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

Welcome to Matters of the Mind.

Now this 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 Fort Wayne by dialing in the Fort Wayne area (969) 270 zero or if you're calling any place coast to coast you may dial toll free at 866- (969) to seven to 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 WFYI org that's matters of the mind WFYI and I'll start tonight's program with an email question I recently received.

>> It reads D÷ndar to favor what is the best supplement not a prescription for depression is it St. John's Wort or St. John's Wort was a very popular supplement 25 years to go.

>> It was on the cover of Newsweek and many, many people were taking St. John's Wort in the mid to late nineteen as well.

>> St. John's Wort has this property called as a monoamine oxidase inhibitor.

In other words it inhibits the breakdown of serotonin and norepinephrine and dopamine and in doing so it can help with depression.

>> St. John's Wort was indeed studied versus Zoloft and it was found to be fairly equivocal to Zoloft for a mild depression but not so much for the more moderate to severe depressions St. John's Wort requires three times a day dosing.

>> It has a lot of drug interactions such that for instance it can make certain birth control pills less effective the ones that contain estrogen derivatives and as a side effect it can cause pretty nasty sunburn if you're exposed to the sun for a long period of time.

>> So St. John's Wort for a lot of reasons wouldn't be one of my top choices due to the three times a day dosing which is inconvenient due to the drug interactions and due to potential side effects.

>> And you know it might help with mild depression but not with more severe depressions that many people experience.

So with that being said, what's my number one supplement I would suggest for depression?

Well, first off we ought to be taking vitamin D unless you're a primary care clinician does not recommend vitamin D vitamin D as a supplement is probably the best supplement we can all take not only for depression but also to decrease our risks of cancers.

And it's also been shown to possibly decrease the risk of infections from viral infections such as covid so it might decrease your likelihood of getting covid if you take vitamin D supplements somewhere between two thousand units and five thousand units a day typically especially in the wintertime.

What I recommend as a specific supplement for depression that's not a prescription product I probably recommend in twenty twenty two a product called Saffron SRF Protein.

It's a spice from Greece and predominantly now in Iran but it's a very expensive spice because it's very difficult to cultivate and I would have thought as a spice that costs between five hundred dollars up to five thousand per pound that it would be a very expensive supplement.

But I've seen a lot of different sources where you can get saffron 50 milligrams twice a day which is the common dosage for about 80 cents a day and for 80 cents a day.

That's pretty inexpensive as a supplement.

Many people will take supplements cost more than that.

The reason I like saffron is because no one you can take it with antidepressants and some people have done that where if they've had disturbances like sexual problems with the SSRI is the serotonin the selective serotonin reuptake inhibitors such as Zoloft, Prozac, Lexapro selective if they've had sexual side effects from those they could take saffron and there's been some small studies showing that saffron added to accessorize will decrease the sexual side effects of Essa's rice.

>> So not only can you take them with antidepressant medications that actually might make the depressants work better I can't say that about St John's Wort St John's Wort does interact with the antidepressants and actually can cause you to have a condition called serotonin syndrome if you take the depressants with St John's Wort.

>> So with saffron you can take with antidepressants No one it's only twice a day dosing it tends to not have that many side effects headache and sometimes nausea will be reported.

But what I really like about saffron it can be used for other reasons than depression.

>> Now No one it seems to have this unique property where it increases the oxygenation to the back of your eye.

It's called the retina and in doing so can possibly decrease the likelihood of macular degeneration.

>> The macular is the part of the retina that's responsible for allowing you to see things and fine tune your vision and with older adults people over fifty fifty years of age macular degeneration is the number one reason for blindness.

>> So it seems to increase the oxygenation of the retina so saffron can do can increase the organization of the retina and possibly decrease the likelihood of macular degeneration.

So I like it because it can help with depression.

It can help oxygenate the retina itself.

It can also suppress the appetite and decrease appetite.

So people are using for weight loss and it has a lot of antioxidant activities that seem to have some nice effects in terms of allowing the brain to get more fluffy and possibly decrease the likelihood of Alzheimer's dementia.

>> So I'm always looking for that type of product out there that can do a lot of things with just one one pill maybe twice a day in the case of saffron.

So I think it has a lot of potential for about 80 cents or a dollar perhaps a day.

So that's something you can watch.

>> It has some studies particularly out of Iran where it's been harvested and been produced and other studies involve now look better how to people in these different studies.

>> So they're kind of small studies but they look fairly promising pharmaceutical companies drug companies will often look at a plant and they'll try to isolate chemicals from a plant and then produce various pharmaceuticals based on that, saffron has about 150 chemicals in it but the main chemicals in it that are having all these good qualities are carotenoids and these are chemicals that could probably be isolated in a pharmaceutical company, might be able to take off on that and then be able to put the funding in the studying literally thousands of people and looking at it very carefully for safety and how well it works.

