Good evening, I'm psychiatrist Jay Fawver live from the Bruce Haines studio in Fort Wayne , Indiana.

Welcome to Matters of the Mind now in its 10th 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 you may call any place coast to coast toll free at 866 (969) 27 two zero now on a fairly regular basis where our 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 a via the Internet at matters of the mind all one word at WSW ECG that's matters of the mind at WSW Eigg and I'll start tonight's program with a question I recently received.

>> It reads Dear Dr.

Fauver, are there any long term risks for antidepressant use?

I was on Prozac also known as Fluoxetine for ten years before switching to Effexor.

>> That's Venlafaxine and bupropion.

That's Wellbutrin for the past two years.

So now you're on Effexor and Wellbutrin for the past two years you'd previously been on Prozac for the past ten years prior to that time Prozac or Flock's team has a serotonin reuptake inhibition effect.

>> What that means is basically if your neurons are firing out like a shotgun, little pellets of serotonin, the serotonin gets preserved by getting back into the firing neuron like a vacuum and that's called a reuptake pump.

>> The serotonin reuptake inhibitors like Prozac are blocking the vacuuming of serotonin back into the neuron.

>> Well, also those little reuptake inhibitors like Prozac will also inhibit the vacuuming of calcium into the bone.

>> So the biggest risk long term with a serotonin antidepressant use will be the possibility of osteoporosis.

You might see about a 12 percent higher risk of fractures on the wrists as well as the hips for people who have been on long term antidepressants that affect serotonin, women are more effective than men.

>> Obviously and you can get around that somewhat by simply taking a calcium supplement if you're over 55 or if a menopausal.

>> So if you're menopausal, if you're over 55 years of age, especially if you're a woman and you're taking a serotonin type antidepressant medication, there's many of them Prozac, Zoloft, Celexa, Lexapro, Paxil effects or is one of them.

These are the type of antidepressants that can inhibit the vacuuming of calcium into the bones, putting a person at a bit higher risk for fracture outside of that generally the antidepressive medications with long term use will not give you medical difficulties.

>> You might have heard about a phenomenon called tardive dyskinesia.

That's where somebody is on a dopamine receptor blocker.

We've called antipsychotic medications but those medications are blocking dopamine and they can give you twitches and tics later on as a delayed side effect.

The antidepressant medications typically are not prone to doing that.

>> Thanks your email.

Let's go to our first caller.

Hello Joseph.

Welcome to Mars The mind.

>> Joseph, you had mentioned that your first cousins all develop serious mental health conditions when they went to college.

Should you be concerned when you go to college?

Well, Joseph, no one I'd be concerned did your cousins, for instance, use marijuana or alcohol specifically when they went to college?

>> Now keep in mind a lot of mental health conditions begin for people between the ages of 16 and 24 years old, for instance, schizophrenia has its average onset of age at sixteen four four boys, four girls 24 years old for bipolar conditions.

It can be earlier than that.

But if you use alcohol or marijuana as a young adult, it's going to trigger a lot of those symptoms.

>> So I'd wonder did your cousins perhaps use any alcohol or marijuana as a way of inducing those conditions?

>> If so, that's all the more reason for you not to use marijuana and really go lightly if you drink any alcohol at all in college because those can be factors other type of conditions that occur in college will be relationship difficulties in college.

There's a lot of pressure for developing relationships.

You're expected to develop relationships and if people are having those kind of difficulties, try to get a handle on that proactively and get involved in counseling to try to deal with that.

>> But I'd be curious, Joseph, what kind of difficulties your cousins were experiencing when they went to college and try to get a better understanding of that?

>> Joseph, thanks for your call.

>> Let's go our next caller.

Hello, Mary.

Welcome the mayors of mind.

Mary, you want to know what are differences in managing seasonal depression versus regular depression?

>> Seasonal depression, Mary is where you will distinctively and predictably get depressed typically in the wintertime and that will be from October to April.

Now some people will get more hyped up in the wintertime.

That's fairly rare.

Other people get more manic in the spring but their seasonal disturbances with the mood and if you predictably get more depressed in the wintertime, there's things you can do.

