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>> Good evening, I'm psychiatrist Jeff Alver live from Fort Wayne , Indiana.

Welcome to Matters of the Mind now and as twenty seventh 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 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 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 via the Internet at matters of the mind all one word at WSW Edgard that's matters of the mind at WFYI Borg and I'll start tonight's program with a question I recently received.

It reads during a half hour Can we cure depression?

>> I've done well the past few years but I wonder about depression coming back.

I'm in a new relationship and I have a new job.

I'd like to figure out ways to make me move beyond this.

I presume and the potential for depression the more episodes of depression you experience the more likely you can have a recurrence later on and the general rule of thumb will be three strikes and you're on that means that if you've had three or more episodes of depression lasting for at least two weeks, you probably need to be on an antidepressant on going otherwise you'll have a 90 percent chance of relapsing.

>> But the good news is we do have some newer medications coming out for the treatment of depression among which have been ketamine as ketamine also known as bravado and a more recently one called veloute which gives you high doses of dextromethorphan.

The bottom line is those particular medications will affect a whole different chemical that we've been focusing upon for the past six decades that chemical being a neurotransmitter called glutamate glutamate seems to rapidly increase the fluffiness of the brain.

>> And here's what happens when you get depressed recurrently your brain neurons become less fluffy and it's like a a tree in your backyard.

and instead of having 30000l up- little branches on it, it only has twenty thousand branches.

That's what happens to your brain when you have ongoing depression your brain literally starts to shrivel up.

It's not that the neurons are dying off, it's just that your branches are getting less fluffy.

What do you do when you see a tree that has fewer branches?

You tend to give us some fertilizer and that's what the neurotransmitter glutamate can do if you can enhance glutamate transmission you can basically make the little neurons more fluffy.

>> We call it gluconate genesis and in helping somebody with the agenesis what we're trying to give them is the ability to get more fluffiness in the brain itself.

>> So yeah, the possibility will be there if we can make the brain fluffy enough you'll have less likely less of a likelihood for recurrence with depression.

>> But in the general rule of thumb will be if you've had recurrent depressions, especially if they're really severe and they gave you a lot of difficulties such that you lost your job, you had trouble with relationships or even made a suicide attempt.

Those kind of depressions were very hesitant and having somebody stop their medication or stay off of it.

You're in a position where it sounds like you're not taking medication for depression now you're doing all right but you're noticing that you have some stressors coming up now stresses are great if you can tolerate them.

>> We expect stresses in our lives.

We want stresses in our lives because stress makes you stronger.

Stress is basically a means of change in your day to day situations or a new relationship can be a stress.

A new job can be a stress.

That's great if you can cope with it.

So what makes people have difficulty of tolerating stress about past life experiences, difficulty with coping, other things going on in their lives so you have to take that in consideration.

So now we're looking at this whole phenomenon called stress resilient stress resilience is basically defines your ability to put up with stuff so with better stress resilience you'll be able to deal with stress better and that's what we're really hoping now.

So there are some scales we're actually using as questionnaires to determine how stress resilient somebody might be so no longer are we simply asking people about their sleep and their crying episodes and their level of sadness and their concentration?

We're now starting to ask people about their abilities to put up with stuff better and to be able to be more resilient to changes occurring because that's normal.

If you can put up with things if you can be flexible when the stresses happen, that's normal and that's good if you don't go through a lot of stresses in your life and you don't have a lot of things that are changing your life , sometimes that can make you more prone to depression when something bad does happen.

They did studies of soldiers who had post-traumatic stress disorder, the ones that had more PTSD in combat were the ones who had fewer life experiences that were stressful compared to the ones who did have life experiences that were more stressful.

So stressful life experiences can in many ways make you stronger.

>> So what do you do now?

You've got a new relationship.

You've got a new job.

Keep an eye on your sleep.

Keep it on your ability to make good decisions.

Keep it keep in mind that if you have a more trouble with anxiousness and anxiety and worry those can all be precursors to getting depressed and by all means you can always talk to your primary care clinician or if you have a mental health clinician available keep in contact with him or her for the purpose of determining if you need to go back on an antidepressant, if you need to increase your psychotherapy, whatever needs to be done.

