CHAPTER 11: M IS FOR MIND STORMS: SOOTHING THE ABNORMAL ELECTRICAL ACTIVITY THAT DRIVES MOOD SWINGS, ANXIETY, AND AGGRESSION

There was always one instant just before the epileptic fit . . . when suddenly in the midst of sadness, spiritual darkness and oppression, his brain seemed momentarily to catch fire, and in an extraordinary rush, all his vital forces were at their highest tension. The sense of life, the consciousness of self, were multiplied almost ten times at these moments which lasted no longer than a flash of lightning. His mind and his heart were flooded with extraordinary light; all his uneasiness, all his doubts, all his anxieties were relieved at once; they were all resolved in a lofty calm, full of serene, harmonious joy and hope, full of reason and ultimate meaning. But these moments, these flashes, were only a premonition of that final second (it was never more than a second) with which the fit began.

FYODOR DOSTOEVSKY (WHO SUFFERED WITH TEMPORAL LOBE EPILEPSY), THE IDIOT

I walked into my California clinic one day, and my office manager quickly pulled me aside and said, “Daniel, you have to see Tommy.” I let her know that I already had 14 people on my schedule. But she just dismissed me and said, “Daniel, you need to see Tommy. He’s really cute. He’s nine years old. He’s from Orlando, Florida. And he’s read your book Change Your Brain, Change Your Life.” Okay, a nine-year-old who read my book? Now I was paying attention.

I found Tommy in one of the other doctor’s offices, and when the young boy saw me, he yelled, “Hey, you’re Dr. Amen!” What he said next absolutely floored me. “Dr. Amen, I have a left temporal lobe problem.”

“Really?” I asked. “How do you know?”

He said he had taken the checklist in the book. “I have a really bad temper, and you write that people who have bad tempers often have temporal lobe problems.” He was right. Then he added, “And I used to see ghosts.” I asked him what he meant, and he said, “I used to see these green things float in front of my eyes. I thought they were ghosts, and they would scare me until I read your book and realized they were just illusions that people with temporal lobe problems get.” Then he looked at me with his big, beautiful blue eyes and said, “Last year, to get rid of the bad thoughts in my head, I tried to kill myself.”

The thought of this sweet young boy trying to kill himself because he thought he was seeing monsters broke my heart. But he was right. People who have temporal lobe problems do tend to have dark, evil, awful thoughts; I think of them as mind storms. And sadly, they often try to kill themselves. Tommy completely blew me away. I asked him if he had seen his scan yet, and he said no.

“Want to?” I asked.

“Oh, yeah!” he replied.

So I took him and his parents to the imaging center, and when I showed him his scan, it was very clear that he had a left temporal lobe abnormality.

Tommy’s Surface SPECT Scan

TOMMY’S SURFACE SPECT SCAN

Decreased activity left temporal lobe

“See, I was right,” he said. A nine-year-old had accurately predicted what his own brain scan would look like. When he was able to confirm that his mind storms were actually just temporal lobe problems, it gave him hope that we could help him get rid of those bad illusions. That’s where the power is in this —you can figure out your brain health/mental health issues even without being scanned. In my mind, that’s so exciting and powerful, leading to what’s most important —you getting well.

TIM AND WENDY

Since 51 percent of the population will have a mental health issue at some point in life,[438] I often say during lectures that “normal” is a myth. It is more normal to have an issue than to not have an issue. “Normal” is a setting on your dryer or a city in Illinois. I once gave a lecture in Normal, Illinois. It was fun to go to the Normal grocery store, be interviewed on the Normal radio station, and finally meet Normal people. Since I’m from California, that was a treat. Yet I found the Normal people there actually had the same problems I had seen everywhere else. At the lecture, I met a psychologist, Wendy, who told me her husband, Tim, was really struggling. He had been arrested for domestic violence, and Wendy was on the verge of divorcing him, which was breaking her heart. She loved him and knew something was the matter with his brain, even though her own therapist said he had a personality disorder and she should leave as soon as possible. So Wendy and Tim flew to California to see me.

Tim was 54 years old and told me he struggled with memory problems, depression, and irritability. He also frequently saw shadows out of the corner of his eyes and heard an annoying buzzing sound, for which his doctor could not find a cause. His temper flare-ups just seemed to come out of the blue. “The littlest things set me off. Then I feel terribly guilty,” he said, crying. “If she leaves me, I don’t know what I will do, even though I understand why everyone tells her she should go. Please help me stop these rage attacks.”

