Good evening.

I'm psychiatrist Jay Fawver, and welcome to Matters of the Mind.

Matters of the Mind is a mental health question and answer program where you have the chance to choose the topic for discussion.

So if you have any questions concerning mental illness that I can answer on the air, depending on your venue, you may call me, you may text me, or you may write me via the internet at MattersOfTheMind - all one word - @wfwa.org.

That's MattersOfTheMind@wfwa.org.

And all we ask is that you provide us a first name and let us know the town from where you're calling.

So with that being said, let's start with our first email tonight.

Our first email reads, “Dear Dr.

Fawver, I understand that vitamin D is incredibly important for mental health and overall health.

Why is it so important for mental health and how does it work?” Basically, vitamin D is a pro hormone.

In other words, it's a precursor to a hormone.

It's has a it's hormone with little bridge on it.

And it's in our skin.

Upon exposure to ultraviolet light, it turns into an active form.

And basically it can help with the mood.

If you have a vitamin D level under 55, which is a general rule of thumb in terms of a level that we will assess.

Under 55 can give you a greater likelihood of depression.

They actually studied vitamin D levels with people in psychiatric hospitals up in Denmark.

It's pretty dark in Denmark and in Denmark, they found that people had higher likelihoods of mental health admissions for depression if they had lower vitamin D levels.

So what they did is they increased vitamin D levels.

And for many people, that's kind of like sunshine in a pill.

If you give them a vitamin D supplement.

So it can be very effective.

We're now finding the vitamin D levels, to an adequate amount can actually decrease the risk of many, many different types of cancers and can decrease the likelihood of various types of dementias.

So vitamin D is a hormone-like substance that can be very impactful for mental health and in various medical conditions.

Thanks for your email.

Let's go to our first caller.

Hello, Phillip, welcome to Matters of the Mind.

Phillip, you had mentioned that you've been feeling very lost in your life, currently.

Is that a normal feeling for a young adult?

Many young adults, Phillip, anywhere between, oh, adolescence up to 24-25 years of age will notice that they're kind of at a time in their lives where they're no longer in the methodical routine of going to school, and they're kind of getting out on her own.

They're away from their parents.

They're trying to become independent.

They're trying to develop relationships, they're getting jobs, and they're kind of at a transitional point in their lives where they're wondering, okay, what should I do now?

That can be a normal feeling.

You should have a little bit of that anxious uncertainty at that time of your life, because that can motivate you to keep going.

The key for you, Philip, is I'd recommend that you maintain social connections, stay, keep talking to people, find friends relationships, try to maintain a connection with your family in some way, shape or form and in maintaining those kind of connections.

Network, network and be able to, determine how other people are dealing with similar situations who are your age and where they're going through life circumstances as you.

Many young adults, they get out of high school and they will just routinely go to college because that's the next thing you're supposed to do.

But many other people are deciding not to go to college.

They're trying to get, some, some work productivity early on in their lives.

They're trying to become independent earlier and, they're trying to get out on their own.

So it's normal to have that degree of uncertainty, always realizing whether you're in college, whether you're out there working independently, always realizing that it's okay to shift gears and maybe go at a different direction than you might have thought you were going to go at 18 years old.

I mean, between 18 and 22 and 24 years of age, you might have all sorts of different ideas on what direction you can go.

And, you might change those plans accordingly.

And that's okay.

As long as you have some direction, some purpose in which you're trying to maintain.

Thanks for your call.

Let's go to next email question.

Our next email question reads, “Dear Dr.

Fawver, what causes mental illness?” Well, I'll try to be succinct because mental illness is very complicated, but I'm going to try to narrow down mental illness to five factors, one of which you probably know already genetics.

Genetics is how we're hardwired, but genetics are kind of like having light switches in your house.

If you have 20 light switches in your house, it's one thing to turn them all on.

It's another thing to turn them all off.

And if you're like me, you love dimmer switches.

So light switches are there for the purpose of giving you the proper degree of light based on the brightness, need.

So if you're late afternoon, you have a few lights on late in the evening, you're gonna have a lot more lights on.

So you modulate how many light switches and how intense the light will be based on the need for light.

That's where your genetics come in.

We all are hard, hardwired with genetics, but our genetics will need to be turned on or off, and they can be turned on or off inappropriately or appropriately.

So genetics are highly influenced by other stuff.

So genetics are how your hardwired.

But genetics will not always predict what kind of health conditions you're going to experience, because of the other four factors being stuff happening.

