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Cameron Psychiatry.

Providing counseling and care for those that may struggle with emotional and behavioral challenges.

More information available at CameronMCH.com.

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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 10th 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 issue, give me a call here.

>> The PBS Fort Wayne site by dialing (969) 27 two zero or if you're calling any 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 concerning mental health issues that I can answer on the air, you may write me via the Internet at matters of the mind all one word at WFA record that's matters of the mind MWF organophosphates Tonight's program with an email I recently received it reads Dear Dr.

Favor with counseling and medication 80 milligrams of Lacassine daily I've managed major depression disorder for 30 years.

>> My father died in December and he's been struggling again and I've been struggling again.

I feel extremely sad and empty lack of interest in life , things I enjoy doing and other on offer and I wish I had died to my family doctor told me that I have complicated grief but that what I'm feeling now is exactly what I felt about almost 30 years ago when I was first diagnosed with depression.

Is grief making my depression worse or my suffering from another major depressive episode relapse?

>> Yes and yes.

I mean grief is another brick on that pile of stresses that you've endured in life and anytime you have a severe a significant loss, especially a loss of a close family member, it's going to be a significant impact on your resiliency and it can trigger another depressive episode.

So that is a factor.

>> So on one hand grief is exacerbating another depressive episode now Prozac or Fluoxetine 80 milligrams a day is a fairly high amount.

>> You've been on it for three decades.

It sounds as if you've taken it for that long and 80 milligrams a day.

>> Flock's team can sometimes kind of have a Poupart effect.

>> It kind of develops a tolerance for some people where by increasing serotonin to the degree that 80 milligrams of Fluoxetine would do, you can sometimes indirectly decrease dopamine and be a little bit more inclined to having depressive episodes if the situation presents itself.

>> So in that case you can talk to your clinician about possibilties other than Fluoxetine or Prozac we've had over twenty four different antidepressant medications become available over the past 60 years so we have a lot of options from which to choose Fluoxetine or Prozac being one of them.

It did come out about nineteen eighty seven so it's been around for a long time and it was the first of several medications as specifically and selectively affected serotonin.

So flock's near Prozac is primarily affecting serotonin.

That's been your go to medication for quite some time.

>> It might be time for you to take a medication.

It works a little bit differently but it has some similarities to Prozac to give you that same same kind of effect with Fluoxetine or Prozac I'm always asking people do you feel better going from twenty milligrams to forty milligrams from forty milligrams to sixty milligrams to 60 milligrams to 80 milligrams because if you got to a point where it didn't give you any more benefit that's where you want to go back down.

Then the second question will always be what percentage of improvement would you estimate that you've acquired from the Fluoxetine or Prozac at eighty milligrams for instance if zero percent is no help at all hundred percent is fantastic.

What kind of range between zero percent one percent benefit do you think you've received from it?

So we try to fine tune the flock's team and we might replace it with a medication to work kind of like flu vaccine so grief can add another significant stress on top of the pile of stresses you've endured in your life .

>> You know, trauma is something that will affect everybody to some degree.

>> Some people deal with it relatively in a fairly good coping manner and other people don't.

>> So part of it's genetics but much of it is past life experiences and how well you've dealt with situations in the past because we do learn from tragic events from our past.

So it's not that you would be inevitably depressed if you had bad things happen in your life in the past.

It's a matter of how you cope with them and how you've been able to do endure and go forwards.

Life experiences will often allow us to have significantly greater resiliency and we're able to put up with stuff over the course of time.

>> Thanks for your email.

Let's go to our first caller.

Hello John.

Welcome to Mars.

>> Mind.

Are there any medical supplements or specific foods that one can benefit from that mental activity?

>> That's been a question has been asked many, many times over the past 30 years, John.

>> And I wish I could give you a recipe of saying, you know, you want to take this you want to have this supplement, you want to eat these foods and you'll have great functioning, a great functioning brain but it doesn't really work that way.

>> So I'll kind of lay some out for you in order because we know that a deficiency of certain vitamins or minerals can lead to more depression and difficulty with concentration.

>> The top of the list I can think of especially in the northeast Indiana area where PCBs Fort Wayne lies will be vitamin D if you have a vitamin D deficiency as D and dog you could have a greater likelihood of having depression and difficulty concentration.

