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>> Good evening.

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

And welcome to Matters of the Mind.

Now as twenty six year matters, 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.

But if you're calling coast to coast you may call toll free at 866- (969) to seven to zero now on a fairly regular basis we are broadcasting live every Monday night from our spectacular Fort Wayne studios which lie in the shadows of the Purdue Fort Wayne campus.

And if you have any questions that I can answer on the answer on the air, you may write me at the email of Matters of the Mind all one word at WFB ECG that's matters of the mind at WFB.

Craig starts tonight's program with a question I recently received.

It reads during Revolver I've been self medicating with marijuana for my stress.

I've tried counseling and it doesn't help as well as marijuana.

What can I do?

Well, cannabis is something that if especially if you're under 24 years of age can suppress the growth of the white matter of your brain so it can cause you to have trouble with processing information and basically literally decrease your IQ over the course of time.

>> So if are under 24 years of age you really need to find other means of helping you with relaxation of the marijuana.

Now there are a lot of behavioral techniques I mean going back to simply exercising as a means of helping you relax and be a start aerobic exercise where you're trying to get your heart rate it increased is very good for a lot of people who suffer from depression but a lot of people will notice that they have stress relief when they use resistance or weight training.

So there's different types of exercise that can be helpful for different types of psychiatric symptoms.

>> A lot of people will notice that if they will change their diet in some ways that sometimes will help their ability to tolerate stress and everybody's different and you just have to track what seems to work for you.

So for some people it might be a low carb diet.

Other people will be intermittent fasting.

>> It all depends on what works for you in terms of helping you with anxiety and stress.

But quite frankly the first thing will often do when we hear about somebody using marijuana on a regular basis is realizing that they're using it for a reason.

Many people will use cannabis as a means of helping with decrease in anxiety because cannabis makes you not care as much and it just decreases anxiety and sense that it makes you a little bit more apathetic and unfortunately it can decrease motivation and that's why I always will tell oh 18 19 year olds going off to college to don't use marijuana because if they use it that's a key factor in terms of their having difficulty staying in school because of the use marijuana when they're under stress it makes them not care and they can withdraw from classes and it can affect them socially as well.

>> Many people when they start using marijuana when they're 13 or 14 years of age and use it regularly through high school and even into their twenties and into the early 30s will be in their early 30s and they'll have not uncommonly the emotional maturity of somebody who might be an early adolescent when they started using marijuana simply because marijuana basically not only stunts the growth of the brain but I think it stunts the emotional growth as well.

>> So people will have difficulty over the course of time being able to emotionally grow and and be able to adapt to their environment.

>> Anxiety is common during your adolescence, especially in social situations.

>> We should all learn how to adapt with that type of anxiety and learn from it.

If you use marijuana you don't care and you go through your adolescence and into your early adult years not really learning those experiences of coping with those social situations.

So with that in mind will often use a medication like Gabapentin as a means of helping people get off marijuana.

Now marijuana will affect the cannabinoid receptors that are in the brain and give you a calming effect but gabapentin will affect the calcium channels in such a way that will make the little neurons less prone to fire abnormally high if you're under a lot of anxiety so the gabapentin will help with decreasing the anxiety in that matter by decreasing the excessive firing of the neuron.

It'll also indirectly affect the limbic system here this little amygdala right here and with followed by the limbic system up here going up through the hippocampus of the brain.

The limbic system is on the inside part of the brain and that is what controls your anxiety and helps you cope and tolerate things.

>> And the limbic system, the amygdala which is the anxiety and and anger and rage center of the brain right there that is communicating with the front part of the brain which is the reasoning part of the brain.

>> So what you're trying to do when you're trying to treat anxiety is often OK dial up the front part of the brain so the front part of the brain can help you think through your life circumstances and thereby dampen down the firing of the amygdala and decrease the overall activity of the limbic system so that you don't feel overwhelmed by stress.

So what will often do is give people some behavioral techniques to help them get off the marijuana but also we can't ignore that marijuana does have physical effects on the brain in terms of helping with anxiety and if you stop marijuana abruptly, one of the symptoms can be extreme anxiety and difficulty with sleep and not uncommonly when people are are stopping marijuana abruptly if they've been using heavy doses they'll have vomiting so marijuana withdrawal is sometimes can be characterized by vomiting projectile vomiting which can be very serious.

