.

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

>> Welcome to Matters of the Mind down as twenty six 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 here 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 I am 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 off the air on the air you may write me via the Internet at matters of the mind all one word you have a dog that's matters of the mind at WFYI and I'll start tonight's night's program with a question I recently received.

>> It reads Dear dear father, I have suddenly had an increase of dreams while I'm sleeping usually multiple dreams in one night.

>> I don't have any new medications.

>> Is this a symptom of a bigger problem?

I would say not necessarily based on the nature the dreams of the nature of the dreams are not threatening or persecutory.

>> You probably would be OK now people will often dream more especially when they're not getting enough sleep so they're more tired.

>> They might dream more than some times people will dream more when they're under more stress.

>> A component of clinical depression can be that you dream more and one of the advantages of the medications used for depression forty years ago was that it was a they would suppress dreams so if you're having nightmares, if you're having scary dreams, if you have dreams that awaken you in the middle of the night and your heart's pumping in your sweaty and it's frightening, that could be a bigger issue.

>> But I would say that dreaming overall is a pretty good thing.

>> Dreaming helps your brain kind of recharge.

Dreaming helps this part of the brain over here which is the hippocampus part of the brain that helps with your memory center because when you're dreaming the front part of your brain, the thinking part of your brain shuts down.

So when the thinking part of the brain shuts down it causes you to necessary lose judgment and you will have very abstract dreams.

>> That's why a lot of dreams won't make sense unless you really think through them.

Many dreams will represent things you're going through in a very symbolic way over the past 24 to 48 hours and the later in the night you dream the more recently those events are generally occurring and the dreams that occur shortly before waking up many, many times will be even more meaningful to you about what's happening over the past day or so and it can be a little bit of an insight into what's going on in your life and what's concerning you, what's bothering you.

But you have to think very symbolically very abstractly dreams typically don't mean precisely what you're able to recall and if you don't try to think about your dreams immediately it's like the old blackboards where the dreams are erased very, very quickly.

Your brain's very good at erasing dreams unless you write them down and let's just start talking about them unless you think through them first thing in the morning.

But you're right Keith.

When you're right when you first start talking about dreams increasing, you can often notice that you're change you're changing your medication or you have some kind of other condition going on.

>> But if you haven't changed medication recently, the dreams are probably somewhat benign with the exception of maybe you getting more sleep when you need more sleep you'll often have more deep sleep where you're very deep into sleep.

The brain waves are very high and low and there are very wide apart and you if awakened during a deep sleep you'll be very confused for a few seconds and then you come out of it with dream sleep same type of thing.

Often it's called sleep deprivation or people haven't gotten enough sleep.

>> They'll notice they're dreaming more so that can be a factor.

Thanks for your email.

>> Let's go to our first caller.

Hello Keith.

Welcome to The Mind.

>> Keith, you had mentioned that you recently started a new medication for your anxiety but you don't feel a difference yet.

>> Does it take a while to build up or should you contact your doctor?

I would say Keith, you know it depends on the nature of your anxiety and depends on the nature of the medication.

>> For instance, if you're taking medication for anxiety that's related to worry and just ruminating about things and dwelling on things those type of medications for that matter such as Bruce Byron and the so-called SSRI, the selective serotonin reuptake inhibitors do take three or four or five weeks to gradually help you with the worry and rumination.

But if you're taking medication for panic, where are you having blasts of anxiety where you have an increased heart rate, you're shaky, you're having diarrhea, nausea, feel like you're going to die your head spinning those types of episodes of panic are often treated with benzodiazepines such as Xanax, Klonopin out of and which typically work very fast and we often use the antiepileptic medications in a similar manner such as gabapentin or pregabalin as a means of quickly relieving the panic attacks, hydroxyl is an antihistamine that sometimes can be used for a similar type of situation so it depends on the nature of the anxiety is being treated, the type of medication is being used.

But I often mentioned to people you know, when I hear about somebody having blast of panic I often wonder are there other things going on?

For instance, if you have a blast of panic where you have a really fast heart rate that could be from especially for women postural orthostatic tachycardia syndrome also known as Pott's that can give you an increased heart rate.

