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

Welcome to Matters of the Mind now on its twenty seventh year matter, 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 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 every Monday night from our spectacular PBS Fort Wayne studios which lie in the shadows of the Purdue Fort Wayne campus.

>> And if you'd like to contact me with an email question that I can answer on the air, you may write me a via the Internet at matters of the mind all one word at FWC dot org.

That's matters of the mind at WFB Egg and I'll start tonight's program with a question I recently received.

>> It reads Do not favor how can I tell if I have chronic stress and are there any lifestyle changes that might help prevent chronic stress?

>> Well first off, remember that chronic stress is not all bad.

>> Stress just simply means there's a change in your life and your situations might be changing.

>> You're enduring new challenges and expectations.

>> That's not all bad.

There is a movie classic movie called Groundhog Day.

>> Couple of decades ago Bill Murray was the star and it basically was themed after a nightmare type of situation where a person was experiencing the exact same thing every day.

In other words, he didn't have any stress stress just means change.

>> Now when we talk about problematic stress that means you have change that is overwhelming your ability to cope based on your past experiences and your coping mechanisms.

>> So a change that is overwhelming you OK that the problematic stress but stress itself is OK. >> So chronic stress where you're overwhelming your bandwidth of ability to cope and deal with the stress OK that's that's a problem.

How do you deal with that?

No one try to identify what kind of stresses that you're encountering and take note of what you can change about those life circumstances and what you can't if you're getting stressed out about what's happening in the Middle East and you're not in the State Department yourself that you can't doing about it, that's nothing for you to be worried about and to be so called a stressed out about.

So some people will find themselves getting stressed about situations in which they have no control so no one try to identify and write them down what kind of changes you're encountering day to day and then identify what you can do about them and what you can.

Many people will find that they have uncontrollable stress because they are procrastinating on things they don't really want to do and then their deadlines are coming up to get these things done and they feel overwhelmed and they can't sleep which by the way is a means by which you can find stress intolerable because if you lack sleep the rational reasoning part your brain starts to not work so well because when you're sleeping this front part of your brain rests in the resting it recharges and you can think more clearly the next day if you're thinking about all these changes, these stresses going on day by day and you're ruminating and dwelling on them and you can't sleep that will affect your ability to reason through your life circumstances and the difficulties that you're trying to endure.

>> So what you want to do is list out the different stresses, identify what you can and cannot do about different stresses that the stresses in which you can find some control over them by all means try to do something about them and give yourself a game plan on what you're going to do about them now we'll always talk to people about watching your diet because many people are stress eaters.

>> If you're a stress eater you're going to be prone not uncommonly to gravitate more toward carbohydrates, especially refined sugars where you're giving yourself a blast of carbohydrates and in doing so you're increasing your insulin.

>> Increasing insulin will temporarily throw more tryptophan into the brain.

Tryptophan is a building block for serotonin and that feels good for a while.

But then then you crash so refined carbohydrates the sugars out there aren't good for you when you're stressed eating.

But many people instinctually will stress try to eat more protein and try to limit your diet the best you can.

Intermittent fasting from many people will work out during this time where they skip breakfast they just eat a moderate lunch if they can get by on that without binge eating and try to eat moderately during about a six hour time window during the day.

What else can you do?

Exercising is fantastic.

Any kind of physical movement can help you deal with stress.

Many people will notice when they get headaches and tension aches in their shoulders and back.

They do really well with some kind of resistance exercising which means lifting weights and doing so under a supervised pkind of setting can be very helpful and moving around aerobic exercise such as walking, running, bicycling, elliptical machines anything you can do to get the heart rate going can be helpful because when you increase the heart rate you're releasing a little protein in the heart that actually goes to the brain and decreases their likelihood that you'll be overly stressed out.

So there's a lot of things you can do about chronic ongoing that's what we call unmitigated where you're not dealing with so well chronic stress is not good for the brain.

It actually physically makes the little neurons of the brain shrivel up so you got these neurons especially in the front part of the brain and in the hippocampus area, the memory center of the brain over on the temporal lobe they will shrivel up.

They don't die.

The neurons don't die but they shrivel up and it's kind of like a plant that needs more fertilizer.

So instead of having fifty thousand branches it might only have thirty thousand branches.

