An Early Life of Substance Abuse: Alcohol, Cocaine, Marijuana

Zach Skow’s struggles with alcohol and drug addiction began early. By the age of 10, he had already started drinking, sneaking wine and vodka from cabinets at home. Not long after, drugs entered the picture. He began using marijuana at 13 and later discovered cocaine at 16.

Reflecting back, Zach has said that for as long as he can remember, he felt addicted to drugs and alcohol. He did not feel normal. He felt uncomfortable in his own skin and found it difficult to handle pressure or stress. Alcohol, he recalls, helped him cope with those feelings and made it easier to function in the world.

But what he did not understand at the time was that his brain was playing a powerful role in driving these behaviors.

Substances like alcohol and drugs trigger the release of dopamine, the brain’s “feel-good” chemical. For someone already struggling with emotional discomfort, this temporary relief can quickly become reinforcing. Over time, the brain begins to crave that escape, making it harder to stop the cycle.

What started as a way to self-soothe gradually became a pattern that would shape the course of his life, long before he had the insight or support to understand what was really happening in his brain.

Video: “If I Didn’t Have Those Dogs During That Experience I Would Have Killed Myself”: Zach Skow’s Story

Liver Failure, Sobriety, and Working with Dogs

Years of an out-of-control alcohol use disorder and drug abuse eventually brought Zach to death’s door.

In 2007, his body began to shut down. He remembers turning yellow, a visible sign of severe liver damage. What he would later learn was ascites, a serious condition linked to liver failure, had taken hold. The situation was life-threatening, and it forced a moment of reckoning.

At the same time, Zach committed to sobriety.

The early days were anything but easy. Withdrawal was intense, both physically and emotionally. But in the middle of that struggle, something unexpected began to change the trajectory of his life.

He started working with dogs.

What began as fostering quickly turned into something more. He brought in one dog after another, volunteered with animal rescue organizations in Tehachapi, CA, and immersed himself in caring for animals that, like him, needed a second chance.

He also began walking regularly and made significant changes to what he put into his body.

At the time, these activities were pursued simply as a way to survive. Zach did not know that he was intuitively drawn to what was helping him heal. 

Indeed, animal therapy is recognized in research as a positive adjunctive therapy in substance use disorder recovery. Additionally, research has found that the positive effects of exercise can be an effective intervention in addiction recovery. 

He also did not realize that these acts of self-preservation would eventually become his life’s work and purpose.

Looking back, Zach has been candid about just how critical that connection was, saying, “If I didn’t have my dogs for that experience, I would have killed myself.” They gave him a reason to keep going when everything else felt uncertain.

Related: Does Alcohol Kill Brain Cells? What Science Really Says

Discovering Amen Clinics and the Comprehensive Evaluation for Addiction 

Zach’s journey took another pivotal turn when, as he describes it, “very miraculously,” someone from Amen Clinics reached out after hearing his story on a podcast and seeing his work online.

“That led me into the process of understanding what status my brain is in,” Zach recalls.

Working with Amen Clinics’ psychiatrist, Dr. Steven Storage, Zach underwent a brain SPECT scan and a comprehensive evaluation. 

From the start, he felt supported. “Dr. Storage is just the best. I love that guy,” he says. 

But the results were not easy to hear. “We walked through them, and they were difficult,” Zach explains. “I was essentially told that I had degrees of brain damage that we can work on.” 

It was a sobering moment, no pun intended. Years of substance use had taken a measurable toll. The effects of alcohol on the brain over the course of years were visible. But instead of leaving him discouraged, the experience gave him understanding.

“I’ve damaged myself over the long haul. I’ve got to repair myself kind of over the long haul,” he says. “So I’m optimistic… and now I have a much better understanding of what’s going on with me.”

Even more validating was seeing the science align with his experience. “What Dr. Storage thought we might see in my scans was exactly what happened.”

For Zach, this was more than a diagnosis. It was confirmation, clarity, and the beginning of a new path forward grounded in brain health and real solutions.

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How Is Depression Traditionally Diagnosed?

Major depressive disorder is traditionally identified through:

• Clinical interviews
• Symptom checklists (based on the Diagnostic and Statistical Manual of Mental Disorder, known as the DSM-5-TR)
• Patient history
• Functional impairment (reported effects on daily activities and relationships)

While these are useful steps to take, the symptoms of depression can overlap with other mental health conditions, making accurate diagnosis more difficult. And co-existing factors, including anxiety, trauma, or attention deficit hyperactivity disorder (ADHD), also called attention deficit disorder (ADD), can complicate accurate diagnosis further.

Related: What Doctors Can’t Tell You About Your Depression, Anxiety, or Anger

With traditional diagnosis, there is no biological testing, though numerous biological factors can contribute to depression. Without looking at the very organ affected, the brain, or having an accurate diagnosis, doctors often take a trial-and-error approach to treatment. Unfortunately, this can lead to delayed symptom relief, persistent adverse side effects, and patient discouragement. 

Can Brain SPECT Imaging Help Identify Depression?

SPECT is an acronym for single photon emission computed tomography. This type of imaging provides a functional brain scan, as opposed to structural imaging tools such as MRI or CT scans, which show the brain’s anatomy. 

As a state-of-the-art nuclear medicine study, SPECT measures blood flow and activity levels in different areas of the brain. This shows how the brain is working. It identifies areas of healthy activity, overactive activity, or underactive activity in different regions of the brain.

SPECT imaging does not diagnose depression on its own. But it can reveal brain activity patterns commonly associated with depressive symptoms. SPECT may also help differentiate depression from other conditions that are present.

SPECT therefore provides additional data beyond symptom reporting. With a clearer picture of the brain’s workings, SPECT imaging helps guide a more personalized understanding of what may be happening in the brain. This information then helps guide a more accurate diagnosis and targeted treatment.

What Brain Patterns Are Associated With Depression?

