Appendix A

ANSWERS TO COMMON QUESTIONS ON FINDING MORE HELP

This appendix will answer common questions about seeking more help for resistant mental health issues:

WHEN IS IT TIME TO SEEK PROFESSIONAL HELP?

This is relatively easy to determine. I recommend that people seek professional help when their attitudes, behaviors, feelings, or thoughts interfere with their ability to be successful in the world —whether in their relationships, in their work, or within themselves —and self-help techniques, such as the ones in this book, have not helped them fully alleviate the problem.

WHAT SHOULD I DO WHEN A LOVED ONE IS IN DENIAL ABOUT NEEDING HELP?

Unfortunately, the stigma associated with “psychiatric illness” prevents many people from getting help. People do not want to be seen as crazy, stupid, or defective, and they often don’t seek support until they (or their loved one) can no longer tolerate the pain (on the job, in relationships, or inside themselves).

Here are several suggestions for people who are unaware that they would benefit from help or are unwilling to get the assistance they need:

  1. Try the straightforward approach first (but with a new brain twist). Clearly tell the person what behaviors concern you. Tell him that the problems may be due to underlying brain patterns that can be tuned up. Explain that help may be available —not to cure a defect but rather to optimize how the brain functions. Tell the loved one that you know he is trying to do his best, but unproductive behavior, thoughts, or feelings may be getting in the way of his success. Emphasize access to help, not the person’s defect.
  2. Give the loved one information. Books, videos, and articles on the subjects you are concerned about can be of tremendous help. Many people come to see me because they read a book or article I wrote, or saw a video I produced. Good information can be very persuasive, especially if it is presented in a positive, life-enhancing way.
  3. Plant seeds. When someone remains resistant to help, even after you have been straightforward and given him or her good information, plant seeds (ideas) about getting help and then water them regularly. Drop an idea, article, or other information about the topic from time to time. Be careful not to go overboard. If you talk too much about getting help, people will become resentful and won’t pursue it, just to spite you.
  4. Protect your relationship with the other person. People are more receptive to those they trust than to those who nag and belittle them. I do not let anyone tell me something bad about myself unless I trust him or her. Work on gaining the person’s trust over the long run. It will make him or her more receptive to your suggestions. Do not make getting help the only thing that you talk about. Make sure you are interested in the person’s whole life, not just in potential medical appointments.
  5. Give new hope. Many people with mental health problems have tried to get help and found that it either didn’t work or made them worse. Educate your loved one on new brain technology that helps professionals be more focused and effective in their treatment efforts.
  6. There comes a time when you have to say, “Enough is enough.” If, over time, the other person refuses to get help and his or her behavior has a negative impact on your life, you may have to separate yourself. Staying in a toxic relationship is harmful to your health, and it often enables the other person to remain sick. Actually, I have seen that the threat or act of leaving can motivate a loved one to change, whether the problem area is drinking, drug use, or an underlying condition like attention deficit hyperactivity disorder (ADHD) or bipolar disorder. Threatening to leave is not the first tactic I would take, but after time it may be the best approach.
  7. Realize that you cannot force people into treatment unless they are dangerous to themselves, dangerous to others, or unable to care for themselves. You can do only what you can do. Fortunately, today there is a lot more we can do than even 10 years ago.

HOW DO I FIND A COMPETENT PROFESSIONAL?

At Amen Clinics we get many e-mails, social media posts, and calls each week from people all over the world who are looking for competent professionals in their area whose mind-set is similar to mine and who utilize the principles outlined in this book. Because some of these principles are still on the edge of what is new in brain science, such professionals may be hard to locate. Still, finding the right person for evaluation and treatment is critical to the healing process. Choosing the wrong one can make things worse. There are a number of steps you can take to find the best person to assist you:

  1. Get the best person you can find. Trying to save money up front may cost you a lot in the long run. The right help not only is cost-effective but saves unnecessary pain and suffering. Don’t rely on a physician or therapist solely because he or she is on your managed care plan. That person may or may not be a good fit for you, and you shouldn’t settle for someone who isn’t a good fit. If he or she is on your insurance plan, that’s great. Just don’t let that be the primary criterion if you can help it.
  2. Use a specialist. Brain science is expanding at a rapid pace. Specialists keep up with the latest developments in their fields, while generalists (family physicians) have to try to keep up with everything. If I had a heart arrhythmia, I would see a cardiologist rather than a general internist. I want to be treated by someone who has seen hundreds or even thousands of cases like mine.
  3. Get information about referrals from people who are highly knowledgeable about your problem. Oftentimes well-meaning generalists give very bad information. I have known many physicians and teachers who make light of diet, supplements, and lifestyle interventions. It may help to seek out a functional or integrative medicine doctor, who has specialized training and likely can refer you to other physicians as needed.
  4. Once you get the names of professionals, check their credentials. State medical boards will have a public record of any legal or ethical trouble.
  5. Set up an interview with the professional to see whether or not you want to work with him or her. Generally, you have to pay for a consultation, but it is worth spending time getting to know the people you will rely on for help. If you sense the fit isn’t good, keep looking.
  6. Read professionals’ writing or go hear them speak. Many professionals write articles or books or speak at meetings or local groups. If you read their writings or hear them speak, you can often get a feel for the kind of people they are and their ability to help you.
  7. Look for a person who treats you with respect, who listens to your questions, and who responds to your needs. Look for a relationship that is collaborative and trusting.

