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>> Good evening.

I'm psychiatrist Jay Fawver live from Fort Wayne , Indiana.

>> Welcome to Matters of the Mind now in its tenth 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 a call here.

The Fort Wayne area bardoli (969) 27 two zero or if you're calling any place coast to coast you may dial toll free at 866- (969) to seven to zero.

>> Now on a fairly regular basis we are broadcasting live every Monday night from our spectacular PBS Fort Wayne studios which lie in the shadows of the Purdue Fort Wayne campus.

And if you have any questions I can answer on the air you may write me via the Internet at matters of the mind all one word at a dot org that's matters of the mind at Wadongo.

>> Let's start tonight's program with a question I recently received.

It reads a favor I'm afraid to let my kids play high contact sports after reading more on head injuries, can you talk about further consequences of head injuries even after periods of healing?

>> It's all relative based on the age of the child, the head protection, the severity, the head injuries.

>> So it's a judgment call between parents and children.

I'm not going to give you a definitive answer whether your children should play contact sports because even soccer which you often think of not being highly contact sport soccer often will result in concussions for people but the younger you are and the more severe the head injury, that's where it can be more traumatic later on.

We do know now compared to twenty years ago that the brain is highly resilient such that the brain can recover whereas 20 30 years ago we didn't think that it could.

So I think as time goes on we're going to have better remedies and better means of assessment for head injuries.

My goodness, back in the 1970s when I played football, if you had a head injury you were thought to have a ding and if you could look how many coaches how many fingers the coaches were holding up in front of you, you went back in the game.

We know now that's what you shouldn't do because now somebody needs to be assessed for a head injury very carefully.

They need to have the rest.

They sometimes have to stay out of any competition for a week or two and that's actually healthier way to go about it.

So I think the key is if you have a head injury to treat seriously and try to have the rest of the brain needs thereafter.

Thanks for your email.

Let's go to our first caller.

>> Hello Phil.

Welcome to matters of Mine.

Phil, you've mentioned the you've tried quitting smoking five times and you keep going back to smoking through a medication that's new that can help quit for good.

The medications that have been around the longest have been Chantix and bupropion and those are usually the go to medications for quitting smoking.

>> Chantix is a medication that will go to the nicotine receptors in the brain and will stimulate them just a little bit and fool the brain into thinking you're smoking the nicotine receptors are in this area called the nucleus accumbens and if you stimulate that area with nicotine it will cause the brain to have a sense of joy because it's releasing dopamine and you get a surge of dopamine release from the nucleus accumbens.

Here's a front part of the brain looking at you.

Here's the middle part of the brain nucleic accumbens is right in the middle there right smack in the middle of the brain and if nicotine stimulates that you have this feel good effect.

>> You have a muscle relaxation effect and you can actually have a little bit of sharper concentration briefly but then that effect goes away.

>> So the whole idea of Chantix is it'll fool the brain into thinking it's getting a little bit of stimulation release a little bit of dopamine and if you couple the Chantix with bupropion or Wellbutrin that doubles the likelihood that you can quit smoking in itself.

So those are the main medications being used ongoing.

They've been around for twenty years now.

Any new medications maybe do the glucagon like peptide type one receptor agonists, the clip receptor agonists known most people know those medications as Acemoglu side of them because probably the most popular that we hear about they're used for Type two diabetes.

They're used for weight loss.

They're used I think in the future a lot for addiction.

So I think there's a lot of potential for the clip one agonists for helping people with quitting smoking too.

There's a lot of study going into those right now but the main medication we have right now, Phil, will be the Chantix and the bupropion often in combination and you could even use those with nicotine patches nicotine gum in small amounts as a means of slowly tapering off the nicotine.

So from a pharmaceutical standpoint there are a lot of fairly inexpensive ways to try to mimic the effect of nicotine and slowly get off of it.

But the first key will be to identify why you want to quit smoking.

Keep those wise in your mind if you have goals in mind in terms of what you'd like to achieve, you want to have better stamina .

You want to be able to go into social events without the need to smoke a cigaret if you have certain goals in mind that's always where you want to start.

