.

>> Good evening.

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

Welcome to Matters of the Mind now and its twenty fourth 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.

>> PBS for Wayne by dialing in the Fort Wayne area (969) 27 two zero or if you're calling any place else coast to coast you may dial toll free at 866- (969) 27 two zero now on a fairly regular basis I am broadcasting live every Monday night from our spectacular PBS 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 a via the Internet at matters of the mind all one word at WFB org that's matters of the mind at Edgard.

>> I got several emails this past week so let's get to them.

The first email reads Dear Doctor Favorite Is it possible to be on too much lithium?

>> I am taking nine hundred milligrams at night.

>> Good side effects make it appear as if I am having a stroke or Parkinson's disease.

>> Yes you can be on too much lithium.

Lithium is a salt and it's in the same column in a periodic table as potassium and sodium so you can get too much lithium and we have to be careful about getting too much lithium because your kidney will process the lithium in a similar manner.

So what'll happen is that if you get too much lithium you can get shaky, you can have nausea, you can have diarrhea and you can have difficulty with a headache and you can feel pretty terrible getting too much lithium about 120 years ago there was lithium in certain soda pops and when people would drink too much of the soda pops they'd initially feel mellow but then they'd get physically sick.

>> So lithium was taken out of the old soda pops around in the early 20th century lithium was found to be effective for Mujtaba zation in the 1940s and it's been used since that time as a salt not only for mood stabilization but it can be used at small doses to actually decrease suicidal thinking so lithium is useful for a lot of different reasons.

Number one, it can provide mood stabilization and kind of level out your mood from having unnatural highs and often followed by unnatural lows and it can be used for the purpose of kind of giving you a decrease in likelihood that you'll be thinking about suicide or acting suicide.

>> Now for mood stabilization it can be used at nine hundred milligrams a day but a lot the current thinking is perhaps that would be excessive if you go higher on the dosage you can get a higher blood level on lithium and that can be more anti manic if you're in a manic episode.

It's thought for some strange reason when somebody manic when they're not sleeping they're talking a mile a minute.

They're racing in their thoughts.

>> They're socially intrusive, they're impulsive when they're manic they need more lithium because the kidney's process lithium faster when you're manic so you'll have lower blood levels of lithium while you're manic.

So people often need these higher doses of lithium when they're in a manic phase but then when they start coming out of it and they level out or maybe even go into a little bit depression, they need lower doses of lithium.

So it's important we watch lithium levels or we can watch for a particular side effects people might experience.

So you might be on the same dosage of lithium for quite some time and all of a sudden you're feeling kind of sickly from it.

It's because of the blood level might be gradually creeping up.

What's a good blood blood eleven point six ML equivalents per leader is often considered to be a reasonably good blood level on lithium.

>> Some people go to point nine when you get up to about one point one mil equivalent per liter you can have more side effects and if you go higher than that you'll certainly have some side effects and again you can have diarrhea, upset stomach headache shakiness.

>> That's why people sometimes look like they're having a stroke or even having Parkinson's symptoms because they can have difficulty with balance when they get to the higher doses.

So obviously it's not a pleasant feeling for people to encounter and some people will actually say they don't want to take lithium because they encounter those side effects.

Well, it's because of too high of a dosage in too high of a blood level you get too high or low dosage in too high a blood level that can cause you to have problems.

Now sometimes you can have higher than expected blood levels if you take so-called nonsteroidal antiinflammatory agents let's say you have some aches and pains and you take Advil, Motrin, you take Mobic.

If you take those kind of medications for aches and pains you can increase a lithium blood level by about twenty five percent.

Also if you take certain water pills to blow off excessive water, keep in mind that lithium is processed in the kidneys in a similar manner as is sodium.

Well it'll compete with sodium and you can sometimes have higher than expected blood levels of lithium if you're taking a water pill that's also processing sodium.

If you go in a high sodium diet, lithium levels will decrease.

