Digital Social Hour - Unlocking Brain Health: The New Psychiatry Revolution | Dr. Steven Storage DSH #685

Starting point is 00:00:00 The old dogma of mental health is, if you have a mental health condition, there's something wrong with you. You come into an office, you say a bunch of symptoms, the psychiatrist tracks those symptoms, does a checklist, you get a diagnosis, and then they give you a medicine that corresponds to that diagnosis, right? Psychiatry shouldn't be practiced that way. Ultimately, mental health conditions are brain health conditions. All right, guys, we got Dr. Stephen Storridge here from Amen Clinics. Had a great brain scan this morning with you. Thanks for having me, man. I'm so glad you came in. Yeah, it'll be exciting to look at your scans later. Yeah, we'll reveal those guys halfway through. But first off, how'd you get into all this? So psychiatry actually was sort of an accident for me. I knew I wanted to get into medical school. I wanted to be a doctor.

Starting point is 00:00:48 I thought I was going to do emergency medicine. For a while, I thought I was going to be a surgeon. And then I had my psychiatry rotation. And I just like connecting with people. I like talking with people. I like getting to know them on that level. And so psychiatry spoke to me for that reason. But then I started off in sort of like traditional psychiatry, you know, the way psychiatry is to me for that reason. But then I started off in sort of like traditional

Starting point is 00:01:05 psychiatry, you know, the way psychiatry is usually practiced and it didn't feel all that fulfilling. So then that's what brought me to Amen Clinics where we have a really radically different approach to mental health. We view mental health disorders as brain health disorders ultimately. Yeah. I like your approach because it seems more preventative rather than a treatment. Yeah, and holistic as well. The old dogma of mental health is if you have a mental health condition, there's something wrong with you, right? And you see that in how diagnoses are given, right?

Starting point is 00:01:39 You come into an office, you say a bunch of symptoms, the psychiatrist tracks those symptoms, does a checklist. And if you meet a certain number of them, you get a diagnosis and then they give you a medicine that corresponds to that diagnosis, right? That works sometimes, but not all the time, right? And psychiatry shouldn't be practiced that way. Ultimately, mental health conditions are brain health conditions. And so what we do at our clinic is we actually look at the brain, right? Go figure. The organ that drives all this stuff. And then you really get down to what's actually going on as opposed to guessing.

Starting point is 00:02:12 Yeah. So do mental health conditions show up on these brain scans? Absolutely. Yeah. So we use the scan as one tool, right? So we're not diagnosing straight off a scan. It's not like I look at a scan and say, hey, you have this, this, and this, right? But you use that scan in the context of someone's history, someone's computerized testing that they do in our clinic, and then you get a really good picture of what's

Starting point is 00:02:33 actually going on. And for example, like ADHD is a huge topic, right? Traditionally, there's like two or three types of ADHD that people recognize. Inattentive ADHD, hyperactive ADHD, or a combo. And what we found in our work is there's actually seven different types of ADHD. And that's why not all people respond to the same treatment. You got to figure out what's actually going on so you can tailor treatment. Yeah. I've only heard of ADHD and ADD. Yep. I haven't heard of the other five. Yeah. So in the past, ADD referred to just like the inattentive type, attention deficit disorder. ADHD was attention deficit hyperactivity disorder. So where people are more hyperactive, impulsive.

Starting point is 00:03:12 Now it's all called ADHD and you specify the subtype, right? So it's like inattentive or hyperactive. But in our work, like I said, we've identified seven different types, which I'm happy to go through. But ultimately, they all require different sorts of treatments. Yeah. And I feel like, cause when I between what as a society we expect kids to do and what they are more prone to succeed at doing. Right. So like, think about it. If you have a child who is creative, spontaneous, thinks outside the box, and you're asking them to just sit in a desk or at a desk for hours and hours and hours, that's not going to be the best fit for every

Starting point is 00:04:05 brain. So in our society, one out of every eight kids meets criteria for ADHD. Wow. Right. One out of eight, which is really, really high. Not all those people continue to have ADHD into adulthood, right? Because many people can grow out of it based on the prefrontal cortex continuing to develop, but it is a real thing. It does cause significant symptoms in some people, but we shouldn't be throwing meds at everyone just, you know, because there's definitely an over-medication problem. Yeah. What did they try to put you on? I don't remember. Ritalin, Adderall? I think Adderall. Yeah. Yeah. Vibans and Adderall. Yeah. Yeah. Yep. That sounds about right. But yeah, one out of eight. Wow. That's higher than I thought, actually. Yeah. No, it's pretty high. And then a lot of people don't even figure out that they have ADHD until later in life, right? Because if, you know, some people coast, right, through elementary school, middle school, high school, they can rely on their intellect to just kind of like push through. And then once you reach a certain threshold, when like there's a lot of demands on your brain, you might start

