I'm psychiatrist Jay Fawver and welcome to Matters of the Mind.

Matters of the mind is a weekly mental health program where you have the chance to choose the topic for discussion.

So if you have any questions that I can answer on the air, you may write me a via the internet at MattersOfTheMind - all one word - @wfwa.org.

That's MattersOfTheMind@wfwa.org.

And if you're able to do so, you may call me or you may text me.

All we ask is that you leave a first name and let us know the town from where you're calling.

So with that being said, let's start with our first email for the It reads, Dear Dr.

Fawver, I'm not sure if I'm just tired or burnt out from my job or other aspects of my life.

How do I know what's going on?

Some days it feels like a nap would help.

Some days I think I'm ready to just find a cave and give up.

You might want to contact your primary care clinician first and foremost to see what might be going on.

In other words, we often hear about people feeling tired for no particular reason.

They have trouble with concentration.

They are having trouble with frequently nodding off during the day, and they might have a condition called sleep apnea, where you're not getting adequate air flow to the lungs at night and thereby not getting oxygen to the brain.

So sleep apnea is where you might snore or pause in your breathing at nighttime.

Some people will have diabetes.

Low blood sugar can be a factor.

They can have low iron as a factor.

Some people can have difficulty with having problems with other metabolic kind of conditions.

Low thyroid is a common reason why people will just not feel right.

So you want to make sure medically you're on the right track.

First and foremost, you know you burn out work.

Is it a problem with depression?

The primary care clinician can sort out what kind of things might be stressing you out at this point.

If you're not sleeping adequately, that will be a big factor.

For instance, some people will not be sleeping adequately because they have environmental noise and things are keeping them up at night.

Sometimes people are having childcare issues where they have to get up, off and on, and if you are not sleeping adequately at nighttime, you'll have difficulty with being able to get the front part of your brain charged adequately, to be able to be wakeful during the day and be alert.

So you burn out at your job?

Could be, but it's just that you want to check out all these other medical and psychological factors.

First and foremost, thanks for your email.

Let's go to our first caller.

Hello, Lydia.

Welcome to Matters of the Mind.

Lydia, you want to know why do people often repeat the same unhealthy patterns, even though they know they're harmful?

There's a phenomenon called repetition compulsion.

Sigmund Freud talked about it 100 years ago.

Repetition compulsion is where you have a tendency to keep doing the same things over and over again, even though, well, they've not been found to be healthy in your past.

And the factor there is that there's a sense of comfort with sameness.

So if you're doing the same type of things week after week, month after month, even though they're causing you to have poor outcomes and consequences, you might continue doing them because you're comfortable with that kind of pattern in your life.

So if you, for instance, had in your childhood an abusive, emotionally abusive parent, for instance, you are more likely to have the repetition compulsion of being an emotionally abusive parent yourself, because that is the kind of environment in which you're comfortable.

So what we're trying to do in counseling, not uncommonly, is try to break up that cycle of repetition compulsion.

We're often, yeah, somewhat more prone to repeat the kind of patterns, good or bad, that we've witnessed and identified with our parents as we've grown up.

We were modeling after our parents, not uncommonly.

Now we want to certainly promote the kind of behaviors that have found to be positive, but we want to on the same, on the same hand, decrease the behaviors that are negative with the poor consequences.

So you want to balance that out.

But repetition compulsion is a phenomenon where you repeat the cycle of poor behaviors, even though they've not worked out for you so well before, either by modeling from parents or other people around you, or just being comfortable with the same kind of behavior yourself.

Thanks for your call.

Let's go to our next text.

Hello, Karen from Dayton, Ohio.

Karen, you want to know about creatinine and beta-alanine in a particular supplement called trypsin and chromium picolinate from your local warehouse store, you use those with taurine, and for glycine agonism, there's a statement on the bottle.

Apparently it talks about this combination being a carnosine booster.

Why is that important?

And also is probenecid needed for NAC absorption.

Carnosine basically is a potentially anti-aging supplement in a sense that it can help with muscle health, bone health - potentially might be able to decrease the likelihood of dementia and improve glucose balance with somebody who's prone to having diabetes.

So carnosine is an important supplement.

It can be made naturally in the body with the consumption of various meats, because it is a combination of two amino acids histidine and alanine, I believe.

Carnosine is can be manufactured by the body, but you can take it as a supplement.

You mentioned probenecid NAC, N-acetylcysteine.

