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Cameron Psychiatry.

Providing counseling and care for those that may struggle with emotional and behavioral challenges.

More information available at CameronMCH.com.

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Good evening.

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

Welcome to Matters of the Mind now as 20 60 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 ,you may call me in the Fort Wayne area by daily (969) 27 two zero or if you're calling any place coast to coast you may dial toll free at 866 (969) 27 two zero now on a fairly regular basis we are broadcasting live every Monday night from our spectacular PBS Fort Wayne studios which 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 WFYI Moorgate LB's Matters of the Mind at a Dog and I'll start tonight's program with a question I recently received.

>> It reads Dear Dr. Farber, why do some birth control medications affect mental health ?

>> What role do hormones play in a teen's mental health and in mental health in general?

>> Well, birth control medications will affect estrogen and progestin and estrogen and progestin will go up and down in a menstrual cycle.

Estrogen go sky high progestin will go sky high.

Then they start dropping and when you have those fluctuations in estrogen and progestin you can have moodiness and for some women roughly four out of five women they'll notice some mood disturbances to some degree for a three to five days before their menstrual cycle each month.

>> And when that happens they'll notice that it's that time of the month it's coming.

>> If they do a calendar and they watch when their flow will be starting, they kind of predictably know when they're going to have some bad days.

>> Well, that's related to the estrogen and progestin fluctuations now birth control pills sometimes can dampen that out occasionally with some birth control medications by dampening out the estrogen and progestin twin peaks and valleys it can cause for some moodiness.

Now the good news is the birth control medications that we have now compared to twenty five years ago don't even have close to the same degree of mood disturbances compared to the medications that were taken.

Twenty five years or so ago.

>> But if you do have any moodiness, any depression, increased anxiety, difficulty sleep related to taking any kind of birth control medications by all means talk to your clinicians because there's a lot of different varieties that can be taken out there now thanks for your email question.

>> Let's go to our first caller.

Hello J.D.

Welcome to Matters of Mind.

Well, Janice, you had mentioned your spouse is on Zoloft, also known as sertraline for anxiety and is now experiencing depression.

Is that normal?

Should we stop the medication?

>> Zoloft is a medication that increases serotonin and secondarily slightly to increase dopamine transmission.

But by increasing serotonin it can give you somewhat of an emotional numbing effect which can be great for a lot of anxiety conditions including post-traumatic stress disorder, obsessive compulsive disorder, generalized anxiety which is a fancy term for worry.

You have all these anxiety conditions where if you increase serotonin you can dampen down the anxiety itself .

>> Now women by nature have about half the amount of serotonin swimming around in their brain serotonin comes from the middle part of the brain down here called the Rafie Nucleus and the Rafie Nucleus is an area the midbrain and it's kind of in the middle part of the brain down here and sprays in various sites and the gray matter of the brain.

>> And in doing so it can give you a calming effect.

But women neurologically just have half as much serotonin as men and it's thought that that's why women are more prone to having anxiety disturbances.

>> So Zoloft can be a great medication for anxiety for a lot of people because it will dampen down the excessive moodiness and the emotional people can sometimes experience when they're having a lot of anxiety.

But the problem is when Zoloft goes higher and higher and higher sometimes despite its slightly increasing dopamine, it can block the dopamine effect because increasing amounts of serotonin can secondarily decrease dopamine and make you feel blah and I'll make you not care.

You won't enjoy things.

You won't find pleasure in things.

It just makes you feel blah.

I wouldn't necessarily recommend stopping medication on that basis.

>> I talk to your clinician, let your clinician know what's going on in your clinician undoubtably would decrease the dosage and find that sweet spot for you to have less anxiety but yet not have that emotional numbing effect.

Many people on a medication like Zoloft, Prozac, Lexapro, Celexa they'll say they don't they don't have joy, they don't have sadness but they just have a feeling of being flat lined so they just have this emotional numbing effect and it's not a pleasant feeling to experience.

We call the experience alexithymia where you just don't have much emotional overall some people get to the point where they get any donia anhedonia means that you have difficulty having fun and when you have difficulty finding things pleasurable and you have to have trouble finding fun in your life , that's a key predictor that you're going to have more depression down down the line.

>> So we don't want people to have those kind of experiences but any medication increases.