>> Phil, Phil, thanks for your call.

This our next caller.

Hello Alice.

Walking to matters of mind unless you want to know why do you binge eat when you become depressed, when you become depressed your brain instinctually will think that it needs more serotonin.

>> So how do you get more serotonin in the brain?

Serotonin goes in the brainstem and it kind of sprays little amounts of serotonin into the gram better on the outside if you can if you get more serotonin in the brain you'll have a brief feel good effect and a brief feel good effect is where you'll have a sense of calming and less anxiety and that's what serotonin can do if you binge eat.

>> What I'll do is immediately increase insulin if you increase insulin with a high carbohydrate diet for instance, which is what many people will crave increasing insulin will help push more tryptophan into the brain itself.

There's a little netting called the blood brain barrier and if you push more tryptophan across the blood brain barrier into the brain itself tryptophan as a building block for serotonin so indirectly very briefly if you eat a very high carbohydrate diet and are binge eating, you can blast more tryptophan into the brain causing very transient increase in serotonin and they can give you a sense of bliss and a calming effect.

>> Very briefly, the problem is you crash and the insulin increases and decreases will often cause a mood fluctuation.

>> It's itself that many times cause people to have trouble with concentration and and energy levels and so forth.

So it's not a good means by which to try to help with the mood.

So for many people the best way they can alleviate mood disturbances will be to go on a more high protein low carbohydrate diet because that's stabilizing or insulin if the insulin is not bouncing up and down often that's going to help your mood and a lot of different ways.

>> The ketogenic diet which is basically high protein, low carbohydrate diet was a diet that was identified one hundred years ago as a means of treating some types of seizures.

>> So this ketogenic diet had effects on the brain and it certainly relieved sometimes of seizures back even a century ago.

>> Thanks for your call.

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

Our next e-mail question reads Dear dear father, I live in a place that holds a lot of negative memories for me.

Most days I'm forced to recall negative childhood experiences.

I do feel like moving could be a good choice for me and logically logistically that's possible.

Do I need to learn to deal with these memories or should I move?

It all comes down to what's practical.

Some people do indeed have post traumatic memories to such degree that they physically have to leave that environment and that's really OK. You're not necessarily running away from it.

It's something that can alleviate those memories as long as you have those memories under control such that future similar circumstances don't trigger the past memories.

And again you can leave the actual situation and leave the setting where the bad memories occurred.

But if you go someplace else you'll notice sights, smells, sounds can sometimes trigger the past memories so you want to get the so-called post-traumatic stress symptoms under control first and foremost.

>> But logistically if you can move out that's fine.

>> That's what many people do.

Many people, Lou, will move away from their childhood home as a means of in their childhood town as a means of trying to get away from the childhood memories that were not very pleasant for them and that's very, very consistent with good health for a lot of people and there's not a problem with that unless you're not able to do so and then you have to kind of work through it and deal with the memories as they occur when you're on that same site.

Thanks for your email.

Let's go to our next caller.

Hello Ray.

Welcome matters the mind Ray.

>> You are asking a question many people will ask me what's what do we think of our artificial intelligence and how will it affect psychiatry A.I.

is a means by which people can utilize as a tool to help process a lot of information objectively and where is being used in psychiatry?

We'll be looking at different symptoms symptom complexes for people they're called phenotypes and try to determine the best treatment that might be available for them based on large populations of patient results.

Now it's not highly refined just yet but the first thing we need to do a psychiatrist is start to gather up the symptoms and try to gather up as many symptoms as we can very efficiently.

How can you do that?

What you can do that through questionnaires.

>> So I believe that getting patients to rate themselves on lots and lots and lots of questionnaires looking at various domains of symptoms, looking at depressive symptoms, anxiety symptoms, looking at cognitive symptoms, all these different ways that people can find distress with from a psychiatric standpoint if you gather up all their symptoms, the hope is that someday we'll be able to put those symptoms into a big bucket of of a computer system with A.I.

and we'll be able to sort out OK, do they need this medication or that medication?

Would they benefit from this type of therapy or this type of therapy if they have therapy?

