Good evening.

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

Welcome to Matters of the Mind now.

And it's 27th 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 by dialing 9692720, or if you're going anyplace else coast to coast, you may dial toll free at 8669692720.

Now on a fairly regular basis, we're broadcasting live every Monday night from our spectacular PBS Fort Wayne studios, which lie in the shadows of the Purdue Fort Wayne campus.

And I can answer your emails why you're writing me via the Internet at matters of the Mind.

All one word at WSW dot org that's matters of the mind at W f w dot org.

And I'll start tonight's program with a question I recently received.

It reads your favor How does a healthy diet interact with normal use of antidepressant medication?

My elderly father has recently been hospitalized and I have noticed a marked improvement in his mental health.

His appetites improved and he is eating much better at the hospital.

Or maybe he's getting nutritious food at the hospital.

Many people who are elderly are living on their own.

They don't eat properly and they can get malnourished and they have decreases in protein, specifically albumin and decreases in magnesium, decreases in protein, decreases in magnesium can be a factor in terms of making you more depressed, more cognitively impaired, where you have trouble with memory.

Many people will have disturbances with vitamin absorption, so they might have difficulty with vitamin B12 especially, and low vitamin B12, which gets absorbed in the small intestine after hopping a ride on something called intrinsic factor from the stomach.

Low vitamin B12 can be a factor in terms of causing a depression and having trouble with concentration and memory.

In your older years.

So nutrition is important and it'll be important to get your father maybe on some kind of program like Meals on Wheels or some way that upon his returning home or back to his original place of residence, he gets some kind of balanced, ongoing meals that would help him out.

Thanks for your email.

Let's go to our first caller.

Hello, Gloria.

Welcome, American Mind.

Gloria, you had mentioned earlier on SERTRALINE, that's also known as Zoloft, 25 milligrams every morning and evening.

But you're made aware that you should not take it because you have a condition called macular degeneration.

You want to keep your vision, obviously, and you want to know if that's true.

Well, macular degeneration is something where you'll have difficulty with blurred vision and have difficulty focusing on any particular objects, because that's where you focus your vision.

Now, I want to stay on my lane.

I'm a psychiatrist, so I don't want to give you a lot of information about macular degeneration.

Certainly talk to your eye doctor about that and your eye doctor can determine if certainly is a safe medication for you.

But there are a couple areas where you would not want to take sertraline.

Number one, if you have any hemorrhagic issues.

Hemorrhagic means you're easily bleeding.

And if you have a tendency to having bleeds on the back of the retina, yeah, that could be a factor because sertraline or Zoloft is a medication that will block the vacuuming of serotonin into the neurons, and in doing so it keeps more serotonin bouncing around out in the periphery.

It also will block the vacuuming of of serotonin into platelets.

And the way platelets get sticky will be by vacuuming serotonin into platelets.

And that makes them sticky that way.

So if you have a condition where you're prone to having little bleeds, you might have difficulty with a medication like Sertraline.

So that's one condition.

Secondly, all antidepressant medications have a precaution and a warning on their labeling where you have to be careful if you have a condition called acute neuro angle glaucoma, that's where you'd have a painful eye and blurred vision.

Acute angle glaucoma means you have too much ocular or eye pressure, and that will cause you to have trouble with possibly loss of vision as well.

So at a press of medications can dilate the pupils.

And if you have uncontrolled, untreated, acute neuro angle glaucoma that can further close off the duct that's trying to drain off the fluid from your eye.

All antidepressants can delay the pupil.

So any difficulty with hemorrhaging or any difficulty with glaucoma, in addition to the possibility of your having macular degeneration, would be two would be eye issues where you'd need to be careful.

So definitely talk it over your with your eye doctor to see if that's an issue for you.

Thanks for your call.

Let's go.

Next caller.

Hello, Jackie.

Welcome to Myers of mind.

Jackie, you had mentioned you take a natural supplement for sleep.

How long does it take before the supplements are effective?

If it's melatonin, Jackie, it usually takes hour somewhere between 3 to 5 days.

Melatonin basically gives the brain a hormonal chemical signal to go to sleep.

It's like a puff of smoke lasts for about 30 minutes and then gets out of your system.

Basically, it's mimicking the same kind of chemical we all produce right smack in the middle of the brain here from the pineal gland, which is right there in the middle.

The brain.

The pineal gland is a little pea shaped body that releases melatonin when it gets dark.

So when it gets dark, melatonin is released.

It gives your brain the chemical signal to go to sleep.

But melatonin typically does not keep you asleep.

So that could be a factor.