When Tim was six years old, he fell out of a second-story window. He didn’t remember if he lost consciousness, and his parents were no longer alive to ask. As a child, he had learning problems and had gone to the principal’s office a lot for fighting. He had tried antidepressant medications, psychotherapy, and couples counseling, but they didn’t help. His brain SPECT study showed significantly low activity in his prefrontal cortex (PFC) and left temporal lobe. Low PFC activity often is associated with poor forethought and impulse control. Abnormal activity in the temporal lobes, especially the left side, is associated with mood instability, irritability, learning and memory problems, illusions (such as seeing shadows and hearing buzzing), and rage for little to no reason. It can cause storms of activity in the brain that hijack the mind.

As a young psychiatrist, I was inspired by the story of the late Jack Dreyfus, the financier who founded the successful Dreyfus Fund. In his 1981 book, A Remarkable Medicine Has Been Overlooked, he told the story of how, despite his fame and fortune, he awakened in terror and fell into a deep depression that conventional treatments didn’t help. He sensed electricity in his body that intensified his feelings of fear, anger, and anxiety, and it reminded him of epileptics he had seen. He asked his doctor if he could try the anti-seizure medication phenytoin (Dilantin), and within a day of taking it, his symptoms of emotional distress began to dissipate. In his book, he wrote, “A few days later my need for psychotherapy was gone.”[439] Dreyfus went on to spend $60 million of his own money to study the usefulness of Dilantin for a variety of “mental health” conditions, such as anxiety, violence, and mood swings.

When I first learned about brain SPECT in 1991, one of its primary uses was in evaluating seizure disorders. When patients were having seizures, there was increased activity on SPECT; in between seizures, there was decreased activity. Neurosurgeons often used SPECT to know where to operate on patients with uncontrollable seizures. I thought of Jack’s story while working with Wendy and Tim.

On the anti-seizure medication lamotrigine (Lamictal) to stabilize Tim’s left temporal lobe, then a stimulant to activate his PFC, along with neurofeedback and our other BRIGHT MINDS strategies, Tim’s rage attacks stopped, his memory improved, and his relationship with Wendy became the best it had been in 20 years. Wendy later told me that our work together completely changed how she worked with her own clients.

Tim’s Surface SPECT Scan

TIM’S SURFACE SPECT SCAN

Decreased PFC and left temporal lobe activity (arrow)

THE WORLD’S MOST POWERFUL HYBRID ELECTROCHEMICAL ENGINE

Your brain is the world’s most powerful hybrid electrochemical engine. It uses electricity and neurotransmitters to help you think, feel, and act. Electricity (the flow of charged ions) is constantly moving throughout your body, causing your heart to beat and your muscles to contract. Yet nowhere is electricity better documented than in the roughly 100 billion biological wires (neurons) in your brain.

A neuron’s main job is to generate an electrical signal called an action potential, which occurs if it is sufficiently “excited” by other nerve cells. The action potential of a single neuron is like a tiny lightning bolt —this is part of the reason why neuroscientists talk about neurons “firing” when they’re active —and it may stimulate many other neurons. The stimulated neurons can then generate their own action potentials, which travel to and stimulate still more neurons, creating a coordinated network that performs a specific brain function.

Action potentials race down axons at about 60 miles per hour. The signals can travel this quickly because, as the human brain develops from childhood to adulthood, axons are wrapped and insulated by a special fatty substance called myelin that enhances transmission speeds. Axons that are not insulated by myelin, either by design or disease, transmit signals 10 times slower.

Action Potential

ACTION POTENTIAL

A neuron’s main job is to generate an electrical signal called an action potential, which occurs if it is sufficiently “excited” by other nerve cells.