There was a study done in Denmark years ago showing that people who had lower vitamin E levels were more prone to having to depression and hospitalizations due to depression.

>> So vitamin D is at the very, very top of my list then John second on down the line it's not so much fish.

Well it used to be thought fish oil or special supplements like ginkgo biloba might be up there but they're really not.

I think second down the list would be the possibility if you had a folic acid deficiency where you didn't metabolize folic acid appropriately.

It's called Shefa.

It's called methyl tetrahedral folate reduc tace but shefa is the breakdown is the means by which folic acid is broken down and it breaks down into elemental folate.

So elemental folate is the in byproduct folic acid.

Some people need the vitamin elemental folate and you don't know if you need it or not for sure unless you get genetic testing.

But about one out of three of us could benefit from Elmsford folate many times obstetricians will just automatically give women Elmdale folate because they don't know if they can break down folic acid adequately or not.

But folic acid is very, very important during pregnancy because if you're low on folic acid and the byproduct Elmau faithfully during pregnancy, the baby is at a higher risk for spinal bifida which is a disorder where the back as opened up a little bit and the spinal cord is exposed and it can lead to a lot of complications from that.

>> So I'd say if you have a genetic deficiency of Shefa, which is an enzyme that breaks down folic acid that thereby could be the second main concern I would have for anybody.

>> You know, there's been a lot of concern more recently about magnesium deficiency.

We've known about that for a long time for people who are malnourished.

We've known about magnesium deficiency for people who had difficulty with alcohol use disorder where they drank excessively and perhaps that led them to being malnourished.

But magnesium is something that many, many people could find beneficial especially as they get older, especially as we get older, especially over 60 65 years of age.

>> We don't tend to absorb a vitamin by the name of vitamin B 12 adequately vitamin B 12 gets absorbed in the small intestine but it needs to be carried to the small intestine by this little substance called intrinsic factor that's in the stomach.

>> And as we get older we don't have as much intrinsic factor being released from our pradel cells in the stomach.

So it's like lacking a bus transportation to another area of your body.

>> You need to catch the bus of the intrinsic factor in your stomach to be able to transport the vitamin B 12 to the small intestine as Werbe 12 it's absorbed so as we get older we're more prone to have it vitamin B 12 deficiencies especially if somebody has ever had any bariatric surgery where they've had some of their stomach cut out for the purpose of weight loss or if you're taking a very common medication use for prediabetes or Type two diabetes by the name of metformin Foremans been around for decades, used to be called Glucophage as a as a brand name medication.

Metformin is a generic medication many, many people are taking that form is a very good medication for a lot of people because will decrease the insulin production and decrease the amount of glucose being absorbed in the gut so for many people metformin can be a really nice medication but metformin is something that can decrease the absorption of vitamin B 12.

So it's recommended that about once a year if you're on metformin you might want to get a vitamin B 12 level and you can get vitamin B 12 supplementation by either an injection or through a sublingual tablet.

>> That way it doesn't have to go to the stomach to get absorbed.

It gets absorbed in the mouth.

So I would say probably in that order you looking at vitamin D l methyl folate magnesium is probably third in line and then vitamin B 12 those are the four supplements now could I speculate on dietary and nutrition benefits?

I'd say probably based on everything I've seen over the course of time and it's a diet I try to adhere to myself.

The best I can do would be to do intermittent fasting where you don't have breakfast basically and you just try to eat at about a six hour window every day.

You try not to eat outside of the six hour window and that way you're doing intermittent fasting for four six hours where you're fasting and then you're eating for about eight hours.

>> So it's a sixteen hours of no caloric intake or a limited caloric intake with still having fluids during that time.

But what you're doing here is giving your pancreas a rest where you're not releasing high amounts of insulin throughout the entire day.

>> High amounts of insulin is not good for the brain in such a way that the brain relies on insulin to get to regulate blood glucose levels all over the body.

There's no insulin receptor.

There's no insulin activity in the brain itself but there are insulin receptors in the brain.

Insulin can't get into the brain but interestingly enough insulin receptors in the brain.

