Good evening.

I'm psychiatrist Jay Fawver and welcome to Matters of the Mind.

Matters of the Mind is a weekly mental health program where you get to choose the topic for discussion.

So if you have any questions concerning mental health issues that I can answer on the air, you may write me via the internet at MattersOfTheMind - all one word - @wfwa.org.

That's MattersOfTheMind@wfwa.org.

And if you're able to do so during the program, you may call or text me.

So let's begin tonight's program with an email I recently received.

It reads, Dear Dr.

Fawver, are there any particular cognitive behavioral therapy or dialectic behavioral therapy exercises to improve my self-confidence?

Lately I feel like I'm making constant mistakes and my confidence is shot.

Well, I give you some general ideas concerning ways of building your confidence.

Number one, focus on the small wins as opposed to the defeats that you might be encountering.

Or as you mentioned, the mistakes.

If you talk to any past, if you read about any past inventors or more recent innovators, they'll all say the same thing that they learn from their mistakes.

The classic statement of Thomas Edison how many light bulbs did he fail upon before he came across one that worked?

And you hear about that with many, many innovators.

So the key will be for you to try to focus on what you're doing right, as opposed to what you're doing wrong.

And the whole concept of cognitive behavioral therapy, part of which is thinking about having those automatic thoughts where, oh my goodness, I made a mistake.

I'm a failure.

No, you want to get away from that.

You want to learn from your mistakes.

And it goes along with kids and adolescents in athletics.

They shouldn't be devastated if they lose a particular game or an event, they should learn from that particular experience.

They should work toward achieving success thereafter.

It's not that they enjoy losing, but they should be able to learn from their losses and be in good sports.

Just try to do better the next time and focus on yourself, as opposed to the comparison of other people.

And that's what where social media can be devastating, especially for young people, where when you look at social media, everybody's doing great.

Everybody's having the big wins.

They don't talk about the struggles people are encountering.

To give you a personal side note here, I'm a a electronic medical record software builder.

As a software builder, you're designing code and you're building code for the purpose of helping process information, to allow the note for physicians and nurse practitioners to be able to be more clear and help with decision making in taking care of patients.

Well, in building those templates, 90% of the building is testing, testing, testing.

And you're trying one thing.

It's failing, you're trying another thing that's failing, and you're going back and forth, back and forth.

I've been doing this now for seven years, and you have to get used to things failing before you see that win.

But when you see that win, when you see that improvement with the medical record itself, it can give you a little bit of a boost in dopamine, and it gives you a bit of a of a high when you see that the same can be true when you finally after many failed attempts, you finally achieve something.

And that's how you attain confidence.

So you attain confidence by accepting the small defeats and learning from them, but not feeling devastated by them.

And then very importantly, focusing on those small wins and the progress you're making.

Thanks for your email.

Let's go to our next text.

Text is from Ted from Fort Wayne.

You have a time change question.

You hate the time changes.

Yeah, I kind of do too, Ted.

Do the time changes affect the mental health?

I think the time change that affects the mental health the most would be in the spring when you, as they say, lose an hour, but basically you're losing the hour of sleep in the springtime.

And sometimes it takes people a few days to recover from that.

Our bodies, our bodies love rhythms, so our bodies love to go to bed at the same time every night.

Our bodies love to get up at the same time every day.

If you can get yourself in that rhythm and have that routine day by day, that's what the body, preferably will, will thrive upon.

So if you can get in that rhythm, that's great.

Well, what happens to the time change?

It throws you off for a day or two because you've gone to bed at a different time.

You're getting up at a different time, and it takes about a week to adapt.

And I think that's going to be the argument every time it comes around, year by year.

When it goes in front of our administrators at Washington, D.C., should we go back to having the same time all year, or should we go to a daylight saving time?

There's going to be arguments either way, but for most people, I think they feel like you do, Ted.

They prefer not to have the time changes and you can kind of impact people, but you have to adapt to the time changes well.

It is kind of nice to have more light in the morning compared to if you didn't have the time change, but you have to be able to embrace that.

Ted, thanks for your text.

Let's go to our next caller.

Hello, John.

Welcome to Matters of the Mind.

John, you want to know what are the main mechanisms for psychosis?

Well, John, psychosis basically is a condition where you're losing touch with reality.

And the best way I can describe it will be if you're losing touch with reality.

It's like like doing a living nightmare.

So you're wide awake, but you're going through a nightmare.

