Good evening.

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

Matters of the Mind is a weekly mental health program where you get the choose the topic for discussion.

So if you have any questions concerning mental health issues that I can answer on the air, you may write me via the internet at MattersoftheMind - all one word - @wfwa.org.

That's MattersofTheMind@wfwa.orrg.

And if you're able to do so during the program, you may also text or call me.

So let's begin tonight's program with an email I recently received.

It reads oh, Fawver, how common is multiple personality disorder and can it be treated?

Multiple personality disorder is now known as dissociative identity disorder, DID.

And it's a condition by which people, not uncommonly, will have difficulty under some kind of stress to flip into a different personality and often dissociate in such a way that they don't remember what's been going on around them when that happens.

So with dissociative identity disorder, they dissociate, or they lose track of time for a few seconds or a few minutes under stress, and then they go into a different personality.

That's where dissociative identity disorder comes in.

They go into a different personality.

Now, why would they go into a different personality?

It's basically a coping mechanism by which people learned as an early child to kind of get away and zone out from their particular trauma that they were enduring.

It's not uncommon to see people who have been sexually abused, severely physically abused.

What they do is they just zone out and they just are going into a different place during that time, and sometimes going into a different type of identity or personality will be something in which helps them cope.

Now, if some people will go into a personality of strength, some people will go into a childlike personality.

They go into different personalities, often based on the difficulty of that they're experiencing.

Now in a stressful situation as an adult, the problem will be with dissociative identity disorder is people will inadvertently go into these different dissociative spells and they might briefly flip into a different personality, forgetting that they did it.

And it's often just from maybe their coworker speaking a little bit harsh with them, their spouse saying something derogatory to them.

Just something that hurts their feelings or something is somewhat stressful for them, will cause them to flip into these different personalities.

So that's where it can be difficult to endure as an adult.

It is treatable.

Multiple personality disorder, dissociative identity disorder is treatable primarily with psychotherapy.

The idea of psychotherapy is to help you cope with life circumstances in such a way that you don't need to dissociate or flip into these different personalities when you're under stress.

Previously, years ago, hypnosis was a treatment of choice for that kind of condition.

Now we're going to use different types of type of of psychotherapies to help you deal with the different personalities.

Sometimes medication can be used as a means of helping you with greater stress resilience.

Stress resilience just means being able to put up with stuff better.

And there are medications that can do that as well.

Thanks for your email.

Let's go to our next text.

Hello, Pam, welcome to Matters of Mind.

You had contacted us from Fort Wayne and you want to know about inflammation.

Hello Dr.

Fawver, in a previous episode I heard you say that inflammation of the brain.

I heard you allude to inflammation of the brain.

What is this?

Inflammation of the brain?

Pam is basically where you have the individual neurons that are getting basically flooded or marinated with inflammatory proteins.

We have fancy names for these inflammatory proteins, such as interleukin six, tumor necrosis factor alpha.

These are all inflammatory proteins again released by our little cells that surround the neurons.

Now we have 80 billion neurons.

And each of these individual neurons are surrounded by about ten glial cells.

Glial refers to glue in Latin.

And glial cells hug the neurons and they nourish the neurons.

And it's about ten per neuron.

And they're kind of like a pit crew.

If you look at an Indy car race and watch that, you'll see a pit crew of about seven pit crew getting around the car in about seven seconds.

The pit crew can change four tires and pump in a full load of fuel, and off the car goes in about seven seconds.

Well, we have a similar pit crew around each of our individual neurons.

If those if those little pit crew in in the brain, which are called glial cells, if they get sick or they're not functioning properly, they release inflammatory proteins.

Now, it's an interesting phenomenon because when they release inflammatory proteins, they will then cause greater toxicity to the neurons themselves.

And the neurons don't act properly.

And that's when people get depressed.

They have bipolar disorder.

They have conditions like Alzheimer's, dementia, all sorts of bad things can happen from inflammation of the brain.

And it's interesting you ask that particular question about inflammation, Pam, because one of the treatments for inflammation of the brain can be a glycogen, a glucagon like, like peptide, glucagon like peptide number one agonist, which is called a GLP-1.

Medications like semaglutide, also known as Ozympic.

These medications are used for diabetes.

They're used for weight loss, but they're also used now for the possibility of helping people with mood conditions.

They're being studied now for mood disorders and bipolar disorder.

Opiate use disorders are very commonly addressed with this GLP-1.

