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>> Good evening.

I'm psychiatrist GAO Fauver live from Fort Wayne , Indiana.

>> Welcome to Matters of the Mind now in its 25th 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 in the Fort Wayne area by dialing (969) 27 two zero or if you're calling long distance you may dial toll free at 866- (969) 27 two zero not 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 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 WFB blog that's matters of the mind at WSW a dog.

And let me start with a question I received just this week.

It reads Dear Doctor, Father, could you explain what the sympathetic nervous system is, what things could cause it to stay stuck on good things like being neglected as a child be affecting me as an adult?

>> What are ways to calm down and not be so much on edge while the sympathetic nervous system is basically part of the autonomic nervous system that will cause you to have a heart fast heartbeat, a dry mouth sometimes people will have constipation when they're having that occur people will get tremors and shakes.

>> Think about speaking in public for the first time ever and how you felt.

That's the sympathetic nervous system really kicking off.

It's opposed by the parasympathetic nervous system which gives you more of a calming effect and there's always that balance between the two that you want so you don't want excessive parasympathetic nervous system activity because that'll give you an excessively slow heart rate and lightheadedness and also give you diarrhea for that matter.

>> So you want to have that balance between the sympathetic and parasympathetic nervous system.

You are right that if you will look at your childhood experiences, if you've had difficult childhood experiences and a lot of childhood stress, you will be more well higher strung and higher strung means that your have a higher amount of sympathetic nervous system activity and for some people that goes into full-blown post-traumatic stress with post-traumatic stress you can have a difficult time with having nightmares.

>> You can be really jumpy and on edge and you can always be expecting something bad to happen such that you want to stay away from people and avoid situations that might remind you of the past stress all that is involving sympathetic nervous system.

So you want to get that in balance.

What can you do to offset that, you know, deal with the stresses if it's a precipitate but also you want to try to turn on the parasympathetic nervous system the best way possible that can be done with the breathing especially with more exhalation than inhalation.

So if you want to inhale for three counts, you want to exhale for six counts because when you're exhaling that's when you're getting greater parasympathetic activity occurring.

So when you hear about all these breathing exercises that many people will recommend, it's because you're trying to balance that inhalation with exhalation and if you're feeling a lot of anxiety exhaling for longer periods of time can often be very helpful for people.

Hyperventilating will sometimes cause people to have panic attacks because you're inhaling very quickly and hyperventilating will sometimes actually cause the panic attack.

So what you want to do here is try to slow down your breathing and exhale more slowly.

Overall exercising is a marvelous way of increasing parasympathetic activity because when you're exercising you bet you are increasing your sympathetic activity during that time but because there's certain chemicals released during exercise you do not have panic attacks typically during exercise for instance, those particular proteins that are released to the heart that will actually slow down the heart during exercise that will protect it from having a panic attack during that time.

>> So when you have these proteins released it gives you a calming effect afterwards so that 30 minutes after exercising people will feel energized but yet calm.

>> Now much of that is related to another couple of chemicals in the brain called glutamate and GABA glutamate is an excitatory chemical in the brain.

>> It's all over the brain and GABA is an inhibitory chemical in the brain.

It puts the brakes on so glutamates the accelerator gabbers the brakes and you want those in balance in a similar manner as you do with the sympathetic and parasympathetic autonomic nervous system.

>> So with the glutamate and GABA if you exercise intensely for 30 minutes to forty five minutes for thirty minutes after you exercise you'll get this peak in glutamate and GABA simultaneously and then allow you to feel energized but yet calm and that's why many people after the exercise they'll really appreciate that they did it.

>> They'll feel really good after the exercise even though they go into exercising with dread and they don't want to feel the discomfort and the achiness they might have during exercising.

But yet when they're done they emotionally feel much better.

That's because you are changing brain chemistry for the good so exercising can do some of the best things you can do for brain chemistry by increasing glutamate and GABA in doing so you also balance out the sympathetic and parasympathetic nervous systems.

But yeah you'd mentioned the childhood stresses they can get you a little bit more on edge in general.

