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>> Good evening.

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

Welcome to Matters of the Mind now entering its twenty sixth 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 at PBS Fort Wayne by dialing in the Fort Wayne area (969) 27 two zero or if you're calling a place 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 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 via the Internet at matters of the mind all one word atwa dot org that's matters of the mind at WFB.

Eager to start tonight's program with a question I recently received it reads You're not your father.

My child is starting college in the fall but struggles with their mental health .

>> How can I best prepare to send them off when a child is going off to college?

>> It's an exciting time.

>> It's a huge change never one you have great connectivity through the Internet.

Such that you can communicate with them by text, by emails you can maintain regular contact.

Back in the old days children and their parents had to write letters back and forth and that might be once a week once a month now you can communicate back and forth almost day to day to keep a really close eye on them.

>> Secondly, if your child already has some mental health issues, I would connect them specifically with a therapist in your home community and have that therapist if the means are available to do so.

Communicate with your child in therapy by telehealth.

Now you can go to the campus itself, the college campus and be seen by therapists there.

>> But I don't know who you could really find based on the different situations at the where the child might be attending school.

I don't know if I trust therapists or some of the colleges but in your local community you have more established therapists who have been around hopefully for a longer period of time and have greater connectivity that way.

>> So I'd love to see the child have some kind of connection by telehealth.

The next key would be would be to encourage your child to establish a very strong and healthy social network at school.

>> Perhaps some of the child's trusted friends are going to the same school, have some connectivity there but also well maintain a relationship with friends and other students who have similar values, similar goals and are involved in similar majors in studies because that can be very helpful.

I strongly encourage the child to go to class.

Sometimes you can get kind of tough and the child might start avoiding classroom activity because it's getting kind of strenuous and it's getting stressful.

Once the child starts avoiding classroom activity it tends to go downhill from there and then you find that they have trouble that first semester to which are highly critical for the child's success.

But most importantly I tell this to all adolescents going off to college to say stay away from marijuana and stay away from alcohol.

It'll be all over the place no matter almost what campus you will attend, you will find ready access to alcohol and marijuana and marijuana makes you not care.

>> Marijuana will impact the concentration.

It makes you calmer and it makes you less stressed out about different things and a lot of people are using it.

But the problem is it's highly predictive that the use of marijuana and alcohol especially that first semester and then going on to that first year can be predictive of your dropping out of school.

So I'd make those recommendations at this point but make sure the child has some connectivity locally with a trusted therapist or a clinician who might be able to prescribe the child your child the medication that he or she needs that the most important thing will be to have some kind of therapeutic support back home.

>> Thanks for your email.

Let's go to our next question.

Let's go next email.

>> Our next question is do not fall over.

What are the Rad's rapid acting antidepressants, the rapid acting antidepressants or what are called Arad's?

I thought they were legalized in Australia.

>> When will they be legalized here?

The Rad's will likely the ones you might be thinking of and from Australia are these hallucinogens or the psychedelic?

These are medications that basically will stimulate a part of the brain very uniquely unlike the medication we've been using for the past 60 years that will primarily affect serotonin, norepinephrine and dopamine.

The Rad's or the rapid acting antidepressant medications will affect this particular receptor called of mice kinase B receptors not my myson kinase B receptors upon stimulation will drastically start to affect the scaffolding of the nerve growth.

>> In other words the hope of mice and premising kinase B receptors once activated kind of act as the foreman for construction of the neurons and it's thought that when people are under chronic stress and they're under chronic they have chronic depression they will have a shriveling up of their individual neurons.

So if your neurons should have one hundred thousand branches on them, maybe they'll shrivel up and shrivel up and only have sixty or seventy thousand branches will upon the stimulation of mice some kinase B receptors you will have kind of an influx of this Miracle-Gro type of effect, this growth factor for the scaffolding and the branching out of the individual neurons.

They work very fast.

They can work within a matter of minutes to ours and we've had some experience with Araz already with ketamine being used.

