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>> Good evening.

I'm psychiatrist Jay Fawver 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 the Fort Wayne area by dialing (969) 27 two zero and if you'd like to text during the program hopefully I can receive it on the air.

>> You may text me at two six zero (969) 27 three zero.

>> Give me a name and tell me where are from so I can make it more personable that way now on a fairly regular basis I am 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 with an email question that I can answer on the air you may write me via the Internet at matters of the mind all one word at WFYI Egg that's matters of the mind all at a dot org and I'll start on its program with a question I recently received.

>> It reads during Evolver I just got diagnosed with Attention Deficit Hyperactivity Disorder ADHD as an adult woman and have started taking Vyvanse .

Should I be aware of any interactions with my current Lexapro prescription or any other symptoms of the new medication to watch out for Vyvanse is is also known as less dexamphetamine.

>> It's a medication that is basically something that breaks down when it gets in your gut.

So it has a little bit of lysine amino acid weighing on it within with the lysine amino acid wing on it.

>> It's just won't work at all.

>> But once it gets to the stomach acid and the stomach juices and the liver metabolism will clip off that lysine wing and it becomes dextroamphetamin .

So it's a long active medication in that regard because as the day goes on that lysine wing gets cut off, cut off, cut off very gradually.

>> So Vyvanse will typically last about eight 10 even 12 hours for a lot of people.

Lexapro on the other hand primarily will increase serotonin.

Now many people will take Lexapro also known as escitalopram.

It'll take it for the purpose of giving them a calming effect.

Now I'm often very careful when I see somebody on a medication it increases serotonin when they have ADHD because many people with ADHD by nature will have difficulty with worry and anxiety and rumination because they're always wondering you know, they're worrying about what they didn't do, what they forgot what what they're procrastinating upon.

>> They're always stressed out because of their underlying ADHD.

So the first question will be if you can adequately treat your ADHD with a stimulant such as Vyvanse, would you have as much worry and anxiety?

>> So Lexapro at higher doses can dampen or suppress the benefit of a medication like Vyvanse because increasing serotonin can indirectly decrease dopamine.

You're trying to increase dopamine in the frontal lobe here especially with a medication like Vyvanse.

So Vyvanse will increase dopamine and norepinephrine to some degree and whereas Lexapro is increasing serotonin and indirectly decreasing dopamine.

So Lexapro can sometimes be helpful because if you have a little bit of Lexapro on board it can decrease some of that excessive worry but we're always trying to knock it out of the park ideally with one medication of Vyvanse can take care of the underlying symptoms themselves.

>> That'd be great.

Now you know you're getting too much Vyvanse if you feel jittery you have a fast heart rate.

>> You're not sleeping as much if you feel hyped up.

Many people will find those kind of side effects from a stimulant being somewhat welcomed because they feel like they're getting a lot of energy and they get a lot done.

Unfortunately it's kind of like wearing eyeglasses that are too thick for what you really need.

>> If you get too high of a dosage of Vyvanse, your concentration, your attention span, your distractibility will actually be worsened even though you might feel emotionally more hyped up your concentration, the distractibility, the purpose upon which the Vyvanse is being used will sometimes be compromised.

So you don't want to take too much Vyvanse if you do you back off the dosage on your clinician supervision.

>> So we're trying to find just the right dosage of Vyvanse and if you have ADHD, if it's authentic as a particular symptom cluster by all means that's something to be very helpful for you.

Vyvanse is typically dose between ten and seventy milligrams of sweet spots between 30 and 50 milligrams for some people but I see a lot of adult patients who do fine at thirty milligrams and sometimes even twenty milligrams.

>> So you can't go based on your gender or your age.

>> You can't go based on your body weight.

You just have to go based on how it's working for you and again it's kind of like eyeglasses.

>> We don't base eyeglass strength based on your age or your gender or your weight.

We look at how well your eyeglasses are doing for you based on the outcomes of the focusing itself.

Well the same for a medication like Vyvanse for ADHD we're looking for good outcomes for you if you're able to be more productive in paying attention to things, making fewer errors in your day to day work, knowing that it will smoothly get out of your system toward the end of the day as opposed to a medication such as a short acting stimulant like Adderall immediate release Ritalin Ameet release those kind of medications will get in your system for about four or five hours and then many people will crash what we like about a medication like Vyvanse it's longer acting, it's smoother and it's release and it's smoother on its let thank you for your email question.

