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

Welcome to Matters of the Mind now in its 24th year Matters 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.

>> 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 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 a via the Internet at matters of the mind all one word at WFB dot org and I'll start tonight's program with a very, very topical question because it's Valentine's Day and reads Director Fovea since it's Valentine's Day I'm curious about how the brain reacts when someone is in love.

>> Does being around people you love impact the way the brain processes other emotions and behaviors?

>> That's a very good question for Valentine's Day because when you're out with your first date and you're early in your romance and you're early in your relationship with some buddy with whom you're showing a love interest, there's this chemical in the brain called oxytocin.

>> Oxytocin is also known as the love hormone.

Oxytocin comes from a from the pituitary gland which is right down here.

This is the front part of the brain looking at your pituitary gland is down here and the pituitary gland releases oxytocin and oxytocin is also known as vasopressin.

>> So a lot of hormones and chemicals in the brain do have two different names but oxytocin is what's commonly used what oxytocin will do.

>> It goes to the right front part of the brain and helps you.

Mira another person's behaviors.

In other words, it helps you connect with somebody else as you're paying attention to them.

>> You look at their social cues, you can tell if they're interested in what you're having to say.

You can establish eye contact with them based on the social cues and you kind of sometimes consciously and unconsciously or mimic their behaviors.

>> And in doing so there's a bond that develops early in a relationship oxytocin and levels are very high but as a relationship progresses over the course of months, years and decades, it's oxytocin.

>> When you're in the presence of that love interest will go down and down and down so you have less oxytocin over the course of time.

>> Now what does does oxytocin interact with other neurochemicals?

>> Yeah, it does especially with dopamine.

It will impact directly and indirectly how dopamine is released.

>> Dopamine comes from the nucleus accumbens which is right smack in the middle of the brain right above the pituitary gland and the nucleus accumbens when it releases dopamine it makes you feel happy, it makes you feel motivated, energetic and you feel good.

>> So it goes goes it makes sense that when oxytocin is released and you're having this bonding experience with somebody with whom you're showing a love interest, it can also neurochemically make you feel good and dopamine is also related to addiction.

>> So you put all that together.

Some people can get addicted by trying to pursue new love interests and that gets them into trouble some time.

>> So if you imagine the cascade, let's say you're really like the feeling of going out for a date the first time or two and you really enjoy the thrill of a new relationship.

>> Well, that's fine if you want to date one person or another another you don't really get involved in deep relationships but let's say you start getting involved with somebody and after a six months or eight months go by, as B.B.

King said, the thrill is gone and you know, it's just not as exciting anymore.

>> It's because you're still looking for that thrill that you got early in a relationship with that intense release of oxytocin and dopamine.

>> Now oxytocin in a synthetic form is known as pitocin and a lot of women who have delivered babies can recall the pit drip being given a pit drip as basically pitocin that is synthetic oxytocin.

It increases contractions in your uterus and we'll get that baby a little bit farther away in the in the delivery room.

>> So a pit drip is a synthetic form of oxytocin, oxytocin, the proteins we just can't take it as a pill.

>> You know, you wonder well gee, if I'm losing interest in my loved one and I've been married now for seven years.

I've been married for ten years I'm just losing interest.

Can I just take a pill of oxytocin to get that bonding hormone going again?

Proteins don't get absorbed very well in the stomach.

So oxytocin is a protein just as it could absorb very well as a pill.

>> It's being studied as a nasal spray.

So as a nasal spray for depression and especially for autism, that's where I'm really interested in how it's going to do because part of the problem with autism is a lack of activity in that right front part of the brain where you're trying to mirror other people's movements and you're trying to mirror the social behaviors of others and it's thought that if you give individuals with autism oxytocin that might help relieve a lot of those social interaction disturbances that they have.

So I'm interested in seeing how it does for that.

But it's also being studied, as you can imagine for depression because it indirectly affects dopamine which seems to be disturbed when people get depressed.

>> And that's why on the other hand oxytocin affects dopamine.

Dopamine can affect oxytocin such that if you have diminished activity of dopamine and you're depressed clinically you're going to have difficulty really developing bonding relationships with others not only because you might have some social awkwardness but also because there might be a disturbance in the oxytocin pathway as well.

