FAQ

 

About Amen Clinics

What makes Amen Clinics different?
Improving the health of your brain and your quality of life is our primary goal, and it all starts with learning how your brain functions. Why? Your brain controls everything you do—from decision making and motivation to healthy relationships and stress resilience. When your brain works right, you work right too!

With full evaluations, we obtain:

  • Detailed clinical histories on your biological, psychological, social, and spiritual background
  • Neuropsychological testing
  • Questionnaires and checklists
  • Brain SPECT imaging

We use all of this data we to create an individualized targeted treatment plan specifically for your needs and the way your unique brain functions. Whenever possible and medically appropriate, we like to begin with more natural treatments.

What is the success rate of Amen Clinics?
We have been formally tracking outcome data on our patients for more than 5 years. Of the 5,000+ patients we have studied so far, we have some of the highest outcomes published anywhere. On average our patients are complex and have failed 3.3 providers and 5 medications prior to coming to us. After only six months, 84% of the patients we have treated at Amen Clinics report significant improvements and 85% report an improved quality of life. For our patients who are treated elsewhere, 75% report significant improvements. We believe we have these high success rates because our use of brain imaging allows us to see how each individual’s brain functions so we can create the most targeted treatment plan—unlike traditional psychiatrists who virtually never look at the organ they are treating.

 

About SPECT Imaging

What is SPECT imaging?
SPECT stand for single photon emission computed tomography. It is a nuclear medicine procedure that is widely used to study heart, liver, thyroid, bone, and brain problems. Brain SPECT imaging gives you and your doctor information on the blood flow and activity patterns of your brain.

What is the purpose of the brain SPECT imaging procedure?
Brain SPECT imaging is a proven and reliable measure of brain blood flow and activity; therefore, it is used as a tool in the evaluation and treatment process at Amen Clinics. SPECT imaging effectively shows us the patterns of activity in your brain. It lets our physicians to observe three things: areas of the brain that work well; areas of the brain that work too hard; and areas of the brain that don’t work hard enough.

Why are SPECT studies ordered?
Some of the common reasons include:

  1. Evaluating suspected seizure activity
  2. Evaluating suspected cerebral vascular disease (such as stroke)
  3. Evaluating cognitive decline and suspected dementia or other memory problems
  4. Evaluating the effects of mild, moderate and severe head trauma
  5. Evaluating the presence of a suspected underlying organic brain condition that contributes to behavioral or emotional disturbances
  6. Evaluating aggressive or suicidal behavior
  7. Evaluating the extent of brain impairment caused by drug or alcohol abuse or other toxic exposure
  8. Subtyping the physiology of underlying mood disorders, anxiety disorders, or attention deficit disorders
  9. Evaluating atypical, unresponsive or mixed psychiatric conditions
  10. Following-up to evaluate the physiological effectiveness of treatment
  11. General brain health check-up

Is the use of brain SPECT imaging accepted in the medical community?
Science has repeatedly recognized the value of brain SPECT imaging for assessing brain function. There is a robust amount of scientific data that support the utility of SPECT for revealing the blood flow patterns underlying many different types of brain problems. Dr. Daniel Amen has authored or co-authored more than 70 peer-reviewed published research studies on brain SPECT imaging. In addition, our website has a collection of more than 2,700 abstracts on brain SPECT from researchers around the world.

Are there alternatives to having a SPECT study?
In our opinion, SPECT is the most clinically useful study of brain function for the indications listed above. There are other studies, such as positron emission tomography (PET) and functional MRI (fMRI); however, they are considerably more costly and are performed mostly in research settings.

Where else can I get a brain SPECT scan?
Brain SPECT imaging for neuropsychiatric indications is only offered in a few centers around the country. We believe we our clinics are the best places in the world to have this study done because of our 26 years of experience and extensive research on this subject, in addition to the comprehensive individualized treatment plans we give to our patients.

What is it like to get a SPECT scan?
Each scan takes approximately 20 minutes, and you will have two scans on separate days: one while your brain is at rest, and one while focused on a concentration task. For each scan, you will sit in a quiet room and a small IV line will be placed in your arm. During the “concentration” scan, you will take a 15-20 minute computerized test that measures your attention and focus. For the “baseline” scan, you will be instructed to sit quietly and relax. During this period of time (whether you are taking the computer test or relaxing), the imaging solution will be injected through the IV and taken up in your brain. Once the imaging solution has been absorbed, you will lie down in the scan machine, which has three cameras that will rotate around your head.

