Good evening.

I'm psychiatrist Jay Fawver and welcome to Matters of the Mind.

Matters of the Mind is a weekly mental health program where you get to choose the topic for discussion.

So if you have any questions concerning mental health issues that I can answer on the air, you may write me a via the internet per email at MattersOfTheMind - all one word - @wfwa.org.

That's MattersOfTheMind@wfwa.org.

And if you're able to do so during this program, you may call or text me.

And let's start tonight's program with a text I just received over this past week.

It reads, Doc, does the level of microplastics in human brain or body contribute to mental illness diagnosis?

Is there a medical diagnosis for microplastic toxicity?

Thank you.

Lance from Fort Wayne.

Microplastics have been studied extensively with animals, Lance.

And what they've done is they've given animals microplastic contaminants.

And they do realize that the microplastics cross the blood brain barrier.

Why that is important is because our brain has this nice mesh all around it, called the blood brain barrier, and it prohibits toxins and extraneous substances from getting in.

Microplastics can cross the blood brain barrier, and in doing so, they can cause inflammation in the brain and cause animals some difficulty with cognitive processing and thinking in general.

Does that happen with humans?

Well, that's what we don't know specifically.

We don't have a diagnosis of microplastic toxicity.

We do have diagnoses of heavy metal toxicity that can be addressed and that can be measured in the blood for many people.

So for instance, if somebody has lead poisoning, that's a toxic effect from a heavy metal.

So that can be addressed accordingly.

But over the course of time I think microplastics will be studied further.

There are some instances where microplastics inadvertently were on the gloves of their researchers and inadvertently caused some enhanced blood levels and serum levels and brain levels of different microplastics.

So that was an error.

But generally, with humans, we need more study concerning microplastics in the real world setting.

We're all exposed to microplastics.

Does it give any specific cognitive impairment to which we're aware?

We don't know.

I mean, I remember 40 years ago there's a lot of concern about aluminum, aluminum being associated perhaps with Alzheimer's dementia.

Aluminum is a metal.

But it was found that that wasn't really the case.

It was a different association as opposed to consumed aluminum itself.

So thanks for the text.

Let's go to our first caller.

Hello, Mary.

Welcome to Matters of the Mind.

Mary, you want to know how do you determine if someone has successful mental health treatment?

Well, Mary, if somebody in counseling, they're getting medication management.

I think determining if they have successful mental health treatment is not unlike if somebody had a knee replacement.

Okay.

Somebody gets a knee replacement.

Yeah.

You're going to look at how well the knee is bending.

You're going to look at that angle affliction with a knee replacement.

You're also going to look at what somebody is able to do and what kind of activity they're able to do after they get the knee replacement.

So you get to look at symptoms such as the flexing of the knee.

And you're also going to look at functional outcomes in terms of what they can do.

I think the same should be true with mental health treatment.

So if you're in counseling you get a medication management.

There should be some kind of measure of your symptoms of depression, anxiety, ability to think there should be some kind of measure of your symptoms.

For instance, with depression, there's a simple questionnaire called the Patient Health Questionnaire - PHQ 9 - because it's nine questions, and it'll give you a score of how depressed you might be feeling.

So you start with getting a score of your symptoms.

Just like you look at flexion on your knee following a knee replacement.

Secondly, not only do you get that objective measure of your symptoms, but also simply ask the patient how the patient feels as if he or she is doing compared to before the treatment was initiated.

So before counseling, before the medication, if that's rated as zero, how are you doing now on a scale of 0 to 100 or 0 to 10, have some kind of measure of the patient providing a subjective degree of any improvement at all?

There's a particular scale called the Patient Global Impression Severity Scale.

And that is a scale is a seven point scale.

It's a numerical scale where a patient can determine how severe their symptoms are.

And they also have an improvement scale where they can determine how much their improvement.

Improving that scale is used in research studies.

But simply asking a patient in the real world, hey, I'll scale a 0 to 10 zero being you know, better at all ten being you're fantastic.

You like how you're doing, how are you doing those skills, 0 to 10?

So that's a subjective outcome measure in which you can ask patients.

Then I think it's very important, number three that we always try to determine patient goals of treatment.

We try to do that early in treatment.

What are the three main goals in which you'd like to see achieved?

How would you like to feel better overall this way, this way and this way?

If you can take a look at those three main goals at the start of treatment, you're always trying to measure, are those goals being achieved?

And finally, outside of looking at just patient goals, look at what they're doing.

Are there are they able to socialize?

Are they getting out of bed more?

Are they going to work?

Are they calling off more as many days as they did before from work?

Are they enjoying things they used to enjoy?

Those are all called functional outcomes.

