good evening.

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

Welcome to Matters of the Mind now and his twenty eighth 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 in the Fort Wayne area by dialing (969) 27 two zero or if you'd like to text me you may dial you may text me at two six two zero (969) 27 three zero you can text me on the air as I speak now on a fairly regular basis.

>> I am broadcasting every Monday night for our PBS Fort Wayne studios which lie in the shadows of the Fort Wayne campus and if you'd like to contact me with an email question that I can answer on the air, you may write me via the Internet at matters of the mind all one word at WFYI Big That's Matters of the mind at WFA Oregon.

I'll start tonight's program with a question I recently received.

>> It reads Dear Dr.

Fauver, I get the whole seasonal affective disorder thing but what I'm wondering is if quickly changing weather patterns can have a similar effect.

>> Do a few cold days or rainy days in a row affect someone's mental health ?

What you're referring to barometric changes actually barometric changes or will be where the where the pressure will go up or down and that gives you cold systems and you get rain and all sorts of weather patterns that will affect you if you have migraine headaches and if you have arthritis not so much for anxiety or depression to our awareness anxiety and depression are more affected by the brightness of the light especially you feeling more depressed.

There's a phenomenon as you mentioned called Seasonal Affective Disorder also known as sad, also known as winter depression because most people will notice if they have a tendency toward winter depression though they'll feel somewhat more depressed with lack of energy, more social withdrawal.

They want to eat more that occurs around November goes into about March and the reason that occurs because look at the middle of the brain here eyeballs will receive the brightness of the intensity of the light and that brightness of the intensity of light will give a signal to the pineal gland right smack in the middle of the brain.

>> The pineal gland secretes melatonin and when it gets darker day by day in the mornings and evenings the melatonin levels will go up and it's thought that that's contributing primarily to seasonal affective disorder.

Women are eight times more likely to get seasonal affective disorder compared to men and it's certainly affected by latitude.

The higher latitude more north you go the more likely you're going to have seasonal affective disorder.

But barometric pressures do not seem to affect the mood or anxiety outside of being disappointed if it might be raining and you have something to do outside but it won't really affect the mood as you'll see with other medical conditions like migraines or arthritis.

>> Thanks for your email.

Let's go to our first caller our first caller is from John.

>> Hello John.

Welcome to Matters of Mind.

John, you had mentioned that your doctor said that you should start taking medications for your anxiety, that your daughter said that the medication will change your personality and you won't be able to feel any emotions.

Is that true?

John, that's a question I've been hearing for the past 40 years ever since Fluoxetine or Prozac came out in 1987 and it was followed by a Zoloft research and then Paxil or Prox teen then we've had other serotonin medications come out.

This serotonin reuptake inhibitors are particularly helpful for dulling the emotions they give you emotional blunting now you'd think well gee, why would anybody want to do that?

>> Well, if you are if you're really highly anxious and you have panic attacks, if you're having social anxiety you worry excessively.

If you enhance serotonin it will dampen down some of the excessive emotions.

>> And in doing so sometimes you can so-called lose your personal if you get too high of a dosage and we call it emotional blunting.

So when people have emotional blunting they will just kind of feel dull and they won't feel happy.

They won't feel sad.

They'll just kind of feel in the middle.

That's what your daughter is referring to now there's different types of medications outside of the serotonin medications for anxiety sometimes we use the anti seizure medications for anxiety such as gabapentin also known as Neurontin and Pregabalin also known as Lyrica.

Sometimes people will use carbamazepine called Trileptal .

>> Those are anti seizure medications that can be used for anxiety.

We're trying to get away from the use of benzodiazepines like Xanax, Klonopin, Valium, Ativan those are medications that you know can make you more cognitive and have give you difficulty thinking and processing information and yeah, they can be habit forming the longer you take.

And so we're trying to get away from those and of course there are supplements that can be used with negligible side effects.

Althea Anine Saffron and in AC and Acetylcysteine those can sometimes be used with help with anxiety conditions and acetyl is another one that's a of B vitamin supplements so I Nosratollah AC Saffron and Elfie and these are the main medications we'll hear about as supplements to use for anxiety with negligible side effects for most people.

>> John, thanks for your call.