>> Serotonin can do a great job for anxiety but if you get too much it'll cause you to feel that emotional blaw effect and that's what often is interpreted as depression coming on.

So talk to your spouse's clinician about that.

Thanks for your call.

Let's go next caller.

Hello.

>> Welcome to Matters of Mind.

Chuck, you want to know what are the signs of bipolar disorder type two is that genetic bipolar disorder type two is one of the types of bipolar conditions, Chuck, and it's basically phenomenon where people can have a little highs in their mood for a four to six days and during those four to six days they won't get themselves into trouble so much but they'll do things a little bit to the extreme that are noticeable by other people.

>> They don't need to sleep quite as much, might be a little bit more impulsive but they don't do things against the law.

They don't get themselves into financial trouble but they're a little bit more talkative.

They go from topic to topic but on conversations and people notice they're much more lively during that time they might get a little bit more irritable during that time but it's not highly problematic.

But the big problem with bipolar disorder with those little four to six days of hypomania is that you can crash into a two week or more low and so crashes in the lows that will really bother people.

So with bipolar disorder type two we will often give people a mood stabilizer to prevent them from having the little highs which are quite pleasant for a lot of people but they end up causing the person to crash and if you crash that's where people will often feel miserable.

>> So many people with bipolar disorder Type two will be given a mood stabilizer in addition to an antidepressant medication.

It is genetic a little bit more than depression itself.

>> Depression is about thirty five percent genetic with bipolar disorder type two it's about 40 to 50 percent genetic.

It's not guaranteed that if you have family members with that condition that you will get that condition bipolar disorder type one on the other hand is about sixty five percent genetic and that's where people have big manic spells.

They get him in a lot of trouble and they may or may not have depressive follow up after that.

But bipolar one disorder is where people have extreme high manic episodes and those are more genetic than bipolar disorder.

It's interesting though that people with bipolar two disorder often have a higher likelihood of suicide compared to people with bipolar one disorder or BI or major depression itself.

>> So people having little highs and then crashing into the big lows can have a lot of difficulty with having suicidal thoughts.

So it's not uncommon that we see that.

>> Thanks for your call.

Let's go next caller.

Hello Michelle.

What kind of mind Michelle?

You want to know if I've ever heard of people experiencing the sound of glass breaking in their head and what's that mean?

Is that a symptom of something bigger?

It's difficult to say, Michelle.

It could be an ear, nose and throat difficult where you're having a type of tinnitus.

Maybe you have a cyst on your inner ear.

You have tinnitus where it's a ringing in your ear and it's coming across maybe as a sound of glass breaking in your in your head.

The sound of glass breaking could be related to loss of hearing.

So when people are having a loss hearing, sometimes their brain will fill in the blank and actually create sound that is not there.

So I'd want to know is it on one side is it on both sides of the head when people have difficulty with more serious psychiatric problems they'll have a lot more things going on than the isolated symptom of perceiving the sound of glass breaking in their heads.

>> They'll have other conditions for either of us for instance having difficulty with paranoid sensitivity.

They'll have difficulty with hygiene.

>> They'll have more social withdrawal problems concentrating in addition to having these sounds going on in the background.

>> So I'd say the first thing you ought to do if you're experiencing the sound of glass breaking inside and you're hearing that shattering going on inside your head, talk to your primary care clinician.

You might want to get checked out with an ear, nose and throat doctor.

But in psychiatry we call that particular symptom and auditory illusion where it's not specifically related to a distinct auditory hallucinations where you can hear a voice talking to you or you have something very distinctive.

An illusion is where you have a sound that sounds like something and it's not a clear cut hallucination in that in that regard.

So I'd recommend that you see a primary care clinician to check you out and see if there's any ear nose, her throat difficulties that might be contributing to some of that myself.

>> Thanks for your call.

Let's go to next email.

We have another email waiting for us here.

The email Regidor to Farber if people just watch their diet and exercise, would we have a lot fewer mental health problems?

>> I don't like that word just because just watching your diet and exercise it sounds so simple.

>> So why don't people just watch their diet and exercise more?

We'd have fewer mental health problems because people feel better if they watch their diet and exercise more.

>> That's true.

But we have to think about the chicken or the egg here.

