Healing Anxiety and Depression [Paperback]

Daniel G. Amen (Author), Lisa C. Routh (Author)

Book Description

Publication Date: December 7, 2004

Dr. Daniel Amen-a pioneer in uncovering the connections between the brain and behavior-presents his revolutionary approach to treating anxiety and depressive disorders. Healing Anxiety and Depression reveals the major anxiety and depression centers of the brain, offers guidelines and diagnostic tools to determine the specific type of anxiety and depression, and provides a comprehensive program for treating each type. Based on new brain science-and featuring treatment plans that include medication, diet, supplements, exercise, and social and therapeutic support-this groundbreaking book will help readers conquer these potentially devastating disorders and change the way they think about anxiety and depression.

Editorial Reviews

About the Author

Daniel G. Amen, M.D., clinical neuroscientist and psychiatrist, is the director of four Amen Clinics. An expert in the field of the brain and behavior, he lectures to thousands of professionals each year. He has won writing and research awards from the American Psychiatric Association.

Lisa C. Routh, M.D., a neuropsychiatrist with special training in brain imaging, has extensive experience in brain injury and disabled children, and has diagnosed and treated thousands of people with depression and anxiety.

Excerpt. © Reprinted by permission. All rights reserved.

CHAPTER 1

Seeing Anxiety and Depression:

Brain SPECT Imaging

Sean was one of the cutest, brightest ten-year-old boys with blond hair and big blue eyes we had ever seen. He came into our clinic clutching Dr. Amen's book Change Your Brain, Change Your Life, which his mother had given to him and which he had actually read from cover to cover. Based on what he had read in the book he predicted that he would have problems in his deep limbic system and left temporal lobe. When we asked him how he knew this, he said that he had periods of really bad depression, a very bad temper, and that he had tried to kill himself the year before when he was feeling really sad. He also said that sometimes he saw shadows and bugs crawling on walls when there were none. As part of Sean's evaluation we did a brain SPECT series. When we reviewed the scans with Sean it became clear that he had perfectly predicted his own SPECT results. He had excessive activity in the brain's emotional center (the deep limbic system) and decreased activity in the left temporal lobe. As he and his parents looked at the images on the computer screen, tears rolled down Sean's and his mother's cheeks. "I never wanted to feel bad or be so mad," he said. "I always wanted to be good. I guess I know why I had those problems." On the right treatment, guided by the scans, his history, and our clinical observations, Sean's mood and temper stabilized and he thrived in school and at home.

A picture can be invaluable. Once we started our imaging work we could clearly see that these diseases were in fact brain problems. From the first month performing scans, more than twelve years ago, imaging has changed the way we look at patients. Before we were able to perform brain scans, our approach to diagnosis and treatment was based on patient interviews and symptom checklists, such as those found in the DSM (Diagnostic and Statistical Manual) published by the American Psychiatric Association. The DSM, now in its fifth version, is considered by many to be the bible for diagnosing psychiatric illness. Unfortunately, psychiatric diagnoses in the DSM are still based on symptom clusters and have little or nothing to do with underlying brain dysfunction.

Shortly after starting the imaging work, we learned to use the scan images like radar to help us target treatment toward the specific brain regions that were abnormal. The greatest aspect of our work was observing that effective treatment causes a patient's brain to actually start healing. We could change brain patterns, see it on a follow-up scan, optimize brain function, and subsequently help people heal from the inside out.

Using brain imaging to help diagnose psychiatric illness was not part of our training, even though we trained at some of the most respected institutions in the country. Dr. Amen trained at the Walter Reed Army Medical Center in Washington, D.C., and Dr. Routh at the Mayo Clinic in Rochester, Minnesota, and Timberlawn Hospital in Dallas, Texas. Brain imaging is usually not a significant part of the curriculum in most psychiatric training programs. Although most psychiatric illnesses are strongly brain-based, psychiatrists don't look at brain function because:

* imaging is usually not a part of psychiatric training programs;

* imaging is not a part of psychiatric tradition;

* most psychiatrists do not know how to read brain scans or what the results mean;

* most psychiatrists are not sure how to use information from brain scans to help with diagnosis and guide treatment;

* many psychiatrists believe it is hard to get brain imaging studies approved by insurance companies in the age of managed care;

* most psychiatrists still perceive brain imaging tools as experimental;

* many psychiatrists are uncomfortable with technology.

