.

>> Good evening.

I'm psychiatrist Forfar live from the Bruce Haines studio in Fort Wayne , Indiana.

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

So if you have any questions concerning mental health issues, give me a call here in the Fort Wayne area by dialing in by dialing two six zero four I'm sorry to zero (969) to seven to zero but if you'd like to text me we have the text option now where you can text me live during the program at two six zero (969) 27 three 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 Peruto four in campus.

And if you'd like to contact me with an e-mail question I can answer on the air.

You may write me via the Internet at matters of the mind all one word at WFB that's matters of the mind at EG and I'll start tonight's program with an email I recently received it regional over how can people with post-traumatic stress disorder and ADHD navigate treatment when their nervous systems need both the calming of hyper arousal and support of for sluggishness or executive function fatigue?

>> Many medications seem to help one side of that equation but worse than the other.

>> Well that's the fine balance post-traumatic stress disorder ADHD attention deficit hyperactivity Disorder a lot of letters there but they do have some similar circuitry in the sense that you can have trouble with distractibility and irritability with both conditions.

>> So there is some overlap with these symptoms.

So what we want to always do is investigate what symptoms specifically are overlapping with post-traumatic stress disorder and ADHD.

ADHD is a condition that starts in childhood.

It's present more days than not.

You know with ADHD you'll have more difficulty with cognition and attention span distractibility when you're more challenged by certain situations where you have difficulty with being able to maintain the bandwidth in your brain to pay attention on things post-traumatic stress disorder due to a trauma or repeated trauma earlier in your life it could have been last year could have been going all the way back to childhood.

It will also cause you to have trouble with attention span concentration, distractibility difficult to focus being more jumpy and hyper vigilant where you're always kind of on guard.

There are certain medications a do have overlapping abilities to help both conditions such as the Alpha to agonists fancy term for medications like forseen also known as intuitive which is the long acting gwon forseen in the clonidine also known as counterprotest is real blood pressure medications or blood pressure medications can actually stabilize the circuitry of the brain to make you less jumpy and less distractible and that those kind of medications will indeed improve both sides of the coin with PTSD and ADHD.

Now with PTSD the therapy is fairly specific from a psychotherapy standpoint many people will get eye movement desensitization and reprocessing treatment that's also known as MDR.

We'll often have people do rapid resolution treatment are less studied but rapid resolution therapy has a lot of interest efficacy for many people so it works for a lot of different people.

>> It's less studied at this point but it's an interesting type of treatment with ADHD it's more coaching on how how to be more tactful, how to socially interact, how to maintain your priorities and make lists on what's most important to get done and what's next most important to get done because people with ADHD they'll start things and then they'll do something else.

>> Then they'll do something else and they have trouble with vigilance and getting things done to their completion.

>> So there is a lot of coaching that can be done with ADHD.

So the psychotherapy for PTSD and ADHD are different if you have PTSD and ADHD.

Yeah you can have trouble with the anxiety component of PTSD but quite frankly ADHD has a big anxiety component too because when you have ADHD you're running behind a lot of times you're procrastinating, you're worrying about things and you're just not able to take the next step to get things done.

So they do have some overlap from pharmacology standpoint we're trying to treat those overlapping symptoms but you can treat both with different medications and sometimes some similar medications.

>> Thanks for your email.

Let's go to our first caller.

Hello Patty.

>> Welcome to Matters of the Mind.

Patty, you had mentioned that you're struggling with depression.

You've been on a couple different antidepressant medications.

Your doctor is now recommending trying an antipsychotic medications truly the next step or is there something else you could try?

Well, the first thing you want to do, Patty, is make sure you have the proper diagnosis and you can talk over with your clinician the rationale for the diagnosis that you're currently in in countering the diagnosis of major depressive disorder can often failed with certain antidepressant medications.

There's the so-called monoamine antidepressant medications that primarily affect serotonin, norepinephrine and dopamine and I presume you've probably failed on a couple of those.

So if you failed on the two of those the next step would be going to an entirely different mechanism of action such as a medication is going to affect glutamate like ketamine as ketamine also known as bravado or although is an oral formulation that can also enhance glutamate but adding an antipsychotic medication.

