Nine .->> Good evening, I'm psychiatrist Jay Fawver live from Fort Wayne , Indiana.

Welcome to Matters of the Mind now in its 27th 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 dialing (969) 27 two zero or four calling any place coast to coast you may call 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 lie in the shadows of the Fort Wayne campus.

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

>> It reads Durata favor Is there anything I can do to help with my anxiety and any lifestyle changes I should make?

>> Best thing you can do to deal with anxiety I would think right off the bat would be a journal try to journal on a day to day basis about your current worries, what you're trying to do about them, what you hope will happen and what you wish won't happen and just kind of journal that very briefly day by day or even week by week for that matter if you journal day by day, week by week and then review how you journal a year ago five years ago and you go back on your past journaling etc.

this way of giving you some reassurance that the things you worried about in the past that worked out there are not that big of a deal.

You got past them.

So journaling is a very, very powerful tool to deal with anxiety.

>> Now what you can can you do physically one of the best things you can do physically is to exercise.

It's something that people don't realize helps them until they do it.

And you talk to a lot of people after they exercise for 30 minutes they'll say wow, I feel so much better.

>> I should do that all the time then it's a matter of getting back out and doing it again when you exercise.

>> It's an interesting phenomenon in the brain because when you exercise the brain releases glutamate which is an excitatory chemical and also releases GABA which is an inhibitory canik also you got to accelerating chemical and breaking chemical both increasing at the same time and in doing so many people will notice that when they exercise they feel more energetic but they also feel calmer and as they leave the site where they had exercise whether it be walking, bicycling, whether it be running, lifting weights all these different types of exercises can be helpful and giving you a calming effect but giving you an energizing effect.

Doing that day by day can help in many different ways.

It can help with your concentration or focus.

It can help with your sleep.

It can help with your overall ability to feel better and have improved wellbeing.

>> So exercising is a very, very good means of helping with your mood and your concentration.

>> There was a high school in the northeast Illinois area years ago that had a program where they had their middle school and high school kids exercise every morning for about 30 minutes.

>> They just went out and ranpo.

They did some kind of exercise.

They noticed their grades improved and the likelihood that they needed coffee in the morning decreased substantially .

Naperville High School is the name of the school and it was a study that was done twenty five years ago but it was still valid because it showed that exercising in the morning even for middle and high school kids who don't want to exercise at all typically the mornings was very helpful and this is despite their often needing to sleep in in the mornings many high school kids need to sleep in later the mornings because that's how their circadian rhythm tends to run.

When you're an adolescent years of age you typically want to sleep later in the morning but you want to stay up late or at night.

>> That's just not you being a lazy teenager.

That's how your brain is working.

>> So your circadian rhythm naturally wants you to stay up later and get up later when you're an adolescent.

If these kids are exercising it actually energized them in the morning and got them going more on their scores were among the best not only in the country but in the world when they looked at their science and the literature scores.

So Naperville High School that was done back in the 1990s I believe where they did that on a regular basis.

Fascinating, fascinating phenomena at the time.

But exercising is a marvelous means of helping with anxiety.

I don't recommend a lot of supplements for anxiety.

I don't think it's really worth it.

But if you are to take a supplemet that you want to try something very simple the active ingredient ingredient of green tea which is called the Anine it's something that some people can take two hundred milligrams three times a day you have to drink about twenty cups of green tea to get that kind of amount.

So we'll often recommend to people if they want to take some kind of supplement they can try that.

But it's a lot easier just to simply try to exercise on a regular basis and journal on a regular basis.

Those two things can help a lot of people from an anxiety standpoint.

The third thing I could recommend outside of exercising journaling would be something along the lines of just trying to understand what's causing your worries and trying to get a better handle on the worries itself.

Having some kind of purpose in your life , having some meaningful activities, trying to look at the whole picture where you understand the world is not all about you.

>> It's about you being part of the world and serving the rest of the world around you.

So getting the focus off yourself often can significantly decrease the number of worries people will have.

>> Thanks for your email.

Let's go to our first caller.

Hello Michael.

Welcome to the mind.

Michael, you want to know if it's possible to bring someone out of psychosis without medication or professional help psychosis Michael is a potentially brain damaging events.