So you need more branches on your little neurons and when you're on a chronic stress or you eventually get to the point where you have clinical depression, those little neurons start shriveling up and they lose their branches.

>> So what we're trying to do in the treatment of depression and people with chronic stress is we're trying to make the neurons more fluffy and in doing so we have medications now that kind of will infuse natural Miracle-Gro into the brain and allow you to have more fluffy neurons is called brain derived neurotrophic factor BDNF is a means by which you can make neurons more fluffy.

>> So newer treatments coming out now for depression which is often due to chronic unmitigated stress will actually make neurons more fluffy within a matter of hours based on animal studies.

>> Thanks for your question.

Let's go to our first caller.

Hello Doug.

Welcome to Matters of Mind.

Hello Doug.

Oh, you want to know what are the benefits of the new antipsychotic koban fee for schizophrenia?

Koban is a medication that affects acetylcholine also known as muscarinic receptors.

Doug.

And in doing so it's an entirely different mechanism of action than we've been addressing for schizophrenia for the past six decades or so.

>> About six decades ago you had this brand new medication as an anesthetic discovered by a French anesthesiologist called Chlorpromazine.

Chlorpromazine is also known as Thorazine and it was the first antipsychotic and it was used as an anesthetic and they noticed that when they gave it to people who had impaired thinking with delusions, hallucinations, what we now know is schizophrenia they actually had a relief of their symptoms.

>> So in the 1950s, 1960s you had a lot of people who were psychotic and they were institutionalized in state hospitals.

>> They were released from a state hospitals because they could take medications like what we now know as Thorazine and other antipsychotic medications that came out thereafter.

So since the 1950s, 1960s all we've had for schizophrenia are predominantly medications that block dopamine as their main mechanism of action for relieving the delusions.

>> Delusions are false beliefs that can't be possibly true and hallucinations those are called so-called positive symptoms.

Positive symptoms are not good symptoms.

There are symptoms that are very prominent and most people on the outside can tell there's a big problem.

There are these people so the dopamine blocking agents would primarily relieve the so-called delusions and delusions hallucinations.

>> Then in the early 1990s clozapine was the first of the newer so-called atypical antipsychotic medication to come out.

They blocked dopamine in this limbic system area on the side part of the brain but they also blocked serotonin 2A receptors in the front part of the brain.

If you block serotonin 2A receptors in the front part of the brain, you release dopamine in the front part of the brain that can help with motivation, concentration and just brighten up quite a bit.

So that was a second mechanism of action we had starting about oh twenty thirty years ago.

So that's where you're blocking serotonin receptors in the front part of the brain to increase dopamine in the front part of the brain.

>> Now we have this newer medication.

>> Benfica is a medication that is affecting acetylcholine so we're not talking about dopamine anymore.

>> We're not talking about serotonin anymore.

We're talking about acetylcholine.

It's an entirely different mechanism of action now are there downsides to it?

Sure.

I mean as a downside you can have difficulty with constipation fast heartbeat, heart rate.

People can sometimes have puffy skin they call it angioedema and if your liver or your kidneys aren't functioning so well you don't want to take it.

It can in some cases be associated with liver damage.

So we have to be careful with liver and kidney functioning.

But if used for a healthy otherwise healthy individual it can be a very safe and effective medication.

>> But the excitement and psychiatry right now, Doug, is that it's an entirely different mechanism of action compared to anything we've had since the 1950s.

>> Doug, thanks for your call.

Let's go our next caller.

Hello, Shelley.

Welcome to Matters of Mind.

>> Shelley, you want to know our vivid dreams and indication of possible health mental health issues maybe Shelley, when you aren't sleeping so well you'll often have a rebound effect where you will sleep more deeply and you actually can have more dreams.

Now historically we've always heard the people with clinical depression will have more dreams.

They'll start earlier in the night and there'll be more intense.

You can have scary dreams which can be associated with post traumatic stress disorder PTSD but scary dreams are not diagnostic of PTSD.

>> In other words, if you have scary frightening dreams it does not mean you've been traumatized.

That was a misperception about 30 years ago the has since been debunked so if you have bad dreams yeah.

>> It could be from sleep deprivation.

Maybe you're going through some tough times in your life .

Dreams are symbolic.

They're abstract.

In other words they aren't well actually writing the play of what's actually happening in your life are very, very symbolic.