>> I don't like the term antipsychotic but that's what they're still called.

These are dopamine receptor blockers.

There's about a dozen of them out there.

We've used a lot of them over the course of the years for the treatment of depression but we're now using several specifically for the purpose of augmenting or improving the benefits of a traditional antidepressant medication.

The ones we use the most will be medications like Braila La Tuta will sometimes be used Abilify you will often hear about Carolita more recently being used supplied as a medication that is FDA approved now for the add on treatment with an antidepressant medication result is a medication that's being used on top of an antidepressant medication.

>> These medications do more than just block dopamine.

>> So when you hear about antipsychotic medication by definition those are medications that are affecting blocking dopamine.

But there's these other medications are also blocking serotonin 2A So the bottom line is antipsychotic medications of a particular type added on to an antidepressant can improve your likelihood of getting a good response by 70 percent.

>> I bet it can actually improve your likelihood of remitting and actually getting well by twice as much as compared to the president itself.

>> So there are benefits what we always have to be careful about with the antipsychotic medications to different degrees will be weight gain, metabolic disturbances, extra pyramidal symptoms such as shaking is a shuffling gait stiffness sedation and sexual disturbances.

Some of these newer antipsychotic medications are not as problematic as others.

>> So I think the key will be you want to have a medication going to work for you and help you feel like you're able to do the things you'd like to do again in life and bring enjoyment and pleasure back in life .

But you also want a medication that's going to be less likely to cause you all these difficulties with glucose disturbances, lipid disturbances, weight gain, neurological side effects and so forth.

So you've got to balance that out and be very careful in which medication is chosen.

So an antipsychotic medication can be another line of treatment that again it doesn't mean that you're psychotic.

>> We use antipsychotic medications to relieve psychosis such as auditory hallucinations where people are hearing voices where people are not there and you can have an antipsychotic medication helping with delusions where people have fixed false beliefs.

That's not necessarily what would be treated for you if you're using the antipsychotic medication for depression but they can provide benefit and that can can be a next line of treatment.

>> Thanks for your call.

Let's go next caller.

Hello Pam.

>> Welcome to Matters of Mind.

Pam, you want to know how do you test for bipolar disorder and schizophrenia there is no blood test for bipolar disorder and schizophrenia.

>> They both share dozens of Ginnette genetics and there's about two hundred different genes that can affect somebody with bipolar disorder and schizophrenia.

So you can't do a blood test because of genetics are quite varied.

If somebody has a family member, a first degree relative especially with schizophrenia or bipolar disorder, that will dramatically increase the likelihood of the condition itself with if you have one parent for instance with schizophrenia you have about it an eight percent chance of having schizophrenia yourself.

So there is a genetic risk having schizophrenia.

On the other hand, bipolar disorder is about sixty five percent genetic so it does run in families.

That will be a bit of a clue if you have a first degree family member father, brother, father, brother, sister, a mother with bipolar disorder or schizophrenia you have a first family member that is a risk itself.

So how do we diagnose them?

We diagnose bipolar as disorder and schizophrenia by very careful questioning.

We look at the symptoms with bipolar disorder.

We look for symptoms of not needing to sleep feeling very energetic periodically having difficulty with impulsivity, racing thoughts that are occurring periodically.

You may or may not crash into depression thereafter.

>> So bipolar disorder is basically a mood disorder whereby means to and polar means one extreme or another.

So bipolar disorder is where people are going from one extreme to the mania possibly to the extreme of depression.

So they're going up and down by asking people very specific questions we can diagnose and sort out if somebody has bipolar disorder there are many different types of bipolar disorder.

We call it bipolar disorder spectrum where people have bipolar disorder type one type two psychotherapy a borderline personality disorder is a type of bipolar disorder.

You have major depressive disorder with mixed features.

These are all different types of bipolar disorder.

So we have to sort out what type of bipolar disorder somebody might be exhibiting and then direct our treatment or that particular type with schizophrenia.

>> On the other hand, that is typically a lifelong condition that starts so the average age of 16 years old for a boy twenty four years of age for a woman women will have the onset schizophrenia symptoms a little bit later than men presumably due to their estrogen.