So the glucagon like peptide number one agonists are the type of medications that can directly in the brain, decrease inflammation.

Now they've got to be studied further to determine if there's going to be any long term bad effects that can occur with these kind of medications used in these conditions.

Some patients might notice they feel kind of emotionally blah.

The biggest issue I see right now with GLP-1 agonists will be the muscle loss that people experience.

When you take a medication like semi semaglutide, it can cause you to have significant muscle loss.

So now I'm hearing a lot of nutritionists and endocrinologists who are prescribing the GLP-1 agonists.

They're saying you really got to do resistance training.

And I've been recommending that to many people I've seen over the years who are on these medications, because if you're having muscle loss, that's going to affect in different ways and stay strong.

So resistance training is very, very important for these people.

But the decrease in inflammation of the brain is what's intriguing us as psychiatrists.

It's very some of the medications that can decrease inflammation of the brain, one of them being lithium as well as various other medications.

But inflammation of the brain is thought to be one of the sources, one of the causes of many mental health conditions.

Thanks for your text.

Let's go to our next caller.

Hello, Tyler.

Welcome to Matters of the Mind.

Tyler, you want to know about lithium.

How is it help with bipolar disorder?

Well, it does decrease inflammation, but basically lithium is a salt.

It's a salt on the periodic table that's similar to sodium.

So the body looks at lithium and sodium in a similar manner.

And that's how it's excreted.

So if you have a higher sodium diet, if you're taking lithium as a prescription or lithium level can decrease if you all of a sudden restrict lithium in your if you all of a sudden restrict sodium in your diet, lithium levels can increase.

Now, naturally we don't have natural lithium in our bodies, so it's not a matter of checking lithium level if you're not taking lithium.

But if you are taking lithium, there's levels that typically are effective somewhere between a level of 0.6 milliequivalents per liter up to no more than 1.2.

As you get higher on the lithium dosage, you can have such side effects as shakiness, headache, diarrhea, some uncomfortable side effects as you go to high on the lithium dosage.

But lithium is particularly effective for people with bipolar disorder, type one.

These are people who experience at least one week of manic symptoms where they get themselves into trouble, and during these manic symptoms, they might notice they have a decreased need for sleep.

They are talking really fast.

They go from topic to topic to topic.

They're very impulsive, and that's where they will do things and say things that they later regret doing and saying.

So lithium can be very good at stabilizing the brain chemistry in that way.

It has some other mechanisms for depression in the sense that it can decrease suicidal thinking, low doses of lithium by means that we don't really understand low doses of lithium, even below the therapeutic threshold of lithium, can decrease suicidal thinking.

And I've seen it very dramatically with my patients over the years.

If you simply give somebody 150mg of lithium and they have suicidal thoughts with an antidepressant medication, it can be very effective in decreasing suicidality.

So lithium is a medication is often used for bipolar one depression as well as mania.

But it stabilizes the mood.

It's particularly helpful for people who have distinctive episodes of highs or lows.

They don't have the mixture of highs and lows at the same time, and it's particularly effective for people who don't tend to have any more than about four highs or lows in a year.

So they're not rapid cycling and they're not they're not exhibiting mixed features of bipolar disorder.

Lithium is typically best dosed in a controlled release formulation all at bedtime.

The textbooks all talk about lithium being given in the immediate release formulation three times a day.

Number one, many people can't remember three times a day to take any medication.

But number two, if you dose it all at bedtime, it helps with the sleep.

But it also is safer on the body itself.

So we prefer to dose lithium entirely at bedtime in a controlled release formulation.

Thanks for your call.

Let's go to our next caller.

Hello, Ann, welcome to Matters of the Mind.

Ann, you want to know, is it normal for your antidepressant medication to cause severe stomach pain and nausea?

Not normal, Ann, I think that's probably related, number one, to probably an antidepressant effect that's affecting serotonin.

So serotonin has 14 different receptors associated with it.

A particular serotonin receptor is serotonin receptor number three.

And in the in the gut about 90% of the body serotonin is in the gut.

And if you stimulate serotonin receptors type three, that can cause you nausea all by itself.

Now, stimulating serotonin receptor number three is the mechanism by which you're trying to block when you use a medication like Zofran, also known as ondansetro.

So ondansetron as an anti-nausea medication frequently used by people who experience nausea and Zofran is very inexpensive nowadays, but it's a specific serotonin type three blocker, and if you block serotonin type three receptors, you can decrease nausea.