Women are eight times more likely to have that than men.

You can have a cardiac arrhythmia where you have apfasd paroxysmal atrial tachycardia.

>> It's where your heart just starts pounding really, really fast sometimes going up to 180 beats per minute really, really quickly you can have a pulmonary embolism where you have a blood clot in the lung that will give you horrific anxiety and people who have high thyroid if your thyroid is elevated because you recently maybe changed your thyroid dosage, that can give you a lot of anxiety.

So I'm often looking for the underlying reasons for anxiety.

There are a lot of medications that can treat the symptoms of anxiety but we often have to look out for the underlying causes, especially if they're coming across as panic.

>> Keith, thanks for your call.

Let's go to our next caller.

Hello Chanel.

>> Welcome to Mars the mind Show.

Now you had mentioned that you don't have an appetite when you're under stress and should you be concerned, Chanel when people get under stress what happens is adrenaline goes up now a chemical cousin of adrenaline is norepinephrine when adrenaline or norepinephrine go up, you notice a few things.

You might notice that your mouth is drier.

You might notice that during that time you get a little bit of constipation, perhaps you get kind of dry eyes.

>> But with that norepinephrine going up you will notice not uncommonly that you're going to be sharper with your thinking because of norepinephrine goes up it will fire up the front part of the brain which is the thinking part of the brain.

That's the part of the brain I mentioned earlier that shuts down when you're dreaming but when you're really focusing and concentrating, norepinephrine goes up when you get under a lot of stress in your anxiety level goes sky high a little amygdala down here which is the anxiety, fear and anger center of the brain that really gets fired up and sometimes that will cause the front part of the brain sometimes overreact and cause people to ruminate about things.

If you have a lot of norepinephrine, if you get under a lot of stress, sometimes it will decrease the stomach motility.

>> Some people get constipated when they're under stress and for those people they might notice they're just not hungry.

So lack of appetite can be a symptom of excessive stress.

What makes that worse for some people?

Well, if they drink a lot of coffee, caffeine will actually give you a decrease in appetite.

And for some people if they consume a lot of coffee with caffeine that can be particularly problematic for them during that time.

Tea is not so bad in that regard.

Tea has chemicals in it that actually will decrease anxiety while at the same time give you a little bit of an energizing effect.

And that's why ethylene which is the active ingredient in green tea especially can be a nice chemical for anxiety for some people.

>> So tea will be less prone to creating you creating decreased appetite or increase in blood pressure compared to the caffeinated coffee that many people will drink.

>> Shanelle, thanks for your call.

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

Our next e-mail question reads your daughter Fovea I just started taking antidepressants and I've noticed that I've lost my appetite.

>> Another person also appetite there.

Am I on the wrong medication or do I need to just get used to a lot of answer?

>> Oppressive medications will actually increase the appetite if you lose your appetite.

It does not mean that you're necessarily on the wrong medication.

>> Now when I think about the traditional antidepressants medications that affect the appetite one way or another we're talking about medications that increase norepinephrine dopamine and or serotonin.

Those are the that's a trilogy of the neurotransmitters that we've been discussing for the past 60 years.

If you increase serotonin, you bet sometimes that will decrease the appetite.

It was first noticed back in 1987 when this medication called flu a flu ox team also known as Prozac came out when Prozac came out a lot of people had decreased appetite and people looked at that favorably, especially people who are prone to binge eating when they got an order under a lot of stress so the serotonin medications can decrease your appetite sometimes as a side effect, sometimes as a favorable effect for people who are binge eating while they're depressed.

I mentioned earlier norepinephrine norepinephrine is kind of like a byproduct of adrenaline, norepinephrine and dopamine kind of run in tandem in the sense that they can be both be alerting they can help with concentration, they can help with motivation but they both can decrease the appetite.

>> That's why stimulant medications which do increase dopamine and norepinephrine as a side that can sometimes decrease the appetite unfavorably especially for younger people.

So the medications that are used, the stimulants such as the Ritalin products, the amphetamine products they're increasing dopamine and norepinephrine and they can sometimes up the appetite of the antidepressants that specifically increased dopamine and norepinephrine and we're talking more about bupropion or Wellbutrin and there's a newer medication available now called Sovaldi although he has has bupropion in it but it also has dextromethorphan and dextromethorphan is an old cough medicine has been around for sixty five years but if you have really high levels of dextromethorphan that can help with depression by affecting another chemical called glutamate.

