.

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

>> Welcome to Matters of the Mind now in its 25th year, Matters of the Mind is a live call in program where you have a chance to choose the topic for discussion.

>> So if you have any questions concerning mental health issues, give me a call here at PBS Fort Wayne by dialing in the Fort Wayne area (969) 27 two zero or if you're calling any place coast to coast you may dial toll free at 866- (969) to seven to zero.

Now on a fairly regular basis I am broadcasting live every Monday night from our PBS Fort Wayne studios which lie in the shadows of the new 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 a via the Internet at matters of the mind all one word at WFYI org that's matters of the mind at a dog and I'll start tonight's program with a question I recently received.

>> It reads Dear Doctor Father I have a loved one who struggles with depression.

Why does there seem to be a connection between our energy levels and these episodes of depression?

Well, some people who have depression will have an inflammatory effect on the brain.

Not everybody but some people will.

And when the brain is inflamed during the course of depression you can have a disturbance in this middle part of the brain here called the basal ganglia and with the basal ganglia is disturbed.

>> You have difficulty with fatigue, poor motivation.

>> You don't enjoy things.

You have sleep disturbances and it causes sometimes appetite problems as well.

>> So you'll have poor energy often related to difficulty with inflammation and now there are some medications that we're using now that do a particularly good job of relieving inflammation as thought at one point my goodness, why don't we just give these people nonsteroidal antiinflammatory agents like Advil, Motrin, leave these type of medications?

>> Well, not everybody did so well on those and there's a question of how well they get into the brain anyway.

So now we're talking about using medications like lithium which has been around as a salt for many, many years and lithium at low doses can provide antiinflammatory effects during the covid pandemic there was a particular antidepressant medication called Luvox, also known as Fluevog, something you might have heard about in the news every now and then people were wondering why are you using an antidote precent that's also used for obsessive compulsive disorder for covid Will Luvox has a unique feature and that it will affect these Little Sigma Sigma one receptors and if you affect sigma one receptors you can decrease inflammation.

So Sigma one receptors are in the inside part of the cells and they would decrease inflammation.

So Luvox even though it's an anti depressant that's used for OCD could actually decrease inflammation in the brain and that was what was happening with some people of course deserves further study.

But inflammation seems to lead to fatigue, sleep disturbance is appetite's disturbances and just having difficulty with motivation and often will go hand in hand.

>> Thanks for email.

Let's go to our first caller.

Hello Steve.

Welcome to Matters of Mind.

>> Well, Steve, you want to know how how to headaches affect mental health ?

There are four main kind headaches, Steve.

>> Their sinus headaches, cluster headaches, migraine headaches and tension headaches.

So if we look at those one by one, tension headaches are often seen for people who are really anxious and as you can imagine, they're tense and when you have a tension headache, the brain itself is not actually getting pressed down.

>> But the thin muscles on the outside of the skull are just tightening and tightening down and it's causing all this dull ache and the door ache will be there throughout the day with tension headaches.

The more you exercise, the more you get around, the more you do things, the less they will get tension start to get worse as the day goes on typically because you're worried about things, you're tense about things you're stressed out.

>> So that's what a tension headache will be.

A tension headache typically gets worse as day goes on but you can still work.

>> By contrast, a migraine headache is commonly associated with people who do have bipolar disorder, especially women.

Women with bipolar disorder are four times more likely to have migraine headaches compared to women without bipolar disorder and with migraine headaches they are often worse.

>> First thing in the morning I saw lady last week who said the migraine headaches awakened her at about four or five in the morning and that's a classic migraine.

>> They wake you up right out of a blue first thing in the morning.

They're horrible in the morning they cause you to have sensitivity to light.

They can make you feel nauseated.

Some people will vomit.

You will have difficulty with increased sensitivity, a sound touch and it's kind of similar to what you'd expect with somebody who's having a seizure disorder because with a seizure disorder it will get worse if you lack sleep and often with migraine headaches people will have more migraines if they lack sleep.

Migraine headaches can be precipitated by menstrual irregularities with women as the estrogen and progesterone are going up and down that will often trigger the migraine headaches.

So we'll hear about migraine headaches and mental health when people have bipolar disorder, when they have menstrual disturbances that are causing dysregulation of the estrogen progesterone and we will often treat the migraines with the same type of medications that we use for the purpose of helping with bipolar disturbances such as antiepileptic medications.