We have argued for more than twelve years that it is crucial for psychiatrists to look at the brain on a day-to-day clinical basis. The field is changing, although much more slowly than we would like. We are actively involved in teaching the imaging techniques in this book to psychiatric residents and other physicians around the country.

Physicians have a number of different ways to look at the brain. MRI and CT scans are examples of anatomical studies. They tell us what the brain looks like, but not what it is doing and therefore are rarely helpful as diagnostic aids for neuropsychiatric and behavioral problems. Using a car engine analogy, the problem is usually with how the engine works, not how it looks. A car engine may look beautiful in a photograph, yet it may not start. Can you imagine how long a service center would remain in business if the mechanic's standard reply to a car owner's complaint was, "Well, it looks just fine"? Yet this is exactly what the vast majority of people who have brain dysfunction hear from the medical community after their EEG, MRI, or CT results come in. We have no doubt that in most cases these brains "look just fine" because the problem is not with "looks" but rather with how the brains work.

Currently, there are five ways to evaluate brain function:

Electroencephalogram (EEG), a technology that is seventy years old, uses electrodes to record electrical activity from the scalp and infer information about brain function. It has poor resolution and is rarely helpful for psychiatric purposes.

Quantitative EEG studies (QEEG) is a more sophisticated version of EEG that uses computers to enhance electrical signals, but still relies on inferring data about the brain through the scalp, skull, and coverings of the brain. Dr. Amen used QEEG before he switched to SPECT in 1991.

Positron emission tomography (PET) is a nuclear medicine study utilizing minute doses of radioisotopes to look at living brain blood flow and metabolism. PET studies provide elegant views of brain function, but the equipment tends to be available in research centers and cannot be accessed by large numbers of patients.

Single photon emission computed tomography (SPECT) is also a nuclear medicine study that evaluates cerebral blood flow. SPECT is the study we perform at the Amen Clinics. We find it the most practical and cost effective, and it provides amazing pictures of brain function.

Functional MRI, or fMRI, a newer study, is taking over much of the research in psychiatry. fMRI's advantages include no radiation, as opposed to PET and SPECT, but it is in the early stages of use with little clinical application to psychiatry at this point.

SPECT: A Window into Anxiety and Depression

Before we go further, it is important to understand SPECT technology. SPECT stands for single photon emission computer tomography. It is a sophisticated nuclear medicine study that allows us to visualize brain blood flow and metabolism. In this study, a radioactive isotope is attached to a substance (Ceretec) that is easily taken up by the cells in the brain. A small amount of this compound is injected into a patient's vein, travels through the bloodstream, and locks into brain cells. As the isotope breaks down it releases energy in the form of gamma rays. The gamma rays are like beacons of light that signal where the compound is in the brain. People do not have allergic reactions to SPECT studies. Special crystals in the SPECT "gamma" camera detect these beacons of light as the camera rotates around the patient's head for about fifteen minutes. About 10 million gamma rays strike the crystals during a typical scan, and a supercomputer then translates this information into sophisticated blood flow/metabolism maps and three-dimensional images of the brain. Physicians and researchers use these maps to identify patterns of brain activity that correlate to healthy brain function and those that are associated with psychiatric and neurological illnesses.

SPECT imaging belongs to a branch of medicine called nuclear medicine. Nuclear medicine studies measure the physiological functioning of the body. They are used to diagnose a multitude of medical conditions: heart disease, certain forms of infection, the spread of cancer, and bone and thyroid diseases. Brain SPECT studies help in the diagnosis of brain trauma, dementia, atypical or unresponsive mood disorders, strokes, seizures, the impact of drug abuse on brain function, complex forms of Attention Deficit Disorder, and atypical or aggressive behaviors.

Brain SPECT studies were initially used in the late 1960s and early to mid-1970s. CT and the more sophisticated MRI anatomical studies replaced SPECT studies in the late 1970s and 1980s. At the time, the resolution (image clarity) of those studies was superior to SPECT for seeing tumors, cysts, and blood clots. Yet, despite their clarity, CT scans and MRIs could offer images of only a static brain and its anatomy; they gave no information about the activity of a working brain. In the last decade it has become increasingly recognized that many neurological and psychiatric disorders are not disorders of the brain's anatomy, but are problems of brain function.