But bupropion is in all reality and for some people to have decreased appetite with that too.

>> So yes it can be related as a side effect with your medication.

The bottom line is if you're having a decreased appetite you have to weigh the pros and cons of do I want to stay on this medication or not?

>> If it's intolerably decreased with your appetite you may want to look for another medication at that point but you have to weigh the pros and cons of any medication and its side effects and determine is are you willing to stick with it for a while because with some medications by all means some medications you'll notice that the side effects will diminish over the course of time and obviously as clinicians we can always adjust the dosages for many people will try to have them maybe take a lower dosage of medication because genetically they might be a slow metabolism, slow metabolism to different medication might have five times the blood levels of an extensive or a normal metabolism.

So if you're a slow metabolize on a medication it might just mean that you need a lower dosage.

It could be a good medication for you but you just need a lower dosage.

>> Thanks for your email.

Let's go to next caller.

Hello can walk into my mind can you want to know about the pros and cons of ketamine and ketamine bravado which is a nasal spray?

Ketamine came out in 1970.

It was actually created by an organic chemistry chemist up in Wayne State University back in the 1960s.

>> It became approved as an anesthetic in 1970.

So ketamine has been around a long time for anesthesia.

>> Ketamine was used off label or without approval for the FDA off label for depression about twenty years ago and it has been used in that way since.

Ketamine is a medication that will affect glutamate.

>> Now I mentioned earlier the trilogy of norepinephrine, serotonin and dopamine.

They have been studied for the past 60 years.

>> They've been treating people who we've been treating people with those type of medication for the sixty years and now we're talking more about glutamate.

>> Glutamate lives in the gray matter.

Ah the outside part of the brain glutamate is the accelerator gabbers the brakes.

So you've got the accelerator glutamate and you've got Gabb the brakes.

>> So what we're trying to do now when we treat people with depression, with ketamine and it's left sided piece is ketamine which is bravado.

What we're trying to do is fire up the glutamate outside part of the brain.

So it's like pushing on the accelerator on the car and it's opposed by this other chemical by the name of which is like the brake.

So where does norepinephrine dopamine and serotonin fit in?

>> They come from the brain stem.

The brain is kind of shaped like cauliflower and you got the stem of the brain that's where norepinephrine and serotonin and dopamine reside.

They will project to the gray matter of the brain and basically work and in consultant roles with glutamate and GABA.

>> So when you think about glutamate being the accelerator GABA being the brakes, serotonin, norepinephrine, dopamine they're kind of in the passenger seat giving advice on if the glutamate should push on the accelerator more or if the Gabba should push on the brakes more.

>> And I always remind people that talk therapy still has its role when we treat people with mood disturbances.

Talk therapy helps you steer a wheel so it's helping you actuall get to where you want to go.

But glutamates the accelerator Gabb is the brakes and that's where ketamine and as ketamine are working now what are the drawbacks of those treatments?

>> Usually with all medications you can always have side effects during the treatment of himself's you can have an increase in blood pressure for about forty minutes during the treatment within the two hours of each treatment for ketamine or as ketamine.

So we do monitor blood pressure for people.

You can't have a history of any bleeding or any difficulty with weak blood vessels in the brain because like with exercise which could increase the blood pressure while you're exercising using ketamine or Eschaton can do the same during the treatment itself.

But at the end of the two hours of monitoring for ketamine or ketamine you can typically leave with your blood pressure being normalized thereafter.

That's the biggest drawback when you have side effects from ketamine and that's ketamine typically is very time limited usually within that same day such that day by day you're not noticing those side effects.

The nice thing about ketamine and is ketamine since they're directly working on the accelerator of the brain, the glutamate they are working very fast.

So many people will get a very quick response unlike these medications that affect serotonin, dopamine and norepinephrine where it might take them weeks to give effects because remember they're coming from the brainstem.

