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Tuesday, 30 December 2008 10:46

Visionary or Voodoo? - Page 8

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Another woman had been diagnosed with Alzheimer's after she'd nearly burned down her own home and lost her driver's license. Amen scanned her and found no signs of the characteristic abnormalities associated with dementia. But he did see that her deep limbic structures were "on fire" (a favorite bit of Amen-speak to describe brain areas of severe overactivity). This suggested depression, which can sometimes mimic Alzheimer's symptoms of memory loss, apathy, indifference, and disorientation. Amen prescribed Wellbutrin--an antidepressant and stimulant--and voila` again! Within weeks, she'd regained her memory, and her mood was much better. Within six months, she got her driver's license back.

"How many experiences does a psychiatrist have like these in a whole career?" Amen asks. "I had five of them in the space of a few weeks."

By Amen's lights, SPECT was not diagnosing new conditions. The scans didn't remotely correlate with DSM diagnostic categories, but they often revealed the inaccuracy of previous diagnoses and suggested functional anomalies that shed light on otherwise unexplained symptoms. Nor were his treatments miraculous, radical, or novel; they apparently just hit the target better than earlier interventions. In short order, he was a true believer in the modality. "I thought, 'How can I do psychiatry in good conscience without using scans when I don't really understand what is going on? How can I just continue to rely on guesswork when I have this tool at my disposal?'"

Between 1991 and 1995, he became something of a SPECTomaniac, reading everything he could find, attending meetings about SPECT, and ordering SPECT scans on hundreds of patients at the local hospital. He was asked to talk about SPECT at hospitals and at the University of Colorado medical school. He wrote a research paper comparing SPECT brain images of ADD children to those of normal children. He became an enthusiastic promoter of SPECT.

But there were signs of smoke from an impending firestorm almost from the beginning. In 1992, at a meeting of the American Psychiatric Association (APA), where he attended an all-day course on the use of SPECT in child psychiatry, he went to a lecture by National Institute of Mental Health child-psychiatry researcher Alan Zametkin. This would-be colleague used PET scans (a form of nuclear imaging with higher-quality resolution than SPECT, though more difficult and expensive to use) in a groundbreaking study of what ADD brains look like. Zametkin, says Amen, was one of his heroes, so he went up to him after the talk in the spirit of a fan approaching a star. "I told him that, partially based on his work, I was using SPECT in my own practice," remembers Amen.

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