Well, could the therapy be done generated through either some successful means of generated therapy where interestingly enough the patient actually gains an attachment to the A.I.

generated responses to to the computer itself?

So it's an interesting phenomenon and I don't think it's necessarily unhealthy in that way because of what you're doing is responding to the recommendations that A.I.

is generating and again, I can only be generated based on what a person will program into it.

Many people are very suspicious about computer generated images and recommendations but basically the computer has to be programed.

So if you program the computer in a very responsible manner, you can have it gather some very good information for you and thereby generate a treatment plan where we're using a like activities now will be having questionnaires for instance generate the note for us as clinicians so you can have in the electronic medical record systems nowadays questionnaires that patients will complete within three to five days before each appointment and based on how they respond to those questionnaires, the pertinent responses go directly into the know.

So the clinician who's evaluating the person already has much of the note already generated basically indirectly generated by the patient, him or herself.

So that note is generating giving the clinician ideas on what direction to go.

Now that's not true.

I but in psychiatry that's a tool by which we can utilize now and I think the key is to not overlook different things.

>> It's so, so easy to overlook different areas if you don't ask and there's only so much time in an appointment to ask questions.

So we want to ask questions about past trauma childhood trauma which is very predictive of trauma responses.

We want to know about attentional difficulties with ADHD symptoms.

We want to know about depressive symptoms.

Do you have periods of time for you having highs and lows is more bipolar symptoms that really differentiates the assessment to such a degree that will determine what direction you need to go with with medication and with psychotherapy.

Now many people will ask me what's the role of psychotherapy?

Well, if you if you think about how the medication works, the medication basically works as an accelerator and brake and the whole neuro transmitter network is affecting the braking and the accelerating in the brain.

So it's a fine balance of the gray matter of the brain accelerating and breaking the psychotherapy or counseling.

As for the purpose of providing for the direction you need to go or want to go in life so if you're not familiar with your certain life's circumstances you're going through a tough time in which you're having difficulty coping by all means you need a GPS like interaction and that's what psychotherapy brings to the table.

So when I drive to Chicago for instance, I always have my GPS on if I drive to Fort Wayne or some local area I don't need a GPS because I'm familiar with it.

That's the way psychotherapy works with psychotherapy.

If you're going through some difficulties on the job with your marriage, with social interactions, if you're going through life difficulties that are particularly problematic for you and you've not learned how to navigate those experiences, that's where you need a GPS like interaction and that's what psychotherapy brings at the table.

So psychotherapy is not always necessary in all situations.

You know, I don't believe that people should have a lifelong psychotherapist with whom they meet every week but there's going to be circumstances where you need psychotherapy.

The idea of psychotherapy is always have a goal in mind, have a goal in mind in terms of what direction you want to go, what you want to achieve from the psychotherapy and that way it's not an indefinite type of interaction.

Thanks for your call.

>> Let's go our next e-mail question our next e-mail question reads deductive over what's the likelihood that a woman who delivers a baby will become depressed about four out of five women will get depressed within one month after delivering a baby to some degree it's not horrific.

It's not to the point where it's debilitating but they'll lose a little bit of sadness is there?

They're still bonding with the baby.

They're still taking care of themselves.

So about four to five women will notice a little bit of a dip.

However, about one out of thirteen women will get what's called postpartum depression.

Postpartum depression is where sometime during the third trimester toward the end of the pregnancy or the within the first month after delivery you could have the onset of really bad depression that is incapacitating.

You have a hard time getting out of bed, taking care of yourself.

You don't want to take care of the baby.

You're not bonding with the baby.

It's a very dangerous situation not only for the mother but also the baby because the baby's not getting bonding experiences.

If there's a man in the household, if the man for instance has an underlying mood disorder himself, he's more likely to have an exacerbation of that mood disorder if the woman is having a postpartum depression.

>> So a postpartum depression affects a lot of different people.

So it's a very dangerous situation.

So postpartum depression itself is occurring about one out of thirteen people you might have heard about something called postpartum psychosis.

It's Andrea Yates is the famous name from 20 years ago where she drowned five of her children in her fifth episode of a severe postpartum depression which evolved into a psychosis they goodness that's a very rare circumstance.

