Hi, I’m Dr. Daniel Amen, psychiatrist and brain disorder specialist. Ask me anything!

How do you respond to accusations that your practices are not based in evidence, that you are the Dr. Oz of neuropsych?

https://www.washingtonpost.com/lifestyle/magazine/daniel-amen-is-the-most-popular-psychiatrist-in-america-to-most-researchers-and-scientists-thats-a-very-bad-thing/2012/08/07/467ed52c-c540-11e1-8c16-5080b717c13e_story.html

Thanks for this question. on www.amenclinics.com we he have 3,000 scientific abstracts about SPECT in psychiatry. I have published 60 papers, which report we have the best outcomes on complex psychiatric patients and that SPECT changes what doctors do 8 times out of 10. If you read the Washington Post article you will notice many of my colleagues who refer and support our work. 40% of our new patients are referred by our own patients. The critics in that article have never come to the clinics even though I have invited them. I stand behind our work and have done so for 25 years.

What's wrong with Donald Trumps brain?

It is a fascinating question. I wrote an Op Ed piece for the LA Times on whether or not we should scan presidential candidates. I have my suspicions about all of the candidates. See this link.

http://www.latimes.com/news/la-oe-amen5dec05-story.html

What do you think of the new Will Smith movie coming out about brain injury in the NFL? Did you encounter any political problems when you began researching NFL players?

Love the movie. Powerful, clear and very scary. Was a consultant for it. The NFL was not happy about our work, but there was great enthusiasm among players.

Marijuana seems to be an effective medication for seizures/epilepsy, depression, anxiety, ADHD etc. Have you done any research on the effectiveness of marijuana as a medication for these or other disorders and conditions? What is your stance on marijuana as a medication?

I have scanned literally thousands of brains on marijuana. It shows toxic effects on scans. Yes, it can help with anxiety, but often makes depression and ADHD worse. Xanax helps with anxiety but is toxic to brain function. I think of marijuana the same way. Perhaps CBD by itself will be helpful. I caution my patients about its use.

What do you mean with "toxic effects"?

It makes the brain look older than the person is. It is a pattern we see with alcohol and infections. Not a good thing.

I enjoy daydreaming about torturing and killing all sorts of people, even people I like. Do I need to worry?

This is a fascinating question. As long as your frontal lobes are OK and you can control your behavior, you can keep these thoughts in check and stay out of jail or hell. The brain is a sneaky organ. We all have weird, crazy, sexual, violent thoughts that no one should ever hear. Your brain acts as a filter. Keep it healthy.

I read something, somewhere about low fat diets causing decreased brain function. Is there truth to this?

Yes. 60% of the solid weight of the brain is fat. Cholesterol levels under 160 are associated with depression, suicide and murder.

I know a lot of people who take SSRIs who claim to have serotonin deficiency in their brain. Is there a way to actually measure serotonin levels in the brain, and if so, why isn't it being used as a diagnostic tool for treating depression?

A lot of people use urine testing to measure serotonin levels. Unfortunately, no one has shown what is in your urine is matched with what is in your brain. When we do brain imaging with SPECT we have shown low serotonin levels are associated with increased anterior cingulate activity and worried, rigid, inflexible thinking. I talk a lot about this in my newly revised book, Change Your Brain, Change Your Life.

Hi Dr. Amen. Can a person who has taken high doses of benzodiazepines for many years (over ten) ever recover their short term memory? Once going off of all benzodiazepines is there a chance for brain function to go back to the level it was at when the person started taking the prescription? Thank you.

Yes, that is the most exciting news from my work. You can heal troubled brains by putting them in a healing environment.

What do you consider to be the singles greatest threat to long-term brain health?

There are many, but if I had to choose 1 it would be diabetes and pre-diabetes, which damages the brain and now affects 50% of the population according to a recent study in JAMA.

So would that mean the highest impact lifestyle changes we can make to better our brain are things like diet and exercise?

You bet. I play this game with my daughter called Chloe's brain ... Is this good for my brain or bad for it?

Assuming I dont get an infection, would eating the brains of my enemies make me smarter?

No evidence that this will help.

Dr. Amen:

I know that you've had some focus on ADHD in particular in your clinical and SPECT work, and I imagine that because of your notion of 7 types of ADHD, you are likely aware of some of the newer research within the last few years suggesting Sluggish Cognitive Tempo as a third axis for diagnosis alongside Hyperactivity-Impulsivity and Inattentiveness.

What are your thoughts on how SCT fits in with your current ADHD diagnosis model? Have you scanned patients that would fit the criteria for SCT, and how do you classify them within your system?

Yes, there are many types. Sluggish Cognitive Tempo patients usually go with low overall activity. the question we should ask is why? Head trauma, toxic exposure like mold, vascular disease, marijuana exposure, etc.