There's a common ingredient in many different sleep medications called Doxylamine.

Doxylamine is the active ingredient in a lot of over-the-counter medications like you to Sam and a lot of sleep medications have doxylamine and a doxylamine is merely an antihistamine anti means again.

So if you block histamine, it makes you more sleepy and tired.

Right now my histamine sky high years might be too.

When you're a wide awake, your histamine sky high.

If you want to block the histamine that makes you sleepy.

So doxylamine is often an ingredient that works pretty fast.

But melatonin sometimes takes a few days to really give you its full effect with melatonin.

Many people will take extraordinarily high amounts.

Do so under a primary care doctor or a sleep medicine doctors supervision, however, because to higher melatonin can actually make your sleep worse and give you nightmares.

We often recommend no more than five milligrams of melatonin, maybe 30 to 45 minutes before going to bed to give your brain that chemical signal to to go to sleep.

Thanks for your call.

Let's go.

Next caller.

Hello, Carlos.

Welcome to Marijuana Mind.

Carlos, you want to know if people with ADHD have super focus in crisis situations?

The answer is yes.

Carlos, when you're when you have ADHD, there's often a misconception that if you can pay attention to some things really well, you can't have ADHD.

That's a misconception because when you have ADHD, the problem is your front part of your brain that helps you pay attention.

Doesn't work so well unless you're getting stimulated by something exciting, challenging, new, interesting, then a whole different part of your brain kicks in.

This part of the brain called this nucleus accumbens will kick in and fire out more dopamine.

Just a little spray to the front part of the brain is all you need that fires up a chemical called glutamate, glutamate and excitatory chemical.

And it'll fire up this front part of the brain.

So if you're really under the gun, if you're pressured, you'll often have actually hyperfocus on medications.

You'll have better than average focus if you're in a crisis situation.

And that's why many people with ADHD will seek out exciting, challenging crisis like jobs.

It's not uncommon for them to go into firefighting, police work, emergency room medicine, people with ADHD thrive on a lot of stimuli around them because that keeps their brain excitable.

Where they have trouble will be paperwork and they have trouble doing desk work and getting things done that just aren't that interesting.

That's why, I mean, many people with ADHD will have trouble in school.

They tend to be really good students when it's interesting, but they have trouble getting through some of the more mundane academia that is often required in a lot of school work.

So if they can get through that, then they can often get to a work environment which can be much more exciting for them.

Thanks for your call.

Let's go.

Next caller.

Hello, Samuel.

What kind of areas of mind?

Samuel You'll want to know if you're prescribed anxiety medicine by your family doctor, Should you follow up with a psychiatrist?

Well, I'm a psychiatrist, Samuel, but there's not enough of us.

There's fewer and fewer psychiatrists across the country.

We're being replaced primarily by the primary care doctors that used to be in the 1980s.

For instance, primary care doctors just didn't treat depression at all.

Now, primary care doctors are prescribing about 80% of all antidepressant medications.

And we have 28 oral and a presence from which to choose.

So we have a lot of different antidepressants from which to choose, but there's not that many of us.

So as a psychiatrist, we will often serve and consulting kind of role to primary care, as well as to nurse practitioners who will work with us.

So if you're on an anxiety medicine, there's a lot of safe ones out there that certainly would require a specialist to oversee you.

Spiro Abuse Bar is a medication that will specifically and selectively affect serotonin and thereby decrease worry.

So if you ruminate about the what if, what if, what if about the future, that's called generalized anxiety.

That's mainly or abuse.

Byron will come in easy to prescribe, not addictive.

And that's something a lot of primary care doctors find themselves comfortable in prescribing.

There's hydrocortisone.

I don't highly recommend hydrocortisone to a lot of people because again, it's an antihistamine as an antihistamine, it'll calling it down, but it also makes you sleepy.

So I like people to stay awake during the day and hydrocortisone will just make you a little bit sleepy.

And that relieves anxiety.

But that's not always the best way to get around that.

We're finding more and more primary care clinicians being reluctant, fortunately, to prescribe benzodiazepines like Xanax, Valium out of the hand, Klonopin.

If you're taking those medications and they're being prescribed by a primary care doctor, you might want to change oversee somebody who's a specialist in the mental health field, like a psychiatrist or a psychiatric nurse practitioner or a family nurse practitioner who is in the field of psychiatry.

And the reason I say that is because benzodiazepines with long term use can double your concentration, slow down your speed of processing in your brain.

So you can't think as clearly and think as quickly from topic to topic to topic.

So with benzodiazepines, we don't recommend those long term.

