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>> Good evening I'm psychiatrist Fauver live from Fort Wayne , Indiana.

Welcome to Matters of the Mind now as twenty third year are matters of the mind is a live call in program where you have the chance to choose a topic for discussion.

So if you have any questions concerning mental health issues give me a call here at PBS Fort 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 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 via the Internet at matters of the mind all one word at a dog that's matters of the mind at WFB a dog and I start tonight's program with a question I recently received it read your daughter Fauver does oppression cause memory loss?

>> Is there a way to differentiate if the memory loss is caused by depression or by something else like age?

Will memory loss can indeed be influenced by depression?

>> Here's the brain looking at you on the side part of the brain.

You have this library part of the brain called the hippocampus and it's what we hear in this yellow temporal lobe section.

>> It's very sensitive to stress, is very sensitive to the stress hormone called cortisol.

>> And when we get more depressed and we get more stressed out, cortisol increases.

It goes to this hippocampal area and there have been studies with women showing that with long term untreated depression this part of the brain does indeed grab a shrink.

>> Now it might affect women more than men because women have this particular part of the brain especially influenced by estrogen because estrogen works as fertilizer for that part of the brains was estrogen decreases periodically either prior to a woman's periods or during menopausal years that can impact the memory as well.

>> So depression itself can impact that part of the brain called the hippocampus.

There's a condition called Alzheimer's dementia with Alzheimer's dementia.

The hippocampus gradually shrinks and that's part of the reason why people have short term memory loss with Alzheimer's dementia .

>> But if people have depression in the older years it increases the likelihood of developing Alzheimer's dementia by four times so depression can accelerate the impact of memory disturbances as we get older over the course of time.

>> Now when I hear about somebody having memory loss, I'm thinking about a lot of different things.

I'm thinking do they have thyroid disturbances?

Do they have glucose disturbances because thyroid and glucose disturbances can be factors as we get older sometimes we won't be able to absorb vitamin B 12 quite well enough because we have a little transporter in our stomachs that will transport like a bus vitamin B 12 in our small intestines and it's called intrinsic factor and as you get older you just don't have enough of those little intrinsic factor busses to transport your vitamin B 12 into the small intestine to get absorbed.

So sometimes as you get older you get low on vitamin B 12.

>> That will be a factor in terms of affecting your memory and concentration.

>> I'm going to want to know as a psychiatrist how long have the memory disturbances been going on?

At what age did they have their onset?

Do you have anybody in the family who has difficulty with memory or even Alzheimer's dementia?

>> So there's a lot of other factors like that that will be involved.

How can you tell if it's depression versus Alzheimer's dementia or depression?

>> The memory disturbances will often be very intermittent and people just don't care with all with depression people will does not want to answer your questions.

They will just not care.

They'll give up on doing challenging calculations and challenging memory tasks.

>> They just don't care.

People with Alzheimer's dementia will try and they'll do the best they can to get a little bit anxious about not being able to answer the questions and they'll try to hide it and cover it up some in some ways but they get somewhat distressed that they can't answer the questions people depression will just get to the point where did they just don't care and it's important to differentiate that because if you have difficulty in the older years with memory disturbances, we want to make sure that we treat depression if it's there if you have depression you're going to have the sadness, you'll have crying spells periodically might have some difficulties enjoying things.

Many people with depression will have energy problems, low self-esteem.

They'll talk badly about themselves.

They'll talk about death and dying quite a bit and these are symptoms that can be somewhat characteristic of depression, especially if you've had those kind of spells earlier in your life .

>> So if you treat depression not uncommonly it can fire up this little hippocampus area of the brain and help bring back that memory.

>> Now that's the question can you grow back nerve cells once you've lost them?

>> It's not that you need to grow back nerve cells.

>> It's just that you need to make a more fluffy now we have 100 billion neurons in our brains and each individual nerve cell or neuron has about 10000 thousand connections and as you get more depressed you start to lose those little branches and it's like a tree that starts to lose its branches.

They're not as fluffy less fluffy neurons become neurons that can't communicate to other neurons as well.

That leads to memory disturbances, mood disturbances, paw paw paw abilities to make good decisions and process through information.

>> So when we're treating somebody for depression what we're often trying to do is make the front part of the brain and especially the hippocampus a little bit more fluffy and that increased fluffiness actually increases the growth in the volume of the brain sections themselves and that can improve the memory over the course of time.

