.

>> Good evening.

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

Welcome to Matters of the Mind now and his twenty seventh year matters.

>> 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 that I can answer on the air you may write me via the Internet at matters of the mind all one word at www.

>> Now on a fairly regular basis we are broadcasting live every Monday night from the Bruce Haines studio which lie in the shadows of the Fort Wayne campus here in Fort Wayne .

>> And if you'd like to contact me with an e-mail question that I can answer on the air, you may do so through that email of matters of mind at BFW ECG.

>> Now let's start tonight's program with an email I just recently received.

>> It reads during doesn't favor my family doctor has suggested journaling for me to deal with depression and anxiety but I seem to only write and vent about the same problem or worry over and over again.

>> Is there a more simple and creative way to improve my mental health through journaling?

I think it's important for you to journal not only about your challenges and your struggles but journal about your gratitudes.

>> It's one of the best techniques that many people will find will be helpful when they struggle with depression and anxiety because if you journal about your gratitudes, what kind of things make you feel grateful?

>> What kind of things are you thankful for experiencing that can be really therapeutic and many people will think about gratitude during the time of Thanksgiving last part of November every year.

>> But on the other hand if you do so on a day to day or week to week basis, that can be a big make a big difference for you.

>> So journaling about your gratitudes as opposed to simply your struggles and your challenge challenges can be helpful now journaling about your struggles and challenges can be helpful because if you look back on those struggles and challenges several weeks or months later that can be helpful because you can start to sort out gee, I kind of worked through that that kind of took care of itself and it can reassure you that if you're dealing with something that's difficult now that you've dealt with things in the past that took care themselves and you were able to cope one way or another.

>> So it gives you reassurance that you have overcome challenges in the past.

So journaling about your challenges that's OK.

Just make sure to look back on them a few months later and see how they came out.

But very importantly journaling about your gratitudes always consider what kind of things can make you feel grateful.

>> Thanks for email.

Let's go to our first caller.

Hello Kim.

Welcome to mastermind Kim.

>> You want to know what does it mean to have a treatment resistant mental disorder?

I don't like that term, Kim.

I know it's a commonly used term and it's considered to be a validated term treatment resistant mental health disorder treatment resistant mental health disorder simply means that the treatments that have been trialed have not been effective and by definition for depression for instance, it means you've tried two different treatments and they have not succeeded.

And the problem with that is the two treatments you might have tried might have had the similar mechanism of action.

So if you tried to medications that predominantly increased serotonin and they both didn't work well that by definition gives you a treatment resistant diagnosis treatment resistant diagnoses are important for certain treatment modalities because a treatment looks like a bravado also known as ketamine is FDA approved for treatment resistant depression.

So you have to have had failed on two prior antidepressants.

Simbi acts as a medication.

It's a brand new medication of a combination of Prozac and Zyprexa Fluoxetine and Olanzapine and that is a medication FDA approved for treatment resistant depression as well.

But that just means you failed on a couple of treatments from that perspective it means you've tried a couple of treatments.

Doesn't matter what mechanisms they have.

You tried a couple of treatments and they didn't work out for you whether it's depression, schizophrenia, bipolar disorder.

Many people will need to try different treatments now the kind of treatments people have tried and either succeeded upon or failed upon will be important for us to know as clinicians because we need to kind of line up those mechanisms of action on what worked better than something else or what gave you more side effects.

And we try to put all that in kind of a stall to look at all your different treatments and their mechanisms of action to determine what direction we want to go with future treatment.

>> So if you failed on a couple of medications that had similar mechanisms of action, we don't want to go that direction again.

>> We want to go a totally different direction.

So treatment resistant mental health disturbances simply mean that you've tried a couple treatments and they failed.

>> Thanks for your call.

Let's go next caller.

Hello Chloe.

Welcome to Matters of Mind.

Chloe, you want to know how important is it to have family support during a mental health crisis?

>> Family support is phenomenally important, Chloe, because family support can help you kind of stay grounded and your family obviously has in many cases known you for quite some time and probably know you as well as anybody outside the family and I always encourage family members to be part of the treatment now the individual patient need to have the confidentiality and we have the one to one interaction but it's nice to get family interaction and family perspective on how somebody is doing.

