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Psychedelics & Neurostimulation for Brain Rewiring | Dr. Nolan Williams

Episode 93 Oct 10, 2022 2h 44m 18 insights
In this episode, my guest is Nolan Williams, M.D., a triple board-certified psychiatrist, neurologist and professor of psychiatry and behavioral sciences at Stanford School of Medicine. He is also the Director of the Stanford Brain Stimulation Lab. We discuss clinical applications for brain stimulation, behavioral protocols and novel drug treatments to halt and reverse mental health disorders, including depression and post-traumatic stress disorder (PTSD). We first discuss the neural circuits for self-identity and mood and stress control. We discuss Dr. Williams’ work using transcranial magnetic stimulation (TMS) to depression, trauma, PTSD, and other mood disorders. We then dive deep into the history, biology, modern use, and safety margins of the various psychedelics, including MDMA, LSD, ketamine, ibogaine, ayahuasca, and psilocybin, as well as cannabis and the use of SSRIs in both adults and children. Finally, we discuss behavioral treatments for mental health disorders, including sleep and sleep deprivation, light exposure, exercise, and training to control the brain-heart-rate pathways. Regardless of age, all those interested in mental health should benefit from the incredible breadth and depth of Dr. Williams’ knowledge and the clarity with which he conveys that information. For the full show notes, visit hubermanlab.com.
Actionable Insights

1. Rapid Brain Circuit Re-calibration (SAINT)

Engage in the Stanford Accelerated Intelligent Neuromodulation Therapy (SAINT) protocol, which involves five times the normal TMS dose over five days, using spaced learning theory to optimize brain stimulation. This approach aims to reorganize brain activity, specifically re-timing the dorsolateral prefrontal cortex over the anterior cingulate, leading to rapid and durable remission from severe depression.

2. MDMA-Assisted PTSD Therapy

Under strict medical supervision in a clinical trial, consider MDMA-assisted therapy for PTSD. One to a few sessions have shown significant anti-PTSD effects, with about two-thirds of participants experiencing clinically significant improvement that can last for years.

3. Ibogaine for Memory Reconsolidation

In a medically supervised setting, utilize Ibogaine to re-experience and re-evaluate past life memories, including moral injuries, from a detached, empathetic perspective. This process, often described as a ’life review’ or ‘10 years of psychotherapy in a night,’ appears to facilitate reconsolidation of memories and forgiveness, leading to dramatic improvements in life aspects for individuals with PTSD.

4. Psilocybin for Depression Relief

In a clinical setting, consider psilocybin-assisted therapy for depression, which appears to downregulate and unpair the over-connected subgenual anterior cingulate and default mode network. During the session, ’letting go’ of control and allowing the system to assume a new state is crucial for therapeutic effect.

5. Brain Stimulation for Mood Regulation

Utilize transcranial magnetic stimulation (TMS) to excite the left dorsolateral prefrontal cortex or inhibit the right dorsolateral prefrontal cortex, as both approaches have antidepressant effects. This directly targets the brain’s mood regulatory regions, restoring the governance of the prefrontal cortex over deeper emotional areas.

6. Daily Electrolyte Intake

Dissolve one packet of Element electrolyte mix in 16 to 32 ounces of water first thing in the morning and during physical exercise. This ensures adequate hydration and proper electrolyte balance (sodium, magnesium, potassium) for optimal brain and body function.

7. Daily Meditation & NSDR

Engage in regular meditation, Yoga Nidra, or Non-Sleep Deep Rest (NSDR) protocols, using apps like Waking Up, for various durations. These practices help place the brain and body into different states and can greatly restore cognitive and physical energy.

8. Exercise for Mild Depression

Incorporate regular exercise into your routine, as it appears to be an effective treatment for mild depression. Exercise may work by influencing heart rate and potentially brain-heart connections, contributing to improved mood.

9. ERP for Compulsive Behaviors

For conditions like OCD, engage in Exposure and Response Prevention (ERP) therapy by intentionally exposing oneself to triggers that elicit obsessions, then preventing the compulsive response. This helps the individual learn that the feared outcome does not occur, fostering a ’letting go’ of the compulsion.

10. Consistent Sleep for Mood

For overall mood regulation and mental health, prioritize establishing and maintaining a regular light-dark cycle and consistent sleep rhythm. This helps re-regulate the circadian system, which is often dysregulated in depression.

11. Delay Cannabis Use (Youth)

Parents should avoid exposing children and teenagers (up to age 25, before prefrontal maturation is complete) to high-potency THC cannabis. Early use of potent cannabis can potentially lead to an exacerbation of psychosis later in life, with at least a four-fold increase in psychotic episodes.

12. Acknowledge Alcohol’s High Societal Risk

Recognize that alcohol carries the highest combined personal and societal risk among commonly used drugs, surpassing heroin and cocaine. Despite its cultural ubiquity, it is associated with significant health issues and societal harms.

13. Openly Discuss Mental Health

Engage in open conversations about mental health challenges, as many people experience similar internal struggles. Talking about these issues helps reduce stigma and fosters a sense of shared experience, which can be beneficial for individual well-being.

14. Join Depression Clinical Trials

If experiencing depression or other mood disorders, consider applying for clinical trials at research institutions like Stanford’s Brain Stimulation Laboratory (bsl.stanford.edu). These trials offer access to cutting-edge experimental treatments and contribute to scientific understanding.

15. Cannabis: THC vs. CBD

Be aware that cannabis contains various cannabinoids, with THC being pro-psychotic and pro-epileptic, while CBD is anti-psychotic and anti-epileptic. The effects of cannabis on mental health, particularly psychosis, appear to be related to the proportion of CBD to THC.

Understand that ketamine’s antidepressant effects are significantly linked to its opioid properties, not solely its dissociative effects. While dissociation may be necessary, blocking opioid receptors with naltrexone dramatically reduces ketamine’s antidepressant impact.

17. SSRIs for Mood Disorders

For certain forms of depression, obsessive-compulsive disorder, and generalized anxiety, selective serotonin reuptake inhibitors (SSRIs) can be effective. Their therapeutic action is likely due to brain plasticity effects rather than a direct correction of a ‘chemical imbalance.’

18. Triple Therapy for Circadian Reset

Under strict medical supervision, triple therapy involves sleep deprivation, a calculated phase shift, and simultaneous bright light exposure to re-entrain a dysregulated circadian system, which can produce a profound and durable antidepressant effect. This is not for home use due to complexity and potential for increased anxiety.