It happens about one out of a thousand to one out of two thousand women who deliver a baby.

But a postpartum psychosis almost always is a feature of bipolar disorder.

So what women are experiencing with a postpartum psychosis is actually an exacerbation of an underlying bipolar disorder where they have a psychotic manic manic episode that can also evolve into depression.

So after delivering a baby there's progesterone drops and when the progesterone drops abruptly you'll have a situation where your hypothalamus is in your pituitary right here in the middle of the brain they're kind of like on fire and when the progestin is dropping you don't have this biproduct progesterone called ALAH pregnant alone that calms down this whole axis of the hypothalamus, the pituitary.

So without the pregnant alone around you can have difficulty with sleep anxiety.

It causes extreme depression and incapacitation in that manner.

>> So the difference between the baby blues which is occurring with about four to five women versus postpartum depression is postpartum depression is incapacitating and goes on for over two weeks.

Baby blues you'll have sadness for a few days but you're still able to take care of yourself and take care of the baby.

Big difference there because with postpartum depression we now have treatments that can specifically address that in a very expedited way.

So we're really trying to look for postpartum depression because of its effect on the mother, the child and other family members as well.

>> Thanks for email.

>> Let's go to our next caller.

Hello Paul.

Welcome to Matters of Mind all you want to know.

>> Well, the drug interactions with CBD CBD primarily inhibit the breakdown of certain medications that go through this particular Cytochrome 450 ISOO enzyme three four.

That's fancy language for saying some medications will have increased blood levels if you use CBD and that's what often tell patients if you use CBD and it's working for you for pain, anxiety, sleep, whatever you're in an area of which you're using him use it on your own but don't use it with any medications that I might give you or that your other clinicians might give you because there's a very high likelihood that some of the medications we're giving you are going to be metabolized or broken down by that isoo enzyme called 384 Watts CBD will do is inhibit that isoo enzyme cause increased blood levels and that can give you more side effects and you're going to say well gee, these medications I'm taking I hate them because I'm having all these side effects.

It's because the CBD oil or CBD itself is increasing the blood levels so by itself controversial whether CBD has medical utilization.

I just tell people if you're using other medications be very aware that you might be having side effects from the other medications that weren't previously apparent.

People often ask about marijuana safe, the dominant marijuana can can inhibit this particular ISOO enzyme called one two and in doing so increase blood levels of various other types of medications so marijuana can increase blood levels of certain medications.

CBD can increase blood levels of other medications.

So you put those two together sometimes you can get a lot of side effects that you might not have had previously and the side effects of for instance in a hypertensive medications can be that you have a lowering of the blood pressure because you're getting higher level of the medications themselves.

So the medications that are being prescribed can sometimes have more side effects because they're having higher blood levels overall.

Paul, thanks for your call.

And let's see we have another email question.

Yes, we do.

>> Here it is in that region of the favor as I approach middle age, I find myself sometimes depressed.

This is new for me.

I have questions question of my accomplishments so far in life .

Is it normal and how should I deal with it?

I would really you know, as you reach middle age sometimes you reach the pinnacle of what you want to accomplish in life when you're an adolescent, when you're in the early 20s, you've always got these goals in mind.

>> You're going to finish school, you're going to get a relationship, you're going to maybe have children.

>> You're going to have a certain size a house.

You have all these goals in mind.

Sometimes people achieve those goals.

What do you do then?

The key will be to always have another chapter in mind, always have more goals in mind, never get stuck on being satisfied where you were as an adolescent or a young adult in terms of what kind goals you want to achieve.

It's great that you achieved him but the key will always be to look beyond the current goals you might have achieved because they might be behind you now it's also important for you to be a mentor to other people.

You've accomplished your goals, help the younger people be able to achieve theirs as well and give them some advice and wisdom on your mistakes and the areas where you found were beneficial.

So it's important for you to not only try to achieve more goals and look for more goals yourself but keep the whole picture in mind and look around and see how you can help other people.

>> That altruistic mindset is something that many people will try to pursue as they get older because when you're younger you don't have the time to think about other people and how you can help them out.