Let's go to our next test text message we have Erica from Marion, Indiana.

Welcome to Matters of the Mind.

Erica, you had asked why do some antidepressant medications cause suicidal thoughts if it's for depression?

>> Erica, what happened twenty five years ago there was a big study done on children and adolescents and young adults up to twenty four years of age and they looked at the serotonin medications and the serotonin and norepinephrine reuptake medications and they found that a couple of them, particularly Effexor and Paxil caused more of a likelihood of causing suicidal thoughts and behaviors compared to placebo or sugar pill.

>> This is twenty five years ago.

>> Well, it turns out that Effexor and Paroxetine have kind of funky metabolism.

Effexor gets out of your system really fast because it's only about thirty five percent protein balance so it doesn't hang on the protein very long paroxetine or Paxil it it inhibits its own metabolism.

>> So when you stop Paxil Croxton it gets out of your system real fast because it's no longer inhibited its own metabolism.

So with that in mind, those two medications were the main culprits that in some cases would increase suicidal thinks thoughts and behaviors.

But a further analysis twenty years later on those studies showed that the children, adolescents and young adults who had the increase in suicidal thoughts and behaviors had specifically difficulty with racing thoughts decreased need for sleep, increased impulsivity symptoms that we would now call bipolar disorder.

>> We wouldn't put that population on an antidepressant by itself anyway.

>> So with that being said, if you have a a person who has mood swings and bipolar disorder symptoms, we need them on a mood stabilizer nuttiness and not just an antidepressant.

If you put those people on an antidepressant medication they're more likely to get more moody, more irritable, more impulsive.

>> So the key recommendations now will be if you start something on antidepressants, keep an eye on them the first couple of weeks and make sure they're not feeling worse.

If they feel worse, you might be you might have misdiagnosed them and they might not just have depression.

>> They might have actually bipolar disorder.

But those black box warnings, those box warnings remain on all antidepressant medications warning that if a child, adolescent or young adult patient takes an antidepressant they can have increased suicidal thinking or behavior OK?

They can adjust the actual studies demonstrated that it was a slight increase versus placebo and it was particularly for those people who had more moodiness that we would now consider to be bipolar disorder.

So it's fine nuance in that regard.

Speaking of suicidal thinking, the medication of all medications that seems to increase suicidal thinking the most will be the benzodiazepine medications.

They could increase suicidal thoughts by four times compared to many other antidepressant medications.

So if you take Xanax, Klonopin, Valium and Ativan yeah, it might chill you out for a while.

>> It may give you more of a calming effect but those medications are much more likely to increase suicidal completion compared to other medications.

>> The medications have actually drastically decreased.

>> Suicidal thinking, interestingly enough, will be antidepressants to some degree but even more so lithium is ketamine also known as bravado is another one Klonopin or Clunies Pam has been known for a long time to be to have anti suicidal features.

>> There's another Klonopin or close a clunies of Pain is a medication that is also known as Clozaril that decreases suicidal thinking and olanzapine also known as Zyprexa can decrease suicidal thinking.

So there are certain medications that can be used specifically to decrease suicidal thinking.

Lithium has been around for a long time.

Lithium came out for mood stabilization way back in nineteen forty nine and it has this effect on the brain work can decrease inflammation specifically in the brain's lithium.

It's assaults from the ground.

It can decrease suicidal thinking by decreasing inflammation and the brain even for somebody who doesn't have bipolar disorder so low doses of lithium have been shown to be very helpful for people having suicidal thoughts and will often use lithium at 150 milligrams every day just for the purpose of helping somebody with these recurrent obsessive suicidal thoughts and often will see results within a week or so.

Some people by nature of their obsessions will have obsessions about harming themselves and if that's the case we can give a small dose of lithium to try to help that out.

>> Thanks for your text.

Let's go to our next caller.

>> Hello Ben.

Walking to matters of mind, Ben, you want to know how do you know if relations ship stress is affecting your mental health ?

>> Is there any healthy way to set boundaries in a relationship, a relationship then whether it be with someone and you're of an opposite sex, whether it be a romantic relationship, whether it be a friendship could be should be a reciprocal type of relationship.

>> And so here's how it works.

