Most Important Lesson from 83,000 Brain Scans

Daniel G. Amen, MD

Most Important Lesson from 83,000 Brain Scans

Daniel G. Amen, MD

Maverick Maverick

How do you know unless you look?How do you know unless you look?

1972…1972…

Fell in love with psychiatry because it has potential to change generations

Fell in love with psychiatry because it has potential to change generations

1979 …1979 …

Brain SPECT ImagingBrain SPECT Imaging

1991 …1991 …

+ Psychiatry+ Psychiatry

= Revolution = Revolution

Healthy Brain SPECT ScansHealthy Brain SPECT Scans

Surface View Active View Surface View Active View

Healthy vs 2 StrokesHealthy vs 2 Strokes

Healthy Stroke Healthy Stroke

Healthy vs Alzheimer’s DiseaseHealthy vs Alzheimer’s Disease

Healthy Alzheimer’s Healthy Alzheimer’s

Healthy vs Traumatic Brain InjuryHealthy vs Traumatic Brain Injury

Healthy TBI Healthy TBI

Healthy vs Drug AbuseHealthy vs Drug Abuse

Healthy Drug Affected Healthy Drug Affected

Healthy vs OCDHealthy vs OCD

Healthy OCD Healthy OCD

Healthy vs Seizure ActivityHealthy vs Seizure Activity

Healthy Seizure Activity Healthy Seizure Activity

All Day Conference on SPECT in Psychiatry

All Day Conference on SPECT in Psychiatry

1992 …1992 …

Researchers Complain Scans Only for ResearchResearchers Complain

Scans Only for Research

Psychiatrists only medical specialists who rarely looks at organ they treat

Cardiologists look

Neurologists look

Orthopedists look

All other specialties look

Psychiatrists guess

Before Imaging

There is a reason most psychiatric medications have “Black Box” Warnings

Early Lesson ADHD

Anxiety

Depression

Addictions

NOT single or simple disorders

All have multiple types

Two Patients with Depression

Rx needs to be tailored to individual brains

Early Lesson

Mild traumatic brain injuries are a major cause of psychiatric illness

Mild Traumatic Brain Injury

Mild?

Undiagnosed Brain Injuries Are a Major Cause of:

Undiagnosed Brain Injuries Are a Major Cause of:

Homelessness

Drug and alcohol abuse

Depression

Panic attacks

ADHD

Suicide

Judges and defense attorneys sought our help to understand criminal behavior

> 500 convicted felons, including 90 murderers

Our work taught us that people who do bad things often have troubled brains

Many of these brains could be rehabilitated

More Lessons

What if we evaluated and treated troubled brains,

Rather than simply warehousing them in toxic, stressful environments?

In my experience, we could save tremendous $$ by making people more functional

So when they got out of prison they could work, support their families and pay taxes.

Radical Idea?

“A society should be judged not by how it treats its outstanding citizens, but by how it treats its criminals.”

