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Is It Depression, Anxiety, OCD, Or All Of The Above?

Dr Daniel Amen and Tana Amen BSN RN On The Brain Warrior's Way Podcast

One of the biggest takeaways from brain SPECT imaging is that without looking at the brain, a surprising number of patients are completely misdiagnosed. Often times these patients are prescribed medication that makes them worse instead of better. So what are some of the most common misdiagnoses? In this episode, Dr. Daniel and Tana Amen describe why certain symptoms of depression, anxiety, and OCD can appear similar on the surface, and how to know if you should be looking for a second opinion if you’re not getting better.

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Daniel Amen, MD:

Welcome to the Brain Warrior’s Way podcast. I’m Dr. Daniel. Amen.

Tana Amen, BSN RN:

And I’m Tana Amen. In our podcast, we provide you with the tools you need to become a warrior for the health of your brain and body.

Daniel Amen, MD:

The Brain Warrior’s Way podcast is brought to you by Amen Clinics, where we have been transforming lives for 30 years using tools like brain SPECT imaging to personalize treatment to your brain. For more information, visit amenclinics.com.

Tana Amen, BSN RN:

The Brain Warrior’s Way podcast is also brought to you by BrainMD, where we produce the highest quality nutraceuticals to support the health of your brain and body. To learn more, go to brainmd.com.

Daniel Amen, MD:

Welcome back, everyone. We are so excited that you’re with us. I know these are crazy times. We’re going to continue to answer some of your questions, and in this podcast it’s going to be, “is it depression, anxiety, OCD, or all of the above?”

Tana Amen, BSN RN:

I love that. So before we get started, we’re going to read a couple of reviews, and please post a screenshot of yourself and send it to us, tag us, but also send us your questions, your concerns, and your comments. If you go to brainwarriorswaypodcast.com to the comments section, you can leave us a question, comment or review. We really, really love your reviews, we appreciate them, they’re what help us keep going and keep us rated higher, and share what you’ve learned. And we are, we want to know how this information is helping you, and what, if you could change something affecting you, just think about that through the episode, if there’s something bothering you, what would you do differently if you could change it?

Daniel Amen, MD:

So this is from the United Kingdom, [inkd9 [00:02:06], inkd9. “The work of amen clinics, books and podcasts has been a defining mission in my life for caring about human health, and the wisdom is abundant and helpful. This motivated me to join the Brain Health Coaching Certification Course.”

Tana Amen, BSN RN:

Oh, [crosstalk [00:02:20].

Daniel Amen, MD:

Thank you. “I can’t be more grateful for Daniel and Tana for doing this podcast on top of everything they do.” Thank you. And then from [progressforever [00:02:31], “I am ADD, and I think my son too, your tips and tricks are so helpful to deal with our brains. I would love to give you 10 stars if I can. Thank you for everything.”

Tana Amen, BSN RN:

That’s so great.

Daniel Amen, MD:

So is it depression, anxiety, OCD, or all of the above? It’s such an interesting question.

Tana Amen, BSN RN:

It is.

Daniel Amen, MD:

And we make diagnoses based on symptom clusters with no biological data. And on average people who come to Amen clinics have 4.2 diagnoses. They have failed 3.3 providers and five medications. So I’m just not a fan of how we diagnose things, because you could meet so many different diagnostic criteria when basically your emotional brain is working too hard. We call it stuck in overdrive, and you can’t sleep, and you’re anxious, and you’re worried, and if things don’t go a certain way you can get upset. And you know, you could list all of, but the question really is, what are you struggling with and how can you help it?

And I generally think of OCD, where you can’t get rid of bad thoughts or bad behaviors, right? It’s like you have a scratch on a record and the thought or the behavior just loops and goes over and over again. Anxieties where you’re just masterful at predicting the worst and have physical stress symptoms, muscle tension, headaches, tummy aches, can’t sleep, diarrhea. And depression is just this sort of chronic sadness. One of my patients yesterday described it as a cloud-

Tana Amen, BSN RN:

Oh, it’s [crosstalk [00:04:35].

