SPECT Imaging and Dr. Amen: The Controversy

This past September Dr. Amen delivered a TEDx talk revealing the what he calls the single most important lesson learned after studying 83,000 brain scans over the past 22 years.

In his talk, Dr. Amen calls on the value SPECT imaging has in enhancing diagnostic accuracy and improving treatment outcomes for patients. He says, “Before imaging, I was throwing darts in the dark and had unintentionally hurt patients, which horrified me. There is a reason that most psychiatric medications have black box warnings. If you give them to the wrong person you can precipitate a disaster."

Dr. Amen explained how SPECT imaging lead him to realize early on that illnesses like ADHD, anxiety, and depression are not single-issue disorders in the brain and that each has multiple types. Later his research lead to findings on the way mild traumatic brain injuries can be a major cause of psychiatric illness and can go untreated because the problem can't be identified by traditional behavioral health treatment.

He makes suggestions based on his findings for improving the efficacy of America's criminal justice system as well, "Research has shown us that undiagnosed brain injuries are a major cause of homelessness, drug and alcohol abuse, depression, panic attacks, ADHD, and suicide. Judges and defense attorneys have sought our help in trying to understand criminal behavior and to date we have scanned over 500 convicted felons, including 90 murderers."

Furthermore, Dr. Amen believes his research shows strong evidence for the ability to rehabilitate troubled brains once they've been properly diagnosed.

However, some behavioral health providers disagree

For all that brain imaging allows us to see, there are some things that can never be picked up by a SPECT scan. For example, delusional activity in the brain can be identified physically in the brain, but it cannot be qualified or investigated. You can't see the reactions in thinking caused by the delusions either.

You can see scar tissue, seizure activity, tumors, and brain abnormalities through SPECT imaging, but you can't see the rate of thought transmission. The imaging reveals the brain, rather than the mind.

It's a distinction some providers find hard to make. The question, "what is the mind?" is philosophical in nature, rather than biological, and doesn't have an easy answer.

If the brain is just an organ, like any other, it can be medicated. The rate or neurotransmission can be improved and modulated.

But there are some conditions that can't be seen in the brain. Extreme narcism, as seen is narcissistic personality disorder is an issue of 'wiring' and is diagnosed by cues interpreted by a behavioral health provider. Diagnosis and treatment are more than a matter of neurochemical transmission or dopamine depletion.

Dr. Amen can see ADHD on an MRI because he can identify that parts of the brain are working at different speeds. What a psychiatrist deals with is the context of what the person is saying, how the individual interprets stimuli.

In paranoid personality disorder, an individual can medicate symptoms like the agitation from paranoia. But psychotherapy is ultimately going to be the relief for the paranoia itself.

There is also the cost-efficiency of brain imaging. How feasible is it that the average behavioral health consumer will be able to afford a brain scan with the average cost of SPECT imaging at $1100, with some sources reporting as high as $3,000 [1][4]?

Conclusion

Dr. Amen is a controversial figure, though respected by many, in today's academic circles [2][3].

His advances in brain imaging are surely exciting, though it may not be time to 'diss' traditional behavioral health care just yet.

What do you think of this controversial topic?

[1] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3149839/

[2]http://www.sciencebasedmedicine.org/dr-amens-love-affair-with-spect-scans/

[3]http://articles.mercola.com/sites/articles/archive/2012/10/28/psychiatry-needs-spect-imaging.aspx

[4]http://www.psychologytoday.com/blog/in-therapy/200902/seven-questions-daniel-amen/comments