They're giving advice to the glutamate and GABA and the outside part of the brain and in doing so they need to make some protein changes of the receptor level that might take six or eight weeks for a lot of people.

So we've gotten used to waiting six or eight weeks for the past several decades for antidepressants to work.

Now that we have ketamine and ketamine we are noticing that we're getting really fast results within a matter of hours for a lot of people with the Depression.

>> Ken, thanks for your call.

>> Let's go to next caller.

Hello Joe.

Welcome to Matters of Mind.

>> Hello.

Hello Joe.

I'm doing OK.

Thanks.

Hey, so good to talk to you.

I am all about these new studies about the two mg. Yeah.

And there's two crystals in there.

First off what are the size of them?

Are they the size of like pieces Bryce you know a particle of a peaceful rise.

pHow big are the crystals in the pineal?

It's right there right smack in the middle about the size of a small pea that's large.

It is it kind of hangs down there.

It's kind of in the middle there.

The pineal gland is about the size of a pea and it's it just it's just about the pituitary gland and a little bit better.

>> Look, it's right about there and basically the pineal gland will be a little gland that has a tremendous amount of sensitivity to light.

>> So in the winter time when it's darker there's less light hitting the retina and with less light hitting the retina you'll have less of a signal going to the pineal gland with less of a signal going to the pineal gland you'll have an increased amount of melatonin.

Melatonin is sometimes referred to as the vampire hormone because it rises when it gets dark.

So it's thought that when people have a tendency toward winter depression they're particularly sensitive to the darkness and they have more winter depression because they get more melatonin presumably during the daytime and unnecessarily and they feel tired.

They don't want to be around people.

They get more depressed, they get more fatigue.

They have poor concentration and they want to hibernate and that's from a biological standpont it's it has a role in hibernation for mammals.

How interesting.

Yeah, you're right, Joe.

There's going to be a lot more studies about it.

I remember hearing for the first time about seasonal affective disorder which is now called winter depression not uncommonly but I first heard about it in the late 1980s and I thought it was pretty interesting because if you stimulate the eyes with bright light in the wintertime we call it light therapy.

>> It's where you sit a foot or two away from a really bright light and you sit there for about twenty or thirty minutes first thing in the morning from about November through March and you do it every morning first thing in the morning.

Basically what you're doing there is you're shutting down the pineal gland so it's not secreting as much melatonin and in doing so it treats depression and for many people they've had dramatic relief from that.

And I often refer to to a light therapy for somebody who has winter depression as well as making sure their vitamin D levels at least fifty five or more vitamin E levels, especially for those of us up here in northeast Indiana not uncommon they will slip down the single digits in the winter time.

So I always want people get their vitamin D level up in the wintertime because vitamin D also is manufactured in the skin upon exposure to ultraviolet sunlight.

>> So with vitamin D it's the ultraviolet sunlight that stimulates the vitamin D production with winter depression it's actually the intensity of the light and the bright light that we're talking about is the light intensity during the summertime at about 10:00 a.m.

So that's kind of light intensity we're talking about.

>> So some people you know, if you can get out at 11:00 a.m. or so noon, the sun's up.

It's a bright sunny day.

If you going to get outside and go for a walk for twenty minutes, that'll help.

Not only will you be getting some fresh air and some exercise but you'll also be getting exposure to light.

But that all comes back to that little small safe side pineal gland.

>> Can I ask another question?

OK, Joe the crystals if you put the crystals under pressure do they make a radio frequency?

>> Beats me.

I don't think we're advanced to really know that so far in terms of knowing how to really deal with the crystals right now and what impact that might have.

>> So I know Joe well thank you so much for everything that you're doing and I love that I'm able to ask you about the conille gland is such a big part of our everyday observance of reality.

>> I appreciate everything you're doing.

Thank you so much.

Already have good night.

Let's go next caller.

>> Hello Amy.

Welcome to Matters of Mind.

Amy, you want to know about the signs of a borderline personality disorder borderline personality disorder?

>> Amy is generally related to having difficulty with attachment to a parent typically the mother at a young age we're talking about prior to the age of four years old.

