Good evening.

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

Welcome to Matters of the Mind now as twenty third year Matters of the Mind is a live Call-In program where you have the chance to choose the topic for discussion.

So if you have any questions concerning mental health issues, give me a call here at PBS Fort 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 call toll free at 866 (969) 27 two zero now on a fairly regular basis we're broadcasting live every Monday night from our spectacular PBS Fort Wayne studios which lie in the shadows of the Fort Wayne campus.

And if you'd like to contact me with an email question that I can answer on the air, you may write me via the Internet at matters of the mind all one word at a dot org that's matters of the mind that a dog and I start tonight's program with a question I recently received.

It reads Dear Dr. Fauver, how does inflammation affect the brain and how is it associated with depression?

What makes a person more likely to have an influence named brain?

>> Well, when we've talked about inflammation of the brain more recently we've been talking about the covid infection because covid as a virus will go to the brain and inflamed the brain and that's why for one reason people will have difficulty with smell when they experience covid because this little olfactory nerve right in the middle here the part of the brain becomes inflamed and that decreases your sense of smell.

>> It's not nasal congestion with cover that causes a loss of smell.

>> It's actually the effect on the old olfactory nerve itself.

So we know that covid inflamed the brain.

There are various other viruses that can inflame the brain.

A depression itself can inflame the brain and when depression inflames the brain it can cause you to have all sorts of symptoms such as poor motivation, low energy.

>> You kind of walk and talk more slowly or kind of slow down in general you have difficulty recalling things so you have difficulty with processing speed in your brain.

>> Poor concentration of fatigue is often prominent when people are having an inflamed brain and will give you these symptoms of depression because you don't enjoy things and it's thought that when you have difficulty with an inflamed brain this front part of the brain called the anterior cingulate is overactive.

This part of the brain over here called the amygdala is overactive.

That will cause you a lot of anxiety and the middle part of the brain down here, the basal ganglia and the ventral striatum that's what those are called that decreases dopamine and that gives you all the fatigued symptoms, the slowness, the the sensation that you're kind of all slowed down what causes inflammation of the brain where a lot of different things can cause it that lead to depression.

Loneliness is a factor and we've seen that a lot with the covid restrictions in twenty twenty and twenty twenty one with the current restrictions, loneliness can cause you more inflammation of the brain.

>> Another factor will be early childhood abuse and that's actually a predictor later on that you might have some difficulty with depression.

>> So early childhood abuse can actually predispose you to having an inflamed brain later in life and finally a sleep deprivation.

>> If you don't get adequate sleep you're more likely to have an inflamed brain.

So lack of sleep kind of cascades into having all these brain disturbances and inflammation of the brain with depression can be one of them.

>> Thank you for your email question.

Let's go to our first caller.

>> Hello Jenny.

Welcome to Of Mind.

Hi, Dr. Fauver.

Hi, Jenny.

I have I just have a question about my antidepressant.

I've been on Cymbalta for several years and I feel like it's really not working that well for me anymore and I was wondering if after so long can they stop working for you?

>> They can, Jenny.

Sometimes as we get older we'll have other medical conditions that can make an antidepressant stop working.

For instance, you want to make sure that you don't have a condition like low thyroid.

You want to make sure that your iron is OK. You want to make sure your glucose is OK because sometimes and just progressively over the years you get these other medical conditions going on.

>> Sleep apnea is another factor where somebody might snore at night.

They're not getting adequate airflow in their lungs thereby decreasing their oxygen to the brain at night.

That'll give the antidepressant the perception that it's not working so much.

Another factor that will cause an antidepressant not to work so well later on will be if you have overwhelming stresses the kind of pile up and you're having a hard time coping with different things in your life but taking a aside if that's not the case for you, sometimes it could be dose that being a condition where you're too high and that sounds really weird because if you take a higher dosage of an antidepressant, why wouldn't you feel better?

>> Well, these medications like Cymbalta will affect norepinephrine and serotonin but norepinephrine serotonin sometimes will talk to dopamine and if you increase norepinephrine or serotonin, sometimes dopamine will decrease.

