.

.

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

Welcome to Matters of the Mind now in its 25th year are 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 in the Fort Wayne area by dialing (969) 27 two zero or if you're calling long distance you may dial coast-to-coast at 866- (969) 27 to zero.

>> Now on a fairly regular basis where 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 and I can answer on the air you may write me via the Internet at matters of the mind all one word at WFA org that's matters of the mind at WFYI Dog and I'll start tonight's program with an email I recently received.

>> It reads Durata Volver I've noticed when I'm sad and it's darker outside I eat more meal time and junk food in between.

>> Is there a way to retrain my brain?

How do I reward systems?

>> How do the reward systems in our brain work?

How do they affect habits and even things like addictions?

Can mindfulness play a role?

Well basically when you're sad and it's darker outside it can be a vicious cycle because your brain instinctually is thinking that it needs to feed it more serotonin now serotonin has a byproduct called tryptophan and it's a building block for serotonin and so you need tryptophan to build serotonin.

>> So the way that you can get more tryptophan to the brain is by increasing your insulin levels.

>> How do you increase insulin levels by carbohydrates?

>> So it's a vicious cycle.

You might crave carbohydrates as a means of indirectly increasing serotonin to help with anxiety and depression and give your brain somewhat of a calming effect.

>> But in the long on you feel lousy because in your insulin drops and when you get these spikes of insulin and drops in insulin it'll cause you to feel lousy.

So the first thing to do is try to back off the carbohydrates if it's in a box or a bag basically don't eat it because those are the kind of things that will tend to crank up the insulin levels excessively, try any more protein, more protein, more fiber especially during the wintertime and during the wintertime.

Especially important for you to try to get a little bit of physical activity first thing in the morning.

Some exercise 20 minutes of walking is great first thing in the morning go outside maybe for just a few minutes.

It's kind of cold out there but it exposes your brain to the light because we now know and we have for the past 30 years that darkness in the wintertime will actually give a signal to the brain that it's dark and the signal to the brain goes to the pineal body from the retina and the pineal body is right smack in the middle of the room.

The pineal body will secrete melatonin and appears you get excessive melatonin during the daytime making you tired, making you kind of feel like blah sometimes more depressed and that will cause you to somewhat withdrawal.

>> So it's important in the wintertime especially to exercise expose your brain to some light periodically and that can be a natural outdoor light or it can be a light box that some people will use inside go easy on the carbohydrates and try to socialize.

Many people in the wintertime at least in the Midwest don't socialize adequately in Wisconsin and northern Minnesota they embrace the winter times and they have all these festivals and are always socializing.

>> So try to get out and about among people.

We were told over the covid restriction years that we shouldn't be around other people especially in the wintertime.

But from a mental health standpoint it's very, very important to have that kind of contact overall.

>> Thanks for your email.

Let's go to our first caller.

Hello Bartholemew.

Good good to see.

>> Thanks Doctor.

Are you doing tonight?

All right.

Thanks Will.

My question is kind of simple but complex.

Oh how healthy do you feel texting is with phones and people try to deal with they just don't have the courage to call and speak but can they hide behind vague comments and questions?

And when I go to meet them it's really hard to deal with them because we've set up a superficial idea of something that we can't talk about and I mean that might have some mental effects down the road or you think people are just hiding from the truth and I don't know, I'm just leave it at that to tell what you think.

>> I think you're I think you're spot on Bartholemew because when people are texting you don't have the emotional overtone associated with speaking to somebody face to face.

>> You don't have the eye contact.

You're not picking up on the social cues that you would if you were to seeing somebody face to face.

>> So texting is good for leaving somebody a brief message saying I'm going to be ten minutes late or how about meeting at this time brief messages great for texting but to try to convey a message beyond that just base beyond basic information probably not a good idea because you need that emotional overtone and and the complexity of that when people have autism, for instance Bartholemew people with autism will have difficulty picking up social tones from other people.

In other words, they can't read their faces.

And when you have autism it's thought that is right front part of the brain is a bit underreact even when that part of the brain is underactive, you don't have the ability to mirror other people's behaviors which we naturally do and we're conversing with people and there's an inadequacy of these neurons that are called mirror neurons with people with autism and they're right up here on the right front part of the brain.

