Dr. Daniel Amen: Brain SPECT Scans
- Wednesday, 09 May 2012
My mother recently told me about a webinar she participated in with a psychiatrist whose main focus is ‘brain science’. She was very excited to discover his work because she is a world-renowned therapist and pioneer in the development of social services for survivors of mass atrocity crimes—specifically Holocaust survivors.
The doctor she was referring to is Dr. Daniel Amen, a physician, psychiatrist, teacher and five-time New York Times bestselling author who has written 30 books (and another one is on the way). Dr. Amen is “the brain guy” – one of the world’s foremost experts on applying brain imaging science to clinical psychiatric practice. He is doing incredible work that is changing the way doctors think about and treat psychiatric disorders.
I was very excited to interview Dr. Amen. He was passionate, down-to-earth, inspiring, and funny! I hope you enjoy reading the interview as much as I enjoyed interviewing him.
Naturally Savvy (Andrea):What inspired you to become a psychiatrist?
Dr. Amen: I went to medical school wanting to be a pediatrician, but four months into my schooling my wife tried to kill herself. She was referred to the Department of Psychiatry and after working with them and seeing how they helped her, I fell in love with the practice. I really liked the idea of learning about people’s lives and helping them be better overall in their lives.
Before medical school, I was an X-ray technician and I learned a lot about organs. I kept asking my professors, “Why aren’t we looking at the brain the same way we study other organs? Isn’t the brain an organ of behavior?” All other types of practitioners take a look at the organs they are treating, so it didn’t make sense to me why psychiatrists were just guessing about the brain.
In 1988 I started doing a study called Quantitative EEG that looks at electrical activity in the brain. In 1991 I attended my first lecture on brain SPECT imaging, a technique that looks at blood flow and activity patterns in the brain. This literally changed my life. I started scanning my patients, and it made a huge difference for me, and them!
Naturally Savvy (Andrea): What were you able to see that others couldn’t by using the SPECT scans?
Dr. Amen: After looking at tens of thousands of brains, I realized that our brain controls everything we do, think, feel and act. When our brain works right, we work right. When our brain is in trouble, we are much more likely to have trouble in our lives.
When I graduated medical school I wanted to be a great psychiatrist and a great writer. I wanted to translate what researchers were doing and make it easy to understand for the general public. What ended up being a totally unexpected path for me was arguing with my colleagues that psychiatrists should start acting like other doctors and start looking at the organ (the brain).
Naturally Savvy (Andrea): Does having the ability to really get to know someone by looking at their brain come into play in other areas of your life? Can someone really have the perfect brain?
Dr. Amen: Yes and yes. I scanned my mother and she has an unbelievably beautiful brain (I was so irritated that day. I had such brain envy!). My mother, who raised me, was a very unusual woman. She has a drop-dead gorgeous brain and as a result she is sweet, reliable, balanced, and predictable—and because of this I expected all women to be like her. But they weren’t! I realized that if I was going to date someone, I really needed to scan their brain to see who they really are. It’s a running joke in our house that if you date one of my daughters for more than four months, you need to get your brain scanned!
Naturally Savvy (Andrea): You said when your brain is in trouble you are in trouble. Does that work both ways?
Dr. Amen: As I learned more about the research, I realized that if someone has hypertension, diabetes, sleep apnea, etc. all of those conditions can negatively affect and damage brain function. There are 18 published studies that state as your weight goes up, the physical size and function of your brain goes down. That conclusion should scare the fat off anyone! I call it the “Dinosaur Syndrome” – big body, little brain. And if we continue on the obesity path we are on, we are going to become extinct!
Naturally Savvy (Andrea): Your research paves the way for how any mental illness or psychiatric disorder can be diagnosed and treated. This is very exciting information.
Dr. Amen: Someone can kill himself or herself, and no one will look at their brain. Another person can murder six people and society will label them as ‘bad’ and put them on trial for life, but no one will take the time to really look at their brain to try and figure out why they did it in the first place. It’s crazy!
My work has allowed me to take a deeper, more thoughtful look into why people do what they do. I just happened to fall in love with the three pound piece of mush between my ears (and your ears) and it has been the most exciting, wild ride.
Naturally Savvy (Andrea):Are you the only one doing brain SPECT imaging?
Dr. Amen: For many years I was one of only a few, who did it, but now there is a budding movement and people are beginning to embrace this work. Truth be told, those who don’t join in are going to get left behind. Hospitals now do it, and there are clinics opening everywhere including my own. We will have six by the end of the summer across the U.S.
