.

good evening.

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

Welcome to Matters of the Mind.

Now let's 50 years 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 in the Fort Wayne area by night dialing (969) 27 two zero or if you're calling out of state or long distance you may toll free at 866- (969) to seven to zero.

>> Now on a fairly regular basis I am broadcasting live every Monday night from the 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 read on the air, you may write me via the Internet at matters of the mind all one word at WFB a dog that's matters of the mind at WFYI and I'll start tonight's program with the first question I received.

>> It reads Fauver Is there a bonding hormone effect between humans and dogs?

>> I remember this study that was done years ago where dogs sat by men as the men were doing math problems and then the wives sat by men as the men were doing math problems and it was shown that these stress hormones when dogs were sitting beside the men was much they were much less compared to when the spouses were sitting beside the men.

So I think that kind of intrigued a lot of people concerning what happens when a dog is at your side and lo and behold somebody did a bonding hormone study looking dogs and people, men and women and they found that if you stared into a dog's eyes for a prolonged period of time, the bonding hormone called oxytocin went up by one and a half times and the dog's brain and the person's brain the bonding hormone went up by three times.

So the bonding hormone oxytocin which comes from this little part of the brain called the pituitary gland right in here oxytocin goes up three times in a human when the human is looking into the dog's eyes for prolonged period of time.

>> And if your dog is anything like mine, your dog will stare at you for a real long time without looking away so try that with your dog and you'll find maybe a sense of bonding going on there.

I imagine particularly with younger dogs when you're early in the relationship with the dog but your oxytocin is a bonding hormone that goes up when humans are on their first date.

He goes up when people are having intimate relationships.

Bonding hormones will certainly stabilize and go up when people are having long term interactions with people.

>> So the bonding hormone is something that allows you to feel engaged with somebody else.

You feel more attached to them.

You feel more of an interpersonal relationship with them.

So the bonding hormone oxytocin does go up and it's not that that's the hormone that is deficient when people have autism spectrum disorder and that's why oxytocin nasal spray because oxytocin is a protein it doesn't get it absorbed very well in the stomach and it gets broken down very quickly in the stomach with a stomach acids.

But oxytocin is a protein if you use it as a nasal spray it gets to the brain a lot quicker and there's a lot of studies going on using oxytocin as a means of treating autism because it's thought that lack of oxytocin might be a contributing to autism and that's why people with autism will have difficulty with that interpersonal engaging.

They'll have a hard time mirroring the interpersonal relationships with other people and mimicking their behavior as we often do when we're conversing with people and just naturally so with that being said, oxytocin is a very important hormone that tends to go up when you're bonding.

So thanks for your email.

Let's go to our next caller.

Hello Jerry.

Welcome to Matters of Mind.

>> Jerry, I wanted to you wondered why do we sometimes have lucid dreams and how does that work?

Jerry you'll often hear about lucid, very vivid dreams when you're a little bit more sleep deprived than usual.

>> So if you've been sleep deprived you tend to go into a deeper sleep.

Now there's a couple types of very important phases of sleep.

There's the dream sleep to which you refer that's called a rapid eye movement sleep and then there's the non REM or non rapid eye movement sleep which is a very deep sleep.

>> It has these very deep high spread out waves on the EEG or electroencephalogram the brain waves and the deep sleep is very important to allow you to feel physically restored after you come out of it and when you first go to sleep especially when you're really tired.

>> It's the deep sleep that starts out then about an hour, hour and a half later you have your first set of dreams and you'll have dreams sleep throughout the night and as the night goes on you'll have longer duration of dreams and they didn't become more frequent such that if you're still sleeping early in the morning round after seven eight hours you're going to be dreaming more then than you were initially in the night itself.

>> But people will have very lucid dreams when they haven't had much sleep and very commonly people will have very vivid dreams that are quite abstract and they're symbolic when you're going through a lot of stuff in your life .

So when you're going to a lot of stress, a lot of things are going on, you'll have these vivid lucid dreams during that time and they might not make a lot of sense to you.

>> Don't read too much into them if they involve a particular person.

