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

Welcome to Matters of the Mind now and it's twenty third 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 at PBS for Wayne by dialing in the Fort Wayne area (969) 27 two zero or if you're calling any place else coast to coast you may dial toll free at 866- (969) 27 two zero now on a fairly regular basis I am broadcasting live every Monday night from our spectacular PBS thirty Nine Studios right here in the Fort Wayne area and if you'd like to contact me via the Internet you may write me at matters the mind at WFA dot org that's matters of the mind at WFMU A Dog and I'll start tonight's program with a question I recently received it reads Dear Doctor Father what's the best way to break my sugar habit?

>> I find myself drinking too much soda and eating sugary snacks frequently in addition to being bad for my physical health care.

Too much sugar have a negative effect on your mental health .

Yeah, you really can't.

I mean you can always talk about the variations of insulin that goes up and down as you're consuming lots of sugar and you're blasting yourself with carbohydrates and one of the best ways to try to break that would be No one try to increase your protein content and decrease your sugar content, try to definitely avoid any refined sugars, refined sugars are probably the most problematic, especially those with fructose.

So if you use fructose that will dramatic it's a sweeter tasting carbohydrate.

So fructose is often something people desire but unfortunately that has more detrimental effects on your liver because liver has a difficult time metabolizing fructose.

So try to avoid refined sugars if you're going to have sugars, try to have natural sugars, natural carbohydrates but most importantly try to go more toward a higher carbohydrate diet and many people will find that when they will consume sugars they want to binge on them and it becomes an ongoing cycle.

>> So be very careful when you pick up that first cookie because one cookie can lead to the second cookie very, very easily.

So you want to be careful about just starting to consume those type of things.

Intermittent fasting is something we often recommend in my practice intermittent fasting is where you intentionally will not eat for 18 to perhaps 20 hours a day, drink plenty of fluids during that time but not consuming any food during that time can be very helpful in trying to break this sugar habit.

But it becomes an ongoing cycle.

Yeah.

What does that do to the mental health ?

Well when you eat sugar it does push insulin higher and by pushing insulin higher it promotes an increased transport of tryptophan into the brain.

Tryptophan is a building block for serotonin so it fuels the brain into getting the good neurotransmitter increased in the brain called serotonin.

>> So briefly you feel better when you have a high sugar consumption but that readily crashes so you get this on off effect a lot of time and that's why many people become somewhat moody as they've had a high sugar diet.

They've actually studied highish sugar diets with children and adolescents with ADHD and surprisingly there was found to be no association.

A lot of people just insist that their children are getting really hyped up on sugar and that's worsening their behaviors.

>> But at least with ADHD that's not been shown to be established just yet even though you might see some other types of behavioral disturbances, it's not specific to ADHD.

>> Thanks for your email question.

Let's go to our first caller.

Hello Robert.

Welcome to Matters of Mind.

Robert, you want to know if there's any advances on the treatment of schizophrenia on the horizon and any hope for a cure someday right now, Robert, I think we're hearing about the ability to manage schizophrenia better and I think the direction you're going to be hearing about in the future will be not just focusing on blocking dopamine receptors, not just focusing on blocking serotonin type 2A receptors, which is another receptor has been focused upon for the past 25 years.

We're going to hear a bearing about modulating this chemical called glutamate.

It's thought that people with schizophrenia in the front part of their brains have a glutamate disturbance and that's what caused have so much difficulty with insight awareness, the so-called negative symptoms where they have difficulty socializing and expressing their emotions adequately.

Glutamate will probably be the neurotransmitter we hear most about over the course of time and we have some advances that might be coming down the pike within the next two or three years.

Robert is kind of like diabetes.

We don't have cures for type one or type two diabetes necessarily but we have really good ways to control it and that's what we're going to be hearing about with schizophrenia as time goes on.

One of the biggest advances just in the past ten years, Robert, has been the use of longer acting in a long, long acting injectable.

>> So nowadays people can get medication like in Vegas sestina that will last people for a month and it's something that can be fairly dramatic.

And there's another formulation called trends that actually can last people for three months Abilify Mentana is something else that can last for a month for a lot of people.