>> When dopamine decreases you have less motivation, more tiredness, difficulty with concentration.

You don't have the energy that you might have had before and you feel like the antidepressants no longer working.

>> So sometimes it's a matter of lowering that dosage, adding something else and trying to work around that.

But when we first heard about the so-called of it's called Taqi full axis with antidepressants, it's where they kind of out over the course of time we heard that most commonly with medications that increased serotonin, Prozac, Zoloft, Lexapro, Celexa, Paxil we heard about some kind of out over the course of time and that's the simplistic term for attacking flaks.

But the reason they tended to just not work over the course of time is because by increasing serotonin for prolonged periods of time indirectly you're decreasing dopamine and when you decrease dopamine you get all those sensations that the antidepressants isn't working anymore.

>> The work around there is the decreased decrease the dosage of the serotonergic medication and then add something like Wellbutrin or be appropriate to try to help with the dopamine so there's ways we can get around that.

>> Jenny, Jenny, thanks for your call.

Let's go to our next caller.

Hello, Michael.

Welcome to Matters of Mind.

Yes, I have ADHD anxiety and depression and I had a question on vitamins like the maximum amount of vitamin D and the other one was as far as the vitamin E vitamins which which one of the vitamin E would be the most helpful in these conditions if vitamin E is an Elmer I would not recommend vitamin E anymore.

>> We used to maybe 20 years ago with when people were on antipsychotic medications we thought vitamin vitamin E might be helpful but then we later found out it wasn't so helpful .

It's an antioxidant but it just doesn't seem to help that much for mental health conditions.

So I wouldn't recommend vitamin E as an element of vitamin D as in dog you about five thousand units a day is considered to be safe for most people but there is a blood test for vitamin D and a blood test for vitamin D should be at least fifty five and you could always assess if it's too high vitamins A and K are all stored in the liver and you can get excessive amounts of those vitamins so you have to be careful about how much you take.

I often recommend to a lot of people for vitamin D two thousand units throughout the year but during the wintertime when you're just not getting any sunlight vitamin D can be used at the higher amounts for a lot of people and that can be five thousand units when you're in the sunshine in the summertime it's 10:00 a.m. in the morning if you're out and about and you're in a bathing suit, maybe a lifeguard you're getting about 10 thousand units of vitamin vitamin D over the course of about an hour of sun exposure the late morning.

>> So vitamin D at five thousand is throughout the winter months at could be really helpful mainly for the mood it's been thought to decrease various types of cancers as well the risk for cancers but especially for the mood they've done studies over in Denmark on vitamin D finding people with depression who were hospitalized were more likely to have lower amounts of vitamin D compared to people with depression who are not needing to be hospitalized.

So vitamin D deficiencies tended to increase the likelihood of depression for the people over in Denmark.

>> So I often recommend especially during the winter months people take at least two thousand units of vitamin D every day and you can go up to five thousand units make sure your liver is working OK.

Always talk to your primary care clinician just to check out make sure it's safe for you.

Michael, thanks for your call.

>> Let's go next caller.

Hello Sue.

Welcome to Matters of Mind.

>> I'll see you know about samme supplements.

What are the benefits drug interactions OK to take while pregnant generally so I would not recommend a supplement while you're pregnant there's just not enough known about a lot of the supplements and you can always defer that to your obstetrician just to see what kind of recommendations he or she might have while you're pregnant.

Sam is basically a supplement that does affect this particular enzyme called OMT Kantako method it's chemical or methyl transferee so C OMT is an enzyme that breaks down dopamine and when you break down dopamine that can sometimes make you more depressed and what Sammy will do is sometimes hinder its ability to break down dopamine thereby indirectly increase dopamine.

Samme is something that I don't typically recommend so much to a lot of people I see because the people I see have been struggling with depression long enough.

>> They want an antidepressant that has more definitive benefits than Sammy might have but it's not typically used so much anymore.

Sammy used to get used to be used way back in the oh boy back in the 1980s before we had all these newer antidepressants come out.

So we just don't see Sammy used that much anymore.

It kind of went hand in hand with using Saint John's Wort.

