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>> Good evening.

I'm psychiatrist Jay Fawver live 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 at PBS Fort Wayne by dialing in the Fort Wayne area (969) 27 two zero or if you're calling a place coast to coast you may dial toll free at 866- (969) 27 two zero now on a fairly regular basis we are broadcasting live every Monday night from our spectacular 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 that I can answer on the air concerning mental health issues, you may write me via the Internet at matters of the mind all one word at WSW ECG that's matters of the mind WFB, ECG and I'll start tonight's program with an email I recently received.

>> It reads Your Doctor Fauver Ivan taking a lithium Orte supplement that I purchased online for six months and my anxiety seems to have improved.

>> Is this just a placebo effect?

Is there any danger of me continuing with the supplement supplements have not been well studied however low dose of lithium might have their advantages might have its advantages.

>> Lithium is a salt.

It actually is on the periodic table the same column is sodium so it competes with sodium in terms of getting out of the body.

>> So if you have a high sodium diet you'll have lower lithium levels.

>> If you have a low sodium diet all of a sudden you'll have higher lithium levels.

We don't check lithium levels routinely because your lithium level typically would be zero in your blood level you get lithium levels and you're taking higher doses of lithium.

>> So how about five or ten milligrams of lithium or était like you've described maybe it could be helpful.

>> Now there's a lot of evidence that low doses and prescription doses of lithium all the way down to a hundred and fifty milligrams a day can be helpful for perhaps decreasing suicide thinking and suicidal behavior the countries around the world that have higher lithium levels in their water supplies will typically have lower suicide rates.

So that's been studied areas like Argentina, Japan have lower suicide rates, areas of Texas with higher lithium and their water supplies will have lower suicide rates.

So this has been studied over the course of time such that in six history we will prescribe the lowest doses of lithium available in a capsule and that would be one hundred fifty milligrams a day and that's it.

>> And sometimes we get raised eyebrows from pharmacies when they see us prescribing those doses because her bipolar disorder where you usually hear lithium being associated we're going to use doses of six hundred nine hundred milligrams a day and that's typically in a controlled release once a day formulations so that will give you less problems with the kidneys.

>> The drawback of taking a lithium supplement without medical supervision will be the possibility of kidney problems because lithium can have damaging effects on the kidneys and as many as one out of five people.

However, that damage to the kidneys will often be seen with much higher doses, especially if the doses are taken two or three times a day.

>> So if you are taking a lithium supplement, do so with caution.

>> Check it over with your primary care clinician just to see if it's if it's going to interact with any other medication you might be taking.

>> Try to take it once a day.

Don't take it more than once a day and if you can find controlled release version that's always going to be safer because when we use the regular lithium we at the higher dose at least we do try to give the controlled release version and try to give it once a day because that seems to be safer on the kidneys.

The other factor concerning lithium is that with some people can suppress their thyroid functioning because lithium is something that does help thyroid get made and in some ways you can suppress a release of thyroid if you give somebody excessive amounts of lithium so that can cause lithium to kind of get in a position where it's backing up the thyroid.

People can get goiter and their thyroid functions can go down, down, down.

>> We often measure that with the thyroid stimulating hormone which is a hormone that comes from the pituitary gland right up here in the middle of the brain and there's a hormone called S.H.

thyroid stimulating hormone as is going up and up and up.

>> It represents the brain's need for higher amounts of thyroid.

So the TSA is going up and up and up.

It represents a need to give somebody supplemental thyroid lithium by going to the thyroid right there in the neck can sometimes suppress thyroid release causing the brain to have to go higher and higher.

>> And for those people we'll give them lithium ongo if it's really helping them.

But we sometimes give them thyroid supplementation.

Ideally we'd like to get them off the lithium when we see that happening.

But sometimes lithium is giving them unique effects and we want to keep them on lithium for that reason.

Lithium is unique effects will be several.

Number one, it's a very good mood stabilizer.

It's been around since the 1940s and it was given to a lot of people back in the old days in the state hospitals who were hospitalized with bipolar disorder back in those days in the 1930s and 1940s, people were hospitalized for weeks and weeks if not months and months with manic depressive disorder.

They get in all sorts of trouble when they had manic they get depressed, they get suicidal and they're going back and forth with their moods.

Lithium did a remarkable job suppressing the mood swings because it has this peculiar effect on the brain in the sense that it suppresses inflammation in the brain.