>> We're going to use certain medications in the wintertime such as bupropion or Wellbutrin which was mentioned earlier.

That's a medication.

It's going to increase norepinephrine and dopamine and it's been specifically approved for winter depression also known as seasonal affective disorder.

>> We're also going to encourage people to get some sunlight early in the morning the best they can in the wintertime, maybe go for a twenty minute walk in the morning when the sun's coming up on the sunny days.

>> Otherwise get a light box light boxes are very effective in treating winter depression.

You said about a foot or two away from it.

It's a bright light.

You your clinician, your primary care clinician can perhaps tell you about that.

But it's a very bright light in which you sit in front for about twenty minutes or so every morning.

You do it every morning from roughly October through March as a means of awakening your brain because the theory behind winter depression or seasonal affective disorder is that your brain is responding to the amount of brightness in the light it has less to do with wavelength, it has more to do with brightness of the light.

So in the wintertime there's less brightness to the light and I'm going to pull my brain apart here in the front part of the brain.

Here's looking at you and the retina gets stimulated by by bright light and the bright light will thereby suppress melatonin in the pineal gland which is a little pea shaped gland right smack in the middle of the brain.

>> The pineal gland secretes melatonin and it's thought that if you have less brightness of the light coming to stimulate the pineal gland you'll have less you'll have more melatonin being secreted.

>> So with darker days melatonin goes up, melatonin goes up and you can feel kind of blah.

>> You don't want to socialize as much.

You eat more.

You sleep more as kind of a instinctively a hibernation mode people will tend to acquire in the winter time.

So you go into this hibernation mode.

How do we deal with that?

Well, we can often use medications like bupropion and Wellbutrin.

>> Sometimes people use the serotonin medications but very importantly there's three things you can really do from a behavioral standpoint to try to help yourself get over to winter depression number one exercise number to really go easy on carbohydrates and all the cookies and everything in which were exposed in the wintertime because they're so prominent but they can actually make you more depressed because of the high carbohydrate intake .

So exercise carbohydrate limitations and thirdly socializing, socializing is one of the best things you can do in the wintertime stay active.

Many people become more reclusive in the winter time because well, it's cold outside and it's important especially in January and February when the parties are tending to subside, try to get around people and maintain meaningful relationships.

>> Thank you for your call.

Let's go our next caller.

Hello Earl.

Welcome to Matters of the Mind .

Earl, you want to know does exposure to scary images as a kid damage your mental health as a as a child?

Does that damage your mental health and how can you stop yourself from remembering those things in adulthood?

>> I think earlier you're describing traumatic experiences as a child and it's something we do indeed encounter if you're under eight years of age and you have overfit or of the ten specific items that have been identified on this scale called the adverse childhood experience scale, it's called the ACS Adverse Childhood Experience Scale.

>> There's ten items and that was developed because these researchers looked at over 200 different traumatic experiences that can really affect a kid and they determined that there were ten things ten things that were most important and impacting a child's early brain development and can predict depression and anxiety on down the line.

>> So if you've been exposed to parental separation or divorce, a parent went to jail, you had emotional abuse, you had sexual abuse, you had physical abuse, you had drug abuse or alcoholism in the family.

>> If you have over four of these different items on the adverse childhood experience, Gail, you're more likely to as an adult have depression and anxiety.

>> Well, can you just ignore that?

Well, it's best not to dwell on it and we do the best we can to get people not to try to recollect and ruminate and try to rehash all those bad experiences.

>> We do try to get people to allow them to to allow them to live in the future as opposed to living in the past with all those bad experiences.

But we do know that predictably people who have those past traumatic experiences aren't going to respond to certain types of medications like the serotonin reuptake inhibitors, especially if they have a particular Jenny, the genetic profile.

>> So it's not a matter of forgetting those particular experiences.

It's a matter of dealing with them, putting them behind you and being able to cope with your future life expectations as you would hope as opposed to living in the past.

>> Thanks for your call has got an email question.

Our next e-mail question reads Dear Dr.

Foster in the movie City Slickers, Curley said that we should all strive for one thing.

Do you agree with his assessment and what would your one thing be that you should strive for ?

