Why Psychiatry Needs to Add Brain SPECT Imaging, Especially in Complex Cases
One of my own recent interests has been brain plasticity - the ability of your brain to recover, repair, and regain functionality that had previously been lost. This idea conflicts with the conventional view that once you lose brain function, it's permanently lost.
Dr. Daniel Amen is a physician and board-certified psychiatrist. He's written five New York Times bestselling books, and is the medical director of the Amen Clinics in Newport Beach in San Francisco, California; Bellevue, Washington; Reston, Virginia; Atlanta, Georgia; and New York City.
He's also one of the foremost experts on brain imaging science, which is the topic of discussion in this interview. Brain plasticity features heavily in Dr. Amen's work with SPECT imaging.
"About 10 years ago, I wrote a book called Change Your Brain, Change Your Life. It's based on the imaging work that we've done," Dr. Amen says.
"We can actually see the damage in your brain done by a wide variety of things. But on what I call a brain-smart program, you can literally improve the function of your brain, which is happening through neuroplasticity. Your brain can actually look and feel younger, or look and feel more repaired. Very few people know that."
SPECT Imaging - An Invaluable New Tool for Psychiatry
That the human brain has a tremendous amount of 'plasticity' was demonstrated in one of Dr. Amen's studies on active and former NFL players. Football players may have been hit in the head upward of 10,000-20,000 times in their lifetime, and this results in a significant amount of brain damage for many. On Dr. Amen's program, 80 percent of them showed significant improvement, including boosting function and blood flow to the prefrontal cortex.
"We've had this rash of NFL suicides, which just breaks my heart, because what they don't know is that there is help available to them," Dr. Amen says.
Brain SPECT imaging is different from the anatomical MRI or CT scans. SPECT measures blood flow and activity patterns. It looks at how the brain works. It's similar to positron emission tomography (PET) scans, which looks at glucose metabolism. When using SPECT imaging, physicians look for three things:
- Areas of your brain that work well
- Areas of your brain that are low in activity, and
- Areas of your brain that are high in activity
The job then becomes balancing the different areas of your brain. The Amen Clinics have performed over 74,000 scans on people from 90 different countries. Dr. Amen estimates they have more experience with this technology than anyone else in the world.
"It's very exciting," Dr. Amen says. "I often say psychiatrists are the only medical doctors that never look at the organ they treat. And when you never look at it, you miss brain trauma, you miss seizure activity, and you miss toxicity...
I'm a classically trained psychiatrist... I was taught to use psychotherapy and medications, and that's pretty much it. Some of the medications I was taught to use like Xanax, Ativan, or Valium for anxiety disorders, when I first started ordering SPECT scans, I saw that they made the brain look like [it had been exposed to] alcohol, and that they were really toxic to brain function. That horrified me, and it was the imaging work that led me to look for natural ways to decrease anxiety."
... When we make a diagnosis, for example of depression, it's a symptom. It shouldn't be a diagnosis. Making the diagnosis of depression, I tell people, is like making the diagnosis of chest pain. And doctors don't give people the diagnosis of chest pain, because it doesn't tell you what's causing it, and it doesn't tell you what to do it for. Depression is the same way.
If you don't get any physiological data on their brain, how would you target [the treatment] to their brain? It becomes – what's happening in psychiatry today – guesswork and multiple shots in the dark. I just argue with my colleagues that that's just not smart. We can do better."
Common Causes of Depression and Anxiety
Dr. Amen's work shows that most cases of depression and anxiety are really symptoms of underlying brain dysfunction. For example, depression can arise if brain activity is too low in your frontal lobes. This inactivity means you cannot inhibit your negative feelings. Depression can also be a symptom of heightened or excessive activity in your frontal lobes, as this leads to an inability to stop thinking the bad thoughts in your head.
A traumatic brain injury can also result in symptoms of depression. In fact, according to Dr. Amen, this is very common.
Other brain-related factors include toxic exposures, and/or a combination of poor lifestyle habits such as a poor diet and lack of exercise. Dr. Amen's treatments to optimize brain function focus on the four-pronged approach of diet, exercise, nutritional supplements, and correcting negative thought patterns.
How Brain Toxicity Alters Your Behavior
One of the major benefits of SPECT imaging is the ability to identify damage caused by toxic exposures. Dr. Amen explains just how significant such findings can be for the proper treatment:
"I had a patient recently who is diagnosed with ADD. He saw the best ADD doctor in the country. He made the diagnosis basically after 10 minutes of listening to his story. When we scanned him, he had a totally toxic-looking brain. Of course, you have ADD symptoms if you know there's damage to the front part of your brain. It turned out he had arsenic poisoning. He needed a detoxification program, not more Adderall."