It's thought that when people have manic episodes, when they're not sleeping, they're impulsive, they're talking a mile a minute.

They're going from topic to topic deciding when people have manic episodes it's sort of their brain is inflamed and it's been evidenced by this particular protein called one hundred when you're in a manic episode, one hundred in the brain is going sky high.

Lithium has been shown to suppress that medication it suppresses that will be Depakote.

So there are certain medications that can suppress inflammation the brain lithium and one of them recently there is research showing that small amounts of lithium can actually increase the length of the chromosomal telomeres.

>> Telomeres are like the caps on the tips of the chromosomes.

>> It's pretty interesting because as we age those caps on our chromosomes get shorter and shorter and shorter.

>> Lithium has actually been shown to be one of the few substances that can actually increase the length of those caps thereby potentially increasing longevity.

>> Now that's a stretch but there's a potential there as a question can the use of small doses of lithium as you're taking as a supplement actually enhance longevity and improve the number of years somebody is going to live?

Now you're taking lithium mainly for anxiety and you're finding it to be beneficial.

I can see that happening years ago over a hundred years ago lithium was actually placed was actually in Seven-Up type Sodus so they put lithium in soda pop and they'd put it in various various kinds of drinks that were used as supplements that people were selling on the back of their wagons and things like that.

>> And this is over a hundred years ago.

Well, lithium is in those substances because lithium had this calming effect for people and it helped with anxiety, help with sleep lithium will give you an increased depth of sleep and enhance the deep slow wave sleep that people all need to recharge the batteries at night.

So lithium has benefits in a lot of different ways.

Lithium however was at that point in those kind of doses drawer pulled back a little bit and the Food and Drug Administration didn't want people selling lithium just off the back of their wagon and it started to get regulated at that point because if you drink if taken too much lithium, you get sick and you get sick with diarrhea, you get headaches, you get shaky.

That's called lithium toxicity and of course one thing can happen after another and like with a lot of supplements when a little bit doesn't work for somebody, people like to take more and more and more of it and that's the danger of taking lithium supplements just kind of off the shelf that you might think.

I wonder how much might work for me and you take more and more and more and you can get some lithium toxicity.

So I check it over with your primary care clinician and go from there and see if there's a possible use for lithium.

Take a look at you on the medications.

What drug interactions might there be ?

>> I mentioned salt, a low salt if you all of a sudden going to lose salt diet your lithium levels will increase if you take ibuprofen Naprosyn if you take the so-called nonsteroidal antiinflammatory agent, they can increase lithium levels by twenty five percent so a little bit of lithium will be increased by 25 percent if you take something like Advil or Motrin.

>> So you do have to be aware of certain things like that.

So you know, I don't think it's going to be studied that much lithium is not a brand name product.

>> No company owns lithium.

It's a salt from the dirt so it's not going to get studied extensively.

>> And the National Institute of Mental Health , they're probably not going to study low doses of lithium.

A lot of people think that a lot of our drug research comes from the national Institute of Mental Health .

>> Only less than 10 percent of our drug research comes from the federal government.

Most drug research comes from individual companies and individual companies fund to study their drugs that they've developed as a means of making a profit.

And that's how a lot of medications are developed by individual companies that are capitalistic and they're trying to make a profit on a product that they might have discovered and they want to have available to the public.

>> Thank thanks for your question.

Let's go to our first caller.

Hello Jane.

Welcome to the mind, Jane.

>> You know, are there are certain types of people who should not take lithium well off the bat?

>> Jane, I'd say if you're going to take lithium number one, you shouldn't be pregnant.

That's always controversial.

Can you take lithium during pregnancy or not?

There's a slight chance of heart abnormalities but those chances have been somewhat decreased and somewhat minimized over the past ten years.

>> But it used to be thought that babies would have more heart abnormalities if they took lithium.

So it's going to give lithium during pregnancy.

You got to be really careful about it.

I just think there's a lot of other things you can give to pregnant women who are needing something for mood stabilization.

We have a lot of other options besides lithium nowadays but you definitely don't want to go with lithium if there's any difficulty with the possibility of any transgenic effects and that slight possibility might be there with with lithium if a woman's pregnant.

Another reason why somebody shouldn't take lithium would be if they have kidney problems.

Kidney is excreted through the kidney.

