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

Welcome to Matters of the Mind now and his 24th 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 you're calling 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 the shadows of the Purdue Fort Wayne campus.

>> And if you'd like to contact me with an email question concerning mental health issues that I can answer on the air, you may email me at matters of the mind all one word at WFB dot org.

That's matters of the mind at WFB Vague and I'll start tonight's program with a question I recently received the question reads A revolver what does impulsivity mean?

>> Impulsivity is basically where an individual is doing something and saying something that they ordinarily wouldn't do or they might later regret.

>> So when somebody impulsive they're doing things without really best the best judgment and from a psychiatric standpoint when we think about the neurobiology of impulsivity, it's usually because the front part of the brain is a bit underactive for whatever reason people can be impulsive perhaps because they have bipolar disorder where they have mania, where the front part of the brain is underactive.

>> They might have ADHD which often the company is accompanied by impulsivity with a front part the brain and the middle part of the brain is not functioning properly.

>> Some people who have a frontal head injury and they have a traumatic brain injury and they get hit in the front of the head, they will have difficulty with impulsivity so impulsivity is where you will blurt out things you'll do things that you later regret and you say things that you later regret and that's the key.

It's one thing to be spontaneous.

It's one thing to be somewhat eccentric but it's quite another to do things that you might later regret and they get you into trouble and we often will perceive impulsivity as being a psychiatric disturbance ,especially when it's occurring episodically where it occurs now and then and you're out of character for your usual personality when doing it.

So impulsivity is where you're just not using very good judgment and the day to day activities that you do and they get you into trouble and like any psychiatric disturbance with impulse, it's a condition it's a problem where it's causing you trouble getting along with other people, being able do your job, be able to go to school is causing you what we call functional impairment because with any psychiatric disturbance it has to be accompanied by functional impairment to be a really an authentic neurobiology neurobiological condition.

>> We've seen impulsivity with some people with the more recent covid infections because covid infections do indeed affect the brain.

That's why people have difficulty smelling because covid infections will affect this olfactory nerve.

>> Right.

Here's a brain looking at you so the olfactory nerve is on the inside part of the brain as it tips up and that's affected by covid virus covid virus.

>> So we know that covid virus gets to the brain will affect your sense of smell but for some people it's actually affected their mood and rarely will it affect them to the degree that they have significant problems from it.

>> But as a psychiatrist I've certainly seen that happen with some people where they needed mood stabilizers, they needed a medication for depression or maybe for concentration because they had long term problems from the covid virus and we call that long a syndrome where they have ongoing problems after getting a covert infection and that can be accompanied by impulsivity as well.

>> Thanks for your email question.

Let's go to our next email.

Our next email reads Your daughter Fauver.

>> How do you know if someone is experiencing too much stress?

Well, stress is a relative term and you have to think about stress as basically meaning it's a change in a person's life now every day we endure changes and change is not a problem for people when we think about stress it's often the changes in which we have difficulty coping with the changes.

>> So stress is basically a change and it's often a stress for people if they don't have that much change in their lives because they will have trouble with the degree of sameness on a day to day basis.

>> There is actually a movie made back in the 1980s called Groundhog Day starring Bill Murray where basically every day was the same for him and that was a nightmare because every day was so similar and in the same way we need change.

>> We need some stress in our lives day to day to keep us sharp, to keep our life somewhat exciting.

>> For instance, if you've endured a major storm where a lot of stuff happened that you didn't expect previously, it's a horrific thing to endure.

>> But you know, it often brings a community together to endure the storm.

>> It's a big change.

You learn new skills like chainsawing that you might not have learned otherwise.

>> You learn how to store your food and you're better prepared for the next storm to occur.

And I'm talking about the storms.

I'm talking about weather storms.

We can also talk about the storms of life in a figurative manner when you are enduring stresses and changes in things in which you have to cope and you have challenges that you need in which you need to overcome that's making you stronger each time there have been studies done on individuals who had prior stressful events occur and when they had major events occur like 9/11 with the towers coming down in New York City, the people who had previously endured a lot of stress and a lot of changes already were the least likely to get post-traumatic stress from 9/11.