The Actors in Your Brain

An axon branches thousands of times, with each branch forming an electrical or chemical contact, called a synapse, to another neuron. The synaptic space is the tiny area between connecting neurons. At the end of each of the axon’s many branches is a mushroom-shaped terminal, which contains molecules called neurotransmitters. Neurotransmitters can excite or quiet (inhibit) other neurons. Each neuron makes a single type of neurotransmitter, such as glutamate, gamma-aminobutyric acid (GABA), dopamine, norepinephrine, serotonin, acetylcholine, or histamine. The primary excitatory neurotransmitter, glutamate, is released by 75 percent of all neurons in the brain, and the primary inhibitory neurotransmitter, GABA, is released by about 20 percent of all neurons in the brain. When the action potential reaches the end of the axon, it stimulates the release of thousands of neurotransmitter molecules into the synaptic space. The neurotransmitters float across this space, and some of them will bind to receptors on the receiving ends of neurons and may stimulate or inhibit action in the receiving neurons.

All of this electrical activity is taking place inside your skull on a millisecond-by-millisecond basis. And it needs to occur precisely for optimal brain functioning and good mental health.

HOW DISEASES IMPAIR BRAIN FUNCTION

Some diseases of the brain start by damaging the brain’s wiring or impairing the ability to create the right amount of electricity. In a sort of Goldilocks scenario, too much electricity or too little electricity can be a problem. It needs to be just right. Brain trouble can occur because of

• Fewer synapses in a network, which is common in depression or a lack of mental or physical exercise
• Fewer neurons in a network, which happens in Alzheimer’s disease
• Impaired generation of action potentials, which can happen if you have three or more alcoholic drinks at a time
• Damage to neurons that slow the speed of action potentials, common in head trauma or strokes
• Excessive electrical activity, seen in seizure disorders

Abnormal electrical activity not only can change the activity of the brain, but can also change the mind and cause mind storms that can be associated with temper outbursts, depression, suicidal thoughts, panic attacks, distractibility, and confusion. As far back as 1907,[440] Emil Kraepelin discussed interictal dysphoric disorder (IDD) —ictal refers to seizure states; interictal means between seizures. He observed depressive symptoms mixed with euphoric moods, irritability, fear, and anxiety as well as with intense fatigue, pain, and insomnia in patients with untreated epilepsy.

Abnormal electrical activity can not only change the activity of the brain, but it can also change your mind and cause mind storms that can be associated with temper outbursts, depression, suicidal thoughts, panic attacks, distractibility, and confusion.

Mind Storms Risk Factors
(and the Four Circles They Represent)

• Seizures or history of seizures

• Periods of spaciness or confusion

• Frequent complaints that things look, sound, taste, smell, or feel “funny”

• Sudden, repeated fear or anger

• Irritability that tends to build, explode, and then recede, often leaving one feeling tired after a rage

• Periods of panic and/or fear for no specific reason

• Visual or auditory changes, such as seeing shadows or hearing muffled sounds

• Frequent periods of déjà vu (feelings of being somewhere you have been before)

• Mild paranoia

• Headaches or abdominal pain of uncertain origin

The tactics of an evil ruler to promote mind storms are simple.

THE EVIL RULER WOULD . . .

Discourage the population from getting brain scans or other diagnostic tests to see if their psychiatric symptoms are being caused by abnormal electrical activity.

THE BENEVOLENT RULER WOULD . . .

Encourage people to get brain scans or other diagnostic tests to determine if abnormal electrical activity may be at the root of symptoms of mental illness.

PRESCRIPTIONS FOR REDUCING YOUR MIND STORMS RISK FACTORS
(AND THE FOUR CIRCLES THEY REPRESENT)

The Strategies

1. 1. Care about how your brain cells fire and talk to each other.

1. 2. Avoid anything that increases mind storms. Are there lifestyle or food choices that make seizures or mind storms more likely? Yes, there are many, including:
   • Stress
   • Tiredness
   • Lack of sleep
   • Forgetting medications
   • Hyperventilating
   • Alcohol and drug abuse
   • Low or high blood sugar states
   • Missing meals
   • Premenstrual syndrome (PMS)
   • Illnesses
   • Pain
   • Video games for vulnerable brains
   • Excessive screen time
   • Unrecognized Irlen syndrome (see page 167 in chapter 9, “H Is for Head Trauma”)

1. 3. Be aware of the triggering effect of certain foods, food colors, and food preservatives —especially sugar, MSG, aspartame, and Red Dye #40 —on mind storms (social because your family and friends influence what you eat). For example, one of my patients became violent whenever he ate foods prepared with monosodium glutamate (MSG). When we scanned his brain after ingesting MSG, we saw that his brain had changed into a pattern more consistent with our aggressive patients. This is important: MSG doesn’t have to be labeled unless it is a single food additive. It can be disguised by being added in with other ingredients and not disclosed. It is commonly hidden in bouillon, soy protein isolate, vegetable protein isolate, and whey protein isolate. Note that anytime the words yeast extract appear, it is actually MSG.