>> If you all of a sudden go in a low sodium diet, lithium levels will go higher.

So we always advise people to stick with their usual diet.

If you are sweating a lot and you're having a lot of difficulty with working out and getting hot outside especially in the summertime, just make sure to drink plenty of fluids and you can always drink fluids with electrolytes preferably sugar free drinks that would have electrolytes in them and that would allow you to replenish some of the sodium imbalance that you might be experiencing when you're sweating heavily.

>> But people sometimes have the misperception they can't sweat if they're on lithium you can sweat it just that you need to replace the fluids and the electrolytes if you are sweating.

>> Thank you for your email question.

Let's go to our first caller.

>> Hello Leo.

Welcome to Matters of the Mind.

Yes, hi.

I just had a brief mental health question.

Sure was.

Yeah.

What is technology's impact on mental health for teens?

Because you know, as we see like teenagers specifically and young adults, they're being negatively impacted by social media and technology.

So I just wanted to ask what could like possibly be the cause of this like is it social media or toxic people or is it the screen time or just maybe elaborae on that a little bit.

>> I think you've elaborated great really well right there, Leah, because you're exactly right with social media and with technology you have to be careful about the screen time now a lot of our books nowadays are on our tablets and our smartphones and all these different things.

>> So we're reading off of we're reading our material not out of paper books anymore but off of the screens and that's OK as long as you're using your screen time in a productive manner.

So it's very important to monitor adolescents on what they're what kind of use of the social media and their technology they're currently generating their time in terms of viewing those type of things .

Back in the old days if people needed to research a topic they would go to a library.

They'd spend hours in a librarian an entire afternoon just to research a few topics excuse me nowadays they can actually go to social media, you can go to different search engines and you can research a topic very, very quickly now that has a lot of potential benefits.

>> It's like an automobile an automobile mobile is very efficient in transportation and getting you where you need to go.

But it does have some hazards and some dangers with it.

So with social media you can easily easily get distracted and diverted into in terms of your original intention and what you were studying and it consumes a lot of time and I often recommend to people if they go to social media or if they're using screen time for recreation, set a time limit on it and be very specific on what time you're going to go off of it because it can consume your time and make you hyperfocus so long that can actually make you stay on it longer and longer and longer.

Now there's a lot of aspects of social media that can be problematic.

Social media is something where people are often going for the likes and it's a different phenomenon in a real natural social situation because if you're doing things and saying things for the purpose of trying to get approval from other people, it can avert your real focus for the healthy type of social relationships you should really encounter.

So if people are involved in social media, they're involved in technology often encourage them to have real face to face interpersonal relationships.

Now the covid restrictions we endured for about a year and a half almost two years significantly blunted the ability for adolescents to socialize and a lot of people in the mental health field were recognizing that the adolescents and especially my concern was the small children because they weren't picking up social cues, they weren't having natural interactions.

They were interacting more by the Internet and when they did in Iraq face to face they had masks on with masks.

It was actually literally and figuratively leaf masking the expression on people's faces that we need to be able to interpret what they really mean.

>> So when people were wearing masks, small children, adolescents especially couldn't pick up on the facial expressions that they were learning to be able to socialize.

You do the best you can looking at the eyes and listening to the intonations of the voice but it's sometimes very difficult to pick up the full spectrum of of of the facial expressions when people were wearing the masks so that was another factor as well during the social restrictions.

>> So it's important that you monitor the amount of time that somebody is on social media.

You might need to as a parent block certain sites.

It can be somewhat toxic to the interactions and what you'll often find is with an adolescent when they're exposed, when or spending so much time on social media or on technology itself, they become more awkward in social interactions and it's important that we continue to place adolescents and children in social interactions, real life social interaction so they can still learn how to deal with people on a face to face basis.

>> Leah, thanks for your call.

Let's go to our next caller.

Hello, Mike.

What can the mastermind like you want to know about how does Levodopa help with Parkinson's health and mental health ?

