.

>> Good evening.

I'm psychiatrist Jeff Ofer live from the Bruce Haines studio in Fort Wayne , Indiana.

Welcome to Matters of the Mind now and it's twenty seventh year Matters of the Mind is a live Call-In program where you have the chance to choose the topic for discussion.

So if you have any questions concerning mental health issues ,give me a call in the Fort Wayne area by dialing (969) 27 two zero or if you're calling any place coast to coast you may toll free at 866- (969) to to seven to zero now on a fairly regular basis we are broadcasting live every Monday night from our spectacular PBS Fort Wayne studios that lie in the shadows of the Fort Wayne campus.

>> And if you'd like to contact me with an email question that I can answer on the air, you may write via the Internet at matters of the mind all one word at The Hague that's matters of the mind at WFB ECG and I'll start tonight's program with an email I just received this past week.

>> It reads Director Fauver I have recently heard that there are studies that have found a decrease in the level of five I five in dhol acetic acid in the spinal fluid of suicidal persons which seems to have a link to impulsivity what might cause five to be lower in some people and it can be corrected basically five HIPAA is a byproduct of serotonin so it's kind of like measuring your exhaust fumes in your automobile to determine how much fuel you're consuming.

So five is just a byproduct of serotonin and you can measure it with a 24 hour urine measurement and even more accurately a spinal fluid tap and look at how much was in the cerebral spinal fluid in doing so it's a measure of how much serotonin is transmitting in the brain now serotonin comes from this little area in the middle part of the brain called Arafeh Nucleus.

It sprays out to the cortex of the brain.

It's only responsible for about one or two percent of transmission of all the chemistry of the brain.

So it has a very minor role but it's important and in the sense that in the front part of the brain which is the part of the brain where you control impulses if you're low on serotonin that can cause you to be more impulsive, more ruminative, even more aggressive.

>> So the thought was and this is back in the nineteen ninety five a studied the thought was that if somebody is low on serotonin you give them a serotonin mechanism of action for an antidepressant such as Prozac, Zoloft, Celexa, Lexapro, Paxil, Luvox these are all medications that enhance serotonin and in doing so they can give you a calming effect and they can calm down the impulsivity aggression and the anger, the rumination that can occur being low on serotonin.

But there's more to it than just being low on serotonin.

>> Now we know that glutamate other neurotransmitters are a factor.

So that's where we don't have to talk to people to sort out what symptoms they might be experiencing to determine what might be causing their particular symptoms.

For instance, if somebody is aggressive, they're impulsive, they're irritable.

We want to make sure they don't have bipolar disorder.

>> Bipolar disorder is a phenomenon where they'll have manic highs where they don't need to sleep.

They'll be impulsive during those times they'll talk a mile a minute going from topic to topic to topic.

>> They'll be socially intrusive.

So with bipolar disorder we want them on a mood stabilizer and if they have decreased serotonin well that goes back to many times childhood because a big predictor of somebody who's going to have low serotonin transmission will be childhood trauma especially before the age of eight years old.

So if you had sexual sexual physical emotional abuse, if you had a parent who was in prison, if you had parental separation or divorce, if you had particular childhood traumas prior to the age of eight years of age, you're more likely to have disturbances and serotonin transmission.

The brain genetics will play a small role.

>> There's a particular gene called Celsi six a four SLAC six a four has a long arm and a short arm and you inherit these arms from your mom and your dad .

>> You have two short arms and you have childhood trauma as a kid you're more likely to have more trouble with depression later on.

So genetics will be a little bit of a role.

Childhood trauma will be a role and your ability to cope with different things based on your life experiences will be a role as well.

So how do we correct these disturbances on serotonin?

Well, you give somebody a serotonin medication that gets really confusing for people though because you hear about these school shooters who were on serotonin medication in many cases and you think oh my goodness, it must be the serotonin medications that cause them to be aggressive.

>> You have to be careful there because you have to sort out were they even taking the medications at the times of their aggression?

Was there a reason why they replaced the medications?

I mean if they are placed on medications because they were aggressive and irritable, you know, that might have been a reason why they were placed on the medications but they just weren't working.