A variety of brain patterns are associated with depression:

• Decreased activity in the prefrontal cortex (PFC), the brain’s executive center (involved with tasks such as problem solving, planning, and judgment). This can affect mood regulation and motivation. Decreased activity in the PFC has also been associated with lack of forethought, poor judgment, and impulse control problems.
• Increased activity in the limbic system, the brain’s emotional center. This region enables humans to experience and express emotions and helps regulate emotional intensity. 
• Overactivity in certain brain regions linked to rumination. For example, excessive activity in the brain’s anterior cingulate gyrus, basal ganglia, and/or the deep limbic system is associated with trouble shifting attention from negative thoughts or behaviors.
• Low overall brain activity (present in some cases of depression). 

Mental health conditions, including depression, are complex. But research and imaging studies suggest associations between certain symptoms and brain patterns. SPECT helps provide a deeper understanding of depression when used alongside traditional diagnosis methods.

Depression Is Not One Condition

Not all depression looks the same. Different individuals may have:

• Low activity patterns, associated with low motivation or fatigue
• Overactive patterns, linked with rumination and anxiety
• Mixed or complex presentations, such as mixed anxiety/depression (depression and anxiety occur together 75 percent of the time)

With a database of nearly 300,000 SPECT scans and having treated more than 100,000 patients over decades, our work at Amen Clinics has revealed that depression is not one thing. In fact, our clinicians have identified seven types of depression and anxiety, each with a distinct pattern of blood flow and brain activity:

1. Pure Anxiety often results from too much activity in the basal ganglia, setting one’s “idle speed” on overdrive. 
2. Pure Depression often occurs with excessive activity in the deep limbic system. This type may experience symptoms from chronic mild sadness (dysthymia) to crippling major depression.
3. Mixed Anxiety/Depression involves a combination of both Pure Anxiety symptoms and Pure Depression symptoms. This type shows excessive activity in the brain’s basal ganglia and the deep limbic system.
4. Over-Focused Anxiety/Depression involves excessive activity in the brain’s anterior cingulate gyrus, basal ganglia, and/or the deep limbic system. This type may have trouble shifting attention and often gets locked into anxious and/or negative thoughts or behaviors.
5. Temporal Lobe Anxiety/Depression is related to too little or too much activity in the temporal lobes (involved in moods, emotions, and memory). There can also be overactivity in the basal ganglia and/or deep limbic system. As a result, this type may experience irritability, rage, or confusion.
6. Cyclic Anxiety/Depression is associated with extremely high activity in the brain’s basal ganglia and/or deep limbic system. This activity can hijack the brain for periods of time in a cyclical pattern.
7. Unfocused Anxiety/Depression types may show low activity in the PFC, in addition to high activity in the basal ganglia and/or deep limbic system. Unfocused Anxiety/Depression is often misdiagnosed as ADD/ADHD because of its similar symptoms. Brain imaging allows for a more accurate diagnosis.

With seven types of depression, each having their own presentation and symptoms, a one-size-fits-all treatment often does not work. The treatment protocol for one type might make another type’s symptoms worsen. Using brain SPECT imaging helps create a more effective treatment plan because it is customized to treat the individual’s type of depression.

Video: Seven Types of Anxiety & Depression

Why Symptoms Alone May Not Tell the Whole Story

Depression symptoms can overlap with other conditions. For example, the same symptoms of depression could also be the symptoms noted for any of the following conditions: 

• Anxiety
• Trauma
• Hormonal imbalance
• Sleep disorders
• Thyroid dysfunction
• Nutritional deficiencies

Therefore, symptoms alone may not tell the whole story. Ruling out medical causes is essential before diagnosing major depressive disorder.

How Amen Clinics Uses SPECT Imaging in Depression Evaluation

With our brain health-first approach, Amen Clinics uses SPECT imaging as an integral part of a comprehensive evaluation. 

SPECT is combined with diagnostic tools such as:

• A detailed clinical history
• Neuropsychological testing and assessments 
• Lab tests, if needed

This collection of data, including the SPECT scan, helps our clinicians gain a clear understanding of what is really happening in the brain. If you have depression, they will typically be able to identify which subtype you have, plus any co-occurring conditions. 

Then, using precision medicine, they can design a treatment plan tailored to address any identified brain dysfunction, as well as boost overall brain and body health.   

A clinician reviews your SPECT scan and personalized treatment plan with you in detail.

SPECT scans also help clients and their loved ones understand that the symptoms of depression are not flaws, character defects, or personal weaknesses. Seeing the brain function issues on the brain scan depersonalizes depression. Knowing that this condition is rooted in brain function helps reduce shame and blame.

Moreover, this kind of scientific and compassionate understanding increases the motivation to make meaningful lifestyle changes. At follow-up appointments, the clinician and client can track results over time.

A Whole-Body Approach to Treating Depression

The brain-body connection is crucial in treating any mental health condition. Factors such as diet, physical activity, and sleep all significantly impact mental well-being.

Therefore, holistic psychiatry as practiced at Amen Clinics may include:

• Nutrition
• Supplements
• Sleep optimization
• Exercise
• Therapy
• Medication when appropriate

This whole-body approach to holistic psychiatry offers many natural ways to treat mental health conditions, including depression. But what works for one type of depression may not work for another. That’s why treatment is always personalized to the needs of the individual. 

Related: 9 Natural Ways to Help Depression

How Brain Imaging Can Support Personalized Treatment

Brain SPECT imaging offers numerous benefits for clinicians and their clients. This cutting-edge diagnostic tool:

• Helps identify the underlying brain patterns behind symptoms
• Guides treatment selection
• May reduce a trial-and-error approach to treatment

Individuals are different, and each person’s depression symptoms are unique. Therefore, treatment should be individualized and brain-based.

Why Journaling Can Support Mental Health

The brain has a tendency to replay worries on a loop. Psychologists call this rumination, a pattern that can intensify anxiety and depression. A 2022 literature review study on expressive writing found that structured writing exercises can help reduce rumination and support more effective processing of stressful experiences.