The second factor being stuff happening, stuff happening in your life will be life circumstances.

Life circumstances can affect your genetics.

It's called epigenetics.

Life circumstances prior to the age of eight years old, prior to the age of eight years old, life circumstances of a highly stressful nature can predict later on in life you're a likelihood of having depression or anxiety - so early childhood trauma.

And we measured by a scale called the Adverse Childhood Experiences Scale, the ACES, the Adverse Childhood Experiences score.

If there's ten items that if you score affirmatively on more than four of them, it's highly likely that you'll have some degree of depression or anxiety later in life unless something is done.

So early childhood experiences can be a factor - and even later experiences in life.

If you have catastrophic stresses that are incapacitating for you to endure later in life, you lose a job, you get divorced, you lose a child.

All sorts of bad things can happen.

Those life experiences will flip your genetics off and on, sometimes inappropriately, to the point where you can have tremendous difficulties with mental health issues.

So you got genetics, you've got life circumstances affecting the genetics and then affecting your ability to cope with those life circumstances will be your coping techniques and your coping abilities.

So if you've experienced some bad stuff already and you've learned how to cope with it, you will be able to better endure those traumatic life experiences later on.

They studied this back, during 9/11/2001, in New York City.

They found that the people who had experienced some traumatic life circumstances already were less likely to endure post-traumatic stress symptoms due to 9/11.

The people who had not experienced many life circumstances that were traumatic before had more difficulty with post-traumatic stress.

So if you do experience prior life circumstances that were traumatic, but you got over it, you learn to cope with those life circumstances, you're less likely to have mental health problems.

But if you have difficulty navigating through life circumstances and you lack coping abilities, that can be a factor.

So genetics, life circumstances and coping with life circumstances will be three factors with mental health issues.

The fourth factor being lifestyle.

With lifestyle you always think, diet and exercise, right?

There's more to it than that.

Diet is important.

Exercise is very important.

But other aspects of lifestyle will be meaningful, productive activities.

Meaningful, productive activities, having a purpose in life will be a significant factor in terms of influencing your mental health.

And that includes socializing.

So meaningful, purposeful activity, socializing, exercise, diet those are lifestyle issues that could affect mental health and they can affect your genetics.

And finally, the fifth factor that can influence mental health will be medical illness.

And included and included in medical illness, would be sleep apnea, thyroid disturbances, fibromyalgia, diabetes, a lot of different medical conditions.

But I also would include in medical illnesses, substance use disorders such as alcohol, cannabis use, opiate use, narcotic use.

Those kind of substances will induce a medical condition in you that will often trigger the genetics inappropriately and result in you're having mental health issues.

So the five factors that I can very succinctly narrow down in terms of what causes mental illness and and what you could do to really target mental health issues will be genetics, life circumstances in the past that you can't change, but you can change how well you cope with them.

That's number three.

Number four lifestyle issues.

And number five, the medical illnesses that you want to address as soon as possible.

So those are the five factors that I'd certainly summarize as being the most likely to contribute to mental health issues.

Thanks for your email.

Let's go to our next text.

Hello, Alex from New Haven.

Alex, you had asked, about, “why do some people always forget things?” If I have somebody coming to see me as a as a patient, Alex.

And they say I'm always forgetting stuff.

I want to know several things.

I want to know, Alex.

I want to know how long has it been going on?

Do you always have difficulty forgetting things?

Does it go back to when you were a kid?

Is it more recent?

Have you had any blood tests more recently?

Are you having difficulty forgetting things just over the past year and over?

Are you over 55 years of age?

I'm going to wonder about all these different things.

Because if you've always had difficulty downloading information, I'm going to wonder about ADHD - Attention hyperactivity disorder, or attention deficit disorder - ADHD will be a condition where the front part of your brain has difficulty paying attention to things.

So the left front part of your brain especially, is a little bit underactive and you have trouble with attention span focus.

And you, if you have trouble with attention span and focus, you'll have difficulty shifting gears at the time you need to shift gears in your brain to a network that allows you to download the information into your hippocampus over here on the side.

So the hippocampus is the library of your brain.

And if you have a hard time shifting gears to pay attention to something, you can't download information into the hippocampus.

Okay, that's ADHD, attention deficit disorder or attention deficit disorder with hyperactivity.

So that can be a factor.

As you get older, well, hypothyroidism I see this all the time.

Women especially, but a lot of men who will have low thyroid.

