good evening.

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

Welcome to Matters of the Mind now in its 10th year matters the mind is a live call 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 tell toll free at 866- (969) to seven to zero in on a fairly regular basis.

>> I am broadcasting live every Monday night from our spectacular PBS Fort Wayne studios which these chateaux 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 a via the Internet at matters of the mind all one word at a dot org that's matters of the mind at WSW Egg and I'll start tonight's program with an email I received over the past couple of weeks.

>> It says Dr. Fauver, would you please explain the difference and similar similarities of depression versus anxiety?

Aren't several of the medications the same for both?

How can that be?

What are the most successful for each disorder?

>> Well, if you think about kind of a cascade of anxiety often leading to insomnia which frequently will lead to depression, it's kind of a continuum.

Yeah, there's different networking in the brain that will influence more anxiety symptoms versus depressive symptoms.

But the bottom line is they all kind of run together and that's why indeed you will see some medications that typically will help both anxiety and depression.

>> The most popular antidepressant medications that will affect both anxiety and depression will be the ones that affect serotonin.

>> Serotonin comes from the brain stem.

The brain looks like a big, big head of cauliflower and it does indeed have a stem and in the stem itself is where serotonin, norepinephrine and dopamine will originate.

So here we go.

>> We got the brain a part here the brain is looking at you right here pulled apart the brain hears the inside part of the brain the stem down here is where norepinephrine, serotonin and dopamine gets spewed to the outside gray matter of the brain and serotonin is one of those chemicals that gets spewed to the outside gray matter of the brain when serotonin is in the gray matter of the brain, it gives a calming effect.

>> It kind of dampens down the emotions.

So if you're highly anxious and you're having panic attacks, you're hyperventilating, you're worrying, you're ruminating about things increasing serotonin can just chill you out a little bit and give you a little bit of a calming effect.

>> Now the downside of a serotonin antidepressant will be a frequent complaint where people say they don't feel happy, they don't feel sad, they just feel kind of blah.

It's not a good feeling.

We call it alexithymia but people just don't have any joy.

>> They kind of feel emotionally dampened.

That's not good.

It means you're getting too much of a serotonin dampening and those people will often use a different type of antidepressant.

>> But in the past 60 years there have been 29 oral antidepressants become available on the market.

>> We have a lot from which we can choose but you often notice this cascade between anxiety, difficulty with sleeping and depression.

>> So how's that work when you have a lot of anxiety ruminating you're dwelling on things you're nervous about things this front part of the brain on the temporal lobe it's called the amygdala that's kind of kind of the volume control for anxiety, anger, rage, rumination and if that part of the brain is over active you'll typically get the hijacking of the front part of the brain.

The front part of the brain is the part of the brain used to reasoning through things and to have logical thought.

So if you can't reason through things adequately and you can't maintain logical thought, you can't cope with your current life circumstances so well when that happens you don't think clearly and you get more depressed and when you get depressed you don't enjoy things you lack motivation to do things you want to naturally socially withdraw.

You might have trouble with your eating.

You want to have trouble with just getting things done in life that becomes a clinical depression if it goes on day by day for over a couple of weeks and as part of that will often be difficulty with sleeping because when you worry and you ruminate and you dwell on things often it'll keep you awake at night when you have difficulty with sleeping it too.

>> Not only will anxiety do this but difficulty sleeping will also compromise the front part of the brain and not allow you to think clearly day by day by day.

>> So lack of sleep is a key psychiatric vital sign if you go see a psychiatrist or somebody the mental health field at some point during your appointment they're going to ask you how your sleep doing.

It's kind of like checking your blood pressure if you go to a primary care office we want to know how your sleep's been doing.

>> What do we want to know?

We want to know are you getting to sleep reasonably well?

>> Are you staying asleep or having any nightmares or waking up too early upon awakening?

Awakening.

Do you feel refreshed?

Do you feel awake during the day?

Do you have to take frequent naps?

>> Do you feel like your your sleep is adequate for you?

We're always going to be asking about sleep and a lot of different dimensions and there's one particular questionnaire called the Insomnia Severity Index that asks eight questions concerning the quality of your sleep and in asking about quality your sleep it kind of gives us an idea of what disturbances you're having with your sleep overall.

So what we'll often find is when people are anxious and they're worrying about things, they have trouble going to sleep.

But as they start to have more of a clinical depression, yeah, they might have trouble going to sleep but they also awaken too early.

