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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 are 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 in the Fort Wayne area by dialing (969) 27 two zero and four 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 and answer on the air, you may write me a via the Internet at matters of the mind at Edgard that's matters of the mind all one word at the morgue.

>> I'll start tonight's program with a question I recently received.

It reads Dear Dr. Fauver, I am having both knees replaced in the next few weeks I find that I'm both anxious and depressed about the surgery.

>> I've been told to expect some pain during the recovery and I'm also feeling just plain old old that I have to have this surgery.

>> Any advice for me?

Yeah, we have to accept that our bodies naturally will kind of degenerate over the course of time.

>> The advantage of getting older is we have experience and wisdom and we want to use that to our advantage.

>> But yeah, the bodies are just kind of made to wear out and that wonderful aspect of of a knee replacement is it can replace a worn out joint to give you a better quality of life.

>> So I would suggest to you that you in the course of preparing for knee surgery No one try to lose a few pounds because it will make it easier in the recovery process.

>> But I would strongly suggest doing the exercises that they recommend because they will recommend that you strengthen your legs with some exercises and if you could look online and do a little bit of yoga now I'm not talking about doing chance and all that.

>> I'm just talking about simple yoga moves to be able to increase your flexibility but especially your balance as you are recovering from the knee surgery itself with a knee surgery they'll have you get on an exercise bicycle, they'll have you get an elliptical machine, things like that.

>> Start doing those now and try to be prepared as you can going into the surgery itself.

>> It is a surgery that can give you some pain for a little while but that short term pain can give you some long term benefits.

So the main thing is, you know, if you're having difficulty with sleeping and you're having pain from the knees keeping you awake even before the surgery which will often happen, talk to your primary care clinician or even your orthopedic surgeon about giving you some medication to give you some relief for the pain from the arthritis itself prior to the surgery.

>> But keep focusing on the long term benefits.

Talk to other people perhaps who have had these surgeries and how it's literally changed their lives because many people were incapacitated back in the old days.

>> We just would sit around and use canes and we'd be incapacitated.

Nowadays people following these surgeries have significantly better quality of life because they can get around and do more things and as we're doing more things often they can even better manage their weight and they just will be able to enjoy life because of their increased ability to ambulate.

>> So talk to some other people about it.

>> Make sure that you're getting into a good mindset prior to the surgery itself.

And again, remember the long term benefits from that.

>> Thanks for your email.

Let's go to our first caller.

Hello Mike.

Welcome to Mars The Mind Mike.

>> You all know how do you know if depression is caused by inflammation?

Depression can sometimes be related to inflammation because when you get depressed, when you get really stressed out for a long period of time, the lining around the brain itself it's called the brain the blood brain barrier, the lining kind of opens up a little bit and lets things in that really shouldn't be let in including inflammatory proteins.

>> But on the outside of the brain there's these little cells called macrophages and they are activated during inflammation.

>> Well, they don't get into the brain themselves but upon proper signaling the inside part of the brain has cells called microglia.

The microglia are the inflammatory cells inside the brain when people have ongoing stress that they're not managing they have increased depression overall the microglia can get more activated and the brain littler literally becomes inflamed.

>> There's a substance called s 100 that is a protein that goes sky high in instances like mania and depression.

So you can have these inflammatory proteins in the brain itself.

When the brain gets inflamed certain things will happen.

The front part of the brain right up front here, a brooding area that becomes overactive and the thinking part of the brain and the judgment part of the brain on the left side the front becomes underactive and what you'll notice if you have symptoms of inflammation of the brain you'll not only have sadness a natural sadness day by day by day but you'll also have difficulty with having trouble moving around.

>> We call it psychomotor retardation where you just feel like you're kind waxy and you just don't move around so well so you're kind of slowing your movements.

People with inflammatory symptoms will have difficulty with concentration where it'll feel like your brain is kind of sluggish.

Back in the old days when we had a modem for Internet, you know, it'd take all day for the modem to get rolling to be able to go page to page.

That's how your brain feels your speed of processing will decrease.

>> So you'll have difficulty not only the sadness slowness in moving around, you'll have trouble.

Poor concentration, fatigue and low energy is a common common symptom of inflammation related the brain and finally a difficulty with with sleep will be a common symptom of inflammation.

