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>> Good evening live from Fort Wayne , Indiana.

Welcome to Matters of the Mind.

>> I'm psychiatrist Jeff Offer and I'll be with you for the next 30 minutes if you have any questions concerning mental health issues, give me a call in the Fort Wayne area by dialing (969) 27 two zero or if you're going anyplace else coast to coast you may dial a 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 I can answer on the air you may write me a via the Internet at matters of the mind all one word at MWF a dot org that's matters of the mind at WFYI Dog and I'll start tonight's program with a question I recently received.

>> It reads Dear Dear Dr. Faber can Fluoxetine cause someone to lose appetite?

>> I have a loved one who hasn't been eating like he used to presumably he's on Fluoxetine.

Fluoxetine is a medication that came out in 1987.

It was a serotonin medication thought to be fairly selective but it was selected for some receptors that led to decreased appetite.

>> So in nineteen eighty seven imagine prior to that time all the different antidepressant medications predominantly would increase the appetite.

They'd give you a dry mouth, they make you lightheaded.

They could cause to have difficulty with constipation a lot of side effects prior to nineteen eighty seven when Prozac came out so Prozac also known as Fluoxetine came out in nineteen eighty seven and did not cause those particular side effects and instead of causing weight gain it actually would cause some people to lose their appetites.

It also allowed a lot of people to feel more alert and awake and it was considered a revolutionary antidepressant in nineteen eighty seven because it was the first of the now seventeen newer oral antidepressants that had been able to come out.

>> All it did primarily was increase serotonin transmission but it did have a special serotonin receptor called serotonin receptor to see by affecting that receptor it decreased the appetite.

So yes Fluoxetine has been used therapeutically to decrease the appetites.

>> Matter of fact, it's FDA approved for binge eating disorder people who tend to eat excessively and also for bulimia for people who tend to binge in their eating so it can be used for eating disorders.

>> That is a side effect.

Sometimes when people use Fluoxetine they'll notice they have decreased appetite and for people who don't need decreased appetite that's considered to be an adverse event that we don't want to see.

>> Typically it's dose related to higher doses can give you ore of a decreased appetite and that's why people who take Fluoxetine specifically for weight loss will sometimes go up to 40 even 60 milligrams a day.

Now the downside is the weight loss is not typically sustained.

>> People will lose weight for a while and over the course of time they gradually will gain it back.

>> But it was something that at least didn't cause weight gain from the start.

>> A lot of the older antidepressant medications would cause weight gain and that was always always a limitation for them.

>> Thanks for your email.

Let's go to our first caller.

Hello James.

Welcome to Matters of Mind James.

>> You want to know what age schizophrenia present itself and what are the warning signs schizophrenia for men typically will have an average age of onset at sixteen years of age and for women at twenty four years of age it's thought that estrogen will protect women from developing schizophrenia knows a lot of neurodevelopmental things happening in the brain with schizophrenia.

But women if they have estrogen available they will tend to have a delay in some of the neurodegeneration that occurs with Fredi it's thought that the front part of the brain slowly kind of fades away.

>> It's kind of shrinks down in some areas and with the early symptoms of schizophrenia that will include social anxiety perceiving that other people kind of have it in for you individuals with early warning signs of schizophrenia and their adolescent years are called to have pre morbid symptoms.

>> Those pretty morbid symptoms can also include perceiving that you can hear noises kind of in the background you might not hear hallucinations where you have distinct voices just yet but you might hear things in the background.

People with pretty morbid symptoms of schizophrenia will have paralyzing anxiety and they'll often become more reclusive.

>> They'll have a significant deterioration in their academic work, their socialization and they tend to have difficulty relating to others many times in their adolescent years or hygiene will deteriorate more so than what you would expect as an adolescent and they have a difficult time processing information.

>> Those are the early symptoms of schizophrenia.

When somebody has our first psychotic episode as we often discuss their first psychotic episode will be characterized by extreme paranoid thoughts and frequently people will hear voices talking to them that other people can't hear.

So these voices are called auditory destinations and the paranoid thinking will often be delusional in content where they have fixed false beliefs.

In other words, the thoughts that they're having are not true at all.