So there's something going on there with insulin activity being somewhat toxic to the brain.

>> So you know, we've always heard over the course of time that high glucose is are not good for you.

>> High insulin levels are worse.

So you don't want these high insulin levels that are getting triggered by high carbohydrate diet or eating throughout the day.

So you want to give your pancreas arrest, you want to drop that insulin level down as much as possible.

It looks like that's the best thing you can do for the brain.

So intermittent fasting with a ketogenic diet where you're limiting your carbohydrates, not restricting them in entirely but you're limiting your carbohydrate intake to try to diminish that spiking of insulin.

>> And I think over the past five years based on what I've seen in the psychiatric research, it's the ketogenic diet, the high insulin provoking diets that are more the high insulin provoking guys are more problematic for a lot of people with mood disturbances 100 years ago it was promoted that for children with a lot of epilepsy type conditions they were doing better with ketogenic diets where they had low carbohydrate diets or no carbohydrates diets in some cases and that actually help with her seizures.

Well, seizures are based in the brain and I think in the same way we can say that moodiness and depression can be impacted by a low carbohydrate diet, low insulin activity which can be helped with intermittent fasting.

>> It's a long answer to a short question but thanks for your call.

>> Let's go to our next caller.

Hello Charmaine.

Welcome to Matters of Mind.

>> Charmaine, you had mentioned you were diagnosed with schizoaffective disorder for some time ago and you knows your memory is decreasing.

Is that caused by the disability itself or the medication?

Charmain it could be either medication will block dopamine and sometimes by blocking dopamine it could hinder your ability to to concentrate and pay attention.

The front part of the brain the front part of the brain is the thinking part of the brain.

That's the part of the brain where you used to pay attention and to process information and go from one thought to another and control your impulses.

The medications, the older medications that were used in schizoaffective disorder primarily blocked dopamine and by doing so they blocked dopamine over not only in the side part of the brain which is the area of the brain who where you want to block dopamine, excessive glutamate, excessive dopamine activity in the side part of the brain is what provokes the hallucinations and delusions and the fixed false beliefs and all the bad thinking people will have blocking dopamine and that sort and that side part of the brain s great.

That's what you want to do.

But if you also blocked dopamine the front part of the brain that can hinder a person's memory and concentration.

So for that reason the newer medications that have been coming out over the past twenty five years are blocking dopamine in the side part of the brain but they're not directly blocking dopamine in the front part of the brain are blocking the serotonin 2A receptors by blocking serotonin 2A receptors.

>> You actually increase in the front part of the brain so it's depending on what type of medication you might be taking.

They might affect dopamine transmission in the front part of the brain in different ways.

There's a medication came out called Carolita about three years ago.

Caplets specifically was basically blocked serotonin 2A receptors in the front part of the brain with very little effect on dopamine and thereby will have very limited impact on concentration or attention span.

So that's been a good medication for that purpose alone.

Brailer is a medication and also will affect certain dopamine receptors and in doing so can improve concentration and won't cause a difficulty with concentration like we've seen in the past now where schizoaffective disorder can cause you to have memory problems, attention problems and so forth will be if you've had recurrent psychotic episodes.

Recurrent psychotic episodes will be where for a period of time a week or so you've had difficulty with auditory hallucinations, fixed false police we call them delusions, agitation, anger and lack of sleep.

>> Psychotic episodes are very damaging to the brain.

They caused this extraordinary high release of glutamate and glutamate in high amounts in the brain will be toxic.

That can cause some people to have difficulty with memory center specifically over on the side part of the brain.

So glutamate toxicity related to a psychotic episode can lead to memory problems overall overall and when something is schizoaffective disorder it's not uncommon that they will often self medicate when you self medicate with alcohol.

Alcohol for instance will certainly damage this hippocampus memory center of the brain on the side.

Marijuana is something many people will try when they have schizoaffective disorder to try to self medicate their symptoms.

Marijuana is something that not only worsen psychotic episodes but also will give you difficulty with being able to grow white matter in the brain .

White matter is like insulation around the individual neurons and with a lack of insulation around the individual neurons people can indeed have difficulty with concentration, focus paying attention to things and it's been shown in chronic marijuana use will actually lower the IQ for people compared to what it would be expected to be overall .