So when you're going through a nightmare, you're a your brain is in this abstractive mode where things might not make so much sense and it can be very scary.

When you're sleeping and you're having a nightmare, the logical part of the brain up front here is shutting down.

So what shuts down that logical part of the brain from a neurobiological standpoint?

Well, three ways that we know of today.

You can affect glutamate.

You can affect serotonin and you can affect dopamine okay.

Affecting glutamate.

If you fact glutamate that's a PCP psychosis.

If you have a PCP psychosis it can affect glutamate.

And it gives you the kind of dissociative out of touch with reality type of psychosis people can experience.

Then you can have a serotonin two - serotonin receptor two - type of psychosis.

And that's what you get from LSD.

LSD you can get kind of a dreamy state.

You can have flashbacks thereafter.

So LSD gives you a different type of psychosis compared to PCP.

PCP affects glutamate, LSD affects serotonin two receptors.

And then finally you have the classic psychosis from dopamine.

That's the dextroamphetamin type of psychosis.

With dextroamphetamin, you can have agitation, you hear voices.

You can feel very paranoid and scared about things around you.

Now, the important thing about treating psychosis will be that we need to figure out what kind of psychosis somebody is experiencing, whether it's a PCP type related psychosis, is it an LSD type of related psychosis.

Is it more like methamphetamine?

Because you're going to try to address your medications based on the particular symptoms people are having.

So that's often the task we experience when we're trying to identify what kind of psychosis somebody is enduring.

Thanks for your call.

Let's go to next text.

Hello, Bob from Columbia City.

You want to know about methamphetamine?

Is that similar to a chemical makeup to amphetamine?

And are there physical and mental damages caused by methamphetamine?

Yeah, methamphetamine is, as you can tell, kind of a chemical cousin to amphetamine.

Amphetamine is something that's going to profoundly affect dopamine.

So as they say on the street, they talk they call methamphetamine meth.

Why would somebody want to take meth?

Well, if you take meth, the methamphetamine will go straight to the middle part of the brain here to the nucleus accumbens.

That's the pleasure center of the brain.

So that's the brain looking at you here.

This is the inside part of the brain.

The nucleus accumbens will blast out dopamine.

And if you blast out dopamine abruptly, you'll have a lot of energy.

You'll have increased focus temporarily.

And you can have a sense of joy and happiness.

That's very brief, because the problem with dopamine, its very transient in its effects.

It'll give you really good effects for a while.

Then you lose those effects.

Methamphetamine, as well as amphetamines, will cause the dopamine to get shot out of the neurons, but also will block the vacuuming of the dopamine back into the firing neurons.

So if you think about the neurons, the dopamine neurons as being like shotguns, you're increasing the firing of the shotguns themselves toward the targets.

And our brains have this ability to vacuum in these neurotransmitters or these chemicals to the firing neuron that's preserves the bullets, so to speak.

Well, in the case of amphetamine and methamphetamine, you're firing out more of the dopamine, but you're also blocking the vacuuming of it.

So you're getting more dopamine floating around very acutely.

And it'll cause you to need more and more to get the same effect.

And then, of course, methamphetamine will typically give people more physical problems, and particularly they have trouble with tooth decay with methamphetamine.

So it can be very dangerous.

The problem with any addictive substance is you want to do it more and more and more, despite the consequences that are occurring.

Thanks for your call.

Let's go to our next text, Patricia from New Haven.

You want to know about attention deficit disorder?

Does it show up later in life?

And what are the treatments for someone whose A.D.D.

is hindering them and staying focused to get things done, or whose impulses have hindered the relationships.Well, the first part of that, Patricia.

Late onset, adult onset attention deficit disorder, I think, is an oxymoron.

It doesn't happen that way.

If you have the late onset of difficulty with attention span, concentration, initiative, procrastination, if that's occurring later in your life.

Boy, I want to look for a very specific other things than classic attention deficit disorder.

So I'm going to look for the possibility of hypothyroidism, sleep apnea, classic for causing people to have symptoms of A.D.D.

in the adult years.

Menopausal symptoms very commonly will be seen with women in their 40s and 50s.

All of a sudden they can't concentrate.

They can't keep their mind on things.

Type two diabetes can be can emerge later in life.

So there's a lot of medical conditions that might be occurring to give people symptoms of attention deficit disorder.

Now A.D.D.

or A.D.H.D.

with hyperactivity or impulsivity, by definition, needs to start in childhood, typically by middle school.