You should it should be a give and take relationship and that relationship with whom you're involved should actually bring out your attributes and not cause you to feel worse about yourself or make you feel as if you're having a detrimental encounter every time you meet with this person.

>> So a relationship if it's a healthy relationship should make you should bring out your strengths and actually make you a better person.

>> So it's kind of a give and take in that regard if you're having an unhealthy relationship even to the point of it being an abusive relationship, you need to be aware of that if that type of relationship is causing you to feel anxious and depressed every time you're encountering that person, you've got to kind of step back and wonder why you're still involved in that relationship again, whether it's a romantic relationship or a friendship if it's a family member, OK, you do still have to deal with family members but with family members I would certainly encourage people to try to work out that issue because family is something that is constant.

I don't recommend as was very popular twenty five years ago that you just an entirely dis your family members and you don't have any contact with them.

I think you should still try to need to work things out and try to get some resolution there.

But if it's a friendship or a relationship that is not something that is permanent and it doesn't need to be you need to ask yourself if you still want to be in that relationship.

But again, it should be a give and take.

You should not be a therapist to your relationship with whom you're involved.

>> It shouldn't it should be reciprocal reciprocal where you feel like you're getting something out of that relationship as well.

>> Thanks for your call.

Let's go our next caller.

Hello Bill.

Welcome to my mind, Bill.

>> Unfortunately you said your wife died recently.

I'm sorry to hear that you were married for 57 years and you have a hard time of the death.

One of the things that you can do to help you mourn her death the first thing you do is try to make sure you're getting some sleep, keep in contact with your primary care clinician to make sure that your health is staying intact.

It's very common, Bill, within six months of a spouse's loss, especially if you've been married for over fifty seven years.

>> It's very common to literally die of a broken heart in a way that happens.

It's a cardiac arrhythmia.

The cardiac system has a large electrical system tied into it and that electrical system due to a thought of a broken heart it's called broken heart syndrome.

You can have an aberration or an abnormality of that electrical system and your heart kind of flutters and you can die that way.

>> So the first thing you want to do is make sure you're still getting your sleep.

Many, many people after the loss of a spouse don't get their sleep and lack of sleep not only affects you from a mental health standpoint but can significantly affect you physically and it can be very detrimental on the body.

Secondly, try to get outside every now and then don't stay in the house any more than you need to if you've never walked the neighborhood or walked in your area before, this is a good time to start walking, walking.

Getting fresh air is fantastic for your mental health any time especially when you're mourning a loss getting outside the house and expect to feel sad, expect to have crying episodes, expect to have that that empty empty feeling inside that's going to happen.

It's going to be a punch in the gut if you lose your your wife as you've described but try to get outside and do some physical activity, take it a notch further, try to be around people socially.

This would be a good time to maybe rekindle some social relationships you might have passed by over the course of time.

You've mentioned you've been married fifty seven years.

I imagine you might be retired if you're retired.

>> OK, try to get involved with some social relationships because retiring often will socially isolate people anyway if you're still working in some capacity that is fantastic gives you purpose and meaning is something to do if you're not employed.

Yeah you want to rekindle the social relationships but if you're not employed you want to have some kind of purposeful meaningful activity on a day to day basis.

You need to have something to do and that can be having an exercise routine where you go to a health club where you play pickleball or whatever you want to end up doing because I get you around other people.

>> But it also helps you physically try to maintain some kind of meal schedule because if your meals were kind of lacking over the course of time, this is a good time to try to figure out on a regular basis what you're going to eat proactively.

Don't impulsively eat fast food or find something very quickly have kind of a meal plan set out for you for the next week week by week by week because many people when they're grieving the loss of a spouse, they don't eat properly and that's why many caring individuals in the church community or a social community will bring by food when somebody is grieving because often when you're grieving, preparing meals will be the last thing that you consider.

So there are a lot of different things you can do but keep in contact with your primary care doctor to keep keep an eye on your overall health .

Thanks for your call.

I wish you well.

Let's go our next e-mail question our next e-mail question regional evolver.

My mother has been diagnosed with depression and has given up on a lot of her usual activities.

I don't want to see her take a medication but she's refusing to watch her diet exercise or get good sleep.

>> What are her options?