>> Well, that's what we use as we're interacting with somebody face to face and you you hit it dead on there, Bartholemew because when you're texting you don't have that and it's very important when you're texting to realize that texting can be taken wrong goes along with the email to email is very important.

Many times email can efficiently be used to convey information and exchange ideas without having prolonged meetings and the commute that is required for meetings.

But we need to be reminded that people can take texting and emails wrong because you're not face to face with somebody.

>> So it's texting is great in terms of exchanging basic information or texting often and a means but in a manner by which you don't want to interrupt somebody if they're doing something else.

If you telephone them sometimes you can cut in on our conversation and interrupt them.

Texting is just for the purpose of exchanging information and that's where it should be left.

If you're exchanging ideas buddies by texting you're right Bartholemew that can be problematic from a mental health standpoint.

Bartholemew thanks for your call.

>> Let's go to our next caller.

Hello Bill.

Welcome to Matters of Mind.

Bill, you want to know is all natural apple cider vinegar good for the heart and brain?

I wouldn't say necessarily for the brain, Bill.

>> Apple cider vinegar has been proposed to be somewhat effective in modulating insulin levels and helpful for some people to type two diabetes and that's all I've heard with that.

It can give you acid reflux as a problem as a problem overall.

But I wouldn't as a psychiatrist recommend apple cider vinegar for the purpose of brain benefit.

>> It might have other health benefits but that's outside of my my scope of practice Bill, Bill, thanks for your call.

>> I want to go back to the prior email I discussed were the the person who was sending me the email about winter depression also asked about addictions and the whole nature of addiction which is really a separate phenomenon when you have addictions basically you're getting this high in excitement when something's happening and you get this little dopamine surge from this area of the brain called the nucleus companies right down here right in front of the pituitary gland and when the nucleus accumbens gets stimulated you get this surge of dopamine, you feel good.

So the nucleus accumbens is like the Las Vegas of the brain .

>> It's a fun place and it secretes dopamine and to get that same dopamine rush sometimes from an addictive standpoint you need more and more and more of a high to be able to be achieved and because of that people will tend to have more reckless behavior as they're trying to chase after that high.

So an addiction basically involves needing to go back to do something again and again and again to be able to get the same excitement and the same motivation and the same energized effect from a particular behavior.

>> Now overall you can get that dopamine rush, that dopamine excitement by exercising on a regular basis and you can get that from having stimulating activities.

People will get a little bit of that dopamine rush when they're watching a football game.

That's why people enjoy lives sports because there's the excitement of watching the game, the unpredictability and there's actually increased testosterone release that it's been shown with men when they watch sporting events.

So dopamine release can occur when you're watching sporting events and doing any kind of activity that can be exciting for you now exercise is something is kind of interesting because yeah, it will increase dopamine release and give you that feel good effect but dopamine increases to somewhat opposing chemicals one being glutamate which is an excitatory chemical and another one being gabb which is inhibitory chemical.

>> So glutamate is for the purpose of giving you energy motivation get up and go gabb is the brakes on the brain and they oppose each other when you exercise you will actually increase both glutamate and GABA so you're getting more energy and you're getting more excitement and enthusiasm from exercising but you also get a calming effect from exercising because you're also increasing the breaking chemical in the brain.

So many people in the exercise will notice yeah they feel more energized and they feel better after the exercise and they're glad he did but they also feel calmer after exercising.

So that's why exercise is so important for a lot of people and I'm often advocating especially in the wintertime that people exercise for twenty thirty minutes at a time.

>> Nothing highly intensive necessarily but just go for a walk and just do something physically active to get the heart rate going up for a few minutes and try to get some exercise that way because that can offset many of the different effects from winter depression overall.

>> So thank you for email.

Let's go to our next caller.

Hello Matt.

Welcome to Matters of Mind.

Matt, you want to know the difference between borderline personality disorder and bipolar disorder, borderline personality disorder that has a connotation among clinicians such that it can be difficult to treat and I don't think you should because I believe the borderline personality disorder is actually a variance within the bipolar disorder spectrum.

In other words, as part of bipolar disorder, when we talk about bipolar disorder alone we're often talking about bipolar disorder type two and bipolar disorder type one bipolar disorder type two is where somebody will have little highs manic episodes where they don't need to sleep.