Two technological advancements have once again encouraged the use of SPECT studies. The early SPECT cameras were called single-headed cameras because they used only one imaging device and took as long as one hour to rotate around a person's brain. People had trouble holding still for that long, the images were fuzzy and hard to read (earning nuclear medicine the nickname "unclear medicine"), and they did not give much information about the activity levels of the deep brain structures. Then multi-headed cameras were developed with special filters that imaged the brain faster with enhanced resolution. Advancements in computer technology allowed for improved data acquisition. The brain SPECT studies of today, with their markedly improved resolution, can see deeper into the inner workings of the brain with far greater clarity.

We typically do two scans when we evaluate a patient's brain. We do a baseline scan during which the patient is asked to let his mind wande... --This text refers to an out of print or unavailable edition of this title.

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Product Details

• Paperback: 352 pages
• Publisher: Berkley Trade (December 7, 2004)
• Language: English
• ISBN-10: 0425198448
• ISBN-13: 978-0425198445
• Product Dimensions: 9 x 6.1 x 0.9 inches
• Shipping Weight: 11.2 ounces (View shipping rates and policies)
• Average Customer Review: 4.5 out of 5 stars  See all reviews (49 customer reviews)
• Amazon Best Sellers Rank: #22,373 in Books (See Top 100 in Books)
  • #43 in Books > Health, Fitness & Dieting > Aging > Depression

Customer Reviews

Most Helpful Customer Reviews

271 of 275 people found the following review helpful:

5.0 out of 5 stars A Fascinating Integration of Medicine and Psychology, February 18, 2004

By 

A Customer - See all my reviews

This review is from: Healing Anxiety and Depression (Hardcover)

Many books are one-sided arguments for the causes of depression and anxiety. According to these biased books, depressions stems from:

Past child abuse and other negative environment factors

Holding your body in a depressing way - bent down, frowning, etc.

Medical causes

Poor diet, lack of exercise

Isolation

Fill in the blank

But this book is different.

Healing Anxiety and Depression is a refreshing book, for it takes all of the above factors and mixes it into a complete approach to the causes and treatment of anxiety and depression.

Moreover, Daniel Amen, M.D. and his co-author, Lisa C. Routh, M.D. have pioneered the use of a brain imaging technology known as SPECT: Single Photon Emission Computed Tomography. This interesting brain scanning method is different than other methods because it allows one to see how certain parts of the brain interact to cause these debilitating conditions. Other
methods of brain imaging only give a surface view of the brain - which is of very little use for psychiatry.

The authors also touch upon how these areas of the brain cause insomnia, suicide and violence as well. They also point out the different causes of anxiety and depression between the genders. They convincingly describe gender differences from social, psychological, and biological perspectives.

In short: they give you the full picture on depression from every possible angle - literally. In between the pages, interspersed among case histories, personal stories, and scientific explanations, you will find actual pictures of the five areas of the brain they have focused on via SPECT technology:

1.) Basal Ganglia
2.) Deep Limbic System
3.) Anterior Cingulate Gyrus
4.) Temporal Lobes
5.) Prefrontal Cortex

Furthermore, the authors have taken these five areas of the brain, and through thousands of their own patients, compiled their findings on how these five areas interact to cause seven variations of depression and anxiety:

1.) Pure Anxiety
2.) Pure Depression
3.) Mixed Anxiety and Depression
4.) Overfocused Anxiety/Depression
5.) Cyclic Anxiety/Depression
6.) Angry Anxiety/Depression
7.) Unfocused Anxiety/Depression

There's only one drawback to this book: the technical terms can be a bit annoying. I constantly flipped back to beginning chapters to refresh my memory on what they were talking about. The medications and dosages - and their variations, are mind-boggling. Ask your doctor about them.

Despite this, the book is worth the extra memory and concentration required to comprehend it.

It's very empowering too: Dr. Amen is a strong advocate for natural supplements, exercise, and deep diaphragmatic breathing. He also gives the reader a simple, flexible, easy-to-follow diet that'll maximize your brain function. More wisely, however, he directs you towards a way of eating that's based not on a one-size-fits-all mentality, but a diet that is focused on your
particular type of anxiety and/or depression.