He also describes a much more personal case where SPECT imaging turned out to be a veritable lifesaver. Four years into his SPECT imaging work, his sister-in-law called him about her then nine-year-old son, Andrew. The boy had attacked a little girl on the baseball field that day for no particular reason.
"I was horrified, and said, 'What else is going on with Andrew?' She said, 'Danny, he's different. He's mean. He's surly. I went into his room today, and I found two pictures he had drawn. One, he was hanging from a tree. The other one, he was shooting other children.' I've been doing imaging long enough to go, 'You need to bring him to see me.' What we found was he had a cyst the size of a golf ball occupying the space of his left temporal lobe. It's an area we've subsequently really tagged to violent behavior. When they took out the cyst, his behavior went back to normal.
Still, sometimes when I tell the story, I'll cry, because I think about all the people we're throwing away like Andrew as 'bad,' when in fact, they may be sick.
Optimizing the brains of people who struggle, suffer, or even do bad things is not popular. But it's the right thing to do. If someone has problems with aggression, let's scan them and see if they've not had a brain injury. We actually uncovered 20 different brain cysts over the past 2 decades. I had a case last year of a teenage boy who wanted to cut his mother up into little pieces. He had a cyst the size of a tennis ball occupying the space of his left temporal and frontal lobe. We need to look at what we do before we start changing people's brains. It's logical... but the profession is very slow to change. I always argue that there's no downside to looking."
How Brain Dysfunction Can Cause Psychiatric Disorders
In his work, Dr. Amen has identified seven types of anxiety and depressions, six types of ADD, five types of overeaters, and six types of addicts. As an example, he reviews some common types of overeaters and the recommended treatment for them:
Here the front part of their brain works too hard. According to Dr. Amen, that is typically related to a deficit in the neurotransmitter serotonin. When serotonin levels go low (serotonin is, in large part, inhibitory to your brain), your brain starts to over-fire. To address this, Dr. Amen recommends intervention that boosts serotonin. While this can be done using one of the SSRI's – Prozac, Paxils, Zoloft, Lexapros, and Celexa - you can also boost your serotonin levels naturally, using 5-HTP, L-tryptophan, St. John's Wort, or saffron.
"There are multiple studies now with saffron, showing it has equal efficacy to antidepressants, and there are virtually no side effects to taking higher doses of saffron," Dr. Amen says. "A compulsive person leads us to a serotonin intervention. Exercise is also a serotonin intervention. It boosts serotonin in your brain. Head to head comparisons of exercise to Zoloft [show] they're equally effective at 12 weeks, but in 10 months exercise beats the socks off Zoloft."
"Please don't put them on a serotonin drug or a serotonin intervention, because you'll lower their prefrontal cortex more and ultimately make them more impulsive," Dr. Amen warns. "That's why you have the research that came out in the early 90s about Prozac making you kill your mother. Well, in fact, it can disinhibit people, because of what it's doing in your brain. In impulsive people, we want to raise dopamine."
You can raise dopamine with drugs like Phentermine, an appetite suppressant, or Ritalin, Adderall, or similar stimulants. But you can also do it with green tea and with L-tyrosine. "We've actually seen Rhodiola do something very similar in the brain," Dr. Amen says.
- Compulsive overeaters, people who just can't stop thinking about food.
- Impulsive overeaters. Here, SPECT scans usually show low activity in the prefrontal cortex, indicating they cannot inhibit their behavior. They don't really think about food all the time, but as soon as they smell it, they feel the urge to eat. Low prefrontal cortex activity is generally associated with poor impulse control. It's also associated with attention-deficit disorder (ADD).
Using Food as Medicine
Certain foods also raise serotonin, such as simple carbohydrates. This is another explanation for why you can become addicted to sugar, wheat, and pasta. According to Dr. Amen, carbohydrate foods such as sweet potato, brown rice, and oatmeal will also raise serotonin, but not in the same powerful way that will get you addicted, so clearly these are better options.
"A high-protein, low-carbohydrate diet is very good for impulsive people, because it helps them focus," Dr. Amen says. "But it's a disaster for our compulsive people, because they start to focus on the things that upset them."
Another dietary factor of great importance is probiotics, ideally in the form of traditionally fermented foods. According to Dr. Amen, as much as 95 percent of the serotonin in your body is produced in your gut, so strategies designed to optimize gut production of serotonin could certainly go a long way toward optimizing your mental health. I've become truly passionate about teaching people to massively increase the amount of fermented foods they're eating - specifically fermented vegetables, as these are some of the most palatable fermented foods for most people - to replenish the beneficial bacteria that produce serotonin.