ZATZ and they're fixed because you cannot talk them out of the many times people when they develop schizophrenia will have a hard time processing information and they'll speak in such a way that it's very difficult to understand where they're going with their conversation and how many times will get agitated they won't sleep and at that point is quite apparent that they're very ill but prior to their developing those symptoms sometimes for years they'll have these pre morbid symptoms.

Now the good news is not everybody with pretty morbid symptoms will go on to having schizophrenia but pretty morbid symptoms can be somewhat predictive of schizophrenia, especially if you have a family history of schizophrenia.

>> It's thought to be about six or eight percent genetic if one of your parents house gets schizophrenia, if a and if identical twin of yours has schizophrenia means they have the exact same genetics, there's a 50/50 chance of having schizophrenia.

So it's thought that schizophrenia is about 50 percent genetic but the other 50 percent is environmental.

So what's the environmental mark?

What's the environmental aspect especially with the increased recreational use of marijuana, marijuana tends to increase the likelihood of schizophrenia by 200 times.

>> So if you have the genetics, if you have the premier of The Simpsons already and then you smoke marijuana, it's thought that's something in THC will tend to elicit the symptoms of psychosis very, very quickly now not for everybody.

>> You've got to have the foundational pre morbid symptoms that are kind of lingering there to actually trigger the marijuana with the use of a trigger schizophrenia with use of marijuana.

>> But the concern that a lot of us in the mental health field will express is that if you already have a lot of anxiety and somebody offers you marijuana, you are more prone at that point to develop a psychotic reaction the marijuana and why do people use marijuana many times because they want to treat their anxiety and they want to get feel calmer and for many people it will make them calmer.

>> But if you're prone to having psychosis it will elicit the symptoms of psychosis itself.

So it's one of the key indicators that are key precipitant is like lighting a match on gasoline if somebody predisposed to havingey are- psychosis, other factors can include head injuries in some cases more social isolation, having difficulty with communication skills.

All those type of things can increase a person's likelihood for developing psychosis.

>> But again average age for males sixteen years old, average age for females 24 years old.

>> Thanks for your call, James.

Let's go to next caller.

Hello Liam walking matters of mind, Liam, you mentioned that you just started using Zoloft that's also known as sertraline and you're having stomach issues.

Does this go away or should you contact your clinician clinician?

You should always contact your clinician if you're having any concerns at all.

>> But we're off the bat here sertraline Zoloft is a medication that does increase serotonin a little bit different way than Fluoxetine or Prozac does.

>> But Zoloft research really does increase serotonin 90 percent of your body serotonin is in your gut and when you increase serotonin in your gut you can sometimes have a burning sensation in your stomach.

You can have diarrhea.

You can have some some difficulty with nausea in some cases so you can have all these different gastrointestinal symptoms especially when you first start sertraline Zoloft.

Now that typically goes away over the course of time it goes away.

It's related the dosage if you start out with a lower dosage often that can cause you less of a gastrointestinal problem over the course of time so a lower dosage can be easier to take and also take it with food can often decrease the nausea.

>> So when somebody telling us that they're having nausea and gastrin has no problems with Zoloft will often say No one if you wait it out it can get better.

No to take it with food and number three, if we need to do so we can at least temporarily decrease the dosage.

>> Those are the three ways we can often get around the gastrointestinal problems that we see with Zoloft.

>> You're you're right.

I they do typically go away as time goes on.

>> It's rare that somebody will be on sertraline or Zoloft for several months and still have those gastrointestinal issues partly because nobody would take it that long if they're having gastrointestinal issues.

But the people who do have gastrointestinal issues will notice that those symptoms resolve usually over the course of a few weeks or a couple of months.

>> Thanks for your call.

Let's go our next caller.

Hello Olivia.

Welcome to Mars the mind.

>> Olivia knows that you find yourself zoning out in conflict situations.

>> Is that normal?

Yeah.

What's happening, Olivia, as that when you're zoning out your brain is having a hard time kicking in to thinking clearly and hears the side the middle part of the brain, the front part of the brain is up here back part of the brain is back there.

This is the middle part of the brain.

When you're zoning out you're using your so-called default network of the brain.

There's three networks of the brain.

There's a default network that's primarily down here below.