   When Trey was seven years old, his parents noticed that whenever he ate something bright red or drank a red Slurpee, he had various tics and strange neurological affectations, and his behavior became more aggressive and hostile. He would cry easily and storm off in a huff or throw things. His mother tried to minimize these foods in his diet, but he would often get them at school: Cheetos, Doritos, fruit punch, Red Vines, lollipops, and so on. What she didn’t realize was that many of the “healthy” foods she was serving him at home —strawberry yogurt, whole-grain strawberry bars, and even canned pasta sauce and ketchup —contained an ingredient common to those other snack foods: a dye called Red #40.

   When Trey reached the age of 14, his folks brought him to the Amen Clinics to confirm their suspicion that he was reacting to this food additive. His brain SPECT scan showed remarkable overall increased activity (mind storms) with exposure to Red Dye #40. After seeing the impact this common food coloring had on their son, Trey’s parents became vigilant about reading every nutrition label closely and stayed away from the offending item. By staying away from Red Dye #40, Trey stabilized his moods and behaviors and became a kind, sweet, helpful young man.

   Trey’s Baseline Active SPECT

   TREY’S BASELINE ACTIVE SPECT

   

   Mild increased activity

   Red Dye #40 Active SPECT

   RED DYE #40 ACTIVE SPECT

   

   Dramatic increased activity with Red Dye #40

1. 4. Be cautious with video games and flashing lights. If you have a vulnerable brain, avoid flashing lights and excessive video game playing. I’ve had a number of patients who have had seizures while playing video games even though they did not have prior seizures, and others who became violent or highly emotional from video game play. It is a phenomenon called photophobic seizures, which happened to 685 children in Japan on December 16, 1997, while they were watching a Pokémon animated series.[441]

   In the show, the animators used a rare rapid strobing technique that flashed red and blue lights to make an explosion look especially cool. Suddenly, children across Japan passed out, had blurred vision, felt dizzy or nauseous, had seizures, or experienced temporary blindness. The incident, which became known in Japan as Pokémon Shock, was a disaster for children’s animation in Japan, and Pokémon and Nintendo stocks took a hit.[442]

   Other patients of mine have become violent after playing video games. Granted, these cases may be extreme, but I cannot see much good that comes from playing these games for hours a day, and I believe they have the potential for harm. My best advice at this point is be careful and limit screen time and video game exposure to no more than one hour a day.

2. 5. Engage in behaviors that decrease mind storms.
   
   • Spend time in prayer or meditation every day. I mentioned this in chapter 5 to help improve blood flow; these practices also help manage stress.
   
   • Take antiseizure medications: At Amen Clinics, we use antiseizure medications, when appropriate, to calm the mind storms of our patients. We tend to use
     • Lamotrigine and valproic acid for bipolar disorder
     • Lamotrigine for resistant depression
     • Gabapentin for social anxiety, irritability, insomnia, and pain
     • Pregabalin for pain
     • Oxcarbazepine for irritability and moodiness
     • Topiramate for binge eating disorders and migraines

     It’s also important to note that prescribing treatment and medications in the right order is critical for healing. For example, for some people with mind storms, we start with antiseizure medications, then recommend a ketogenic diet (see below), then proceed with other therapies. Doing it the other way around may not have been as effective.

   
   • The ketogenic diet: This diet has been used in treatment-resistant epilepsy since the 1920s. It cuts seizure frequency in children by more than 50 percent.[443] There are a number of studies showing it may also be helpful for mood stabilization.[444] One of my patients who had a severe case of premenstrual dysphoric disorder (PMDD) noticed her moods were significantly better on the diet. Right before her period, her brain showed severe overactivity, which lessened considerably on the diet.