Why do you recommend two scans?
Two scans will allow us to evaluate the changes in brain blood flow patterns from a resting state to a concentration state.

Are there any side effects or risks to the study?
Since a SPECT scan is a nuclear medicine procedure, it requires the injection of a very small amount of a radioisotope through a small needle into a vein in the arm. The medicine we inject is not an iodine-based dye; therefore, people typically do not have allergic responses to it. The average radiation exposure for one SPECT scan is 0.7 rem. This exposure is similar to the amount from a nuclear bone scan or brain CT scan—both of which are routinely ordered for many common medical conditions (i.e. bone fractures or head trauma).

Will the SPECT study give a diagnosis?
No. A SPECT study by itself will not give a diagnosis. In fact, no imaging study by itself is a “doctor in a box” that can give accurate diagnoses on individual patients. SPECT imaging helps the physician understand more about the specific function of the brain. Each person’s brain is unique which may lead to unique responses to treatment. At Amen Clinics, diagnoses about specific conditions are made through a combination of clinical history and personal interview, information from family members, questionnaires and checklists, SPECT studies and neuropsychological tests.

How is radiation used in SPECT?
The radiotracer that we use for SPECT is called Technetium 99m. Its signal is detected by the scanner. Combining Tc99m with other molecules (like HMPAO – “Ceretec”) allows Tc99m to enter specific/desired tissues. This allows us to understand something about the functioning of that tissue.

SPECT requires an injection of 20 to 25mCi (millicuries, the measure of radioactivity inherent to a radiopharmaceutical – in our case, Technetium 99m). The biological effect a dose of radioactivity has on tissues (effective dose), cannot be linearly extrapolated from the radioactivity of a dose of administered radioisotope, and it varies with tissues, so a total radioactivity exposure (effective dose) for the whole body is calculated. This is measured in rem (Roentgen equivalents to man) or Sieverts (one Sievert = 100 rem).

The typical effective dose of radiation from one SPECT scan (based on patient mass) is on the order or 250-300 mrem (millirem). Two of our SPECT scans are roughly equivalent to, or a bit less than, one CT scan of the abdomen or pelvis (about 0.7 to 1.0 rem, depending on protocol).

This amount of exposure is well below the cut-off level (10.0 rem) for any known potential or observable health risks.

For more information on radiation you can visit the Health Physics Society website at hps.org, hps.org/documents/pregnancy_fact_sheet.pdf, hps.org/documents/Medical_Exposures_Fact_Sheet.pdf – please note that our radiation doses for two scans are on the order of the listed dose for one scan in this publication.

About 5% of the total dose goes to the brain. About 40% of the tracer is excreted within minutes by the kidneys and the remainder by the gallbladder over about 24 hours. Tc99m has a half-life of just over 6 hours.

A final issue to be addressed is the idea that susceptibility to the deleterious effects of radiation increases with decreasing age. That is to say: the idea that children are more sensitive to radiation than adults. The understanding of this issue is an ever-evolving one. While a developing fetus is very much sensitive to ionizing radiation, there has been no clear evidence that children are more susceptible to radiation. This resulted in a past (1989) statement from the NIH to the same effect.

Preparing For Appointments

How many days do I need to be at the clinic?
You should allow two to three days (for 2-4 hours each day) for the complete evaluation process, but the days do not have to be in a row.

Will I be seeing Dr. Amen personally for the evaluation?
No. Due to his writing, research, and teaching duties, Dr. Amen has very limited clinical time. However, all of our physicians have been personally trained by Dr. Amen.

Do I need to be off medication before the study?
We know some people worry they may not get accurate scans while on medication, but many of our patients are scanned on their medications and the scans are still very valuable. NEVER discontinue any medication or nutritional supplement necessary for your physical health. These include, but are not limited to, blood pressure medications, blood thinners, diabetes or thyroid medications, and medications that treat heart or lung problems. If you decide to be scanned off all medications and supplements, YOU MUST do so under the guidance of your healthcare provider.