Although there's a lot of newer medications for migraines that are phenomenal that have come out through injections, some of them are coming in the pill and the pill formulation and they do a really nice job on relieving migraines as well.

But as you can imagine, if you have migraine headaches you're more likely to have a worse quality of life and it's going to cause you to have difficulty getting things done and it's going to make you more prone to depression because you get frustrated about things.

So in the mental health field will often see people attention headaches who are really anxious they're stressed out.

We'll see people with migraine headaches and migraines and insomnia and depression often go they cascade on each other.

>> Cluster headaches will be the third type of headaches that I can describe.

>> Cluster headaches are more associated with middle aged men who are smoking nicotine and drinking alcohol.

>> Cluster headaches are like a ice pick going through the eyeball and one side of the face will get kind of warm.

>> Your your eye will water, it'll turn red.

You'll get a stuffy nose just on that side.

They're called cluster headaches because they tend to cluster around the same time every day and cluster headaches when we see that from a mental health standpoint we always want to make sure people are doing the best they can to really try to eliminate the use of alcohol and and we try to get him off the nicotine cigarets which can make the cluster headaches much, much worse in those cases.

But there are certain medications that are used for cluster headaches including pure oxygen.

>> People will breathe in pure oxygen that can relieve them and then sinus headache, sinus headaches and we'll hear about those in the mental health field but they're not the top of the list.

>> We hear more about tension headaches, migraine headaches and cluster headaches probably in that order.

But sinus headaches are basically where you tap over your sinuses and they hurt.

You might have a fever, you might have a stuffy nose but they make you feel terrible .

You feel lousy.

You feel not only congested but you feel tired and achy because of the tension of the because of the sinus headaches and the sinusitis will sometimes cause you to have a full body infection and that will cause you to feel really lousy as well.

>> So those are the different types of headaches that we'll hear about in the mental health field.

>> And as a psychiatrist I'm always remembering I'm a physician.

I'm a medical doctor first.

So as a medical doctor, a physician first I'm trying to look at the underlying factors that might be worsening the mental health issues.

So if somebody is having migraine headaches I want to see what I can do for the migraines and the depression or moodiness going along with it if they're having tension headaches.

Yeah, we want to do something about the tension headaches not only from a medicinal standpoint but we want to certainly advise people to exercise move around and do something to relieve the tension whether that involves doing certain mental exercises to relieve the tension.

Deep breathing exercises can sometimes do that and as I mentioned with cluster headaches we're often looking specifically at the use of alcohol and nicotine as a means of achieving alleviating those headaches.

>> Steve ,thanks for your call.

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

Our next e-mail question reads your doctor Fauver I have encountered some fairly severe back pain lately.

I am at a point where I am going to get some treatment for the situation.

One concern I have is possible interactions with the Celexa.

It's also known as Citalopram that I take Freddi with any pain relievers that I might be prescribed should I be concerned Celexa is a medication that particularly goes through a pathway from a metabolic standpoint calls to C to C 19 and it's not going to interfere with a breakdown of narcotic medications.

>> That's a good thing.

So if you were to take pain medication such as narcotics, Celexa would not have a direct interaction with a narcotic medications themselves.

Now if you have pain, especially if you have back pain or any kind of muscle pain or nerve pain, the clinicians might recommend changing from Celexa considering if assuming that's working for you but changing from Celexa which just increases serotonin over to Cymbalta also known as Dellucci Cymbalta will increase serotonin into norepinephrine and eight to one ratio.

So it's increasing norepinephrine quite a bit doing so and getting that dual effect it will decrease the impulse sensation of pain coming up the spinal cord and thereby the deluxe or Cymbalta can help with pain syndromes like that.

We use it not only for muscle pain but also for nerve pain and it's not uncommonly given after somebody has surgery.

So what I'm thinking about you're having a surgical procedure for pain.

I'm thinking your clinicians might want to change you from a Celexa over to Cymbalta now if you stayed on the Celexa we could still work around that.

You'd want to be careful with a medication like Celexa and take a medication like aspirin or Motrin or Aleve because those medications can make your platelets less sticky and when platelets are less sticky you're more likely to get petechiae or bruise ability between the Celexa which makes those platelets sticky and the instead medications like Advil, Aleve and even aspirin.