     The ketogenic diet can be challenging to maintain, but when it works it can be powerfully effective. The main idea is for you to get more calories from protein and fat and significantly less from carbohydrates. You cut back on carbohydrates that are easy to digest, like sugar, soda, pastries, and white bread —you should do this anyway. When you eat less than 50 grams of carbohydrates a day, your body runs out of blood sugars and eventually (usually after three to four days) starts to break down protein and fat for energy. This is called ketosis. People use this diet most often to lose weight because it takes more calories to convert fat into energy than it does to convert carbohydrates, and it helps you feel fuller longer, but it has also been shown to help seizures, diabetes,[445] acne,[446] and even some forms of cancer.[447]

   
   • Neurofeedback: Neurofeedback can help calm electrical activity in the brain by training you to gain control of your brain waves through self-regulation. See chapter 9 “H Is for Head Trauma” for details.

1. 6. Get seven to eight hours of sleep each night (social because your work, family, or friends may influence how late you stay up or get up). See chapter 15, “S Is for Sleep.”

1. 7. Take nutraceuticals that help calm or control the excitability of the brain. Work with your physician to determine which one is best for you and the right dose.
   • Magnesium has a calming effect on neuronal function, is involved in more than 300 biochemical reactions in your body, is vital for your body to make energy, and plays a key role in blood sugar regulation. Low magnesium is associated with seizures, inflammation, diabetes, anxiety, and depression.[448] With the standard American diet, 68 percent of Americans do not consume enough magnesium. Some researchers believe that supplementing magnesium can decrease seizure frequency,[449] and others have shown it is helpful for severe stress,[450] migraines, depression, chronic pain, anxiety, and strokes.[451] The mineral is found in green leafy vegetables, such as spinach, kale, and Swiss chard; legumes; nuts; and seeds. In general, foods that contain dietary fiber provide magnesium.

     Dose suggestion: The typical adult dose is 50–400 mg a day.

   • GABA (gamma-aminobutyric acid) is an amino acid that helps to regulate brain excitability and calms overfiring in the brain. GABA and GABA enhancers, such as the anticonvulsant gabapentin and L-theanine (found in green tea), function to inhibit the excessive firing of neurons, which results in a feeling of calmness and more self-control. Low levels of GABA have been found in many mental health disorders, including anxiety and some forms of depression. Rather than overeating or drinking or using drugs to calm your anxiety, natural ways to boost GABA may help. I often recommend GABA supplements. Researchers report that GABA does not cross the blood brain barrier (a network of blood vessels that protect the brain), but the studies are contradictory,[452] with some showing an increase in alpha brain waves (which indicate a relaxed state).[453] Nonetheless, GABA still has a calming influence on the brain imaging studies we have done.

     Dose suggestion: The typical recommended dosage ranges from 100 to 1,500 mg daily for adults and from 50 to 750 mg daily for children. For best effect, GABA should be taken in two or three doses a day.

BRIGHT MINDS: MIND STORMS

STEPS TO CREATE MENTAL ILLNESS . . . AND MAKE MY NIECES, ALIZÉ AND AMELIE, SUFFER

1. 1. Don’t care about how your brain cells fire with one another.
2. 2. Engage in habits that increase your risk for mind storms.
   • Live a stress-filled life.
   • Skimp on sleep.
   • Abuse drugs and alcohol.
   • Consume a diet high in sugar and skip meals.
   • Eat foods containing Red Dye #40, MSG, and other food additives
   • Don’t address premenstrual syndrome (PMS) or chronic pain.
   • Play video games for hours on end.
   • Use fluorescent lights
3. 3. Avoid the strategies that decrease your risk for mind storms.

STEPS TO END MENTAL ILLNESS . . . AND KEEP MY NIECES, ALIZÉ AND AMELIE, HEALTHY

1. 1. Care about the electrical activity in your brain.
2. 2. Avoid anything that increases your risk for mind storms.
3. 3. Engage regularly in healthy habits that decrease the risk for mind storms and treat them when necessary.
   • Practice stress-management techniques.
   • Get seven to eight hours of sleep each night.
   • Eliminate drugs and limit alcohol.
   • Consider a ketogenic diet.
   • Seek treatment for PMS or chronic pain conditions.
   • Limit video games.
   • Consider neurofeedback and nutraceuticals to calm overfiring in the brain.
   • Take antiseizure medication, if necessary.

Pick One BRIGHT MINDS Mind Storms Tiny Habit to Start Today

---

1. When I feel stressed, I will use stress relief techniques like deep breathing and meditation to calm these feelings.
2. When I go shopping, I will avoid foods with a lot of sugar as well as those with dyes and preservatives.
3. When I play video games, I will limit it to one hour per day.
4. When it gets close to bedtime, I will follow a sleep routine to help me fall asleep faster.
5. When I eat, I will consider adopting a ketogenic diet.