We call that terminal insomnia where they want to get up at six or seven a.m. but they're waking awakening at four a.m. and they can't get back to sleep and it's not that they don't need more sleep.

>> They need more sleep because they're tired and they can't concentrate so much during the day.

But if you have any disturbances with sleep it will affect your ability to think and thereby it'll give you more depression.

>> So we use many different antidepressant medications for various reasons.

>> You know the various reasons we call that a phenotype you hear about a genotype where you think about somebody's genetics.

Genetics will influence how medications will work for you but a phenotype is where we look at the actual symptoms themselves and to some degree we might find that some people may need a medication that's more going to be affecting serotonin, more affecting dopamine, more affecting norepinephrine and we've kind of used that guideline for the past six decades now we're looking at a whole different spectrum of medications that don't just affect norepinephrine serotonin and dopamine.

>> We're looking at a whole group of medications affecting gabber affecting glutamate.

These and glutamate are the brakes and the accelerator and the gray matter of the brain respectively.

So GABA puts on the brakes glutamate puts you on the accelerator when you hear us talking about antidepressants, I think in the next ten, fifteen years you're going to be hearing a lot about medications that are affecting GABA and glutamate.

>> So with that being said, we have a lot of hope from a neurobiological standpoint on how people can get feeling better.

But early on we want to try to get that worry and anxiety under reasonable control so it doesn't turn into insomnia which thereby can give you a clinical depression.

>> Thanks for your email.

Let's go to our first caller.

Hello Cheryl.

Welcome to America.

>> Sure you want to know about after a long term use of opiates, how effective is methadone and what I recommend that to cope with urges to reuse?

Well, methadone has been around for decades now, Cheryl, and methadone is a means with maintenance treatment that basically is stimulating the MUE receptor.

There's three different types of receptors for opiates.

>> There's Musa's cap and they're dealt and there's Delta.

It's affecting MUE receptors if you stimulate new receptors a short term basis and that's what the short term opiates do like Percocet, Norco and Fentanyl for that matter.

>> They're stimulating the receptor very quickly and in doing so they're giving you an addictive quality to a methadone kind of gives you a low level stimulation of your receptor over the course of days and even weeks for that matter.

>> So just taking methadone every now and then is enough to give somebody a little bit of maintenance treatment and doing so No.

>> One, it keeps you out of opiate withdrawal, opiate withdrawal where you feel the chills, you have diarrhea, headache.

You people feel miserable during opiate withdrawal on the way they get around opiate withdrawal is to find another opiate.

So methadone at least prevents that from occurring.

But there's other ways that we can now try to help people with opiate withdrawal and maintain that to keep them in remission from opiate dependance.

We use medications like Suboxone .

There's a lot of medications out there to effect opiate receptors in different ways to decrease the likelihood that somebody is going to relapse.

>> So if methadone is working for you or for one of your loved ones for whom you're asking, that's something that can be used long term.

>> But there's a lot of other options to make people less likely to relapse and that's the key.

We don't want people to relapse when people relapse on opiates there's a greater chance that they're going to take higher and higher amounts when they take higher and higher amounts of opiates eventually shuts down the breathing when you hear about people dying from opiate overdoses because they took too much and it shut down their breathing and with you don't with when you're not breathing that's something where it'll end up in your dying.

So we want to make sure that we try to get the opiate dependency under control with whatever it takes.

>> Thanks for your call, Cheryl.

Let's go to next caller.

Hello Max.

Welcome to Mastermind Maximiliano.

>> You want to know how long does it take for an individual to overcome childhood trauma from alcoholic abusive parents?

Well, Max, there is a particular scale called the Adverse Childhood experience scale that's called the ACS.

It's a ten item scale and it's not that if you score over four out of those 10 items saying yes, you're going to be at a higher risk later on in your life to have more difficulty with anxiety, likely depression, it's also a somewhat of a predictor that you might not do as well as you possibly could with a serotonin medication like Zoloft, Prozac, Lexapro, Celexa or Paxil.

>> Those are just serotonin based medications.

>> They will they will no doubt your emotions some.

But in terms of having the best quality of life possible, you might need a different type of medication or an add on medication like bupropion or Wellbutrin.

>> So early childhood experiences are very, very important for kind of setting the template and the the hardware for the brain itself.

>> If you've been if you've experienced trauma before the age of eight years old, that seems to be a magic date for a lot of people.