>> Let's go to our first caller.

Hello Sally.

Welcome terrorism.

>> Sally, you want to know where should you start if you're concerned about your child's mental health ?

>> I would start Sally with your pediatrician.

Your pediatrician can assess your child's overall functioning to see if your child is having any difficulty with asthma with any physical problems such as anemia, bellyaches.

>> There's all sorts of physical type of things that can affect your child's mental health and then your pediatrician will be a good source, somewhat of a gatekeeper to determine if the child if your child needs to go see a therapist or see a child psychiatrist or somebody who might specialize in child mental health issues.

>> A child can have difficulty with mental health based on overall anxiety, difficulty with depression, children can get overly depressed as well as attention deficit hyperactivity disorder.

>> One of the first things that a clinician will often assess for a child, Sally, will be to try to determine if the family members have similar symptoms.

So for instance, if you as the child's mother had similar problems when you were younger, the clinician is going to explore OK, how did you do where the those problems treated?

Were they not treated?

How do you do as you grow up because it's kind of like an indirect way of assessing somebody genetic functioning if you have a first degree family member a mother, mother, father, brother, sister with similar problems when they were that child's age, usually we're going to try to look back and sort out what kind of problems might be there now forty years ago or so Attention Deficit Hyperactivity Disorder for instance, wasn't really assessed that that distinctly it started getting more assessed about twenty five years to go.

So if you had difficulty with focus and attention span and concentration and your child is having similar issues that can be a factor anxiety conditions you might have had anxiety when you were younger and your child might be having similar bouts of anxiety.

Now we want to see what kind of anxiety was present was a social anxiety was it obsessive compulsive disorder?

Were there more panic attacks?

Was there generalized anxiety which we call worry?

What kind of anxiety was there overall and was your child in any incidences where there were were there was trauma involved whether there be emotional abuse, sexual abuse, physical abuse, any kind of trauma itself can lead to that child having what we call post-traumatic stress symptoms that should be addressed sooner rather than later.

>> Now a child's personality development will start to really develop by about the time of eight years old.

>> So those early life stresses, those early life traumas, they can be very impactful on how a child is going to do later on in terms of developing any difficulties with anxiety or depressive disorders.

>> Sally, thanks for your call.

Let's go next caller.

Hello Paul.

Welcome to Mars The Blind.

Paul, you know, are there any long term side effects in taking lithium?

Your physician wants you to start taking it to stabilize your mood.

Well, Paul, lithium is particularly good for the purpose of stabilizing the mood because lithium has an antiinflammatory effect on the brain.

>> Lithium comes from dirt and we've been using it in bipolar disorder manic depressive disorder since the 1940s.

So it's something that's been around for a long, long time.

>> Lithium is most safely used, Paul, when you use it in a controlled release formulation and preferentially all at bedtime.

>> So it's something you could talk to your clinician about if you're not taking controlled release and you're not taking it all bedtime back in the old days people would get immediate release lithium you take it three times a day.

Not only is that very difficult to take but it also is tougher on the kidneys and that's a side effect you can have.

>> Your clinician is going to be checking you for kidney tests and thyroid tests.

Your kidney functioning can be somewhat suppressed with the long term use of lithium that's related to the dosage the higher the dosage and especially if you're using it in the immediate release formulation that can be tougher on the kidneys.

>> Now people sometimes worry that if they if they use lithium they can't sweat.

>> I've heard that misconception for a long time.

It's that you can't sweat just you just need to stay hydrated.

>> So if you're sweating have an electrolyte enhanced type of beverage that's going to help offset that.

But if you have a low sodium diet as you would and you can have lower sodium with excessive sweating if you don't replenish the salt you can have higher lithium levels so low sodium will give you higher lithium.

>> So that's some point sometimes where that misconception will be if you sweat a lot you can't take lithium while you can sweat a lot just make sure that you replace the electrolytes that you're losing in the sweat itself.

So if you have a high sodium diet, if you have a higher sodium diet than usual, you'll actually decreased lithium lithium levels.

>> One thing I often tell people about lithium will be be careful about taking any so-called nonsteroidal antiinflammatory aget that's called an INSEAD medications like Advil, Motrin these are medications often used over the counter for pain and even fever for that matter.

These so-called insets will increase lithium levels by about twenty five percent.

