Good evening, I'm psychiatrist Jay Fawver live from the Bruce Studio in Fort Wayne , Indiana.

Welcome to Matters of the Mind now in its 10th year Matters of the mind is a live Call-In program where you have the chance to choose the topic for discussion.

So if you have any questions concerning mental health issues, give me a call in the Fort Wayne area by dialing (969) 27 two zero or if you're calling long distance you may call it coast to coast toll free at 866 (969) 27 two zero and we now have the opportunity for you to be able to text me with a question on the air at two six zero (969) 27 three zero two zero (969) 27 three zero.

>> All I ask is that you give me a name to which I can refer and tell me where you're from or what town you're from and I can answer the text immediately on the air hopefully at that time on a fairly regular basis we are broadcasting live from our spectacular PBS Fort Wayne studios which lie in the shadows of the Purdue Fort Wayne campus.

>> And if you'd like to contact me with an email question that I can answer on the air, you may write me a via the Internet at matters of the mind all one word at WSW Vague that's matters of the mind at WFB Edgard start tonight's program with an email question I recently received.

>> It reads Due to the Fauver how would I help myself to stop being a hypochondriac?

I am very anxious about my health all the time to an excessive degree.

>> Well we don't use the term hypochondriac anymore.

We use the term illness anxiety disorder and as the name implies you're anxious about the potential for an illness.

And here's the problem about anxiety with an illness if you have anxiety concerning an illness, the deep parts of your brain, the more primitive parts of your brain actually think you do have the illness so from your brain's perspective you're taken on the anxiety and the apprehension and the uncertainty of having the illness itself even though you don't have the illness.

>> So you're actually destroying your your health by worrying about the potential for an illness.

>> So it's kind of goes round and round and what we'll often do with people who have illness anxiety disorder is allow them to emphasize the gratitude they have for the health they are currently experiencing.

So their good health we try to help them remember what they have going for them so we have them try to remember the different ways that they are establishing health and we do remind people, yeah, there's illnesses that occur.

>> We've got to be realistic about that and we all have a certain expiration date where we do have mortality.

>> We can't we can't change that.

We all have that expiration date but the same time we have to remember that if we're persistently anxious about illness that hasn't occurred yet, our brain will unfortunately in the primitive areas interpret that illnesses as already occurring and create a lot of stress unnecessarily.

So you want to focus on your your aspects of health and vitality that you still are experiencing and joyo know it as the time goes on.

Yeah, your broad body does naturally break down do the best you can to try to support it and eat healthily, exercise on a regular basis and actually socializing is good for the mental health so try to maintain as much activity as you can while you can realizing that illness can come and if it does you deal with it at that time.

>> Thanks for your email.

Let's go to our first text.

It's from Lucas.

Hello Lucas.

Welcome to Matters of Mind.

Lucas, you're from Fort Wayne .

You texted in and said I frequently forget to take my sertraline that's also known as Zoloft for days at a time and struggled to take the medicine at the same time every day with this cause long term damage.

The good news Lukas's won't cause long term damage by forgetting to take the search plane unless the search planes really helping them.

Now my question is if you're forgetting for days at a time, is it doing much for you or on the other hand has it worked so well that you might not need it anymore?

That's always a good thing but many people will use sertraline Zoloft for depression.

They'll use it for anxiety conditions and as they use it over the course of time they find that they don't need it so much which is great if that's the case, talk to your clinician about the possibility of tapering you off of it entirely so you don't have to worry about taking it if you're missing it for days at a time.

I question if it's even worthwhile for you to take so with that being said, if you miss a day here and there of sertraline you'll get zings apps, zings and zaps in the hands and the feet.

You'll feel lightheaded and dizzy.

Some people get those apps and their scalps.

It's an unfortunate type type of phenomenon where if you miss a dose each of the medications in that class where they affect serotonin and norepinephrine you'll have some discontinuation phenomenon.

So that's uncomfortable to do that.

So I talk to your clinician about the possibility of you tapering off certainly an entirely if you need it you need it.

OK, if that's the case, try to take a daily sertraline is not so important as some of the medications that take exactly the same time every day but get to a routine of taking it where it's easy for you.

>> So for some people they'll notice that it's easier to take in the morning.

