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

>> Welcome to Matters of the Mind.

>> Now in his 10th year Matters of the Mind is a live call in program where you have the chance to choose the topic of discussion.

>> So if you have any questions concerning mental health issues, give you a call the Fort Wayne area by dialing (969) 27 two zero or if you're calling 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 that I can answer on the air, you may write me via the Internet at matters of the mind all one word at WFA Edgar that's matters of the mind at WFYI ECG and I'll start tonight's program with a question I just recently received.

>> It reads Jarda to favor Is it possible to inherit trauma from previous generations?

>> My family has had a tough time for well over a hundred years with poverty, prejudice and war though things may seem good now are we unconsciously transmitting trauma to our younger generations?

>> Well, you know the whole idea of heredity trauma is probably not related to a hard wiring djinnit genetics based on the trauma itself but more on the possibility of your influence of having experienced the trauma with post-traumatic stress symptoms.

>> In other words, if you have a parent who was traumatized by war, by abuse, by weather or whatever kind of situation might have occurred to have inflicted that trauma there, the parents reaction to those kind incidences might have an impact on you based on the parents having difficulty with rage, irritability, impatience and so forth because those can all be symptoms of post-traumatic stress.

>> So it's not that you are hard wired to inherit the very same trauma they've experienced.

>> It's more that you're hard wired to to experience the impact of the trauma itself and that's particularly impactful for you when you're under eight years of age.

>> So if you're under eight years of age and you're around a parent who is emotionally abusive, who is very highly reactive due to post-traumatic stress that can have an impact on you and that can hardwire your brain.

So it's not the actual trauma itself that's hard wiring your brain.

>> It's the parents reaction to that trauma.

We saw that all the time over the past 20, 30 years with Vietnam veterans who then had children, the Vietnam veterans who had children.

>> If they had a lot of post-traumatic stress symptoms as a parent they would then cause the children sometimes to be anxious and they'd be somewhat on guard and on edge and you'd think well gee, it's almost like these young children who become adolescents and young adults also have the similar type of symptoms.

>> It's that they were influenced by their parental behavior so the parents can significantly influence a child's behavior long term if that child is exposed to emotionally abusive, sexually abusive, physically abusive behavior especially before the age of eight years of age as a young child the front part of your brain is growing up until the age of twenty four but especially before eight years of age.

That's very important.

That's why I will often use this questionnaire called the ACS questionnaire the Adverse Childhood Experience Questionnaire and the questionnaire is a scale by which we determine if somebody has experienced certain types of trauma.

They determine a long time ago that certain types of trauma were more likely to impact you later on from an emotional standpoint of physical abuse, sexual abuse if a parent was separated, divorced, if you had a parent who had a problem with drug abuse, if you had a parent who went to jail, these are all specific type of traumas as a child if you experience you are more likely later on to have emotional disturbances yourself and if you have four out of ten or more of those kinds of experiences, it's somewhat predictive on what antidepressants might work and what might not.

If you have depression for instance, if you have if you have over four of those type of experiences as a child, it's predictive that the serotonin based antidepressants won't work so well.

Now the serotonin based antidepressants only work really well in about one out of three people anyway.

But if you've had early childhood experiences with trauma, they're even less likely to work.

>> So some people wonder well gee, my friend takes Lexapro, my friend take Zoloft.

>> It works really well for them.

Why is it not working for me?

Well, a factor might be that you had different life , early life experiences and that could be an influence.

>> Thanks for your email.

>> Let's go to our next caller.

Hello Diane.

Welcome to Mastermind Diane.

>> You want to know what would be the cause for a person to repeatedly talk out loud while in a different room and have a private conversation to themselves?

>> Well, sometimes I am thinking about a less pathological form of that.

>> If somebody is talking to themselves and they're in a different room all by themselves sometimes how people think sometimes people are more auditory learners.

Now some people like myself are more kinesthetic learner where I like to be doing things as I learn some people have to hear things out loud so they're the people that like to go to lectures and hear the words spoken.