It's real simple.

It competes with sodium.

So from the kidneys perspective it doesn't the kidneys don't know the difference between sodium and lithium.

So if you have lithium around it's going to excrete it like sodium and sodium.

>> Lithium will compete with each other.

So if you have kidneys that aren't working so well, you're going to have a hard time getting rid of the lithium and lithium will go up and up and up.

I probably wouldn't give lithium for somebody who needs Motrin or Advil or leave on a day to day basis.

>> If I do I'm going to give it a really low dosage and watch their blood levels just be aware that if you take those kind of over-the-counter pain medications your level on lithium can go up by twenty five percent.

People ask me all the time does this apply to aspirin?

It does not for some reason aspirin doesn't have any effects on the lithium blood levels.

>> We often use lithium with other medications but if you're already having some trouble with a dilemma where you're swelling in the ankles and your puffy all over because you have fluid retention, lithium might not be the best medication for you because lithium is a salt and lithium can as a side effect give you fluid retention.

So if you're already trying to deal with fluid retention, lithium could be a problem with that diuretics water pills which you're trying to blow off the extra water for people will cause lithium levels to increase.

So we have to be aware that if you're giving somebody a so-called thiazide diuretic, especially that diuretic, that water pill can increase lithium levels.

>> So we're going to look for drug interactions in general Jane.

People who wouldn't take lithium I mentioned the pregnant women lithium can sometimes cause people to have some difficulty with shakiness as they get to the higher doses.

>> This was well publicized oh ,about thirty years ago there was a professional golfer who had bipolar disorder and he had he was on lithium and lithium was very effective for his mood but it affected his putting game because he had a little bit of a tremor and because of that a lot of people 30 years ago didn't want to take lithium because they heard about this professional golfer who had a tremor and that affected his putting game.

>> Well, we have since realized that you can get around that tremor and a lot of different ways.

No one you can give a controlled release lithium which is a once a day lithium lasts all day.

Secondly, you can give lithium just at bedtime and as I mentioned earlier, lithium can actually deepen the sleep.

>> It increases slow wave sleep.

So it has a lot of good benefits on the sleep.

>> And thirdly, if you do have a tremor with lithium, keep the dosage as low as you possibly can but also you can give certain medications like the so-called beta blockers, propranolol metoprolol these these are medications that will suppress the the tremor that's thought to be related to lithium itself.

So there's ways to get around the tremor if that's going to happen.

But for those kind of people, if they're having tremors or having side effects, some people just can't tolerate lithium for whatever reason and we go lower and lower.

>> But unlike 20 years ago, Jane, we don't start people on six hundred and nine hundred milligrams a day typically anymore we'll often start people at just 300 milligrams a day and if somebody is having a mood disturbance, they're having depression.

They're having suicidal thinking a little pinch of lithium.

I've seen one hundred and fifty milligrams of lithium a day for some people give them dramatic relief with suicidal thinking and thoughts that they just want to kill themselves.

I've seen people get dramatic benefits from that as soon as a week and there's something about lithium at small doses that can decrease a lot of suicidal thinking for people.

And the nice thing about lithium at 150 milligrams a day you know what you're getting the problem with supplements that was asked earlier in the email question the problem of supplements sometimes you don't know what you're really getting in those supplements.

>> They may or may not even have any lithium in them then might not be dosed properly because supplements are not highly regulated for what's actually in them unlike prescription medications and even over-the-counter medications that you often see that prescription medications are very highly regulated in terms of knowing that you're getting what's in the capsule or the tablet itself and that's where 150 milligrams of lithium can be safe for a lot of people.

>> Jane, thanks for your call.

Let's go to our next e-mail.

Our next e-mail reads Your doctor Fauver can you treat eating disorders with medication or there's different types of eating disorders.

>> There's any anorexia nervosa.

There's bulimia nervosa and there's binge eating disorders.

The main three starting with anorexia nervosa, anorexia nervosa will be and it's usually young women but it can happen with young men too.

>> But younger people women more than men but they perceive they are fat and they're getting skinnier and skinnier and they're getting malnourished.

They will get so malnourished sometimes that they are highly constipated but they lose muscle mass and they start having hair loss and they have nutritional deficits such that they start losing protein and one thing leads to another and there they're very malnourished.

That's anorexia nervosa but they perceive that they are fat and when they look in the mirror they see something that other people aren't seeing.