Writing things down helps slow those thoughts. Putting feelings into words also creates distance. Instead of being caught in an emotional spiral, you can get outside of it, gaining perspective. 

If you struggle with negative thoughts, it will also allow you to clearly examine a persistent negative thought and ask if it is really true. So often, our thoughts lie to us. When you question them, it helps reduce their negative influence. 

Journaling allows the brain to organize experiences into a clearer, more accurate narrative, making stressful events easier to understand. Research suggests that putting emotions into words supports cognitive processing and helps create meaning.

Journaling for mental health works best when it’s treated as a personal practice, not a task to get “right.” Some entries will feel insightful. Others may feel repetitive or incomplete. Both are part of the process. The real benefit comes from showing up and allowing your thoughts to unfold over time.

Related: How to Take Charge of Your Mental Health Journey

How to Start a Journal for Mental Health

Starting something new, especially something so personal, can feel awkward at first. If you’re hesitating because you’re worried about doing it wrong or that you won’t know what to write. That’s normal, too. But it doesn’t have to be scary. 

Instead of thinking about journaling as a creative project, try reframing it as a personal health habit like stretching or taking a walk. It’s simply a space where you can check in with yourself. Here’s how you can start:

Step 1) Choose a Format That Feels Comfortable

There’s no correct journaling format. What matters most is choosing a method that feels natural and private.

Notebook Journaling

Many people prefer a traditional notebook because writing by hand slows thinking down and encourages reflection. It can also help you feel grounded in the present, which is particularly beneficial as part of a morning or nightly ritual. Research shows that handwritten expressive writing exercises can improve emotional processing and reduce psychological stress in some participants.  

Benefits:

• Encourages deeper reflection
• No digital distractions
• Tangible record of personal growth

Considerations:

• Privacy concerns if others might read it
• Less convenient when traveling

Notes App or Digital Journal

Typing into a phone or computer works well for people who think quickly or prefer convenience. Just keep in mind that screens are social spaces by design. A 2022 study shows how digital devices interrupt attention and cognitive focus, so be aware that there is a greater potential for distraction if you are using one. 

Benefits

• Easy to access anytime
• Password protection available
• Faster for longer entries

Considerations:

• Screens can introduce distractions
• Some people feel less emotionally connected while typing

Guided Journals

Guided journals provide prompts or structured reflection questions. According to a 2018 study, structured writing prompts can help you explore emotions more effectively than completely unstructured writing, especially for beginners. 

Benefits:

• Helpful if you struggle to start
• Encourages deeper reflection on different topics

Considerations:

• Less flexibility in writing flow
• May feel restrictive for individuals more experienced with journaling 

Ultimately, the best format is the one you’ll actually use and enjoy doing. Try them all to see which one feels most natural and comfortable. Whatever you choose, make it a habit you return to consistently.

Decide When and How Often You’ll Write

Consistency matters more than the duration of your journaling session. It doesn’t require long sessions to be meaningful. A 2021 expressive writing study used sessions lasting about 15 to 20 minutes over several consecutive days, suggesting that relatively brief writing periods can still support emotional processing and reflection.

For everyday journaling, even 5 to 10 minutes can be enough. Try choosing a simple time anchor, such as:

• After your morning coffee
• Before bedtime
• During a quiet moment after work

Think of it less as an assignment and more as a personal ritual where you pause during the day to give your thoughts room to breathe. If journaling every day feels like too much, do it every other day. If you miss a day, just pick up again as soon as you can. Consistency is the goal. 

Set One Simple Ground Rule

Some people abandon journaling because they feel pressure to write well. Framing it as simply writing words on the page, instead of trying to make it sound polished, can help. A 2022 systematic review found many types of journaling interventions were associated with improved mental health symptoms. Setting just one small rule can remove that mental pressure and give you the freedom to just start writing.  Here are some “rules’ that can free up the process: 

“I don’t edit myself.”
Embracing free-flow journaling encourages a meditative flow, where thoughts move more freely without constant self-monitoring.

“Spelling doesn’t matter.”
Journaling isn’t an essay or novel plan. Imperfect writing often reflects more honest thinking, so just be honest with yourself. You’ll know what you meant.

“This is just for me.”
Your journal is a private space for you. No audience, no expectations, and no grades. Being honest with yourself can be the hardest step, but it’s worth it.

These rules are there to help you turn journaling into a place of honest expression that helps you regulate your emotions and heal your mental health.

Video: This Is How Negative Thinking Impacts Your Brain 

How to Write a Journal for Mental Health

Once you’ve started journaling, the next challenge is pretty common.

What exactly do I write?

Many people open a notebook and suddenly feel like their thoughts are a blank slate. That’s normal, too. Writing about your mental health doesn’t require dramatic stories or deep insights. 

Research suggests that simply expressing thoughts and emotions through writing can support emotional processing over time. Often, the most helpful entries start with what’s happening right now.

Start With What’s Present

Instead of trying to analyze your entire life story, begin with simple observations of your daily life. Some research shows that focusing on the present moment is linked to lower levels of stress, anxiety, and depression.

You might start writing about:

• Current emotions – Are you feeling frustrated, tired, hopeful, or anxious?
• Physical sensations – Do you feel tension in your shoulders? Is your heart racing? Have you been fatigued lately?
• Moments that stuck with you today – Any funny moments? Did you have a bad day? Did you laugh or cry today?  

These details may seem small, but they create self-awareness. Over time, journaling can reveal the patterns in your stress, mood, and daily experiences.

Use Simple Prompts When You Feel Stuck

Prompts are most helpful when you feel stuck because they can gently guide your thoughts without forcing them. Try starting with phrases like these:

“Right now, I feel…”

Write whatever emotions or moods are present at that moment, even if they seem contradictory.

“Something that’s been weighing on me lately…”

This prompt can help you identify recurring concerns, unresolved thoughts, and previously unknown mental burdens.