Probenecid is an old medication.

It's been around for a long time, used for gout, so it can influence uric acid levels.

But about ten years ago, the combination of Probenecid and NAC, N-acetylcysteine, that combination was used in mono, in monotherapy by itself or in combination.

And they found that in combination, probenecid did seem to increase the particular reduced compound, called GSH.

GSH is known as glutathione, and so it's a particular antioxidant that can decrease the likelihood of cell injuries.

So if you've had a traumatic brain injury, for instance, NAC gets across the blood brain barrier and gets into the brain.

NAC is something we will use for the purpose of helping people with a traumatic brain injury.

Potentially you could use probenecid with NAC.

What they're doing is they're increasing GSH in a different way.

It's not that the probenecid is increasing absorption of NAC particularly, it's just that they're both increasing this particular chemical called GSH in different ways.

And in doing so, that can help prevent cell death, particularly associated with cell injury from a traumatic brain injury or something like that.

Thanks for your text.

Let's go to our next caller.

Hello, Ruth.

Welcome to Matters of the Mind.

Ruth, you want to know what are some of the reasons why someone would not respond to a serotonin selective serotonin reuptake inhibitor?

Ruth, about one out of three people out there are genetically prone to do really well with an SSRI.

Now SSRIs are used predominantly nowadays for anxiety, but for depression especially.

SSRIs are going to be really, really responsive for about one out of three people.

So SSRIs selectively and specifically will increase serotonin in the brain.

So if you increase serotonin in the brain you're going to hit all 14 different serotonin receptors.

Some of them you want to maybe maybe hit some of them you don't.

But you're going to increase serotonin receptors all over the brain.

The issue can be, well, what if serotonin is not your problem?

What if it's not an issue?

And they've actually done studies on people who had a induced deficiency of serotonin manufacturing, such as a tryptophan sparing diet, where they specifically avoid substances that contain tryptophan.

Tryptophan is a precursor or a building block for serotonin.

And if you avoid tryptophan, you potentially would have the building of less serotonin.

If you do that, if you're not prone to having depression, there's no problems.

If you're prone to having depression, there can be a problem.

So it all comes down to is serotonin the problem is serotonin something that needs to be enhanced.

So if serotonin is not the problem, it's kind of like wearing eyeglasses.

If you don't need eyeglasses, your vision gets worse.

If you don't need eyeglasses and you put them on the same with SSRI, if it's not the right medication for you, it might not help you that much.

Now there is a genetic test that we will sometimes use called an SLC6A4 genetic test, and we're looking for two long alleles.

An allele is a gene.

We each have a gene from our mom, we have a gene from our dad.

And we have hundreds of these genes.

And with these particular genes you're looking for two long alleles for SLC6A4 that would predict that you have a good response to an SSRI.

It's not deterministic.

It's not going to be definitive in any way.

It's just going to be increasing your probabilities that an SSRI might be do better for you for the particular condition in which you might be treating.

Now it's used for SSRIs or used for depression.

They're used for anxiety and anxiety conditions in which we might read.

We might treat somebody with an SSRI could be something along the lines of generalized anxiety disorder, post-traumatic stress disorder, obsessive compulsive disorder, panic disorder, and social anxiety.

Those are all anxiety conditions that can be treated with a serotonin medication.

Now, serotonin medications in general will give you a bit of an emotional dulling effect.

They give you a little bit of an emotional numbness, so they'll dampen down the emotions just a bit.

For some people, that's exactly what they need because they're overly emotional.

They're irritable, they're overreacting.

They cry too easily.

In those cases, a little bit of a serotonin medication can be helpful.

However, if you get too much of a serotonin medication, you can feel emotionally blunted.

We call it alexithymia as a fancy term there, but it basically means that you're not feeling happy, you're not feeling sad, you just kind of feel blah.

And for those people, you can find the backing off of the dosage, or maybe changing to a different type of medication can be helpful for.

So number one, you might just not be a good fit for a serotonin medication.

Number two, sometimes the serotonin medication will work initially, and then they kind of wear out over the course of a few months.

Why would that occur?

Well, it's because the serotonin medications indirectly will decrease another neurotransmitter by the name of dopamine.

So if you increase serotonin over the course of several months, you could indirectly decrease dopamine.

If you decrease dopamine, you might notice that you can't concentrate as well.

You don't have as much energy, you don't have as much enthusiasm and excitement about life, and you just feel kind of blah from that perspective.