So they'll be symbolic of what might be troubling you or what you might be thinking about during the day.

But they aren't giving you necessarily a predictor for the future and you shouldn't read too much into them.

Try to think about the underlying meaning of the dreams themselves.

>> Thanks for your call.

Let's go our next caller.

Hello Marcus.

Welcome mind.

>> Marcus, you want to know why does stress make you sleepy when you feel overwhelmed?

>> Are you to sleep?

Yeah, we call that difficulty with stress resilient stress resilience markus's a target symptom that we are now trying to have to identify more in psychiatry.

>> There's a scale a five item scale I believe it is called a brief resilience skill and a brief resilience skill basically is examining how well you're able to put up with stuff every day.

>> So if you're struggling dealing with things day by day and it's called difficulty with stress resilience you'll notice that your brain has to work a lot harder.

>> You're thinking, thinking, thinking more intensely.

You're trying to work through your problems and you're really firing up this dorsal lateral prefrontal cortex here when you're trying to think through problems and it can make you tired when this part of your brain gets tired.

>> What happens is if you think about an automobile driving down the road it releases exhaust fumes, the exhaust fumes and the brain is called adenosine.

You might have heard of ATP ATP breaks down the ATP is the fuel of the brain.

That's what gets the brain energized.

It's the fuel ATP will release exhaust fumes.

It's called adenosine when adenosine builds up in the brain it'll make you tired.

That's why people find benefits when they drink coffee .

>> Caffeinated coffee with caffeine will mimic adenosine at the adenosine receptor in the brain, knock off adenosine and thereby make more awake and alert.

>> So that's why caffeine in slow forms I'm not talking caffeine tablets.

I certainly don't recommend those because they get in your body, they go to your brain real fast and then are gone and actually and feel worse with caffeine tablets.

>> If you sip on caffeinated coffee over the course of two or three hours over the course of time you can give your brain a slow marination of caffeine and in doing so the caffeine is competing with the adenosine that those adenosine receptors when adenosine stimulates those receptors you feel tired and sleepy and you can't think when caffeine goes to those receptors it knocks adenosine off and then you feel more awake to learn.

>> And this is why for many people caffeine can be helpful.

What else helps when you're stressed out you feel sleepy, take a 20 minute nap.

>> It can do a remarkable job in energizing the brain and it's kind of like giving your brain a little bit of a boost of a battery recharge because when you sleep for twenty or thirty minutes once again you're knocking off the adenosine.

>> Your brain is recharging and when it recharges like that you're able to better you're able to better think through your difficulties and be able to download memories and thoughts more efficiently.

This is why I'm often recommending to medical students who I teach to try to get a twenty minute nap to thirty minute nap toward the end of the afternoon maybe early evening before you do your evening studies because you'll be able to download information so much more easily .

>> So adenosine is the exhaust in the brain that makes you tired and sleepy.

Caffeine will knock off the adenosine receptors and course sleep a brief nap will help you reset those receptors as well and allow you to feel less stressed out and be able to think more clearly.

But when you're not sleeping so well, which is happening so often, Marcus, when people can't sleep so well they get overly stressed.

>> They have difficulty, stress, resilience, difficulties, stress, resilience and that gives you difficulty with sleeping and it's a vicious cycle.

>> So what you want to do is try to get those naps in and think through your difficulties the best way possible.

Marcus, thanks for your call.

Let's go our next e-mail question we have another email that came up here it regional revolver.

>> I get headaches when I'm having anxiety and is there a correlation between headaches and anxiety?

>> There is because when you get headaches related to anxiety, what's happening is your skull all around your brain here.

>> It's a thick skull.

It's hard.

You know what happens is your muscles which are very thin muscles all around, especially your temporal areas and your occipital area in the back there they're very thin and they will squeeze down and it's squeezing down.

>> They can give you this tightness all around there if you have a headband like headache that goes to the back as well, that's called a tension headache if you have a migraine headache that's coming on one side of the brain or one side of the head or another, a migraine headache will be sharp.

Intense will often make you need to go lay down and sleep it off.pIt's incapacitating.

A migraine will often be accompanied by nausea not-uncomn vomiting.

So that's a migraine headache.

A sinus headache is where you have tenderness above the sinuses, above your eyes typically or right below the eyes you'll often have nasal congestion and very commonly a fever associated with that.