So you know, we take all those matters in consideration could be the medication, the underlying illness or even the substance use that some people will use to self medicate.

All those factors can be reasons why people might have trouble with memory concentration, attention span with a condition like schizoaffective disorder.

>> Thanks for your call.

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

Our next e-mail question reads We don't have all of our what are the effects of moving on the brain from simply taking two minutes to stand up and walk around at work to thoughtfully moving and focusing on breathing like yoga to more rigorous rigorous exercise like jogging?

Do these all do something?

Do they do different things?

Well, there's been a lot of research over the recent years on the effect of exercise on the brain and when we talk about exercise we're talking about getting your heart rate up for about one hundred and fifty minutes a week.

>> So we're talking about two and a half hours a week that does not have to be two and a half hours all at one time.

>> Probably better to split it up at least twice a week so you could do an hour and fifteen minutes one day an hour and fifteen minutes another.

>> Most people will do thirty minutes five days a week.

That's great but two and a half hours of exercise a week is what's recommended.

>> There's a study that was recently available showing that men over 50 when they did not exercise for at least ten days there were significant changes occur in the brain.

>> These were men who previously were physically active and they were told do not exercise, do not move around that much, just take it easy for ten days.

Let's see what happens.

Your brain well within ten days or is decreased blood flow to this area called the hippocampus.

That's the area into which I referred to previously concerning the memory center of the brain.

>> The hippocampus will have decreased blood flow within ten days of limited exercise on the hand if you start exercising again blood flow increases to the brain and that will basically stimulate the hippocampus to start growing again.

That's the first thing can happen.

Secondly, when you exercise for some reason I don't understand there's this natural fertilizer of the brain called brain derived neurotrophic factor brain derived neurotrophic factor.

>> BDNF is the brain's natural Miracle-Gro and somehow someway moving around exercising will increase brain derived neurotrophic factor and that's particularly exercise where your heart rate gets up and maybe up to 70 percent of your maximum maybe 60 percent of your maximum.

>> In other words, your heart rate's getting higher than usual.

So brain derived neurotrophic factor can be an issue or a benefit for you.

>> You'd mentioned yoga, something that wouldn't cause your heart rate to increase yoga is great from a stretching and flexibility perspective.

It can decrease your stress level because when you're when you're participating in yoga you're getting tremendous flexibility with your joints.

>> But you're also relaxing during that time because when you're trying to hold those particular postures in yoga you can't be worrying about what the kids are doing your job.

You can be worrying about stuff happening in your life .

>> You're basically focused very intensely on those particular postures you're having.

>> So with yoga basically it will decrease your cortisol level cortisol, a stress hormone stress hormones will be detrimental to the body stress hormones and excessive amounts like cortisol will actually fry that hippocampus and cause it to shrink up.

So chronic stress is really bad for the brain.

If you can do something that makes you feel less stressed out no longer any kind of exercise that will decrease the stress hormones.

Now if you exercise as well you'll feel less stressed out, less stressed out, you'll feel more relaxed overall resistance training is very, very good for anxiety because when you do resistance training you're intensely exercising your muscles.

You're making them contract which thereby allows your muscles to be more relaxed when you're anxious you're more prone to tightening up your muscles and feeling more tense.

So resistance training with weightlifting is very, very good for anxiety.

It's always been thought that aerobic activity where you're increasing your heart rate the bicycle walking briskly, running elliptical machines those are the kind of exercises that can increase your heart rate and they've always been thought to be helpful for a more depressive symptoms and feelings, feelings of sadness, another benefit of exercise will be that it will decrease inflammation again by a manner by which I don't know but somehow exercise to decrease inflammation not only in the entire body but also in the brain in the body.

There's these little white blood cells called macrophages in the brain they're called Michael Microglia but these are basically little white blood cell type structures that will decrease inflammation and chew junk in your body.

>> So exercise helps you decrease inflammation and gets rid of a lot of the junk in the body.

>> So there are many, many, many benefits of exercise.

Why don't we just simply prescribe exercise to everybody?

We do in many cases but quite frankly getting people to do the do the exercise is something the is very difficult.

