Using Brain SPECT Imaging for Mental Health Treatment | Dr. Rishi Sood of the Amen Clinics

I think one big take home could be, since, you know, we look at the brain, is that your brain is involved in everything you do. When you're making decisions, think about those decisions with your brain in mind. For instance, your thoughts, how you think can affect how your brain feels. And if you think negative thoughts, that can strengthen kind of negative parts of the brain. If you think positive thoughts, that can calm down certain areas in the brain. So how we think matters. It can be challenging to think positively, though, when we're suffering to seek help if it's just insurmountable, internalizing less and just being more open and more vulnerable. I think really to think about our decisions with our brain in mind.

Welcome to the Mental Health Entrepreneur Podcast. We are here to inspire creative ideas and connections for entrepreneurs and advocates working to address our mental health crisis. As you listen, I hope you will experience new ideas and motivation to innovate in your business, your community, and in your life. Welcome back, everyone, to the Mental Health Entrepreneur Podcast. I'm your host, Rachel Harrison, and with me today is Rishi Sood. He is with the Amen clinics. So welcome, Dr. Sood. I'm so excited to have you here today. And I want to just start off by even talking about the Amen Clinics. Some people may have heard of them, some people may not. But what is it that the Amen Clinics do primarily?

Yeah. So first off, thanks so much for having me. Really excited to be here. My background, you know, I'm a psychiatrist, been at the clinic for now almost 10 years. And what we do at the clinics is we try to use a holistic approach. You know, the big thing about kind of what we do is we use imaging, so brain imaging. We actually look at the brain and we use that to sort of inform treatment. So we use this type of imaging called SPECT imaging, which I can get into.

Yeah. And so I think what's interesting from my knowledge of SPECT imaging, I mean, in the mental health world, I don't know of anybody else that's using imaging in the work. Is that correct?

So, yeah, there's. So Dr. Amen started using imaging in 91, and since then, no one has used imaging, which is quite frustrating. But now out of Stanford, they're actually using imaging to subtype different types of depression. So people are finally realizing that we actually want to look at the brain to help us understand and address these complex conditions. So you're absolutely correct. No one has really looked at the brain, but now we're beginning to look at the whole.

It's Fascinating, because in the mental health world, you know, when we typically are trained and learn how to diagnose most people, that is all largely based on symptoms and symptom clusters. Right. So there's a lot of, like, how patients are reporting things and how doctors are hearing that. And this SPECT scan gives us, I guess, more definition, something more solid to go on.

Yeah, absolutely. So conventional training is such that you kind of talk to. So when I did my training, my residency, my fellowship, we talk to people who need people. With people, we would give them some questionnaires, we measure them up, categorize them, and then sort of say, you need this treatment, which was usually some sort of psychotherapy and some sort of medication. Like you said, that could be, you know, depending on the day, that person could answer a question one way, depending on how the clinician is feeling, depending on how the world they're going to kind of then maybe make that diagnosis. So, you know, with spect, we're using more. What we'd consider more objective, and we're using a database. It's an iterative process. And we're not just like, oh, this is it. We're continuing to learn. So I think it's. It's definitely not something we want to do alone on its own. Like, I never can ever look at a scan and just diagnose someone. You know, I think the human condition way too much for that. But, yeah, we want to. Want to combine the different modalities. Yeah.

And so how did you get into this work? I'm curious to hear your story.

Like I was saying, I was trained in New York City, did my training from 2009 to 2014, and loved connecting with people that you're working with. You want to help. But I just felt like it was just, you know, a pill dispenser. You have this condition. Here's a drug, you know, here's Prozac, here's Adderall. Definitely not against using medications. Believe that there is a time and a place for that. But I felt like we needed to sort of think about things in a more nuanced, complex way. And one day, it was just like watching TV, saw Dr. Amen. And really, one thing that stood out was when he said, the harder you try, the harder it gets. And that's something we sometimes see in a certain type of adhd. And he showed an image of someone's brain when they weren't concentrating and they were concentrating, and then when they were trying to concentrate, part of their brain dropped out. And I was like, wow, that's such a cool analogy. And like they're literal brain changes and it'd be cool to kind of understand this a little bit more. So that kind of sparked an interest.