There's a particular antidepressant medication called mirtazapine or Remeron.

It's been around since about 1995 and as a mechanism will block serotonin three receptors as well.

So if you have nausea related to an antidepressant medication it's increasing serotonin.

Number one we're going to look at well how long has it been going on.

Can we decrease the dosage because the nausea is related to the dosage?

Can you take the medication with food?

That often helps tremendously.

So if you take the medication with food, especially peanut butter and eggs and avocados, if you take it with food often, that will relieve the nauseam.

Many times the nausea related to antidepressants medications will be short lived.

It's going to occur over the course of 2 or 3 weeks, and we kind of ride it out during that time.

You can use on ondansetron, for instance.

During that time if it's related to serotonin.

And we'll look at how well it's working for you.

Within 2 or 3 weeks, a medication that's affecting serotonin within 2 or 3 weeks should give you at least 20% benefit.

Doesn't sound like much, but it's a very key predictor that it's going to give you long term benefits.

So a little bit of a benefit as soon as 2 or 3 weeks can be predictive that you're going to do well over the course of time.

So if somebody is doing really well at 2 or 3 weeks on a medication that possibly is increasing serotonin, they're feeling better, but yet they have nausea.

I'm wondering, number one is a nausea decreasing with time.

And number two, can we simply decrease the dosage, take it with food as a means of mitigating the nausea itself.

So there's ways to get around it.

There are other reasons why people can have nausea from an antidepressant, for instance, Bupropion as a medication that's increasing norepinephrine and dopamine.

Bupropion is also known as Wellbutrin has nothing to do with serotonin, but it's a medication that can increase some nausea just by enhancing dopamine.

This the same kind of effect you'd get from a stimulant medication.

If you increase dopamine, sometimes it can give you kind of a sickly feeling.

That's why people, when they first try the nicotine cigarettes can feel nauseated.

It's the dopamine effect in the gut.

So if it's related to dopamine, it's a whole different phenomenon.

So we'll hear about dopamine increases causing nausea.

We hear about that with Bupropion.

There's a nasal spray called Spravato that's used for depression that will sometimes cause nausea.

And that's thought to be due to the dopamine increase as well.

Do we get around that?

Is once again wait it out.

Number two decrease the dosage of whatever you're using.

And number three, sometimes we'll give a little bit of a medication like promethazine also known as Compazine.

Prochlorperazine, long word there.

They're also known as Compazine as a means of decreasing the nauseated nausea related to a medication.

It's increasing dopamine.

So there are many different options there.

But it's not normal for you to experience side effects.

But if you do, we just sometimes have to work around it.

Let's go to our next email question.

Our next email question.

Let's go to our text question from Rita.

Rita, you have a question about antipsychotic medications.

Why do the antipsychotic medications increase appetite and cause weight gain?

Well, Rita, we have a lot of different antipsychotic medications that have come out over the past 30 years.

And there are side effects have primarily been that they will increase the appetite is thought that they're affecting serotonin two C receptors, particular serotonin receptors and and do it.

And doing so they can increase the appetite to a limited degree.

They have an antihistamine effect that will increase the appetite.

But it's thought that it might have something to do with the type of serotonin receptors that are affecting.

Now some of the medications won't affect appetite as much as others.

Doesn't mean they're better, it just means that they aren't affecting those particular receptors.

Now, a medication like olanzapine, also known as Zyprexa, profoundly could increase the appetite.

We've noticed that since it came out in 1996, and just in the past few years, we found that if you combine a medication with a olanzapine called Samidorphan, that's a formulation called LYBALVI, is olanzapine, with Samidorphan.

With Olanzapine and Samidorphan in combination using LYBALVI that does not seem to increase the appetite and weight gain like we see with Olanzapine by itself.

So there's ways to get around that, but some of the medications that increase the appetite will give you the weight gain.

It was notice that early in these studies on these antipsychotic medications, it was noted that individuals who gained the most weight early on often had the best antipsychotic effect with schizophrenia.

That sounds weird, but if you think about it, when you're experiencing psychosis and you're really ill with schizophrenia, you're going to be paranoid and you're going to be careful while you eat.

You're not going to want to eat.

Many times you've got to think your food is poisoned.

All these awful thoughts are coming to your mind, and you're losing weight when you're psychotic.

Not uncommonly, well, these people who lost a lot of weight when they're psychotic as they improve dramatically, they actually gained a lot of weight.