Thanks for your email.

Let's go to our first caller.

>> Hello Julie.

Welcome to Matters of Mind.

Julie, I want to know if there's any depression medications that make TMJ temporal mandibular joint worse.

>> TMJ is basically where you get a tightening of the jaw and bruxism is the term for the tightening of the jaw.

>> But TMJ is up here at your joints or the jawbone connects to the skull and you know if you have bruxism you can worsening TMJ the medications most commonly associated with worsening TMJ will be medications that are enhancing serotonin the ones that are primarily used in those situation will be Lexapro, Celexa, Paxil, Zoloft and Prozac.

Luvox can be used as well.

Then you have the serotonin and norepinephrine reuptake inhibitors such as Fat Zema Presti Effexor and Cymbalta.

So any of those medications can sometimes make TMJ worse.

Julie, you'd notice it by more grinding of your teeth bruxism is the term that's often used for that.

Often dentists will notice that you might have a little breakdown of enamel if you're clenching your jaw particularly at bedtime but that will make TMJ worse.

What do we do in those cases?

We typically will try to get somebody over to a non serotonin or a limited serotonin type medications medications that may affect more dopamine, norepinephrine or I mentioned before a medication that affects more glutamate and in doing so you get away from the serotonin side effects.

But enhancing serotonin, Julie, can sometimes increase the likelihood of having jaw tightening and TMJ.

>> Julia, thanks for your call.

Let's go to our next caller.

>> Hello Lewis.

Welcome to America.

Mind Lewis, you want to know about the connection between the brain and muscle testing when someone pushes one area of the body and get a different response in another part?

>> I'm not really clear what you're asking there, Lewis.

If somebody presses on one part of the body and you get a different response to another part, I'm not sure where you're going with that.

>> But what I can tell you is the left side of the brain affects the right side of the body, the right side of the brain over on the right side on this little strip here that will affect the left side of the body.

And if somebody has a stroke on one side of the brain or another, it will affect the opposite side of the body.

So I might be doing what you're referring there are called electro myelogram so that look at muscle twitchiness and they look at the ability to find nerve impulses in certain parts of the body and the left side of the brain will affect the right side of the body.

The right side of the brain will affect the left side of the body at least from the neck down.

Lewis, thanks for your call.

Let's go our next e-mail question.

Our next e-mail question reads Dear to the farmer our cigars addict in the same way cigarets are and what are the ways to quit cigar smoking?

>> I think it depends on the frequency and the amount of cigar smoking to which you referring cigars have a high potency of nicotine but people don't usually smoke cigars to the degree that they will cigarets now cigarets usually tend to inhale the smoke.

It goes to your lungs.

>> People sometimes smoke one pack two packs, three packs or more of cigarets and in doing so they're taking deep inhalations to get that nicotine and they're smoking throughout the day off and every two hours because if they don't the nicotine drops very abruptly and in doing so the nicotine can put you into withdrawal as it's getting out of your system with cigars.

People will often smoke them in such a way that it's mainly going to be affecting the absorption in their mouths so people smoke cigars in a different ways than they will smoke cigarets.

So even those cigars are more potent with nicotine.

>> People usually are smoking one cigar after another after another after another.

Now the dangers of cigars will be that you're inhaling the cigar smoke which has very potent nicotine content in it into the mouth and into the throat and that's where Sigmund Freud who is a he was a frequent cigar smoker.

He died of cancer in his throat so you can have difficulties related to cancer in the mouth and throat that can give you problems with cigar smoking in a different way than cigaret smoking which will often give you more difficulty in the lungs with emphysema and bronchitis and other respiratory related issues.

>> But from an addictive standpoint I would say for most people the cigarets are probably more addictive because you're having that ongoing stimulation of nicotine into the nucleus accumbens part of the brain.

So as I take the part of the US I take the brain apart nucleus Compass is kind of in the middle part of the brain that's the part of the brain where nicotine is stimulating and in doing so it's firing out all those dopamine dopamine makes you feel good, makes you feel relaxed, helps you concentrate.

