.

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

>> Welcome to Matters of the Mind now in its 25th year, Matters of the Mind is a live call in program where you have the chance to choose a topic for discussion.

>> So if you have any questions concerning mental health issues, give me a call here at PBS Fort Wayne in the Fort Wayne area by dialing (969) 27 two zero or if you're calling any place coast to coast you made 866- (969) 27 two zero.

Now on a fairly regular basis I am 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 e-mail 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 WFB Eigg that's matters of the Mind at WFYI org and I'll start tonight's program with an email I recently received.

>> It reads Dear Dr. Fauver is genetic testing for psychological medication effective?

Why don't more places use it instead of the trial and error method if it is effective?

>> And thank you for the kind words that you also added.

Genetic testing is something that's been available in psychiatry for about 15 years and in my practice for instance, we started using oh about ten years ago and we since used it on several thousand people at their at their willingness we don't mandated for treatment.

We use about half the people that we've treated over the course of the years and what it does it just gives you an added dimension of treatment information and as an example with the treatment of diabetes you could treat somebody diabetes based on their symptoms.

You could ask them if they're feeling tired of the urinating excessively, if they're having poor concentration, blurred vision.

>> Those are symptoms of diabetes and from a primitive standpoint you could do what they did in the old days.

The clinician could take the person's urine because the urine of a person with poorly controlled diabetes is very sweet and in Africa they could they often assess diabetes by having somebody urinate in the sand and if ants came walking around your urine that meant you had blood sugar, you had sugars spilling out into your urine and that it was indicative of a higher blood sugar.

>> So with that in mind, that's how you could assess diabetes.

>> But when now we have an added piece of dimension where you can do blood glucose and we like this glucose called an A1 see like postulated hemoglobin where you can look at the average blood glucose for the past two or three months so you can use that as an added piece of information in psychiatry we use genetic testing as an added piece of information.

>> The agency is not affinity for diabetes.

You still want to still examine somebody and question them in terms of their history in the same way with genetic testing it's not definitive and that's where a lot of clinicians will get a misunderstanding that if you do genetic testing it will automatically guide you to the medication type somebody needs and the dosage somebody needs.

>> It helps but it's not automatic.

You have to start going back to square one and talk to the patient now off the bat we need to have a diagnosis.

We need to determine what kind of condition the we're treating.

Secondly, we need to look at our past medication treatment responses, what medications worked, what didn't work, what doses were used, how long were they used, what kind of problems did they have with different medications?

>> Thirdly, we want to know what family members responses were to various medications.

That's a big, big clue in terms of understanding what medications somebody might need.

Second next we will look at their current medications are already taking because those medications can affect how medication we prescribe might get broken down.

So we want to see what are taken from them from their other clinicians and from their prescriptions.

>> Next we want to look at any use of alcohol or drugs of abuse because they can certainly affect how well medications are metabolized.

That's why we strongly recommend that people do not use cannabidiol or CBD oil when they're using medications because CBD oil can interact with so many different medications and affect how they're metabolized.

So you put all those different factors together then you add the genetic testing.

So just because it's a little bit more of a layer of understanding how somebody might respond to medications and what genetic testing will do is it'll help determine first and foremost how somebody breaks down their medications now in the package inserts that are brought out by the Food and Drug Administration with every medication it describes how medications are broken down and it actually gives you warnings that if somebody is a slow metabolism on this enzyme that breaks down this medication or through a fast metabolism, you adjust the dosage, you adjust the dosage low or high respective because if they are slowly breaking down the medication you want to give them a lower dosage if they're high metabolism and they're quickly metabolizing the medication, you might want to give them a higher dosage.

How would you know that unless you have the genetic testing available?

So first and foremost if for no other reason I'd say we should be doing genetic testing just to understand how a person breaks down various medications.

I saw a man today who had a fairly unusual mutation in terms of one of the genes where he broke down medications very, very quickly and he had not responded very well to many, many medications, many of which did go through that particular enzyme.

So that can't be ignored.

