.

Cameron Psychiatry.

Providing counseling and care for those that may struggle with emotional and behavioral challenges.

More information available at CameronMCH.com.

good evening.

I'm psychiatrist Fauver Lee from Fort Wayne , Indiana.

Indiana, welcome to Matters of the Mind now in its 26 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're calling long distance call you can dial toll free at 866- (969) 27 two 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 Purdue 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 WFA a dot org that's matters of the mind at WFA dot org and I'll start tonight's program with a question I recently received.

>> It reads Dear Dr. Fauver is it harder to quit smoking when you have other health struggles or is it just as well to tackle smoking and whatever else you are challenged with?

Well, I'm going to presume you're talking about tobacco smoking.

>> We'll start with that.

Tobacco smoking releases nicotine and that's the pleasurable chemical that people are attempting to to use to achieve a good feeling and with tobacco smoking at the nicotine you're getting increases in dopamine in the brain to some degree you're getting norepinephrine fact you're getting a muscle relaxant effect.

>> But the whole idea behind nicotine people can get a bit of an antidote press in effect and they can improve their concentration to some degree so people will use nicotine as a means of feeling good and helping with depression.

>> So when somebody is struggling with stopping nicotine we often have to sort out what part of the struggle is nicotine withdrawal which will make you feel terrible in self versus losing the good effect that nicotine was giving you.

>> And for that reason years ago there was a medication by the name of Wellbutrin.

>> It was studied for the purpose of offsetting the antidepressant effect of nicotine because Wellbutrin also known as bupropion came out in 1989.

>> It's been available since it's used to increase norepinephrine and dopamine to some degree that's what nicotine will do.

>> It'll increase norepinephrine and dopamine and in doing so improve your concentration sometimes improve the mood.

>> So Wellbutrin was studied as a means of helping people get off of nicotine and had a trade name at the time called Zyban.

So Wellbutrin also known as Zyban which is are the brand names of the program were used as a means of helping people get off nicotine and they still are if you combine Wellbutrin or Bupropion or Zerban for that matter with a medication called Chantix, Chantix will go to the middle part of the brain at the nucleus accumbens if I can get my brain apart here and it will partially stimulate the nicotine receptors there and in doing so it'll make the brain think that you're smoking but you're not and will decrease the craving for nicotine.

>> So the nuclear nucleus accumbens is kind of right here in the middle of the brain, the front part of the brain looking at you.

>> So the middle part of the brain has the nucleus accumbens.

Chantix will go right there and make the brain believe that you're smoking and if you do smoke it will actually block the effect of nicotine to some degree.

>> So Chantix will release about 30 percent of the dopamine that you might get released from nicotine.

So get some effect there.

But if you add Chantix with Wellbutrin and use that combination, you're twice as likely to come off of nicotine based cigarets compared to just using Chantix alone.

>> So it's a common combination of using the Zyban or Bupropion now also known as Wellbutrin.

>> It's we're using that kind of medication with the Chantix as a means of helping people get off of cigarets.

Now there was a lot of controversy about 20 years ago with Chantix because people would Chantix and they'd have nightmares and they'd have these awful dreams and retrospectively it was realized that people on placebo in those same clinical trials where they use Zyban versus placebo when people stop smoking the people on placebo had nightmares too.

>> So it was recognized that the nightmares were part of nicotine withdrawal.

It wasn't due to the Zyban itself so that warning was actually taken off by the Food and Drug Administration years ago.

So will often use the common portion of Zyban would be appropriate not only to help you get off the get through the nicotine withdrawal but also to decrease the let down you might have with depression.

>> People wonder with adolescents do adolescents start smoking nicotine cigarets because they're depressed because they have attention deficit disorder?

Are they self medicating or does the nicotine actually cause them to later have those problems especially with depression?

It's now recognized that it's the nicotine that causes your brain to have more difficulty with depression later on as opposed to adolescent self medicating.

>> But I'd be the first to say a lot of adolescents do self medicate with nicotine based cigarets for ADHD and a lot of cases because nicotine based cigarets will increase dopamine n a similar manner as do the stimulants but not as efficiently as the stimulants.

So the nicotine will help to some degree.

The problem with nicotine it wears off so fast and then you have the craving you have to smoke another cigaret and some people have to smoke three to four packs a day as a means of getting a nice level effect of nicotine in their system throughout the day now I've been talking about smoking tobacco.

