.

>> Good evening.

I'm psychiatrist Fauver live from Fort Wayne , Indiana.

Welcome to Matters of the Mind now in its 10th 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 that I can answer on the air, you may write me or you may contact me by phone tonight at (969) to seven to zero if you're in the Fort Wayne area calling any place else you may dial toll free at 866- (969) to seven to zero now on a fairly regular basis I am broadcasting live every Monday night from our spectacular 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 WFYI Vague that's matters of the mind at WFB Eigg and I'll start tonight's program with a question I recently received.

>> It reads Do not favor what kind of lifestyle changes will help with my symptoms of depression and are there any alternative treatments other than medication?

Well the alternative treatments other than medication can always be counseling talk therapy.

>> You can have a coach in your life .

The idea of alternative treatments outside of medication will be to help you navigate to your intended goal so if you think about the medication as being like an accelerator or brake, you know this chemical called Glutamates Accelerator the brake is Gabb.

>> So in the gray matter of the brain you've got this accelerant Google glutamate and gabbers the brake and they're balancing each other out now then you've got serotonin, norepinephrine and dopamine coming from the brainstem down here projecting and very minute amounts up to the gray matter of the brain giving advice to the accelerator and brakes.

>> So serotonin, dopamine, norepinephrine those are neurotransmitters that we're trying to target with various traditional antidepressant medications.

We're trying to target their effects on glutamate and GABA so the biological aspect of treatment depression will be with medication to try to get the brain working better.

But counseling, talk therapy, coaching group therapy those type of things support groups especially what they help you do is try to navigate to your eventual goal through kind of helping you steer the life vehicle to get you where you need to be.

>> So that's where you'll often recommend for people.

What kind of alternative treatments can you do?

Exercise is the very best thing you can do to help with depression because exercising itself will actually increase brain fertilizer.

>> It's called brain derived neurotrophic factor but exercising can increase brain fertilizer and make your little neurons more fluffy because when you're really stressed out and you're having trouble with depression for a long time, your neurons they don't die off at the just that they become less fluffy.

So instead of having 30 thousand little fluffy branches on your neurons you might have just ten or twenty thousand branches.

So what exercise will do in a similar manner with many medications you're trying to make your little neurons more fluffy and fluffy neurons work better.

That's the first thing you can do.

Second thing you do will be try to do things that are fun.

Many people when they get depressed they start giving up things that used to be enjoyable for them.

So if you give up enjoyable activities you tend to have more depression and becomes a vicious cycle in that way with more depression you don't want to do the things that used to be fun so try to get yourself to do things that used to be enjoyable and that includes socializing during the covid pandemic when we had the lockdown's and people were socially isolated, there was not only a pandemic of covid that was being discussed but there is a pandemic of mental health issues because mental health issues just escalated during all that social isolation because we know that lack of socialization is certainly a risk factor for depressive conditons.

So for that reason socialization can be very, very important for many people.

>> You have to have some kind of purpose.

You have to have some kind of meaning in life .

So it's important for you to try to identify what kind of things you have for which to live.

So what are your life goals?

What are your aspirations?

Why are you here at this time to be able to serve others andp?

>> So what's your overall purpose and meaning in life at this point and going along with that what kind of things are you are you joyful about what can what kind of things give you gratitude and what kind of things are you're grateful for experiencing you we often think about the different conflicts and the things we have.

The trouble is but it's very, very important for us to perhaps even keep a journal about the things that for which you might be thankful and gratitude often leads to happiness itself.

So a lot of different things you can do to try to help you& from lifestyle changes as well as alternative treatments for depression.

But that would include the treatment with medications.

If you're getting to the point where you're what we call functionally impaired, we will use medications for people who were having trouble socializing, going to work, doing the things they ordinarily would do because of the depth of the Depression .

That's where medications will make the brain work more normally to try to get back on track.

Thanks for your email.

>> Let's go to our first caller.

Hello Rod.

Welcome to Of Mind.

Rod, you had mentioned you have a family member who refuses to take their medication daily like me to explain the importance of taking medication as prescribed and not just during an episode of Tippins Rod because some people for instance you had mentioned anxiety medication.