>> Levodopa is a precursor to dopamine so it's a building block to dopamine and when you think about Parkinson's disease in the middle of the brain is called the nigra, the nigra strata and the the nigra strata is a little piece of the brain that pumps out dopamine and it's all with Parkinson's disease.

You have a decreasing volume of this particular area of the brain all the way down to 40 percent or even 30 percent of what it would be expected to have a decreasing volume of the dopamine production area when that happens, well, you have difficulty with tremor.

You have trouble with stiff movements.

You might have some drooling in some cases people who often have difficulty with facial expression that's all related to Parkinson's disease.

Well, levodopa does get across the blood brain barrier and it will help produce a little bit extra dopamine and that thereby will decrease some of the symptoms of of Parkinson's itself.

Your second question is does aerobic exercise help with mental health and opium production?

I often bring up this study.

It was done at Naperville, Illinois High School in the late 1990s in Naperville High School they had a group of middle school and high school young men and women who would work out and do aerobic activity.

They'd run on the track for thirty minutes to an hour at the start of the school day.

So in other words they're having some almost like physical education starting the school day and they would wear straps around their chest to monitor their heart rates and the idea was not to compete with each other.

>> The idea is just to keep track of how you're doing with your own heart rate and your overall physical health because a decrease in heart rate is an indication that you're getting in better aerobic shape and it was found that these adolescent middle school and high school age kids they were exercising in the morning and they had an improvement with their academic scores, some of the best academics in the entire world based on standardized testing and they also appeared to have better mental health and they've continued this practice over the course of the years and it was thought that the reason that they had improvement with academics and their mental health was because of they had an enhancement with dopamine as you had mentioned, but they also had enhancement with this particular chemical called brain derived neurotrophic factor which is like the brain fertilizer and with brain derived trophic factor when you exercise it actually front fertilizes this front part of the brain that's important for thinking and concentrating and and keeping your mind on things.

>> And it was noted that the kids that were voluntarily exercising and it was voluntary for them even though you'd think young adolescents would absolutely despise getting up a little bit earlier than expected, they actually look forward to it and they apparently by reports drank less coffee and that was noted by the maintenance people in the school saying that there were fewer coffee cups and the trash can in the morning when they had this exercise routine going every morning all they did was they ran for about 30 minutes to an hour first thing in the morning and that's what we often will recommend for people.

We recommend that people exercise about twenty minutes to thirty minutes ideally in the morning twenty to thirty minutes of exercise in the morning actually fires up the brain and actually helps increase the functioning the blood flow from the heart.

It's thought that you when you exercise you get this increased atrial protein factor that actually decreases the heart rate pounding and the beating in a good way.

So as you getting better aerobic shape your heart rate rhythm will be more normalized and your heart rate will slow somewhat and it's thought that an ongoing exercise especially in the aerobics sense will help you with that now often tell people if they're having trouble with anxiety, the best thing they can do is resistance training is called anaerobic exercise but resistance or weight training is actually better for a lot of people when they're having difficulty with anxiety itself.

But aerobic exercising whether you're running your bicycling, you're on an elliptical machine that kind of exercising it's increasing your heart rate can slow down your heart rate in the long run in the long run and actually help you with being able to concentrate allow you to feel sharp as the day goes on if you have worry and anxiety and your tense weight training or resistance training can actually be preferential for you.

And either way 20 or 30 minutes in the morning, roughly five days a week can be fine.

Now you can bank some of your exercise and perhaps if you don't hurt yourself exercise for an hour or even an hour and a half to count for two or three days of exercise.

You hear about the people who are the so-called weekend warriors where they do all are exercising on Saturdays and or Sundays.

They can sometimes not get the same benefit because they're overtraining on those two days.

It's nice to spread out your exercise throughout the week and I always advise people especially if you are in a position where you have a big meeting you have to concentrate quite a bit.

