Landmark Endorsement for Brain SPECT Imaging in Psychiatry

In a landmark decision in May 2021, the Canadian Association of Nuclear Medicine (CANM) unanimously adopted new procedure guidelines for brain single photon emission computed tomography (SPECT) imaging for psychiatry and neurology. The prestigious scientific body endorsed brain SPECT imaging for the assessment of many common issues affecting tens of millions of people, including:

• Neuropsychiatric disorders, such as ADHD, bipolar disorder, depression, obsessive compulsive disorder (OCD), and posttraumatic stress disorder (PTSD)
• Suspected dementia, such as Alzheimer’s disease, frontal temporal lobe dementia, vascular dementia, and mild cognitive impairment
• Traumatic brain injury
• Substance abuse
• Strokes

CANM emphasized that as with all other forms of imaging studies, SPECT must be used in conjunction with clinical information and judgment. Historic news! The Canadian Association of Nuclear Medicine (CANM) has unanimously endorsed brain SPECT imaging for the assessment of ADHD, bipolar disorder, depression, OCD, PTSD, Alzheimer’s disease, TBI, substance abuse, and more.

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WHAT IS SPECT?

SPECT is a nuclear imaging study that measures blood flow and activity in the brain. It shows 3 things:

• Areas of the brain with healthy activity
• Areas of the brain with too much activity
• Areas of the brain with too little activity

SPECT is different from other brain imaging studies, such as MRI and CT, which are anatomical scans that look at the structure of the brain. SPECT looks at how the brain functions, which is more helpful for neuropsychiatric issues. SPECT first emerged in clinical use in the late 1980s as a way to assess dementia, brain injuries, seizures, and strokes. Despite a growing body of scientific evidence over the past three decades showing that SPECT can provide valuable information related to a wide variety of conditions, traditional psychiatry has been resistant to using it in the clinical setting. Psychiatric organizations, such as the American Psychiatric Association (APA), suggested the imaging technology was useful for research but not yet ready for clinical practice. As a result, psychiatry remains the only medical specialty that rarely looks at the organ it treats.

AMEN CLINICS: A PIONEER IN THE USE OF SPECT IN CLINICAL PSYCHIATRY

Daniel G. Amen, MD, founder of Amen Clinics, has been using SPECT in clinical psychiatric practice for 30 years. “When I first started to use SPECT, I felt it made me a better doctor. A 44-year-old patient was in denial about his alcohol and cocaine abuse. After seeing the ‘toxic’ pattern on his scan he completely stopped the substances. A 16-year-old teen was depressed, aggressive, and impulsive. She had seen multiple psychiatrists before getting a scan, which clearly showed a traumatic brain injury pattern. On further questioning, she remembered a bad fall from her bike a month before her symptoms began. On appropriate treatment she did much better,” Amen says. In the early 1990s, the APA and clinical psychiatrists showed increasing interest in the potential of SPECT and related neuroimaging tools. A paper in The American Journal of Psychiatry detailed how the APA once gave all-day courses on SPECT but subsequently dismissed the use of SPECT and related neuroimaging because it did not match their diagnostic bible (the DSM, which it owns and profits from). Academic psychiatrists and the APA eventually argued against using scans alone as a diagnostic tool. According to Amen, “My colleagues missed the point of imaging. SPECT scans add important information that physicians could not get from talking to patients. Getting some biological data on patients, even if imperfect, was better than getting no information at all. Researchers from Creighton University found that having a SPECT scan on admission cut hospital stays for bipolar teenagers by more than half.” A psychiatrist, neuroscientist, and bestselling author, Amen adds, “Experienced clinicians can tell if someone is likely to have ADHD, OCD, or bipolar disorder without the benefit of these tools. But what clinicians cannot do, and will never be able to do, without functional brain imaging is to know the underlying brain biology of the patients they treat.” Without functional brain imaging, a psychiatrist cannot tell if inattention, depression, or aggression is from:

• Low blood flow from vascular disease
• A premature aging process
• An inflammatory process, related to low omega-3 fatty acids or gut problems
• A genetic abnormality
• Lasting physical trauma from playing football in high school
• Toxic exposure from carbon monoxide or mold exposure, which needs to be treated
• Seizure activity
• A brain infection
• Nutrient or neurohormone abnormalities
• Blood sugar abnormalities
• Undiagnosed sleep apnea
• A brain that is working too hard and needs to be calmed down
• A brain that is not working hard enough and needs to be stimulated

A NEW FUTURE OF PSYCHIATRY WITH BRAIN SPECT IMAGING

In light of CANM’s breakthrough endorsement, brain SPECT imaging is likely to gain wider acceptance in the field of psychiatry, especially in complex conditions or treatment-resistant patients. Assessing underlying brain function in these cases can be very valuable in finding the right treatment plan. If you don’t get the right diagnosis, you won’t get the right treatment. “Functional brain imaging with SPECT takes psychiatry from a generalized symptom-cluster diagnostic and treatment specialty without any biological evidence to a more objective specialty, one that is solidly based on using state-of-the-art brain mapping tools to help optimize the patient’s brain function,” Amen says. The psychiatrist adds, “It’s my hope that tools like SPECT will help us stop using the term ‘mental illness,’ which increases shame and stigma, and call these issues what they really are—brain health issues that steal people’s minds. Get your brain right and your mind will follow.” When you or a loved one are not responding to traditional treatment for depression, anxiety, ADHD, bipolar disorder, or other mental health issues, brain SPECT imaging can help. Seeing is believing and learning about any areas of brain dysfunction can be critical in getting an accurate diagnosis and the most effective and targeted treatment plan. At Amen Clinics, we’re here for you. We offer in-clinic brain scanning and appointments, as well as mental telehealth, remote clinical evaluations, and video therapy for adults, children, and couples. Find out more by speaking to a specialist today at 888-288-9834 or visit our contact page here.