In general we recommend patients:

  • Discontinue stimulants four days prior to the first scan appointment and stay off of them until the scan appointment(s) are completed.
  • For other psychiatric medications, it depends on the particular half-life of each medication (meaning how long it stays in your system). Always check with your doctor before reducing or discontinuing your medication. Only reduce or stop medication under your doctor’s supervision.
  • If helpful, you can arrange to have a phone consultation between one of our doctors and your personal physician to discuss questions about discontinuing medication and supplements prior to your scans.

Do I need a referral from my doctor in order to make an appointment?
No. If you would like to investigate your need for SPECT imaging, you may contact the clinic directly. Our intake coordinators will discuss your situation with you and, if deemed necessary, will schedule a full evaluation with scans. A staff medical professional reviews all new intakes for medical necessity.

Do you offer phone consultations prior to scheduling an appointment?
Yes. If you would like to schedule a consultation with a physician, you can do so by calling any of our clinic locations. The charge for a half-session (up to 30 minutes) is $200 and a full session (30 – 60 minutes) is $400.

Can Amen Clinics accept scans performed elsewhere?
Many people come to Amen Clinics seeking a second opinion on scans performed elsewhere. While there are some compatibility considerations, we are happy to perform this service.

To arrange the reading, contact our Imaging Department at (949) 236-8632. The patient will need to sign forms authorizing the release of their medical information to their physician. The optical disk should be sent to the Southern California office to the attention of Nuclear Imaging Coordinator (please see address below). Fees are $400 per scan, and must be paid in advance.
IMPORTANT: you will need to ensure that the scans are compatible with our software, database, and reading protocols.

  • Scans must be performed with a Picker Prism 3000 camera (S or XP model). Low–energy, high-resolution (LEHR) fan beam collimators are preferred, but parallel hole collimators are an acceptable substitute. In the absence of a Prism 3000 camera, a Picker Axis camera may be used. A Picker Prism 2000 is a third alternative.
  • Usual tracer dosage is 20-25 millicuries of Ceretec (dose calculated by weight). Neurolite is not a recommended substitute radiopharmaceutical for our protocol.
  • Please note that Ceretec is not a dye and there are no known serious allergic reactions to this substance.
  • Ideally, concentration studies should use the Connors Continuous Performance test, which we use at Amen Clinics. This test, which takes about 15 minutes, focuses the brain on one activity.
  • The scan should be acquired with a step-and-shoot acquisition protocol (rather than a continuous acquisition protocol, such as RAS). Patient motion should be minimized and the study should be performed to acquire a minimum of 10 million counts.
  • The raw, unprocessed, non-compressed data should be loaded onto an optical disc for delivery. (Please contact our Nuclear Imaging Department to obtain details about acceptable media formats.
  • Please refer your scan technologist to the camera Stop Conditions Chart below for acceptable acquisition settings.

Send your optical disc to:
Amen Clinics
ATTN: Nuclear Imaging Coordinator
3150 Bristol St #400
Costa Mesa, CA 92626

Once these criteria are fulfilled and you have made the appropriate arrangements with our office, your study will be read and we will provide a report for the referring physician. Thank you very much for your interest in Amen Clinics.

Refer to the Stop Conditions Chart

Fees And Financial Information

Who do I call to get answers to financial questions?
Our staff is committed to clear communication and transparency every step of the way. If you have questions about fees, please call us at 1-888-564-2700.

If you are a current patient with questions about payment status, please call the clinic at which you were treated.

Does insurance cover the cost of SPECT studies?
Reimbursement by insurance companies varies according to your plan. Amen Clinics, Inc. does not bill insurance. At the end of the evaluation, patients are given a “walk-out statement” containing applicable diagnosis and billing codes, which can then be submitted to insurance companies for possible out-of-network reimbursement.

Do you offer any discounts, payment plans, or financial assistance?
We offer a 10% discount for family members and friends referred by patients who have had complete evaluations with SPECT scans.

Because we want everyone to have access to the health care services they need at Amen Clinics, we have partnered with CareCredit to offer interest-free financing. You can read more about CareCredit below.