>> Psychosis is where somebody has lost touch with reality and during that time it's like having a seizure when people have epilepsy and they have a seizure, a seizure is a toxic phenomenon occurring the brain where there's excessive glutamate and the glutamate is that excitatory chemical.

>> But in the case of seizures there's too much and you're you'll have a seizure.

It's not a good idea to not seek professional help if you've had a seizure because the idea of having treatment for seizures to prevent another one if you have another seizure and another seizure at another seizure, it's actually toxic to the brain and it could damage the brain.

>> The same can be true with psychosis.

Now if somebody is having a psychotic incident and is due to a drug related phenomenon such as let's say they took LSD if they took LSD and they're psychotic, OK, maybe you can talk them down from it if it's a one time occurrence.

>> But if it's related to a severe emotional state, you might want to get them treated as soon as possible because if they're having a psychotic out of touch with reality experience, they want to get out of that experience as soon as possible because during that experience there's a lot of damaging things going on the brain in the long run you can have a dementia like experience where you start shrinking this part of the brain called the hippocampus because increased neurotoxicity can shrink very delicate parts of the brain among which are the hippocampus and that's very important for memory.

So you can have a destruction of your memory if you have recurrent psychotic events in a similar manner you can have if you have recurrent seizures the brain as well.

>> So you want to take a psychotic episode very seriously if it's drug related, if it's a one time incident, sometimes people do indeed get talked down from it.

But we also want to have that person checked out to make sure it's not a recurrent event schizophrenia, bipolar disorder sometimes severe depressions can be accompanied by psychotic events where people are losing touch with reality.

So you want to make sure you understand the underlying reason for the psychosis itself and that's the best reason to seek professional help if somebody is having a psychotic experience.

>> Michael, thanks for your call.

Let's go next caller.

Hello Shannon.

Welcome to Mastermind Shannon.

>> You want to know if clozapine also known as Clozaril triggers dementia if it runs in your family or if your older clozapine itself is considered to be one of the best if not the best medication for schizophrenia?

It does have some toxic effects associated with it, including some possibility of decreasing bone marrow production of white blood cells, particularly in the first two years of its use.

It can also have some detrimental effects on the heart and that's why people on clozapine have to be carefully monitored.

>> But clozapine inclose real is an extremely effective medication for schizophrenia.

Sometimes it's used for bipolar disorder now schizophrenia and bipolar disorder by their disease state themselves can give you difficulty with dementia and memory disturbances overall.

>> So in other words, clozapine I wouldn't say is directly associated dementia but the conditions for which clozapine will treat can be associate with dementia including mood disturbances and schizophrenia.

>> So I think the first goal would be to try to get those conditions under good control with whatever type of whatever type of medication seems to be most effective because schizophrenia, mood disorders, the conditions for which clozapine treats are the with dementia itself.

>> Thanks for your call.

Let's go our next caller.

>> Hello Mario.

Welcome welcome to Matters of Mind.

Mario, you want to know if people with anxiety and depression are more likely to experience disturbing dreams, possibly people with anxiety such as post-traumatic stress, especially if they've experinced extremely traumatic events in the past sexual abuse ,physical abuse.

They've been involved in a motor vehicle accident combat if they've been involved in some very traumatic incidents in the past, the brain's still processing that not uncommonly.

>> And when you're sleeping at nighttime, Mario, the logical part of your brain up front here is shut down because you're a logical part of the brain the rest because during the day when you're thinking really hard you're using this front part of your brain over and over and over again and it gets tired.

So what do you need to do?

You need to recharge it like a cell phone battery.

The way you recharge the front part of your brain is by going into REM sleep.

>> When are you going to dream sleep?

You don't have any logic during that time because the logic part of your brain is shut down so you have all these abstract illogical dreams and if you've been traumatized in some way, shape or form, it's possible that you can have more disturbing dreams.

Now it's not diagnostic.

Twenty five years ago there was a phenomenon called false memory syndrome where some therapists were inadvertently and mistakenly telling their patients that if you have bad dreams it means you've been abused.