So we're hearing about these type of formulations for people that can stay in their system because one of the problems with schizophrenia, Robert, will be the lack of awareness you have an illness and the self awareness part of the brain is over here in the side right in that little crevice right there.

It's called the insula and that's the part of the brain that makes you aware of well who you are and what kind of problems you might be experiencing.

>> People schizophrenia just aren't aware that they have a problem and for them the whole world is the problem and they'll hear voices.

They'll have these thoughts that can't possibly be true and it's difficult to reason with them in that kind of state.

The idea with the medications is try to stabilize them to the point where they can still function in society and they can have meaningful lives and in twenty twenty one the goal with schizophrenia will be for people to have a life like anybody else.

They can go to work, they can be married, they can have a social network of friends and family so there shouldn't be limitations on people's schizophrenia as there were thirty or forty years ago back in the old days 50, 60 years ago the treatment for schizophrenia was to institutionalize people nowadays we expect to be out and about in society but it's going to take these kind of medications with innovative features that have long acting properties to allow these people to have meaningful lives.

And that's what we're seeing in the future.

Robert, thanks for your call.

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

Our next e-mail question reads Your doctor Fauver My husband has been off of alcohol for nearly 20 years and an explicitly he has been recently had an urge to drink again so far he has been able to stay dry at least for the past twenty years until drinking again.

What could be going on in his brain after all this time sober?

>> Well, a lot of people with schizophrenia I'm are with alcohol dependance will have difficulty taking that first drink once again and it's always been debated.

>> Can somebody with a history of alcohol dependance go back to controlled drinking and just have a drink once and once in a while and that's like playing Russian roulette.

You just don't know and it's a big gamble to make because with alcohol dependance, which is the area in the middle part of the brain called Nucleus accumbens and it's a part of the brain stimulated with alcohol for people who are prone to alcohol dependance that's not stimulated in other people and that's why all of we're often asked people as an adolescent or young adult when you had the first drink, how did it make you feel if it made people feel buzz?

>> They felt kind of tired.

They felt kind of relaxed.

That's one thing.

But there's a subset of people out there that feel really happy and they have a sense of joy when they drink alcohol.

>> Those are the people who typically get in trouble with it and those are the people who can commonly relapse upon it because they'll get a sensation they'll get an emotional response to alcohol that's very unique.

And for those people neurobiological there's a difference with their brains and they're wired differently could it is partly genetic but there's something differently about their brains and I always warn adolescents, young adults if you get that sense of joy and extreme happiness when you drink alcohol, you need to be very, very careful that you drink any alcohol in the future because your brain once he gets exposed to that feeling you can crave more and more and more and that's where the craving for alcohol comes in.

We have medications like a grossetjte for instance that will dampen down the craving is called Campral is a brand name medication dampens down the craving for alcohol by affecting specific little receptors in the brain where if you drink alcohol it doesn't affect you as much.

So it dampens down that sense of joy in that feeling of happiness that you get from drinking alcohol.

>> So you're going to always be prone to relapsing if you have that extra drink.

The key is and it's always an emphasis for people with alcohol use disorder if you are sober for 20 years and you happen to drink, have a few drinks and you start drinking more and more and more, you got to stop the train as soon as possible and get sober very quickly.

It's not a total failure if you start drinking again but you just need to stop the procession of drinking more and more and more as soon as possible.

The more people drink alcohol the more likely you're going to have brain damage.

Women are actually more likely to have a brain damage than men.

But men as they escalate the usage can have more and more brain damage.

Women metabolize alcohol one third of the rate the men do because they lack this enzyme called alcohol hydrogen that's in the stomach and liver and that's the enzyme that breaks down alcohol.

Women have one third of that enzyme compared to men.

So one drink for a woman is like three drinks for a man, three drinks for a woman like nine drinks for a man.

>> So women are very prone to getting these higher levels of alcohol levels in their bodies, giving them more difficulties with their livers, their hearts and especially their brains because alcohol is very prone to go to this memory center of the brain over here called the hippocampus and it just fries the hippocampus and that's why many people who are older are more prone to having difficulty with alcohol related dementia compared to younger people because as you get older that hippocampus is more sensitive to getting atrophy or shrinking and alcohol can have a big contribute it in doing that.