>> So I'm excited to see what oxytocin is is able to to do over the course of time for the treatment of depression as it's used more as a nasal spray now with all good things are going to be drawbacks and that indeed could be the case of oxytocin if oxytocin is main mechanism of action is by enhancing dopamine.

Well, we know that enhancing dopamine as I mentioned before ,can be somewhat addicting because when you increase dopamine as you do when you smoke cigarets, for instance, nicotine increases dopamine and that's why nicotine is very addictive for people sometimes if you're going for that dopamine rush the dopamine high, you need more and more and more of it to give you the same pack.

>> So the question is going to be if we start using oxytocin as a nasal spray to try to help with love bonding attachment, social interactions and even depression, will that dose need to go higher and higher and higher and eventually will this phenomenon occur that's called Taqi full access where it just doesn't work anymore and we see that happen with some medications where you keep going higher and higher on the dosage and just doesn't work anymore.

That's most dangerous by the way with narcotics, with narcotics as you block the Meurice chapter there's three main receptors with opiates the receptor the Kappa receptor in the Delta receptor.

>> When you block the receptor with narcotics you can get this feeling of bliss and happiness and some people will say they will have taken a narcotic like Percocet for back pain and help or back pain.

>> But for the first time in their lives they felt normal.

They felt happy, they felt chilled out, they felt good and they wanted to keep taking the Percocet for their mood.

Well, what happened when you take the Percocet for your mood, you got to go higher and higher and higher and higher eventually it doesn't work and you get to the ceiling effect on a narcotic.

>> We're all of a sudden it goes to respiratory suppression center and you just don't breathe anymore and you stop breathing and that's why narcotics are so dangerous because people will go higher and higher and higher on the doses to try to get that good effect because that good effect is just going away unless you go higher and higher.

But you get that ceiling where at a certain point it shuts down your breathing and then you stop breathing.

>> That's why so many people are in force.

They are dying of narcotics.

But oxytocin is a love hormone that certainly has a lot of pertinence on Valentine's Day.

But that effect does fade the more times you date somebody, the longer you get to know somebody and that's what we're always trying to bring back by by keeping relationships fresh and new.

>> You know, I always encourage people to to still go out and date your love interest even if you've been married one, two , three, four or five decades.

>> You know, keep it fresh in some ways.

Keep we're always getting to know our loved ones and as you get to know them, you're putting more of those pieces in on the little jigsaw puzzle.

>> I always compare relationships to being like a jigsaw puzzle early in the relationship you've got a 500 piece puzzle.

Let's say early in a relationship you've got about five or ten pieces.

>> All right.

And on top of those five or ten pieces you've got a big blast of oxytocin in your brain.

So you've got all this bonding going on.

There's excitement.

You've got five or ten pieces.

>> There's a lot of people's pieces you don't have.

So what you do early in a relationship is you're a magic what those other pieces are as a matter of fact you might even be manufacturing them artificially thinking I'm going to make this person the person I want I want them to be.

>> And of course that doesn't work out and as you get to know somebody more and more, not only does oxytocin start to fade, you also start to get more of those pieces and you start to realize, huh, I didn't know this person was like that and you might find some of their traits to be unfavorable and that's where you have to balance out the good and bad for anybody.

>> Thank you for your email.

>> Let's go to our first caller.

Hello and welcome to Matters of the Mind and you want to know about I'm not sure about the name of the medication you're telling me here right.

Open that's not a medication.

>> Rosero is a medication we use for sleep but you've used a particular medication for sleeping problems and you stopped hearing about it because it gives you difficulty breathing problems.

I'm not familiar with a medication called RIL Pan but I think you might be talking about maybe Zolpidem which is also known as Ambien.

You might be talking about Lorazepam also known as Ativan Klonopin also known as Clunies Pam.

Those PAMA medications are medications that can give you difficulty with breathing and when you're over 80 years of age as you had mentioned, women over 80 years of age can be at a higher risk not only for difficulty with shutting down their breathing but also having difficulty with memory problems.

