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

>> Welcome to Matters of the Mind now and as 26 year Mutter's in 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 (969) 27 two zero.

>> If you're calling any place coast to coast you may dial toll free at 866- (969) to seven to zero and 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 WFA org that's matters of the mind at the dot org and I'll start tonight's program with an email I recently received.

>> It reads to Father is Alethia Neném over-the-counter supplement any good for mild anxiety LTT that is actually the active ingredient in green tea and to get an adequate amount to help you in the amount of green tea you'd have to drink about 20 cups of green tea a day to get some kind of relief.

>> So many people will indeed use Elfy and supplements and they get them over the counter and if you take around 200 milligrams three times a day that can help some with anxiety.

>> We've had some pretty good luck with Elfy and for some people who experience anxiety in my office but by the time the people get to me they have more severe anxiety.

They have difficulty with sleep ,they have trouble depression, they have other factors.

But on a day in and day out basis you could al-thani safely again active ingredient and green tea and it's something you can use long term.

It's something that typically does not give any side effects to speak of and usually when a medication gives limited side effects it means it has a very limited amount of psychoactive active activities.

>> So if it tends to be very well tolerated, that's a good thing but it might not be doing that much overall for a lot of people.

>> But keep the dosage low enough.

It can be something that might be effective with good tolerability overall.

>> Thanks for your email.

Let's go to our first caller.

Hello Jill.

>> Welcome to Matters of Mind.

Joe, you want to know what is somatic therapy?

Is it similar to eye movement desensitization and reprocessing also known as MDR somatic therapy?

Jill is kind of an old term referring to some kind of physical therapy for the purpose of treating depression, anxiety, mood disturbances, cognitive disturbances and so forth.

So somatic therapy generally has historically referred to medication treatment, electroconvulsive therapy more recently transcranial magnetic stimulation and we can even say ketamine as ketamine.

Those are somatic treatments and basically their physical treatments that are affecting the brain.

But I think when we talk about affecting the brain to some degree talk therapy or counseling is a physical treatment in the sense that indirectly it will fire up the front part of the brain.

>> The problem people are experiencing many times with depression and with anxiety disorder disturbances is they get stuck in this particular mode of networking of the brain called the default default mode Network.

The default mode network is where you get stuck in this inner structure of the brain.

It tends to get stuck in those areas and you are you become more prone to daydreaming.

You start to think back about your past, your brood about autobiographical material and you just kind of get stuck in doing that now there's nothing wrong with it if you're simply sitting around and you're trying to be creative, that's where you're going to try to have a very creative type of outsie the box thoughts.

>> That's where entrepreneurs can kind of think and that's OK.

But the problem with depression and with anxiety is people have a hard time kicking in this second network called the Salient Network part of the Salian network as the dorsolateral prefrontal cortex which fires up in the front part of your brain here in a basically Maxin says hey, pay attention to this because this is important that fires up the executive network.

The executive network is the thinking part of the brain that's the part of the brain where you're in deep thought, you're concentrating on things.

You're paying close attention to various materials in which you might be trying to to concentrate upon.

So the idea in using talk therapy or psychotherapy is to try to get you to focus on the here and now and not ruminate about the past and not get stuck about the past because if you ruminate about the past, your emotion all vying control can kind of kick in.

That's called the amygdala.

It's up here in the front part of the temporal lobe, the amygdala is the part of the brain.

>> It's an almond shaped structure that's responsible for guilt, anger, anxiety and that's the part of the brain that can become overactive when that's overacting it'll hijack the front part of the brain.

So the thinking part of the brain doesn't work so well.

So you get stuck in this ruminative worry and anxiety.

So with talk therapy or counseling the whole idea is to try to consciously kick you out of that default mode network and get you back in to the thinking executive network where you can actually focus on the here and now and go forward and not get stuck in the past.

The problem is with depression a lot of anxiety disorders that salian network that bridge between the daydreaming mode, the thinking mode that bridge doesn't work so well and it won't kick you in to the thinking mode you get stuck in that daydreaming mode and you start brooding about the past and you can't let go of that.

