.

Good evening, I'm psychiatrist Jeff Alver live from Fort Wayne , Indiana.

Welcome to Matters of the Mind Now and its 26 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 (969) 27 two zero or if you're calling Coast to coast you may dial toll free at 866- (969) 27 two zero.

>> Now on a fairly regular basis we are broadcasting live Monday tonight 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 via the Internet at matters of the mind all one word at WFB a dog that's matters of the mind at WFB Oregon.

>> I'll start tonight's program with an email I recently received.

It reads Fauver are the brains of how are the brains of men and women different the brains of men and women are quite different and this has been studied over the past 100 years.

>> How would you know they're different well upon their deaths.

>> So a hundred years ago they would have autopsies and could compare the two and it was discovered one hundred years ago that the brains of women were a bit smaller than the brains of men and some male chauvinist took advantage of that fact and made a big deal out of it.

>> But what he didn't identify initially was that even though women's brains are smaller, this area called the corpus callosum took the brain apart here this middle areas they called the corpus callosum.

It's a band of tissue that connects the left side of the brain to the right side of the brain so that band of tissue connects the left and the right side and then you put the brain together and the brain works that way.

So the left side of the brain works one way the right side of brain works another.

>> Women tend to have a better connection between the left and right side allowing them to have a broader range of emotional experiences and basically they're using the right side of the brain to a greater degree comparatively to the left side of the brain compared to men.

>> That's one way that the men that the brains of women and men are different.

Another way that the brains of women and men are different is that women have about 20 percent more norepinephrine projections norepinephrine and allows you to pay attention to things and refocus your attention to something that might be important.

In other words, norepinephrine is kind of like a chemical clutch.

Back in the old days we had these automobiles that had clutches in the clutch allow you to shift from one year to another.

Our brain needs to do that when we have to pay attention to something that may be important.

Women do a better job than that and that's why women will often be much more socially aware of things happening around them than men may men may be oblivious to social nuances that women are very quick to pick up upon.

So that's a second way the brains of women and men are different.

A third way will be that women's brains tend to have about 50 percent less serotonin transmission.

So even though the women have more norepinephrine transmission they have about 50 percent less serotonin transmission making them more vulnerable to anxiety disturbances such as PTSD, social anxiety, obsessive compulsive disorder, panic disorder and even seasonal affective disorder for that matter.

>> So these disturbances that we often hear about with women can partly be related to serotonin and it's thought in the same manner that when women are going through menstrual changes the days before their menstrual flow each month for instance that can be disrupted by estrogen or progesterone changes which lead downstream to serotonin disturbances.

So there are subtle differences between the brains of men and women that we have to consider when we're treating them.

That's why when I'm treating a woman I'm always going to ask about her menstrual cycles where she is in terms of her her her temporal relationship to menopause.

>> Is she in menopause?

How long she been in menopause when she hit menopause?

Did it make a difference in her mood and her cognition?

>> Same after delivering a baby.

So you consider all those different things that have been happening happening during a woman's hormonal lifespan.

>> Thanks for your thanks for your email.

Let's go to our first caller.

Hello, Paula.

Welcome to the Mind.

>> Paul, you wondered if someone battling an eating disorder and depression would be appropriate to take Cymbalta .

Cymbalta is also known as Dellucci 18.

Cymbalta is a medication that will increase the transmission of serotonin to norepinephrine by a ratio of about eight to one.

So with that increase in serotonin and norepinephrine you get a norepinephrine effect and for many people that will suppress their appetites and won't typically make them as emotionally blunted or emotionally dull as they might have been if they are on the serotonin medication itself.

>> Prozac was the original medication that was Food and Drug Administration approved for binge eating disorder and if you have binge eating disorder where you eat an excessive amount even though you're already full and you do so in private many times with binge eating a medication that increases serotonin can be helpful.

>> Cymbalta could another option now why would we choose Cymbalta specifically for people with a depression and any disorder there'd be three reasons.

>> Number one, if Cymbalta previously worked really well for you for depression, if Cymbalta was working well for depression and depression thereby was exacerbating or provoking an eating disorder, that would be a good reason.

Number two , you could use Cymbalta if you had a family member who did really well with Cymbalta with depression and possibly an eating disorder.