>> Other people are more visual learners where they like to see things written down.

>> They like the bullet points and they are able to learn better visually.

>> So if a person's talking to themselves sometimes they're just trying to learn and remember something out loud.

>> Now that's a less positive pathological case or pathological case if somebody is speaking to themselves in terms of having a conversation with themselves, they might be hearing voices.

Now that is a condition that we'd call schizophrenia or a psychotic disturbance but psychotic disturbances where you will literally hear a voice inside your head or outside your head and voice voices as clear as you'll hear a mind right now.

>> And the reason for this is that there's a disturbance in the hearing part of the brain and the speaking part of the brain up front.

Now generally you should be able to when you think a thought you typically think a thought in words and that thinking of a thought in words is in the front part of the brain here if you hear somebody talking to you that's in the back part of your brain and the auditory cortex there's a band of tissue called the Arquit physicalist the differentiate if you are thinking a thought or if you're hearing somebody talking to you if the Arquit physicalist is impaired you can't tell the difference.

>> So a thought that you're thinking becomes a voice in your head and it sounds very, very clear and when people are more sick with schizophrenia they'll hear voices occurring on the outside of their heads and they'll often talk to that voice back and forth.

Do they know it's a voice outside their head?

They it's as clear as it is is it is my right now so they will often respond to that voice.

Now that's a pathological situation where somebody speaking out loud because they're in a conversation.

So that's a psychotic disturbance that generally warrants treatment because that can be impairing you can imagine if you're trying to go through life and you hear his voice talking to you all the time.

Yeah, that's going to be very, very distracting.

So that's something you'd want to have treated the treatment for .

It would be using an antipsychotic medication that would strengthen the transmission and the ability of the argument for social physicalist to differentiate the thinking part of the brain to the hearing part of the brain.

>> Thank you for your call.

Let's go next caller.

Hello James.

Welcome to Matters of the Mind .

>> James, you've mentioned you've been on an antidepressant for a year and it's worked well until lately.

Would you need to switch or add a second medication when you're seeing a psychiatrist and what's that process?

>> I'll give you a definite maybe James, if you I'd want to look at several different situations.

OK, the antidepressant medication you've taken for a year had you taken it previously and had it worked well previously, that would be a good sign.

>> Has a family member taken that antidepressant and it worked really well for a long time.

That'd be a good sign.

Have you had some recent life stresses that might have caused you to have difficulties with what we call resilience?

>> Resilience is a fancy term for just referring to your ability to put up with stuff so if you take an antidepressant medication and helps you this much with putting up with stuff but then a lot of things happen.

>> For instance, you have trouble with your spouse, you're having trouble with work relationship.

Your children are causing difficulties in your life .

All these things are happening then your level of resilience sometimes will be somewhat impaired where you're not able to put up with stuff as much and the antidepression medication might be perceived as not working so well if you're taking an antidepressant and it worked well for a long time and then you start having highs where you have an underlying bipolar condition, bipolar conditions will be where you have a natural elevation's in your mood where you can have giddiness and sometimes you can have even irritability.

>> But during a time you don't need to sleep as much.

You are more impulsive.

You say things and do things you ordinarily wouldn't do or say and those kind of situations you need probably a mood stabilizers so an antidepressant medication might work for a while then quit working because you start having the highs come back and forth.

I don't want to consider comorbid medical conditions so if somebody has an antidepressant those working really well all of a sudden it seems to out it might be that you have an underlying medical condition like sleep apnea, low thyroid, diabetes, low iron these are all medical conditions that can all of a sudden make an anti depressant feel like it's not working.

Another possibility for an antidepressant not working would be if you took some kind of supplement for instance KBD if you all of a sudden took some CBD drops because a friend recommended them to you, you might notice that your antidepressant doesn't work as well as it did before because CBD has a tremendous number of drug interactions and I always tell people if they want to take CBD as a as a supplement for whatever reason that's OK. >> Just don't take with other medications because it's very likely it's going to interact with other medications and make the other medications more intolerable or even not work for that matter.

