good evening, I'm psychiatrist Jay ForFour live from the Bruce Haines studio in Fort Wayne , Indiana.

Welcome to Matters of the Mind now in its 10th 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 concerning mental health issues, give me a call.

The Fort Wayne area by dialing (969) 27 two zero or four calling coast to coast you may dial toll free at 866- (969) to seven to zero now a fairly regular basis.

>> We are 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 and I can answer on the air you may write me a via the Internet at matters of the mind all one word at WFYI a dot org that's matters of the mind at WFYI Egg and I'll start tonight's program with an email I recently received.

>> It reads Do not offer I take bupropion as also known as Wellbutrin to treat some minor depression and help me stop smoking.

>> So far it's been working well.

It's been six weeks since I had a cigaret fantastique.

The question is this this I still enjoy using a small amount of marijuana on occasion.

Will this affect my medication in any way?

The marijuana itself will not directly interact with people.

Opiate bupropion is metabolized by a particular enzyme called Cytochrome P for fifty two B6 and THC or cannabis will primarily affect a different ISOO enzyme called three a four.

So no it will not directly interact with the bupropion to give you a pharmacokinetic interaction it can give you a pharmacodynamic interaction in the sense that cannabis for some people can cause them to have difficulty with cognition, memory, attention span, distractibility and it can sometimes worsen the motivation for somebody.

>> So the pharmacodynamic interaction between cannabis and appropriate would be the bupropion might not work so well for depression now it depends on your age if you're younger especially under the age of twenty four years old, you're much more likely to have more difficulty with the use of even small amounts of marijuana because marijuana does inhibit the growth of white matter of the brain and the white matter.

>> The brain is like insulation so there's natural insulation around your individual neurons help the neurons be able to transmit information and unfortunately cannabis will inhibit that growth especially before twenty four years of age.

We used to think that if you started using marijuana or even use a small amount in your 30s and 40s that wasn't that big of a deal.

Now we think there is because people even in their 30s and 40s can still have difficulty with memory and concentration if they use even small amounts of marijuana.

So it depends on how it's affecting you.

You can talk it over with your primary care clinician but no one it would not directly interact with the blood levels of appropriate but it might affect your ability to maintain motivation and have get up and go and that minor depression that you mentioned might be somewhat compromised in this recovery .

But congratulations and getting off tobacco cigarets for the past six weeks, that's a great achievement.

And the good thing is after six weeks you're kind of in the clear with tobacco cigarets.

Nicotine is very addictive but it is screamingly difficult to get off of it especially the first month you're at the six week mark.

>> It's a good step.

Thank you for your email.

Let's go to our first caller.

Hello, John.

Walking to Mars the mind John.

You want to know about some potential long term outcomes if you don't get depression treated clinically significant depression is not just a sad mood.

>> We should all have a variation of emotions.

We call that the normal emotional vicissitudes where you should have happiness, sadness, anger, anxiety, apathy based on life circumstances.

That's all OK otherwise you're a robot.

You don't want to be an emotional robot.

You want to have emotions that will kind of sway and vary based on your life circumstances.

>> But those emotions should not be catastrophic where you get to the point where they start to impair your ability to do things, go to work, socialize, interact with your family, you want to be able to control your emotions so that you can still be productive.

So clinical depression is where you have symptoms of depression such as low motivation, low energy, poor concentration, sleep disturbances, lack of enjoyment with things sad mood crying spells suicidal thoughts sometimes those are all symptoms of depression.

They're there for a couple of weeks or so and they significantly cause your ability they significantly hinder your ability to be able to get things done that you like to get things done so you have trouble at work, you have trouble at home, you have trouble socializing and that's a clinically significant depression.

Clinically significant depression is thought to possibly have an inflammatory basis that's still getting studied right now but it is significant depression primarily based on the evidence that's out there will cause a shrinkage of the individual neurons.

In other words, they're less fluffy.

So if you have chronic untreated depression the neurons will become less fluffy such that look at the side part of the brain here the memory center, the brain especially the it's called the hippocampus the hippocampus should have individually on each neuron about 50000 connections and if you are clinically depressed month by month, year by year, those fifty thousand branches will shrink down to possibly just thirty or twenty thousand branches.