I've primarily over the past twenty years for depression and people had dramatic effect with ketamine and then over the past four years we've had ketamine also known as bravado that is approved by the Food and Drug Administration as a nasal spray and we often see results with that within a week or so we've had more recently the psychedelics coming out the which include MDA MDMA which is methylene deoxy methamphetamine and that's a medication that upon taken at the appropriate doses allow a person allows a person to have a greater degree of self-awareness and more empathy for other people.

>> So MDMA it's known as ecstasy.

People use it for a high on the street but under a very controlled therapeutic setting at the proper dosing it can be very quick acting for the treatment of depression.

Psilocybin is getting approved over in Australia right now.

Psilocybin also effects that tobramycin kinase B receptor very, very quickly.

It's thought that it's roughly a thousand times more potent on that particular receptor than even ketamine.

>> So we're excited about these type of medications coming out in the United States.

They're not expected to be available maybe until the summer of twenty twenty four .

>> But the nice thing about Australia approving a year prior to us is that Australia can hopefully figure out what can work and what doesn't work and we don't have to deal with some of the obstacles they might encounter upon using the rapid acting antidepressant medications.

But it's a different time in psychiatry.

For the past six decades we've had medications that are primarily affecting serotonin, norepinephrine and dopamine and it takes weeks for those medication to go to work and people might have a partial response.

They might have a high relapse rate with ketamine, with ketamine and with these psychedelics and hallucinogens coming out, it's hope that we can have a faster onset of action and more persistent retention of the of the improvement over the course of time.

>> We do have an oral medication alcohol call Velarde or Velarde is a medication.

It combines bupropion which is also known as Wellbutrin in addition to dextromethorphan which is approved in 1958 as a cough suppressant.

That combination dramatically increases the blood levels of dextromethorphan such that you can get some stimulation very quickly at that trouble Myson Kinase B receptor site and get a quick onset of action.

So as an oral medication with all Valide we have sound we have found that people often will have a nice response with that within a couple of weeks as opposed to waiting several weeks.

It's not as potent as ketamine or ketamine but it's something that also can give a fairly quick response.

>> Thanks for your question.

Let's our next caller hello Kyle.

>> Welcome to Matters of Mind.

Kyle, you mentioned you'd wondered seasonal depression is limited only to the winter or can you have symptoms in the summer?

>> The symptoms in the summer, Kyle, usually will be where you get a little bit more hyped up a little bit on the manic side in the wintertime.

>> That's what most people encounter.

So when people have seasonal affective disorder also known as winter depression quite commonly seasonal affective disorder is usually influenced by the darkness of the skies.

>> The skies start getting darker and the about in the fall around October November and with less light hitting the eyeballs the you have less of a light signal going to the pineal body which is right here in the middle of the brain in the pineal body you have a greater release of melatonin that can make you more tired, more depressed, more socially withdrawn and give you a greater appetite for different things.

>> Typically in April or May people come out of that and you might rebound to go to the other extreme and get a little bit more manic with the increased sunlight people who are prone to seasonal affective disorder well not uncommonly have high energy decreased need for sleep and they get kind of irritable in the summertime now rarely will people have just the opposite where people get more revved up in the fall and winter and more depressed in the in the summertime.

That's very, very rare.

>> Usually it's more depressed in the fall and winter and more romantic feelings in the summertime.

Women are around four times more likely to have winter depression or seasonal affective disorder compared to men that's thought to be related to the fluctuations in estrogen and progestin and the treatment for it will be number one try to exercise number to try to socialize even they don't like to if you have winter depression you can also sit in front of Bright Light Box in October , November, December, January especially for maybe thirty minutes first thing in the morning we do give medication for winter depression such as Wellbutrin or Blueprint which I just mentioned which is a component of ability which could probably be used for winter depression as well.

But the idea is to allow people to be more functional, be more active, be more socially interactive.