“One thing I keep thinking about…”

Repeating thoughts often signal something important on your mind that you’re trying to process. Even a few sentences responding to these prompts can open the door to deeper reflection.

Let the Writing Be Messy

One of the most helpful mindset shifts is accepting that messy writing is normal and can be quite helpful to understanding how you think. Your journal might include a few:

• Repeated thoughts
• Half-formed ideas
• Sudden emotional shifts
• Suppressed moods

But that’s not a bad thing. This is just your natural rhythm of processing experiences. Your human brain rarely follows a perfect structure in how you think. Journaling just gives your thoughts space to unfold.

Mental Health Journaling Prompts You Can Reuse

If you’d like more structure while you’re learning how to journal for mental health, specific prompts in the form of questions can help guide self-reflection without overthinking it. The examples below help you emphasize awareness, emotional regulation, and balanced thinking.

Stress and Overwhelm

• What’s been taking the most mental energy from me lately?

• If I could remove one stressor today, what would it be?

• What situation feels hardest to navigate right now?

Mood Tracking

• What emotion showed up the most today?

• When did I feel most calm or relaxed?

• Did anything unexpectedly improve my mood?

Self-Reflection

• What lesson did today teach me?

• What do I need more of right now: rest, connection, boundaries?

• What thought pattern do I notice repeating?

Gratitude (Without Forcing Positivity)

• What smaller moment felt meaningful to me today?

• Who or what supported me best this week?

• What am I quietly thankful for right now?

Gratitude journaling doesn’t mean ignoring difficult emotions. You simply add balance by noticing supportive moments in order to see the full picture outside of yourself.  

Related: The 5-Minute Morning Routine to Boost Your Brain

Common Journaling Mistakes (and What to Do Instead)

Journaling is most helpful when it feels supportive rather than stressful. However, these common habits can make it feel like a chore. Here are a few ways to reframe things when you start feeling off-track.

Trying to “Fix” Feelings Instead of Describing Them

Most people start journaling and immediately try to solve their problems and figure out all of their emotions.  Instead, focus on describing what’s happening now. Understanding often comes with time.

Writing Only When Things Feel Bad

Journaling during difficult moments is helpful, but writing occasionally during calm periods provides balance. It also makes journaling feel less like an emergency tool and more like a supportive habit.

Stopping Because You Missed a Few Days

Everyone knows life gets busy. Missing a few days, or even weeks, doesn’t erase the value of journaling whenever you can. It’s as simple as returning to it when you’re ready. Your journal isn’t keeping a winning or losing score on how often you write, and you shouldn’t either.

When Journaling Isn’t Enough on Its Own

Learning how to journal for mental health can be a powerful self-reflection tool, but it isn’t a cure-all treatment.

If your emotions feel intense, persistent, or overwhelming, support from a qualified mental health professional can make a meaningful difference. Therapists, psychiatrists, and other mental health professionals are trained to help you navigate complex emotional experiences.

A 2019 study suggests that expressive writing may complement other therapeutic approaches. For example, writing interventions have been studied as supportive tools for people facing stressful medical diagnoses, showing improvements in emotional well-being and quality of life. 

Still, journaling works best as one tool among many. It can work especially well when combined with professional guidance. 

But you don’t need to feel like something is wrong with you to gain the benefit of writing to understand yourself more.

Making Journaling a Sustainable Habit

The easiest way to maintain journaling is to connect it to an existing routine. Attach it to something you already do. A 2024 systematic review found that attaching a new behavior to an existing routine is one of the most effective ways to make it stick. Here are a few examples to think about trying:

• Write for five minutes immediately upon waking
• Reflect briefly on your day before bedtime
• Journal after a daily walk when your head is clear

Over time, lowering your expectations can also help sustain the habit. Instead of writing long entries every day, allow your practice to evolve from short bursts like:

• Some days might include one sentence
• Other days might include several pages
• Occasionally you may skip writing altogether

Journaling works best when it adapts to your life, not the other way around.

WHAT IS COGNITIVE DECLINE?

Much more common among aging individuals is what is called cognitive decline. They experience some brain changes and cognitive deficits that occur as part of the aging process, but their ability to function in everyday life is not impaired.

Chiefly, researchers have found that brain aging impacts some cognitive abilities, such as processing speed and some memory functions, visuospatial, language, and executive function abilities.

Medical research has identified the following features as characteristic of normal cognitive aging:

• Having Memory Lapses—For example, you might occasionally misplace things but can find them after retracing your steps.
• Being Forgetful—For instance, you might forget an appointment or name, but you can recall them at a later time.
• Ability to Maintain Daily Functions—As mentioned, these cognitive changes do not significantly impact your ability to do your day-to-day activities.

Many health professionals refer to this as “normal cognitive decline.”

However, Dr. Daniel Amen and the brain health specialists at Amen Clinics have found that cognitive decline may be common, but it is not normal. In fact, the brain-imaging work at Amen Clinics shows that age-related deficits can be reduced with lifestyle interventions, according to research.

Related: How Old Is Your Brain (And How to Make It Younger)

Unfortunately, there are millions of individuals who have cognitive decline and structural changes in the brain that are more dramatic. These people may suffer from either mild cognitive impairment (MCI) or some type of dementia, such as Alzheimer’s disease.

WHAT IS MILD COGNITIVE IMPAIRMENT?

When concerns with memory go beyond what’s considered normal cognitive changes, the symptoms may be due to mild cognitive impairment. Symptoms of MCI include trouble with memory, language, and judgment.

Yet, while the symptoms are more serious than normal cognitive aging, they still don’t impair daily functioning. 

Related: What Is Mild Cognitive Impairment?

It’s estimated that roughly 8 million U.S. adults suffer from MCI—and about 90 percent of them are unaware they have it.

