February 20, 2023

.

Good evening.

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

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

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

And if you'd like to contact me with an email question that I can answer on the air, you may write me a via the Internet at matters of the mind all one word at WSW ECG that's matters of the mind at UFW Edgard I'll start tonight's program with a question I recently received.

It reads Your daughter Fauver how do I know I'm drinking too much coffee ?

>> It seems I need coffee all day long.

Well, how does coffee work?

Well basically it has antioxidants which have very good medicinal values but the reason you might be drinking coffee all day long is to get the caffeinated effect now caffeine in coffee keeps you awake, keeps you motivated and provides energy.

>> How does that work?

>> Well, basically caffeine mimics a chemical by the name of adenosine as we go throughout the day.

>> Adenosine is like the exhaust fumes when we're burning off energy and our brains.

>> So the exhaust fumes of adenosine will kind of make you tired as the day goes on and the adenosine will also decrease this chemical called dopamine.

>> So as you go throughout the day normally based on your normal homeostatic rhythms you'll get more tired as the day goes on and you'll have a little bit less motivation as the day goes on.

Now you'll have circadian rhythms that kind of give you spurts of energy here and there .

>> But what caffeine will do is it structurally is similar to adenosine so it goes to the adenosine receptors stimulating those adenosine receptors with with adenosine will make you tired and decrease dopamine.

But if you use the caffeine to go to those receptors, caffeine makes the devastated receptors thinks that it's adenosine blocks the receptor effect and makes you less tired so caffeine will make you less tired because it fuels the brain into binding at the adenosine receptor and thereby does not make you as tired you're able to stay awake.

The fatiguing effect of adenosine itself is no longer a factor and dopamine will increase and that's why a lot of people will notice when they use caffeine they have a bit more energy, they have better concentration.

They might get some dilation of the pupils a little bit and they'll notice that they'll have more motivation to get things done.

>> But there is a drawback to that because if you use more and more caffeine over the course of time like many chemicals that increase dopamine, you can get used to that effect.

>> So as I open up the brain here, there's the inside of the brain, the nucleus accumbens is right in here in the middle part of the brain the nucleus accumbens will secrete dopamine .

>> That's the feel good motivating energizing chemical in the brain.

And if you keep stimulating dopamine with something along the lines of caffeine, you can kind of get used to that effect so you might need more more caffeine to get the same effect.

>> Coffee has about 100 to 120 milligrams of caffeine in it per cup whereas TI has around 30 or 40 milligrams of caffeine and that's why for a lot of people they'll do better if they have if they have tea first thing in the morning because it gives them a little bit less of a caffeine jolt and then they have coffee later on that will be more appropriate for them if you sip on coffee or sip on tea throughout the day you'll get a constant flow of caffeine that way and thereby knock the adenosine off the receptors and thereby allowing you to maintain energy.

But a lot of people will notice that when they drink high amounts of coffee all day or they use caffeine throughout the day they'll notice that they have better concentration .

Some of these people have a condition called attention deficit disorder or ADD if it has the hyperactive component or the impulsive component it's called ADHD and for those people they have decreased activity in this front part of the brain up here it's called the dorsolateral prefrontal cortex decreased activity in this part of the brain lot will cause you to have difficulty with attention on things that aren't very interesting though you'll have more trouble distractibility.

You'll have more trouble with impatience.

You'll just have our time focusing on things for a longer period of time.

So for those people they will self medicate the attention deficit disorder in ways not unlike using eyeglasses to help you focus your vision if you're nearsighted, if you use caffeine for add it will help you with focus and concentration.

It's just that the effect won't last very long.

Caffeine gets in your system gets out of your system pretty fast.

So for caffeine to work best for attention deficit disorder self medication you'd have to kind of sip on coffee throughout the day and many people don't do outdoor.

They'll chug down a cup of coffee within 30 minutes or so and it'll last them for a while but then it gets out of their system.