Dr. Amen agrees:
"I've really been thinking a lot about gut health. Your gut is really the second brain. They're totally interconnected... If you have a leaky gut or an overgrowth of poor gut bacteria, you are not producing serotonin and the other neurotransmitters that you need to stay healthy.
In the last seven or eight years, my last couple of books have been about the connection between physical health and emotional health, and how people can use food as medicine.
If you look at the spices that have specific brain-optimization qualities –for example, saffron and your mood; cinnamon, it's a natural aphrodisiac that also helps to balance blood sugar and helps people focus; and oregano and rosemary that have been shown to boost blood flow to the brain – really what you eat is either helping your brain function better or it's hurting it."
How to Decelerate the Aging Process in Your Brain
Dr. Amen's book Use Your Brain to Change Your Age is based on his lectures over the last 15 years. In it, he discusses a study done with 8,000 people. What he found was that over time, the blood flow to your brain decreases.
"It's sort of like how your skin falls off your face as you age. The same process is happening in the brain. You can – with your behavior – accelerate the aging process, or you can decelerate it.
... We can actually prove you can improve your brain through the imaging work that we do. There's a whole chapter in the book about reclaiming your brain. Say you've been bad to your brain. You've been overweight. You've drank too much. You didn't exercise. You're one of our NFL players, and you've been hit in the head multiple times. If you adopt a brain-smart program... you can slow or even in many cases reverse the aging process in your brain."
He describes his brain-smart program as six words:
- Brain Envy:"You have to care about your brain, because it controls everything you do: how you think, feel, and act, and how you get along with other people," Dr. Amen says.
- Avoid Bad: "You need to avoid anything that hurts your brain – drugs obviously, brain injuries, obesity, but also sleep apnea. Anything that damages blood vessels damages the brain. Same for hypertension, cardiovascular disease, negative thinking, untreated depression, the standard American diet, and alcohol."
- Do Good: This includes optimizing your diet, getting physical and mental exercise, along with taking helpful supplements. It also includes learning to think in more positive ways.
A couple of years ago, Dr. Amen wrote a home study course for anxiety and depression. When they tested it on participants around the country, a significant percentage of them reported losing 20-30 pounds without trying.
"That got me very excited, because what I realized is with a better brain, you get a better body," he says. "Because ultimately, your health is driven by all of the decisions that you've made in your life, and those decisions come directly from the health of your brain."
You can learn more about the work at the Amen Clinics at www.amenclinics.com. The clinics performed brain SPECT imaging in the context of a full clinical evaluation. They also provide a wide variety of treatment options. The online community, The Amen Solution at Home was developed by Dr. Amen to be a sophisticated coaching program to help people optimize their brains and bodies.
It starts with a neuropsychological assessment tool, which, in about 35-minutes, will test your memory, reaction time, focus, level of stress, and mood. Based on how you score, it gives you personalized games to strengthen your weak areas. It also has brain healthy recipes, relaxation exercises, and teaches participants how to eliminate negative thinking patterns.
"It's one of the tools that our NFL players used," he says. "We're very excited, because as we saw their scores go up, the blood flow to their brain improved.
Working out your brain in a regular way is important... The important thing is to learn something that you don't know anything about. Because if I just kept learning about vitamin D, for example, that would be useful, but it's really not stretching my brain. So I learn about gardening, I learn about cooking, I learn a new language, I go to a new place, or learn a new way to move my body, which I think is incredibly important. But the orthodoxy in my profession is pretty rigid. And I'm saddened by it, because it needs to change. Now it became a mission for me."
While getting a SPECT scan can be expensive, it may save you tons of money in the long run. According to a recent study by Dr. Amen and his colleagues, getting a SPECT scan will change what your doctor does 79 percent of the time.
"He'll give you a different diagnosis or a different treatment plan based on what the scans add to the clinical evaluation," Dr. Amen explains.
"We have a new outcome study that we're publishing on 500 consecutive patients that came to the Amen Clinics who were complicated. After six months, 85 percent showed significant improvements in their quality of life. We are very excited about our work. And we have been teaching our colleagues about it for decades. We're not trying to be proprietary with it at all. There's a whole group in Vancouver that does it based on my work and a whole group in Toronto, Florida, Texas, and Chicago.
But it's horrifying what's happening overall in psychiatry. I would be very cautious about seeing a psychiatrist that is not gathering data on your brain before he or she puts you on multiple medications."
You can also pick up any of Dr. Amen's books, to learn more:
- Change Your Brain, Change Your Life
- Change Your Brain, Change Your Body
- Use Your Brain to Change Your Age
- Unleash the Power of the Female Brain is his latest book, which will be released in February 2013