So I'm reluctant to prescribe those medications that are the traditional sleeping medications that have the potential for addiction because number one, they they artificially knock people out and that's not a normal way to go to sleep.

>> And secondly, they can give people difficulty with memory disturbances and with the older medications especially the so-called benzodiazepines Temazepam as one from a long time ago also known as Restoril Diazepam is Liberum Floras EPAM Diazepam as Valium Flurry's a payam is Dalle we hardly ever see that used anymore but it's a long active medication that would help people sleep but it can suppress the breathing especially with older people.

But I'm more concerned about the memory problems that I see with people in their older years so yeah, talk to your clinician about any sleep medication and ask is it problematic for breathing suppressing the breathing center with older people like the narcotics can be is it could have difficulty with memory disturbances as you get older and is it safe to use long term without getting used to it or are you just told me and it was Lorazepam that's also known as Ativan Lorazepam or Ativan.

>> It's a safe medication for a lot of people because it's entirely excreted by the kidneys.

So if you have some liver problems lorazepam safe, it has a relatively short duration of action compared to Lorazepam also known as Dumaine.

So if of that class of medications it's not the worst at least.

But you are right it can give you difficulty with memory breathing problems and the potential for needing more and more of it over the course of time I try not to use the medications like Lorazepam or Ativan for more than a couple of weeks for people if I can get by with it.

>> I have a lot of other medications I can use that tend to be a bit less toxic on the brain and less likely to cause you to become accustomed to using them.

>> And thanks for your call.

>> Let's go to our next email.

Our next email reads Dear Doctor Father, how do I know if I shouldn't take an antipsychotic medication for my mood?

>> I've heard of dangers occurring with them.

>> If you've watched some of the television commercials for instance, we call them direct to consumer ads.

>> A lot of the television commercials involve medications that are antipsychotics and they're talking about using them for depression or maybe for an add on for mood stabilization.

>> What does an antipsychotic an antipsychotic is a medication that will block dopamine receptors.

All right.

So the newer antipsychotic medications will block dopamine receptors but they also will block serotonin type 2A receptors in the front of the brain.

>> Serotonin has 14 different receptors and they go by numbers and letters and serotonin to receptors if you block them actually fire up the activity of dopamine in the front part of the brain.

>> If you fire up dopamine in the front part of the brain you can help with happiness and motivation and energy in a good way without firing up the nucleus accumbens down here.

>> If you fire that part of the brain up and increase dopamine there you can have more trouble with addiction.

>> So the idea is we want to enhance dopamine in the front part of the brain without causing addiction.

>> How can you do that by blocking serotonin to a receptors and that's how a lot of antipsychotic medications work.

>> The danger of antipsychotics will be the whole concept of tardive dyskinesia.

It typically starts in the mouth and the tongue, especially when you're thinking about other stuff.

So if you are distracted you're trying to think about all these other things you might move or altham mouth around you might move your tongue around.

You might have hard blinking where you blink more frequently sometimes we'll see that with people who get anxious anyway.

But if you're on an antipsychotic medication for the mood that can increase the likelihood of tardive dyskinesia then we have to deal with those symptoms themselves and those symptoms can be embarrassing at the least and debilitating at the most for some people.

>> So who would not be a good candidate for a medication that's as an antipsychotic medication for their mood?

>> No one, if you're using it primarily just for the mood that can be a bit of a risk factor.

But there are genetic risks.

We do a genetic testing which will look at this particular gene called dopamine to receptor genes and with dopamine receptor genes you've got a possible gene that's a C C as in CAT and you've got a gene called Delete DTL Delete Gene.

>> So there's a C C gene and delete gene and you get one gene from your mom, one from your dad .

>> So if you get a C from your mom and C from your dad that puts you at less risk if you have a C from your mom and a delete from your dad or a C from your dad and delete from your mom that puts you at higher risk a delete a little piece of that gene puts you at higher risk for tardive dyskinesia and if you have the rare circumstance where you have a delete gene from your mom and a delete from your dad , your delete delete for the dopamine receptor that puts you at exceptionally high risk for tardive dyskinesia.

