>> Good evening.

I'm psychiatrist Jay Fauver live from Fort Wayne , Indiana.

Welcome to Matters of the Mind .

>> Now in his twenty second 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 Fort Wayne by dialing 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 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 a dot org that's matters of the mind at WFYI dot org and I'll start tonight's program with a question I recently received.

>> It reads Dear Dr. Farber, my grandmother is starting to have some memory loss and I'm worried it could be dementia or Alzheimer's.

Could you explain the difference between the two diseases and the symptoms, the first symptoms of each?

Well, dementia basically is a broad category and Alzheimer's is a type of dementia.

So it's like describing an automobile mothers different types of automobile the same way Alzheimer's dementia is a type of dementia that other types of dementia can be vascular dementia which is related to strokes.

You can have Lewy body disease causing dementia where people have Parkinson's symptoms not uncommonly and they will have memory difficulties from that.

But the most common types of dementia will be Alzheimer's dementia and vascular dementia.

>> In both cases you can have difficulty with short term memory loss, especially with Alzheimer's dementia.

>> People often initially will have difficulty with geographical dementia and the reason for that will be the side part of the brain over here is the part of the brain this kind of a memory center of the brain and that's where your geographical Oriente will occur.

So that tells you how to get to the grocery store and that tells you how to get walking down the neighborhood hood and remember your way back things like that.

And this is the part of the brain that starts to shrivel up when people have Alzheimer's dementia.

>> It's also very sensitive to the effects of alcohol.

So if people especially women drink excessively over the years it'll shrink up that area and that's why women are so much more prone to having difficult with alcohol related dementia because not only will alcohol be very toxic to this part of the brain that women tend to have only about one third of the enzyme in their stomachs and livers that break down alcohol.

So when women have two drinks it's like a man having six drinks so women are more sensitive to the effects of alcohol specifically on that part of the brain right there as women go through menopause, estrogen drops estrogen is somewhat protective on the memory center of the brain.

So as estrogen drops you have less protection for the memory center of the brain.

That can be a factor too.

But early on people can have difficulty with loss of geographical orientation then short term memory will be a problematic.

People have difficulty recalling how to name different things and that's why people with Alzheimer's dementia will become less talkative and they become more withdrawn because they just can't get the words out with conversation and sometimes they appear to be more sullen and more depressed .

There's a lot of factors involved with Alzheimer's dementia.

Age is the number one risk factor.

As we get older we're more likely to have trouble with our memory.

But other factors can include having a genetic risk of an apolipoprotein E4 versus an E3 or two Geno type.

>> So some of it is genetic head injuries can be a factor.

High blood pressure, diabetes and depression are all medical reasons why people can have Alzheimer's dementia and now we're realizing that sleep apnea is a factor in causing dementia.

Maybe bring it out being a factor with it.

>> So Alzheimer's dementia is a type of dementia versus vascular dementia which is different type of dementia where people will have difficulty with strokes and as they have a stroke they have the stepwise decrease and deterioration of their of their memory and attention span.

>> So with each stroke they abruptly have a fall off of their difficulty, memory and concentration and attention span with Alzheimer's dementia is a very gradual process occurring over the course of several years.

Thanks for your email.

>> Let's go to our first caller.

Hello Donna.

Welcome to Matters of Mind.

Hi.

Hi.

>> My question is I actually am inpatient in rehab right now although my asthma is acting up and I'm in the hospital so I had a lot of time to write down some questions and I was curious as to is addiction really hereditary?

>> It really is Donna.

Now you know people will always debate well gee if somebody didn't start on alcohol and try a narcotic or try cocaine , they wouldn't have gotten addicted.

OK, I get that.

But put that aside.

Some people are more prone to having difficulty with getting this little part of the brain called the nucleus accumbens.

It's right smack in the middle of the brain.

There is the brain looking at you there in the middle the brain is the nucleus accumbens and that part of the brain for some people upon exposure to alcohol, upon exposure to opiates or narcotics, they can get a specially good feeling.

>> And I always warn adolescents and young adults if they feel especially good and euphoric and happy when they drink alcohol for the first time.