So you have to sort out the pros and cons of all that.

>> But typically a medication that enhances serotonin is going to have a calming effect for a person.

That's why those medications are typically used for social anxiety, obsessive compulsive disorder, panic disorder, generalized anxiety disorder which is a fancy term for worry.

These are all anxiety conditions that can be calmed with an enhancement of the serotonin in the brain and that thereby can increase the level of five and a and the spinal fluid and then in the urine and be an indicator that you're getting increased serotonin in the brain.

Do we use five HIPAA as a marker?

It's interesting in research settings because it helps us understand some things concerning how the brain works but it's not something we're going to practically use on a clinical basis day by day.

>> Thanks for your email.

Let's go to our first caller.

Hello John.

>> Welcome to Matters of Mind.

John, you want to know is it possible for someone to override are logical side of the brain with their emotional side and can religious beliefs override reason?

>> OK, let's first talk about the logical part of the brain.

The logical part of the brain is the right of the brain.

The logical part of the brain is the dorsolateral prefrontal cortex, the orbital lateral prefrontal cortex that helps with judgment.

You've got some inside parts of the brain here the anterior cingulate which is over here that's the pros and cons part of the brain.

Should I do this or should we not do that?

>> That's the part of the brain that helps you decide that.

So you've got this thinking decision making part of the brain in the front.

>> This is the part of the brain that should determine your behaviors.

Here's what happens when people get depressed, anxious that part of the brain doesn't work so well because the networking going to the emotional part, the brain which is predominantly right here in the amygdala in the temporal lobe area, the amygdala is shaped like an almond and amygdala in Latin means almond shaped.

So amygdala is the heart for the anger, anxiety, irritability part of the brain and if the amygdala is too hot or if it's overly active it will sometimes override the thinking part of the brain.

And if that networking or the thinking part of the brain isn't reassuring the amygdala to calm down, this is not that big of a deal.

>> The amygdala will just take off and make you angry and irritable.

That's why people with depression and anxiety will have increasing activity in the amygdala itself.

>> So yeah, the logical part of the brain should calm down the amygdala normally.

Why do we use medications when we use medications to try try to strengthen that networking talk therapy or counseling is trying to help you enhance the ability of the front part of the brain to do its job and allow you to think through situations before reacting.

So the reacting will be from the amygdala itself so you can override the emotional aspect of the brain with thinking through it and if your brain's working well enough you can do that.

>> The religious beliefs cannot override reason often and the good way the religious beliefs will be manifested by the ventral medial prefrontal cortex which is right in here.

So the brain looking at you here on the inside is the ventromedial prefrontal cortex.

That's where your religious values will be embedded where you identify those values as being part of you.

That's your identity.

>> Those are your values.

Those are how you identify your way of wanting to to live and your religious values are part of the thinking part of the brain itself.

>> So they will enhance your ability to think through different scenarios based on your your values and your beliefs.

>> So it all works together very nicely like that.

>> But the role of counseling will be to try to help the thinking part of the brain the role of medication will be to biologically allow that to all work well and many medications for instance will calm down the amygdala so it's not so prone to overreact to different things.

>> Let's go our next e-mail question and our next e-mail question reads a favor an acquaintance of mine told me upon my meeting her that she is an animal and I presume we're going to describe what animal it is because we want to protect your identity and your acquaintance's identity is this a mental illness?

>> I've been a psychiatrist for thirty nine years now.

I didn't hear about people wanting to change their identities or believing that they had an identity of an animal.

I didn't hear about that until about five years ago.

>> So you know, it's a relatively new phenomenon when I've treated for the past thirty nine years conditions like depression, anxiety conditions, schizophrenia, bipolar disorder those conditions look the same now for the most part that they look thirty nine years ago, thirty years go this phenomenon of people having an identity that's different than their own biology is a relatively new phenomenon.

Is it a mental illness?

My answer might surprise you because I don't believe it is.

I believe what we consider a social contagion.

>> What's a social contagion?

A social contagion is where you might already have some difficulty with social connectivity with others you might feel kind of socially awkward and you want a sense of belonging and social media will not only encourage but to basically cause you to take on these other identities that might not match with your biology.

