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>> Good evening.

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

Welcome to Matters of the Mind now in its twenty sixth 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 in the Fort Wayne area at (969) 27 two zero or if you're calling any place coast to coast you may dial 866- (969) 27 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 that I can answer on the air, you may write me via the Internet at matters of the mind all one word ATWA Doug that's matters of the mind at WFYI Big and I'll start tonight's program with one of two emails that I received over this past week.

>> The first one reads You're to a over I can't sleep because I keep replaying situations that happened throughout the day that I wasn't comfortable with.

>> Is this common actually anxiety will often lead to difficulty with sleep but unfortunately difficulty with sleep will thereby predispose you to having depression on down the line where you have trouble with concentration, motivation, sadness, enjoying things.

>> So we want to get the difficulty with sleep under control as soon as possible.

Now there are different networks of the brain three main ones one called the default one called the salient network, one called the executive network.

These three networks are all supposed to be working in tandem.

The default network is the network that you use in your brain when you're just sitting around.

>> You're not thinking about much.

You're thinking about the past .

>> You might even get to the point where you start thinkin more intensely about the past and you think about past regrets.

But it's kind of a daydreaming type of network where you're not thinking a whole lot about anything.

It's during the default network that people can be very creative and artistic.

That's when musicians will often free associate and compose music so the default network can have some good and bad features about it.

If you get stuck the default network you tend to ruminate and dwell on things.

The Salyut network is fired up especially by a little part of the front part of the brain called the dorsolateral prefrontal cortex as well as this back part of the brain back here the mainly the dorsolateral prefrontal cortex will alert you to say Hey pay attention to this.

This is important.

So the dorsolateral prefrontal cortex fires up this salient network.

>> The Celian networks take you out of the takes you out this daydreaming mode, this kind of this kind of hazy mode where you just not thinking about anything and it throws you into the executive functioning network.

The Executive Functioning Network is the network that allows you to think, focus, concentrate, keep your mind on things and make decisions, process information and so forth.

>> People with depression anxiety get stuck in that default network.

They ruminate about the past.

They worry about things.

They have regrets and the salian that work doesn't allow them to go to the executive network so they get stuck in this ruminative network.

>> And what happens when you go to bed?

It's all dark, it's quiet, nobody's around.

You start thinking about stuff .

>> It's important to think through your daytime difficulties before you go to bed somehow some way journaling is fantastic.

I've talked to a lot of people who journal on a regular basis especially journaling before you get too close to bed time journalng later in the evening perhaps and when you journal you can kind of reflect on what's happened during the day and especially you can start thinking about what you can do about your life circumstances and what you can't some life circumstances you can't do a whole lot about yourself and you can worry about him.

You can dwell on them but nothing's going to happen based on you're doing that.

>> On the other hand, there are some things in your life where you can take action, decide that one way or another based on your life circumstances but try to map that out earlier in the evening at nighttime.

>> Make sure you go to bed when you're tired at nighttime.

Make sure you get off of the smart phones, get away from television especially television news late at night can be really problematic in terms of keeping people awake not only the brightness of the television screen but also the actual news you're hearing about it can kind of get on your mind and make you worry about things.

So I'm always telling people from a sleep hygiene basis be careful of what they're doing for about 30 minutes to an hour before they go to bed.

Now if you are comforted by watching sitcoms late in the evenings, the ones that you might have seen several times before and that kind of slows your mind down a little bit.

That's perfectly fine.

Reading is great especially if you can read chapters where at the end of the chapter you can put the book down and go to bed.

I don't encourage people to read novels at night where it just goes on and on and on because you might have a hard time getting sleep.

You tend to go in the sleep cycles for an hour and a half a piece where if you don't go to sleep when you should be going to sleep when you're tired, chances are your brain's going to wake up for another hour and a half and then is going to take another hour and a half to go to sleep.

So you got to catch the bus so to speak and not not miss it when you're tired.

When you're sleepy you need to go to bed, turn off the lights during that time if you're watching a ballgame, if you're doing something that's wakes up the brain, it might be a while to go back to sleep.

>> So I would suggest that's for the difficulty with with worries and dwelling on different things and deliberating about things during the day.

Try to deal with that earlier in the evening as opposed to waiting until the lights are out and it's nice and quiet all of a sudden thinking about it at that time.