So there might be an interaction there.

But if you're taking a narcotic not so big of a factor with Celexa sometimes narcotic with Celexa will make you feel a little bit more sleepy or more loopy if you take the narcotic with a Celexa.

But it's not usually that bad at all.

And I'm just thinking if you're going to get treated for a pain condition they might change you from Celexa over to Cymbalta or Dellucci not uncommonly.

We will use a couple of the medications for pain syndromes with Celexa and that could include gabapentin also known as Neurontin and Pregabalin also known as Lyrica.

These medications don't interact with Celexa.

They have entirely different mechanisms of action and they can also relieve pain especially as you're recovering from the surgery itself.

>> So I wish you the best with that and thanks for your email.

Let's go to next caller.

Hello Rex.

Welcome to the Mind, Rex.

You all know the difference between addiction to drugs and addiction to things like gambling when it comes to the mind from a brain standpoint, Rex is very similar.

>> My goodness, when you have an addiction to something it causes you to do something even though it's getting you into a lot of trouble and it caused you to come back to do it more and more and more even though it's getting you into a lot of trouble, you're actually neglecting your daily expectations and your responsibilities including your work, your family and your social activities because you're addicted to something with addiction and not uncommonly will cause you to lie about it.

So somebody asked you are you still doing this or that?

And you say Oh no, I gave that up.

Well, when you really are and that's why we often hear about people hiding alcohol for instance in various places around the house where they perceive that people can't find it.

And if you'd mentioned as the example gambling gambling is an addiction as can many different things that cause you to do things in increasing amounts even though they're getting into trouble.

And what we're talking about as a common theme with all this will be this area of the brain that's kind of the Las Vegas of the brain that is will fire out all this is these dopamine and this excitatory chemical called the nucleus cumins it's right smack in the middle the brain and it fires out dopamine when you're getting excited about something or another and it's cause you to have a higher and higher amount of the stimulation as time goes on.

>> So that's why some people will use small amounts of cocaine early on then they go to higher amounts.

>> Same with nicotine and same with gambling.

You need more and more of an excitatory stimulus to get that high and when people get the high from something like gambling it's the same kind of high from a biochemical standpoint as they would get from a drug of abuse.

So from a brain perspective it all looks the same.

It's that surge of dopamine release and to get that same kind of surge to get that same kind of euphoria, to get that same kind of really good feeling, you have to have more and more of a dose of the drug or of a dose of the behavior to be able to get you there and people will sometimes say well how do I know it's in control?

>> What's in control when you don't need to keep doing it again and again and it's under control when you are able to not get in trouble with it with your spouse, with it's not causing you to neglect your usual duties at work.

>> It's not causing you to to withdraw from socialization.

>> In other words, it's not causing you functional impairment.

>> So that's where you cross the line to gambling when it's causing you functional impairment and you're not able to do the things responsibly that you need to be doing day to day.

So that's where it's important to get help for that now can you can you do can you continue to become involved in that behavior in a controlled type of manner?

Well, it's not highly likely and I'm not highly optimistic when people who have alcohol dependance by history when people have been addicted to nicotine, they've addicted to gambling or pornography, whatever that addiction might be if they want to go back and just be engaged in those kind of behaviors once in a while just because they want to socialize with other people, perhaps with the drugs and alcohol or with the gambling, they need to be very careful because that brain has very profound memory of those past behaviors.

>> And if you give the brain a little bit of a taste of those past behaviors, it'll just take off and cause this tremendous craving to return to those behaviors.

>> So if somebody has a history of alcohol use disorder and they're trying to get back involved with it again, yeah, we try to focus on harm reduction.

We try to get people to not hurt themselves any more than possible.

>> But I'm I'm a big fan of doing the best you can with having extreme limitation on the addictive type of behaviors or the drugs of abuse and doing the best you can to entirely abstain from those kind of drugs of abuse or behaviors keeping in mind that it's not always realistic for some people to totally avoid them.

So in those cases you need to make sure that if you are exposed to gambling that you have friends and families and trusted loved ones around you that are able to get you away from the table or get you away from the behavior as soon as possible when they see it's kind of get you revved up a little bit.

