Type 4: Over-Focused Anxiety/Depression involves excessive activity in the brain and is associated with people who have trouble shifting attention and get locked into anxious and/or negative thoughts or behaviors. People with this type—which occurs more frequently in the children or grandchildren of alcoholics—tend to worry, hold grudges, and have problems with oppositional or argumentative behavior. Conditions that fit into this type include:
COMMON SYMPTOMS OF TYPE 4: OVER-FOCUSED ANXIETY/DEPRESSION
People with this type generally have 4 symptoms from Pure Anxiety (Type 1) and/or Pure Depression (Type 2) in addition to at least 4 “over-focused” symptoms.
Anxiety symptoms include:
The tendency to say “no” without first thinking about the question
TYPE 4: OVER-FOCUSED ANXIETY/DEPRESSION IN THE BRAIN
Brain SPECT imaging findings associated with this type show excessive activity in the brain’s anterior cingulate gyrus, the basal ganglia, and/or the deep limbic system at rest and during concentration. Sometimes there is markedly increased activity in the anterior cingulate gyrus with concentration; other times it calms a bit with concentration.
Anterior cingulate gyrus (ACG): The ACG is the brain’s gear shifter. When there is too much activity in the ACG, people cannot shift their attention properly and end up stuck on negative thoughts or behaviors. When this is combined with excessive basal ganglia activity, people get stuck on anxious thoughts. When this is combined with too much activity in the deep limbic system, people get stuck on negative depressing thoughts. Many people get stuck on both anxiety-provoking and depressive thoughts. When ACG overactivity becomes worse with concentration, it usually means that as the person tried to focus on something, they become more anxious or more stuck on negative thoughts or behaviors. The more intensely they concentrate, the worse the problem becomes.
Basal ganglia: This set of large structures toward the center of the brain surround the limbic system. They are involved with integrating feelings, thoughts, and movement, along with helping to shift and smooth motor behavior. Research suggests the basal ganglia are involved in forming habits. At Amen Clinics, we’ve noticed they are also involved with setting the body’s anxiety level. In addition, the basal ganglia help to modulate motivation and are involved with feelings of pleasure and ecstasy (which is why drugs like cocaine and methamphetamines work in this part of the brain).
Deep limbic system: This system is one of the most interesting and critical parts of being human and is power-packed with functions, all of which are critical for human behavior and survival. The limbic system typically includes the thalamus (involved in relaying information), amygdala (fear center), hippocampus (memory center), hypothalamus (emotional center), and olfactory cortex (sense of smell).
INTERVENTIONS FOR TYPE 4: OVER-FOCUSED ANXIETY/DEPRESSION
This type is best treated with interventions that increase the neurotransmitter serotonin as well as strategies to help you get unstuck.
Diet: For many, eating a diet that is higher in complex carbohydrates (“smart carbs”) and lower in proteins is effective. Specifically, consume foods that are high in L-tryptophan, which is a building block of serotonin, such as sweet potatoes, hummus, salmon, turkey, eggs, nuts, and seeds.
Supplements: The nutraceuticals 5-HTP and saffron
Exercise: Burst training can be especially helpful for this type.
Stop your thoughts: Whenever you notice yourself getting stuck on negative or anxious thoughts, envision a red stop sign and think “STOP!”
Keep a journal for your thoughts: To help prevent anxious or negative thoughts from looping endlessly in your mind, write them down. This helps get them out of your head.
Consider options: Before automatically saying “No” to things, take a few moments to think about options. This helps you get unstuck and increases mental flexibility.
Depression, anxiety, OCD, PTSD, phobias, eating disorders, and other mental health issues can’t wait. During these uncertain times, your mental well-being is more important than ever and waiting until life gets back to “normal” is likely to make your symptoms worsen over time. 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. Depression is not a single or simple disorder. The sadness or emptiness you experience may be very different than the hopelessness or helplessness someone else feels. But traditional psychiatry doesn’t typically recognize these differences and often gives everyone who is depressed the same diagnosis and the same treatment plan. This will never work because depression is a symptom of many different causes. You need to find the root cause.
Depression is a symptom with many different causes. You need to find the root cause.
Giving someone the diagnosis of depression is exactly like giving them the diagnosis of chest pain. Why don’t doctors give people the diagnosis of chest pain? Because it doesn’t tell you what’s causing it or what to do about it. It could be from a blocked artery, grief, or heartburn from the pepperoni pizza you ate. There are many biological issues that contribute to depression that psychiatrists, psychologists, and other healthcare providers may miss.
Based on the brain SPECT imaging work at Amen Clinics, which has the world’s largest database of functional brain scans related to behavior (over 160,000 scans from 155 countries), as well as clinical experience with tens of thousands of patients over more than 30 years of practice, it has become evident that there are not only multiple causes of depression but also multiple types of depression. Specifically, the neuropsychiatrists at Amen Clinics have identified 7 types of depression and anxiety, which occur together 75% of the time.
This blog series will explore each type, including the common symptoms, brain SPECT findings, and effective interventions.
TYPE 2: PURE DEPRESSION
Type 2: Pure Depression results from excessive activity in the brain’s emotional center, the deep limbic system. This type is associated with primary depressive symptoms that range from chronic mild sadness (dysthymia) to the devastating illness of major depression. If you’re struggling with these feelings, you may be one of those people who tries to smile through your depression, or you may be among those who can barely get out of bed.
Some of the most famous, creative individuals we’ve scanned, including musical artists, actors, and writers, have overactivity in the deep limbic center. People with this brain pattern tend to be sensitive, deeply feeling, and empathic, which can be channeled in their art.