>> As a matter of fact there is a scale that we use called the adverse childhood Experience Scale also known as Aces and the Aces is something that will be a predictor for somebody having more anxiety and more traumatic experiences later on.

If you score five or more out of the ten items on the Aces questionnaire, you're higher likelihood for having anxiety and depression as an adult and is somewhat predictive.

It's one of many things we use as a predictive to determine if somebody's going to respond well to a serotonin antidepressant medication such as Lexapro, Zoloft, Celexa, Paxil, Prozac these are all serotonin medications and if you score five or more on the ACS that be a five, six, seven or eight , eight , nine or ten if you score those higher scores on the aces you can have less likelihood of doing well with a serotonin antidepressant.

It's one of many factors that we will consider when we look at somebodies possibility of responding to various medications.

>> But it's not deterministic but it's probabilistic.

>> It's not the final determining factor in terms of who will respond to a serotonin antidepressant but it just gives you a little bit more or less probability on how somebody does on their adverse childhood experience scales.

So it's one of many different type of determining factors that can influence this one way or another for an antidepressant medication.

>> Thanks for email.

Let's go to our first caller.

Hello Tina.

Welcome to Mary's mind.

Tina, you want to know how phobias develop phobias develop basically because you've had exposure to something and during that time it fires up your anxiety volume control.

>> So when you think about your anxiety from control is right here in the front part of the horn of the thumb of the brain called the temporal lobe it's called the amygdala.

The amygdala in Latin means almond shaped.

This is the temporal lobe.

People sometimes wonder temporal doesn't that mean time?

>> Why is the temporal lobe here off the side of your of your skull?

Why is that called temporal lobe?

Well, it's called temporal lobe because it does refer to time and the reason the temporal lobe is called what it is is because if it's location it's located in your temple area out here in the temple area is where you first go gray with your gray here.

So that's related to time.

So because in your temporal area here that's where the first go gray that's why they call that the temporal lobe because it's out there on the side of the skull where your hair will first start going gray.

So with time it goes gray.

They call it the temporal lobe .

That's how they came up with that name.

So the amygdala is almond shaped in in Latin and it's a little almond shaped body right up here in the front part of the brain.

It increases in its activity when you're scared when you're fearful, even when you're angry.

So if you've been exposed to something and it very briefly gives you that fearful feeling right beside the amygdala is your memory centers so that memory center downloads that kind of experience associating seeing that bug or seeing that particular fearful thought or or image associates that with with fear and anxiety.

>> So every time you even think about that kind of object that might cause you a phobic response, you'll have all this anxiety and sometimes people have full blown panic attacks.

What you want to do, however, Tina, is to desensitize that little anxiety and fearful volume control by exposing yourself to the same type of things again and again and again.

So the things that made you fearful, that made you scared, that made you phobic those very things you need to expose yourself repeatedly and that's how you desensitize yourself and one from a neurobiological standpoint what you're doing is are turning down the volume control in the amygdala right here in the front part of the temporal lobe.

So that's what you want to do now what you also want to do is try to get the thinking part of your brain, the logical part of the brain go to work and if you the logical part of the brain to go to work up here, it can overpower the anxiety that you might inherently experience.

So if you can think yourself through and just cognitively restructure what that particular fearful type of thing really means, you can thereby decrease the anxiety.

>> For instance, if you're afraid of snakes and that's a big fear for a lot of people.

>> If you can rationally understand that certain snakes are poisonous in certain ones are not and the ones that are poisonous well they can be OK to pick up if you wish to do so and in doing so you'll have less anxiety when you pick up a nonpoisonous garter snake for instance and that can actually decrease your overall anxiety for snakes.

Now you should be fearful of snakes that are poisonous know the ones that have the specifically shaped head, the diamond shaped heads that are more poisonous if they rattle you probably don't want to be around them so cognitively and logically understand which stakes snakes are poisonous and which ones are not.

The problem a lot of people will endure is that they'll see a snake and they'll associate all snakes with being poisonous in all snakes being dangerous, educating yourself about snakes in terms of their toxic mannerisms would be something you do in firing up the front part the brain which is the intellectual thinking part of the brain that maintains your rational thought.