>> Thanks for email question.

>> Let's go to our next caller caller hello Nick.

Welcome to Matters of Mind.

Well, Nick, you had mentioned or you'd wondered is marijuana addictive or not and safer to use than alcohol?

Well, here's my perspective on the use of a THC or the active ingredient marijuana.

Nick, a lot of people have trouble giving it up despite it causing them negative consequences and the whole concept of an addiction, Nick, is where you continue to use it even though it's getting you into trouble and you might actually crave it and might need to use larger amounts than you initially intended to do.

So that's always a matter of perspective, Nick.

Some people will use marijuana as a means of helping them relax and getting them to sleep and they don't seem to have any trouble with it in that regards.

The trouble I see with marijuana, Nick, is when you use it especially with a younger brain, somebody under 24 years of age, the younger brain is going to have delayed growth with marijuana.

Are you going to have a suppression of the white matter growth in the brain especially if you use the marijuana before twenty four years of age when the brain is still growing?

>> So my big emphasis in the use of marijuana, Nick, is to not use it before the age of twenty four years years old after twenty four years of age.

It's debatable what it does to the brain one way or another but it's undoubtably very toxic to the brain when you're using it before twenty four years of age and it has been shown especially for young adults to increase the likelihood of schizophrenia if you are prone genetically to having schizophrenia especially so for those people hands down I'd recommend if you're under twenty four years of age you don't use marijuana at all.

How about if you're over twenty four years of age?

If it's getting to the point where you're so preoccupied with using marijuana that affects your social relationships and it's affecting your ability to get things done during the day and including employment that includes employment.

Some people will use marijuana and it's probably like alcohol in that sense where they use it to the point of abuse or even the addictive potential as you mentioned where they start getting themselves in trouble with it and they start to avoid responsibilities.

Marijuana will make not care.

And that's why I strongly emphasize to individuals going from high school to college don't start using marijuana that first year or two in college because college is stressful.

College creates a lot of anxiety of obligations.

You have deadlines, you have assignments to complete.

You have tests that creates a lot of anxiety.

>> So if you use marijuana it makes makes you not care anxiety is motivating anxiety fires up this chemical system called norepinephrine and makes you want to get things done.

It creates a sense of urgency and it makes you want to get things done and makes you need to study and get your assignments done.

Marijuana will make you not care and many people will drop out of that first year in college or second year in college because they start using marijuana.

They don't care and they get farther and farther behind in their work.

So there's certain times in your life where you certainly should not use marijuana if marijuana is giving you difficulty concentrating on the job, if it's getting you trouble with motivation, if it's causing you trouble with keeping up with your assignments on the job, that can be a problem because again ,marijuana can make you not care with many people and these are people I see as a psychiatrist they start getting depressed, they start having trouble with concentration, they start having a little bit trouble with memory and then when they add other things to the marijuana like Xanax, Valium, Klonopin, next thing you know, they're just tranquilize to the point where they have trouble functioning on a day to day basis.

So I think it's really individual concerns how problematic marijuana can be for somebody.

>> Budnick I'd recommend if you're under twenty twenty four years of age or under you definitely don't use it because it's been shown to definitively be damaging to the brain we have to remember that the marijuana potency of the THC in twenty twenty one is not the potency that we had twenty or thirty years ago.

It's much more potent now.

We have stronger hybrids out there so it's a much more potent formulation now and if it's causing you to have any difficulty at all in your social or occupational or academic work, that's where it can be a problem for people.

And I advise people to use it with extreme caution.

If you're going to come to a psychiatrist and say well gee, I'm having trouble depression, anxiety, sleep and you're using marijuana, I'd advise you not to even consider going that route because a psychiatrist really can't prescribe you medications if you're using marijuana because marijuana has so many drug interactions.

The same is true for CBD cannabidiol CBD has a lot of drug interactions and it's very difficult to use psychiatric medications when you're on those kind of formulations.

So if you're on CBD, if you're on marijuana, if it's working for you, that's up to you.

What direction to go?

Hopefully it is and you don't have any trouble with it.