>> Now there are certain medications that can increase fluffiness in the brain.

Among them will be the antidepressant medications.

Lithium is an old medication.

It's been around been available since the 1940s and in some forms even before that time.

But in the 1940s was determined that lithium as a salt was effective for helping people with mood stabilization and it became officially used in the nineteen late 1940s as a mood stabilizer to help people of manic depressive disorder who have had highs and lows.

>> But lithium at low doses can significantly improve the fluffiness of the brain by enhancing what's called brain derived our trophic factor BNF is like the Miracle-Gro of the brain so the speculation now will be should we be giving people low doses of lithium even if they don't have big highs and lows of their mood because a small amount of lithium might actually stimulate the growth of their brain and a lot of different ways.

>> We've heard a lot about lithium recently because at least in my practice and myself and my colleagues are writing a paper on this right now but we're finding that individuals who had covered related difficulties with mood disturbances appeared to have had inflammation of the brain that inflammation of the brain and directly appeared to be caused by such inflammatory proteins as tumor necrosis factor tumor necrosis factor is a protein that goes up when somebody has covered and what decreases tumor necrosis factor lithium and we've used lithium for a lot of people who had significant and severe mood disturbances with the covid related mood disturbances and the even psychosis in some cases and we find that that's particularly helpful for people.

>> So when we think about individual memory disturbances there's a lot of different things we can consider.

I want to make sure that they metabolically are in good shape.

>> I want to make sure that their thyroid and glucose is in good shape, that they're not depressed and finally especially with an older person if they're telling me they're having memory disturbances, there's something I always want to consider and that will be sleep apnea.

Sleep apnea is so prevalent in our society and it was actually first described by Charles Dickens as he talked about this older man who had a big thick neck who had Pickwick in type of body appearance and we always think about these heavy overweight men with thick necks who snore very loudly as having sleep apnea while sleep apnea is basically condition where you're not getting adequate airflow to your lungs at night because you're snoring when you snore you're just closing off your airway.

>> So it's like you're suffocating and you can't get adequate air into your lungs without adequate air into your lungs.

>> You don't get enough oxygen to the brain with less oxygen to the brain throughout the entire night periodically that the next day will cause you to be tired, you'll be sleepy, you'll want a nap and you won't be able to think and you'll have trouble with concentration.

>> So I've identified a lot of people in my psychiatric career who came to see me having difficulty depression.

>> They were tired.

They weren't motivated.

They couldn't think very clearly and they thought they had depression in a clinical sense.

But lo and behold they had sleep apnea and once you treat them for sleep apnea within about a month you can get a dramatic improvement in their overall demeanor with energy, with concentration, with her mood.

>> So it's something we always want to consider.

Thanks for your email question.

Let's go to our first caller.

>> Hello Amy.

Welcome to Mariza Mind.

>> Oh, Amy Amy, you want to know how do you get diagnosed with sleep apnea back in the old days, Amy, we did need to refer everybody to a sleep lab and a lot of people didn't like to do that.

But sleep labs are really nice because they do hook you all up with these wires and they get you an EEG and these wires and they look at your oxygen, they look at your breathing pattern ,everything and they watch you overnight.

>> But quite frankly, Amy, a lot of people didn't want to do that.

They didn't want to sleep in a lab overnight and they didn't want to have something.

Somebody's watching them sleep throughout the night so several years ago they came out with these home poly sonograms and this is what I prefer if it's appropriate.

Now some people have medical conditions where it's not appropriate.

They need to be monitored more carefully but with a home poly sonogram you go to a sleep medicine lab at the referral of your doctor who will make right that order and the sleep medicine lab will give you a unit and you hook up this unit on your chest and under your nose and on your finger they'll look at your auction and basically this this unit will assess you for snoring and your breathing throughout the night and assess your oxygen levels throughout the night and even your heart rate for that matter.

>> And the bottom line is when you pause in your breathing or if you snore and you're not getting enough air flow, what happens?

>> Your oxygen level goes down and your heart rate goes up during that time not uncommonly what will often occur then, Amy, is that people will say that they keep waking up throughout the night so they want a medication for sleep.

>> Well, that's not going to be what's going to be the the appropriate treatment for them.

Just getting a medication for sleep when you're having trouble breathing throughout the night is not the adequate treatment you need.

