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

>> Welcome to Matters of the Mind now in its third year, 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 coast to coast you may dial toll free at 866- (969) to seven to 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 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 to add to matters of the mind all one word at WFYI dot org that's matters of the mind at WEF dot org and I'll start tonight's program with a question I recently received.

>> It reads Dear Dr. Fauver, can your mood affect how well the covid vaccine works and the answer to that is yes.

>> If you are depressed clinically significantly depressed when you get the covid vaccine injection you may not respond quite so well.

>> This is something that's been studied over the past year since we've had covid vaccine what's called the covid vaccine available whether it be the Johnson and Johnson version of our version of the version Moderna that version these vaccinations do affect the building of antibodies in what's called your MRSA, which is kind of the factory of where antibodies can be built.

Those are factories where proteins can be built outside of your nucleus in the cytoplasm or in your cell itself.

>> But it's not in the main nucleus which we'd know as where the DNA will sit.

>> So in the cytoplasm you have the antibodies being built if you have clinically significant depression those antibodies might not be manufactured adequately.

>> So it's been found in some studies across the world that if you have clinically significant depression when you get the vaccinations you might not respond as well and I'm hoping will be able to see this whole phenomenon behind us as time goes on and only so much of an issue.

>> But it's something that can be a risk factor for whre the vaccination might work not so well.

>> It might not work so well if you are clinically depressed when you get the vaccination itself.

>> Thanks for your question.

Let's go to our next email or next e-mail reads Dear Dr. Fauver, I've heard you mentioned inflammation related to depression.

>> What are some possible problems that could contribute to inflammation?

>> Well, depression can and contribute to inflammation and it's thought that that's why the covid vaccine wouldn't work.

>> So how do you get your brain inflamed?

How does that all work?

Well, there are several risk factors for inflammation of the brain.

No one can be sleep deprivation if you don't get enough sleep there's evidence you can have increased brain inflammation no to loneliness and that was actually a factor that we've seen with the covid restrictions when people were forced to stay at home and they weren't allowed to go out as much, they weren't allowed to go to work.

>> They weren't allowed to socialize especially over the year 2020 and some 20 21 people who more loneliness were more likely to get depressed and it was thought that that loneliness actually provoked inflammation in the brain so you can have sleep deprivation, loneliness a third factor in terms of causing inflammation would be a history of childhood abuse.

It's something that will often carefully assess for somebody who's newly being evaluated at the psychiatric clinic online you'll see this particular scale called the Adverse Childhood Experiences Scale.

>> It's called the ace scale.

It's ten items and those ten items were found at a major medical center to be the main ten items in childhood that were predictive of giving you difficulty with depression later on in life .

>> And those ten items have to do if your parents divorced, if there was drinking and alcohol use in the household as a child, if you had a parent who was incarcerated, if you were emotionally abused as a child or slapped or pushed against the wall, those type of things specific type of abuses or traumatic events earlier than eight years of age can put you at higher risk for depression later on.

>> And it's thought that the reason you're at higher risk is if you have those kind of situations occurring as a child, it put your brain at a higher risk for inflammation later on.

>> So sleep deprivation, loneliness, a history of childhood abuse those can be factors in terms of causing inflammation and we're now talking about covid infections causing the brain to be inflamed and part of the reason why you can't smell and can't taste adequately when you have a covered infection is because covid does cross gets across the get across the blood brain barrier.

The brain has this fine mesh all around it that protects it from stuff getting in.

>> But the covid virus does go into the brain and it goes right through to the olfactory nerve and it will inflame the fracture refractory nerve as well as other parts of the brain.

>> But that's why you lose your sense of smell and taste when you're having difficult difficulty with a covert infection because you need a sense of smell to be able to taste.

>> That's why that's a key factor.

About three about two out of three people who have covered infections will notice they lose that sense of taste and that's related to the loss of smell overall.

>> So those are factors that can lead to inflammation of the brain overall.

>> Now what happens when the brain gets inflamed, when the brain gets inflamed you can have specific symptoms that we hear about.

>> Basically you have an overactivity this front part of the brain and that creates anxiety and when you have anxiety that fires up the anxiety center down here so people with inflammation of the brain will have a natural anxiety but they'll also have difficulty with motivation.

