Being Human | Amit Etkin
Channel: World Economic Forum
Date: 21/10/2015

AZT and Prozac were invented in the same year. While patients with HIV have seen good health outcomes, those with mental illness have not been getting better. That’s according to Dr. Amit Etkin, assistant professor of psychiatry at Stanford University. In this video for the World Economic Forum, Etkin explains why he thinks mental illness is not caused by chemical imbalance, but by faulty neural circuits. He’s been pioneering a non-invasive way to stimulate broken wires in the brain.

Click on the link above full for the full presentation, or read highlights below. 

On the price of mental health 
“My job is to try to heal people and help ameliorate their distress. People with emotional disorders like depression or anxiety. The problem has been, however, that psychiatry is at a standstill. Our ability to do anything about that the suffering that we recognize is very limited.”

“This story is going to start almost thirty years ago. 1987 was an interesting year. The stock market crash Black Monday happened. Madonna started reaching the peak of her career and we saw movies like Fatal Attraction. Another very interesting thing happened in 1987 in the biomedical space. AZT was introduced as the first drug approved for HIV, as well as Prozac. Prozac was not the first drug for depression, but it was the first in a new series or new class of drugs called SSRIs - selective serotonin reuptake inhibitors. So where are we now with these two conditions?”

“Well HIV continued to be managed successfully and people now live pretty normal lives now. Depression is a different story. Morbidity and mortality associated with any mental illness has not changed over all of these decades.”

On going beyond checklist psychiatry
“Mental illness overwhelms any other chronic disease, in terms of economic and personal impact, and yet we have not moved the bar. How do we diagnose mental illness? Any psychiatric disorders are defined by subjective reports of that person, and we define it based on a checklist. A checklist you could meet any number of ways, so post-traumatic stress disorder can be diagnosed in six hundred thousand different ways. That doesn't sound like biology to me.”

“So what if we start using biology? Let's say brain-imaging scans. We have been doing a lot of in the lab to try to ask questions about the brain basis of mental illness. There are three hundred plus psychiatric disorders in the diagnostic manual of the United States. Maybe simply having a mental illness, as in being distressed, not being able to understand and express your emotion. That might suggest different disorders, but in fact there may be at least a common thread between them.”

“What I'm showing you here is a brain section that shows where - across all psychiatric disorders - there is decrease in gray matter or brain tissue. In this case it's three regions that are the same three regions that are abnormal across all psychiatric disorders, and they actually form an interconnected circuit that we understand quite well. The brain is made of many circuits. What you see here is brain activity unfolding over those circuits. So our job is to build tools and know how to use them to manipulate those circuits better. We also have to appreciate that brains are a really complicated, interconnected place; we have to untangle it even as we build tools that allows to go much deeper, and more precisely in the brain than we ever could before.” 

On using magnets to fix circuits in the brain
“Let me introduce you to transcranial magnetic stimulation (TMS). What TMS does it is an electromagnet placed outside the head and non-invasively turns on little bits of brain underneath our brain. It is an excitable organ and so we're using an electromagnet to talk to an excitable organ.” 

“These are different networks in the brain that you can see in every single person and they're very much the same, or at least highly similar between people. So what does it tell us? Fortunately with brain imaging it's a story that we tell when we take pictures. When you start to intervene with circuits you get what I call the causal connection. You get information about cause and effect in brain circuits. You can start thinking of modulating these circuits. The trick is finding the right circuit to modulate to get you the effects you want.”