And in doing so you have social connectivity with others.

>> We've seen the same thing happen over the course of decades with gang membership.

I mean why do people join gangs?

It's because they want to have some kind of social connectedness.

They don't have the connectedness perhaps with their family or friends.

>> They want to have social connectedness with people in the community.

The gangs will do that.

Well, this is an entirely different phenomenon where people have a particular biology and you look at them and just say oh you looks like you're a human.

But these people are saying that they have the perception that they're an animal and I think rather than rolling your eyes and walking away, try to compare passionately and patiently try to ask him some questions and question you can ask is how do you know how come you feel that way?

So I'll give you an example.

>> I haven't heard about many people wanting to be squirrels.

I hear about other types of animals.

So I'm going to use the example of so we want to be a squirrel just because I don't want to offend people that might perceive there are other types of animals.

>> So let's imagine you believe you're a squirrel and you might ask you why do you think you're a squirrel and you might say well I think I'm a squirrel because I like walnuts.

>> I really like nature especially trees and I'm really distractible so I'm always looking around.

>> I just feel like I'm a squirrel.

OK, having the having different types of qualities and certain types of characteristics of being a squirrel doesn't make you a school.

The fact you like walnuts doesn't make you a squirrel and what you'll often hear about these people is by saying they feel like a particular animal.

They have a connectedness with people often through social media where they also feel like they're of that particular animal and they feel a sense of belonging and it makes them feel good about themselves and they have a sense of identity and they they have a sense that they can connect with other people that way.

So it's almost like doing group therapy in such a way and these people often have that sense of connectedness.

But here's what you'll often hear when people perceive they have a biology that they don't really have, it's often something that they don't want to give up the the social nuances and the comforts of their own biology.

>> In other words, a person who says they're a squirrel OK, you're a squirrel.

Are you living out in the woods with no clothes, gathering nuts and foraging for yourself?

No, they're not doing that.

They're enjoying the creature comforts of being a human by running water and indoor plumbing so they're not giving up the human creature comforts they might have and the same with any other animals they perceive they have some qualities and characteristics of a particular animal but that doesn't make them the animal.

So this is a discussion often have with people when they'll say they perceive they have an identity that doesn't really match their biology and I'll ask them how do you know?

And often what you'll hear is well my friends told me if I have those belief I must be this or that I have a social community.

>> This is very encouraging of me acquiring this new identity.

OK, is that still make it true that you were of that particular identity?

>> So I think in the psychiatric community right now there's a big push and I don't I think it's misguided.

There's a big push that we should simply affirm these kind of beliefs when people say that they have an identity identity that doesn't match their biology, it reminds me back in the 1990s when we were instructed and I didn't do it because I didn't think that made a lot of sense but we were instructed to tell people who had dreams about loved ones who in their dreams if the loved ones were sexually abusing them that loved one must have been sexually abusive toward them at an earlier age and it created a huge malpractise phenomena that occur because it wasn't true and it was kind of a trend in psychiatry in the nineteen nineties that if you dreamt something it must have been reflective of something that really happened in the past.

>> I think we have the same danger as clinicians if we don't establish some kind of compassion inquisitiveness in asking people why they perceive they have an identity that doesn't match their own natural biology and often you'll hear about this difficulty with social awkwardness not sensing that they belong, having a lack of identity, feeling like they're not really making an impact in the world.

So as I said five years ago I didn't hear about all this and five years from now God willing and PBS willing if I'm still on the air on PBS , I don't think we'll be talking about this anymore.

I think it's a social contagion.

I'm not going to say it's a fad.

A fad I think minimizes the impact of all this.

I think it's a social contagion where it's really strongly networked within social media itself.

And if we didn't have social media, I don't think all this type of thing would be happening.

So I think it's a consequence of what we're seeing right now in social media.

So try to be compassionate with your acquaintance if your acquaintance perceives that she's an animal but it in a very caring manner and empathetic manner try to ask why she believes that she might that particular animal and if she's willing to discuss it patiently listen without any judgment.