So we have to take that into account and will often help them detoxify off of marijuana when they've been using it but especially before the age of twenty four years of age when the brain is still growing ,the white matter of the brain typically is suppressed by the use of marijuana.

>> That's the part of the brain that forms the insulin all around the little neurons and if the forms of the insulation around the little neurons and if you dampen that laying down of the insulation around the neurons you'll have difficulty communicating from neuron to neuron.

>> Matthew, thanks for your email.

>> Let's go to our first caller.

Hello Matthew.

Welcome to Matters of Mind.

Matthew know you know how you could relax when you have intrusive thoughts when you have intrusive thoughts.

>> I believe Matthew, you're referring to thoughts that you don't really want to have now sometimes those are just annoying thoughts that can be somewhat distracting and in those cases it's important to try to focus on something else.

>> That's the simple answer.

Yeah, I mentioned earlier the impact of exercising exercising can help you kind of chill out.

Exercising typically relaxes people.

Many people don't want to exercise until they do it and then after they exercise they not only feel a sense of satisfaction from exercising but they feel calm but yet they feel energized at the same time and there's a neurobiological reason for that.

When you exercise you increase both your stimulating neurotransmitter called glutamate which is in the outside part of the brain and you also increase your calming chemical called gabber gamma amino acids.

>> So if you increase both the accelerator and the breaking neural neurochemistry in the outside of the brain, you can feel energized but yet calm at the same time.

>> So this is why we will often recommend to people that they exercise 30 to 40 minutes maybe three times a week would be nice.

Five times a week is even better.

But getting some kind of exercise especially if you have difficulty with anxiety and intrusive thoughts that can be very helpful.

>> Now Matthew, there are types of intrusive thoughts that we truly call obsessions.

Obsessions are due to this inside loop of the brain here.

This is the brain looking at you in this inside here is as a loop and that loops get stuck.

>> You tend to think about things that you don't want to think about in you know, they don't make any sense and they just keep coming around and around.

Those are called obsessions and it's kind of like the old record player where the needle got stuck and the way we break that up not uncommonly will be with high doses of medications that increase serotonin and that's a way of breaking up that loop.

But that's a psychiatric condition called obsessive compulsive disorder.

Obsessions sometimes are followed by compulsions where you do things over and over and over again even you realize you don't need to do them again such as cleaning or checking or or a ruminating about something.

>> And you know, you don't have to keep doing these things over and over again but you feel like you have to to get away from it.

So obsessions come time sometimes can be accompanied by compulsions but the obsessions are the are the type of behaviors where you have thoughts and they don't make sense to you but they annoy you and the more you try to get them off your mind off your mind, the more it can get sometimes.

>> So one way that you can kind of break up that loop the going around and around with the obsession is simply in your mind or outloud.

If you can do it say stop.

If you say stop you activate this left front part of the brain and that sometimes can break up that loop.

It's a simple technique but if you simply think very clearly in your mind or say it out loud stop when you have those obsessive thoughts go to immediately start thinking about something else that can be really helpful.

>> We have we see the same thing with dreams and when you're awakened from a dream if it was a vivid dream, the dream over the course of the morning often will be erased unless you talk about it now if you talk about it and you start trying to think about what that dream is all about or you write it down, you can study your dreams in that manner.

>> But more often than not people will have dreams and those dreams will kind of fade away like a puff of smoke over the course of the morning.

The same thing can happen with obsessions if you redirect your thinking to something else.

>> Thanks for your call.

Let's go to our next caller.

Hello Lewis.

>> Welcome to Matters of Mind.

Good evening.

I was wondering if you could explain the blood brain barrier and what can crossover and what can't cross over and why the blood brain barrier Lewis is basically a nice little sheath all around the brain and some things can cross over.

>> Some things can't always find it interesting that insulin cannot cross over the blood brain barrier or glucose needs to but insulin can.

But it was just discovered recently that there are insulin receptors in the brain so these insulin receptors must have other effects other than just insulin but they have effects on other types of chemicals.