Naturally Savvy (Andrea): Do you find you meet resistance to your work and if so, why?
Dr. Amen: Yes. Researchers are always saying: “you’re work is too experimental and it’s not proven.” So I say, “Where is it proven that if you give a psychiatric patient six medications they have a long-term positive response?” Nowhere, that’s where. It is crazy and this is literally what is happening around the world. People are ending up on multiple medications but there is no actual science to prove that it is useful for them.
My profession needs to be fixed if we are really going to be honest with ourselves.
Naturally Savvy (Andrea): How does the radiation given off by a brain SPECT scan compare to that of a CAT scan?
Dr. Amen: You do get some radiation (1/3 the amount of an abdominal CT scan), but it is a normal medical amount of radiation. You wouldn't want to do 50 of them on someone – but you always have to compare the reward to the risk of having this amount of radiation vs. the risk of having an ineffectively treated psychiatric disorder. I would argue the risk of not having the scan is much higher than getting the scan that could show useful clinical information.
Naturally Savvy (Andrea): What type of success rate do you see with your patients because you are incorporating SPECT brain scans?
Dr. Amen: We do outcome studies of all the patients that come to my clinic. The typical outcome for psychiatric medicine is 31% - no better than a placebo.
77% of our patients (of which the majority are complicated cases) show high levels of improvement across all measures after six months. The SPECT scans are just part of the success. I believe the secret to our success lies in our detailed clinical assessment – biological, psychological, social and spiritual. We believe in really getting to know someone by asking him or her about their family history, social stressors, developmental events, and what their life really means to them. And THEN we do the SPECT imaging. This leads to a much more targeted treatment.
We also believe in adding brain-healthy habits. Our diet really does matter. Exercise, Omega-3s, and our food choices all matter! Once we put all of these important pieces together, we see high levels of success.
Naturally Savvy (Andrea): Your research supports everything we at Naturally Savvy believe in—making better choices now to prevent future health issues.
I love the fact that you incorporate nutrition. Do you test people for deficiencies?
Dr. Amen: Absolutely. Almost everyone we see is pretty deficient in some way or another and our diets are to blame. Our large consumption of corn, soy and wheat and small consumption of fish, leafy green vegetables, avocados, and nuts is a major cause of these deficiencies. Omega 3 deficiency is a major issue. We test the AA:EPA ratio (Arachidonic Acid which is omega 6 to Eicosapentaenoic Acid which is omega 3) on all of our patients. The ratio should be under 3:1 but it is typically 20:1. One pregnant woman was 42:1. It was not being fair to her unborn child to have an inflammatory ratio in her body because she made some bad decisions with the food she was eating. She is not alone.
I’m working on a book coming out next year called “Unleashing The Power of The Female Brain” and there is a whole chapter devoted to preparing women on getting their bodies ready for babies. The female body is so important and if women don’t nurture it properly, they can affect generations to come in a negative way.
Naturally Savvy (Andrea): Next I would like to talk about ADD, ADHD and anxiety. I feel like in particular ADHD is a difficult to treat. In your research, what have you learned about ADD/ADHD that has allowed you to better treat people?
Dr. Amen: My first SPECT patient was Sandy. She was 40 years old and had tried to kill herself the night before she came to my office. She was very bright and had an IQ of 144 but she never finished college because she never studied due to her to distractions. During our session I told her she had adult ADD and that I could treat it but she didn’t want to. I thought she was crazy because I could have really helped her. So I asked her to let me scan her brain and she agreed. The scan showed that when she concentrated, her whole brain dropped in activity. There is scientific literature that says when people with ADD try to concentrate, they have lowered activity in the prefrontal cortex and the harder they try, the worse it gets.
Naturally Savvy (Andrea): Wow, that is so eye opening because children with ADD/ADHD get labeled as not trying hard enough, or being ‘bad’ or not parented properly. Your scan showed this isn't the case.
Dr. Amen: Exactly. In this case, the SPECT imaging was so important because it helped her see that she had a medical problem – not a moral one. What the SPECT imaging does is help me to understand ‘brain’ disorders. It is generally not one thing that is going on with the brain. The scans help me to target treatment for each individual patient and brain. I explained to Sandy that people don’t take medicine because they are dumb they take it to help them focus as it would in her case.
Naturally Savvy (Andrea): How does the treatment at the Amen Clinic compare to the conventional treatment of ADD, depression, etc?