I know it is hard to find a professional who meets all of these criteria and who also has the right training in brain physiology, but it is possible. Be persistent. The right caregiver is essential to healing.

ARE THERE NEW AND INNOVATIVE TREATMENTS THAT CAN HELP ME?

Brain science is evolving quickly, and new treatments are being introduced at a rapid pace. At Amen Clinics we often recommend the following six innovative treatments to help our patients:

Hyperbaric Oxygen Therapy (HBOT): How “Air” Can Boost Healing

Healing cannot take place without healthy oxygen levels. HBOT relies on high-dose oxygen to speed up the healing process and reduce inflammation. Inside an HBOT chamber, where a patient sits or lies down for treatment, the air pressure is 1.3 to 2 times greater than normal. The increased air pressure helps the lungs gather more oxygen, allowing it to get into blood vessels and tissues, where it can increase production of growth factors and stem cells, promoting healing.

Normally, oxygen is carried throughout the body by red blood cells alone. With HBOT, oxygen dissolves into other bodily fluids, such as plasma, cerebral spinal fluid, and lymph and can be carried to regions where circulation is low or damaged. In vascular problems, strokes, and nonhealing wounds, for example, adequate oxygen cannot reach damaged areas and the body’s natural healing ability is ineffective. When extra oxygen is able to reach those areas, it speeds the healing process. Researchers have found that increased oxygen strengthens the ability of white blood cells to kill bacteria, reduces swelling, and allows new blood vessels to grow into damaged tissues. It is a simple, noninvasive, and painless treatment with minimal side effects.

Research also suggests it can be helpful for

In 2011, Paul Harch, MD, and I and other colleagues published a study on 16 soldiers who had experienced blast-induced traumatic brain injuries. We did brain SPECT imaging and neuropsychological testing on the group before and after 40 sessions of HBOT. After treatment, our patients demonstrated significant improvement in their symptoms; full-scale IQ (a term for complete cognitive capacity; up 14.8 points); delayed and working memory scores; tests of impulsivity, mood, and anxiety; and quality of life scores. In addition, their SPECT scans showed remarkable overall improvement in blood flow.

Transcranial Magnetic Stimulation (TMS): An Alternative Way to Heal Mood

A form of “brain stimulation,” TMS is used in the treatment of certain psychiatric and neurological disorders that have not improved with traditional approaches. TMS uses a noninvasive, highly focused, brief magnetic pulse to stimulate activity in the areas of the brain known to affect mood —without the troubling side effects people often experience when they take medication. TMS has been approved by the FDA for the treatment of resistant depression, but there is new evidence that it can enhance memory and potentially help improve a wide range of other brain-related issues, including

Electrical stimulation has been used for healing for centuries, starting more than 2,000 years ago when the Egyptians discovered that certain fish produce electrical impulses that could be used to treat pain and gout. The Greeks and Romans went on to practice these treatments too. Centuries later, in 1745, Altus Kratzstein, a German physician, wrote the first book on electrical therapy, which became the basis for Mary Shelley’s Frankenstein. Toward the end of the 18th century, Italian physician and physicist Luigi Galvani discovered that passing an electrical current through the spine of a frog caused the amphibian’s muscles to contract. He concluded that nerves were not water pipes, as Descartes had thought, but electrical conductors carrying information within the nervous system. Less than 50 years later, Michael Faraday discovered the fundamental principles of electromagnetic induction while attempting to stimulate nerves and the brain. His attempts were unsuccessful, but his advances led to the first successful transcranial magnetic stimulation in 1985. In 1997, TMS was approved for use in Canada, and in 2008 it was cleared by the FDA as a treatment for depression.