>> So it's very important from early infancy to those early toddler years and even before you go to school that you have a really close attachment to a parental figure and that can be a mother or sometimes as a grandparent but typically it's a mother and if you don't have that attachment because the mother or father if he's the primary caregiver, if they have some issues of their own where they're not really able to attach people can have borderline personality disorder where they have moodiness, they can have a sense of of abandonment depression where when they feel abandoned they get horrifically depressed and anxious and panicky.

>> When people have borderline personality disorder they can often have a sense of rage, they can have a quick temper and they can have a sense of emptiness feeling like the life is just empty and they'll often have ongoing suicidal thoughts.

They just wonder why are they still here in many people with borderline personality disorder will get so depressed that they will make suicide attempts sometimes they'll cut it themselves as a means of just relief releasing some natural opiates in the skin they don't realize they're doing that but when they cut themselves they actually have a soothing effect.

But they do that when they get under stress and it's a way of releasing endogenous or natural opiates.

You release natural opiates to your brain and you get a calming effect.

That's why people do it.

They don't realize they're doing it for that reason but they'll cut it themselves when they get into a lot of stress that goes along with borderline personality disorder.

People with borderline personality sorer will often look at the world around them as being all good or all bad.

>> All right or wrong they don't see the gray areas in things so they often will have difficulty with interpersonal relationships, have a hard time holding on to relationships because they can feel highly attached and they have this phenomenon called chameleon personality where they lack identity.

They start to take on the identities and the personalities of people around them in social environments so they have a difficult sense of their own identity.

So the best way of treating them will often be through therapy will give a medication sometimes for depression and if they have severe moodiness and they get stressed out so much that they get into a psychotic episode sure will give them antipsychotics sometimes.

But more often than not borderline personality disorder can be best treated with talk therapy to help people gain an awareness of how they can better cope with situations that they were enduring.

Dialectical Behavioral Therapy DBT is a means specifically that will often address borderline personality disorder and people will have differing degrees of it.

Some people will have borderline personality disorder to such a degree that they can't function in society.

Other people will be more mild who will be noticeable and it's something that can be addressed with individual therapy.

>> Thanks for your call.

Let's go our next caller.

Hello Casey.

Welcome to Mariza Mind Case.

>> You wondered if you're able to check a relative into a facility if you feel they are not stable, you have to have a doctor's order to be able to have somebody involuntarily committed to a psychiatric facility if that's what you're asking Casey.

So a family member can contact a doctor and say here's my concerns, here's the issues and the doctor will typically evaluate a person over the course of three days in a hospital environment to determine if they need to have ongoing treatment involuntarily or many times of people acknowledge that they have difficulty as a patients they'll come into the hospital within those three days they will say yep, I understand why I need to be here.

They sign in voluntarily and they get the adequate treatment at that time.

But you're not able to check a relative into a psychiatric hospital even though they might be doing that on movies.

Sometimes you always have to have a doctor be able to give the OK and again it's not going to be something where somebody goes into a psychiatric hospital for months and months if erratic relative checks them in, the clinicians in the hospital have to agree the they need to be there for a serious reason.

Casey, thank for your call and we've got about a minute and a& half here.

Let's go to our last email.

Let me see if I can answer my last email here very quickly.

Dear Dr. or other changes in the brain that occur when people lie after lie detector tests valid?

Can someone become a good liar?

>> Well, good question.

What happens in the brain when somebody lies is generally this little amygdala to which I referred earlier really lights up that your anxiety center f the brain that's the guilt center, the brain, the anger center of the brain that really lights up when you're lying the front part of the brain when somebody is lying is actually working harder so they have to think about they're lying and a poly polygraph test is not often valid because some people are good liars and the more you lie the more the brain changes to adapt to making you soft, making you believe the lie itself.

So the lie detector test which is checking blood pressure, heart rate perspiration tensing up of the body they can't be valid during that time because some people are really good at lying and they could make themselves believe what they're actually saying.

Thanks for your email.

Unfortunately I'm out of time for this evening if you have any questions concerning mental health issues that I can answer on the air you may write me via the Internet at matters of the mind all one word at WFA ECG.

>> I'm psychiatrist Jeff Olver and you've been watching Matters the mine which is now available on YouTube God willing and PBS will all be available next week.

>> Take care.

Good night