Okay, and then how did you get in touch? How did that go? Did you watch that and like apply for a job or was it more of a process than that?

Yeah, so watched that, kind of reached out, got connected with the clinic. And yeah, I was like, should I do this? Should I not? You know, because, you know, it's not sort of the way we're conventionally trained. So that I just sort of took a chance and yeah, we're here now. But I was. That was a pretty cool journey.

Yeah, that is. So I'm wondering a little bit, as you've done this work, what do you notice, like, what's different about your day to day job from feeling like you were just prescribing medications to now utilizing the SPECT scan? And how's your treatment approach different?

I think one of the major ways in which, you know, things are different is, you know, people are actually able to see their own brain. Like, how often does that happen? How often do we really get an insight into like, what's going on into our actual mind so people actually see their brain? So when I'm maybe wanting to intervene or give a recommendation, there's more of like, okay, this is why another sort of cool piece is we're not just relying on here's a medication or here's a supplementation. We're also talking about sleep, we're talking about exercise because they have such significant impact on the brain, positive impacts. We're talking about how substances can affect the brain. So I think it just sort of increases your ability to talk about these things that are so important because they directly have an impact on brain function.

And do you see people understanding their own conditions more then because they can see it on the picture?

Yeah, definitely. I. I think people have more of an understanding. People have a desire to understand themselves more. Feel like people also maybe pathologize themselves less. Like maybe they see their OCD in a different way. Maybe it's not just that they're obsessional and, you know, compulsive and that leads to dysfunction. But they're also persistent and strong willed. So there's also positive things that can be gleaned from this.

So I'm thinking about people that might be listening and they might be saying, okay, if I were to go in and get a picture of my brain, like, first of all, what would Be a reason to do that. And then second of all, like, what kind of information can people expect to get by doing that?

I think before even, you know, getting your brain scan, do a consultation with us. Not everyone needs a brain scan. So have a discussion. What are the pros, what are the cons? If you've gone through like many, many treatments and you're still struggling, potentially this could be helpful. So what are the limitations of a scan? So this is a functional imaging modality. So meaning we're looking at blood flow. So you know, you're looking to figure out whether you have, and this is a, maybe a terrible analogy, like looking to see if you have like a certain tumor or cancer. We're not gonna be able to pick that up with a scan. If you are trying to diagnose a specific infection, we're not going to be able to pick that up. We may say, okay, your brain has decreased activity, which being related to infections. But where we can be helpful is really helping people who've been struggling with depression, anxiety, ptsd, maybe they had a brain injury and they've gone to, you know, see a variety of people and they're just not getting better. I think the first step would be consultation first and then maybe go from there.

Yeah. And then can you give some examples of. Like you mentioned that the Stanford study was looking at how to differentiate different types of depression. So what kind of information do people, I mean, I know that's a very broad question and it's very individual, but can you give a few examples of what kind of information people might come

away with, you know, without trying to go into too much sort of high level detail? But I think sometimes getting into the, the nomenclature is exciting. And yeah, we can go, let's talk about like. So we look at the brain and we try to understand the brain from a system standpoint. Right. So like you said, we have symptoms, but where are the symptoms coming from? Where are they emanating from? So we look at several structures. We look at the prefrontal cortex.

Right.

So that's involved in decision making. It's like the CEO of our brain. We look at the limbic brain or the deep limbic system or the thalamus. So when, when that's active, people can be more prone to depression. We look at the basal ganglia. When that's active, you can see a little bit more anxiety and then another part. And I'll, I'll stop after this. But we look at the cingulate cortex. And when that's really active, people can really get stuck on thoughts. So understanding how those structures are at play and how there's interplay, then you can intervene more, maybe more effectively. So.

So you might see some areas overactive or underactive or interacting with each other well. Or not so much at all.