COMMON SYMPTOMS OF TYPE 2: PURE DEPRESSION
Some of the most common symptoms seen in people with Pure Depression include:
Persistent sad or “empty” mood
Loss of interest or pleasure in activities that are usually fun, including sex
Restlessness, irritability, or excessive crying
Feelings of guilt, worthlessness, helplessness, hopelessness, pessimism
Sleeping too much or too little, early-morning awakening
Loss of appetite and/or weight loss, or overeating and weight gain
Decreased energy fatigue, feeling “slowed down”
Thoughts of death or suicide, or suicide attempts
Difficulty concentrating, remembering, or making decisions
Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain
Persistent negativity or chronic low self-esteem
Persistent feeling of dissatisfaction or boredom
Although these are the most typical problems associated with Pure Depression, they are not the only ones. At Amen Clinics, patients complain of myriad other depressive symptoms that many people aren’t often aware of.
TYPE 2: PURE DEPRESSION IN THE BRAIN
The SPECT findings that correlate with Pure Depression are markedly increased activity in the deep limbic area at rest and during concentration and decreased prefrontal activity at rest that improves with concentration. Deactivation of the prefrontal cortex at rest and improvement with concentration is a finding that is very common but not always present. In a study of more than 15,000 patients at Amen Clinics, we saw a significant correlation between increased activity in the limbic system and self-reporting of being negative or feeling chronic guilt, having crying spells, and experiencing feelings of helplessness and hopelessness.
The limbic system is one of the most interesting and critical parts of being human and is power-packed with functions, all of which are critical for human behavior and survival. The limbic system typically includes the:
Thalamus—a large structure deep in the center of the brain that relays information to and from the outside world and the cerebral cortex.
Amygdala—an almond-shaped structure in the temporal lobes, involved in emotional and fear responses.
Hippocampus—a seahorse-shaped structure that helps memories get into long term storage.
Hypothalamus—about the size of a pearl, is an important emotional center, controlling the chemicals that make you feel hungry, sexual, sleepy, exhilarated, angry, or unhappy.
Olfactory cortex—our sense of smell, which connects to emotional and memory centers.
INTERVENTIONS FOR TYPE 2: PURE DEPRESSION
In traditional medicine, antidepressants are often prescribed as the first line of defense for depression, but these drugs are not the cure-all many people expect. A 2014 study found that in over 50% of depressed patients, taking antidepressants failed to provide full remission of their symptoms. Unfortunately, treatment-resistant depression is far too common.
At Amen Clinics, relying solely on medication for mental health issues (which are really “brain health” issues) is never the solution. Rather, taking a brain-body approach that addresses all the contributing factors of depression is the best way to feel better fast and make it last. There are many alternatives to antidepressants that can help, such as:
Kill the ANTs: Learning to eliminate the ANTs (automatic negative thoughts) and replacing them with more helpful thoughts can completely change your life.
Practice gratitude: Gratitude helps direct your attention to positive feelings and away from negative ones. A wealth of research suggests that a daily practice of gratitude, as simple as writing down several things you’re grateful for every day, can improve our emotions, health, relationships, personality, and career.
Get moving: Research shows that physical activity improves mood, anxiety, and even cognitive health in patients with depression.
Eat right: Consume mood foods that make you feel better.
Use your sense of smell: Your limbic system is the part of your brain that directly processes your sense of smell. Certain scents—such as lavender and jasmine—are known to have mood-enhancing effects. Use an essential oil diffuser and essential oils with these scents.
Supplements: Omega-3 fatty acids, saffron, s-adenosylmethionine (SAMe), and vitamin D can help.
Depression, anxiety, panic attacks, and other mental health issues can’t wait. During these uncertain times, your mental well-being is more important than ever and waiting until life gets back to “normal” is likely to make your symptoms worsen over time. 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. If all our specialists are busy helping others, you can also schedule a time to talk.
By Mark Filidei, DO Director of Integrative/Functional Medicine at Amen Clinics
In the past year or so, I’ve been fielding so many questions from my patients about using CBD for psychiatric symptoms and other health issues. You may be getting these same questions. In this article, I provide an overview of CBD in neuropsychiatry. To begin, let’s take with a closer look at the endocannabinoid system and how it works.
Endocannabinoid System Basics
The endocannabinoid (eCB) system is involved in modulating a wide range of processes and functions throughout the body, including cognition, pain, mood, fertility, bone metabolism, and immune function.
Experts are still exploring the intricacies of how the system works, but basically, eCBs—also called endogenous cannabinoids—are molecules produced in the human body that are similar to cannabinoids. There are 2 key eCBs in the body—anandamide (AEA) and 2-arachidonoylglyerol (2AG).
In order to activate the system, AEA and A2G bind to endocannabinoid receptors located throughout the body. These cannabinoid receptors are similar to the body’s opioid receptors and nicotinic receptors, which also bind to natural substances. Experts have identified 2 types of eCB receptors—CB1 receptors in the central nervous system (brain, lungs, muscles, GI tract, reproductive organs, immune system, liver, bone marrow, and pancreas) and CB2 receptors in the peripheral nervous system (spleen, bones, skin, immune system, liver, bone marrow, and pancreas).
After eCBs have performed their function, they are degraded by the enzyme fatty acid amide hydrolase (FAAH).
eCBs and Psychiatric Health
Emerging research is showing that the eCB system plays an important role in certain areas of the brain and in various aspects of mental health. For example, CB1 is highly expressed in the brain’s limbic system (involved in setting emotional tone), basal ganglia (involved in setting the body’s anxiety level), and cerebellum (involved in thought processing).
Research shows the eCB system plays an important role in stress-related psychiatric disorders, including post-traumatic stress disorder (PTSD), generalized anxiety, and major depressive disorder. The evidence suggests it is involved in gating and buffering the stress response, dampening anxiety, and regulating mood. This appears to be due to action within the amygdala (the brain’s fear center) and the prefrontal cortex (involved in regulating inhibition of the stress response). Specifically, CBD’s mechanisms of action include the agonism of certain calming serotonin receptors and the inhibition of others.
Cannabinoids for Psychosis and Schizophrenia
A 2018 study in the American Journal of Psychiatryfound that CBD has beneficial effects for people with schizophrenia and the researchers concluded that CBD “may represent a new class of treatment for the disorder.” Other research has found that CBD significantly alleviates psychotic symptoms in people with schizophrenia.