>> So we do take that into consideration when we're looking at somebody's genetic profiles, we look at that particular gene as well.

It's thought that if you have diabetes type type two diabetes that might put you at higher risk for tardive dyskinesia and the longer you're on the Mishicot medication at the higher dosage you're on the necessary medication that puts you at risk for tardive dyskinesia.

The older people, the older people, people over 65, 70 years of age just by nature of their age they're at risk for tardive dyskinesia as well.

>> So we have to take in all those considerations for a lot of people now the younger people we can sometimes pick up who's going to have more tardive dyskinesia if they have what's called extra pyramidal symptoms.

So EPP's or extra Ravenal symptoms will be where they take these medications and they get kind of stiff and they tighten up and they might have a bit of a tremor.

>> Extra pyramidal symptoms will predict tardive dyskinesia later on.

>> So if we hear about EPP's or extra pyramidal symptoms, especially with older people and we know if somebody's genetic profile you put all that together sometimes you can sometimes think that maybe you're not a good good candidate for an antipsychotic medication.

How about we go a different direction now there is a particular test that we give people where we watch them do different things is abnormal involuntary movement scale or an aims.

We try to do that every six months to a year.

>> You do it more frequently early on in some of these treatments and antipsychotic medication every three months to six months.

But after somebody's been on the antipsychotic, if they're doing well we'll have maybe assessed every year specifically with the aims to look for tardive dyskinesia.

If you do get tardive dyskinesia, the first thing we always try to do is try to back off the medication a bit but we can also use medications like Ingres or Austereo as a means of trying to reverse the symptoms themselves of tardive dyskinesia.

>> So there's ways to treat but we prefer not to cause it to begin with so we try to avoid it for people who might be at higher risk.

>> Thanks for your email.

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

Our next e-mail question reads Gernhardt If ever I hear a lot about bipolar disorder on television and in the general public, why is bipolar disorder a top a popular topic and why would anybody want to have it?

Well, bipolar disorder I think you might have heard about that in television because there are a lot of commercials about medications used for bipolar disorder.

>> So let's take a look at bipolar disorder.

Bipolar disorder is basically a condition where you can have highs and lows in your mood.

>> It is about 60 percent genetic.

It's more genetic than depression but the highs are often characterized by not needing to sleep, being more impulsive, doing things and saying things you ordinarily wouldn't say or do.

>> You're talking faster than usual and you're going from topic to topic to topic.

You can make really bad decisions and people will buy things.

They'll have sexual indiscretions.

They'll blurt out things in meetings at their at their workplace and they can get themselves in quite a bit of trouble and that's called bipolar disorder type one if it goes on for at least a week and then people with bipolar disorder type one can crash in a depression sometimes they don't but many times they do.

>> And then there's bipolar disorder type two where they have little highs where other people can notice they're kind of revved up but they don't get themselves into as much trouble .

>> But they'll have little highs for maybe four to six days and during that time, you know, they're not quite sleeping as much but they're more energetic people notice they're much more outgoing but then for at least two weeks thereafter they get really depressed.

>> They want to sleep ten or twelve hours a day.

They're tired.

They don't want to be around anybody.

They lose motivation.

It's like somebody just took the wind out of their sales and they're just really depressed for a couple weeks thereafter.

Cyclo themy is sometimes called bipolar disorder type three where people have two or three days of highs, a few days and lows and they just kind of go back and forth, back and forth, back and forth that cycle.

So those are the types of bipolar disorder we often talk about.

It's not that anybody wants to have bipolar disorder but it can be a great relief for somebody if they've been having these struggles for a long time.

>> And finally somebody's diagnosis and treats it because it can be life changing because you can imagine how disruptive to a person's life these mood swings can be.

It'll affect the relationships people with bipolar disorder are six times more likely to lose their jobs and have to go to different jobs because they say things and do things they shouldn't say and do so it's life changing when somebody can finally get on a mood stabilizer that truly can get there mood stabilized and allow them to have a normal life .

>> And it's not that they want to have the condition.

They just want to be able to be diagnosed and identify that it's there.

And I see the same type of thing happening with kids who for instance, will have nearsightedness.