>> How do you know you're getting too much caffeine while you're getting too much caffeine if you get a bit of a tremor, if you get stomach upset, if you feel jumpy, if you knows your heart starts racing, if you notice that you get a little twitchy, some people get kind of twitchy when they get too much caffeine and most importantly, if you are using too much caffeine day by day, you know you're getting too much of it if the next day upon not getting as much caffeine you get a bit of a caffeine related withdrawal headache.

So in other words, if you're getting withdrawal symptoms from not getting enough caffeine, that can be a problem for you.

A lot of people prefer to decrease the amount of caffeine later in the afternoon and many people just can't drink caffeine after about five p.m. in the evening otherwise they can't go to sleep at 10:00 or 11:00 at night.

So you have to determine what the best dosage will be for you for concentration, energy, focus but not go overboard where you get side effects you withdrawal related affects overall.

>> Thanks for your question.

Let's go to our first caller.

Hello Gary.

Welcome to Marisela Mind.

Well, you want to know if aluminum and deodorant can cause dementia?

>> You know, Gary, that was discussed and proposed way back in the 1980s so that's been a speculation for a long time.

>> Then they had deodorants.

It came out that didn't have aluminum in the issue with aluminum as in the amyloid plaques and in the the Talil tangles of the brain of people with Alzheimer's dementia that some of the pathology seen dementia and sometimes people will have noticeable amounts of aluminum in the pathology of the brain that's responsible for dementia.

I don't think it's definitive enough to go off of caffeine or go off of aluminum in general or to give up aluminum the beverages that are packaged in aluminum cans.

>> I know that was a big push back in the 1980s and for many people they quit using beverages that were packaged in aluminum cans but I don't think it made that much of a difference.

So based on what I am aware in twenty twenty three at this point, Gary, I would not say that the that the amount of aluminum and deodorant or in aluminum cans has a noticeable effect in increasing dementia for people now we're always looking for risk factors with dementia.

The main risk factors for dementia will be number one getting older, getting older is a big risk factor for dementia.

>> About two percent of us can have dementia when we're sixty five but you get up to around eighty or eighty five years of age you have about one out of three chance of having dementia and if you get to be one hundred years of age you have about a 50/50 chance of having dementia and the early signs of dementia will be difficulty with names and you'll have difficult names and that's part of normal aging but it gets to the point where it's just not names of people but it's names of things.

So somebody holds up a brush and you have no idea what it is.

>> You just can't name it.

They'll have to try to name animals and you can't name animals that you could name previously.

So just naming things can be a problem for people when people have dementia they'll have trouble with geographical orientation.

They'll forget where they are and they'll be very confused and that's why many people with dementia will struggle with being able to drive a car because they'll forget how to get home when you have dementia sometimes there can be personality changes.

You may have heard about frontotemporal dementia more recently in the news with Bruce Willis being diagnosed with that, the famous actor who's in his late sixties right now.

>> But frontotemporal dementia mainly affects the front part of the brain as the name implies in the temporal lobes and it will affect your personality and it's it's a tragedy for somebody like Bruce Willis because he needs to memorize scripts and one of the key features of frontal temporal dementia will be you can't remember things well enough to be able to recite words and sentences and you can't remember scripts and over the course of time frontotemporal dementia can give personality changes where you get more irritable and moody.

It used to be called Pick's disease pick a doctor pick is a person who first talked about it over one hundred years ago and that's why it's called Pick's disease.

But frontotemporal dementia is the more common name for that nowadays.

But dementia is something that as number one risk factor is your age.

But another risk factor will be the genetics.

It does run in families various types of dementia run in families and obviously the risk factors for dementia are preventable and that's what we're always looking for aluminum not so much but I'd say blood pressure disturbances, high blood glucose as diabetes can be a risk factor for dementia head injuries can be a risk factor for dementia and high lipids over the course of time can be a risk factor for dementia as well.

>> Gary, thanks for your call.

Let's go to next caller.

Hello Kay.

Welcome to Matters of Mind.