>> But from a safety issue I'm very impressed with saffron because it does not seem to have a lot of drug interactions that we often hear about with other other supplements.

>> I always tell people that with herbs you're kind of on your own in terms of how well they're going to work CBD oil very common supplement people are using CBD is fine by itself but don't use it without the medications.

It has many, many, many drug interactions so that's always the danger in adding supplements.

You might have drug interactions if you're taking other medications with a case of saffron not so much the case from what I've seen so far.

>> Thanks for your question.

Let's go to our first caller and our first caller.

>> That first caller doesn't have a name but that first caller is wondering let's see what should you look out for following a mild stroke so far you're having eyesight problems.

>> Talk to your primary care clinician about that.

>> I'm a psychiatrist but I have a little bit of training in neurology so I know a little bit about strokes when I hear about strokes as a psychiatrist I'm often hearing about people having strokes.

It will affect their mood, their personality changes their memory and in some cases you're having some eyesight problems.

>> Eyesight problems can affect the maybe the back part of the brain.

So this is something where if you're wondering if you've had a mild stroke and you're having eyesight problems, No.

One make sure you see a neurologist they'll often do an MRI, a magnetic resonance imaging of the brain and get a nice picture of the brain to see where the stroke was affecting you and they can recommend specific type of treatments with occupational health , sometimes physical therapy as a means of trying to restore the brain's functioning.

We used to think that if you had a stroke, if you had any damage to the brain, the brain could not regrow its neurons.

Well now we know that it can and also the brain can compensate for damage on the one side of the brain if you have damage on the left side of the brain, sometimes the brain can compensate by increasing its activity in a similar manner on the right side of the brain so the brain can compensate in various ways if you've had damage one place or another.

>> Thanks for your call.

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

Our next e-mail question is going to rehear it is dear not to fall ever since I began leaving the house again following the pandemic I have suffered more panic attacks when I'm out in public or when I have to deal with new people at times it feels debilitating.

>> Are there any steps I can take to help myself?

The first thing you should do if you're having a lot of panic and anxiety upon leaving the house following the pandemic is do so gradually so gradually go outside the house, go out for five minutes one day, 10 minutes the next get around more and more people don't go to the big mall on the first day.

>> Obviously we're going to be flooded with exposure with people go out and just be around a few people maybe to a small little market or a fast food place where you just around a few people at a time so you don't want to overwhelm yourself with a lot of stimuli when you come out of the house.

>> The pandemic restriction is have been debilitating for many, many people were going on almost two years now where we've had the pandemic restrictions and the mental health has been affected.

>> We have indeed seen the suicide rates go up alcohol abuse has skyrocketed and of course opiate overdoses have dramatically escalated over the past two years.

So the restrictions themselves, the lockdowns that we've we've seen, although they might have been necessary, they've had a tremendous impact on people's mental health and I think we're going to be hearing about that for years to come.

So people like yourself are having a hard time getting outside of the house because your brain is conditioned to you being inside the house and not getting out so much.

>> So the best way to get over that is to gradually get out there and expose yourself to the type of things that cause you the fears I talk about us with people who are having fears of driving, whether people having fears of snakes.

They're having fears of heights .

What you need to do is gradually get out there and do the things that make you fearful very slowly.

You don't want to overwhelm yourself where you're having panic attacks and you feel out of control but you need to retrain your brain to not having that kind of anxiety by that gradual exposure.

>> It's called desensitization.

That's the term that we use in psychiatry.

>> We're upon doing things and exposing itself to things that you fear you'll become less and less fearful of those type of things.

>> For instance, if you are afraid of snakes, the best thing you can do is to get around some non poisonous snakes perhaps at the zoo or someplace where you have the opportunity to do that and go ahead and pet them and play with them and those type of things and that can get you over the fear of snakes.

The best way to get over a fear of flying is to go on a few flights and often hear about this with a lot of people.

They will have a terrifying flying fear of flying and once they fly one time two times three times with each flight it often gets easier.

So for the first couple of flights they might need a medication like Xanax to allow them to get on a plane and feel comfortable in the fuselage there and be able to take their flight.

But then the second, third and fourth flight they might not even need those antics anymore because your brain becomes desensitized to those kind of things that are causing you the fears once you get out there and you do more and more things so with the pandemic restrictions, a lot of people have had to stay by themselves.

>> Now we're having to get out and round people some people are having a lot of fears concerning the infectious nature of the virus.

So we've been told to socially distance and course social distancing is an oxymoron socializing and distancing or two entirely separate things.

So the idea is to keep yourself the distance from other people but on the other hand that's impaired some people's abilities to actually have that interpersonal connection.

We do the best we can with interacting with people by video but for many people that interpersonal connection is still lacking if they're not seeing people one to one, especially if they're supposed to stay six feet or more away.