>> So many people will use nicotine as a means of really firing up that area if you're kind of marinating that area all day long with nicotine, it causes you to want to keep coming back for it.

And dopamine is indeed the chemical that draws people back with addictive behaviors.

>> Thanks for your email.

Let's go to next caller.

Hello Mark.

Welcome to Mastermind Mark.

You had mentioned you have issues finishing projects you just can't push through is that a sign of adult ADHD?

>> Mark, I'd want to know how long you've been having difficulty finishing projects because it has only been in you're in your 30s I'd say is probably another factor and I want you checked out for various other medical conditions, other medical conditions in the psychiatry that we're often assessing will be, Ralph, about sleep apnea if somebody has difficulty with snoring, they're pausing and they're breathing at night.

They're not getting enough air flow to their lungs at night.

They're by not getting enough oxygen to the brain.

>> Sleep apnea will indeed give you difficulty with concentration, focus, motivation, initiative and perseverance the next day because you'll have trouble with getting enough oxygen to the brain at nighttime.

>> So that will give you symptoms of ADHD in some cases especially the inattentive symptoms depression if somebody has depression day by day by day, one of the key symptoms they'll notice will be difficulty was the speed of processing.

It's like having slow computer speed in your brain so you'll have trouble with speed of processing.

>> So with computers there are these little mechanisms they're called CPU's that really enhances the computer speed.

You have the same ability in your brain and when you have clinical depression your computer speed in your brain will significantly slow down.

We'll often look for other medical conditions like thyroid conditions, diabetes, low iron for some people for instance, if you have a slow gastrointestinal bleed that will give you a low ion sometimes can your liver problems can give difficulty with concentration.

But if you're having trouble pushing through as you mentioned, that is called perseverance and difficulty.

The perseverance is a symptom of attention deficit disorder but by definition attention deficit disorder needs to start in childhood.

>> Yeah, it can affect you in different ways as you go through life if you're more academically or occupationally challenged you might have a noticeable difficulty with concentration on things that aren't that interesting later in life and you didn't notice that problem earlier on.

So we always have to consider those type of factors but with attention deficit disorder typically it's a day by day difficulty to some degree not unlike nearsighted.

>> If you had nearsightedness you don't have good days with your vision and bad days with your vision.

Every day is pretty bad and you need corrective lenses for the nearsightedness.

That's what people will often need for attention deficit disorder if the aid is bad enough causing functional impairment, giving you difficulty socially occupationally, academically.

>> You bet that's where treatment can be helpful.

Thanks for your call.

Let's go our next caller.

Hello Benjamin.

>> Welcome to Matters of Mind.

Hey Doctor.

How you doing?

I'm doing all right.

I was wondering this it's a little off from what you were talking about but marijuanapsmot cigar smoke.

You name some long term negative effects of marijuana smoke as well maybe does it cause attention deficit disorder?

They now have little pouch things that are plastic you can pull out we take a whiff in public and blow it out.

Nobody even sees smoke yet.

People are trying to gain some type of high and things.

I know all that stuff as opposed to what the Lord had planned for man and not on the right track.

So what do you think?

>> I'ma hang up.

Thanks.

Okay Bejamin thank you for your call because that is very relevant to what we're discussing with marijuana smoke itself.

>> It was thought years ago it would be more hazardous to the lungs than cigaret smoke or cigar smoke and it was not found to be more hazardous to the lungs in the thinking was well maybe it's because people don't use marijuana all day long like they will cigarets people people will often change the chain smoke cigarets so they're always getting exposure to smoke to their lungs.

>> So maybe it's a dose type of issue with marijuana smoke itself.

My biggest issue concerning marijuana, Benjamin, is that its effects on the brain if you're under 24 years of age it has been shown to suppress the white matter growth of the brain.

What that means is basically it's suppressing your insulation of the individual neurons.

The individual neurons have this insulation on it and it's called white matter and it allows the communication from one part of the brain to better send transmission electrical transmisson to another part of the brain.

>> And if you are using marijuana, what we do know with certainty looking in MRI studies and this has been studied for the past twenty years now you're going to have less white matter development and that can be permanent.

So the right off the bat, Benjamin, I'm always telling people if you're under 24 years of age because that's when the brain is still growing you definitely don't want to use marijuana.