Functional outcomes look at how well somebody is doing in their day to day lives.

So I think having an objective measure of symptoms, having a subjective measure of symptoms in terms of how the patient feels as if he or she is doing, having goals met in the course of time, following treatment with therapy or medication, and finally having the functional outcomes measured.

So there are ways we can determine if somebody is doing well with their treatment.

And I think we should measure those on a regular basis.

Thanks for your call.

Let's go to our next caller.

Hello, Phil, welcome to Matters of the Mind.

Phil, you want to know our ultra processed foods addictive?

Ultra processed foods are typically the foods you get out of out of a bag or a box.

Just to put it quite simply, we're not talking about fresh vegetables and fruit.

We're not talking about meats here.

Ultra processed foods or chips and fast or junk food is what it is often called so ultra processed foods, can they be addictive?

I think it all depends.

Phil, if you use a if you eat a particular substance and you eat it to the point where you're doing so on a regular basis and you feel like you need to have more and more and more to get the same good effect.

If you have difficulty with irritability, if you can't acquire that food and you really crave it, that's those are symptoms of addiction.

So addiction will cause you to need more and more of it to get the same good effect.

Addiction will be where you crave something.

Addiction also is where you have functional impairment.

So that's kind of where the gray area does the eating a fast food or ultra processed food cause you to have functional impairment where you can't get things done so well?

I think it could be argued that if you gives you difficulty with irritability and poor concentration and difficulty with sleep, and causes health problems in general, such as cardiovascular problems or worsening of migraine headaches, some kind of overall medical problems.

I think it could be argued that ultra processed food can be addictive in that manner.

I hear this commercial every now and then on the radio, where it's a commercial for ultra processed food of a particular type, and they say that it's so addictive you'll crave it.

I'm thinking, why would you market a substance to be addictive and be something that you crave?

I mean, from a marketing standpoint, that's what they want you to do.

They want you to buy more of the product, but why would you try to sell it in that manner?

Addictions are not good where you're needing more and more of something.

You're getting more irritable if you don't have it, and it causes functional impairment.

So ultra processed foods can be potentially addictive depending on how you define the addiction in your life.

But everybody's different, and I think a lot of it has to do with the dosage, how much of the altar processed foods you're consuming and how often you're consuming them overall.

If you have ultra processed foods, once in a while might not be a problem for you, but if you have it on a more regular basis than you really ought to for your own mental and physical health, that's where it can be a problematic.

Thanks for your call.

Let's go to our next email question.

Our next email question reads Dear Dr.

Fawver, what are the symptoms of iron deficiency?

How is it and what can be done about it?

Iron deficiency can be manifested by restless legs.

Not uncommonly, I hear about people having restless legs sometimes where they can't keep their legs still.

And the first thing I'm going to do is look at what medications they're taking, because some of the serotonin medications and some of the antipsychotic medications that are blocking dopamine can give you restless leg.

So if the medications don't seem to be problematic, another issue can be low iron.

Low iron can give you restless legs.

And the way that we'll measure it will be with an iron profile, which is a very common measurement.

But something that might maybe be more accurate is a ferritin level.

Ferritin is a protein.

That's the storage means of iron.

And often your iron profile can be normal, but ferritin will be low.

Ferritin is like the strategic oil reserves we have here in the United States where you have all this oil that's kind of stored away in case of emergency.

That's what ferritin does.

It stores away the extra iron so your iron profile can be fine but your ferritin level might be low.

How is it treated?

Well number one try to figure out why you have low iron.

If it's dietary for instance, you're not eating enough of the green vegetables.

You're not getting enough red meat.

If it's dietary, that's an issue.

You can determine if you have a gastrointestinal bleed.

Women sometimes who are heavy menstruaters can have low iron.

So try to determine what's causing the low iron.

Can you determine it just by symptoms?

Well, the symptoms of having low iron can be not only restless legs but also difficulty with concentration, foggy memory, tiredness, wanting to sleep excessively.

It overlaps a lot with low thyroid, so some people can have low thyroid and low iron.

But the symptoms of low thyroid and low iron can often over overlap.

But low iron more specifically will give you the restless legs, whereas low thyroid will not.

So there are some differentiations there, but it can be measured to determine your iron level.

Thanks for your call.

Let's go to our next caller.

Hello, John, welcome to Matters of the Mind.

John, you want to know about mirtazapine.

Mirtazapine means also known as Remeron.

Would mirtazapine be a good medication for depression and low appetite.

Mirtazapine is an interesting medication.

John.

It came out at about 1995 and it was different than the traditional serotonin reuptake inhibitors that were available at that time.