>> Tina, thanks for your call.

>> Let's go to our next caller.

Hello Raymond.

Welcome to Matters of Mind.

Raymond, you want to know about hot tea with ginseng?

Is that good for stress?

It might be Ray.

>> I used to use ginseng twenty five years ago.

Twenty five years ago is very popular to use ginseng as a supplement because it was thought to help with the concentration and focus and has I always tell people Raymond, ask your doctor or ask your health care professional your your physician's assistant, your nurse practitioner ask them what supplements they might take because those are the supplements you probably want to take.

So if a health care professionals taking certain supplements you might want to consider that myself.

I don't take ginseng anymore.

I did back in the 1990s.

I thought theoretically it could be good for concentration memory but as time went on no one I didn't notice much of a difference one way or another.

>> So that was the key factor for me.

>> If I didn't know as much of a difference I wasn't going to be continue to stay on it and then as I saw the studies about ginseng ongoing versus sugar pill, I wasn't that impressed.

So I don't think ginseng is the best thing you can do for stress right now Raymond.

>> Now you had mentioned hot tea.

Hot tea has about thirty milligrams of caffeine in it and coffee for instance has one hundred twenty one hundred fifty milligrams of caffeine depends on how strong your coffee .

So coffee has a lot more caffeine in a perk up.

>> But the nice thing about tea, Raymond, is it has a combination of the caffeine but it also has an a combination of the caffeine with the morning evening is remarkable for anxiety.

>> So the beauty of tea is that you're getting this combination of a stimulant that keeps you awake by blocking the adenosine receptors so you've got the caffeine going and then you've got anything that works entirely differently giving you an anti anxiety effect.

Now if you take orphaning as a capsule you want about two hundred milligrams three times a day you'd have to take you'd have to drink about twenty cups of coffee to get that equivocal amount.

>> But the nice thing about tea versus coffee is tea doesn't does not make you anxious.

>> It allows you to be alert but it doesn't make you anxious like coffee can coffee can make you kind of alert but yet jittery because of the caffeine content alone.

The nice thing about tea is it has some caffeine in it but it's offset by that lithium ion that's in it.

That's also very good for anxiety.

So sometimes we'll prescribe the all by itself capsules so people don't have to drink so many cups of coffee but not uncommonly we'll just advise people to keep sipping on hot tea or cold tea all day long as a means of trying to help with energy level help focus and concentration while also keeping you calm overall people sometimes wonder why tea does make them jittery like coffee does.

>> That's the reason he has the lithium ion especially green tea has more Healtheon in it than the black tea Raven.

>> Thanks for your call.

Let's go to next email our next email reads Dear Dr. Fauver, can you point out the different parts of the brain and how they function interact?

I'll show you a few parts here.

I already mentioned the front part of the brain, the dorsolateral prefrontal cortex on the left front side.

That's your part of the brain that you use to pay attention to concentrate, to keep your mind on things, to focus, focus, focus.

This is the part of the brain that shuts down at nighttime while you're dreaming because you can imagine if it's part of the brain's working really hard all day you need to shut it down and not make it work so hard and give it some rest.

So if you give this part of your brain some rest at nighttime with sleeping and especially with dreaming that can help.

I've told medical students for over two decades now that they need to take a power nap later in the afternoon, early evening, maybe thirty minutes to an hour for the purpose of resting this thinking part of the brain when you awaken you can actually think more clearly and you can remember things better overall.

>> Then you got this part of the brain right over the eyeball called the orbital lateral prefrontal cortex.

The orbital lateral prefrontal cortex helps you decide should I do this or should I do that?

It's the executive functioning part of the brain.

I refer to it as the Captain Kirk of the brain.

If you're a Star Trek fan makes the final executive decision on what you should do that's the orbital lateral prefrontal cortex.

It becomes overarm, active if you get really anxious and you worry about things you've done a brute about things and you'll think about things over and over and over again that becomes overactive in those cases then you've got the amygdala I mentioned before the fear anxiety center and then got the temporal core cortex having the hippocampus over here but a very important part of the brain is right underneath the right there is the corpus.

Some comes around here.

