>> 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 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 long distance coast to coast you may dial toll free at 866- (969) to seven to zero now on a fairly regular basis we are broadcasting live every Monday night from our spec other PBS Fort Wayne studios which lie in the shadows of the Purdue Fort Wayne campus.

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

>> It reads Dear Dr. Fauver can an adolescent or teen outgrow their anxiety or depression and can it become less of an issue when someone reaches adulthood?

>> Well, as children were especially sensitive to traumatic experiences whether it be chaos within the household separation or divorce of our parents alcohol, drug use, mental health issues among family members and before the age of eight years of age it's thought that your personality starts to slowly develop and you start to make interpretations of whether or not the world is a dangerous place and how you're supposed to live in it.

>> I often emphasize to people though until the age of twenty four your brain doesn't fully grow and that's reassuring for a lot of young adults and actually a lot of parents of young adults because the front part of your brain is a part of the brain that you use to make good decisions.

Part of the brain that makes you think before you act think before you talk that part of the brain is still growing until you're twenty four years of age.

So theoretically there should be lots of restrictions on how much freedoms were given until the age of 24 because you are truly working with an underdeveloped brain.

>> So we have the legality of voting and drinking at a younger age than twenty four years of age.

>> But you have to remember at that age your brain hasn't quite developed.

>> So with that being said you'll notice that you'll be able to put up with stuff at the age of 26 and 28 that you couldn't when you were 22 or 19.

>> So I'll often emphasize to people that by the time the adolescent gets out of high school becomes a young adult, maybe goes off to college, the things that the parents said previously start to make a lot more sense.

And to paraphrase Mark Twain, his dad got a lot smarter as Mark Twain got older.

>> So it's a type of thing that we have to recognize that you can grow out of some of the angst of the childhood drama that sometimes will will encounter the moodiness, the irritability, some of that or is hormonal.

Sure.

If you have the the waxing and waning of the hormones as you're going through the adult years that can cause a little bit more emotional turmoil in itself beyond notice that with life experiences and with the ability to develop coping skills and as I say the front part of the brain developing and growing more and more that judgment center of the brain starts to develop and starts to get through some of those chaotic life experiences that we all have to encounter.

>> So yeah, to a degree there is hope with depression and anxiety you can outgrow some of that.

You can have better coping skills and with life experiences you can get past that.

>> However, the longer you have difficulty with depression, the longer you have difficulty.

The anxiety, the more likely it becomes kind of it takes on its own nature over the course of time and you can live with it chronically if left untreated if it kind of festers and most tragically it can cause you a lifelong consequences if you drop out of high school for instance because of depression or anxiety or worse yet let's say you try to medicate the depression or anxiety you're having at the age of 14 or 17 years of age with alcohol or marijuana which at the time sounds like a good idea.

I mean you feel better if you use alcohol or marijuana because they make you not care.

You feel calmer.

So it seems like a good idea.

The problem is especially marijuana even more so than alcohol will suppress the growth of the front part of the brain.

So this very part of the brain you're trying to well grow and mature is being stunted in its growth with the use of marijuana and with the legalization in several states of recreational marijuana it's becoming more socially acceptable to use that.

So we have to be aware that these very important decisions we make as adolescents and young adults can have lifelong impact.

>> Thanks for your email.

>> Let's go to our next caller.

Hello Joe.

Welcome to Matters of Mind a kind of a related question you had mentioned you're wondering about using marijuana before his age of twenty four years of age.

>> Can that cause bipolar disorder?

Jila might not cause bipolar disorder but what using marijuana for the age of twenty four will cause is a suppression of this white matter growth white matter growth like the name sounds is white matter and the brain and that's basically insulation of the individual nerve fibers .

If you suppress the growth of the individual nerve fibers your nerves don't talk with one another as well and it's thought that we have as many we have many, many different nerve fibers.

They each individual nerve nerve has ten thousand connections to other nerves and if you don't insulate them properly they can't maintain that communication.

So the biggest consequence I see Gio with people who use marijuana before the age of twenty four years of age and there are studies confirming this will be number one they have more difficulty with intellect, concentration, decision making.

They have trouble with focus and concentration.

That's why a lot of people wonder if they have attention deficit hyperactivity disorder when they're using marijuana because it looks it mimics the same type of symptoms.

Secondly, people who use marijuana at an earlier age will often have trouble with motivation.

>> It suppresses your drive, your initiate your willingness to do things and that's why a lot of employers at least in past years have done drug screens especially on factory workers because they want to know if people are using marijuana because it makes them less motivated and less productive at their workplace if they're using marijuana.

>> So those are the biggest issues.

Will it cause bipolar disorder directly?

Probably not directly bipolar disorder which by nature is a condition that's an inflammation of the brain that causes you to have difficulty with big eyes and big elevations of the mood where you can be more irritable or happy for a brief period of time typically days if not a couple of weeks.