>> Estrogen is somewhat protective of the side for the psychotic symptoms but there seems to be some kind of hormonal influence with schizophrenia.

>> Schizophrenia is as a condition where you are hearing voices that nobody else can hear.

The voice can be inside your head or outside your head.

You're having perhaps fixed false beliefs where you have difficulty with things that happen, things that are happening around you that are not true and they're causing functional impairment where you're having trouble with work, socialization, schooling, concentration, difficulty so-called negative symptoms will be very prominent with schizophrenia where people will be highly anxious in the presence of others.

They'll be lack, they'll have less motivation, less initiative.

They can't get things started and they'll often in talking to them especially when they're psychotic will go from one topic to another to another to another and it'll be very difficult to follow them.

So schizophrenia is entirely different from bipolar disorder.

However, they do have overlapping genetics but one of the first tip offs will often consider will be if you have a first degree family member who has bipolar disorder or schizophrenia.

>> Thanks for your call.

Let's go to our next caller.

Hello Jerry.

Welcome to Matters of Mind.

Yes, I had a question about see ivermectin if I'm pronouncing that right and nicotine patches a lot of people are using for anxiety, depression and other diseases.

>> I didn't know what your thoughts were on that ivermectin.

>> Jerry, as you probably recall was discussed quite a bit during the covid pandemic and this has been studied that much for depression or anxiety.

I'm certainly not one to discard the possibilities that medications like ivermectin can be effective for conditions such as anxiety or depression.

They just haven't been studied that much nicotine patches Jerry can give you a back door, a very back door means of helping with depression.

And for many people, Jerry, if you have depression you also have anxiety and in fact people with depression three fourths of them will have anxiety symptoms and anxiety symptoms will be where you worry, you ruminate, you're restless, you're pacing around and then when you have anxiety and worry and rumination about the future, you can have difficulty .

>> Sleep and lack of sleep will give you difficulty in the front part of your brain to be able to recharge and be able to cope with challenges that are occurring day by day.

So the bottom line is there's a cascade of anxiety, insomnia and depression that many people experience.

>> So ivermectin whoknows might be one possibility.

It's not a treatment that I've ever pursued for anybody but nicotine patches.

>> They're typically used to get people off of nicotine cigarets so nicotine patches of where you put a patch on your arm, your chest, your waist in the idea the nicotine patch is a slowly release nicotine over the course of the day and in doing so it can mimic the effect of a nicotine cigarets nicotine cigarets will fire up this temporal lobe part of the brain, the yellow part of the brain and in doing so help some people with concentration and focus.

Secondly, nicotine will go to this middle part of the brain and fire up the air.

The brain called the nucleus accumbens increasing dopamine and giving you a feel good effect helping with depression and for many people even anxiety for that matter.

And I think that's a wonderful medication.

Why shouldn't everybody take nicotine was because as you probably know, nicotine can be addictive in other words is addictive in a sense that the longer you use it and the more you use you'll find that it doesn't work so well in the long run so it fades in its effects.

>> That's why nicotine je decades ago sure that was a primary means of helping with depression in focus and concentration for people but anymore yeah it wouldn't be a preferred treatment for depression and anxiety and you think how could nicotine help with anxiety?

Well many people who have a condition like attention deficit disorder for instance which we talked about earlier attention deficit disorder is a phenomenon where your brain appears to be a little bit lacking in dopamine.

So if you can fire up the dopamine with nicotine that does help with attention and focus for the people with attention deficit disorder.

However, it's not a good long term treatment.

But people with ADHD as I've mentioned before, will have a lot of anxiety because they're often ruminating about what they haven't done or are falling behind the procrastinating.

They are noticing that they have trouble with social tact and that can often get them in trouble socially.

So they're often worrying about how they came across somebody because they have a hard time thinking of what they say before they actually blurt it out so I can understand how nicotine could help some people who have ADHD.

It's kind of a back door treatment as is quite frankly a medication like caffeine.

Caffeine is a medication and it pharmacologically can help with anxiety and focus for people who have ADHD.

But it's not the best treatment we have but it's a mild means of trying to address those symptoms.

>> Thanks for your call.