>> So then you have the possibility of well OK they are depression medication just pooped out that happens commonly with these so-called serotonin antidepressant medications Prozac, Zoloft, Lexapro, Celexa, Paxil these are medications that predominantly will increase serotonin transmission and in doing so they can indirectly decrease dopamine transmission and for some people they'll say they feel emotionally doll.

>> They don't feel happy, they don't feel sad.

They don't enjoy things this you're kind of blah and in those cases sometimes you can on one hand add an antidepressant medication like bupropion which increases dopamine and norepinephrine and then where do you determine that will often have people gauge how much better they're feeling on their current antidepressant if they ask them, you know, zero to 100 zero percent being the antidepressants not helping at all.

One hundred percent is fantastic.

You like how you feel.

Where are you feeling on a scale of zero to one hundred percent based on how that person's doing for you if they give me a score above 50 percent are usually leave the antidepressant on board and add something else, maybe another antidepressant that has a different mechanism of action and were commonly using low doses of the so-called antipsychotic medications that are dopamine receptor blocking agents and in essence they're further modulating how serotonin, norepinephrine and norepinephrine affect your brain.

>> Those medications include low doses of a belief safai result Varella Coprolite a lot of different medications out there that we're using now as a means of adding on to the antidepressant to kind of season the soup so to speak and make them work a little bit better if that's all you need, that's great.

Sometimes we do indeed need to change to an entirely different mechanism of action the serotonin, norepinephrine and dopamine medications we've been using for the past 70 years.

>> Sometimes they just don't give people the kind of effect they want.

So in the past five years we've had two medications come available that affect glutamate not just norepinephrine serotonin and dopamine.

>> One of the glutamate medications as a nasal spray that people can now use by itself called Salvato and was bravado you used as a nasal spray it or a monitor?

It's such a condition in an office setting for two hours at a time twice a week the first month, once a week, the second month and then it's spread out in your frequencies thereafter .

But the bravado is a medication that strongly will affect glutamate transmission of ality an oral medication that will affect glutamate transmission.

You can take it day by day by day and it's something that works entirely differently than the so-called serotonin, norepinephrine and dopamine medications.

>> So sometimes you just have to change to an entirely different mechanism action to try to get that kind of response.

>> But I don't want to look at the whole picture there.

I'd want to know that something happened recently that kind of set you off if something happened and you're having difficulty coping with your life circumstances by all means sometimes you need counseling or psychotherapy and people will often tell me I'm talking about medication and chemicals and all the stuff.

>> Where does psychotherapy come in and what does it come into play?

>> I often will compare the use of medications to driving a car.

When you're driving a car you need an accelerator to work.

You needed a break to work.

The accelerator is glutamate.

The brake is Gabb so you've got accelerator and brake gabbin glutamate that are working in this gray matter of the brain and they're like a teeter totter.

>> The accelerator and the brake are bouncing back and forth on the outside part of the brain.

>> Serotonin, norepinephrine and dopamine kind of give a little bit of advice to the glutamate and GABA and they're coming from the brainstem down here to spring up little little sprinkles of serotonin, norepinephrine and dopamine to tell the brain to speed up or slow down accordingly based on what seems to need and with that in mind, what there what's the role of psychotherapy?

>> Psychotherapy is kind of like when I drive through Chicago I've got to have my GPS on.

I can't keep everything straight.

I need the GPS talking to me.

Turn here, go here and with GPS it helps you navigate to your intended life goals if you don't really know where you're going at the time and you don't have life experiences.

So with psychotherapy it's like GPS where you not haven't experienced those kind of stresses before.

Psychotherapy can help you kind of navigate to where you want to go and what you need to do about certain situations just like GPS we tell you turn here, turn there.

That's the whole role of psychotherapy to get a professional's outside opinion based on your current circumstances, your coping mechanisms, your past life experiences, you put all that together and the psychotherapist will try to help you navigate your current situation just like GPS helps you navigate to your intended destination.

>> Hope that helps.

Thanks your call.