>> You can have irreversible suppression of brain volume if you do so now how about if you're over twenty four that's been controversial but a couple of years ago I did see a study that people even in their mid thirties who were using marijuana for the first time did indeed have some difficulty with cognition.

Now what kind of difficulty with with memory concentration and attention span you're going to have?

>> Usually it's initiative a lot of people will notice when they use marijuana they have less motivation, less initiative, less willingness to get stuff started so people using marijuana will have some symptoms of attention deficit disorder where they won't be able to concentrate, they won't be able to pay attention but they'll have trouble getting things started and maintain initiative and they have trouble with perseverance, getting things done.

>> So the thing about marijuana that people like Benjamin is that makes them not care and I'm always warning these young adults going off to college don't start using marijuana or continue using if you're already using it, don't start using or to continue using it when you go to college because it'll make you not care.

It'll make you less stressed out about the academic challenge you might be experiencing but it'll make you not care.

And that's why many, many industries will screen their employees for marijuana even in states where it's legalized.

They don't want to use marijuana on the job because it makes you less productive as an employee and with my coworkers I wouldn't want them using marijuana because they just won't care.

It'll make them less stressed out.

They'll feel less anxious and THC is the active ingredient in marijuana asthma as well as many other chemicals in there.

But THC is what people like because they get a they get a high they get a nice pleasurable effect from it in many cases.

But it does affect the brain development especially if you're younger and a big issue that I see with marijuana, Benjamin, will be not that it causes everybody to get psychotic but if you have a family history or if you have a propensity of your brain to get psychotic, it can significantly increase the likelihood you will get psychotic and we could possibly significantly decrease the incidence of a condition called schizophrenia if people didn't use marijuana in their adolescent early adult years.

I always wonder, you know, how many people out there wouldn't have developed schizophrenia if they didn't use marijuana as a trigger.

So it's something that can kind of spark the fire of schizophrenia when it might not have developed otherwise but my bigger concern about marijuana across the entire population right now, Benjamin, is that it does cause you to have trouble with attention span.

>> It's thought to decrease the IQ of potentia of somebody if they start using it on a regular basis.

What I will see not uncommonly if somebody started using marijuana when they were 13, 15, 16 years of age it seems like their emotional maturity stops right there because it's normal and it's expected to feel socially anxious when you're an adolescent.

>> So when you're going through your teenage years you bet you're supposed to be socially anxious.

You're supposed to feel awkward and you got to get over that.

If you use marijuana at thirteen, fourteen, fifteen years of age you don't care.

You just get through and you don't develop those coping mechanisms as an adolescent that you need to get through those awkward years and here you are you're still using marijuana in your 20s.

All of a sudden you're in your 30s for whatever reason your spouse, your children for that matter might ask you to stop using the marijuana.

You try and you have trouble with emotional maturity.

You have to develop the coping techniques to be able to overcome some of the type of stresses people will have been able to learn to to in which to cope when they're adolescents.

So it does tend to stunt not only brain growth but also I think it's stunts emotional maturity quite uncommonly.

>> Thanks.

Thanks for your call.

Let's go to our next caller.

>> Hello Lewis.

Welcome to Matters of Mind.

I wanted to clarify what I ask about before muscle testing was oh I'm well thank you Lewis push down on your arm and then you think about certain certain things and something triggers like you get weaker or stronger depending on what you're thinking about.

>> I'm not familiar with that technique, Lewis.

I am familiar with some techniques where you can press and it's a technique used with acupuncture where people use acute puncture needles and they will push the needles in certain areas when they're stressed out in certain ways for instance, you can press an acupuncture needle on your ankle and get stress relief in that way.

So I think what you're referring to is the technique of acute acupuncture for the purpose of relieving anxiety and that is legitimate.

United States but it's used over in Europe, especially in England where acupuncture can be used specifically for that purpose for muscle relaxation and sometimes even for relief of anxiety.

Lewis, thanks for your call.

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

Oh, we have another caller.

>> Hello Peggy.

Welcome to Mariza Mind.