That's a sinus headache and then you can have what's called a temporal headache where you have difficulty with a headache occurring at the same time of the day typically around the same time of the day of being a four o'clock headache or a five o'clock headache, it will give you a pinpoint like pain just below the eyeball, give you a watering of the eyes, give you a red eye and that's common for people who have difficulty with smoking.

People might have some hormonal changes.

>> People who drink alcohol periodically will have that kind of headache but that's the kind of headache that occurs pretty much the same time every day for many, many people.

So there's different types of headache, attention.

Headache is where you have this outside squeezing on the skull itself and it's called a tension headache.

What can you do about that?

One of the best things you can do about that is exercising.

If you exercise many times you can relieve a tension headache and that's the difference between a tension headache and a migraine headache.

>> If you have a migraine headache, if exercise is going to be incapacitating, you won't be able to do it.

Tension headaches you actually feel better when you start exercising and for that reason all I recommend that people exercise if they have tension headaches, shoulder aches, low back pain these people often need to move around some exercise aerobic and anaerobic where you do the resistance training those type of exercises can be very, very good for any muscle related aches that are related to anxiety.

>> Thanks for your email.

>> Let's go our next caller.

Hello Cindy.

Welcome to Matters of Mind.

Cindy, you want to know why does your brain fill in missing letters, incomplete words?

>> Because you're your brain Cindy kind of has been there before and it kind of knows the path.

So it's kind of like walking down a trail in which you're very familiar or even walking in your house in the darkness you know the path.

>> So you are kind of going to go through that direction.

Your brain will do the same thing and that's why when we read quickly when we skim information we're often reading right down the middle of the page perhaps and you can kind of pick up a lot of the message and you pick up the theme of the story itself even though you're not reading it letter by letter or word by word, you're kind of filling in the blanks because your brain has been there before.

It kind knows the territory.

It knows certain words will go together.

I hear a lot about a lot of this type of phenomenon occurring with musicians.

Musicians won't read note by note by note.

Musicians will start thinking about chords and they'll start thinking about patterns of the music itself as opposed to looking at note by note by no.

That's the way our brains will operate our brains like patterns and if you're familiar with patterns your brain kind of fill in the blanks.

>> Thanks for your call.

Let's go our next caller.

Hello Beth.

Walking to Mars the mind Beth you want to know does attention deficit hyperactivity disorder or other mental health disorders prevent someone from forming deep relationships?

>> It depends both a part of having a mental health disturbances psychiatric disturbance will be what's called functional impairment if you don't have functional impairment where you have difficulty with relationships, work, social academic difficulties, you got to have some kind of difficulties.

They're related to those symptoms you might be experiencing including ADHD.

Yes, that would be a significant impairment.

So with ADHD the problem that people may notice is they will often lack tact because they will say and do things they ordinarily wouldn't say or do.

They just kind of blurt things out and they will often come across to some people as being uncaring.

For instance, their loved one might ask them to do something or remember something and they forget because with ADHD you have a difficult time downloading information that you are having problems in which you're processing because you have limited attention span so you can have difficulty with relationships related to mental health issues and part of the treatment will be number one, correct the underlying neurobiology disturbances that are causing this mental health problem and psychiatric disturbances but also having some coaching and psychotherapy talk therapy can be helpful in helping you identify where and why you might be having these relationship difficulties.

Beth, thanks for your call.

Let's go to next caller.

Hello, John.

Welcome to Arizona.

Mind John, you know our omega three fatty acids really beneficial to brain health .

>> So what are the benefits?

I'll give you a definite maybe here, John.

I think there's been a lot of discussion about omega three fatty acids for the past 30 years and I always will tell people, you know, if you really want to know what supplements you should take, ask your clinician, your nurse practitioner, your physician what they take as supplements.

>> What I hear about omega three fatty acids, I hear a lot of doctors for a while they might take them and then they don't take them and they don't notice a big difference so many times when they do take them.

I think omega three fatty acids have better research with heart health .

So if you're going to take omega three fatty acid versus omega six fatty acids which is thought to be detrimental for some people, omega three fatty acids can give you greater benefit for heart health .

Some for brain health because keep in mind that 60 percent of our brain is fat.