If you have low thyroid that will give you difficulty with fatigue, difficulty with constipation, you might have some hair loss, dry skin, but you can also have trouble with just feeling like you have a slower download speed in your brain and you'll have a lot of trouble with forgetfulness.

Diabetes, blood sugar disturbances can be a factor.

Low iron when some people are anemic because of a gastrointestinal bleed, perhaps.

Maybe they're a vegetarian.

Being anemic can give you difficulty with, concentration and memory, as can Vitamin B12 deficiencies.

I mentioned earlier, vitamin D deficiencies.

Vitamin D deficiency certainly can affect your memory.

Sleep apnea.

We see this all the time.

When people have difficulty with sleep apnea, they will have trouble with snoring or pausing in their breathing at nighttime.

Thereby they don't get adequate air to their lungs and they don't get oxygen to the brain.

They will have difficulty with memory and concentration the next day, and they often wonder if they have dementia, but it's actually sleep apnea.

So there's a lot of medical, medically treatable, different things before we start talking about Alzheimer's, dementia for those people over 55 years of age.

So I'd say if you're having trouble with memory, try to look back to when it started, how often it occurs.

Is it just episodic?

If it's episodic here and there could be a mood disturbance like depression, but talk it over with your primary care clinician initially.

Primary care clinician might want to run some blood tests and, do some overall evaluations for any medical conditions that might be contributing to it.

Thank for your text.

Let's go to our next text.

Hello, Sophie from Auburn Sophie, you mention you have an earworm.

It's a very sad song that you have on rerun in your head ever since your sister entered the hospice.

It will not stop.

It's been for weeks.

How can you resolve it?

And earworm is a real phenomenon, Sophie.

It's where you have got a song in your head and you have a hard time getting your mind off that song.

And is it a psychiatric disturbance?

Not really.

It's a phenomenon that, not uncommonly, we'll hear about when people will have a song that they might associate with a life circumstance, and they have a difficult time getting off their head.

Now, what I'll often recommend to people, if they're humming a same song over and over again, it's getting on other people's nerves around them, or they have trouble just getting the song off their mind.

Listen to different songs.

I know it sounds simple, but when you listen to different songs and you start playing those songs over and over in your head, you might have a different association from the same song you've been hearing.

But if you have a song in your head because a family member went into a hospice.

Yeah, that song with the association with a hospice might be sticking around there, but the best thing to do is to try to listen to other songs to get it off your mind.

I know that's a simple, simple answer to a very complicated question, but I hope that helped you out.

Let's go to our next caller.

Hello, Tom, welcome to Matters of the Mind.

Tom, you had mentioned that vitamin D is more of a neuroactive steroid than a traditional vitamin.

Because of that, does it really affect our mental health?

Yeah, you're you're exactly right, Tom.

I didn't want to go into the specifics of that.

A neuroactive steroid is a synthetic or a natural steroid.

Neuroactive means it just goes to the brain.

So, you know, it's it's a we call it a vitamin.

But I actually mentioned earlier that we it's actually a pro hormone.

It's more of a hormone that does affect not only the brain.

I don't want to limit to the brain.

So I don't want to just call it a neuroactive steroid.

I think it affects the whole body because it can affect your physical health.

And something about vitamin D in adequate amounts can actually decrease the risk of all forms of cancers to various degrees.

It's very intriguing how, adequate levels of vitamin D can help people, but a neuro active steroid, as you, mentioned, is basically a steroid that does affect the brain chemistry as it does, but it's not limited to the brain overall.

Thanks for your call.

Let's go.

Next text.

Hello, Jaleena from Edon.

Jaleena, you want to know about, your daughter being 21 years of age.

Your daughter had an acute psychosis five days ago.

In the hospital.

Was injected with, risperidone - Uzedy.

Is the drug safe?

And can she drive or ever have kids?

Risperidone is the main ingredient.

There is, Uzedy is a subcutaneous injection right underneath the top of the skin.

And it's injectable form of risperidone.

Risperidone has been around since 1992, I believe it's been around for a long time.

It is a medication in which we do feel comfortable with people taking while they're pregnant.

So it does not seem to cause any tertogenic or harmful effects to the baby.

So risperidone is a medication that we are comfortable using.

It, when somebody is pregnant.

Secondly, can she drive?

It's it depends on her level of sedation.

Risperidone can cause some sedation, but people can drive on it.

So, driving is not a contraindication or a, prohibition with risperidone as long as you're not sleepy with it.