And it's more of a day by day disturbance where it's kind of like nearsightedness.

With nearsightedness, you don't have good days with your vision and bad days with your vision necessarily.

You have pretty much every day will be similar in this difficulty, unless you're able to sit close to things and circumstances are changing for you.

With Attention Deficit Disorder, people will have more trouble with academic type of activity where they're not interested in something.

They're kind of bored, something very methodical for them.

People with attention deficit disorder will do really well, and matter of fact, they can actually hyperfocus if they're challenged, if they're doing something novel and exciting, if they're really into something, so they can do really well if they're highly interested.

But with attention deficit disorder, it's basically a networking disturbance in the brain, okay.

The affects dopamine.

And as I mentioned before, it is where the front part of the brain might be a little bit less prone to to be active in the front part of the brain might not be quite as energized when you have attention deficit disorder.

So you're having trouble focusing and concentrating.

So the networking of the brain will be quite frankly, you have these three main networks of the brain.

You've got the default mode network, you've got the salient network and you've got the executive network.

So you've got three networks.

The default mode network is where your engines kind of just idling.

Okay.

You're not thinking about anything in particular.

You might be thinking about past events.

Your your brain's kind of idling as you're driving down the highway.

You're not highly thinking about anything.

You're not really focusing and concentrating during that time.

Our brain should be able to shift into the executive mode network, where you're really able to focus and you're concentrating on something very specifically, and that gear shift that takes you from the default mode network to the executive network, that's the salient network.

So the salient network is like a shifting of the gears from the default network, where your brain is kind of idling to the executive mode network where you're really focused and concentrating.

The problem will be that ability to shift.

And that's what the salient mode work does.

So the salient mode network kind of keeps you stuck in that daydreaming mode where your brain is kind of idling and you're having a hard time paying attention to something that you need to be reading, page after page after page.

What do we do for attention deficit disorder?

We're trying to indirectly and directly fire up that salient network.

In other words, we're kind of putting some lubrication on that, on that shifting ability with the salient network and allowing you to get into the executive network for longer periods of time.

But it's not a disturbance necessarily an energy.

It's more a disturbance in being able to shift into that focus and concentration network itself.

As you have mentioned, when people have attention deficit disorder, they'll have trouble getting things done.

They can have trouble procrastinating.

They have a hard time initiating different events.

Some people will just want a stimulant.

Well, stimulants are a means by treating by by which we treat attention deficit disorder.

But we have other means as well.

And all of them are basically focusing on that ability to shift from the default mode network up to the executive network.

Thanks for your text.

Let's go to our next caller.

Hello, Paula.

Welcome to Matters of the Mind.

Paula, you mentioned that you have no energy or motivation.

Is there something you need to take to help?

Well, I'd want to go back to square one.

As I mentioned previously, Paula, I want to know when did this start.

Anybody in the family have similar disturbances and have you ever had this experience before.

Okay.

That's number one.

Number two.

Do you have any medical conditions where this might be a factor?

Have you recently had a baby?

Do you have trouble with any disturbances with thyroid?

Sleep apnea is huge for a low energy and poor motivation.

If you have sleep apnea, you can be snoring or pausing in your breathing at nighttime.

WIth sleep apnea, The problem will be lack of airflow to an adequate degree and thereby not getting enough oxygen to the brain.

If you don't get enough oxygen to the brain at nighttime while you're trying to sleep, you'll feel really tired and have low motivation the next day.

If it's something that occurred more recently but it's never happened to you again, I think more of long lines of a possible medical condition.

As I mentioned before, glucose disturbances can be a problem there.

We hear about people with low iron, so if you have low iron, you could have difficulty motivation and get up and go low iron often give people restless legs interestingly enough as well.

So we'll hear about those type of things.

If you've had something, oh, catastrophic or a significant loss in your life recently, that could be a trigger that you're getting into major depressive disorder.

So I wouldn't necessarily grab an antidepressant medication for you right off the bat.

I really want to know how long has it been going on?

Was there any medical triggers for it?

So you want to have the medical workup to make sure physically you're in good shape?

I'd want to know if you have any family members with similar disturbances because depression can run in families.

Sleep apnea, low thyroid, diabetes can all run in families too.

So I want to look for let's see if there's any pattern among family members with similar symptoms overall.

Thanks for your call.

Let's go to our next email question.

Our next email question reads what's the difference between bipolar personality disorder?

I think you mean border okay, bipolar disorder, cyclothymia, and borderline personality disorder.