We are using some antiepileptic medications for anxiety now that appear to be safer than benzodiazepines, but yet they're more effective than beause by our own or even hydrocortisone medications like gabapentin.

Pregabalin.

Sometimes you'll hear about lamotrigine being used for anxiety.

So we use these other medications as alternatives.

So there's a lot of options out there.

The first thing I would ask you, if you're seeing your primary care doctor, though, is if you're taking a benzodiazepine like ADD of a Valium, Klonopin, Xanax, those are the kind of medications where you certainly would want to see a specialist in the mental health field.

If you're not, it depends on how you're feeling.

If you're feeling pretty good, based on how you're doing at this point, you're not having any significant side effects.

You could stick with your primary care doctor because they are prescribing most of the medications out there now for depression and going along with things.

Depression will be anxiety.

So depression, anxiety, sleep.

They often go hand in hand for a lot of people.

Thanks for your call.

Let's go.

Next caller.

Hello, Sherry.

Welcome to of mind.

Sherry, you mentioned you take Trazodone for sleep and it usually takes about 2 hours for it to kick in.

But you find yourself still waking up in the night and you find it hard to go back to sleep.

Is there anything else you can take?

There are many other things you can take as an alternative to trazodone.

Sherry Traves.

Adam has been around since 19 1992.

I think it came out sounds about right in 1992, it came out as a medication for depression and we hardly ever use it for depression anymore.

We use it predominantly now for sleep because it helps somebody get to sleep typically within 30 minutes.

It gives them a deep, good quality of sleep and then gets out of the system typically by eight or 9 hours.

But transition doesn't work for everybody.

It serotonin based in how it works.

Not everybody does well with that kind of medication.

So if you're having difficulty with it kicking in, two things you can do under your clinician supervision.

Number one, move it up a little bit and take it a little bit earlier.

Some people will find that they need to take Trazodone as early as seven or 8:00 at night when they want to go to bed at 10:00.

Secondly, adjusting the dosage, we will adjust the dosage with trazodone, typically between 25 milligrams, up to 200 milligrams at bedtime.

You go above 200 milligrams at bedtime.

It typically doesn't help any more for sleep.

So that's how we're kind of obsessive.

Trazodone is the right medication or not adjusting the dosage and maybe taking it earlier.

There are many other medications that could be safely used for sleep among women, among which would be gabapentin, which I mentioned earlier, being used much more commonly for anxiety and sleep.

Now, it's original approval back in the 1980s was for the purpose of treating epilepsy.

So we don't use Gabapentin that much anymore for epilepsy.

We use it more for anxiety and and difficulty with sleep as well as pain.

Pregabalin is the chemical cousin to gabapentin.

That's sometimes because used for is used for sleep as an alternative to trouser.

Doan Well used.

Murtaza Peter Rimmer on for sleep.

If you don't have any difficulty to appetite increase that you can encounter with Murtaza I mean, great medication for a lot of people who are undergoing chemotherapy for cancer.

Older adults who are having trouble with her appetites, as we heard earlier from that gentleman and get more taste.

Pain can be a good medication for a lot of people as long as they can tolerate the appetite, increase or if they need the appetite increase.

Murtaza Peen has five different mechanisms of action, two of which will certainly improve the sleep sleep quality.

Overall, we use low doses of an old medications, but there also is a 1960s called docs happen at tiny little doses docs but is a very good medication for not only blocking histamine and helping your brain go to sleep, but also decreasing the firing of histamine.

So I mentioned earlier hydroxy and it just blocks histamine docs.

Penn will do two things.

It blocks histamine, but also decrease the firing of histamine and only lasts for about 8 hours.

If you take a very, very tiny dosage, 3 to 6 milligrams at bedtime.

The common antidepressant dosage for docs Penn, for instance, is between 75 and 150 milligrams at bedtime.

So 3 to 6 milligrams a bedtime.

A document is all it's necessary to help somebody decrease the histamine transmission and help them go to sleep.

Melatonin, I mentioned earlier, and it's going to help you maybe get to sleep, but it's not going to keep you asleep.

So it's wouldn't be our first choice for somebody having a lot of difficulty with sleep in general.

We're going to often look at your sleep hygiene.

We want to know, are you getting up, trying to get up at least the same time every day, going to bed at the same time every night, Any television or smartphone watching late at night.

The brightness of the screen can sometimes keep you awake.

What are your sleep habits like?

Or do you have a dog or a cat who's jumping up and down the bed all night?

That can be a factor.

Do you have a noisy area outside of you?

We often recommend sound machines for people in those kind of situations.

So we're going to look at your overall sleep hygiene and look at a sleep pattern on that.

