.

>> Good evening.

I'm psychiatrist Jeff Ofer live from Fort Wayne , Indiana.

Welcome to Matters of the Mind now that'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 Fort Wayne by dialing in the Fort Wayne area (969) 27 two zero or if calling a place coast to coast you may dial toll free at 866- (969) to seven to zero.

Now in a fairly regular basis we are broadcasting live every Monday night from our spectacular PBS Fort Wayne studios which lie in the shadows of the Purdue Fort Wayne campus.

And if you'd like to contact me with an email question that I can answer on the air, you may write me via the Internet at matters of the mind at all.

>> One word at UFW ECG that's matters of the mind at WFA org and I'll start tonight's program with a question I recently received.

>> It reads Dear Dr. Fauver my adult son struggles with minor depression and anxiety.

>> He does fairly well under the care of a doctor but he uses marijuana occasionally.

What are the possible concerns of someone who has depression using marijuana?

>> Are there similar concerns with alcohol use?

Well, basically the brain continues to grow until you're twenty four years of age.

So the biggest concern I have for a young adult would be the marijuana suppressing the growth of the brain.

>> There's white matter in the brain and the white matter will act as insulation on the individual nerve fibers.

>> And if you suppress the growth of white matter as marijuana does, you can cause difficulty with nerve endings being able to communicate with each other.

>> Each individual neuron has ten thousand connections and each connection has this sheath of white matter on it.

>> We call it myelin and marijuana will suppress the growth of that up until the age of twenty four years old imaging studies that demonstrate that so the problem with marijuana use especially prior to twenty four years of age will be that you can have difficulty with being able to have this white matter growth in there thereby have difficulty with intellectual deficits as you're going on in the years.

>> You can also have as a young adult difficulty with motivation and I see this not uncommonly with high school students and college students who are under a lot of pressure and they're anxious so they use marijuana and the marijuana makes not care if you use marijuana and it makes you not care, it's more likely you're not going to be able to get your academic assignments completed and then you tend to decline in your academic functioning.

>> I'm often reminded that to people who are going into college because in the college environments it's so prevalent that marijuana will be available.

>> You've got big exams coming up.

You're really anxious.

You are having difficulty perhaps with sleeping.

Somebody offers you marijuana, it settles you down, you feel better but yet at the same time you're not motivated to study so marijuana can significantly impact a person's intellectual functioning but also their motivation.

And if you already have depression in my experience people with depression just don't do well long term with use of marijuana because again it makes you not care, makes you more fatigued and sometimes in some at some cases it will cause you to have trouble with even concentrate.

Now the use of alcohol affects a different part of the brain.

The use of alcohol will affect this area.

The brain over here called the hippocampus.

>> It's the memory center of the brain.

It's of like the library of the brain.

The hippocampus is very sensitive to the impact of alcohol.

>> Alcohol will fry the hippocampus and by frying it means it'll shrink it down some.

>> So alcohol will affect a different part of the brain whether you're younger, whether you're older at any age and especially if you're a female because women tend to break down alcohol at one third the rate that men will so one drink for a woman will be like three drinks for a man, three drinks for a woman is like nine drinks for a man and alcohol will have more of an impact on a woman's brain compared to a man at the same amount of drinks.

>> Alcohol can have also some other effects on the entire body that can be detrimental for women.

>> So alcohol, marijuana not good for adolescents and young adults and I'm often reminding people of this as they are approaching the age of twenty four years of age.

That's the time of your life .

You really don't want to use marijuana and stay away from alcohol especially up until twenty four years of age after twenty four years of age it's debatable whether marijuana significantly has long term impacts on the brain to the degree it might have when you're younger.

But at the same time a lot of people I see just aren't doing so well when they continue to use marijuana.

Now here's what we'll often do in psychiatry we often try to figure out what reasons there will be for somebody using marijuana.

>> I saw an individual a day who was using marijuana periodically, periodically at nighttime to be able to help him sleep well.

>> I gave him something more specific and safer and better studied for the purpose of helping him sleep.

So that's kind of the strategy we will use.

>> So that being said, let's go to our first caller.

Hello John.

Welcome to Mars.

The mind.

>> How are you doing today, sir?

Hi, John.

I'm doing OK.

I'm doing well.

>> It's a pleasure to be on your show with you.

My my pleasure as well, John.

Yeah.

Are you enjoying your night just you know, just being respectful so far so far.