That was part of his metabolism and that was unique to him.

>> A second reason we will look at genetic testing will be to take a look at what kind of medications might work best and now that's not real precise but it gives us an idea there are certain types of genetic results and genotypes as we call them that will predict that somebody might do better on this medication or that medication.

Now again, it's not definitive and you can't just look at that particular gene and say that's how we're going to decide all of our medication approaches for this patient.

You still have to talk to the patient and look at all those other parameters.

And a third very important factor that we examine with genetic testing well, somebody will be somebody if our metabolism status as far as methylene tetra hydro folate redacts it breaks down folic acid which is vitamin B nine folic acid vitamin B nine breaks down into methyl folate elmsford folate helps you manufacture chemicals such as serotonin, norepinephrine and dopamine if you poorly metabolize folic acid, you can have difficulty with depression, anxiety, concentration but you can also be at risk for diabetes and stroke and many other medical conditions.

It puts you into a more inflamed, jittery state of the body if the situation is as is kind of set up to cause you to have that kind of problem.

So if you are a poor metabolize are on fire, we will recommend somebody to take methyl folate the byproduct of folic acid so they don't have to worry about not breaking down folic acid.

So there's a lot of reasons to do genetic testing as an added dimension.

But where clinicians will get upset about anybody using it will be No one.

>> It's it's not definitive.

It's not going to be something that you just do and you decide based on the genetic testing what medications somebody needs.

Now some of the genetic tests will make that inference and that's where it's kind of given a typecast to a lot of genetic testing.

Some genetic test will say for you this is a good medication, this is a bad medication.

They don't know anything about you so you can't make that determination.

They don't know your past medication treatment responses.

They don't know anything about your history, your diagnoses, your symptoms.

You might be having your family histories, responses they don't know about your other medications.

You have to put all those together to determine what medications might be best for you specifically.

But some genetic testing companies have come out with that kind of algorithm that said this or that medication might be good or bad for you just based on the genetics and you can't make that determination.

There have been some studies done on genetic testing with conflicting results.

Some of them looked at genetic testing and they didn't assess the patient in either way and they said genetic testing didn't do any better than people who didn't get genetic testing.

Well, you have to put the whole package together.

You put genetic testing as an added dimension on top of these other factors and that's why you're not seeing in a lot of studies.

So from my perspective I do believe that genetic testing is something that's very important and if it was of no expense to our patients, we'd certainly want everybody to be able to do it across the board because it's something it gives us a little bit added piece of information just like that lab test might help.

Yeah, yeah.

You can treat somebody with diabetes without the lab tests it's very difficult to do and a lot of clinicians clinicians won't do it.

They'll insist on having the blood tests for them to have that added piece of dimension of understanding on how you're doing with your blood sugars in the same way in psychiatry with genetic testing it's not something that we have to have available for the purpose of treating somebody but it sure is nice.

>> Thanks for your email.

Let's go to our first caller.

Hello John.

Welcome to Mars The Mind.

Yes, I'm focused on healthy living senior wanting to further fine tune my supplemental diet.

Your thoughts on your use of niacin and or aspirin to heightening circulation and energy and your recommended dosage and your over time to be increased to what end to be taken in combination.

>> Thank you.

Thank you John.

I'm a psychiatrist so I want to stay in my lane here John because I can talk about medications or medications and supplements that pertain to my field.

You're referring to niacin which is a means by which historically prior to the advent of the lipid lowering medications that are prescription medications known as well known to us such as Lipitor and Crestor or those kind of medications niacin used to be used that it had this particular problem with called what's called a niacin flush and the nice and the flesh was often mitigated by the use of an interior coated aspirin to offset that.

>> So again, that's more of cardiology questionnaire when you specify you're talking about niacin and and aspirin, I wouldn't recommend niacin an aspirin from a mental health standpoint they don't have any beneficial effects from a mental standpoint to my knowledge.

But they can have substantial benefits from a cardiac standpoint and that's where you would talk about that over based on your needs with your primary care clinician or even better yet if you have a cardiologist they can tell you whether you're a good candidate for niacin and niacin can have some difficulties in terms of liver functioning.