>> So the brain basically is fueled by glucose about 20 percent of all of your energy expended in the whole body throughout the day is expended in your brain.

>> So it's a highly active type of phenomenon here but it will not allow certain things to cross over and that includes medications that includes molecules that are too large some type of chemicals can cross over, some can't tryptophan for instance, can cross over.

A tryptophan is a building block for a serotonin but serotonin can't cross over so you have to have these little byproducts and these little building blocks of a lot of chemicals for them to cross over to be able to build the chemicals in the brain.

Now some of the chemicals are built by build the building blocks that are actively pumped into the brain across the blood brain barrier and some art now Lewis, one of the factors that we see with some of the neurodegenerative conditions is that sometimes that blood brain barrier breaks down and stuff starts getting in that shouldn't be getting in and that can cause infections and a out of toxicity.

So we're always considering what crosses over the blood brain barrier.

Some medications do more so than others so some medications will cross across the blood brain barrier and we'll use those selective to try to help people with getting more of a calming effect.

Other medications might not cross cross the blood brain barrier and we'll use those as a means of helping with the symptoms in the rest the body.

So we take that into consideration but it's basically just kind of a netting all around the brain and it selectively let some things in and doesn't let other things and overall it has its own defense mechanism.

>> We've got our little white blood cells on the outside part of the brain and macrophages are part of that white blood cell system that's outside the brain the rest of the body.

So you've got these macrophages that just kind of chew up bacteria.

Well, the macrophages don't get inside the brain inside the brain we have the same kind cells but they're called microglia entirely different but they are also chewing up bacteria and things that get inside the brain.

So inside the brain you've got microglia outside the body and the rest of the body you've got the little white cells that are called macrophages.

So there's different ways of fighting off infection in the brain versus outside the body.

>> Lewis, thanks for your call.

Let's go to next caller.

Hello, Robert.

Welcome.

The mastermind Robert, you had mentioned you had gastric bypass and gastrointestinal issues for many years but your doctor says you're fine.

>> Is there any connection between the gut in the brain?

Yeah, you know, Robert, the gut is extensively hooked up to the brain and we really can't separate it separate the two of them about 80 percent of the body serotonin is in the gut.

So when we talk about serotonin disturbances which in the brain can cause trouble with anxiety, depression, premenstrual symptoms, obsessions as I mentioned earlier, panic disorder or social anxiety those can be affected by serotonin transmission and it's thought that women have about 20 percent less serotonin transmission than men and that's one of the reasons why women are much more prone to anxiety and some depressive disorders.

>> So when you think about the gut, we've got to think about how it's able to process different chemicals and you know, there there's probiotics which are basically means by which you can change the bacteria of your of your gut and in doing so that improvement with gut health overall can affect sometimes the transmission of the chemicals in the brain.

>> We don't have a really good understanding on that just yet.

>> But every year or so you're hearing more about more and more about things in terms of how we can improve gut health .

>> I don't think we're really at a point where we can treat most psychiatric conditions by just giving somebody a probiotic or giving them intestinal bacteria to improve their intestinal flora and thereby affect their mood and anxiety.

>> But I think we're getting closer as time goes on to understanding that and when you have intestinal bacteria that are not really favorable for the absorption of some medications that can sometimes make some medications not very well absorbable.

So that can be a factor as well.

>> So I think we're going to be learning more about gastrointestinal issues as they relate to the brain issues over the course of time.

But for instance, if somebody has panic attacks they can have diarrhea associated with they're having difficulty with panic attacks.

It's not uncommon that we'll hear about people having heartburn and stomach ache when they get under a lot of stress.

Other people will get constipated when they get into stress because with higher adrenaline you have a constipating effect.

So there's different phenomena that we can we can hear about and as a psychiatrist all often be exploring the type of irritable bowel somebody might might might have because based on the type of irritable bowel symptoms they have, I can choose different medications that might not only affect their mood and anxiety but also affect their overall gastric motility.

>> Robert, thanks for your call.

Let's go our next caller.

Hello Dan.

Welcome to Matters of Mind.

