Can You Really Diagnose Psychiatric Illnesses With a Scan?
Daniel Amen is a Psychiatrist who has made quite a name for himself—and a ton of money, by using single photon emission computed tomography (SPECT) scans to diagnose and manage patients with brain disorders. He claims that these expensive scans help him to make more accurate diagnoses and guide him in making proper treatment decisions. He is also a very good salesman, promoting his approach on late night Infomercials.
I support using objective tests to manage patients, but are SPECT spans really for prime time? I have carefully looked at this issue and my answer is a firm no. SPECT scans involve injecting radioactive substances into your body and exposing your body to the same amount of radiation that you would receive from natural sources in one year. Every expert other than Daniel Amen still considers this test to be experimental when it comes to diagnosis and treatment.
Show Me the Evidence
One glaring problem is that despite that fact that Dr. Amen has ordered over 50,000 SPECT scans on the patients seen at his clinics, there are no published studies supporting the use of these scans for diagnosing and treating patients. Science is often clumsy and inefficient, but it is the only tool we have to differentiate the wheat from the chaff. Pet theories are a dime a dozen, but theories supported by controlled studies are worth their weight in gold.
We certainly need new theories when the old ones no longer seem up to the task. The CARB syndrome concept that forms the core of this web site is a new and unproven theory. Although I do use it to manage patients, I do so in a very conservative manner. I stick to the standard of care when managing patients. I use the same treatment tools that are available to other clinicians, but I use them in a different way than my colleagues based on the CARB syndrome model. It’s as if everyone has a hammer and saw, and most folks are using a hammer to cut down trees and a saw to hammer nails and I am doing the opposite. As a clinician, I am only interested in theories if using them gives me improved results and at some point these results must be supported by controlled clinical trials.
Labels, Labels Everywhere
Dr. Amen has identified six sub-types of ADHD using SPECT scans whereas the DSM-IV classification identifies only three subtypes. In my opinion these classifications are meaningless. All patients who appear to qualify for a diagnosis of ADHD have low levels of dopamine and norepinephrine in their brains. Some patients with ADHD also have low levels of serotonin, qualifying them for diagnoses such as depression, anxiety or obsessive-compulsive disorder. Rather than plastering patients with arbitrary labels, to me it makes more sense to assess patients by their symptoms.
If they have low levels of dopamine or norepinephrine, then treatments should be targeted to these neurotransmitters. The same is true for serotonin. You don’t need a SPECT scan to determine which neurotransmitters are deficient—you just need to ask the patient the right questions. I suspect that Dr. Amen already knows this and he uses this expensive test to line his pockets rather than to help him diagnose and treat patients.
Good Clinicians Don’t Need to Rely on Unproven Tests
Dr. Amen seems very adept at managing patients with complex psychiatric disorders. I am also very adept at managing these patients. He uses expensive SPECT scans to do so, and I don’t. What does that tell you? Perhaps these scans are a good way to help Dr. Amen make his next boat payment, but not at diagnosing and managing patients. I suppose that I could also order these scans on all my patients. I could then tell them that I use them to make a diagnosis and treatment plan. If the patients do well (and most of mine do), they would believe that these scans were useful. The patients would be none the wiser and I would be richer. There’s only one little problem and it’s called ethics.
In medicine we are guided by one simple rule—first, do no harm. Injecting radioactive substances into patients and subjecting them to a year’s worth or radiation for no clear purpose clearly fails the ethics test. Insurance companies don’t support the use of SPECT scans for diagnosis and treatment of psychiatric disorders so patients must foot the bill for these expensive tests. In my view this is clearly an unethical rip-off. On his web page there is a prominent link to “interest free financing and payment plans”. If you decide to visit Dr. Amen, I suggest first clicking on this link—there’s a very good chance you will need a little financial assistance to take advantage of his bogus diagnostic scans.
Bravo Doc, bravo…When i fist saw Dr Amen speak on PBS i was very intrigue with the supplements, exercise and dietary regimen he promoted for brain health.. I thought they were really good, i have known supplements like fish oil and ginko etc to be fantastic not just for brain health but overall health and yes they are BOTH connected..However you are 120% (taxes included) right on the SPECT scans they are far to risky and dangerous in my opinion, good call Doc…
Doc
I’ve looked at some of his supplements and most of them are quite good. I also agree with most of his dietary advice. I don’t object to people selling health related products as long as they are safe. Soon we will be selling a supplement called CARB-22 that is targeted to restoring monoamine neurotransmitters in people with CARB syndrome.
I use a combination of symptoms and lab tests to access people for CARB syndrome. Dr. Amen still views most mental illnesses as separate diseases. Although there are relatively rare cases of traditional mental disorders, in my opinion many people being diagnosed with depression, anxiety disorders, ADHD, PTSD, bipolar II and similar disorders have only one disease–CARB syndrome. For example, if you are depressed, lose your appetite and lose weight, you have traditional major depression where high dose SSRI medications might be appropriate. If you feel depressed, have an increased appetite (carbohydrate cravings) and weight gain, you have CARB syndrome, not true major depression. This disorder can be treated without medications in most cases.
You don’t need a SPECT scan to tell the difference between these two disorders. You just need to ask the patient the right questions.
I was really disappointed in your article about Dr. Amen. I have read every book he’s written and totally agree with what he says. I wish I had had a brain spect instead of feeling like a guinea pig while getting antidepressants and suffering from the side effects. They did more harm to me than good and I switched to natural supplements for relief.
To say he is unethical is simply reprehensible on your part. I think you are unethical for never discussing sleep apnea or sleep breathing disorders instead of “carb syndrome.” Even Dr. Mercola the end of Sept. had an article on sleep apnea. No matter how many supplements and healthy eating you participate in, if you have a small jaw or problems with nasal breathering, you will feel terrible or have chronic illness. Sleep breathing disorders have a strong link to ADHD, depression, anxiety, heart disease, diabetes, stroke, high blood pressure, etc.
Please research sleep apnea and Upper Airway Resistance Syndrome and you will have second thoughts about your “carb syndrome” theory. In every book Dr. Amen has written he does say you need to correct sleep apnea first before doing anything else. Likewise, as I stated above, Dr. Mercola has even recognized it. See the following link http://articles.mercola.com/sites/articles/archive/2012/09/24/speech-therapy-for-sleep-apnea.aspx?e_cid=20120924_DNL_art_1. Also Dr. Steven Park, an ENT in New York has excellent information. Use his link for his latest info. on Kevin MD blog: http://www.kevinmd.com/blog/2012/11/speech-achilles-heel-human-race.html
Before you berate other doctors for being unethical, look at yourself also.
I appreciate your comments. If you read my post carefully, you will see that I agree with most of what Dr. Amen does. I agree with his dietary recommendations and many of his supplements. I also address obstructive sleep apnea in my patients when it is present. The majority of cases of OSA are due to excessive body fat and CARB syndrome often plays a role in these cases. People having a small airway are clearly a minority when comes to OSA.
I disagree with Dr. Amen in one area–the use of SPECT scans to diagnose and treat patients. Nothing in your comments supports the use of SPECT scans so I think we agree more than we disagree. If you don’t agree with the CARB syndrome concept, that’s OK. I readily admit that it’s an unproven theory, but I find it very useful in managing patients. That’s why all my recommendations are very low risk or no risk. I can’t say the same for SPECT scans. My goal is to get you to think for yourself when it comes to health issues. It’s clear that you are doing so and I congratulate you thinking for yourself. When you do so, we don’t always have to agree.
Dr. Bill Wilson