>> All right.

So you're right.

I mean if people watch their diet on a regular basis and were more conscientious about limiting anything that comes from a box or a bag and not eating refined carbohydrates watching their sugar intake if they ate more of a ketogenic diet my goodness, we've heard about the dening diets with childhood seizure disorders for one hundred years now where our ketogenic diet is where you limit carbohydrates and you eat more protein and fat and is very effective for seizure disorders especially with children.

>> But now we've realized that a ketogenic diet is very good for the mood and it's very good for concentration.

A lot of the people out in Silicon Valley who are working with software actually have come to realize that a ketogenic diet combined with intermittent fasting where you don't eat breakfast and you might go 16 hours maybe 20 hours before your next meal day by day by day and you allow yourself to have a rest of your of your insulin levels in that way, thereby burning off some ketones which come from fat that can be helpful as well.

>> Exercising increases to very important chemicals in the gray matter of the brain.

If you exercise on a regular basis you can increase glutamate which is inters energizing and you can increase gabb which is calming and that's why when people exercise they feel good.

They have an energized effect after exercising but they also have a calming effect.

If you do it on a regular basis and you're really into the zone and you're feeling well without here's the problem when people get depressed, when people have various anxiety conditions, when people have ADHD they are prone to having disturbances with motivation, energy level good judgment sometimes and they will start having difficulty with eating properly.

They'll have a craving for carbohydrates.

They won't have the motivation to take care of themselves physically and kind of a spiral from there.

>> So I think it's important that we don't shame people with mental health disturbances in saying well gee, if you just diet and exercise you'd feel a lot better.

They would but let's think about the underlying condition.

I'm more prone to thinking OK, where did you start having difficulty with eating more carbohydrates?

>> What did you notice that you weren't exercising as much because a lot of these are just good healthy habits.

>> That's that's correct.

But you can often have an exacerbation of getting into bad habits if you have mental health problems.

So let's get at the underlying core of this and take care of the mental health problems for a lot of these people who are having trouble with blasting themselves with carbohydrate and not getting the physical activity they need.

We said the same phenomena with Type two diabetes.

That's where you have adult onset diabetes.

When people have adult onset diabetes Type two diabetes they'll often have difficulty with motivation energy level.

They crave carbohydrates.

They don't sleep well.

They have all these horrible habits.

>> But you have to think about it.

Their insulin levels are sky high and their insulin is no longer as sensitive as it used to be and they're having trouble with glucose regulations that will give you difficulty with your thinking, your energy level, your motivation.

Yeah, we understand those people are going to have a lot of time.

What a hard times exercising and watching their diets but exercising and watching their diets will help them with the type two diabetes.

The same is true for depression and anxiety.

We have to take care of the underlying condition of depression anxiety many times before we can get these people into the healthy habits.

>> So it's a nice it's a it's a balance but I always encouraging people don't feel ashamed that you're not doing the right things in your life .

Let's get to the underlying reason why you're having trouble with exercising and watching your diet.

Let's do something about that.

Thanks for your call.

>> Let's go to next caller.

Hello Matthew.

Welcome to Matters of the Mind.

Matthew, you mentioned that you have obsessive compulsive disorder and medication is not effective.

>> Is there anything new on the market for obsessive compulsive disorder?

>> Matthew, from my awareness the last time we had a newpmedie compulsive disorder was about twenty five years ago and that was Luvox flu vaccine.

So vaccine is a medication that will increase serotonin transmission and obsessive compulsive disorder as basically a condition where you will have obsessions and those are round and round thoughts that you can't get off your mind and you know they don't make any sense but you can't get them off your mind.

>> And then due to those obsessions you often have compulsions where you do things to try to get rid of the obsessions and you'll do things like checking and counting and and questioning different things and you can't get those compulsions off your mind and you keep doing them and doing and doing them.

We often hear about the compulsive hand washer is the people to check the door and check the locks repeatedly and they have a hard time getting through the day without counting over and over and over and they have to do things a certain number of times.

>> Well with OCD you've got the circuitry in your brain that's going round and round and round and it's very much like an old record player where the needle gets stuck and that's what OCD is all about.

The only medicinal treatment we have for that will be to increase return in transmission.