But before eight years of age, if you've experienced trauma, you're more likely to have more difficulties yourself with anxiety and difficulty later on.

>> Now some people recover well, some people don't recover so well.

How do you recover?

Well, what does it's is somewhat impacted by genetics if you have certain genetics and we can identify this by doing genetic testing sometimes but certain genetics will predict that you will have a greater likelihood of anxiety depression later on in life if you had early childhood trauma means excuse me so there's a gene called SLC six eight four if you have two short ends of the genes for SLC six eight four and you had early childhood trauma, you're much more likely later on in life to have anxiety, depression and much more likely to not respond so well to the serotonin medications.

>> If you have the longer genes well for instance you're less likely to have difficulty depression even though you had childhood trauma.

>> So there is a genetic influence on how much that early childhood experience will result in later on depression and anxiety.

Another factor will be early coping mechanisms.

For instance, if you had a good relationship with a grandparent or somebody who is an adult and they were meaningful in your life at an early age despite your having parents that might have had some problems and been abusive toward you that can help you recover.

So that's something that with the coping mechanisms you'd be less likely to have difficulty later on in life .

So we'll often find that we'll look at genetics, we'll look at people's ability to cope and we'll look at early life experiences a means of determining if someone is going to have depression, depression difficulties later on in life or not.

But as I mentioned earlier, there's twenty nine different antidepressant medications that have been approved by the Food and Drug Administration since the 1950s.

>> So we have a lot of different medications from which to choose.

But knowing about early childhood trauma, knowing about some of these genetics, knowing about somebody's past medication treatment responses and even in their family members past responses that can all be helpful in helping us to put the whole picture together if to use a medication that helps us determine what kind of medication might help you the best.

>> Thanks for your call.

Let's go to next email.

>> Our next e-mail reads Dear Doctor Father, I'm considering a New Year's resolution to quit smoking.

Good for you.

Is it harder to quit smoking when I'm also dealing with anxiety if I can't eliminate the nicotine will it affect my anxiety medications?

>> It's always best to get the anxiety and depression under good control but it's kind of a vicious cycle.

Sometimes you can have anxiety related the nicotine because when nicotine wears out of your system as you very well know in all likelihood you tend to have a lot of withdrawal.

Withdrawal from nicotine will be manifested by feeling nervous and I'm feeling anxious.

I've seen some patients over the course of my career who came to me with panic attacks and the panic attacks were from withdrawal of a substance like nicotine, caffeine or something that was causing them withdrawal itself.

So anxiety can be related to the nicotine itself.

>> Now the first couple of weeks can be kind of rough coming off the nicotine.

>> So that's why I will often recommend and sometimes medications like Chantix, nicotine patches, bupropion or Wellbutrin these are all medications that will give the brain a little bit of a nicotine boost or nicotine like boost in the case of Wellbutrin and give you a feeling like you're using nicotine in kind of health help with that let down overall.

>> But many, many people will use the early early your New Year's resolution as a means of trying to go off nicotine.

>> I'd love for you to be able to get your family on board, get anybody around you on board, be supportive of it, tell people tell people around you that you're quitting smoking and you're going to try to go without cigarets.

So that way it puts a little bit more accountability on you.

So let other people know about it all off and tell people, you know, try to get off the nicotine itself in the manner that works for you.

I've heard all sorts of stories about how people get off nicotine.

Many people say they go off of the cold turkey.

Some of those people will say they used nicotine gum.

The key with nicotine gum will be to keep it in your mouth for a while to let it get dissolved and get the nicotine absorbed underneath the tongue.

That's how nicotine gets absorbed in the mouth.

Some people will use the patches that just prevents the nicotine withdrawal.

Bupropion, as I've mentioned appropriate is a medication that increases dopamine and norepinephrine and combined with something like Chantix which also mimics the effect of nicotine, it can double the likelihood that you're going to stay off cigarets somehow some way.

>> So go about getting off the nicotine.

In what way works for you?

Some people will say they decrease by one cigaret a day and they actually have a count on how many cigarets are smoking that also has a way of getting around the withdrawal.

>> The problem with nicotine is it gets out of your system very, very quickly within a couple hours so you could have some withdrawal even though you're on a small amount of the nicotine itself.

>> So it's something where you can talk to your clinician about different possibilities for helping you get off the nicotine.

But there's a lot of different options out there now I wish you the best and thanks for your call.