>> Those are the people who are more prone to having problems.

So the bottom line is, Dana, we're wired differently and some of us have this genetic wiring where we're more prone to getting into trouble when we try different substances like that.

Now with narcotics quite frankly, Don, it can be very innocuous.

You can have an injury of some type and be prescribed a narcotic and maybe the doctors give you 30 days worth and you only need three days worth.

The next thing you know you're just going to continue to take them and they can make you feel happy and give you this sense of emotional bliss.

So with narcotics sometimes you know it's something that the physician is we physicians have inflicted on people.

>> We've learned that over the past 20 years.

Donna, I remember 20 years ago where clinicians were being encouraged to prescribe abundant amounts of narcotics because the perception was they were safe.

Yeah, if you took too many of them you could stop breathing and die.

But generally they were considered to be safe overall and not addicting one and the long acting stronger, more potent narcotics were thought to be the safest.

So OxyContin which is a very popular narcotic back in the nineteen was taken off the market a few years ago because it was initially thought to be impossible to abuse while it was readily abused and was highly abused over the course of time.

>> But OxyContin is oxycodone and oxycodone is a strong form of codeine basically and it was something that was highly abused.

People who will abuse narcotics will often get this sense of emotional bliss.

They'll have this happiness, this feeling of contentment that you can't get naturally in a lot of cases and if you already are prone to depression you'll really get a profound effect from that.

But if you have a genetic propensity to having that problem, Donna, yeah, it can run in families now.

>> Another factor that leads to addiction kind of running in families will be the pattern of abuse.

So if you grew up in a family where people readily drank alcohol and alcohol, ran freely in the family, you're more prone to pick up that particular habit.

So yeah, there's an environmental predictor where if it's considered to be something is very acceptable to drink alcohol or use narcotics or use drugs of abuse.

Yeah, you're more prone to try it and do it and accept it.

But there is likely a biochemical and an actual physically genetic factor that will lead to addiction for a lot of people has to do with that nucleus accumbens and the brain the pleasure center of the brain and we all often call it it's a part of the brain that releases this chemical called dopamine and and in doing so it can give you a sense of joy and happiness.

And if you go back to that substance and you keep getting that feeling again and again and again, well generally you need more and more of that substance over the course of time to get the same effect and that's a phenomenon called tolerance.

That's the technical term is full access but with tolerance it means you need a higher and higher amount to get the same effect in the case with narcotics you'll go higher and higher on the dosage to get the same emotional effect but eventually will get to that cap where you're you stop breathing and that's why it's at least to the tragic deaths for a lot of people who use narcotics they've got to keep chasing that high to go higher and higher.

>> But that ceiling for the dosage that you need to shop to stop breathing that doesn't go higher.

That stays put so you'll get up to a point where you just stop breathing and then you die with with the narcotics cocaine , methamphetamine, those kind of substances.

>> Anybody can feel euphoric, happy and cheerful and energized with those kind of stimulant medication so that can occur with anybody but the key with any addiction, Donna, is to encourage people not to start them, not to try them because if you experiment with those kind of things you don't know how your brain's going to respond.

And we see this with schizophrenia not uncommonly where people start to dabble with the use of marijuana and the marijuana that's being used nowadays is a very high potency marijuana several times higher than what it was just twenty years ago, even 30 years ago.

So when we talk about marijuana today we're talking about hybrids that are much more potent and they're more prone to making people well, psychotic and mentally ill in the state of Colorado which is the first state to recreationally legalize marijuana, there's a catastrophic outbreak of suicide in adolescents and young adults and it's associated with the use of marijuana in many cases.

So marijuana is something that we're seeing having a catastrophic effect on individuals, especially the children and young adults with their mental health .

>> Your brain still growing until you're 24 years of age.

Marijuana suppresses the white matter growth of the brain and decreases the ability for the brain to physically grow and that can affect individual's IQ, IQ are thought to be lower for these people who use marijuana as adolescents and young adults as they get into the 30s compared to what they would have been had they not used marijuana.

