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

>> Welcome to Matters of the Mind now and it's twenty third year Matters of the Mind is a live call in program where you have a chance to choose the topic for discussion.

So if you have any questions concerning mental health issues, give me a call here at PBS or Wayne by dialing in the Fort Wayne area (969) 27 two zero or if you're calling any 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 PBS Fort Wayne studios which are 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, you may write me a via the Internet at matters of the mind all one word at a dog that's matters of the mind at WFYI a dog and I'll start tonight's program with a question I recently received.

Dear Dr. Fauver, I heard you talk about genetics affecting a person's mental health .

>> How do things that happen to us affect the genetics?

I thought that genetics never change.

The genetics in us are hard wired so the genetics and never do change.

>> But genetics are encased in a insulations so to speak.

>> It's called a histone and it makes the little DNA with the outside covering look like a pig in a blanket.

>> Pigs in a blanket are a wonderful using their little hot dogs even better with little sausages inside than there.

>> They're inside this chrysanths flaky crust and what happens is the DNA is like the little hot dog in there and it's always the same.

But what differs is that the histone on the outside of the hot dog can move around and it can change based on environmental stresses, medical illness stuff is happening.

>> So when that histone changes around and moves it will expose certain parts of the DNA that might not have been exposed previously allowing the DNA to either express itself or shut down different proteins.

In other words, you might have DNA that might put you at risk for certain diseases.

>> But you know what?

Those those diseases never come about because you don't have the right kind of stresses to cause that DNA to be exposed and allow that histone to kind of open up and bend and twist in such a way that would expose that part of the DNA.

So let's say you have a propensity toward lung cancer.

Now we all know that a risk factor for lung cancer is long term smoking.

>> So if you don't smoke maybe that part of your DNA won't be exposed so you won't have that risk necessarily.

>> We see the same kind of issues occurring with various types of psychiatric illnesses people with depression, people with anxiety as some people who are identical twins for instance with they have an identical twin exact same DNA.

Some people will get one kind of influence people don't as because of how they might have been exposed to different environmental factors.

So the DNA is how you're hardwired and we take that in consideration when we do genetic testing and genetic testing will help us kind of understand how quickly a breakdown of medications, what medications might be best for you based on the mechanism of action.

We might get some understanding on some other factors like how quickly and how well you break down folic acid which is vitamin B nine .

>> Some people don't break it down very well.

Some people do and we can see that based on the genetics and that way we can recommend supplementation of the byproduct of folic acid but overall genetics will give us a clue on what direction we should go.

It's not definitive because again those genetics might not express themselves accordingly if you don't have the proper stresses that will cause the genetics to overreact or underreact in certain situations in terms of making different proteins.

>> But genetics will be affected by the environment itself even though the actual genetics won't change.

The environment will influence how the genetics will be expressed whether overreacting or underreacting in certain situations causing subsequent psychiatric disease.

>> Thanks for your question.

Let's go to our first caller.

Hello Doug.

Welcome to the Mind.

Doug, you had wondered if I had seen a recent concert.

I don't typically pay much attention to concerts.

>> I know there were thoughts on the crowd reaction, things like that as a psychiatrist I just don't usually follow that Doug so that wouldn't be something I could really comment on.

I think when we hear about violence within crowds and things like that and people running all over each other, it's a mob mentality that sometimes can occur and it's not something as a psychiatrist that I typically would tend to examine or even study for that matter.

So that's something that would be asked of the sociologists out there.

What's the mindset of people and mass populations like that?

Why would they would influence would they be influenced in such a way that that concert that occurred in Houston?

Doug, thanks your call.

Let's go our next email question.

Our next email question reads Dear dear father, are there specific life events that trigger mental illness and how do we deal with these the most profound life events that will trigger mental illness will be adverse childhood experiences under the age of eight years old, particularly.

And the younger the more likely you're going to be more influenced by mental illness when bad things happen.

Now we actually have a scale called the adverse childhood experiences.

Scale is called the ace of scale.

>> It's ten items and it basically asks item by item about specific adverse or troublesome or traumatic childhood experiences.

>> And we talk about childhood experiences because when you're a small child very influential parts of the brain are developing so you've got the front part of the brain vastly developing when you're a small child it really doesn't fully develop until you're twenty four years of age.

>> But when you particularly younger than eight years of age, if you have bad stuff happen to you, emotion abuse, sexual abuse, physical abuse, emotional Umbanda by your parents one or both your parents for instance has a mental illness.

>> A parent goes to jail.

These are all traumatic experiences.

>> It can be traumatic to a child's brain and we have to recognize that in the field of psychiatry because when you've had these kind of experiences as a child later on you can have post-traumatic stress.

>> But one of the key medications for post-traumatic stress first line will be the so-called serotonin medications also known as the SSRI.