Daniel Amen, MD:

… that always follows her.

Tana Amen, BSN RN:

For me it was like mud. Can’t walk through it. So one thing I love about you, even though sometimes it frustrates me, but mostly I love it, is that you don’t, you just are really resistant to labeling people with anything until you really figure out what’s going on with them, right? And I mean, I’ve got family members where I’m like, “I know what’s wrong with them, they’re just a royal pain in the blank,” but you don’t do that. You’re just very, you are very, very thoughtful about how to break down what’s happening for a person. And one of our questions is why is ADD misdiagnosed with bipolar disorder or OCD?

And that’s a really interesting question, because the other thing, there are a lot of things that are misdiagnosed as bipolar that I’ve noticed. Things like PCOS, which I had. Now, I wasn’t diagnosed with bipolar, but people thought I had this very masculine, intense drive, which that-

Daniel Amen, MD:

You get-

Tana Amen, BSN RN:

… which, that for women is not considered a normal thing. So that then makes people look at you, like, “Why is that person so intense or so driven?” And then that can cause problems.

Daniel Amen, MD:

You part of it was the PCOS for women, that polycystic ovarian syndrome, where their ovaries have multiple cysts. Those cysts produce androgens, testosterone-

Tana Amen, BSN RN:

The testosterone is too high.

Daniel Amen, MD:

And they can be more intense.

Tana Amen, BSN RN:

More aggressive-

Daniel Amen, MD:

And when we discovered that and treated her, I got this most bizarre phone call. I’m at work. I remember it like it’s yesterday. So our first fight was on the kind of dog that we were going to get. I wanted this cute little-

Tana Amen, BSN RN:

I don’t like little dogs.

Daniel Amen, MD:

… King Charles Cavalier, a lapdog you want to just pet him, makes you happy, and she wanted-

Tana Amen, BSN RN:

No. I like big protection dogs.

Daniel Amen, MD:

Killer.

Tana Amen, BSN RN:

No, no-

Daniel Amen, MD:

Yes, you wanted, like, killer-

Tana Amen, BSN RN:

No, but I like Mastiffs, Shepherds, Dobies, Rotties.

Daniel Amen, MD:

And then, so we get her PCOS treated, and she calls me up and she found a pocket poodle online. And she said, “Don’t you think that would just-

Tana Amen, BSN RN:

Four pounds.

Daniel Amen, MD:

… be so cute to have a little dog you could put in your purse?” And I’m like, “Who stole my wife?” It’s like, “Did aliens come and just, like, occupy her body?” And then we end up with this little yappy thing, [Tinklebell [00:07:07] of all things. And I’m like, “How did this happen?”

Tana Amen, BSN RN:

But along with that was also, I started nesting. I didn’t want to be on the, I always wanted to be on, go, go, go, go, work out two hours a day just to burn off the energy. It’s just… And so all of that sort of settled down. I wanted to be home more, I was more cuddly. And I thought something was wrong with me, to be quite honest with you. So for this person who’s asking, I think people get misdiagnosed because that kind of drive, not just from PCOS, but from, when you’ve got intense drive of any kind, sometimes people look at it and other people on the outside are like, “Whoa, that’s not normal energy.” And so that’s one of the things I just wanted to address. At our clinics, what we do is we take your whole profile, right? We’re going to test your blood, we’re going to look at your brain, we’re going to look at your nutrient levels, your hormones. And that’s why it’s just so important, so you don’t get misdiagnosed.

Daniel Amen, MD:

So let me answer this question specifically, because ADD often gets misdiagnosed as bipolar disorder. So bipolar disorder, like the name implies, is you go between two poles, that you have periods where you’re normal, periods where you’re manic, so it’s also called manic depressive disorder. Manic is you have extra energy, you don’t need to sleep, your thoughts go fast, you could become hyper-sexual, hyper religious, spend money impulsively. You can even become psychotic and believe you’re an agent of the Russians or that the NSA is tapping your phone. Except they are.