So you'll hear about these different symptoms of inflammation all often accompanied by difficulty enjoying things.

So if you're having trouble with low energy you're having trouble with fatigue or having trouble moving around, you can't concentrate.

Bottom line is you can have difficulty with just enjoying things and when people give up enjoyable and pleasurable activities they often get more or more depressed.

>> So it's a vicious cycle.

You start to withdraw from people, you tend to not do the things that used to be fun and then you get more depressed and then you become more reclusive at that time it's all related inflammation itself.

>> Do we check for inflammatory proteins just yet now not necessarily with inflammatory proteins we can check a CPK which is often checked with people who have muscle disturbances and breakdowns with that you can look at C reactive protein a CERP which looks at inflammation specifically but as CERP if it's over one and a half it can be suggested there's more inflammation there than you might expect if it's over three on the level on the C reactive protein that's more indicative of inflammation itself.

But we're not at a point now where we're actually doing blood tests looking for inflammation because by the time the inflammatory proteins get from the brain to the rest of the body there can be some breakdown.

>> So they might not be quite accurate but the day might come where we look at specific inflammatory proteins in the body itself in the bloodstream that might help us predict who might respond better to a specific inflammatory treatment.

>> Thanks for your question.

Let's go to next caller.

Hello Jay .

Welcome to Matters of Mind.

>> Yes.

Second time caller your thoughts of using or even substituting caffeine as an anti depressant mood stabilizer or even anti anxiety medication?

>> Interesting question there, Jay .

Caffeine if you sip it slowly all day long is the caffeine level can stay in your system at a decent amount of caffeine basically has more of an awakening effect but it does have a secondary effect on dopamine.

So let's look at the awakening effect.

>> There's a little chemical in our brain called adenosine.

Adenosine will go up the up and up and up and the blood level in the body as we get more tired that's just basically called homeostasis whereas the day goes on we should get more tired.

That's from adenosine so so adenosine goes up and up and up you can naturally feel more tired, more dull.

What does caffeine do?

Caffeine will go to those little adenosine receptors, knock them off and make the brain perceive that the adenosine is not there.

So basically if you think about the little receptors for adenosine as being a bunch of bar stools and you've got three bar stools for instance and they're all they all have adenosine sitting on them that makes you really tired and you have trouble with thinking put caffeine in the mix, caffeine comes in and knocks the adenosine off the bar stools and caffeine sits there instead so the brain is more awake, you're more alert and secondarily you can have better concentration.

>> Why is it secondarily because with increases adenosine you can decrease dopamine decreases in dopamine will give you difficulty with concentration so indirectly adenosine will cause decreased dopamine release and cause you to have trouble with concentration.

>> That's why small amounts of caffeine throughout the day can give you help with keeping the adenosine at a lower amount off those receptors and thereby helping with concentration so some people will self medicate their attention deficit disorder.

>> For instance with caffeine they've got to do it right.

>> You've got to do it right in a right manner though if you use small amounts of caffeine not so much with tablets, with the tablets they're too easy to take when people take a tablets two hundred milligrams they give this two hundred milligrams shot and caffeine gets metabolized so quickly that you just have to have low doses throughout the day.

So if you're going to use caffeine you want to maybe have a 200 milligram cup of coffee which is what some people will use a large cup of coffee and sip on it over the course of a couple hours you think well maybe it will get cold during that time.

>> That's OK. Go heated up if you need to but don't drink the whole cup within fifteen minutes as many people do because the caffeine gets in your system you get a very high blood level during that time you feel jittery and anxious heart starts racing.

>> You might get a little upset stomach if you're noticing any of those kind of effects you're getting too much caffeine at one time so you want to slowly keep the caffeine in your system, maybe have that cup last year for a couple hours to be able to kind of sip on it over the course of time.

>> Would it be effective?

Well, people ask me how did people treat depression and poor concentration one hundred years ago they use caffeine so they use caffeine.

>> They used nicotine obviously that's why nicotine was so popular.

>> That's nicotine in the form of tobacco is really a market that got our country started back in the sixteen hundreds and seventeen hundred.

So tobacco has been used for centuries as a means of helping with concentration and helping with energy in a similar manner.