They see themselves as being fat.

Other people see them as being horrifically emaciated.

>> Well, when you have anorexia nervosa it's considered to be a psychotic disorder.

So as a psychotic disorder you can use antipsychotic medications for people with anorexia nervosa.

>> So for those people we often use low dose antipsychotic medications to try to help the reasoning part of the brain which is in the front part of the brain.

The front part of the brain is the reasoning part of the brain, the side part of the brain helps you stay in touch with reality and antipsychotic medications do work in both areas in the side part of the brain they block dopamine, decrease it front part of the brain, they increase dopamine and in doing so you can improve the sense of reality and the ability to concentrate reason through your difficulties respectively.

So antipsychotics can work for for anorexia nervosa for bulimia nervosa.

That's where people are binge eating and then they often make themselves vomit.

So the people who make themselves vomit can be treated specifically with certain medications like Fluoxetine or Prozac.

Prozac came out in 1987 and came out at twenty milligrams a day for depression then we found within about ten years it was a very good medication at much higher doses specifically to decrease the urge to make it to a binge and then make it make yourself vomit.

>> So Prozac at 60 and 80 milligrams a day has been used specifically for the purpose of relieving bulimia.

>> Bulimia is also associated with exercising intently trying to compensate for the excessive amounts that you might have perceived that you ate a lot of people bulimia have enhanced parodic glands so their cheeks get kind of puffy and that's because with persistent vomiting and with selenium these people don't get skinnier and skinnier.

They actually get heavier and they're prodded glands actually grow and swell because of the disturbances they have with making themselves VARMA once in a while people will be given medications that will kind of tighten up the esophageal sphincter at the top of the stomach.

>> In other words, the stomach has a little this little ring around it at the very top the help but stay closed and there are certain medications to be given to help that Ringsted close who is more difficult to vomit.

That's not that really helpful and people blame you just get mad that they can't and they figure out other ways to compensate for their eating if that happens.

So it's not a preferred route but we always have to remember when people have bulimia, when they overeat, they're doing it because they're often stress eating and that's affecting the serotonin system.

When they vomit they get a rush, they get a thrill to norepinephrine and especially a dopamine effect.

>> So people when they make themselves vomit are getting a rush kind of a high off the vomiting itself.

>> It's not a very healthy high obviously it's a it's a high that's very maladaptive.

>> It's not unlike people who try to suffocate themselves as a means of getting a high.

>> It can be very dangerous.

It can give you a lot of health disturbances but when people are trying to get that high they get a dopamine and norepinephrine rush then they feel guilty and they feel guilty that they did it and then they're depressed again.

So people with bulimia when they are making themselves vomit after binge eating are having all these different fluctuations and we call them vicissitudes of of emotions.

>> We're just going back and forth and all over the place.

So you always want to look at the underlying reason why somebody might be making themselves vomit for that matter.

And many times people are making themselves vomit as a means of trying to help with depression.

So if you go back to the underlying reason why they might have some depression, that's often where we might start.

People will often not only make themselves vomit when they're depressed but sometimes they'll cut it themselves and a lot of parents and even clinicians for that matter get very, very anxious when they hear about study somebody cutting it themselves and some people need stitches and it's a very dangerous kind of behavior to have.

>> But many people who are cutting cutting at themselves are not trying to commit suicide.

>> They're merely trying to relieve the emotional pain that they're experiencing.

So if you cut your arm number one, you feel the physical pain in distract you from the emotional pain that you're experiencing with your depression.

But secondly, when you cut off your arm it's a malfunctioning way of doing it but you're releasing opiates into your bloodstream or natural narcotics are getting released into your bloodstream and in a sense you're taking an opiate giving you a sense of bliss and sometimes happiness.

>> So when people cut it themselves they get a sense of relief from the depression.

They might be experiencing but they also get a little bit of a calming effect in doing it.

>> And next thing you know, they've got scars all up and down their arms and it's it's a maladaptive way of trying to handle their emotions.

And you see this a lot of times with adolescents especially but sometimes younger adults and once in a while I'll see somebody in their 30s, 40s or even 50s who still cutting at themselves as a means of trying to relieve the emotional tension and depression.

And again for those people same with people with bulimia.

We're trying to go back and sorting out, OK, what's going on here?

What got this started?