And number three, you can consider it Cymbalta if you knew some these genetic testing it's not deterministic but predictive that with Cymbalta if you have a particular genetic profile that we can identify in might point us toward Cymbalta in those regards.

But the nice thing about Cymbalta does not usually increase the appetite or increase the weight which would be helpful.

>> So for some with binge eating for anorexia nervosa where you're losing weight and you're have a distorted body image, those people usually need a different type of treatment from an eating disorder standpoint.

>> But for depression and binge eating especially where you're noticing that you get depressed and you have eating disturbances if Cymbalta had previously worked for you, if worked for a family member or if you have reasonable genetics for it, that would be a reason why Cymbalta could be useful.

Thanks for your call.

Let's go to our next caller.

Hello John.

Welcome to Mars The mind.

John, you mentioned that you're part of a small percentage of people who are sensitive to electromagnetic meters installed.

It's called a just cause mental health issues.

You wondered if that's a real phenomenon.

>> It's something that hasn't been extensively studied in psychiatry.

The impact of electromagnetic meters but is something that over the course of time might be further assessed now what I recommend if you're sensitive to electromagnetic meters, I'm not going to give you any profound advice here.

I'm going to just say stay away from them.

But I can't advise you to use any particular shields.

I'm not aware of those type of things.

John, thanks your call.

Let's go to our next e-mail question.

Our next question reads the Farber When I have episodes of depression I find that I eat more.

It's probably emotional eating or stress eating.

Is this common?

I'm trying to at least have healthy choices around my kitchen but it seems to be easy to everyone to have depression when you have depression you typically will crave carbohydrates when people eat high amounts of carbohydrates they will indirectly trigger increased insulin release when there's increased insulin there's a greater transportation of tryptophan into the brain.

Now tryptophan is a building block for serotonin.

Serotonin can give people an antidepressant and antianxiety effect so people will instinctually eat especially carbohydrates when they get depressed.

>> What do they do that well, when you get depressed your brain is care is is perceiving there's something wrong and when the brain instinctual he perceives there's something wrong.

Eating is a means of doing something about it.

So if the brain is perceiving that you're starving, for instance, it'll trigger you to have an increased appetite and the same can happen with depression.

The brain is depressed.

There's decreases in activity in the front part of the brain.

There are certain characteristic changes that are occurring and the brain will try to fix that inherently and that can sometimes trigger the appetite instinct to make you want to eat more carbohydrates especially but indirect you're going to want to eat more carbohydrates many times when your depressed that will initially give you a little bit of a high.

>> But in the long run the carbohydrate release especially with the increase in insulin can cause you to have a bit of a glucose crash.

Then you feel lousy and it's kind of back and forth.

So people when they blast themselves with carbohydrates will often regret it later on because they'll say they actually feel worse.

And I'm often warning people about that during the winter time because with winter depression people will often want to eat more carbohydrates not so often offered to you but if you eat more carbohydrates during the wintertime it can make you feel more sluggish and more tired and want to want to sleep more.

So eating more sleeping more is very common during the dark days of winter and people need to be careful about that when it's bright outside especially try to go outside for a 20 to 30 minute walk, get some fresh air but more importantly get that light that can be available for you out there.

>> Thanks for your call.

Let's go next caller.

Hello Carlos.

Welcome to Mastermind Carlos.

>> You want to know if you can get effective therapy without talking about your childhood?

I want help but I don't want to look backward if somebody is to ask me that Carlos in my office I'd ask yeah, you can get some effective therapy by looking at the here and now and going forward.

As a matter of fact, there's some very good therapies that do that dialectic behavioral therapy being one of those therapies where you're mainly dealing with coping mechanisms and looking forward.

>> But if somebody says to me as a psychiatrist they really don't want to go back into their childhood, I'm curious what might have happened in the hildhood because what will tip me off in that case is when it happened and how it happened and why it happened.

In other words when it happened if something traumatic happened to you before the age of eight years of age, it's highly likely you're going to provoke anxiety later on.

>> So early childhood trauma can provoke provoke anxiety later on.

>> I'm not going to cause make somebody go back and relive it.

I just want to know what happened because if it happened at an early age that can be a factor how it happened I want to know was it a one time incident or was it a long term?

