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>> Good evening.

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

Welcome to Matters of the Mind now going on its twenty sixth year matters of 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 had (969) 27 two zero.

And if you're calling long distance coast to coast you may dial 866- (969) to seven to zero now and a fairly regular basis.

I'm broadcasting live every Monday night from our spectacular PBS Fort Wayne studios which lie in the shadows of the Purdue Fort Wayne campus.

And if you'd like to contact me with an email question that I can answer on the air, you may write me a via the Internet at matters of the mind all one word at WFA drug that's matters of the mind at WFYI Dog and I'll start tonight's program with an email I recently received.

>> It reads Dear Mother Father does mental illness show up during adolescence and are there differences between males and females?

>> That's a very good question.

>> You can often hear that the personality is formed as early as eight years of age and there's a lot of trauma that can occur in young childhood with parental abandonment, sexual physical emotional abuse.

All these things can happen in childhood and it can significantly impact you later on in life .

>> So as you go through childhood and early adolescence, you bet environmental health issues can can start to evolve and there's a questionnaire that we use called the Adverse Childhood Experience Scale the ACS scale that asked him questions concerning childhood trauma and it can be really pretty predictive on what kind of symptoms you can have later on in life but also very importantly what kind of medications might work or not work, especially if you have depression based on how many those early childhood traumas you have.

So you often will hear about the early childhood traumas kind of forming the personality.

I saw somebody earlier today as a patient.

>> She's in her 50s and she's still traumatized by the four years of bullying that she went through in high school.

>> So it can affect you in a lot of ways early on because you have to remember that the brain does not fully develop until you're twenty four twenty five years of age and the last part of the brain to develop is the front part of the brain.

That's the reasoning part of the brain.

That's the thinking part of the brain.

That's the judgment part the brain and if that brain part of the brain is not fully developed and you're going through all these different traumas, your emotional volume control can kind of take over that's down here in this area called the amygdala when the emotional volume control takes over, it hijacks the thinking part of the brain and you can thereby have difficulty with networking appropriate responses to different circumstances.

So you might have more difficulty with depression, you could have more trouble with anxiety.

Women are twice as likely to struggle with depression and anxiety because presumably because of the estrogen and progestin that can cause them to have disturbance is with serotonin and various neurotransmitters in the brain.

>> Women also are more likely to be more socially and interpersonally connected because they have 20 percent more norepinephrine fibers than men now norepinephrine and keeps us aware and alert of various things happening around us.

So if you have 20 percent more norepinephrine fibers as a woman you're going to be more in tune to what's happening around you and that's why you'll often hear from women that they have very close interpersonal relationships whereas men and women might have a friend here.

They're a bit many times men will be very, very close to their dog.

So with men it's not so important that they have these interpersonal relationships because it's difficult for them to have that kind of attachment because neurobiological there they're wired differently.

>> Thanks for your call.

Let's go to our first first caller.

Hello, Ray.

Welcome to Matters of Mind.

>> Ray, you want to know why do people dream and is there a way to stop Ray you do not want to stop dreaming.

>> Dreaming is a good thing.

Dreaming is good unless you have nightmares which is a whole nother matter.

>> But dreaming basically occurs at nighttime where you're going into rapid eye movement sleep rapid eye movement sleep starts at about an hour and a half after you go to sleep unless you're really tired and you're taking a quick power nap you might go into a dream sleep very quickly.

So with dreaming this left front part of the brain is called the dorsolateral prefrontal cortex dorsal meaning it's on top lateral to the outside dorsolateral prefrontal cortex is the part of the brain that you use to pay attention and to think really intensely especially about something that's not so interesting.

So as you listen to me, Ray, you'll be thinking and trying to concentrate you you'll try to maintain your concentration but you're going to be using this part of your brain here when you dream this part of the brain shuts down, it shuts down and it shuts down where you have a dramatic decrease in norepinephrine.

So norepinephrine I mentioned that earlier women have more of the social connections related to 20 percent more norepinephrine fibers.

So norepinephrine just shuts down and then you go into the dream sleep.

It's called rapid eye movement sleep because your eyes will get kind of fluttery underneath underneath the eyelids as you're sleeping and you'll also go into full body paralysis.