The serotonin inhibitors basically will block the vacuuming of extra serotonin back into the firing neurons.

So it keeps serotonin.

They keep serotonin floating around and swimming around for longer periods of time.

Serotonin in the brain will stimulate one of 14 different serotonin receptors.

Serotonin receptors all do different things.

In the case of mirtazapine, it will increase the firing presynaptically or from the shotgun itself.

It will increase the firing of norepinephrine and serotonin.

But it will also affect several of the serotonin receptors very specifically, one of which is serotonin receptor type three, if you will, with you if you if you if you stimulate serotonin receptor type three, it can give you nausea.

What mirtazapine will do is block receptor type three.

So if you already have some nausea, the mirtazapine can decrease the nausea by blocking serotonin receptor type three.

That is the same mechanism of action by which ondansetron also known as Zofran will give you.

So ondansetron is a medication used for nausea.

It's the same mechanism by which mirtazapine will work to decrease nausea.

So mirtazapine will decrease nausea.

It also increases the appetite by blocking histamine receptors.

So that's why you take mirtazapine at bedtime.

It'll make you sleepy.

But it will also powerfully block histamine receptors.

If you block histamine receptors, not only do you feel sleepy, but you also feel more hungry.

So that's why some antihistamines will make you more hungry in general.

Mirtazapine will do that.

So mirtazapine is a medication is typically given for people with depression, a very good antidepressant.

And it also helps with anxiety, but it can secondarily help with sleep and appetite.

Now that's the biggest reason why some people will go off of mirtazapine, because they'll get too much of an appetite and they'll gain weight with it.

But if you have difficulty with low appetite, maybe you're getting some chemotherapy for cancer treatment.

Perhaps, my goodness, women who are pregnant, women who are pregnant often have nausea.

Mirtazapine has been shown to be a relatively safe medication throughout the duration of pregnancy.

It's always a situation where you talk to your obstetrician about the possibility of mirtazapine, but we have prescribed mirtazapine throughout pregnancy because it can help with nausea and appetite and depression and anxiety for a lot of women, and it appears to not be teratogenic or cause problems with the baby's overall health.

Thanks for your call.

Let's go.

Next email question.

Our email question reads.

Excuse me, Dear Dr.

Fawver, what's better for tremors?

Propranolol that's also known as Inderal or metoprolol.

Metoprolol is also known as Toprol.

So propranolol metoprolol, theyre so-called beta blockers.

Propranolol will block two types of beta receptors type one and type two, whereas metoprolol or metoprolol, some people pronounce it a little bit differently.

It will specifically and selectively block beta receptors type one.

Of the two, just answering your question.

Yeah, propranolol is probably a better medication for tremors themselves because it blocks beta receptor one and two.

Now metoprolol, also known as Toprol, will also block beta receptors type two to a slight degree, but it's very specific, more selectively on beta receptor type one.

Beta receptors, type two or if you block those, as better for tremors.

However, beta receptors type two will also go to the lungs and sometimes give you difficulty with breathing.

That's why metoprolol or Toprol will be used.

Beta receptors, type two will also go to the pancreas and sometimes suppress the release of insulin.

So that can be problematic for people who have diabetes issues.

So with that being said, some people get metoprolol or Toprol even though they have tremors, because it can help to some degree at higher doses for the tremors themselves.

Metoprolol and propranolol B in beta blockers are commonly used for high blood pressure, and they are very commonly used for a fast heart rate.

So if you have a fast heart rate, arrhythmias, or whatever, the source of your fast heart rate might be, the beta blockers can be helpful.

We also use beta blockers, not uncommonly for migraine headaches.

They have a lot of different uses, but they get used for tremors, either from medications such as lithium, for instance the propranolol, or metoprolol sometimes can be used for tremors that are related to what's called an essential tremor, also known as familial tremor.

Because familial tremor will cause a shakiness for people, especially when they get under stress, especially when they're anxious.

Some people get under stress with a performance they might be encountering and they're trying to perform.

They're trying to speak in public.

And when that happens, sometimes a beta blocker can be helpful there, too.

So propranolol will usually be preferred somewhere between ten, 20, maybe 40mg at the time of the performance itself, or on a regular basis for the purpose of trying to help with tremors in general.

Thanks for your email.

Let's go.

Next caller.

Hello, Jim from Fort Wayne.

You have a question about dementia.

Will methylene blue help with dementia?

I don't know, I mean, methylene blue is a medication has typically been used over the course of the years for urinary tract infections.

It will make your urine blue.

It's something I learned in pharmacy school with some experiments that were done.

So methylene blue will make your urine blue.

And it's something that's most commonly given for people during urinary tract infections.

