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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 or Matters of the Mind is a live call in program where you have the chance to choose a topic for discussion.

>> So if you any questions concerning mental health issues, give me a call here in the Fort Wayne area by dialing (969) 27 two zero and if you're calling coast to coast you may dial toll free at 866- (969) 27 two zero now on a fairly regular basis we are 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 WFB a dog and I'll start tonight's program with an email I received this past week.

>> It reads Dear Dr. Fovea, I can't sleep.

I've tried antipsychotic medications such as Zyprexa, Risperdal and Seroquel the first to gamae tardive dyskinesia and sakwa gamae restless leg syndrome.

Nothing else worked.

I don't know what else to do.

Any advice before I visit a sleep neurologist next month?

Well, keep that appointment with a sleep specialist next month because sleep specialists will identify particularly if you have sleep apnea and restless leg movement and they'll also identify if you have what's called narcolepsy which can cause you to have difficulty with sleeping at night.

So sleep medicine specialists will look for a particular types of problems and they can give you some good ideas themselves in terms of the reason why you can't sleep.

>> You mentioned antipsychotic medications.

Antipsychotic medications will help with sleep primarily because they do two things they block serotonin 2A receptors and they are antihistamines so they're very strong antihistamines but they block serotonin 2A receptors.

There's roughly 14 different receptors for serotonin.

They go by numbers, letters, serotonin to a is one of them.

>> If you block that particular receptor you'll get a greater quality of sleep.

The reason you got tardive dyskinesia with Zyprexa and resveratrol is because they also block dopamine receptors and especially if you don't have a psychotic disturbance and you merely have a mood disturbance or sleep disturbance if you block dopamine receptors you're more likely to out more dopamine receptors and thereby have twitches and tics in your face and shoulders and that's called tardive dyskinesia.

You can have restless leg movements with Seroquel because it two blocks dopamine and if you block dopamine you can have difficulty keeping your legs still.

>> So other options are out there and I'm sure you might have some of them but you can start with the antiepileptic options we often will use gabapentin or Lyrica for the purpose of giving somebody a better quality of sleep.

The nice thing about Gabapentin for instance, is that it can give you greater depth of sleep and help with dream sleep and it gives you a better quality of sleep such that it gets out of your system by the next morning.

Lyrica is its chemical cousin Gabapentin or is called Neurontin Lyrica is called Pregabalin so they're kind of chemical cousins.

They don't work on dopamine receptors and serotonin 2A receptors.

>> They work more on the calcium channels.

Then you have the other types of medication.

This is where we often will start and that's with Trazodone, the serotonin modulator serotonin modulators are blocking serotonin 2A receptors but unlike the antipsychotic medications they are not giving you the tardive dyskinesia effects because they have no effect on dopamine among the other medications in that class can be mirtazapine also does a nice job with helping with the depth of sleep but it can give you weight gain as a side effect will sometimes use the old low dose tricyclic antidepressant medications like Doxa Him Docs has been around since the 1960s at tiny little doses three to six milligrams of bedtime that can actually decrease histamine release and block histamine receptors by itself such that histamine keeps the brain awake and if you block histamine and actually block histamine release you can feel a lot more sleepy.

>> So Doc's been at three to six milligrams at bedtime well below the usual antidepressant doses of one hundred fifty milligrams a day document.

>> A very, very low doses can help there.

We also have the Orexigen or Hypocretin blockers the antagonist for a Ruxton also like histamine keeps awake if you block Eareckson it'll go abruptly go to sleep.

>> So medications that have been on for a long time such as Bell Samarrah can help block Rexon and give you a better quality of sleep overall melatonin than the melatonin agonists are often used so there's a lot of different medications out there.

But I think the first thing you need to do in terms of determining why you're not sleeping is identifying what might be the pattern there.

Are you having any brief naps during the day?

Are you having daytime sleepiness?

Are you having restless legs at night?

>> Do you have sleep apnea symptoms?

Those type of factors will be assessed by the sleep sleep medicine.

>> Doctor, thanks for your question.

Let's go to our first caller.

Hello James.

Welcome to Matters of the Mind.

>> James, you want to know if if you take psychiatric medications is it safe to take ibuprofen?

It might, James.