So we have Paxil, Zoloft, Lexapro, Prozac, Celexa.

>> These are all medications that are typically used for post-traumatic stress disorder.

But that PTSD experience was triggered by that early childhood experience.

They often don't work.

So the so-called SSRI or serotonin medications just typically don't work that well if somebody had a lot of childhood experiences now how many is the key?

>> Well, we just don't know what that cutoff point was.

>> But if somebody has four or six or eight bad childhood experiences that you can go back to saying that they had this type of bad experiences, this type of bad experience, well, we tend taking consideration maybe they're not going to respond so well to the so-called serotonin medications.

I saw a person today who had six out of 10 on those on that scale for adverse childhood experiences that a lot of stuff going on in their childhood and well she didn't respond so well to past serotonin medications and it kind of all made sense that she wouldn't have done so.

So we take that into consideration.

I mentioned earlier genetic testing with genetic testing.

There's a particular gene we look at called the serotonin transporter gene and if they have a short ALIL on that l'oeil is one type of gene and we've got two genes to illegals with each gene.

>> So if you have a short l'oeil and another short oleo, it's much more likely that if you had traumatic experiences especially as a child you're not going to respond to those so-called SSRI or the serotonin medications again to the most widely prescribed medications out there for depression and even anxiety for that matter.

But you just don't tend to do so well with them if you've had a lot of bad childhood experiences before the age of eight years old.

>> So that's something that's probably a key factor that early childhood experiences in terms of how the environment will predict mental health problems later on.

>> Another factor will be the use of marijuana especially before the age of twenty four years of age.

>> Now this is getting a lot more researched especially since Colorado legalized the recreational use of marijuana about nine years ago because the state of Colorado is kind of like a test tube for how marijuana legalization for recreational use affects younger people.

Now granted it's thought that people under I think it's 18 or 21 years of age out there I'm not sure but it's thought that OK, you shouldn't be purchasing marijuana before a certain age but up until the age of twenty four years of age the brain is still growing and as we know with alcohol if alcohol's readily accessible younger people do get access to it.

So younger people especially in Colorado are getting easier access to marijuana.

So at the age of 12, 14, 16 years of age we're seeing in Colorado a mental health crisis emerge because of the easy access to marijuana.

Now there will always be people out there arguing that if it's recreationally legalized we can track it more at the state level.

It can be taxed and all these these proposed advantages of legalizing drugs of abuse in that way.

>> But we have to remember that marijuana is highly toxic to the brain itself.

So if there's two things that I can identify as significant environmental factors for people that can predict mental illness later on it's early childhood traumatic experiences and the use of marijuana before the age of twenty four years of age.

>> Thanks for your thanks for your email.

Let's go to next caller.

Hello Jeff.

Welcome to Of Mind.

Jeff, you mentioned that you have a coworker who has attention deficit hyperactivity disorder or ADHD and that's interesting because a lot of people will notice other people having ADHD symptoms that might be a family member.

>> It might be a coworker and you had mentioned that it seems that it also shows he also shows autistic type of features ADHD does not have a direct relationship to autism although people with autism can indeed have more anxiety and more ADHD going along with it.

>> But it's not a direct connection.

There are different phenomena.

ADHD is a condition where you have difficulty with attentiveness and that's because the left front part of the brain is not working properly and people with ADHD often have trouble with distractible and it's because the middle part of the brain over here is not working so well.

So what we often try to do with ADHD is help with the focus and attention span and help also decrease the outside distractions.

Now the problem with outside distractions will be people will say they have so many they noticed so many outside phenomena occurring that it's hard to maintain their attention span on one thing and the topic of focus so they get easily distracted.

They'll say that their thoughts are hopping from one thought to another so quickly it's like having a TV remote control and you're going from one channel to another to another to another.

>> People are doing that in their brain.

So you can imagine people with ADHD indeed are having difficulty going to sleep and they often will have trouble going to sleep because they have a hard time shutting the computer off up here in the brain.

But once they get to sleep they want to oversee sleep in the morning.

>> So a lot of people with ADHD are night owls so they like to sleep in in the morning.

Unlike bipolar disorder, when people have bipolar mania those people don't need to sleep.

They'll go for stretches of days if not weeks where they just don't need to sleep and they get by with two or three hours at a time and they're raring to go the next day with autism a little bit different phenomena with autism there's thought to be a decrease in the so-called mirror neurons and the right side of the brain in the front there and these are the neurons that allow you to connect to other people interpersonally.

You look at somebody's mannerisms, you are talking to them and you kind of get a sense for how they might be feeling about something people with autism often talk and talk and talk and you have a hard time following what they're saying and they kind of go off on long monologues when they're talking to people and they speak with very little intonation in their voice.

>> We call it pedantic speech where they talk and talk and talk and they don't really allow other people interrupt or express their thoughts and it's because they lack mirror neurons.

