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>> Good evening.

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

Welcome to Matters of the Mind now in its 25th year of 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.

>> PBS Fort Wayne by dialing (969) 27 two zero or if you're calling coast to coast you may dial 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 PBS Thirty nine studios which lie in the shadows of the 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 via the Internet at matters of the mind all one word at WSW a dot org that's matters of the mind at a dog and I'll start tonight's program with an email I recently received.

It reads Dear Dear Father, I have been taking medication for depression for 30 years.

>> I'm forty five years old and have had two strokes.

Could all my medications be causing the strokes also am I at risk for Parkinson's disease?

>> And I think I understand the context of your questions because people with depression will be at higher risk for strokes in general it's a complication of depression.

We call it a medical comorbidity when people have depression over the course of time treated or untreated, they can have a higher risk for cardiovascular disease which means they can have blood vessel disturbances, depression in itself can be considered to be an inflammatory condition for many, many people.

>> So when you get depressed sometimes you will feel tired and achy.

>> You don't have motivation and you kind of feel like you have the flu only it goes on day by day by day.

>> That's a inflammatory manifestation of depression itself and because of that inflammatory metaphor manifestation that can be there, you can have a impact on the blood vessels where you get atherosclerosis that can contribute to strokes itself.

>> So it's not necessarily the treatment for depression that might be contributing to the strokes.

It can be the depression itself .

Now Parkinson's disease, it's been speculated over the course of time do antidepressant medications, especially the ones that increase serotonin, can they indirectly decrease dopamine and they can and that's why some people on the serotonin antidepressants like Prozac, Paxil, Zoloft, Lexapro ,Celexa, those medications can make you feel kind of emotionally dull and you feel kind of emotionally numb.

You don't feel happy, you don't feel sad, just kind of feel emotionally flatlined and sometimes people on those medications notice you can't cry as easily and that's all related presumably due to an indirect decrease in dopamine.

>> But a decrease in dopamine itself does not cause Parkinson's disease.

Parkinson's disease is a condition where this middle part of the brain it's called the substantia nigra substantial refers to a body nigra refers to a dark body.

So substantia nigra is right here in the middle of the brain.

This part of the brain will spew out dopamine and if you increase dopamine transmission from that area you have smooth body movements and you don't have tremor and you can walk in a normal fashion as opposed to the shuffling gait that many people with Parkinson's disease will have.

So the answer to present medications do not appear to have direct effects on decreasing the activity of the substantial nigra for you to get Parkinson's disease is thought that you need to have a 50 percent or even thirty percent degree of functioning with a substantial nigra but the remainder is not working so well so it's a substantial decrease in the activity of a substantial nigra at only about a 30 percent or 50 percent the grea functioning to get the symptoms of Parkinson's disease where you get a tremor, you get a shuffling gait, you might have a blank look on your face.

People with Parkinson's often have bowel disturbances where they have a hard time holding their bowels.

They might have more slobbering and it can be a long term manifestation of certain environmental factors.

>> But with Parkinson's disease it's not thought to be directly related to the serotonin and depressants.

>> Thanks for your email.

Let's go to next email.

Our next email reads Dear Doctor Father, I've heard of these hypnosis seminars that help with smoking and weight loss.

Can they really help your brain deal with these addictions?

Hypnosis in general can help especially with smoking for weight loss maybe here's the problem with using hypnosis for weight loss with hypnosis it's very good and quite effective for stopping an entirely stopping a behavior with weight loss.

>> You want to decrease the caloric intake, you want to increase your exercise.

Its difficult to stop the behavior of eating because you still have to eat.

>> So with weight loss it's kind of hit or miss in terms of how effective the hypnosis can be with smoking.

>> I think it's more effective with that because with smoking you can actually cause somebody under a hypnotic trance to find the whole concept of smoking and the effect of smoke and nicotine to be so disgusting that when they think about smoking they can get physically sick and that's the whole idea they don't get overtly sick but they can kind of feel nauseated and find the idea of smoking to be detestable.