>> So if somebody calls you a fat head, they're actually giving you a compliment because that's a good thing for your brain to have more fat in it and sixty 60 percent of it being fat, much of that is related to omega three fatty acids.

So if you're having a deficiency in omega three fatty acids, sure you can have some difficulty with having some of the fatty effect on the brain itself.

>> There were studies years ago looking at Japanese women who ate a high level of fish and they had higher levels of omega three fatty acids and based on that study it was found that they had a fifty times decrease risk of post-partum depression after they delivered babies.

>> So that was thought to be a possible signal that hey, maybe there's omega three fatty acids can be really helpful for depression.

I haven't been as impressed as I would have liked otherwise as a clinician I'd be taking omega three fatty acids every day myself oh do it off and on.

health but they can possibly help with brain health .

>> But you probably won't notice a dramatic difference if you were to start omega three fatty acids unless you were significantly deficient oven that's a long way.

>> You know you'd try a a supplement of omega three fatty acids for maybe a month or so and see how you felt.

But most people won't notice a meaningful difference.

Twenty years ago, not uncommonly clinicians would recommend Omega three fatty acids as a supplement and you know that's an extra expense.

>> And while people would often do is they'd pay for their omega three fatty acid supplement but they wouldn't pay for their prescribed antidepressant medication so they often wouldn't get the benefit they otherwise would have had.

>> Thanks for email.

Let's go to our next Hello Kenneth.

>> Welcome to Mars The mind can if you want to know is there a link between vision loss and socializtion, isolation and depression not only vision loss, Kenneth, but also auditory loss.

>> So if somebody is losing their hearing they will be more socially disconnected and it can give you and doing so more social isolation and possibly depression vision loss.

It depends on how gradual it has emerged.

If you weren't horrible automobile accident, you all of a sudden lost your vision the ability to adapt and cope to that change could be a precipitant to having more depression where you'd feel demoralized, you'd have lack of motivation, you wouldn't find interesting things and so forth.

>> So if it's a gradual vision loss with a condition like macular degeneration for instance, that's something you can adapt easier than if you had sudden vision loss.

>> It's not uncommon for a lot of medical conditions to present that way where if you have a medical condition and it's an abrupt change in your ability to function, you're more likely to have difficulty to have the coping bandwidth in which I referred earlier to be able to tolerate that stress.

>> If you are overwhelmed with something that's occurring very, very suddenly you're more likely to have difficulty with tolerating that particular stress.

So acute stress where it's overwhelming and you're finding difficulty finding the coping means can give you a higher likelihood of depression in many cases.

>> Thanks for your call.

Let's go to our last email our last email reads Dear Daughter Father, what can I take or do to help ease my fear of flying in terms of taking any medication to ease your fear of flying?

>> It's a common strategy for us to give somebody just a very small dose of alprazolam also known as Xanax.

>> You just take it while you're in the in the terminal itself you're getting ready to board your flight.

>> You're at your gate.

They announce your gate, they say your flight's ready to go.

You take a little bit of a Xanax during that time if you're not prone to addiction and we're only talking about just taking off before a flight.

Now here's the most important thing as you fly more and more chances are you'll become more adaptive to it.

>> Now why are people often anxious about flying?

For one thing, you're in this metal fuselage inside the plane and you're totally helpless.

You are so over a mile up into the air.

>> So if you if you experience turbulence which is kind of like going over a bumpy road that can be scary for a lot of people.

Keep your seatbelt on so you'll go bouncing around and hit your head on the ceiling.

>> But turbulence is not something that usually leads to planes crashing.

The crashing occurs at liftoff and at during landing.

It's not when you're well up in the air when you can often have that turbulence.

So understaff landing what's happening when you're up there?

Some people get kind of freaked out when they hear the wheels get more engaged and they hear that grinding the wheels coming back in understanding what's happening around you in flight.

Can golf be helpful?

My younger daughter's a flight attendant.

They explain that type of thing to people all the time so that could be helpful for you.

>> Unfortunately I'm out of time for this evening.

If you have any questions concerning mental health issues you may write me a via the Internet at Matters the Mind at WFYI.

We're going to try to get to the question the next program God willing and PBS willing.

>> I'll be back again nextpweek.

You've been watching Matters of the Mind on PBS Fort Wayne, thanks for watching.

>> Goodnight