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

You're more impulsive, you're more irritable, you're more angry and you have more mood swings.

>> So using marijuana can be a sociopath moodiness especially when you're trying to stop marijuana.

>> I saw a lady earlier today who noticed that every time she tried to stop marijuana she got more angry and more irritable.

>> So we're going to try to give her some medications to try to help her with that to help her get off the marijuana itself because she's truly motivated.

But getting off of marijuana can actually make you more irritable but actually causing bipolar disorder.

I'm not aware of it actually causing a mood disturbance that directly that would last on going after the use of after discontinuation of the use of marijuana.

>> Jill, thanks for your call.

>> Let's go our next caller.

Hello, Nancy.

Welcome to Matters of Mind.

Nancy, you had asked about a vitamin D and can you overdose on it theoretically you could kind of overdose on vitamin D, Nancy, because vitamin D, E and K are stored in the liver and if you just take these massive amounts of it we're talking ten thousand units a day day after day after day you could get an accumulation of it and what it does is it accumulates in the liver itself.

So you want to talk to your clinician about the possibility of of supplementing with vitamin D typically for most people if they don't have any liver problems two thousand units every day is very safe for some people they can get by with five thousand units every day, especially in the wintertime.

Vitamin D is actually a hormone that's manufactured in the skin upon exposure to ultraviolet light.

>> So if you expose yourself in a summer time at about 10:00 or 11:00 a.m. to about 20 minutes of sunlight you can produce about ten thousand units of vitamin D right there in your skin.

Well, a lot of us don't do that and if we use sunscreen that will suppress that.

So for that reason the best way to get vitamin D supplementation in twenty twenty one quite frankly is by taking a vitamin D supplement which would be a pill or a capsule and two thousand units every day is a very common supplemental dosage.

Now why would I recommend vitamin D for anybody?

Well a lot of us are low on it and there is a blood test that's typically no longer covered by insurance but there is a blood test and you want to ideally have that blood level above fifty five or so and many of us if we check a blood level what's going to be 15 I saw level of 15 on the on a man today it's going to be a down there at seven or so so blood levels especially in the wintertime when we have very limited exposure to the sunlight it's going to be low.

>> So with that being said, low vitamin D can make you more likely to be depressed in Denmark they did studies on individuals who had needed psychiatric hospitalization for depression and he found in Denmark where it gets pretty dark in the winter times people had lower vitamin D levels and they attributed that to depression itself.

So lower vitamin D can give you depression.

Lower vitamin D levels can also possibly increase the risk of all causes of cancers.

So vitamin D has a lot of benefits overall it is a hormone.

It's something it's manufactured in the skin.

Can you get in the diet to some degree milk is fortified with vitamin D but it's not as effective is if you take a real cheap form of a capsule or a tablet.

Vitamin D three is why you'll often see out there it's version of vitamin D and that's what you'll get over the counter.

So yeah, I often recommend vitamin D and a version of vitamin D three two thousand units every day.

Some people will indeed take five thousand units every day.

>> There is a dosing strategy for people who have known vitamin D deficiency like my man today who I heard that vitamin D level of fifteen those people are sometimes take ten thousand units a week for several weeks to get their vitamin D levels up adequately and then they take a small amount of vitamin D ongoing but especially as we get into the wintertime vitamin D supplementation can for many, many people decrease the risk of of depression now in nursing homes it's common practice to give the older adults in nursing home supplemental vitamin D ongoing because not only does that help with mood not only to decrease risk of cancer but also helps calcium get into bones so it strengthens bones that way and when people are in nursing homes they don't get much sunlight so they're often in many cases mandated to get vitamin D supplementation in nursing homes Nancy, thanks for your call.

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

Our next e-mail question reads Dear Dr. Farber, can't I think already answered that one if an adolescent or teen outgrow their anxiety or depression if I didn't already answer that one I think I have memory problems myself but I think I answered that one.

OK, here we go.

Dear Father, I heard recently about a study indicating that dogs can have ADHD.

>> I wondered if somebody's going to ask about this if you if you have heard about that study and I have how it does apply to humans.

This was a study looking at dogs in Finland, OK, Helsinki they did study a whole bunch of different dogs and as you can imagine, dogs can be hyperactive.

>> Some dog breeds can be less attentive than others and it was often based on the age males were more likely than females dogs to have difficulty with attention span focus and hyperactivity and you know, the breed made a difference but they did find there were some behavioral differences.

The dogs that had more attention as you as you can imagine the dogs got more exercise were less likely to be hyperactive but they did perceive there was a similar phenomenon with dogs as there were with humans with attention span distractibility.

>> So I was really interested when I saw that paper because I thought great, they might have done brain scans on these dogs to see if there were differences because with humans it's the left front part of the brain that's underactive and giving you difficulty.