Family members can be supportive.

Family members can be encouraging and family members can help you stay grounded because they'll often they'll often notice that you're doing better or worse even before you realize it because they're looking from the outside looking toward you.

You're with yourself all the time so family members can hopefully be a means of trusted support to give you a good idea on how you doing.

>> Thanks for your call.

Let's go to next email question.

Our next email reads Dear Doctor Father, how do you manage and deal with grief on a daily basis?

>> I am extremely depressed and anxious by the time of after losing more loved ones.

Please help.

How do you deal with grief on a daily basis?

Well, number one it's important to reminisce still reminiscing give you some time self some some time to reminisce but it's also very, very important to try to get back in your functional daily activities socializing staying active with interactions with friends and family exercising.

>> Be careful about your diet.

Many people when they are stress eating during the times of grief they'll eat a lot of carbohydrates and carbohydrates can make you feel terrible especially if you're binge eating on them.

>> So watch your diet, try to exercise more, try to interact with friends and family and stay productive, stay active doing things.

>> It's very important that when you're grieving not to kind of withdraw to the point where you're not maintaining productive activity, you're not taking care of yourself.

That's why you need to get out of the house and stay out of the house.

People who are grieving during the times of the covid pandemic restrictions had a horrific time with their mental health .

>> It was a terrible, terrible time in psychiatry of those two or three years where people were expected to socially isolate, it was detrimental for many people's mental health and it continues to this day as residual effects but hopefully we won't see those days again and we can keep people interacting with each other and socializing and that's what was so troublesome during the covid pandemic.

>> If you stay socially engaging with people, if you stay productive in your day to day activities that can really help you with grief overall.

Thanks for your call.

>> Let's go to our next caller.

Hello Juan.

Welcome to Mars.

The mind mind you want to know what you want to know how steroids affect the male brain and does it have the same effects on the female brain?

>> Steroids will have a little bit different effect on male brain female brain there is a difference between the male brain and female brain.

>> The male brain is larger than the female brain but don't start feeling too good about that just yet because women tend to use both sides of their brains more efficiently than do men because of this little corpus callosum is bandha tissue right in the middle of the brain that connects the left to the right side of the brain so women will use their left and right side of the brain even though their brains might be smaller in some regards women have this particular area called the But women's hippocampus hippocampi that's the memory center of the brain will be much more sensitive to the effects of of estrogen probably some more so than men.

So when women are decreasing their estrogen levels they could have more trouble memory mindo notice that so much because men typically are not getting estrogen to the degree that women will women will have the moodiness because of progesterone going up and down when progesterone is going down progesterone byproduct is called pregnant alone when pregnant and goes down it's like you're in Xanax withdrawal .

You're like anxious, irritable, you have trouble sleep and that's what happens during premenstrual symptoms.

What happens during menopause for a lot of women when their progesterone is going down and they get more anxious because of that effect.

Men again don't have that kind of phenomenon with progesterone because men have negligible progesterone overall men do have testosterone.

>> Testosterone is very gradual.

Men don't go through what's called menopause to the degree that women go through menopause with menopause.

>> Yeah, there's a slow decrease in testosterone but it's very subtle and it goes on over the course of years if not decades after a man is in in his mid forties and testosterone can help with drive motivation.

However, a man can overcome some of that with resistance training if a man continues weight training resistance training that can retain a lot of the benefits that testosterone is providing and we now know that men and women do tend to decrease in this particular level of creatine in their system.

We can always talk it over with your primary care clinician to see if you'd be a good candidate for creatine supplements.

Five grams a day is what people will typically take.

But as men and women get older they have decreased creatine in their muscle, their heart, their brain and that sometimes can be detrimental in terms of muscle development and heart strength and even brain nourishment.

So creatine is a very safe a supplement for most people and it's something in which you can talk with your primary care clinician as a means of trying to help in ways that the testosterone might no longer be beneficial for you.

>> One thanks for your call.

Let's go next caller.

Hello Diana.

Welcome to mind what you want to know about premenstrual symptoms.

>> How does it cause mood swings, irritability?