But talk to your primary care clinician about different options.

You might have.

Thanks for your call.

Let's go next email.

Our next email reads, Dear Dr. Farver When the weather gets cold, I always find that my mood takes a turn and I feel more down and sad.

My mom always as always saying I should go exercise as it would help raise my mood.

Can exercise really help improve your mood?

Well, actually, you mentioned the weather getting cold.

It's not the weather getting cold.

Giving you more depression is probably more the darkness day by day.

We have fewer hours of light during the day.

And as we get into the dark days of winter, the darkness will make you more depressed.

So exercising can help, especially if you're exercising outside.

In the early morning light.

So we'll often recommend to people who are having what's called winter depression to try to get outside and enjoy the early morning light.

10:00 11:00 am going for a 2030 minute walk, exercising of any kind in a YMCA or any exercise club.

Anything like that can be very nice because it gets you it gets the brain a little bit more fired up.

When people exercise, they'll increase this excitatory chemical.

I mentioned earlier called glutamate, but they also will increase a calming chemical called GABA glutamate.

Accelerator gab is the brake and they are what make the outside part of the brain work.

I hear you hear me talking about serotonin, norepinephrine, dopamine.

They're coming from the brain stem down here and they're kind of spraying little amounts of their chemicals up to the gray matter to give us some advice to glutamate in GABA.

But glutamate excitatory GABA is a calming chemical.

When you exercise, you increase both of them.

So that's why when people exercise, they'll notice that they feel more energetic, but at the same time they feel calm.

It's a nice feeling and that's why a lot of people, when they exercise, not too much, but they exercise enough to give them that kind of feeling.

They think how to do this more often.

So exercise is good throughout the year, but especially in the wintertime, also for winter, depression, people should not only exercise more, but also socialize and stay around.

People watch your carbohydrates in the winter time.

That's a key factor for many people with winter depression, you have a winter depression.

You're getting a little bit more down because the darkness of the days, it's people are very prone to increasing carbohydrates, increasing refined sugars.

And it just makes you feel really lousy in the long run.

And finally, in the wintertime, if you have access to getting a light box, that can be dramatically beneficial.

Sitting in front of a bright light, it's called a light box.

It has a particular light strength to it.

That would be 10,000 lux l u x a lux is the light intensity of a international Campbell whatever that is, one meter away from you.

So 10,000 lux is the light intensity of the sun.

About 10 a.m. on a summer day.

So it's a bright light.

You sit about a foot or two away from it.

In the winter months, it wakes up.

The brain gives you more energy, more get up and go and relieve some of that winter depression.

Part of the reason for winter depression is because it's dark outside.

When it's dark, that little pineal body in your brain that I mentioned earlier, right smack in all the brain, a little pineal body starts spewing out more melatonin than you need.

So you're getting more melatonin going out there because your brain is saying, hey, it's dark outside.

Your retina are getting the signal that it's dark, Melatonin is getting sprayed out and it's making you tired and you want to withdraw that and then you want to eat all the time and you want to sleep all the time.

You want to hibernate.

So it truly is a hibernating mode.

So that's where exercising can kind of wake up the brain and give you the perception that you're not really needing to hibernate.

Hibernated at that time.

Thanks for your email.

Let's go to next caller.

Hello, Robin.

Welcome to America.

Mind.

Robin, you want to know, can people experience forms of depression with chronic illnesses such as eczema or psoriasis?

These are dermatologic dermatological conditions.

Acne is a very prominent contributed to difficulties depression as well.

Robyn It has to do with your perception of what's going on with your skin.

Having an appearance where you have asthma or you have eczema or psoriasis or acne, that's a part of it.

However, we can't forget that when you have an inflammatory condition of any kind in your body and these are inflammatory conditions on the skin, when you have an inflammatory conditions, inflammatory proteins can go to the brain and inflammation of the brain can make you feel depressed.

How does that make you feel?

Makes you feel tired.

You don't enjoy things, you don't have motivation, You have difficulty concentrating in your ability to process.

Information is kind of slow.

So these are all symptoms of inflammation in the brain and we're getting to the point where we're really trying to hone in on trying to take care of those symptoms.

Are we at a point where we're doing blood tests for inflammatory proteins?

Not yet.

It's not definitive to that degree, but we can pick up symptoms people are experiencing.

So difficulty enjoying things, a classic symptom for inflammation.

So if we hear about those symptoms, we know people are having inflammatory conditions.

What can we do specifically?

If they're having inflammatory conditions from a medication choice?

We can use medications that we know might decrease inflammation.

So we'll use medications such that that increase serotonin and norepinephrine.