>> We call it a complex post-traumatic stress condition where it's happening again and again and again those kind of conditions can be more difficult to treat and you'll often find that medications that are typically used such as a serotonin medications might not work as well for people who had early complex childhood trauma.

>> So I want to know what it was and when it happened.

But I'm not going to cause somebody to go back and rehash it again and again and again.

>> People will do that in movies where you watch a movie with a psychiatrist or psychologit and they're taking somebody through their trauma and they get cured because they relived all their trauma and they they came out a winner that time.

>> It doesn't work that way.

I mean going back and reliving the trauma especially under hypnosis does not give you affective outcomes.

>> So it's important to know what happened when it happened and how it happened as an early childhood experience.

So as a clinician it's important for me to determine the course of treatment based on that knowledge.

But I'm not going to want to have you relive it again and again and again.

So there are some treatments that don't make you go back and relive the trauma necessarily like I said dialectic behavioral therapy being one of them interpersonal therapy where you're just dealing with your relationship with other people can also be a factor and can be helpful for a lot of people.

>> Thanks for your call.

>> Let's go next caller.

Hello Julie.

Welcome to Matters of the Mind .

>> Julie, when you had one or two , when do I think a doctor would use lithium as an antidepressant?

>> Julie Lithium is a salt.

It's been around since nineteen forty nine what's been on the ground forever but ever since the ever since the birth of the earth but lithium is in the ground.

It's a chemical type of cousin to sodium and that's why if you have a high sodium diet you'll have lower lithium in your system if you're taking lithium if you have a low sodium diet you'll have higher lithium in your body.

Lithium in our body will be typically zero but we can use it as a supplement as a means of mood stabilization.

>> It's Food and Drug Administration approved for bipolar disorder, especially bipolar mania.

It's very good for manic highs where people don't need to sleep.

They're impulsive.

They have racing thoughts but we use low doses with depression.

>> Julie, when people have chronic suicidality I've seen remarkable success with this over the course of the past thirty years as I've used it at very tiny doses.

A common dosage for lithium will be 900 milligrams a day but not uncommonly 150 milligrams bedtime or 300 milligrams of the controlled release version at bedtime can dramatically decrease your thinking about suicide and the preoccupation with that.

>> It's thought that lithium will do several things but the first thing it'll do it'll increase brain drive neurotrophic factor in the front part of the brain but it can also give you a very strong profound antiinflammatory effect and in giving you an antiinflammatory effect of the brain it can help with mania.

But for some people with depression it can do a good job for that.

It's not for everybody but the thing I would suggest with lithium, Julie, is you don't always have to get the so-called therapeutic level to get an effect for the treatment of bipolar mood stabilization.

You often want a level between point six ML equivalents per liter up to one point two or so.

>> The higher the dose dosage you go, the more side effects you get.

The side effects from lithium can be mental dulling, tremor, headache, diarrhea.

>> These are all side effects of getting too much lithium and that's why many people will be opposed to to taking it.

The key with lithium will often be for depression at least use a very low dosage maybe a blood level no more than point three milligrams per liter, maybe point four ML equivalents per liter where you're not getting side effects but yet you're getting that efficacypfor decrel thoughts.

>> And I've seen people have improved with suicidal thoughts within a week in terms of using lithium so it can be a dramatic improvement for a lot of people .

>> Julie, thanks for your call.

Let's go to our next caller.

Hello and welcome to Matters of Mind.

Hi.

Hi.

And I was wondering so if if hypnosis is real and then also I am a skin picker.

I always have been I've done the dry skin of my lips and now I'm since menopause I'm picking on my and my thumbs.

Is there a therapy or a medicine that can help with this?

>> And then I'll answer your first question first.

Hypnosis is a real phenomenon.

I was trained in hypnosis 35 years ago and I've been able to self hypnotize and that's what we'll often train patients to do.

We don't use it as much anymore but it's very good for habits.

It's very good Frangaise for instance.

>> Twenty six 27 years ago when I first started going on the air on television I was terrified I'd feel my heart racing.

>> I didn't like the idea of sitting in front of a camera talking to people.

It seemed very impersonal but the same time I knew there were people out there watching and that caused a lot of anxiety.