>> The soldiers that go off to combat in the Middle East, the ones that endured a lot of stresses before they went into combat were less likely to come out of combat with post-traumatic stress.

>> So I'm not one to say you need less stress in your life .

>> I'm always emphasizing to people that you need to be able to adapt better to the stress that you're enduring and you do that through talk therapy trying to get a different perspective on things.

We do use medications as a means of helping people with stress, resilience, stress, resilience, basically being able to put up with stuff better.

And if you have a diagnosable depression, a mood disturbance ,you have a lot of anxiety that's causing you to have trouble putting up with stress.

That's where medications can come in for those people.

>> So we'll use a combination of talk therapy and medication for people.

And here's what happens when you when you're enduring stress and these changes that are just overwhelming for you because you haven't experienced them before.

>> These are new experiences for you.

You haven't learned to cope with the changes before and maybe there's a bit of a biological component from a genetic standpoint that makes you less likely to be able to tolerate those stresses.

>> What happens is the anxiety, fear and anger volume control which is right here in the temporal lobe of the brain is called the amygdala.

This part of the brain really lights up and over basically hijacks the thinking part of the brain in the front so you can become overwhelmed with anger, fear, anxiety and when that happens the front part of the brain which is the thinking part of the brain and the judgment part of the brain, it doesn't work so well and that's why when people are overwhelmed with fear and anxiety and anger they don't make a lot of good decisions and they become overwhelmed.

They start to blurting out things they say things they do things they ordinarily wouldn't say or do and it's because they're front part of the brain isn't thinking so well.

>> So what we're often trying to do in psychiatry is help people kind of tone down the amygdala activity so they're not feeling so distraught and they're not making their decisions based on their emotions because your emotions can sometimes cause you to make some bad decisions sometimes.

So we're trying to calm that part of the brain down and we're trying to fire up the front part of the brain by helping them think through their problems.

We call that top down treatment, stop being the front part of the brain and downby in the amygdala part of the brain we always want people to have more control of their life circumstances by thinking through what's happening.

But we'll hear about people having difficulty with such anger and irritability and anxiety and fear that they just can't think and this is what causes people to get into a paralyzing mode.

>> A little bit of anxiety is good for us.

>> I mean we need the anxiety.

We need the fear.

We need some anger every now and then as the situation calls for it.

>> But when those emotions become exaggerated, that's when the front part of your brain doesn't work so well and that's when you don't think through your decision so well.

So we want people to have normal emotions.

People often ask what's what's pathological depression?

>> What's normal mood?

A normal mood is where you have happiness, sadness, anxiety, fear, apathy.

>> All these different emotions are perfectly normal and we should have those otherwise we'd be just robots where we wouldn't have any emotions.

>> That's not a good thing either.

So you want to have emotions but you want to react to situations as a circumstance would expect you to react to those situations.

You don't want to overreact.

You don't want your emotions to cause you to say things and do things that you ordinarily wouldn't say or emotions should motivate us to do things that are in our best interests.

>> Your emotions of anxiety before you have a job interview, before you have an exam in school anxiety is a perfectly normal emotion because anxiety will actually to a small degree fire up the thinking part of the brain.

>> So I'm always emphasizing to college students, to people who are new at their jobs that a little bit of anxiety in a workplace or in the school environment is perfectly fine.

>> You don't and you shouldn't use anxiety medications like Xanax and Valium and Klonopin, even marijuana for that matter to calm down anxiety because some people perceive that any feelings of anxiety or fear are pathological and they perceive that they need to do something if they feel the emotion of anxiety.

>> That's not that's that's not what you want to do.

You want to allow that anxiety to motivate you to get things done.

>> What I'll often warn individuals in their late teens they're going off to college.

>> I'll warn them don't use marijuana when you're going into college because in college you'll hear about marijuana getting passed around the place it's readily available.

>> People are using it as a means of decreasing their anxieties.

>> Many people will use alcohol as well so marijuana and alcohol are often used in college environments to self medicate the anxiety.