Kay, you want to know what I'd recommend for someone who suffered from depression most of their adult life being isolated from others will contribute to depression and obviously it sounds like you're concerned about that when you're isolated from other people it kind of will cause depression to blossom.

We saw that with so many people during the covid restrictions that people endured because with alcohol restrictions they were not not allowed to socialize and yeah, it was OK for a week or so but then it got to the point where a lot of people got more and more depressed and it speculated that that's why many, many people resorted to substances of abuse and the opiate epidemic issues with sky high during that time and it's thought that overall depression tripled during the covid pandemic restrictions and it's thought that that social isolation was directly contributing to that.

So there was a big mental health crisis that occurred due to the lockdowns due to the social isolation that people had to endure.

So with that being said, there's different types of treatments people can use for depression.

There's always the psychotherapies, the talk therapies, the interpersonal therapy, cognitive cognitive behavioral therapy is very popular for people who have depression group therapy especially if you have difficulty with socialization, if you're having difficulty within a marriage, obviously marital therapy can be helpful.

So there's different types talk therapies that can be beneficial but we're finding that for many people medication choices can be very helpful for them.

Now back in nineteen eighty seven Prozac came out and that was the first of roughly six newer antidepressants that became available over the course of the following thirty years or so because after Prozac these other medications became available that enhanced serotonin, norepinephrine and dopamine in different ways and those are chemicals that if you affect them they can affect your mood and help you with motivation and energy and concentration.

More recently we've had a medication called ketamine which is a nasal spray that's used under supervised situation.

You'll sit in an office for two hours and be monitored very closely twice a week for the first month, once a week, the second month than every other week or weekly thereafter.

But as ketamine has been very effective for helping people with depression or other medications did not help them.

And the reason is this ketamine is a medication that's stabilizing his chemical called glutamate glutamates and excitatory chemical.

It's an accelerating chemical in the brain and glutamate is a chemical that if you get to love it you can have trouble with depression and poor concentration.

>> But if you get too much of it you can actually have seizures and psychosis.

So you want just the right amount of of glutamate and glutamate regulation is very, very important.

>> So it's ketamine is one way to do that.

Another medication has been used just for the past several months is a medication called All Valide of it is regulating glutamate a little bit different way than the glutamate is regulated with US ketamine there are some similarities in how they act but it too is regulating glutamate and we're fighting people on as ketamine and all valide getting improved treatment responses to a greater degree than what they got with the previous medications.

So I'm always emphasizing to people that if something or another didn't work for you in the past, the first thing we need to do as clinicians is to have an adequate diagnosis where we will determine if you have depression, if you have bipolar disorder, if you have post-traumatic stress disorder.

All these different factors can affect how somebody responds to medication and to psychotherapy .

So we want to determine what kind of condition we're actually treating.

Secondly, we want to look at your family history family history is very, very important in determining what kind of medication responses people might have some people in the families might do really well with certain medications not so well with others.

So we want to look at your family history of medication treatment responses.

We want to look at other medical conditions that you might be experiencing when people, for instance, have sleep apnea, low thyroid glucose disturbances, low iron, they can all give you difficulty with mood and anxiety where antidepressant medications might not work so well.

>> So we want to kind of think outside the box for people and very importantly we want to look at what medications you've actually taken in the past and what kind of dosage did you take?

>> How long did you take them?

How did they do for you?

Did they give a side effects?

>> Did they give you bad effects that you give you good effects in any way?

We try to sort all that out looking at the different mechanisms of action of the medications you've been taking and from that make a good educated choice on what direction we can go with medication.

>> Genetic testing is is an additional dimension of treatment that we can consider if we use genetic testing it gives us a little bit better idea on which medications might work better for you a little bit of an idea there.

But they also very importantly genetic testing will give us idea on if you need a high dosage or low dosage of certain medications because we all have genetics to break down medications at different rates in different classes.

So what gives us an idea on which medications you will break down quickly and which ones you'll break down slowly and we need to adjust the dosage accordingly and also with genetic testing can we determine if you're a metabolizing folic acid adequately?