That's why when some people awaken during dream sleep it's kind of frightening because they can't move not for maybe two or three seconds but it's kind of frightening when they wake up during dream sleep people sometimes confuse dreams, sleep with sleepwalking.

It's a whole different phenomenon.

Sleepwalking occurs during this really deep sleep where you're it's good to recharge the body and allow the body to be rested and dream and deep sleep or slow wave sleep occurs within twenty or thirty minutes after you go to sleep the first sleep that you usually will encounter of the first type of sleep.

>> That's a whole different phenomenon that will occur when you're sleepwalking or you're having night terrors upon awakening in the middle of the night and screaming those aren't nightmares night terrors so it's a different type of phenomenon.

We treat them differently as well.

Ray, you'd mentioned how can you stop dreaming?

Well, as I mentioned, don't want to stop dreaming entirely because if you dream it fires up this part of the brain on the side here called the hippocampus.

>> That's the library of the brain that your memory center of the brain dreaming is good for the brain.

And I'm always emphasizing that to people because as people get older and they start to go into the early symptoms of Alzheimer's dementia, one of the things they'll notices they're not dreaming so much anymore.

That's not good.

If you quit dreaming entirely you can have difficulty with memory and processing information the next day.

Now you might be dreaming.

You just don't remember it.

So if you're awaken during a time when you've been dreaming you'll remember it first thing in the morning upon awakening you might remember some of your dreams but you might be dreaming even though you don't realize it.

But if you're having nightmares where you're having difficulty with having these terrible dreams throughout the night, there are medications that we give people to suppress dreams sleep for instance I mentioned before that norepinephrine will decrease dramatically when you're dreaming.

>> Well if he increased norepinephrine with medications like noradrenalin or increase the norepinephrine transmission with something that stimulates a little lower Bonifant receptors like Want Forseen which is an alpha to stimulant agonist medication you can actually suppress dream sleeps and we sometimes do that Ray when people are enduring post-traumatic stress disorder symptoms and they're having nightmares and they're frequently awakening because they're having abstract representations during the dreams of what happened in their past events.

So for those people we might give them Guarch to see what I give tripling something to suppress the dream sleep specifically so their dreams are so intense now it's an interesting phenomenon, Ray.

I mentioned earlier that this front part of the brain shuts down dramatically when people are dreaming there are conditions like schizophrenia or psychotic disturbances where people lose touch with reality.

What happens to those people is this left front part of a brain dramatically shuts down not just at nighttime when they're trying to sleep but also during the day.

So if you can imagine having a psychotic type of disturbance where you're out of touch with reality and you look around the world in such a way that it's like you're having a walking nightmare so you're having this walking nightmare throughout the day because your left front of your brain isn't working so well.

So when somebody's psychotic they're walking around having a nightmare.

You might remember if you've had a nightmare and in the past that it's a very frightening experience.

Imagine having that frightening experience of a nightmare while you're wide awake during the daytime.

That's what it's like to have psychosis and that's the neurobiological basis of of psychosis.

The reasoning part of thinking part of your brain up here is not working.

That's dramatically shut down.

Ray, thanks for your call.

Let's go our next hello Joanie.

>> Welcome to Matters of Mind.

Do anyone know if the electrical charge in the air during a thunderstorm can cause mania?

I haven't heard of that so much, Jony.

I'll tell you what does cause mania.

Mania is a component of bipolar disorder where people will have highs and during their highs yeah, they might feel real good but sometimes they get really irritable and mean during those highs.

They might have several days where they don't need to sleep and they'll talk really fast going from one topic to another to another and they will talk to everybody and anybody so during a manic episode you might spend more you might do things with less discretion and you'll say things and do things that you later regret.

That's a manic episode and it occurs episodically just periodically there are triggers for one of the biggest triggers for for mania can often be getting less sleep and that's why it's so important that people with bipolar disorder Jonie get enough sleep overall .

So you know, you might wonder what caused the manic episodes sometimes as less sleep a stress that keeps you awake.

In other words, if you start thinking about different things that can be a factor.