Why do they like mirror neurons?

>> There's a particular hormone called oxytocin.

It's called the bonding hormone also known as the love hormone.

Oxytocin comes from the pituitary gland which is down in this lower part of the brain on the inside.

>> And oxytocin when released will allow you to feel a bonding with another person such that after a woman, for instance, delivers a baby, the levels of oxytocin can go up 80 times what it usually would be.

It's interesting that when men have their loved one deliver a baby and the men have fathered that baby, oxytocin does not go up.

>> It only goes up for the women.

So it's an interesting phenomenon there.

But oxytocin appears to be important in the developmental aspect of the brain and it's thought that individuals with autism where they have that difficulty with social connectedness especially they appear to lack oxytocin early in their life spans and there's thoughts that maybe we could give oxytocin not as a pill because it'll get chewed up by stomach acid really, really fast.

>> It can only be given either as an injection or maybe it's a nasal spray.

So these are the kind of research studies being considered for the treatment of autism.

But a lot of people with autism do have trouble with concentration and focus but they don't necessarily go hand in hand because they're entirely different phenomena but they can be associated with each other but they're not automatically associated with each other.

If you have difficulty autism often you have a hard time putting up with changes.

You have a hard time dealing with stresses and you might do such things as banging your head repeatedly because you're so frustrated about a change in your environment so people with autism will have trouble with a change of something in their environment such that they become extremely frustrated people with ADHD will have trouble with stress but they'll have impatience.

>> They have trouble.

The distractibility basically people with ADHD will also have trouble filtering out a lot of extraneous stimuli and that's where the distractibility comes in.

But this little thalamus in the middle part of the brain is kind of like the separate central operator and people will notice this with ADHD as well as autism and a condition known as schizophrenia where the central operator is impaired and you just have this bombardment of all these stimuli going on around you and you can't keep your mind on things.

>> So these are the kind of phenomena that can occur with especially with ADHD and autism but they are indeed separate conditions.

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

>> Our next e-mail question reads Dear Dr. Farber, in what situation are medications better than counseling?

I'm wondering because I don't know if I should take medications for depression or start counseling.

Medications are specifically better than counseling and depression.

If you have difficulty with concentration, if you have a lot of fatigue, if you're not enjoying things so well and if you're specifically thinking about suicide.

>> So those are the four areas where medications repeatedly do better than counseling itself and we often will think about medication use for people as a means of laying the foundation to help them with counseling.

In other words, medication and various types can potentially increase the fluffiness of the brain.

It's thought that when people have trouble with ongoing persistent depression they have less fluffiness of their brain such that there are little neurons which should have ten thousand branches on the average well they start to shrink up and it's like a bunch of trees losing their little branches out there and when you have less branching on your neurons you can't think is clearly so anymore.

>> The thought is we want people to have more branching other neurons.

We want them to increase that this particular chemical in their brain called brain derived neurotrophic factor as well as other particular chemicals and these chemicals are increasing the fluffiness of the brain, increasing the branching of the little neurons and thereby allowing the neurons to communicate with each other better.

>> And that's will be often the role of medication treatment.

Various medications can increase that branching in the neurons and in doing so might be able to better help people with difficulty with fatigue, poor concentration, suicidality and difficulty with not enjoying things.

>> We call that anhedonia where they're not enjoying things but medications really do a nice job helping with those particular situations.

>> I remember back in the 1980s when I was in my psychiatric training we used to always emphasize that people should have counseling first and then only as a last resort.

They got medications well in the nineteen nineties and maybe about twenty years ago we realized that people didn't do so well in counseling if they couldn't think if you can't concentrate and you can't focus you're often not going to be aware of the problems you're experiencing and you can't follow the guidelines.

The counselor is trying to allow you to follow and trying to guide you upon.

So we now realize that if people have particular symptoms such as fatigue, poor concentration, lack of enjoyment things and suicidal thoughts, those will be specific factors where medications will often pretty predictably do better than counseling and self right up front and we often add medication with counseling but anymore more we tend to precede the use of counseling with the use of medication.

>> Thanks for your email question.

Let's go to our next caller.

Hello Lucy.

Welcome to Arizona Mind.

Hi.

Hi.

Hi Lucy.

I have a couple questions.

My mom recently has had three strokes.

I should have one with me and we land online and she had the ambulance there and she had two more than that.

She's she's kind of weak.

Yeah, she'll have three weeks but her mind is gosh never mind.

Thank you.

>> Well, Lucy had mentioned your mother had three strokes and when people have strokes basically it's a loss of blood flow to certain parts of the brain and there's another type of stroke.

It's called a hemorrhagic stroke where people have bleeding in certain parts of the brain and bottom line is you're not getting adequate blood flow and thereby you're not getting adequate oxygen in certain parts of the brain.