Folic acid is vitamin B nine so it's B vitamin but folic acid needs to be broken down into elemental folate for it to work on serotonin, norepinephrine and dopamine.

So some people need to take the byproduct of folic acid because they don't break down folic acid adequately.

And the only way you're going to definitively know that is by looking at the genetic testing.

So there's a lot of different things we can use nowadays for the purpose of helping with depression for people who have endured depression for a long time.

>> But I often advise people to go back to doing things it used to be pleasurable.

One of the things that people will do when they get more and more depressed they give up what used to be pleasurable and when you give up pleasurable activities it's a vicious cycle and it makes you more depressed .

>> So if you used to do something that was enjoyable or fun, try to go back to doing that again even though it wasn't it's not something you really want to do because you're too depressed to do it so part of depression is where you don't enjoy things.

You're motivated, you're having low energy.

You want to go back to doing the things that used to be fun and try to have fun again and sometimes that's kind of tough to do when you first coming out depression.

>> OK, thanks for your call.

Let's go next caller.

Hello Rick.

Welcome to Matters of Mind Rick.

>> You want to know if there's a difference between people being left brained or right brained or is it just a myth not a not a myth, Rick.

>> Basically women have a thicker corpus callosum now the corpus them is right in this big band right in the middle of the brain and it connects the left side of the brain on the right side of the brain, women will have a wider corpus callosum so that just by the structure of the brain so there are differences in brain structures between men and women.

>> So with that in mind, women tend to use the left side and the right side of their brain a little bit more effectively than men.

Men will be predominantly left brained left brained means that you're more analytical analytically thinking you tend to think more with details and facts and facts right brain you more abstract.

You're seeing more geometric figures right brain you're more artistic in a lot of ways.

So there's a difference in how the left brain the right brain work.

Now Rick, keep in mind that if you have a massive stroke on one side of the brain, the other side of the brain does tend to compensate to some degree over the course of time maybe over the course of six months, a year, even two years.

>> So it used to be thought that if you had damage to a certain part of your brain that it was dead forever.

And now we realize the brain is what's called neuroplastic.

It tends to regrow in different ways and it can compensate for areas of the brain that are damaged.

But that corpus close them that big band of tissue in the middle of the brain that connects the left side of the brain and the right side of the brain.

And you might have heard about some famous people in history who lacked a corpus callosum the character on which Rainman the movie with Dustin Hoffman 20 30 years ago was based the character on which Rainman was based.

He didn't have a corpus callosum and if you don't have a corpus callosum and your left side and your right side of your brain are not connecting, that will give you some outside of the box thinking and that can give you some autistic features and people can have some really some extraordinary abilities to memorize and to recite different things.

So the corpus callosum is important for connecting the left side of the brain, the right side of the brain.

But at the same time apparently don't absolutely positively need it to be able to function.

>> You might actually have some extraordinary abilities if you don't have the corpus callosum but it's probably necessary for the purpose of integrating thought processing socialization people with autistic spectrum conditions will often have difficulty with being able to connect socially to other people because they have trouble with mirroring others and there's actually a set of neurons in the right front part of the brain up here called mirror neurons in the right front part of the brain and these mirror neurons as the name implies are for the purpose of mirroring the behaviors and the facial expressions of other people.

So as we talk to people, whether you realize it or not, if you don't have autism No one you're looking at them in the eyes and no to your to some degree just naturally mirroring some of their behaviors as you're trying to connect to them.

And that's actually a a little bit of a strategy when you're conversing with somebody and trying to connect to them intentionally try to mirror some of their behaviors being very subtle about it.

Don't be annoying about it but just mirror some of their behaviors as if they're folding their hands, if they're moving their feet in a certain way by all means you can mirror those kind of behaviors and it's a way of socially connecting to other people.

Individuals with autism disorder have struggles with doing that.

Rick, thanks your call.

>> Let's go to our next email.

Our next email reads Dear to the father what is normal mental health ?

>> This is a common question I hear people will say, you know, use psychiatrists to diagnose people with depression.