CBD and Depression
A growing body of research shows that CBD has antidepressant properties. A 2019 study found that CBD interacts with multiple neurotransmitter systems, including the serotonergic, glutamatergic, and endocannabinoid systems. Plus, it induces cellular and molecular changes in regions of the brain related to depression.
CBD and Anxiety
Current evidence, including a 2015 review of existing research in Neurotherapeutics, strongly supports CBD as a treatment for generalized anxiety disorder, panic disorder, social anxiety disorder, obsessive compulsive disorder, and PTSD.
CBD and Neuroprotection
Among the evidence on CBD and neuroprotection, a 2016 study found that CBD attenuates brain damage associated with neurodegenerative and/or ischemic conditions. In addition, the researchers noted that CBD affects synaptic plasticity and facilitates neurogenesis.
CBD vs. Psychiatric Medications
When it comes to treating mental health disorders, medications often come with a host of unpleasant and potentially unhealthy side effects. CBD, however, is associated with a wide range of additional health benefits, such as reducing sugar levels, decreasing inflammation, and reducing arterial blockages.
If you’re considering recommending CBD to the people you serve, it’s important to be aware of the most up-to-date research and the latest legal status of CBD products in your state. It’s also critical to keep in mind that since it has only recently been legalized in some states, we don’t have a lot of information yet about its long-term effects on brain health. As always, make the most informed decision for your patients.
About the Author: Mark Filidei, DO, Amen Clinics Orange County, CA
Dr. Mark Filidei is an Internal Medicine physician and is the Director of Integrative/Functional Medicine for Amen Clinics. Functional Medicine incorporates the latest developments in systems biology, genetics, and a deep understanding of human physiology to address complex medical and mental health issues. Dr. Filidei’s approach is to find the root cause of a person’s health problems including metabolic, genetic, and environmental factors, and to treat those problems in as natural a way as possible by using targeted nutritional supplements, correcting hormone and metabolic imbalances, improving lifestyle and diet, and detecting and treating toxin exposure and infections like mold and Lyme disease.
Anxiety and depression are not single or simple disorders. The nervousness you feel may be very different than the panic or dread someone else experiences. But in traditional psychiatry and medicine, healthcare providers often lump people with these conditions into a single box with a cookie-cutter approach to treatment. But giving everyone who feels anxious or depressed the same treatment will never work.
Based on the brain SPECT imaging work at Amen Clinics, which has the world’s largest database of functional brain scans related to behavior (over 160,000 scans from 155 countries), as well as clinical experience with tens of thousands of patients over more than 30 years of practice, it has become evident that there are multiple types of anxiety and depression. Specifically, the neuropsychiatrists at Amen Clinics have identified 7 types of anxiety and depression.
This blog series will explore each type, including the common symptoms, brain SPECT findings, and effective interventions.
TYPE 1: PURE ANXIETY
Type 1: Pure Anxiety often results from overactivity in the basal ganglia, setting one’s “idle speed” on overdrive. Sufferers feel stirred up, anxious, or nervous. If you have Type 1: Pure Anxiety, you may feel uncomfortable in your own skin. Some Amen Clinics patients report feeling as though they could “climb the walls” or that they are “crawling out of their own skin.” You may be plagued by feelings of panic, fear, and self-doubt. It’s common to suffer from physical feelings of anxiety as well, such as muscle tension, nail-biting, headaches, abdominal pain, heart palpitations, shortness of breath, and sore muscles.
Amen Clinics has identified 7 types of anxiety and depression. Type 1: Pure Anxiety often results from overactivity in the basal ganglia.
It’s as if you have an overload of tension and emotion. The symptoms may be a consistently disruptive presence in your life, or they may come in unexpected waves. Irrational fears and phobias may also be a burden. If you’re like most people with this type, you may have a tendency to avoid anything that makes you anxious or uncomfortable, such as places or people that might trigger panic attacks or interpersonal conflict.
People with Type 1: Pure Anxiety tend to predict the worst and look to the future with fear. You may be excessively shy or startle easily, or you may freeze in emotionally charged situations.
12 COMMON SYMPTOMS OF TYPE 1: PURE ANXIETY
Frequent feelings of nervousness or anxiety
Panic attacks
Avoidance of people or places due to a fear of having anxiety or panic attacks
Symptoms of heightened muscle tension (headaches, sore muscles, hand tremor)
Periods of heart-pounding, nausea, or dizziness
A tendency to predict the worst
Multiple persistent fears or phobias (such as dying or doing something crazy)
Conflict avoidance
Excessive fear of being judged or scrutinized by others
Being easily startled or a tendency to freeze in anxiety-provoking or intense situations
Shyness, timidity, and getting easily embarrassed
Biting fingernails or picking skin
TYPE 1: PURE ANXIETY IN THE BRAIN
On SPECT scans, Pure Anxiety is associated with increased activity in the basal ganglia, seen on both concentration and resting studies. The basal ganglia are a set of large structures toward the center of the brain that surround the limbic system. They are involved with integrating feelings, thoughts, and movement, along with helping to shift and smooth motor behavior. Research suggests the basal ganglia are involved in forming habits.
At Amen Clinics, we’ve noticed they are also involved with setting the body’s anxiety level. In addition, the basal ganglia help to modulate motivation and are involved with feelings of pleasure and ecstasy (which is why drugs like cocaine and methamphetamines work in this part of the brain).
The integration of feelings, thoughts, and movement in the basal ganglia causes you to jump when you get excited, tremble when you’re nervous, freeze when you’re scared, or get tongue-tied when the boss is chewing you out. The basal ganglia allow for a smooth integration of emotions, thoughts, and physical movement, and when there is too much input, they tend to lock up. When the basal ganglia are overactive (as we have seen in the case of people with anxiety tendencies or disorders), people are more likely to be overwhelmed by stressful situations and have a tendency to freeze or become immobile (in thoughts or actions).
Interestingly, some of the most highly motivated individuals we’ve scanned, such as entrepreneurs and corporate CEOs, have significantly increased activity in this part of the brain. We theorize that some people can use this increased activity in the form of motivation to become “movers” in society.