The problem with tobacco smoke is the aromatic polycyclic hydroxy carbons which is in the smoke itself can be very dangerous and cause the carcinogenic effects for a lot of people.

So tobacco has nicotine in it that also works on dopamine in a different way than caffeine does caffeine.

>> If you consume three or four cups coffee for instance total for the whole day that's thought to be fairly safe.

As a matter of fact it might be advantageous just in decreasing the likelihood of Parkinson's disease, possibly Alzheimer's disease and then decreasing likelihood of diabetes.

>> But again we're talking about three or four cups a day reasonable cups.

We're not talking about pots necessarily.

>> You know you're drinking too much coffee in the form of caffeine where if you feel shaky, if you feel nervous, if you have a fast heartbeat, if you get headaches especially not only while you're using it but while you're going off of it if you have caffeine withdrawal probably means you're getting a bit too much caffeine during that time with the energy drinks.

Take a look at how much caffeine is in there.

>> If you're seeing over two hundred milligrams of caffeine in any energy drink, be very, very careful because that's again a situation where you can't knock that energy drink down in fifteen minutes.

You've got to let it last over the course of two, three or four hours especially if it has a lot of caffeine is so caffeine is very, very useful.

>> It's just that it needs to be used in a very small amount over a long course of time allowing one cup of coffee last year for a couple hours and that can be somewhat helpful for concentration and focus.

>> Now caffeine can sometimes be affected by other medications.

>> For instance, there's an old medication called the Offline that can have a drug interaction with caffeine but be aware of what other medications you might be taking sometimes caffeine will have interactions with them so overall caffeine can be pretty safely used as long as you limit it to the equivalent of three or four cups of coffee a day J j.

Thanks for your call.

Let's go to our next caller.

Hello Margaret.

Welcome to Matters of Mind.

Margaret, you want to know about massage therapy?

Does it work on partial leg amputation?

>> I might defer that particular response to an orthopedic clinician or maybe a pain management clinician.

Margaret, I want to stay in my lane as a psychiatrist using a massage therapy on a partial leg amputation.

You're probably doing some stimulation there of some nerves.

You're getting some muscle relaxation for massage with that particular intervention as a psychiatrist when I hear about a partial leg amputation, I'm all I'm often hearing about ghost pain or phantom pain where you'll have pain going down the leg even though the the distal part of the remaining part of the leg is not there and when that happens people have nerve pain and they'll have burning and tingling sensation.

And as a psychiatrist we might give those people and antiepileptic medication like gabapentin or pregabalin once in a while we might give carbamazepine for the purpose of relieving phantom pain in those cases.

>> But massage therapy I leave that to the orthopedic clinicians in the pain clinicians.

>> Margaret, Margaret, thanks for your call.

Let's go our next e-mail question our next email question reads Dear Doctor Father, why do people keep using nicotine when they know it's bad for them?

>> Well, nicotine is addictive now.

Caffeine has some amount of addictive qualities to it.

That's why I said be careful if you notice a lot of withdrawal from caffeine where you feel extremely tired, you actually get headaches if you don't have caffeine available because that's how you know you're getting in trouble with a nicotine more so nicotine goes to this particular part of the brain called the nucleus accumbens right in the middle of the part of the brain and on the outside of the brain it goes to the outside there and stimulates the office of a nicotinic receptors and in doing so it can help with concentration, motivation, energy and it actually gives people a bit of a muscle relaxation effect when they use nicotine.

>> Those all sound like great things, right?

Well, the problem nicotine going by going to the nucleus accumbens will stimulate dopamine release and when you stimulate dopamine release unnaturally you can feel really good and you can feel really happy and really motivated to really energetic that the problem is to get that same chemical effect you have to keep using more and more and more of it.

>> The problem with nicotine is now when people will have their first cigaret for instance with a candy and they often feel nauseated because nicotine by increasing dopamine abruptly makes you feel nauseated, makes you feel sick to your stomach and you might even vomit so you don't hear you hear occasionally about people when they have their first nicotine cigaret actually vomiting at that time because they got the surge of dopamine.

>> It was very abrupt but then they keep smoking cigarets over the course of time and they no longer have the nauseating effect.