They're talking really fast.

They're going from topic to topic to topic.

>> They're impulsive and it goes on for four to six days and then they have these big lows depressive episodes.

They don't enjoy anything.

They're sleeping too much.

They don't socialize, they're withdrawn.

That goes on for at least two weeks.

>> So bipolar disorder type two is where you have a little highs for four to six days.

Then you crash furloughs for at least two weeks.

>> Bipolar disorder type one on the other hand is where you have one week of Skyhigh mania that gets you in a lot of trouble again during that time you don't sleep so much.

You get impulsive, you do things and say things ordinarily wouldn't save me.

People with bipolar disorder type one often have difficulty on the workplace and with their marriages and with bipolar disorder type one you may or may not crash into a so what does borderline personality disorder fit in there?

>> Well borderline personality disorder is basically where you might have bipolar disorder in your family history because there seem to be linked genetics between bipolar disorder and borderline personality disorder.

In my perception they're not too far from just being the same as borderline personality disorder is a variant of bipolar disorder in my in my belief.

But with borderline personality disorder your mood is reactive to people in situations so stuff happens and you're under stress and especially with interpersonal relationships you feel rejected.

>> You feel like somebody has done wrong and you feel devastatingly depressed and during that time you can get very irritable, you can have a hair trigger temper.

>> You have these mood swings people describe themselves as having roller coaster moods and it's usually reactive to people and activities now with bipolar disorder type one Type two people would just wake up on a Wednesday morning and they they're higher than a kite or the low.

>> It just comes on out of the blue but with borderline personality disorder those mood swings are typically provoked.

>> So it's a treatable condition.

Yeah, they're both conditions evolve mood swings but you treat them kind of with the same medications with bipolar disorder you're going to use mood stabilizers not unlike using a cruise control on a car to keep it from going too fast or keep it from going too slow .

>> A mood stabilizers simply is for the purpose of leveling out your mood so you don't overreact when situations are somewhat stressful and then you don't crash into depression.

>> So we use mild well tolerate mood stabilizers for borderline personality disorder to basically help people put up with stuff.

Now earlier I mentioned that chemical called glutamate.

It's thought that when people get depressed they get way too much glutamate in their system and that causes them to be irritable and snappy and they have a hard time tolerating things.

>> There are medications like Lamotrigine that we commonly used for borderline personality disorder that is an anti seizure medication and as Nattie seizure medication it's affecting glutamate such that you don't have excessive glutamate transmission and thereby it's leveling out the mood and many people will find that they like the effect of Lamotrigine or Lamictal because it doesn't cause weight gain typically doesn't cause sedation or a lot of side effects.

>> It tends to be very well tolerated.

Lamotrigine and has the potential side effect if you increase the dosage too quickly you can have a rash on the neck or face and get this really serious condition and one out of four thousand cases called Stevens Johnson syndrome and we have to watch for that and it typically occurs within the first two months of taking limosine if you're going to have that particular reaction.

But it's quite rare more commonly seen with adolescents and young adults and especially when somebody is taking up the dosage on the motor gene way too quickly.

So when we use the motor gene or Lamictal we're going to use very low doses for the first four weeks and gradually increase the dosage.

>> But that's the kind of medication we'll use with borderline personality disorder.

Now with bipolar disorder it's more serious form of mood swings with bipolar disorder it's thought there's an inflammatory state of the brain where you have this particular chemical called s 100 protein.

>> So s 100 protein is an inflammatory chemical that increases in the brain that will cause somebody to be irritable and manic and they can't sleep so that's thought to be an inflammatory condition when you have a big manic episode.

So for those patients we often find the medication like lithium can be helpful because lithium is an anti inflammatory on the brain.

It calms down the overall brain inflammation and lithium is a very, very good mood stabilizer for people were having predominantly manic episodes.

So we'll use lithium sometimes we use a medication like Depakote which also has a very strong antiinflammatory effects We use medications that are the so-called antipsychotic medications.

Antipsychotic medications used to are used not only for psychosis but they're used for mood stabilizers with bipolar disorder type one where you have a manic highs you want to be careful using any antidepressant because antidepressants can sometimes provoke the highs and cause you to cycle more if you have bipolar disorder type two you can use an antidepressant very cautiously, often with a mood stabilizer.