So talk therapy or counseling indirectly will eventually help the front part of the brain and it's a physical type of treatment in that way medication treatment, TMS, MDR these type of treatments do affect the brain physically in different ways but they're all doing the same type of things where they're trying to fire up the front part of the brain to allow you to concentrate more on the here now and make good coping decisions.

Many people when they get depressed they get bogged down with not making really good decisions and some people can get even to the point where they get psychotic when you're psychotic you don't have contact with reality and you can't look around you and determine what's real and what's not real and then you can get perceptual changes where you start hearing voices that aren't there or seeing things that aren't there and many people can be very distressed by that obviously.

>> Thanks for your call.

>> Let's go to our next caller.

Our next caller is Frederick.

Hello Frederick.

Welcome to Mars.

Mind Frederick, you asked why do people choose to take just medications and not go to therapy?

>> Is that safe?

>> You know, before the middle 1980s, Frederick psychotherapy was the main means of treatment that goes back to a hundred years before that where people might go into psychoanalysis and they'd be on the couch for two or three times a week with an analyst behind them and the chair they might go through psychodynamic therapy where they are getting involved in insight oriented therapy, cognitive behavioral therapy became more popular in the 1960s and 70s primarily where you try to look at underlying automatic thoughts that might cause you to have certain behaviors and in behavior therapy.

So there's all these different talk therapies that have been available.

What happened, Frederic, in about 1980 seven we had this medication come out called Fluoxetine also known as Prozac and it wasn't any better than the older medications but the older medications, the so-called tricyclic antidepressants trade names or Ellisville Synacthen tofor now they were very good in what they did.

>> It's just that they had a lot of side effects going along with them.

>> In other words, they increased serotonin and norepinephrine but in doing so they also blocked histamine.

They blocked acetylcholine, they had Alpha1 blockade.

In other words they had all these other factors that were kind of mixed in.

So they were kind of like a vegetable soup that had all these different ingredients, some of which you didn't want.

So the older medications prior to nineteen eighty seven they worked pretty well but you had dry mouth, you had weight gain, you felt sedated, you're lightheaded, you're constipated, you felt lousy so prior to nineteen eighty seven this goes back to when I was in my psychiatric training our main treatment back in the old days was talk therapy and I was trained primarily in talkptherat that I was wasting my pharmacy background because I was a pharmacist before I went to medical school and many people thought I was wasting my pharmacy background because I was getting involved in all this talk therapy and I was kind of dismissing medication treatment for people because there weren't that many 1987 Fluoxetine came out that started a flood of newer medications that were available and many of these newer medications early on they worked as well as the older medications but they were more tolerable.

So Prozac or Fluoxetine, the reason it was on Forbes magazine's top 100 inventions for the twentieth century wasn't because it worked any better for depression and just the people were willing to take it so they didn't have the dry mouth, they didn't have the light headedness, the weight gain.

So they're willing to take it following Prozac than we had Zoloft and we had Paxil.

So we had all these other medications and since Prozac we thereafter had about sixteen oral medications that have come out now more recently over the past few years about ten years ago we had twenty six which does affect serotonin but it's very selective on affecting five of the 14 different serotonn receptors.

>> So it's more selective and specific and what it does to intelligence is advantage over Prozac and Zoloft and the older medication would be it would help with your speed of processing.

In other words, you'd be able to concentrate more efficiently and focus on things in a different way.

And it also did help with what's called Anhedonia and Etonians where you don't enjoy things and lack of pleasure in daily activities as a big factor for a lot of people, as a risk factor for people getting depressed again.

So if you don't have fun anymore you just can't enjoy things.

>> You're going to be at higher risk for having a relapse of the depression itself.

Trent did address that to some degree in the past ten years and more recently we've had an oral medication by name of all Valide come out of is not affecting directly serotonin and norepinephrine and dopamine.

>> It's affecting glutamate and if we look at the outside part of the brain out here, glutamate is what basically runs the outside part of the brain.

The gray matter, the brain glutamate is the excitatory neurotransmitter of the brain and in doing so it will fire up, concentrate on motivation.