>> That's because their brain and their body for that matter will be acclimating or getting used to the effect of nicotine.

>> So the reason nicotine is addictive is because it's stimulating dopamine and it keeps going higher and higher in the system.

Well, why do people keep using nicotine if they know it's bad for them?

>> It's hard to get off of it.

That's the whole concept of addiction where you do something even though you know it's bad for you and you might even hide it from other people.

>> So the phenomena of addiction is where you do something even though you know it's not good for you.

>> You try to stop it and you know it's something that other people are opposed to you're using so you try to hide it from them and then when you try to go off of it you have withdrawal and in the case of nicotine withdrawal, people can have difficulty with feeling extremely agitated.

They have trouble with sleeping.

They'll often have nightmares.

There's a medication called Vranica and also known as Chantix.

Chantix came out fifteen years ago a long time ago and Chantix is a medication.

It's still available.

It will help people get off cigarets but Chantix got a bad rap when it first came out because when it was used in the same clinical trials with sugar pill Chantix and sugar pill were found to be related to nightmares and retrospectively was perceived that those nightmares were probably related to nicotine withdrawal.

But Chantix got the blame early on that warning got on the Chantix labeling.

So a lot of people were under the understanding that Chantix was causing the nightmares were retrospectively it was probably the nicotine withdrawal that was more responsible for .

>> However, some people do get nightmares with nicotine withdrawal.

Could it be related to Chantix or not?

>> Chantix is partially blocking that dopamine receptor giving you a little bit of the effect of of getting getting a little bit of a stimulation as well as a blockade of the nicotine receptor.

>> So it's giving a little bit of a dopamine release so it Chantix will give you a little bit of dopamine release about thirty five percent of the dopamine release that regular nicotine would.

>> So it's giving you a little bit of a good effect but blocks the effect of nicotine itself on that receptor.

So if you do smoke cigarets while using Chantix you won't notice as much.

We often use other medications with Chantix when people are trying to get off of nicotine for instance, we use Chantix with a medication like Dock's Happen.

Why docs have Dr. Ben is a really good medication.

A blocked nightmares and doc spin can also decrease nausea and that can all be related to nicotine withdrawal.

>> Wellbutrin Bupropion is an antidepressant medication that will increase dopamine and norepinephrine in a different way than nicotine.

>> So if you use Chantix with Wellbutrin or be appropriate you'll have twice the likelihood of getting off the cigarets that way so we can be very creative in helping people get off of nicotine from a pharmacological standpoint.

But there's so many other social factors involved if you're wanting to stop cigarets and get off nicotine number one, everybody in the household needs to be supportive of it and everybody else in the household needs to do it too.

>> They need to quit smoking as well if they're if they're smoking.

Secondly, if you're using nicotine you need to have something going on with your hands, have something in your hands because nicotine is very much of a habit where people are used to having the cigaret or the nicotine device in their hands and there's an association with having something in your hands to your brain saying that's a good thing to be doing and it's a habit and the habits of having a cigaret after eating or after particular activities will often be something that people are accustomed to doing create another habit and do something more healthy.

Some people will have a haversack or available.

They'll have something else available to have something in their hands and have that association between their hands on their mouth and get them away from the nicotine device or the cigaret itself.

Now there are patches out there.

Nicotine patches do exist and the idea of the patches will be to use a lesser and lesser amount of nicotine to give withdrawal.

>> So compared to 30 years ago there's so many different ways to help people get off of nicotine that's been that have very well studied.

>> Thanks for your call.

Let's go to our next caller.

Hello Lexie.

Welcome to as a matter of the Mind.

Let's you want to know about the difference between sleep apnea and oh I'm sorry you're thinking about central apnea and obstructive sleep apnea.

>> So there's central apnea where your brain throughout the night if you just quit breathing so you quit breathing for no particular reason obstructive sleep apnea is where you're snoring or you're pausing in your breathing and then don't take a gasp an air you could pick up the difference between central sleep apnea and obstructive sleep apnea with a sleep medicine study you call the police on the ground so you'd wear this device overnight to see how your breathing is doing and see what your oxygen levels are doing.