>> That's exactly what you don't want to do because you want the anxiety of studying it for examinations.

You want the anxiety of taking an examination because that helps you concentrate better because anxiety to a small degree will fire up this left front part of the brain.

It's got a fancy name to it called the dorsolateral prefrontal cortex.

That's the thinking part of the brain is the part of the brain that used to pay attention.

>> A little bit of anxiety will fire that part of the brain up to a higher degree.

Now over whelming anxiety is where you shut down the front part of the brain.

>> You freeze, you go into the paralysis mode and you can't think at all and yes, who are some people we will treat that degree of anxiety with the medication is to get him started in a small amount of alprazolam or Xanax Clonazepam or Klonopin can help those people but we're very, very selective in how we use that because if you use too much of those kind of medications you get to the point where you don't think as clearly and that's why we're getting away from using those medications on a day to day basis because alprazolam or Xanax if used half a milligram three times a day like so many people are using and it's as if you're persistent, slightly inebriated with alcohol from a concentration standpoint your ability to process information is slowed to the point is if you had a blood alcohol level of 08 and if you're taken alprazolam or Xanax on a day to day basis, it's as if you're your brain functioning with a blood alcohol level of a point away and that's legally impaired drive in our state of Indiana.

>> So we're getting away from using those medications as a means of tranquilizing the brain.

Many people when they've been on medications like Xanax, Ativan, Klonopin, Valium, they'll they'll often say that when they get off those medications they can think more clearly and they can focus again and it's like they have a new brain and they didn't know that because they had been on those medications for so long.

>> So we're trying to get them away from doing using those kind of medications now over the past ten or fifteen years it's become much more acceptable in society because of some states legalizing the use of recreational marijuana.

So instead of Ativan or Xanax or Valium for that matter, Valium was in nineteen seventy nine the number one medication prescribed of all medications.

>> So people are getting away from using those medications which is a good thing but now they're going more to marijuana as a means of medicating the uncomfortable feeling of anxiety they might fear and what happens when you use marijuana?

>> It actually shrinks up the white matter of the brain.

The white matter the brain is the insulation of the brain and the insulation of the nerves themselves allow the nerve impulses to carry messages from one nerve to another more efficiently.

>> If you use marijuana it's it suppresses that growth of the white matter decreases the ability for the brain to function properly and that's why people with long term use of marijuana are more likely to have difficulty with processing information and actually their intellectual functioning tends to be impaired.

>> I used to think and that applies to people under twenty four years of age more than the older people because people under 24 years of age still have brain development.

That's progress and we've known for years that if you use marijuana prior to the age of 24 years of age on a regular basis I'm talking about two or three times a week or more you can have suppression of the white matter part of the brain.

>> So there's actually suppression of the brain growth if you use marijuana on a regular basis before twenty four years of age.

>> We now know based on a study that just came out over the past couple of months that even if you use marijuana in your middle age time periods, your 30s or 40s, you're also likely to suppress brain matter grow then and it's thought that those people might be at even more risk of for dementia or memory impairment later on.

>> So no longer we do we really emphasize that you shouldn't use marijuana before 24 years of age.

You might compromise your brain functioning if using marijuana on a regular basis after 24 years of age based on some of these recent studies.

>> Thank you so much for your question.

>> Let's go to our first caller.

Hello Deborah .

Welcome to Matters of Mind Doctor.

Father, I have a question certainly what is electroconvulsive therapy used for and what does that treatment do to your brain?

>> Deborah ECT is a treatment that's been used since the 1940s.

>> I think that's when it started it was noticed that people had epilepsy and they had a seizure and if they had depression prior to having the seizure they felt better and they felt more alert.

>> They felt more awake.

They felt pretty good.

So oddly enough it was found that people who had seizures were less likely to be depressed after the seizure itself.

Now the seizure itself is not good for the brain if it's not controlled in that way and you can hurt yourself when you have a seizure and bite your tongue in all sorts of things.

>> But it was found back in the nineteen forties that if you had a seizure and had preceding depression the depression might get better.

>> So for that reason in the 1940s there are various ways to induce seizures.