So marijuana Nakata takes stimulants, alcohol these are all drugs of abuse and there can be a genetic component but again there's a behavioral component where we really have to educate people that these are medications and the medications that shouldn't be experimented with as a as a young adult and as an adolescent you need to be very, very careful in starting those and being aware that they can cause problems on down the line, especially if you have a genetic history in the family of those kind of problems.

Donna, thanks for your call and I wish you the best with your rehabilitation.

>> Let's go to next caller.

Hello Debbie.

Welcome to Mars the mind.

Well, this is kind of on the tail of what you were just speaking about and I agree it should you know all these marijuanas types that are certain it's not regulated I'm talking about medically you know, glaucoma patients were given medical marijuana because it does help.

I worked in a renal unit where it stimulates appetite.

I'm talking about control not put in the streets.

There is hybrids but when you've got a doctor controlling the substance, they're finding that it does help less effective body than alcohol.

You know, Purdue was sued.

They went out of business because doctors over prescribe that knowing it was addictive drug.

Let's be honest, it's been in the news for years and so why is that not a something that doctors should consider if it's medically regulated?

>> You referring to medical marijuana?

I'm afraid to doctor like you're saying kids using it and this and that.

Yeah, well, you know but there's finding out if you do research that doctors if they medically you know, control it that it does help things like glaucoma, you know, cancer patients that appetite's have, you know, weight and they want him to and it does a lot more less damage than narcotics and painkillers.

So why are doctors looking into known it shouldn't be a street drug.

>> It should be given to kids.

But why not medically regulate it?

It is medically regulated in some states.

>> The problem with the medical marijuana that we're seeing we first saw this in Michigan here in the Midwest a lot of people were obtaining medical marijuana for conditions other than the conditions for which it was originally approved such as glaucoma specific types of seizures.

Chemotherapy patients need the appetite's stimulation.

It can have unique features on the so-called endogenous cannabinoid system the brain and give people benefits in that way.

But that Debbie, what we found in down here in Indiana is a lot of people going to Michigan with their medical marijuana card not using it for the purpose of medical purposes.

They are getting it for recreational purposes.

So yeah, you might think well doctors were regulating it but it's kind of like with OxyContin as you mentioned now when you mentioned Purdue that's not Purdue University of which I'm an alumnus Purdue University did not manufacture OxyContin.

That was Purdue Pharmaceutical Company which is a whole different type of company.

It has a similar name but OxyContin was marketed quite heavily back in the 1990s as a long acting potentially safe narcotic because it had this coating the shell on it that thought to be well preventing it from being abused and getting a high blood level early on.

Well, people readily realized all you had to do is just crack that shell with a hammer and next thing you know you had immediate release oxycodone at that time.

>> So OxyContin you know back in the nineteen nineties early 2000s, some physicians such as me myself we're getting chastised because we were not prescribing narcotics at that time for depression and it was a fairly well advocated that if people had any pain at all it's considered the fifth vital sign.

But if people had any pain at all and had depression it was just kind of a a no brainer you're supposed to give them narcotics because of narcotics had helped them with the mood.

But we readily found that wasn't the best way to go.

I remember Goman twenty five years ago insisting that I give him Percocet which is a potent narcotic for the purpose of relieving his depression.

And he said that some psychiatrist at well-known academic centers were advocating such practice.

So whether it be morphine, Percocet, OxyContin, these type of things he was insisting that that's what I should prescribe as a psychiatrist and if I didn't I was out of date and I was behind the times.

So as a physician you have to make that choice of what you want to do individually in a practice.

>> So as a physician you can decide if you want to prescribe medical marijuana and control it for your practice but you just have to be careful.

There's a tremendous diversion value with that kind of practice so people will obtain medical marijuana which is fairly highly potent.

It is controlled but people will obtain it and then use it for purposes other than the medical reason why it was originally approved by the state.

So with that being said, yeah, narcotics will indeed have antidepressant features.

Methadone is used by a lot of people for depression.

The problem with methadone it's a long acting narcotic but it can cause it to have that gradual tolerance over the course of time.

So they're studying the left sided piece of methadone right now it's called dexterous methadone dextra methadone is actually the left sided piece you'd think would be the right side piece by being called dextroamphetamin but it's actually the left side of the piece but the left side of a piece of methadone does not have the tendency for addiction.