But I've not heard of any incidences where an electrical charge in the air during a thunderstorm itself induces mania.

Who knows?

Jonie, I might be telling you something entirely differently ten years from now if that's determined it's very difficult to study that kind of phenomenon obviously because how do you get a controlled environment where you can create an electrical charge for people and potentially induce or not induce mania?

So it'd be a difficult study to do.

We're looking for other more approachable factors to prevent mania like helping people sleep and help them to deal with the day to day type of stresses that might induce the mania itself.

>> Jody, thanks for your call.

Let's go next caller.

Hello, Doug.

Welcome, Massasoit.

Doug, you unknown is it normal to stress too much about your health or financial well-being ?

>> What's too much?

It's called Generalized Anxiety Disorder where you are overly worried and overly ruminative about stuff happening in your life and you're worried about the future.

>> You're worried about the what if what if what if and I believe it was Mark Twain who said he's had a great many troubles in his life and 90 percent of never happened.

So if you think about worry and ruminating about things that might happen in the future, this front part of the brain right above the eyeball it's called the orbital lateral prefrontal cortex orbital because it's above the eye orbit and lateral because it's a little bit on the outside here.

>> This is the part of the brain that you use to try to when you ruminate about different things and it becomes excessive, really active when you're ruminating and it's somewhat the decision making part of the brain.

So if you imagine part of the brain as being like the ruminative executive, this is the part of the brain where it's like a boss just can't make a decision and if he gets fired up too much that's a problem.

Now there are some conditions for instance oh with some types of depression that will actually become underactive and you can't make a decision about anything but with anxiety conditions I mentioned earlier bipolar mania you'll have a disruption of the orbital lateral prefrontal cortex.

It'll cause you to ruminate excessively.

Doug, the first thing I'd recommend for somebody who's stressing out too much about their health or financial well-being is to keep a diary, keep a diary, just write a few lines in it day by day if need be or even week by week and just talking a diary how things are going for you, what kinds of things are concerning you identify in your diary what you can do about different things and what you can't and then look back on that diary three months, six months even one year later and you'll come to realize that many, many of the things that you worried about either work themselves out or turn out to not be that big of a deal if you did encounter some of the things that made your worries valid, you coped and you managed with them.

But it's all part of experience as we get older, Doug, many people will tend to worry less because of experience and wisdom.

You've lived all these different things and you've learned coping strategies.

>> Adolescents and young adults often worry quite in many cases quite excessively and what they'll do in their adolescent years and early 20s perhaps is they'll use marijuana because they don't want to feel the anxiety that comes along with considering future challenges.

>> And if you use marijuana as a young adult it can suppress the brain growth and thereby cause you to have further difficulty with intellectual functioning and being able to process information.

And it's not uncommon if you hear about somebody who's used marijuana as a means of managing their worries when they were 13 or 14 and now they're thirty three or thirty four twenty years later they often have the emotional maturity and the coping abilities of a thirteen or fourteen year old because if you use marijuana for twenty years and you started in adolescence it will often delay your ability to progress.

It's normal to have worries Doug.

It's normal to wonder about the future.

But when you are consumed with it, especially things in which you have no control, that's where it becomes a problem.

What often happens the progression will be you'll have trouble with anxiety and worry and that will keep you up at night and when it keeps you up at night as I mentioned, little anxiety volume control here gets fired up when that part of the brain gets fired up.

You can't get to sleep at night so the sleeping part of the brain can be impacted by the prefrontal cortex that allows you to dream if you don't dream or more likely to have trouble with concentration the next day and it cascades where you start to look at the world around you a bit differently and in doing so you might notice that you get more depressed.

You don't enjoy things so much you have more hopelessness, less motivations of the cascade that we often will hear.

Doug will be this cascade of worry and rumination leading to lack of sleep and that thereby leads to depression.

>> Clinically significant depression is where you are depressed and you don't enjoy things for at least two weeks or so and it causes you to have impairment being able to socialize, go to work, go to school.

You have impairment with your functional capacities and that's a clinically significant depression where you have depression and difficulty enjoying things along with several other symptoms.

So this cascade of anxiety leading to insomnia leading to depression is very common and that's why in psychiatry insomnia is so impactful that it's something that we consider a psychiatric vital sign.