>> This is the part of your brain that you're using when you're zoning out.

You're not thinking about anything anything in particular .

You just kind of daydreaming.

You ruminate about things but you're not really putting your brain to work to really think about anything intensely when you're zoning out you get stuck in that default mode.

>> That's not always good because under stress you should kick in and go to a higher level of concentration.

That higher level of concentration is triggered by what's called the salian network.

So you've got the default network that's kind of making you just kind of think about things in the background.

You're daydreaming now thinking real real intensely on anything.

The Salyut network is the network that slaps on the face and says hey, you need to pay attention to this and that kicks you in to the executive network.

So the executive network is the network that works on the outside part of the brain.

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

It helps you pay attention, fous, decrease distractions.

That's the part the brain you need when you're in conflict situations.

But sometimes when you're having a difficult time getting back to that type of network of the brain it's because you're salian that work is not working so well.

>> We see this all the time with people who have depression, people who have been traumatized with post-traumatic stress disorder .

>> They get stuck in this default mode network where there are ruminative there are not able to enjoy things.

>> They're thinking more and more about themselves and all the things that they did in the past and all the regrets they have.

That's your default network work in there when you're just ruminating about the past and you're doing this autobio biographical perspective on yourself where you're just not thinking about the here and now depression severe anxiety will keep you in that default network and that Salyut network, the one that slaps you on the side of the head and says pay attention.

>> We need to focus on the matters at hand that's not working so well, so anymore we're not looking at depression anxiety as being simply mood disturbances.

>> We're looking at them as being disturbances in the brain where your networks are not functioning properly and there is actually ways to study those networks not with everyday patients necessarily but in research settings you can study those networks and that's how it has been determined that those networks are not functioning so well.

So the idea and treating people with depression is from a neurobiological standpoint with medications is a make that salian that work work better to be able to kick you in to the thinking network and of course the whole idea of psychotherapy or talk therapy is to help this thinking network kick in to help you understand what's going to be in your best interest on a day to day basis.

But to get to that thinking at work, that executive work network, you have to be able to get that ceiling work network kicking in and going to work.

So for many people I'll describe this as kind of the ceiling.

That work is kind of like a clutch if you remember the old automat, the old manual drives where you actually had to push the clutch and go from first gear to second gear, push the clutch and go from second gear to third gear.

People who have difficulty severe anxiety disturbances, depression they don't have that clutch.

They can't go from the from the default network to the executive network because their clutch isn't working so well.

>> So when we treat people for depression, anxiety, what we're trying to do is help that clutch work better so they can kick into that underlying default network to the thinking network which is called the executive network.

And when you're zoning out it's because you're stuck in that default network and that's something that does warrant some treatment at this point Olivia.

So thanks for your call.

I recommend that you go ahead and seek out a primary care clinician or perhaps a mental health clinician to try to help you with that.

>> Olivia, thanks for your call.

Let's go to our next email our next email question reads Dear Dr. Fauver, I is staying physically active a proper way to address mental health .

I found that it's so easy to shelter myself from all interactions when I have had episodes.

My advice to others would be to get out, take a walk, go shopping and see a friend even though it seems tough.

>> That's great advice and I would wholeheartedly agree exercising is remarkable because there's actually a reason why it makes you feel so good.

There's two chemicals especially in the gray matter of the brain out here.

One chemical is called glutamate and one chemical is called GABA.

And since I'm on a roll here with Automan Automotive analogy's glutamate is like the accelerator gabb is like the brake and glutamate and GABA are in opposition on the outside a part of the brain to allow you to think and feel good and have motivation and enjoyment and things.

>> Glutamate has to be just where it needs to be and gabardine need to be just where where it needs to be.

>> When people have depression they tend to have lower amounts of glutamate and GABA so they're not really functioning and they're not clicking on all cylinders when you exercise you increase both glutamate and GABA and people will often say when they finally get out there to exercise they feel energized but yet they feel calm and you wonder huh how can you do that?

Well it's because you're feeling energized because you have increased glutamate in the brain and you also have increased GABA in the brain.