You could have also been asking about smokin cannabis, marijuana smoking many, many people use marijuana as a means of helping them sleep, helping them with aches and pains, helping them with anxiety especially anxiety provoking situations, social anxiety.

>> People will use marijuana quite frequently for that purpose.

The problem with marijuana especially if you start using it prior to the age of twenty four years of age that will cause physical changes to occur in the brain where your brain just won't function as efficiently later in life .

Your brain's still growing until you're twenty four years of age.

If you use marijuana early on it will probably cause you to have more anxiety, more difficulty concentration the new ordinarily ordinarily would experience so marijuana use is commonly used for the purpose of helping with anxiety and sleep for a lot of people.

But the problem is it typically makes the problem worse.

I saw a young lady today who had been using marijuana since she was 15 and now she's in her late 20s and she's using marijuana every night while she can't sleep now because she's using marijuana every night but if she doesn't use marijuana in her sleep is even worse.

>> So we had to go with something else.

And when we get people off of marijuana, the first medication we often choose to try to mimic the good effects of marijuana will be gabapentin also known as Neurontin.

Occasionally we'll use Pregabalin or Lyrica but those medications will in some ways mimic the good effect of marijuana and help with anxiety and sleep but yet not cause the dependency and the mental impairment that marijuana will cause.

Many people who use marijuana will have a slowing of their processing speed.

So it's like having slow Internet and your brain where things are kind of slowed down.

It's so subtle people don't realize it until they get off the marijuana for at least two or three months.

It takes marijuana about two or three months to get out of your system before you can actually realize that you can think more clearly.

>> Thanks for your email question.

Let's go to our first caller for tonight.

Hello Joyce.

Welcome to Matters of Mind.

>> Joyce, you want to know what are the common what are the most common mental health conditions that are gin genetic the number one mental health condition that would be genetic would be attention deficit hyperactivity disorder.

>> It's about 75 to 80 percent genetic as a medical condition .

>> ADHD or ADD is second only to psoriasis.

The skin psoriasis condition people with psoriasis that's highly genetic ADHD or add a second to that.

So ADHD is almost as genetic as height.

So if you look at family members and look at the heights you'll see that's highly genetic.

>> Well that's kind of how ADHD is.

So ADHD would be the number one genetic condition we see in psychiatry.

Number two I would say is probably bipolar disorder.

Bipolar disorder is considered to be about sixty five percent genetic.

>> It's not always going to be seen there but it is does have a strong genetic component .

Number three would probably be schizophrenia schizophrenia.

It's about 50 50 percent genetic if you have an identical twin who has the exact same genetics as you, you have a 50 percent chance of having schizophrenia if your identical twin has schizophrenia.

So it's not guaranteed even schizophrenia which is highly genetic still has that environmental component.

>> So I'd say in order ADHD bipolar disorder and schizophrenia are the three top genetic conditions that we see in psychiatry.

>> Thanks for your call.

Let's go to next caller.

Hello Linda.

>> Welcome to Mastermind Linda .

You want to know can antidepressant medications help with grief?

I'll give you a definite maybe on that one.

>> And if you have grief that leads to giving up on life thinking about death yourself, having trouble with appetite, getting into this clinical depression day by daypt devastated with functional impairment related to the grief and antidepressant medication could help you with that.

>> You used to be thought that you should be over grief in a matter of six weeks to six months sometime in there you should be getting over the grief.

There's different types of grief and we realize here are three decades later that that's not the case at all.

If you have grief where you periodically lament on your tearful about your your loved one for whom you're grieving or the grief of a loss of a situation, you should feel sad periodically but you should still be able to sleep.

>> You should still be able to eat and you should still be able to get things done if you're having trouble sleeping, eating or getting things done, that's where you might be crossing the line and we call that clinical depression.

That's where we would use the antidepressant medications Linda.

>> Now antidepressant medications we use for grief would probably be the more serotonin based antidepressants many people when they struggle with depression related to grief they'll have difficulty with crying excessively.

They'll have trouble with extreme anxiety.

They'll have trouble with being able to frustrate to to tolerate for these frustrating situations and just getting in life so the serotonin medications will often give you a bit of an emotional numbing effect now that is not so good for some people.

>> If you think about the pendulum, you want the pendulum to come in the middle.