In a 2015 study, researchers from the University of São Paulo in Brazil studied the effect of TMS on memory in 34 elderly men and women with mild cognitive impairment (MCI). The scientists divided the participants into two groups. One group received 10 sessions of active TMS to stimulate the left front side of the brain, and the other group received sham (or fake) treatments. Cognitive testing before and after TMS showed the treatment group significantly improved on tests of everyday memory when compared to the sham group. Based on these findings, the researchers suggested that TMS might be effective as a treatment for MCI and “probably a tool to delay deterioration.”[389]

TMS is a targeted treatment, and, unlike medication, it has no systemic side effects (because it doesn’t get into your bloodstream). It is usually well-tolerated. Side effects are generally mild to moderate, and include headaches, scalp discomfort at the site of stimulation, tingling, spasms or twitching of facial muscles, and lightheadedness. These improve shortly after a session and decrease over time with additional sessions. Serious side effects are rare but may include seizures and mania, particularly in people with bipolar disorder. Treatment sessions last about 40 minutes, and you can resume your normal activities immediately afterward. After a full course of treatment, which ranges from 16 to 30 sessions, a high percentage of patients report a significant reduction in symptoms and experience improvement in their quality of life.

Ketamine Infusions: A Solution for Depression and Pain

When nothing else seems to work, I consider giving ketamine infusions.

Sixty-year-old Georgia had been in psychiatric care for decades. She struggled with anxiety and depression and had tried many different treatments, including multiple medications, multiple therapists, TMS, and nutritional supplements. When her depression worsened, she came to see me. She was having serious suicidal thoughts. We agreed she should try ketamine infusions.

Due to its hallucinogenic effects, ketamine has a reputation as a popular and illicit party drug, going by the nickname “Special K.” It dulls pain, and users often feel detached or dissociated from their own bodies. It was first developed in the 1960s as an anesthetic and was given to soldiers during the Vietnam War. The drug has also been used in emergency rooms for curbing suicidal thoughts, making it a potential lifesaver. It’s been put to use as an animal tranquilizer as well.

In 2000, researchers started studying ketamine as a treatment for depression and discovered that it improves mood much faster than traditional antidepressant medications and sometimes works when other drugs have failed. More than 100 studies have shown that ketamine has antidepressant effects.[390] Unlike antidepressants, which work by enhancing neurotransmitters like serotonin and dopamine, ketamine is thought to change the way brain cells talk to each other —similar to a computer reboot or hardware fix. It blocks a type of brain receptor thought to be involved with depression and pain, known as NMDA. Now, in a growing number of clinics, people with depression or pain for whom standard treatments haven’t worked are being helped by a series of four to six infusions.

Georgia didn’t like how she felt after the first treatment. Although ketamine made her feel weird, I encouraged her to go through the six-session course, as nothing else was working. After the second session everything changed. She called me and said she felt happy for the first time in decades. She felt energetic, clearheaded, and sexual. The depression lifted, but she still finished all six sessions and continued with monthly booster infusions. Two years later she remains improved.

Ketamine doesn’t work for everyone, and the science of it is still emerging. But if you feel stuck, and nothing is working for serious depression or pain syndromes, it is worth considering. To learn more about ketamine treatments, visit the Ketamine Advocacy Network at www.ketamineadvocacynetwork.org.

Neurofeedback: Change Your Brain Waves to Get Healthier

Neurofeedback is a specialized form of biofeedback that gives people information about their brain waves, using sophisticated instruments to measure and change brain-wave patterns. More than 1,000 scientific studies show that neurofeedback can help a wide variety of mental health and brain-related conditions, such as

It can also help

Your brain produces a number of brain-wave patterns:

The basic neurofeedback technique uses behavioral reinforcement to help people change their brain-wave state. The more they can concentrate and produce fast beta brain waves, for example, the more rewards they can accrue. With Amen Clinics’ neurofeedback equipment, a child or adult sits in front of a computer monitor with a biofeedback game. If he increases the beta activity or decreases the theta activity, the game continues. The game stops, however, when the player is unable to maintain the desired brain-wave state. People find the activity fun, and we gradually shape their brain-wave pattern to a healthier or more optimal one. This treatment technique is not an overnight cure. You often have to practice this form of biofeedback for 20 to 60 sessions to be able to recreate it on your own. But the results are worth it.

Audiovisual Entrainment (AVE): Better Your Brain with Sound and Light

Imagine sitting in a room at home with goggles and headphones on. Strobe lights flicker through the goggles and pulses come through the headphones, both designed to stimulate your mind. Our minds “think” in states of brain-wave frequency, and changes in frequencies are based on brain activity. When we stimulate the brain audiovisually with light and sound pulses, it begins to mimic or follow the same frequencies. This is called entrainment. In a sense, audiovisual entrainment (AVE) speaks to the mind in its own language —the language of rhythmic frequency —using a special machine that produces light and sound. The science of brain-wave entrainment, which means your brain picks up the rhythm in the environment, is one of the fastest-growing technologies in brain enhancement.