It works entirely differently than the other medications that affect serotonin, norepinephrine and dopamine because they primarily affect they're coming from the brain stem.

>> If you look at the brain looks like a big cauliflower and has a stem coming off of it and the brain stem is the origin of norepinephrine, dopamine and serotonin and they will affect the outside part of the brain.

But glutamate is kind like the accelerator on the brain.

Serotonin and norepinephrine and dopamine are kind of sitting in the passenger seat advising glutamate.

>> Should you speed up or should you slow down?

So the norepinephrine serotonin and dopamine those are the main neurotransmitters we focused upon over the past G sixty years and just more recently we were talking more about glutamate.

>> When we talk about glutamate that's also what ketamine is affecting us.

What is ketamine is affecting as ketamine is a intranasal administer whereas ketamine is an IV formulation that people infuse over the course of thirty thirty five minutes and in doing so they can get a very dramatic and fast recovery from depression entirely differently than anything we've seen in the past.

So you know people sometimes wonder when I'm going to retire.

>> I'm telling them it's difficult for me to retire because there's so many exciting things coming around the bend here we have these glutamates aging medications that I've been waiting for my entire 35 year career and now we have them available.

>> So I want to be in a position where I can help people in using those Frederich ,thanks for your call.

>> Let's go to our next caller.

Hello Kirk.

Welcome to matters.

Mind you, I know that you wanted me to know that you're experiencing burnout and you're having burnout between work andt can reenergize and not feel zoned out on your downtime?

I think I know what you're referring to here, Kirk, but when you talk about burnout it means you're doing the same thing every day and you don't feel like you really have a strong means of changing your daily environment.

For instance, when we talk about burnout times people talk about work burnout.

They get stuck in a rut.

They have bosses who aren't really allowing them to be very innovative and they will tend to just get discouraged in going into work day by day by day.

So burnout is where you work harder and harder and you're working more efficiently but you can't get things done to see any any evidence of of success.

>> So that causes a lot You can have burnout at home if you're doing the same thing every day and you're not enjoying things and again we call that anhedonia where you're not involved in pleasurable activity.

So whether it be work or at home, the first thing I recommend to people is try to change your environment to the best way possible and be able to do things that show meaningful progress whether it be at work, whether it be at home, at home, start getting involved in hobbies, activities you might have forgone for a while back, get involved in things that you used to find pleasurable so that will be a way of relieving that so so-called symptom of anhedonia that refers to no fun and means no fun means is Sidonia so anhedonia refers to no fun so people need to get back involved in things that are enjoyable but in the workplace you need to find the challenges that might be lurking behind the different barriers you might you might be encountering.

>> So despite your boss, despite the administrative struggles that you have, you need to find challenges that will be new and exciting for you to allow you to keep going forward in that case work a lot of people will change jobs when they're burnt out when well if they hung in there and they found more interesting things to do within the jobs despite all the obstacles, they might be able to hang in there a while longer.

>> But I often tell people to hang in there another year or two years and find other things to do within the workplace to keep yourself from getting burnt out and before you decide to go to something else and sometimes people have to decide to go to another workplace when the current struggles are just under unsurmountable.

>> Kirk, thanks for your call.

Let's go next email our next e-mail reads Dear daughter Fauver, I can't fall asleep because I keep replaying situations that happened throughout the day that I wasn't comfortable with is as common.

>> This question comes up quite commonly for a lot of people on this program and in my practice for that matter is where you go to bed.

>> You turn out the lights, it's nice and quiet and for the first time all day you have a sense of peace and you have the ability to think about stuff.

So what I often tell people is to think about stuff well before you go to bed early in the evening perhaps try to write out in a journal the different challenges you're encountering and encountering and then try to figure out what you can do about these challenges and what you cannot do and let go of what you could change.

So if you're going to bed and you're thinking about all these different things, keep in mind your brain goes in these one and half hour hour cycles where it's like catching a bus and if you don't catch the bus every hour and a half you're going to have to wait for the next bus.

>> So there's a good chance that if you wake up say eleven o'clock, eleven thirty at night when you've just gone to bed an hour or so earlier you're going through your first cycle and you might just need to get up for a little while until you get tired again.

