.

.

>> 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 a chance to choose the topic for discussion.

>> So if you have any questions concerning mental health issues, give me a call here.

>> PBS Fort Wayne by dialing in the Fort Wayne area at (969) 27 two zero or if calling any places coast to coast you may dial toll free at 866- (969) to seven to 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 on that I can answer on the air you may write me a via the Internet at matters of the mind all one word at WFA a dog that's matters of the mind at WFYI Dog and start tonight's program with an email I recently received.

>> It reads Dear Dr. Fauver I have what I think most would call a very minor depression and anxiety.

How do I know when it's time to get treatment?

>> Should I start with my family doctor?

A minor depression is basically well from a diagnostic standpoint you have fewer than five symptoms of depression.

A major depression is where you have five symptoms of depression.

>> They go on day by day by day for at least two weeks and very importantly it gives you functional impairment where you have difficulty on the job socializing with your relationship so it gives you difficulty getting stuff done that you need to get that you need to get done on a day to day basis.

So that's called functional impairment.

>> So with a minor depression.

Yeah.

If it's not that bad it's not getting in your way yet.

You're still able to do things you can contact your primary care doctor to get things started because what often happens is a cascade.

You'll have difficulty with anxiety and you'll worry about things and ruminate about things that are out of your control.

>> The anxiety will lead to difficulty with sleep and difficulty with sleep is a psychiatric vital sign where if somebody has trouble with sleeping it often will then cascade into two depression.

People will often wonder Do I have anxiety or do I have depression?

Often they overlap because anxiety starts down here in the amygdala part of the brain.

That's the anxiety, anger, irritable irritability, volume control and when that gets overactive it will sometimes shut down the thinking part of the brain hijacks the thinking part of the brain in the front when the thinking part of the brain in the front gets hijacked you tend to ruminate about things and you don't think logically.

That's why people when they get depressed they can't think clearly.

They often have difficulty with awareness that they are getting depressed.

They don't enjoy things.

They lack motivation and they have trouble with energy level and get up and go.

>> So you have this cascade of anxiety, insomnia and depression going one after another after another if you're having difficulty with some minor depression and anxiety.

Number one, the first question I would ask is have you ever had a significant depression in the past if you did?

Yeah, I think you might want to warrant getting some treatment sooner rather than later.

>> Secondly, as anybody in your family had difficulty depression depression does have a genetic component.

It is about thirty five thirty five percent genetics or runs in families.

So if you have people in the family who have experienced severe depression that can be a factor.

>> The third thing I'd always consider in terms of getting treatment will be why do you have coming up in your life ?

Do you have a job change?

Do you have any difficulty with relocation?

Do you have stresses coming up that you ordinarily wouldn't be experiencing if those were happening?

Be aware that if you're already having some depression and anxiety that can cascade into a worsening depression and anxiety if you have something precipitating like a significant change that it's occurring in your in your life but often a big tip off that somebody is going to be having trouble over the course of time with depression will be the difficulty with sleep night by night and that means frequent awakenings No one awakening in the middle of the night and having a difficult time getting back to sleep, still feeling tired and still feeling like you didn't get enough sleep the next day and that will often lead to trouble with concentration and obviously we do look for a medical causes for all of that thyroid disturbances glucose disturbances, low iron especially for heavily menstruating women and sleep apnea will be the main medical conditions we will consider when somebody is having depression.

>> Thanks for your email.

Let's go to our first caller.

Hello Thomas.

Welcome to Matters of Mind.

>> Well, Thomas, you want to know how much sleep would I recommend for someone over 50 years old and how does that help with mental health ?

There's an old misperception, Thomas, that when somebody gets older they don't need as much sleep.

Well, that's a misperception because as we get older we need just as much sleep as we did when we were younger.

>> It's just that we don't sleep as deeply as we did when we were younger.

And there are several things that happen as you get older Thomas number one, you might not dream as much now dreaming is good.

>> I always emphasize to people it's good to have dreams now if they are terrifying dreams of their nightmares and they cause you to awaken screaming that's a whole nother phenomenon there.

>> But dreaming is normal.

Dreaming should be very abstract.