>> Originally it was done with Fluoxetine or Prozac at doses around eighty milligrams a day which is two to two to four times higher than the usual doses that we use for depression.

>> Zoloft Ritalin which I mentioned earlier is a medication that's used up to four hundred milligrams a day for OCD.

>> But Luvox of oximeter I think that's going to be the best bet for a lot of people because it does increase serotonin but secondarily it will stimulate this particular receptor called and a sigma one receptor and if you stimulate sigma one receptors it can have an antiinflammatory effect and receptors it has a secondary effect on serotonin and glutamate and other chemicals the brain.

So the bottom line is by increasing serotonin and sibling stimulating the sigma one receptor you can have a relief of OCD symptoms but that's the best type of medication we have nowadays for OCD.

>> Sometimes medication will be added to the serotonin medication such as the anti epileptic medications sometimes sometimes anti antipsychotic medications at low doses will be added.

>> But for OCD some of the best treatments will be behavioral therapy which has been available for thirty years now for OCD to try to teach yourself to either out loud or inside your brain say stop when you start these obsessions, when you start to compulsions and you start washing your hands over and over again if you can say out loud and quietly perhaps so other people don't hear you stop if you say that that actually you can change the secretary of the brain and knock off that Neil was going around and around your brain and allow you to stop.

So saying the word stop is actually a very simple behavioral technique that I found to be very effective for a lot of people.

Matthew, Matthew, thanks for your call.

>> Let's go our next caller.

Hello, Dylan.

Welcome to Matters of Mind.

Dylan, you want to know if the abuse of psychotropic medication can cause long term mental health effects?

>> It depends, Dylan, on which type of medications to which you refer.

>> Now the abuse of a stimulant for instance, a stimulant when you take a higher and higher amount of it can give you energy for a while and then it goes away.

>> It can give you suppression of the appetite for a while and then it goes away.

So the abuse of a stimulant which we'll hear about predominantly with a medication like Adderall Adderall is one of the more abused stimulants on the market right now.

>> It's frequently passed around like Tic Tacs in the community.

So it's it's very important that we as clinicians are very careful about how often and how much Adderall we do prescribe.

For instance, in my practice I haven't prescribed Adderall for people on a regular basis probably for over ten years or so I will be more likely to prescribe the longer acting stimulants that don't tend to cause you to get a higher that energizing effect.

>> The other type of medications out there that potentially can get abused will be the benzodiazepine medications Ativan, Xanax, Klonopin, Valium.

>> These are medications that will make you feel calm.

They work very effectively and going right to this area of the brain called the amygdala.

>> They go there, they turn down the volume control on anxiety and irritability and they make you feel calm and they work very well for that.

>> The problem is you have to keep taking them more and more and more not uncommonly to get the same kind of effect.

>> And then as we get older, if you keep taking those kind of medications like Xanax out of an Klonopin, you can actually have a diminution of your concentration and memory.

So you have trouble memory disturbances especially as we get older.

>> Even younger people though with depression if you're in your 30s and 40s and you're taking a medication like Xanax or alprazolam on a regular basis, you might feel calm but you'll notice that you can't process information as efficiently so you'll have trouble with processing speed in your brain such it'll feel like your brain is on slow Internet and you're kind dragging along with your thought process and people don't realize how slowly their brains have been working until they get off of a medication like Xanax or Klonopin and many people will feel more depressed when they're on Xanax or Klonopin.

They'll feel calm but they'll feel more depressed.

So we're often trying to get people off of those medications that can give them long term problems.

>> Thanks for your call.

next e-mail reads Dear Dr. Fauver, is it common for someone to be an extrovert most of their lives and then for no apparent reason prefer quieter evenings in the man cave?

>> I think I don't think my loved one has any mental health concerns but I find myself surprised by this.

>> I don't know I mean for a man to to whom you're referring to be an extrovert his entire life and all of a sudden be more reclusive, I'd wonder OK, what's going on in his life ?

>> Is he recently retired because many times when people retire they lose that social network and they become more reclusive and that's OK for a while.

But many people can notice those are early symptoms of depression, depression as a mood disturbance can cause a person to get a little bit more withdrawn if a person starts using marijuana for instance, they'll often be more inclusive and they won't want to rally around people so much and they just want to chill out, not think about anything for that matter.

