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

Welcome to Matters of the Mind now in its 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 mental health questions you'd like to ask me on the air, you may contact me here at PBS Fort Wayne Studios by dialing the Fort Wayne area at (969) 27 two zero or if you're calling Kostikov you may dial toll free at 866- (969) 27 to zero now on a fairly regular basis we are broadcasting every Monday night from our spectacular PBS Fort Wayne studios which lie in these 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 there via the Internet at matters of the mind all one word at WFA a dot org that's matters of the mind at a dog and I'll start tonight's program with a email I recently received.

>> It reads Jadot Evolver.

How do you explain a runner's high?

>> When does that seem to occur when you're exercising while runner's high used to be thought to be due to endorphins but the funny thing about endorphins those are kind like the natural opiates in your system they don't cross this mesh that's called the blood brain barrier.

>> We have this blood brain barrier which is like a fine net all over the brain and it doesn't allow in endorphins.

So for decades people have been talking about how endorphins are responsible for the runner's high because the endorphins are the natural opiates that go to the brain and give you a feeling of bliss, fullness and contentment.

>> Well, there's some recent work that's been done and you might have heard about this up in Wayne State University where they're speculating that the runner's high is more due to our endocannabinoid.

>> That means the endogenous or inner natural Carnivúle cannabinoids in our ear about marijuana and marijuana as a cannabinoid and people smoke that they use it in various forms and they get a feeling of contentment and bliss and they decrease their anxiety in using marijuana.

But we have those natural cannabinoids in our bodies and they get released in the brain when somebody is exercising.

So people sometimes wonder well why can't you smoke marijuana and get the same effect?

The problem with marijuana it has components in it that can be damaging to the brain, especially if you're under 24 years of age and causing the brain to have a suppression of the white matter growth so people who use marijuana often have difficulty with concentrate and memory and in the long run motivation's there's a lot of side effects to marijuana that are detrimental.

>> Your natural endocannabinoids the cannabinoids that your brain will produce are produced with exercise and that's getting studied right now.

>> But the runner's high typically occurs at about 40 minutes and it's about 40 minutes after intensely exercising.

>> A lot of people have thought it had to do with the natural glycogen loss in the liver because if you exercise and exercise your natural glycogen which is a storage of the glucose in your liver gets gets exhausted so you don't have any more glycogen.

So your body has to kind of switch over to fat burning mode and it was thought that was partially responsible for the runner's high.

But at that 40 minute mark of intense exercise it's now thought that there's these and dodginess cannabinoids that get released and it gives you this sense of euphoria and happiness and helps your concentration.

A lot of studies have been done showing that thirty minutes to an hour of exercise in the morning can help you with concentration especially later that morning and that's been actually studied in high school .

Children up in Naperville, Illinois was where it was first studied over twenty years ago were they had middle school and I believe grade school children came out too but they actually had them exercise in the morning before they went to class and their academic performances increased dramatically and it was thought to be due to the exercising in the morning that actually helped them with their concentration.

So the runner's high occurs about forty minutes after intense exercise.

It's debatable right now whether it needs to be aerobic exercise like being on the elliptical bicycle or running or can it be with weight lifting the twenty minutes of really getting that heart rate up where you your heart rate is going fast enough where it's kind of difficult to talk when you're exercising do that for about 30 or 40 minutes and you're going to get a runner's high not uncommonly and that high is a sense of contentment ,bliss, happiness.

A little bit of a thrill comes from that but it could be partially from the exhaustion of the glycogen from the liver but also from the natural cannabinoids in the brain.

>> Thanks for your email.

Let's go to our first caller.

Hello Thomas.

Welcome to Matters of Mind.

>> Well, Thomas, you wondered how common is it to overdose on caffeine?

Your sister recently collapsed and seem to have a few seizures after drinking a few energy drinks.

She's OK.

But it was it was scary.

>> And you want to know how common is that?

It's as common as it would be for people drinking excessive amounts of energy drinks.

Energy drinks can be kind of tricky.