Starting point is 00:05:10 noticing ADHD symptoms. So there is such a thing as adult ADHD too. But you know, as with anything, you got to be careful with how you diagnose things. Because if you're just going off symptoms, people can get overdiagnosed all the time. Absolutely. Yeah. I didn't know you could grow out of it too. I thought that was something you had for life if you got diagnosed. No, no, many people do grow out of it. There are some people though, who as a kid don't notice that they have ADHD and then as an adult they do, right? So like you can see different patterns depending on the circumstance. Yeah. So that happened with my father. So he got diagnosed with Asperger's at 60, which is super late. So his whole life, he didn't know he had it.

Starting point is 00:05:43 Oh, interesting. Isn't that wild? That is wild. Yeah. How did he, how did he end up getting diagnosed? I think he just went to a, what is it? A therapist that does that diagnosis? I'm not sure. Um, but yeah, so 60 years old, I mean, he was always different, but we just never had a label for it. Does something like autism or Asperger's show up on a brain scan? Yeah, no, it absolutely does. It absolutely does. And there's actually a lot of heritability when you think about ADHD and autism. You know, like heritability refers to how much of a condition is due to genetics versus not genetic factors. And so it goes from zero to one, right? Zero would mean genetics have nothing to do with it at all. One means genetics are the only thing at play. And for ADHD, it's like 0.7 to 0.9.

Starting point is 00:06:26 Whoa. Right. So it's a highly genetic condition. It's not the only factor, but it's a huge factor. And autism's high too. It's high as well. Yeah. Wow. So now I'm really curious to see my results. I've already seen them. So I'm trying not to do it, to spill the beans here until we look together. We're about to reveal them guys. It's my first time seeing them by the way. So it'll be fun. Yeah, no, it will be fun.

Starting point is 00:06:45 Nothing scary, nothing dangerous. Okay, that's good. What's the worst result you've seen and is it fixable at a certain point? Yeah, so that's the beautiful thing. The types of scans that we use are SPECT scans. Stands for a mouthful, single photon emission computed tomography.

Starting point is 00:07:02 The point is what we're looking at is blood flow in the brain. So the pictures that we look at are not of actual we're looking at is blood flow in the brain. So the pictures that we look at are not of actual brain tissue. It's blood flow in the brain. And we care about blood flow because it tells you about activity level. So ultimately, if there are regions in the brain that have really high blood flow, that tells you that that's a high activity region. Low blood flow means low activity. And blood flow is changeable, right? So we have a lot of people who come into the clinic with traumatic brain injuries, for example. We see a lot of former NFL players.

Starting point is 00:07:29 And their scans initially are loaded with what look like holes. They're not literal holes, but they're areas where there's a significant reduction in blood flow. And then they go through a treatment protocol, supplements, hyperbaric oxygen. Sort of depends on the person. Everything's tailored. And repeat scans can look way, way better. and then ultimately we're not treating a scan we're treating the person the person feels significantly better yeah that's very exciting because there's professional athletes that retire like boxers and NFL players and you could see when they get older

Starting point is 00:07:58 their brain really deteriorates absolutely and then with, right? CTE traditionally can only be diagnosed post-mortem with a brain biopsy. Oh, wow. Right? But with a spec scan, you can really get a clue as to what's actually going on and you don't have to go in for a biopsy, which is nice. Interesting. My roommate in college had 12 concussions. 12? Yeah. Oh my gosh. You might need to send him over for a scan. I'll try to find his number. It's been like 10 years, but yeah, he always was in la la land, man. Yeah. Well, hopefully he watches this episode.

Starting point is 00:08:28 Hopefully. And remembers it and comes to the clinic. Well, dude, should we get into this? Yeah, let's do it. Let's do it. Let's get into the results, guys. We'll pull them up shortly. Sounds good. So what we've got up here are example scans, right? So these are not your scans yet. These are examples of a pristine, maximally optimized brain. Okay. And so again, the type of scan we do are spec scans. Spec scans are looking at blood flow. So there's two different types that you're seeing here. The one over on the left-hand side is looking at blood flow to the surface of the brain. So the outside of the brain, that's