It's because during the latter part of that monthly cycle progesterone is going down as progesterone goes down you have decreased pregnant alone without decreased pregnancy alone you have more anxiety, irritability and difficulty with insomnia and that's where the irritability will come from.

>> You also have a decrease estrogen that those last few days before your monthly period and with the decrease in estrogen estrogen again is very sensitive in this area in the hippocampus and estrogen is something that helps with the memory and concentration.

So many women will feel like they have memory disturbances during those last days before their periods.

So premenstrual symptoms will be symptoms that occur anywhere between three days before your periods all the way up to two weeks before the periods premenstrual dysphoric disorder is a different type of phenomenon but premenstrual symptoms will not typically be functionally impairing to the premenstrual dysphoric disorder will be premenstrual symptoms also known as premenstrual tension can be annoying for a lot of women.

Over 80 percent of women will notice premenstrual symptoms prior to their menopausal symptoms as long as the ovaries are still functioning so it's something that can be treated sometimes with oral contraceptive medications which will artificially give you the estrogen and progesterone treatment during the entire month but also medications like sertraline Fluoxetine those trade names are Zoloft and Prozac respectively.

>> But those medications can increase serotonin and it's thought that when estrogen is decreasing inadvertently indirectly a serotonin is also decreasing.

So when serotonin decreases you can also feel irritable and grouchy and more moody and depressed during that time increasing serotonin gister in those days with a medication like sertraline or Fluoxetine can be helpful for a lot of women and that's why those two medications are FDA approved for premenstrual dysphoric disorder for women exclusively get depressed and functionally impaired on those days before their periods.

>> Thank you for your call.

Let's go next caller.

Hello Earl.

Welcome to Mastermind Earl.

>> You want to know when a person has a very strong opinion and then quickly changes the next day frequently that a sign of mental illness I don't know or could be that they're kind of having a hard time with understanding what their point of view will be on things.

>> So if you look at the middle part of the brain here, you've got the ventral medial prefrontal cortex right in here the ventral meaning on the lower side medial being on the inside ventromedial peripheral frontal cortex helps you establish your opinions and your biases, your values and your identity for that matter.

>> And if it's not really strongly engaged I mean it's a it's healthy to have an open mind but that ventral medial prefrontal cortex on the inside part of the brain is where you establish your opinions and your bias and your ideologies concerning how you look at the world around you.

>> So if somebody is telling you something that opposes those views, it can cause you anxiety and that's where the dorsal medial prefrontal cortex kicks in because the dorsal media front prefrontal cortex helps you stay socially engaged with those people around you and the dorsal medial prefrontal cortex is asking yourself is it worth it?

>> Really fight these people and argue with them about my difference in opinion or should I kind of go along with them or should I just actually align with their views?

So if somebody has difficulty with their own identity, you can imagine how if they're around people who have opposing viewpoints on a different day, maybe they'll shift to those different viewpoints.

>> Definitely not a mental illness IRL.

Well, that's a mental illness basically where you have an anxiety mood, cognitive thinking disturbance that affects your ability to get along with other people, get your job, sleep, eat, take care of yourself socially engage.

>> That's what a mental illness is all about.

We're on a day to day basis.

You're having trouble really dealing with society and taking care of yourself and making good decisions and being able to be a productive person.

So if you're changing that opinion will not be problematic in that regard.

Shouldn't be a difficulty for that kind of person who changes their opinions based on perhaps who they might be around.

>> Thanks for your caller.

Let's go next caller.

Hello, Sidney.

>> Welcome to Meyers of line.

Sidney, can you ask can you have psychotic symptoms while you sleep sleeping basically put you into psychotic symptoms?

>> Certainly psychotic symptoms will be where you lose touch with reality and that's what happens when you sleep because your reality focus is right here in the left dorsolateral prefrontal cortex.

>> That's your reasoning part of the brain that's the thinking part of the brain is the part of the brain that allows you to judge, you know, what's going on around you and make good decisions.

>> This whole part this front part of your brain shuts down when you're sleeping especially in REM sleep.

>> So when you're in rapid eye movement sleep this logical thinking part of the brain shuts down.

>> That's supposed to happen suddenly because that part of the brain is it needs rest.