They're designed to drink one at a time and not drink them with coffee and only have one during the day if you have more than one energy drink a day you're probably putting yourself at risk for the possibility of caffeine intoxication.

Energy during drinks can have anywhere between two and three times the caffeine.

That coffee might have an energy drinks will have a lot of other components in it.

>> Some of them are not so bad like like like the B complex chemicals that are in energy drinks but they do have a lot of caffeine in them and when you use that amount of caffeine in a very short period of time you can have a cardiac arrhythmia and that means heart rhythm starts to get thrown off a little bit and sometimes that can lead to a disturbance in oxygen in the brain and that can lead for some people to have a seizure.

>> So with an energy drink use them in moderation and no more than one a day it's worthy's easily adolescences.

Young adults will knock down two or three energy drinks back to back to back and that's where they can get in trouble.

We've heard about that over the course of the years with their having rhythm disturbances of the heart increases in blood pressure as well as the seizures in some cases.

>> So this is it's less common now I think than ten years ago when people didn't really understand the impact of energy drinks.

>> But I think people are starting to hear that excessive consumption of energy drinks can be problematic for some people.

>> Thanks for your call.

>> Let's go to next email.

Our next email reads Dear Dr. Fauver, why does depression cause physical tiredness, fatigue and weakness in people when you hear about physical tiredness, fatigue and weakness in people, what do you think about how you think about flu like symptoms?

>> So these people who have difficulty with tiredness, they are they're achy all over and they're very fatigued and they might have sleep disturbances.

They have depression but they sound like they have the flu.

>> The only difference is with the flu the symptoms might be there for a week, two weeks, three weeks at the very longest with depression.

>> They're there week by week by week and they just don't go away and they don't get any better for some people it's because both the flu and the depression for some people have inflammatory components.

>> The flu and depression will increase these inflammatory proteins once called interleukin six another one called tumor necrosis factor.

But these are inflammatory proteins that increase with depression and can increase with with influenza.

So there's the same type of inflammatory proteins that will increase for people.

So what happens is Worthy's inflammatory proteins go to the front of the brain and that's the part of the brain that regulates motivation initiative wanting to do things and if you have inflammatory proteins in the front part of the brain it will suppress the front part of the brain's activity such that you just don't care about things.

>> And that's why a lot of people with depression won't enjoy things they previously enjoyed.

They don't have the initiative to get started on something and they just don't have the enthusiasm to get started and the problem will be with depression when you start to give up pleasurable activities, things that you used to enjoy, it caused you to be more depressed because as you can imagine, if you don't do things that are fun or enjoyable, do you end up getting more and more depressed and it becomes a vicious cycle.

>> So one of the first things we try to do to help people get out of depression is to get them to go back to do the things they used to enjoy doing, find their passions and go back to doing those kind of things.

It might have been years since they last did those type of things.

Lack of socialization is often a big problem for people with depression because when you're depressed not only do you feel badly about yourself but you often perceive that other people feel the same about you so you don't want to be around other people.

>> You don't have the initiative, you don't have the mental energy to be in social activities.

>> So it's exhausting to be in social groups when depressed but when you're depressed it's very important to try to get out and get around people again and try to socialize.

You can always talk to your primary care clinician about the possibility of any medication treatment or any referrals for medication counseling or talk therapy is for the purpose of trying to help you talk your way out of the depression itself and help you rationalize what's really happening around you as opposed to what you think might be happening based on your depression because when people get depressed their anxiety and fear and anger center for that matter in the front part of the brain over here it's called the amygdala that will hijack the thinking part of the brain in the front and when you hijack the thinking part of the brain ,you don't think through things rationally so you perceive bad things are happening around you where really quickly that might not be the case now our perception of the world around us will often be tainted by our past experiences.

>> For instance, if you've had four or more really bad childhood experiences before ten years of age four or more of those bad childhood experiences before eight or ten years of age will put you at risk for depression later on especially if you have a certain genetic makeup genetic makeup plus the environmental stresses as a small child will often lead to a much greater likelihood of depression.