What you do not want to do dopne don't look at any news events, don't look at television, try to read something that's not highly interesting but also that has chapters and you don't want to read a novel at night unless there's certain cut offs in the novel where you can stop periodically because you want to be able to read a few pages then determine if you're ready to go back to sleep.

>> But more often than not if people awaken especially in the middle of the night and your brain starts replaying a lot of things that happened during the day, you need to get out of that so-called default mode network to which I referred earlier.

>> That's the ruminating network at your brain.

It's in the deep structures of the brain.

>> You want to get out of that default network and go into the thinking network and the thinking network is indeed are what you would engage if you started reading something and starting to try to pay attention to something that would allow your default mode network.

>> You're ruminating Network you're daydreaming network, your autobiography Fickle Network that would allow that to get shifted away and might take an hour and a half for you to get sleepy again but keep reading until you get sleepy and then go from there.

>> Thanks for email.

Let's go.

Our next caller.

>> Hello Carla.

Welcome to Matters of Mind.

>> Carla, you want to know the difference between dissociative identity disorder and bipolar disorder?

They're quite different, Carla.

>> Dissociative identity disorder is a phenomenon we've known about for decades now.

It's where people have experienced typically a severe trauma earlier in their lives and when you experience trauma it can be sexual abuse, physical abuse.

>> It can be a severe complex trauma.

>> It goes on and on and on and the only way you can adapt to enduring that trauma is to zone from it.

We call it dissociation.

It's where you basically get yourself distance from what's happening and you just dissociate from it in a sense that you put yourself in the role of a lamp and you're just not there when all these awful things are happening.

Well, it becomes a coping technique and even in later years when the abuse is no longer occurring, people can sometimes go into this dissociative mode when they get under any stress.

So let's say they just have some pressure on the job.

They have a little bit of an interpersonal conflict with a coworker or maybe a friend.

All of a sudden they might dissociate because that's just unconsciously what the brain did when they were younger and some people will dissociate to a different personality and they'll go to the personality that seems to be the most the most likely to allow them to cope with that particular situation.

So it could be a very strong personality, could be a very submissive personality.

>> It could be a personality that kind of reminds them of how they coped in the past.

>> So that's a dissociative identity disorder.

It's a disorder where people will zone out in the presence of severe because of severe stress from the past but with any types of stress they're kind of still experiencing it now bipolar disorder is entirely different.

Bipolar disorder refers to by being two or two and polar means one extreme or another.

So people with bipolar disorder typically have highs and lows with their moods.

The highs are characterized by decreased need for sleep, impulsivity, racing thoughts, social intrusiveness, impulsivity whereas the lows will be characterized by just the opposite where people want to sleep all the time, they want to withdraw from others and they get very depressed.

People with bipolar disorder have different degrees of bipolar disorder.

Some people have more highs and more lows.

Most people have three times more lows than they do high so the lows are typically more prominent.

But the problem with the highs of the get you into trouble there are certain types of bipolar disorder where the bipolar mania gets you into trouble so you might be more sexually promiscuous during that time, might spend more money and get yourself into trouble there.

>> You might do say do things and say things you ordinarily shouldn't.

Now there's something called hypomania which is seen in bipolar disorder type two bipolar disorder type two is where you have four to six days of a little high.

>> It doesn't get you into a lot of trouble but other people notice it and you notice where you don't need any sleep as much and you're a little bit more revved up and you're a little bit more enthusiastic but you don't get in a lot of trouble during those little highs.

>> The problem with those allies, even though they sound very favorable to some degree you crash into a low so was like you run out of gas so you have these four to six days a little highs then you go into these big lows for two weeks and you crash.

>> People will come to me when they're in the big lows and when they're the big lows they hate the lows.

>> They prefer to have the highs more commonly I'm often emphasizing to people if you have bipolar disorder type two if you have the highs is more like you're going to have the lows.

So with a little highs you might have they might not get you in a lot of trouble but youre going to run out of gas and go into the big low.

>> So what we're trying to do is get somebody's mood stabilized where they don't don't have unnatural lows.