>> John, I hope you are too.

I am.

I am.

I had a question relating to your marijuana.

Yeah they do you do you prescribe would you prescribe marijuana or would you prescribe pharmaceuticals?

>> Johnny you know in the state of Indiana we're not licensed to prescribe marijuana and surrounding states they are.

>> But what I don't know we've got better stuff, John, when I look at the rationale for using medicinal marijuana, we just have better things to be able to address that my biggest concern about medicinal marijuana, John, is if somebody comes in and says I'm anxious and marijuana seems to help me to some degree and then somebody starts using marijuana for the purpose of relieving their anxiety, no one I want to make sure nobody under the age of 24 years old is getting their hands on that marijuana because what happens, John, we saw this happen in Michigan.

Michigan had medicinal marijuana.

People got their medicinal marijuana cards.

People from Indiana would go to Michigan to be able to get the medicinal marijuana.

So what happened?

They started selling it especially to younger people because younger people wanted the marijuana from from from Michigan and had better access to it.

>> So younger people there's a lot of evidence out there, John, that younger people just don't do well with the use of marijuana because it suppresses that white matter growth of their brain and it can affect their intellect and I think it can affect their long term functionality because it's going to dampen in many cases their motivation.

It's going to cause them to have difficulty with being able to think and concentrate and make good decisions over the course of time.

>> So my biggest concern, John, is these younger people using marijuana and like this individual today he was quite a bit older than twenty four years of age but he was using marijuana night by night for sleep.

>> I asked him are using anything else and will you use a little Benadryl?

>> But there's a lot of better stuff out there than Benadryl for sleep that's not addicting.

>> You know, I'm not a big fan of using Ambien or Lunesta or Sonata.

These are the traditional sleep medications.

I'm not a big fan of using those more than a couple of weeks on in but you can use a lot of other medications such as Trazodone, low dose detoxified even Gabapentin for the purpose of helping you sleep.

>> So John, in my practice I'm trying to get more specific on what people are trying to do for their treatment.

>> If you use marijuana under 24 years of age, not only does it affect your intellectual functioning and your possible degree of motivation but if you are genetically wired such that you have a propensity for developing schizophrenia, there's something about marijuana that can trigger the schizophrenia which is a horrible long term psychiatric condition.

It does have treatments fortunately in 2022 but it's not a condition you want to evoke unnecessarily.

So it'd be kind of as we say in the sports community and unforced error if you use marijuana and you provoke schizophrenia, it's just a horrible shame that that happens because you didn't have to happen.

And in many cases people might not have developed schizophrenia had they not starting USMA using marijuana.

Now John, why do people use marijuana?

They use it to kill themselves out.

They use it to make themselves calmer.

>> They use it to be able to put up with stress better.

We're dealing in stressful times and people will use marijuana sometimes they feel calmer and they have less anxiety.

>> I'd like to get to the root of the problem there and try to determine what's causing that anxiety not only from a psychological standpoint but from a digital standpoint.

>> If we didn't have better things than marijuana let's say this was one hundred years ago and all you had was basically alcohol and you had cocaine a hundred years ago as the medicinal treatments for depression well maybe we'd use marijuana back then but nowadays we have 16 different oral antidepressant medications that have developed over the past twenty five years past thirty five years.

>> So we've had all these different newer antidepressant medications come out and in they're coming out.

>> We just have a lot of options from which to choose.

We're also trying to get more precise in what medications to use John, because there are certain some medications or do better for certain symptoms of anxiety or depression or even moodiness.

>> So you got to really be careful what you're treating.

Their marijuana is kind of like a shotgun approach or treats a lot of different symptoms that people are trying to address and it will cause a lot of different side effects because cannabis will have a lot of different chemicals in it and some chemicals are helpful but some aren't so helpful for you.

If we use medicinal medication we at least know what molecule we're giving you so plant based medication has a lot of different chemicals in it.

A lot of medications came originally from plants where they took specific chemicals from the plants and might use those chemicals and possibly modify them and tweak them a little bit to allow them to have fewer side effects or possibly be more effective.

>> There's a medication called Naltrexone.

>> It's an opiate blocker.

Naltrexone has been tweaked a little bit from a molecular standpoint to perhaps be able to help with depression and even appetite suppression and then tweaked molecule of naltrexone is called Samme Dauphine.

So Samme Dauphin is basically a medication very specific medication that possibly can dampen down the appetite.