You need something that can give you a positive airway pressure where you increase the air pressure to keep your airway open and it's called Seiple BiPAP.

>> They have auto apap which will automatically adjust based on how much error you need in terms of any positive air throughout the night.

>> But it's diagnosed basically by looking at how many times you will pause in your breathing at night.

>> They call it an H i apnea hyper hypoxia index and they look at that particular index to determine what degree of sleep apnea you have and if it's mild, moderate, severe, they'll perhaps give you different recommendations if it's only mild and it's not that big of a deal but it could be a factor sometimes I'll just simply recommend that you lose weight because if you lose weight sometimes you lose neck fat and that will decrease your likelihood for the snoring at nighttime.

>> Sometimes they'll recommend the dentist gives you a plastic device the mouth piece that you put in your mouth.

>> Many dentists are very well trained to understand how to do this and what the idea the dental mouthpiece will be is to tell your your chin forward a little bit and you'll be able to keep your airway open.

But if it's more moderate severe getting some means of positive airway pressure to keep your airway open can be essential.

>> Amy, what I often tell people to do is if they get diagnosed with sleep apnea, follow through with the recommendation for for what the sleep medicine folks are saying.

>> But give it about a month.

Give it a month week by week by week.

You should notice some bit of a difference there in a lot of people will notice a dramatic difference as soon as one week.

>> But you should know the difference with your energy level, your concentration, your motivation.

You should notice that upon Awakening in the morning you're more wide awake and quite frankly a lot of people when they wake up in the morning, if they have sleep apnea, they have headaches in the morning you'll notice that you don't have a headache in the morning anymore and you have more wakefulness in the morning so it can make a pretty big difference once the mask is fitted properly once you have the proper settings for your airflow.

So I strongly recommend it for so many people I actually did accounts in my practice a couple of years ago and one out of six of our patients in my psychiatric practice have been diagnosed at some point with sleep apnea either by myself or somebody else in the community.

I'd be in the primary care doctor, the internist or somebody else in the community but a lot of people with mental health problems do have sleep apnea.

We have to address it.

I remember a dramatic case twenty years ago when I was first starting to look for sleep apnea.

>> I mean we had a fellow who was ready to get electroconvulsive therapy or ECT because he had so much difficulty depression and no antidepressant seemed to help him one thing after another was failing and we didn't think about sleep apnea so much back then but we gave it try and had this guy tested for sleep apnea and lo and behold he had severe sleep apnea to this day he never had to get ECT.

He is still treated with an antidepressant but he is being treated with for sleep apnea and the idea that the endgame with sleep apnea is we're trying to identify it first knowing that sleep apnea can cause you to have an increased cortisol release.

>> Why what your brain thinks is you're suffocating all night if you're not getting adequate airflow to your lungs, your brain sends all this chemical signal that you're suffocating so cortisol go sky high.

>> What happens when cortisol goes sky high?

You put on more belly fat, more belly fat puts on more fat around your neck as well and you're more likely to have difficulty with snoring because of the increased cortisol release.

And when that happens it's more difficult to lose weight.

So I'm often telling people an advantage of getting treated for sleep apnea will be that you might be able to lose weight a little bit easier because you're able to breathe a bit easier at nighttime and you're getting adequate airflow.

>> Amy, thanks for your call.

Let's go to our next caller.

Hello Nick.

Welcome to Matters of Mind.

>> Nick, you want to know what science should you look for in someone with depression who is good at hiding?

>> You know, Nick, men are really good at hiding depression.

We tend to hide depression really, really well.

>> Women are more out there with depression.

Women will cry.

More men when they get depressed often get more angry and irritable and they get more snappy about it.

But people with depression will have classically the difficulty with sadness and they might take it out on themselves or on other people.

In other words, some people will take out their depression and just feel as if they're a bad person.

Everybody else thinks they're a bad person other people with depression will feel badly about themselves then they start taking it out on other people and saying they're bad people and they start getting irritable and angry at other people and they just think life is awful.

>> So that's one thing.

Another thing that will often happen, Nick, is that people with depression will quit doing stuff.

>> It's fun.

They won't do things that used to be pleasurable.

So you know, you ask out somebody with depression who used to go out and do different things with you and they keep declining.

>> They don't want to do this or that.

They start to give up their pleasurable activities and it's a vicious cycle because the more people give up their pleasurable activities with depression, the more depressed they get and then the more depressed they get, the more likely they want to give up their pleasurable activities.