[INSERT HEALTHY AND ANXIETY SCANS – ACTIVE SCANS]
INTERVENTIONS FOR TYPE 1: PURE ANXIETY
In too many instances, people with anxiety turn to anti-anxiety medication as the first and only thing they do to calm their nerves. Unfortunately, prescription drugs for anxiety, such as benzodiazepines (“benzos”), come with troublesome side effects. For example, benzos are associated with decreased overall brain activity, and they’re habit-forming. In addition, research in the Journal of Clinical Neurology shows that taking them for long periods of time raises the risk of dementia by over 50%.
Medications aren’t the only answer. In fact, there are many natural alternatives to anti-anxiety pills, including:
Diaphragmatic breathing—deep belly breathing whenever you’re feeling stressed or nervous
Hand warming—learn to warm your hands using mental imagery
Heart rate variability (HRV) training—enhance your HRV to lower anxiety
Supplements—GABA, l-theanine, and magnesium soothe anxiousness
ANT Therapy —learn to challenge the automatic negative thoughts (ANTs) that make you anxious
Meditation and hypnosis—these practices calm stress and anxiety
EMDR Therapy—EMDR (eye movement desensitization and reprocessing) helps overcome anxiety related to trauma
Learning how to deal with conflict—handling issues rather than running from them helps keep anxiety in check
Neurofeedback—this biofeedback technique can lead to greater relaxation
Anxiety, panic attacks, depression, and other mental health issues can’t wait. During these uncertain times, your mental well-being is more important than ever, and waiting until life gets back to “normal” is likely to make your symptoms worsen over time. 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. If all our specialists are busy helping others, you can also schedule a time to talk.By Melissa Quinn, MD
Depression is taking a devastating toll on humanity. Worldwide, depression is the third leading cause of disability. In the U.S., it’s affecting a skyrocketing number of people. During the pandemic, Census Bureau Statistics on 42,000 people found that 24% of respondents reported significant symptoms of major depressive disorder. Among 18-29-year-olds, the number was even higher with 36% reporting depressive symptoms.
This common condition can have devastating consequences—causing problems with energy, focus, motivation, sleep, appetite, libido, and more. Some people are left feeling so helpless and hopeless, they develop suicidal thoughts and behaviors. Suicide is the 10th leading cause of death in the U.S. In 2018, 48,344 people in the U.S. died by suicide and there were 1.4 million suicide attempts. That boils down to an average of 3,836 attempts per day.
The Traditional Approach to Treating Depression
For decades, pharmaceutical antidepressants have been the primary medical intervention for depression (outside of lifestyle interventions such as dietary changes, exercise, and mind-body practices). Typically, it takes 4-12 weeks of use for patients to experience a decrease in symptoms. Unfortunately, 30%-60% of individuals do not respond to SSRIs (though there are genetic tests to help identify these clients and therefore help with improved treatment decisions).
Some people try several different antidepressants without relief, leading to a form of depression known as treatment-resistant depression (TRD). This often leads to months of inadequate medication treatment that can leave the person feeling more hopeless than prior to starting treatment.
Considering the dire statistics and the shortcomings of antidepressant medications, it’s clear that we are in desperate need of more effective treatments for depression and suicidal ideation.
Ketamine: A Potential Breakthrough
Increasingly, psychiatrists are turning to ketamine as another option. Used as an anesthetic drug for about 50 years, it deadens pain and can cause feelings of being dissociated from one’s own body. A growing body of scientific evidence, including a 2017 study in the Journal of Clinical Psychiatry, has found that ketamine has antidepressant effects. And it enhances mood much more quickly than traditional antidepressants. A 2018 review of over 20 studies on ketamine in Drug Design, Development, and Therapy showed that it produces significant decreases in depressive symptoms in just 24 hours.
Here’s what you need to know.
Mechanisms of action: Unlike traditional antidepressants that affect neurotransmitters, including serotonin, dopamine, and norepinephrine, ketamine works differently. It is an agonist of the N-methyl-D-aspartate (NMDA) receptors, which work on the glutamate neurotransmitter systems. Although the full mechanism that ketamine induces is not fully understood, we do know that it increases levels of brain-derived neurotrophic factor (BDNF), which plays a role in the growth and maintenance of neurons.
Types of ketamine delivery: Ketamine can be delivered in a variety of ways, and each route differs in its bioavailability. The rates are:
Intravenous: 100%
Intramuscular: 93%
Intranasal: 25-50%
Sublingual (under the tongue): 30%
Orally (by mouth): 16-24%
Psychotherapy-assisted delivery vs. IV therapy only: Ketamine encourages open-mindedness, however, it’s the therapist who enhances this effect by doing deeper integration work to promote growth and change. With this guided process, patients can weave the experience into their daily life to support long-term change. In some places, ketamine IV therapy is being offered alone without psychotherapy, but the doses are very small, and it doesn’t offer the added benefits of working with a mental health professional.
Frequency: Ketamine is typically administered during psychotherapy sessions that last 2-3 hours each with 2 sessions per week for 3 weeks.
Consider set and setting: A patient’s mindset is a critical element to consider for any psychiatric experience, and ketamine administration is no different. Be sure your patients have realistic expectations regarding what to expect during the process and make the setting a comfortable one.
Not a solo treatment: Some patients may look to ketamine as a sort of “magic bullet” that can eliminate depressive symptoms. As mental health professionals, it is up to us to inform patients that ketamine will be most effective when it is part of a comprehensive treatment plan that includes brain healthy lifestyle changes, nutritional supplements, psychotherapy, and more.
Side effects: Ketamine’s safety and tolerability have been demonstrated over nearly 50 years. Side effects may include dizziness and a rise in blood pressure. As such, individuals with severe hypertension or heart disease are not good candidates.
Potential for addiction: A 2018 study in the American Journal of Psychiatry found that ketamine’s antidepressant effects activate the opioid system, but decades of research show that ketamine is not physically addicting. However, it can be used inappropriately. For this reason, it is best used only in a clinical setting where the administration is monitored by a healthcare professional.