So do the best you can to be able to interact with people who are maintaining that social distancing or the physical distancing that is a better term than social distancing.

>> Let's go to our next caller.

Hello Suzanne.

Welcome to Matters of the Mind .

Hello, Suzanne.

You're on the air.

Hi.

I have a complicated situation.

My husband had a stroke two years ago.

His left carotid was totally closed and he had many, many plaques and his right hand is here and his cerebellum.

>> We had to leave New York and move here to Indiana by husband did extremely well in acute physical therapy and then subacute physical therapy.

He was transferred into a new nursing home because I was going to be coming out of New York and wanted to live on the same complex that he was as soon as I got out here he caught covid and by the time he recovered from the covid six weeks later he had lost all the physical advancements that he had made.

He was great at the practice of walking by himself with a cane and and a brace on his leg.

Now he doesn't want to see me.

He doesn't want to talk to anybody.

His friends and coworkers or former call him and after a minute he says he's busy and he's got to go.

He won't watch television or listen to music read a book Alawa to read anything to him or interact with him.

He told me he doesn't want to see me giving him forty milligrams of Prozac and is being seen by a social worker and I believe a psychologist and they don't want to increase the medicine and I don't know what to do for him and to make things worse I just had my leg cut off and I just went into rehab today and that's where I'm calling you from.

I'm I'm I don't have the energy to fight and try to get him to do more because I'm trying to take care of me.

Suzanne, you mentioned he's seeing a social worker and a psychologist who's prescribing the Prozac for him.

I don't know to be honest.

They had him at twenty and I said listen, you know, you need to give them more.

You can go up to 80 milligrams and they said we know and they put him at forty.

>> OK, well, Suzanne, you had mentioned the cerebellar stroke which is in the back of the brain down here and then of course the right side of the brain has been affected.

>> Well, that can affect your mood and it can affect motivation initiative with Prozac.

Prozac came out in nineteen eighty seven when it came out the usual recommended dosage initially was twenty milligrams and as you know you can go up to 80 milligrams but will often go up to 80 milligrams a day for obsessive compulsive symptoms and sometimes binge eating.

>> The problem with Prozac is that no one about one of the three people do really well with it and this goes for any of the serotonin medications whether they be Celexa, Paxil, Lexapro these are medications that increase serotonin and about one out of three people do really well with them and we're getting some hints on who's going to do better and who's not going to do so well with those medications based on genetic testing.

But we have to be careful in terms of using Prozac going to may not help somebody.

As a matter of fact, going higher on the dosage of Prozac might make you not care.

>> Now my biggest concern for your husband at this point, Suzanne, is based upon what you've described that he might be getting too high of a dosage of Prozac where it no one can inhibit the breakdown of other medications such that other medications of various types can go higher.

So we might be getting higher doses of other medications indirectly because Prozac will inhibit the breakdown of certain medications.

>> But number two , if you increase Prozac too high for somebody, especially if they're not a good genetic fit for it can actually make them feel more well apathetic.

They lose their initiative and they get up and go and that could be what's happening for him.

>> So is alternatives.

We will not uncommonly look for medications that have different mechanisms of action than just increasing serotonin as Prozac will do.

For instance, if somebody had a stroke especially we might consider very some of the medications he might have taken these but we might consider these such as Cymbalta Dellucci eighteen Cymbalta or Occitan as medication increases serotonin and norepinephrine and thereby can maintain the initiative and get up and go for a lot of people we might consider especially for somebody with a stroke a medication along the lines of Lamotrigine or Lamictal it stabilizes glutamate and in doing so can decrease some of the excessive glutamate transmission that sometimes happens after somebody had a brain injury such as a stroke because when you've had a brain injury of any kind there's an excessive amount of this chemical called glutamate this release glutamates and excitatory chemical you might think well gee that should help.

Well if we increase glutamate too much it actually makes you more depressed and more irritable and more moody.

So Lamotrigine anti seizure medication that stabilizes glutamate so that's another possibility.

And finally one of our favorite medications for people who have had trouble with initiative get up and go motivation following a stroke will be a medication has been out for about nine years now.

Caltrain telex its chemical name Vaud Occitan.

But Trin Telex is a medication that seems to help with speed of processing of information the brain it helps with motivation initiative and unlike Prozac that predominantly increases serotonin.

>> The trend will increase chemicals such as acetylcholine, glutamate to a normal level but also can increase dopamine, norepinephrine and serotonin.

>> So it does a lot of things.

>> So the general rule of thumb, Suzanne, will be in trying an antidepressant medication within the first two weeks you should have at least 20 percent improvement.

>> You know, a lot of people will say you have to wait four to six weeks to see what an antidepressant is going to do.