Bipolar disorder itself is a catchphrase for a lot of different types of people having highs and lows with their mood.

So you can have manic highs.

Manic episode is where you don't need to sleep.

You are having racing thoughts.

You're intrusive with other people's conversations, you're impulsive during that time.

You have an extremely high energy where you're maybe doing a little of this, little that, little this, little that, and you're not getting things done.

And it's episodic.

It's not like that every day.

It's episodic.

It comes and goes.

Now when people have the manic highs, typically they'll go on for a few days, maybe a couple of weeks, and then you can crash into a low, the lowest, characterized by just the opposite type of symptoms, where you're tired, you want to sleep all the time, you don't want to be around anybody, and you can't concentrate at all.

So you can have these highs and lows.

That's bipolar disorder, okay?

There's type one where people have at least one week of highs or manic episode where they're functionally impairing.

In other words, you can't get things done at work, at home, socially.

You can't get things done.

So that's bipolar disorder type one.

Type two is where you have 4 to 6 days of little highs that are noticeable, but they're not highly functionally impairing.

But then you have at least two weeks of big lows.

That's bipolar disorder one and bipolar disorder type two.

Cyclothymia is where you have little highs, little lows, little highs, little lows.

The little highs lasts for a few days, the little lows lasts for a few days.

They're not highly functionally impairing but they're annoying.

So you notice the moodiness.

That can be kind of annoying.

And it's not directly related to the third condition you mentioned, borderline personality disorder.

Borderline personality disorder will be where somebody is highly reactive to interpersonal stress or things that are happening around them, where they're reactive with their mood.

They can get within a matter of seconds, extremely elevations in the mood, extreme depressions.

They will often have difficulty with trust, pervasive anxiety.

People with borderline personality disorder will often see people in the world around them as being all good or bad, that can be devastated by changes occurring around them.

They take things very personally, and people with borderline personality disorder, especially younger people, will make frequent suicide attempts.

And it's thought to be a type of bipolar disorder.

Quite frankly, if somebody has borderline personality disorder, keep in mind it's a type of bipolar disorder where the mood swings are triggered by people and things.

So stuff will trigger the mood swings with borderline personality disorder.

That's why borderline personality disorder does respond very well to therapies like dialectic behavioral therapy.

It can respond to medications with mood stabilizing medication if the mood instability is the predominant symptom.

So with borderline personality disorder we're trying to really focus on stress resilience.

In other words, we're trying to help people with therapy and with medication to put up with stuff better.

We're going to treat bipolar disorder type one and two cyclothymia and borderline personality disorder differently.

So it's important that we sort out what's what.

When people says, we'll say they have mood swings.

Thanks for your call.

Let's go to our next caller.

Hello, Leah.

Welcome to Matters of the Mind.

Leah, you want to know, can you take Zoloft and BuSpar at the same time?

You actually can, Leah.

Zoloft is a medication that's been around since 1992, and it came out after Prozac.

And Zoloft is a medication.

It slightly increased dopamine as well, but mainly it's increasing serotonin.

And what the Zoloft is doing, it's decreasing the vacuuming of serotonin back into the firing neuron.

I mentioned that earlier with the amphetamines, but with Zoloft it's going to focus on the serotonin neuron.

If you think of the serotonin neuron as being like a shotgun that's firing out serotonin pellets, the serotonin pellets will go to all 14 different serotonin receptors.

And the receptors have numbers and letters associated with them.

So you've got serotonin receptor one A and two A and you've got serotonin receptor three.

And all these different receptors out there.

There's 14 of them.

Zoloft will stimulate all 14 of them.

Buspirone will be very selective.

And just go to serotonin one A receptors.

Now what does serotonin one receptors do if there's too much serotonin activity.

Serotonin one A you can have difficulty with excessive anxiety.

For too little, you don't have enough motivation.

So what Buspirone or BuSpar is doing is specifically and selectively going to serotonin receptor one A and fine tuning it kind of like a dimmer switch to allow you to get just the right amount of ability to put up with stuff.

Now, BuSpar or buspirone won't work so well with panic attacks or post-traumatic stress disorder, but it can work with ruminative worry where you're just worrying about stuff that might happen.

That's where BuSpar comes in nicely now.

BuSpar came out in 1985, I believe it came out about a year or two after Xanax did, and when BuSpar came out, everybody thought, oh, it's going to replace Xanax and people won't have any trouble with addiction.

That didn't happen at all.