---

[438] Ronald C. Kessler et al., “Prevalence, Severity, and Comorbidity of 12-Month DSM-IV Disorders in the National Comorbidity Survey Replication,” Archives of General Psychiatry 62, no. 6 (June 2005): 617–27.

[439] Jack Dreyfus, A Remarkable Medicine Has Been Overlooked (New York: Dreyfus Medical Foundation, 1992).

[440] Emil Kraepelin and A. Ross Diefendorf, Clinical Psychiatry (New York: Macmillan, 1907; Delmar, NY: Scholars’ Facsimiles and Reprints, 1981).

[441] Luke Plunkett, “The Banned Pokémon Episode That Gave Children Seizures,” Kotaku, October 20, 2015, https://kotaku.com/the-banned-pokemon-episode-that-gave-children-seizures-5757570.

[442] Ibid.

[443] Kirsty Martin et al., “Ketogenic Diet and Other Dietary Treatments for Epilepsy,” Cochrane Database of Systematic Reviews, no. 2 (February 9, 2016): CD001903.

[444] Emmanuelle C. Bostock, Kenneth C. Kirby, and Bruce V. Taylor, “The Current Status of the Ketogenic Diet in Psychiatry,” Frontiers in Psychiatry 8 (March 20, 2017): 43.

Elisa Brietzke et al., “Ketogenic Diet as a Metabolic Therapy for Mood Disorders: Evidence and Developments,” Neuroscience and Biobehavioral Reviews 94 (November 2018): 11–16.

James R. Phelps, Susan V. Siemers, and Rif S. El-Mallakh, “The Ketogenic Diet for Type II Bipolar Disorder,” Neurocase 19, no. 5 (2013): 423–26.

[445] Laura R. Saslow et al., “An Online Intervention Comparing a Very Low-Carbohydrate Ketogenic Diet and Lifestyle Recommendations versus a Plate Method Diet in Overweight Individuals with Type 2 Diabetes: A Randomized Controlled Trial,” Journal of Medical Internet Research 19, no. 2 (February 13, 2017): e36.

[446] Antonio Paoli et al., “Nutrition and Acne: Therapeutic Potential of Ketogenic Diets,” Skin Pharmacology and Physiology 25, no. 3 (2012): 111–17.

[447] Daniela D. Weber, Sepideh Aminzadeh-Gohari, and Barbara Kofler, “Ketogenic Diet in Cancer Therapy,” Aging 10, no. 2 (February 11, 2018): 164–65.

[448] Javad Anjom-Shoae et al., “The Association between Dietary Intake of Magnesium and Psychiatric Disorders among Iranian Adults: A Cross-Sectional Study,” British Journal of Nutrition 120, no. 6 (September 2018): 693–702.

[449] Alan W. Yuen and Josemir Sander, “Can Magnesium Supplementation Reduce Seizures in People with Epilepsy? A Hypothesis,” Epilepsy Research 100, nos. 1–2 (June 2012): 152–56.

[450] Etienne Pouteau et al., “Superiority of Magnesium and Vitamin B6 over Magnesium Alone on Severe Stress in Healthy Adults with Low Magnesemia: A Randomized, Single-Blind Clinical Trial,” PLOS One 13, no. 12 (December 18, 2018): e0208454.

[451] Anna E. Kirkland, Gabrielle L. Sarlo, and Kathleen F. Holton, “The Role of Magnesium in Neurological Disorders,” Nutrients 10, no. 6 (June 6, 2018): e730.

Emily K. Tarleton et al., “Role of Magnesium Supplementation in the Treatment of Depression: A Randomized Clinical Trial,” PLOS One 12, no. 6 (June 27, 2017): e0180067.

[452] Evert Boonstra et al., “Neurotransmitters as Food Supplements: The Effects of GABA on Brain and Behavior,” Frontiers in Psychology 6 (2015): 1520.

[453] A. M. Abdou et al., “Relaxation and Immunity Enhancement Effects of Gamma-aminobutyric Acid (GABA) Administration in Humans,” BioFactors 26, no. 3 (2006): 201–8.