>> It's time to go to sleep.

Thanks for your email.

Let's go to our first caller.

Hello Tom.

Welcome to Matters of Mind.

Tom, you wondered is it possible that mental illness is caused by heavy metals in the food in the environment?

You know, it's been discussed for a long time, Tom, whether lead for instance, that was highly prevalent in paints several years ago, if that was an issue and it was thought to cause led intoxication with young children and thereby caused difficulty with concentration and focus but could we attribute heavy metals as being a predominant factor with mental illness?

That's not the current thinking, Tom.

But we are always learning different things about mental illnesses and the causes behind them so I wouldn't rule out something along the lines of heavy metals but in the year twenty twenty three we have not identified any particular heavy metals that are more prone in certain mental illnesses than others being the biggest culprit.

>> The other heavy metals hard to say not really big factors.

There's been a lot of speculation about that.

Should people get these heavy metal binders that would they could take and then they flush out the heavy metals and some people have speculated that those type of things who are not clinicians, they've done that in some naturalistic settings.

But I haven't seen where it's highly advantageous for people to do that.

>> Thanks for your call.

Let's go to our next caller.

Hello Donna.

Welcome to Matters of Mind.

Donna, you had mentioned that you're a widow.

You're kind of a homebody not interested in a new partner.

Can you navigate how can you navigate to the next chapter in your life alone?

>> I wouldn't be one to necessarily be able to give you specific ideas without really knowing you at this point, Donna.

>> But the main thing I emphasize is OK, you mentioned you're a widow, you're a homebody.

>> You're not interested in a new partner and you want to navigate to the next chapter in your life alone.

That's OK. Could you do it by yourself in your house?

>> You could.

But a factor that we now know that as a contributing to depression and even dementia, Donna, will be social isolation.

>> There's something about having a social network and probably face to face although I think some arguments could be be made.

You could have a social network by by video to some degree but something about those face to face interactions are really important.

>> So our biggest concern about you would be having any difficulty with being able to get out and socially interacting with other people.

>> Now if you're a widow and you're somewhat of a homebody in general, you might you might find situations where you can interact with other people to be able to share life experiences and that can be other widows and there are a lot of opportunities to do that within your community.

>> Thanks for your call us your next caller.

Hello, Betty.

Welcome to Matters of Mind.

Betty, you want to know if there's any buddy in our community who does what I can tell you about the our friends with the Federal Communications Commission do not like us to give specific referrals on programs such as PBS so I can't give you specific names.

But I can tell you, Betty, electroconvulsive therapy is a very effective treatment for a while for the biological aspect of treating depression and it is still has done its you'll you'll not have too much difficulty finding communities to who do electroconvulsive therapy.

It's been available since the late 1940s.

It was found in the late late 1940s.

>> People who had epilepsy if they had depression with epilepsy when they had seizures inadvertently they had seizures, they felt less depressed.

So then over the course of the time it was found that if you could invoke that seizure activity in the brain in a safe manner without giving any damage to the body, you could significantly relieve depression by firing up the front part of the brain.

>> That's why ECT Electroconvulsive therapy is done typically where a stimulation is on the right front part of the brain that gives you less difficulty with concentration focus which is primarily impacted by the left front part of the brain.

So the stimulus is that the only non on the non dominant side which is typic on the right side some people will get bilateral or both sides of the front part of the brain stimulated with it's a it's a stimulation that typically occurs Monday, Wednesday and Friday in a very controlled setting in a recovery type of room.

It's kind of in the surgical suite and a lot of places where they can monitor you very carefully but they will give you a short term general anesthesia, a muscle relaxant.

They give you ventilation because your muscles are all shut down overall and the idea with the ECT is to give your brain this electrical activity for somewhere between 90 seconds about thirty seconds to two minutes is typically what the usual duration of the seizure is and it's firing up this chemical the front part of the brain very abruptly called brain derived neurotrophic factor BDNF beedi and if it gets fired up you'll tend to have an improvement in the fluffiness of the brain very quickly.

It's called a short acting, a short acting antidepressant treatment but with BDNF it tends to make the neurons more fluffy, more fluffy neurons are.

Neurons are able to communicate with each other better and in doing so it can give you a very quick onset of action.