Some of the most common symptoms of mild cognitive impairment may include:

• Forgetting things more frequently
• Missing appointments or social engagements
• Difficulty with language or finding the right word
• Trouble making decisions, finishing tasks or following instructions
• Getting lost in places one knows well
• Poor judgment
• Losing one’s train of thought or failing to follow the plot of a movie or book
• Trouble tracking a conversation
• Family and friends notice these changes

It’s not uncommon for people with MCI to also experience depression, anxiety, short temper/aggression, or a lack of interest in life. More people with MCI than without it will eventually develop dementia.

WHAT IS DEMENTIA AND ALZHEIMER’S DISEASE?

Dementia is an umbrella term for certain neurodegenerative diseases. There are four common types of dementia that damage important brain functions and lead to:

• Cognitive impairment
• Memory loss
• Language difficulties
• Changes in behavior and personality

Dementia significantly interferes with a person’s ability to perform everyday activities like bathing, dressing, cooking, managing finances, driving, and social engagement. As dementia advances, the level of support needed for care and increases as well. 

An estimated 55 million people around the world live with some form dementia. More than 6.5 million U.S. adults currently have Alzheimer’s disease, the most common form of dementia, and that number is expected to double by 2050.

Common signs and symptoms of dementia may include the following:

• Problems with short-term memory
• Difficulty paying bills
• Trouble preparing meals
• Forgetting appointments
• Getting lost in familiar areas
• Difficulty interpreting what is seen
• Struggling with vocabulary, verbal expression, and following conversations
• Impaired judgment
• Loss of restraint/increased impulsivity
• Changes in mood or personality
• Apathy
• Compulsive and repetitive behavior

WHAT CAUSES MCI AND DEMENTIA?

There’s no single cause of MCI and dementia, but rather a host of risk factors that contribute to its development, including:

• Family history of Alzheimer’s disease or other dementia types
• Traumatic brain injury (TBI), including concussions
• Obesity and eating a poor diet
• Diabetes or prediabetes
• Untreated sleep apnea
• Underactive thyroid
• Hypertension or prehypertension
• Lyme disease and other infections that can affect the brain
• Some medications
• Coronary artery disease, including heart problems
• Exposure to toxins
• Alcoholism and substance abuse
• Depression, ADD/ADHD, and posttraumatic stress disorder (PTSD)
• Periodontal (gum) disease
• Chronic inflammation
• Cancer/chemotherapy

WHAT RESEARCH SAYS ABOUT SUPERAGERS

Over two decades ago, researchers at the Cognitive Neurology and Alzheimer’s Disease Center at Northwestern University decided to study what is going right in the aging brain as opposed to studying pathology.

They became aware of certain individuals who appeared to defy normal brain aging, more serious memory deficits, and neurodegenerative issues. They sought to study these people in hopes that it might provide information helpful in treating Alzheimer’s disease and other forms of dementia and launched the SuperAging Program in the year 2000.

They coined the term superager and defined it as an individual 80 years or older with a demonstratable memory test score at or above the norm of 50- to 65-year-olds.

During initial recruitment, just 10 percent of the people screened who believed they had outstanding memories were included in the research. Since its inception, the program has studies 290 superagers. A total of 79 of these individuals donated their brains to the program for autopsy research after death.

In an initial study, published 12 years into the program, the researchers noted that superagers exhibit significantly greater cortical thickness and volume than their cognitively normal age-matched peers. In addition, they show no cortical atrophy.

Since this region is associated with attention, and attention supports memory, the finding reveals that keen attention may possibly be what supports the exceptional memory function in superagers.

SUPERAGERS AND SOCIAL CONNECTIONS

In the 2025 study published in Alzheimer’s and Dementia mentioned earlier, the SuperAging Program researchers compiled new and revelatory observations based on over 20 years of data.

Here are some of the characteristic findings about superagers:

• Diverse: The studied superagers were a diverse group of individuals. They did not share a particular healthy diet, exercise regimen, or take a particular medication.
• Extroverted: The superagers were somewhat extroverted and gregarious.
• Place High Value on Connecting Socially: They took time for and valued connecting socially with others.

The importance superagers place on building and maintaining social connections was one of the most significant commonalities noted about them.

Their high sociability makes sense and even aligns with previous studies on aging populations. Indeed, social connections and aging well are closely linked.

Highly social people are more resistant to cognitive decline as they grow older, research shows. Studies also suggest a link between larger brain size and greater social connectedness.

On the other hand, loneliness, defined as having a lack of meaningful social connections, appears to have a detrimental impact on aging brains as it is associated with cognitive decline, memory loss, and increased dementia risk.

A 2024 review study on loneliness and aging analyzed data from more than 600,000 participants. It found that feeling lonely increases the risk for dementia by 31 percent.

Related: 7 Ways to Be Less Lonely

While other factors are at play in superagers, this finding alone speaks volumes in terms of the potential protections an aging brain may enjoy from an individual developing strong social connections.

SUPERAGERS AND THE BRAIN

Scientists have discovered that superagers’ brains have special features that help explain why they stay sharp and socially connected well into later life.

Here’s what makes their brains different:

• Resist Alzheimer’s Changes: Superagers show fewer buildups of amyloid and tau proteins (the changes often seen in Alzheimer’s disease). And even when small amounts are present, they don’t seem to harm memory.
• More Memory Cells: They have higher numbers of neurons in the entorhinal cortex—a brain area that plays a big role in making memories, processing what you see and hear, and helping you navigate spaces.
• Special Social Neurons: Their brains contain more von Economo neurons—rare brain cells also found in highly social animals like dolphins, whales, and great apes. These cells are linked to empathy, self-awareness, and managing emotions. Having more of them may explain superagers’ strong social connections.
• Stronger Attention and Learning System: Superagers’ cholinergic system—which supports focus, learning, memory, and even blood flow—stays healthier compared to others their age.
• Lower Brain Inflammation: They have fewer overactive immune cells (called microglia) in their brain’s white matter. Too many of these cells are linked to Alzheimer’s and other memory problems.