Well, that's kind of like a Trivial Pursuit question but I did indeed watch city slickers Phenomenal Move movie Curlee was played by Jack Palance as this is a movie in which Billy Crystal was having a midlife crisis.

So he goes out and becomes goes to a ranch camp and herds cattle for a couple of weeks or so.

And Curly was the really gruff a ranch hand that was out there and he said there was one thing in which you should all strive for that one thing was to find meaning and purpose in your life and only you could find it.

>> So that was the moral of the story that was kind of close we should all have meaning and purpose for our day to day activities.

>> But first one thing that can predict happiness I'm stating is based on the research that has come out over the past almost 100 years now watching people long term the one thing has to do with relationships and you'd think maybe that one thing if you watch people over the course of decades that would predict happiness that would be maybe wealth, notoriety, success, health .

>> No, it's relationships always all about relationships.

So the people has they been followed over the course of decades studies is going all the way back to the 1930s 1940s as people were followed over the course of decades it all came down to their happiness in later life all came down to the meaningful relationships they endured and that could be from a marital relationship that could be from very close friendships not just acquaintances.

>> We're talking about friends who will actually call you out and confront you on different areas your life and it's a give and take relationship so it's not a one sided relationship, a give and take true friendship can be very, very helpful.

So the people that had meaningful relationships long term were the ones who had the greatest happiness in life .

>> So I think, you know, Curlee kind of had a right where he said finding meaning and purpose because we're always asking people about meaning and purpose in their life .

We're always asking people what gives you pleasure?

>> What are you doing to give yourself pleasure?

Well, that's part of it, you know and Curly had it right in that regard.

But I think they probably could have made a little bit more accurate when let's see Billy Crystal's character I forget his name but when Billy Crystal's character in City Slickers went home with that calf by the name of Norman taking the calf home to this family I think would have made more sense that it was his family that gave him more a meaningful perspective on life .

>> So having the meaningful relationships I think would have been Billy Crystal's character is one thing that he should have really been pursuing but great movie from a lot of perspectives and it was a nice little life lesson on midlife crisis.

So thanks for bringing that up.

City Slickers, good movie.

>> Let's go to next caller.

Hello Timothy.

Welcome to Matters of Mind.

Timothy, you want to know from a psychological perspective would what I recommend that young couples live together before getting married to to try to establish compatibility?

That's a controversial question, Timothy, that I'm going to give you the research.

>> Number one, marriage is very important in all of our lives because if you get a college degree, if you get a job and get married, those three things in that order typically you're more likely to have a prosperous independent lifestyle that were you will not need government assistance and you won't find yourself getting lonely and thereby depressed.

>> So from a psychological standpoint, finishing high school, getting a job and getting married are three very important goals that everybody should pursue to try to become independent as a young adult.

>> So with that being said, OK, you talk about marriage over the past twenty five years there's been a trend for more cohabitation with the perception that if you cohabitate you get to know each other more and more and you decide if you'd want to be married or not.

>> The issue becomes if you're cohabiting it's more difficult to break off that relationship or let it be said engagement.

>> So if you're engaged and you're living together, OK, if you're engaged and not living together, it's easier to break off the engagement for whatever reason.

But if you're living together you actually have the so-called skin in the game where you're sharing rent, you're sharing finances, you're sharing a relationship while you're not really totally committed to marriage yet once you make that step of committing to marriage then it's not so easy just to back out of it.

So when you're living together, yeah, you can back out of it.

But many times when they're living together or cohabiting they'll kind of slide in the marriage as opposed to saying yeah, this is something I really want to do.

>> So the research is showing that cohabiting is not predictive of a greater likelihood you're going to have a successful marriage or like a divorce later on.

>> It's not showing that at all.

However, marriage is something that is very good for a person's mental and physical health because people who stay married over the course of the years if they have a symbiotic type of relationship as they should a married couple should make each other stronger.

A married couple should actually bring out the other person's strengths and actually mitigate their weaknesses and you should each have a profile where you complement the other person's personality profile so unlike some of the dating profiles that are out there where you're trying to find your perfect match from a personality standpoint, I don't think you want that because you don't want to marry somebody just like yourself.

