.

>> Good evening.

I'm psychiatrist Jay Evolver live from Fort Wayne , Indiana.

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

>> If you have any questions concerning mental health issues, give me a call.

The Fort Wayne area by dialing (969) 270 zero or if you're calling any place else coast to coast you may dial toll free at 866- (969) to seven to zero 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 a via the Internet at matters of the mind all one word WFYI dawg that's matters of the mind that WSW ECG and I'll start tonight's program with a question I recently received.

>> It reads You're not a father.

My daughter just lost her first boyfriend and seems to be really depressed.

>> She's pushing me away and locking herself in a room.

How do I help her?

>> Well, there's a lot of different questions that might come up with those two sentences.

Your daughter being how old you know she might be at an age where she's not mature enough to be dealing with a lot of relationships by losing her boyfriend I presume that means broke up with him as opposed to his losing his life .

>> So big difference is there what I often recommend to adolescents and you can do so as a parent as encourage them to keep diaries of what's going on in their lives.

It's got to be a private diary.

It's got to be something that's not going to be highly disclosed if not needed and it's something where she can write in her diary perhaps once a week, once every few days just what's going on in her life and encourage her to look back on her diary and and her notations.

>> Look back after three months after six months after a year she's going to find that the things that she thought were catastrophic and things that were causing her to maybe wonder if she even should go on living because that happens all the time with adolescents.

They wonder if they should even go on living things that appear to be that catastrophic aren't that big of a deal as they go through life .

So no one your daughter probably wasn't mature enough to really deal with an interpersonal relationship, especially an intimate relationship perhaps with a boyfriend at that stage of her life .

She lacks the coping abilities to deal with loss.

The best thing for her to do is to continue to socialize and not be as focused on that boyfriend is our only relationship now as a parent it's very important for you to share her past experiences of your own as adolescents we all made no mistakes.

We learn things as we went through life but I think as a parent it's very important for you to disclose and be very a parent in terms of what kind of things you went through as an adolescent, how it felt, how you dealt with it and how you overcame it.

So the first boyfriend the early relationships can be catastrophic in the end but you have to really encourage the adolescents that you know, you get over it, you look back on it when you're in her early 20s, your early 30s and you wonder what was I going through at the time?

>> And I always emphasize to adolescents that their brain is still growing.

Here is the brain front part of the brain is still growing into your twenty four .

The front part of your brain is the decision making part of the brain.

It's the part of the brain that controls the impulses.

This front part of your brain doesn't fully develop until you're twenty four .

So when you're 14, when you're 16, when you're 18 things that appear to be catastrophic in your life not that big of a deal when you get older and that's why a lot of young adults when they get to be twenty to twenty four twenty five the stuff their parents told them when they were younger starts to make sense.

>> So you can encourage that with your daughter.

>> You know she's going through a time of her life where yeah it's tough going through adolescence.

I think most of us would agree that we wouldn't want to go back to our adolescent years and relive that necessarily unless we had the knowledge that we did as adults.

It's tough time for a lot of people part of us because you're you lack the maturity your brain still developing and you don't have the coping skills.

>> You don't have the experience that leads you to be able to overcome losses like the loss of a relationship at that time.

>> Thanks for your email.

Let's go to our first caller.

Hello George.

Welcome to Matters of Mind.

George, you want to know what's a connection between sleep and mental health when you treated your sleep apnea, your mental health improved?

>> That's fantastic, George.

Sleep is very, very important for mental health because when you're sleeping the front part of the brain which I just mentioned rests.

So when you're in a deep sleep, when you're in a dream sleep the front part of the brain right over here is the attentive part of the brain is called the dorsolateral prefrontal cortex.

>> This is the part of the brain that you use when you're really focusing on something that might not be that interesting.

>> It rests at night when you're in dream sleep.

>> So if you're sleeping well and you're going through all the different phases of sleep, you're getting good sleep efficiency.

>> That part of the brain is able to recharge if it's not allowed to recharge the judgments that the part of your brain or thinking part of your brain and thereby your coping part of the brain doesn't work so well.

So sleep actually allows to recharge your ability to put up with stuff and have better stress resilience as we call it.