Lucy, when your mother experienced strokes depending on where The Strokes affected her brain, she might have had different problems.

In other words, she might have had more trouble with memory if the stroke affected the side part of the brain over here she might have had trouble with movement depending on the where the stroke affected the side part of the brain.

If the stroke primarily affected the front part of the brain, maybe she'd have trouble with her personality changes.

So based on where the stroke occurs you might have different type of responses.

We do know that when people have any kind of stroke Lucy, it's a condition where it's traumatic to the brain with any traumatic brain injury you can have a disturbance in this excitatory chemical called glutamate glutamates all over the brain and it's an excitatory chemical.

>> It's an accelerator for the brain and if you have a trauma to the brain such as a stroke or maybe a head injury, you'll have this abnormal release of glutamate.

>> Excessive glutamate can give you likelihood for a seizure and it can also give you difficulty with concentration and focus and irritability and impulsivity.

So what we're often trying to do after somebody had a stroke if they've had personality changes or if they've had trouble with moodiness or irritability, we're often trying to stabilize those kind of symptoms with a medication such as an anti seizure medication that will prevent seizures but also help stabilize the mood by stabilizing glutamate.

>> So glutamate is something that's all over the brain.

It's opposed by this chemical called Gabba Gamma Butyric acid but GABA and glutamate are kind of opposing forces glutamates like the accelerator on the brain gabbers the brake on the brain and we need them both because if you have too much glutamate you'll have like I said, seizures, even psychosis you'll have irritability, moodiness, impulsivity.

>> GABA calms that down.

>> Now GABA is a chemical that will influence the anxiety and anger and fear control center which is here at the brain.

>> It's called the amygdala and if you give to if you give a medication it enhances the transmission of GABA excessively.

You feel tired, you don't care and you can have trouble with concentration.

So you've dampened down the excitatory glutamate excessively with excessive gabb and that's why we're very careful in giving medications that are known as benzodiazepine days of pain especially for older folks such as Xanax, Ativan, Valium, Klonopin.

These are medications that will suppress the energizing effect of the brain to such a degree that you can have trouble with memory and concentration and focus and and get up and go.

>> So we want to always balance that out.

So when somebody had a stroke Lucy, we have to remember that stroke is a traumatic has a traumatic effect on the brain and depending on where that stroke is located, we want to make sure that we are able to address those symptoms the best we can.

>> Lucy, thanks for your call.

And we have another email I believe and it reads Dear Doctor Father, how does losing sleep affect the brain?

>> Are there any medications becoming available that specifically affects sleep and depression?

>> There's this particular chemical in the brain called or Rexon and if you enhance or rexon you'll tend to be very awake and alert.

>> It's kind of like histamine if you increase histamine the brain you're very awake and alert and we have medications like Oh Provigil and Nuvigil they work on the front part of the brain.

They enhance dopamine to some degree but they do increase histamine and if you increase to mean you're wide awake, if you block histamine such as with medications like antihistamines, they're used for allergies but they also make you tired.

>> So histamine enhances alertness in the brain or rexon also known as Hypocretin same chemical to different EAMS or Rexon Hypo Kryten same thing.

It will go up when you're wide awake so when you're wide awake or Rexon or Hypocretin go up.

So how do you help somebody with sleep sometimes when you give them a medication just to throw out a name here Bell Samrat Bloks or Rexon and by blocking or Rexon it makes your sleepy really fast.

There's a condition called narcolepsy you might have heard about narcolepsy where you have this abnormal Tranz, this abnormal decrease, this plummeting of Eareckson every now and then all of a sudden you just go to sleep and you go right into dream sleep even though you previously were wide awake and people with narcolepsy can have difficulty with their knees buckling, they just go to sleep just on a whim.

It's because they have this abrupt drop in or Rexon or Hypocretin.

So keeping that in mind, a medication the blocks are rexon can help you sleep as long as you're just taking it at nighttime.

>> So we now have medication ins that are actually Ulriksen enhancers that can possibly keep you awake and keep you more alert.

So on one hand or Rexon blockers will help you sleep or Rep. Eareckson enhancers will keep you more awake and those medications added on to an antidepressant medication might give an added mechanism of action in terms of helping somebody with depression overall.

So with that being said, as time goes on, I think we're going to be hearing more about sleep medications that also help with depression because three fourths of relieving somebody of sleep of depression will be to relieve any sleep disturbances they might have had.

>> Thanks for your call.

Unfortunate amount time for this evening.

If you have any questions concerning mental health issues you can write me a via the Internet at matters of the mind all one word at a drug.

>> I'm psychiatrist Jeff Oliver and you've been watching Matters of the Mind on PBS Fort Wayne God willing on PBS willing.

>> I'll be back again next week.

>> Thanks for watching.

Good night