He also has his own version of cognitive therapy: ANTS (Automatic Negative Thoughts) and ANTeaters, developed by Amen as a child psychiatrist to help make the ideas a bit more concrete for children. Amen's short chapter on the power of thoughts can help you take more responsibility for your own
thinking.

Closing with "32 Strategies to Overcome Anxiety and Depression," along with a chart summarizing "diagnostic and treatment principles," this book will give you the real knowledge you need to manage your life on a whole new level.

91 of 92 people found the following review helpful:

5.0 out of 5 stars Astonishing, March 8, 2005

By 

N. St-Amand "Nat" (Toronto, Canada) - See all my reviews

This review is from: Healing Anxiety and Depression (Hardcover)

Dr. Amen is definitely one of the best when it comes to mental illness. Having suffered from depression, and more severely, anxiety, I browsed through the health section at my local bookstore looking for answers. And I definitely found them in this book. This book talks about the 7 types of depression and anxiety, how they are caused, what brain chemicals are causing the symptoms and where in the brain the problem lies. Dr. Amen uses SPECT nuclear imaging to see the brain in its depressed/anxious states. Along with descriptions of all of the 7 types are images of the brain with that type of depression/anxiety. I narrowed down my depression/anxiety to be a type 4, followed the advice it suggested, and have been 90% depression and anxiety free for 6 months. A MUST read for anyone suffering from a mood or anxiety disorder.

109 of 112 people found the following review helpful:

5.0 out of 5 stars A "Must Read" for Anyone Facing Anxiety/Depression, November 3, 2003

By 

Kelly Frey (Aliso Viejo, CA USA) - See all my reviews

This review is from: Healing Anxiety and Depression (Hardcover)

Healing Anxiety and Depression is an easy-to-read book that shines a spotlight on anxiety and depressive disorders from the perspective of brain functioning, as opposed to the traditional diagnostic approach based primarily on symptom clusters. In this book, Dr. Amen and Dr. Routh clearly explain the following five major interconnected brain circuits that underlie most of these disorders:

* basal ganglia-sets the body's idling level
* deep limbic system-sets the mind's feeling tone
* anterior cingulated gyrus-helps shift attention
* temporal lobes-helps mood stability, temper control, and memory
* prefrontal cortex-helps with decision making, attention span, judgment, and impulse control

The authors describe in detail the functions associated with each of these brain components, as well as the common difficulties that arise when that particular part of the brain is not functioning well. They proceed to propose a new way of approaching treatment for anxiety and depression, based on their finding that anxiety and depression commonly occur together, that they are largely the result of brain dysfunction, and that there are seven different types of anxiety/depressive disorders, with a number of effective treatment approaches for each type. The seven disorder types the authors describe are:

* Pure Anxiety
* Pure Depression
* Mixed Anxiety and Depression
* Overfocused Anxiety/Depression
* Cyclic Anxiety/Depression
* Temporal Lobe Anxiety/Depression
* Unfocused Anxiety/Depression

The book explores each disorder type in detail, including illustrating the brain functioning patterns the authors have found associated with each, based on their work with Single Photon Emission Computed Tomography (SPECT) scans. It also contains a questionnaire to help the reader identify if he meets the criteria for each disorder type (this questionnaire is not meant to render a diagnosis).

When describing their treatment approaches for each disorder type, the authors go well beyond a thorough discussion of prescription medications to include discussion of natural supplements, diet, cognitive therapy (e.g., changing Automatic Negative Thoughts, or "ANTs), the healing power of relationships, the impact of breathing properly, and biofeedback.

The authors also explore gender differences (e.g., hormonal factors) associated with anxiety/depressive disorders, and the impact of these disorders on families. They include a whole chapter on the topic of insomnia, and conclude with a host of resources.

As is typical of Dr. Amen's books, this book takes a complex subject and breaks it down into essential components that are easy to understand. By including "healthy brain" SPECT scans next to the scans of people suffering from one of the seven anxiety/depressive disorder types, the brain functioning patterns seem very clear. By including real-life anecdotes about the patients that correspond with the brain scans, including their diagnoses, treatment approaches, and treatment results, the book leaves the reader with a feeling of great hope that these disorders can be accurately diagnosed and treated.