Ibuprofen will increase your likelihood to have more bleeding because ibuprofen like aspirin can decrease the ability for the little platelets to in serotonin.

>> So if you can't in serotonin you'll have platelets that are less prone to be able to stick together.

Well, the serotonin medications that are in the class of serotonin reuptake inhibitors Lexapro, Zoloft, Paxil, Celexa, Prozac those medications are serotonin reuptake inhibitors and what they do is they block the serotonin pump from in the serotonin.

So if you put the serotonin reuptake inhibitors on top of ibuprofen, you can have more difficulty with little speckles in your noticed increase.

>> Visibility doesn't always happen.

It's always related to the dosage.

When we take a look at that, the biggest issue with ibuprofen would be lithium lithium.

>> It's not a huge problem with ibuprofen unless you don't tell your clinician that you're using ibuprofen, lithium levels can increase by about twenty five percent if you all of a sudden start taking ibuprofen for aches and pains and with that in mind we can adjust lithium dosage is just that we need to know that you're on about ibuprofen but if you're on ibuprofen we want you to lower lithium dose each day by day because the ibuprofen can increase lithium levels.

>> I've seen people be on a very stable dose of lithium for a long time and all of a sudden they take ibuprofen because they tweaked their ankle or they have a bit of a shoulder ache and all of a sudden their lithium levels go higher up to point eight or 1.0 where they usually were at point six or point seven and they start getting physically sick.

>> They get diarrhea, they get headaches, they get tremors.

These are all side effects you can have from excessive lithium .

So lithium is the biggest issue with ibuprofen.

The serotonin reuptake inhibitors I think would be number two .

Those are the biggest be the biggest concerns I'd have with any psychiatric medication with ibuprofen.

>> James, thanks for your call.

Let's go to our next email.

Our next email reads Dear Dr. Fauver, can you speak to the risks associated with not treating long term anxiety as well as the benefits of treatment for anxiety?

>> I was finally treated in my 40s unaware that it was a lifelong struggle.

>> I wonder how my life would have been different if I had treated it earlier with good news is we know that if you eventually get treatment for anxiety you can get some recovery from it and get back your quality of life.

>> Here's the issue with long term anxiety or long term depression got the brain right here and with the brain there's a hundred billion little neurons, neurons or nerve cells.

>> One hundred billion neurons and each individual neuron has between sixty thousand to 100000 connections.

They have branches on them.

So you have these neurons that look like trees with sixty thousand two hundred thousand little branches coming off the trees with long term anxiety.

Number one, you get increased cortisol release, increased cortisol release does some bad things.

Cortisol release can cause your memory to be impaired because it will shrivel up the hippocampus area of the temporal lobe temporal lobes on the side of the skull there.

So the temporal lobe has the hippocampus.

The hippocampus is the memory center of the brain.

That's the part of the brain that you you will use to be able to recall things and put your past memories and coping skills to work if you shrink that area down, you can have trouble short term memory and word finding difficulty and that actually is a precursor for some people to dementia as we all get older.

>> So you could have long term term anxiety that can lead to long term depression shrinking up the memory center.

Secondly, if you have a shrinkage of the individual neurons you're more prone to having difficulty with sleep.

And many times we see this cascade where people have ongoing anxiety.

The anxiety causes them to have a fast heartbeat.

They get shaky, they get nervous.

They don't want to be around people and they have trouble with worry.

>> They ruminate on things, they dwell on things and that's because this front part the brain right up here are the orbital lateral prefrontal cortex.

>> The front part of the brain gets overactive and you overthink things and you dwell on things that keeps you awake at night lack of sleep thereby cascades into depression and despair because the left front part of the brain over here is not working so well the dorsolateral prefrontal cortex.

>> So you get this cascade of symptoms with anxiety leading to insomnia leading to depression then it goes back and forth.

So you don't have a clear cut condition where just anxiety, just depression.

There's a networking in the brain that gets disrupted and what we're trying to do and we treat depression and a long term anxiety is to make the front part of the brain the thinking part of the brain, the decision part of the brain work better and more efficiently.

So the thinking part of the brain will tell the anxiety part of the brain, the amygdala down here in the temporal lobe tell the amygdala to back off and not hijack the thinking part of the brain.