So I was able to use hypnosis on myself to get myself on the air the first few times and after a few times of doing something you're not as anxious about it anymore.

And now I need to drink coffee to get me awake to come in here in the evening because I've worked all day so hypnosis is a real phenomenon.

It's very effective for habits.

It's not good so much for eating disturbance.

>> Ah overeating smoking is pretty good for a bit.

Not very good for overeating because you still need to eat now in terms of the picking itself it's from an anxiety perspective you have a set of very key statement there that you've noticed the picking increased after menopause to me that tells me it's probably a disturbance of serotonin that you're identifying after a menopause.

>> The first thing you do is& from a behavioral standpoint be aware of doing it and catch yourself doing it as soon as possible.

>> Some people do will wear white cotton gloves, white cotton gloves sometimes it sounds weird you do it around the House not not necessarily in the society because it's not socially appropriate nowadays to necessarily wear white cotton gloves but white cotton gloves because they're white because you can see them cotton because you don't sweat as much but when you're at home you can wear white cotton gloves to allow your the skin to grow back in areas where you've picked.

>> But a lot of that's an anxiety condition that can be triggered by menopause.

>> Menopause will do a lot of different things but it can make people more anxious and give them more difficulty with sleep especially early on they call that perimenopause over the first two years as you're first going into the menopausal symptoms and that's where you'll have the hot flashes and difficulty with sleeping not uncommonly and you know, there are medications for that like Clonidine early on Venlafaxine has been studied with menopause.

I'm not a big fan using it.

I just don't see it work that much.

But I know it's it's something it has been used with menopause but mainly I would think with picking itself we call it a condition that's called neurotic dermatitis where you pick it yourself and you actually can sometimes cause lesions.

>> That's a condition where you can use a small small small amount of an antihistamine because many people will pick as a means of stimulating histamine and if you pick as a means of stimulating histamine you can get a bit of a calming effect and even alerting effect from that.

So picking does have some neurobiological effects on the brain severe picking where people are actually getting to the point where they're causing themselves lesions or even cutting it themselves where they're having self mutilating behavior, then we'll go with a medication that will block opiates like Naltrexone.

Naltrexone is a medication that will block opiates and if you block the opiate release in your skin upon cutting it the skin or self mutilating that will decrease the kind of a high you get following that kind of behavior because self mutilation of the skin will release natural opiates from the skin that goes the brain and you get a sense of blissful feeling.

So when people are cutting in themselves yeah they're doing it sometimes out of frustration, out of anger at themselves.

>> But many times people will cut it themselves because whether they realize it or not they're getting a neurobiological effect on the brain.

The problem is like with any neurobiological effect on the brain that you're trying to create like that you have to do it more and more to get the same effect.

So like with opiates that you take orally to get that same effect with cutting you have to do it more and more.

So that's why we try to get the train back on the track there and get somebody on a medication like Naltrexone as a means of just trying to decrease the cutting itself and decreasing the benefits people sometimes feel from it.

>> And thanks for your call.

Let's go to our next caller.

Hello Shannon.

Welcome to Matters of Mind.

>> Shannon, you want to know our antidepressant medications addictive like painkillers?

No, they're not painkillers I just mentioned they're the opiates.

>> Painkillers will stimulate these MUE receptors.

You there's three different type of receptors for opiates.

There's mucus and Delta MUE receptors if stimulated will give you pain relief.

But they also make you feel happy and blissful and calm and they make you feel good.

>> So the only way people can get that effect all over and over again is by taking more narcotics and more painkillers and they take higher and higher amounts.

Unfortunately you get a certain level of taking a painkiller or a narcotic and you're your breathing stops and that's how people die of narcotic overdose.

They're using the narcotics as a means of feeling blissful as feeling good, happy.

They feel normal many times when they feel when they take narcotics so they like those effects.

>> It's just that when you keep taking more and more of the of the dosage you'll eventually shut down your breathing antidepressive medications do not affect me receptors at all.

They affect norepinephrine serotonin and dopamine norepinephrine serotonin and dopamine come from the middle part of the brain.

>> The brain's shaped like a boxing glove.

Here's the thumb over here on the right on the left side here and if you look at the inside of the boxing glove you've got the stem here.