Think about who that person reminds you of or what they what they mean to you with your relationship with them.

But when you're dreaming about a person you're not actually dreaming about the person him or herself.

It has to do with who that person represents in your life and what they mean in your life .

So when you hear about people dreaming more you'll tend to remember your dreams in the early morning hours if you're awake and during a dream.

So during your dream sleep your heart rate's going faster, your body is somewhat paralyzed if you've ever awakened in the middle of the night and you couldn't move it's because you're just coming out of a dream sleep not uncommonly but your body knows that because you're dreaming and you're having all these actions in your dream it needs to be naturally paralyzed so your body doesn't move while you're in dream sleep at least naturally it does not but your heart rate will go up, your breathing will get faster and as during dream sleep not uncommonly when people have sleep apnea that's when they will snore the most and there are throat kind of collapses down on the on their trachea and they'll they'll snore the most when they're in the dream sleep.

So one of the old treatments for sleep apnea was a very good treatment but it was an old treatment was to give medications that would absolutely actually suppress dream sleep nor tryptophan was around back in the 1980s and it would suppress dreams, sleep and that's kind of a backdoor way of decreasing the likelihood of having problematic sleep apnea during the night.

Now we know that if you have sleep apnea where you're either pausing in your dreaming or pausing your breathing or you're having difficulty with getting enough oxygen to the lungs throughout the night because your snoring in your throat is collapsing on your on your trachea, you'll be able to be better treated with something called positive airway pressure where you wear a mask or something under the nose as a means of pushing air into your lungs past the obstruction when you're having difficulty with breathing with sleep apnea so we don't have to use suppressants for dream sleep and we don't want to now because dreams sleep is very important dream sleep helps restore your memory so dreams sleep is where you'll have a decreased amount of activity in this dorsolateral prefrontal cortex in the front part of the brain and then the side part of the brain called the hippocampus is your memory center and your dreaming will tend to fire up the memory center.

>> So I always tell this to medical students that if you're having difficulty with recalling things because you're staying up late at night trying to study things you need to take at least a 30 minute to an hour nap because a brief nap will help get this thinking part of the brain arrest and allow you to download more information into your memory center of the memory centers called the hippocampus.

The hippocampus is in the temporal lobe.

That's this yellow part of the brain.

It's over on the side the brain, the temporal lobe, temporal you think time temporal get its name?

Well, when you think about time the reason temporal lobe got its name is because the temporal was right over here on the temple and temporal refers to time.

It's on the temple that people start to go gray first so they go gray because of aging and time.

So for that reason this side part of the brain right inside the temple was tall.

It was called the temporal lobe because it's right inside the part of the brain that are part of the scalp that starts to go gray first.

So the hippocampus is in that part of the brain.

The hippocampus is just on the top part of the temporal lobe.

That's kind of like your memory storage center.

It puts memories into context and allows you to be able to pull memories and pull coping mechanisms from the past when you're going through a tough time.

>> Jerry, thanks for your call.

Let's go to our next e-mail.

Our next e-mail reads Geared up to favor how does ketamine work?

Ketamine's been around for a long time.

It was originally developed at Wayne State University back in the 1960s by a an organic chemist by the name of Calvin Stevens and it got approved for anesthesia in nineteen seventy.

>> So it's been around for anesthesia.

I've most typically for the past fifty some years ketamine started getting used for depression and I think that's maybe the context of your question is starting to get used for depression a little over twenty years ago and ketamine is a medication that's used IV for depression.

It's used at less than half of the anesthetic dosage so it's used at a very small dosage but it's enough where you'll feel kind of a haze during the 40 minute or so treatment that you get and people who are getting ketamine treatments typically will get them to sometimes even three times a week.

You don't want to give it to more often because it can be too powerful.

But basically ketamine is doing a few things.

Ketamine is releasing a break on this chemical called glutamate.

>> It's thought that people who have trouble with depression are chronic unpredictable stress have disturbances in glutamate transmission.

>> Now glutamate is the excitatory chemical.

It involves over half the neurotransmission of all the chemicals in the brain.