Deep dreaming often doesn't make sense and that's OK. >> Dreaming is good for the brain because the dreaming will fire up this area of the brain here called the hippocampus and the hippocampus is the memory storage center of the brain and dreaming helps fire that up.

When you're dreaming you shut down the thinking part of your of your brain the logical part of your brain is called the lateral dorsal prefrontal cortex and this part of the brain up here in the front is the part of the brain that you're using to concentrate and think and focus on something and maintain some logical thought at nighttime that no normally shuts down.

>> When that shuts down you go into sleep and it's called rapid eye movement sleep REM sleep and that actually helps you the next day be able to retain memories.

So when you're dreaming that's a good thing.

As we get older we tend to dream less and as people approach Alzheimer's dementia, many people with dementia will dream less and less and that's one of the theories behind why they might be struggling with having memory problems over the course of time.

>> So we want people to dream as they get older the best we can.

Secondly, there's a phenomenon called non rem sleep where people will have difficulty getting into a deep sleep.

>> You know you're getting into a deep sleep where if you happen to awaken from that deep sleep you're kind of confused for a few seconds.

You don't know where you are.

You don't know what you're doing.

>> That's a very deep sleep and that's good for helping energize your entire body.

So the deep non REM sleep is very good to help your body get physically recharged whereas the REM sleep is often more important for memory and concentration overall in both those phases of sleep we need to still get them as we get older now as you get older, Thomas, sometimes you have more time on your hands and as you go into semiretirement than retirement you kind of go but go to bed whenever you want and you get up whenever a one sometimes that can disrupt your sleep circadian rhythm.

>> So it's important that even as we get older we try to get to bed about the same time every night with the expectation that we'll get up at about the same time the next day have not interrupted sleep the best you can be aware that snoring or difficulty with witnessed apnea where you don't breathe four times during the night that can't those can be symptoms of sleep apnea.

So as we get older we're more inclined to having sleep apnea.

So we need to watch out for those as we get older by nature we're more likely to have Type two diabetes where our pancreas just doesn't work as well and glucose disturbances will often affect the sleep itself where the glucose can go high and low as we get older we need to be very aware that if we eat later into the evening it can keep us up up later at night not only because our stomach can cause us a little bit of a gastric reflux but also eating late at night can disrupt the blood glucose is for a lot of people if you exercise later in the evening as you get older that can sometimes keep you awake.

I'm a big fan of exercising but as you get over 50 years of age, Thomas is probably more important that you try to exercise earlier in the day rather than later in the day simply because exercising after about six p.m. or so when you're over fifty years of age can sometimes keep you awake.

So you have to be aware of that but keep awake and keep aware of your environment at nighttime.

If you have dogs and cats in the room be aware they might be waking you up periodically during the night as we get older Thomas it's not uncommon that men will have a little bit larger prostates causing them to get up and go to the bathroom a little bit more at night.

So be aware of your fluid intake especially after six or seven p.m. in the evening that the fluid intake can affect how often you're getting up at night.

Getting up at night is OK as long as you're not stumbling around you're able to go back to bed and you're able to go back to sleep.

But as we get older, Thomas, it's not uncommon to sleep less deeply and it's important that we do all we can to try to get maintain that depth of sleep.

And one of the best ways you can do it quite frankly is exercise in the morning if you exercise in the morning or the afternoon, you're more likely to get a deeper sleep at night.

>> Exercise often has a direct correlation with the depths of sleep later on.

So that's something that's often very important.

Caffeine intake is something that we often discuss if you drink any caffeine after three or four p.m. sometimes that'll influence your wakefulness into the evening.

>> So especially as we get older we have to be aware of how much caffeine we're drinking at night.

Caffeine is an interesting chemical because caffeine has a similar type of has a similar type of structure as is chemical called adenosine and as we go through the day this chemical called adenosine goes up and up and up in our in our brains and then it causes to naturally get more and more tired as the day goes on.

>> And that's called homeostatic rhythms where you just naturally get more tired as the day goes on.

>> If you drink caffeine or a caffeinated beverage the caffeine looks like adenosine and blocks the effect of adenosine so it naturally will wake up the brain in that matter some people will have trouble with caffeine because of the take in too much.