Now from my perspective I think it's better to do hypnosis on an individual basis as opposed to a group because a hypnotist is somebody who will watch the response of the person under the hypnotic trance and based on that individual response will change the cadence of his or her tone and inflection to the speech in terms of how the how the hypnotist is presenting the information to the person under the trance so I think it's probably going to be better for somebody to do hypnosis on a one to one basis as opposed to a group because the hypnosis in front of a big group can't individually address what's happening for some people to be to to be successfully induced into hypnosis you have to be suggestible.

You have to have a lot of trust in the hypnotist if you're not suggestible, if you don't have the trust, you're not going to go into a decent trance.

So for those people they might not go into a trance but other people can easily go into a trance and the idea with hypnosis many times is to teach yourself how to do it.

Yes, you can do self hypnosis.

>> I've done it myself.

I was trained in hypnosis many years ago and was able to use hypnosis on myself and that's the idea ideal state where you can use it on yourself and you can go in and out of the hypnotic trance to try to improve and change some behaviors.

>> Thanks for your email.

Let's go to our first caller.

Hello Bonny.

Welcome to Matters of Mind ABody you were interested in getting a light box.

You don't know where to start.

How about some information examples I can't on the error of due to the Federal Communications Commission regulations specifically recommends certain companies but I would certainly suggest to you that you go to an Internet browser and look up different ideas concerning light boxes and different ways we can get them.

I will tell you what to look for with a light box though Bonnie No one you want a light box light intensity of ten thousand looks like X so let's look for a light box intensity of ten thousand x one Lux is the light intensity of a international candle one meter away from you so about one meter away from you you have what's called an international candle.

That's how they measure a lux ten thousand lux is basically the light intensity on a summer day at about 10:00 in the morning.

So it's pretty bright.

You want to sit about a foot and a half away from it.

The size of the light box doesn't matter so much.

I've seen these little light boxes on caps I've seen like boxes sitting upright.

I've seen small ones.

>> You want it large enough where it can hit your retina and give you that light intensity that you're trying to achieve with the ten thousand Lux you said about one or two feet away from it every morning during the winter months especially and sit there for about twenty minutes.

>> Don't look right into it.

>> If you look right into the light box you can get a headache and sometimes it's thought that people could even get retinal damage if they stare into the light box for a significant period of time.

You want to look away from it but you want it's still hitting your retina so you want to be able to read do something else while you're in front that light box.

Now you don't want to have the light box sitting across the room is probably not going to do much for you.

You want to right in front of you about a foot or two away twenty minutes at a time and I often recommend to people from around October until the end of March.

So during those six months the first thing they do in the morning for a lot of people is they're putting their makeup on.

They might sit in front of it then many people will read in the morning.

That's a good time to do it as you're having your breakfast perhaps.

But you want to use that light box first thing in the morning earlier the better for about twenty minutes or so.

What will do?

>> Basically it will suppress the activity of the pineal gland.

Pineal gland is a gland right smack in the middle of the brain the size of a little pea and in the pineal gland or sometimes it's known as the pineal body.

>> It secretes melatonin and if you use a light box first in the morning it immediately suppresses melatonin because melatonin will go down as light increases the stimulation of the retina in the retina will give a direct chemical transmission to the pineal body or pineal gland and that will decrease melatonin.

>> That's what you want to do with a light box.

>> You want to decrease the activity of the pineal gland and in doing so hopefully you can have more energy have decreased a decreased likelihood for one to crave carbohydrates in the winter time people in the wintertime naturally want to hibernate so the idea will be you'll need less sleep with a light box and using it first in the morning helps you regain that normal circadian rhythm that you will typically have in the spring and summer when it's brighter outside many people in the fall will have difficulty getting out of bed.

They want to sleep extra amounts of time.

They don't feel as motivated that they have more tiredness and it's thought that some of these people are having what's called a winter depression or seasonal affective disorder.

Women are more likely than men by a ratio of eight to one to have winter depression or seasonal affective disorder.

>> It might have something to do with the ebbs and flows of estrogen especially before menopause after menopause it's about 50 50 in terms of who's likely to get winter depression but a lightbox is a great natural way to try to enhance the the brain activity in the wintertime and decrease the likelihood of having all these symptoms of winter depression.