So the original olanzapine or Zyprexa trials showed the people who had the best antipsychotic effect for schizophrenia were indeed the ones who had the most weight gain.

So it was kind of a yang and yang there.

But we still don't like people to have the weight gain.

So there are ways it's not the weight gain that caused them to improve it, just that that was an after effect of their they're improving overall.

Now many people use the so-called antipsychotic medications for bipolar disorder, mood stabilization as well as schizophrenia and sometimes for depression as well.

We don't want to have a lot of these people experiencing weight gain.

So we have a lot of ways to kind of get around that.

And I think any medication that comes out over the next few years that's in that class of medications, which we would call antipsychotic medication, any medication that comes out probably is not going to have weight gain as a factor associated with it, because we need to get past that.

Already, people with schizophrenia, bipolar one disorder already, they have difficulty with type two diabetes.

And that was noticed 100 years ago, 100 years ago, before these antipsychotic medications even come out.

It was noted that people with conditions that we would now call schizophrenia and bipolar disorder, people would have higher blood sugars.

And we didn't even have a psychotic medications back then.

So the stress of having schizophrenia and bipolar disorder causes increased cortisol.

Increased cortisol makes you more likely to become insulin resistant, and that causes you to have higher blood sugars and eventually type two diabetes.

So what we want to do is try to improve the overall symptoms without causing the blood sugar or the metabolic abnormalities.

Thanks for your text.

Let's go to our next caller.

Hello, Tim, welcome to Matters of the Mind.

Tim, you want to know what part of the brain is used when you're challenged or hurt, and how and how do you cope.

It sounds like you're describing Tim, a phenomenon where, okay, you're under a lot of stress, you've been offended, you're trying to cope with different circumstances.

So what are the brain part of the brain are you using to try to help you through all that?

Well, there's different parts of the brain that might help you with coping in general, Tim.

Number one, you're going to rely on past experiences.

Hippocampus over here on the side part of the brain is in the thumb part of the brain.

The hippocampus is going to store past memories.

And you're going to hopefully be able to remember how you coped with different things in the past.

Secondly, there's a little part of the brain in here.

Let's see.

It's right, right above the corpus callosum called the ventral medial prefrontal cortex.

It's right in here the ventral medial prefrontal cortex.

Medial meaning medial meaning it's on the inside of the brain.

Ventral meaning it's on the lower part of the top part.

But ventromedial prefrontal cortex allows you to think through your current life challenges and compare those current life challenges to your own personal values and your past experiences.

Grabbing some of those memories from the hippocampus.

And it's going to compare how these particular challenges match up with your past coping abilities and your whole identity itself.

So the ventral medial prefrontal cortex really fires up when you're trying to cope with a particular circumstance.

And as you learn from any, any particular circumstance, as you are enduring really challenging experiences, your neurons become more fluffy.

And when they become more fluffy, that's called neuroplasticity.

So instead of, gee, having maybe 30,000 branches on an their on, you might have 50,000 branches.

As they can become more fluffy, it actually caused you to have greater resilience.

Resilience basically makes the neurons stronger.

It's like shellacking the individual neuron branches.

They grow in a number.

They get increased branching over the course of time, and it helps you learn from past experiences.

So as I often tell parents and grandparents, you know, you don't want to protect your children from scary experiences, from new challenges for from situations in which they might fail because they're learning from all those experiences.

We have to allow children to experience challenges and especially help them learn to fail, and learn how to actually recover from any kind of disappointments.

So as we're allowing them to do that, we're enhancing the little branching in their brain in that particular middle part of the brain, called the ventral medial prefrontal cortex.

It allows you to cope better.

Now if you don't cope so well with life circumstances based on functional MRIs, they've done that part of the brain.

That part of the brain doesn't lighten up.

So brighten up so much.

So in other words, if you can't cope with the experience very well and you're feeling overwhelmed, this part of the brain here that should get fired up when you're going through a particular life challenge, it goes quiet and you don't want that to happen.

You want it to get fired up and actually make you stronger in the long run.

So sometimes atheists like Frederick Nitschke, Nietzsche, Nitschke was the linebacker for the Packers.

Nietzsche was a philosopher, German philosopher.

He said, what doesn't kill us could make us stronger.

And yeah, as I said, sometimes atheists can get it right.

But what he's saying is, if it doesn't actually physically kill you, a challenge that you're enduring can actually make you stronger and stronger and stronger.