>> Peggy, you had mentioned the you have uncontrollable crying and you wonder if it could be related to your having a stroke.

>> Is there anything you can do about it?

Well, Peggy, I'm going to presume that you've had a stroke in the past when you've had a stroke in the past.

>> You bet it can give you difficulty with crying for a reason.

We call it pseudobulbar affect pseudobulbar affect also known as Pibor is a condition where the front part of your brain kind of isn't regulated by the other parts the brain and you have emotional difficulty the control with crying laughing you can have irritability in some cases it's basically because the front part of the brain which regulates the emotions and your to maintain impulse control it's not working so well.

So if you have had a stroke in different parts of the brain and they're affecting how the front part of the brain is able to work, that can give you something called pseudobulbar affect and there are medications that can be used for pseudobulbar affect depending on what type of symptoms you have.

But it's a real phenomenon and it can come across as uncontrollable crying for some people.

Not historically, Peggy, we've used medications that simply increase serotonin.

I mentioned earlier Celexa, Lexapro, Paxil, Zoloft, Prozac, Luvox these are medications that all increase tone and in doing so they dampen the emotions.

If they dampen the emotions you'll have less crying but any more we're using other medications like NUEDEXTA.

We're using medications like Lamotrigine.

These are medications that affect glutamate and in doing so they dampen down the excessive glutamate that's released when people have difficulty with stroke.

So when you have a stroke you have excessive glutamate release and that can cause you to have more moodiness in some cases.

So a medication like NUEDEXTA for instance will regulate that as will a medication like Lamotrigine.

>> Peggie, thanks for your call.

Let's go our next caller.

Hello Don.

Welcome to Matters of Mind, Don.

You want to know about the science behind hypnosis hypnotherapy for panic attacks you've been doing hypnotherapy .

>> Your panic attacks have remitted significantly more.

He's also been great.

That's fantastic given what he thinks you're doing there with hypnotherapy, you're allowing yourself to get more relaxed and if you're more relaxed and you have less anxiety, you're less prone to having a panic attack.

On other words, there's something called anticipatory anxiety that kind of leads up to difficulty with having a greater likelihood for a panic attack.

>> So if you can use hypnotherapy as a relaxation technique and I've used hypnotherapy myself, Don on my on myself I you can do self hypnosis.

You can learn how to do that is a very effective tool.

I did it thirty, forty years ago to help me with anxiety and help me relax before I get on live television.

I mean there's ways you can put that to effect what you're doing there is you're chilling out this front part of the brain over here called the amygdala.

>> The amygdala is the tip of the thumb.

The brain's kind of kind of shaped like a a boxing glove and at the tip of the thumb is the amygdala, you know, and you're using hypnotherapy.

You're calming yourself down, your relaxing your whole body and in doing so you're going to be less prone to having panic attacks.

So that's the main reason of therapy for you is probably helping with a panic attack because you're dialing down your anxiety volume control and doing so you're making yourself less prone to having panic attacks.

So I congratulate you on that, Don.

>> Keep it up.

Let's go to next caller.

Hello, Joanie.

Welcome to Matters of Mind.

Joanie, you want to know does eye movement andpdesensitizatiog MDR contribute to neuroplasticity?

>> I mentioned neuroplasticity earlier where it's making your neurons more fluffy.

It might to some degree and the reason I say that, Joni is because I think a lot of psychotherapy techniques indirectly and very gradually do help with brain development.

>> In other words, if you're less stressed out, if you're coping life circumstances better, I think it is going to allow natural fertilizer.

It's called brain derived neurotrophic factor BNR to be released.

>> What these medications that are affecting glutamate are doing is they're doing so very, very quickly within a matter of hours.

>> But MDR psychotherapy counseling when those techniques are successful it can have a reversal on your brain's fluffiness in a good way and that could be beneficial for you.

>> Joanny, thanks for your call.

Unforced the amount of time for this evening.

You have any questions concerning mental health issues?

You can write me via the Internet at matters of the mind all one word at WFTDA Dog I'm psychiatrist offer and you've been watching matters of mine on PBS Fort Wayne now available on YouTube God willing a PBS willing I'll be back again next week.

>> Thanks for watching.

Goodnight