Starting point is 00:09:00 like the thinking brain, the cognitive brain. And the way you read it is by the shape not the color Okay, so the colors over on the left don't mean a thing It's all about the shape and what you're looking at are four different angles of that blood flow map Okay, so the one in the top left is looking from below on the right. It's looking at the right side on the left It's looking at the left side and then the bottom right hand corner is Bird's-eye view got it. Okay, and so what we're looking for are things like holes and dents Okay, so those aren't literal if you see a hole or a dent It doesn't mean the person has an actual hole or a dent in their brain a hole corresponds to about a 30%

Starting point is 00:09:40 Reduction in blood flow and activity okay, compared to the surrounding tissue. Got it. So that's the left side. Over on the right side, we're looking at blood flow way deeper in the brain. And you can think of a big picture as the emotional brain scan. So we're visualizing regions that are involved in emotional processing. And the way you read this one is color. It's all about color now.

Starting point is 00:10:03 There's only three colors, blue, red, and white. Blue would correspond to calm baseline activity, the brain doing its thing, doing what it's supposed to do. That's blue. Red would be medium. So think of it as like 5 out of 10, heating up. And white would be really high activity, 10 out of 10. So typically in a brain that's maximally optimized, nothing's going on. You expect mostly blue towards the front and then a bunch of red and white in the back. Okay. And

Starting point is 00:10:31 there's a reason for that. The reason for all the red and white in the back is a part of the brain called the cerebellum in the back of our head. Cerebellum is the coordination center. Ultimately it coordinates everything, movement, speech, thoughts, thoughts emotions it's constantly working and it's jam packed with brain cells got it so these are optimal charts right these are optimal charts these are what we work towards with our patients okay cool so now we'll pull up my results and see how it compares yeah so we'll start with um with the surface view and i'll pull it up side by side and then we can take a look at the deep view afterwards. Cool. All right, let's do it.

Starting point is 00:11:07 All right. So what's going on here? That looks like a face on the left, top left. It does look like a face kind of scrunched up looking at you with a smirk. No. So basically what we're seeing here are some areas of reduced activity. Again, nothing scary, nothing dangerous, but I just want you to focus on three main findings. Okay. The first is at the very top here. Okay. So this part of the brain is right above the eyeballs. It's a part of the brain called the inferior orbital prefrontal cortex. So literally it's located above the eyes. And that part of the brain is the executive center. It's the part of the brain that's responsible for focus, attention, sustaining attention, impulse control. So when you see it go down when the person is trying to concentrate, that is very suggestive of ADHD. Wow.

Starting point is 00:11:59 They were right. So I think they probably were right. And, you know, people think of ADHD as an inability to focus. Like I can never focus. That's not true. That's not what ADHD is. ADHD is a challenge with modulating focus. So people with ADHD can hyper focus better than anyone out there.

Starting point is 00:12:20 Right. So like my younger brother has ADHD. And I remember as a kid when he'd play video games, he could get lost in that world for six hours straight without even feeling hunger. Right. And that is an example of hyper focus. People with ADHD are the people who can go deeper into any topic when they're interested in it. Interesting. And if they're not interested in it, it's a struggle. That's why I sucked at school then. But you're really good at this. I'm good at podcasting. Wow. So that's the prefrontal cortex. The other finding that you've got are reduced activity

Starting point is 00:12:54 here and here. And these are called the temporal lobes. They're located right by the temples. And the temporal lobes are responsible for a couple things. They're responsible for mood regulation. They are responsible for memory. And they are also responsible for social interaction. And so when people have reduced activity there, it can sometimes show up as challenges with mood regulation, challenges with memory, and then maybe some social awkwardness. Interesting. So the top reasons that I tend to see that in people are chronic sleep deprivation, which is why I was asking you about that earlier. Yeah. Head injury. Have you had any big head injuries? Not diagnosed. A soccer goal fell on my head once, but I didn't get it diagnosed. Well, there's some evidence of head injury that

Starting point is 00:13:43 we'll talk about in a second, but head injury can cause the temporal lobes to go down. The other thing that can cause it is chronic stress. And then also, people who are on the autism spectrum disorder are more prone to having reduced activity in the temporal lobes, interestingly. Got it. So with the family history of that, it makes you sort of wonder a little bit. Right. Um, so the other factor that I see here are reductions in the top front and the back. And whenever I see reductions at the top front and the back at the same time, that's really suggestive of head injury.