Now otherways to address winter depression.

>> No one will be exercising try to exercise ideally in the morning.

But if you get some exercise later in the afternoon that's still OK.

I don't recommend for a lot of people that they exercise after 7:00 p.m. because that sometimes will keep people awake if you're younger and I'm referring to people under 30 years of age sometimes can get away with that.

But as you get over 30 and especially over 40 years of age, it's more difficult to exercise in the evening because it's more likely to keep you awake at night.

>> So you ideally want to exercise in the morning.

Secondly, watch your carbohydrate intake in the wintertime.

>> It's so tempting to eat more and more carbohydrates and unfortunately that will cause you to have more difficulty with feeling tired and it's kind of rebound effect you gain some weight, your insulin levels go up and that caused you to have more of a difficulty with depression and anxiety and even difficulty with concentration sometimes.

So we don't want to fire up the insulin excessively in the long run.

>> Increasing insulin higher and higher makes your body less less sensitive to the insulin and that gives you insulin resistance and that is a precursor to Type two diabetes.

So we don't want to go that route, go easy on the carbohydrates in the wintertime and especially helpful will be to socialize, be around people.

>> They do a great job of this up in Minnesota and Wisconsin where they have winter festivals.

They embrace the winters and they have all these winter activities and it's very important you try to take advantage of those the best you can to try to socialize, stay active and be around people.

We saw that the covered restrictions over the course of a couple of years they were just devastating for the mental health of so many people not just because of the isolation in the household and not being able to go to work and get out and about and do things.

It was because they couldn't be around people and we all need to socialize.

It's a predictor for a mental health impairment if you don't adequately socialize with others it's actually a predictor for dementia for older adults if you're less sociable you're more likely to have trouble with your memory and concentration and we see that with older adults who are getting more and more socially isolated.

And I think as the research comes in on the retrospective analysis of the impact of covid restrictions, we're going to find that a lot of people in nursing homes and assisted living as they were having more social isolation, it was not only having emotional and psychiatric impacts on them but physically it was affecting them because they were not allowed to have the visitors and they were not allowed to socialize as they would be expected.

So socialization is a very good treatment for winter depression as well if you got to use a medication for winter depression there as there is actually a medication that is approved by the Food Food and Drug Administration for winter depression and that's Wellbutrin, bupropion, bupropion or Wellbutrin will increase the transmission of dopamine and norepinephrine in the brain and in doing so it's an activating energizing anti depressant that does suppress the appetite somewhat.

About one out of four people do better at lower doses and about three out of four people do better at the higher doses of Wellbutrin and that's something in which we will examine with genetic testing on occasion there's a particular gene called C OMT that can be a bit of a predictor for what direction we need to go in terms of who needs the higher doses and and lower doses of the Wellbutrin or bupropion.

>> We also look at another particular enzyme that's coated by a gene called the B to Gene the Eisen's Cytochrome P 450 286 I'm sorry to be six isoo enzyme that will tell you how quickly you break down the Wellbutrin so some people break down Wellbutrin very quickly and they need the higher dosage and some people break it down very slowly.

About nine percent of people out there will have a two B6 mutation where they need the lower dosage of Wellbutrin just based on that.

>> So in terms of winter depression treatment, Bonnie Lightbox is a good place to start get some physical activity, try to go easy on the carbohydrates socializr and if you need a medication, a medication like Wellbutrin can be helpful and we do indeed have some people treated with Wellbutrin just over the winter months and the rest of the year they might not take it and it's called Seasonal Affective Disorder also known as winter depression body.

>> Thanks for your call.

Let's go to our next caller.

Hello Corey.

Welcome to Mastermind Corey.

>> You want to know does the brain have bones in it?

The brain does not have bones in it itself.

>> The brain has an outer shell called the skull and the skull is a fine outer shell.

It's very rock hard.

As a matter of fact, the front part of the skull is one of the hardest bones in the entire body.

>> But inside the skull is this lining on the brain called the meninges and you'll hear about a meningioma for instance.