So if you're sleeping well that's going to help sleep apnea where you're not getting adequate airflow to the lungs thereby not getting adequate oxygen to the brain without adequate to the brain the brain which basically is responsible for the expenditure of 90 percent of your energy in your entire body if your brain doesn't have adequate auction at nighttime during those six or eight hours you're supposed to be sleeping, you won't be able to recharge the brain and you'll have difficulty with thinking you'll have trouble with decision making, have a troubled memory.

You'll have trouble being able to process information in your brain if you have sleep apnea.

>> So you treat the sleep apnea which is a very treatable condition with CPAC, with BiPAP, with auto OPAP, with using a mouthguard opens up your airway at night.

>> Nighttime has a lot of different ways to treat sleep apnea.

But if you treat sleep apnea so that you're no longer snoring and you're no longer pausing your breathing, perhaps at nighttime you can increase that air flow to your lungs and thereby increasing the oxygen flow to the to the brain.

>> So if you treat sleep apnea usually within two to four weeks people will notice a pretty dramatic improvement with their concentration, their mood and many and many times their energy level overall many people with sleep apnea still awake and perhaps with a headache they'll awaken with nausea.

They have a lot of tiredness and sleepiness during the day the first thing will often check will be their thyroid functioning because if you have low thyroid it too will mimic many of the symptoms of sleep apnea.

But sleep apnea something even in psychiatry where we're monitoring on a very, very close level first started monitoring people for sleep apnea apnea back in the 1990s.

So we're talking 30 years ago now.

>> So not that I'm going to treat sleep apnea as a psychiatrist with a device, but I'm going to try to identify it so I will order sleep studies for people to acquire.

>> You can do a sleep study at home now sleep studies at home are called home Polisi milligrams.

>> They are diagnostic of sleep apnea.

If you do have the features of sleep apnea where your airflow is decreased, your oxygen levels are decreasing and the poem poorly sonograms are pretty accurate for a lot of people.

>> So you can actually diagnose sleep apnea in the convenience of your home and a lot of cases.

>> But if you have sleep apnea it's very, very important for it to be treated.

It's something that we can screen for a lot of people by simply asking them do you snore?

Do you are you urban witness pausing in your breathing in nighttime?

>> Are you really sleepy during the day?

Those are key factors that can indicate the possibility of sleep apnea and risk for sleep apnea will be a thicker neck, a neck over 17 inches can be a risk for sleep apnea for a man six inches or more for a woman.

If you have high blood pressure that could be a risk for sleep apnea and if people lose weight often they can help relieve some of the symptoms of sleep apnea.

>> But for some people, even if they're slender, it's based on the structure of the throat and the tongue.

>> If somebody opens their mouth and you can't see the back of their throat very easily, the tongue might be anatomically large enough to close off the airway.

>> So even skinny people can have sleep apnea.

But it's something we're observing on a regular basis now we're trying to treat it because I think 20, 30 years ago before we talked about sleep apnea, people would just be assumed to be depressed because sleep apnea itself will give you that fatigue, poor concentration kind of feels sluggish and sleepy all day.

>> People historically could have been thought to have just depression so they'd be given inactivating medication for depression and it wouldn't work so well now we see that if you can treat the key factors for sleep apnea that will often reversal of those symptoms.

>> Thanks for your call.

Let's go next caller.

Hello Danny.

Welcome to Matters of Mind.

Danny, you want to know the main reason for skin picking, a nail biting and how can you stop it?

Well, a lot of it's a habit, Danny.

Yeah, you can always say it's a little bit of anxiety when people are thinking and they're kind of lost in their thoughts they will often get into the habit of skin picking and nail biting the other type of skin picking which is basically self injurious where people will actually try to hurt themselves and in doing so even cutting themselves what they're often trying to do is release opiates which are naturally occurring in the skin and if you cut yourself damage the skin, you can release opiates.

It's a weird phenomenon but people can have the opiates flow to the brain and they get a calming effect from actually cutting at themselves.

>> Not a good recommended way to get that calming effect.

Other people will simply pick up their skin or they'll do nail-biting.

Those people are often just kind of lost in their thoughts.

The first thing to do is obviously be aware of it and try to distract yourself with something.