So you have this 50 percent or more shrinkage of the individual branches.

So imagine Gwon going out in your backyard and noticing that a bush is just kind of shriveling up.

What would you want to do with that Bush?

Well you need to give it some nutrition, water and fertilizer that's what we're trying to do and we treat depression.

We're trying to get these little individual branches of these neurons that have shrunk back up to speed.

>> Now twenty years ago I remember seeing these MRI scans of women who had been untreated for depression over the course of years and you just see the shrinkage of this particular area.

>> It was thought back then that the hippocampus was actually dying and these women would have difficulty with memory and concentration and we thought well gee, depression is literally destroying their brains.

Well, it's not that the neurons are dying, it's just that they're shriveling up so rather than having that bush in the back yard that is dying, it's shriveling up.

It needs fertilizer, it needs water.

That's what's happening with your brain when you have chronic depression basically you're losing certain natural nutrients and with the loss of those nutrients your brain's not going to work as well and that's where you'll have all these symptoms of depression.

Another really big factor with depression is this middle part of the brain and it's over here called the sub general cortex.

It's general underneath the this area that looks like a knee that's called the general cortex subgenera means it's right underneath that part of the brain actually really fire up and it gets smaller when people have depression when that part of the brain fires up, you tend to brood on things.

You ruminate, you can't make decisions.

You start to retrospectively think about all the regrets you've had from the past and that's damaging to the brain itself.

So it's damaging the brain as it will often affect your sleep.

>> So a cascade we often hear about with depression will be that you'll have difficulty with rumination and brooding.

You'll have trouble with thinking about all the past regrets you've had.

You think about all these catastrophic things that can happen in the future and next thing you know you're taking all those thoughts to bed with you and you're ruminating at night.

You're not sleeping by not getting asleep.

You're awake and awakening in the middle of the night.

Lack of sleep is damaging to the brain itself.

So there's this cascade of anxiety leading to insomnia and that leads to clinical symptoms of depression.

So yeah, it is damaging to the brain.

That inflammatory component to the brain can not only affect your cerebral cortex and your central nervous system but when you have chronic depression it can also affect you from an inflammatory standpoint and give you a greater likelihood of having stroke, diabetes, heart disease and even obesity because chronic depression will increase the stress hormone called cortisol and with the increase in cortisol that can cause you to have more belly fat and that's a complication on down the line because that thereby can put you at a higher risk for heart disease and sleep apnea because with more fat in the belly you can have more fat in the neck that can give you more snoring with more snoring.

You can thereby have less oxygen flow to the brain at nighttime when you're sleeping that will give you a cascade of medical problems itself.

So with untreated clinical depression yeah, it can affect you not only emotionally it can affect you with your concentration, certainly affect you socially but it does have physical outcomes.

>> Thanks for your call.

Let's go to our next caller.

Hello Earl.

Welcome to Matters of Mind Earl .

>> You want to know is it harder to quit smoking if you're already dealing with depression and anxiety?

Yeah, it probably is.

>> But here's the here's the kicker, Earl.

You know, chicken or the egg a lot of adolescents start smoking and they're using nicotine as a way of treating depression.

We used to think the nicotine was causing depression.

>> It goes back and forth.

Nicotine use as an adolescent will indeed make you more likely to have depression as an adult because you're basically giving an imbalance of dopamine and norepinephrine even as an adolescent.

>> So starting nicotine as an adolescent will give you a greater likelihood of having depression later on.

But many adolescents and young adults will start smoking cigarets and using nicotine as a means of treating depression and maybe ADHD that might be untreated because nicotine increased norepinephrine and dopamine and those are chemicals that can improve mood and cognition.

>> Unfortunately nicotine is a poor way of enhancing those various neurotransmitters so there's better ways to do it.

But if you already have depression often you're using the nicotine as a means of enhancing dopamine and norepinephrine.

So we will often use a particular medication which I previously referred called bupropion also known as Wellbutrin and it has a brand name called Zyban that has been specifically used in the past for smoking cessation.