So that's something we're always trying to get people to do do the stuff that used to be fun even though you don't necessarily feel like doing them.

>> Some people with depression will talk about lack of sleep and you know when you start Lacon you start having a lack of sleep.

It's not it's like your cell phone just not getting adequate charge on the battery.

You're just not able to be up to to be able to get things done during the day so you're not as productive.

You're going to be more likely to call in sick for work.

>> You're going to be missing obligations.

You just don't engage in conversations as much people with depression will be a little bit more withdrawn and they tend to be more to themselves.

They might even get more anxious when they're out and about with other people so they just don't hang around beer on people.

>> So as a friend, Nick, you might notice that somebody with depression just doesn't seem like themselves and especially if you've known these people for a long time, you'll notice they're a little bit more cranky.

They are not as sociable.

They decline the fun activities that they used to do with you and you just notice and you just kind of have that instinct that there's just not something about there's something not right about them and I'll also often ask that to patients I see are other people are family members saying something about what they think your personality has been like over the past few weeks or past few months?

Have other people been able to tell there's something different about you because other people often realize there's something wrong or something different about you even before you know because you're with yourself all the time?

>> Well, other people are going to be seeing you every now and then.

>> They can often tell a difference in terms of your personality, your demeanor, your ability to process information and they'll often bring it up to you.

>> So Nick, as a as a friend or family member seeing somebody who might be depressed yeah, I bring it up to them that hey, you just don't seem like yourself lately anything going on and just try to be that trusted friend and allow them to have somebody with whom they can speak to be able to talk through different problems are having and try to direct them to their primary care clinician as a means of trying to initiate some help for them.

>> Nick, thanks for your call.

Let's go to our next email.

Our next email reads Dear Dr. Fauver, I am taking 40 milligrams a day of Prozac.

>> It's also known as Fluoxetine 300 milligrams a day of gabapentin and one milligram of mirror that's also known as Prema Pixel and I'm taking that at bedtime.

My mood is not bad but I'm still having restless legs.

What's the highest dosage of CapEx I could use?

Well, for a restless legs we're often going to go up to a half milligram one milligram a mirror and if you have Parkinson's disease which is a condition where you have decreased transmission at with dopamine murawiec subprime pixel will specifically stimulate these receptors for dopamine and for Parkinson's disease.

>> My goodness they'll go up to six milligrams or so at bedtime.

>> So my biggest concern about your question is, you know, OK, you're taking 40 milligrams of Prozac.

We have to remember that Prozac also known as Flock's team increases serotonin and when you increase serotonin you can indirectly decrease dopamine.

>> A side effect of Prozac can be restlessness and specifically restless legs.

There's a phenomenon called akathisia where people just can't sit still and they are restless and they have a hard time pacing.

>> That's a side effect of Prozac at higher doses but a bigger concern specifically based on the nature of your question the three medications you're taking will be gee I wonder if Fluoxetine or Prozac is actually causing you restless legs.

>> About one out of three people tend to be a good genetic fit for Prozac.

Two out of three people aren't and the two out of three people who aren't a good genetic fit for Prozac will typically have more side effects.

>> It may or may not work for them but they'll have more side effects even if it does work and a side effect they might notice would be restless legs increasing serotonin can decrease dopamine decreasing dopamine can give you restless legs.

>> So I'd want to know in your case you're taking gabapentin at nighttime and I'm wondering if you're taking gabapentin also for restless legs so you've got two medications potentially on board there Gabapentin and Tropiques also known as BEXELL that are trying to offset restless legs that might be caused by the high dose of Prozac.

So I want to take a good look at all that type of combination you're taken there to really determine is it really restless legs inherently that we need to treat or do you just need to decrease the Prozac or maybe go to something else?

And if something else could be a medication that doesn't just increase serotonin but might be a so-called serotonin norepinephrine reuptake inhibitor like Cymbalta STIC at high doses perhaps you could use a medication like Wellbutrin which is a whole different type of antidepressant that has no serotonin effect.

>> So there's a lot of different ways you can treat depression other than Prozac.

But when I see this cascade of a high dose of Prozac and then I see a couple of medications on top of it that are specifically related to treatment for restless legs, that makes me wonder if the Prozac is not causing restless legs.

>> So talk it over with your clinician about the possibility of instead of increasing mirror picture preme effects on more and more for the restless legs do something about the restless leg now what can you do about it?