>> You want to marry somebody who has personality traits are quite different than yours but yet you share similar values and that's what's most important sharing sharing similar values, ideals and what you find meaningful in life .

>> So cohabitate not not something I'd recommend based on the research out there but a long engagement could be helpful to try to understand if you're compatible because you're always going to be learning about each other during the engagement period even if that goes on over the course of a year or two .

>> And quite frankly if you've been married over four or five decades, you're still learning about each other.

>> So it's an ongoing process.

Don't expect it to be a Damascus type moment where all of a sudden you realize this is the person for you know, it's a very gradual type process for people where they gradually learn about each other over the course of time.

But cohabiting research shows that's not the way to go.

>> Thanks for your call.

Let's go our next email question our next e-mail question reads dear to discover how do you do a better job of controlling your how do I do a better control job of controlling my emotions?

It seems like it's so easy for me to get very invested in situations that might tug at my heartstrings.

>> It might be hard for me to let go of those situations.

>> I think it comes back to something that I discussed earlier where you don't want to be ruminating about the past.

>> I've mentioned before that the best NFL quarterbacks are the ones who can throw an interception and they pretty much erase the impact of that interception as they go back out to the next series of downs they're going to play.

>> So if you can do the best you can to leave your past behind you and not always be looking in the rearview mirror if you're driving down the road and you just focusing on the rearview mirror and you're looking at the person behind you who you think is tailgating, you can have an accident because you're not looking in front of you.

>> So you got to keep focusing on the front what's forward?

Yeah, we learn from our past we could be offended by different things but if we let it consume you and you dwell on it, it's going to eat you out, eat you up from the inside.

>> So it's a type of situation where you want to keep looking forward but knowing about the mistakes and your experiences from the past, that's all important.

But you don't want to dwell on it and don't want to be consumed by it always keep looking forward and thinking about the future and thinking how you can improve and things to come.

Now granted some people will have psychiatric disturbances that we have to address whether unnaturally irritable they're having moodiness.

There's conditions like attention deficit hyperactivity disorder.

There's PTSD where people can be hyper vigilant or jumpy because of past experiences where they're triggered by certain situations.

There are psychiatric situations like that where we can treat the irritability and and the anger that people can have unnatural.

But more often than not I'm emphasizing to people that it's important from a counseling standpoint to keep looking forward and not look in the past so much.

>> Thanks for your call.

Let's go to our next caller.

Hello, Max.

Welcome to Matters of Mind.

>> Oh, Max, this must be movie night because you're asking me about Christmas movies and you had mentioned there's a lot of Christmas movies to watch this holiday season which one would I recommend to be most impactful on improving mental health ?

>> Well, a lot of people think Christmas Carol.

But I think Christmas Carol, which my granddaughter's by the way watched this afternoon Christmas Carol is is a good feel good movie but it's more about holiday festivities.

>> It's about relations.

>> Yes.

Which is always important but I wouldn't put that at the top of the list.

I'd actually say it's a wonderful life and despite Jimmy Stewart apparently not liking the colorized version colorized version of It's of It's a Wonderful Life really brings out the beauty of the background of the scenes that they had.

>> What's nice about it's a wonderful life you haven't seen I don't want to spoil it for you but it basically helps you understand that your life has a big impact on other people and I can leave right there.

But it's it's very important from a psychological standpoint what I notice about a wonderful life it does involve a person who's thinking about suicide and this person is thinking about suicide.

>> It's very accurate in this regard when people become suicidal they often have this sense of hopelessness and there might be something that kind of takes them over the edge where it's one more stress and without one more stress they get hopeless.

>> They don't see any meaning for the future.

They think everybody's going to be better off without them.

>> It's a Wonderful Life addresses that so remarkably well and they did so when Jimmy Stewart was just coming back after being a bomber pilot.

>> He had a lot of post-traumatic stress disorder so he put a lot of his emotion into his character.

So It's A Wonderful Life is a remarkable movie that from a mental health standpoint that's what I'd certainly recommend over the Christmas season.

>> Thanks for your call.