And in those cases, sometimes we'll add a medication that increases dopamine like bupropion pramipexole, and these are medications that will increase dopamine in various ways.

So we might use a medication with the SSRI if we don't take the SSRI away.

Now one of the best predictors in my experience of how a medication is going to be doing for somebody will be looking to see if they have any family members who have responded or not responded so well to particular medications.

So if you have a family member who is responded really well to an SSRI like S Citalopram you might do very well with that particular medication as well.

If you have a family member who's done poorly on this SSRI and this SSRI and this SSRI, we would probably want to put you on an SSRI.

We look at particular genetic influences, not only by looking at your own genes, but also looking at your family members responses to treatment as well.

A key reason, as I saw with a lady earlier today, that you wouldn't respond to an SSRI would be if you just don't have a depression.

That's called a major depressive disorder by itself.

If you have a condition called bipolar disorder and SSRI by itself might cause you to feel worse.

Now, the person I saw earlier today had difficulty with sky high manic episodes periodically, but when this person took an SSRI, the sky high manic episode were even more prominent.

So if you take an antidepressant medication by itself, and you have an underlying bipolar disorder where you're prone to having highs manifested by manic episodes where you don't need to sleep for a day or two or more, perhaps you are more impulsive.

You have racing thoughts during that time.

You do things and say things you ordinarily wouldn't do or say.

That manic episode can be precipitated by an antidepressant medication like an SSRI by itself.

Obviously, we'll always look for other medical conditions where if an SSRI is not working for the particular symptoms in which we're trying to treat, we always want to address other medical conditions that might be contributed, contributed to your symptoms other than just depression.

Thanks for your call.

Let's go to our next text, Pam from Fort Wayne.

You have a question about traumatic brain injury.

Is encephalitis considered a traumatic brain injury?

I certainly would consider encephalitis, which is an infection of the lining of the brain itself.

Meningitis is the actual outside lining, but encephalitis is the top part of the brain itself.

And encephalitis is a brain infection.

That's going to be a traumatic brain injury.

And what does that mean from a psychiatric standpoint, Pam?

When I hear about somebody having a recent history of encephalitis, which is an infection of the brain, I'm going to consider that they probably need a medication that's going to settle down or cool, cool out.

This particular chemical called glutamate.

Now, glutamate is a neurotransmitter in the brain that works as the accelerator on the brain.

So 80% of the gray matter of the brain is influenced by glutamate transmission.

So glutamate is the accelerator GABA is the brake and glutamate and GABA have to be in fine balance.

When you've had any traumatic brain injury that can be a concussion, that can be meningitis, which is the outside lining of the brain, encephalitis, which is the inside lining of the brain, the inside part of the brain itself.

With that kind of infection, you bet you can have symptoms of what we'd call traumatic brain injury.

And those symptoms can include irritability, moodiness, poor concentration, fatigue, variable sleep, difficulty with interpersonal relationships, sometimes apathy.

Those are all symptoms of traumatic brain injury that we might address with the medications going to stabilize glutamate.

If it's really severe, we might cautiously use an old medication called Depakote also known as valproic acid.

Specifically will block glutamate transmission.

We'd preferentially like to use lamotrigine or luminol, which will decrease the outflow of glutamate, which could be excessive for somebody with any traumatic brain injury.

NAC, which I mentioned before n acetylcysteine, as long as somebody does not have a sulfa allergy because NAC is related to sulfa, NAC can be helpful in modulating kind of a balancing out glutamate in the brain.

So, not uncommonly, we might use a combination of lamotrigine and NCA for the purpose of stabilizing glutamate for somebody who's had any traumatic brain injury.

And that would include encephalitis if you have the symptoms of a traumatic brain injury.

So we look at the symptoms and we look back to when those symptoms began.

If they started shortly after you experienced encephalitis, we take that consideration.

Thanks for your text.

Let's go to our next text.

Hello, Tonda from Fort Wayne.

You have a question about the difference between depression and anxiety.

They go hand in hand, Tonda.

People ask me all the time, do I have depression or anxiety?

My answer is often yes.

And here's how it often works.

Many people will start out their symptoms of having some anxiety.

They start worrying about things.

They feel kind of panicky.

They get scared about what might happen in the future, and they start ruminating and dwelling on things that starts to fire up this little part of the brain here called the amygdala.

The amygdala is an almond shaped body in the front part of the temporal lobe, the yellow part of the brain here.