Other issues that may respond to ketamine: In addition to effectively treating depression, ketamine may also be helpful in treating anxiety, post-traumatic stress disorder (PTSD), emotional trauma, and addictions.
About the Author: Melissa Quinn, MD, Amen Clinics Los Angeles
Dr. Melissa Quinn is a psychiatrist who is double board-certified by the American Board of Psychiatry and Neurology. Her passion is to help people heal, get psychologically well, find the relief they deserve, and help them to become the best version of themselves. She helps children, adolescents, adults, and families get their lives back on track with a whole-person—and when appropriate—a whole-family approach. By developing her clients’ inner strengths, she shows them how to reach their highest potential.
She knows that people are seeking a range of solutions for prevention, health, and healing. As a result, Dr Quinn became passionate about learning integrative approaches and was subsequently board-certified in Integrative and Holistic Medicine through The Academy of Integrative Health and Medicine. She later went on to peruse a fellowship in Transcranial Magnetic Stimulation (TMS) through Duke University and Ketamine Assisted Psychotherapy through PRATI (The Psychedelic Research and Training Institute). She enjoys working with a variety of clients, but she specializes in working with patients with ADHD, depression, anxiety, panic disorder, obsessive-compulsive disorder, and posttraumatic stress disorder. In August, former First Lady Michelle Obama revealed on her podcast that “I am dealing with some form of low-grade depression.” She’s not the only one. Pandemic-related depression is sweeping across the nation and around the world. A survey in JAMA Network Open found that the rate of depression symptoms in the U.S. increased more than 3-fold during the COVID-19 pandemic, jumping from 8.5% before the pandemic to nearly 28%.
But depression has also been linked to having COVID-19. A 2020 study in the Journal of Alzheimer’s Disease shows that one of the consequences of COVID-19 includes depression, in addition to anxiety, attention problems, obsessive compulsive disorder, memory loss, and more. Another 2020 study appearing in the journal Laryngoscope found that in people with COVID, experiencing a loss of smell and taste was associated with depressed mood and anxiety.
New research shows that up to 80% of people with COVID report experiencing anosmia, or the loss of smell. Surprisingly, depression and anxiety were more likely to be found in people with olfactory dysfunction than in those with other symptoms, such as shortness of breath, fever, or cough.
THE SCIENCE OF SMELL AND MOOD
A wealth of scientific research has shown that our sense of smell and our moods are intertwined. For example:
When scientists chemically blunted the sense of smell in mice for a 2018 study, it induced depressive behavior in the rodents.
In another study on elderly Koreans, an impaired olfactory function was associated with a significantly higher degree of depression in addition to lower cognitive performance and decreased quality of life.
A 2016 review of the existing research on anosmia and depression showed that the relationship appears to be a 2-way street. People with depression are more likely to have problems with a sense of smell than healthy controls, and people with anosmia are more likely to have symptoms of depression. And the greater the loss of smell the more severe the depressive symptoms.
SENSE OF SMELL AND EMOTIONS IN THE BRAIN
The area of your brain involved with smell (olfactory cortex) is located near your limbic system (the brain’s emotional centers), including the hippocampus, which is involved with mood and memory. These areas tend to deteriorate and die together.
Not only is the loss of smell associated with depression, but it is also linked to memory loss and Alzheimer’s disease. Having trouble smelling peanut butter, lemon, strawberries, or natural gas is associated with a higher incidence of significant memory problems, according to research. Scoring poorly on a smell test is considered a warning sign of Alzheimer’s disease later in life.
If you experience a diminishing sense of smell or the sudden loss of your ability to identify scents, it may be a sign of trouble. Take note of any other health symptoms (fever, cough, fatigue) that may be related to COVID-19, and take stock of your emotional well-being and memory to see if you notice any changes. Be sure to make an appointment with a healthcare professional.
SMELL THE ROSES
To improve your sense of smell, give your sniffer a daily workout. There is evidence that repeated exposure to certain odors can improve the ability to smell. In a study from Aristotle University in Greece, 111 patients with anosmia repeatedly trained their sense of smell twice a day using 4 odors (phenyl ethyl alcohol, eucalyptol, citronellal, eugenol). After 8 weeks, compared to a control group, participants noticed significant improvement that lasted up to a year. If you have this issue, put your nose to work.
Certain scents have also been found to improve mood and ease depression. Essential oils that support healthy moods include lavender, chamomile, rose oil, lemon, and jasmine.
Depression, memory loss, and other mental health issues can’t wait. During these uncertain times, your mental well-being is more important than ever and waiting until life gets back to “normal” is likely to make your symptoms worsen over time. 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. If all our specialists are busy helping others, you can also schedule a time to talk. Have you ever experienced trauma? Were you physically, emotionally, or sexually abuse? Have you been subjected to intense stress, such as surviving a fire, flood, or assault? Were you the victim of bullying at school? Or maybe you’re being traumatized by the coronavirus pandemic?
Emotional trauma tends to activate the limbic or emotional centers of the brain. When trauma is severe or prolonged—think of the months-long pandemic—your brain’s emotional centers can get stuck.
In some people who experience trauma, the brain gets “stuck in overdrive,” making you feel anxious, fearful, and sleepless. This can develop into post-traumatic stress disorder (PTSD), a condition that affects 3.5% of U.S. adults, but that may affect far more people due to the pandemic.
In some people who experience trauma, the brain gets “stuck in overdrive,” making you feel anxious, fearful, and sleepless.
If you’ve experienced emotional trauma, your brain may be stuck too. Take a moment to assess whether your symptoms are more in line with a brain that’s stuck in overdrive or a brain that’s stuck off.
WHAT IMAGING SHOWS ABOUT BRAINS THAT ARE STUCK
Understanding what’s happening in the brain is critical in terms of getting help for your symptoms. Here’s why. People with PTSD are often misdiagnosed with traumatic brain injury (TBI) because the 2 conditions share many overlapping symptoms. Similarly, people with trauma-related depression may be misdiagnosed with ADD/ADHD, bipolar disorder, or even dementia.