It's best to exercise in the morning for about twenty or thirty minutes.

Doesn't take very long.

Just try to get some exercise in first thing in the morning and it kind of wakes up the brain something as simple as doing five or ten burps.

A lot of people in the exercise field no a buppies arts where you get you jump up and down and you are on the ground and you're doing a push up then you pop back up and you get back on the ground to a push push up then you pop back up.

>> Those are called Buppies and they can wake you up actually much more efficiently than coffee first thing in the morning.

And if you do that for a few times it kind of wakes up not only the body but the rest the brain as well.

Thanks for your call.

Let's go to our next e-mail.

Our next e-mail reads Dear Dr. Fauver, could you please give us a little history of mental health care in America?

>> I've seen some old asylums and prisons.

I think I've seen some old asylums and you're mentioning the prisons currently are being used for as as mental facilities.

>> So here's what's happened in the past hundred years.

One hundred years ago you'd have the state hospitals, huge state hospitals would house five to seven thousand individuals with depression, anxiety, schizophrenia as we now know and they would work at the hospital.

>> They these patients would actually do farm work.

>> They'd take care of animals and they were trying to maintain productive lifestyles as the years progressed.

Well, we had medications like lithium come out as I mentioned earlier in the 1940s in the 1950s you had antipsychotics becoming becoming available so people were able to get more stabilized instead of staying in the asylums or the state hospitals for years in some cases they were able to be released in a matter of months and then that came down to a matter of weeks as time went on.

And currently with most psychiatric hospitals for instance, people will be stabilized within a matter of four to six days and they'll be discharged to outpatient treatment.

So the the focus for mental health in many cases has gone from long term inpatient stays at these state hospitals which it housed thousands of people were they'd stay for months if not years now to where they're having shorter length of stays and it was well meaning but unfortunately some people got left out and across the country you'll have some of the homeless people who have serious mental illnesses.

Some states have the ability to allow these people to get involuntary treatment.

I know it's very controversial but when people lacked judgment to take care of themselves, they sometimes need involuntary treatment as a means of getting medication to allow them to be able to think clearly enough to be able to make good decisions and not be impulse even be able to have a reasonable quality of life.

>> Some of those people do need a commitment and they can get long acting injectable medications.

>> So whereas a hundred years ago people might be in asylums now people are getting long acting injectable treatment for the purpose of having a better quality of life.

>> But the people who are getting left out are the ones who are homeless.

They're for whatever reason drug dropping through the cracks and they're not getting adequate treatment.

Those people unfortunately get themselves into trouble.

They unfortunately will incur some criminal offense and they get arrested and they end up in the jail system or even the prison system.

>> And it's thought that the Los Angeles County jail, for instance, is the largest facility for housing people with mental health issues in the entire country right now because in the Los Angeles County jail that's where a lot of people are arrested and taken to that particular facility and many of them have mental health problems.

So when you have mental health problems, sometimes you're more likely to do things and say things that get you into trouble and that gets you into jail overall.

So whereas 100 years ago those people might have been in asylums nowadays many people if they don't get on long acting injectable medications or they don't take their medications as as recommended, they might end up in the jail system because they've done things something they shouldn't have done.

>> Now what we try to do is get people stabilized to the point where they can think clearly enough, they can socialize with others and one of the more effective rehabilitation means for people with chronic mental illness in the 21st century will be this particular means of rehabilitation called the clubhouse the clubhouse is a type of world wide facility where people can go and they have a meaningful daily activities.

They have things to do and they have social relationships.

Many people in the clubhouse will go there throughout the day Monday through Friday typically and they'll get their GEDs if they not graduate from school and many times they'll be able to seek skills to be able to pursue employment.

And the whole idea is despite your having a chronic mental illness, you're still able to have a reasonable quality of life because you're able to socialize, you have meaningful relationships, you have things to do.

