FREQUENTLY ASKED QUESTIONS

Improving the health of your brain and your quality of life is our primary goal, and it all starts with learning how your brain functions. Why? Your brain controls everything you do—from decision making and motivation to healthy relationships and stress resilience. When your brain works right, you work right too! With full evaluations, we obtain: 

• Detailed clinical histories on your biological, psychological, social, and spiritual background 
• Cognitive testing 
• Questionnaires and checklists 
• Brain SPECT imaging 

We use all of this data to create an individualized, targeted treatment plan specifically for your needs and the way your unique brain functions. Whenever possible and medically appropriate, we like to begin with more natural treatments. 

We have been formally tracking outcome data on our patients for more than 11 years. Of the 16,190+ patients we have studied so far, we have some of the highest outcomes published anywhere. On average, our patients are complex and have seen 3.3 providers and 5 medications without success prior to coming to us. After only six months, 84 percent of the patients we have treated at Amen Clinics report significant improvements and 85 percent report an improved quality of life. For our patients who are treated elsewhere, 79 percent report significant improvements. We believe we have these high success rates because our use of brain imaging allows us to see how each individual’s brain functions so we can create the most targeted treatment plan—unlike traditional psychiatrists who virtually never look at the organ they are treating.

SPECT stands for single photon emission computed tomography. It is a nuclear medicine procedure that is widely used to study heart, liver, thyroid, bone, and brain problems. Brain SPECT imaging gives you and your doctor information on the blood flow and activity patterns of your brain. 

Brain SPECT imaging is a proven and reliable measure of brain blood flow and activity, and it is used as a tool in the evaluation and treatment process at Amen Clinics. SPECT imaging effectively shows us the patterns of activity in your brain. It allows our physicians to observe three things: areas of the brain that work well, areas of the brain that work too hard, and areas of the brain that don’t work hard enough.

Some of the common reasons include: 

1. Evaluating the effects of mild, moderate, and severe head trauma.
2. Evaluating atypical, unresponsive, or mixed psychiatric conditions.
3.  Evaluating aggressive or suicidal behavior. 
4.  Evaluating the presence of an underlying organic brain condition that contributes to behavioral or emotional disturbances. 
5.  Evaluating the extent of brain impairment caused by drug or alcohol abuse or other toxic exposure. 
6.  Subtyping the physiology of underlying mood disorders, anxiety disorders, or attention deficit disorders. 
7.  Evaluating suspected seizure activity. 
8.  Brain optimization/brain health checkup.
9.  Evaluating suspected cerebral vascular disease (such as stroke).
10. Following up to evaluate the physiological effectiveness of treatment.

Science has repeatedly recognized the value of brain SPECT imaging for assessing brain function. There is a robust amount of scientific data that supports the utility of SPECT for revealing the blood flow patterns underlying many different types of brain problems. Dr. Daniel Amen has authored or co-authored more than 90 peer-reviewed published research studies on brain SPECT imaging.

In our opinion, SPECT is the most clinically useful study of brain function for the conditions listed above. There are other studies, such as positron emission tomography (PET) and functional MRI (fMRI); however, they are considerably more costly and are performed mostly in research settings. 

Brain SPECT imaging for neuropsychiatric indications is only offered in a few centers around the country. We believe our clinics are the best places in the world to have this study done because of our 30-plus years of experience and extensive research on this subject, in addition to the comprehensive individualized treatment plans we give to our patients. 

Each scan takes approximately 20 minutes, and you will have two scans on separate days: one while your brain is at rest, and one while focused on a concentration task. For each scan, you will sit in a quiet room, and a small IV line will be placed in your arm. During the “concentration” scan, you will take a 15-20 minute computerized test that measures your attention and focus. For the “baseline” scan, you will be instructed to sit quietly and relax. During this period of time (whether you are taking the computer test or relaxing), the imaging solution will be injected through the IV. Once the imaging solution has been absorbed, you will lie down in the scan machine, which has three cameras that will rotate around your head.

Two scans will allow us to evaluate the changes in brain blood flow patterns from a resting state to a concentration state. 

Since a SPECT scan is a nuclear medicine procedure, it requires the injection of a very small amount of a radioisotope through a small needle into a vein in the arm. The IV is only inserted for about 10 minutes, and numbing cream is available. The medicine we inject is not an iodine-based dye; therefore, people typically do not have allergic responses to it. The average radiation exposure for one SPECT scan is 0.7 rem. This exposure is similar to the amount from a nuclear bone scan or CT scan—both of which are routinely ordered for many common medical conditions (i.e. bone fractures or head trauma). 