Getting misdiagnosed means you may be given a treatment plan that isn’t right for your brain. It can stimulate a brain that’s already stuck in overdrive, making you feel even more anxious and on edge. Or, it may further calm a brain that’s already stuck off, making you feel more numb, exhausted, and disoriented.
Functional brain SPECT imaging can help. A pair of brain imaging studies from Amen Clinics (published in Plos One and Brain Imaging and Behavior) shows that emotional trauma can leave a lasting imprint on your brain. The study in Plos One found that people with PTSD showed increased in the limbic regions, cingulum, basal ganglia, insula, thalamus, prefrontal cortex, and temporal lobes. And both studies showed that SPECT imaging can distinguish PTSD from TBI with high accuracy.
With trauma-related depression, it’s important to differentiate from other mood disorders, such as bipolar disorder, as well as other conditions like ADD/ADHD or dementia. Looking at the brain can help you get a more accurate diagnosis.
BALANCE YOUR EMOTIONAL BRAIN
The good news is that if your brain is stuck—either in overdrive or off—you can get it unstuck. And there are many natural ways to help you do it.
If your emotional brain seems to be stuck in overdrive, you can calm it with the following:
If you feel shut down, you can activate your brain with:
physical exercise
upbeat music
scents, such as peppermint or eucalyptus or
stimulating supplements, such as rhodiola, green tea, or L-tyrosine
neurofeedback (a non-invasive, medication-free treatment)
When your brain gets unstuck, you’ll be able to move beyond past emotional trauma and feel happier, more motivated, and more at peace.
PTSD, depression, anxiety, and other mental health issues can’t wait. During these uncertain times, your mental well-being is more important than ever and waiting until life gets back to “normal” is likely to make your symptoms worsen over time. 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. If all our specialists are busy helping others, you can also schedule a time to talk. In the pandemic, depression is hitting Americans harder than COVID-19. A new study from JAMA Network Open found that half of U.S. adults are experiencing some symptoms of depression. That’s 3 times higher than the pre-pandemic rate.
These statistics are depressing and will contribute to a legacy of mental health problems. But there’s one industry that’s happy about the alarming trend—the pharmaceutical industry.
After the global success of Prozac, the “chemical imbalance” theory of mental illness burst into the public consciousness, and many people began proactively asking their doctors to fix their low moods with pills. Famously, after actress Carrie Fisher was cremated, her ashes were placed in a green and white Prozac-pill shaped urn.
Taking pills may seem like an easier and quicker solution to bad moods than taking the time and effort to develop brain-healthy habits, build skills, or change troublesome behavior. Yet, there is a dark side to the mind-meds that is often overlooked. Thousands of lawsuits claim that Prozac and other psychiatric medications increase violent or suicidal behavior. Virtually all antidepressants and antipsychotic medications have black box warnings, which, in simple terms means the FDA cautions patients in the strongest terms to pay close attention to potentially extremely harmful or dangerous threats to their health.
At Amen Clinics, we have published papers on depression (Journal of Alzheimer’s Disease), as well as on ADD/ADHD (Journal of Psychoactive Drugs), revealing the SPECT patterns that are associated with both positive and negative responses to medications.
PILL PUSHERS
Despite the problems, the pharmaceutical industry is incredibly successful at marketing psychiatric medications to doctors and the general public. From 1996 to 2005, the industry tripled its marketing budget with a 500% increase in direct-to-consumer advertising.
Prescription drug ads often do not adequately explain side effects, and because of repeated exposure, many people tune out those statements at the end of TV commercials, often delivered in a rapid-fire manner, such as, “This drug may cause permanent liver damage, seizures, an allergic reaction that leads to fatal throat swelling and suicidal tendencies.” Patients in the U.S. are more than twice as likely to ask for drugs seen in ads compared with those in Canada, where most direct-to-consumer advertising is prohibited.
There is no doubt that psychiatric medication saves lives, especially for people who have more serious mental health disorders (which are really brain health issues), such as bipolar disorder and schizophrenia. Yet, it’s critical to be cautious with antidepressants, because once they are started, they can be hard to stop, and they do not just reset your brain, they change it.
A 2017 Oxford University study in the Journal of Affective Disorders found most SSRIs—such as Prozac, Paxil, Zoloft, and Lexapro—do not just decrease negative emotions, they reduce all emotions, including love, happiness, and joy. Participants felt separated from their surroundings and cared less about important things in their daily lives. They felt like their personalities had changed.
WHO’S PRESCRIBING ANTIDEPRESSANTS?
One of the most disturbing trends is that nearly 85% of psychiatric medications are prescribed by primary care physicians, nurse practitioners, and physician assistants in short office visits; and 72% of these prescriptions are accompanied by no diagnosis in the charts, according to research in Health Affairs.
These medical professionals often do not have the time or specialized training to develop comprehensive treatment plans or to tell you about more natural and safer solutions. Some primary care physicians do a wonderful job handling mental health issues, while others cause more harm than needed.
THINK SKILLS, NOT PILLS
As record numbers of people experience depression due to the pandemic, our society does not need more of the same in terms of treatment. When it comes to depression, we need skills, not just pills.
When it comes to depression, we need skills, not just pills.
It’s time for a new way forward that is rooted in neuroscience and hope. Depression and other psychiatric issues really are so much more than just a “mental illness.” Your brain creates your mind. The issues that affect your mind stem from your brain, your body, your thoughts, your social and work interactions with others, and your deepest sense of meaning and purpose. To fully heal from depression, you need to address all of these factors. Only then can you feel the way you’d like to feel and live the life you desire.
Depression, anxiety, and other mental health issues can’t wait. During these uncertain times, your mental well-being is more important than ever and waiting until life gets back to “normal” is likely to make your symptoms worsen over time. 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. If all our specialists are busy helping others, you can also schedule a time to talk. Suicide is devastating for the loved ones who are left behind. Family and friends often say they didn’t notice any signs of suicidal tendencies, which leaves them wondering what they might have missed. But what if brain imaging could predict who will attempt suicide?