>> You don't want to be controlled in your Decision-Making by your emotions and that what was what will happen long term anxiety will cause to make bad decisions it'll cause you to withdraw from opportunities that you might have found beneficial.

>> It will cause you to not enjoy things a long term anxiety will cause you to be less productive and be involved in fewer pleasurable activities with with these kind of conditions we call that functional impairment because you're not as active socially, you're not doing as many things as you could on the job.

>> You're not involved with pleasurable activities and you put all that together.

>> It'll increase the likelihood of having long term anxiety and depression.

>> So it's great that you're getting that treated because it can be reversible those little branches that shrivel up with long term anxiety and long term depression can regrow and you can use medicinal treatments for instance that will increase the branching quite quickly exercising for 30 minutes five days a week is phenomenal for giving the brain a good boost of natural brain fertilizer so exercising can really boost up this chemical called glutamate which is excitatory in the brain and gabb which is inhibitory.

You got the glutamate that's the accelerator gabbers, the brakes it's nice to have those increase in tandem in a proportionate manner.

>> Exercise will do that if you exercise intensely for about 30 minutes you'll notice that about thirty minutes later you feel pretty good, you feel more energetic and you feel calmer.

>> That's because thirty minutes after you exercise intensely you will have increased in glutamate which will give you a feel good effect and you'll have an increase in GABA which gives you a calming effect.

So it's a it's a combination of an excitatory effect but yet you're calm.

>> That's what exercise does for you.

Now here's the challenge and I just talked to a woman about this today.

I mean it's tough when you're depressed and you're fatigued.

You don't have any motivation.

You don't have enjoyment things you don't wanna be around people you don't want to go to the gym to exercise.

So it's difficult to get the motivation and the initiative to exercise if you feel depressed.

>> So what we often try to do is get somebody out of the Depression and then get them involved in the things that in the long run will help their overall quality of life.

Thanks for your question.

Let's go to our next caller.

Hello, Gayle.

Walking to the mind you want to know about why do we sometimes have dreams that later give us a sense of deja vu dreams?

>> Basically guilt will come from the the reason to have dreams is because the left front part of the brain the thinking part of the brain, the part of the brain that you used to really focus, focus, focus on something especially if it's not interesting that part of the brain at nighttime shuts down.

>> So the part of your brain that is involved logic and rational thought shuts down while you're dreaming.

Dream Sleep is also known as rapid eye movement sleep because your eyes underneath your eyelids will be fluttering all over the place during dream sleep and during dream sleep your body is paralyzed and that's what will really cause a lot of people apprehension if they awaken during REM sleep they can't move.

>> That's normal.

That's expected.

That's perfectly natural.

It's just that you shouldn't be waking up in the middle of your dreams but if you wake up in your dreams you can't you can't move for a few moments and that's actually protective.

You don't want to be acting out your dreams otherwise you'll bop your bed partner and you'll be running all around.

>> You don't want to do that.

You want to have your body paralyzed during your dream sleep.

>> So why will you sometimes perceive that you had a sense a dream that might have given you a sense of deja vu?

>> You might want to record your dreams to verify that because deja vu is a real experience.

It's where you perceive that you were already doing something or that you predictably were able to do something later on.

Deja vu comes from this part of the brain right over here.

Hippocampus is in the temporal lobe of the brain.

Deja vu is right up here.

That's the part of the brain that gets overly activated with deja vu.

Now why would that part of the brain get overly activated for some people?

No one fatigue if you're not getting enough sleep, your brain doesn't work properly and one thing it will do is give you this perception that you've already experienced something that you really didn't.

So it's right above the memory center.

It'll give you the perception that you did something that you might not have already done including dreaming for that matter.

>> Deja vu can be activated if somebody has a temporal lobe seizure.

>> So if you have seizure activity in the temporal lobe you'll have these spells of deja vu where you feel like I've done this before in my life .

I already I've already been through this.

I know exactly what's going on.

>> So fatigue, a seizure and sometimes a head injury if you have a head injury to the side of the head, sometimes that'll disrupt those neurons in the just above the temporal lobe there that can be responsible for giving you the deja vu experience.

And so there's various traumatic experiences, traumatic insults to the brain they can give you deja vu fever can sometimes do that but it's this little part of the brain right beside the temporal lobe giving you the false sense of perception that you've experienced something already that you really didn't.