Xanax came out in 83 and BuSpar came out a couple of years later.

And Xanax works on benzodiazepine receptors.

It works on chloride channels, whereas BuSpar was working on serotonin mechanisms of action.

So they work entirely differently, BuSpar is not addicting.

And you'll often hear about the warning of the possible serotonin toxicity interaction with BuSpar and Zoloft.

Now, theoretically, well, that's not something that typically would happen.

But if you have any difficulty with the sense of what we call serotonin toxicity, where you have a fast heart rate, sweating is tremor, diarrhea, okay, that combination is not working out so much for you.

But if that combination was causing you any side effects, the key would be to probably decrease the dosage on the Zoloft as opposed to the BuSpar.

But Zolofts generic name is sertraline.

BuSpar is goes by the generic name of buspirone and they can be used together if you just watchful of serotonin toxicity.

You see in the package insert for both of them the precaution about serotonin toxicity.

But that's because they both affect serotonin.

But if you look at how they affect serotonin, Zoloft by flooding the system with serotonin and BuSpar selectively going to one of the serotonin receptors and fine tuning it like a dimmer switch, it makes sense that they shouldn't cause you toxicity and using them together.

Thanks for your email.

Let's go to our next text.

Hello, Kurt from Lagrange.

You have a question that reads what happens in the body, stomach and brain when someone has taken antipsychotic medications for 30 years, is now off of them and on mood stabilizer.

You're doing well in the mood stabilizer for almost a year now for bipolar disorder.

That is fantastic, Kurt.

If you've been on antipsychotic medications for 30 years, okay, antipsychotic medications are mood stabilizing medications in themselves.

The antipsychotic medication by definition will block dopamine receptors to some degree, and the newer ones will block serotonin two way receptors.

The older ones don't.

So the antipsychotic medications can be used as mood stabilizers.

Now, many people will allude to mood stabilizers as being just lithium.

Lamotrigine, Depakote, Tegretol, Trileptal.

Maybe those are antiepileptic medications as well as lithium, which is a salt.

Those aren't the only mood stabilizers.

The mood stabilizers across the board, even though there is no formal classification for mood stabilizers, but the medications that tend to provide a cruise control for your mood to keep it from have a highs or lows will be lithium, the antiepileptic medications, and the antipsychotic medications.

Now, the antipsychotic medications have entirely different mechanisms of action across the board.

So you might have been on one years ago even for decades.

And then you go on another one.

It's a whole different type of medication.

So when we talk about antipsychotic medications, we often don't talk about them as a group.

We talk about them more individually now because they have different mechanisms.

Lithium is a medication.

It's been around since the 1940s.

It's a salt.

Came.

It comes from the ground.

And lithium is in the same chemical class on the periodic table, the same column as is sodium.

So lithium can interact with sodium.

If you take in too much sodium, you can decrease your lithium level.

If you go on a sodium free diet for a while, your lithium level goes up.

So lithium is a very good mood stabilizing medication, particularly for a manic episodes.

If somebody is having fewer than four highs or lows in a year's time.

So it's not very good for rapid cyclers or people having a mixture of highs and lows at the same time.

It's good for people who have distinctive manic episodes.

Periodically, we very commonly will use the anti-epileptic medications such as lamotrigine, also known as Lamictal We use.

Gabapentin or neurotic neurons and can be used.

Those are medications that are working more on glutamate and more on sodium and calcium channels.

So they're working as you would try to fight off epileptic seizures in such a way.

They're trying to stabilize the actual actual brain electricity.

And then the antipsychotic medications, they're working on serotonin, two way receptors, they're working on dopamine.

They're working entirely different ways.

And often we'll put together maybe lithium with an antipsychotic.

We might put together an antipsychotic medication with anti-epileptic medication.

We'll use concoctions trying to keep the doses on each concoction low, because a lower dosage of any medication, you'll have fewer side effects.

So as opposed to giving somebody a high dosage of one medication, that could cause them many more side effects, we prefer to go with a lower dosage and use a couple of different medications together.

Thanks for your text.

Unfortunately, I'm out of time for this evening.

If you have any questions that I can answer on the air, you may write me via the internet at MattersOfTheMind - all one word - @wfwa.org.

That's MattersOfTheMind@wfwa.org.

I'm psychiatrist Jay Fawver and you've been watching Matters of the Mind on PBS.

God willing and PBS.

I'll be back again next week.

Thanks for watching.

Have a good evening.