>> You should be able to predict in two weeks how that depression is going to affect somebody if they have a 20 percent or more improvement overall and then you wait four to six weeks for the full improvement if you're not seeing a significant improvement at four to six weeks on Prozac twenty or forty milligrams day, it probably needs to be changed to something else.

Now you'd mentioned he's being seen by a social worker and a psychologist.

Well, they can't prescribe so he's probably being prescribed the Prozac by a neurologist perhaps or maybe a primary care clinician and that's who you want to really discuss medication options just knowing that the Prozac might not be the best thing for him.

Now on the other hand, Suzanne, if he's having difficulty with obsessive compulsive symptoms where he's overthinking things, he's having to wash his hands for ten minutes at a time.

He keeps checking and rechecking and rechecking that can be a manifestation of a stroke typically the front part of the brain, not the back part of the brain.

But if that was happening yeah, going up to 60 and 80 milligrams a day Prozac can be helpful but Prozac might not be helping at this point.

And my biggest concern would be that it can be detrimental for him at these higher doses simply because higher doses Prozac just makes you not care and it makes people apathetic at the higher doses.

That's because if you just increase serotonin more and more which is why Prozac does you indirectly decrease this chemical called dopamine dopamine, the chemical that we need for joy, happiness, initiative, enthusiasm and if you suppress dopamine you lose all of that and you end up kind of withdrawing and having a difficult time being around other people.

We not uncommonly hear about that with stroke patients but we often hear about it with people who get too high of a dosage on Prozac.

>> I did mention genetic testing.

Genetic testing can be done.

>> Traditional Medicare does cover genetic testing a lot of cases now but it's mainly going to be looking at this particular gene that's called the SLC six say for it's a serotonin transporter gene and we have found that it to some degree does predict who's going to do well on a medication like Prozac and who's not and will also look at the different genes that code for the enzymes that break down Prozac so some people will break down Prozac very quickly and they need higher doses.

Some people break down Prozac very slowly and they need really low doses.

So we take that into consideration if we get genetic testing.

So genetic testing I've done genetic testing on about five thousand people now and we have found that we're learning more about it and as time goes on, a lot of payers such as Medicare traditional and law, the commercial insurance companies are paying for it because they're realizing that we're able to hone in on the proper medication at the right dosage earlier treatment as opposed to trying this and then trying this and trying this.

>> Suzanne, thanks for your call.

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

Our next e-mail reads Dear Dr. Fauver, can hallucinations be a symptom of schizophrenia hallucinations where you will see things that aren't there or you will hear things that aren't other people can hear those are common symptoms of schizophrenia.

>> Schizophrenia has as key components hallucinations which are perceptual disturbances.

>> You see things or you're hearing things that other people can't see or hear and along with that wisk to fornia you can have what's called delusions.

>> Delusions are fixed false beliefs.

They're fixed because you can't talk somebody out of them and they're false because they can't possibly be true.

>> So fixed false beliefs are delusions and they are also characteristic of schizophrenia.

>> Schizophrenia is a day to day phenomenon.

Some people can have psychotic episodes periodically but even in between episodes they can have difficulty with processing their thoughts, getting their thoughts together, being able to express themselves in a clear and coherent manner.

People with schizophrenia will often have autistic features where they have a difficult time really relating to other people so they have difficulty with social interactions and they get easily startled upon exposure to loud noises or changes in their environment.

>> Those are autistic features and many people with schizophrenia will have struggles with expressing their emotions properly.

They might have dampened effect.

They dampened affect affect which is the means of expressing their emotions so they might not appear to be able to express their emotions properly.

We treat schizophrenia with a variety of medications.

The antipsychotic medications in twenty twenty two do not just block dopamine as they did decades ago.

>> Nowadays the newer antipsychotic medications will have effects on serotonin to a receptors which are the brain and it's thought that people with schizophrenia will have an abundance access the amount of serotonin 2A receptors in the front part of the brain and if you block those serotonin 2A receptors in the front part of the brain you can actually improve concentration, increase dopamine release and the front part of the brain which is what you want while still in some cases blocking dopamine release in this mesolimbic system as middle part of the brain.

That's the part of the brain where dopamine is excessive and causing people to have difficulty with hallucinations and delusions.

So the tricky thing about schizophrenia will be you have excessive dopamine the middle part of the brain and not enough in the front part of the brain.

And that's why people have trouble with concentration and focus because of the lack of dopamine in the front part of the brain.

>> Thanks for your email.

Unfortunately I'm out of time for this evening.

I'm psychiatrist Jeff Offer and you've been watching Matters of the Mind on PBS Fort Wayne.

>> If you have any questions concerning mental health issues you can contact me by email at Matters the Mind at WFYI dot org and I'll try to get your question on the air.

Thanks for watching.

God willing and PBS willing.

I'll be back again next week.

Have a good evening.

Good night