>> The attention span and this middle part of the brain here was the part that was malfunctioning in humans to give you a difficulty with distractibility.

So with ADHD you have difficulty inattentiveness and distractibility and for some people that also leads to impulsivity and hyperactivity and that's what you see in humans.

>> I was hoping they would do scans of dogs and see the same phenomenon I didn't see those scans appearing in this paper.

>> So from the paper I read it talked about the need for dogs to be able to have socialized time with humans.

It's the dogs that were left alone didn't get the physical activity.

They were more likely to be impulsive and hyperactive but they did perceive there was an overactive ah there was a overlapping element there of hyperactivity and inattentiveness in focus with with some breeds especially with younger dogs and male dogs.

>> So it didn't really surprise me what I saw from that but I hope they do some follow up studies on that because if we can understand how ADHD might affect dogs, obviously it helps us understand what more we can do for humans.

But for dogs the key appeared to be if you have hyperactive dog that's very inattentive, you want to make sure to give that dog more social attention with family members and you want to make sure they get that dog some exercise.

>> I think we've already kind of figured that out.

>> Let's go to our next caller.

Hello, Ken.

Walk on Mars the mind.

Yes, sir.

I know I've dealt with depressive symptoms for about twelve years now and tried a number of medications to get there and I just have quite a bit over the hump recently I've heard about some new treatments, some DMP by small pharma in the UK I believe and also Johns Hopkins is doing some study on psilocybin and I wanted to know what you felt about those two or if you had any kind of information on them and how as one go about becoming a trial recipient of those treatments you're talking about hallucinogens hallucinogenics can at low doses we call them micro dosing.

>> They can help especially with post-traumatic stress and maybe depression psilocybin being the one that I think it has the most potential for getting on the market more in the near future.

I don't think in that you're going to be able to take those home with you and just take them as you might with Zoloft or Cymbalta or Wellbutrin which are common antidepressants.

I think what's probably going to happen with those kind of treatments is you'll be dosed with those treatments any controlled outpatient office setting in a similar manner as how we dose people now with ketamine as ketamine is the left sided piece of ketamine and as ketamine is FDA approved, it's something that I've completed over 3500 treatments with that for patients.

So it's something that is available and with ketamine you come into an office, you get a nasal spray of ketamine, you sit there and you're monitored over the course of two hours and during those two hours you can have some trouble with you can have the experience of sedation and what's called dissociation where you have a little bit of an out of body experience.

The out of body experience might last for about 20 to 30 minutes.

Typically the same phenomenon can occur with this micro dosing of the hallucinogenics.

Now the hallucinogenics LSD if you remember back in the old days LSD was quite popular.

It basically enhances your connectedness with the world around you and it's thought on that basis that the hallucinogenic LSD psilocybin and so forth can possibly help you with past traumatic memories because it basically in chances your empathy for people and the world around you so you can kind of get a broader scope during that time of treatment it would be microdots to very small doses and the idea would be that that could from a neurobiological standpoint affect particularly serotonin transmission in the brain and that's the main target of these hallucinogenics can it is changing the way the brain is processing serotonin in the idea would be for good long term effects.

>> We're probably no sooner than about a year away from seeing those available.

Some of the university settings are starting to use some of those.

So you think about in the Midwest, Cleveland Clinic, MIT, University of Michigan does some mood mood research.

>> The Indiana University School of Medicine sometimes will do moods research.

>> You're typically going to hear about that with university settings but I'm not hearing in the real world where I work any availability of the hallucinogens to be available yet.

>> But oh that's ketamine did come out in March of twenty nine and we've been using that for about two and a half years now.

The nice thing about that being available is that now that we've been using ketamine and we've been able to monitor people over the course of those two hours and we have the protocol in place to do that, I think our abilities to do that with hallucinogens will be easier for us to do because we kind of have the protocol data.

>> We understand how to monitor the drug use and the the blood pressures, the dissociation process, the sedation and be able to assess if people are ready to go after the two hour time period.

But I have not yet in the real world type of settings right now can hurt of the availability of those.

But I think they're coming there's there's a lot discussion about it and I would say maybe as late as twenty twenty two maybe sometime in twenty twenty three we're going to be able to have access to the hallucinogens at micro dosing for post-traumatic stress and depression.

Those are the two conditions I'm hearing that we might be using those medications at micro dosing but we'll always be able to monitor and set a monitored setting.

We're not going to hand these out to people for them to pick up at their local retail pharmacy to take it home obviously because the possibility of diversion on the street it's going to be only treatment under a monitored setting can thanks for your call.

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

Our next email question reads Dear Dr. Fauver, my doctor has told me that you can't trust clinical trials for medications .

He said that we should rely on real world experiences.

Can you clarify what he meant?

I think I can clinical trials basically are what will allow a medication to get approved by the Food and Drug Administration.