Instead of just Crime and Punishment

Crime, Evaluation and Treatment

Fyodor Dostoevsky

Single Most Important LessonSingle Most Important Lesson

You can literally

change people’s brains

and when you do

you change their lives

Active and Retired NFL PlayersDamage Seen Across Whole Brain

High Levels of Improvement Possible

Reversing Brain Damage Is Exciting New Frontier, But the Implications Are Wider

From Failure to Success

Before After

Nancy

Before After

Andrew

Supplement SuccessMind the Gap

Supplement SuccessMind the Gap

Brain Healthy SupplementsBrain Healthy Supplements Pros versus cons

For all – multiple vitamin, fish oil, vitamin D

Brain type

Craving control

Mood

Energy, Focus

Memory

Supplement BenefitsSupplement Benefits Never have to reveal to insurance company

Less expensive

Generally significantly fewer side effects, but not NO side effects

Some effective for mild to moderate problems

Generally, have increased compliance

Supplement ProblemsSupplement Problems May be more expensive because usually not

covered by insurance

Many not aware of potential side effects

Quality control/standardization issues

Consultant may be clerk at the grocery store

Fewer studies as it is hard to maintain patents on these products

Recommendations for All

Multiple vitamin

More fish or omega 3 fatty acid supplement

Test and optimize Vitamin D level

Then, issue specific strategies

Multiple Vitamin Most people do not eat 5 servings of fruits and

vegetables a day

1998 NEJM, “Eat right and take a multiple vitamin”

2002 JAMA, “It appears prudent for all adults to take vitamin supplements for prevention of chronic diseases.”

MV - Placebo controlled trial of 215 men -- significant improvement in perceived stress, general health, vigor after 33 days

NeuroVite Plus 50 brain supporting nutrients

including ALC, ALA, PS, CoQ10

Complete MV/mineral complex

High B vitamins, B6, B12, 5MTHF

2,000 IUs Vitamin D

Phytonutrients – blueberries, spinach, tomato, apple, broccoli, 2 glasses of wine (without alcohol)

Digestive enzymes

Omega 3s Low Levels Benefits Heart disease

Strokes

Depression

Suicidal behavior

ADHD

Dementia

Obesity

Heart

Skin

Eyes

Joints

Brain

Decrease appetite & cravings

2-3 grams a day

Omega 3 Power

Highly purified

Independently tested

2.8g fish oil in 2 capsules

60/40 EPA to DHA ratio

No fish burps

Low Levels of Vitamin D 2/3rds of Americans Depression Alzheimer’s disease MS – replacement helps prevent relapse Heart disease Diabetes Cancer Obesity Interferes with sense of fullness

Vitamin D 25 hydroxy-vitamin D

Normal between 30-100 ng/dl

Optimal between 50-90 ng/dl

Give Vitamin D3 if levels low and retest level so you optimize it and don’t overdo it

Universal risk factor for multifactorial diseases, such as diabetes, heart disease, strokes, cancer and dementia

Brain Type Help Impulsive

Compulsive

Impulsive-Compulsive

Sad

Anxious

ImpulsiveFocus and Energy

ImpulsiveFocus and Energy

Boost Dopamine

CompulsiveSerotonin Mood Support

CompulsiveSerotonin Mood Support

Boost serotonin

Impulsive-CompulsiveFocus and Energy + Serotonin Mood Support

Impulsive-CompulsiveFocus and Energy + Serotonin Mood Support

+ +

SADSAME Mood and Movement Support

SADSAME Mood and Movement Support

Boost dopamine and norepinephrine

SAMe

AnxiousEveryday Stress Relief

AnxiousEveryday Stress Relief

Craving ControlNot Just for Food Cravings

Craving ControlNot Just for Food Cravings

Restful SleepThe Hammer

Restful SleepThe Hammer

Brain and Memory Power BoostMind the Gap of Your Mind

Brain and Memory Power BoostMind the Gap of Your Mind

Brain Power Basics Brain Power Basics

NeuroVite Plus

Omega 3 Power

Brain & Memory Power Boost

3 High Quality Studies

Brain Power BasicsDouble Blind, Placebo Controlled Trial

Brain Power BasicsDouble Blind, Placebo Controlled Trial

Significant improvement in blood flow to brain

Brain Power Basics2 Double Blind, Placebo Controlled Trials

Brain Power Basics2 Double Blind, Placebo Controlled Trials

Significant improvement

Overall cognitive function

Memory

Reasoning

Processing speed/accuracy

Executive function

Mood

Emotional identification

Lower hostility

Lower somatization

Less obsessiveness

Amen Clinics NFL StudyDamage Seen Across Whole Brain

Brain Healthy Program 62 players with follow up

scans/cognitive tests 50 showed improvement Especially in:

Memory (69%) Attention (53%) Mood (38%) Motivation (38%) Sleep (25%)

RP – Stanford and Broncos5th to 53rd %ile in Memory

RP – Stanford and Broncos5th to 53rd %ile in Memory

Before After

Think DrinkThink Drink