One of our key approaches to treatment of mood and behavior disorders is brain SPECT imaging, a type of brain scan that shows brain function. For decades now we have used SPECT as a tool to see how a patient’s brain function factors into their psychiatric condition.
Even though we have seen the power of brain imaging, it remains uncommon for most psychiatric doctors to get images of their patients’ brains.
The Search for Psychiatric Biomarkers
If you had chest pain, a cardiologist would consider your symptoms, do sophisticated imaging of your heart, plus an EKG and blood tests. He or she would be looking for certain biomarkers before forming a diagnosis.
Biomarkers are objectively measured indicators of a biological state, something that would give a higher certainty of insight into the physiological reality beyond the symptoms that the patient is experiencing. For instance, a biomarker for a heart attack is an elevated level of the protein complex troponin.
At Amen Clinics, when we do a scan of a patient’s brain, we are looking for biomarkers like elevated or decreased blood flow in certain areas of the brain.
With the recent storm of criticism surrounding the new Diagnostic and Statistical Manual of Mental Disorders (DSM-5) produced by the American Psychiatric Association and the NIH announcement that they would not be funding new studies based on the DSM approach to diagnosis, we predict that we will be seeing a lot more research into the merits of brain imaging for the diagnosis and treatment of psychiatric disorders.
Risks are Revealed
Our own database of scans looked at the activity in the right insular cortex in over 8,750 patients. This is what we found.
Increased blood flow in the right insular was positively associated with:
• Bipolar disorder
• Anxiety disorders, including generalized anxiety disorder
• Obsessive compulsive disorders
• Substance abuse disorders
• ADHD
Low insular activity was more highly correlated with:
• Depression
• Dementia
People with Bipolar disorder also have increased right insular activity. Using right insular hyperactivity as a biomarker for an SSRI medication when someone may have an underlying Bipolar disorder may actually flip him or her into a manic episode. In other words, it can make a patient much worse.
In addition, prior studies have shown that SSRIs can help Generalized Anxiety Disorders and some forms of OCD, but SSRIs usually make people with ADHD worse and they often don’t care that they are worse, because they have less anxiety.
Symptoms, Biomarkers and the Whole Person
We are coming to grips with the fact that the old approach of diagnosing and treating psychiatric disorders using symptoms alone is ineffective, and in many cases actually makes things worse. Likewise, using brain imaging by itself can’t always tell the entire story. To understand and treat psychiatric conditions effectively, we need to listen to our patients, evaluate their brains and develop targeted treatment plans.
Let Us Help You Today
Our experienced staff will help you learn more about your brain. If you’re ready to take control over your future, call us today at 888-288-9834 or visit our website to schedule an appointment. New research is showing that transcranial magnetic stimulation (TMS) has significant benefits for many sufferers of treatment-resistant major depressive disorder. At Amen Clinics, we have found TMS to be an effective option for many patients. Treatment of depression with TMS is effective for many people; it is safe, easy and there are virtually no side effects. Now we know that for some people whose depression doesn’t seem to be resolved with medication, supplements or psychotherapy, TMS is a viable option for long-term relief.
Some depressed adults just don’t get results from medication, or the side effects from medication are too much to bear. In 2008 the FDA approved transcranial magnetic stimulation for treating depressed adults for whom at least one antidepressant has failed to effectively resolve the symptoms of depression.
TMS works by using pulsed magnetic fields to stimulate neurons in the parts of your brain that affect mood. The result is increased blood flow and glucose metabolism, which may elevate your mood.
The recent study was led by investigator Linda L. Carpenter, MD, assistant professor, Department of Psychiatry and Human Behavior, Brown University School of Medicine, and chief, Mood Disorders Program, Butler Hospital, in Providence, Rhode Island. It involved over 300 patients from across the nation who suffered from “drug resistant” depression, and it showed two important results:
Acute treatment with TMS provided symptomatic improvement in 62% of patients, and 41% of patients experienced complete remission.
After 12 months, out of those who had gotten relief from that acute TMS treatment, 68% achieved symptomatic improvement, and 45% reported complete remission.
It should be noted that the benefits of the acute treatment coincided with a common sense course of continuing antidepressant medication and additional TMS treatments when symptoms reoccurred.
Amen Clinics Approach to TMS
We added transcranial magnetic stimulation to our arsenal of treatments options at Amen Clinics because we understand that no two brains are alike. Some brains do not respond as well to medication or supplements as others; some brains are more powerfully impacted by physical exercise and dietary changes; some respond well to magnetic stimulation. Often, it’s the right mix of many treatments that makes the difference.
At Amen Clinics, we find that TMS is most effective when guided by SPECT imaging that tells us what is happening physiologically in the patient’s brain. You can contact our brain health advisors at Amen Clinics online here, or call at 888-288-9834.
