May 7, 2026 · 38 min
Neurosurgeons use deep brain stimulation to disrupt OCD and binge eating
Essentials: Compulsive Behaviors & Deep Brain Stimulation | Dr. Casey Halpern
This episode reveals how direct physical modulation of the brain is transforming the treatment of severe, treatment-resistant psychiatric and compulsive disorders.
- 1Deep brain stimulation uses implanted electrodes to deliver targeted electrical impulses that disrupt abnormal brain activity.
- 2Specific neural circuits governing cravings and impulsivity can be modulated to treat severe binge eating disorder.
- 3The field of neurosurgery is transitioning from highly invasive implants toward emerging non-invasive brain modulation technologies.
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Dr. Casey Halpern explains how modulating specific brain circuits can help patients regain control over severe binge eating behaviors.
The brief
Neurosurgery is moving beyond physical trauma and structural repair to directly treat psychiatric conditions. Dr. Casey Halpern joins the podcast to explain how targeting specific brain circuits can disrupt severe, deeply ingrained compulsive behaviors.
At the center of this frontier is deep brain stimulation. By implanting electrodes into precise neural pathways, neurosurgeons can deliver electrical impulses that interrupt the aberrant signaling responsible for obsessive-compulsive disorder.
The same neurological mapping applies to eating disorders. Dr. Casey Halpern explores how identifying the specific brain circuits that govern cravings and impulsivity allows clinicians to intervene in severe cases of binge eating disorder.
While deep brain stimulation currently requires invasive surgery, the field is rapidly evolving. Researchers are actively developing non-invasive technologies that promise to modulate these same deep-brain circuits without opening the skull.
What was said on this episode
17 statements · 9 positive · 4 negative · 2 mixed · 2 neutral
Deep brain stimulation places an insulated wire into a brain region involved in Parkinson’s disease.
“Deep brain stimulation is a procedure where we have to place a very thin wire that's insulated deep into a part of the brain that's involved in Parkinson's disease”
Listen at 1:40
Clinical electrode stimulation can immediately relieve tremor.
“If we can deliver stimulation through that electrode in the clinic, we have immediate relief of tremor.”
Listen at 4:01
Controlled obsessive-compulsive traits can be advantageous, but uncontrolled traits constitute OCD.
“if it can be controlled, it's an asset. But if it goes awry and is uncontrollable, then it becomes obsessive compulsive disorder.”
Listen at 6:39
SSRIs and tricyclics are useful first-line medication options for OCD.
“SSRIs are sort of the first line for OCD, but also tricyclics can be helpful.”
Listen at 7:02
Exposure and response prevention is probably the most effective OCD treatment option.
“Exposure, response, prevention, is probably the most effective option”
Listen at 7:33
About 30% of OCD patients continue suffering despite standard therapies.
“there's still about 30% of patients that still suffer from OCD.”
Listen at 8:17
Surgical OCD treatments generally achieve an approximately 50% responder rate.
“We can generally achieve a responder rate of about 50%”
Listen at 9:51
Perturbing the nucleus accumbens appears to influence compulsive behavior.
“When it's perturbed, it seems to gate compulsive behavior”
Listen at 12:41
Nucleus accumbens-cortical circuits are likely major circuits in compulsive disorders and addiction.
“the nucleus accumbens and the cortical areas that we've been discussing that sort of send projections to these areas are probably at least one of the main circuits involved in these kinds of things.”
Listen at 14:01
Repeated exposure to strong rewards can disrupt normal nucleus accumbens functioning.
“repeated exposure to something like a drug of abuse or any type of reward, that is a really strong reward in a way, it can hijack normal functioning of the nucleus accumbens.”
Listen at 15:30
TMS may identify and modulate circuits that temporarily improve OCD.
“We believe we can use TMS to define a circuit that if modulated, improves ocd, albeit temporarily.”
Listen at 20:52
A targeted TMS treatment for anorexia and obesity may eventually be developed.
“perhaps one day there will be a TMS target for anorexia and obesity.”
Listen at 21:22
Disease-specific human brain studies will eventually enable noninvasive lesion or modulation treatments.
“in the end, it's getting into the human brain that we need to do in the disease specifically, that will eventually lead to a non invasive approach, either a lesion or modulatory approach.”
Listen at 27:13
Stopping cognitive behavioral therapy causes many patients to return to previous behaviors.
“if you stop it, many of these patients go back to their old behaviors.”
Listen at 32:16
Physiological signals can potentially anticipate the onset of impulsive behavior.
“I certainly think that there is a way to use our own body's physiology to anticipate when these impulses are coming online”
Listen at 35:22
Deep brain stimulation has treated roughly 200,000 people, versus compulsive-disorder problems affecting 50 million Americans.
“You know, we've only done about 200,000 deep brain stimulation surgeries ever. So I mean, the problem we're talking about here is 50 million Americans.”
Listen at 36:00
Huberman predicts the discussion will inspire more people to enter medicine or neurosurgery.
“I predict that will be happening. That will happen. Excuse me. As a consequence of what you've shared today”
Listen at 37:16
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