Some people say it's easier to take a bedtime.

I'll encourage people to get a pill box and just take it day by day by day or they can see if they took it or not.

But if you don't take it exactly the same time, certainly it's not highly problematic and needing to take it the exact same time every day some medications you really need to take at the same time every day examples would Effexor also known as Venlafaxine another medication being Paroxetine or Paxil.

>> These medications can give you some discontinuation phenomena if you don't take them about the same time every day but certainly it's not one of them.

>> Thanks for your text Lucas.

Let's go to our next text.

We have another text from Caroline.

Caroline, you asked about high cortisol levels.

Do high cortisol levels affect your feelings of safety?

I'm challenged by the feeling that my faith has failed and I feel unsafe all the time.

Caroline high cortisol levels are a result of feeling really stressed out.

So when you're stressed cortisol starts going higher and it's not uncommon for people to try to exercise to try to deal with cortisol levels because cortisol levels when they're elevated will cause you to have higher glucose and cause you to have difficulty with metabolic disturbances such as a higher waistline.

So high cortisol is not healthy for you exercising is one way to try to deal with that because chronic unmitigated stress can cause you to have high cortisol while you had asked about possibly losing your faith and wondering about other factors associated with it, I think what you're describing is the chronic unmitigated stress that people will experience where you have it.

>> You haven't encountered these particular stresses in your life and in doing so you haven't been able to navigate how to get through them and that will increase your cortisol levels.

So people ask me all the time how do I get rid of stress?

>> Well, you don't want to get rid of stress in general because if you got rid of all stress your days would be exactly the same day by day by day and you might think well that would sound great.

>> Not really.

You'd get really bored if your days were the same every day we need to be challenged.

We need to be sharpened so to speak, as a means of getting us more motivated to do more things and be able to enjoy life so part of the human experience is to be able to adapt to challenges and challenges are what stress is all about when you have chronic unmitigated stress it's where the stress is overwhelming for you.

You have to experience what kind of stresses before you're not sleeping you can't think through them.

You can't process information adequately.

And as I always mentioned to people, when you're under that kind of stress what's happening your little amygdala down here in the temporal lobe gets all fired up.

You got one on the left side, one on the right side and when the amygdala gets fired up you can't sleep very well because anxiety is keeping you awake at night.

>> If you don't sleep very well, the front part of your brain doesn't get adequately recharged.

If the front part of the brain doesn't get adequately recharged, you can't think through life's problems adequately.

So those day to day changes that we all should experience you're going to find difficult in which to navigate and adapt and that's the whole concept of psychotherapy or counseling with psychotherapy or counseling.

It's like a GPS for the brain a counselor or a psychotherapist trying to help you navigate through life's difficulties similar to a GPS in your car.

Calpurnia navigate to a location in which you're not familiar so it helps you turn right or left.

The therapist looks at your life circumstances, looks at your strengths, look at your looks, your weaknesses, your resources and the therapist will let you navigate the direction you where you need to go.

So I think that's the key for you right now to try to get some control over the stresses you're experiencing at this point and that indirectly can decrease the cortisol excesses that people sometimes can experience.

>> Thanks for your text.

Let's go to our next caller.

Hello Lydia.

Welcome to Matters of Mind.

Lydia, you want to know about weight loss drugs like Mozambique?

Can they affect your behavior?

Mozambique is a one it's called Simeulue Tide.

It's in a class of medication called glucagon like like peptide Lukken look like a peptide GOP type one glucagon like peptide type one agonist.

So they call them clip one agonists or GLP ones so that class of medication has been extensively studied.

Many, many, many people are talking about them nowadays because they are dramatically decreasing the appetite and they can actually physically help you with weight loss by decreasing fat.

My biggest concern about Zembiec or any GLP one agonist is that they can decrease your muscle mass and as a psychiatrist I want to stay in my lane here because I don't want to get into the area of other specialists.

>> But as a psychiatrist what all hear about people sometimes on the GLP one agonist such as Mozambique they'll say that they're losing muscle mass and that will make them tired and give them less initiative and less strength.

>> So when I hear about that I emphasize to people on the one agonist to do resistance training as we get older we tend to naturally lose muscle mass after about thirty five years of age you gradually lose muscle mass.