>> So when you're thinking really hard all day, you know you need about six or eight hours of your brain getting some rest free to think clearly the next day.

>> So just like your cell phone needs to reread charged every day, so does your brain and the way your brain gets adequately recharged will be by sleeping.

So when you're sleeping you go into REM sleep and rapid eye movement sleep by nature of shutting down the thinking of your brain will cause you to have some irrational thoughts, a lot of abstract thinking if you happen to awaken during a dream sometimes you'll see things or even hear things that aren't there and so that can be considered to be a psychotic symptoms but it's not considered to be a psychotic in the sense that you would need an antipsychotic medication for treatment itself.

There are different types of hallucinations people can have.

There are hypnagogic hallucinations where people will have visual hallucinations where they see things that aren't there as they're going to sleep.

Hypnagogic hallucination some people will awaken in the middle of the night especially when they're overly tired and have what's called himno topic hallucinations is where somebody awakens at 2:00 and 3:00 in the morning and all of a sudden they see things around them that's your brain still dreaming and that's not considered to be a psychotic type of phenomena.

>> So we would not treat somebody in that kind of situation with medication.

Thanks for thanks for your call us our next e-mail question our next e-mail question reads Dear Dr.

Volver, I've taken Prozac eighty milligrams a day for thirty years to treat depression, generalized anxiety disorder and obsessive compulsive disorder because Prozac is no longer available.

>> I've been taking Fluoxetine generically instead at the same dosage eighty milligrams I'm finding that the generic is not working and wonder what other serotonin reuptake inhibitor medication in which you could switch Prozac or Fluoxetine is brand name medication was made by Lilly down in Indianapolis and it went off the market in production in December of twenty four so it's been off of production in this past year.

>> Lilly as a business decision just decided they weren't going to make brand name Prozac anymore.

Brand name Prozac came out in December of nineteen eighty seven so it's been out for a long time but they just said there's so many generics out there wasn't worth it for them to take the to manufacture the Prozac in the brand name for formulation anymore the brand name formulation if it's eighty milligrams it's within one percent of eighty milligrams from a bioavailability standpoint.

>> So when you're taking eighty milligrams a brand name Prozac your dog and eighty milligrams of brand Prozac it's fluoxetine almost right on the money at eighty milligrams if it's generic it could be as little as do the math in my head here as little as sixty four milligrams so yeah you could get quite a bit less fluoxetine maybe sixty four milligrams or so instead of eighty milligrams if you change over to generic fluoxetine.

So what can you do.

>> Well what you're needing to treat OCD and depression what you're needing is a strong serotonin reuptake inhibitor and there are several out there all of this SSRI will have a similar mechanism of action as does Fluoxetine or Prozac issues.

>> They work a little bit different ways but the main mechanism of action of all the serotonin reuptake inhibitors will be blocking the vacuuming of serotonin back into the firing neurons or more serotonin will stay floating around.

>> So how else could you do that whether the brand name medication called Trents it's still brand name it will be brand name until then this next year I believe it goes generic but it's still a brand name but you can't get brand name Trin Telex also known as Vaud ATeam but Trin Telex at twenty milligrams a day is giving you pretty potent serotonin reuptake inhibition.

>> Twenty milligrams of of twenty Alex is giving you about seventy five percent Riptech inhibition so it's giving you Riptech inhibition on serotonin pumps comparable to what you might see with brand name Prozac sertraline or Zoloft peroxide or Paxil Lexapro or Escitalopram those are all other SSRI and they might work for you but they're all generic as well.

But you could try a different type of a serotonin reuptake inhibitor.

>> The brand name trend is still available and you might want to go with that as a possibility.

Talk over with your clinician and see if it would be a good fit for you.

It's something in which we have found many people who have been on brand name Prozac.

>> They do well on brand name trends Alex twenty mgs what people will often take.

>> Thanks for your call.

Let's go our next caller.

Hello Felix.

Welcome to Matters of Mind.

>> Felix, you want me to describe the symptoms of disruptive mood dysregulation disorder and how is it treated disruptor disruptive mood dysregulation disorder is a term used for children and adolescents who have a lot of moodiness now they used to be diagnosed with bipolar disorder then was found that you know, as they grew up they didn't really have bipolar disorder.