They won't enjoy things.

They'll get fatigued because this middle part of the brain called the basal ganglia that shuts down and they don't care so much anymore and they can't think they can't concentrate.

So it's when people get inflammation of the brain they feel like they have the flu only it's their day by day by day while their brain is inflamed and it gives them all these depressive symptoms.

>> Now are we at a point where we will do routine blood tests on inflammatory proteins for people with depression?

Not yet.

But that day I think is going to come probably within the next five years.

There's one inflammatory protein.

>> It's fairly inexpensive.

It's commonly used by the cardiologists, the heart doctors it's called C reactive protein a CRP and you'll see that all the time on blood tests.

Have you been seen by cardiologists elevated CERP increases the risk for heart disease because inflammation increases the risk for atherosclerosis.

Well, inflammation increases the likelihood you're going to have depression so it kind of goes hand in hand.

>> So CRP could be a risk factor for depression for some people if that's elevated.

>> We have seen that in a few studies that people that have elevated C reactive proteins or people have more information they do better on medications that don't just increase serotonin.

You know, we're always wondering which medications should we initiate if somebody has depression?

>> If you look at all the psychiatric guidelines, we're all supposed to start these medications that increase serotonin like Lexapro, Celexa, Prozac, Zoloft, Paxil these are all medications that have been around for over two decades now and they work pretty well for some people but about two out of three people just don't do well with those medications.

>> So who are those two out of three people?

Well, number one, you can have the people that are not a very good genetic fit that might not do on the serotonin medications .

>> These are the people who have this particular gene type called SLAC six eight four.

They have two short genes as opposed to the longer genes.

If you have two short genes you're less likely to respond to the serotonin medication so we can look at genetics for people and sometimes predict who's going to do better or worse on those particular medications.

Somebody else might not do well on the serotonin medication will be somebody who has over four of those ten risk factors on the adverse childhood experience scale.

>> So the ace scale or the adverse childhood experience skills 10 item scale if you have four or more of those particular questions answered.

>> Yes.

In terms of early childhood trauma that increase the risk for inflammation of the brain and thereby might give you less of a response on the so-called serotonin medications.

>> Another factor who might not do well with the serotonin medication will be somebody that does have that elevated C reactive protein a C reactive protein.

>> It's really high again indicates inflammation.

So the moral of the story is if you have inflammation of the brain a suggestion that you have risk factors for inflammation, you might not do so well on the traditional serotonin antidepressant medications that are commonly recommended as first line treatment across the board.

>> So we're trying to figure out OK, how can we get people better quicker?

>> One thing we'll do is we'll look at their symptoms.

We'll look at what kind of symptoms they might be experiencing.

We don't stop there used to be we just look at some of these symptoms and determine if they needed a medication.

It's more sedating or more activating and kind of go from there all we try to look beyond that we look at what medications they've taken before and we look at the classes of medications they've taken, what worked and what didn't work.

>> We look at what family members might have taken, what worked and didn't work for the family members because the family members response to any kind of medical condition will be similar to your response if it's a mother, father, brother, sister, son or daughter, if it's a first degree relative, their response to medications with a similar condition that we might be treating for you will often be very similar.

So that'll be a consideration if somebody has had that early childhood experience where they've had a lot of traumas in childhood, we might not start with a serotonin medication for reasons that I mentioned where those patients might need to start on a different class of medication.

>> So genetic testing it's a it's a possibility and it's a nice added dimension to help us understand who might do better on one medication or another.

But to the other extreme you shouldn't use genetic testing exclusively as a means of determining which medication to use and that's a big misconception about genetic testing.

>> People sometimes say I just want my genetics tested then determine which medication I should take.

Well, we look at other factors.

We look at your symptoms.

We look at your past responses to medication.

We look at your early childhood experiences.

>> We look at your family history treatment responses and we look at all these all these other factors and they will add genetic testing on top of that as a means of helping us be a little bit more give us a little bit more of a clue on what direction we should go.

>> Thanks for your question.

Let's go to next caller.

Hello Alan.

Welcome to Matters of Mind.