So that's the biggest drawback of that.

But as a psychiatrist it's not something as a supplement I'm going to recommend now John, I'm going to take that one step further.

What what psychiatric supplements would I recommend?

No one first and foremost at the very, very top my list is vitamin D. I'm a big fan of vitamin D it's called vitamin D to number two .

You'll just see vitamin D on the shelf.

Two thousand units is a commonly recommended dosage that's over the counter.

Sometimes people will use five thousand units especially in the wintertime but two thousand units every day can be used.

You can get vitamin D levels sometimes they're covered by insurance sometimes or not but a vitamin D level ideally should be above fifty five and a lot of people have vitamin levels when we check them in the single digits.

So those are people who need to get their vitamin D levels up quite extensively and that's why some people will take fifty thousand units of vitamin D once a week out of their doctor's supervision for several weeks to get that vitamin D level up to a substantial amount.

Why is vitamin important?

They did studies in Denmark years ago with people who are depressed and they found that people who are depressed typically had lower vitamin D levels in Denmark.

They're way farther north and we are in Indiana.

So they found that that higher that higher latitude tended to make people more depressed because they have darker and longer days up their days of darkness at least or they had shorter days and longer periods of darkness.

So that's why vitamin D levels were so important for them.

That's the first supplement that I'd certainly recommend.

Folic acid is very important if you're a normal metabolism.

>> I mentioned to our emailer earlier that there is a enzyme that you can measure and you can assess your activity by genetic testing if you are a normal metabolism of Shefa or your metabolizing at least sixty five percent folic acid, you could be a good candidate for folic acid itself.

>> Four hundred million four hundred micrograms or 400 micrograms every day up to a one milligram every day would be perfectly fine on folic acid.

But if you are not a adequate metabolize are on your such that your activity is less than 50 percent at that particular at that particular enzyme you want to take elements of folate and we recommend 10 to 15 milligrams for a lot more people with elmsford folate in various forms and you can always talk to your clinician about the types of forms that are available.

There's been a lot of discussion over the course of time about various other supplements out there from a mental health standpoint.

But without knowing your genetic testing results we couldn't give you a lot of precision one way or another outside of the vitamin D which is kind of a no brainer.

We don't recommend that people take fish oil by itself as much as we used to.

Fish oil is pretty good for a lot of people.

You do have to be aware that it can decrease the likelihood of your blood clotting to some degree and give you an increased risk for bleeding, especially if you're taking certain medications that increase serotonin and have different mechanisms that will decrease the bleeding themselves.

So you have be careful about using fish well with other supplements or with other medications sometimes.

But it used to be thought 90 years ago or about 20 years ago that people could take fish oil as a means of treating the depression itself and it was OK for some people but for a lot of people just didn't work out so well.

So that kind of trend has gone by the wayside.

But a tried and true means of taking a supplement from a psychiatric standpoint has been vitamin D and I think that'll be a sustained means of using supplementation for quite some time.

>> John, thanks for your call.

Let's go to our next email our next email reads Dear Dr. Fauver, I get depressed in the winter more so than in the summer with a lightbox help.

>> My mom said she would get me one for Christmas.

How do they work?

>> Well, good for your mom because they can be beneficial for a lot of people.

>> Here's how they work.

You have the brain here looking at you and and the inside of the brain is called the pineal gland.

It's this little piece Shapland right in the middle there.

It's real small gland.

It's around gland when your lights are exposed, when your eyes are exposed to bright lights, the back of your eyes have what's called a retina on them.

>> The retina will sense the brightness of the light and send a signal to the pineal gland.

If the lights are bright it shuts down the pineal gland activity and decreases its production of melatonin.