>> It's the pendulum is on one side too much.

You'll feel extremely anxious.

You'll have difficulty with sleeping.

You'll have trouble with tolerating with tolerating frustrating situations that means you're getting too little serotonin in your brain.

You want to come back in the middle but if you get too much serotonin transmission going on, you'll feel emotionally numb.

>> You won't care about anything and you feel kind of blah and in those kind of situations people don't like how they feel so we don't want you to feel it emotionally blah.

>> But serotonin based medications can dampen down and give you a little bit of an emotionally numbing effect and those serotonin medications we typically we use using the trade names it would be Lexapro, Celexa, Zoloft, Prozac, Paxil these are all serotonin based medications that will dampen down the emotions now in the United States those medications are often used first line for depression across the board.

If you look at all the psychiatric guidelines Lexapro, Celexa, Prozac, Zoloft especially are the medications recommeded first line.

>> But in Europe they realized that only about one out of three people get really good benefit for depression in general with a serotonin based medications and you often go to something else.

So in Europe they actually start people on medications that are serotonin and norepinephrine based like Cymbalta Effexor Stik Fed Zema will be another one they might use and sometimes they'll use Wellbutrin or bupropion which I mentioned before that will mainly affect dopamine and norepinephrine so they won't use the serotonin based medications first.

>> That's kind of the practice I've used for the past ten or fifteen years because I know I've only got about a one out of three chance for somebody doing really well with depression in general with a serotonin based medication don't feel better.

They'll have less crying a little bit less anxiety.

But many people in a serotonin based medication and will have some difficulty with feeling kind of emotionally blaw they will have trouble with concentration and they won't enjoy doing so well.

The serotonin based medications will not help you so much with enjoyment having fun, taking pleasure in your life day but day by day so will often go with a different type of medications affect different neurotransmitters such as norepinephrine, dopamine and more recently in the past few years we've been talking about this neurotransmitter called glutamate which gives people more of an excitatory based lift and it will help with enjoyment and pleasure because that lack of enjoyment, Linda, will be a big, big factor on why people don't get well if you can't enjoy things, if you don't take pleasure in things, if you can't simply from a sensory standpoint enjoy the world around you if you can't enjoy social interactions, those are all predictors that you're going to stay depressed for a long period of time and when people have difficulty with enjoyment, especially associated with grief will often find that those people aren't the ones who are going to get well and get over the grief easily so will want to look at the particular cluster of symptoms people are experiencing.

And very importantly I'm going to ask people what are your main goals if your main goal is to chill out the anxiety and just to be able to take a deep breath and look the world around you without so much angst by all means you might do well with a serotonin based medication.

>> I saw a woman about three weeks ago and I did that very thing.

She had a lot of ADHD but she did have some anxiety and her main goal was not to improve the ADHD.

>> It was simply to decrease the anxiety partially associated with ADHD.

But her main goal was to just kind of calm down the anxiety so she could get through life a little bit easier that way.

So I didn't give her a medication that increased serotonin Lexapro and she feels better.

>> She's calmer and that's all she needed.

That's all she wanted at this point.

So if she was good with that, she can certainly stick with that.

Linda, thanks for your call.

>> Judy, you had questions about a B seventeen powder and you want to know about these type of different type of chemicals to prevent cancer and how about taking it for five years?

>> Judy, I'm a psychiatrist so as a psychiatrist I deal with conditions of the brain.

Now all often deal with conditions that affect people in other medical ways.

But I wouldn't be the best person to ask about medications or supplements that would prevent cancer.

So in my field will often look at other medical conditions as possible reasons why people might still not feel well so we'll look at conditions that end up being diagnosed with sleep apnea.

>> We'll look at conditions and symptoms that can appear to be like a low thyroid.

We'll look at low iron.

We'll look at diabetes.

We'll look at other medical conditions not uncommonly because low sleep apnea, for instance, is a very, very common condition where people might snore at night and sometimes they'll pause in their breathing and then what they're doing is they're not exchanging airflow adequately in lungs and thereby getting less oxygen to the brain.

>> If you have sleep apnea you could be really tired.

You can have trouble poor concentration.

You can actually feel depressed the next day especially the morning many people with sleep apnea will have a headache the following morning.

>> So as a psychiatrist, yeah, I'm dealing with the brain but I'm also looking at other conditions that can affect the brain.