And it's basically the volume control for anger, anxiety and fear.

So the amygdala gets fired up when you get some anxiety.

What happens then?

Well, the amygdala starts to hijack the front part of the brain, and you start having trouble sleeping because you're trying to go to sleep and you're worrying about different things, and one thing leads to another.

If you don't have adequate sleep, you will have a compromise, a compromise frontal lobe reset so your front part of your brain doesn't get recharged adequately.

If the front part of your brain doesn't get recharged adequately, you don't reason as well as you ordinarily would do, so you don't cope.

You have to trouble figuring out, is this the best thing to do?

Or is this the best thing to do?

So you have trouble with symptoms that would lead to depression.

So you often hear about this cascade, Tonda, where you go from anxiety to insomnia to depression.

And that's why we're always asking a psychiatrist about your sleep.

Because sleep is like a psychiatric vital sign.

We always want to know your quality of your sleep, because if you have poor quality asleep, you are very likely to thereby progress into having trouble with depressive symptoms.

Depressive symptoms are basically where the front part of your brain just doesn't work so well.

It hasn't been recharged adequately.

The thinking part of the brain is right up here, particularly on the left front side.

It's called the dorsolateral prefrontal cortex.

That helps you pay attention and concentrate.

The decision making part of the brain is above the eyeball, called the orbital lateral prefrontal cortex.

It decides, should I do this?

Should I do that?

And on the inside part of the brain, the anterior cingulate gyrus looks at the consequences.

It examines the consequences of, gee, if I do this, this is going to happen.

If I do this, this is going to happen.

So it kind of waves the consequences back and forth and sorts out what might be in your best interest.

So you have all these different parts of the brain that are affected by anxiety and insomnia.

So anxiety and insomnia, depression, they often go hand in hand.

There used to be a phenomenon called agitated depression.

And we talked about it 30 years ago.

Agitated depression is where somebody will have a lot of anxiety and worry, restlessness and irritability.

And nowadays we might consider that to be kind of a bipolar spectrum phenomenon where we want to have somebody on a mood stabilizer.

But if the anxiety has the quality more of a ruminative feature where you're worrying about things and you're having trouble with getting things done because you're overthinking different situations, that kind of anxiety will often lead to depression for a lot of people.

Thanks for your text.

Let's go to our next text.

Hello, Tom from Columbia City.

You want to know about Minnesota just passing the grandparents happy hour law, where residents in nursing homes can be served alcoholic beverage beverages.

Will that help or hurt mental health of people living in nursing homes?

I would have I wasn't familiar with that particular law that came down.

Tom.

Alcohol in nursing homes.

Yeah, I know that people can have alcohol in nursing homes, and I think it depends on the particular individual.

Late afternoon, maybe early evening would be a safe time to use alcohol.

But I remember Tom, my goodness, 35 years ago it was not uncommon for people in nursing homes and assisted living facilities to be encouraged to drink alcohol at bedtime to help them sleep.

Terrible idea, because alcohol actually compromises your ability to sleep well.

And lack of efficient sleep is certainly a means by which you can have a higher risk for not only depression, but also Alzheimer's dementia.

So if you don't sleep well night after night, week after week, month after month, and you're not getting efficient sleep where you're getting a deep sleep, you're not getting adequate dream sleep that can actually set you up for a greater likelihood for Alzheimer's dementia.

Now, I believe that individuals should be assessed one by one in a nursing home and determine who might be a better fit for the consumption of alcohol, but it certainly needs to be limited, and it probably should be earlier in the evening or late afternoon, as opposed to right at bedtime.

But I'll take a look at that particular law that's I didn't know there was a law.

One way or another, I to my awareness, you could still serve alcoholic beverages in assisted living facilities in nursing homes.

But I'm in Indiana.

That might be something they do differently up there in Minnesota.

Thanks for your text.

Let's go to our next caller.

Hello, Ryan.

Welcome to Matters of the Mind.

Ryan.

You want to know how do you deescalate when a conversation gets heated, number one.

How do you deescalate?

The first thing to do is not take the words personally.

And what you often here, Ryan, will be when somebody is losing an argument, they start raising their voice and they start interrupting, and they will try to talk over the other person because they're losing the argument.

I think with any means of discussion where you're in opposition to your opinions, okay, let each other talk and sit back, check your breathing rate, keep your pulse nice and low.

Stay calm, but you should be able to have a discussion about an opposition to your beliefs.