So when the lights are bright melatonin goes down when the dark day after day after day melatonin kind of goes up when it's dark more often than not especially in the dead of winter melatonin goes up and thereby you have a tendency to decrease the production of serotonin in its serotonin has been an extensively studied neurotransmitter for the past twenty five years and when your serotonin transmission is disturbed you can have trouble with overeating, oversleeping, socially withdrawing, feeling kind of blah all the time and and sometimes feeling kind of anxious and having a sense of impending doom so it can be a very miserable feeling and some people can get it clinical depression during the wintertime because of that serotonin disturbance.

>> So one of the means by which we will treat winter depression will be a bright light box.

>> You sit in front of it about a foot or two away every winter time for about twenty minutes and you don't look right into it because if you look right into it can get a bit of a headache and start to it's so bright it can give you a bit of a retinal damage.

It's going to have a light intensity of what's called ten thousand lux LRU x ten thousand Lux is is the light intensity that you'll experience about 10 a.m. in the morning on a summer day.

>> So it's pretty bright light and you're getting that first thing in the morning every morning in the winter time when you have that light box sitting at your table as you read in the morning maybe perhaps as you have breakfast but you're sitting there for about twenty minutes with that light box exposure and on top of that it's awful.

It's awfully helpful to exercise because exercising and using the light box can have the very nice synergistic effect overall.

>> So the light box basically is suppressing the excessive outflow of melatonin this coming from the pineal body and thereby disturbing the serotonin transmission in the brain itself.

So the idea is to reverse all of that.

What I like about the light box is within one week you're going to notice whether it's working or not and a lot of lightbox companies allow you to return it within 30 days and you can take them use a trial of it every morning for the first week.

But even people with mild winter depression will often notice they just feel better when they're using that light box every morning.

>> So use it first thing in the morning.

You don't want to use it in the evening.

They have in some nursing homes used it at four or five or six p.m. just to keep people up a little bit longer so they won't go to bed at seven pm because as people get older their circadian rhythm tends to ship shift and they want to go to bed at about seven or eight p.m.

Sometimes when they get up at three or four in the morning well that's too early for much of the staff.

So it's important for people in the nursing home environments to try to stay up a little bit later so they can have a more standardized circadian rhythm with the rest of the staff.

Well, by the same token, you want to use your lightbox first thing in the morning to basically wake up your brain.

So use the lightbox as some people will use coffee perhaps first thing in the morning to try to awaken them and get them going.

>> The light box is something that can be used typically from the months of November till about late March and then you'll find you just don't need it so much anymore.

The best thing to do as the sun starting to get up a little bit earlier is to go out for an early morning walk for twenty thirty minutes.

That's all you need.

You don't need to go out for an hour or anything like that.

Twenty minutes thirty minutes often is going to be plenty for a lot of people.

>> Thanks for your call.

Let's go to next caller.

Hello Jerry.

Welcome to Matters of Mind Jerry.

You want to know what effect does having a good meal have on the brain?

I find it's easier to socialize after a meal.

It is for some people, Jerry.

Some people will have glucose disturbances where they're just not as sharp from a mental standpoint or a cognitive standpoint if they have not eaten.

So some people who are especially prediabetic for instance, their blood sugars are having rapid fluctuations if they have a meal they especially if they've had some protein in the meal they will have kind of a stabilization of their ability to focus and concentrate during that time.

So it's all comes down to what makes people feel better if exercising helps you socialize or if having a meal helps you socialize, that is fine and that can be useful for you.

But having a meal basically will help stabilize the blood glucose for a lot of people, help you concentrate and give you some in some ways a sense of well-being if you eat a meal that has tryptophan in for instance, it will in the long run increase serotonin.

That's why people who have Turkey which is loaded with tryptophan can feel kind of tired afterwards.

>> And that's the classic turkey dinner crash where you feel very tired afterwards and you feel like you have and have to have a nap because tryptophan quickly increases.

Serotonin in the brain can have the brain give the brain a bit of a calming effect and sometimes it'll help people from a socialization standpoint as well.

Jerry, thanks for your call.

Let's go to our next caller.

Hello, Thomas.

>> Welcome to Matters of Mind and how's it going?

>> I'm doing OK, Thomas How are you?