So you'll have all these different type of things that could be occurring.

But I'd start that conversation.

You know, you used to be around people all the time.

What's going on?

Why are you being more reclusive at this point?

But sometimes there can be reasons behind that.

But if it was a love one of mine, I'd be asking some questions about what might be going on because I do this all especially would go into retirement.

>> They just shut down and a predictor for Alzheimer's dementia will be lack of intellectual stimulation but also lack of social stimulation.

So as those of us over 65 or 70 years of age start becoming more reclusive and and we're no longer in the work environment anymore, it can be a predictor for having trouble with memory disturbances long term because we need to be around people and we need to have that social connectedness that's there.

>> Thanks for your email.

Let's go next caller.

Hello Jim.

Welcome to Matters of Mind.

>> Yeah, I have a couple of questions a while back you said that marijuana affects the white matter in the brain.

I was wondering does CBD do the same thing?

>> And second question do you subscribe to Life Extension magazine all answer the second question first do I subscribe to Life Extension magazine?

I do not but that doesn't mean I can't endorse it one way or another but I don't subscribe to it.

>> So marijuana versus CBD my biggest concern with CBD will be if you take other medications CBD causes so many drug interactions it'll cost some medications to give you a higher level.

Some medication will be at lower levels.

CBD is really tricky and you have to dose it just right.

>> I just talked to a lady today who's in a pain management clinic and they're prescribing CBD for her.

It's just it just needs to be so carefully prescribed to be able to be effective.

I don't believe, Jim, that CBD affects the white matter of the brain but when we're talking about white matter of the brain, we're talking about individuals primarily under 24 years of age.

And I love the fact that you heard me say that because the white matter of the brain is the brain's natural insulin.

It's called myelin and it's the brain's natural insulin or insulator is what it is.

>> So it's the brain's natural insulation overall and it insulates the individual neurons.

>> We have all these neurons.

We have one hundred billion neurons in our brain and they all have all these connections anywhere between 20 and 50 thousand connections with each individual neurons.

You got all those wiring going on in the brain and all that wiring is protected by these insulating sheaths called myelin.

>> The problem with marijuana before the age of twenty four twenty five years of age when the brain is still growing is that marijuana significantly suppresses the myelin development and the brain.

>> You need myelin.

You need the white matter of the brain to be able to have good connectedness between one part of the brain and another and it's for that reason that people will have difficulty especially in their early years before twenty four years of age with motivation, with concentration.

>> And there's been some estimates that if you continue to use marijuana on a regular basis over the course of your late teens and early 20s, you can substantially decrease your IQ points compared to what they would be otherwise.

>> So that's why I'm always emphasizing to young adults don't use marijuana especially before you're twenty four twenty five years of age because it can possibly give you irreparable damage to the brain by suppressing that white matter again the white matter is important for connectedness between one neuron another you might have heard about a particular condition that's commonly discussed out there that's the where the myelin is is diminished and then shrinking down some and it's called multiple myeloma.

>> Those type of conditions can give you difficulty with being able to concentrate and be unable to focus and keeping your mind on things.

So if you have myelin sheath disturbances it can give you difficulty with concentration and judgment and that's what marijuana can cause for a lot of people long term.

>> So with marijuana definitely disturbances with a brain where the myelin sheath is not being adequately developing developed over the course of time CBD we don't know for sure just yet what effect that has but it's not apparently as toxic on the brain as marijuana is.

>> My biggest concern with CBD will often be its drug interactions.

>> But secondarily, Jim, I'm wondering when people are using CBD, why are they using it?

Are there other means by which we can help people other than CBD to try to help them often with the anxiety that they're experiencing?

Jim, thanks for your call.

Unfortunately I'm out of time for this evening.

So if you have any questions that I can answer on the air that you'd like to send me, you can email me via the Internet at matters of mind at FWC dot org.

>> I'm psychiatrist Jeff Offer and you've been watching Matters The Mind which is now available also on YouTube God willing and PBSC willing.

>> I'll be back again next week.

Have a good evening.

Thanks for watching tonight Cameron Psychiatry.

Providing counseling and care for those that may struggle with emotional and behavioral challenges.

More information available at CameronMCH.com.