>> Now that might not seem like much but if you have a lithium eleven point six you're feeling pretty good if you take Advil, Motrin, the so-called instead medications for pain or fever you might notice the lithium level going up to about point eight and at that point you can notice yourself having some toxicity effects.

How do you know you're taking too much lithium?

You have diarrhea.

Shakiness is a common symptom of getting too much lithium.

Headache will be not uncommon.

Nausea sometimes people will have all sorts of gastrointestinal problems so you'll notice that you're taking too much lithium if you feel more physical symptoms overall and you just feel don't feel right.

>> So what we try to do with lithium not uncommonly is keep the blood level between about two point four million gallons per liter.

That's kind of lower than what's recommended labs.

A lot of times the labs will often recommend point six to one point two ML equivalents per liter for lithium levels.

Lithium levels are best obtained first thing in the morning about twelve hours after your last dosage even if if it's a controlled release formulation.

>> But be watchful if you get a level of point eight or point nine or 1.0 yeah that's in the therapy range and it can work really well for preventing manic episodes.

It's just that you might notice more side effects at that level, especially if you have a little fluctuation in your sodium intake, especially if you happen to take a motor a Motrin or an Advil, the so-called INSEAD medication.

>> So we'll often watch for that.

>> Lithium is particularly good for mood stabilization if you have what's called bipolar one disorder where you have extreme manic highs where you are not needing to sleep, you're impulsive, your thoughts are racing from one thought to another.

>> You're intrusive on social interactions.

You'll do things and say things that you later a great regret and that goes on for at least a week and it's occurring less than four times a year.

>> We're having these big manic episodes that would be called bipolar one disorder if you have a mixture of manic episodes and depression at the same time those are called mixed features.

Lithium doesn't tend to work so well for the mixed features.

If your rapid cycling with highs and lows having more than four episodes of highs and lows of a year lithium might not work as well with that either.

>> So lithium can be very useful in stabilizing the mood for bipolar one disorder.

>> We often commonly used tidy little doses of lithium as little as 150 milligrams at bedtime for people who are having suicidal thoughts.

I've had amazing success over the course of my almost 40 year career in using a small amount of lithium for people typically at bedtime they'll typically have no side effects from them but a small amount of lithium can again have an antiinflammatory effect on the brain and in doing so can decrease suicidal thoughts and intentions.

So many times people who have these chronic thoughts of wanting to kill themselves will do really, really well with a small small small lithium.

The blood level is almost negligible for these people.

They obviously will not have difficulty with kidney functioning and it tends to be very safe treatment itself.

But it's not being used for mood stabilization.

It's used specifically for suicidal thoughts.

The toxicity from lithium again can be from kidney problems.

The second thing would be thyroid disturbances.

Sometimes lithium will suppress the release of thyroid hormone from the thyroid gland and that would sometimes necessitate the use of a little bit of supplemental thyroid.

It's not thought to be extremely dangerous for a lot of people, just something that we'll watch probably every three to six months for people who are taking lithium depending on the dosage, the lower the dosage the better.

But you also want to make sure it's working if you're using primarily for mood stabilization.

>> Thanks for your call.

Let's go to our next caller.

Hello Sam.

Welcome.

The mastermind Sam, you want to know does ibuprofen what was INSETs I mentioned before?

Does it interfere with antidepressants?

>> Ibuprofen is a medication that can affect how well your little platelets are able to clot so ibuprofen will inhibit the clotting of platelets and in such a way you can have more Brous ability antidepressant medication that affects serotonin, the so so-called selective serotonin reuptake inhibitors such as Paxil, Zoloft, Lexapro, Celexa and Prozac these are the so-called selective serotonin reuptake inhibitors.

>> They can also inhibit the the clotting of the platelets themselves, the binding of the platelets and the aggregation is what we call it.

So what you'll notice is you'll have more Brous ability and sometimes people can have more stomach bleeds and stomach ulcers because of that.

So if you take ibuprofen chronically ongoing, the biggest interference would be if you're taking a medication that's affecting serotonin because ibuprofen will also increase the likelihood that you're not going to be able to aggregate the platelets.

>> You can have increased Brous ability and so forth.

That'd be the biggest concern I'd have.

Secondly, ibuprofen if used at a high dosage can affect the kidney functioning.