Let's go to our next e-mail question.

Our next e-mail question reads Dear to favor I was talking to a friend about new information regarding the clinical use of psychedelics.

He called it micro dosing.

What can you tell me about this micro dosing is in fact a means by which psychedelics are being used.

>> They're still very much into research and the research setting right now there was a failed trial recently for post-traumatic stress that kind of put a lot of the research back.

The psychedelics such as psilocybin have been discussed for the purpose of treating depression post-traumatic stress disorder at these very, very, very tiny doses like one twentieth the dosage that somebody might use on the street with the intention of then being monitored over the course of several hours during that so-called psychedelic experience with hopes that they'd get significant remission of their symptoms.

>> The psychedelics do indeed work differently than the traditional medications.

There's a lot of excitement about them.

It's just that they need to be used properly.

It used to be that the psychedelics were thought to need the at the shoulder psychotherapist available to talk somebody through the experience.

Now it's simply called psychological support where the psychotherapy is not so important as is simple support and reassurance by somebody whether be a psychotherapist or whomever at the bedside of the person when they're getting the psychedelic experience.

So I think we're maybe maybe a year or two years out were they're being used on a regular basis but a year or two ago I would have thought the same thing.

So they've been kind of pushed back a little bit right now but psychedelics might have a place in the future specifically for depression and post-traumatic stress disorder .

>> Thanks for thanks for your email.

Let's go to our next caller, our next email.

>> Our next e-mail is Do Not Favor Many schools in the area have started to ban cell phones during school hours for students.

>> Have you heard any feedback about this if it's beneficial for students while being my first question is OK, cell phones in the school setting why would a student need a cell phone in the school setting?

I understand laptops, iPads and so forth.

They are important for the education but why is the student using a cell phone in the school setting?

So I would wonder what the purpose of all that is way back in the day you might remember this yourself there there was an issue concerning passing notes in school and as we recall when people students passed notes in school that was disruptive to the teachers presenting the lesson.

>> So if you have a cell phone, what do you do with a cell phone?

You're texting.

>> I think there are times where a student needs to be informed by a parent about some kind of an emergency.

The student needs to contact the parent or somebody for an emergency purpose that can be done through the administrator within the school itself.

But I'm not hearing a real good reason for students to have cell phones on them in the classroom unless they are being used in some type of way for education again that's often used for iPads or for tablets.

I've not heard one way or another about the mental health benefits of of prohibiting cell phones with students in schools.

>> But I think the answer would be obvious.

I don't think it's there's a lot of good reasons for students to have cell phones in the school setting itself.

>> Thanks for your email.

Let's go next caller.

Hello Robert.

Welcome to Matters of Mind.

>> Robert, you want to know does magnesium help with sleep or depression anxiety?

>> Robert Magnesium is an essential to charge cation.

It's in the same category on the on the chemical chart as is calcium.

So magnesium can help with a lot of people for sleep.

I often recommend magnesium citrate.

It gets a little bit better absorb for a lot of people but magnesium citrate is important for helping with sleep for some people it does help with anxiety .

For some people it helps with depression especially if you if you're nutritionally deprived of magnesium for some magnesium level below one point eight usually means that you're too low on it.

Why would you be low on it?

Well, if you are prone to drink and alcohol for instance and heavy doses, a lot of alcohol can drop your magnesium level can make you tired.

It can give you difficulty with sleep anxiety and can cause a lot of different problems is magnesium safe to take while a problem with magnesium for some people will be it can give them diarrhea, magnesium will get the gut going and it can give people diarrhea.

>> So if it's causing diarrhea obviously maybe you want to take it twice a day, take a lower dosage but a common dosage for magnesium would be about 400 milligrams at bedtime and many people do use it for sleep.

>> There is a particular genetic profile.

We identify where it can be benefited with the use of magnesium and it's called a chemical or methyl transferee a C OMT met met genotype if there's a vowel valve and genotype if you have a Memet genotype of C OMT which is what we see in about one fourth of the entire population, those people specifically can maybe do better with magnesium but we're not at the point where we're going to prescribe magnesium for certain situations.