>> Some people will only have a panic attack about every two weeks.

I don't have any trouble with that person situationally taking a medication at that time.

>> We hear about it all the time where people will have difficulty with a public speaking type of situation and during that time they might take a medication of blocks adrenaline called propranolol and they only take a during that time the rest the time when they're not under those kind of stresses they don't need to take the medication.

So there are some situations where people can indeed take medication for anxiety just as needed.

We'll even have people take a medication like Xanax also known as alprazolam just as needed for instance to get on a plane.

They'll be in the boarding area .

They'll take the Xanax at that time before they get on the plane on the plane and they get in that enclosed fuselage and while they're encountering turbulence upon takeoff, perhaps they're calm during that time and the more times you do something, whether it's flying in a plane or public speaking, the easier it gets.

So sometimes we will have somebody do this episodic treatment for their anxiety.

The same will go for anxiety related to premenstrual symptoms for women.

We might have women just take a serotonin medication like Zoloft or Prozac just on the five or seven days before their periods and it'll work fine.

So there are times where you can take a medication episodically.

Now here's the situation in which you may be referring somebody who is having overwhelming life impairing anxiety on a day to day basis not willing to take a medication day by day, OK, if they have talk therap, if they exercise, if they try to do all the right things in life , that's fine.

But some people despite trying to do all those different things will still have incapacity, anxiety and impairment in trying to do the things they're trying to do.

>> So for those people you bet it's all coming down to do you feel better on the medication or do you feel better not on the medication right now we have twenty nine different antidepressants from which we can choose going all the way back to 1958 when they first started coming out.

So the antidepression medications not only help with depression, many of them do help with anxiety if you take them day by day by day.

So if you feel better on the medication for anxiety on a daily basis that's great.

But there are medications like Xanax, Ativan, Valium, Klonopin we don't want people necessarily taking those every day if they can get away with it and then there's medications that are so the so-called gabapentin whites these are anti seizure medications that have a little bit of different effect than the so-called benzo opinions do the Xanax out of an Klonopin Valium, the gabapentin organs are gabapentin and pregabalin which will be Neurontin and Lyrica respectively.

>> But these medications work a little bit differently in on the nerve themselves and they make them they give the nerve a little bit less of an itchy trigger finger so the nerves aren't as likely to fire excessively which for some people give them anxiety so we might have them take gabapentin or Lyricapsomety basis.

>> But even with those medications occasionally we are indeed having people take them episodically.

So I think it just differs from person to person, Rhod.

And I think it's something in which your family member can discuss with their with their clinician.

>> Thanks for your call.

Let's go our next caller hello Kent.

>> Welcome to Matters of Mind.

>> Hi.

Can I have a question concerning congestive heart failure and medications?

I know medications that should be avoided if one has congestive heart failure but also has issues with anxiety, PTSD depression Rosabeth can't tell you mentioned congestive heart failure when somebody has congestive heart failure sometimes they are prone to having a little bit lower blood pressure than usual.

>> Is that the case for you by chance?

I guess yeah.

>> So for you three medications come to mind concerning the use of four for post-traumatic stress disorder that might not be able to be used with somebody who has congestive heart failure prazosin, god-forsaken, clonidine those are three medications that are often used for PTSD symptoms because they make you less jumpy.

They decrease nightmares, they decrease the so-called hyper vigilance where you're always on edge during the daytime.

>> So we probably wouldn't want to use Prazosin Clonidine or Gwon Forseen for somebody with congestive heart failure.

What would we use?

We'd probably be more inclined to use the serotonin medications by chance.

Are on a blood thinner likepCoug like that.

>> You have some in those cases?

>> Yeah.

If you're on a blood thinner like Coumadin warfarin what that that what they will do we call blood thinners.

But what they do basically is they make the platelets less sticky.

So you're less inclined to having sticky platelets sticky platelets will cause you to have blood clots so people will take medications to make their blood thinner in that regard.

But if you're on those kind of medications, you probably don't want to be on a serotonin medication.

A serotonin medication would need to be used very cautiously because if you're on a medication like Coumadin, orphan warfarin or anything, it's making your blood less sticky, your platelets less sticky.