>> You don't want to exercise in the winter time but that's the best time to do it because exercise all by itself can stimulate to a mild degree that particular receptor to which I referred earlier which is tobramycin kinase B receptors.

If you stimulate that receptor you thereby stimulate the growth factors which can act as the scaffolding for a little neurons out there and make a more fluffy and make it more branched.

>> More branched neurons make you less prone to having difficulty with depression overall.

Thanks for your question.

>> Let's go to our next caller.

Hello Sarah.

Welcome to Mastermind.

Hello Sarah this is Jerry.

>> Hello Debbie.

I apologize for you sir.

Okay I have a question.

My girlfriend's daughter has seizures.

I mean I have seizures but she has seizures that are costing and she finally went in to the doctor.

But I know from my neurologist that if you have so many rich your neurons in your brain because I have seizures since I was a fetus.

So I was just wondering if you constantly have seizures all the time.

My girlfriend's daughter does can you get your neurons to get fixed or no, that's an excellent question, Sarah.

>> With chronic persistent seizure activity you have excessive glutamate release with excessive glutamate release in the brain.

Keep it in mind glutamate is an excitatory chemical in the brain.

>> It involves over half of all the different synaptic transmissions in the brain.

>> Glutamate is the excitatory accelerator of all the chemicals in the brain when you have seizures, excessive glutamate being released, imagine if you have an electrical circuit in your house where you're a particular circuit.

It's going to the television set, the space heater, the ion all these different circuits.

What'll happen is that particular electrical circuit can blow a Fuze or just cause excessive electricity and you can start a fire unless you have a circuit breaker.

>> So the key with glutamate is it's a good medication or I'm sorry a good chemical to have in control.

>> But if you have excessive glutamate it can actually cause damage in the damage it causes Cytotec toxicity exciter toxicity is where you start to fry the individual neurons.

So as I mentioned before, individual neurons might have up to one hundred thousand branches and if you have persistent seizures you're going down to maybe eighty thousand branches, sixty thousand branches and so forth.

Can you bring that back?

Yes, because we're finding that with some these so-called rapid acting antidepressant medications there is the potential for branching and growth of that branching with a matter of days in many cases.

So if people have traumatic brain injury, if they have a history of stroke, if they have evidence of neurotoxicity the brain where they've had a frying of those branches, I think as time goes on we're going to be hearing more about the use of antidepressant medications that are these rapid acting antidepressant medications being used directly as a means of trying to regrowth those parts of the brain.

But the key with seizures will always be we want to get him in control seizures like psychosis for that matter recurrent psychosis can do the same thing .

There is a damaging effect on the brain.

For instance, if somebody has recurrent psychosis where they're losing touch with reality, they actually have a shrinkage of various parts of the brain.

It's not that the neurons nerve cells are dying.

It's just that they're becoming less branched.

They're less fluffy intellectually cause the gray matter of the brain to kind of shrink down so that's why we want to get seizures and psychosis in good control and the big key over the next five years or so will be how can we regrow the brain rapidly?

And I think with these rapid acting antidepressant medications that directly stimulate the regrowth of the branches of the brain, they might have potentials and many, many different areas in the future.

>> Thanks for your call.

Let's go our next caller.

Hello Margaret.

Welcome to Matters of Mind.

>> Margaret, you want to know if depression can turn into autism?

Not typically, Margaret.

Autistic disorder is a developmental condition that starts in childhood and it starts in childhood in such a way that you can have decreased activity in this right front part of the brain that allows you to have social connectedness and that's often a key factor for autism.

You have difficulty mirroring the actions of others and picking up on the interpersonal communication from other people and that can often lead to a lack of empathy and a lack of awareness of how other people might be feeling and you have a hard time empathizing or putting yourself in their position.

>> So autism a key feature will be that difficulty with social connectedness so autism can lead to depression because people get frustrated with their autistic symptoms.

