03/01/2024
PSYCHIATRY IS STUCK IN AN OUTDATED SYSTEM
Psychiatry remains the only medical specialty that virtually never looks at the organ it treats. Cardiologists look at the heart, orthopedists look at the bones and muscles, and obstetricians look inside the uterus. Psychiatrists guess. If you’re depressed, anxious, unfocused, obsessive, addicted, suicidal, homicidal, or psychotic, no one will look at your brain.
THATS INSANE.
Mental health issues affect all of us. Either you’ve struggled personally, or you know someone who has. No one escapes. The incidence of mental illness had already reached an epidemic level before the pandemic hit.
Every 14 minutes someone commits su***de in the United States. Su***de is the second leading cause of death for those 10 to 34 years of age, according to the National Institute of Mental Health (NAMI). From 1999 to 2017, su***de rates increased by 33 percent, decreasing overall life expectancy, while from 2001 to 2020 cancer deaths decreased by 27 percent, according to the CDC.
Every eight minutes, someone dies of a drug overdose, and the recent op**te crisis in America is only getting worse year after year.
According to a large epidemiological study in Archives of General Psychiatry, 51 percent of the U.S. population will struggle with a mental health issue at some point in their lives.
Since the pandemic, things have gotten worse. The numbers have skyrocketed with deaths from drugs, alcohol, and su***de at the highest level in recorded history, according to a 2022 report. A 2022 study in BMJ found that people who have had COVID-19—even mild cases—are 60 percent more likely to struggle with mental health problems. And one of the study’s authors states that over 2.8 million new cases of psychiatric illness can be tied to COVID infections.
How will the vast majority of these people be diagnosed? The same way Abraham Lincoln was diagnosed with “melancholia” over 180 years ago.
PSYCHIATRY: A DESPERATELY NEEDED NEW WAY FORWARD
Today’s psychiatric diagnostic system is virtually the same as in Lincoln’s day with doctors talking to patients about their symptoms and looking for symptom clusters—without any biological data.
For example, let’s say you go to your primary care physician and say you’re depressed. You’ll likely be diagnosed with depression and given an antidepressant. If you say you’re anxious, you usually get an “anxiety disorder” diagnosis and anti-anxiety medication. Or if you say you have trouble with attention, you may be diagnosed with an attention-deficit disorder (ADHD) and a prescription for stimulants. These medications can help some people, but they also make some people worse. And all psychiatric medications have FDA black box warnings, meaning they have serious and sometimes life-threatening side effects or risks.
THE CONSEQUENCES OF ''BRAINLESS PSYCHIATRY'' ARE STAGGERING. JUST LOOK AT THESE STATISTICS.
25 percent of Americans are taking at least one prescription mental health medication
More than 337 million antidepressant prescriptions in 2021
27 percent of doctor visits result in a prescription for benzodiazepines
85 percent of psychiatric medications are prescribed by non-psychiatrists in brief office visits
Despite the pharmaceutical revolution in psychiatry, outcomes have not improved since the 1950s. Psychiatrist Thomas Insel, the former Director of the National Institutes of Mental Health (NIMH), wrote in the Journal of Clinical Investigation, “The unfortunate reality is that current medications help too few people to get better and very few people to get well.” This is consistent with what Insel’s predecessor, Steve Hyman, former director of the NIMH, wrote in a 2012 commentary in Science Translational Medicine, that we have failed to progress significantly in the last half-century in medications to treat psychiatric illnesses.
A ''MEANINGLESS'' PSYCHIATRIC GUIDE''
Part of the problem is psychiatry’s steadfast reliance on the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5), the “bible” of psychiatric conditions. An explosive 2019 study in Psychiatric Research confirms that making psychiatric diagnoses based solely on symptom clusters is scientifically meaningless. The study, led by University of Liverpool researchers, focused on a meticulous analysis of five chapters in the DSM-5: anxiety disorders, depressive disorders, trauma-related disorders, bipolar disorder, and schizophrenia. Their main findings highlight many of the shortcomings of the current diagnostic paradigm:
There is a major overlap of symptoms among diagnoses.
Many diagnoses overlook the role of psychological trauma and head trauma.
The current approach rarely takes the individual in mind.
This study’s deep dive into the numbers shows just how murky and inconsistent the diagnostic model is. For example, “There are almost 24,000 possible symptom combinations for panic disorder in DSM-5, compared with just one possible combination for social phobia.” Equally concerning is their finding that “two people could receive the same diagnosis without sharing any common symptoms.” And the sheer number of combinations of symptoms makes the ability to arrive at an accurate diagnosis nearly impossible.
Take this stunning fact, for instance: “In the DSM-5 there are 270 million combinations of symptoms that would meet the criteria for both PTSD and major depressive disorder, and when five other commonly made diagnoses are seen alongside these two, this figure rises to one quintillion symptom combinations—more than the number of stars in the Milky Way.” The researchers conclude that following a different approach may be more effective than remaining committed to what they called a “disingenuous categorical system.”
It doesn’t have to be this way.