We ask well everybody we see how they're sleeping and you do that either directly or you can do that through a questionnaire.

There's a questionnaire a question questionnaire called Insomnia Severity Index basically ask the details of how you're sleeping.

Are you getting to sleep?

Are you staying asleep?

Do you do you feel refreshed upon getting up to other people?

Notice that you seem to have lost sleep.

Various questions will be in the insomnia severity index and we use that for a lot of a lot of patients prior to their coming into the office and they complete the questionnaires and that way we know when they come in how their how their sleep has been doing.

It's very, very important for us as mental health clinicians to check out on the sleep I mentioned earlier the the likelihood of lack of sleep provoking mania the same way rumination lack of sleep can actually make a person more depressed over the course of time.

So how much is stressing out?

How much is worrying too much about your health or financial well-being?

Well, how much is worrying too much about where it keeps you up at night?

That's where it often starts and if it keeps you up at night and you become consumed with it and it causes you to have difficulty with functioning day to day with getting your work done, being able to socialize it might even affect you physically.

Many people who have chronic worry will have trouble with their stomach.

They'll have backaches or go to the physicians and the nurse practitioners much more frequently because they are physically ill and in such a way chronic worry and anxiety in such a way can make you physically sick.

>> So this is why we're looking at the mind body connection of how the brain can affect the rest of the body with so many different illnesses and a lot of it is from worry.

>> Doug Doug, thanks for your call.

>> Let's go to our next email.

Our next email reads Dear Dr. Fauver is the brain capable of growing even as we age the brain itself doesn't grow with the brain growth you're going to get is around twenty four twenty five years of age so the actual neurons themselves will grow to a certain point when you're twenty four twenty five years of age what will happen over the course of time the branching on the individual neurons can increase or decrease now branching of neurons is very important because there's one hundred billion individual neurons so that's where we're going to start one hundred billion individual neurons and these individual neurons have anywhere between forty thousand and one hundred thousand connections apiece.

So it's a very extensive elaborate web that we have in our brains now the individual neurons, the one hundred billion euros each one of those has six to ten pit crew members around them and those pit crew members are called glial cells.

>> They nourish the brain.

They will nourish the individual neurons.

They will clear away excessive junk and the glial cells which are like the pit crew around the neuron.

If you watch the Indy 500 this year, you notice they have six pit crew around their individual cars and they can change for car tires and fill you up with 18 and a half gallons fuel within about five to seven seconds based on what I remember so you've got this really efficient pit crew around the Indy cars in the Indy five hundred one the same thing happens in the brain.

The neurons have a very efficient glial cells system around them that are allowing them to function.

These glial cells will deliver blood as necessary with oxygen glucose and they will clear away junk and just thinking about the junk with Alzheimer dementia for instance, it's thought that the glial cells quit acting as the garbage collectors and the junk accumulates in a junk and can include amyloid and tau protein the kind of clogs up a lot of the different synapses of the brain and that cause you to have memory troubles with depression.

>> The glial cells don't function so well so excessive glutamate gets up.

>> Glutamate is an excitatory chemical and it's opposed by GABA which is inhibitory chemicals.

You got glutamate and GABA glutamate acting like the accelerator gabb acting like the brake and they have to be invalid's serotonin norepinephrine dopamine gaba they all affect glutamate in its transmission but glutamate and gaba need to be in balance and they need to be adequate in terms of their levels when you're functioning on a day to day basis and it's thought that with excessive glutamate it actually burns the individual neurons themselves if you fertilize your lawn this spring and you put too much fertilizer in certain areas of your lawn, you'll notice that that part of the lawn burns.

That's what happens when you have excessive glutamate in your brain.

It can make those 100000 connections decrease down to sixty thousand connections or so and that's thought that the decreased connectivity in the brain is what causes depression.

And when you think about it that means you have difficulty with concentration, motivation and doing things.

It's because you have less branching of the individual neurons.

So if you think about your neurons as being looking like trees that have all these little branches on it, if you have decreased branching occurring the neurons can't communicate effectively and that's why it's not that you're losing neurons as you get older or when you have depression the neurons are still there.