>> So I've seen people who have recovered from depression very ,very quickly using ECT.

Now often people will get antidepressant medications with the ECT but ECT is a very effective means of still helping people depression.

Thanks for your call.

Let's go to our next caller.

Hello Shannon.

>> Welcome to Matters of Mind.

Shannon, you wondered if psychosis is not a mental illness, why are people prescribed antipsychotics?

I'm not really clear about your question there, Shannon, because psychosis is a mental illness.

Psychosis is basically a disturbance where you are not perceiving the reality of the world around you accurately.

>> In other words, you might hear voices of people talking to you.

You might see people doing things that you ordinarily would not see antipsychotic medications they primarily will block dopamine in many cases but some of them we're finding that we don't even need to block dopamine.

>> But as a rule antipsychotic medications block dopamine and in doing so they are diminishing the excessive transmission of dopamine that's seen over here in the hippocampus and the temporal lobe the same when people are psychotic.

>> When people are psychotic they have fixed false beliefs.

Those are called delusions.

They have beliefs can't possibly be true but they insist they're they're true.

And if you are going through a psychotic episode, think of it as being similar to having a nightmare, a waking nightmare when you have an a waking nightmare, the left front part of the brain is not working.

It's shut down now dreaming normally.

Yeah.

When we dream normally this left front part of the brain that we've been using all day to concentrate very intently on different things it does shut down but it shuts down excessively when you're having nightmares and when that's occurring you can have nightmares that are very frightening.

>> You wake up and you think thank goodness that's over with .

>> Well that's what happens.

People are psychotic when people are psychotic their brain is basically living a nightmare.

You're wide awake but you're experiencing a nightmare nightmare things around you might seem like they're in reality but it's something it's very frightening for a lot of people antipsychotic medication can block dopamine.

They have a lot of effects on a lot of different chemicals such as serotonin.

Now we are talking about the effects on a cell COLENE so antipsychotic medications are there for the purpose of trying to bring your back your brain back to reality so it can work once again.

>> Let's go to our next email.

Our next e-mail reads Dr. Farber Is dementia inevitable for those with Parkinson's disease?

And I think this is an entirely separate question here by the same caller is leaning over the counter as a supplement any good for mild anxiety?

>> So dementia with Parkinson's disease when you have Parkinson's disease early on you might have some drooling, you might have a kind of a shuffling gait.

>> You don't move your arm as much as you're walking.

You have this fixed expression on your face.

You might have a little bit of a tremor, a little bit of a tightening to your arms.

>> We call that cog wheel and that's Parkinson's disease and with Parkinson's disease anywhere between five out of ten to even eight out of ten people can develop difficulties with memory and concentration and judgment over the course of the next twenty years.

So you'll hear about people having the movement disturbances with Parkinson's disease and it can occur as early as in the 40s or 50s for some people and those people have some risk for having memory disturbances and dementia later on in life is not guaranteed but they can later in life and it might be as much as 20 years later there's Lewy body disease which is often associated with dementia.

This is where people will often have what's called Lilliputian hallucinations with Lewy body disease.

>> Lilliputian hallucinations refer to Gulliver's Travels where he went to the island of Lilliput and saw little people well with Will Lilliputian hallucinations people with Lewy body disease will often have the perception visual hallucination of seeing small people or small furry animals for some reason and they'll see him running around.

>> They're not highly distressed about him.

They just notice that there's little kids in the room and they what they will talk to them in many cases is if they're really there with Lewy body disease you can also have difficulties with lower blood pressure upon standing and over the course of time, yes, you can have difficulties dementia with that but it's not guaranteed.

We're often focusing on the movement condition itself early on in the treatment.

>> Thanks for your call.

Let's go our next caller hello.

Can walk matters the mind can you wonder is there an alternative to ketamine treatment and how soon will they become available?

>> Can't ketamine treatment is considered a rapid acting antidepressant treatment similar to ECT although ketamine is a medicinal treatment for rapid acting improvement with depression ketamine was FDA approved Food Drug Administration approved in nineteen seventy after it was initially created and Ormoc Organic Chemistry up in Michigan and ketamine was initially approved as an anesthetic.

>> It's a very nice anesthetic in the sense that it helps people not perceive their surroundings while they're getting a procedure done and they don't aren't troubled by things so much.