>> So it's a moodiness that's out of control a little bit higher than what you would expect considering the child's age or the adolescence age for that matter.

So it's often treated with mood stabilizers so it will be treated similar as well.

Bipolar disorder which is a mood disorder disorder that typically starts when you're 16 ,18, 20 years of age and it will start not uncommonly with manic episodes where you're not needing to sleep, you're having racing thoughts, you're impulsive, you're doing things and saying things you ordinarily shouldn't do as a mood disturbance where all of a sudden you crash into a low.

Not everybody will crash into a low but it's a shift in the moods.

That's the whole phenomenon of bipolar disorder by means to polar means one extreme or another disruptive mood dysregulation disorder is a diagnosis of childhood or adolescence when they notice these kind of phenomena occurring but it will be treated with medication and obviously since the child in adolescence is going to be overseen by caregivers, those caregivers and family members need to be involved in treatment as well to try to help out.

>> Thanks for email.

Let's go to next caller.

Hello Pete.

Welcome to Matters of Mind.

>> Pete, you had mentioned your cousin had a nervous breakdown when she went off to college.

>> What advice do you give students who are stressed out away from home?

I'd say you know the nice thing about our technology nowadays is you can stay in contact on a very regular basis with not only your family members, your friends from home but actually your therapists.

>> Your clinicians can do telehealth if you're in the same state then which the clinician is licensed.

>> So there's a lot of ways to stay in connected.

>> But when you go off to college the first thing I often recommend to 17 18 year olds who are going off to college is don't smoke marijuana.

You're going to be offered to you.

But if you use marijuana it can give you a calming effect and make you not care, which is not good when you're trying to keep up with your academic challenges but also you can have difficulty with having a psychotic episode or having a so-called nervous breakdown as you described, a nervous breakdown is a generic term for having a lot of anxiety, sometimes losing touch with reality and being able to not function so income there's a lot of different kind of conditions that can occur but I'd say maintain contact with family, friends, therapists, clinicians don't use marijuana, stay away from alcohol especially if you're stressed out going off to college and try to maintain some kind of extracurricular activity.

>> You're going to be stressed out in college because there's there's different academic challenges for you but they can be really fun.

Your days in college you're not going to be in class hour after hour after hour.

>> You're going to have a class for an hour then you're going to have two or three hours as a break than a class for another hour.

So I strongly encourage kids going off to college to stay physically active, stay socially engaged, try to stay away from any substances of abuse and get involved in some extracurricular activities to try to give your brain a little bit of redirection some time and by all means maintain contact with your clinician or your therapist upon your being away from from home.

>> Thanks for your call.

>> Let's go next caller.

Hello Giovanna.

Welcome to Matters of Mind.

Geovanni, you want to know how does Paudie trillion affect brain growth?

>> I mentioned marijuana just now.

That's the main thing I'm concerned about with brain growth especially for adolescents and young adults because marijuana will suppress the brain growth.

>> Do we know of any medications or poor nutrition that suppresses the brain growth?

>> I wouldn't say to the degree of something like marijuana but poor nutrition.

>> Yeah, if you have a high process food diet similar to what you see with a heart disease, it's not going to be highly effective for brain growth especially for a child or a young adult because the brain needs a lot of nutrition especially the good fats, the omega three fats, fatty acids that can help with white matter growth, white matter growth is the insulation for the brain very important to help the brain communicate from one side to another so a diet of fruits, vegetables, a a reasonable amount of fat can be helpful in terms of helping you think and concentrate.

>> But when you have a lot of processed food, a lot of fried food that can sometimes make people feel really foggy and weird about some people having a gluten intolerance where gluten will make them have a lot of difficulty concentration and make them feel foggy as well.

>> Giovanna, thanks for your call.

Unforced I'm going to call it time for this evening if you have any questions that I can answer on the air, you may write me via the Internet at Matters of the mind all one word at WFA Edgar I'm psychiatrist Jay Farber and you've been watching Matters of the Mind on PBS Fort Wayne now available on YouTube.

>> Thanks for watching God willing and PBS will be back again next week tonight