So the glutamates giving you the energy the gap is giving the calming effect so you can feel energized but yet calm after you exercise typically after about thirty minutes and people often ask me what kind of exercise does somebody need any kind of exercise is good even brisk walking but physical resistance training the weight training resistance training is very good for giving people more of a calming effect and decreasing anxiety and a lot of cases.

But it's also been found to be very good for depression, aerobic exercise.

Are you getting the heart me going that's fantastic for your cardiovascular health but it can also be good for your mental health with helping with depressed mood and often a little bit of aerobic activity with weight training is great.

The best way to weight train is to go from one station to another to another and keep yourself moving as opposed to resting in between rate weight training.

>> Many people will do some reps and then they'll rest for five minutes and they'll do some more reps.

The best thing to do with weight training weight training is to go from one type of weight lifting to another to another to another because that way you get your heart going as well but that kind of activity is very, very good for a person's mental health .

>> Now here's the problem.

Let's say somebody has a severe heart condition and their hearts not pumping so well.

So they're tired and they're fatigued.

They don't have much ability to to exercise.

If you have a severe heart condition you can tell that person what you just need to get out there and run a five K and start training for a half marathon because that'll help your heart.

>> Well, it will to some degree but your heart's got to function to a degree that you can start that training.

>> So what do you do?

You go to the cardiologist.

They sometimes will give you medication so they'll provide you with certain interventions to make the heart pound better and that's great with depression.

>> Often people lack the initiative and the motivation to even take that first step to exercising.

You might prod them and say well gee, if you just exercise you'd feel so much better.

That's true.

But many times people have depression to the point that it causes them so much functional impairment they just can't get out there so much.

>> So we have to be sensitive to people.

We're having a hard time getting out of the house and exercising but it becomes a vicious cycle where if you don't exercise you don't want to exercise.

If you don't socialize, you don't want to socialize.

If you don't get out of the house, you don't want to get out of the house.

And we saw this particularly during the covid pandemic restrictions that was devastating for the mental health of so much of the community and many people are still not recovered from a because when they were told to isolate at home and they were so isolated many people found it more and more difficult to get out.

So we're seeing right now even two or three years after a lot of those restrictions will still we're still seeing people who are having trouble with social anxiety because they became accustomed to isolating and not being around people.

>> So it's almost as if they're having relearned a lot of their social skills.

>> Again, thanks for your email.

Let's go to our next caller.

Hello Noah.

Welcome to AM.

>> I'd known you'd mentioned that you're under so much stress that you feel it in your muscles.

Did you seek a medication or some other strategies that helped?

No.

I think 30 years ago you might have been given a muscle relaxant and those are great in the sense that really relax your muscles, they give you somewhat of a tranquilizing effect.

>> But I wouldn't say it's a good long term reason if you're under stress and you feel the muscle tension I was just mentioning exercise.

One of the best thing you can do for muscle tension is resistance trainin.

So weight lift weights, lifting of weights, resistance training and doing so under the watchful eye of a trainer to make sure you're doing them properly can be remarkable for giving you a relaxation of your muscles.

>> Many people will notice as they tense their muscles and then relax, intense their muscles and relax over the course of time they'll feel more relaxed.

So if you have specific muscles that are very, very tight, the best thing you can do it will be to exercise those muscles because in the long run they will be more relaxed.

Like I said, I was trained as a pharmacist back in the 1970s when I was a pharmacist behind the counter in a hospital in a retail store in the early 80s I saw a lot of muscle relaxants getting dispensed and quite frankly what they did is they made people feel calm but it would be nicer if those people could find other means of interventions to decrease the muscle tension itself because when you're anxious often you tighten up your muscles inadvertently.

>> So the best thing to do would be would be to purposely tighten up the muscles and then relax, tighten up the muscles, relax and do those exercises throughout the day.

>> But if you wish to simply lift weights, that's even a better way to do it.

No, no thanks.

>> Your call.

Let's go next caller.

Hello Amber.

Welcome to Mars the mind.

>> Amber you want to know can adults get stuck in an age of their adolescent emotional immaturity, adolescent emotional immaturity?

>> There's I think Amber, you're referring to adults who have the emotional maturity maybe of an adolescent.

>> How does that happen?

Well, sometimes people can have a traumatized event where it does cause them to be stuck in that earlier age of emotional maturity.