It's something that people can try.

You don't want to get too much of it usually four hundred milligrams twice 400 milligrams every day is a reasonable amount.

And you have another question is there a better antidepressant medication that doesn't cause stomach or bowel problems?

Are all the antidepressant medications prone to causing some anger problems?

Actually not I mean a medication like Mirtazapine or Raemer on is a medication that will actually give an anti nausea effect for a lot of people.

It's often used for sleep in many cases mirtazapine or ramrodding medication.

>> We commonly give to people who are as character as a characteristic of their depression are losing weight and they can't eat.

We give it to people who are undergoing chemotherapy and they lost our appetite so Mirtazapine or Emran can be beneficial in relieving nausea for many people and it actually increases their appetite.

The medications that are most problematic for the stomach will be the medications that increase serotonin.

Serotonin is 90 percent of all the body serotonin is in the gut.

So if you increase serotonin using a so-called serotonin reuptake inhibitor and SSRI like Effexor Cymbalta Stik those medications are increasing serotonin as well.

And if you increase serotonin sometimes it can give you some nausea and sometimes diarrhea.

So increasing serotonin can often give the gastrointestinal bad effects that people here.

So what do we use alternative world use medications like mirtazapine a as I mentioned and now we are going more to the glutamate Terje type of antidepressants result being the day to day I'm sorry Abilify.

I'm stuck on the antipsychotic medications all Velarde being a medication we use to affect more of the glutamate mechanism action I mentioned Abilify or exalted Braila.

Those kind of medications can be added on to an antidepressant at a lower dosage sometimes to try to decrease any stomach problems people can have.

>> Thanks for your call.

Let's go next caller.

Hello Mary.

Welcome to Matters of the Mind .

Mary, you had mentioned that your husband broke his leg about three weeks about three weeks ago and he seemed to be really depressed at that time.

>> Do physical injuries play a role into depression?

How's how does that work when you have any kind of physical trauma, Mary, you can't have an inflammatory effect.

Your body responds with inflammation and in your brain you have these little inflammatory cells called microglia microglia when they get really fired up, you bet they can cause you to have symptoms of depression such as Lokomotiv and poor energy difficulty the concentration lack of enjoyment with things those are all symptoms of an inflammatory type of so-called phenotype or a symptom characteristics of depression when you have an inflammation associated with it.

So any kind of trauma that led to inflammation and breaking your leg can do that can make you really depressed in some cases goes away but that is a factor now another factor is when you break your leg and you're physically immobilized and you're just sitting around that makes you depressed because you're frustrated.

>> You can't do the things you you'd like to do and we all experience that as we age.

>> We're frustrated that we can't do the things we did when we were 16 and 18 and 22.

So get older and you get frustrated by that.

But as you get older you hopefully will gain more wisdom and have understanding that OK, maybe you can't do the things you did when you were younger but you have much more understanding about the world around you and you can put your mind to good use that way.

>> And also as you get older hopefully you can adapt when you break a leg it's a sudden type of thing and all of a sudden you you're immobilized if you have arthritis gradually builds up on you, you try to do the things to try to offset it but it can be a month by month ,year by year type of thing with any kind of stress if you have time to adapt to it.

>> It's a little bit easier to become resilient to it I mean to put up with it.

>> So if you have time to adapt to any kind of stress, a lot of times it's easier to cope with that kind of stress.

But if it's a sudden stress, sudden physical injury that can be more impactful for a person's overall emotional wellbeing and sometimes depression can be an after effect of that.

>> Mary, thanks for your call.

Unfortunately I'm out of time for this evening.

If you have any questions concerning mental health issues, you may write me a via the Internet to add to matters of mind at WFB or ECG and I'll see if I can answer your question on the air the next time I'm psychiatrist.

Jeff Offer and you've been watching Matters of the mind now available on YouTube God willing and PBSC willing.

>> I'll be back again next week.

Thanks for watching.

Good night