Corpus callosum connects the left and the right side part of the brain.

Women have a thicker corpus callosum so the women will tend to have the greater connectivity between the left side and the right out of the brains.

>> So if you take the corpus closest, close them and go all around here to where it looks like a knee underneath and knee knee is referred to as a as a general in EU A-L I think it is General General been there so underneath the general part of the of the Corpus Loathsome it's what's called the sub general cortex.

The subgenera cortex is the part of the brain that actually becomes overactive to a toxic degree.

When somebody gets really depressed it actually shrinks down in size but it kind of overcompensates and has increased metabolic activity when people get depressed that's important because when you get depressed this part of the brain functions improperly by lighting up too much and not working very efficiently and actually shrinks down in size.

But it doesn't work very efficiently if this part of the brain is not working very well, it'll cause your anxiety and your emotional volume control to override and basically short circuit your ability to think so this is a part of the brain that allows your thinking part of the brain to talk to the emotional part of the brain and tell your emotional part of the brain to chill out in the event that you're going through a stressful situation.

So you need this connectivity part of the brain to be able to connect the thinking part of the brain to the emotional part of the brain to keep you from being overwhelmed with stressful events.

So we call that stress resilience when people get really stressed out about different circumstances and little things get to them, they'll often get very anxious, depressed, angry and that's the part of the brain that needs to work.

>> The middle part of the brain needs to connect the front part of the brain to the emotional part of the brain.

>> Thanks for email.

Let's go to next caller.

Hello Donald.

Welcome to Matters of the Mind .

Hello Donald.

You're on the air.

Oh hey Doctor.

I'm just wondering why I do not get affected by caffeine.

It will not keep me awake and then I the one little part of history is as a youngster we would have coffee supan evening before we went to bed.

>> What's coffee soup?

Well, it is coffee and then you put bread and bread in it.

>> Yes, that it tastes very good.

>> Oh well we thought it did because the coffee had a lot of sugar in it.

OK, I was going to ask my next question.

>> I mean OK I can be on board with that with sugar maybe some cream.

>> Yes OK so you use that before bed.

How did it affect you Donald when when you use coffee soup you drink you ate coffee soup at in the evening before bed.

>> How did that affect you back then that you went to sleep?

We never had any effect and why did you why did you eat coffee soup before going to bed?

>> I think it's because it was the least expensive thing that my parents could have got.

Yeah.

So we grew up in a very wow.

>> Modest home.

Well you know that's interesting.

Coffee is an appetite suppressant .

>> Coffee has caffeine in it.

It has various antioxidants in it that can be helpful.

Good for your health and it can actually decrease the likelihood of Parkinson's disease, diabetes, a lot of health benefits to coffee .

The downside of coffee is the amount of caffeine you get in it because caffeine basically how it works.

>> Donnel it knocks off this little chemical called adenosine on these so-called adenosine receptors.

>> So here's how this all works as you get tired as the day goes on, you get kind of sleepy.

>> You're not thinking quite as clearly adenosine which is coming from ATP ATP, ATP we heard about that back in high school biology.

>> It's basically the energy of the body it lets off these fumes called adenosine adenosine is like a film that gets released as the day goes on you get more and more sleepy adenosine goes adenosine receptors and make you tired if you knock off the adenosine from the administration senario receptors you don't feel as tired, you don't feel sleepy and you can concentrate better .

>> That's what caffeine does.

Here's the problem Donelle it'll knock it off for a while but then your body kind of gets used to that effect and then it doesn't work so well anymore.

>> So I imagine you're having coffee soup as a child with that caffeine kind of gave you a tolerance to caffeine in general.

>> Now in your case if you're still having difficulty with tiredness, there's other ways to deal with it.

Obviously getting some fresh air exercising people who are physically able to do so will sometimes do five push ups and just wake themselves up.

But not everybody will respond adequately to coffee because you can't get tolerant to it.

>> The general rule of thumb, Donelle, is that if you drink more than about three cups of coffee a day which comes out to about 400 milligrams of caffeine a day, you'll get tolerant to it and you'll get used to it and it won't work so well for you.