It's just that you have less branching with less branching.

That's what's causing a lot of different psychiatric conditions.

So the focus in psychiatry now is looking at medications that can quickly and efficiently modulate glutamate and allow you to get the right glutamate balance a little bit of glutamates great.

And you want the right amount of glutamate.

>> You don't want too much now again glutamates opposed by Gabba Gabba is the breaks and when you exercise exercising intensely for about 30 minutes for 30 minutes after you exercise you'll get this peak level of glutamate and gaba that's why you feel energized after you exercise but you also feel calm and that will peak about 30 minutes after you exercise.

So exercise is a marvelous means of keeping the brain healthy.

>> People ask me all the time about different herbs or supplements or foods they should use for their brain.

There's nothing has been determined to be more effective in terms of helping with brain health than exercise and again exercises increasing the excitatory chemical and the inhibitory chemical.

So it's a nice balance and it does so at its peak about thirty minutes after you exercise.

So a lot of people will say that they they hate going into exercise but after they do it they feel really good and it's because from a neurotransmitter standpoint your brain loves the exercise itself.

>> Thanks for your call.

Let's go to our next caller.

Hello Mino.

Welcome to Matters of Mind meaning you want to know what causes depression, what causes depression, depression itself is about 30 percent genetic so it's not guaranteed that you're going to have depression if you have a family member or a mother, father, brother, sister with depression it's not guaranteed you'll have depression but about a 30 percent risk there know what contributes to the rest environmental stresses at a young age.

>> I mentioned earlier the adverse childhood experience scale the ACS scale, the adverse childhood experience scale is somewhat of a predictor on who might be at risk for depression or anxiety later on in life .

So we tend to watch that particular scale.

I watch it not only for young adults but also for older people just to see what they endured at an earlier age for older people especially an ace score above four out of ten total of ten items there but a score over four can predict that a serotonin reuptake inhibitor and SSRI like Zoloft, Prozac, Lexapro might not work for depression.

Don't know why but there's various theories on why that might happen.

But if you have a lot of childhood experiences a serotonin and the president might not work for you so with that in mind we do have genetic markers for depression.

They're not really precise but the nice thing about genetics that we use for depression it will be that it'll predict what type of medication we might be able to find to be more effective but also genetically if you're more prone to break down certain medications quicker or slower compared to others.

So it gives us a little bit of idea on what dosage we should use for a medication.

One of other factors can contribute to depression medical illness if you have sleep apnea, low thyroid, diabetes, low iron these are medical conditions that can contribute to depression symptoms themselves.

We always want to look for the medical underpinnings of depression.

A lot of thoughts over the course of time with the possibility of the gut bacteria and using probiotics as a means of treating depression.

It's valid.

It's just that there's a lot of controversy on which probiotic we use such that we're not going to use it for everybody in that way.

It helps for some people helps that doesn't help for others.

There's an inflammatory component to depression.

I mentioned earlier the glial cells that surround the little neurons and support the neurons but some of these glial cells can release inflammatory factors so some people when they get depressed they actually literally have an inflammation of the brain when your brain is inflamed you don't enjoy things.

You can't think you are much slower in your movements and you'll have trouble with motivation and you feel like you have the flu.

So if you think about the flu, it's an inflammatory kind of component.

Well, that's how depression can be too.

Only is their day by day by day.

There's a lot of different factors in terms of what causes depression meana I mentioned earlier the less fluffy branching of the individual neurons can be a factor and that's because with chronic depression you can have excessive levels of glutamate in the brain and that's becomes neurotoxic and makes the branching less so when we treat depression we want to make sure we do the best we can to try to bring back the fluffiness of the neurons and give people what we'd call Miracle-Gro for the neurons themselves and that's what our medications do.

Mina, thanks for your call.

Unfortunately I'm out of time for this evening.

If you have any questions about mental health issues that I can answer on the air you may write me via the Internet at matters of the mind at work.

I'm psychiatrist Jeff Offutt.

You've been watching Matters of the Mind on PBS for Wayne God William PBS willing I'll be back again next week.

>> Thanks for watching.

Goodnight