But in many cases people are having trouble with those kind of substances and then they come to me as a psychiatrist wanting to have treatment for conditions that the CBD or the marijuana for that matter might be causing and that's where we often get into a debate with that with our patients trying to get them to stay off the marijuana, try to find ways to help them look for alternative treatments for their anxiety or their difficulty with sleep.

Nick, thanks for your call.

Let's go next caller.

Hello, Claudia.

>> Welcome to Mars.

The mind you mentioned you've had episodes of depression and anxiety starting in your early 20s.

>> You're now forty eight years old.

What's caused the depression and anxiety and you're seeking relief from it.

>> What can you do?

Well, if you had the onset of depression, anxiety and early 20s part of that reason Claudia would be being female.

>> You're twice as likely to have depression, anxiety goes along with the gender of being female.

So with that being said, sometimes you can be a hormonal issue so estrogen and progesterone increases and decreases are more likely to set the environment in the brain to have depression and anxiety.

>> Secondly, if you've had a child during that time in early twenties, childbirth will sometimes provoke provoke depression anxiety such that estrogen and progesterone are sky high when you are pregnant and then it plummets during the delivery the post pregnancy time, the postpartum time period.

>> So for those people will often hear about the first episode of depression or anxiety.

Sometimes it actually emerges into a bipolar condition where people can have mood swings for the first time and very rarely people can have a postpartum psychosis where they actually lose track with reality Claudie, there's a lot of other reasons for depression .

You can have genetic reasons.

About a third of depression is genetics.

A third of it does run in families.

That's why as a psychiatrist I will always ask people did anybody else in your family have similar symptoms and if so, did anybody else in the family have treatment for the depression or anxiety because not only does depression anxiety run in families, the treatment response will run in families.

So if somebody in the family mother, father, brother, sister especially if they had a good or bad response to particular medications, that's extremely important for me as a clinician to know.

So that's something we'll often try to examine.

We're always look at your use of alcohol, marijuana, any other substances out there that might be triggering that because sometimes those kind of substances can trigger anxiety and depression.

>> In your early 20s it mentioned your forty eight years of now we're always going to typically ask do you snore news?

Does anybody ever notice that you stop breathing at night because you can have this ongoing difficulty, depression and anxiety that just doesn't seem to get better if you have what's called sleep apnea.

Sleep apnea is where you lack air flow to the lungs adequately at night time that decreases oxygen to the brain with less oxygen to the brain.

You can have more difficulty with depression, anxiety.

Many people with sleep apnea will get anxious at night because quite frankly they are literally waking up because they're snoring because it's as if they're suffocating so sleep apnea can cause you sleep disturbance is because if you start snoring, if you start having trouble the airflow it can wake you up.

So it's not uncommon people sleep apnea might wake up after 30 or 40 minutes and wonder what what's causing them to wake up to to awaken and it can be the sleep apnea itself being a woman, especially in running in families you can have low thyroid low thyroid is something we will often examine and you know, technically the normal thyroid stimulating hormone levels should be below five and the higher the level comes from the little pituitary gland which sits right in the middle of the brain down here and the pituitary gland has a thyroid stimulating hormone secreted from when the thyroid levels are going low.

So the TSA is going higher means the thyroid levels are too low.

So in the labs they'll say it's a four point five or five is OK.

However, the average age for most people is around one point five or two .

So when we see a TSA age getting above two point five from endocrinology standpoint I get it they might not consider that to be abnormal.

>> But what I as a psychiatrist see people with the above two point five I often hear about them having trouble with depression, fatigue, hair loss in some cases dry skin constipation.

They'll have these symptoms of very subtle hypothyroid and we sometimes call it subclinical hypothyroidism.

We might give them a little bit of a thyroid hormone to not only improve their thyroid functioning but also help their depression and help their energy level and their concentration being very careful not to give them too much because too much thyroid supplementation can give you potentially loss of bone density and and sometimes cardiac arrhythmias if you get too much thyroid.

So we don't want to do that haphazardly.

We do it very cautiously.

So that can be a factor with anxiety and depression hormones as I mentioned before looking at medical conditions then you look at your life circumstances, Claudia, we all go through different stresses in our lives and and people wonder does stress cause depression?

Does depression cause you to have more difficulty with stress?

It does go back and forth.

