Prof. Dr. Tarhan, stating that measuring brain functions guides psychiatric treatment, said, "Our brain is a magnificent organ. It is responsible for everything we do, think, and feel. In psychiatric disorders, the first physician usually makes the diagnosis and starts medication. If the illness does not improve within 6 months in the first stage, it is necessary to move to the second stage. In this case, it is also necessary to be able to perform measurements in the brain."
Prof. Dr. Tarhan: "Magnetic stimulation therapies work very quickly in OCD and depression. These also emerged as a result of brain imaging. This is a personalized treatment. We should not delay people with stigmatization, labeling, and ineffective treatments."
Üsküdar Üniversitesi Founding Rector, Psychiatrist Prof. Dr. Nevzat Tarhan, evaluated the topic of brain mapping in the treatment of psychiatric illnesses.
Prof. Dr. Nevzat Tarhan pointed to electrical and chemical neuroimaging among brain imaging methods, stating that imaging of oxygen and glucose changes in the brain also exists, and these are functional and operational imaging techniques.
Structural state of the brain
"There are also anatomical imaging techniques. In the form of brain mapping like Computed Tomography (CT) and MRI, they show only the structural state of the brain," said Prof. Dr. Tarhan. He noted that these methods, used by brain surgeons, indicate whether there are tumors, masses, or volume-pressure changes.
Prof. Dr. Tarhan explained that the method used in psychiatry also involves other functional and operational brain imaging techniques, which provide information about how the brain works in different states, how it works in specific illnesses, and how each region functions.
Prof. Dr. Tarhan explained that what is meant by brain mapping is generally the imaging of the brain's functional activity, known as functional imaging, adding, "The oldest of these is EEG, which measures the flow of electrical signals in the brain."
"Unnecessary medication is not given by diagnosing every active child with hyperactivity"
Prof. Dr. Tarhan stated that in the 1990s, qualitative analysis of brain signals was performed, where brain signals were examined, the oscillation and vibration of brain waves were measured, and a normal database was created. This was then compared with patient data, and areas deviating from normal were presented in a mapping format.
Prof. Dr. Tarhan stated that this method is currently known as QEEG and is used routinely. He also mentioned that a special device has been developed in the USA for attention deficit and hyperactivity, thereby preventing unnecessary medication from being given by diagnosing every active child with hyperactivity.
Prof. Dr. Tarhan stated that patients are not satisfied when there is no concrete feedback, adding, "For example, you tell someone they are diabetic, and when you measure and show their blood sugar, they cannot object. We also perform brain imaging. After taking the bioelectric wave of the brain with QEEG, we look at the person's brain. There are areas of organization in the brain, we show these and say, 'look, there's a war in your brain.' If there is a beta wave in the brain, we say there is a war, or if there is slow secretion, we describe it as 'the brain is tired, the serotonin and dopamine levels in the brain have dropped.' This is because electrical communication in the brain simultaneously shows chemical communication and other functions in the brain. A network working map of the brain, a neural network map, emerges there."
"We also take brain mapping after performing the treatment"
Prof. Dr. Tarhan explained that these methods help in diagnosing individuals with depression or panic disorder, stating, "We look and say, 'this region of your brain has become hypersensitive, you're reacting catastrophically to a small thought or fear. This is not within your control, it's involuntary,' and when we say this, the person feels relieved and their compliance with treatment increases. Subsequently, there are treatments like magnetic stimulation therapy that may be applied depending on the situation. After performing the treatment, we also take brain mappings. We measure whether there is a change, by what percentage it has changed, and if it has improved."
Prof. Dr. Nevzat Tarhan stated that a cardiologist examines a person's cardiovascular system and makes a diagnosis, adding, "The target organ of our mental and nervous structure is the brain. That is, after the 2000s, how our brain works began to be understood. Even at NASA, there are nearly 2,000 postdoctoral students working on the brain, working on Neuroscience. The brain is seen as the new frontier of science. Many things in the brain, such as what consciousness is, and the connections between mental activities and brain activities, have become more understandable. Consequently, we saw that most of the diseases we called mental illnesses, the causes of which we could not understand, have a biochemical counterpart in the brain."
Turkish scientist contributed to the literature…
The USA's renowned FDA agency approved the use of Brain Mapping in Attention Deficit and Hyperactivity Disorder in 2013. Turkish Psychiatrist Prof. Dr. Sermin Kesebir also discovered the relationship between slow-fast wave disturbance in Brain Mapping for Bipolar Disorder and emotion dysregulation in 2022, publishing it in the prestigious Frontiers in Psychiatry Journal and incorporating it into the literature. Now we will be able to better observe diagnosis and drug effects.
"Brain and gut communicate"
Prof. Dr. Tarhan noted that in internal diseases, inflammation in the gallbladder can change with stress, and continued:
"We call it bowel disease. These can change with stress. If they can change, what is the relationship between the gut and the brain? Yet, the brain and gut communicate. The brain and gut communicate with each other, transferring information. They do this not only through electrical pathways but also chemical pathways. It sends signals like 'speed up, react, contract,' and it contracts, and from there, messages about these activities go to the brain via the Vagus nerve. The brain says 'danger passed, relax,' and if the person relaxes their brain, their stomach, intestines, all relax. The brain works like an orchestra conductor; if we don't understand our brain, we cannot treat illnesses. Therefore, the brain should be the organ of study for a psychiatrist, a professor of psychology."