St. John's Wort was a very popular back in the 1980s early 1990s and then since about nineteen eighty seven we've had sixteen oral antidepressants become available so we just have a lot more antidepressants from which to choose.

They have a lot more established safety and and benefit profiles than the supplements do.

So Sammie's not something I typically recommend now desu so thanks for your call.

Let's go to next caller.

Hello Trevor.

Welcome to the mind.

Trevor, you wondered about vitamin supplements.

Can they expire, expire and lose effectiveness?

>> Generally all vitamins all over the counter medications, all prescription medications they will have an expiration date on them now their expiration date is something we should take seriously and we should discard those kind of medications after the expiration date.

>> But the United States military the VA system did study medications particularly anti biotics which tend to expire a little bit quicker than other medications and they found that they were a little bit more potent even after the expiration date.

>> But as a general rule of thumb, when you read the expiration date, you really need to discard it after that time some supplements and some prescription and over-the-counter medications can actually lose their effectiveness and lose their potency the longer they sit on the shelf like that.

So usually safe to discard medications following the expiration date, Trevor, thanks for your call.

Let's go to our next e-mail.

Our next e-mail reads directive over what is transcranial transcranial magnetic stimulation TMS treatment is it a good alternative to antidepressive?

Occasion's TMS or transcranial magnetic stimulation is a treatment which traditionally is used for about thirty one minutes and use on the left front part of the of the scalp and you said it there it said it gives you pulses of magnetism and you do it every day Monday through Friday for about six weeks now there's different types of TMS now where they're able to do them for a shorter brief periods of time and they're thought to be more potent.

A lot of study done on TMS has been around for many years.

We often use it in addition to antidepressant medications.

What I really like about TMS is that you sit in the chair for thirty five forty five minutes as you get it placed and you have it taken off so you're there in the office no more than an hour but then you leave and you drive and you might have a little bit of a headache the rest of the day but you can go back to work and you can function quite normally over the course of six weeks.

Hopefully you can get a better and better effect.

Some people do.

Some people don't.

So it's something that has some effectiveness.

>> It's different in terms of how it works.

But basically this left front part of the brain if you stimulate it with magnetism it can get fired up and it's left from part of the brain called dorsolateral prefrontal cortex.

It's underactive when people get depressed.

So when people get depressed this part of the brain just isn't functioning so well.

So you lose your motivation.

You can't concentrate.

You have difficulty with enjoyment.

>> That's because this left front part of the brain up here is not working so well.

So the idea of TMS is to stimulate that part of the brain with magnetic pulses and that's how it's been studied and that's how it's been used for over ten years now.

>> Thanks for your call.

Let's go next caller.

Hello Mike.

Welcome to America.

Mind.

>> Hello, Mike.

Well, Mike, you wondered about you have ADHD, you have depression, you have anxiety.

>> Is there a type of vitamin B that helps the best if you're going to take a type of vitamin B, Mike, there's three different types, maybe four different types of vitamin B that you could consider taking for depression.

>> You could take thiamin especially if you've been prone to drinking alcohol excessively over the course of time because people who drink excessive amounts of alcohol can benefit from thiamin.

>> That's vitamin B one riboflavin as vitamin B to now that's something that you could use for depression.

It's been particularly helpful for people who have migraine headaches but riboflavin as vitamin B to then you've got B6 which is Paradoks seen vitamin B6 paradoxically that has been shown to be helpful for some people with depression.

>> Then you have vitamin B nine which is folic acid about one out of five one out of four people have a deficiency in the ability to breakdown folic acid into its active byproduct called elemental folate.

So vitamin B nine is folic acid.

Some people have genetic makeup where they just don't break it down adequately.

We can actually measure that and if you do have that genetic propensity where you can't break down folic acid adequately, then we give you the acte byproduct called for folate and that has been shown to help with depression.

I've actually seen that happen in my practice where we give the in byproduct of folic acid for people to have a so-called methylene tetrahedral folate ductus deficiency.

>> I actually said that right after if you have that deficiency, don't break down folic acid adequately.