But it's all it is is Naltrexone which has been around for a while.

It's an opiate receptor blocker .

Well you can enhance that ability to block opiate receptors by changing this little part of the molecule and by doing so you can block the opiate receptors at about five times greater potency with Sammy Dauphine versus Naltrexone.

>> So a lot of medications originally came from plants but it's just a matter of figuring out how those chemicals worked and can you take those chemicals from plants and make them work a little bit better by making minor modifications.

>> John, thanks for your call.

Let's go to our next e-mail.

Our next e-mail reads Dear Dr. Fauver, I often have minor to moderate knee pain.

Most nights I take two ibuprofen tablets in the evening usually with a small amount of food.

This controls the pain and helps me sleep.

Could there be any long term side effects from daily ibuprofen use?

>> Well, first off I want to remind you I am a psychiatrist so in my scope of practice I don't really use ibuprofen for pain.

It's outside of my scope of practice but I will put my pharmacy hat on.

>> I was a pharmacist before I was a physician and in 1974 when I was starting pharmacy school that's when ibuprofen became available.

>> The United States.

So I do remember the history of ibuprofen and the rationale for being used.

It's a non-narcotic medication has been used since well since nineteen seventy four.

It works on the prostate gland in system and in doing so it can increase your likelihood for gastrointestinal bleeding not only from its effects on the prostate system but also it makes platelets less sticky.

Now as a psychiatrist I have to take that into account because when I know that somebody is taking ibuprofen I want to be careful not to give them a serotonin reuptake blocker such as Prozac, Zoloft, Paxil, Lexapro, Celexa.

>> These are medications that make platelets less sticky in a different way than ibuprofen.

>> So ibuprofen makes platelets less sticky this way and the serotonin antidepressants makes platelets less sticky.

>> Another put them together and you can have more incidences of bleeding in the stomach.

So that's one instance of where you can have trouble with long term ibuprofen use.

But a bigger incidence will be with kidney problems.

We heard about this back in the 80s and 90s where a lot of professional athletes they were knocking out ibuprofen left and right and medications similar to that and they ended up having kidney problems.

So now my understanding is there's recommendations not to take a medication like ibuprofen long term for the knee pain.

>> But hey, as being a person who's had a knee replacement myself, I know what it's like to have knee pain and I know how it can keep you awake at night.

>> So I would recommend talking to your primary care clinician or perhaps your orthopedic specialist about some other options as a psychiatrist we often will think about knocking down as many birds with as few stones possible.

So when somebody is having difficulty with sleep due to knee pain we often think about a medication called gabapentin also known as Dareton.

>> It is a medication that will affect these little calcium channels in the body and by decreasing the firing of little calcium channels it will decrease pain.

But it also helps with sleep.

Gabapentin also will help somebody get into a deeper sleep.

So we like the fact that gabapentin can be used in that way unlike Ambien, Lunesta or the benzodiazepine medications like Xanax or Klonopin, gabapentin does not tend to have the propensity to get you to the point where you crave it or you want to use more and more of it.

>> Now there are a few people one study showed only two or three percent of the population who could be prone to getting in trouble with gabapentin and want to take more and more and they get a buzz off of those are the people for whom we don't want to use gabapentin and you generally don't want to use Gabapentin or Neurontin for people who are already on narcotics it can amplify the effects at the so-called mbewe receptor of the narcotic and cause people to get more of a high when they use narcotics.

So people typically even though gabapentin can help with pain, we typically don't use it with narcotic medications for that very reason now with immune receptors, gabapentin does not affect those MI receptors.

Narcotics do ibuprofen does not affect the receptors but narcotics do and narcotics do with those MUE receptors it will stimulate the receptors.

>> There's three different types of narcotic receptors that are most prominent the receptor receptors you want to stimulate those for the purpose of getting pain relief.

If you stimulate the so-called Delta receptors you will have a sense of joy and happiness if you block the kapa receptors you also can get some appetite suppression and some help with happiness.

>> So three different main types of receptors as a fourth type of receptor I think it's called the opiate like receptor number one.

>> There's not much known about that one so I couldn't tell you much about that one at all.

But there's different types of opiate receptors and they do different things.

Some of them want to block some you want to stimulate based on a condition at hand.

But ibuprofen will not affect the narcotic receptors, the opiate receptors.

Gabapentin won't either.