Year by year by year and it's very important as an older adult to do resistance training to build up that muscle mass.

The GOP one agonist actually shrink down the muscle mass as well as the fat.

Now on the good perspective, a GOP one agonist if you're losing fat that's going to have you lose out of adipose tissue.

If you lose adipose tissue, you're going to have less inflammatory inflammatory proteins.

Fat cells will fire off inflammatory proteins.

Inflammation of the body is not good.

Inflammation causes a lot of illnesses but inflammation proteins will go to the brain and cause you to have more depression, a sign of depression related inflammation of the brain will be sadness, lack of enjoyment, things low motivation, low energy and poor concentration.

>> Those are all symptoms of an inflamed brain and that can come from fat cells.

So on one hand the behavior behavior changes from some glutamate type products can be good in the sense that you'll have less inflammation and you might have more energy and better concentration in some ways, however, you can feel fatigued if you lose the fat and the muscle because if you lose the muscle you're going to be less strong.

So I would strongly emphasize that depending on the issue if you're having behavioral changes to look at the issue at hand, see if the GOP won agonizes worth it to continue the problem with those I'm hearing it again and again.

Once you go off of them the fat comes on really fast.

So once you're on them, keep in mind it's probably going to be a long term relationship.

So you're not going to be engaged to the GOP once again as you're going to be married to it and that marriage is a long lasting covenant from what I'm hearing from people going to be a lot of studies on those medications over the next few years.

I'm looking forward to seeing how it turns out because I'm here and studies saying the GOP one agonist war will possibly decrease the likelihood of Alzheimer's dementia so I'm really excited about hearing about potential uses of these medications in all sorts of areas.

But there can be some drawbacks and you have to be conscientious about that.

Thanks for your call.

Let's go next caller.

>> Hello Trisha.

Welcome to the line.

Tricia, you had asked about your child getting your child is bullying other kids at school.

>> Is there an underlying reason why a child might be bullying others and why should you do if your child is bullying others?

>> It comes back to one factor and one factor only from what I hear I'm not a child psychiatrist but you've probably heard it before.

If a child is a bully, that bully is likely has a very low self-esteem and children who will bully others often lack the empathy toward others.

But they also have a very low self-esteem themselves and bullies will often find power in their intimidating other people and that's not a good thing obviously.

>> And sometimes you'll be gravitating toward gangs because then gang the gang behavior are really tight niches and clicks can give them a further sense of empowerment that you will give them a sense of belonging.

>> So if your child is bullying other children, take a look at your child's self-esteem and try to address that in various other ways and give your child self-esteem in various ways but also really emphasize to your child the importance of empathy and helping your child understand that about the feelings of others and how he or she may be coming across to other people.

>> Thanks for your call.

If you have a text question you like to text me on the air, I'll try to answer your text on the air and you can text me at two six zero (969) 27 three zero and again remember to include your name and where you're from and I'll go the next text with James James you have a question about exercise and depression James from Fort Wayne James you're wondering can exercise cure depression or does the treatment of depression require medication?

Exercise can have a significant impact in treating depression.

>> James and I've heard the same phenomenon with the ketogenic diet a low carbohydrate diet.

These exercise low carbohydrate they can significantly help depression for a lot of people how do they help?

>> Well basically exercise is a means of treatment.

You could certainly convey but where you'll increase a couple neurotransmitters at the same time one being glutamate, one being gabber glutamate is the accelerator in the brain.

Glutamate consists of about 80 percent of all neurotransmission needs outside thinking part of the brain whereas GABA is the brakes on the brain so glutamate the accelerator gabbers the brakes glutamate sitting on pushing on the right pedal gabbers pushing on the left pedal and they're working in tandem exercise enhances both glutamate and GABA.

>> That sounds weird but the effect of it will be you feel energized from the glutamate but you also feel calmer from the Gabba and many many many people will say after the exercise whether it just 20 minutes or 40 minutes they'll say they feel more energetic but yet they feel calm at the same time and rarely ever hear about anybody say they feel worse after exercising.

If they do, they probably overdone it.

They're dehydrated, they've got electrolyte disturbance.

Something's going on and feeling worse after exercise.