Some people compare the brain to being like a big head of cauliflower with a stem in the stem itself is where you release the norepinephrine serotonin and dopamine.

It goes to the outer part of the brain.

Well, that's not addictive by affecting serotonin and norepinephrine and dopamine, the doses we use for the antidepressant medications will affect dopamine to a point but they won't cause addiction now if you stimulant medications like Ritalin products, if you use amphetamine products or even cocaine for that matter.

>> Yeah, then you're profoundly increasing dopamine release and similar to the receptor activity at the for the opiates you have to go higher and higher and higher to get that kind of effect.

>> But generally with antidepressant medications the way they're affecting dopamine, norepinephrine serotonin they're not addictive now we have some newer medications for depression that have come out over the past twenty years and especially over the past five years that will affect glutamate.

>> I mentioned norepinephrine, serotonin and dopamine are affecting this brainstem here area and they will fire off their neurotransmitters to the out part of the brain, the outside of the brain is called the gray matter of the brain.

That's the part of the brain that you're using for concentration, attention span, focus keeping your mind on things this outside the part of the brain is predominantly run by a chemical called glutamate 20 years go an old anesthetic medication by name of ketamine was starting to get used for depression.

Ketamine has been around since 1970 as an anesthetic but about the year 2000 it started to get used IV for depression glutamate enhancement of the outside part of the brain will directly affect your ability to enjoy things and be able to have motivation and relieve the sadness.

>> So ketamine has been used for the past twenty years unofficially or off label is never approved by the food and Drug Administration for depression.

>> But then is ketamine came out as a nasal spray as ketamine is also in its bravado.

They came out about five years ago as a nasal spray that will also affect glutamate and when now we have a medication by the name of novelty which is an oral medication that will affect glutamate.

>> So when we're affecting glutamate we're affecting the gray matter of the brain directly.

>> That's the excitatory part of the brain that is being run by glutamate.

>> Now we're the serotonin, norepinephrine and dopamine fit in with glutamate transmission.

>> Glutamate transmission is like the accelerator on a car whereas then you have norepinephrine which kind of acts as a clutch and allows you to shift from one thought or one area of attention to another side norepinephrine even though it's being fired from the brain stem will go to the outside the part of the brain and kind of work as a clutch.

>> Dopamine can give joy and happiness and indirectly allow you to maintain attention and focus but it's got to go through glutamate to do so and serotonin good medications or good neurotransmitter for anxiety.

>> I mentioned earlier that women have about 50 percent less serotonin transmission than men making them more prone to having anxiety conditions and difficulty with panicking social anxiety OCD post-traumatic stress disorder and so forth.

So there's a lot of other reasons why people can have difficulty with serotonin but serotonin, dopamine, norepinephrine they're all kind of like in the passenger seat of the car advising the glutamate accelerator to go faster or slower.

>> Thanks for your call.

Let's go to our last email.

>> Our last email reads Jodie Foster How does stress affect us physically and mentally?

>> Well, basically stress is a change and a change.

That is where you find it difficult to cope and difficult to manage will affect you in such a way that it you can manage it and you can have difficulty on the other hand with being able to be able to face up to it.

And if you have overwhelming stress and difficulty coping with your current life changes your life circumstances, the first thing that starts happening is you might ruminate on it and you get stuck in ruminating on what's going on in your life that can lead to insomnia insomnia thereby can cause you to have difficulties emotionally, cognitively and physically because if you don't sleep well it's going to cause you problems and a lot of different areas and chronic insomnia for many people can affect them physically and mentally, physically can affect your appetite.

It can increase the likelihood you'll have whole body inflammation.

We can have higher likelihood of diabetes, heart disease and even stroke on down the line.

So there are a lot of physical manifestations that can occur with ongoing unmitigated stress.

Now if you can manage the stress and you can manage that and cope with the changes going on in your life , that's great.

>> It's where you can't cope with them.

That's where it's a problem.

Thanks for your call.

Unfortunately I'm out of time for this evening.

If any questions concerning mental health issues give me a call here at PBS Fort Wayne on the night that we're on the air or just write me via the Internet at matters of the mind all one word at WSW ECG.

I'm psychiatrist Jeff Offer and 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 tonight