>> That's a tumor of the lining of the brain.

You'll hear about meningitis, meningitis is an inflammation of the meninges of the brain and that's an infection for people.

So a meninges is a covering of the brain.

The brain itself has a jello like consistency and it's not multicar like I'm showing you right here.

A brain when it's in somebody's skull is a kind of a tan pinkish type of tint.

>> We talk about gray matter with the brain but that's usually after it has been sitting for a while we have the gray matter which involves the neurons and the white matter which involves the individual axons or they little tails and the stems of the neurons that are transmitting information to neighboring neurons.

So axons and those little branches of the neurons they are aligned with myelin and myelin.

Gigio White sheath appearance and when the myelin she has disturbances like plaques that will give you condition like multiple sclerosis and that's because the nerve transmission cannot adequately deliver information from one neuron to another.

We have billions of neurons in the brain and with each individual neurons there's thousands of connections so you've got tens of thousands of connections going on the brain and it's because of these connections having impairment that you can have such conditions not only like multiple sclerosis but also with depression and anxiety.

It's thought that with depression one of the disturbances will be that you have less branching of the individual neurons so you should have ten or twelve thousand branches per individual neuron and if you have depression you actually have fewer branches.

So it's like a tree that's kind of shriveling up when people get depressed and that's the biological basis of depression you'll have less branching occurring that will cause you to have such disturbances a little lower energy but very specifically people who have depression will have less branching of their neurons in the front part of the brain here where you think and it's hard to pay attention when people have depression when you have depression it's hard to process information in a quick matter.

>> So it's kind of like your brain having slow Internet speed when you're depressed you just don't go from one thought to another and you can't process information very quickly.

So a key symptom of depression will be slow processing speed.

>> There's ways to test that from a psychological standpoint but slow processing speed is quite prevalent and is thought to be due to the less branching with depression.

You can correct that we have specific medications that are known now to correct that branching and with successful treatment of depression you tend to have the improved branching that's occurring now it's thought that the branching is decreased because you have less fertilizer on the brain.

We have this natural fertilizer in the brain called brain derived neurotrophic factor of BDNF brain derived neurotrophic factor is the natural Miracle-Gro of the brain and that will increase these other chemicals that have fancy names to it like Amthor million target of rapamycin.

>> These are the kind of chemicals that are needed in the brain to keep fertilizing those neurons to keep getting and keep branching out more and more.

>> And it used to be thought that if you had neuron death in your brain you had no chance of recovering that or regenerating neurons around.

>> Now we know you can.

>> So the idea in treating depression or any kind of neurological disturbance that affects a shrinkage of the brain will be to try to increase the branching of the brain and by by doing so we increase these chemicals that are acting as natural fertilizer overall core.

>> Thanks for your call.

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

Our next e-mail question reads Dirda to favor is there a way to measure dopamine in the brain?

>> I had mentioned dopamine in relationship to Wellbutrin.

>> Wellbutrin also known as bupropion is used for winter depression.

It's an activating energizing antidepressive medication that will increase the transmission of dopamine as well as norepinephrine.

If you increase dopamine you can have more energy, better concentration, you can have more motivation, more enjoyment things.

>> Dopamine is the feel good chemical of the brain.

It helps with pleasure and vitality from a neurobiological standpoint.

So is there a way to measure dopamine in the brain short of sticking a catheter into the brain itself?

No.

However, there's an indirect way of measuring dopamine.

Dopamine in the brain in this has been done in some studies and it's watching the eye blinking the faster the eye blinking eyes for somebody as they're watching an activity or doing an activity the more dopamine transmission is occurring and dopamine transmission is thought to decrease if somebody is having some difficulties with concentration, attention span and even memory.

So if you want to assess somebody dopamine transmission indirectly you can have them do a particular task and you can measure their numbers of eye blinks and compare to other people and you put that all together and the idea would be to try to determine their degree of dopamine transmission.

Are we doing that practically in the real world from a clinical perspective?

No, we're not doing that just yet.

We're not measuring somebody's eye blinks and determining if they need a medication like Wellbutrin or a stimulant or they need a medication for 8D or not doing that just yet.