>> Let's go next caller.

Hello, welcome to Arizona.

>> Mind because you want to know what are the side effects of Zoloft?

>> Zoloft is also known as sertraline.

It came out in nineteen ninety two .

>> It's been out for a long time.

Zoloft is a medication.

It is basically increasing the transmission of serotonin in the brain and by doing so it's increasing serotonin gives you a calming effect.

That's why Zoloft is good for anxiety but also has anti depressant effects by increasing serotonin.

>> What are the side effects if you get too much typically especially early on you can have nausea.

That's why we often recommend people that people take it with food, you can have diarrhea and that's one of the biggest side effects we'll hear from Zoloft diarrhea where means you're getting a little bit too much too early perhaps 50 to 200 milligrams will be the usual dosage of Zoloft.

>> But we'll have some people start out of twenty five milligrams even twelve point five milligrams as a means of kind of getting over that taking it with food can decrease the nausea and the diarrhea effects.

Now some people by increasing serotonin excessively for them can have headaches, they can have restless legs, they can have tremulousness, sweatiness.

Those are all serotonin side effects and some people will notice that they're not interested in sex.

They will have decreased libido and sometimes difficulty with sexual functioning overall.

So there are various side effects out there concerning Zoloft or with any medication for that matter.

If you look at the package insert and all the details about Zoloft, you'll see all sorts of different side effects with it and any medication the key will be what side effects are you experiencing and can they be overcome with a lower dosage because we're always trying to find that fine balance between between a lower dosage and efficacy.

So we want to work but we want you to not have any side effects and sometimes you just have to go to a certain dosage where that won't be problematic for you.

>> Thanks for your call.

Let's go our next email question our next email reads Dear Dr. Fauver, do colors have an effect on mental well-being?

I often notice that colors usually the hospital and my doctor's offices are pastel colors.

You're very observant through my eyes these colors can be quite sedating well they're supposed to be calming.

>> You'll you'll typically not go into a psychiatric office where the colors are really bright, bright red, bright yellows.

Sometimes bright greens can be kind of stimulating for some people.

So the pastel colors will often be perceived as more calming.

Some people will want to keep that in mind when they're putting colors in their houses.

They might have a bright red room in a room where they might be very active and and have like a game room in that regard.

>> But yeah, colors can have an effect on a person's mood.

It's very subtle.

You you'd like to likely have to have an underlying mood disturbance for the colors to exacerbate the mood disturbance itself.

But your colors can't have an impact on on a person's mood.

Thanks for your email.

>> Let's go to next caller.

Hello Shaun.

Welcome to Matters of Mind.

Shaun, you want to know after your parents of deceased and you find out that they put two previous children up for adoption and you were supposed to be put up for adoption, how should you deal with that?

>> Not really sure about that, Sean.

>> You know, sometimes you'll find out things about your parents after they've deceased family secrets might come out.

You might have a lot of different questions if you're wondering if you were adopted or not.

You can always get genetic testing and they can genetically try to link you to the biological siblings.

I know of a man in his 80s who just recently found out that he had brothers and sisters from his biological family.

>> So bottom line is you're still you and you still have your individual capabilities and your genetics don't create meaning and purpose in your life .

>> You still have your own individual identity and you have to remember that.

So yeah, it's sometimes can be enlightening to hear surprises especially after the death of a loved one.

But keep in mind you still have that individual identity and your own life experiences on which you can focus upon.

Thanks for your email.

>> Let's go to next email question.

Our next e-mail question reads your daughter Fauver when does a person know that they need to get treatment for winter depression?

>> What's the difference between winter depression and seasonal affective disorder also known as sad winter depression is something that is also known as seasonal affective disorder in the clinical sense.

It was first studied and identified the 1980s.

Remember when it was first getting noticed?

A psychologist out in Seattle, Washington was talking a lot about it and by finding out that light therapy, bright light therapy was helpful for the theory was that if you lived farther south you would have less winter depression did studies where people in the northern part of the United States had higher likelihoods of what would be called winter depression or seasonal affective disorder.

People down in Sarasota, Florida, for instance, had lower rates so they said oh must be the light.

>> And then it was discovered that in Norway they didn't have that much winter depression.

So over the past ten years or so there's been a lot of discussion about winter depression being yeah, partially influenced by the dark days but also partially influenced by your expectation of what winter should be like.