Exciting brain imaging research from 2017 in Nature Human Behavior found that based on brain scans alone, a computer could identify with 94% accuracy rate which study participants had suicidal tendencies.
Earlier research from Amen Clinics, the world’s leader in brain health—including a 2009 brain imaging study in The Journal of Neuropsychiatry and Neurosciences on 12 people who completed suicide and a 2011 brain imaging study in Translational Psychiatry on 21 people who completed suicide—found abnormalities in brain function in these people. Both of these studies found decreased cerebral blood flow in specific areas of the brain, including the prefrontal cortex (see below). The researchers concluded, “This work suggests that SPECT might be useful in predicting risk for suicide completion in subjects with depression or treatment-resistant depression.”
“Finding biological biomarkers in the brain that are associated with suicidal thoughts and behaviors could ultimately save lives,” says Dr. Daniel Amen, founder of Amen Clinics, which has built the world’s largest brain imaging database related to behavior.
“Finding biological biomarkers in the brain that are associated with suicidal thoughts and behaviors could ultimately save lives.” — Dr. Daniel Amen, founder of Amen Clinics
The need to address suicide is becoming more critical as the rates of suicidal ideation are skyrocketing due to the pandemic. Approximately twice as many U.S. adults have seriously considered suicide in the past 30 days compared with 2018, according to the CDC’s Morbidity and Mortality Weekly Report. In the report, more than 1 in 10 of the 5,412 respondents reported seriously considering suicide in the previous 30 days. Even more startling is that over 1 in 4 people ages 18-24 had seriously contemplated ending their own life. And over 30% of unpaid caregivers for adults and 22% of people considered essential workers had suicidal thoughts.
This comes on the heels of already-rising suicide rates, especially among young Americans. Suicide is the 10th leading cause of death overall, but it is the second leading cause of death among 10-24 year-olds, according to the CDC. From 2007-2017, teens ages 15-19 experienced a 76% increase in suicides, and the suicide rate for 10-14 year-olds nearly tripled.
We need to reverse this trend. It’s time to take advantage of advanced brain imaging technology to help detect people who are at risk.
BRAIN ABNORMALITIES SEEN IN SUICIDAL PEOPLE
Brain SPECT imaging, which measures blood flow and activity in the brain, reveals underlying brain abnormalities in people with suicidal tendencies. In addition to the studies mentioned above, Amen Clinics has also done brain scans on over 300 people who attempted suicide and on thousands more who have seriously contemplated dying by suicide.
What do these brain scans show?
People with suicidal thoughts and behaviors tend to have abnormalities in brain activity. What follow-up scans on these patients show is that with the right treatment, there are ways to heal underlying brain health issues and reduce the risk of suicide.
Here are 4 of the most common SPECT findings in Amen Clinics patients with suicidal tendencies along with proven strategies to heal the brain.
Concussions and other traumatic brain injuries are associated with an increase in suicidal tendencies, according to research in the American Journal of Public Health. Head injuries can negatively impact brain function and have been linked to increases in depression, anxiety, substance abuse, which can contribute to suicidal ideation. Head injuries are far more common than you might imagine, and even minor blows to the head can cause trouble weeks, months, or even years later. At Amen Clinics, brain imaging studies show that 40% of patients have signs of a previous head injury. Surprisingly, many of them don’t remember experiencing a head injury, or they think their past head trauma—whether it was from falling off a bike, falling down a flight of stairs, or from playing tackle football—was insignificant. Brain scans show they are highly significant.
Healing head trauma: Hyperbaric oxygen therapy (HBOT), neurofeedback, hormonal therapy (head injuries often disrupt hormone production), and nutritional supplements (ginkgo, acetyl-l-carnitine, huperzine A, N-acetyl-cysteine, alpha lipoic acid, and phosphatidylserine) facilitate the healing process.
Temporal Lobes
Abnormal brain activity in the temporal lobes—especially in the left temporal lobe—is commonly seen on the brain scans of people with suicidal tendencies. According to an Amen Clinics study, 62% of patients who had seriously contemplated suicide or who had made an attempt had abnormalities in the left temporal lobe. The temporal lobes are involved in mood stability, memory, and learning. Problems in the left temporal lobe also include anger and aggression, dark or violent thoughts, sensitivity to slights, word-finding problems, auditory processing problems, reading difficulties, and emotional instability.
Healing temporal lobes: Neurofeedback, nutritional support (higher-protein, lower-carbohydrate diet), the supplements GABA and theanine, music therapy, singing, and anger management can be helpful.
Prefrontal Cortex (PFC)
Low activity in the PFC is a common finding on SPECT in suicidal people. The PFC is involved in impulse control, judgment, and decision-making, but when it is underactive, it is associated with impulsivity, poor judgment, and bad decisions. Having a “sleepy” PFC is one of the hallmarks of ADD/ADHD, and a 2017 review of 26 studies in the World Journal of Psychiatry shows that people with this common condition are at increased risk of suicide. The researchers conclude that early diagnosis and treatment of ADD/ADHD—and the co-occurring psychiatric disorders—can play an important role in the prevention of suicide.
Healing the PFC: Physical exercise, neurofeedback, goal setting, nutritional interventions, support (higher-protein, lower-carbohydrate diet), meditation, green tea, the supplements rhodiola and ginseng, and asking “Then what?” (thinking about the consequences of your actions) are beneficial strategies to strengthen the PFC.
Anterior Cingulate Gyrus (ACG)
The ACG is the brain’s gear shifter, and it helps you shift your attention from one thought to another. Too much activity here, which is commonly seen on SPECT in suicidal people, makes people more likely to get stuck on negative thoughts. A 2020 study in Translational Psychiatry builds on prior research showing that dysfunction in the anterior cingulate cortex (where the ACG is located) is associated with suicidal ideation and suicidal behavior.