>> So you want to be very careful with long term high dosage use of ibuprofen if you're taking certain antidepressant that need to go through the kidneys which pretty much describes a lot of them except for prestige and Effexor, those medications don't really need to get metabolized that much of the kidney.

>> So if you damage your kidneys with high levels long term use of ibuprofen that can affect the antidepressants as well.

Sam, thanks for your call.

Let's go our next e-mail question.

Our next e-mail question reads dear to discover what are the pros and cons of the different medications treating bipolar disorder, bipolar disorder kind of allude to that earlier bipolar disorder is where you have highs and lows.

>> The BI refers to two polar means one extreme or another.

>> So you're having one extreme or another of moods.

So on the highs as I mentioned earlier, you're having manic episodes characterized by decreased need for sleep.

You're more impulsive, you have racing thoughts, you're intrusive, you're having difficulty with irritability.

>> You might have a good mood or really high mood but you can also have an angry irritable mood and the bipolar disorder type one will get you into trouble.

In other words, you do things and say things you ordinarily wouldn't do or say and you do things with regret that you find out later on there's bipolar disorder type two where you'll have little highs for four to six days and they don't get you in a lot of trouble.

Other people could notice it and you'll notice it because when you come out of those four or six days higher than normal mood you'll crash into at least two weeks of depression.

So with that we need to stabilize the mood and also help with the depression side itself.

So there's lots of different treatments for bipolar one disorder bipolar disorder and then we have major depression with mixed features where people will have anywhere between a few hours of having the highs up to up to three days or so.

So what will often do is we'll use bipolar, we'll use lithium for bipolar one disorder if you're having fewer than four episodes a year and you're not having the manic episodes mixed with the Depression, the mixed features of bipolar disorder can be miserable for people.

I saw a lady this morning who had the mixed features of bipolar disorder.

She had a highs at the same time of having depression.

How's that look?

>> Well, you're going to have racing thoughts.

You don't you're not able to sleep but the same time you feel really depressed and you don't enjoy things.

>> So it's a mixture of highs and lows.

It's an absolutely miserable type of feeling to have and lithium doesn't do so well with that will often use the so-called antipsychotic medications that are now used for many other things than psych than psychosis.

So we use medications like capelet altitude of Reller Abilify the risperidone.

These are all medications that can be used for mood stabilization.

Not uncommonly though we use the antiepileptic medications and those medications are like a motor gene Trileptal Tegretol Depakote not used so much anymore but especially the motor gene also known as Lamictal and Trileptal also known as carbamazepine and we'll use these medications in combination not uncommonly because they have different mechanisms of action.

The biggest drawbacks of the antiepileptic medications some of them can be problematic during pregnancy.

Some of them aren't so problematic during pregnancy but they aren't antiepileptic medications are fairly effective for bipolar mood stabilization whereas the antipsychotic medications are often much more effective in stabilization.

But they can have more sedation and sometimes can cause some side effects of their own of the antipsychotic medications, the medication it probably has the fewer side effects of all the antipsychotics for bipolar disorder would be capped later where it doesn't cause weight gain doesn't cause as much difficulty with with shakiness and tremulousness like Parkinson's symptoms doesn't cause sexual disturbances.

So it tends to be very well tolerated.

So we have a lots a lot of options for mood stabilization at this point for the purpose of stabilizing bipolar disorder.

>> Thanks for your email.

Let's go to our next text.

Hello Tom.

>> Welcome to Mars, the mine.

You're from Columbia City.

Tom, you had asked what are some things you could do to beat the retirement blues?

>> Well, Tom, I I'm I'm answering that question a lot for people over the past few weeks and I think more people are retiring which is fantastic.

But if people will look forward to their time retirement save up throughout your life .

But I think when you go into retirement you got to have a plan that you're not at the end of your life so to speak.

You still can have some productive days ahead of you now naturally our bodies they wear down and we have to kind of accept that our bodies are kind of like an old classic car were over the course of time.

It needs some maintenance but it's going to naturally wear down and you do the best you can to keep it up and sometimes you have to replace a few far few parts.

So that's what we often have to do with the classic cars.

That's what we have to do with our bodies.

>> So the best thing you can do to take care of your body as you get older and you're in retirement, I'd say my going to start working out on a regular basis you might not have had the opportunity to exercise as much when you are working.