No. A SPECT study by itself will not give a diagnosis. In fact, no imaging study by itself is a “doctor in a box” that can give accurate diagnoses on individual patients. SPECT imaging helps the physician understand more about the specific function of the brain. Each person’s brain is unique which may lead to varied responses to treatment. At Amen Clinics, diagnoses about specific conditions are made through a combination of clinical history and personal interview, information from family members (if available), questionnaires and checklists, SPECT studies, and neuropsychological tests.

The radiotracer that we use for SPECT is called Technetium 99m. Its signal is detected by the scanner. Combining Tc99m with other molecules (like HMPAO—“Ceretec”) allows Tc99m to enter specific/desired tissues. This allows us to understand the functioning of that tissue.

SPECT requires an injection of 20 to 25mCi (millicuries, the measure of radioactivity inherent to a radiopharmaceutical—in our case, Technetium 99m). The biological effect a dose of radioactivity has on tissues (effective dose) cannot be linearly extrapolated from the radioactivity of a dose of administered radioisotope, and it varies with tissues, so a total radioactivity exposure (effective dose) for the whole body is calculated. This is measured in rem (Roentgen equivalents to man) or Sieverts (one Sievert = 100 rem).

The average radiation exposure for one SPECT scan is 0.7 rem. Two of our SPECT scans are roughly equivalent to, or a bit less than, one CT scan of the abdomen or pelvis (about 0.7, depending on protocol). 

This amount of exposure is well below the cut-off level (10.0 rem) for any known potential or observable health risks. 

About 5 percent of the total dose goes to the brain. About 40 percent of the tracer is excreted within minutes by the kidneys and the remainder by the gallbladder over about 24 hours. Tc99m has a half-life of just over 6 hours. We always encourage patients to drink plenty of water.

There’s an advantage to using SPECT (as opposed to PET) in the way we do things: When our clinicians sit down to read a SPECT scan, they use unsmoothed tomographic data acquired at a resolution of 6.6 millimeters. Compare this to cases where PET is used in a clinical setting: the resolution is at best between six and eight millimeters. Clinical SPECT is, in fact, of better resolution. Now, while it’s true that the university PET scanners get marginally better resolution than we do (of about 4.5 millimeters), nobody reads these PET scans clinically like we do. Instead, they use them in statistical comparisons against groups of other scans, in which case their resolution smoothed to7mm, and in many cases, they’re smoothed to a resolution as low as 10mm. At any rate, clinical SPECT wins again.

Some physicians say, “I don’t need a scan for diagnosis, I can tell clinically.” Is this true? Often, well-trained physicians can tell clinically. But that is not when you order a SPECT scan. You order scans when you are confused, the patient hasn’t responded to your best treatment, or the patient’s situation is complicated.

There is less than 3 percent variability in SPECT scans over time for the same activity. Our own clinical experience, scanning people sequentially, and sometimes 12 years apart, is that SPECT patterns are the same unless you do something to change the brain. SPECT is a reproducible and reliable method for sequential evaluation.

You should allow two to three days (for 2-3 hours each day) for the complete evaluation process. Unless you live at a distance from the clinic, we prefer these days to be consecutive to optimize your time. 

No. Due to his writing, research, and teaching duties, Dr. Amen has very limited clinical time. However, all of our physicians have been personally trained by Dr. Amen in The Amen Clinics Method.

We know people worry they may not get accurate scans while on medication, but many of our patients are scanned on their medications, and the scans are still very valuable. NEVER discontinue any medication or nutritional supplement necessary for your physical health. These include, but are not limited to, blood pressure medications, blood thinners, diabetes or thyroid medications, and medications that treat heart or lung problems. If you decide to be scanned off all medications and supplements, please consult your prescribing physician before discontinuing any medication.

In general, we recommend patients:

• Discontinue stimulants four days prior to the first scan appointment and stay off of them until the scan appointment(s) are completed.
• For other psychiatric medications, it depends on the particular half-life of each medication (meaning how long it stays in your system). Only reduce or stop medication under your doctor’s supervision. 
• If helpful, you can arrange to have a phone consultation between one of our doctors and your personal physician to discuss questions about discontinuing medication and supplements prior to your scans at an additional cost. 