But it's just giving us some ideas that there might be some what we call biomarker is a biomarker is where you look at physical type of activities in somebody's body and from that try to deduce what kind of medication they might need for various conditions we use other types of clues in that way we when we try to determine a medication and what kind of medication somebody needs, we look first and foremost that there are symptoms and we try to match up their symptoms with the best medications for those symptoms.

Secondly, we look at their past medication history.

It's very, very important to do that as a clinician, look very methodically at what medications somebody has tried what's the dosage might have been, how long they took it, what side effects they had, what good effects they had.

If they went off of the medication, why did they go off?

So we want to methodically based on mechanism of action with every medication they've taken look at what they've taken and what what it did for them.

We also in determining a medication we want to look at what family members have taken for similar symptoms.

So if you have a father, for instance, who has experienced depression and your father's taken this medication or that medication, we want to know what those medications are.

We want to know how your father did with those.

We also want to look at what other medications you might currently be taking very importantly because we want to look at drug interactions with those medications.

But sometimes quite frankly those medications might be contributing to some the problems.

For instance, if you take a high dosage of topiramate or Topamax, great medication for migraine headaches, it's good for seizures, is good for appetite suppression.

We use doses of of topiramate not uncommonly for those purposes.

But if you go above about 100 or 200 milligrams a day, you can start having a doubling of your concentration.

>> You got more depression.

So we want to look at the other medications not only to see if they might be contributing to your psychiatric problems but we also want to know if there's going to be drug interactions with those on the medications.

We will many times look at other medical comorbidities to determine what kind of factors might lead us to deciding on one medication for another versus another.

>> So we'll look at conditions like thyroid disturbances, sleep apnea, diabetes and see if they might be a factor and that can cause us actually to take away medications rather than add them on.

So a lot of other factors out there that can that can lead us to taking the prescription for one medication versus another and making that kind of decision.

>> Thanks for your call.

Let's go our next caller.

Hello Dean.

Welcome to Matters of Mind.

Yes, I was wondering I have neuropathy and when I take my medication Xanax it seems to be getting better for a short period after I think it's Xanax and then it gets somewhat worse in between doses and then I take my next dose gets better again.

Does that relax the nerves or what's called an out or do you have any suggestions on what else I could take for your gabapentin?

>> Also I was going to ask you about that dealing with with neuropathy Dean it's the type of thing where you've got an itchy trigger finger on your nerves and it causes tingling and pain in your nerve ends.

>> You've got this teeter totter effect of two chemicals glutamate and gabber glutamate is a stimulatory neurotransmitter gabbers inhibitory neurotransmitter and when you have neuropathy it's thought that the glutamate is exceeding Agaba the Gabba effect.

>> So you're getting more excessive stimulation thereby getting false perception of pain and and tingling if you take gabapentin which would be the first thing I'd ever recommend for anybody with neuropathy it basically decreases the itchy trigger finger of a neuron firing excessively and balances out that GABA and glutamate transmission.

>> But quite frankly Dean Xanax, Ativan, Klonopin the medications that are called benzodiazepines will enhance the transmission of Abha for a while.

>> But the problem is you can kind of get used to that effect and you need higher and higher doses of benzodiazepines with gabapentin or Neurontin.

That is not typically the case.

So typically gabapentin will be used for that purpose and again it all comes back to trying to balance out that teeter totter effect between glutamate and Gabb in enhancing GABA we do have means by which we can decrease glutamate ways of decreasing glutamate could be medications like Gene and Depakote just to name a couple of them.

But your you have the correct perception they're deemed Xanax is a benzodiazepine can decrease pain perception quite quite commonly for a few hours at least.

>> Dean, thanks for your call.

Unfortunately I'm out of time for this evening if you have any questions that I can answer on the air concerning mental health issues, you may contact me via the Internet at Matters of the Mind at WWE dot org.

>> I'm psychiatrist Jeff Oliver and you've been watching matters of the Mind on PBS Fort Wayne God willing and PBSC willing.

I'll be back again next week.

Have a good evening.

Good night