>> The serotonin reuptake inhibitors, the so-called SSRI like Zoloft, Paxil, Lexapro, Celexa they can also make the platelets less sticky.

In other words, they are blocking the vacuuming of serotonin back into the platelets as well as the neurons.

If you block the vacuuming of serotonin into the platelets, the platelets don't get sticky and if they can't stick together so well and that's why people when they're taken serotonin medications are probably going to be more inclined to have difficulty with little petechiae which are a little many bruises all over them.

And if you're taking that with warfarin that can be an issue.

So a medication that lowers your blood pressure might not be in the best interest for you even though you have PTSD, Zoloft, Celexa, Lexapro, Paxil.

If there used to be very used very cautiously for somebody on a medication that's also a blood thinner and making the platelets less sticky.

So then the option would be the possibility of taking a medication is going to affect more glutamate.

Now a medication affects glutamate is going to give you an excitatory effect in the in the brain itself but in doing so can help with depression and we're finding that secondarily some of these medications that are affecting glutamate can also help with post-traumatic stress symptoms.

So these medications can be ketamine which is known as bravado.

It's a nasal spray given twice a week the first month once a week, the second month and then the decrease in frequency thereafter for many people.

But the bravado is affecting glutamate as a nasal spray for people who have what's called treatment resistant depression.

They failed on two antidepressant medications in the past and now they're trying this it's bravado would not have an effect on your blood pressure in terms of making it go down and it certainly wouldn't have an effect on the stickiness of the platelets.

>> So that would be an option off label hasn't ever been improved but ketamine ketamine is something that's an injection many people will have to pay out of pocket for ketamie.

Ketamine is the parent compound of bravado.

It's bravado or a shadowman as the left sided piece of ketamine it's bravado has been approved by the Food and Drug Administration as well as insurance's ketamine has not and then a third option would be if you have depression you could still affect glutamate by using a medication like all Valide although it is a combination of dextromethorphan which is an old cough medicine has been around for sixty five years and bupropion which has been around them since nineteen eighty nine is an anti depressant.

>> Bupropion is increasing the blood level of dextromethorphan by over 30 times and extending its duration of action by over seven times.

Bottom line is if you have high levels of dextromethorphan in your brain you will affect glutamate favorably and in our experience we have noticed that people not only get relief with depression and using authority but they secondarily can get benefit with anxiety symptoms which are often accompanying the post-traumatic stress symptoms.

So there are other options out there.

>> I would simply advise you to be careful that you careful any serotonin reuptake inhibitors there are going to make the platelets sticky and be careful with any medications you might lower your blood pressure overall.

>> Thanks for your call.

Let's go our next caller.

Hello Tony.

Welcome to Mastermind.

Hi.

Yes Dr Paul.

First of all I'd like to thank you for everything you do for us.

Oh my pleasure Tony.

As so was explained to the gentleman before the answer that's for the phone.

I'm 74 years old.

I dealt with depression since I was 37 and one of the things that comes from time to time that that is sort of attacks me is obsessions starts is about starts about can get rid of the thoughts and then it becomes an obsession and I have a hard time getting rid of that obsession and usually basically doing a lot of praying and everything else is what has helped me.

>> But is there anything else out there that I should be doing?

You nicely described obsession in a sense that you're describing these thoughts that you can't get off your mind.

>> Correct?

It's do they seem like unnatural thoughts?

>> Do they seem like thoughts?

Teto really want to have there?

And they there are thoughts that keep gnawing at your gnawing at you and gnawing at it and they don't make a lot of sense.

>> Yes, absolutely.

Yeah.

Worry is a phenomenon where you have thoughts that come to your mind but they're realistic.

You're worrying about your finances.

You're worrying about your family.

>> You're worrying about your job.

Those aren't obsessions and many people mix those up.

You've very nicely described what's considered to be a true obsession and obsession basically.

>> Yeah.

You're old enough to remember record players like I am.

>> So obsession is basically where if you have a record player the needle stuck.

All right.

the needle stuck and instead of getting stuck on music with a record player in your brain, the needle stuck on a thought and the thought doesn't make sense and it comes back to annoy you.