But with borderline personality disorder we're often going to be much more conservative and using the medication and we're just trying to stabilize out the mood some sometimes we'll use an antidepressant.

Sometimes we use a bit of a as needed medication for anxiety.

But the main treatment for a borderline personality disorder will be talk therapy to be able to just help you understand what's setting you off in different situations and understanding the type of activity that you have developing interpersonal skills and just trying to create coping mechanisms that you can deal with with with borderline personality disorder.

>> People often are very impulsive and they have a difficulty with interpersonal relationships often because they have a track record of very traumatic experiences.

They have post-traumatic stress disorder in many cases but they've had traumatic experiences in their growing up years.

They've had difficulty with their parental engagement.

They felt like they've been abandoned as children and that hard wires the brain into having more reactivity, more moodiness, more depression, more anxiety, more difficulty to trust.

The brain is actually hardwired in those kinds of situations to be more active to stress and that's where we'll use medication to try to get things back on track as you're developing the coping mechanisms in talk therapy, thanks for your call.

>> Let's go to next caller.

Hello Allen.

Welcome to Matters of Mind.

>> Collin, you mentioned using ecstasy years ago.

That's a medication that will affect serotonin transmission and now you're having uncontrollable mood swings.

Will that go away and should you seek help?

Alan, I'd suggest that if you used it in years past it's a medication.

It does affect the serotonin transmission and it might have thrown you off a bit.

>> Uncontrollable mood swings not uncommon as an after effect from that.

>> So yeah, you could probably benefit from a mood stabilizer if and the key word there is if you're having difficulty with functional impairment, if you're having trouble with your job, you're with getting along with other people.

If you're having trouble getting through day to day by day life because of those mood swings, that's where you want to seek treatment.

Will it go away?

I can give you a definite maybe the bottom line is the longer you've been using any substance like ecstasy and the higher doses, the more likely is going to be there for a longer period of time than you'd like if used just on an isolated basis just maybe once or twice maybe it's not going to be there more than six or eight months.

But I'm often talking to people about the use of marijuana in this kind of context, Alan, because marijuana at high doses and frequent use can no one suppress the growth of the brain.

But it also can provoke psychosis in people who are genetically prone to having psychosis.

So some people have a genetic predisposition to having a condition like schizophrenia where they have psychosis.

They can hear voices when people aren't around.

They have these delusional thought patterns with which involve fixed false beliefs and they might not have had those kind of conditions had they not used marijuana when they were in their early adult or adolescent years.

>> So we're often recommending to people especially if you're under twenty four years of age never, never, never use marijuana because it's so damaging to the brain it suppresses the white matter growth of the brain, the white matter growth of the brain is the shielding.

>> It's the insulation of the individual neurons and if you suppress the growth of the White matter of the brain you'll never one based on a lot of research out there have lesser IQ than be expected later years but no to have more of a likelihood for having depression, poor motivation and eventually there's a significantly higher likelihood of somebody getting psychotic because of the marijuana itself ,especially with a higher potency marijuana that we see with the new hybrids now compared to twenty five thirty years ago with the plants you have hybrids you're mixing and matching different plants together and you're getting more potency with your THC tetrahydrocannabinol Dayal and in doing so you're getting higher potency of the hallucinogenic effect that can evolve from the from the THC itself.

So we're often recommending to people that they don't use the marijuana especially before twenty four years of age.

>> Now I used to think that OK, once you get in your 30s and 40s it might not do too much harm.

But there was a study that would that came out in the American Journal of Psychiatry just this past year showing that if people did continue using marijuana in their 30s and 40s they did indeed have lower IQ than expected.

They had more trouble with their intellect, their concentration, their focus, their memory compared to what they would be expected.

>> So now it appears that even that that cognitive impairment we hear about with the adolescents, young adults if you start and use marijuana in your 30s and 40s, that can still be a factor.

And I bring that up because a lot of states are recreationally legalizing marijuana when that occurs it's the society perceives that the government if by endorsing the recreational use of marijuana that they've determined that it's safe and has low long term effects and a lot of people will actually tell me that the states wouldn't legalize it if it wasn't safe and didn't have long term harms.