But during the anesthesia itself their blood pressure actually will increase now with a lot of people who have had automobile accidents or some kind of trauma, the issue always will be the blood pressure decreasing especially other medications that can lead to decreases in blood pressure.

Ketamine is unique in the sense that it actually increases the blood pressure while you're having anesthesia.

>> So the World Health Organization has highly recommended ketamine as a treatment for anesthesia across the entire world.

>> So ketamine was used for anesthesia for about 30 years and about the year two thousand IV ketamine started getting used for depression.

So I've ketamine use for depression.

That's a treatment that occurs over the within an hour IV infusion.

With that IV infusion people can have a rapid recovery with depression.

It was never FDA approved for depression because it was never studied for depression with the FDA with those kind of clinical trials because ketamine was not owned by any particular company.

So if a medication is not owned by a particular company, nobody is going to invest the billions of dollars required to get the FDA approval.

>> So ketamine is used off label over the course of the past twenty twenty three years.

>> So what's happened over the past five years is we have this nasal spray called ketamine.

It's ketamine is the left sided iece of ketamine.

It has about 80 percent the potency of a ketamine infusion which is thought to be adequate when we dose the ketamine up to eighty four milligrams each treatment as ketamine is used twice a week the first month once a week, the second month and then either once a week or every other week thereafter over the course of time and you negotiate with your clinician on how often it needs to be done long term.

But as ketamine is indeed an alternative to ketamine in a sense that they're both working on the glutamate system, the traditional depressants that we've seen over the past decades have primarily worked on serotonin, norepinephrine or dopamine.

Serotonin, norepinephrine or dopamine are like chemicals that are sitting in the passenger seat where glutamate is the accelerator GABA is the brake so glutamate is directly accelerating on the mood the entire outside of the brain is modulated by glutamate.

>> That's how the brain works.

The Excitatory Neurotrauma a neuro transmitter of the brain is glutamate and ketamine, norepinephrine and dopamine kind of provide advisory roles on how much glutamate should increase or decrease.

>> But it's a glutamate Tergat glutamate disturbance that's thought to be highly predictive of depressive symptoms including lack of a lack of enjoyment of things which is called anhedonia.

>> It's a key residual symptom on why some people don't get well.

They don't enjoy things.

They don't take pleasure in things they don't have fun anymore.

If you if you normalize the glutamate effect that can have a key impact.

There are so ketamine can normalize glutamate.

It's ketamine can normalize glutamate and there's a third medication now it's been available for about a year called Valide although it has a combination of bupropion which is an old and a president's been around since nineteen eighty nine and dextromethorphan which is a course Presson that's been around for sixty five years.

>> Dextromethorphan at high levels can signify only affect the glutamate system now although it is not the same as ketamine or ketamine but it has significant effects on the glutamate system such that in my experience in treating patients with all Valide I'm seeing I'm seeing them not only have a significant improvement within two weeks but they also have particular improvement with stress resilience where they're able to put up with stuff better and that return of joy and pleasure in life and that's a tricky symptom to attack with our traditional antidepressants we've had for the past six decades.

>> So there are ways to affect glutamate in ways other than just using ketamine as ketamine.

>> The other one that the antidepressants coming out in the future are primarily going to be affecting glutamate or gabber glutamate.

>> The accelerator gabbers, the brake so they work in balance like that.

You might have heard of an antidepressant medication that came out a few months ago by the name of Zoove Zoove moves alone is the chemical name of it.

But Zoove is a medication that is used for postpartum depression and it's very interesting it works on Gabb but it works within two weeks and you take it every day as a postpartum women woman who's have severe depression following the birth of a baby.

She takes it for two weeks every day and then the depression goes away and the five women don't need any more treatment for the rest of the year.

So there's always been around fifty milligrams a day is thought to be the ideal dosing.

It's been a bit available over the past month or so but that's something we see ourselves using much more in the future, especially as we identify women with postpartum depression because women with postpartum depression they're severely depressed and there's a danger there not only to themselves but also to their baby because some women go so depressed they harm their babies but more commonly they just don't bond with the baby.

And if you don't bond with a baby early on that can be highly impactful for the baby's mental health .

So it's not only affecting the mother's mental health but it's affecting the baby's mental health .