You have to have the energy.

You have to have the the ability to sleep.

You have to have the motivation.

Once people start exercising they feel good and when you exercise there's two things that happen in your brain glutamate goes up that's an excitatory neurotransmitter.

Then you've got Gabb that goes up that's a calming transmitter so you've got an exciting neurotransmitter and a calming neural neurotransmitter can commonly increasing at the same time so you feel more energized but more relaxed.

>> So with that being said you'll often sleep better at night.

I often recommend to people that they exercise before 6:00 pm if you exercise in the evening or at bedtime unless you're maybe in your 20s or early 30s it might keep you awake.

But when you exercise later in the evening in your later life you might keep more prone to keep you awake but will often recommend to people that they exercise 30 minutes a day, five days a week preferably in the morning or early afternoon and that has a lot of good benefits for the brain.

Thanks for your email.

>> Let's go to next caller.

Hello Roger.

Welcome to America mind yes, a couple of questions real quick.

One does multivitamins is it better to take like individual vitamins over multivitamins?

And my second question was whether cause neuropathy to get worse when your anxiety is higher.

>> Yeah, Roger, I'm a psychiatrist so I'll mention all allude to the first question concerning vitamins in a very generic matter I would recommend taking vitamins based on known deficiencies a multivitamin back when I was in pharmacy school back in the 1970s.

>> The thinking in the nineteen seventies was that a multivitamin would pretty much cover everything.

>> Then there were studies done on people who took multivitamins for decades and they actually didn't have as good a health as people who did not take multivitamins so well about twenty years go I quit taking a multivitamin every day if you know of particular deficiencies especially as you get older you might be more prone to wanting to take certain vitamins.

>> That's why I'll often recommend vitamin D possibly vitamin B 12 based on a person's circumstances a B complex vitamin might it does include vitamin B 12 but there are certain vitamins that you specifically might want to take based on your age based on one of the medications you might be taking.

>> So you take all those type of things into factor neuropathy doesn't usually get highly influenced by anxiety although we do use some medications for anxiety and neuropathy such as gabapentin and Pregabalin those are Neurontin and Lyrica respectively.

>> But with Allison help not only with the neuropathic pain but also with the anxiety.

Fibromyalgia is a whole different condition fibromyalgia will indeed get worse with anxiety and depression but neuropathy doesn't usually get worse with anxiety and depression itself.

>> Pain can in general but not usually neuropathy.

Thanks for your call.

It's our next caller.

>> Hello Cedric.

Well welcome to Bear of Mind Cedric.

You want to know what I'm not sure what you're asking there.

>> Cedric, what do you I'm going to have to pass on your question, Cedric.

>> I can't really understand what your question is.

Let's go next caller.

>> Hello, Jane.

Welcome to Matters of Mind.

>> Jane, you want to know how to sleep deprivation affect the brain when you sleep?

Jane, the front part of your brain to which I referred earlier is a part of your brain that is you're using for concentration.

You're using your focus, you're using for attention span all day long.

So it's working and working and working all day long when you sleep it just totally shuts down and that's why when you dream your front part of your brain is not working.

>> So a lot of dreams don't make a lot of sense because your reasoning part of your brain is just shut down.

So that's why a lot of brain dreams are abstract.

They don't make a lot of sense.

So if you have sleep deprivation, what you can imagine is the judgment part of your brain, the thinking part of your brain doesn't work so well.

So what you notice is that things don't make a lot of sense to you as time goes on you can actually get psychotic if you lose adequately, if you lose significant sleep over the course of several weeks where you can lose touch with reality because the front part of your brain hasn't been given time to rest.

>> Jane, thanks for your call.

Unfortunate I'm out of time for this evening if you have any questions concerning mental health issues, you may write me here at PBS Fort Wayne by addressing your email to Matters of the Mind all one word at WFYI dot org.

>> I'm psychiatrist Jeff Offer and I've been watching matters of mine on PBS Fort Wayne now available on YouTube God willing and willing.

>> I'll be back again next week.

Thanks for your call.

Goodnight Cameron Psychiatry.

Providing counseling and care for those that may struggle with emotional and behavioral challenges.

More information available at CameronMCH.com.