>> So you want to keep that balance on having enough caffeine and coffee to be able to give you the beneficial effects of knocking off the adenosine slowly throughout the day.

And as a general rule of thumb, if you don't want to take in a whole bunch of caffeine at one time, you want to use it slowly throughout the day.

But you're one of those folks download from your tolerance as a young child eating the coffee soup, drinking their coffee soup hot whatever you'd say in terms of using the coffee soup, that is something that gave you a tolerance to the caffeine as time went on.

That's an interesting phenomenon but I learned something from you tonight, Donnel.

I had never heard of coffee so but it kind of makes sense because if you're looking to suppress your appetite let's say it's eleven o'clock in the morning, your stomach's growling a little bit a good time to have a cup of coffee at that time because the coffee can't suppress the stomach growling and can suppress your appetite at least temporarily during that time especially if you drink it slowly over the course of an hour, hour and a half.

>> Donald, thanks for your call.

Let's go to next caller.

Hello Peter.

Welcome to Mary's Mind.

>> Peter, you know is if there's a specific drug that causes sleepiness when you have bipolar symptoms.

>> Yeah, there's a lot of different medications, Peter, that will make you somewhat sedated if you have bipolar symptoms.

>> Bipolar symptoms will be where you have some difficulty with not needing to sleep for a few nights and then you have racing thoughts the next day you will be impulsive.

The next day you're talking a mile a minute.

The next day that's when you're on the manic high and then you crash into these lows where you want to sleep all the time and withdraw from people.

>> You get very depressed and you don't want to do anything.

The manic highs are manifested by decreased need for sleep and lack of sleep.

For some bipolar disorder is like throwing fuel on flames.

>> It just fires up the manic symptoms overall.

So we want people to sleep the medications we use the most to help people sleep by taking them at bedtime from a mood stabilization standpoint will be lithium that's been around for decades.

We can use antiepileptic medications like Depakote which we don't use so much anymore.

>> It's a very effective medication for bipolar disorder.

It's just the Depakote will cause a lot of weight gain for people.

We have to watch liver function tests and CBC's looking at the white blood cell counts occasionally.

But the so-called second generation antipsychotic medications are often very, very good for helping people sleep bipolar symptoms and they include Seroquel Zyprexa being the two most popularly used.

We'll use Carolita not uncommonly for people to help them sleep will use sometimes Valadares various medications that can be used that can help you sleep but you don't want to cause sleepiness during the day and that's always the balance.

Peter, we don't want to give somebody a medication is going to make him tired or sleepy during the day so we'll give these medications preferentially at bedtime to try to improve the sleep quality and try to help him sleep.

Now sometimes we'll give medications just as needed to help with difficulty with sleep that comes along with bipolar symptoms.

Gabapentin Neurontin is a common medication.

Lyrica, also known as Pregabalin can be used at bedtime carefully at low doses Trazodone can actually help sleep with a bipolar type of phenomenon because triacetone at higher doses doses above one hundred fifty milligrams or two hundred milligrams at bedtime we'll give you an antidepressant effect and possibly even fire mania but low doses of Trazodone between 50 and 250 and 100 milligrams typically at bedtime will specifically block the serotonin 2A receptors and in doing so give somebody a better quality of sleep overall.

So we'll use low doses of that for helping somebody to sleep.

But if somebody has bipolar symptoms where they have these big highs and big lows, we certainly want them to get a good night's sleep night by night by night and that good night's sleep can be achieved.

No one with a mood stabilizer itself or with a secondary medication as an as needed medication and try to help them sleep overall it's thought that bipolar mania with the exacerbation will often be precipitated by lacking dream sleep and deep sleep.

Deep sleep is very important to help you physically feel more refreshed and fired up.

Dream sleep is more important for memory and concentration the ability to think the next day and if you lose deep sleep and dream sleep you'll have a lot of trouble with being able to rationally think the next day and that's where people get into trouble with having more manic behavior.

So we want to get people sleeping well when they have bipolar symptoms overall.

>> Peter, thanks for your call.

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 WFA a morgue.

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

I'll be back again next week.

Thanks for watching.

>> Goodnight