>> Dan, you want to know if you should stop taking your antipsychotic medication if you're having surgery, then you specifically mentioned antipsychotic medication which typically is not a factor prior to surgery.

>> So we would not really find that somebody would have to stop their antipsychotic medication prior to surgery.

Just make sure your anesthesiologist knows that you've been on a certain medications and the reason people have to stop certain medications prior to surgery will be No one if the medication can be associated with more bleeding.

So medications that are associated with increased bleeding can be the serotonin reuptake medications such as Zoloft, Paxil, Celexa, Lexapro and Prozac.

Those are all SSRI eyes sometimes NRI serotonin norepinephrine reuptake inhibitors such as Cymbalta Stik Zema or Effexor they can sometimes and give you enough of a serotonin reuptake inhibition to make the platelets less sticky and increased bleeding as well.

>> So that's number one factor will often hear about we're talking about psychiatric medications in general.

>> We don't want to increase bleeding during surgery.

Secondly, based on what kind of anesthesia you might get will sometimes not want people to take certain medications that might interfere with the metabolism of the anesthesia and the anesthesiologist can often discuss that with you or with us as clinicians so we don't want to have drug interactions that can be a factor.

And the third factor can be if you're going to get pain medications after the surgery and many people do we don't want them on these so-called benzodiazepine medications such as Xanax, Klonopin and Valium.

>> Those medications will amplify the the pain medications effects and you might think well that's a good thing, right?

Well, of course they can also not only just improve the pain and amplify the pain medications effect for pain but also can shut down your breathing.

So those kind of medications are not recommended with narcotic or opiate medications.

The Gabapentin OIDs such as pregabalin or Gabapentin aren't as bad as they can to some degree but we're getting away from using the Gabapentin Neung medications with opiates as well.

But they appear to be safer than the benzodiazepines.

But those are the three main reasons we'd have people taper off or stop their medication prior to a surgery if the medication is going to increase bleeding if it's going to change the metabolism of anything during anesthesia.

And thirdly, if there's any interaction with narcotic medication.

>> Thanks for your call.

Let's go to next caller.

Hello Janet.

Welcome to Mastermind Janet.

You want to know if there's any new medication on the market for bipolar disorder type two and which medications are the most effective?

That's always debatable, Janet.

>> Basically bipolar disorder type two is where you'd have anywhere between four and six days of hypomania where you're talking the faster you're more energetic, you're not sleeping as much a little a little bit more impulsive but it's not getting, you know, a lot of trouble.

>> So the highs are called hypomania spells and they're not getting you into trouble but they're there and unfortunately after having a four to six day high you crash into over two weeks of depression.

So this is a condition that's been very difficult to treat over the course of time.

There are medications that are being studied for bipolar disorder Type two because you're mainly wanting to affect the down side of the spectrum of depression.

In my experience over the course of time bipolar disorder type two can be treated with such medications as Cap Leida Serik well lutist Lietuva Lunesta was on my mind.

>> It's a sleep medication La Tuta and a medication that's been around for a long time called Lamictal Lamingtons and Antiepileptic Medication and as an anti epileptic medication it tends to stabilize the glutamate transmission and thereby decrease the likelihood of people having highs or lows.

So right now the main medications I'm seeing used for bipolar disorder Type two can be some medication has been around for a long time LATU to colitis Seroquel Lamictal we're starting to see raillery used low doses for several people because low doses seem to be a nicely helping people with the mood instability of having the highs and lows.

>> So I think over the course of time we'll be hearing more about medications that are affecting glutamate directly in helping people with depression especially bipolar disorder type two depression we've had it ketamine out as an anesthetic since 1970 and it's been used off label without Food and Drug Administration approval formerly since about the year 2000.

>> S ketamine has been available since twenty nineteen and that's a nasals intranasal spray that is used for treatment resistant depression.

But I think over the course of time is ketamine maybe all valide being another one.

Those are medications that can affect glutamate and I think over the course of time they might be researched more for depression as well as mood stability.

So there's a lot of things coming down the pike for a bipolar disorder type but that's a condition it's very difficult to study because it only involves just a few days of the little highs but then the big low.

So you know, if you just treat the lows that's great.