>> So when we're trying to help somebody to sleep who's having difficulty with pain in the knees by all means that will keep you awake at night and if you carefully and judiciously use ibuprofen under your primary care clinicians close observation it could be safe but just be aware that the stomach problem where you can have some difficulty with acidity in the stomach you can even have some trouble with bleeding in the stomach and the kidney problems could be an issue if you took high doses long term.

>> Now a couple of nighttime I don't know if that's a problem or not but talk it over with your primary care clinician might want to check your kidney tests every now and then to make sure that's doing OK and also look at what are the medication you might be taking because if you're taking medications that otherwise can affect the kidneys or the could be a factor in itself in using those with ibuprofen.

Thank you for your email.

Let's go to next caller.

Hello Benjamin.

>> Welcome to Matters of Mind.

Hey Doctor.

How are you doing?

Hi Benjamin.

I'm doing OK.

Thanks.

OK here's my question.

Oh you were talking about ibuprofen and things regarding the knee and I actually was taking a leave like religiously for about two years when I would go play ball.

You bet and yeah and I didn't really think anything of it and I just felt like down the road it might have been hurting certain areas of my kidneys and things and then I'd switch to a joint type of pill which I don't know if that I take three of those every night and I've been taking those for two or three years.

Is that all going to be down the road going to cause some pain and in a psychiatric sense is it going to affect some neuronal level for the brain?

And I'll just let go with that.

>> Thanks so much, sir.

I'm glad you added that last part there, Benjamin, because I remember I'm a psychiatrist.

I'm not an orthopedic specialist but I want to try to stay in my lane here in Tromsx terms my discussion.

But if you take ibuprofen, if you take a called a nonsteroidal antiinflammatory agent, will it affect the brain detrimentally long term?

>> Probably not.

That's the good news.

As a matter of fact, there's some speculation out there and it's a very speculative that some people have in increased inflammation in their body when they get depressed.

This is where we in psychiatry have talked about this.

There's been studies done on these called so-called insets or nonsteroidal antiinflammatory ages for some people with depression the problem is they haven't worked so far.

But we thought several years ago that we could check this particular chemical called a C reactive protein, a CRP C reactive protein is an inflammatory protein that increases in the state of inflammation.

>> We thought that, you know, some people have increases in their state of inflammation.

>> Maybe we could treat them with an inset maybe like ibuprofen or Aleve like you mentioned Benjamín, but they didn't seem to work out.

So we probably need to go a different direction there.

So from a psychiatric standpoint, I wouldn't speculate that a nonsteroidal antiinflammatory agent would be detrimental to the brain.

You have to think about the rest of the body and that certainly applies to the kind of dosage and duration that you take.

Medications are kind of like radiation with radiation in and radiotherapy.

You know what you think about the dosage, the higher the radiation, the more dangerous it can be and the longer duration of the radiation, the more dangerous it can be.

Dosage and duration are important for radiation.

Dosage and duration are important for medications as well.

So we want to keep the dosage to a reasonable level and hopefully in the case of nonsteroidal antiinflammatory agents like Ibuprofen, Aleve like you mentioned, that wouldn't be a problem if you took them at a low dosage for a long duration or a higher doses for a short duration.

>> So you want to always balance that out.

But from the brain's perspective they don't seem to be detrimental from what we can tell so far.

>> Benjamin, thanks for your call.

Let's go our next caller.

>> Hello Michelle.

Welcome to Mars The Mind Share.

You want to know about the effects of KBD gummies CBD gummies have CBD in them.

>> Obviously they are readily available and CBD is a medication plant based medication that we have to consider has a lot of interactions with a lot of other medications.

So what I'll tell people show is if you're going to use CBD, don't use any medications for me.

>> Don't even think about using medications for depression or anxiety.

There's so many interactions that can occur between CBD and various other medication.

>> So with CBD in the purest sense CBD without all the extraneous type of chemicals sometimes that are added to it, CBD in its purest sense can have some good effects by itself if it's working for you and it's cost effective for you and it's affordable, that's up to you in terms of how you use that because I've actually seen some beneficial effects of CBD in its purest sense.

>> However, it has a lot of interactions with other medications.

>> In other words it does not play very well in the same sandbox with psychiatric medications.

>> You don't want to use them together because you're going to get some medications.

It it'll be at a higher level.

Some medication will be at lower levels.

We call that a pheno conversion where with pheno conversion you have the enzymatic breakdown of medications affected by other chemicals and in the case of CBD as a chemical it's affecting the enzymatic breakdown of lots of other medications for anxiety, depression, mood stabilization and so forth.