What's happening in the front circuitry of your brain is the front part of the brain looking at you on the inside of the brain, the circuitry is going round and round and round and it gets stuck.

>> Now I imagine over the course time you've been treated with serotonin medications like Zoloft, Paxil, Lexapro, Celexa, Luvox maybe of you having those kind medications, they are all increasing serotonin and sometimes will break up some of that circuitry that's going round and round and round of those medications.

>> Two of them in particular will have additional effect outside of just increasing serotonin transmission which can break up obsessions.

One of Luvox flu vaccine is the chemical name of that but Luvox it'll increase serotonin transmission but it will also specifically stimulate this particular receptor called Sigma one receptors if you stimulate sigma one receptors that seems to give people an added benefit in relieving obsessions because well, it's thought that maybe obsessions are due to inflammation.

So if you stimulate Sigma one receptors as you can with Luvox I mean or Luvox you can decrease the obsession in that manner and that's why a lot of us believe the flu vaccine or Luvox works a little bit better than many of the other medications used for obsessions Zoloft research Trelane also has a little bit of a Sigma ones Luvox Luvox as a sigma one stimulator was used during the covid pandemic when people had covid infections and 50 milligrams a day was used to decrease the inflammation in the lungs because it has antiinflammatory effects.

So it's thought that if you have obsessions part of the reason you have obsessions is because there's an inflammatory element going on in the brain and a medication like Luvox could possibly be helpful for that.

>> OK OK thank you very much Dr my pleasure.

>> Thanks for calling in.

All right.

Bye bye.

You bet.

Let's go to our next caller.

Hello Dean.

Welcome to Manage the Mind.

Well let's go to our next email.

Looks like our next caller pmight not be there.

Let's go to our next oh Dean.

You have you have you have a you have a question for me?

Well, Dean, I think oh, OK. Dean, it sounds like you wondered how to deal with the stigma of having a mental illness.

>> Dean It used to be much more pronounced back in the 1990s 1980s were people with depression anxiety had a lot of stigma about getting treated for mental health issues.

Now we know enough about the neurobiology of depression, anxiety, mood swings that we understand that these mental health conditions have a neurobiology component.

In other words, there's a chemical component to all of this and the chemical component is such that we know that there are means of treating this.

How do we know?

Well, I mentioned earlier in the fluffiness of the neurons with fluffy neurons you bring your brain tends to work better.

You can actually put markers in people's brains just temporarily put them under a functional scanner and actually see how fluffy their neurons might be.

And this can be done obviously in research settings but it's identified that especially in the hippocampus in this yellow part of the brain in the amygdala, the anxiety part of the brain, those parts of the brain just shrivel up when people get depressed for long periods of time.

So we understand now where we didn't back the 1990s 1980s.

We understand now there is a certain there's a biological component to psychiatric conditions.

So I think the first thing to deal with with the stigma of having a mental health issue I think of a sense of the stigma of having a heart condition, a stigma of having cancer, the stigma of having any illness itself.

This just happens to involve the brain.

But I think we've come a long way in the past 30 years and dealing with the stigma of a mental health issue because we're understanding the more the biology, the space behind as opposed to it being simply an attitude problem.

Dean, thanks for your call.

Let's go next caller.

Hello and welcome to Matters of Mind.

Dan, you've mentioned that and you mentioned that you have a sibling who's confessed to having an alcohol problem as bipolar disorder type two and three other health conditions verall.

>> So having a sibling having an alcohol problem, bipolar disorder, bipolar has two disorder as you may know and is where somebody will have four to six days of having little highs that aren't highly functionally impairing it.

Then they have these devastating big lows for over two weeks where they get very depressed and the fact that they're having little highs and then big lows, the lows can be even more pronounced because they've kind of been to the mountaintop a little bit here and then they go down, they crash.

>> So if you have bipolar disorder type two , if you're inadequately treated, you're not commonly going to resort to alcohol or some kind of substances of abuse to give you some relief and I've seen some people with alcohol dependance and they end up in the hospital with alcohol dependance and they started out drinking alcohol just to sleep and next thing you know they were drinking more and more and more alcohol and they kind of took off from there.