They can get a shakiness, they can get a tremor and they can need more and more as time goes on.

So be aware of how much caffeine you're using and not to overdo it to the point where it causes you to get dependent on it or get addicted to it.

But caffeine will block adenosine and thereby giving you a wakeful effect.

>> Caffeine will also stimulate these dopamine receptors and dopamine receptors help with motivation, energy and concentration and by stimulating dopamine receptors it can actually help you with all those type of things with caffeine in small and reasonable amounts can very be very good for wakefulness, concentration, motivation and energy.

Thanks for your call.

Let's go our next caller.

Hello Ken.

Welcome to Matters of Mind staff by the way.

Thank you Ken.

Oh yeah yeah I'm I'm currently on forty milligrams of flu Occitan team forty milligrams abuse by room and two hundred milligrams of modafinil a day.

I take a small amount of lithium in the evenings I my friends and family have noticed I've had some tremors that I didn't think we're all a little small but apparently they've been noticeable enough that a couple of people have said something and I have had some my wife would describe it as a convulsion like episode sometimes in my sleep or I'm shaking fairly violently and in the last week I had two disturbing incidences where I had an uncharacteristic uncurious what's the word uncharacteristically angry outburst, sudden anger just I'm just not a person.

This is just so unlike me and I had a week where I had to know physical threat to anybody of any kind just an angry outburst verbally I wondered if if given the medications that I'm on if you would have any idea if they might be contributing to some of that in order can I think the main contributors to irritability, some restless at night time, maybe some shakiness in order no one would be Fluoxetine.

Forty milligrams a day.

>> Secondly, Modafinil less likely and very less likely you Spirent that'd be my third option in terms of potential aggravates of what you're describing right now Fluoxetine forty milligrams a day it's increasing serotonin when you increase serotonin sometimes it can make you a little bit more shaky and tremulous.

>> Sometimes it can kind of give you an effect in the evening whereas it's kind of working out of your system can make you have some sleep disturbances.

>> Some people do indeed have nightmares related to Flock's team or the medications and the serotonin LARC kind of getting out of their system in the evening and irritability can be a potential there now can the big question for you would be did you notice a difference when you went from 20 milligrams of Fluoxetine to the next dosage up which is forty which is typically forty milligrams not immediately I couldn't say that not immediately.

>> Not within a week or so I would guess I hadn't noticed anything though.

Did it help going from twenty milligrams to forty milligrams help with depression or I guess it didn't have outbursts here lately.

I'd been the medication changed several weeks before I had these angry outbursts.

>> Got you OK. Is that where we're going?

>> Yeah sure is because again it takes about six weeks for Fluoxetine to level out in the system so when you go from a twenty milligram dosage to forty milligrams dosage of Fluoxetine you might not see the effects of that until about six weeks later.

>> Now the big question Ken is was it worth it when you went from twenty milligrams fluoxetine up to forty milligrams a day did it help with depression, did it help with anxiety, did it help with anything?

>> Because that's always my question for people when you increase that dosage, was it worth it?

Did it help you in any ways because sometimes people say well I increased the dosage it was supposed to help me with this or that but it didn't and if anything I had more side effects and that's kind of what you're describing.

>> Could that have happened for you?

Well, I you know and it's it's so hard to put a timeline and everything.

I think as far as depression goes, I don't know that it made a huge difference.

But I did I did however have these you know, uncharacteristically angry outbursts and it would have been probably six weeks since that dosage was changed.

So given that information, I think maybe it might be worthwhile to back off the twenty again and see if that makes a difference.

>> Yeah.

Talk to your clinician about that because twenty milligrams for most people does just fine .

Forty milligrams of Fluoxetine is sometimes necessary for people who happen to metabolize it really fast and we sometimes will pick that up with genetic testing but sometimes it's just a matter of looking at the time course when you increase the dosage how do you feel over the next four to six weeks and did you have any noticeable changes in your behaviors?

>> What you're describing to me is more what we call serotonin toxicity and serotonin toxicity is characterized by shakiness feeling kind of revved up a little bit more irritable.

>> Some people will get headaches, some people will notice that they have some difficulty with restlessness all by itself.