Tana Amen, BSN RN:

Except they are, right.

Daniel Amen, MD:

The NSA are, they are tapping your phone.

Tana Amen, BSN RN:

They are.

Daniel Amen, MD:

Anyways, I digress. It’s clearly a period of time that’s way different than your usual state. And then that could go on weeks, sometimes even months. And then you cycle to either normal, or to the other pole where you are depressed. You can’t get out of bed, you’re sad, you’re negative, you have suicidal thoughts, you have no energy, you can’t think, you’re flooded with automatic negative thoughts. And you’re up, and then you’re down. And they’re weeks to months at a time. People who have ADD can go through that six times a day, where they get a storm of ideas, then they’re sad, and-

Tana Amen, BSN RN:

That’s hilarious.

Daniel Amen, MD:

But it’s not to the magnitude. It’s, they’re sort of always restless, and they’re sort of always a bit impulsive. They’re always distracted.

Tana Amen, BSN RN:

But are they as intense?

Daniel Amen, MD:

Generally not.

Tana Amen, BSN RN:

Yeah.

Daniel Amen, MD:

And that’s how you can tell. And they’re not psychotic. And-

Tana Amen, BSN RN:

Because we’ve got someone, I have a family member who, I think she’s bipolar. But the extreme rages, and it’s not quite the same as people I know with ADD who are just goofy and, and they can be goofy, they can make goofy decisions, they can be impulsive. And they’re kind of funny actually, a lot of times, or annoying with the impulsiveness. But this is different. It’s really intense. And it seems like to me, it’s like, it seems like drugs. It literally, it looks like this person is on drugs when that happens. Don’t you think it can look like that?

Daniel Amen, MD:

It certainly can.

Tana Amen, BSN RN:

In fact, I’ve accused her of being on drugs when in fact I found out that she was in this manic phase. So.

Daniel Amen, MD:

And so getting the proper diagnosis is critical to getting the right treatment. And that’s where imaging is so helpful.

Tana Amen, BSN RN:

Blood work.

Daniel Amen, MD:

Or working with a psychiatrist who really understands. Now, OCD, and sometimes OCD and ADD are actually confused with each other. With ADD, you have trouble paying attention, with OCD, you actually have trouble shifting your attention. And both look like you can’t pay attention. But the hallmark symptoms of ADD, short attention span, distractibility, restlessness, disorganization, procrastination, and impulse control issues. With OCD, you get bad thoughts called ego dystonic. You don’t like these thoughts, bad thoughts that loop, and they go over and over and over again. Or ego dystonic behaviors like checking locks, not stepping on cracks, having to have things done just a certain way, or you get very anxious or often very upset. So knowing the right diagnosis is critical to getting the right help.

Tana Amen, BSN RN:

So what’d you learn today? Post it, tag us, leave us a question, comment or review, go to brainwarriorswaypodcast.com and leave it in the comments section and we’ll enter you into the drawing for one of our books, either my cookbook, The Brain Warrior’s Way Cookbook or your book, The End of Mental Illness. Thank you.

Daniel Amen, MD:

Stay with us.

Tana Amen, BSN RN:

If you’re enjoying the Brain Warrior’s Way Podcast, please don’t forget to subscribe, so you’ll always know when there’s a new episode. And while you’re at it, feel free to give us a review or five star rating, as that helps others find the podcast.

Daniel Amen, MD:

If you’re considering coming to Amen Clinics or trying some of the brain healthy supplements from BrainMD, you can use the code podcast 10 to get a 10% discount on a full evaluation at amenclinics.com or a 10% discount on all supplements at brainmdhealth.com. For more information, give us a call at 855-978-1363.