But yeah, exercise will stimulate these natural brain.

Fertilizer's in the brain called growth factors brain derived neurotrophic factor mammalian target of rapamycin.

These are natural fertilizers in the brain.

Exercise to some degree can stimulate those particular natural exercise natural fertilizers medication can do the same medication.

>> We often do it very quickly.

For instance there's a medication and came out for anesthesia twenty five years ago called ketamine.

>> It's been used what we call off label or unofficially for the past twenty five years in the IV form Salvato came out as ketamine.

It's the left side a piece of ketamine came out in 2019 and now we have all Velarde which came out about three years ago.

It also affects glutamate.

So you've got ketamine as ketamine novelty.

They're indirectly affecting glutamate and in doing so what they're doing is indirectly enhancing the brain fertilizers and allowing the little neurons to become more fluffy.

Now if you look at the neurons themselves, neurons look like a plant.

You've got the roots on the plant, you've got branches on the plant.

Individual neurons have roughly 50 to 60 thousand branches per neuron.

So imagine a plant having fifty or sixty thousand branches all over it.

>> That's how a neuron should look if you have ongoing stress depression, you're having difficulty coping through life .

>> You're a little neurons get all shriveled up just like a plant would get shriveled up if that plant was under fertilized or under water.

>> So what you try to do is fire up the branching of the plant, the roots and the branches themselves and thereby the neuron can work can work more effectively ongoing exercise can make the branching more likely.

But in terms of somebody with a clinical depression where it's significant to the point where they're having trouble going to work, going to school, trying to do the things they'd like to do if they're having ongoing depression like that medication can work faster and what we try to do is once you're feeling better from medication, get out there, exercise, socialize, do things that are enjoyable, do the things that will further enhance that fertilization because it's one thing to get feeling better, it's another to start doing things that will actually be meaningful to allow you to stay well.

>> So we want you to get well but want to stay don't stay well on the way you stay well is by doing things that are meaningful on a day to day basis.

>> Thanks for your text.

>> Let's go our next text our next text is from Carolyn from Angola.

Hello Carolyn.

You're asking what is borderline personality disorder and how is it treated?

Well, borderline disorder in my head from my perspective as a type of bipolar disorder, bipolar disorder is where you'll have distinctive elevations of the mood, decreased need for sleep racing thoughts, distractibility, impulsivity and in the case of borderline personality disorder, he can have ongoing distrust, anxiety and difficulty with with moodiness.

>> That's like a roller coaster .

>> So borderline personality disorder is a type of bipolar disorder where you're very reactive to stress.

You're very reactive to your environment and people around you.

>> So when stuff is happening you around you with borderline personality disorder you're very quick to react.

You'll be impulsive, you will overreact, you'll be devastated with this perception of of abandonment.

>> You'll have difficulty when somebody says something the wrong way to you.

>> You'll have rage, anger sometimes people with borderline personality disorder will have transient psychosis where they're briefly out of touch with reality, with reality.

This all happens very quickly for a matter of minutes hours but rarely more than a day and that's borderline personality disorder originates often from childhood experiences.

>> If you've had a mother father, brother or sister in the family who was emotionally distant to you, especially a parent or you were abandoned as a child if you as a child had emotional, sexual or physical abuse, maybe had post-traumatic stress disorder, you're more likely to have borderline personality disorder later on.

>> So it's a condition where yeah, on one hand there's the drama that everybody experiences to some degree in adolescence but with borderline personality disorder that exaggerated reaction to the environment or people around you will be noted in your 20s and even 30s for that matter.

>> But and my mind borderline personality disorder is more of a condition that's related to bipolar disorder that's reactive to people in situations you treat it with dialectical behavioral therapy, various various types of counseling can help with borderline personality disorder.

>> We do use mood stabilizers to help people to put up with stuff better so we try to help people with what we call stress resilience so we give them mood stabilizers to help them put up with the stresses that they're saying.

>> Thanks for your text.

Let's go to our next text.

Hello Tom.

Welcome to the mind Tom.

>> You're from Columbia City.

You were wondering about retirement.

You've just retired and you were very excited about it.

>> That's fantastic, Tom.

However, I seem to seem to be struggling with not having to go to work and finding something to do with my day.

