Can Brain SPECT Imaging Help Identify Depression?

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.