I haven't heard about it specifically used for dementia, but it might have some antioxidant effects that might be helpful.

Wouldn't rule it out.

Hey, maybe ask me in about 5 or 10 years and God willing, if I'm still doing this program, we can maybe look at methylene blue for the purpose of dementia.

But in 2026, I'm not here in about a lot of use for methylene blue for dementia.

Thanks for your call.

Let's go to our next caller.

Hello, Tom.

Welcome to Matters of the Mind.

Tom, you want to know why do you have trouble sleeping in when you're exhausted?

There might be something going on there in terms of the nature of your difficulty with sleeping.

If you're exhausted and you're trying to go to bed and you're having a hard time getting to sleep.

It could be from a sleep hygiene issue.

If you're exhausted, you might have had some caffeine a little bit later in the night.

You might have eaten something within two hours going to bed.

It might be because your sleep hygiene, where you're looking at social media or even watching television too close to bedtime, there are things that can cause you to kind of stay awake.

Getting to sleep at night is like catching a bus.

It comes by about every hour and a half.

If you miss that bus, let's say 10 p.m., you're tired, you're ready to go to sleep.

But then you bring out your cell phone and you look at some social media.

You get hooked into the algorithm, which knows the kind of things you like to watch.

The next thing you know, half hour, hour goes by, it's 11:00 at night and you're wide awake.

You've got to wait for the bus to come back around, maybe in another half hour or so.

So if you're doing things at nighttime that might be keeping you awake, that could be a factor in itself with causing you to have difficulty with sleeping.

I'm always interested in what medication people might be taking because some medications can disrupt your sleep.

I mentioned beta blockers earlier.

Yeah, we use beta blockers for a lot of different conditions, but they sometimes will worsen nightmares.

I talked to a person earlier today who had been on a beta blocker, and I asked why she stopped it, and she said it made nightmares really prominent, even though nightmares weren't typically a problem for her.

So beta blockers can give you nightmares and that'll disrupt your sleep.

I hear about people who have difficulty with sleep apnea, sleep apnea as a condition where we're always monitoring where people can be snoring at nighttime.

They might have difficulty with pausing in their breathing at night.

And when that's happening, they're not getting adequate airflow to the lungs.

The oxygen of the brain, oxygenation of the brain is inadequate, and that will cause people to frequently awaken throughout the night.

They have no idea why they're awakening, but they're basically awakening throughout the night because they're suffocating.

And if they get identified as having sleep apnea and subsequently treated, it can make a dramatic improvement on their overall sleep quality as well as their mood and energy level and cognition for the next day.

So sleep apnea is a factor.

I'd certainly talk it over with your clinician to take a look at any other underlying medical issues you might have going on there.

Take a look at your medications and try to sort out why you're having trouble sleeping, even though you're exhausted.

It's a fine line, but it can usually be determined what's going on.

If you don't sleep adequately, the front part of your brain, which is the thinking part of the brain, that's the part of the brain that you use to cope.

And that's where you establish resilience.

You're able to put up with stuff that part of your brain is not getting adequately recharged if you're not sleeping at night, if that part of the brain is not getting adequately recharged, you have a hard time with coping the next day, you have a hard time putting up with stuff.

So when we look at sleep quality for people, it's like a psychiatric vital sign.

We want to make sure people are sleeping well, getting to sleep, staying asleep, feeling refreshed upon awakening.

And in doing that, sometimes you have to sort out the medications are taking underlying medical conditions like sleep apnea.

Yeah, sometimes people who have a lot of worry will awaken throughout the night and they're thinking about different things.

We often recommend having a really specific worry diary for those people.

If you're worrying, as those lights go off at night when it's quiet and it's the first time all day you've had time to think about your worries, by all means, try to write down your worries on a day to day basis earlier in the day, and then about every month, every three months or so, look at your past worries and kind of look back and think, how did that all work out?

Because many people will notice that the things that were very worrisome for them earlier worked out one way or another, made not have worked out the way you'd hope, but many of them work out and not something to worry about anymore.

So as you as you watch your worries over the course of the years, you can kind of reassure yourself that things work out one way or another, and worrying about them in the middle of the night.

Keeping you awake is not the best thing for your mental health.

Thanks.

Your thanks for your call.

Let's go.

Next email question.

Our next email question reads, Dear Dr.

Fawver, for someone considering a switch from an older medication, what should they know and what should they discuss with their doctor?

So you're thinking about switching from an older medication to a newer medication.

The first thing I'd wanted to determine would be, what are your symptoms that you're trying to address?

I'd want to know your goals, as I mentioned earlier.

So what are you trying to achieve by going from an older medication to a newer medication?