You could decrease the Prozac near clinicians supervision but also any time somebody has restless legs I always want to know if iron level is OK. >> It sounds weird but if you're iron level drops because you're getting older you're not eat enough iron not getting adequate absorption of iron.

>> Let's say you're a woman and you're heavily menstruating you might have a slow gastrointestinal bleed.

There's various reasons why people will have low iron.

>> Some people just don't eat enough eat enough iron so they won't have enough dietary intake and they don't have they don't eat red meat or green leafy vegetables so their iron will drop if your iron decreases.

Not only will you be turned away for a a a for for giving your blood at the red Cross but also you can have restless legs as a as a symptom of of low iron so I want to make sure that's OK. Another reason why people can have restless legs will be if their kidney functions are not real good.

So if your kidneys are failing failing on you a little bit that will give you difficulty restless legs as well.

So I'm always going to want to check low iron and if somebody is at risk for poor kidney functioning I'm going to want to check their kidney functioning.

But the third thing I'll always consider when somebody has restless legs is looking at their medications to see if they have medications that might cause restless legs.

>> And in your case I think it could be the Prozac.

I mean if you had restless legs all your life even before Prozac, that could be another issue.

But Prozac 40 milligrams a day is a pretty good dosage and that can certainly exacerbate or worsen the likelihood of your having restless leg so rather than increasing MetroPCS which is used for restless legs in your case I'd prefer to back off the Prozac and maybe try on a different medication for depression and go in a different direction there.

Talk it over with your primary care clinician or your mental health clinician who might be treating you with the Prozac.

First though, thanks for your very interesting email.

>> Let's go to our next email.

Our next e-mail mail reads Dear to favor my friends say that I may have bipolar disorder because I get to be really moody at times I feel physically sick when I get around a lot of people and I have to leave.

>> How do I know if I had bipolar disorder and what can I do about it?

>> Well, this is a situation where you want to listen to your friends if your friends say hey, you're not quite right, you're not the same as you used to be, pay attention to them because if they do so in a well-meaning fashion and any friends do I mean listen to them because they realize there's something different about you.

So talk it over with your primary care clinician, your mental health clinician and here's what the mental health clinician is going to do.

>> I'm as a psychiatrist I'm going to take your friend's perceptions very seriously because they know something's not quite right with you.

>> So I'm going to ask you with bipolar disorder, do you notice there are days one, two or three days or more where you don't need to sleep as much at night?

>> Do you notice during those days you're more energetic or even more irritable for that matter and your mood distinctively changes?

>> Do you notice that you talk faster than usual during those days when you've not slept and your thoughts are going from one thing to another to another specifically on those days where you have not slept, do you make some judgment calls that might come into question and other times you buy things, say things, get yourself into trouble during those days when you're on the so-called Hy's and then after a few days of the highs do you crash into a low now there are different types of bipolar disorder.

There's a type of bipolar disorder that we call major depression with mixed features.

That's where people will have one, two or three days where they're kind of on the high side but then they crash for two weeks in a depression that's called major depression with mixed features.

>> There's bipolar disorder type two where you have four to six days of distinctively elevated mood doesn't get you in a lot of trouble but a lot of people can tell there's a big difference there after those four to six days of distinctly elevated mood then you crash into depression for at least two weeks.

Then there's bipolar disorder type one where you get floridly manic for a whole week or more and you get yourself in a lot of trouble when you're floridly manic and you make a lot decisions and have some indiscretions you ordinarily wouldn't participate in.

>> So for bipolar one disorder we certainly treat that with mood stabilizers.

Bipolar two disorder and with major depression with mixed features we might treat those kind of conditions with antidepressants in some cases there's a little bit of a mild bipolar disorder called Sikelel Thymine where people will have a few days high a few days low but that's something that's more subtle.

>> And bottom line is friends will often notice it if it's emergency but you want to take them seriously and try to do something about that because when you have mood swings it can get you in trouble in various ways and significantly impact the quality of your life .

>> Thanks for your question.

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

I am psychiatrist Jeff Oliver and you've been watching matters of mind on PBS Fort Wayne God willing on PBS willing.

>> I'll be back again next week.

The only questions I can answer on the air concerning mental health issues brought me via the Internet at Matters of the Mind at WFYI dot org.

Thanks for watching.

Have a good evening.

Good night