Now there's a part of the brain called the insula insulin's right inside the thumb of the brain.

>> So if you look at the thumb of the brain, that's the temporal lobe.

I guess it's looking at me now here's the insula right there.

Insula is your perception of self-awareness.

It gives you the perception of self-awareness knowing who you are and it actually gives you a sense of reality and allows you to know who you are, what you're all about, what your values are and so forth.

It gets disrupted if somebody has a psychotic disorder.

So if you have somebody with a psychotic disorder where they lose touch with reality, they will have disruption with the insula itself.

So we often will try to address that with various medicinal means to try to get somebody back to that sense of self awareness overall goal.

>> Thanks for your call.

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

>> Our next e-mail question reads Dear Doctor Father, I saw that Australia is now prescribing psychedelics to treat depression and post-traumatic stress disorder.

Do you think that's a promising new treatment that could be effective psychedelic medications and we're talking about psilocybin.

We're talking about MDMA.

We're talking about LSD.

These are the kind of medications that are making a comeback in a very controlled micro dosing setting.

In other words, we're not using the doses of these different type of psychedelics that we're used on the street years ago.

MDMA is actually a stimulant medication.

>> It's a chemical relative to methamphetamine but it's used in a controlled safe environment as small doses and what they're doing with psychedelics that we'll be seeing in the United States I'm predicting mid mid twenty twenty four mid about a year down the line mid twenty twenty four we'll have the psychedelic available for us.

And what do you do in terms of psychedelic treatment for depression or PTSD?

What you'll do is you'll sit there getting a very tiny dose each any clinicians office with a therapist at your side for hours now this is going to be highly controlled.

It's going to be very strongly regulated by our Drug Enforcement Agency and the FDA.

But it's where the therapist will be sitting at your side for hours.

How many hours could be two hours.

Could be six hours.

It all depends on how the FDA determines it should be done now I love the fact that Australia's going to get their foot in the door first because they get to try it out and we can learn from their experiences good or bad and we can figure out what works for post-traumatic stress disorder.

The early research with psychedelic medications such as psilocybin will be one treatment for post-traumatic stress disorder and you're basically cured.

>> We don't have medications that do that in psychiatry now this is going to totally throw off every treatment that we've ever done with PTSD and I think for depression as well we already have three treatments for depression that are primarily focusing on glutamate.

We have ketamine.

It's been available as an IV injection for about twenty years now.

>> Ketamine IV can give people dramatic impacts with a with an infusion and they're now using ketamine under the tongue.

They're using it in various other ways but an infusion is the best way to get it in your system ketamine we have escaped hemin also known as bravado which is a nasal spray and we have ability which is an oral medication that is also affecting glutamate transmission.

We have three medications affecting glutamate.

If you affect glutamate directly in the way these medications will do, you increase the fluffiness, you increase the branching in the brain theoretically within a few hours.

>> So it's working very, very fast.

That's the way psychedelics will work.

They're not affecting glutamate directly so much.

The psychedelics are stimulating serotonin 2A receptors and doing so they're giving you a tremendous sense of awareness and they give you a sense of reality that you hadn't experienced before.

>> Now that sounds kind of weird and sounds like a a a perceptual disturbance you wouldn't necessarily want to have.

>> But the whole idea here is the therapist will talk you through these experiences that you're these experiences that you're feeling during that time as you're going through it.

>> But the impact of the psychedelics appears to be quite prominent now the key will be you can't do it on your own.

You can't just take a psychedelic on your own at home.

>> You can't get some methamphetamine.

You can't get LSD.

>> You can't get Celsi but you don't want to get that off the street and just go home and use a few doses.

Sure.

People are going to do that.

>> But in terms of the prescriptive treatment itself, it's going to be highly regulated and I think we're about a year away from doing it.

I can consider mid twenty twenty four will have it available here in the United States.

So as a psychiatrist I'm very, very excited about that because I think it's going to dress these very difficult to treat conditions like PTSD and severe depression in such a way that we've never seen before.

But we're already seeing some really good impacts with ketamine as ketamine and even all veloute for depression treatment that we hadn't seen previously.

>> Thanks for email.

Let's go to our next caller.

Hello Dean.

