Over the last 30 years, Amen Clinics have built the world’s largest database of functional brain scans—over 150,000 and growing—related to how people think, feel, and behave. Our brain imaging work has completely disrupted how we help our patients get well.
WHY SPECT IS CONSIDERED REVOLUTIONARY IN PSYCHIATRY
How can you know what’s going on inside your head if nobody ever looks? Experienced psychiatrists can tell if someone is likely to have ADHD, OCD, or bipolar disorder without the benefit of these tools. But without functional brain imaging tools like SPECT, clinicians will never be able to know the underlying brain patterns of the patients they treat, so they are handicapped to throw medicated tipped darts in the dark at their patients. SPECT is a state-of-the-art brain mapping tool that can give psychiatrists more information to help our patients more effectively.
WHAT IS SPECT BRAIN IMAGING?
SPECT stands for Single Photon Emission Computed Tomography. It is a nuclear medicine study that evaluates blood flow and activity in the brain. Basically, brain scans show three things:
- Areas of the brain that have healthy activity
- Areas of the brain that have too little activity
- Areas of the brain that have too much activity
Then based on what we see, our job is to balance your brain—to calm it down if it is working too hard or stimulate it if it is underactive.
SPECT Surface View Brain Scan
A healthy “surface” scan, looking down from the top, shows full, even symmetrical activity. The color is not important, it’s the shape that matters. Surface scans help us see areas that are healthy and those with low activity.
SPECT Active View Brain Scan
A healthy “active” scan shows the most active parts of the brain. Here blue is average activity and red (or sometimes red and white) are the most active parts of the brain. In a healthy scan, the most active area is in the cerebellum, at the back/bottom part of the brain, which makes up just 10 percent of the brain’s volume but houses half of the brain’s neurons.
With SPECT, you can see healthy vs. unhealthy brains. Look at the following scans of people with Alzheimer’s disease or who have had a stroke.
BRAIN IMAGING TESTS: REST AND CONCENTRATION SCANS
At Amen Clinics, we generally perform two SPECT studies on patients—one taken while you are at rest and one performed while you are doing a concentration task. We have found that doing these two studies provides greater insight into the overall functioning of your brain. Think of it like a stress test of the heart. In some people, problems with brain activity or blood flow only become visible when you push your brain to work.
Knowing how your brain functions both at rest and during concentration plays an important role in getting an accurate diagnosis and in finding the most effective treatment plan. As we typically tell our patients, two scans are better than one, but one scan is way better than none.
THE #1 THING SPECT BRAIN IMAGING REVEALS ABOUT THE BRAIN
One of the main things we have learned from our brain imaging work with SPECT is that mild traumatic brain injury (TBI) ruins people’s lives. Your brain is very soft, about the consistency of soft butter, and the inside of your skull is very hard and has sharp, bony ridges. Your brain can be easily damaged. About 40% of the patients who come to Amen Clinics have experienced a TBI. And so many of them don’t realize that head injuries and concussions, even if you don’t pass out, are associated with a high degree of mental health challenges.
THE BIGGEST DISCOVERY SPECT HAS REVEALED ABOUT PSYCHIATRIC ISSUES
One of the biggest things brain SPECT imaging has taught us is that psychiatric issues are not single or simple disorders. They all have multiple types.
Based on our brain imaging work, we have identified:
It’s critical to know your type in order to get treatment that is targeted to your specific needs.
3 WAYS SPECT BRAIN SCANS IMPROVE TREATMENT
SPECT brain scans improve treatment in a number of ways, including:
- Show evidence of trauma, exposure to toxins like chemotherapy, or infections like Lyme disease
- Show if medications are toxic
- Help prevent mistakes
7 WAYS SPECT HELPS PEOPLE WITH ADDICTIONS
SPECT can be very powerful in treating people with addictions because it:
- Breaks denial
- Increases compliance
- Helps understand comorbidities
- Encourages follow-up scans
- Decreases stigma (helping you see that the problem is medical not moral)
- Decreases shame, guilt, self-loathing, and anger
- Increases, compassion and forgiveness for families
SPECT BRAIN SCANS: COMMON PATTERNS, CAUSES, AND INTERVENTIONS
When it comes to psychiatry, brain imaging changes everything. At Amen Clinics, we have identified some of the common patterns we see in brain scans, what may be causing them, and the corresponding interventions.