So we strongly discourage the use of CBD with any psychiatric medications.

>> So that's kind of where we are with CBD.

It's not as dangerous as THC from what we can tell on the THC as I mentioned before and cannabis is tetrahydrocannabinol Dayal that's the type of chemical that suppresses the brain growth and can cause you to have a possible greater likelihood of psychosis if you're a younger adult with CBD in the purest sense if you can get pure CBD not thought to be as dangerous and damaging but it does have a lot of drug interactions overall.

>> Shalal thanks for your call.

Let's go to our next email.

>> Our next email reads Deardourff over how does caffeine work?

Is it as addictive as nicotine?

>> Caffeine has some addictive components.

Ask anybody who's who drinks a pot of coffee every day how they feel around mid-afternoon and starting to wear off so caffeine can be addictive for people.

>> It can be physically addictive or it can cause you a headache shakiness.

You can feel real irritable if you don't have it you can feel really tired sometimes it does have that component but here's how caffeine works.

It kind of works in a different way.

The nicotine nicotine will go right to the pleasure center of the brain.

>> It's called the nucleus accumbens right smack in the middle there and it helps fire out dopamine.

So Nick of his caffeine nicotine makes you feel happy, motivated, energetic helps with the concentration by firing out all those dopamine directly by going to the nucleus accumbens caffeine on the other hand works a little bit differently.

>> Caffeine makes the brain think that you have extra adenosine now what adenosine is if you remember your high school biology ATP is the fuel of the body and fuel of the brain and ATP breaks down to ATP that now stands for adenosine.

>> So adenosine is kind of like the fumes of the energy.

>> So it's kind of like the exhaust fumes of your energy in your body.

So as you go through the day adenosine gradually increases kind of like the exhaust fumes of the energy in the body.

>> So as adenosine goes up and up and up it makes you more and more tired.

You have some trouble concentrating and thinking now you might get a little bit of a surge there.

>> It's called a circadian rhythm in the mid-afternoon where you feel like you get a second wind but as the day goes on it's called a homeostatic rhythm.

>> The homeostatic rhythm is primarily due to you're getting more and more tired as the day goes on because adenosine is gradually increasing.

>> Caffeine in the brain mimics the effect of adenosine words in the brain caffeine will get in the way of adenosine, block the adenosine receptors and offset that Ferdy fatiguing and tiring effect of adenosine.

So in the brain caffeine and decene look the same but adenosine will make you tired when it goes to the receptors for adenosine.

>> Caffeine goes there knocks adenosine off makes you not so tired now what happens in the long term downstream that will increase dopamine.

>> So if you block adenosine receptors with caffeine you downstream will increase dopamine because when you have more and more adenosine building up dopamine goes down ,down, down.

>> So as the day goes on you feel more tired.

You have a hard time concentrating 100 milligrams, maybe 80 milligrams of caffeine will knock some of the adenosine off all of a sudden.

>> Yeah, more energy and get up and go.

>> But I mentioned dopamine.

Dopamine is what causes people to get addicted and if you use more and more caffeine as the day goes on and you're drinking more than the equivalent of two or three cups of coffee, we're talking maybe 300 maybe 400 milligrams a day of coffee.

>> That's where you can have trouble 300, 400 milligrams of caffeine that's in two or three cups of coffee.

That's where you can get in trouble with needing more and more caffeine to give you energy and get up and go because you're indirectly affecting dopamine and that is where caffeine and higher and higher and higher doses can cause you to have difficulty with a little bit of addiction .

>> In the last thirty seconds I'm going to answer your question didn't Denise welcome to the mind that you asked medication changes don't seem to be helping.

What can you do to alleviate severe anxiety and depression?

>> I'll give you my twenty second answer on that, Denise number one, make sure you have the right diagnosis.

Have your clinician reassessed what's going on?

Look at medical reasons or psychiatric reasons even those social reasons try to figure out what's causing that anxiety and address it directly then medication changes can be made accordingly.

>> Denise, thanks for your call.

Unfortunate time for this evening.

>> If you have any questions that I can answer on the air concerning mental health issues, contact me through the Internet at Matters of the Mind at WFB dot org.

I'm psychiatrist Jeff Oliver and you've been watching matters of the Mind on PBS Fort Wayne, thanks for watching.

>> Have a good evening.

Good night