You can be happy, sad, angry, anxious, detached or apathetic as the situation calls for .

Those are all normal moods and you want to have those normal moods otherwise you're going to be an emotional robot so you want to have normal moods as the situation calls for it.

It's when you have these unnatural moods and you just wake up on a Wednesday morning and all of a sudden you're higher than a kite.

That's where it becomes necessary to have a mood stabilizer to know previous there we're talking about people having talk therapy versus medication treatment.

This is an example where talkptr talk therapy will help you reason through some circumstances maybe gain some awareness to the different impulses and how they're getting you into trouble.

But medication management sometimes is necessary to make the brain work better and that's where medication management can be helpful in psychiatry in a similar manner that medication management can be helpful in cardiology with cardiology.

Yeah, there's cardiology physical therapies.

Gamal strengthen the heart but sometimes with cardiology you need to have the blood vessels opened up.

>> You need to have certain medications to make the heart stronger.

You need to have medications to lower the blood pressure.

You can tell somebody well gee, if you just did physical therapy, if you did cardiac rehabilitation, if you trained on a regular basis and ran a five K, your heart would be fine.

Well, maybe it wouldn't maybe your heart doesn't have the strength to do that.

And for some people based on genetic predisposition, based on their past experiences in their lives, based on their coping strategies that they've learned or not learned so well they can have trouble being able to tolerate stressful situations in the future.

So when we look at psychiatric conditions it is a combination of genetics.

>> That's how the brain is hardwired.

But then you have early life traumas in early life stresses that will impact how well you're able to cope with things and a lot happens before the age of eight years of age.

If you've been traumatized as a child before eight years of age and you have not established that attachent with your parents if you've been sexually physically abused before the age of eight years of age that will put you at a dramatically higher risk for having anxiety and mood disturbances later on in life .

So early life experiences can significantly impact a person's likelihood to have mood anxiety disturbances later on.

>> Let's go to the next caller.

Hello Ruth.

Welcome to Matters of Mind.

Ruth, you want to know about borderline personality disorder?

How would I describe borderline personality disorder?

>> Ruth is basically a condition where people will have highs and lows very quickly based on attachments, based on interpersonal stressors.

>> In other words how they perceive their relationship with somebody else.

>> They can very quickly based on that kind of interaction get really sometimes even to the point of getting psychotic where they lose touch with reality.

>> People with borderline personality disorder have roller coaster moods and they can be very quick and volatile in terms of having rage in even physical aggression.

Sometimes some people have borderline personality disorder will get so distressed they'll want to hurt themselves physically take it out on themselves and they will cut of themselves.

They might overdose periodically and even threatened suicide if not try to complete some gestures so people with borderline personality disorder will often be chronically distrustful.

They'll have ongoing anxiety.

Where does from where does it originate with borderline personality disorder?

It comes down to that lack of attachment.

As a small child I mentioned earlier a lot of things that can happen before the age of eight years of age that can affect you for your entire life .

So as early as three and four years of age if you don't have that strong bonding with a parental figure, it can be a grandparent, it can be some kind of parental figure.

But you need that bonding at an early age to be able to have that trust that can affect you throughout your entire life .

So if you don't have that kind of bonding at an early age throughout your entire life , you can have difficulty with interpersonal relationships.

You can see the world around you and people for that matter as being all good or bad all right or wrong.

>> And you don't see the gray areas.

You don't see a negotiable different areas out there.

So people with borderline personality disorder for that reason will have these roller coaster moods that will be very, very reactive to interpersonal relationships and life stresses the difference between borderline personality disorder and bipolar disorder because it sounds a lot similar .

Borderline personality disorder is based on attachments with others and reactive mood based on stuff that's happening in your life bipolar disorder you can wake up on a Thursday and all of a sudden you're high or low the moods all over the place sometimes with very limited stress.

>> Ruth, thanks for your call.

Unfortunately I'm out of time this evening.

If you have any questions that I can answer on the air concerning mental health issues, you may write me via the Internet at matters of the mind all one word at WFA eg I'm psychiatrist favorite.

>> 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