It does not cause you to stop breathing as you take higher doses and it specifically will block this particular receptor in the brain called NMDA receptors and if you block NMDA receptors you can actually have an anti depressant effect.

That's how ketamine and ketamine will work as which we use for depression.

>> So they have legitimate antidepressant features within them but we have to figure out how to dissect the molecules themselves to be able to get the safest means of delivering those kind of medications while maintaining the benefit from them.

So with methadone well the thought is maybe just use the left sided piece of methadone and create an anti depressant just from that left side of the piece.

The same thing was done with ketamine which is also known as bravado.

Bravado has on the market now for just over two years and bravado as is ketamine.

It's the left side of piece of ketamine.

Ketamine has been available as an anesthetic since 1970 and it's a very safe and very effective anesthetic but it got used on the street again we used inappropriately but ketamine great medication for anesthesia but got used on the street I.V.

and people were going after the ketamine high with it and for that reason ketamine is highly regulated.

>> It started getting used for depression years ago IV and more recently like I said two years ago bravado was ketamine started being used as a nasal spray in a controlled environment where people use the nasal spray and sit for two hours after each treatment and then they're monitored over the course of time.

But as ketamine is four times the left side, a piece of ketamine as ketamine is four times more potent than the right side a piece of ketamine.

So that's why the left sided piece of ketamine is used for the purpose of using it as a nasal spray.

But the nasal spray itself of ketamine will tend to enhance and anti antidepressants effects so it can significantly and dramatically in some cases relieve depression for people who haven't really gotten the best response they otherwise would have received.

So ketamine is bravado has been a means of helping somebody with a refined product that has been on the market for a while.

So whether it be ketamine and you refine that to get a different formulation where you can use it by nasal spray whether you use a narcotic and try to refine the actual narcotic itself to make it safer and possibly more effective, that's what's being done in the labs right now to try to develop newer antidepressant medications.

Historically, Debbie, for depression the main emphasis was norepinephrine, dopamine and serotonin.

>> That's been those have been the three chemicals that have been really chased upon for the past three decades and now the focus is more on mechanisms of action outside of those three chemicals and trying to help people with other means of treatment and the same way goes for medical marijuana.

>> I think over the course of time there will be components of cannabis that will be used to treat people for depression.

The biggest problem right now with medical marijuana is people diverting it and getting in the hands of people who shouldn't be getting it and that includes people under 24 years of age.

And again, there's exceptions for Debbie.

There's medical exceptions for people as you mentioned who have particular types of seizure disorders difficulty with appetite while under chemotherapy they're having difficulty with glaucoma that haven't been successfully treated with traditional medication.

So with those exceptions in mind, we just need to keep in mind that it's been catastrophic to see what's happened in Colorado from a recreational legalization of marijuana that's occurred about nine years ago.

So it's something that we need to look at is as a country to try to really think twice about recreationally legalizing marijuana for that reason.

But as you'd mentioned, the can have some medical benefits but we have to be using those those type of products in a very, very controlled environment.

Perhaps the people need to come into the doctor's office and sit there like we do with us ketamine and use the medical marijuana in monitored type of environment with us ketamine patients can't use that on their own.

They have to come to our office.

They need to use the spray.

They sit there, they're monitored for two hours.

Then they leave.

We don't give them the devices of us ketamine or bravado and send them on their way and that's what's happening with medical marijuana right now.

People are given the medical marijuana and sent on their way and they often in many cases were diverted or use it inappropriately.

>> Debbie, thanks for your call.

Let's go to our next e-mail our next e-mail reads There it is.

>> Dear Dr. Farber, what's the best supplement for anxiety?

I get impulsive and irritable really easy and don't want to take a prescription medication for anxiety.

>> You know, there's an active ingredient in green tea called Elfie.

Anything else the is something where people will take capsules of it of doses of two hundred milligrams three times a day or so and you might think well gee why can I just drink a whole bunch of green tea?

Well you'd have to drink about twenty cups of green tea a day to get that dosage but healthy and I've seen that do a really nice job for a lot people.