HOW TO BECOME A SUPERAGER

Being more social may be one of the keys to achieving superager status. However, researchers believe what it’s probably a combination of behavior, as well as genetics and biology that makes superagers.

That said, building and maintaining meaningful social connections may help to protect your memory and brain function. Enjoying quality social connections, of course, will also add to your overall well-being.

What Is Paternal Postpartum Depression?

Paternal postpartum depression (PPPD) is one of the forms of clinical depression experienced by fathers and non-birthing partners during pregnancy, childbirth, or in early parenthood.

PPPD presents ongoing mental, emotional, or behavioral symptoms, including feeling withdrawn, irritability, anxiety, low mood, and trouble connecting with the newborn baby. These changes go far beyond normal adjustment stress.

Depression after childbirth is not limited to mothers. Fathers and non-birthing partners are also likely to experience major mood changes as they transit to parenthood because of factors like hormonal shifts, increased responsibilities, sleep deprivation, and brain-based stress responses.

Although PPPD may share similarities with maternal postpartum depression, it usually shows up differently. Non-birthing partners and fathers can show fewer outward symptoms of sadness and instead undergo emotional numbness, anger, behavioral changes, and increased anxiety.

In short, paternal postpartum depression is a brain-based mood disorder that can develop in fathers and non-birthing partners after a child is born, and if left untreated, it may impact relationships, mental health, and daily functioning.

How Common Is Paternal Postpartum Depression?

Experts view paternal postpartum depression as a significant and measurable concern and not a rare experience. Research estimates that at least 10 percent of fathers experience depression within the first year after their children are born, and that they are frequently overlooked and under-supported.

Studies focus on the first year after children are born, as the main period where fathers are at a higher risk of PPPD. It can appear anytime during the first year, whether in the first month, from three to six months, or later in the year.

Research also suggests that there’s a higher likelihood of fathers developing PPPD when their partners are also experiencing postpartum depression. This suggests the interconnected nature of family mental health after children are born.

The actual rates of paternal postpartum depression could be higher than the reported ones due to stigma, inconsistent screening, and underreporting. Some fathers don’t seek help or go for routine check-ups for mental health after childbirth.

When they have symptoms, they can be misinterpreted as adjustment issues and stress instead of clinical depression.

Why Paternal Postpartum Depression Is Often Overlooked

PPPD is often underrecognized, which may leave many fathers without the support they need. Here is why:

Cultural Expectations About Fathers

Our modern culture has always expected fathers to be emotionally steady, strong, and supportive after the birth of a baby. Such societal norms make fathers feel like admitting to feeling sad or struggling with emotions is a sign that they are weak. That discourages them from seeking help.

Misinterpretation of Symptoms

Paternal postpartum depression can show up differently compared to maternal postpartum depression. Although mothers can show more overt sadness, fathers usually display anger, irritability, or withdrawal. Sometimes, those behaviors are mistaken for fatigue, stress or personality traits instead of signs of depression.

Irritability and Sadness

Since depression in fathers usually shows up as emotional numbness or irritability rather than clear sadness, it’s likely to be overlooked by family members, partners, and even healthcare providers. That can cause a delay in recognition and treatment.

Lack of Screening Tools for Men

Most of the postpartum mental health clinics are specifically designed with mothers in mind. The standardized tools for detecting depression in fathers are limited. That leads to missed opportunities for early intervention or underdiagnosis.

Social Stigma

There is a social stigma around men’s mental health, which usually prevents fathers from speaking openly about the struggles they are going through. Most fathers have the fear of being judged or not living up to the “ideal father” expectations, which keeps them from reaching out for help, even when their symptoms are interfering with their relationships and well-being.

Signs and Symptoms of Paternal Postpartum Depression

PPPD shows up in different ways, as illustrated below. Again, its symptoms can vary from one father to another.

• Irritability or anger: The state of being short-tempered or feeling unusually frustrated, even because of small issues. That can strain relationships with children, partners, and coworkers.
• Emotional withdrawal: This is where fathers pull away from their families, friends, or even the baby. They usually find it hard to connect emotionally with their loved ones as they did before.
• Increased work focus or avoidance: Some fathers immerse themselves in hobbies, work, or other activities to escape the responsibilities at home. This masks the underlying depressive feelings.
• Sleep changes: They tend to struggle falling or staying asleep, even when their babies sleep. Or, on the other hand, some fathers sleep excessively. Sleep changes can easily worsen mood and energy levels.
• Loss of interest: After childbirth, some men experience reduced enjoyment in social activities, hobbies, or time spent with family. Those activities that used to bring pleasure begin to feel meaningless.
• Risk-taking behaviors: Sometimes, fathers may start engaging in dangerous or impulsive actions like unsafe physical activities or reckless driving. That can be a way of coping with their emotional distress.
• Increased substance use: In some cases, fathers may start using drugs, drinking alcohol, and relying on other substances more than usual. The use of substances can temporarily numb emotions

While these steps can be helpful in determining diagnosis, this approach has limitations. First, ADHD often involves symptoms that overlap with other conditions, such as anxiety, depression, and trauma.

According to CDC statistics, nearly 78 percent of children with ADHD have at least one other co-occurring condition, including:

• A behavior or conduct problem (affecting about half of cases)
• Anxiety (affecting about four in 10 cases)
• Depression
• Autism spectrum disorder (ASD)
• Tourette syndrome

One study found that nearly one million children in the U.S. may be misdiagnosed with ADHD.

There are many reasons for this but one major factor is immature behavior being misinterpreted as ADHD symptoms. The study found that the youngest kindergarteners are approximately 60 percent more likely to be diagnosed with ADHD than the oldest children in the same grade.

In addition, the standard model of ADHD diagnosis doesn’t include any biological testing.

Most patients and doctors wouldn’t imagine treating the heart without fully examining it, but modern psychiatry often avoids looking at the very organ it aims to treat: the brain.