Some of them will will stimulate this particular receptor called sigma one receptor sigma one receptors.

If you stimulate them, you'll decrease inflammation.

For instance, there's a medication called Fluvoxamine.

Fluvoxamine is also known as loo blocks, and it was used commonly during the COVID pandemic when people had COVID infections and their lungs were inflamed with the COVID virus, they got an OCD medication, Fluvoxamine or Lou walks, and they didn't get it because they had OCD.

They got it because Fluvoxamine is a very good medication that will stimulate Sigma one receptors.

In doing so, it decreases inflammation.

So some antidepressant medications such as fluoxetine or velarde, these are kind of medications that will stimulate signaling receptors and decrease inflammation, hopefully thereby relieving the difficulty with the inflammation.

Inflammatory markers such as low motivation, poor concentration, lack of enjoyment, things, fatigue.

Those are all symptoms of inflammation for people.

And you can have those kind of symptoms when you have various skin conditions that are associated with inflammation.

Thanks for your call.

Let's go.

Next caller.

Hello and welcome to American Mind.

And you mentioned you take a low dosage of Seroquel also known as quetiapine, 25 milligrams at bedtime.

What to know about my thoughts on that medication the dosage 25 milligrams of quetiapine and is really really, really close to drowsy tone.

You're not getting enough of a dosage there to block dopamine significantly.

You're basically you're blocking serotonin type two receptors and that's pretty much what the president is doing.

You're getting a little pinch of an antihistamine effect with QUETIAPINE, but its main effect for sleep is goes hand-in-hand with the use of tramadol.

And so if it's my choice, I'd probably want to be on trazodone rather than typing, because as you go higher on the dosage of quetiapine, you do start blocking dopamine.

If you block dopamine, you're more prone to having twitches and tics in the face and shoulders.

It's called tardive dyskinesia.

You don't want to block dopamine unnecessarily.

You don't really get that effect with quetiapine.

Do you get it to about 150 milligrams or higher.

So 25 to 50 milligrams you're getting a little bit of a serotonin to a blockade effect there and a little bit of an antihistamine effect.

Those kind of mechanisms are very, very similar to what you're seeing with Trazodone anyway.

So if it works for you, that's perfectly fine.

Your clinician will probably be checking to make sure you don't have those twitches and tics consiste you'll be monitored over the course of time for that and thanks for your call.

Let's go.

Our next caller.

Hello, Jane.

Welcome to American Mind.

Jane, you'd mention you have cancer on your eyelid and need to have surgery, but you're scared to be sedated.

How can you get over that fear?

Is there anything that can help?

I would certainly suggest, Jane, that you talk to your clinician about the possibility of giving you something just to calm you down, because quite frankly, when you're say it sedated in surgery, you don't know it, so you'll do fine during that time.

It's often the anticipate anxiety that's most problematic for people and in that case are a lot of different medications people can take just to calm them down as they go into surgery, for instance.

Oh, my goodness, 20 years ago I had a surgery where I had linds replacements on both of my eyes.

And yeah, I got a really good dose of Valium before the surgery, and I didn't really care.

As I watched the doctor operate on my eyes and put the lenses in.

So if you get enough of a medication for anxiety, you won't care during that time.

And such use short term is perfectly safe.

It's the long term use of medications for anxiety is where you get in trouble.

Jane, thanks for your call.

Let's go to our last email.

Our last email reads, Dirt on Forever.

Can lack of sleep lead to depression?

Absolutely, positively.

Insomnia.

Sleep disturbances will be a psychiatric vital sign.

So anytime you see a psychiatrist, we're going to always be asking you about sleep.

We actually sent out a questionnaire at my practice called the Insomnia Severity Index.

It's eight questions asking about the quality of your sleep.

And we track that.

It's a numerical score that we assess, but we track that score over the course of time.

But lack of sleep will cause you to not be able to recharge this left front part of your brain, especially the left front.

Part of your brain is the part of the brain that you use for logic and reason and concentration and focus.

That's why when you don't sleep well, you have trouble with concentration in the next day.

But also you have trouble logically thinking through stressful coping mechanisms.

So you're under a lot of stress.

This stuff's happening all around you.

You have difficulty with coping because you have trouble thinking through different strategies during that time.

If you haven't slept well.

So lack of sleep certainly can lead to depression for many, many people because it'll change your perspective on the world around you.

Thanks for your email and of course I'm out of time for this evening.

If you have any questions concerning mental health issues, you may write me via the internet that matters The mind All one word at wfwa.org I'm psychiatrist Jay Fawver.

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.