Exactly. So, yeah. So you may see under activity in the focused part of your brain and then overactivity and anxious part of your brain. So that can lead to different presentations.

Yeah, that definitely sounds like it can. We had a nutritionist from your clinics on the pod a few months ago. And so I know that nutrition is a piece of your treatment, but can you talk about. I know you said medications are also a piece of your treatment. I know it would look different for everybody again, but what's just an example of maybe some areas that treatment might look like for people after they get a scan and sit down with someone and have it evaluated? What can they expect then?

I believe that this should always be collaborative. It's very easy for me to come in with my agenda and say, this is what you need. But I think it's important to understand where a person is on a motivational level. If I sort of say, you need to go exercise and they have no desire or no will to exercise, that recommendation is kind of just a very basic recommendation. So I think meeting people where they are, we try to, like, if someone wants to, we'd love to work with people on the sleep level, on the nutrition level, on the physical activity level. Understanding how EMDR could be effective, trauma therapy could be effective. So really kind of multimodal, but really working with that individual who comes in and seeing how we can effectively help them.

Yeah, I love that. I'm curious, in an ideal world, right. Where do you see mental health treatment going? Like, what would your sort of. If you could have a magic wand, what would mental health treatment look like in our country?

I think more access. So everyone having access. And I think effective access, access that can resonate with the community of people. You know, I may not be the right fit for everyone. So who may be that fit? I do believe in using technology to help disrupt this and help this. I believe in using generative AI. It'd be great use AI have coaches sort of thinking ahead, but coaches to sort of intervene with people 24, seven. Right. A lot of our work is asynchronous. Meaning, like, much of the stress doesn't go on during the time of the appointment. A lot of the stress occurs in between appointments. So how can we asynchronously connect with People. So AI coaches. Yeah, this is like next gen, but like clones of a therapist like yourself who can, like, speak your language, who can then help more people, and then you can supervise, you know, so that's. That's really kind of like out there. But I. I would love.

Oh, and what if they say something I wouldn't agree with?

Right, right. There's risk there for sure.

Yeah.

I think in an optimal world, like where we could sort of have more of the effective people who are delivering care and ensure. Deliver good care so that they're going to help more people. So that's where I would use the tech piece. I think as a society, I would love for us to slow down. The country's really stressed. The country's really divided. So there, There are other facets there that I think seep in, but there's a lot that needs to be done. What about you? What do you. What do you think?

I know, I. I mean, I've started this podcast to try to get ideas. Right. And so I've been listening to lots of different people. But I think. I think one of the things that I see is that we need some ways. I'm not sure about AI, but kind of along the same lines of what you were saying. We need ways to do more group work or to have sort of like stages, almost be able to triage people where they start maybe in a group, and then the more distressed people might go to a different group, and then we might have individual after that. There might be a way to reach more people from a group. Yeah, Groups are complicated for lots of logistic ways and reimbursement ways and all of that. So that's a whole other. Whole other thing. Also, something very interesting that I'm interested in is the idea of checkups, like prevention, some kind of mental health checkup, like you get physical health checkup, and that could be a way to catch things earlier, I imagine. You see what I see that a lot of times by the time people come into therapy, they are pretty severe in terms of their symptoms, or if they're coming in for relational issues, that relationship is like on its last leg. Right. And then they come in and they want to try to rehabilitate that. And it's difficult at those levels, and treatment's longer. Right. So I do think, also looking on that prevention side, what could we do for someone to catch something that's a start of depression, but it's not severe at all. And after maybe just a couple sessions, they're feeling better.

That's awesome. Yeah, because once you're in like that hole, it's really, really hard to, to dig yourself out. You know that exercise is good for you, you know that nutrition is probably good for you. You know, maybe there's a med out there, but actually feeling better is. And it's. If you intervene earlier, for sure. So like brain checkups, kind of like that, like.

Yeah, exactly. You could do a scan of everybody once a year. I don't know if you need to do it that often. Right. That could be. I know that might be expensive, but you know what, that leads me to a question. What are the barriers for this? I've known about Dr. Amen for a long time and I've always wondered why is this not more widely used? Why is this not standard of care?