>> So that could be from the flu vaccine itself.

>> Modafinil what time of the day do you take the Modafinil again in the morning?

Yeah, by the evening it's yeah it's gone and and we were we had discussed splitting it up into like an eight o'clock and twelve o'clock house the house but generally I take the one dose in the morning just to get me wrong I've got sleep apnea on top of a few other things but yes I generally take the Daily Dose in the morning I imagine by the evening I'm off of that by now we love the Modafinil for a lot of reasons.

>> It does mainly three things.

>> Number one, it increases this chemical in the front part of the brain called C for C FOMC kind of a weird name but it's a activating awake awakening type of chemical in the front part of the brain.

>> If you increase it it makes the brain more awake.

Secondly, modafinil will increase histamine and you might have heard about how the antihistamines like Benadryl make you tired and sleepy if you increase histamine it actually wakes up the brain.

So increasing histamine is another way of waking at the brain and the third thing modafinil very slightly is it'll increase dopamine.

Dopamine is the feel good chemical in the brain.

That's the motivating energizing chemical the brain that's what we all want need to get us a little bit more motivated.

Modafinil does all those different things typically without having an addictive feature, addictive quality to it and modafinil does not usually make people too irritable when they get a little bit too much.

>> It's possible.

But what you're describing is more from the higher dosage of Fluoxetine and of course Fluoxetine stimulates all 14 different serotonin receptors PUE Spyro and abuse bar which you'd mentioned you're taking at forty milligrams a day beuse bar just will affect one of those receptors.

>> It's called serotonin receptor 1A and it kind of dials in like thermostat what the proper amount of stimulation on serotonin one a receptor should be so very unlikely but Spirent is a factor there.

So what you're describing to make in is getting a little bit too much serotonin effect from the Fluoxetine.

Talk to your clinician about the possibility of dialing that down a little bit and see if you feel just as well on twenty milligrams a day as you did 40 if you need further help with depression.

>> Yeah, there's other things that can be used to kind of wrap around that.

>> Yeah.

Thanks for your call.

Let's go to our next caller.

Hello Tom.

Welcome to Matters of Mind.

Tom, you want to know if vitamin D to is not readily available?

Why recommend it?

It's typically pretty readily available if you look on the shelf vitamin D two can be available.

D3 is even more available.

Others subtle differences between those different compounds.

But a vitamin D three is the most common form that you'll see on the shelf.

But it's not too difficult to find vitamin D to but it doesn't matter so much which type people will take.

>> Tom vitamin D generally is a as a pro hormone it's in the skin and as a pro forma it means if it's stimulated in this case by ultraviolet light it will break down into a hormone.

So vitamin D is actually a hormone.

Hormones go to the other parts of the body and do good thing.

>> So vitamin D three is what you'll often see over the counter on the shelf.

>> But if you look for vitamin D too you can sometimes find it but vitamin D three is what people most commonly will take when you look on the shelf and you see thousand years or five thousand units available in the wintertime, it's not uncommon for people under their clinicians recommendations to take five thousand units every day.

>> But the most common dosage year round of vitamin D in the form of D3 three would be two thousand units every day.

You can't get blood levels on vitamin D ideally of blood level should be over fifty five if it's under fifty five people can be at higher risk for depression and there's some speculation out there that low vitamin D might be a factor in some autoimmune conditions as well as some cancers.

So it's highly recommended people keep their vitamin D levels at an adequate level and if you just get vitamin D over the counter it's often vitamin D three although vitamin D two can be found.

>> But from my perspective vitamin D three is is just fine for a lot of people.

Tom ,thanks for your call.

>> Let's go to our next e-mail question and our next e-mail question raised your daughter Fauver how much exercise is enough especially in the winter when I really don't want to exercise in the wintertime?

>> One of the best things you can do is try to get some kind of physical activity.

One of the reasons for winter depression will be that people get more cooped up and they just don't get as physical physically active.

>> So lack of physical activity will be a contributor to depression in the wintertime.

So how much exercise is necessary?

>> There is a study that was recently released that looked looked at middle people over fifty years of age and have followed them for quite some time and it showed that simply increase their heart rates for as little as two minutes two or three times a day was enough to enhance their longevity as they evolved over the course of several years.