>> Welcome to Matters of Mind .

I haven't heard, Dean, that EMG or electro myalgia gram will electro myelogram would be helpful for depression or anxiety because mainly affecting the peripheral nerves themselves.

>> Same with infrared lighting Dean.

I haven't heard myself that infrared lighting would help.

However, if you have winter depression were predictably every year you get depressed in the wintertime you will notice that if you sit in front of a bright light, a bright light that specifically has a light intensity of ten thousand Lux éluard is a light intensity, a light intensity of an international candle as defined by some international association international candle sitting one meter away from you.

>> That's one lux well multiply that by ten thousand.

>> It's basically the light intensity in the morning at about 10:00 a.m. on a summer day.

>> So it's a bright light and you sit in front of it from October through March morning by morning every morning for about 30 minutes each morning.

It has a dramatic impact for a lot of people who predictably get winter depression.

So I'm thinking that could be helpful for people from any neuromodulation standpoint we're talking about vagal nerve stimulation and there's a product that was released in Australia interestingly enough that actually is a direct stimulation of the vagus nerve I'm hearing that can be helpful for some people.

There's the vagus nerve implant that some people have had for seizure disorders.

They have used it occasionally for depression itself.

>> So as we go along in the years to come, Dean, I think we're going to be hearing about these different types of treatment that might help with depression in ways that we hadn't considered before.

>> I don't know if an electro myelogram with with a stimulation the peripheral nerves would be of any help in the future.

>> We know that bright light therapy can help with winter depression.

Who knows?

Could infra red lighting help as well?

I think for infra red infra red lighting to be effective you would have to hit the retina in a safe manner where it wouldn't would not cause any retinal damage.

But the whole reason bright light therapy works for winter depression is because the light intensity of the of the light that's going to the retina will give a signal to the pineal body which is right down here in the middle part of the brain.

This little piece shaped little body, the pineal body, the pineal gland.

It releases melatonin when it's dark if you stimulate the pineal gland upon having light received to the retina, it'll actually decreases melatonin and thereby will give you more wakefulness and less depression.

>> But excessive melatonin can make you tired, make you want to eat all the time.

>> You're more socially withdrawn.

You're you're more depressed.

That's what happens.

People have winter depression and that's why they'll use the bright light therapy as a means of treating that.

>> Dean, thanks for your call.

Let's go to our next caller.

I'm sorry.

Let's go to our next email.

Let's go to our next email here it is Deardon favor how does our capacity to learn progress throughout our lifespan we can learn throughout our lifespan if we are willing to continue to learn many people will kind get set in their ways.

>> You have to learn when you're in middle school and high school and you're in college or early in your career you have to learn because that's how you make a living.

>> But a lot of us we go into retirement and we kind of take it easy.

>> We don't consider learning anymore because we don't have to to make a living.

We've already made our living and we are living on our retirement funds.

>> So it's easy in your later years to sit back and not be willing to learn new things.

>> But I think that's when we should especially be cognizant of learning new things.

And as you learn new things I mentioned that branching of the neurons earlier as you learn new things, your little neurons get more branching because as you learn different things just like exercise you can increase that natural brain fertilizer called brain derived neurotrophic factor which is one of twenty different growth factors in the brain that will be stimulated upon exercising and learning new things.

>> So learn something in which you have a passion to learn something you might not have had the time to learn when you're early in your career and there's so many different options out there for people socializing is very, very important to you to continue neuron growth we want to do all we can as we get older to try to limit the impact of our medical condition comorbid such as diabetes, hypertension those are all very damaging to the brain.

High glucose is damaging the brain such that with Alzheimer's dementia it's actually been termed sometimes diabetes type three because it's so linked with diabetes.

>> So we have to take care of our brains from a medical standpoint.

>> But learning is very, very important for the brain and you do have a capacity to learn as you get older.

>> Thanks for your email.

Unfortunately I'm out of time for this evening if you have any questions concerning mental health issues I can answer on the air.

>> You may write me a via the Internet at matters of the mind all one word at WFYI Dot org.

>> I'm psychiatrist Jeff Olver and you've been watching Matters of the Mind on PBS for Wayne God willing and PBSC willing.

>> I'll be back again next week.

Thanks for watching.

Have a good evening