Huberman Lab
Essentials: Compulsive Behaviors & Deep Brain Stimulation | Dr. Casey Halpern
07 May 2026
Chapter 1: What is deep brain stimulation and how is it used in neurosurgery?
Welcome to Huberman Lab Essentials, where we revisit past episodes for the most potent and actionable science-based tools for mental health, physical health, and performance. I'm Andrew Huberman, and I'm a professor of neurobiology and ophthalmology at Stanford School of Medicine. And now for my discussion with Dr. Casey Halpern. Casey, I should say Dr. Halpern, welcome. Thank you.
Great to be here. You're a neurosurgeon, which I consider the astronauts of neuroscience. For those that aren't familiar with the differences between neurosurgery, neurology, psychiatry, if you could just educate us a bit, what does a neurosurgeon do and how do you think about and conceptualize the brain?
Chapter 2: How are compulsive behaviors linked to brain circuits?
The scope of neurosurgery is quite broad. We take out brain tumors. We clip aneurysms in the brain. We take care of patients that have had traumatic brain injury, concussion, spine surgeries, 90% of what neurosurgeons do around the country. taking care of herniated discs and lumbar fusions. So the scope is the entire central nervous system, including the peripheral nervous system.
We take care of patients with carpal tunnel syndrome and nerve disorders. Historically, neurosurgeons did everything in that domain, but now we subspecialize and I'm lucky to be at Penn Medicine, where we can focus on one of these areas. So I'm chief of stereotactic functional neurosurgery.
Chapter 3: What treatments are available for obsessive-compulsive disorder (OCD)?
All I do is deep brain stimulation surgery. And a complement to that is focus ultrasound or transcranial focus ultrasound, which is a non-invasive way to do an ablation in the brain, recently FDA approved. and it's FDA approved for tremor at the moment.
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, for example. But that's actually not the therapy. The therapy is delivering electrical stimulation through the tip of that wire, or one of the tips, as there actually are multiple contacts at the bottom of the wire.
Chapter 4: How does the nucleus accumbens influence addiction and binge eating?
They're very small. It's a bit more like I have to implant a tool to deliver you a medication, but that medication is going to be in the form of electricity, and it's going to be delivered into a very small region of the brain. I'm very privileged to be able to interact with the human brain in this way. It's always in the with the goal of trying to provide somebody with a meaningful therapy.
But when we deliver electrical stimulation, these electrodes, while they might be sitting in a very small region of the brain, there are regions within a few millimeters of where these electrodes are that, if stimulated, could cause a temporary, very brief a moment of laughter, like you said, or a moment of panic.
And of course we can just shut that electrode off, but often these side effects could be therapeutic. And actually that's how we have discovered ways to use deep brain stimulation, not just for movement disorders like Parkinson's disease, but for example, patients with Parkinson's disease,
Chapter 5: What non-invasive brain stimulation techniques are being explored?
that have a psychiatric comorbidity like depression or obsessive compulsive disorder. A lot of these patients are highly compulsive and impulsive. sometimes these problems actually melt away. And we're trying to help their tremor, but the patients also tell us that their gambling issue has gotten better or their mood has improved.
Chapter 6: How can artificial intelligence help predict impulsive behavior?
And why is that? Well, you know, there's probably more than one reason. You know, you can help somebody's mood by making their tremor go away, of course. But we see laughter in the clinic sometimes. And why is that? And that's because we're stimulating parts of the brain that are not just involved in these motor circuits, but they're also involved in
what we call a limbic circuit or part of the brain involved in emotion. And if we learn how to modulate those areas therapeutically, step-by-step, we can actually develop these therapies for other indications like depression.
I would say the most impressive and consistent effect we have when we have a patient with tremor who has been tremoring for the past 20 years, if we can deliver stimulation through that electrode in the clinic, we have immediate relief of tremor.
Chapter 7: What role does awareness play in managing cravings and impulses?
That is the effect that inspired me to be a neurosurgeon when I was in college. I've never really wanted to do anything else except help develop that type of therapeutic for another kind of symptom.
I'd love to learn more from you about OCD. Do you perhaps just tell us what is OCD? What are some brain areas involved? What are the current range of treatments? And what's the difference between someone who is obsessive and somebody who has true OCD?
My perspective on OCD may be a little bit different than a psychiatrist who lives and breathes OCD and sees patients every single day with OCD. I probably take care of three to five patients a year with deep brain stimulation for obsessive compulsive disorder.
Chapter 8: What are the future directions for treating compulsive behaviors?
So I don't see these patients as routinely, but my laboratory is geared as a researcher. I'm very focused on trying to improve outcomes of deep brain stimulation for OCD. So I do feel I have expertise and a perspective to share. I do feel that as a neurosurgeon, I am...
obligated to better understand where the obsessions in the brain come from and how we can interrupt them to stop the compulsion that's associated with the obsession better than we're actually doing it. I've been leading an endeavor with a number of collaborators around the country to try to better understand these circuits in the brain. study them in humans, both invasively and non-invasively.
That would be with an electrode-based surgery, sort of like we do in epilepsy to understand where seizures come from. We want to understand better where obsessions come from, but we're also working with imaging experts and geneticists to understand OCD at a broader level as well. I consider OCD to be a spectrum disorder in a way.
And I apologize to those who might feel that I'm using that term incorrectly. I'm using it in a way to describe patients that have obsessions and even some related compulsions might not meet criteria for OCD. As a neurosurgeon, I'm really obsessive about safety and compulsive about my surgical procedures.
I think that some aspect of OCD, which we often joke about, but we should consider seriously because people do suffer from this, some aspect of it helps us. There are famous CEOs that probably have some level of OCD, surgeons and scientists alike. So perhaps if it can be controlled, it's an asset. But if it goes awry and is uncontrollable, then it becomes obsessive compulsive disorder.
And I tend to see the patients that are the most severe. So they have failed medication and there are multiple medications that are worth trying for OCD. Some can actually be very helpful.
Which neurotransmitter systems do they tend to poke at?
Well, SSRIs are sort of the first line for OCD, but also tricyclics can be helpful. So this is still the serotonin system. But as we know, the serotonin system interacts with the neurodegenerative system and the dopamine system. So it's hard to... be specific to one of these things.
And I think that's also why it's hard for us to predict how these medications are going to work for these kinds of patients. But tricyclics and SSRIs can be very helpful and are definitely first line. And there's others. Exposure response prevention is probably the most effective option, which is kind of like cognitive behavioral therapy, but these are different and offered by psychologists.
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