So that's the whole concept of harm reduction.

You're trying to reduce the harm associated with addictive behavior, realizing you might slip up every now and then do it once in a while.

But that doesn't mean total failure at all.

We expect people to occasionally slip up on those kind of behaviors and that will happen and from a neurobiological standpoint it all comes down to the effect of dopamine and the craving the dopamine causes a lot of people regifting.

>> Thanks for your call.

I believe we have another email.

Our next email reads Dear Dear Father, what is LDN therapy?

>> That would be a low dose naltrexone by doctor suggesting I use it for fibromyalgia.

>> Well low dose naltrexone has been in the literature and the psychiatric literature for about seven years now about twenty fifteen or so I started seeing a lot of things about it in about twenty eighteen saw even more and I didn't know what to think about it at first because there's a concept of pharmacology it's called homoeopathy.

>> The homeopathy is where you use these minuscule little doses of medications that don't have any therapeutic benefit but they're just tiny, tiny tiny doses of various herbs or a various beneficial uses medication.

That's why homeopathic medicine is often not even a prescription because it's such miniscule doses.

>> Well, with Naltrexone and LDN therapy means low dose naltrexone naltrexone is typically dosed at 50 to 100 milligrams a day for the purpose of decreasing craving for alcohol and actually decreasing the appetite for some people.

So Naltrexone has been around since about the early 1990s.

I think it's been around for a long time and very safe medication to use.

It will block opiate receptors so you have different types of opiate receptors.

You have opiate growth factor receptors, you have receptors, delta receptors, kapa receptors and naltrexone blocks opiate receptors and in doing so it will decrease the high that some people get when they drink alcohol because indirectly drinking alcohol increases the natural output of opiates so it decreases the high and the enjoyment you get from alcohol.

>> So thereby it decreases the craving.

But low dose naltrexone we're not talking about fifty milligrams a day.

We're talking about four point five milligrams of naltrexone a day which is roughly one tenth of the usual dosage of Naltrexone we're using.

So what the heck is going on?

Well low dose naltrexone apparently has some really good effects on the immune system and that's why it's being used with Crohn's disease multiple sclerosis at tiny doses because it's an interesting phenomenon when you just very, very lightly block certain opiate receptors at a very subtherapeutic amount for what we're used to doing.

>> It'll cause your brain to release more of its endogenous or natural opiates.

In other words, your brain produces its own opiates.

They're called endorphins and if you block opiate receptors your brain naturally will release more opiates on its own without addiction and give you pain relief.

>> And some people have had dramatic effects from conditions such multiple sclerosis, Crohn's disease, fibromyalgia I've heard about it used in that area to what I love about low dose naltrexone treatment.

It's very, very tolerable people tolerate the treatment exceptionally well.

It's just that you can't take a narcotic with it because it's going to the narcotic dosage is going to be affected.

It's going to be to some degree blocking the effect of the narcotic which isn't all bad because we've seen a lot of studies over the course of the past twenty years with narcotics and fibromyalgia.

They typically don't work for fibromyalgia anyway.

>> So as long as you don't use a narcotic with that low dose naltrexone that would be fine.

But now Truxton also has some petri dish or animal type of studies for cancer treatment because it's thought that if you block the opiate growth factor receptors that actually decreases the growth and proliferation of some cancer cells which is an exciting treatment because what a simple treatment for cancer just the low dose naltrexone for the purpose of decreasing the likelihood of cancer proliferate proliferating.

So I'm excited about seeing what the future of low dose naltrexone might be.

I don't think it's homeopathic in nature.

I think it's something that is just giving a little bit of a different effect on blocking over receptors compared to what we see with the traditional doses of 50 and 100 milligrams a day.

There is a dosage of Naltrexone in a medication called Contrave which is a combination of bupropion which is also known as Wellbutrin and Naltrexone.

So you have that combination there for the purpose of decreasing the appetite.

But that's in higher doses.

Low dose naltrexone treatment LDN in treatment is simply four point five milligrams a day which is a very, very tiny dosage of the usual dosage of Naltrexone.

Thanks for your email.

>> Let's go to next caller.

Hello Luther.

Welcome to Matters of Mind.