A review of 20 clinical studies concluded that AVE was helpful for people suffering from cognitive functioning deficits, stress, anxiety, PMS, and behavioral problems.[404] It has also been found to improve overall brain activity[405] and help with

AVE can help improve your health on many levels: In studies, students showed an increase in GPA, concentration, and memory; seniors benefited from improved memory, cognition, and balance, which results in fewer falls;[412] and adults benefited from improved academic, corporate, and sports performance. Research publications show AVE efficacy with ADHD, seizure disorders, substance abuse, autistic spectrum disorders, mild traumatic brain injury, posttraumatic stress disorder, and depression.

The idea of using rhythm and frequency to facilitate shifts in our brain is nothing new. From music to sunlight, sound and light have long played a central role in shaping our human consciousness. When we listen to music, certain songs can make us happy, sad, or irritated. Fast beats tend to speed up our brain waves. Slow beats tend to slow down our brain waves. Through the amazing use of AVE, we are able to stimulate the brain with rhythmic pulses of light and sounds at specific frequencies to purposefully guide the brain into different brain-wave patterns. I like AVE because it is so easy to use and cost-efficient, and you can use it in the comfort of your own home, on your own time. If you are looking for a clinically proven, pharmaceutical-free way to improve your life and want to learn more about how AVE can help, go to www.mindalive.com.

Irlen Lenses: Brain-Calming Glasses

When I first heard about Irlen syndrome (also called scotopic sensitivity syndrome), I thought it was nonsense, mostly because I hadn’t learned about it during my training. Sometimes I can be really narrow-minded. But when a friend who had severe, debilitating migraine headaches told me that being diagnosed with and treated for Irlen syndrome completely cured her headaches, I needed to know more.

Helen Irlen, PhD, is a school psychologist. Back in the early 1980s she was working under a federal research grant with college-educated adults who struggled with learning and reading difficulties. At that time she discovered that colored, filtered lenses could reduce stress on the brain and allow it to function better.

Irlen syndrome is a visual processing problem, where certain colors of the light spectrum tend to irritate the brain. It runs in families and is common after traumatic brain injuries. Anyone experiencing symptoms of anxiety, irritability, depression, or decreased concentration should be screened for Irlen syndrome. Common symptoms include

Heather, 42, had been in 10 car accidents when she came to see us for symptoms of ADHD, anxiety, and depression. During her history she told one of our physicians that she had trouble reading and fluorescent lights gave her headaches. Suspecting Irlen syndrome, he sent her for an evaluation.

When Heather was at the evaluation center, I got a call from one of my sisters, who had taken my nephew to be evaluated for Irlen syndrome at the same time. Several weeks earlier we had been together in Las Vegas for my birthday. We were on our way to an arcade on the second floor when halfway up the escalator I noticed my nephew was not next to me. He was still at the bottom of the escalator, having trouble getting on. He had depth-perception issues (common with Irlen syndrome), and rather than just walk onto the escalator like most people, he stood anxiously at the bottom before finally, very carefully, stepping on. He also was having trouble in school and was anxious and irritable. He needed to be evaluated.

I was with a patient when my sister called, so I didn’t answer my phone. But when she called a second and third time, I thought my mother had died, and I answered, “What?”

“Danny,” she said, “you can’t believe what just happened with one of your patients. Heather is here from your clinic, and when she put the Irlen lenses on, the doorknob came out from the door. The bookcase came out from the wall. An overweight man walked by, and she blurted out, ‘Potbelly.’ It was like she saw in 3-D for the first time.”

When we saw Heather two weeks later, she was beaming. With the Irlen lenses, her focus was better, her anxiety was reduced, and her mood had improved. Her prior brain scan had been remarkably overactive, but the Irlen lenses significantly calmed her brain.

HEATHER’S “ACTIVE” BRAIN SPECT BEFORE

Active SPECT scan showing large regions of activity in scattered areas.

Excessive activity in many brain areas

WHILE WEARING IRLEN LENSES

Active SPECT scan showing less activity in all areas.

Overall calming effect

We were all excited about Heather’s progress until a few weeks later when her physician told me she was struggling with depression.

“What happened?” I asked.

“Like Paul Harvey always says,” he replied, “here’s the rest of the story. When Heather was a child, she was a prodigy guitar player. Apparently, she was amazing and gave performances around the area where she lived. But she could never learn to read music because the notes would move and dance on the page. At the age of 12, she took the guitar by its throat and smashed it, and she never played again. Now, 30 years later, she finds out that she has Irlen syndrome and is mourning the loss of what could have been.”

Heather did not need Prozac to deal with the depression. She needed grief therapy, which we gave her. Within a few weeks she was back to feeling great and bought herself a new guitar. To learn more about Irlen syndrome, visit www.irlen.com.