Starting point is 00:14:18 So I can't date this, right? I can't say, oh yeah, that occurred five years ago, 10 years ago. Yeah. But it is suggestive of what's called like a coup contra coup injury. date this, right? I can't say, oh yeah, that occurred five years ago, 10 years ago, but it is suggestive of what's called like a coup contra coup injury. Um, so maybe the soccer goal falling on your head could be, yeah. Hard to say. Um, so those are the main findings on this game. Otherwise the blood flow pattern looks really good. This looks like a brain that generally belongs to someone who's in good health, right? Nice. Yeah. Okay. So it wasn't the worst. No, not at all. And there's no better or worse than these things, right? It's just figuring out

Starting point is 00:14:48 what are our relative strengths and what are our relative vulnerabilities, right? Ultimately. So that's looking at the outside. Yeah. You want to see the inside now? Yeah, let's see the inside. Okay. So now I have your deep scan pulled up next to the sample. Remember, it's all about color now. And you have two interesting findings on your deep scan. The first is something called a diamond pattern. So if you take a look at this top left corner here, you can notice that there are four little spots that are increased in activity. If you connect those dots, it would look like a

Starting point is 00:15:25 diamond. And so we've done over approximately 250,000 scans. And in that huge database, what we found is that people who have a diamond pattern are far more likely to have experienced some type of past emotional trauma that continues to have a hold on their brain on some level. So I don't know you all that well. I don't know what that would be, right? But that would be the suggestion based on the scan. I can see that. And then within that diamond, the hottest spot by far you can see is right in the middle. It looks like a little golf ball in there. And that structure is known as the thalam Okay. And it looks like a little, a little golf ball in there. And that structure

Starting point is 00:16:05 is known as the thalamus and the thalamus is the emotional gatekeeper to the brain. So when it heats up, the most common association is low mood and depression. So again, I'm meeting you for the first time. I don't know you all that well, but the suggestion would be, you know, could low mood be a part of what you deal with from time to time? Okay. And then the other finding that's really relevant is notice in the back. You know, we talked a lot about the cerebellum and how that's normally the hottest structure in the brain. It's looking pretty cool here.

Starting point is 00:16:39 And there's a reason for that. It turns out that the cerebellum is best friends with the prefrontal cortex. They are literally wired together and they fire together. So if one of them goes down, the other one usually goes down too. Okay. And so we saw already your prefrontal cortex was down a little bit and so is the cerebellum. Got it. Okay. Um, so overall your scans are pretty suggestive of ADHD, some type of past emotional trauma, and only you know what that is. And then some suggestion of potential autism spectrum. Wow. Although I don't diagnose autism spectrum straight off a scan, I would need to get to know someone for a lot longer to make that call. But there are a couple features here that we sometimes see.

Starting point is 00:17:29 Wow, that is interesting. And what is the cerebellum purpose? Because that shut off on me, right? Coordination. So all things coordination, not just physical coordination, but also coordination of our thoughts, right? Keeping our thoughts organized, coordination of our emotions, keeping our emotional response organized. Interesting. Yeah. My thoughts are all over the place. So that would make sense. All right. Yeah. Interesting. Wow. Thanks so much. This is really, really, you know, good to know, I feel like, because now I can try to work on this. Yeah, absolutely. And the cool thing about it is working on it doesn't just mean the medications that they were trying to throw at you when you were 10 years old, right? Working on it can look very holistic, right? There are natural ways of

Starting point is 00:18:10 healing the brain. Some of the best things out there are like high intensity cardio, for example. If someone does 20 minutes of sweat inducing cardio four days a week, that dramatically increases blood flow to the brain and it naturally increases serotonin level, which calms down all that red and white stuff that you're seeing there. And for the cerebellum, a good way of activating the cerebellum would be racket sports. So things like tennis, pickleball, ping pong even, you know, like that's a solid way. I'm going to have to get a ping pong table at the house. I think you will.

Starting point is 00:18:43 Or maybe get a net on the dining room table or something, you know? Wow. Beer pong doesn't count. Yeah. Ping pong. Ping pong will do it. So is the goal not to have any red and white on this skin? Not necessarily. Right. Because there's also strengths that comes with this stuff. Right. So for example, this little spot up here that's red, that's a part of the brain called the anterior cingulate and when it heats up it's also a marker of persistence and strong will right so people who like grind people who can get things done people who can succeed so that's not something you necessarily want to go away got it the basal ganglia are these two and those confer strengths of being like a go-getter, being driven, being type A, like really like trying to get things done again. So similar to the anterior cingulate.