Luther, you want to know if there's a correlation between caffeine addiction and nicotine addiction they affect entirely different receptors overall Luther with they do share ah the commonality of affecting dopamine dopamine in the long run.

>> But with caffeine addiction what you're doing with caffeine is you're blocking these little receptors called a Dennis S. As I adenosine adenosine as we get through the day and we're getting more and more sleeper sleepy this chemical called adenosine is going up and up and up and up and when this chemical is going up and up and up you naturally get sleeper sleepier and then it stimulates its receptors and you feel tired.

Caffeine blocks those receptors and indirectly caffeine can increase dopamine while with nicotine you're going right to the nucleus accumbens, the Las Vegas part of the brain that fires out those dopamine.

So you're getting a direct effect on effect on dopamine.

So that's why between the two of them yeah.

Nicotine's more addictive than caffeine is caffeine.

It can make you addicted in the sense that it makes you need it to stay more awake to be able to block those little adenosine receptors so you need it to stay awake and at higher and higher doses now caffeine can be safely used up to the equivalent of about three or four cups of coffee a day which actually is around 400 milligrams of caffeine a day which sounds like a lot you want you don't want to do is just pop caffeine tablets all day long.

They have about 100 milligrams sometimes 200 milligrams of caffeine in them in them.

>> Be very careful with the energy drinks out there.

Some of the energy drinks and the supplements that are available have between 200 to 400 milligrams of caffeine and one serving so you can get a boost from the caffeine and get this very intense wakeful effect.

But they're also getting the effect there from dopamine and to a lesser degree norepinephrine.

>> That's why caffeine can really increase the blood pressure.

So if you're having high blood pressure, if you're having gastric reflux, where you're having heartburn, if you're getting a tremor, those can be indications that you're getting a little bit too much caffeine.

So you need to back off of that.

But caffeine can be very useful in maintaining your alertness throughout the day.

>> It can actually improve your productivity up to a point to the point where it causes you to need more and more of each day.

>> You know you know you're somewhat addicted to caffeine if you notice that you need more and more and higher and higher amounts to get the same effect.

>> Otherwise you're really sleepy and many people will get that caffeine withdrawal headache when they notice the caffeine is wearing off and that's where you don't want to cut your coffee a little bit with decaf as well as regular caffeinated coffee and try to back off the caffeine that way.

But nicotine addiction quite different.

Some people will use caffeine with nicotine but what they're doing there is are affecting entirely different chemistries of the brain and they have different receptors that are being affected in that way.

So caffeine addiction mainly is affecting that receptor for adenosine whereas nicotine is mainly affecting dopamine directly.

>> Thanks for your call, Luther.

Let's go to our next caller.

Hello Thomas.

Welcome to the Mind of Thomas.

You want to know about the negative effects of smoking on the brain really?

Thomas, when you think about smoking nicotine is one thing we just talked about that but smoking has a couple hundred of chemicals.

The aromatic polycyclic hydrocarbons and smoke can cause a lot of damage to the brain and can cause a lot of drug interactions for that matter.

But if you smoke cigarets, my biggest concern on the brains from the brain's perspective is that smoking cigarets will cause a difficulty with the tiny little blood vessels in your brain from being able to carry blood.

So I'm most concerned with smoking on the atherosclerotic effects on the blood vessels of the brain itself.

Yeah, it can have some dopamine effects.

>> It can cause you to have some difficulty with needing more of the dopamine hit such that you're more likely to in the long run to have depression.

We've seen that with adolescents used to be thought that if adolescence 14 15 years of age were smoking we thought they were simply self medicating depression.

Now we've realized with 20 and 30 and 40 year follow up studies the adolescents who started smoking might not have been depressed at that time when they started smoking.

They're actually setting the foundation for a lifelong of lifelong history depression because smoking at an early age and increasing that dopamine hit like that at an early age can later on cause you to have a greater likelihood of depression because your brain's needing more and more of that dopamine to be able to stay out of depression overall dopamine is a feel good chemical that helps with motivation, concentration, enjoyment and if you don't have enough of it you can feel really lousy.

>> Thomas, thanks for your call.

Unfortunately I'm out of time for this evening if you have any questions concerning mental health issues that I can't answer on the air you may write me a via the Internet at matters of the mind all one word at WFA EDG I'm psychiatrist Jeff Oliver 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.

Good night