Can we treat it in another manner?

So for those people we might give them an antidepressant to be able to stop the vomiting or the cutting for that matter.

And then there's something called binge eating disorder, binge eating disorders are used too much and you eat to the point where you're uncomfortably full.

>> You eat several times a day.

You eat in between meals.

You're eating in the morning, afternoon, night time you're hiding your eating, you're eating even though you're not full or even though you are full you just keep eating and it feels uncomfortably for you with binge eating disorder.

>> You're not making yourself vomit.

You're not compensating for it.

You're just having a hard time slowing down your eating and it's got to have effects on now maybe serotonin but maybe dopamine for that matter and people who are eating excessively are trying to feed their emotions.

>> People have heard that said for a long time.

>> Yeah, they're trying to feed their emotions because when you eat it does give you some hormonal release.

There's a little bit of a serotonin effect and that's why Prozac was studied back in the 1990s for the purpose of of trying to suppress the appetite because it did affect these receptors called serotonin serotonin to see receptors and then topiramate or Topamax came out as a medication that was studied for migraines.

>> It's an anti epileptic medication studied for migraines well had a nice side effect for a lot of people in the sense it has suppressed their appetite.

It too will affect serotonin to see receptors.

So there's something about serotonin going on there.

But the past few years we've had this other medication come out called Vyvanse.

Vyvanse is amphetamine medication and unlike oh some of the unfettered means you might have heard about people typically don't get high on Vyvanse.

>> It's a slow release medication.

It's a type of medication.

The breaks down into another medication once it gets to your stomach and liver.

>> So it's kind of like if you have a cap on a pin, if you try to write with that pin that's the cap still on it doesn't write you take the cap off the pin.

>> The PIN writes well that's what happens with Vyvanse when Vyvanse goes to the stomach liver that cap comes off of the amphetamine and dextroamphetamin is released into the system over the course of typically a ten to twelve hours, sometimes fourteen hours for people but it can help not only for attention deficit disorder but also for binge eating disorders.

So for people who are having trouble with eating excessively ,especially if they have ADHD on top of that we often prefer a medication like Vyvanse which is a slow release amphetamine makes them less hungry.

Now if you get too much of any stimulant like that you can have difficulty with feeling jittery and having difficulty with sleeping.

>> You have a headache and have a tremor that means you're getting too much.

So the idea with using any amphetamine for the purpose of helping with binge eating will be for the purpose of taking enough of it that it suppresses the binge eating overall but yet not taking so much it gives you a lot of side effects.

>> Thanks for your call.

Let's go to our last email here.

I'll ask me email reads Deardourff over how do several concussions to the head cause problems with memory?

Is this what happens to football players and mixed martial arts athletes?

>> Is there anything you can do about it?

A lot of concussions to the head that you hear about with professional football players especially it's called chronic traumatic encephalopathy CTE.

You might have heard about that.

It's basically where they get excessive amounts of this particular protein.

The brain called a towel protein Taew protein.

>> It's the same kind of protein that gets accumulated when people have Alzheimer's dementia.

Alzheimer's dementia is also associated with amyloid accumulation as well.

But tau protein increases and tau proteins are just kind of tangled little proteins and it accumulates in the brain and it's very subtle.

But with each concussion somebody has the more likely they can have this tau protein accumulate and that's why you hear about with mixed martial arts players and people who are playing football, they're getting all these shots to the head and over the course of time that can have a long term chronic effect on you can cause you personality changes, increase aggression, increase moodiness.

Irritability is very common sleep disturbances, memory problems.

These are all symptoms of chronic traumatic encephalopathy.

What can you do about it?

Well, we often will treat it not unlike you'd treat Alzheimer's dementia and give people various memory enhancing medications like rhapsodizing Aricept, Exelon these are medications that can help with memory by increasing acetylcholine but specifically for moodiness will often give them anti seizure medications like Lamotrigine or Lamictal possibly possibly medication like Trileptal orks, carbamazepine.

>> These are the kind of medications we're kind of level out the irritability and moodiness itself.

>> Thanks for email.

Unfortunately I'm out of time for this evening if you have any questions concerning mental health issues give me a email at Matters of the Mind all one word at WFYI Doug I'm Psychiatrist Ja'far and you've been watching matters of mine God willing and PBSC willing.

>> I'll be back again next.

Have a good evening.

Good night