>> So these are people over 50 over 60 years of age who were followed over the course of several years and simply watching their heart rates increase for two minutes here two minutes they're three minutes.

They're throughout the day was enough to increase their longevity.

So any kind of physical activity is fantastic for anybody.

I often recommend to people twenty minutes three times a day just to get the heart rate up.

You typically will feel better when you exercise a little bit.

Any kind of physical physical exercise is great.

It used to be thought that you had to exercise forty five minutes to an hour if it wasn't worthwhile.

>> That's not true.

As little little as twenty minutes is great and that can be with resistance training with weights kettle bells are getting very very popular now even a low weight make sure if you do use kettlebell use them properly but that can be a phenomenal exercise for a lot of people.

>> People can get an elliptical machine, stationary bicycles, treadmills just simply walking a little bit of inclination on a treadmill is fantastic doing that in the wintertime ideally in the morning can be helpful to not only prolong your longevity but improve your health overall.

But as I mentioned previously, exercising especially in the morning actually will improve your sleep at night.

So if you're having trouble sleeping at night even though it might be something you don't particularly want to do, try to get some kind of exercise some kind of physical activity going in the morning and if you can walk outside safely as long as it's not icy, you're not going to fall and hurt yourself.

But if you can walk outside for just a few minutes in the morning it does a great job in terms of just waking you up, helping you physically and mentally right off the bat.

So some kind of exercise is helpful.

I don't put any time limit on exercise and terms of a minimum amount.

I will simply say any kind of physical activity during the day is going to be helpful.

That's confirmed by this recent study of people who were middle age who simply were having some kind of physical activity two or three minutes here and there throughout the day.

They seem to have greater longevity than people who did not do any physical activity at all.

So any kind of physical activity is going to be good for you.

Thanks for your email.

Let's go to our last email.

Our last email reads Dear Daughter Father, how does caffeine work?

>> I mentioned it earlier and why is it addicting for some people caffeine as I mentioned previously is chemically related to this chemical called adenosine adenosine.

>> As we go through the day we'll go up and up and up in levels that our brain when it adenosine goes higher and higher and higher you gradually get more tired.

>> Caffeine goes to the brain and fools the brain into thinking it's adenosine and it will knock adenosine off the receptor of adenosine and thereby adenosine can attach and you don't feel tired so caffeine will knock adenosine off its receptor site and therefore relieve the tiredness.

>> It's often ideal if you don't have any coffee or have any caffeine for an hour or so after you awaken because when you're awake and theoretically your adenosine levels are really low if you have coffee in the morning some people will say I really need coffee in the morning.

>> Well the reason they need in the morning is because yeah they're knocking a little adenosine is already there off the receptor but they're also firing up a little bit of dopamine.

So increasing dopamine transmission by firing up the dopamine receptors which is what caffeine will do can give you a feel good effect and give you an awake full effect right off the bat.

But if you can wait for an hour or two hours three hours before having that first cup of coffee, that's often going to be ideal for you in terms of giving you a wakeful effect throughout the day.

>> Now it can be addictive because it is increasing dopamine transmission if you increase dopamine transmission that's the same thing that nicotine can do and it can make you feel really good.

>> And if you're using the caffeine as a means of increasing dopamine, you can sometimes require more and more and more.

And when that's happening that's when you get in trouble with getting shaky and getting really depressed and tired if you don't have the caffeine.

So try to modulate the amount of caffeine you're taking in as a general rule three or four cups of coffee every day is considered to be pretty safe for most people unless you have gastric reflux, unless you have a tremor that gets worse by the caffeine, unless you physically feel worse with a higher and higher amounts of caffeine.

But for many people three or four cups of coffee having the antioxidant benefits of coffee that can actually be good for you in terms of decreasing the risk for type two diabetes and Parkinson's disease.

>> 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 write me via the Internet at matters of the mind all one word at WSW or I'm psychiatrist Jeff Olver and you've been watching matters of the Mind on PBS for Wayne God willing and PBS willing.

I'll be back again next week.

Have a good evening.

Good night