Healing the ACG: Nutritional support (higher smart carbohydrates, lower protein), supplements (saffron and 5-HTP), exercise, learning how to stop looping thoughts, learning to distract yourself when you get stuck on negative thoughts, and writing out options when you feel stuck can help balance an overactive ACG.
HEALING THE BRAIN HELPS PREVENT SUICIDE
After over 30 years of treating people who have considered suicide, Dr. Amen says it’s clear that “suicide is a permanent solution to a temporary problem.” When the underlying brain dysfunction is treated, however, people’s symptoms of depression, impulsiveness, hopelessness, helplessness, aggression, and negative thinking patterns improve. Putting the brain in a healthy environment with the healing strategies described above provides hope for people who are suffering from suicidal ideation.
“Suicide is a permanent solution to a temporary problem.” — Dr. Daniel Amen, founder of Amen Clinics
If you are having suicidal thoughts, call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255).
Suicidal tendencies can’t wait. During these uncertain times, getting the help you need is more important than ever and waiting until life gets back to “normal” is likely to make your symptoms worsen over time. 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. If all our specialists are busy helping others, you can also schedule a time to talk.
If you’re feeling depressed, you may go to a psychologist, psychiatrist, or your primary care physician (who prescribe 85% of psychiatric medications), who will ask you to describe your symptoms. In most cases, your doctor will listen, do a brief examination, then look for symptom clusters. Based on this, they’ll give you a diagnosis and treatment plan, usually involving one or more psychiatric medications.
For example, you may say, “I’m depressed.” Your doctor will then label you with a diagnosis that has the same name as your symptoms—depression, in this example—without taking any biological information into consideration. And you’re likely to walk out with a prescription for antidepressant medication.
Symptoms don’t reveal anything about the underlying biology of the problems people have. All other medical professionals look directly at the organs they treat, but psychiatrists are taught to assume what the underlying biological mechanisms are for illnesses, such as depression, without ever looking at the brain. Because of this, the root causes of depression are often missed.
Here are 8 facts about depression that traditional medical professionals may miss.
1. Depression isn’t just 1 thing.
Brain SPECT imaging studies show that depression isn’t a simple or single disorder. In fact, there are 7 types of depression and anxiety. Giving everyone the same treatment will never work. You need to know your depression type.
What you need to know: Getting a brain scan can help determine which type of depression you have so you can get the most effective treatment.
2. Head trauma can cause mood disorders.
Mild traumatic brain injury is a major cause of psychiatric problems, but very few people know it. Head injuries, even minor ones, increase the risk of depression, according to research in Frontiers in Psychiatry. At Amen Clinics, 40% of patients had a significant brain injury prior to seeking help. Most of them didn’t connect the injury to their psychiatric issues, and many didn’t even remember hurting their head.
What you need to know: A brain scan can reveal damage from a past head injury that may be contributing to feelings of depression.
3. Chronic inflammation is linked to depression.
Just as inflammation can ravage your body, it can also damage your brain and mind. It has been associated with a wide range of neurological and psychiatric illnesses, including depression. If you’ve been treated for major depressive disorder without success, it may be time to look at inflammation as a possible root cause.
What you need to know: Have your doctor check your inflammation levels with tests for C-reactive protein, homocysteine, and the omega-3 index. Avoid eating pro-inflammatory foods (such as corn and soy). A 2015 study in Brain and Behavior has found that some anti-inflammatory medications (such as aspirin and ibuprofen) and nutraceuticals (such as omega-3 fatty acids and curcumin) have been found to decrease depression in people who have evidence of persistent inflammation.
4. Depression may be a symptom of underlying infections.
Infectious illnesses including Lyme disease, streptococcus (strep throat), toxoplasmosis, syphilis, helicobacter pylori (H. pylori), HIV/AIDS, herpes, and others are a major cause of psychiatric problems like depression that few medical professionals recognize.
What you need to know: If you or a loved one’s depression is not getting better with standard treatment, consider testing for (and treating) infectious diseases that commonly affect the mind.
5. Neurohormonal imbalances can produce symptoms of depression.
In particular, fatigue, difficulty concentrating, brain fog, moodiness, and lack of motivation are common symptoms when neurohormones—such as thyroid, estrogen, progesterone, or testosterone—levels are abnormal.
What you need to know: Have your doctor check your hormone levels and balance them if necessary.
6. Diabesity is tied to depression.
Diabesity is having high blood sugar and/or being overweight or obese. Obesity is associated with a greater risk of depression. According to 2016 research in Current Diabetes Reviews, depression and anxiety are 2-3 times higher in patients with Type 2 diabetes than the general population.
What you need to know: Eat brain healthy foods to help balance blood sugar and to achieve and maintain a healthy weight.
7. Depression may be related to sleep problems.
In general, a single night of staring at the ceiling can make you wake up feeling sad, irritable, or moody. Over time, sleep problems can lead to a higher risk of depression. Research in Dialogues in Clinical Neuroscience shows that about 75% of people with depression also have insomnia. In addition, having untreated sleep apnea nearly triples your risk of depression, according to a 2016 study in American Journal of Geriatric Psychiatry.
What you need to know: Create a healthy sleep routine and if you snore, get checked for sleep apnea and treat it if necessary.
8. Exposure to toxins can cause depressive symptoms.
Your brain is the most metabolically active organ in your body. As such, it is vulnerable to damage from toxins, such as toxic mold, smoke, conventional cleaning products, carbon monoxide, pesticides, and more. Toxins are one of the major causes of psychiatric issues, such as depression, that traditional psychiatrists almost completely ignore.
What you need to know: Avoid exposure to environmental toxins and get tested for levels of mold toxins, especially if your home has ever been flooded or had water damage.
Depression—as well as anxiety, ADD/ADHD, and other mental health—issues can’t wait. During these uncertain times, your mental well-being is more important than ever and waiting until life gets back to “normal” is likely to make your symptoms worsen over time.
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. If all our specialists are busy helping others, you can also schedule a time to talk.