REFRAMING MENTAL HEALTH AS BRAIN HEALTH
From experience with tens of thousands of patients at Amen Clinics, which opened its first clinic over 30 years ago, it is clear that making diagnoses based solely on DSM symptom clusters—such as anxiety, depression, temper outbursts, or a short attention spa—is inadequate and disrespectful to patients. Symptoms don’t tell us anything about the underlying biology of the problems our patients have.
Reframing the way we think about “mental illnesses” by looking at them as brain health issues is more accurate. It is this discovery that completely changed the way Amen Clinics approach diagnosing and treating patients. It is also the underlying reason why Amen Clinics has one of the highest published success rates for complex patients, who have failed an average of 3.3 providers and five medications. In fact, 84 percent of the complex, treatment-resistant patients treated at Amen Clinics report feeling better after six months.
We are on the cusp of a new revolution that will change mental health care forever. It is time to discard the outdated, stigmatizing paradigm that taints people with disparaging labels, preventing them from getting the help they need, and replaces it with a modern brain-based, whole-person program rooted in neuroscience and hope. No one is shamed for cancer, diabetes, or heart disease, even though they have significant lifestyle contributions. Likewise, no one should be shamed for depression, panic disorders, bipolar disorder, addictions, schizophrenia, and other brain health issues.
Over the last 30-plus years, Amen Clinics have built the world’s largest database of brain scans related to behavior. They have performed more than 200,000 brain SPECT (single photon emission computed tomography) scans, which measure blood flow and activity patterns, and over 10,000 quantitative electroencephalograms (QEEGs), which measure electrical activity, on patients from nine months old to 105 years from over 150 countries. Their brain-imaging work has completely disrupted how they help their patients get well.
Take Jarrett, for instance. He was diagnosed with ADHD in preschool. He was hyperactive, restless, and impulsive in addition to having a bad temper, learning problems, and trouble making friends. He had seen five doctors and had been placed on five different stimulant medications. None of them worked, and in fact, they triggered rages and mood swings. Jarrett’s latest physician suggested starting him on an antipsychotic. That’s when his mother brought Jarrett to Amen Clinics.
At Amen Clinics, Jarrett’s SPECT scan showed that he had a type of ADHD they call “Ring of Fire,” in which there is overactivity throughout the brain. Giving stimulants to someone with this type is like pouring gasoline on a fire. On a comprehensive treatment plan tailored to this type of ADHD, Jarrett’s behavior improved. His rages stopped, he made the honor roll or Dean’s list for 10 years, and he started making friends. Today, he’s in college and wants to be a firefighter because, as he says, “On somebody’s worst day, I want to make it better.”
Now, look at Adrianna, who was a healthy 16-year-old when she went to Yosemite with her parents for vacation. When they arrived at their cabin, they were surrounded by six deer. They thought it was a magical moment. Ten days later, however, Adrianna became agitated and started having auditory hallucinations. When her parents sought treatment for her, Adrianna was admitted to a psychiatric hospital and given antipsychotic medications, which failed to help. Over the next three months, Adrianna was seen by 25 doctors and prescribed multiple medications—all at a cost of tens of thousands of dollars. One of those doctors told her mother that Adrianna was schizophrenic and would require medication for the rest of her life.
When Adrianna’s mother learned about Amen Clinics and their brain-body approach, she brought her daughter in for an evaluation. Adrianna’s brain scan showed signs of inflammation, which prompted them to look deeper into the potential causes of her symptoms. After additional testing, it turned out that Adrianna had Lyme disease, an infection caused by deer ticks. Treatment with antibiotics helped her get her life back. She subsequently graduated from Pepperdine University and then went on to get a master’s degree and is now living a happy life. That wouldn’t have happened if she had stuck with the standard psychiatric treatment model.
At Amen Clinics, they have thousands of stories like these of patients who have gotten their lives back after years of suffering. But some people in the traditional psychiatry field continue to cling to the status quo and resist the shift to viewing mental health problems as brain health issues that steal your mind.
ENDING MENTAL ILLNESS BY CREATING A REVOLUTION IN BRAIN HEALTH
Despite pushback from some in the psychiatry field who remain stuck using an outdated paradigm, there is a growing understanding that mental health is really brain health. A growing number of mental health professionals are partnering with Amen Clinics in the care of patients. In fact, over 10,000 medical and mental health professionals have referred thousands of patients to Amen Clinics from over 150 countries on six continents. In addition, the Amen Clinics team has published over 70 peer-reviewed articles on SPECT as it relates to mental and behavioral health in prestigious scientific journals. Discover magazine named an Amen Clinics study on how SPECT can help differentiate PTSD from traumatic brain injury (TBI) as one of the 100 Top Stories of 2015. And other experts—such as the journal Radiology and the Canadian Association of Nuclear Medicine—have validated the use of brain imaging in psychiatry.
A veritable brain health revolution has begun. This brain-based approach provides a new path forward for psychiatry—one that will reduce stigma, increase compassion and compliance, and ultimately help more people be healthier and happier. Isn’t that the ultimate goal?