Let's go to our next text messages from Marie.

>> Hello Marie.

You're texting can low blood pressure make a person more prone to depression and or ADHD and how what can treat low blood pressure?

Well, if you have low blood pressure, Marie yeah.

You can have trouble feeling tired and depressed.

You can have trouble with concentration.

My bigger issue is why do you have low blood pressure if you have low blood pressure because you're hemorrhaging in the bowel that's a problem needs to be fixed if you have low blood pressure due to Pott's postural orthostatic tachycardia syndrome where your heart rate is speeding up real fast in your blood pressure is dropping.

Yeah, that could be a factor that needs to be treated.

So the first and foremost if you have low blood pressure try to figure out what's causing it.

>> Is there a medication you might be taking that's causing it already hydrated a lot of different reasons for low blood pressure get that sorted out.

But a symptom of low blood pressure can fatigue, tiredness, lightheadedness sometimes people will pass out and certainly low blood pressure like low iron can give you difficulty with concentration thanks to your text.

>> Let's go to our next caller and our next caller is Rivkah.

>> Hello Ravina.

Welcome to Mars.

The mind you had mentioned that your daughter has been having short term memory problems for the past three years and you've tried to have a neurological test done for the memory but she can't finish it.

Is there something else that you could try to find out why she's having the issues of the memory problems, the neurological test that would be something they would certainly consider if she's having trouble completing a neuropsychological testing that could be part of the problem itself.

>> So short term memory problems for the past three years I'd want to know Raveena if she's having difficulty as an adult or is this a childhood condition?

If it's a childhood condition, we want to make sure all the medical type of conditions are assessed including the possibility for ADHD.

You can have short term memory problems due to a head injury.

Lothar a glucose disturbances such as diabetes, low iron, lots of reasons out there for poor memory and if she's having trouble completing the neurological testing that would be effective a factor that the neurologist would certainly take into consideration.

But I think most importantly try to figure out why she's having trouble with short term memory especially if she's having trouble completing the testing.

>> Thanks for your call.

Let's go next text.

Hello Michelle from Columbia City.

Welcome to Mars of Mind.

You had texted any recommendations on dealing with empty nest syndrome.

It's a bit of a grieving process.

You bet.

I'm happy for our son and his new beginning but the dynamics of our house have definitely changed.

Well, Michelle, I would certainly recommend it with empty nest syndrome.

Yeah.

Be happy for your son.

He's going on to a new chapter you've done your job and like the empty nest syndrome implies you're the mother bird and you're allowing him to fly off on his way.

So what's the mother bird do?

Well, you look at the next chapter of your life and you keep yourself busy doing other things than having that maternal role so you have a role that you successfully for now finished although you'll always be his mother you'll always have that kind of role maybe in the background but you won't be maybe involved in his life on a day to day basis as you had before.

So the important thing for you will be to socialize, be able to find other interests, hobbies, other types of things you can do in your life now that you couldn't do before keeping in mind that there was a time when you were perhaps single, didn't have any children and you were doing things at that point people have to remember that after their child leaves the household and you get involved with doing things that previously you found interesting and within your physical capacities do things that are still interesting for you now thanks your text.

>> Let's go to next text Ted.

>> Welcome to Matters of Mind Ted you're asking my impression is that we enjoyed a lot of sunshine in the toughest month of the year in January.

>> How important is sunshine to mental health ?

>> It's quite important, Ted.

There's a phenomenon called winter depression also no known as seasonal affective disorder and it's where because of lack of sunshine you get depressed.

>> When people get depressed they go into a hibernation mode in the wintertime.

So what sunshine will do sunshine and bright light will hit the retina and the retina will give a signal to the pineal body in the middle part of the brain here shaped like a pea and pineal body will upon stimulation a sunshine suppress melatonin.

>> In other words you'll feel less tired.

You'll be more awake and alert and sunshine will give you an awakening effect.

So that's why with winter depression if you have a lot of dark days of winter will often recommend a treatment called light therapy.

There are certain places where you get bright light treatment and you sit in front of a bright light for twenty or thirty minutes every morning in the winter months especially on the dark days of winter, on the sunny days of winter.