What Is CareCredit?
CareCredit is a special credit card that can only be used for health, cosmetic, and veterinary procedures. There are no up-front costs or pre-payment penalties. Although individual plans may vary, in most cases, a payment schedule is set up between you and CareCredit, and if you pay off your fees within the agreed-upon time frame, you are not charged any interest. Plus, you are able to receive treatment at the Amen Clinics right away.

You can call Care Credit at (866) 893-7864 or contact them on the web at www.CareCredit.com for more information. You may also apply online at www.CareCredit.com or use their automated phone application by calling (800) 365-8295.

If you are an existing CareCredit Cardholder needing help with your account, please call (866) 893-7864.

Cancelling And Rescheduling Appointments

What is your policy regarding cancellations or rescheduling evaluation appointments?
When we schedule an evaluation, we ask for a non-refundable deposit. We do this because when you are scheduled, we are blocking several hours of appointments on 4 different provider schedules and ordering the scan pharmaceuticals specifically for you.

This initial deposit must be paid at the time appointments are scheduled; it is then applied to the complete payment for services. In order to receive a refund of your initial deposit, you must cancel your appointment no later than 3 business days from the time you initially booked your appointments. If you choose to cancel your appointments after this time, your deposit will not be refundable.

If you need to reschedule, please give us at least 2 business days to make the change, otherwise it will be considered a cancellation.

What is your policy regarding missed appointments and late arrivals on follow-up visits?
We require 24 business hours advanced notice for changing or canceling an appointment, otherwise you will be charged for the appointment. Additionally, if you are late for your appointment or if you miss your appointment, you will still be charged for the full session. If you arrive more than 10 minutes late, our office may have to reschedule your appointment and you may still be charged for the missed session.

Treatment And Follow-up Care

What is the cost of follow-up care?
The price of your evaluation includes one 30-minute follow-up visit, in person or via phone with your Amen Clinics physician. Any further follow-up visits are billed at a rate of $200 per half session with the doctor or $125.00 per half session with one of our nurse practitioners or physician’s assistants. This includes in-person visits, phone visits, writing of additional reports or letters, and, in some instances, e-mails.

How often will I need to come into the office?
Doctor visits vary in frequency depending upon your needs. When medications are changed, your visits will be more frequent. Even if you are stable on your medication, our doctors or other licensed clinicians must see you in person a minimum of once every 6 months. This is standard of practice for psychiatry and is our policy.

Can I have my follow-up visits via telephone or by e-mail?
While we may schedule phone visits for minor adjustments and check-ins, most decisions about your care must be made during in-person visits. E-mail may be used to communicate routine information and questions to your doctor, but this does replace a visit, nor will any medical decision be made via e-mail correspondence.

Can you give me the name of a doctor or therapist in my area for treatment?
At www.amenclinics.com we have a list of professionals throughout the country who are a part of our referral network. However, we cannot guarantee you will find a professional willing to use our work in your care.

Can my doctor at Amen Clinics become my regular psychiatrist?
If you live close by and would like us to provide ongoing treatment for you or your family member, your Amen Clinics’ physician will discuss if this is the best option for you. However, if you are already working with another physician, we ask that you discuss this decision with your doctor.

Will I work with anyone at Amen Clinics other than my doctor there?
We have certified nurse practitioners and physician’s assistants on staff who also manage medications. If you would benefit from psychotherapy or coaching, we offer these services with licensed professionals.

What do I do if I have an emergency?
If you have a negative reaction to medication or other serious symptoms, please call us. We have an after-hours paging system available for urgent matters. However, if you have a life-threatening emergency, please call 911 or go to your local emergency room immediately.

What if I need a refill of medication before my appointment?
Because our doctors’ schedules vary, we request that all medication refills be ordered through your pharmacy. Ask your pharmacy to fax a refill request to the Amen Clinics where you were evaluated and treated. Please plan ahead and allow 3 – 5 working days for refills. Be aware that many states do not allow pharmacies to accept phone refills for controlled substances (such as Xanax and Ativan). Stimulant drugs, such as Adderall and Ritalin, cannot be called in at all.

What if I have questions after my evaluation?
During your initial evaluation, we make every effort to provide step-by-step treatment recommendations. We are always happy to provide a consultation to you or your doctor after your evaluation if additional questions arise. We act as ongoing consultants for many of our patients.