And if you dread winter and you don't enjoy yourself during the winter and you basically endure it, you're more likely to to account for a lot of your life difficulties to it being winter.

In other words, if you have a good attitude during the wintertime you're less likely to have winter depression in Norway what they found was a lot of people embrace the winter months.

>> They will do different things, will have winter festivities but they will have a different kind of lifestyle in the winter as they would in the summer and we can learn from that because we can learn from that if you think about it in the winter, OK, you don't have to do lawn work.

You don't have a lot of obligations you have in the summer in the wintertime you can sort through some things in your house.

>> You know, you always can find it very peaceful when it's heavily snowing.

You don't have to go anywhere that's always stressful for people.

But if you have to if you have to drive any place and you get to stay home, it can be very peaceful in a very calming influence just to kind of hang around the house and get some reading done, do some things you ordinarily wouldn't do if the weather was nice because many times when it's spring or summer or fall and the weather's nice, we expect ourselves to be outside doing things that's kind of been ingrained in us since we were little kids and it makes a lot of sense you should stay active and enjoy the sunshine but in the winter you can't always do that so you have to kind of go to different rhythm in the in the wintertime and do different things.

>> So that might be some times to get some indoor house work done you ordinarily wouldn't do yeah.

You might sleep a little bit longer in the winter but that doesn't mean you have clinical winter depression.

There are clinical winter depressions.

I saw a lady with winter depression about a week ago well clear cut winter depression.

>> She had depression exclusively and it was impairing exclusively from October till about early April every year the rest of the year she's perfectly fine.

So she exclusively had impairing functionally significant depression just during those winter months she had winter depression.

>> But a lot of people who allude to having winter depression will merely say they sleep more, they don't socialize as much.

They feel more tired.

They eat more carbohydrates in the winter time and they kind of withdraw if it's not impairing if if you're still able to get stuff done every day, if you're still able socialize, you're able to go to work, you're able to interact with your family, you're still able to get stuff done that's not considered to be a winter depression.

That's more of a life cycle rhythm disturbance that you're noticing but it's not clinically significant depression including clinically significant depression in the wintertime would be where you just can't get things done and you can't function.

>> So for that kind of depression your lightbox is often helpful.

Bupropion Wellbutrin I mentioned that a couple of times already as a medication that increases dopamine and norepinephrine bupropion as a medication has been actually approved by the Food and Drug Administration for winter depression.

>> Exercising during the wintertime is fantastic.

>> A lot of people don't want to do it but in the winter time that's when you really want to go to the gym on a regular basis because you're not getting the activity you'd like to get on the outside.

So try to get some kind of physical activity in the wintertime and socializing stay so she'll be around people sometimes people during the Christmas holidays can become overwhelmed with obligations and that gets them all stressed out.

>> OK, balance that out but try to socialize in winter months.

That's how the Norwegians do it.

That's how the Norwegians actually had a lower likelihood of winter depression than some of us down here at the southern latitudes.

So I found that interesting.

A lot of it had to do with the overall attitude toward the winter itself.

Let's go to our last caller.

Hello, Matthew.

>> Welcome to Matters of Mind.

Matthew, you mentioned that you have sugar diabetes.

I'm going to figure that David diabetes Mollas Type two or type one and will medication affect your mental health and wellbeing if you have diabetes where the blood sugars are going up and down and they're all over the place, you bet it will affect your concentration, your energy level.

Sometimes people will have panic attacks when their blood sugars are kind of going up and down abruptly.

They can feel very, very tired overall.

So glucose disturbances can certainly affect your overall wellbeing in your mental health .

That's why one of the things that Wilkommen examine when somebody this for an initial evaluation will be the possibility that they've had any blood sugars checked because I've seen people that had a horrific mental health problems.

>> We maybe do a little fingerstick in the office and find other blood glucose phi in the five or six hours and it should be generally less than 126 or 140 or so during the day itself.

>> But if it's in the 400 or 500 it will certainly affect your overall mental health .

Matthew, thanks for your call.

Unfortunate amount of time for this evening.

>> If you have any questions concerning mental health issues you may write me via the Internet at Matters of the Mind at WFYI Georg and I'll see if I can answer that on the air.

>> I'm psychiatrist Jeff author and you've been watching Matters of the mind on PBS Fort Wayne God willing and PBS willing.

I'll be back again next week.

Have a good evening.

Thanks for watching.

Goodnight