Make sure you have the blinds open or go for a walk if it's not too cold out there and try to get some sunshine in because with the sunshine is stimulating the pineal body and suppressing its melatonin release now with melatonin that's released oh due to the dark days of winter like you might expect you feel more tired but you'll also instinctively go into a hibernation mode where your socialize less.

>> You'll want to exercise less, you'll eat more carbohydrates, you feel kind of blah.

You have trouble with concentration and many people will go into this hibernation mode in the winter time because the dark days of winter women appear to be more sensitive to the light from the sun because women are eight times more likely to have seasonal affective disorder compared to men now seasonal affective disorder is where the depression in the winter especially will affect you to the point where you're having a hard time socializing and getting things done.

You really want to get done.

That's where it becomes a problem.

So bright light therapy is one of the best things you can do.

Exercising is always helpful.

Stay sociable during the winter months we do use certain medications to try to get through people through the winter months to try to pick them up a little bit.

But the bright light therapy actually helps the most thanks to your text.

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

Our next email reads Dear Dr.

Farber, I used to take Bew Spirent and I really liked it from day one I'd breathe and sometimes unconsciously take three quick in air breaths while inhaling air.

It felt good and it felt like my stress was leaving my body.

Just curious what that's all about.

>> It is a medication that will basically act somewhat as a as a as a dimmer switch on serotonin 1A receptors.

>> There's 14 different serotonin receptors and if you act as a dimmer switch on one of these receptors serotonin one you can thereby affect how serotonin is affecting the brain and chill out somebody from their anxiety and decrease rumination.

So the whole purpose of Spyro is to decrease rumination.

It's often dose between five milligrams twice a day up to four thirty milligrams twice a day.

But you're mentioning basically doing some breathing exercises where people will indeed take in some short inhalations and then long exhalation.

>> So if you can exhale three times longer than inhaling what it does, it stimulates the parasympathetic system, the parasympathetic system in your in your body it will oppose the sympathetic system and the parasympathetic system will make you calmer.

>> So you'll notice your heart rate goes down a little bit.

You'll feel more relaxed in general and by exhaling that's where the parasympathetic system comes in.

>> I've noticed that sometimes when I've done yearly physical examinations when I'm getting ready to get my blood pressure and heart rate checks, I'll just make sure I do a few quick inhalations.

But a long exhalation actually lowers your heart rate quite a bit.

So that's what you're doing your lower your heart rate undoubtably feeling that sense of calm when you're exhaling very slowly so you're probably taken some quick breaths in and then you're exhaling whether you realize it or not.

You're stimulating your parasympathetic system thereby making yourself physically calmer.

>> Thanks for your call.

Let's go our next caller.

Hello Larry.

Welcome to Matters of Mind.

Larry, you had mentioned during childhood there are a lot of moves and you're wondering does moving during a child's childhood during childhood affect a person's mental health and what can parents do to help with a move?

You know, I've heard it either way, Larry, because I've heard that when people move frequently during childhood they are forced to make new friends and I hear about this with military and military families often commonly it can allow them to be more sociable and more interactive later on so it can have an adaptive effect later in your life where if you're making a lot of moves you're forced to make a lot of new friends and you'll be able to be more outgoing and more engaging with people socially.

>> So the first thing you can do as a parent is be able to help the child be able to talk and interact with people in an environment in which they're not familiar and that can actually be very, very healthy later on.

Now if you're moving for various other reasons because your parents are divorced or separated when your parents is in prison, there's substance abuse and alcohol problems in the household.

>> OK, those are all big stresses that are actually significant on the adverse childhood experience scale the ACS scale as a ten item scale and if you have over four of those particular stresses that you experience before the age of eight years old, you're much more likely than other people to experience anxiety and depression later on.

>> So we're talking about the reason for the moving as opposed to the actual moving itself.

>> So those are kind factors to keep in mind.

>> Thanks for your call.

Unfortunate 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 matters of the mind all one word at eight dot org.

>> I'm psychiatrist favorite.

You've been watching Matters of Mind on PBS for Wayne now available on YouTube God willing and PBS willing.

I'll be back again next week.

Thanks for watching.

Goodnight