Not bad.

I just had a brief question I was trying to see you mentioned something earlier about exercise research.

I just was trying to see is mental wellness and daily exercise how they contribute to a person's mental health .

Kind of talked about it briefly but I'll just get off the phone to listen to you.

>> Thanks.

I have a blessed day.

Thank you, Thomas.

I appreciate that, Thomas about twenty or thirty minutes of exercise as little as five times a week could be great.

>> It basically wakes up the brain when you exercise especially in the morning and that's the ideal time to exercise.

But you can't exercise in the late afternoon that still works if you exercise after six p.m. especially as we get older sometimes it can have an awakening effect on you and keep you awake at night.

>> But I'm a big fan of exercising whenever people can do it as long as it can fit it in their days, as long as it doesn't interfere with their sleep.

If you need to exercise at night that's OK. Just be aware it can have an effect on your sleep.

So ideally people can exercise in the morning that can have a tremendous impact on mental health and people will often ask me Hey doc, why don't you just have people exercise?

They don't have to take medications, they don't have to do all this therapy they need to exercise because when I exercise I feel great.

>> Well that's wonderful if you have the motivation and initiative to exercise part of the problems with with depression for instance will be you feel achy and tired and you don't have the initiative, you don't have the motivation and that can be a deterrent to exercising itself once people exercise almost inevitably they feel better.

They'll they'll say why didn't I do this before?

It's just they don't have the motivation initiative and the stamina to be able to exercise.

It's difficult to get started but once you get started and you start doing it on a regular basis for the first month, the second month and third month, that can be helpful for a lot of people.

But exercising is something that has a dramatic impact on your mental health , not only a sense of well-being but also ability to concentrate now from a sense of specific treatments of particular conditions with exercise.

>> If you use resistance training or weight training that will particularly be helpful for anxiety if you have depression.

It's thought that aerobic treating such as an elliptical running machine treadmill running outside getting on a bike or bicycling on a stationary bicycle aerobic activity that's getting the heart rate up that can be more helpful for depression.

>> So there are certain types of exercise that can be particularly helpful for different types of mental health conditions.

But any kind of exercise can be very, very helpful for anybody.

So it's actually one of those routine type of expectations we have for people.

We want them to get out and move around some and and when I'm talking about exercising going to the gym is great but exercising could just mean going out and walking your dog walking down the sidewalk back and forth a few times, doing more physical activity outside that you might enjoy and having more passion and what you're doing.

Thanks for your call.

Let's go our last caller.

Hello Barbara.

Welcome to Matters of Mind helped me in my late 60s and I just gotten off of North Carolina after being on it for thirty years and I thought I was doing good but I like about a week after I got off of it I'm kind of having heart palpitations and things I didn't have before.

In your experience, would that be kind of normal?

You know, after being on for so long?

I mean I took several months to get often after feeling so I feel like I weaned it really slowly or maybe something else is happening.

I wasn't sure I have a lot of pieces going on and stuff like that.

>> Yeah.

If I was you Barbara I'd try to hang in there and stay off of it for a little bit longer as long as your moods doing OK, as long as your anxiety is doing well nor turtling can as a side effect cause palpitations all by itself.

>> That's a side effect interplaying you're coming off of it and when you're coming off of any antidepressants sometimes you can get these side effects or these discontinuation effects that you might not have experienced earlier.

So keep that in perspective.

Keep close tabs on it, give it another three or four days, another three or four days.

Sometimes we will have people resume it at extremely small dosage and just do an even slower taper.

>> So sometimes if you've been on for thirty years maybe you need a thirty week tapering off of it but try to hang in there and see how you do as you stay off of it for a little bit longer time from what your describing Barbara Barbara, 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 concerning mental health issues, you may contact me via the Internet at Matters of the Mind at WFYI dot org.

>> I'm psychiatrist Jeff Alver and you've been watching Matters of the Mind on PBS Fort Wayne God willing and PBS willing.

>> I'll be back again next week.

Thanks for watching.

Goodnight