But more often than not where I see as a psychiatrist I was mentioning marijuana earlier what I see as a psychiatrist is when somebody starts using marijuana at the age of 15 years of age they will say use marijuana into their 20s or even 30s.

You'll have a person in their 30s who's been using marijuana on a regular basis for 20 years.

>> They will often have the emotional maturity of an adolescent and they have a hard time dealing with their emotions.

They have trouble coping with stress and so forth.

Why why does that happen?

Well, from a neurobiological standpoint marijuana does suppress the growth of the white matter of the brain and in doing so causes the brain to not be able to communicate neuron to neuron.

>> Each individual neuron has anywhere between 30 thousand and fifty thousand connections and if you have decreased fluffiness of the brain or decreased white matter of the brain, white matter is also known as myelin.

>> That's the insulation on the individual neurons that allow the neurons to transmit their electrical information better if you decrease the white matter a decreased insulation which is what marijuana does, you'll have difficulty with being able to tolerate stress.

>> You'll have more moodiness, you'll have trouble motivation.

You have trouble with concentration.

All these symptoms can be symptoms of chronic marijuana use.

So when I see a person who's thirty five and they've been using marijuana for 20 years it is not uncommon.

I've seen this throughout much of my career.

It's not uncommon for them to have an emotional maturity that you would expect of an adolescent.

>> And why is that?

Because when you're 15 years of age you are still developing coping mechanisms to deal with stress and interpersonal conflict if you start using marijuana when you should be learning how to deal with those coping mechanisms now you tend to get stuck at that point because marijuana basically makes you not care and that's why I'm frequently advising adolescents who are going from high school into college do not smoke marijuana especially that first year of college because it'll be offered to you and marijuana makes you not care.

And in college it should be stressful.

>> It should be anxiety provoking.

Some anxiety is fantastic for the concentration because if you fire up your anxiety volume control which is right here in the amygdala, if you fired up a little bit it can improve concentration up here in the dorsolateral prefrontal cortex and allow you focus on concentrating.

>> Keep your mind on things that's fantastic for studying.

So you want to fire up your anxiety volume control a little bit to keep you sharp and keep you motivated and keep you on top of things if you use marijuana just the opposite is true.

>> It calms down the amygdala and just makes you not care and on top of that it has the neuro developmental issues where your white matter growth does not continue to proceed.

>> The white matter growth in the brain development continues until you're twenty four years of age.

So it's been known pretty definitively that any marijuana use part of the age of 24 years of age can be damaging to the brain.

But now you know, we always wonder if you started smoking marijuana in your 30s or 40s would that be problematic?

More recent research has shown that even if you start using marijuana in your 30s or 40s, especially with a higher potency, marijuana is available now it can affect your ability to concentrate.

So as I see a patient who's using marijuana for several years, if they're having difficulty with focus, concentration, motivation and they want an antidepressant or they want a stimulant for that matter for their difficulty, the focus often the first thing we need to do is to get them off the marijuana.

>> Now it's not easy to do.

People often say oh it's no problem getting off marijuana now maybe for some people it's no problem but for many people it is.

So we have to go very slowly on it and sometimes have people transition to a different type of medication such as Pregabalin which is known as Lyrica or Gabapentin which is known as known known as Neurontin.

>> These are medications that have effects on the so-called calcium channels in the brain and in doing so they can give you a calming effect.

>> What we're trying to do is safely mimic the good effects that you got from their marijuana while allowing the marijuana to get out of your system.

>> It takes weeks to get out of the system but we're hearing about more and more recreational legalization of marijuana in various states.

>> In many states people can get it now when they're over 18 years of age.

But that concerns me because your brain is still developing up to twenty four years of age.

So if you're using marijuana between the age of 20 of 18 and 24 years of age, it can be extremely harmful for you.

>> Thanks for recall unforeseen.

>> I'm out of time for this evening.

If you have any questions concerning mental health issues you may write via the Internet at matters of the mind all one word Atwar and I'd love to get to your email question the following week God willing and PBS willing I'll be back again next week.

I'm Psychiatrist J forward.

>> I've been watching Matters of Mind on PBS Fort Wayne.

Have a good evening.

Thanks for watching.

Good night