So we use bupropion kind of as a way of helping the brain step down off the effect of nicotine because nicotine will increase norepinephrine dopamine, the Wellbutrin and reappropriating will do the same.

So that might be a preferential medication we use for somebody who is smoking cigarets in the form of nicotine and they're also depressed.

So we'll often consider that for a lot of people.

But yeah, it's it's more difficult to get off of cigarets when you're already depressed and anxious because you have to sort out how much the nicotine cigarets are actually being used as your means of self medication.

Thanks for your call.

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

>> Our next e-mail question reads Dear dear father, why do I have such a letdown after Christmas holidays?

>> I'm all excited in December but then get really depressed in January.

>> Well, I'll state the obvious when you're excited about something occurring you can be a letdown after that date or that particular event passes and from a neurobiology, neurobiology, neurobiology standpoint that sounds very obvious.

But there's a difference between Christmas and Thanksgiving and there's a difference in the buildup before each of those particular holidays and the letdown thereafter.

So if you think about Thanksgiving, do you see any particular events occurring prior to Thanksgiving?

>> Do you see Thanksgiving celebrations?

Do you think Thanksgiving decorations before Thanksgiving typically not and Thanksgiving revolves around eating food with immediate and to some degree extended family and watching football in the United States.

>> That's kind of how Thanksgiving has evolved.

It's focused around one day you get an extra day off which is Black Friday when you're supposed to go out shopping for Christmas and then it kind of fades after that.

But Thanksgiving is very abrupt.

It comes and goes is very focused and a lot of people don't have a lot of letdown after Thanksgiving.

Christmas is a whole different type of phenomenon with Christmas it's often a four to six week celebration where there's decorations, there's festivities with Christmas you're celebrating that well beyond your immediate and extended families.

You're celebrating Christmas with friends, families, coworkers, neighbors, a lot of people in the community.

It becomes a community event Christmas at December 25th is during a time of the year where it starts to get colder and many people welcome the opportunity to get outside the house and do social activities.

So the build up to Christmas is different from that of Thanksgiving and of course after Christmas you've had four or six weeks of all these festivities if you drop off of the year festivities and your social interactions after Christmas especially going into the dark days of January, that can be very depressing for you now up in Minnesota, Wisconsin, North Dakota they do a great job celebrating the winter with continuation of winter festivities and those months.

So they kind of brought some of that heritage from their ancestor from Norway and Sweden and Finland because they came over here and they were used to celebrating the dark days of winter to maintain their mental health .

So if you can continue to celebrate the winter festival as you go into January and February, that's going to be to your benefit.

But there's actually a neurobiological reason why you might have that letdown after Christmas.

You might think, well, gee, Christmas Day should be it's exciting.

You're really fired up on Christmas Day.

>> Well, yes and no.

They've actually found that if you're anticipating an event it's the anticipating of the event that will increase dopamine in your brain.

>> So dopamine is a feel good excitable kind of neurotransmitter.

>> Dopamine gives you motivation.

Energy gives you enthusiasm.

So when dopamine is sky high in the brain you'll be excited and really fired up about something .

It's the days and weeks preceding Christmas where your dopamine will actually be higher than Christmas Day itself.

So it's the anticipation of not only Christmas but any future event.

>> The anticipation is what establishes the degree of excitement the brain, the actual event, the less dopamine with the actual event itself and the event a lot of studies with people with addictive conditions actually using the drug of abuse might not be what really fires up the brain.

It's the anticipation and the excitement around the the intention to use the drug of abuse that will be more stimulating for the brain.

>> So how do we use that in our day to day lives?

Well, have something in which you can look forward to doing so have something to anticipate even as we get into our older years and semiretirement retirement you have to maintain some kind of schedule and look forward to something whether it be once every three or four days, once a week have something on your calendar that you can look forward to being excited about doing not just major holidays but just life events.

And in doing so you can maintain that dopamine stimulation of your brain where you can be excited about something here in the future that a particular event yeah that'll be OK.

And you might have a letdown after the event if you don't have something else in its place.

So it's important to have regularly scheduled activities in which you can anticipate.

>> Thanks for your email.

Let's go to our next caller.