And that's dealing with life circumstances in in a resilient manner.

And the part of the brain that can do that is right there in the middle.

And a lot of neurochemistry shows that could improve.

Thanks for your call.

Let's go to the next caller.

Hello.

Let's go to our next text.

Hello, Pat.

Welcome to Matters of mind.

Pat to you're from Fort Wayne.

You want to know does allergies affect anxiety.

And there are things like energy levels, bowel issues, headaches and not feeling well all over.

And our labs needed when taking Divalproex Delayed release.

Two different questions there entirely.

I'll start with the Divalproex delayed release, also known as Depakote.

You do need labs for the CBC and liver function tests, as well as the blood level for Depakote.

Depakote is a medication.

It's known as valproate and it's been around for decades, used for mood stabilization, used for anxiety and irritability in some cases.

But it's a medication that where you do need to make sure your liver and your bone marrow still working well, and make sure you're not getting too much of it.

Too much Depakote can cause you to have difficulty with balance and memory disturbances.

Allergies, in general, allergies can cause you to have all sorts of mental health issues.

So we've heard about this with some people with mold allergies, with allergies concerning pollens.

They'll notice.

They'll have more irritability, more difficulty with depression, more difficulty with motivation.

So sometimes giving people a non sedating antihistamine medication or several of them over the counter nowadays.

But a non sedating antihistamine medication can many times improve a person's mood if the mood disturbance is related to allergies.

Now by non sedating I mean a medication that's an antihistamine that does not cross the blood brain barrier, predominantly.

Benadryl or diphenhydramine is an antihistamine.

It's been around for a long time.

50% of that gets into the brain.

So 50% of it gets into the brain as an antihistamine.

If you block histamine in the brain, it makes you sleepy.

So right now my histamine sky high because I'm awake.

So if you block histamine it makes you sleepy.

So a way of helping somebody with sleep, especially younger people, will be to give them an antihistamine like diphenhydramine.

It'll make them sleepy.

However, older people as they take a sedating antihistamine medication.

Older I mean by over 55 years old.

If you take an antihistamine medication like diphenhydramine, it can make you tired and sleepy all the way up to noon the next day.

And driving tests have shown that older people who take diphenhydramine or Benadryl nighttime for sleep.

They might not notice their sleeping in the morning, but they're driving.

Tests will be impaired up until noon the next day.

Don't want to do that.

In general, a non sedating antihistamine medication is one that has minimal crossing over into the brain itself, doesn't cross the blood brain barrier, and that inevitably, for many people, can decrease a lot of the difficulties with the allergy effects people can experience.

Thanks for your call.

Let's go to our next caller.

Hello, Tom, welcome to Matters of the Mind.

Tom, you had another question about brain inflammation and iron toxicity can potentially lead to dementia or Parkinson's.

Iron toxicity can do a lot of bad things neurologically.

So you don't want to have too much iron.

Two little iron can often be measured not only by your iron profile, looking at your red blood cells and the amount of iron in your blood.

But you also look at the storage of protein called ferritin.

Ferritin should ideally be above 3555 as a number.

If the ferritin level gets too low, that could be problematic.

But if you have iron toxicity, not uncommonly, people can indeed have neurological effects.

Iron is not directly associated with inflammation.

Inflammation is a different phenomenon, but inflammation can indeed be associated with the possibility of neurodegenerative conditions like Parkinson's and dementias.

Matter of fact, as I mentioned before, a GLP one agonist is typically going to be considered for somebody who has early stages of dementia and a lot of cases, it'll be interesting to see how that pans out.

But right now, there's discussion about GLP-1 agonists being used to decrease the inflammation that's thought to be related to neurodegeneration.

As we might see with Alzheimer's dementia.

Parkinson's disease is a phenomenon basically where the middle part of the brain, it's called the substantia nigra.

Right down here, the substantia nigra, substantia meaning body, nigra being dark, it's a dark body.

It decreases in its volume by as much as 50 to 70%.

And that's where dopamine arises.

So as dopamine is decreasing, you'll have muscle movement disturbances.

Why does that occur?

A lot of different theories behind that.

But inflammation might be part of it.

Thanks for your call.

Let's learn for some amount of time for this evening.

If you have any questions that I can answer on the on the air, you may write me a via the internet at MattersoftheMind - all one word - @wfwa.org.

I'm psychiatrist Jay Fawverf and 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.