This traditional model can lead to misdiagnosis or incomplete understanding of the individual’s ADHD and any co-occurring conditions. It also fails to recognize that ADHD is not a straightforward, single condition.

Research suggests that less than 20 percent of adults with the condition are appropriately diagnosed and treated for their symptoms.

On a brighter note, informed by decades of performing SPECT brain scans, Amen Clinics has identified seven subtypes of ADHD. Understanding what types of brain function issues are associated with specific symptoms has helped our clinicians in making precise diagnoses and targeted, effective treatment plans associated with better outcomes.

Can Brain SPECT Imaging Help Identify ADHD?

SPECT stands for single photon emission computed tomography. It is a state-of-the-art nuclear medicine study that measures blood flow and activity levels in different regions of the brain.

Unlike structural imaging tools such as MRI or CT scans, which show the brain’s anatomy, SPECT provides functional information. It allows clinicians to see how the brain is working by identifying areas with healthy activity, as well as areas that are overactive or underactive.

SPECT imaging does not diagnose ADHD on its own, but it can reveal patterns of brain activity often associated with attention difficulties. It may also help distinguish ADHD from other conditions with similar symptoms.

By adding objective data beyond symptom reports, SPECT gives clinicians a clearer understanding of what may be happening in the brain, helping guide more accurate diagnosis and targeted treatment.

What Brain Patterns Are Associated With ADHD?

The brain’s executive center, the prefrontal cortex, is a key region in tasks such as attention, focus, and impulse control. In individuals with ADHD, this area often shows underactivity in SPECT imaging. There is also irregular activity observed in attention networks.

Variations can occur within the brain patterns, depending on the subtype, and different brain patterns may correspond to different symptom clusters. Looking at the brain with SPECT gives a clearer picture of the brain activity behind the symptoms.

The Seven Types of ADHD

The brain SPECT imaging work conducted at Amen Clinics has revealed seven types of ADHD, each with a distinct pattern of blood flow and brain activity. They are as follows:

1. Classic ADD: In this type, which is the most common of the seven types, there is normal activity at rest, but during concentration there tends to be decreased activity in the prefrontal cortex, cerebellum, and basal ganglia. This type may “act out” more and is associated with hyperactivity.

2. Inattentive ADD: The second most common ADD type, this involves normal activity at rest, but during concentration there tends to be decreased activity in the prefrontal cortex, cerebellum, and basal ganglia. This type is not hyperactive and tends to be perceived as daydreaming, spacy, or slow.

3. Overfocused ADD: This type has increased activity at rest and during concentration in the anterior cingulate gyrus, as well as decreased activity in the prefrontal cortex, cerebellum, and basal ganglia. People with this type tend to get stuck in negative thinking patterns, get hyper-focused, and have difficulty shifting attention. They may or may not be hyperactive.

4. Temporal Lobe ADD: This type shares the hallmark findings of reduced activity in the prefrontal cortex, cerebellum, and basal ganglia during concentration in addition to decreased or increased activity in the temporal lobes. This type may occur with a head injury and often involves issues with learning, memory, mood instability, and aggression. Hyperactivity may or may not be present.

5. Limbic ADD: This type shows the same underactivity during concentration as types 1-4. However, there is overactivity in the deep limbic system (involved in emotions). There is a tendency toward low energy, moodiness, and negativity. Some, but not all, people with this type display hyperactivity.

6. Ring of Fire ADD: Unlike the other types, this type is characterized by a pattern of too much activity in several areas of the brain. These individuals may experience irritability, impulsivity, and insensitive behavior, and there are some similarities with bipolar disorder. Stimulant medication tends to make this type worse.

7. Anxious ADD: This type combines low activity in the prefrontal cortex and overactivity in the basal ganglia. People with this type are frequently anxious, tense, and conflict avoidant. They fear being judged, predict the worst, and may or may not be hyperactive.

As you can see, not all ADHD looks the same. Some individuals have low activity in specific brain regions, while others have too much activity throughout the brain. Others have mixed patterns. Each type requires a personalized treatment plan although they may have some of the same symptoms.

Brain SPECT imaging helps differentiate between these types. This is especially important to assess, because a one-size-fits-all treatment may not work. In fact, a helpful treatment for one type may actually worsen the symptoms of another.

Why Symptoms Alone May Not Tell the Whole Story

ADHD symptoms can overlap with many other conditions and symptoms, including:

• Anxiety
• Depression
• Trauma
• Sleep disorders
• Hormonal issues

ADHD is frequently misdiagnosed as other mental health conditions, such as insomnia, dyslexia, anxiety, depression, autism, OCD, and more. In addition, ADHD often co-occurs with other mental health conditions, including depression, anxiety, bipolar disorder, substance use disorder, and behavioral disorders. This is called complex ADHD.

Related: Not Just ADHD: How to Spot the Signs of Complex ADHD

It is critical to rule out any medical, biological, and lifestyle-related causes before diagnosis. Many factors, such as traumatic brain injury, infections such as Lyme disease, or poor diet can have a strong impact on both mental health and behavior.

How Amen Clinics Uses SPECT Imaging in ADHD Evaluation

At Amen Clinics, we take a brain-based method to diagnosing and treating ADHD. SPECT brain scans are used as part of a comprehensive evaluation that includes:

• A detailed personal history
• Clinical assessments
• Diagnostic testing as needed

The data our clinicians collect, including your SPECT scan, helps them gain a clear understanding of what is really happening in your brain. Using precision medicine, they can design a treatment plan tailored to your brain and body’s needs.

Your SPECT scan and personalized treatment plan are then reviewed with you in detail. One of the most powerful aspects of this process is seeing your own brain. For many people, it creates a shift in understanding. ADHD is not a character flaw or a lack of effort, but a condition rooted in brain function.

This perspective helps individuals and their loved ones move away from blame and toward a more scientific and compassionate understanding. As a result, shame decreases, and motivation to make meaningful lifestyle changes often increases.