We often hear about this cascade where people feel anxious and they worry about things because they've got stuff going on in their lives and we all have stuff going on in our lives.

>> But when you become preoccupied with it you have difficulty coping with it.

>> You have difficulty managing the stress that can lead to worry and insomnia when you have difficulty with sleep that could affect your judgment and your brain because when you sleep the judgment center of your brain in the front here will tend to be suppressed.

It kind of relaxes.

This is the thinking part of the brain.

That's the judgment center of the brain.

It's got to relax every night and we need about six to eight hours of that part of the brain to kind of relax night by night.

And if it doesn't, you have difficulty with judgment and your perception of what's going on around you during the next day.

>> So lack of sleep will actually cause you to have more depression anxiety because without adequate sleep the emotional volume control the brain is called the amygdala.

It's down here in the temporal lobe that kind of hijacks a judgment and the thinking part of the brain.

So you tend to be ruled by your emotions in that regard when you're not sleeping adequately.

So a psychiatric vital sign we're always going to be asking about it will be how are you sleeping?

We actually use a scale called the Insomnia Severity Index.

It's a questionnaire a very brief questionnaire but we use that for almost all of our patients who come in because we don't know we want to know who sleeps doing are you able to get to sleep, be able to stay asleep?

Do you wake up early in the morning?

Do you feel like you've had an adequate night's sleep?

Do you feel refreshed the next day and does any lack of sleep cause you to have difficulty getting things done?

So we look these kind of symptoms of insomnia knowing that lack of sleep will significantly impact your day to day functioning overall.

I mentioned insomnia.

I mentioned thyroid disturbances.

Low iron can be a factor especially for women if you're a heavy STRADER for instance or perhaps you're a vegetarian, you're not eating much red meat.

That can be a factor in terms of having persistent depression and a final medical issue that I can mention would be diabetes.

We have a higher likelihood of Type two diabetes nowadays blood sugars going to high, blood sugars going to low that can have an impact on your likelihood of having ongoing depression and anxiety.

So for that reason in psychiatry nowadays we're often going to be checking for blood sugars with an agency which is looking at the average blood glucose for the past three months.

We're going to be looking at thyroid levels, looking specifically at the TSA and seeing if that's getting on the high side.

We're often going to be looking at iron levels and that's what will often start in examining somebody for depression.

>> Thanks for your call.

Let's go next caller.

Hello Keith.

Welcome to Matters of Mind.

How are you doing?

Hi Keith.

I'm doing OK.

I was I was my question was I'm just in a state of mind where is like is this not going to work?

I don't want to do nothing else but be in a bit.

I'm trying to see if that's a part of just being, you know, depressed like I don't I don't it's not the energy because I have plenty of energy but I don't want to do nothing like I don't want to do anything but go to work and go to bed, come home and get to bed.

>> OK, Keith, your question kind of cascades right off of what I was talking about.

I have several questions for you.

>> Do you snore at night or does anybody witness your stopping breathing while you're sleeping?

>> No, not that I know of .

No good.

I don't even snore.

Good.

Have you had your thyroid blood sugar or blood sugar checked recently?

>> Yeah, I recently have had a full doctor's exam cholesterol everything blood pressure.

>> Good.

Yeah if you're metabolically in good shape if you're not having any difficulty with sleep apnea it could be depression.

>> Keith Keith depression will cause you to kind of lose your motivation and your initiative your willingness to get out and about it sounds like you still have physical energy but you don't want do stuff now granted, you know, we're always going to ask about a you're abusing marijuana, narcotics, alcohol, all those kind of things.

And of course that that's kind of a given that you don't want to be doing that kind of thing because that'll zap all your motivation.

But depression itself a key element will be that you lack the initiative to do things.

You lack the motivation to do things.

So check that out with your primary care clinician to see what options are available for you.

Keith, Keith, thanks for your call.

Unforced I'm out of time for this evening.

If you have any questions concerning mental health issues, give me a call here at Fort Wayne next week or write me via the Internet at Matters of mind all one word at WFA a drug.

I'm psychiatrist Javor and you've been watching matters of the Mind on PBS for Wayne God willing and PBSC willing.

>> I'll be back again next week.

Have a good have.

Good evening.

Good night