The FDA to be able to thereby market and it takes about a billion dollars.

That's not an exaggeration takes about a billion dollars from the time that you create a medication molecule that you think might work for something to get that researched on animals and then a handful of people that might have the condition that you're researching and then a larger group of people looking at the medications long term effects for safety and how well it works.

>> So it takes an average of maybe 10, 12 years sometimes to get a medication on the market like that.

Now some medications can be fast tracked based on need and they get studied a little bit differently than mean they're any less safe.

It's just that they get fast tracked a little bit different ways.

But the medication we're using in clinical practice now in my world with antidepressants, antipsychotic medications or even in a primary care world such as for diabetes and antihypertensive those medications are always compared versus a placebo, a sugar pill or something that doesn't have any active ingredient in Europe.

They're mandated to always be compared about against something that it's an active medication currently being used for that particular condition.

So in Europe, for instance, if you want to study an antidepressant you compare it with a medication like Paroxetine or Paxil which is used for depression not uncommonly so you want to make that comparison between placebo and sometime an active comparator just to see if it's going to work better and it's always a head to head study.

The researcher doesn't know what they're giving.

The patient doesn't know what they're getting.

So it's called double blind setting but in the clinical trials, quite frankly, a lot of people are it's kind of a sanitized clinical trial where people don't have other kind of medical conditions.

They don't have other psychiatric conditions.

They don't have any other medical conditions.

The people the patients in clinical trials were often in clinical trials because they just have that condition without a lot of other things going on.

>> And with that in mind, sometimes it's not like the real world because in the real world people have what we call comorbidities.

>> They have comorbid anxiety.

They have difficulty with other physical problems.

They they have liver problems.

They have heart problems in some cases and we have to work around all that and you'll find that in clinical trials a medication might work really well versus sugar pill or even versus an active comparator but the medication gets on the market might not work as expected.

So the bottom line is in the real world setting patients have the choice whether to stay on the medication or not in the clinical trials many times at least especially in other countries outside the United States, patients get paid for being in the clinical trials so by golly they stay on that medication no matter what kind of side effects they're having in the United States.

For instance, if people aren't getting paid in the clinical trials they have some side effects.

>> They might hang in there because they want to be a good patient for the research study.

But in the real world they go off of it.

They they call you back after three or four days.

They say I don't want to take this medication.

So in the research world people often stay on the medication in the real world often people will stop the medication and sometimes payers insurance companies just won't pay for the medication in the real world.

>> So people go off of it because of that.

So often as clinicians in the so-called real world we call it the naturalistic setting we have to figure out what's going to work for patients with the medications that we have and if the medication is affordable, if the insurance company for instance pays for the newer medication, we then have to figure out OK, if this patient does have some other medical condition, some other psychiatric conditions, how well can this medication fit in with everything else?

And sometimes that's quite a quite a challenge in itself.

Thanks for your question.

Let's go to next caller.

>> Hello Dean.

Welcome to Matters the Mind.

We have a couple of minutes left here.

Yes, I had a question on I was wondering why some facilities are not able to go back are are not able to continue on with a phone call visit.

And I was also wondering I have been having neuropathy and I had my sugar tested and did not find anything with the sugar water kind of sense anxiety.

So I wasn't sure about that.

>> Yeah, sometimes we'll hear about I'll answer your second question first Dean.

Sometimes we'll hear about neuropathy related to anxiety and that's sometimes related to hyperventilation and when people breathe heavily and they exhale excessively they can get some hyperventilation and they can have some neuropathy from that.

You did the right thing.

You want to check sugar test with their apathy.

Obviously you want to see if there's any neurological conditions.

We often recommend that people see a neurologist where they can do an electro myelogram and EMG to see if there's any disturbances with nerve transmission often b 12 levels are checked that's readily treatable means of correcting a neuropathy.

So you want to take take a look at all the medical conditions that can be out there if somebody does have neuropathy due to emotional disturbances such as anxiety, we want to treat the underlying anxiety and get that under better control for a lot of people.

The first question about why aren't telephone visits over the just talking to someone on the telephone being covered by insurance or payers anymore the federal government is phasing that out.

>> The ability to do that I hear in January the federal and the state levels are just phasing out out so the clinicians who will just do a telephone visit with you will not get paid for that in the future video visits are much more appropriate because you're able to see somebody it's more like an interaction where I can see you, you can see me.

We talk back and forth.

It's just done by video HD quality.

The sound is usually very sharp so it works out very well.

So I do believe, Dean, that video visits are here to stay but I don't think the telephone will be Dean, thanks for your call.

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 a via the Internet at Matters of the Mind at WFA a drug I'm psychiatrist Jeff Offer and you've been watching Matters of the Mind on PBS for Wayne God willing and PBS willing.

>> I'll be back again next week.

Have a good evening tonight