Anxiety will have depression, anxiety and that's true depression, anxiety, apathy, anger, happiness those are all normal emotions.

>> So we should have a normal fluctuation of emotions that's called the vicissitudes of emotions and that's just life .

Otherwise we're robots and we don't have the emotional wellbeing we should we should experience.

>> So having ups and downs throughout the day with your emotions based on the circumstances as they call for it that is perfectly normal and that's really OK where you have abnormal mental health starting with that definition is where these emotions hijack your behaviors and every day because of your anger, because of your depression, you're having trouble on the job.

You're having trouble with the school, you're having trouble with socializing, you're having trouble getting along with other people you can't concentrate and it's because of your mood or your emotions or if your emotions hijack your front part of your brain, your emotions are often based down here in the amygdala.

That's the anxiety and anger volume control on the brain and so little almond shaped body right in the temporal lobe if that can hijack the thinking part of the brain, the front part of the brain.

So if your emotions are out of control yeah on a day to day basis the rule of thumb is a week or two on a day to day basis if it's causing you functional impairment where you're having trouble on the job work, you're having trouble socializing, you're having trouble with interpersonal relationships, you're having trouble getting things done when your emotional state of mind causes you to have difficulty with your day to day living, that's where it's a problem.

So what's normal mental health , normal mental health would be where you can pursue happiness.

You can socialize to a reasonable degree.

You can have interpersonal relationship, you're productive.

>> And I think something we often will try to examine when somebody is having difficulty with their emotions and determining if the recovering will be if they're able to be productive and self-sufficient self-sufficiency is very important.

>> Yeah, we rely on others to a degree but you should be able to take care of yourself.

You should be able to at the very basic level to complete your activities of daily living where you shower and you shave and you get up and you do what you need to do and you get cleaned up then you should be able to take care of your meals and you should be able to feed yourself.

That's a very basic level of self-sufficiency that I'm talking about being able to meet the needs of not only yourself but those around you.

So that's often a measure of improving mental health when we see people being able to be more productive and being able to be more self-sufficient and really in the long run good emotional and mental health will thereby lead to good physical health .

And so if you're emotionally stable you're more likely to be physically stable people with a lot of anxiety, anger, depression, rage they will have difficulty from a cardiovascular standpoint.

They'll have higher cortisol levels leading them to have a higher likelihood of obesity and diabetes.

So they have all these medical complications with their physical health because of their emotional well-being and and it's something will often examined with people you can't separate the emotional state of mind from the physical state of the body.

They go hand in hand.

So if your emotions are out of control, if you don't have good mental health , it can affect you physically over the course of time.

And it's even speculated that people who have a long history of severe mental illness can have higher likelihoods of various types of cancer because cancer is based where the body starts growing cells abnormally and there's always the question what triggers that abnormal growth of cells and it's thought that depression, anxiety, irritability, anger those can be all risk factors for those people.

So when we talk about good mental health , we're talking about being able to be self-sufficient, being productive, being able to pursue happiness.

I mentioned earlier the need for us all to have pleasurable enjoyable activities.

You should be able to find things and do things that are fun for you and you should do those with other people ideally because with social isolation you're more likely to be depressed and when you have all these factors running on all cylinders for you, the idea would be physically you're going to be in better shape and it's an interesting phenomenon when people get more depressed they get more anxious.

They'll go one extreme or another on their diets, on their diets.

They might just shut down and not eat hardly anything at all because when some people get depressed and anxious they just can eat other people get depressed and anxious.

They crave carbohydrates and they start eating salty things that are often crunchy and they'll do this kind of as a self soothing effect.

But if you blast yourself with carbohydrates it temporarily increases your insulin level.

>> If you increase your insulin level it briefly increases the transportation of tryptophan into the brain tryptophan as a building block for a serotonin .

>> So blasting yourself the carbohydrates briefly gives you a sense of calming and a little bit of a self soothing.

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 at WFA dot org.

I'm psychiatrist Jeff Aubury 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.

Have a good evening