Dr. Amen: The DSM-IV (the bible of psychiatry) is really not based on any underlying neuroscience as it lumps different types of disorders together. It doesn’t focus on an individual-by-individual basis. Someone can have major depression and really low activity in the brain, or major depression and really high activity in the brain. Because everyone’s brain is so unique, it is important to tailor treatment for his or her individual case. It’s no wonder not everyone doesn’t respond the same way to medications.
What we should be doing is figuring out what TYPE they are. Giving the diagnosis of ‘depression’ is the same as giving the diagnosis of ‘chest pain.’ It’s just a symptom, it’s not what’s wrong, and it doesn’t tell you what to do.
I have identified six different types of ADD. Once the correct type of diagnosed, proper treatment can be initiated.
Naturally Savvy (Andrea): In general, what type of brain activity have you seen in people with anxiety?
Dr. Amen: Clinically, we see that people with anxiety have increased activity in the basal ganglia and on the right side of the brain. The right side is the more anxious and fearful side. It focuses on problems. The left side is the happy side. Just a tip: if you are going to fall out of a second story window, try to land on your right side!
Naturally Savvy (Andrea): Of course everyone is unique, but overall what type of success have you seen with anxiety-ridden patients and what is the general course of treatment?
Dr. Amen: People who are anxious generally do very well on the program when they know their brain type and do the interventions specifically tailored to their type. Hypnosis, biofeedback and meditation can be very helpful too, as can certain supplements, such as theanine and rhodiola.
Naturally Savvy (Andrea): What do you say to those people who say: “Stop worrying about what you eat. Eat sinful foods when you want to and just enjoy life because stress will kill you faster than the sinful foods will”.
Dr. Amen: People who are actively engaged in their lives and passionate are healthier. Worrying a little bit about your health and wellbeing is a good thing. There is a research project going on at Stanford where they found the people who have a “Don’t Worry, Be Happy” attitude (which by the way, I have always wanted have) die earlier from accidents and preventable diseases. They don’t die happy – they die fat, depressed, and demented.
Naturally Savvy (Andrea): Interesting. The ‘haters’, as we like to call them, like to tell us healthy eating advocates to relax and not stress so much about what we eat or our health.
Dr. Amen:Women are much bigger worriers than men. A woman’s brain, in general, is much busier than a man’s. Research shows that if you worry about your health, you are much more likely to live longer. That’s because when you FEEL the worry it MOBILIZES you to take positive actions. Be healthy, concerned about your health and mindful of what you eat. Don’t be stressed. The Longevity Project by Michael Freedman is a great book and it says that the #1 predictor of longevity is your ability to follow through when you say you are going to do something.
Naturally Savvy (Andrea): How can our readers learn more about what you do and how you can help them?
Dr. Amen: Where we really shine is in treating people with ADD/ADHD, depression, bipolar disorder, etc. It is a great investment because we see the positive results.
By the end of the summer we will have six clinics in the U.S. We have a new one opening in Atlanta mid-summer and a NYC clinic will open at the end of the summer. You can visit my website to learn more about what we offer on my website (www.amenclinics.net).
Naturally Savvy (Andrea): What are the costs involved for treatment?
Dr. Amen: We can help people from a dollar all the way up to $3,600, which would be our full evaluation, which includes two scans.
If someone wants a consultation with one of our doctors, the cost is $175.
Most people really want to get to understand how healthy their brain is. The technology we use is helpful even if you just want to know if you are vulnerable for memory problems later, or how you can optimize your brain function.
Naturally Savvy (Andrea): What if someone wants treatment but can’t physically get to one of your clinics?
Dr. Amen: We have an online community called ‘The Amen Solution At Home’ (http://www.theamensolution.com/home/) where people can take a test. Membership is $30/month and it includes a lot of useful tools. We have a trial membership where it costs a dollar for 2 weeks to try it out.
Naturally Savvy (Andrea): Can you tell us about your new book ‘Use Your Brain To Change Your Age’?
Dr. Amen:One of the things we discovered after looking at all these scans is that as we age, our brain gets less and less active. This is of particular interest to me beause I am 57 years old and I want to keep my brain young and functioning optimally.
The exciting news is that we have been able to demonstrate how you can slow or reverse the aging process by doing certain things. When you live in a brain healthy way, your skin is better, your energy is better, and you move better. This is all covered in my book.
To learn more about Dr. Amen and his groundbreaking work, visit his website http://www.amenclinics.net