. Then, and this is really key, you have opened up the window for plasticity, but then it’s really important that the proper behaviors are engaged in.

And when I did an episode on OCD, I talked about what some of these are. For instance, the person is exposed to the stimulus that causes the obsession, or maybe the obsession arises spontaneously. They feel the impulse to complete the compulsion, the behavior, and they resist with the support of a therapist, but they’re doing this in the context of having elevated levels of serotonin or some other neuromodulator that then allows fewer trials of resistance.

Fewer times of needing to withhold the behavior that this person so badly wants to perform because it’s coming from within. It’s this compulsion literally. Then they are able to achieve plasticity more quickly. Perhaps also transcranial magnetic stimulation. So a conjunction of correct behavior, the withholding behavior, maybe a replacement behavior that’s often used. Use a replacement behavior with the appropriate neurochemical milieu is the solution to OCD.

Here’s some info about Andrew Huberman, if you don’t know him. Here’s the link to the podcast episode I stole the above passages from. It is the February 28, 2024 episode AMA #16: Sleep, Vertigo, TBI, OCD, Tips for Travelers, Gut-Brain Axis & More.

And more of AH on OCD. Plus articles. Right here.

OCD, SSRIs, CBT, ERP, TMS, ECT, MDD, GAD, DBT, OMG.

Thank you to Andrew Huberman for making science make sense.

Thank you #scientists #doctors #research #neuroplasticity

xoxo, d and ruff ruff, bella

 

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