So glutamate very prominent.

>> So what the ketamine is doing for about 90 minutes during the ketamine infusion for about 90 minutes it's releasing the break enhancing glutamate glutamate then goes to a particular receptor called AMPA AMPA receptors if you stimulate AMPA receptors you increase the branching of the neuron.

So if you think of the neurons as needing about one hundred thousand branches on them, think of a tree with one hundred thousand branches when you get depressed or you get really stressed out it's as if those little branches decrease down to about 30 thousand or forty thousand branches.

So you have less than half the number of branches you really need in your brain.

So less branching of your neurons the brain will give you more trouble depression.

You don't enjoy things.

You have poor motivation, you have low energy.

So let's branching can cause you to have a lot of symptoms that we are associated with depression themselves.

>> What ketamine is doing is releasing the brake on glutamate increasing glutamate transmission glutamate is going to AMPA.

AMPA is then stimulating all this growth factor that's basically natural brain fertilizer and that's increasing the branching and the fluffiness of all the neurons so when you think about somebody with chronic depression, somebody who's had depression is not treated, they'll have a shrinkage of the brain but they're not losing neurons.

>> There was a misconception that when people have depression that they have dying neurons, they don't have dying neurons, the neurons are just less healthy and they're less fluffy.

So it's like having a tree that's not as healthy.

It needs a miracle grow and you put the Miracle-Gro on and it gets on and the branching tends to get more fluffy and you can get the flowering going from it the same can happen with your neurons.

If your neurons aren't fluffy enough you'll have a lot of symptoms of depression.

So it used to be that we'd think depression was simply a disturbance of serotonin, norepinephrine and dopamine and that's true.

There's some factors with that serotonin consists of about two percent of the brain chemistry whereas norepinephrine and dopamine consist of less than one percent and they are a factor but they are way downstream from glutamate in other words, they will affect how glutamate is is getting released but it's very indirect.

If you give a medication like ketamine it will tend to enhance the effect of glutamate within a matter of milliseconds.

So it's very, very quick and how it works and you can actually see under the microscope based on animal brains you'll see this branching occurring within neurons within four hours of giving a ketamine infusion.

>> So it's very fast and how it works now ketamine can be used in the clinical offices now it will be used it's called off label use where the insurance companies typically won't cover it because it was never approved by the FDA for the purpose of treating depression.

>> So what we have now is is ketamine which is the left sided piece of ketamine.

Ketamine comes on the right side of the piece and a side of piece.

The left side of piece is ketamine.

It's also known as bravado and that's been formulated as a nasal spray where it's given twice a month or twice a week for the first month, once a week for the second month and then once a week or every other week thereafter.

And so ketamine is used with an oral depressant.

It seems like an orally omnipresent that's affecting serotonin, norepinephrine and dopamine will make ketamine or as ketamine work better.

So that's why we often use them with oral antidepressant medications as ketamine works the same way as does ketamine often works very quickly.

About one out of six people will get a very dramatic effect within just one or two treatments and they continue over the course of a month, two months and they often will feel better and better over the course of that time.

But the biggest side effects of either of those medications will be a sense of floating and we call dissociation where they have kind of an out of body experience for the first 20, 30, maybe 40 minutes where they really feel that out of body experience and then it tends to fade after about an hour after the initiation of dosing with ketamine, it's very tightly regulated by the Drug Enforcement Agency, the DEA such that patients have to sit in our office for a total of two hours with each treatment they're monitored during that time for any trouble with the associations Dacian as well as blood pressure because both ketamine as ketamine will increase the blood pressure in about 40 minutes when the blood levels are peaking.

So about 40 minutes after you give the injection of ketamine or you've given the nasal spray of ketamine, you'll see these increases in blood pressure not unlike what you see with the increase in blood pressure if someone's on a treadmill or they're on an elliptical machine or exercise intensely exercising intensely, they'll have that increase in blood pressure during that time and then it starts to go down after about twenty minutes or so for that reason when people have any difficulty with aortic aneurysms or they have any vasculature that's compromised and they have any weakening of the blood vessels, we don't recommend that they exercise.