What can I do to help with this adjustment?

>> Tom, you need a schedule.

Here's what happens.

People get really excited about retirement the first week goes great what's called a vacation, Tom?

>> I mean basically you're not working.

That's a vacation second week is like a prolonged vacation now you're in the third week, the fourth week, the fifth week now what do you do?

>> Well, when you're working you had places to go, people to see day by day you had obligations you might have work Monday through Friday you had the same routine and your thing and I can't wait till I retire.

>> Well, now you have the opportunity to do things that you want to do now within your financial constraints do what you are able to do at this point but you need to have a schedule don't sleep in day by day.

Be careful about that.

Many retirees will sleep in till 10:00 11:00 o'clock in the morning and they just don't really have a reason to get up get up first thing in the morning.

>> One of the best things you can do in the first in the morning is to exercise, do a Bible study, go out and meet with other people.

>> People who don't have joint replacements are playing a lot of pickleball now I hear about that a lot but you have to have a schedule, have it on your calendar of things to do day by day.

Now you might not need to have the eight hour obligations anymore.

My goodness you get to take a nap when you're retired so you can take a nap in the middle of the day for maybe thirty minutes and get some rest.

That's OK.

But you might not need eight hours of obligations day by day but maybe have four hours of obligations because for all of us it's not the doing of things in the future that are most important.

It's the preparation and the anticipation and the excitement of doing things in the future.

So if you see something on the calendar for Thursday this week and you're getting excited about it, great.

That actually helps your brain work better.

But you're at a high risk for depression if you don't keep yourself busy and do things.

And the wonderful thing about retirement you're financially more stable to be able to do things you really want to do.

But first encourage you to get up at the same time every day the best you can and if you want to sleep until eight or a thirty that's OK.

But don't sleep in till late morning and don't stay up all night.

I mean sounds like fun for a while but it destroys your circadian rhythms.

Try to get the bed at a decent time at night, get up about the same time every morning but have things to do and getting a routine first thing in the morning to get the day started to write can be very helpful.

I've heard some people say that merely making their bed gets their day started properly and then having a routine day by day can really help and that's especially during retirement.

>> So Tom, congratulations on your retirement but time for you to get busy with doing things you enjoy, find pleasure in different things but have a have a specific calendar in mind to keep things on track.

Tom, thanks.

Your text.

>> Let's go to our next e-mail question.

Our next e-mail question reads Dear dear father, my doctor prescribed phentermine for weight loss.

It's giving me a lot of energy and helps with my mood.

But another doctor said I couldn't go with an antidepressant.

How does it work?

Well, Federline is a medication trade name is Adipocytes used to be called fast and it's a medication that will push out push out from a neuron.

>> If you think about the neuron as being like a shotgun ,it's firing out norepinephrine now it will fire out to ten times lesser degree dopamine and 100 hundred times lesser degree serotonin.

So primarily it's firing out norepinephrine and firing out a little bit of dopamine and then firing out even less serotonin.

So here's the deal.

You could probably take a purely serotonin medication if you're really careful because the serotonin medications keep the serotonin floating around in the brain for longer periods of time.

In the case of phentermine you are in firing out more serotonin so if you give a serotonin reuptake blocker it's decreasing the vacuuming of serotonin back into the firing neuron thereby giving you the possibility of serotonin toxicity.

But it's very slight.

The biggest concern I would have with a medication for for depression with phentermine would be a medication that's increasing norepinephrine a medication such as the old tricyclic depression medications or the newer ones such as Zema, Sevele, Prestige, Effexor these are all medications that are increasing norepinephrine and doing so by blocking the uptake of serotonin or blocking the vacuuming of norepinephrine I mean blocking the vacuuming of norepinephrine if you're firing more norepinephrine and blocking the vacuum of it, you can have high blood pressure and have some detrimental effects from that.

So there are certain antidepressants you could take but certain ones you don't want to take on for some amount of time for this evening if you have any questions that I can answer on the air, you may write me via the email at Matters of the Mind all one word at WFB dot org.

I'm psychiatrist Jeff Oliver and you've been watching matters of mind now available on YouTube God willing and PBS willing.

>> I'll be back again next week.

Thanks for watching.

Good night