The advantage of a subcutaneous form of risperidone is that it stays in your system for a long time.

You don't have to take the oral medication day after day after day.

So it's not something where you're relying on taking it, which is nice with somebody with a psychosis.

A psychosis, as you're likely aware, is a condition where somebody loses, their awareness of what's going on around them.

They lose insight, they lose, their understanding of their even having an illness.

So it's difficult to tell somebody to take a medication day by day when they don't even understand they have an illness.

They will see that these things are really happening.

They're all these people are against being all these awful things are happening in my life and they're really occurring.

It's like being in a bad dream.

So taking the medication for that kind of situation is sometimes difficult for people to do.

So they'll take risperidone, being an antipsychotic medication as a means of helping them with the underlying symptoms.

But the nice thing about these injectable, long acting injectables that we now have available will be that they decrease the likelihood that you have to take the medication orally day by day by day.

So the whole idea of adherence is not as problematic because they go in for their injectables periodically.

But you can have, babies while you're taking risperidone, and you can drive as long as you're not sedated.

So I hope that answered your question.

Thanks for your text.

Let's go to our next caller.

Hello, Jessica.

Welcome to Matters of the Mind.

Jessica, you had mentioned your boyfriend is always questioning or interrogating you about, your whereabouts and what you're doing.

Should you be worried about his behavior?

Jessica, he is your boyfriend, still, you don't have that long term commitment at this point.

You have to, well, be aware is he is, does he have a toxic, controlling relationship with you or not.

And, do you want to have a long term relationship with somebody who has that kind of attitude towards you?

So it all comes down to control that might be problematic for you later on.

So it might be setting up some red flags for you.

If he's wanting to make sure he knows where you are at, he's interrogating you about your whereabouts.

Might want to ask yourself if you want to maintain a long term relationship with somebody like that.

Thanks for your call.

Let's go.

Our next email question.

Our next email question reads, “Dear Dr.

Fawver, I frequently have the same recurring bad dreams or nightmares about a past employer.

Is this indicative of some sort of unresolved trauma in the past?” Maybe.

You know, years ago there was a phenomenon called false memory syndrome where patients would go see a therapist and they'd tell the therapist about their dreams.

And the therapist, if we're talking 30 years ago, the therapist would say, that's because you had some traumatic experiences as a child.

It must be, something that happened with your mother or father, and they must have traumatized you.

The patients would go back and confront their parents, and next thing you know, there were lawsuits because a lot of things that were being alleged never happened.

So we want to get away from that.

Dreams are very abstract.

Dreams are very symbolic, and you can't take them at face value.

If you have a dream about a past employer, the first thing I'm thinking in my mind is, okay, that past employer might have represented a father or mother figure for you, or maybe the past employer might have represented somebody who bullied you at an early childhood.

The bottom line is, when you have a dream about a past employer, it probably ain't about the past employer.

It's who that past employer represented and the attitude they might have conveyed when they're around you.

So that's kind of what you're thinking.

Usually with dreams - and dreams will be representative of things that have happened in our recent past, maybe within the past 24, 48 hours.

So your brain's trying to sort out different things, and in doing so, your brain's trying to pull together symbolism or abstract kind of concepts and figures to help you deal with what you're going through in life.

I love analyzing dreams.

When I was in my psychiatric training, I was on the couch every Monday morning and, Friday morning for an hour in psychoanalysis.

I loved it because I had my psychoanalysis sessions first thing in the morning.

The dreams were fresh on my mind.

So I've always been fascinated about the whole concept of dreams.

But dreams are something where if you don't think about what you were dreaming within, about my goodness, 30s or a minute after you awaken, if you don't start thinking about it and processing through the meaning of that dream.

Dreams are like a whiteboard.

They will erase by early morning.

So within a couple hours you might forget all your dreams unless you talk about them.

Unless you think about them, unless you write them down.

So I'll tell people if you really want to try to sort out what's going on in your life, write down your dreams, make a few notes about them in the in your morning journal.

Talk about them with somebody first thing, but always think about the dreams as being abstract.

If somebody is in your dream that you know, it probably is not about them.

It's who they represent.

So they could be very fascinating, but they are like a whiteboard eraser where they erased within a matter of a couple hours after you awaken and you'll forget all about them.

That's kind of how they're designed.

Thanks for your call.

Let's go.

Our next caller.

Let's go to our next caller.

Hello, Bob.