>> It was a trend about twenty five even thirty years ago it was not found to be valid.

You won't hear about it so much anymore but it was called false memory syndrome where the therapist would actually tell the patients that they had been abused and sometimes to be very specific on who they believed abused the patient that was very problematic and entirely inappropriate for a therapist to say that and to have those kind of conclusions when you have abstract dreams are very symbolic You can have dreams about a close family member has nothing to do with that family member.

It has more to do with that how that who that family member represents to you and that could be an employer it can be a friend or somebody outside of that family member really is.

And if you dream about that family member it might not having to do with a family member him or herself.

So we need to keep that all in mind.

But yeah, when you're having some troublesome type of memories that are kind of in the back there, they might kind of come out in an abstract fashion when you're more depressed and when you're more anxious.

Now when people are depressed they tend to dream more so they have increased dreams when they're more depressed.

>> It used to be thought they used to be thought that the antidepressant medications mainly worked by suppressing dream sleep which they did in many cases.

>> So you had worse you had a few or worse or fewer bad dreams but your depression might get a little bit better.

>> But that wasn't the main way that the antidepressants would work.

But it was notable that many of the antidepressant medications did decrease the number of dreams people had on dreaming is very good for the brain.

As I mentioned, you're resting the logical part of the brain and when you dream it tends to fire up the hippocampus area of the brain.

The memory center in which I referred earlier if you fire up the memory center of the brain that actually helps you be able to process information better the next day.

>> So dreaming is good for the brain.

>> It's just that bad dreams and nightmares whether awakening you that's not so good for the brain because you're not getting a good quality of sleep then thanks for your call.

>> Let's go to next caller.

Hello John.

>> Welcome to the Mind John.

>> You want to know if there was a connection in the brain for for curing if there's a way that you could cure dementia and addiction using ultrasound?

>> I wouldn't recommend ultrasound in terms of treating the brain, John, because we got this big thick skull out here on outside of our brain and ultrasound waves would need to go through that thick skull.

>> Probably not a good way of treating any disturbances in connections with a brain for dementia or addictions.

>> Now where you might get some benefit would be with magnetic type of stimulation.

There there are magnetic treatments now that can be helpful for depression would they help with addiction or dementia?

We don't know yet.

So in the future maybe there will be more magnetic type of trans magnetic stimulation.

>> Those kinds of treatments that might be better treatments for those kind of conditions but ultrasound itself probably not so much because of the thick skull that we all have John.

>> John, thanks for your call.

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

>> Our next e-mail question reads Dear to the father Is insomnia linked to depression?

When people have depression it often starts out as worry and anxiety and you start dwelling on stuff and when you start dwelling on stuff it'll keep you awake at night for the first few hours at least then you go to sleep.

>> So initially people will have a condition called initial insomnia where they have a hard time getting to sleep as you have more depression emerge not uncommonly people will have frequent awakenings and then people can have what's called terminal insomnia where they are awakening earlier than they expect awake to awaken and they'll awaken at 3:00 and 4:00 in the morning and they can't get back to sleep.

>> So there's different types of insomnia that can occur.

My biggest concern about insomnia will be if you have ongoing insomnia it will increase the likelihood of worsening depression itself because again when you're sleeping when you go through all the different phases of the dream, sleep is very important to help you think and concentrate and think logically the next day that'll keep you out of depression.

>> But there's also non REM sleep which is a really deep sleep that gives you a very relaxing effect all over your body.

So your body's not so tense but a non REM sleep is where you're going into extremely deep sleep and during that time if you're awakened you will be somewhat confused and a little bit disoriented for a few seconds.

>> So when you are going thrugh a time where you haven't been sleeping well and you finally crash and you go to sleep not commonly you go into non REM sleep very quickly and then you go into REM sleep thereafter so non REM sleep where you're in a very deep relaxed sleep and in REM sleep is when you're dreaming and the logical part of your brain is shut down.

>> That's why you're having all these abstract don't make any sense out of of dreams.