So that's why it's so important for us to treat women with postpartum depression with something is going to work fast and so it's going to be very efficient and effective in their treatment.

What we like about zoove less than one percent of it gets in the milk so that woman who's trying to bond with her baby, she can still feed her baby.

So that's something that's been very exciting for us.

I remember when Zoove was first getting studied two or three years ago I was on an advisory panel looking at Zaazou.

>> My biggest concern was rural women still be able to breastfeed because for many women that's a very important that's a very important aspect of the bonding.

They did milk studies less than one percent any milk concentration less than 10 percent is thought to be pretty safe with a lot of medication.

So if you're milk, concentration of the drug is less than 10 percent and that drug doesn't cause any horrible side for you or the baby that's thought to be pretty safe.

Think about Zoove A for postpartum depression.

The woman can't drive well within 12 hours after taking the medication.

So the way we'll get around that is we'll have the woman take the medication around six or seven p.m. at night.

>> She can drive at six or seven a.m. the next morning.

>> So that shouldn't be too much of a factor.

A little bit of tiredness is the biggest side effect from Zoove, but it's affectng Gabba Gabba again is the brakes on the brain.

It's thought that when women deliver a baby in some cases they have decreased activities of their gabb with decreased activity of Gabb in the brain.

It'll make you more anxious.

You can't sleep, you're more irritable, you can't concentrate in long run you get more and more depressed if you stimulate that GABA receptor in a way different than you differently than you would with Xanax, Ativan, Klonopin they affect Gabb but in a whole different way.

But if you do so in a different way in using services or zoove you can get the relief of the Depression as well.

>> Can't thanks for your Kingson thanks for your call.

Let's go our next caller.

>> Hello Rick.

Welcome to Matters of Mind Rick.

You wonder about flu vaccine You take flu vaccine for your panic disorder but it makes you feel agitated.

>> Is this normal or is it not working?

I wouldn't recommend flu vaccine if you're using it for panic and it's making you feel agitated.

The reason I say that, Rick, is because about two out of three people just don't do well with a serotonin medication for anxiety and if you feel agitated the serotonin medication, it means you're either getting too much of it or it's not the right medication for you.

So the first thing I want to do is make sure you take a lower dosage of it if it's working to some degree because agitation with a serotonin medication is a symptom of serotonin toxicity.

Other symptoms of serotonin toxicity can be a fast heartbeat shakiness nausea, diarrhea, headache, sweating those are all symptoms of serotonin toxicity just means you're getting too much and for many people it's just something it's not going to work out for them so well now women are more prone to having serotonin disturbances than men.

That's how their brains are naturally made up.

Women have 20 percent more transmission with norepinephrine than men and that's why women are much, much more astute about identifying details and having a better, better understanding of social cues than men.

So women have more norepinephrine transmission but they have less serotonin transmission.

>> So serotonin medications sometimes work out better for women than men.

>> But anybody who is having serotonin toxicity off have them back off on the medication or go off to something else Rick.

>> Thanks for your call, Jamie.

We've got about a minute and a half left.

Thanks for your call.

>> Welcome to Matters of Mind.

Jamie, you had mentioned you're having trouble things with issues of anxiety before you go to bed.

>> How can you overcome that so you can sleep?

Kind of mentioned that before if you're having trouble with anxiety before you go to sleep, try to identify and actually journal your worries and your anxious perceptions at least two or three hours before you go to bed think about what type of things might be provoking the anxiety.

You'd be surprised how many people have some caffeine after about five or six p.m. That could be a factor in terms of evoking the anxiety.

But the first I want to do for you is figure out what sources of anxiety that we could identify.

Talk it over with your primary care clinician.

Yeah, there are medications that are not addictive that people can take to chill out the anxiety before they go to bed.

>> And many times once you get the cycle of your circadian rhythms back on track, they take care of themselves.

>> Jamie, thanks for your call.

Unfortunately I'm out of time for this evening if you have any questions concerning mental health issues, you may contact me by Internet so I can answer your question on the air by emailing me at E at matters of the mind all one word at WFB Vague.

>> I'm psychiatrist Jeff Alver and you've been watching matters of mine on PBS Fort Wayne God William Hebes willing.

>> I'll be back again next week.

Thanks for watching.

Goodnight