Well, again, going back to not watching her not being physically active, not exercising it happens with depression quite commonly there's a part of the brain in the middle part of the brain called the anterior cingulate gyrus that's malfunctioning when people get depressed and it gets to the point where they have difficulty with enjoying things and that middle part of the brain called the anterior cingulate gyrus is right up here and it will it has it gives you a sense of personal awareness and you'll have trouble enjoying things lack of enjoyment and usual activities will be a key factor for somebody getting depressed and staying depressed .

So if your mother is kind of giving up on life and not enjoying things that's called anhedonia and means no and hedonism is fun and it's a key symptom of depression that needs to be addressed as soon as possible.

So when somebody has depression it sounds easy.

>> You just need to get off the couch.

You need to exercise, you need to eat properly.

>> You need to sleep.

Telling somebody to do that is kind of like telling somebody who's had a recent heart attack that they need to get physically active and prepare to run a five K over the next few months.

It's probably not going to happen.

Their heart isn't physically strong enough to do so.

So with cardiac rehabilitation that's often what is is attempted.

>> Not only are you trying to get more physically active, you're trying to get the heart stronger.

You're trying to get a better diet overall with cardiac rehabilitation.

Sleep is a key component to that.

But you can't just say somebody just do it because the heart's not strong enough to initiate that sometimes with heart rehabilitation it also involves taking medications for the purposes of improving blood pressure and making the heart physically pound stronger.

We do that with depression.

What we're trying to do with depression is sometimes offer somebody an antidepressant medication to get them out of the funk to fire up certain networks in the brain to allow them to be able to enjoy things but more have more energy.

>> You have more motivation and a natural way.

We're not talking about stimulants when we treat depression.

We're talking about medication that can specifically affect key neurotransmitters.

Glutamate is a key neurotransmitter that has been discussed and we utilize that in treatment for the past two or three years.

But over the past six decades we've used medications that primarily affect serotonin, norepinephrine and dopamine and those kind of neurotransmitters in various ways can help people with depression.

>> How long should she need to be on it?

Well, usually the rule of thumb is she'd need to be on the medication on a regular basis for about a year after that you look at the pros and cons of staying on the medication.

>> But what you don't want is to have you see your mother do is continue to deteriorate because with persistent depression it can affect a person physically as well as mentally, physically and affect you with more heart conditions.

You have an increased risk for a stroke, increased risk for diabetes, increased risk for obesity with ongoing depression you actually have a higher cancer risk and osteoporosis risk where the bones start thinning depression can deteriorate the entire physical functioning of the body.

So you want to try to get that under control as soon as possible.

So keep in contact starting with the primary care clinician that the primary care clinician is able to refer your mother to a mental health specialist that's always in her best interest as well.

>> Well, thanks for your email.

Let's go to our next caller.

Hello, Rosa.

Welcome to Matters of Mind.

>> Rosa, you had asked if you're feeling having an extreme feeling about something.

Isn't there a reason shouldn't we listen to the signs of our body instead of trying to suppress it with medications?

Should I really consider taking medications?

Depends what that extreme feeling might be, Rose if the rose if the extreme feeling is compelling you to do something that would be constructive, that's fantastic.

But if you have an extreme feeling that you want to buy three automobiles and two houses that would be that you're having a manic episode.

So it all comes down to gee, do I take a medication for how I'm feeling or not?

>> It comes down to what's called functional impairment.

Functional impairment is when you're having a mood or a cognitive disturbance that being a thinking disturbance that's influencing you as such a way that it's not in your best interest.

So if you are having trouble socializing, going to work, being around other people, doing things you need to do on a day to day basis and it's being influenced by your mood or cognitive disturbance and all that a medication can be helped out.

So if you're having an extreme feeling if you're having a thought about this or that and that thought is not propelling you into a type of behavior that would be in your best interest, that's where it can be detrimental for you Rosa.

>> So I'd say you can always talk that over again going back to the primary care clinician, you talk it with the mental health clinician you might be seeing and try to sort out, OK, is this feeling something that I should be motivated to carry out or is it not so much in my best interest?

Thanks for your call.

Let's go our next email question our next e-mail question reads Does not a favor are there are different types of anxiety?

>> Are they treated differently and how do you know which one you have there are different types of anxiety.