>> Thanks for calling.

Let's go to our next caller.

Hello Brian.

Welcome to the mine.

Brian, you don't want to know how can you fight intrusive thoughts of not feeling worthy?

>> Brian you know when you have a sense that you're not feeling worthy, there's so many different things that could be going on.

>> I just saw a study that was done at a university where they actually measured how many thoughts a person had and in a single day and it was found that on the average we have about eighty thousand thoughts that come to our mind throughout the day.

OK, and even people who are not depressed on the average four out of five of those thoughts will be negative.

>> So we tend to gravitate toward negative thoughts and I was reading the the commentary on this particular study and they were saying that the reason we have so many negative thoughts is we're always looking out for bad consequences might occur around us.

So we're always on guard that something bad might happen that's just survival.

I always thought about the warm fuzzy feelings out there.

>> You might miss something that's going to harm you.

>> So we instinctually will think about things that might cause us harm but intrusive thoughts about you personally being unworthy can come from this area called this annual Giris of General Giris is down here.

It's below what's thought to be the annual the Jan Cortex which is shaped like a knee so Jan it means knee so it's underneath the knees of general cortex when you're depressed and when you ruminate about the ruminate about things that sub general cortex is on fire, it's really fired up and it's overly fired up and it's thought that one of the reasons that sub general cortex will get fired up causing you to brood about things and causing you to feel really unworthy is an inflammatory process.

So when your brain gets literally inflamed you can have difficulty with brooding feeling badly about yourself, not enjoying things, having low energy, lack of lack of motivation.

>> These are all symptoms that can suggest the possibility of an inflammatory process.

We're trying to get a better handle on all this now from a neurobiological standpoint, why do people have ruminative brooding thoughts that they can't let go?

You can always go back to childhood and say well it might be something in terms your relationship with your parents but I'm thinking from a neurobiological standpoint there are reasons for that.

>> And if you're thinking really bad thoughts about yourself that is a symptom of clinical depression.

>> Clinical depression is where you'll also have difficulty with energy concentration, eating, sleeping, various other symptoms and they go on day by day for at least a couple of weeks and they cause you functional impairment on the job socially getting things done and they get in your way of getting on with your life and yeah, we have currently over 20 different antidepressants which we commonly use to try to treat depression and in doing so it can reverse some of the hypothetical inflammation that's occurring and in causing somebody to have brooding and rumination.

>> Thanks for your call.

Let's go to our next caller.

Hello Mary.

Welcome to Matters of Mind.

Mary had mentioned you have a relative who may be alcoholic and has some depression.

>> What's the best method to approach them with some concerns and get some help?

Mary, if you have a relative OK, hopefully this relative is somebody with whom you have trust if you have a trusting relationship with them we call it an intervention still probably the best way to help somebody understand that they might have trouble with alcohol but you and maybe other relatives, other family members, friends can get together and confront the person and say we really love you.

We're concerned about you.

And for those reasons we're seeing this problem, this problem, this problem.

>> You know, you have so many other attributes and mentioned what are their attributes they're having.

But when they drink alcohol, here's what you're seeing so objectify what's happening with them in a loving, compassionate manner and be very patient in terms of helping them understand that you see it as a problem.

That's the first step.

The next step would be perhaps getting them to see a primary care clinician who can direct them to a proper resource in their area for Alcoholics Anonymous, some kind of detox vacation program that might be necessary.

Al Anon is for family members.

All these different resources are available.

But the first thing you want to do is try to get your relative to have some understanding of how you're seeing the alcohol affecting their lives because quite frankly when somebody drinks alcohol they start to lose insight when they start to lose insight this front part of the brain up here doesn't work so well.

You start a decrease in awareness of what's happening around you and in your life .

You don't notice it and sometimes just takes a loving acquaintance, a family member or friend to be able to point that out to somebody while at the same time saying you have so many good things going for you.

We don't want to see you lose those type of things.

>> So I wish you the best on that.

Thanks for calling.

Let's go our next caller hello Shannon Walk the mastermind Shannon, you mentioned your neighbor's child was on medication to stop being fidgety but when they stopped and changed the medication he started to destroy the house in the classroom.

