• Contents
  • Key Takeaways
  • Source
  • Full Notes
  • Support the Podcast
4 Min Read
Last Updated: 12.06.23

Dr. Casey Halpern: Biology & Treatments for Compulsive Eating & Behaviors

Huberman interviews Dr. Casey Halpern, a neurosurgeon specializing in deep brain stimulation for movement and compulsive disorders. They discuss treatment options and future directions in brain stimulation for psychiatric illnesses, including eating disorders, OCD, and tremor. This episode explores the biology of these conditions and their therapeutic approaches.

Key Takeaways

High level takeaways from the episode.

Deep brain stimulation (DBS) used to treat severe obsessive-​​compulsive disorder (OCD)

  • Neurosurgeons like Dr. Gordon Baltuch perform DBS on 3–5 OCD patients per year
  • Research focused on improving outcomes of DBS for OCD

Obsessions and compulsions exist on a spectrum

  • Some level of OCD can be helpful in certain professions (e.g., surgeons, CEOs)
  • Uncontrollable obsessions and compulsions lead to a diagnosis of OCD

Current treatments for OCD

  • SSRIs (selective serotonin reuptake inhibitors) — first-​​line treatment
  • Tricyclics — also target serotonin system, interact with noradrenergic and dopaminergic systems
  • Exposure response prevention — a type of cognitive behavioral therapy offered by psychologists

Dr. Baltuch’s research aims to better understand brain circuits involved in OCD

  • Invasive and non-​​invasive methods used to study human brain circuits
  • Collaboration with imaging experts and geneticists to understand OCD at a broader level

Cognitive therapies and exposure to stressors can help patients with OCD

About 30% of patients still suffer from moderate to severe OCD

Current therapies for severe OCD include deep brain stimulation surgery and capsillotomy (ablation approach)

  • Both have a responder rate of about 50%, but responders still have symptomatic OCD

Brain areas involved in OCD

  • Dysregulated cortical control areas 
    • Orbital frontal cortex (OFC)
    • Prefrontal cortex
  • Basal ganglia (subcortex)
    • Caudate putamen
    • Dorsal striatum
    • Ventral striatum (including nucleus accumbens)

Compulsive behavior can be seen in various conditions, such as eating disorders and addiction

  • Common denominator: urge to engage in behavior despite the risk

Nucleus accumbens is a part of the brain’s reward circuits

  • Interconnects with many parts of the brain and has various functions
  • Involved in managing urges for rewards, especially when those urges put oneself or others at risk

Not all individuals with obesity have eating disorders, and not all individuals with eating disorders have obesity

Loss of control eating is a common feature in eating disorders, obesity, addiction, and OCD

  • Nucleus accumbens may play a role in the development and maintenance of these conditions

In mice, exposure to high-​​fat food can alter the functioning of the nucleus accumbens within two weeks

  • This altered function may predispose continued behavior and eventually lead to habit development

Binge eating disorder: most common eating disorder, affecting 3–5% of the population

Two-​​hit hypothesis for the development of binge eating disorder

  • Predisposition: all humans have some level of predisposition due to the availability and palatability of modern foods
  • Second hit: could be related to anxiety or other factors that trigger the onset of the disorder

Deep brain stimulation as a potential treatment for binge eating disorder

  • Goal: restore normal functioning to the nucleus accumbens, which is involved in reward processing and can be hijacked by strong rewards like high-​​fat foods or drugs of abuse
  • Human trial in progress

Binge eating disorder patients may binge about once a day or lose control multiple times a week

  • Binge: eating an enormous amount of food in a brief period of time with a sense of loss of control

Both elevated and decreased autonomic arousal and alertness can lead to binge eating

  • Anxiety or stress can trigger binge eating
  • Alcohol consumption can also lead to binge eating, despite its sedative effects

Cheap, refined foods can be dangerous and change reward circuits

  • Headaches from eating such foods may be an evolutionary advantage

Stressful events or recurring stressors can contribute to eating disorders

  • Society’s stigmas around obesity and anorexia can exacerbate the problem

Neurosurgeons are like “astronauts of the brain”

  • This research is on the extreme edge of what we don’t know about brain function

Researchers listen to and analyze single neurons to understand their role in cravings

  • The goal is to identify craving cells and deliver stimulation safely to elevate mood and disrupt the craving-​​binge cycle

Anorexia is a deadly psychiatric condition with a high mortality rate

  • The nucleus accumbens, part of the brain’s reward circuit, may also be involved in anorexia

Preliminary studies have shown benefits of deep brain stimulation targeting the nucleus accumbens for anorexia

Transcranial Magnetic Stimulation (TMS) is FDA approved for depression, OCD, and nicotine addiction

  • Targets frontal lobe for depression and OCD, different target for addiction

Transcranial Magnetic Resonance Guided Focused Ultrasound (MRI-​​guided focused ultrasound) is FDA approved for delivering ablations non-invasively

  • FDA approved for treating tremor in Parkinson’s and Essential Tremor patients

Essential Tremor is the most common neurologic condition in patients over 70

  • 10 times more common than Parkinson’s
  • Lacks public awareness and champions like Michael J. Fox for Parkinson’s

Importance of awareness

  • Detecting internal states and recognizing when veering towards negative behaviors
  • Powerful tool for managing mental health conditions
  • Some patients still struggle despite high awareness and treatment resistance

Artificial Intelligence’s Role

  • Some labs use signature patterns within voice and other cues to help predict depressive episodes
  • Machine learning and AI could potentially help anticipate impulsive behaviors


We recommend using this distillation as a supplemental resource to the source material.

  • Dr. Casey Halpern: Biology & Treatments for Compulsive Eating & Behaviors

    Huberman Lab #91

    Huberman interviews Dr. Casey Halpern, a neurosurgeon specializing in deep brain stimulation for movement and compulsive disorders. They discuss treatment options and future directions in brain stimulation for psychiatric illnesses.

Full Notes

Support the Podcast