Let's go to Amelia.

>> Hello Amelia.

Welcome to Matters of Mind.

Amelia, you want to know will teenagers grow out of anxiety or depression as they reach adulthood?

>> It's a different type of phenomena, Amelia No one I'd want to know is there any family history of depression or anxiety if there's a family history of depression or anxiety where a mother father, brother or sister had depression or anxiety?

OK, there is a genetic influence about thirty five percent or so that that adolescent may have depression or anxiety on going.

And I also want to look at any prior trauma traumatic life events if the adolescent had a prior traumatic life events, sexual abuse, emotional abuse, physical abuse, abandonment of some type a significant loss especially because prior to the age of eight years old that's a very critical time prior to the age of eight years old that particular adolescent will have a greater likelihood of depression or anxiety later we can do genetic testing, genetic testing basically will predict to some degree who might be more prone to developing depression.

But you have to look at all these other factors.

You have to look at the genetics but you look at past traumatic events and how somebody coped and how somebody been able to adapt to trauma going on in their lives.

>> What happens with teenagers is now for those of us who were teenagers, teenage years are often very cadastre for a lot of people because we lack stress, resilience as adolescence.

A lot of people don't have the maturity from an emotional perspective, an interpersonal standpoint to be able to adapt to changes and to losses and to stresses that are occurring.

>> So a teenager might find something that is just catastrophic that you'd find laughable when you're twenty six or twenty eight years old.

>> Why?

It's because as an adolescent the front part of your brain is still growing the front part of your brain is your judgment part of your brain, your impulse control part of the brain.

It's still growing when you're an adolescent and going up to the age of twenty four years old.

>> So things will appear to be catastrophic when you're 18, 19, 20 years old in many cases and it's during that time of you absolutely positively don't want to use substances of abuse such as alcohol and marijuana because it will compromise your ability ability to make good decisions and I always tell adolescents that you don't want to do things in your adolescent years that you're going to find regrettable later on because you're going to do stupid things and you're going to not think clearly when you're an adolescent because your brain is not fully developed.

So don't do stupid stuff when you're an adolescent you're going to look back on those years when you're in your late 20s, early 30s and think, you know, what was I so stressed about that was not that big of a deal.

We need to empathize with adolescents say yeah, it's tough going through those adolescent years and you can have depression and anxiety and you can have clinically significant pressure and anxiety as an adolescent if it's paralyzing if it's impairing your ability to socialize, go to school, be able to get things done day to day, OK?

It needs to be treated with counseling and sometimes medications but with adolescents we have to remember that much of the difficulty with depression and anxiety that an adolescent encounter can be difficulty with normal stress resilience where they're having difficulty putting up stuff.

Now if it gets to the point where they're getting suicidal, they're getting to the point where they're having very dangerous behaviors and not functioning properly.

By golly you need to make sure they get treated and they get treated at that time because you don't want to have something happening to an adolescent at 14 and 15 years of age which may impair his her ability to go on in their intended career or their their their life goals later on.

>> So we want to make sure they're able to do everything they want to be able to do as they get older.

>> Thanks for your call.

Let's go our next e-mail question our next e-mail question reads Dear to offer are women really more attentive to social nuances when interacting with other people women versus men?

>> I think that's a situation where individual results may vary but in general 100 years ago it was found that women's brains were smaller than men and women were used that was used to basically minimize the ability for women to interact in governmental and work situations because their brains physically were smaller than men's.

However, the corpus colossi of women this band of tissue that connects the left side and the right side of the brain it's wider in women it's thicker so women might have smaller brains by volume but they use both sides of the brain better than men.

Secondly, women have twenty percent more norepinephrine branches compared to men.

What's that mean?

Well if you have twenty percent more norepinephrine branches you're often going to be more attentive specifically in social interactions so women will remember people's kids, people's social context more so than men in most cases.

Now as I said, individual results may vary but women in general will have greater social connectedness than men based on the neurobiology of how their brains are built.

>> There is a difference between the brains of women and the brains of men corpus colossi number one the number of branches on the norepinephrine neurons being the second thing.

>> Thanks for your email.

Let's go next caller.