Pattern 1: Scalloping/Overall Decreased Activity
One of the first things we learned from brain imaging is that drugs and alcohol are bad for the brain and lead to a pattern called scalloping or overall decreased activity. Over the years, we realized that some people who didn’t use drugs or alcohol had the same pattern. When we see this pattern, we ask why.
Scalloping can be caused by:
- Toxicity (drugs or alcohol)
- Environmental toxins
- Carbon monoxide poisoning (firefighters)
- Anoxia (near drowning episode, heart attack where you stopped breathing)
- Severe anemia
Stop the toxin.
Brain rehab program (put the brain in a healing environment)
- Care about the brain
- Avoid things that hurt the brain
- Do things that help the brain
- Medications and/or supplements
Pattern 2: Overall Increased Activity
This pattern is commonly seen in bipolar disorder during manic episodes; in inflammatory processes, such as lupus or other autoimmune disorders; and in types of ADHD that are typically made worse by stimulant medication. We call this pattern in ADHD the Ring of Fire.
- Work up and treat inflammation, such as lupus, or food allergies
- Eliminate allergens
- Calming interventions – GABA, magnesium, anticonvulsants
Pattern 3: Traumatic Brain Injury
On brain SPECT imaging, TBIs can appear in different forms, including:
- Focal deficits (one area affected)
- Asymmetries, where one side is hurt, but the other side not)
- Decreases of the prefrontal cortex (91%) and temporal loves (70%)
Brain rehab program:
- Care about the brain
- Avoid things that hurt the brain
- Do things that help the brain
- Hyperbaric oxygen therapy (HBOT)
- Medications and/or supplements that are area specific
Pattern 4: Hyperfrontality (frontal lobes work too hard)
In this pattern, the frontal lobes of the brain are working too hard. It can be seen in the following conditions:
- Obsessive-Compulsive disorder spectrum
- Oppositional defiant disorder
- Autism spectrum
- People who get stuck, worried, rigid, inflexible
- Overfocused depression or anxiety
Increase serotonin to calm the brain through the following:
- Supplements (5HTP or saffron)
- SSRIs (antidepressant medication, if necessary)
Pattern 5: Hypofrontality (low frontal lobe activity)
Hypofrontality indicates low activity in the frontal lobes. It is associated with:
- Traumatic brain injury
- Lack of conscientiousness
- Lack of forward thinking
- Some forms of depression
- Stimulating supplements, such as green tea, l-tyrosine, and rhodiola
- Stimulants, if ADHD
- Stimulating antipsychotics, if needed
- Stimulating antidepressants or SAMe, if depressed
Pattern 6: Temporal Lobe Abnormalities
This pattern indicates one of both of the temporal lobes are unbalanced. It can be seen in:
- Temporal lobe epilepsy
- Temporal lobe dysrhythmia
- Mood instability
- Intermittent explosive disorder
- Ketogenic diet
- Anti-seizure medications
- Memory-enhancing medications or supplements, if memory is the problem
HOW IDENTIFYING THESE PATTERNS INFLUENCES TREATMENT
We published a study in 2012, in which we asked 7 psychiatrists to evaluate 109 consecutive charts without scans and then with scans. In 8 times out of 10, adding the scan into the review changed the diagnosis and/or treatment. In over 1 in 5 cases, the scan revealed an unexpected brain injury, and in another 1 in 5 cases, it revealed unexpected toxicity. And 60% of the time, it changed the medications or supplements recommended.
WITH BRAIN SPECT IMAGING, DO PATIENTS GET BETTER FASTER?
We do outcome studies on all of our patients—we have over 7,000 outcomes on our patients. At the end of 6 months, if they are treated at Amen Clinics 84% of our complicated patients report being improved. And quality of life scores goes up in 85% of patients.
SEEING YOUR BRAIN SCAN CHANGES EVERYTHING
The main thing people can learn from seeing their brain scans is that you are not stuck with the brain you have. You can change your brain and change your life.