>> So we often consider not only your actual symptoms that you might be having of depression and they might be fatigue and low energy and difficulty with initiative like you describe.

But we look at your genetics, we look at your family history of depression or anybody else in the family has had depression.

Plus we also look at any difficulty with bad childhood experiences but bad childhood experiences will kind of set the brain up for a higher likelihood of inflammation and that will cause you to have these kind of symptoms that you're describing the fatigue, the achiness, the poor initiative.

So how do you treat it?

It used to be thought maybe 15 years ago you could treat some types of depression with the antiinflammatory medications think and theoretically if you have symptoms of inflammation, why not give somebody over-the-counter medications like Motrin, Advil, maybe even aspirin for that matter?

Well, that hasn't worked out so well and it's very inconsistent for a while we thought maybe we could look at inflammatory protein measurements like C reactive protein CRP and C C reactive protein is commonly used as a measure of inflammation with heart disease and we thought gee maybe we can do that in psychiatry as well.

It's not highly predictive just yet but what we do know is that somebody has difficulty where it looks like they might have an influence inflammatory type of depression going on.

They don't do so well with these serotonin medications like Prozac, Zoloft, Celexa, Lexapro, Paxil.

They might do better on the medications that increase serotonin and norepinephrine and osbey medications like cimbalom Effexor FETs Zema Press Stik.

These are medications that increase serotonin and norepinephrine and those people do better with the symptoms of body aches, fatigue and the symptoms that might be associated with inflammation.

So when we hear about those kind of symptoms and they sound like ongoing flu like symptoms, we often think about medications other than the traditional serotonin medications that are commonly used in the course of deprssion for a lot of people.

>> Thanks for your question.

Let's go to our next email.

Our next email reads your doctor Fauver is there a way to purposely repress painful memories without any harmful effects?

>> It depends about your perspective of those past painful memories it used to be thought that if you were to hypnotize somebody and have them try to either work through painful memories or forget about them that they could thereby get relieved of their past traumatic memories while that didn't work so well.

So we don't use hypnosis nowadays for the purpose of trying to help people deal with past painful memories.

One of the best ways to deal with past painful memories will be to regain your perspective of the here and now and look forward.

In other words, look through the front windshield as opposed to looking in the rearview mirror mirror because many people can kind of experienced a lot of painful traumatic memories from the past and they keep focusing on those memories and they allow those past memories to define their current identity as it is now.

>> And what we're often trying to do in therapy is to help people look at the here now and look forward despite what's happened to them in the past and if anything learn from what's happened to them in the past.

>> There's a there's a psychodynamic phenomenon called repetition compulsion repetition compulsion is where bad things happen to you and because of that you will tend to inflict those bad things on other people and you hear about this all the time a child who's been abused becomes an adult and that adult who was abused as a child will abuse his or her own children and it doesn't make a lot of sense why would they abuse their own children if they were abused as a child themselves?

>> Well, it's called repetition.

Compulsion is where you tend to repeat past bad stuff that's happened to you and you inflict those bad things on other people and we always try to get people to work past that and to actually recover in such a way that they will actually be an advocate for child abuse and instead of actually being in the prolonged having prolonged victim type of phenomenon so a treatment that will often use for people who have been traumatized in the past to help them look forward as opposed to just repeating their past in therapy will be that dialectic behavioral therapy dialectic behavioral therapy will help people learn skills to help them cope with future events that remind them of past events so they're not always victimized their brain about things that have happened in the past and they're not identified.

>> They're not they don't gain an identity of what's happened to them in the past.

>> They're able to look at the here and now and move forward.

>> So that's the kind of thing we're often trying to do nowadays.

It's good to have an awareness of what happened in the past because if you're having nightmares about certain instances and you can verify that bad things did happen in the past, that can be a phenomenon called post-traumatic stress and we can indeed treat that sometimes with medication and with particular kinds of therapies.

But simply repressing past memories is not always the best thing.

Being aware of the past memories is helpful but not being defined by past past memories.