So having an inadequately treated mood disturbance can sometimes increase the likelihood that somebody is going to drink more and more and more.

So the first thing I'll often do and if I hear about somebody having trouble with alcohol, I'm going to go back to asking OK, when you started drinking and when it started especially to become problematic what was going on in your life at that point?

How were you feeling?

What's alcohol doing for you?

I saw a person a week ago who said the alcohol helped him sleep and next thing you know he just started drinking more and more to sleep.

>> I've seen people who say alcohol is the only thing that makes them feel happy.

Well, for those people, yeah, they're very prone to having alcohol dependance because if alcohol stimulates your brain and it stimulates your brain in such a way that it goes to this little area here in the middle here called nucleus accumbens, that part of the brain is stimulated will fire off dopamine and when it fires off dopamine it gives you a feel good effect doesn't happen for everybody but for some people and it's a big warning sign for some people if they feel really happy when they drink alcohol, they're more prone to getting in trouble with it.

So what we're often doing is we're going back and we're trying to give them adequate mood stabilization with a medication is going to level out the mood so they won't have the highs and the lows and if they're having trouble sleeping, OK, let's give them something that would be not addicting to for sleep and we'll doing that at the same time criss crossing them, getting them off the alcohol while starting some other medication to try to give them some relief at the same time.

So yeah.

Could you tweak your medication and one way or another if he's still drinking if your sibling is still drinking by all means he probably needs to have further adjustments with his medication.

Alcohol obviously is not a real good medication for depression or sleep.

People sometimes wonder about that this if it makes me feel good why couldn't I still use it is because you often need more and more of it to make you feel good.

>> Why can't you use it for sleep?

Well it'll knock you out and help you get sleep but it gives you a very poor quality of sleep thereafter a poor quality of sleep is problematic because if you don't sleep efficiently you're not getting the deep sleep.

>> You're not getting the dream sleep which alcohol will suppress.

You'll have trouble with your cognition, your memory, your attention span, your ability to keep track of things.

So if you have impaired sleep that will be problematic all by itself.

>> Let's go to our next caller.

Hello Janet.

Welcome to Matters of Mind.

>> Janet, you want to know about how common it is for a daughter to abandon her her mother since she's gotten older prior to having a great relationship?

What would cause a person to do this?

I think you're wondering why a daughter would no longer want to have a relationship with her mother when the mother is getting older.

That's very individual, very Janet, if you're if you already had a preexisting poor relationship with a parent.

Yeah, that's can be problematic later on we're instructed in the Ten Commandments commandment number five that we're supposed to honor our parents now honoring them might not mean really liking them or agreeing with everything they've taught you or or respecting men in some ways.

But we need to honor them and that means taking care of them.

Why would a person no longer have a great relationship with their parent?

I think that's really individual based on that that particular setting.

>> Thanks for your call.

Let's go our next caller.

Hello Fred.

Welcome to Matters of Mind.

>> Well, Fred, you mentioned you take 10 milligrams abuse by room for anxiety, 10 milligrams abuse.

Biram Common dosage many people will take 10 milligrams twice a day abuse by room for anxiety.

>> Many people get up to 30 milligrams twice a day abuse Baroin is basically Fred for worry and not so good for panic and really bad anxiety.

But if you tend to ruminate about things and worry about stuff you don't have obsessions.

>> Obsessions are beliefs and thoughts that don't make any sense to you.

You don't want them.

Their worries have to do with things that are bothering you day by day.

So you'd mentioned the bottle says it can also be used for pain abuse and usually is not used for pain Fred.

Now if that's a medication like do fluoxetine yepp that can be used for pain but bu Spyro mainly going to affect these little serotonin receptors to stabilize the effect of serotonin to help with pain.

Usually you need effects on norepinephrine as well so be spierings not typically going to help with pain as well unless you could identify the pains associated with anxiety.

Some people have irritable bowel and they have pain associated with that.

>> If you have irritable bowel and abuse Biron helps it.

That's great.

Fred, thanks for your call.

Enforce the I'm amount 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 via the nternet at matters of the Mind at WFYI dot org.

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

I'll be back again next week.

Have a good night