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Therapy or Medication: Which Option Can Help Me?

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.

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