There's an anxiety goes along with depression.

It's called depression with anxious to stress major depression with anxious distress is where you have depressed mood and then you feel tense.

>> You ruminate anxious about things.

>> You have trouble sleeping, you're nervous all the time but it's predominantly going along with the depression itself.

You treat that kind of phenomenon primarily with an antidepressant.

Do it also address anxiety.

The type of anxiety would be called obsessive compulsive disorder.

Obsessions are unwanted thoughts that your kids can't get off your mind and compulsions are unwanted behaviors or you do something over and over and over again even you don't want to do so.

OCD is an anxiety disturbance that's primarily treated with medications at high levels that increased transmission of serotonin and they stimulate this particular receptor called sigma one receptors in the neuron sigma one receptors will modulate inflammation in the transmission of serotonin, norepinephrine and dopamine.

Those medications would include high doses of Luvox also known as flu Voxer mean and certainly and also known as Zoloft.

>> So those are that's another type of anxious diagnosis we'll have we'll hear about panic disorder, panic disorder is where people will have difficulty with unprovoked extreme anxiety surging within ten minutes where they have a fast heart rate.

They're shaky, they have gastrointestinal problems.

They feel hot or cold.

They feel like they're dizzy.

They feel like they're going to die and it gives them this surge of anxiety.

It's a miserable feeling to have and it'll occur when they're in certain situations initially where they feel like they're back up into a corner.

It's a fight or flight phenomenon.

Initially we might give those patients very carefully a benzodiazepine but more often than not if it's an ongoing difficulty will give them the possibility of a serotonin medication or maybe a antiepileptic medication gabapentin.

So that's a third type of anxiety.

So you have major depression with anxious stress OCD and panic disorder.

Another type of anxiety would be social anxiety disorder.

Very, very common social anxiety is where you feel unsnapped really anxious in the presence of other people now everybody should have social anxiety especially going back to adolescence in adolescence.

That's when people should have severe social anxiety because you're learning how to socialize so you should feel anxious in social situations you learn how to cope with those interactions you practice you develop skills and socializing as an adolescent.

That's all good but over the course of time people will find that social anxiety disorder disturbance can be a problem going into the adult years.

Unfortunately many adults will drink alcohol as a means of self medicating for social anxiety.

>> They go into a social gathering.

The first thing they do is go to the bar and get a drink.

Other people especially as we go into the 21st century will drink will use cannabis products.

They'll use marijuana and especially if you start using marijuana during those very, very important adolescent years when you're trying to develop social skills, marijuana will stunt your ability to develop social skills.

So here you are.

If you're still smoking marijuana in the 30s, you still haven't socially developed.

So social anxiety is very prominent for a lot of people.

Post-Traumatic stress disorder PTSD where people have encountered a very severe trauma sexual abuse, physical abuse, motor vehicle accident, combat trauma.

People with PTSD will have the type of anxiety where the trauma will evoke later on memories and they'll feel jumpy and we call hyper vigilant.

>> They're always on guard of nightmares.

They'll avoid situations or sensory input that reminds them of the past traumatic experiences.

Post-Traumatic stress disorder will often be treated with psychotherapy and sometimes will be treated with blood pressure medications like Prazosin Gwon farseeing clonidine and we'll often use serotonin medications for that as well.

A particular kind of therapy that's good for PTSD will be eye movement, eye movement and desensitize desensitization reprocessing MDR will be very helpful from that perspective the type of anxiety people sometimes will encounter will be phobias phobias where they're afraid and fearful of a particular thing and the phobias can be very problematic for some people where they're afraid of encountering a certain thing that might have given them unnatural type of anxiety from the past.

So those are lots of different kinds of anxiety disorders disorders.

>> Yeah, you need to get diagnosed with the proper one because based on the diagnosis of what kind of anxiety you're experiencing, we're going to use particular treatment to address that.

>> Thanks for your email force.

I'm out of time for this evening.

If you have any questions concerning mental health issues you can write me a via the Internet at matters of mind all one word at WWE dot org.

>> I'm psychiatrist Jay Fovea and you've been watching Matters of the Mind on PBS for way now available on YouTube God willing and PBS willing.

I'll be back again next week.

>> Thanks for watching.

Goodnight