That makes a lot of sense. Thank you.

Just one quick follow-up question: Have you had any more luck making SPECT scanning available to the average patient in terms of healthcare coverage? I know it's hard to justify to health insurance providers such specialized diagnostic treatment.

Still working on it. Most insurance companies don't see psychiatric issues like other medical issues.

How can someone with Hashimoto's improve their brain function, memory, stamina and overall health?

We see this a lot. Make sure you get your thyroid levels optimized, then do all the other great things for your brain I discuss in the new book, such as diet, exercise, simple supplements, and avoiding obesity, diabetes, hypertension, insomnia.

Thank you. Do you notice thyroid deficiency affecting a particular part of the brain in Spect scans?

It tends to have a global negative effect.

You mentioned diabetes and the brain. How does diabetes affect it?

Diabetes damages blood vessels and the brain uses 20% of the blood flow in the body.

What's the one brain disease you are most afraid of getting?

ALS, because there is no cure yet.

Do you think the brain creates consciousness, or does consciousness exist externally and interacts with the brain?

I think that consciousness and the brain interact on each other.

What is the optimum amount of sleep for a 19 y.o student? Trying to get myself into a good routine where I can keep up with the work load and stay refreshed to keep my drive going. Also any tips on how to promote getting to sleep easier? I'm a lucid dreamer and once I've had a dream (particularly bad) I get really anxious and stressed and sleep sort of goes out the window!

7-9 hours is optimal. I'd try to get 8 if you can. Avoid things that hurt sleep (light, gadgets, warm rooms, noise, alcohol or caffeine) ... do things that promote it (dark, relaxation, warm baths, melatonin)

Has any patient's scan caused you to fear them or for them?

Some scans are cause for great concern to make sure our patients take brain health seriously or they will experience bad consequences.

Why do SSRI medications cause the inability or difficulty to achieve orgasm?

Serotonin also works on nerves outside the brain to delay orgasm. It can also lower desire.

What is your take on how vitamin deficiencies play into brain function and mood disorders? --e.g. low B-12, low D?

They are connected. I test all of my patients and optimize them.

Hey Dr Amen, I've been diagnosed with many mental illnesses, the diagnosis keeps changing based on what I view as primitive methods of diagnosing. I don't believe I have any of the illnesses I was diagnosed with except maybe a mild case of autism (I was diagnosed with ADD, bipolar disorder, PTSD, schizoaffective, bpd, MDD, and a bunch of others).

I'm hypersensitive to medications in general, and while receiving anti psychotic medications (when the good doctors at the VA thought I had schizoaffective disorder), I became dissociated/depersonalized, or "lost my feelings," as I describe it. I can't feel time pass, I can't feel anything positive, I can't feel anything but negative things, and even those are "muted" in a weird way, it's like it's not me experiencing them. It's been years like this even though I've done every kind of therapy there is and tried every prescription medicine offered for mental health.

I'm going to Amsterdam in the next few months to try MDMA, heroin, and ketamine because I've concluded from my readings that they might do the trick.

I just want to feel again, and I know that it's like an on/off switch that is currently off. I know I'm not giving you enough information, but based on what I told you, what do you think will turn it "on"? I would like to experience time and positive feelings and just be me again.

I'd get a scan and see what is going on. All those treatments are just more darts in the dark, which worry me.

My family has a strong history of Alzheimer's/severe dementia (no official diagnosis due to lack of autopsies), especially on the female lineage. I would very much like to avoid this fate, and help my mother as much as possible as she gets older. Other than diet and and a healthy lifestyle, what suggestions do you have for keeping your mind healthy? Are there any potential treatments in the future?

Definitely go to http://changeyourbrainbook.com/. There is a whole section in the new book on how you can proactively do everything you can to attack your Alzheimer's risk.

Mr. Dr. Amen do you think we'll cure schizophrenia in the, say, next 15 years?

It depends on the cause of schizophrenia. It's just not one thing. If the cause is Lyme, then it can be cured. If it is mold exposure it can be helped. If it is gluten allergy it can be helped. Unfortunately, no one looks at the brains of most schizophrenic patients so doctors think it is one thing and only use antipsychotic meds.

Why do you think it's not common to examine their brains properly?

It's not part of our tradition. It goes against the DSM-V driven paradigm that symptoms = diagnosis = treatment. No other medical professionals act that way.

One more quick follow up question: Let's say I know somebody who has schizophrenia who came into contact with cat's excrement due to a bet, how likely would it be that toxoplasmosis caused the schizophrenia? Should he tell this to his attending psychiatrist, even if it's now 5 years ago that the illness broke out?

Yes, toxoplasmosis is a cause of psychosis and should be checked.