>> But autism is usually hardwired early on you don't all of a sudden develop autism when you're an adolescent or an adult you might first be diagnosed with it at that time but it usually is something where you're hard wired at an early age and the autistic symptoms can thereafter lead to depression itself.

So usually, you know, autism comes along with many other conditions autism and attention deficit disorder often go hand in hand because with autism people can have difficulty with attention span distractibility focus with both aid and autism people often have difficulty with frustration tolerance.

>> In other words they have trouble putting up with stuff so little things and changes can be very disheartening for them and they can become very stressed out and irritable with with changes on a day to day life both autism and do do respond to talk therapy and especially coaching and counseling to try to help redirect your coping mechanisms.

So instead of getting angry and getting irritable, you talk about how you're feeling at the time and you try to redirect your your attention to more productive types of way of ways of handling the stresses.

>> Thanks for your call.

Let's go our next email our next email reads Dear Dr. Farber, what works better ketamine or the nasal spray?

>> The nasal spray I mentioned is ketamine.

I'm trying to figure out which one to use.

Ketamine has been around since nineteen seventy as an anesthetic as an anesthetic.

>> I started to get used about twenty years ago for the purpose of helping with depression and I've ketamine is infused typically over the course of about 40 minutes and it based on rat brains it actually shows that that branching of neurons to which I referred earlier is occurring within a matter of minutes to up to four hours.

>> So getting this really quick branching of the neurons occurring very, very quickly.

>> So for that reason many of us myself included were very anxious about thinking OK, will there be other forms of ketamine coming out so that it could be more convenient to use as opposed to having somebody get an IV?

And could the Food and Drug Administration approve a medication like ketamine that could be regulated and closely monitored and very importantly it would be paid for different by the different payers.

So with that being said, the ketamine which is the left sided piece of ketamine, there's a left sided piece of ketamine and a right a piece of ketamine is ketamine was developed as a nasal spray, as a nasal spray.

It gets absorbed very well in the nasal passages and as ketamine is trade name is bravado.

>> Such bravado was developed four years ago and it's been used extensively across the country for the past four years.

>> So the question is how you use ketamine or ketamine ketamine will work faster but after about a month or both working about the same so ketamine might work within a matter of a day or two whereas ketamine it might take a week or two or even three weeks to really see a meaningful difference.

But at about the four week mark or the six week mark they're both working about the same.

>> So not uncommonly people might for instance if they're having a really tough time and they're in the hospital or are severely depressed by all means they could benefit from ketamine right off the bat to get the treatment started and transition over to us ketamine and what we're doing now is oh since October of twenty twenty two we've had this medication come out called All Valide that works on a similar receptor the NMDA receptors it works in a different place on the NMDA receptor but in doing so it too can work quickly by downstream increasing activity at that trouble myson kinase B receptor two which I referred earlier that stimulates the growth and the individual branching of the neuron so the idea being you want to perhaps transition from ketamine to us ketamine perhaps and it on down the line continue stimulating that particular receptor in some way with a medication it could be used in a convenient daily dosing where over the course of time the question is after a year after two years if you can actually regrow those particular branches on the neurons, could you actually cure that person's depression so they wouldn't even need medication in the long run now with the serotonin medications, with the dopamine medications, with the norepinephrine medications, even if somebody got well and they were doing really well for a few months, it was still a high risk for their relapsing within a matter of months so they could hang on for a while but they relapse.

It was always frustrating for us now some people and many people do well with those medications ongoing but sometimes a little stress in their lives.

>> It's like a puff of smoke on a smoldering ember with a little campfire.

A puff of smoke might get that fire going sometimes stress can do that when somebody had a recurrent depression over the course of time.

>> So with the traditional medication we've had we've always had to tweak them increase in a dosage, adding something else and the traditional medication were primarily affecting serotonin, norepinephrine and dopamine.

They did affect that type of and kinase B receptor indirectly it would take them a long time to do it and they wouldn't do it as potently.