So don't take those particular oppositional type of positions necessarily personally, and don't make an argument out of something that doesn't deserve it.

Because if you simply calmly address the particular opinions you express and let it go.

If the other person is getting more hyped up, just be aware that they might be realizing they are losing the argument when they're having to talk louder and shout and interrupt, they probably don't want to hear what you have to say anyway.

And be aware.

It's always okay to walk away from discussions that are no longer being productive for either one of you.

Thanks for your text.

Let's go to our next email question.

Our next email question reads Dear Dr.

Fawver, a very a little self-care every once in a while.

It's probably a good thing.

What are some good things we can do to for ourselves that are generally positive for our mental health?

Are there types of self-care that could backfire and not help?

The main self-care thing you should be able to.

You could be able to do what brings joy.

Based on the objective studies that have been done over the past 40 or 50 years have been being able to serve other people in meaningful, beneficial ways where you can see a meaningful, beneficial outcome.

So if you can serve others, either financially worth your time or whatever, and you can see that by serving others, it's providing a good outcome for them that has been shown in several different studies to be beneficial for a person's ability to find joy and happiness in life.

If it's basic self-care, things you can do, such as exercising.

The key thing about exercising is don't do it to a point where you have trauma, physical trauma from the exercise itself, where you injure yourself.

Exercising 30 minutes to 45 minutes, five days a week is usually adequate for most people, and that would include aerobic training, where you're getting your heart rate up, as well as resistance training where you're trying to do some weight work overall.

So those are exercising is very, very important.

Exercise has an interesting phenomenon that occurs from a neurotransmitter standpoint in the brain.

I mentioned earlier glutamate and GABA glutamate accelerator GABA as the brake.

So glutamate will increase excitement and energy whereas GABA puts the brakes on and kind of slows you down.

When you exercise, you increase both glutamate and GABA.

That's why many people in the exercise, they feel good.

I mean, it's most people, if they don't overdo it, they actually feel good after a 30 minutes or so of exercise.

That's because you've increased glutamate and GABA at the same time, so you have more energy after exercising.

Not uncommonly if you're not overdone it, but you also feel calmer.

So you want that kind of feeling.

And from a neurotransmitter standpoint, you're increasing both of those neurotransmitters.

And in doing so, you want to continue doing that about five days a week to maintain that.

So exercising is very good for the mental health.

Everybody is different with nutrition.

Some people do wonderfully with carnivore diets.

Some people do well with low carb diets in general.

Some people do better with strict Mediterranean diets.

Any diet that you're able to maintain and you can track on your own to determine how it makes you feel.

That's the diet you want to continue using, and you always want to stick with a diet that you can maintain.

You can have a lot of different complicated diets out there, but if you can't maintain them, you got to figure out a way to be able to give you something, to be able to give you a food choice that you're going to be able to maintain on a more regular basis.

So exercising nutrition and having socially meaningful relationships, one of the biggest predictors for dementia with older adults will be when they get more socially isolated.

We saw this as a horrific consequence of the Covid lockdowns over the course of a couple of years in 2020 and 2021, where people were not allowed to socialize.

That was not only traumatic for children and adolescents, but it was devastating for older adults, and it actually predicted a higher likelihood of dementia because social isolation is something that can cause our brain to atrophy in some ways, and it can be devastating for overall mental health.

So I would certainly suggest to take care of yourself, certainly exercising, maintaining adequate nutrition and socializing are the three main ways that would be beneficial for you.

Thanks for your call.

Let's go to our next email question.

Our next email question reads what's a myth about psychiatry that I'd wish to it would go away.

I know I've had lots of expectations when I first started seeing my doctor, but brought on by the movies or TV.

So you're wondering, okay, as a psychiatrist, what myth would I like to see go away?

The myth about psychiatry is that it's more of a faith or a religion.

Some people will say, I don't believe in psychiatry.

Well, would you say, I don't believe in cardiology?

I don't believe in gastrointestinal medicine.

I don't I don't agree with oncology.

It's not a faith based kind of treatment.

When we talk about psychiatry, we're talking about the functioning of the brain to allow you to maintain good mental health.

Thanks for your call.

Unfortunately, I'm out of time for this evening.

If you have any questions that I can answer on the air, you may write me via the interne I'm psychiatrist Jay Fawver, you've been watching Matters of the Mind on PBS.

God willing and PBS willing.

I'll be back again next week.

Thanks for watching.

Good night.