You know, there are seven, eight years of age.

They get an eye exam and with an eye exam it's identified that they need glasses.

Now back when I was younger you didn't want to be wearing glasses.

Matter of fact, I can admit myself I cheated on the eye exam until I was about 12, 13 years of age and I knew how to memorize that eye chart before I went up there to read it.

So I kind of got by with having really bad vision for a long time because I didn't want to wear eyeglasses.

Nowadays it's more socially acceptable to wear eyeglasses and you talk these younger kids who wear eyeglasses it's life changing because they can see leaves.

I mean they can see things clearly and when you have somebody with nearsightedness it's not that they want to have nearsightedness.

It's not that they want to have poor vision.

It's just that when they wear glasses it's corrected and they are willing and able to wear glasses for the purpose of being able to see more clearly and it's a quality of life issue and I say this with any medical conditions I'm always looking for various medical conditions when they treat somebody for depression or anxiety.

I'm always trying to figure out what else could be going on between because we're trying really be able to get to the heart of the problem for a lot of people.

Yeah, you can always say from a psychiatric standpoint there are social reasons why people can get depressed.

Used to be thought decades ago there had to be a reason in your life why you were depressed.

Something must have happened to you and that made you depressed.

Well, now we know there's a lot of other reasons.

I mean a thyroid disturbances, sleep apnea where you're not getting enough air flow into your lungs at night that'll give you depression.

People can have depression for all sorts of different medical reasons.

So we have to look at all these other conditions.

It's not that they want to have any of these conditions but if the condition is identified and then it's treated and it improves your quality of life, that makes it all worthwhile.

>> Thanks for your question.

Let's go to our next caller.

Hello Barbara.

Welcome the mastermind.

Hi Doctor.

I've been on Ritalin for like thirty five years at one hundred milligrams and I've been doing fine but starting to hear maybe I shouldn't be on so long because of my heart and other things that maybe I could be doing damage and so starting to get off of it.

I know you have a formula for that.

I have been on working my way down for a month.

I was on seventy five did fine now for two weeks I've been on fifty milligrams and I'm doing fine but I'm not sure how quickly to try to go completely down to nothing.

>> The most important thing Barbara is how are you feeling all I think pretty good I mean I keep functioning so I think I mean I worry and stuff but that's not to and for me way back when I started my career as a psychiatrist, how long ago was I like?

>> Thirty five years ago.

A long time ago nor tripling was our preferred medication before Prozac came out in nineteen eighty seven nor tripling was the medication we wanted people to take because it didn't have as much of the memory impairment and heart problems compared to other medications but nor Darlene is a breakdown product from Amitriptyline Amitriptyline is also known as Ellisville or DEP nor Trapline used to be called Pamela and Lilly owned a version of nor tripling Lilly in Indianapolis.

>> They called it additon so nor has been around for a long time.

It's safer than its chemical cousins the other tricyclic medications because it's less harmful on the heart.

>> It was actually preferred for older adults back in the 1980s and part of the 1990s because you could actually do a blood level on it and you could determine exactly what that blood level was and you can't say that with a lot of antidepressant medications or Trapline had a so-called therapeutic window where you want the level of the medication higher than this but less than this.

So you had this therapeutic window where you could actually see if you had something on the right dosage.

>> You can do an electrocardiogram to see if you're having any interval prolongation which is the biggest concern with more troubling cutesie prolongation is a bit of a concern but not as much.

>> It's not thought, Barbara, that it's doing direct damage to the heart just that if you already have heart problems let's say you had a myocardial infarction, you have congestive heart failure, you have heart problems already.

>> Yeah, nor trapline can be problematic for you.

So you're doing great.

You can go down as slowly as you wished as long as you're feeling well if you need to be changed to something else that affects norepinephrine.

We've got medications like pristinely fed Zema and Cymbalta that have negligible effects on the heart.

>> Barbara, thanks for your call.

Unfortunate I'm out of time for this evening if you have any questions concerning mental health issues that I can answer on the air, you may write me a via the Internet at matters of the mind all one word at WFA a dog.

I'm psychiatrist Jay ForFour 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.

Have a good evening.

Good night