We don't also we also don't recommend they use ketamine or as ketamine.

So that's the main reason why we wouldn't give ketamine or ketamine.

But as ketamine has been around now for four years and others four years of good solid data showing it seems to have no long term problematic side effects same would be expected with ketamine but ketamine hasn't been well studied overall ketamine is getting dabbled with using it in various other ways with sublingual tablets and various other forms.

The problem with those that means of administration will be it's not being very tightly regulated or studied in that manner and you want to want the absorption would be if you use ketamine under the tongue, how well would you really get it absorbed now some people think that they have to get the experience of sedation or dissociation or even increase blood pressure to get a good effect from ketamine or is bravado and that's not the case.

Those are just side effects that some people get.

Some people will get the good effects from those kind of medications even if they don't have all the side effects.

But the side effects typically occur inside of that two hour window after they've received the ketamine or ketamine for that matter and then they go away the rest of the day.

But with each of those drugs you're not really recommended to drive or use machinery for the rest of the day during the treatment itself until you've had a good night's sleep.

So those are medications of come out that are affecting glutamate now as we hear about new medications coming out over the next couple of years, we're going to be here about hearing about more medications that affect glutamate and gabber glutamate and gather kind of the yin and yang of the neurotransmitters glutamate stimulatory and GABA is inhibitory and they balance each other out like a teeter totter.

We used to talk about serotonin, norepinephrine, dopamine and for 30 years all the drug research went into medications that somehow some way either affected those chemicals directly or they've affected the receptors.

>> So that's why we had 17 different oral and depressants come out in the past thirty years.

It predominantly affected serotonin, norepinephrine, dopamine.

Well, just the past year we're hearing about medications that are oral.

They're affecting glutamate.

One of them is all Valide, although it includes a medication that's a cough medicine called dextromethorphan.

It came out in nineteen fifty eight as a cough medicine in addition to an antidepressant medication.

My name is Bupropion also known as Wellbutrin.

Bupropion or Wellbutrin will increase the blood levels of dextromethorphan by thirty times and in doing so it will in a different way a little bit compared to get a or ketamine in a different way it will affect the same receptors in which the ketamine or ketamine effect but it won't give you the dissociation and it won't give you as much sedation as the ketamine or s ketamine.

So for that reason with all Valide you can drive the same day you take it you do take it every day but like ketamine does ketamine it's working pretty fast.

>> So again it's affecting glutamate directly.

It's not affecting directly serotonin and norepinephrine and dopamine.

So that's why it works very, very quickly.

So for many people who useability they're going to notice that they're going to feel pretty good pretty fast.

So it's a different type of mechanism than the traditional antidepressant medications we've had.

There's a medication has been around for a little while now I call Brexit Jhelum and Brexit alone is a medication that's affecting the Gabba transmission so it's more affecting the inhibitory channels of the brain Brexit Sinaloan is a medication that's been approved for infusion for post part EM depression to women who deliver babies who got super depressed after delivering the babies they'd go into the hospital to get an IV infusion for two or three days and then they get released and they'd feel much, much better if they got that infusion.

Well, there's an oral medication that you might have seen in the news coming out over the next few months by the name isn't alone and that's a medication that is another oral medication that works in a similar manner as Broxson alone.

So there's a lot of excitement about that because it's affecting the Gabba receptors whereas all valide as ketamine and ketamine all affect the glutamate receptors.

So we're talking about a whole different type of treatment for depression and anxiety in psychiatry in this in this particular decade.

So we're going a whole different direction of what we used to used to take with the older medications such as Celexa and presumably Zoloft, Prozac, Paxil you'd expect about one out of three people to get a really good effect from those medications but two out of three people don't.

And even if they got a good effect number one, it might take four to six weeks for that good effect to hang around and to get really good it in and then once they get the good effect, there's a good chance that it's going to fade over the course of time so they might not have a sustainable effect over the course of several years I have indeed heard of some people who've done great on medication like Prozac or Zoloft for twenty years but more often than not you'll hear people say it worked for several years and then it kind of faded and we call that tacky Firaxis but it kind of fades after a period of time with these medications affecting glutamate and GABA we're really excited that theoretically there's no indication they're going to fade in their efficacy over the course of time.