Well, Alan, you had asked Ken a daily vitamin with fish will interfere with antidepressants .

>> The good news is, Alino, a daily vitamin the vitamin I'd suggest I'll give you a three vitamin I'd suggest not using brand names.

>> I'm talking about just particular elements here primarily and vitamins themselves vitamin D, vitamin D three is what is often called vitamin Twan sometimes even up to five thousand units a day.

Five thousand units a day is also one hundred twenty five milligrams a day.

So however you see on the shelf usually it's in international units but five thousand international units a day especially in the wintertime can be helpful for a lot of people.

Talk to your primary care clinician, make sure that's OK.

But Vitamin D is a vitamin we recommend across the board& for people with depression it helps with concentration in many cases it's not even recommended that clinicians check vitamin D that much anymore because generally in northeastern Indiana where I work many, many people are low on vitamin D this time of year.

So we just routinely recommend 2000 to five thousand years a day.

So I'd recommend a vitamin D especially during the wintertime if you're having to take an antidepressant you can take an antidepressant with vitamin D the vitamin D often makes it work better.

>> How about zinc zinc 50 milligrams a day can be helpful but it's thought that vitamin D and zinc especially can decrease the likelihood of getting covid and not being as sick if you get covered .

>> So you know we have to talk about covid nowadays it's still very much a part of our lives so we want to do all we can to prevent it and not be as sick if we get it.

>> So probably vitamin D two thousand five thousand units and zinc fifty milligrams a day can decrease the risk of covid zinc can also perhaps help with concentration and focus.

There are a few studies out there showing that people that children especially with ADHD or attention deficit disorder symptoms might do a little bit better if they take fifty milligrams of zinc every day vitamin C debatable one way or another.

>> But vitamin C is making a bit of a comeback because vitamin C is thought to be helpful to decrease the likelihood of covid might help a little bit with the mood but the B complex vitamins this is where it is helpful to know your genetics because if you know your genetics and you know you're able to metabolize at least 50 percent of folic acid, you can take regular folic acid.

But if you're metabolizing less than 50 percent of folic acid based on this gene called methylene tetrahedral folate if you're metabolizing less than 50 percent of folic acid you might need a special form of folic acid.

That's the breakdown product called methyl folate.

>> So in that case that can be dramatically helpful for anxiety and depression.

>> But your original question was well, can vitamins and antidepressants interact?

No, not in that way.

>> Fish oil you mentioned fish well with antidepressant medications there have been a lot of studies in recent years about using fish oil with antidepressants because there was so much excitement about this 20 years ago.

>> Women in Japan who delivered babies didn't have as much postpartum depression.

>> So there was a lot of excitement twenty years ago thinking my goodness, everybody with depression should take fish oil specifically omega three more so than omega six fatty acids and there's some theoretical basis behind that omega three fatty acids might decrease your triglycerides might decrease your risk for heart disease and maybe even decrease your risk for Alzheimer's dementia.

>> But more recent studies looking at fish oil in general has not been have not been definitive in determining that they are helpful for depression .

And so whereas 15 20 years ago clinicians might have recommended fish oil for individuals depression not so much now because now fish oils not been found for depression to be any more effective than placebo.

>> Now to lower your trialist triglycerides to decrease your risk of heart disease by all means you can still take visual but not so much for depression.

It's not the type of treatment we recommend for depression.

However, the good news is fish oil should not interfere with antidepressant medication absorption in any way.

>> There's not a lot of different things out there that will interfere with antidepressant absorption.

>> We do use a medication that's a thyroid hormone called Levothyroxine and if you use Levothyroxine which is a thyroid supplement, you can't take that with food.

>> You want to take that on an empty stomach either an hour before you eat or a couple hours after you eat levothyroxine or tea for a thyroid supplement.

It just does not get absorbed.

Well, if there's food in the stomach and it really doesn't like to get absorbed at first coffee on board.

So if you're drinking coffee and you use your thyroid medication, probably not going to get absorbed so well.

>> So when we use thyroid supplements we tell people to keep them away from food but antidepressant medications in general you can take them with or without food.

There are some medications that need to be taken with food for better absorption such as vibrate for instance.