Welcome to Matters of the Mind, Bob, you've mentioned that you've been on a nasal spray for depression and after trying a few different pills, your doctor says the nasal spray treatment is newer and it's safe.

Could it actually work?

You're referring to Spravato, Bob.

Spravato is the active, left sided piece of ketamine?

Spavatos chemical name is esketamine.

It's a left sided piece of ketamine.

It's the left sided piece of ketamine is four times more potent than the right side of the piece of ketamine.

So they took out the left side, a piece of ketamine and they called it this esketamine that you take out as a nasal spray.

As you know, you have to be in a monitored situation to use Spravato or esketamine, where you sit in a chair for two hours in a clinician's office, and you're monitored during that time because between 20 minutes and 40 minutes, during that two hour monitoring, you'll notice that you'll have kind of a free floating, side effect.

It doesn't happen with everybody, and it is not deterministic on how well it's going to work.

So if you have no side effects from esketamine, great.

But many people will have kind of a free floating experience.

They'll feel drowsy.

Their blood pressure might spike up at the 40 minute mark.

Then it comes back down at the at the one hour mark, not uncommonly, but it's affecting glutamate and affecting glutamate.

It's a whole different neurotransmitter than you might have tried from other medications that you've used orally, because for the past six decades, we've used medications for depression that predominantly affected serotonin, dopamine and norepinephrine.

Well, serotonin, dopamine, and norepinephrine come from the brain.

stem - its the brain looking at you here.

This is the inside of the brain, the brain stem is down here.

And from the brain stem you get sprays of serotonin, norepinephrine and dopamine, kind of like seasonings to the gray matter of the brain up here.

When the gray matter of the brain, most of that is, is being regulated by glutamate.

Glutamate slightly accelerator on the brain.

GABA, you might have heard of a GABA.

GABA is the brakes on the brain.

So you got glutamate as the accelerator.

GABA is the brake.

Serotonin, norepinephrine and dopamine are kind of in the passenger seat giving advice to glutamate to speed up or GABA to slow things down.

So glutamate is affected directly by Spravato or esketamine.

And by directly affecting it.

You can notice some meaningful benefits which Spravato within just 1 or 2 treatments, and as you likely know, the first month you get a couple treatments a week.

The second month you get one treatment a week, the third and month, and thereafter you get one treatment a week or every other week.

We're now using Spravato by itself, or you're not even using any day to day oral medications.

But it was originally designed and approved back in 2019 to be used with an oral antidepressant medication.

But over the past year, we're using it by itself, not uncommonly finding that by itself it can be helpful for depression.

But basically, Spravato is something that it gives you its side effects primarily during that two hours of monitoring, the next crest of the afternoon and the next day, you typically don't notice any side effects at all.

It's not recommended that you drive or operate machinery the same day of getting as Spravato treatment, but the next day you probably won't notice any side effects at all.

So it's a uniquely different type of medication as a nasal spray.

We have a pill that affects glutamate by the name of Auvelity, and it just came out about three years ago.

So we're starting to use more medications affecting glutamate, which is the accelerator on the brain, as opposed to primarily focusing on medications that affect the seasoning neurotransmitters such as serotonin, norepinephrine and dopamine.

So we're getting more options for depression now.

And those options work faster.

And they tend to be more tolerable.

For instance, esketamine, as I mentioned, most of the side effects occur the same day with, Auvelity, that's another medication that affects glutamate in a different way, where you take it day by day.

But with Auvelity, the main side effect will be dizziness and some sedation, typically within 20 minutes of taking the medication and lasting for about eight hours.

But the nice thing about many of these newer medications, they don't cause weight gain.

They don't cause sexual disturbances.

They don't cause a lot of sedation throughout the day, and they tend to work faster.

So I think as we hear about new antidepressant medications becoming available over these next few years, we're going to expect them to work quickly, and we're going to expect them to not cause an intolerable side effects that so many of the medications from the past seem to cause.

I remember when Prozac fluoxetine came out in 1987, it was thought to be a landmark medication and only increased serotonin, but it was thought to be dramatic in its effects, not because it worked at a better, but people kind of tolerate it.

The newer medication is coming out now.

People can tolerate them, but they are working better.

Thanks for your call.

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

If you have any questions that I can answer on the air or concerning mental health issues, you may email me at MattersOfTheMind - all one word - @wfwa.org.

I'm psychiatrist Jay Fawver.

You've been watching Matters of the Mind on PBS.

God-willing and PBS-willing.

I'll be back again next week.

Thanks for watching.

Good night.