So vitamin B one is is thiamin by the vitamin B two is riboflavin vitamin B B6 is Paradoks seen then you have folic acid which is vitamin B nine there is A fifty B twelve you can measure B twelve.

>> A lot of older people lack vitamin B 12 because vitamin B 12 gets absorbed in the small intestine but it has to take a bus ride and the bus comes from the stomach.

>> So you've got this bus that's called intrinsic factor that comes from the stomach and then it goes to the small intestine to actually drop it off and that's where vitamin B 12 gets absorbed.

>> So as we get older our stomach lining gets thinner.

>> We have less of what's these called parietal cells and these cells are what extra secrete the intrinsic factor.

So as you get older you have fewer busses to transport the vitamin 12 from the stomach to the small intestine.

So it's an easy blood test to do so we often will check people for vitamin B 12 deficiency especially as they get older because B twelve will cause you to have some difficulties so that's a good general vitamin to take.

With all that in mind you can take a B complex B complex 50 milligrams across the board is what a lot of people will be recommended to take if they want to take a across the board of vitamin supplement that has the B vitamins in it B complex.

If you look at the label there you'll see all the different types of B vitamins on there.

So that's probably the best supplement to take B complex if you want to take something for depression.

>> Mike, thanks for your call.

Let's go to next caller.

Hello Peggy.

Welcome to Matters of Mind.

Peggy, you want to know if Pugna Genel is good for depression?

It's something that I wouldn't recommend just yet, Peggy, because it's hasn't been studied extensively for depression.

>> It's like a lot of other types of medications that are kind of people kind of wondering whether they will work for depression or not.

We have so many more established medications nowadays for depression compared to speculative type of things.

>> I remember years ago there was a study head to head with Zoloft versus St. John's Wort and it was found that both of them were well tolerated but they were equally effective if somebody had a mild degree of depression.

>> But if you had a more moderate severe degree of depression was starting to really affect your day to day functioning, that's where well supplement medications or supplements and different over the counter things and herbs just didn't seem to help quite as well.

So I would think if you're going to treat somebody for depression you probably ought to use one of the 16 orally available established medications that have come out since 1980 seven we do have other treatments for the more severe types of depression if you don't respond to the traditional type of antidepressants.

So we might use TMS which I mentioned before transcranial magnetic stimulation.

>> Nowadays we have ketamine treatments that can help with depression and I mentioned earlier some depressions will be associated with inflammation.

If you have inflammation there's a way to measure that it's not really mainstream just yet and we're not doing it for a lot of patients.

>> But there's a particular inflammatory marker.

It's a protein called C Reactive Protein CRP and if you have elevated syrupy it's an indication the brain might be inflamed and with that inflammation you might not want to use the traditional serotonin medications and you might find that ketamine could actually work better for you if you have that degree of inflammation.

So there's a lot of different ways we can assess depression nowadays.

But I look at depression in the year twenty twenty one at least similar to how we would with asthma and hypertension and diabetes.

If you have the condition clinically significant you want to treat it seriously and you want to do something about it.

If you had diagnosed coronary artery disease, if you had asthma, you might want to be careful if you were to use a supplement or use some kind of herbal product you probably want treat those conditions very seriously and I feel the same way about depression.

It's we know enough about clinical depression now we probably want to use something that's well established and well studied in its treatment.

Peggy, thanks for your call.

Let's go to our next e-mail question.

>> Our next e-mail question reads Director favor in what ways can too much social media affect mental health ?

I've learned more about this as the years have gone on with adolescence and even with adults they've actually done studies showing the longer you're on social media the more difficult time you can have with depression.

Now why is this and it's been there's been all sorts of different speculations when you read social media you can get really caught up in the stories themselves if their news stories and social media is designed to keep you on the social media.

Facebook in front of Congress did testify that they used algorithms as a means of keeping people on it and keeping them interested and it's fascinating how it works.

>> But basically they they figure out what you like to watch.