Well let's fast forward to sixty years later when you have electroconvulsive therapy or it's still done you have a full body muscle relaxant after and you will have that after having respiratory suppression with a medication called Succinylcholine and these different medications will be used to give you a drying effect and you'll get a general anesthetic.

So the bottom line is during ECT you'll be asleep, you'll have a bag breathing for you.

Some will be breathing a bag for you so you won't be doing your own breathing and your muscles will be very relaxed such that when somebody has ECT when you look at them and watch them having the 90 seconds to two minute episode of seizure during that time they're just quivering a little bit.

>> So it's it's not going to break their bones and it's not going to give them the full body type of effect of the seizures in the past.

>> ECT is a biological treatment that is considered to be one of the best biological treatments for depression that we still are aware of using.

>> It's a treatment that's been around for a long time.

It's used three times a week, six to nine treatments.

Occasionally people will go on beyond that once in a while and sometimes people get once a month treatment for maintenance treatment basically ECT is a means of giving the brain an electrical seizure while allowing the rest of the body to be relaxed and not having a seizure.

So what happens when you affect the brain is in a seizure state?

What does that do to the brain?

And that used to be thought well gee and people have this misperception if you're having a seizure in the brain that's not good for the brain.

Well, it can be good for the brain if it's done on a very controlled basis and you're doing it a specific number of times.

>> Yeah.

Epilepsy if you have uncontrolled epilepsy can actually provoke seizures ECT itself since you're only having the treatments three times a week for a three four weeks occasionally it's not something that seems to cause you to have more seizures that's always been a question.

Does ECT cause you to have seizures?

There's no evidence of that but here's what it does for depression.

Deborah .

It basically fires up the front part of the brain which is underactive with depression.

That's the thinking part of the brain.

>> That's the judgment part of the brain.

That's the part of the brain that when it's dampened in its activity will cause you to be tired and cause you not to enjoy things basically and it just makes you want to give up on pleasurable activities when you fire up the front part of the brain it tends to relieve those kind of symptoms and the way works among the many ways it works it increases this particular chemical very abruptly called brain derived neurotrophic factor.

>> It's known as the Miracle-Gro of the brain.

So it's basically brain fertilizer and when people have difficulty with depression they have an under abundance of brain fertilizer.

>> And if you can think of your little neurons and there's hundreds of millions of neurons but if you think of your neurons as being like trees, it's like the branches of the trees are very limited and they're they're getting pruned off and there's fewer branches on the trees and that's what happens with depression, with ECT.

>> You will tend to get this surge of the brain fertilizer allowing the little neurons to become more fluffy.

So if under a microscope it looks like a bunch of trees that are getting more branches on them, that's what happens with these and it occurs very quickly antidepressant medications and there's been about sixteen newer antidepressants since nineteen eighty seven or so so for the past thirty five years we've seen about sixteen newer antidepressants become available.

>> They will do some of the same things but it takes longer for them to work.

So the traditional antidepressant medications Prozac be in the first the newer ones and then you have all these other antidepressants come out.

They primarily affect norepinephrine serotonin and dopamine and it takes them four to six weeks to give their full effects because it takes four to six weeks to build these little protein receptors that will help you with the depression so they'll affect the transmission of serotonin, norepinephrine and dopamine which are in regional sections of the brain.

>> Now there's a newer antidepressant treatment by the name of a ketamine also known as bravado.

>> It's affecting glutamate.

So instead of needing to wait four to eight weeks for the little receptor changes to occur with the traditional antidepressants as ketamine or bravado is affecting glutamate and it will affect these calcium and sodium channel within a matter of milliseconds.

>> So it's working very fast and that's why about one out of six people who use ketamine his bravado treatment after just one or two treatments they're going to notice a significant response where they're more than halfway improved after just one or two treatments.

>> So we have asked which can help people come out of depression very, very quickly and we now have as ketamine was bravado.

They work in entirely different ways.

>> Can you use that and Pavano people have done it.

So there are studies out there especially with ketamine and ECT so they work in entirely different ways.

But for some people with treatment refractory depression those are very powerful and effective antidepressant treatments for a lot of people.