So once they work they appear to continue working and seem to give long lasting effects.

I know I've seen that with ketamine for patients for whom we've treated for the past four years.

Once it works for them it continues to work as long as they come in on a regular basis .

So whole different exciting direction we're taking in psychiatry now.

Thanks for your email.

>> Let's go to our next caller.

Hello Jerry.

Welcome to Mars The Mind.

>> Hello Jerry.

Are you there?

I am Sam.

Hi Jerry.

Hello.

>> I can hear you just loudly and clearly OK.

I was wondering if all my cell phone late would make you sleepy and I was also wondering how that works along with Rizzolatti.

>> Yeah Jerry l l mythically is a active breakdown in product of vitamin B nine so vitamin B nine is folic acid and about one out of four people don't break down folic acid adequately and folic acid is kind of like a bunch of people going through a turnstile at a stadium so to get into the stadium you have to go through the turnstile with a turnstile for folic acid is called methylene tetra hydro folate reduc tace gfr and there's two different genes for Jafa one is six seventy seven and one is twelve ninety eight .

>> So if you have a mutation on either or both of those genes you can have disturbances with that turnstile working so folic acid can't get inside the brain and the rest of the body.

If you have that mutation you can have a greater likelihood for having depression difficulty concentration.

You can potentially later on have trouble with stroke or heart disease not definitively but it's just a risk factor and we're most concerned about younger women who are having babies.

They can be at a higher risk for miscarriage if they have a message of our mutation that's affecting folic acid.

So element of folate is the end product that you can take that does not have to be metabolized by far and for that reason people will take it every day whether it be ten milligrams, fifteen milligrams on a regular basis.

>> It should not make you tired.

Jerry Rexall T on the other hand can result is medication affects a lot of different receptors and it does so in a good way.

A lot of times it will help people who kind of feel wired up but yet they're kind of tired so it gives them a nice calming and balancing effect but it definitely can make you feel a bit tired itself.

All methyl folate being a vitamin gets along with salty just fine so resulted in a medication that can be used for a lot of different conditions.

It was originally for schizophrenia but we use it for depression now we use it for bipolar spectrum conditions where people have some moodiness and they have some irritability.

So we'll use it as an add on for many people but as a medication by itself it has mood stabilizing features and it seems to have an psychotic features.

But elements of folate with result can be a good combination.

But if you're having sedation probably from the result between the two of those and the way you'd get around that is by taking the result more toward bed time and talking to your clinician about the possibility of even taking a lower dosage because like with any medication you want to fine tune the dosage where you take just the right amount at just the right time.

And I emphasize that because sometimes we have to be kind of creative about that.

Decreasing the dosage for everybody might not be the answer or if you decrease the dosage you might not feel as good and you might not have as good of an effect from the medication.

So for that reason people need to take the same dosage but they just need to take it a different way.

Some people will take half of those dosage in the morning.

Half the dosage is night but if you're having any tiredness more often than not we'll have people take all the dosage at bedtime.

Same with nausea if somebody is having nausea from a medication we just make sure they take it entirely with food.

I mentioned ability of medication if for some people can cause dizziness.

Well, although he's typically given warning and evening, morning and evening if you have dizziness for mobility we're having some people take two tablets at the same time in the evening and that seems to be relieving a lot of the dizziness itself.

So sometimes we have to be kind of creative in how we have people take the medication but eventually they can get back on track once the side effects are relieved and the side effects including sedation very often earlier in the treatment when you have side effects of medications you'll often notice them the first one or two or three weeks and sometimes they fade thereafter and sometimes they don't.

But most of the side effects you'll have will typically occur very, very early in the treatment.

>> Jerry, thanks for your call.

Unfortunately I'm out of time for this evening.

Do you have any questions concerning mental health issues?

You may email me at matters of the mind all one word at a dog.

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

I'll be back come back again next week.

Thanks for watching