Those types of phases of sleep are very very important.pSo if u start to have a disruption of those different phases of sleep and in doing so you lose logic if you lose logic and you can't think of your problems as well, you're less likely to cope and you have difficulty with what we call stress resilient stress resiliece just means you're able to put up with stuff as the situation arises when people have difficulty with stress, resilience or having more and more difficulty putting up with stuff and any more we're looking at symptoms such as stress resilience.

>> We're looking at symptoms of anhedonia which refers to not taking pleasure in things those are very specific symptoms that are lingering and residual with many unresolved depressions, many people with depression.

You know we can treat them with various medications and they'll have less crying.

They'll have more energy, they'll have a little bit more get up and go.

They might even have better concentration.

But if they have lingering difficulty with stress, resilience or anhedonia where they don't cope with things very well or they don't enjoy things very well respectively, they will have a greater likelihood of having another depressive spell later on.

>> So we're trained to use questionnaires and scales by to determine how much difficulty they're having enjoying day to day life something as simple as enjoying a sunrise or a sunrise sunset.

The smell of flowers, their favorite foods, their favorite beverage first thing in the morning.

>> Are they still able to enjoy those type of things when they're as fun to be had?

Are they able to have the fun?

So anhedonia is a symptom that we're often observing but again it goes along with stress resilience.

>> If you have difficulty putting up with stuff, if you have trouble dealing with day to day environmental struggles, you bet that'll make you more likely to have depression later on and that all leads to not uncommonly difficulty with sleep at night.

So it kind of runs together as you have difficulty with sleep.

It gives you trouble with concentration and coping mechanisms as you have trouble with concentration and coping-mu difficulty to sleep.

>> So it goes round and round in that way.

>> Thanks for your call.

Let's go to next caller.

Hello.

Welcome welcome to Matters of Mind.

>> Hello.

Hello William.

Yes can you hear me?

I can hear you fine.

>> You're on the air William OK. My wife is having a problem falling asleep for no reason like driving a car down the road and fall asleep or sitting at the supper table and falling asleep.

That's not good William.

No, not good at all.

I'm a size car about a week ago oh my goodness I'm a psychiatrist but I do carefully look for conditions such as what you're describing.

So what you're describing is either a neurological condition or it's obviously a sleep medicine condition.

>> William, does your wife to your awareness snore at nighttime or does you ever pause and are breathing at nighttime?

>> She has a seatback machine so she doesn't snore anymore.

Good.

>> And is her C Pappe being monitored in terms of its effectiveness?

>> Yes.

Good.

Does she clean it on a regular basis?

Yes.

Good knew the sleep medicine doctors perceive that ongoing sleepiness is something that's related to unresolved sleep apnea treatment or are they thinking it's something else or?

>> Well we have an appointment but it's not until November might want to call them now because she's starting to have some accidents.

>> So I would suggest you let them know what's going on at this point.

>> There's several things going to be going on there.

Number one, let's assume the sleep apnea is properly treated which is fantastic and they can actually monitor that with little computer chips now.

So if the sleep apnea is being properly treated, that's good.

>> Secondly, there's a condition where OK, you have sleep apnea but you're still sleepy so you do need medications that keep you awake despite your sleep apnea beating properly to treat it.

>> And those medications would be medications like our Modafinil which is known as Nuvigil or Modafinil which is new known as Provigil.

>> Has she taken those in the past or is she taking those now ?

>> No, she's not.

Yeah, they're safer than stimulant medications.

Back in the old days we used to give stimulant medication such as the amphetamine or even Ritalin products back in the old days.

But nowadays we're using our Modafinil or Modafinil.

They keep the brain awake and they do that by firing up the front part of the brain during the day because it's thought that some people even if they have adequately treated sleep apnea, they still need increased histamine in the front part of the brain.

And if you increase histamine in the front part of the brain, it keeps your brain awake and that's what our modafinil modafinil will do.

>> So if you think about an antihistamine which blocks histamine making you sleepy histamine enhancers such as our Modafinil, our Modafinil keep the brain awake and give you more of alerting effect, they also will increase this particular chemical in the front part of the brain called C phos c fosi and by increasing C force it also keeps the brain awake.

So from a medicinal standpoint that's what we will often used just to keep people people awake and there are some other medications it can be used to work like that that also work on dopamine and norepinephrine which are energy enhancing type of chemicals as well.