So with ketamine as ketamine dextromethorphan which is in our ability and with the psychedelics in hallucinogenics they're affecting that receptor very profoundly very quickly.

So getting a very quick very quick onset of action.

>> People have asked me for years now how can you get over depression really, really quickly?

>> Well, historically going back to 100 years ago, people use cocaine .

>> Cocaine will bring you out of depression very quickly.

But the problem is it's primarily affecting dopamine, norepinephrine.

>> It gives you a brief high but then you crash in the crash of depression from cocaine use is often worse than the depression you had to begin with.

>> So people are advised using cocaine for depression.

Sigmund Freud one hundred years ago actually prescribed it.

He took it himself and cocaine is properly used in their early 20s, early twentieth century but it's just not a good type of treatment for people because it's not affecting that dopamine kinase B receptor is primarily affecting dopamine norepinephrine.

>> So we'll give you a brief rush of a high but then that fades.

Thanks for your call.

Let's go to next caller.

Hello Angie.

>> Welcome to Matters of Mind and you want to know about your energy level you mentioned why do I have a lot of energy and you can't sleep when you need to start new work projects?

>> Could be a couple reasons for that, Angie.

But the fact that you're starting a new work project number one, you're under pressure when you're under pressure there's a whole different part of your brain that kicks in when you're just doing day to day projects.

>> You'll use this left front part of your brain up here.

It's called the dorsolateral prefrontal cortex.

This is the part of the brain that you use to pay attention to things that aren't particularly interesting and you persevere.

You keep working at it and you get things done using the left front part of your brain.

>> People with attention deficit disorder don't have adequate activity in the front part of the brain and they have a lot of difficulty with persevering and being vigilant in completing work and activity when you're under pressure and you're under a deadline a whole different part of your brain will start to go to work if I give my brain a part here it's called the nucleus accumbens.

>> It's the excitement part of the brain.

>> It kicks in a whole different means of processing information.

The nucleus Cummins is down here in the middle part of the brain and that part of the brain is firing up dopamine and you're getting a lot of energy because you're under pressure and your heart rate will go up.

You might feel a little bit more anxious if might feel like you have a lot of extra coffee on board.

You can't sleep because you're really fired up to get this project so you'll have a lot of energy and you can't sleep because you want to get the project done.

>> Many people in information technology it will often say they have this kind of experience when they're working on code they can work on code all night, all night, all night because your brain is just getting constantly stimulated with the results of the work that you're seeing and the closer and closer you get to getting the project completed, the more excited you get.

>> So it's like you're reaching for the finish line.

Not a big problem unless it gets to the point where that high energy and difficulty with sleep leads into what's called functional impairment where you can't go to work the next day you can't concentrate your sleep deprived.

>> That's where it becomes a problem.

But if you can do this in spurts of activity where you have a lot of energy, you don't sleep for maybe one or two nights and then you get your work done and you're able to go to sleep the next night, that's fine.

That works out OK but people will often have a lot of energy and they can't sleep when they need to get projects done whether and when they have a deadline coming up now better yet, Angie, what you want to do is try to stay on time and do it gradually over the course of time and not feel like you have to get it done all at once.

>> But some people will start a new project.

They get really excited about it.

Hey, if you get ahead of the deadline and you're done a week early, that's even better because here your main project is done.

You've got a week to go.

You kind of think about the project over that subsequent week, make some minor refinements.

>> That's always the best thing to do to try to get ahead of when the deadline is do so if you can try to get the deadline in your mind as being a week earlier than what it really might be.

>> That's that's ideal because then you're probably going to have a better quality of work because you're going to still be thinking about the work that you've already completed but yet refining over the course of the extra time that you have.

>> Angie, thank you for your call.

Unfortunately I don't mind I'm out of time for this evening and 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 WWE Dog psychiatrist Jay Fawver and you've been watching Matters of the Mind on PBS Fort Wayne God willing on willing.

>> I'll be back again next week.

Thanks for watching.

Goodnight