Is he experiencing psychosis?

Does this happen from a gap or overlapping in his prescription?

It's a lot of things could be going on there if the child is taking a medication for fidgeting this I'm suspecting that might be ADHD and if the child was taking a medication for ADHD and changing to another medication No one the ADHD underlying symptoms might be revealed no to another thing could be happening if the child is going from one stimulant to another stimulant and there's still overlapping yeah.

>> You get too much of a stimulant your system can be very agitated psychotic.

>> So I would suggest that the child certainly be immediately reevaluated for the purpose of trying to get the medication stabilized but going from one medication to another can be somewhat problematic for some people because there can be that overlap it's there.

>> Thanks for your call.

Let's go next to your next email.

>> Our next e-mail reads Your daughter Fovea are there are medications that increase creativity as a side effect.

I'm an artist and I have to be cautious about the effect of medications.

Other than that my mental health has an excellent since I found the right doctors medications and therapies.

It's fantastic you found the right doctors medications and therapies because with the proper medications hopefully you won't be taken medications that can dampen your creativity.

>> Now you hear about these creative geniuses out there that who are writers they would have mood swings and they'd be very creative during their manic phases.

They might be musicians and they would do sonatas as did Handel.

He wrote the Messiah while he was manic and you might hear about those type of things.

That's not normal.

That's not naturally what you want to try to accomplish to develop a sense of mania where you will have this artificial creativity.

Yeah, there have been discussions about the use of ketamine.

The use of psychedelics as a means of enhancing creativity will be very, very careful about, you know, using the brain like I say like it's a roller coaster ride.

>> We can't play with the brain like that without some potential for long term effects.

>> If you have depression, you want to be on the right medication to allow you to do all you can do be all you can be.

>> And there are some antidepressant medications, particularly the ones that affect serotonin that can dampen down creativity some if they're used in excessive doses.

We always have to be careful about that.

We're now talking more about the glutamate mechanism of action that's involving ketamine as ketamine which is also bravado.

We have all valide now as an oral medication.

These medications has more effect on glutamate and they don't seem to be dampening creativity and they don't seem to be dampening enjoyment as much as some of the past antidepressant medications.

So the good thing for you is try to cautiously work with your clinicians as a means of getting your mental health as stable as possible.

I just be careful about going the recreational route or trying to go a little bit on the extraneous side as a means of trying to help with the advancement of creativity because it can always be drawbacks with that.

In other words, if you induce yourself into a mania, what's going to happen when your brain runs out of gas and you crash into a depression?

See it all the time with people with bipolar disorder.

>> Thanks for your call.

Let's call our next caller.

Hello Grace.

Welcome to Matters of the Mind .

>> Grace, you want to know how does perimenopause affect emotional regulation and mental health ?

Perimenopause is where you're starting to decrease your frequency of your periods.

>> Often for women it'll occur in their late 30s 40s.

>> Fifty one is the average age of menopause for a lot of people.

But for many women they're hearing about it earlier in life .

What's happening to perimenopause, Grace, is your estrogen levels are going down the hippocampus campus here is studied with little estrogen receptors being studied with estrogen receptors as estrogen is going down, you'll notice difficulty with memory and it can cause you some terrible irritability because estrogen does affect serotonin.

We've been talking about serotonin tonight because enhancements and serotonin in the front part of the brain can help with emotional stability.

So as estrogen is going down, you might notice that serotonin indirectly goes down as well and that can cause you to have more irritability and emotional outbursts and more depression in some cases.

So historically we have indeed been giving women who are going through perimenopause medications that in some way might enhance serotonin.

Bioidentical estrogens have been used quite commonly as a means of helping with that transition.

>> But serotonin and estrogen decreases have been well known over the course of time to be problematic for the some of the symptoms of perimenopause.

>> Grace, thanks for your call.

Unfortunate I'm out of time for this evening.

If you have any questions concerning mental health issues that I can answer on the air, you may write me a via the Internet at matters of the mind all one word at a dog.

I'm psychiatrist Jeff offer.

>> 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 tonight