And if I look at these other conditions that affect the brain, yeah, I might order a sleep study and if somebody gets diagnosed with sleep apnea I'll certainly get them lined up with a sleep medicine clinician who can thereby get them the proper treatment for that same low thyroid.

I might treat low thyroid with a thyroid supplement but if it gets too complicated and they have conditions like Hashimoto's thyroiditis or graves' disease by all means there's a special kind of thyroid conditions where I'm going to have them preferably see a specialist.

So when we talk about oncology or cancer, it depends you know, there are some types of cancer that will identify in psychiatry but generally I'm not one to recommend supplements to prevent cancer overall Judy, I stand my lane on that one and refer you to the oncologist for that.

>> Judy, thanks for your call.

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

Our next e-mail question reads Dear daughter, father, why do some birth control medications affect mental health and what role do hormones play in teens mental health and in mental health in general when you talk about hormonal changes, we're talking primarily about teenage girls now with teenage girls they have the fluctuations of estrogen and progesterone sometimes starting as soon as nine or ten years of age would be in very pronounced by the time they get to be 14 to 16 years of age.

>> Now on one hand the premenstrual symptoms, the symptoms women can have before their periods that can make women anxious, irritable, they can have trouble concentration.

>> They can have physical problems such as bloating and headache.

So that could make for five women feel pretty miserable on those days before their period.

>> So that will be a factor and adolescents will notice that birth control pills will stabilize out the highs and lows of progesterone and estrogen and that can sometimes decrease the mood disturbances associated with premenstrual symptoms now secondly will often hear about the oral contraceptive medications being used to decrease acne because people with severe acne also will have mental health issues often related to their self-esteem.

>> So they the oral contraceptive medication will be there for the purpose of decreasing the fluctuation of estrogen and progesterone about boys.

Boys will have a slow increase in testosterone.

It's slow and sustained.

It's not as fluctuating as the estrogen and progesterone will be for the adolescent girls but the boys will have the slow increase in testosterone obviously given those kind of symptoms of irritability, aggression, moodiness sometimes from that but it's more of a day to day phenomenon.

It's not fluctuating as much now it's thought that estrogen especially will protect girls from schizophrenia.

That's why the average age of onset for schizophrenia for girls is not until twenty four for boys it's sixteen and that's why it's thought that estrogen might have somewhat of a protective effect.

>> But when you have increased estrogen affects and the the progesterone fluctuations like that women will have 50 percent less serotonin transmission in their brains throughout their lives until they hit menopause then they kind of match up with men but throughout their lives women will have about 50 percent less serotonin in their brain.

Thereby they can have more anxiety disturbances such as post-traumatic stress disorder, panic disorder, social anxiety, obsessive compulsive disorder, generalized anxiety disorder.

These are all anxiety conditions related to decreased transmission of serotonin in the brain.

>> So for a woman with a lot of anxiety yeah, it makes sense to give her a serotonin based medication if she has a lot of anxiety like that keeping in mind decreased serotonin in their brains in general.

>> Now women also will have about 20 30 percent more norepinephrine transmission than men so women will have fluffier norepinephrine neurons increased norepinephrine will allow a woman to have greater self awareness and awareness of the environment around them.

>> Now self awareness sometimes that can lead to brooding especially if there's a serotonin disturbance there as well and they can reflect internally, excessively and they will tend to have increased autobio biographical brooding in that way whereas men maybe not so much.

>> But the thing is about that is that women by having increased norepinephrine transmission will be more aware of their surroundings and notice things in the environment that men might miss.

>> So there's a nice balance there for women and having increased norepinephrine transmission but yet they have less serotonin in transmission.

We have to consider that a psychiatrist as we're prescribing medication selectively looking at different symptoms on how people would respond to different medications.

>> Thanks your call.

>> Let's go our next caller.

Hello Stan.

Welcome to Matters of Mind.

Stan, you want to know how to treat Parkinson's disease from a psychological perspective?

Well, the first issue is Parkinson's disease, Stan, is to recognize it's a neurologically based condition where the substantia nigra which is a little part the middle part of the brain is right over here.

The substantial nigra is shrinking down.

That's the part of the part of the brain that's firing as well as dopamine with less and less dopamine being fired out from the substantia nekritz going down a 30 percent, 40 percent, 50 percent decrease.