"Those who believe in the drug's effect recover 40 percent faster"
Prof. Dr. Tarhan stated that if a patient believes in the effect of the medication they are taking, they recover 40 percent faster, adding, "If they don't believe, for example, if someone stands in the middle of a room saying 'I'm dizzy,' there's a 40 percent chance their head starts to spin or sway in experiments. How a person defines their brain, the nervous system takes a position accordingly, perceives and forms connections accordingly. Therefore, if we manage our brain well, we can manage ourselves. He who manages his brain manages himself. This is called neuro-leadership. Even for motherhood and fatherhood, self-awareness, self-knowledge, and self-management are required first. This is also valid for psychiatric illnesses; a person must correctly identify their illness and believe in the medication they are taking, otherwise, they will say the medication they take 'does not treat.' Whereas, medications are pharmacological weapons, they are chemical weapons. If used appropriately and timely, they serve their purpose. If used incorrectly, they cause harm."
"One should not dismiss antidepressants lightly"
Prof. Dr. Tarhan also touched upon the subject of antidepressants, saying, "One should not dismiss antidepressants lightly. They are not drugs to be distributed like Aspirin. A lady accidentally took an excessive amount of antidepressants. Suddenly, her emotions surged, and she fell in love with the doorman. They brought her to us; she was a proper lady, but it was beyond her control; excessive serotonin had been secreted in her brain, and she was suddenly influenced by whoever showed interest."
"Our brain is a magnificent organ"
Prof. Dr. Nevzat Tarhan stated the following:
"Our brain is a magnificent organ. It is responsible for everything we do, think, and feel. In psychiatric disorders, the first physician usually makes the diagnosis and starts medication. If the illness does not improve within 6 months in the first stage, it is necessary to move to the second stage. In this case, it is also necessary to be able to perform measurements in the brain. In cases of treatment resistance, when it doesn't improve with medication, there is a risk of the patient developing chronic conditions. The initial treatment is insufficient; it becomes necessary to administer new medication again or change medication. In such situations, measuring brain function in that individual guides the treatment."
"It is necessary to identify and treat the individual's needs"
Tarhan stated that there are many brain imaging methods, adding, "In brain mapping, the most practical and easily accessible is Qualitative EEG. In some cases, measurements are also made in the brain with functional MRI. Specific tasks are given inside the MRI device. According to these, it is observed which region of the brain is working. There are also PET studies that show oxygen and glucose consumption in the brain, looking at which areas use oxygen and glucose better. MRI provides information about oxygen consumption, oxygen, and carbon dioxide balance in the brain. Even infrared optical scans are being performed. This is about to be introduced to the market. Unfortunately, psychiatric illnesses are increasing nowadays. They are increasing globally, and in such situations, solution methods are also increasing; it is now necessary to identify and treat the individual's needs."
"The dose makes the drug; when given too much, it becomes poison"
Prof. Dr. Nevzat Tarhan stated that diseases progress differently in person A than in person B, adding, "Therefore, in such situations, one should not rely on rote methods. The right drug, the right treatment, and the right duration are required according to the individual's needs. Choosing the right drug is separate; if you give an intravenous drug orally, it will be useless. Similarly, choosing the right drug is very important. The dose you give is important, because the dose makes the drug; when given too much, it becomes poison."
Prof. Dr. Tarhan reminded that the world is experiencing a revolution in neuroscience, stating, "This has clinical implications. Many treatments have become easier, we can better see the results of our work, and genetic analysis of the person is performed. Drug genetics are examined; you give elephant doses of medication to some people and it doesn't work, while to others you give microgram doses and it has a tremendous effect. The reason for this is the metabolism rate in the liver. In some people, the liver cannot process the drug and causes side effects. There is a drug sensitivity panel that we consult to select the drug according to which drug the person is sensitive to."
"Magnetic stimulation therapies work very quickly in OCD and depression"
Prof. Dr. Tarhan explained that dopamine enzyme activity and serotonin enzyme activity in the brain are examined. If dopamine levels are high, meaning dopamine enzyme activation is fast, the level rises. In such cases, he noted, it is necessary to give dopamine-related drugs to some individuals and serotonin-related drugs to others, adding the following:
"Now, based on genetics, we look at the enzymes the body uses for metabolization and administer medication accordingly. This is known as pharmacological drug genetics. The other method involves looking at brain imaging maps to identify which area of the brain is impaired, and then applying magnetic stimulation therapy accordingly. With neuronavigation, for example, we observe which area of the brain works fast or slow and then apply provocative magnetic stimulation therapy. For instance, if a person has OCD or a cleaning compulsion, constantly washing their hands. We use a device to make them imagine their cleaning rituals, and as they repeat them, we observe that region of the brain becoming excited and inflamed. Precisely at that moment, we apply magnetic stimulation. There are voltage-gated ion channels in that region; these channels become desensitized, and magnetic therapy stimulates them, allowing medications to start working from there. Rapid recovery occurs."
"We should not delay people with stigmatization, labeling, and ineffective treatments"
Tarhan finally added; "Magnetic stimulation therapies work very quickly in OCD and depression. These also emerged as a result of brain imaging. This is a personalized treatment. Those who don't suffer from this illness cannot know, it is very difficult. They are often misunderstood; people, with good intentions, wander around with old wives' remedies and various primitive methods. However, medicine has advanced; we can now measure the connection between mental health and brain mapping. We should no longer delay people with stigmatization, labeling, and ineffective treatments."