So if your oxygen levels are going down, it could be because your brain there's a breathing center of the brain in my brain all apart here the middle part of the brain down here, the stem the brain is the front part of the brain.

This is the stem of the brain.

There's a breathing drive center there in let's call the reticular formation that keeps you breathing and allows you to breathe on a regular basis throughout the night if there is a disturbance in that particular part of the brain that is called central sleep apnea and we have to be very careful of what medication we give somebody with central sleep apnea because we don't want that to be even further disturbed.

Obstructive sleep apnea like the name implies is where your snoring, your tracheas collapsing down a little bit and that's where people will often gasp for air and that will wake them.

People with obstructive sleep apnea will have oxygen levels drop down periodically and with any kind of apnea you can have trouble with higher risk for heart attack, stroke, diabetes, all sorts of these metabolic and cardiovascular conditions because if your brain is not getting inadequately throughout those seven or eight hours where you ought to be sleeping, it's going to cause a stress on the body and with a stress on the body cortisol levels go up cortisol the stress hormone with increase in cortisol levels you can have more belly fat deposited.

You can have more fat on your neck deposited more fat in the neck deposit gives you more of a likelihood for sleep apnea and that thereby will exacerbate the whole problem and it's in a vicious cycle in that regard.

So the whole idea with sleep apnea is to get it treated, identify if it's there, if it is get the treatment of it addressed, allow yourself to have normal oxygen throughout the brain.

>> I deal with this as a psychiatrist because many people who I see will have trouble with fatigue, poor concentration, depression.

>> They'll have trouble with energy and get up and go.

>> So these are symptoms of depression.

So I get that.

But they're also symptoms of sleep apnea and we have to sort those kind of conditions out before we do a sleep study test.

We also will ask we'll also check a thyroid test so we want to make sure the thyroid tests are normal prior to doing a sleep study because low thyroid will also give you those kind of symptoms.

>> Lexie, thanks for your call.

Let's go our next hello Tim.

>> Welcome to Matters of Mind.

Tim, you want to know about the nocebo effect versus the placebo effect?

>> Basically a placebo effect is where you will have an effect from any kind of medication over the course of typically six or eight weeks.

>> So you'll get a placebo effect.

It's basically we're getting a sugar pill where over the course of six or eight weeks you're getting a pretty good effect from the medication as you follow the treatment for these particular people over the course of two, three and four months you'll often find that kind of placebo effect is not sustained so you'll they'll notice that they don't have that ongoing sustained effect overall.

So if you take a sugar pill and somebody tells you this is a medication, it's going to do a great job for you.

>> You might feel good for a while and it might be decently effective in short term studies .

That's why a lot of medication studies are extended over the course of six or eight weeks because the placebo effect often will be mitigated as time goes on.

>> Tim, thanks for your call.

Let's see if we have any time for one more question and we have another question by email there.

>> Let's say there we go.

Dear Doctor Fauver, when are the psychodelic treatments going to be available?

Psychodelic treatments are medications like psilocybin.

They've been studied over the past year or so and with psychedelic treatments you are under the influence of a mind altering medication in a very highly supervised environment.

And during that time as you're having flashbacks especially for the treatment of post-traumatic stress disorder and you're going through a lot of these different experiences that are kind of out of the body experience you were sitting beside a therapist literally for hours so a therapist sitting with you for hours as you go through these experiences typically it's about a two time treatment so you might have a four or five hour treatment twice and that will be it.

>> And the whole idea in using the psilocybin and the psychedelic treatment will be maybe two treatments in relieving and even curing post-traumatic stress disorder.

>> There's a lot of excitement behind it.

When will it be available?

I'm hearing as soon as the first part of two thousand twenty four maybe the latter part of twenty twenty four so it could be available within the next year and a half.

So we're excited about that potential.

It'll be highly regulated.

>> Obviously you're not going to be going home and doing this.

It'll be in an office setting with a therapist at your side the whole time.

Thanks for your email.

Unfortunately I'm out of time for this evening.

The only questions concerning mental health issues you may write me via the Internet at matters of the mind all one word at Big.

>> I'm psychiatrist Jeff Oliver and you've been watching Matters of the Mind on PBS Fort Wayne God willing and PBS PBS well I'll be back again next week.

>> Have good evening.

Good night