>> You'll have the movement disturbances where you have the tremor you'll have the shuffling gait, you won't have much arm swing.

>> You'll have more of a flattening appearance to your face where you won't have as much facial expression.

Some people with Parkinson's disease will have gastrointestinal problems.

They'll have some drooling sometimes so they'll have more moisture in the mouths and that's from the dopamine perspective.

Now how do we treat that from a psychiatric standpoint?

>> First thing I'm going to do is often look at somebody's overall awareness, other Parkinson's disease and how it's affecting them if they're having depression.

>> I'm going to certainly give the medications that might affect dopamine or norepinephrine historically that's been bupropion or Wellbutrin which does increase dopamine and norepinephrine to some degree and there's more tryptophan which has extensive study on Parkinson's disease where near tripling is increasing norepinephrine transmission.

So there are medications we're going to use when people have Parkinson's disease.

>> What we do not want to do absolutely positively do not want to do with Parkinson's disease is give any medication to my block dopamine transmission.

>> Well why would you do that?

Well, there are some of the newer medications used as add on to the antidepressants that can help with depression such as Abilify Varella.

>> We might use result.

These are all medications that could do a nice job in helping somebody boost their depression but indirectly they can decrease dopamine transmission.

>> That's where you want to be so careful with giving that to people who already have Parkinson's disease because those people can have a worsening of their Parkinson's symptoms.

We also want to be aware that if we give them a medication like bupropion it's increasing dopamine.

We need watch out for other medications they're taking to increase dopamine because if you increase dopamine excessively you can have manic symptoms where you don't need to sleep.

You're more impulsive.

You might buy things that ordinarily wouldn't buy.

>> You're more irritable.

Those are symptoms of somebody having too much dopamine transmission so you can go the other extreme.

So the treatment of Parkinson's is where you get this nice balance of getting just enough dopamine transmission to help with smooth movements but yet not cause manic behaviors and irritability and decreased sleep.

>> Stan, thanks for your call.

Do we have another call?

>> Yeah, we do have another call.

The next caller is asking if it is Harper if Harper is asking if you don't know how to describe your symptoms with a psychiatrist still be able to see you.

>> Harper, you're wondering if you can't really describe what's going on with you.

>> Could a psychiatrist still evaluate you?

I think we could do several things we can do, Harper.

>> We can give you time to think about your symptoms and give you different questions that might provoke your ability to describe them.

For instance, in my practice we will give people a lot of questionnaires and we give them a lot of questions for that first evaluation because I want to ask is all these different questions about anxiety, depression, sleep?

I want to know what kind of physical symptoms they're having.

I want to know if they've had any past traumatic experiences.

Are those traumatic experiences affecting them now so we can ask you all these questionnaires that can kind of search out what kind of symptoms you're having on those questionnaires will give us a lot of ideas on what direction to go for you.

>> So even though you might not spontaneous be able to describe what's going on for you.

Yeah, if we give you a few questionnares that's kind of an icebreaker to help us kind of get an understanding of what direction we need to go for you.

But a psychiatrist will still see you if you don't know how to how to describe your symptoms as long as you perceive Harper that you're having some kind of emotional or mood or thinking disturbance that is affecting your day to day life .

In other words, you have to have some kind of brain symptom disturbance that's affecting your ability to socialize, to go to work, to be able to go to school, to be able to have a normal life .

>> And very importantly, Harper, if you can't describe your symptoms, I bet you have family members, friends, people who are around you in your day to day life who can probably describe how you're being how your day to day life is being disrupted by your overall mood or your ability to think so if you can't describe those symptoms friends or colleagues or family members often can.

>> So it's not uncommon I will ask for a family member to join me.

We do a lot of telehealth and a family member is often will join a person on telehealth and kind of give me some extra ideas on how a person is doing and that's very, very helpful.

Harper, thanks for your call.

Unfortunately I'm out of time for this evening.

If you have any questions concerning mental health issues that I can answer the error you may write me a via the Internet at matters of the mind all one word at a dog God willing and PBS willing.

>> I'll be I'll be back next week.

I'm psychiatrist Jeff Oliver and this program is also available on YouTube.

>> Thank you for watching.

Have a good evening.

Good night.

Cameron Psychiatry.

Providing counseling and care for those that may struggle with emotional and behavioral challenges.

More information available at CameronMCH.com.