A Whole-Body Approach to ADHD Treatment

Because the brain and body are so closely intertwined, Amen Clinics’ targeted treatment takes a whole-body approach. Our clinicians are trained in holistic psychiatry, which combines cutting-edge neuroscience with natural ways to treat mental health conditions, including ADHD.

An ADHD treatment plan usually includes a combination of the following:

• Nutrition
• Supplements
• Sleep optimization
• Exercise
• Therapy
• Relaxation techniques
• Medication when appropriate

Prescribing medication is not the first or only line of treatment for ADHD, but it can be a helpful aspect of a whole-body approach in some cases.

Treatment includes follow-up appointments to evaluate progress and make adjustments if needed.

Related: 7 Natural ADHD Treatments You Can Start Today

How Brain Imaging Can Support Personalized Treatment

SPECT imaging identifies underlying brain patterns and helps to pinpoint an individual’s specific subtype of ADHD. Because the treatment for one type could be unhelpful or even harmful to another type, this differentiation is crucial.

For example, traditional treatment will typically call for stimulant medication, such as Adderall or Ritalin, for most individuals with ADHD.

However, at Amen Clinics, with data from brain SPECT imaging, we’ve found that stimulant medications can worsen symptoms for some subtypes of ADHD, including:

• Ring of Fire ADHD: As this type is characterized by an overall overactive brain, using stimulants on this type is akin to “pouring gasoline on a fire.” Stimulants often make these individuals feel more irritable, obsessive, and moody.

The valuable insights that come from SPECT combined with data from taking a detailed personal history, clinical assessments, and lab work, if needed, supply our clinicians with the information they need to make treatment choices that make sense for your brain. This kind of tailored care often improves outcomes.

ADHD is complex and varied. Successful treatment protocols should be personalized, not one-size-fits-all.

When to Consider a Brain-Based ADHD Evaluation

Do you suspect that you or a loved one has ADHD? Consider a brain-based ADHD evaluation if:

• Your symptoms are not improving with standard treatment.
• You have received conflicting diagnoses.
• You are experiencing side effects from prescribed medication.
• You have complex symptom patterns.
• You suspect you may have additional conditions co-occurring with ADHD.

Thoughtful evaluation can help better address these complex factors and supply you with an effective treatment plan.

Limitations of Brain SPECT Imaging

While brain SPECT imaging plays an important role in accurate ADHD diagnosis, it is not a standalone diagnostic tool. Imaging results must be interpreted by trained professionals. Scans provide nuanced insight alongside clinical evaluation which give Amen Clinics’ clinicians a complete picture of the condition.

The Importance of Professional Evaluation

ADHD is complex and often misunderstood. Relying on symptoms alone can lead to misdiagnosis, missed diagnoses, or treatment that does not fully work.

A more accurate diagnosis requires a comprehensive evaluation that looks at the whole picture, including brain function, lifestyle, and underlying biological factors.

Advanced tools like SPECT imaging can provide valuable insight into brain function, helping guide more targeted and personalized treatment. When ADHD is properly treated based on brain science and a whole-body approach, lives are transformed.

If you are still searching for answers, consider an evaluation that looks beyond symptoms to better understand your brain and what it needs to perform at its best.

FAQ About Brain SPECT Imaging and ADHD

1. Can a brain scan diagnose ADHD?

A SPECT brain scan is helpful for looking at underlying brain activity and patterns, which can provide valuable insight to inform ADHD diagnosis. It offers critical data that is used in combination with a comprehensive evaluation (such as a detailed personal history, clinical assessments, and lab work when needed) for the most accurate diagnosis and treatment.

2. What does SPECT imaging show in ADHD?

SPECT imaging allows clinicians to see what areas of the brain are working well, working too hard, or not working hard enough. Based on nearly 300,000 brain scans and decades of treating tens of thousands of patients, Amen Clinics has determined there are seven subtypes of ADHD. Each has its own brain patterns and requires targeted treatment plans.

At Amen Clinics, brain scans help identify ADHD types, so people can get a personalized treatment plan for better results.

3. Is brain imaging necessary for ADHD diagnosis?

Many psychiatrists diagnose ADHD without brain imaging. However, a symptom-only approach to diagnosis fails to look at the very organ it purports to treat: the brain. This can create a trial-and-error method of treatment, which can lead to years or even decades of unnecessary struggles. In some cases, it can make symptoms worse.

Brain imaging allows for more targeted treatment for ADHD, which accelerates the healing process.

4. How is ADHD usually diagnosed?

Many medical professionals diagnose ADHD based on clinical interviews, behavioral history, and symptom checklists as outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR). Most traditional medical and mental health professionals never look at any biological data in the ADHD diagnosis process.

At Amen Clinics, our comprehensive evaluation incorporates brain SPECT imaging, a detailed personal history that considers lifestyle factors, additional clinical assessments, and lab work, if necessary. This level of data collection allows our clinicians to practice precision medicine and diagnose with greater accuracy. This leads to more effective, targeted treatment plans.

5. Can ADHD symptoms come from other conditions?

Common symptoms of ADHD—such as short attention span, distractibility, and impulsivity—may be due to other mental health conditions, brain health problems, or medical issues. For example, depression, anxiety disorders, PTSD, traumatic brain injuries, and thyroid dysfunction have overlapping symptoms and may be misdiagnosed as ADHD.

These shared symptoms make diagnosis more challenging. Brain-based tools like SPECT are particularly helpful in obtaining an accurate diagnosis, especially with complex ADHD cases.

ADHD, ADD, and other mental health conditions can’t wait. At Amen Clinics, we practice precision medicine—using brain SPECT imaging and comprehensive evaluations to understand what’s really happening in your brain, not just your symptoms.

Our whole-body approach to holistic psychiatry combines cutting-edge neuroscience with natural ways to treat mental health conditions, including targeted nutrition, supplements, lifestyle strategies, therapy, and medications (when necessary). Every treatment plan is personalized to address the root causes of your struggles and support the health of your brain, body, and mind.