Starting point is 00:19:32 And then the thalamus, when it heats up, people are more prone to being like perceptive, intuitive, deeply feeling, sometimes sensitive, you know, and again, those are strengths, right? Those are strengths. It's just a matter of figuring out which, which findings are serving you, right? And then which findings are holding you back ultimately. Is there anything on here that shows that I'm not in touch with my emotional side? Cause I've gotten that comment before. Yeah. Have you from girls? Yeah. Well, um, I would say that people who fall on the spectrum often notice that about themselves or i should say other people notice it about them yeah so not to jump to conclusions but no it runs in the family what's going on no it runs in the family and a lot of entrepreneurs i notice are on the spectrum totally because because people who are on the spectrum often have a hot anterior cingulate. So they're super driven, super persistent. They find a way to get things done, right? Elon Musk is a great example. And he's out with that. And then also they tend to have ADHD, right? People who have autism spectrum are way more likely to have ADHD. They tend to run together. And so ADHD people, again,

Starting point is 00:20:45 can hyper-focus better than anyone, right? And they can think big picture. They can put together big ideas and come up with game-changing ideas. Yeah. Yeah. There was a negative stigma around autism when I was growing up, but I feel like now it's more embraced. Totally. Yeah, totally. And I think the more we know about the brain, the more we realize, again, that mental health is brain health. Right. So like having autism doesn't mean that someone is fundamentally flawed. Right. It's just a different way of being wired. And who's to say one way is right and one way is wrong. Right. I mean, I think as a society, we need people who are wired in different ways because ultimately that advances us as a society as a whole. Have you ever done any live brain scans for psychedelic therapy? We have seen scans in people who have done psychedelics and the part of the brain that it acts on is in the back right

Starting point is 00:21:41 above the cerebellum. You can see a little bit of activity in yours this is a part of the brain called the default mode network and it's kind of like the brain's third eye right it's the part of the brain that is self-aware self-monitoring it's the part of our brain that tends to light up when we're just daydreaming when we're in our own minds. And psychedelics like psilocybin reduce activity in the default mode network. And so basically what that can do for people with depression or anxiety who are in their heads a lot, and there's a lot of negative content, it can slow that down and provide a bit of a reset. Right. And so this is very much in the early stages, right, of like research. And it's not something that's formally recommended, but that's how it works.

Starting point is 00:22:29 Yeah. That's how it works. What have you seen with people that you know that have taken it, like their results? So you got to be careful with it. It's not for everyone, but I have had patients who have done it on their own who have reported improvements in their depression and their anxiety. But again, you got to talk about it with your doctor to make sure that it's the right fit. Yeah. What's the typical advice you're giving your patients in terms of therapies and treatments? For psychedelics?

Starting point is 00:22:58 Just in brain health? Oh, in general? Yeah, yeah, yeah. So I never assume that the basics are being covered, right? So there's three fundamental pillars to brain health, and those are sleep, screens an hour before bed. So those are just basic sleep hygiene recommendations. For exercise, I tell people get at least 20 minutes of high intensity cardio four days a week as just a basic necessary amount of exercise for your brain. And then for nutrition, it's stuff we all know, right? Like sugar is not good for our brain. Gluten is not good for our brain. Processed food is not good for our brain. And instead focusing on like whole foods, lean proteins, healthy fats, fruits, vegetables, complex carbs. So that's like just fundamental for everyone. And then depending on the person's brain,

Starting point is 00:24:02 we might think about targeted supplements. Sometimes we think about medications if it's necessary, but it's not the first thing I think about. We think about technology-based interventions like hyperbaric oxygen, neurofeedback, TMS, transcranial magnetic stimulation. So there's a whole host of things that can be done to help someone heal their brain. We like to tell people you're not stuck with the brain you have, right? Like brains are malleable. There's a lot of neuroplasticity even into adulthood. That's really hopeful for people watching because I think it was previously thought that brain damage was permanent. Yeah, exactly. But even to use hyperbaric oxygen as an example, when someone steps into a hyperbaric oxygen chamber, they're getting more oxygen delivered to their

Starting point is 00:24:45 brain through pressure. And when you get more oxygen into your brain, you induce stem cell growth. You reduce inflammation. You promote good, healthy blood flow. So brains can't change 100%. And that's part of our message. People really should have a lot of hope. Yeah, that's exciting. Where can people get a scan and learn more about this? So Amen Clinics has 11 sites across the country. I work in the Encino site in Los Angeles County in California. And they can find us online or send me a message on social media. That's fine. I'm on Instagram, Dr. Steven Storage, and we're happy to help out. Perfect. We'll link

Starting point is 00:25:25 it below. Thanks for coming on, doctor. All right. Thank you. Yeah. Thanks for watching guys. See you tomorrow.

Digital Social Hour - Unlocking Brain Health: The New Psychiatry Revolution | Dr. Steven Storage DSH #685

There aren't comments yet for this episode. Click on any sentence in the transcript to leave a comment.