So we'll hear about that.

>> ECT is something that you don't hear about a use so much anymore but it's it's used in the recovery rooms at selected hospitals.

>> So if you go into rural counties you might not hear about being used but in the bigger hospitals you'll often hear about ECT because they have the anesthesiologist and the other recovery room, they have the ECT that's going on that's occurring right there the morning of ECT.

>> Somebody else needs to bring you in to the hospital setting you at the ECT and you have breakfast after ECT you don't have breakfast before ect and you're there for a couple hours and you go home.

You're not supposed to work the rest of the next day the rest of the day don't you shouldn't drive the rest of the day and you'll have that treatment typically three times a week for the first three weeks or so and then you'll have ECT treatments perhaps less frequently thereafter but some people will have one a week, some people have one a month and they'll decrease their frequency as time goes on.

But ECT is still a very safe and effective treatment.

>> I'm really happy that we're still using it because some people get horrifically depressed and it's best for what's called melancholic depression and melancholic depression is where you don't have any appetite and you're losing weight.

>> A melancholic depression will be typically where you awaken in the early morning hours you feel extremely depressed.

>> You don't react as you might expect to a different type of emotions and it'll cause you to have difficulty with energy and many people with that type of depression will do very well with ECT but we will be using ECT probably in the future as we are wait better treatments that will make better the treatments for we have some treatments coming out over the next couple of years that might be kind of interesting and how they work because they'll work more on the hormonal level.

>> You know for the past thirty five years with our traditional antidepressants medications I primarily worked on norepinephrine serotonin and dopamine.

But with the newer treatments we're going to find that we have a greater spectrum of the neurotransmitters in which these different medications can work.

>> So there's 70 different neurotransmitters plus in the brain and we're going to hear about how we can affect more of these neurotransmitters as time goes on.

>> Thanks for your call, Deborah .

Do we have another email question?

We do.

Let's go with the next email question and it reads Your daughter Fauver how do you know the difference between bipolar disorder and ADHD?

>> What are the treatment differences?

>> They're quite different.

They have a lot of similarities.

I mentioned impulsivity earlier.

Impulsivity is where you do or say things you ordinarily wouldn't do and say and you regret them later with bipolar disorder you have impulsivity.

>> It's episodic.

It occurs primarily when you're on the manic side or the manic side is where you can be irritable or really, really happy for a matter of days or even weeks.

>> And during those times you don't need to sleep.

You don't need to sleep to get by on one hour, five hours of sleep a night and you're raring to go the next day.

>> You're very talkative during the manic episodes you're having a flight of ideas where you're going from one thought to another you're very socially intrusive and you'll end up being very impulsive often with spending or getting involved in relationships and with bipolar disorder people will then episodically crash and they'll go into a really nasty depression and they will get very depressed over the course of days or weeks with ADHD.

By contrast ADHD is a day to day phenomenon where every day you can have impulsivity, poor attention span, distractibility and poor concentration and that's their day by day.

>> ADHD is treated primarily with stimulant medications that fire up the front part of the brain.

Bipolar disorder, by contrast, is where people will take medications that are mood stabilizers that work more as a cruise control on the mood.

>> So ADHD is a cognitive condition.

It's a thinking condition whereas bipolar disorder is more of a mood condition.

So they're quite different but they do have overlapping symptoms primarily with the impulsivity, the difficulty with racing thoughts and difficulty asleep so a lot of people with ADHD will have difficulty getting to sleep.

>> So if you go to a clinician and say I'm having trouble with concentration sleep and I'm impulsive, they might think Oh yeah, bipolar disorder.

The big difference is ADHD is a day to day phenomenon just like nearsightedness whereas bipolar disorder the symptoms come and go.

>> Thanks for your question.

Unfortunately I'm out of time for this evening if you have any questions concerning mental health issues that I can answer on the air you may write me at matters of the mind all one word at UFW Edgar I'm psychiatrist Jeff Offering.

You've been watching matters of the mind God willing and PBS willing.

>> I'll be back again next week.

Thanks for watching.

Goodnight