We're always trying to get past that.

>> Thanks for your email.

Let's go to our next caller.

Hello John.

Welcome to Matters of Mind.

Hello.

Hi John.

Hi.

I've been on generic Lexapro for ten plus years and I was wondering if these medications were off or lose their effectiveness over time.

>> John Lexapro is called escitalopram.

It's a left sided piece of Celexa or Citalopram.

>> It's a medication that very specifically and selectively will increase this chemical called serotonin and if you increase serotonin excessively it can indirectly decrease dopamine and when it decreases dopamine the symptoms you'll have will be difficult with fatigue, poor concentration, lack of initiative, lack of enthusiasm and you might even feel kind mentally dull and emotionally flat where you don't see the world around you as being a very happy place or a sad place.

>> You just don't care.

So when people say to me that they've had difficulty with a medication like Lexapro wearing off the first thing I want to know is are they feeling more emotionally flat?

>> Secondly, are they just feeling more depressed that can all be related to this suppression of dopamine?

>> So what do we do historically?

Yeah, you could maybe decrease the Lexapro and your clinician supervision and add a medication like Wellbutrin Wellbutrin specifically selectively will increase dopamine and norepinephrine to some degree and sometimes that's used to offset the effect of Lexapro like that.

>> Sometimes people on Lexapro after five or ten years if the dampening effect of the dopamine is occurring based on your symptoms, we might have you change to a different antidepressant that increases not only serotonin like Lexapro does but also a medication like Cymbalta that increases serotonin and norepinephrine.

So sometimes we'll hear about that and Prozac was the first of the serotonin medications to have that phenomenon occur.

Prozac came out in nineteen eighty seven.

>> Lexapro came out in the early 2000s I believe around twenty four 2005 and with Prozac coming out in nineteen eighty seven people called it Prozac out.

They would just say Prozac worked for several years and then it just seemed to no longer work anymore and it's thought that that has to do with this indirect suppression of dopamine which is a whole different chemical than what Prozac will directly affect.

>> Prozac increases serotonin just like Lexapro does.

But if you indirectly suppress the effect of dopamine that just makes you feel kind of blah and you can't concentrate and you just don't have enthusiasm for things.

>> So there are ways that we will remedy that for some people.

Now if somebody takes Lexapro you had mentioned for over ten years so this wouldn't be the case for you.

>> But if somebody takes Lexapro for maybe two or three months and they felt great with it and all of a sudden they're crashing, sometimes we'll think about bipolar disorder for those people because if you feel really good with an antidepressant for a few weeks or even a few months and then you just crash, you can unfortunately have a different type of situation.

>> We have bipolar disorder having highs and lows and for those people we need to get a cruise control on the mood for those people and we give them a mood stabilizer.

Thanks for your call us girl next caller.

Hello Jill.

Welcome to Of Mind.

>> Jill, you had asked does marijuana use in teenagers and early 20s lead to bipolar disorder?

>> I'm not aware that marijuana use would lead directly to bipolar disorder marijuana use can certainly increase the likelihood if somebody's genetically prone to develop it would be schizophrenia.

So if you use marijuana in the early adolescence or before twenty four years of age and you have a family history of schizophrenia in your brain is kind of hard wired to having schizophrenia you might not ever have schizophrenia until you smoke marijuana than marijuana can kind of take you over the edge and cause you to have your first psychotic episode.

I'm not hearing that marijuana is directly associated with the onset of bipolar disorder.

I have seen marijuana make ADHD worse so people with attention deficit hyperactivity disorder they have a worsening of concentration.

These people might have grown out of their ADHD in their early adult years but by their using marijuana they suppress the white matter growth of the brain, the white matter of the brain is basically the insulation of the individual nerve fibers.

So nerve fibers need insulation just like electrical wires do in our houses.

And if you decrease the white matter of the insulation of the white of the electrical fibers in our brains, the brain doesn't communicate so well from one part to another part that causes you to have difficulty the attention span motive, motivation decision making these are the kind of problems we see with adolescents and young adults and they're using marijuana both bipolar disorder not so much from what I've heard.