Let's go to our next caller.

Hello Johnny.

Welcome terrorism Eid Johnny, you mentioned there's a lot of are there any particular reasons why so many people feel emotionally numb during the holiday season?

I think some people, Johnny, will become emotionally numb because they're overwhelmed by the stresses and obligations and you have to learn to say no to certain obligations.

You have to sort out what you want to do, what you don't want to do.

Other people will feel a sense of loss because loved ones have died, loved ones maybe have moved away.

They're no longer together.

They miss that tradition and the family get togethers they might have had previously.

Some people will feel emotionally numb because they're overwhelmed by family obligations and they get really stressed out and they get angry because they get put in that role of maybe the being the kid in the family even though they're now forty five years old, they're treated as if they're eight years old in the family again.

So it's a very stressful time for them but there are individual reasons why people can feel somewhat overly numb and emotionally stretched over the holidays because people only have so much bandwidth.

So it's important to try to keep it all in perspective and know your limits on what you can do and what you can't do.

>> And if you can't give presents to every single person you'd like to do so OK, just keep that in perspective and maybe have agreements with other family members on what you're going to do and what you're not going to do.

>> Let's go to our next email question and our next e-mail question redistributive or how can medications for schizophrenia make people erratic and even dangerous?

Is this common and how can you prevent this from happening?

The medications themselves for schizophrenia can have side effects such as Akathisia Achilles's where you can't sit still and it cause you to feel more restless and sometimes more irritable and anxious and it's very important for us clinicians to understand the whole side effect of akathisia because we want to address the Athelia as a side effect of the medication and not simply give a higher dosage of that particular medication.

>> So that's the isolated area where medications for schizophrenia can make people more agitated and more restless, even more dangerous.

>> However, usually it's the underlying condition itself that's going to cause the violence and the erratic behavior.

>> So schizophrenia so most people do not become violent toward loved ones with schizophrenia.

>> Some people do and the people who do often hear voices talking to them.

>> The voices can be very commanding and those command hallucinations where they're being told very loudly in their heads to do something violent in nature that's very difficult to resist.

>> So schizophrenia can be a condition where people get very agitated, very angry and they can become violent not usually toward family members or other people but it can occur it's the underlying condition itself.

>> And basically when you think about schizophrenia, the reasoning part of the brain is not working so much.

There's this front part of the brain over here that's called the dorsolateral prefrontal cortex.

That's the reasoning logical part of the brain.

It's not working so well with schizophrenia.

So that's why it's difficult to since simply tried logically talk somebody through a psychotic episode because they can't their brain is not working for logic so they can't reason and logically adhere to the kind of discussions you're having with them.

>> So what we need to do with schizophrenia is fire up this front part of the brain and dampen down the emotional part of the brain this way overactive and that's where your people are getting hallucinations and they're hearing things.

They're having these fixed false beliefs and you can't talk them out of it.

So the condition itself is very complex but it's very important that we try to address it aggressively to try to not cause people side effects like the akathisia that I just mentioned but give them a mitigation of the symptoms they're having by firing off the front part of the brain and dampening down the activity in the limbic system, the side part of the brain and we have medications now do that that have various mechanisms of action.

>> So we have medications that actually increase activity in the front part of the brain and dampen down the excessive activity in the limbic system.

And these medications are called atypical psychotic medications.

>> The new medication called Koban Fee that came out about a year ago and Quabbin Fee is actually specifically and selectively increasing muscarinic or acetylcholine transmission and in doing so it's decreasing the faucet volume of the dopamine.

So it's actually turning down the faucet on dopamine and directly without giving a lot of the side effects the people previously had.

So we have a lot of hope and a lot of optimism about the future treatment of schizophrenia.

Thanks for your call.

Unforced.

>> I'm out of time for this evening.

If you have any questions that I can answer on the air concerning mental health issues, you may write me via the email at the Internet at matters of the mind all one word at WFYI dot org.

I'm psychiatrist Jeff and you've been watching matters of mine on PBS Fort Wayne now available on YouTube God willing and PBS willing.

I'll be back again next week.

Have a merry Christmas.

Good night