I haven't been that effect that excited about kava kava which is a ti it just seems as not really give people the benefits that it was originally proposed to cause more recently in Acetylcysteine in a sea if you do not have a sulfa allergy NASSI in Acetylcysteine is a supplement that doesn't really nice job perhaps at five hundred milligrams twice a day initially going up to a thousand milligrams twice a day but after a week or so it does a nice job in terms of leveling leveling off the edginess that a lot of people will experience .

You mentioned having some difficulty with impulsivity and irritability so maybe it could help with that.

What it's doing it's dampening down the excessive effect of glutamate glutamates and excitatory chemical in our brain.

We all need it.

>> We all have it.

But if you get too much glutamate in your brain you can have depression, irritability, moodiness, even seizures and psychosis if it gets really excessive.

>> So what in a sea does as a supplement at a thousand milligrams twice a day it helps the brain clear out the excessive glutamate in doing so can help with irritability.

>> So as a fairly inexpensive add on medication to other prescription medication we'll use in AC but you could try that by itself for the purpose of helping with anxiety, irritability.

It's been used for impulsivity.

It's been used for gambling disorders.

I believe it's that an innocent has been used for people who are tend to pick their skin and they tend to have difficulty with feeling like they have to pull their hair out literally called trichotillomania and I Nossiter and Nasya been used for those purposes before.

So if you want to try a supplement it's fairly inexpensive in AC or I mentioned before LCN and Elfy inane for many people gives them will give them a calming effect and they'll use it even at bedtime sometimes a bedtime medication has been around for a long time as melatonin obviously melatonin is like a puff of smoke.

>> It'll work for about G three or about 30 40 minutes tops and then it gets out of your system.

It's something that tells your brain to go to sleep but if you power through that time period and you don't go to sleep you might stay up longer.

But melatonin basically gives your brain a very brief chemical signal to go to sleep.

So that could be another option if you're having trouble sleeping as long as well as the irritability and impulsivity.

>> Thanks for your email.

Let's go to next caller.

Hello Phillip.

Welcome to Matters of Mind.

Yeah, I have a lot of things I hi Zezima.

>> Some wear off after time of period.

>> All of it depends on what kind of anxiety medication it is if it's a benzodiazepine medication like Xanax, Klonopin, Ativan, Valium.

Yeah they can and we're also off will be where you need to take a higher and higher amount to get the same effect.

>> I'm always emphasizing to people, Phillip, that when you're being treated for anxiety you still want to have some anxiety that's there if the situation calls for a lot of people will chase after their anxiety or they want to just extinguish all anxiety.

>> Well, think about it, Phillip.

If you've got something to do if you've got a deadline, if you're driving in busy traffic, you should be a little bit anxious.

>> Anxiety fires up our brain to concentrate and keep our minds on things so you don't want to extinguish all anxiety.

Anxiety helps you to get motivated to get things done and keeps you sharp and keeps you alert.

And where people get in trouble, Philip will be where they try to chase after the relief of anxiety and they take higher and higher and higher amounts of medication.

So benzodiazepines yeah from biochemical standpoint they just give you less effects over the course of time and a lot of cases there are other medications antiepileptic medications we use for instance like Gabapentin Lamotrigine I mentioned before Lamictal these are medications that give you less of a likelihood of having that tolerant effect over the course of time the serotonin medication Lexapro, Zoloft, Paxil, Celexa these are medications that will give you an emotional damping dampening in effect where you'll have a little bit of a doubling in excessive emotions.

So it's kind of a backdoor way of helping with anxiety.

>> They typically don't wear off unless you go higher and higher on those doses inadvertently as well.

Chasing after anxiety actually might be normalized so those type of medications don't typically wear off then.

>> Philip Philip, thanks for your call.

Unfortunately I'm out of time for this evening if you have any questions that I can answer on the air you may write me a via the Internet at matters of the mind all one word at WSW Edgard I'm psychiatrist Fauver and you've been watching Matters of the mind Godwill and PBS .

>> Well I'll be back again next week.

Thanks for watching.

Goodnight