No. You may contact the clinic directly. Our intake coordinators will discuss your situation with you and can schedule a full evaluation with scans. 

Yes. If you would like to schedule a consultation with a physician, you can do so by calling our care center at the number at the top of this website. 

Many patients who are unable to travel to an Amen Clinics location have the option to complete their brain scans at a local imaging facility. Once the scans are completed and meet our compatibility requirements, patients can schedule a virtual evaluation with an Amen Clinics physician. To arrange this and get more information, please contact our Care Center at the number listed at the top of this website.

Our staff is committed to communication and transparency every step of the way. If you have questions about fees, please call us at the number listed at the top of this website. If you are a current patient with questions about payment status, please call the clinic at which you were treated. 

Reimbursement by insurance companies varies according to your plan. Amen Clinics does not bill insurance. At the end of the evaluation, patients are given a “walk-out statement” containing applicable diagnosis and billing codes, which can then be submitted to insurance companies for possible out-of-network reimbursement.

CareCredit is a special credit card that can only be used for health, cosmetic, and veterinary procedures. There are no upfront costs or prepayment penalties. Although individual plans may vary, in most cases, a payment schedule is set up between you and CareCredit, and if you pay off your fees within the agreed-upon time frame, you are not charged any interest. This will enable you to receive treatment at Amen Clinics right away.

You can call Care Credit at (866) 893-7864 or contact them on the web at www.CareCredit.com for more information. 

If you are an existing CareCredit cardholder needing help with your account, please call our care center team at the number on the top of the website.

When we schedule an evaluation, we ask for a nonrefundable deposit. We do this because when you are scheduled, we are blocking several hours of appointments on 4 different provider schedules and ordering the scan pharmaceuticals specifically for you.

This initial deposit must be paid at the time appointments are scheduled; it is then applied to the complete payment for services. In order to receive a refund of your initial deposit, you must cancel your appointment no later than 3 business days from the time you initially booked your appointments. If you choose to cancel your appointments after this time, your deposit will not be refundable.

If you need to reschedule, please give us at least 3 business days before your first scheduled appointment to make the change, otherwise, it will be considered a cancellation. 

We require 24 business hours advanced notice for changing or canceling an appointment, otherwise you will be charged for the appointment. Additionally, if you are late for your appointment or if you miss your appointment, you will still be charged for the full session. If you arrive more than 10 minutes late, our office may have to reschedule your appointment, and you may still be charged for the missed session.

Follow-up appointments be conducted in person or via phone or video conference with your Amen Clinics physician. Please contact the care center at the number located at the top of this website for more information. 

Doctor visits vary in frequency depending upon your needs. When medications are changed, your visits will be more frequent. Even if you are stable on your medication, our doctors or other licensed clinicians must see you in person a minimum of once every 6 months. This is standard for the field of psychiatry and is our policy. 

While we may schedule phone follow-ups for minor adjustments to your treatment plan, most decisions about your care must be made during in-person visits. Email may be used to communicate routine information and questions to your doctor, but this doesn’t replace a session, nor will any medical decision be made via email correspondence.

If you live close to the clinic and would like us to provide ongoing treatment for you or your family member, your Amen Clinics’ physician will discuss if this is the best option for you. However, if you are already working with another physician, we ask that you discuss this decision with your doctor. 

We have certified nurse practitioners and physician’s assistants on staff who also manage medications. If you would benefit from psychotherapy or coaching, we offer an array of ancillary services with licensed professionals. 

If you have a negative reaction to medication or other serious symptoms, please call us. We have an after-hours paging system available for urgent matters. However, if you have a life-threatening emergency, please call 911 or go to your local emergency room immediately. 

Because our doctors’ schedules vary, we request that all medication refills be ordered through your pharmacy. Ask your pharmacy to fax a refill request to the Amen Clinics location where you were evaluated and treated. Please plan ahead and allow 3–5 working days for refills. Be aware that many states do not allow pharmacies to accept phone refills for controlled substances (such as Xanax and Ativan). Stimulant drugs, such as Adderall and Ritalin, cannot be called in at all.

During your initial evaluation, we make every effort to provide step-by-step treatment recommendations. We are always happy to provide a consultation to you or your local doctor after your evaluation if additional questions arise. We act as ongoing consultants for many of our patients.