I've seen some people with chronic mental illness who are just thrilled when they got a and when they get an entry level job they're getting minimum wage but they get an entry level job but they have something to do.

People with mental health issues often are not lazy, lazy.

They desperately need some kind of structured environment to be able to maintain daily active work or socialization and the clubhouse environment allows people to have that kind of opportunity.

In the old days people would go into a psychiatric hospital.

They'd stay there for a few days, a few weeks they get stabilized.

Then they go home and kind of sit there at home having nothing to do and having nothing to do get used in a lot of trouble whether you have a mental health issue or not.

We all need purposeful, meaningful activity on a day to day basis and having nothing to do gets you into trouble and that's where people sometimes would medicate their anxiety or their boredom with alcohol or drugs of abuse.

And of course that just sets the cascade for them getting worse overall and sometimes that'll get them in trouble and involved in criminal activity.

So that leads to their getting into jail.

But the hope with mental health problems will be to keep people out of the jail or the prison environments and allow them to have some type of meaningful activity which would allow them to have a quality of life where they can socialize, they can have work and they can go to school.

They can do anything that anybody else would be able to do despite their having a mental health issue years ago if people had epilepsy and long time ago people had diabetes, they weren't expected to have an adequate quality of life.

They were kind of ostracized by society.

Now those people with diabetes and epilepsy have qualities of life that are no different than anybody else and we would expect the same with the medical condition of mental health issues.

>> Thanks for your question.

Let's go to our next question.

Our next question read your letter, Father.

I have been on antidepressants and in counseling for thirty years will I ever be off medication or will I need them forever?

>> I mentioned the analogy a moment ago with epilepsy if you have a head injury and you have a seizure you'll be on an anti antiepileptic medication maybe for six months to a year but then you might not need the medication after a year because your brain stabilizes and you haven't experienced further seizures.

>> The same can help with mental health issues if you've had depression, if you've had moodiness, if you've had anxiety and it goes on for prolonged periods of time, it's more likely you'll need a medication for the Depression, the anxiety.

>> So that's the bad news.

The good news is with increased productivity to your life with exercise, maintain your diet, maintaining social relationships, having purposeful meaningful activity on a day to day basis, your brain can actually well repair itself.

It can become fluffier.

>> I mentioned earlier brain derived neurotrophic factor which allows the brain to become fluffier and that decreases the likelihood of having ongoing depression or anxiety so you can recover from depression but it's more difficult to do so without medications the longer the depression has persisted again unlike similar to epilepsy, not unlike epilepsy where if you've had seizure after seizure after seizure you probably need to be on long term antiepileptic medications and if you've had ongoing episodes of depression or anxiety it's more likely you're going to need to be on the medications for anxiety depression.

So the best thing you can do is despite your taking medication allow your brain to continue to flourish by socializing, exercising, maintaining pleasurable activities, have a meaningful productive activities and relationships do the best you can working with the counselor and triumphs in terms of maintaining an adequate perspective on life .

And I believe I have another email question.

Let's go to our last email question last email question.

Let's see this we have one and last one there it is.

>> It reads dear to to favor how do you know if someone is getting enough sleep when you awaken in the morning you should feel somewhat refreshed and awake where you feel like getting up and you might think I'd never feel like that.

>> Well if that's the case number one, you might not be getting enough sleep.

Number two , you might have a condition called sleep apnea.

Sleep apnea is where you're having a blockade of air flow to your lungs thereby having less oxygen the brain throughout the night and that's often manifested by pausing in your and your breathing during the night but also by snoring.

So if you're not feeling rested the next day you might not be getting enough sleep and there's ways to measure that.

Thanks for your email unforced.

I'm out of time for this evening.

If you have any questions that I can answer on the air you may write me via the Internet at matters of the mind all one word at WFB ECG I'm psychiatrist Jeff Offer and you've been watching Matters of the Mind on PBS Fort Wayne God willing and PBS willing.

>> I'll be back again next week.

Thanks for watching tonight