Hello Todd.

Welcome to Matters of Mind.

Todd, you want to know how does depression or anxiety manifest differently in people with autism and neuro divergent individuals autism and people with neuro who have nerve diverging conditions?

>> They will have difficulty with stress tolerance.

We call it stress resilient being able to put up with stuff so when people have neuro diverging conditions they have autism, they'll get bombarded with stimuli coming from the outside and they can feel readily overwhelmed now it'll look like anxiety and it might even be demoralizing where they get depressed but many times it's a matter of being able to allow them to focus and keep the filter on the outside activity to a point where they can still tolerate what they're able to to manifest in their day to day activities.

>> So what you don't want to do with somebody with autism is overwhelm them with a lot of things at one time and people with autism, people with neuro divergent conditions will have various degrees of those conditions that will treat those conditions sometimes with serotonin medications very, very cautiously but sometimes a serotonin medications can actually make people with autism worse.

There's two medications Erra Pipas Oil and risperidone Risperdal that had been studied with autism.

>> There are medications will block dopamine receptors and block serotonin 2A receptors and in doing so they could allow people to have better stress tolerance.

We often will use Lamotrigine which is blocking the excessive outflow of glutamate.

>> It's thought that when people have autism or diverging conditions they will have an extra sensitivity to the excitatory neurotransmitter glutamate and in doing so they'll be more jumpy and more irritable when all this input coming in to their brain so they can use the motor gene on a day to day basis to try to modulate some of that gwon fixin's another medication it works more norepinephrine so we have medication treatments for autism a neuro divergent conditions if people feel like that anxiety, the irritability, the moodiness is becoming overwhelming for them and obviously there's going to be a lot of coaching for a lot of folks out there with divergent conditions to try to help them coach them through the life experiences themselves and get him in the right environments very importantly get him in the right environments where they can actually put their unique skills to to the best use I mentioned several times Israeli Defense Forces have a team of people with autism specifically on their intelligence, reviewing their intelligence where they can look at photographs and they can look at data coming in and they found that the people with autism can identify particular specifics in those kind of intelligence reports that other people are readily going to miss.

So people with autism can certainly have attributes that the rest of us will lack and it's important to be able to put those attributes to to work for them.

>> Thanks for your call.

Let's go to another caller.

Hello, Jim.

Welcome to Matters of Mind.

>> Jim, you want to know do men and women exhibit different symptoms regarding depression?

You know, a lot of times women are going to get more teary eyed.

>> The effect of estrogen can make women more tearful in the many cases women can be more emotional and that can be sometimes exacerbated by the mood swings they can have with the estrogen and progestin going up and down prior to their menstrual cycles.

Postmenopausal women you'll see that flatten out to some degree and you'll see postmenopausal women having more symptoms of depression and more similar to men.

But premenopausal women will often have a little bit more moodiness and more tearfulness with depression.

Men when they get depressed will often get more irritable and angry men don't often get teary eyed.

They get more angry and irritable when they get depression.

So we'll hear about that men more commonly when they get depressed they'll lose weight.

Women will typically gain weight.

You hear about that type of phenomenon although once again individual results may vary.

Some men might be stress eaters but typically women will be more stress eaters and that's thought to be related somewhat to serotonin because when serotonin is dipping down it might do so when you're having hormonal fluctuations, when serotonin is dipping down you'll tend instinctually want to eat carbohydrates as a means of increasing your tryptophan level.

Tryptophan gets transported in the brainteaser and tryptophan is a building block for serotonin so women will often crave carbohydrates when they get depressed to try to indirectly increase serotonin in their brain so there will be subtle differences with men and women.

But often you'll hear about the tearfulness in women in more anger and irritability with men when they get depressed.

>> Thanks for your call.

Let's well unfortunately I'm out of time for this evening.

If you have any questions concerning the mental health issues you may write me via the Internet at matters of mind at Dawg and I'll see if I can get your email on the air with the next program.

I'm psychiatrist Jeff Oliver and you've been watching Matters of mine on PBS Fort Wayne now available on YouTube God willing and PBS willing.

>> I'll be back again next week.

Thanks for watching.

Good night