But generally medications used for depression can be taken with or without food and with or without vitamin supplements or even fish.

>> Well, if you are taking that thank you for your question, Allan.

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

Our next e-mail reads Dear Dr. Fauver, how are the brains of women different from men?

>> Well, that might be a loaded question, but I'm going to tell you just the facts here.

>> Women's brains are smaller than men and some women might really take offense to that.

But let me go on here.

The left side the right side of the brain will be connected by this band of tic tissue called the corpus callosum.

>> It's a connection between the left and the right side of the brain.

So even though men's brains physically might be a little bit larger, women have thicker corpus colossi.

So this corpus callosum and a woman will be thicker for a woman.

>> So that means that women's left side of their brains and their right side of the brains are better connected.

>> So there will be a different prospect when women look at the world around them because of that because the right side part of the brain as you likely are aware, is associated with creativity, geographic, geographical assessed of the world around you.

>> Their feelings are more socially on the right side of the brain.

The thinking, the logical part of the brain is on the left side of the brain.

>> So just in general, a hundred years ago I believe it was some physicians over in Europe were making a big deal out of how women's brains when they did autopsies were smaller than men's brains, thereby speculating that women had lesser intellectual skills than men.

It's not that women have lesser intellectual skills at all.

>> It's a different type of intellectual processing.

Another difference between women's brains and men's brains that have been discovered over the past ten, twenty years is that women have about 20 percent more norepinephrine branching than men.

>> So what does that mean?

Well, women can be often more socially connected than men because they have more norepinephrine, branching, norepinephrine.

>> A branching allows you to sometimes have greater perception of the world around you and that's why women could be more likely to be more sensitive to anxiety conditions like panic disorder, social anxiety, obsessive compulsive disorder, PTSD, post-traumatic stress disorder.

>> Women can more be more sensitive to anxiety provoking situations because they have more of these norepinephrine branches by 20 percent and compared to men.

>> So in that sense when we talk about men not having as much anxiety as women quite frankly men might be protected by oblivion.

They just don't notice these things around them as much whereas women do and that can sometimes cause anxiety for some people.

>> Thanks for your question.

Let's or our next caller hello Chuck.

>> Welcome to Mars the mind.

Chuck, you want to know about rife machine therapy, rife machine therapy?

You've got me stumped there, Chuck.

I have no idea what rife machine therapy would be.

Could that affect mental conditions?

>> You know, we do use certain technology in the treatment of depression anxiety.

>> One of those technologies will be what's called transcranial magnetic stimulation TMS and it's where you're typically going to put magnetic stimulation on more often than not the left frontal part of the brain for a matter of minutes, sometimes for as short as eight minutes or maybe thirty one minutes.

>> And when you use that those quick pulses for the transcranial magnetic stimulation you're giving a magnetic impulse to that thinking part of the brain that tends to kind of shut down when people get depressed.

>> You do that five days a week for six weeks and for some people that gives them a nice benefit.

>> The great thing about TMS or transcranial magnetic stimulation is that its main side effect can be a little bit of a headache but you can go back to work right away.

So we will use that kind of machine therapy as a means of helping people with depression in the clinic.

>> There are other types of different machines used out there but I'm not familiar with the RIF machine Juk, thanks for your call.

>> Let's go our next caller.

Hello John.

Welcome to Matters of Mind and oh John I can hear you now.

>> Yeah, you're on the air John.

>> OK, we have a family member who is diagnosed with borderline personality disorder when they're in the mood of feelings of inadequacy, they have a tendency to cut at what point should family members do to intervene?

>> John, it sounds like you're already in a loving and caring way overseeing how this family member is doing and here's how this works, John.

>> Borderline personality disorder.

What in the world does that mean?

It's an old term that we still use but it basically means you're on the borderline between neurosis and psychosis.

Neurosis is where you're anxious about stuff.

>> Psychosis is where you're losing touch with reality.

Here's how I can better explain it, John.

>> Think of borderline personality disorder as being a kind of condition where you have mood swings that are extremely sensitive to stuff and people around you.

>> So when stuff happens that are stressful for you, you react dramatically differently than somebody else.

>> Same with interactions with others.

>> You'd react dramatically and people will have quick mood swings.