>> Now I'd also want to make sure, William, that your wife does not have anemia low red blood cell count low hemoglobin can sometimes be a factor in making somebody really sleepy so you can have sleep apnea and have all these other conditions separately.

We'd always want to make sure thyroids OK, women and men, women more than men will have low thyroid as they get older.

>> William, I'm curious have has anemia ever been brought up as a possibility low thyroid or even diabetes are those factors that she's had in the past or currently treated well, she currently tried treating diabetes but none of the others that I know of and she gets a regular blood test because of the dire diabetes.

>> Yeah, the diabetes they'd get an A1 seen.

You want to make sure that's OK sometimes if people have wild blood sugar swings they will be tired from that.

I don't think that you're describing that.

You're talking about herby and sleepy and actually going to sleep to me that no one would be some after effects of having inadequately treated sleep apnea where she needs the medication on top of the C Pap mask itself.

But thyroid cancer low thyroid can make you really tired and sometimes sleepy.

Low iron definitely can and that could be very subtle.

People can have a very small gastrointestinal blood bleed where they have their bowel just slowly leaching out and it's bleeding a little bit of blood and they can have low iron from that.

So I've seen people have low iron have a lot of sleepiness going along with that.

But there's also another phenomenon we don't hear about it so much with people as they get older but sometimes a phenomenon called narcolepsy.

Narcolepsy is where somebody will be standing talking to you and all of a sudden their knees buckle and they going in they go directly into dream sleep very, very quickly and it's not something I would expect to occur older in older life I'd go a lot more along the lines of sleep apnea and other kind of direct conditions like that that can make a person sleepy.

>> But William, you know, as a psychiatrist I don't think that's a mood disturbance or getting sleepy.

I don't think it's anything having to do directly with the emotional state or cognition as things are which I usually treat.

>> But when I see somebody I'm always asking them do they snore at nighttime as have other people told them that they will stop breathing in the middle of the night?

Have they been assessed for sleep apnea?

OK, your wife has but now it's time to maybe look at some other factors that can go along with that.

You'd be surprised how many people are referred to me with symptoms of depression and these are the kind of conditions I will sometimes see in sometimes you can have even more remote type of possibilities as having a cardiac rhythm disturbance where all of a sudden the cardiac goes in the heart goes into cardiac rhythm and that decreased blood flow to the brain that can make you sleepy so way I think there's a lot of things that could be pursued at this point but I wish you the best but get your wife checked out, get her to sleep medicine doctor hopefully sooner rather later.

>> William, thanks for your call.

Let's go to our next caller.

Hello Ben.

Welcome to Mars the mind then you want to know about micro dosing whistle seibold mushrooms you had mentioned it's gaining popularity to treat mood disorders and you want to know what I think micro dosing business where you're using air point three point four milligrams more days than not of psilocybin which is the active ingredient in these magic mushrooms that people will describe these mushrooms can be and they have been studied where they're given and twenty five milligram doses so much higher doses than micro dosing but twenty five milligram doses on a one time basis will work within about thirty minutes last for forty six hours during that time you need to be closely monitored and during that time somebody will be sitting with a therapist as they're being treated for post-traumatic stress or depression so it needs to be carefully monitored.

Psilocybin with micro dosing.

>> Well it's something where theoretically it's increasing the branching and the fluffiness of neurons is called neuroplasticity.

>> That's a good thing for the brain.

But I think we're a year or two away from seeing in the mainstream news.

I would not do it just recreationally to try it out because it can have some toxic effects as with many types of treatments then if we give our brain too much of what might be good it can be neurotoxic and actually cause damage.

And in the case of psilocybin, too much too soon can cause psychosis but it's not thought to be addictive but it needs to be done under supervision then thanks for your call.

Unfortunately I'm out of time for this evening.

If you have any questions concerning mental health issues that I can answer on the air you may write me via the Internet at matters of the mind all one word at WFYI ECG I'm psychiatrist favorite.

>> You've been watching Matters of mind on PBS Fort Wayne now available on YouTube.

>> Godwill and PBS will all be back again next week.

>> Thanks for watching.

Goodnight