Joel, thanks for your call.

Let's go our next caller.

>> Hello Dean.

Welcome to Matters of Mind.

>> I'm sorry.

Did you say how about Dean?

You want to know about MDMA NDR OK Eye movement desensitization and reprocessing MDR is basically a very interesting treatment and it's totally valid.

>> It's a treatment where you have somebody do eye exercises you think what do I exercise I exercises do with how the brain works?

>> Well basically the eye eye exercises help reprogram the front part of the brain.

Then as I often mentioned the front part of the brain is the thinking part of the brain, the front part of the brain is the last to grow.

It keeps growing and growing and growing into you twenty four years of age.

That's why we look back to what we did as adolescents and young adults and we wonder why did we think that or why do we do that?

>> The front part of the brain makes you think before you do something and it makes you think before you blurt out something.

>> So this the part of the brain that's often impaired when somebody has post-traumatic stress disorder because with PTSD if you've had past traumatic events it will cause you to have all these disturbances with impulse and processing information and that's where if you've had traumatic experiences in the past you perceive the world as being a very dangerous place.

>> Well, if you do these eye exercises, eye exercises actually change the functioning of the front part of the brain for the better so they will fire up the front part of the brain and it has something to do with the eye movements themselves increasing the electrical activity of the front of the brain.

>> So it's a it's a valid treatment.

It's not hocus pocus at all.

MDR eye movement desensitization and reprocessing is a means by which we often use to treat people for post-traumatic stress disorder, sometimes borderline personality disorder if they've had past traumatic experiences as well.

>> But it's particularly good for people who have endured past traumatic experiences.

Dean Dean, thanks for your call.

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

Our next e-mail question reads here it is Durata favor is there a mental explanation for people who claim to see ghosts?

>> Is the brain creating this image?

If I hear about somebody who's saying they're seeing Ghost, I want to know a lot of different things.

No one are they seeing the visions out of the corner of their eyes?

>> That's called a visual illusion.

A visual illusion is where you don't see anything distinctly but you see something kind of move out of the corner of your eye often in the darkness when there's less light to light up the area that happens not uncommonly when people have depression.

>> So when people have depression they're blaming their brain will kind of play tricks on them and their brain will cause them to kind of notice things that aren't quite there and they might see things or hear things kind of in the background they might even your soft voices talking to them when they get depressed.

But more commonly they have what's called elementary hallucinations where they hear sounds and whistles and they hear things that other people can't hear.

So if somebody is perceiving they're seeing ghosts, I'm often going to question about that.

There is a condition called Lewy Body Disease where people see distinctive small children and small furry animals for whatever reason these people often have Parkinson's disease symptoms as well but it's older folks typically who will see distinctive type of things.

But if somebody is seeing ghosts, I want to hear more specifically what they might be seeing, how they might be seeing them and kind of assess their overall emotional tone at that point not uncommonly women who have delivered babies the first three to four months after they deliver babies will have these kind of visions that they hadn't experienced before.

>> Thanks for your call.

>> Let's go next caller.

Hello Mike.

Welcome to Mars the Mind.

Well, Mike, you had mentioned you had heard of several near-death experiences about people's lives flashing before their eyes.

>> Is this a genuine genuine biological occurrence?

Probably it probably is.

Mike, as a psychiatrist I've not been one to study near-death experiences but there is a phenomenon where people as they are dying they will talk about these type of things and as they come back and if they've been revived or they they might have been even pronounced dead , they have they have experienced some of these type of phenomena where they perceive that their lives were flashing before their eyes.

>> So I would just leave that up to those people and the people who study that type of thing.

Mike, Mike, thanks for your call.

Unfortunately I'm out of time for this evening if you have any questions about mental health issues that I can answer on the air, you may write me over the Internet at matters of the mind all one word at a dot org.

>> I'm psychiatrist Jay Fovea 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.

Thanks for watching.

>> Goodnight