Some people with borderline personality disorder can get psychotic where they get so stressed out and so overwhelmed they will hear voices they lose touch with reality and for the life of them they'll look like they're psychotic.

But that's psychosis only lasts for a matter of minutes or hours while they're in the midst of that particular conflict.

People with borderline personality disorder will often have difficulty with abandonment depression when they feel like they've been rejected.

Something's not going the way they like.

>> They just feel devastated.

So what do they do?

They will try to self-harm and it's very common for people with borderline personality disorder to cut it themselves and there's a reason behind that John.

>> And the best thing you can do as a family member is try to understand this and try to help them understand as I try to explain it to them because when you cut it yourself, it's not a good thing to do.

>> It's not a good way of coping.

But when people cut themselves ,what they're trying to do is distract themselves from the emotional pain in their brain by having physical pain in their arm.

>> And it's also thought if people cut it themselves they're physically releasing opiates from the skin.

>> We have opiates in our skin.

It's our way of protecting us from having overwhelming pain.

>> So if you have an injury in your arm or your leg that your arm or your leg will release opiates to kind of medicate self medicate some of that pain.

>> So when people when people cut their arms it's as if they're taking opiates and when people take opiates and narcotics and we've heard a lot recently about fentanyl and all these narcotic narcotics people are taking what they are getting from those narcotics will be a feeling of bliss.

>> So on one hand when somebody cuts of themselves, obviously they're under stress.

They're trying to relieve their emotional pain by feeling physical pain but they're trained to self medicate using opiates from their natural skin.

>> Now some people will very commonly with borderline personality disorder use substances, abuse alcohol marijuana very commonly because they're trying to calm the anxiety but they will use opiates, you know, use narcotics because they want that sense of bliss.

>> John, the best thing you can do as a family member is recognize this person does have an emotional disturbance where they have difficulty, especially when things are changing around them.

>> You need to be calm.

You need to be reassuring.

And as a family member, one of the best things you can do would be to try to get connected with a local national alliance on mental illness group.

>> It's called NAMI and NAMI groups are around the country who have a very good one here in Fort Wayne and the NOMY groups are basically a family network of individuals with mental illness.

>> These individuals have bipolar disorder schizophrenia but a lot of them do have borderline personality disorder and helps educate you on how to kind of manage those kind of situations, how to react and a key for you is to stay calm, tell them educate them the best you can on the condition we do have medications that help stabilize their moods and help them deal with stress tolerance.

Sometimes you need to get to him to a hospital when they're starting to do some dangerous things.

>> Obviously if they start cutting themselves you probably want to train professional to assess OK, is this something that is very transient?

>> Is it going to be something leads to more dangerous behavior?

What's the meaning of the cutting?

And it's something we often will try try to figure out.

But John, from your perspective as a family member, try to be supportive and understanding as they're going through all of that.

>> John, thanks for your call.

Let's go to our next caller.

Hello.

Best welcome to Mastermind albeit you had mentioned you're a 91 year old father wakes up and thinks his dreams are real.

Why might that be?

>> You know, best as we get older?

It's an interesting phenomenon.

Often we have less dreams, right.

>> And as we all dream throughout the night we tend to get most of our dreams starting at about an hour and a half after we go to sleep and then as we sleep through the night we tend to have more and more dreams and they become more vivid, more intense.

>> What your father's likely doing is he's awakening in the midst of these dreams now the good thing is at 91 years of age it's great that he's dreaming best so that's a good thing.

Birria suring for him.

>> Some people perceive their dreams are prophetic and that God is giving them messages.

Well, we have to look at their history on that to really validate if that's occurring or not but try to try to be reassuring for him.

But on the other hand he's probably awakening as he's been having a dream and they're very vivid and not considered to be pathological for that matter best.

>> Thanks for your call.

Unfortunately I'm out of time this evening if you have any questions that I can answer on the air concerning mental health issues, you may contact me at Matters the mind all one word at WFYI Dog on the Internet.

>> I'm psychiatrist Jay Fawver and you've been watching matters of mind on PBS Fort Wayne God willing on PBS willing.

I'll be back again next week.

Thanks for watching.

Goodnight