>> Well, it appears to do to be the case and people often compare it to alcohol.

They'll say well, alcohol has been legalized.

Why should marijuana be legalized when alcohol was legalized long ago?

>> I think you could certainly make a debate that marijuana is actually more damaging to the brain for adolescents and young adults people up to twenty four years of age it's more damaging to the brain than alcohol even though our alcohol is not good for the brain of an adolescent or young adult marijuana is probably even worse because it's physically suppressing the growth of the brain as people are getting older such that when they get to to be in their 20s and early 30s they might have difficulty with concentration and memory in such a way that they didn't earlier.

>> I'm often looking for that with people when people say they're using marijuana I'll ask how often and how much do you use because I want to know to what degree they might have that impairment in brain functioning.

So is it true marijuana dependance or cannabis dependance?

Well, technically if you're using it more than about three times or four times a week, that's considered to be dependance.

And if you're using a daily even though you might not have physiological effects of withdrawal from it if you're using a daily it's probably having an effect on your brain that's going to affect your brain chemistry and make you more prone to having difficulty with concentration, motivation, mood overall and even sleep.

And we have to take that in consideration as we're treating people because we know that and we might be able to help them to some degree but it's going to be an uphill challenge if somebody used marijuana on a regular basis for years and years.

>> Alan, thanks for your call.

Let's our next email question.

>> Our next e-mail question reads During the fog of war, can you describe the difference between a mental and physical addiction?

I kind of mentioned that earlier and addiction in general is basically a condition where you're firing up that dopamine in the brain.

>> You're feeling good, you're feeling happy.

It's exciting.

It's energizing and a true addiction is where you typically need a little bit more and more and more of the behavioral or substance to get the same effect both a physical and a and a mental addiction will often be prone to needing more and more of the behavioral or substance to get the same effect.

But also with each of those types of addictions you'll notice that you kind of want to stop but it's difficult to do so it's not something you can just easily stop on your with any addiction whether it be mental or physical you can have problems with lying about it.

>> You don't want other people to know about it so you lie about it and you deceive others to believing that you're not doing the behaviors.

>> So with any addiction if you're lying about it, if you're having a hard time stopping it, if you're noticing that you're needing more and more of the behavior to get the same effect that's what addiction is all about.

>> And what you're doing is you're trying to stimulate that little area of the brain that's secreting the dopamine itself and what's the difference?

>> A physiological or physical addiction is where when you stop it you physically get sick.

>> So for instance, alcohol when you stop alcohol and get shaky, sweating, nauseated, you tend to in some cases even see things and have what's called delirium tremens.

>> But with alcohol withdrawal from it can be quite troublesome.

The same with opiates, with opiates people will have difficulty with diarrhea, they'll get chills.

They'll get a headache when they're stopping opiates abruptly.

That's a physiologic goal, a physical addiction to the substance.

A mental addiction is where when you stop it you might not get physically sick.

>> That can be something like gambling or pornography if you stop it you don't physically get sick but you crave the behavior again.

>> You hide the behavior from other people and you need more and more of the behavior to get the same kind of an effect.

But in both cases, whether it's a mental addiction or a physical addiction, you're arguing that surge of dopamine release and for some people that can include social media.

There's been a lot of studies done in the past 10 years showing that with social media people are getting that little bit of a surge in dopamine every time they see something exciting on social media.

Of course the social media sites have done a very nice job of creating these algorithms to know what you're viewing and they will create scenarios where they keep giving you more and more of that kind of information knowing that your preference viewing certain types of sites and trying to up the ante in terms of how much stimulation you get from each of those sites.

>> So that's all creating a dopamine surge and like any kind of chemical in the brain if you get too much of it, it eventually kind of wears out and you need more of it.

So that's where people get in trouble with addictions.

>> Thanks for email.

Unfortunately I'm out of time for this evening if you have any questions concerning mental health issues you may contact me via the Internet at Matters of the Mind at WFB A Dog and I'll try to answer those questions on the air.

I'm psychiatrist Jeff Oliver and you've been watching matters of the mind on PBS Fort Wayne God willing on PBS willing.

>> I'll be back again next week.

Have a good evening.

Thanks for watching.

Goodnight