Number two, what side effects have you been experiencing with the older medications and what side effects do you really want to avoid with the newer medications?

So I'd want to know, okay, what's the rationale for going to the newer medication?

Many people want to go to the newer medications because they can work better.

But number two, they're more tolerable.

In a lot of cases.

That can be a factor.

Number three, I want to know if a family member of yours, a first degree reality, mother or father, brother, sister, son or daughter have taken the same medications in which you're probably going to pursue.

So if a family member has taken a newer medication and really well with it and had the same symptoms as you have experienced, by all means I'd be interested in maybe pursuing that kind of medication.

And then finally, in pursuing the possibility of going to a newer medication, I'd want to know week by week.

After about two weeks, I'd want to know how you're doing.

So keep close contact with your prescribing clinician.

Sometimes you have to start with low doses of medication and then go up.

Sometimes you can start with a higher doses, with some at occasions.

But generally many people prefer to start with a low dosage and go up being very patient, knowing that if you do start with a lower dosage, you're probably going to have a longer time for the onset of getting the full effect.

So you can be patient with that.

But we are changing some people from older medications to newer medications for various reasons.

Those are the kind of factors you'd want to consider.

Thanks for your call.

Let's go to our last email question.

Our last email question reads, Dear Dr.

Fawver, is a coffee nap something that is beneficial?

A coffee nap is where somebody will drink a cup of coffee and then go right to bed.

Now, a coffee nap.

Okay, you're going to notice that after about 30 minutes or so, you're probably going to be somewhat refreshed.

And if you drank coffee right before you took that 30 minute nap, the stimulating effect of coffee probably won't hit you until about 30 minutes.

So, number one, why would you want to take a nap in the middle of the day?

It's called a power nap.

Not uncommonly, as the day rolls on, you'll have the fumes of your brain exhaust, so to speak, called adenosine.

Increasing and increasing.

Okay, this is the fumes from your ATP, if you remember that from high school biology class ATP breaks down to ADP.

The A and ATP is adenosine.

That's the fuel of the brain.

So ATP is far and away.

Adenosine, adenosine, adenosine is going higher and higher as they goes on as a dentist and goes to the receptors in the brain.

It'll make you feel tired and make you kind of sleepy.

So the best way to take care of the adenosine would be to take about a 30 minute nap.

It can clear out a lot of the adenosine.

That's typically all you need to do to feel awake and refreshed.

The best way to take care of that, oh, midday fatigue would be to take a quick nap.

And if you can do that in your workplace, that's fantastic.

But I would strongly suggest no more than 30 minutes.

So 20 or 30 minutes is all it takes.

If you can ideally get into a little bit of deep sleep where when you awaken from that nap, you're a little bit confused.

That means you got in a deep sleep.

If you can get into dream sleep, okay, narcolepsy is where people can get into dream sleep in a matter of a couple of minutes.

That's a whole nother phenomenon.

But if you can get into a little bit of a dream sleep, that's actually a good sign, because it means that that adenosine is getting cleared out.

The best way to clear out the scene is to take a brief nap.

However, you can also block the adenosine effects on the brain by drinking caffeinated coffee that will kick in in about 20 or 30 minutes.

What it's doing.

It's fooling your brain to thinking that you're not really tired because it's blocking the effect of adenosine.

So that's what caffeine can do.

Up to 400mg of caffeine a day is typically considered safe, which is roughly three, maybe four cups of coffee a day.

But you don't want to drink coffee to the point where it's going to be overly stimulating and addicting, where you can get to the point where you're needing more and more of it to get the same effect.

So my suggestion for you, if you're thinking about a coffee nap where you're knocking down a cup of coffee, then going right to take a nap before it kicks in, a coffee nap will make you feel very energized and it's safe to do.

It's just that.

First off, I'd want you to try simply taking a nap for 20 or 30 minutes, seeing how that does, and saving the coffees for maybe some other time during the day.

Not after 4 or 5:00.

For a lot of people, they don't want you don't take it late in the afternoon or early evening generally, but the coffee itself, the caffeine and the coffee should be reserved for when you want to block the adenosine.

For instance, you need to go for a drive and you can't be sleepy on the drive.

You need the caffeine in the coffee for the purpose of blocking the adenosine.

A nap will actually clear out the adenosine and give you a clear head in that way.

Thanks for your email.

Unfortunately, a lot of time for this evening.

If you have any questions that I can answer on the air, you may write me via the internet at MattersOfTheMind - all one word - @wfwa.org.

I'm psychiatrist Jay Fawver and you've been watching Matters of the Mind on PBS.

God willing and PBS willing.

I'll be back again next week.

Thanks for watching.

Good night.