But when you get older sometimes you can use your wisdom and life experiences as a means of really trying to be a mentor to younger people.

>> Thanks you your email.

Let's go to next caller.

Hello Aaron .

Welcome to Matters of Mind.

>> Aaron , you'd mentioned you're in your 30s and will your anxiety and depression get worse?

>> It's hard to say, Aaron , if you're in your 30s and you've had depression, anxiety for various reasons since you were a child.

Yeah, that can kind of be a chronic condition.

The good news is there in the we have treatments for depression and anxiety now that we didn't have as recently as 10 years ago.

So we have a lot of treatments we didn't have previously also you want to make sure that you had the right diagnosis over the course of time.

So a lot of different reasons for anxiety and depression and the treatments will vary accordingly if you have anxiety and depression for instance and you had a lot of difficulty with childhood trauma, let's say you had a difficulty with your parental separation.

You were emotionally abused, sexually abused, physically abused, you were abandoned as a child and all these childhood traumas if you have more than four childhood traumas like that, it's very unlikely that you'll respond to the very popular and a presence that are known as the S.S. Arise.

The serotonin reuptake inhibitors such as Zoloft, Lexapro, Celexa, Paxil, Prozac these are all medications that predominantly increase serotonin.

But if you've had a lot of childhood trauma before the age of eight years old, there's something about the brain where it gets hard wired and it won't respond to those so-called serotonin medications.

So it's important that we identify what kind of early life experiences you might have encountered because that can predict not only the direction you might need to go in psychotherapy but also what medications we might choose.

We want to know that if you have anxiety and depression, what underlying factors might be there if you have a condition like attention deficit disorder ADHD for instance, attention deficit hyperactivity disorder that in itself can cause a lot of anxiety because you're always getting behind, you're procrastinating, you're forgetting to get things done, you're putting things off, you're overlooking situations and then you worry about what you overlooked that creates a lot of anxiety.

Sometimes people will say they have depression and anxiety.

We have to go back and treat the underlying ADHD or ADD that might have been there since childhood but was never identified or diagnosed.

If you have a lot of difficulty with depression you're fatigued and you might wake awaken with nausea, anxiety and even a headache that could be a condition like sleep apnea.

>> So sleep apnea is frequently overlooked.

>> It's where people will snore.

They might pause and are breathing but they're not getting enough air flow to their lungs at night and thereby not enough oxygen to the brain that will make it really tired and grumpy the next day and it'll often be diagnosed with depression.

But as a psychiatrist I'll often refer somebody to a sleep medicine lab and they can do a home sleep study nowadays and they'll identify sleep apnea.

>> They get appropriately treated and off we go and they tend to feel a lot better within a month with or without medications for that matter.

So with the treatment of sleep apnea that can make a dramatic difference in terms of how somebody responds and we want to look at underlying metabolic issues like thyroid disturbances, glucose disturbances.

>> Diet does make a difference for some people.

I'll always tell people to identify the kind of things that really bother you and for some people it'll be gluten for instance.

So when they have those really good roles and some of these restaurants and they notice they feel lousy for the next two days, that could be a gluten intolerance and that can be a factor as well.

So it's important for us as clinicians to look at the whole picture and that's why I think having multiple questionnaires, asking lots of questions, trying to gather up those symptoms so that we can do our own form of A.I.

and put all that data together and try to figure out what the best course of treatment will be to somebody need a accelerator or brake a fix on their brain where they get the acceleration and braking fixed.

Where does somebody need more GPS with psychotherapy where they can actually navigate to the direction they need to go?

So that's what we need to decide as clinicians and I think we're getting better at it as time goes on but we're getting more for this is sophisticated and understanding what direction we need to go based on our knowledge of how the brain works.

Thanks for your call and for us I'm out of time for this evening.

If you have any questions that I can answer on the air, you may write via the Internet at matters of the mind all one word at WFYI Dog.

>> I'm psychiatrist Jay Fawver and you've been watching Matters The Mind on PBS Fort Wayne now available on YouTube God willing PBS willing.

>> I'll be back again next week.

Thanks for watching tonight