Im taking fish oil every day, im exercising 3 -4 times per week for about an hour, im taking B complex. But im drinking a coffe near every day because im still studying and have a lots of obligations....Is this enough for a brain health lifestyle? thanx Dean

It's a good start. The new book will tell you more ways. http://changeyourbrainbook.com/

What was your path to becoming a brain disorder specialist like? It sounds like a super interesting, but difficult field, I'd be really curious to learn more about how you got into it.

It was quite a journey.

Infantry medic ... x-ray technician ... medical school ... fell in love with psychiatry after someone I loved tried to kill herself ... But psychiatrists didn't use imaging ... My x-ray background caused me to want to look ... So I pushed myself and my colleagues to start looking at the brain of psychiatric patients ... I am still pushing them. :)

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No, the ketogenic diet has some healing properties for the brain. Sugar is more harmful than ketones.

Always diet first. It is the most important thing you can do for your brain.

When I was a child, I got diagnosed with depression. My parents never did anything about it past that point. Now that i am an adult i went out to seek help and got prescribed zolaft. The dosage is too low and is not affecting me other than me having weird dreams. How do i talk to my doc aboit getting a higher dosage without sounding like i just want drugs for recreational use?

Tell your doctor it is not working, and that you want to try a higher dosage. Remember, your doctor should be your partner in health not your boss or your mother.

What's the most interesting comparison or contrast that you've noticed between brains ?

All brains are not the same, even when they have the same symptoms. For example, I scanned 2 15 year old multiple murderers. One had really low activity globally, while one had really high activity. How do we know unless we look?

Do you ever encounter malingerers? What is sure sign that someone is faking the extent of their brain injury?

Of course. The scans can tell if it is real or not real. Check out our article on SPECT and TBI.

http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0091088

My son has absent septum pallucidum, what does this mean?

It is a part of the brain often involved in pleasure. It may be missing in normal people.

What are some activities or tips can you give former military members dealing with PTSD?

Engage in brain healthy habits to help heal the brain. There are simple techniques like EMDR and havening I like. Also check out our new paper, that will be highlighted as one of 2015's top 100 stories in science.

http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0129659

My girlfriend is depressed and based on her actions I would assume she has borderline personality disorder. I want to help her and she absolutely hates medications. How do I approach her about this and what can I do for her?

Psychotherapy, especially DBT, has been shown to be helpful for people with BPD.

Should students with intellectual disabilities be in general education classrooms? If you agree, why? If not, where do you think the best setting would be for a student who has a noticeable but not quite diagnose-able mental disorder?

I'm sure there is plenty of controversy on the topic, though I'd love to hear your personal opinion nonetheless.

It depends on the particular classroom. I would always look for the best fit, the best teacher, the place where the child can thrive, and where the other kids are helpful and supportive.

What is your take on ADHD in children and adults? Over diagnosed or is its diagnosis becoming more robust?

Both overdiagnosed and underdiagnosed, especially in females.

Why won't the FDA approve Moclobemide? I've run the table on pretty much all the SSRI's and I feel like (from what I know about this drug) it could be beneficial.

Not sure of their thinking on this drug. There are other MAO Inhibitors that are approved.

Should I be worried about a constant dull ache in the back of my head ever since I tripped and banged my head into a brick wall 14 years ago?

I wouldn't be extremely concerned. If there are other symptoms such as light sensitivity, memory, learning or mood, I would get assessed.

Dr. Amen -

Why do some traumatized people develop PTSD while other people do not? If someone is born with Gerstmann Syndrome and then experiences something very traumatic are they therefore more "sensitive" to the kind of cognitive process that turns a normal emotional reaction into a long-term disorder of post-traumatic stress?

It depends on many factors, including their prior levels of trauma.

Is there any reason why there are certain disorders that are comorbid with others? For example, I have the delightful combination of ADD/ADHD and Bipolar II. Also, what are your thoughts on the neurodiversity movement or "shaman" view of mental illness? Personally, I am thankful for my meds because they allow me to function pretty well.

I am grateful for meds too. When they work they save lives. With the combo of ADD and Bipolar II I often think of post concussive issues.

So this question is kind of personal, I have been feeling nervous for the past 3-4 months, and I can’t seem to pinpoint the source. This nervousness stems from my stomach, it kind of feels like butterflies but slightly more stressful. What could this be?

Many things, including anxiety, stress, gut health issues. Worth getting it checked.

Has your work changed how you deal with people, or your outlook on life in general?

Best advice you would give to the average person in regards to mental/brain health?

Has your work influenced how you view consciousness or your views on spirituality/afterlife?

Thanks to doing this AMA, it's very interesting. Keep up the good work :)

Our brain imaging work has changed everything in my own life. I love and care for my brain more than ever, and also love and care for their brains of my patients (not many psychiatrists say that) and my own loved ones.