They actually can time how long you're on different sites and they'll keep feeding you that kind of information and they'll feed you those kind of sites that they know you were interested in watching and with social media it it not only involves staying on the social media for a longer period of time but when you're on social media you're often reading about other people and by nature when you're reading about other people you can start to become frustrated with your own life and it kind of causes to be disengaged from reality in that sense because all these people you're reading about seem to be having wonderful lives.

They seem to be doing great.

On the other hand, you going to read social media stories where they're catastrophic and are very depressive stories.

So it's very important that especially for adolescents who are just being introduced to social media, there be a time period a time limitation on how long they're on.

I'm a very big advocate that we should expand our horizons and and look at different perspectives of stories and look at different opinions that people might have but be very careful about how long you're doing it because the longer you're on social media the more likely you will develop depression and difficulty with concentration and some of that might be because you're actually on a screen especially late at night because the blue light from the computer screen or from your cell phone actually has an effect where it can keep you awake and it has a means of keeping you awake and that's why some people were eyeglasses that are blue light blockers that will try to block out some of that blue light coming from the screen late at night.

But be very careful about how long you're on a computer, how long you're on a cell phone late at night because that can keep you awake and lack of sleep is a big factor in creating the cascade that leads to depression.

What you often see is difficulty with anxiety where people worry about different things then they lack sleep because they can't get to sleep and they wake up frequently with lack of sleep with less REM sleep or dream sleep with less slow wave sleep.

The next thing that happens is you get more depressed because you can't reason adequately.

Lack of sleep will affect the front part of the brain that I mentioned before and that affects your reasoning part of your brain with a disturbance with the reasoning part of the brain you get more depressed because you can't think through your day to day problems quite as well.

So that's where social media can be a factor because many people are on social media very late at night and it can affect the sleep.

>> Thanks for your call.

Let's go next caller.

Hello Dean.

Welcome to Mars.

The Blind.

>> I'm sorry you hello Dean.

Good evening.

Yes I was is there a certain type of medications I should be taking?

I was only TUDA and told me off of that.

I was recently diagnosed with diabetes and I said I have low testosterone level so I didn't know there was something else that I should be taken.

They put me on medicine.

It's used for Parkinson's Disease to help with some of my sleep issues in the morning hydroxy and also hydroxyl as an antihistamine.

>> It's less sedating than Benadryl but it does block histamine and can make you calmer and sometimes tired in that regard.

I'm wondering, Dean, with with the diabetes, did you acquire that after you were on the La Tuta or have you develop diabetes as an adult and they call it type two diabetes?

>> It's just beginning right now.

I put on quite a bit of weight and that had a lot of neuropathy going on.

They kept thinking I was anxiety causing it and then they found this in my last Lundahl that it was diabetes say well I'm glad they caught that then.

>> So with diabetes neuropathy I have they put you on either gabapentin also known as Neurontin or Pregabalin also known as Lyrica and know what they did put me on this call Stults I are a PSA mirror mirror mirror PEX is a medication that will stimulate dopamine receptors and in doing so you're right that can help with Parkinson's sometimes it'll help with depression.

PEX has been actually shown to be effective as an add on for depression to give you more get up and go and give you a little bit more perk and decrease your appetite a little bit.

But if you have primarily anxiety first we always wonder Dean is a social anxiety, generalized anxiety which is a fancy term for worry panic disorder, obsessive compulsive disorder those the kind of anxieties we often will examine.

>> Have they told you what kind of anxiety you're experiencing ?

Not really.

Add some also being anxiety going on with that I had full blown anxiety attacks.

>> That one got it.

So there'd be panic disorder with agoraphobia Gabapentin and Lyrica.

Hey, for the purpose of knocking down two birds with one stone that might help you out because they also happen to help with diabetic neuropathy.

So we'll often address anxiety with those kind of medications to also help with diabetic neuropathy.

So that's often the direction to go no to no weight gain is real typical with those.

>> Dean, thanks for your call.

Unfortunate amount of time for this evening.

If you have any questions concerning mental health issues you can write me via the Internet at Matters of the Mind ATWA Doug and hopefully I can get that message next week.

>> Thanks for watching.

I'm psychiatrist Jay Fawver 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.

Take care.

Have a good evening tonight