You can bring somebody out of the lows but they might inadvertently go into the highs and over the course of time the more frequently they have the little highs, the higher the highs get and the more prolonged they become.

>> And you bet about one out of five people will have bipolar to disorder early on and they can convert into bipolar disorder type one type one being where the manic episodes emerge and they occur over the course of seven days or more and they get you into trouble.

So when somebody is having a full blown manic episode that's considered to be bipolar disorder, these people don't need to sleep sometimes for days they will talk extremely fast.

They'll be very impulsive and they'll do things and say things they ordinarily shouldn't do or say and they get themselves into trouble and I have seen people get arrested because of of of regrettable outbursts they might have during the manic episodes themselves.

So bipolar one disorder is where somebody has distinctive manic episodes.

Bipolar two disorder is where the people will have little highs and big lows.

The key with bipolar two disorder is even though patients will tell us all about the depressive episodes, we have to search for those little highs because if they're having little highs we need to give them a little bit of a mood stabilizer.

>> And I mentioned those mood stabilizers being medications like Lamotrigine or Lamictal Latu to Carolita Seroquel, Braila these kind of medications act more as mood stabilizers and we try to get people on the medications.

It's going to level out their mood not unlike what you'd see with a cruise control.

I was just talking to someone about that a day when we give mood stabilizers we're giving them basically a cruise control on the mood we don't want them to go too high or too fast or too low or too slow.

>> So we want them to kind of be leveled out.

We don't want them to be a zombie where they just don't have any emotions at all.

That's not good but we don't want them to have unlatches real highs and lows because that's what gets people into trouble.

>> Yeah.

Thanks for your call.

Let's go to our next e-mail question if we have that and we do here it is it reads Dr. Fovea We lost my husband fairly recently and it has been hard on all of us but my team has stopped talking at first I thought he needed time but it's been almost a month.

>> What should I do if your That's where you can get to the point where it goes good goes beyond grieving now normal grieving my goodness it should involve sadness crying spells you should be reminiscing about the loss of a loved one that's perfectly appropriate.

But when you get to the point where you withdraw socially you can't get things done every day.

>> You're not eating properly, you're not sleeping.

That becomes well what used to be called a pathological grief.

Now we simply call it a major depression and when you have a pathological grief you can have difficulty with the chemical disturbances in the brain that are causing you to have a chemical depression which we call a major depression.

And when that happens it's worth treating because the longer it goes on the more difficult it can be and it can be very persistent.

And most importantly when you have depressive symptoms like that for a long period of time it can cause to have what we call functional impairment.

>> Functional impairment is where you can't socialize, you can't work, you can't go to school, you can't do the kind of things that you need to do every day and it paralyzes you and it's like a dark cloud hanging over your head that doesn't go away.

>> And you have to think about OK, when you're when you've lost a loved one, it's not a treatment for depression is not going to bring the loved one back.

But your perspective in terms of going at this day forward can often change.

So that's where a medication comes in talk therapy with grief counseling often focuses on that how you can actually honor the loved one who's been lost by serving out your life the best way possible and going from this day forward.

>> So it comes down to perspective overall.

>> Let's go to our last question.

Hello, Dean.

Welcome to mastermind Dean over this last minute or so you had mentioned it felt like it feels like you're swimming through mud.

>> What are the signs of depression?

>> Well, let's go through some of them.

It involves day by day difficulty with sad mood, low self-esteem, trouble with appetite sleep, difficulty with enjoying things, classic symptom fatigue, sometimes crying spells especially for women more so than men.

But men get angry and irritable when they get depressed and thoughts of death and suicide can be symptoms.

So those symptoms going on day by day for at least a couple of weeks causing you difficulty getting things done.

>> Those are the clinical signs of depression and we we we've seen over the past six years that the rate of suicide in the United States has increased every single year for the past six years.

That's where we need to recognize depression.

We need to do something about it.

Dean, thanks for your call.

Unfortunate amount of time this evening.

>> If you have any questions that I can answer on the air concerning mental health issues, you can give me a call this next week or just write me via the Internet at Matters the mind at WFYI dot org.

I'm psychiatrist favorite.

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I'll be back again next week.

>> Thanks for watching.

Good night