So I think the emphasis in I'll speak to just kind of psychiatry. Right. Your training is very much DSM focused. Yeah, DSM is mine too. That lists out these symptoms that are very easy to identify with. But like you said, they, they like look at symptom clusters and then from there it sort of tells you, okay, if you meet this criteria, you have this condition. If you have this condition, here's the treatment. And Big Pharma, which helps us sometimes do prescribe medications, not against medications, loves this methodology because it says, okay, you have depression, here's the drug for your depression. Right, you have adhd, here's the drug for your ADHD psychosis, we have a drug for that. So then you're sort of indoctrinated in this sort of phenomenology and it helps, you know, a select number of people, some people, many people don't get better with this sort of approach. So as a result, you know, if you're using that one approach and not really entertaining other approaches, you're going to essentially be blind to sort of realizing that there's actually an organ there that could be that presentation. So I think that's part of the issue is that early on you're not realizing that the brain is involved. You're never taught about these structures or. And if you are, it's maybe for an hour, one hour, over the course of five years of training. It's like crazy. It's mind boggling. I think cost is a barrier.

I figured that one covered by insurance.

Yeah, if we can get this covered by insurance, I think that will make major difference.

Oh yeah.

And so more research is going to be needed. Beyond us just doing this, other people doing this, I think that's going to help. So with the Work that's come out of Stanford. It's. It's sort of exciting to see that people are kind of realizing that the brain is involved. But yeah, I think those are a couple barriers to sort of getting the brain scan.

So what are you passionate about going forward? What are you wanting to invest in? What do you have any specific things you really like to spend your time treating or researching?

Yeah, I mean, I bring up AI and I'm. I promise you, I'm not like the most technically savvy person. Like, I'm not someone who. Not engineering mind by any means, but I do like how if we can use leverage AI to reduce cognitive load, we can really as the human work on the human connection piece. That's what I would love to see.

Interesting.

You know, we have to make sure that what it feeds us is, you know, there are no what we call hallucinations. And it's not just plausible, but actually helpful. But yeah, to really reduce cognitive load to then be able to connect with their clients, really sort of get a feel for what they need. I mean, I think there is a part of what we do where there's a science, but there's almost this art too. 100% for me, like in any encounter, therapeutic alliance is the number one thing. Well, if someone's. Their thyroid's off, my therapeutic alliance is going to be different. But that's a foundational piece, right?

Yeah.

So yeah, I'm kind of excited about the opportunity with AI. I think decreasing stigma, intervening early is another thing that I'm excited about.

All right. I like it. And being smart about AI and ethical about AI. Right. It's interesting that you, because you mentioned AI in order to reduce cognitive load so that more time can be spent on human connection. Right. That's interesting to me because AI potentially could also take away some of that human connection. Right. How we use it seems very powerful.

How we use it is essential in a post Covid world where isolation is. We're in that sort of crisis.

Right.

Yeah.

As we are wrapping up, I would love to ask you if there's anything that you would like to share with our listeners. Maybe some tips for their brains, maybe some big ideas about new things or trying something new. What would you most want people take away from this?

There's so much. Right. I think one big take home could be, since, you know, we look at the brain, is that your brain is involved in everything you do. When you're making decisions, think about those decisions with your brain in mind.

Hmm.

For instance, your thoughts, how you think can affect how your brain feels. And if you think negative thoughts, that can strengthen kind of negative parts of the brain. If you think positive thoughts, that can calm down certain areas in the brain. So how we think matters. It can be challenging to think positively though, when we're suffering to seek help if it's just insurmountable. Internalizing less and just being more open and more vulnerable. I think really to think about our decisions with our brain in mind.

I love that thinking about what our brain needs almost as we're going through our days. Well, Dr. Sood, it was such a pleasure to have you today. Thank you for bearing with my scratchy voice. And if people want to contact Dr. Suit or find out more about the work he does, it'll all be in the show notes. It was just great to have a conversation with you.

Awesome. Thank you so much. Rachel.