>> This is a fantastic time to gradually get into an exercise routine exercise is a type of phenomenon where in the brain you're going to increase a couple chemicals, you're going to increase glutamate.

GABA glutamate is like the accelerator on the brain whereas GABA is like the brakes and you can at the same concomitantly increase glutamate and GABA when you're exercising and that's why after exercising as long as you don't overdo it you can have a sense of increased energy but you can also have a sense of calming so you can feel energized but yet calm and that's why many people they exercise 20 to 30 minutes they'll actually feel emotionally better and they feel a little bit physically better.

>> They might have some sore soreness and it could be a good soreness overall but you don't want to overdo it as you get back into it.

So with retirement I'd say No one try to take care of your classic car body and try to do the best you can to take care of yourself because you can do things in retirement that you didn't have time to do in your work and secondly try to reestablish some relationships with family members and with friends.

You have opportunities now that you didn't have what your employed where you can start to have better and closer relationships with friends and family.

It's actually a predictor for dementia if you start to become more socially isolated as many people do during retirement because they're not around the workplace anymore, if you start getting socially isolated actually increase the risk for dementia and part of that reason is because with social isolation you also have a higher risk for depression.

So depression risk will give you a higher risk for depression for dementia.

The risk for depression will be social isolation.

So you got to be around people try to establish some kind of engagement with family and friends somehow some way with retirement you have to have things to do now the first week or two of retirement you can be all excited and feels like a long vacation and quite frankly it is you can sleep in a little bit more.

You can do some things around the house.

You can putter around with this or that.

You can maybe travel some places around and you have all this time on your hands.

I hear from people who have retired that that gets kind of old after a couple of weeks after a couple of weeks you need to have schedule things to do now for many people I hear a lot about pickleball now with pickleball you can't do that apparently if you have joint replacement.

So it's not for everybody.

>> But I hear that people get engaged in hobbies in their retirement that they didn't do previously.

Now remember when you were working you had to get up at a certain time every day you were expected to go to lunch at a certain time that your day was very structured.

It was very laid out for you and you might have worked only through Friday and then you look forward to the weekends.

Well now in retirement every day's like a weekend and you have to have your day structured to keep yourself busy.

>> Now in the Bible it never talks about retirement.

Retirement is something we're not expected to do.

So you're not supposed to quit on life just because you get to some magic age when you're you can get to your IRA money you need to be able to have some productive activities and sometimes those activities can be things that were totally unrelated to your work.

>> You might do some reading, you might do some artwork, you might do some games and hobbies that you just hadn't taken on before because you didn't have the time.

>> So it could be a very exciting time of your life but it could also be a very depressing time in your life because I've seen and as a psychiatrist some people really crash into severe depression when they get into retirement after they get past about two or three weeks because it's like they lose purpose in life and they're just kind of sitting around waiting for death.

You don't want to do that.

>> This is a new chapter for you and you want to be able to have as meaningful of next few years or decades as possible even though you might not need to be employed.

>> And I've actually heard of many people going into some part time jobs where they work based on how many hours they want to work.

They could volunteer as well but you can get involved in some work like activity that might not be as stressful for you as you were when you were previously employed because you don't have to thank your call.

>> Let's go to our last email question.

Our last email question reads Dear Dr.

Farber, what are some of the pros and cons of different medications in treating bipolar disorder that gets an email I received earlier but I'll go ahead and elaborate upon that one with bipolar disorder there's antipsychotic medications or antiepileptic medications and there's lithium.

So with lithium we're going to use that specific cases.

Lithium can have some detrimental effects on the kidneys or thyroid it if used in high doses for long periods of time will often assess the kidney in the thyroid functioning whereas the antipsychotic medications have various pros.

Cons are many, many different types of them.

They're primarily blocking dopamine.

They're blocking this other receptors called serotonin 2A receptors and in doing so they can provide mood stabilizing effects.

The antiepileptic medications, the older ones like Depakote tend to have harsher side effects.

>> So we're using more like Lamotrigine and also known as Lamictal as well as Trileptal known as carbamazepine now so there's a lot of good options out there for bipolar disorder.

>> Thanks for your email Unfancy.

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 right via the Internet at matters of the mind all one word at big.

I'm psychiatrist Jeff.

All right.

You've been watching matters of mind on TBS Fort Wayne now available on YouTube God willing and PBS willing.

>> I'll be back again next week.

Thanks for watching.

Goodnight