>> In other words, instead of nail biting the skin, tap your finger, do something else to distract yourself away from the skin picking or the nail biting itself.

Thanks for your call.

I'm going to go to the next caller.

Hello Marcel walking two hours the mind Marcel you've mentioned that you're eighty four years young and your memory is slowly declining every day but then it comes back your doctor recommended an alpha brain as an over-the-counter supplement and you want to know what to do to help you brain.

>> The best thing to do, Marcel, is to get a thorough assessment for a reason behind the possibility of memory disturbances.

I'm not really sure what the Alpha Brain Supplement is but I'd want to know if you're 84 years of age, OK, as we all get older we're more likely to have memory problems and some of the memory problems can be treatable.

So I'd want to write off about make sure you don't have what I just mentioned a few moments ago sleep apnea.

So sleep apnea will affect the ability to maintain good memory and if you have sleep apnea that will compromise your memory.

So I want to make sure you don't have sleep apnea.

Number two , I want to make sure you don't have thyroid disturbances.

That'll be a factor as we all get older, our our pancreas is more likely to kind of out.

So as we get older or more could have diabetes.

So if you have diabetes, high blood sugars, that can be a factor for memory disturbances.

A low vitamin B 12 can be a factor.

A low vitamin B 12 is a factor because as we all get older the little bus that is in our stomach it's called intrinsic factor.

>> It's released from our parietal cells in our stomach.

So the bus is called intrinsic factor.

The bus picks up vitamin B 12 in your stomach and takes it to the small intestine where it gets absorbed.

Well, the stomach kind of shrivels up as we get older and we don't have as many busses to transport to B 12.

>> So sometimes people have a low vitamin B 12 which can give you difficulty a tingling and numbness in the hands and feet but it can also significantly give you a memory disturbances.

>> So as an older adult I'd want to make sure anybody had a vitamin B 12 level of vitamin B 12 can be replaced either with injection periodically or in under the tongue pill that can replace vitamin B 12 especially if somebody is taking a diabetes medication M.F.

Metformin, metformin intrinsically sometimes especially with older people can decrease vitamin B 12 and older people might need a little bit extra metformin or a little bit extra B twelve if they're taking metformin.

So I want to make sure all those factors are covered .

There are instances where people can have Alzheimer's dementia.

You can have multi vascular dementia or vascular dementia where people have mini strokes.

So there's different types of memory disturbances that can be there day by day by day.

If you're noticing your memory comes and goes, it might be related to medication that you might be taken and some people that have memory that will come and go that could be related to depression for that matter the words if you have some days where you're more depressed than others depression clinical depression will give you difficulty with processing speed in your brain so you'll have trouble going from one thought to another.

So that's not uncommon as well.

So I want to make sure you had a thorough diagnostic assessment to try to determine the reason behind having memory disturbances.

There are over-the-counter supplements available.

Many of them have caffeine in them.

>> They have various ways to try to enhance the memory.

But quite frankly if there is any over-the-counter supplement that I really felt was dramatically going to improve the memory, I'd be taking it myself.

We had a lot of hope in ginseng back in the 1990s.

A lot of people were taking ginseng myself included thinking that was going to be the means by which we can really enhance our memories didn't work so well, gave a lot of drug interactions but it didn't really work so well.

So I think over-the-counter supplements right now I'd love to see them studied more thoroughly versus placebo.

So you take a sugar pill, one group takes a sugar pill, another group takes these over-the-counter supplements.

Let's see who's going to really do better with their memory.

We don't have those kind of studies out there for the over-the-counter supplements but the over-the-counter supplements are relatively safe to take for a lot of people as long as you're aware of what other medications you might be taking with them because they can once again be drug interactions.

>> Marcell, thanks for your call this grower next caller.

Hello, Robert.

Welcome to bear in mind, Robert, you want to know why does your anxiety get worse when you're dealing with neuropathy since you feel agitated do this neuropathy and anxiety increase your heart rate neuropathy is where you have pain, tingling and numbness in your hands or feet typically can be related to diabetes type type two diabetes can be related to a nerve impingement from a discussion such as a lumbar disc herniation.

So a neuropathy is basically where your little nerve endings are firing excessively.

So to dampen down the nerve endings filing firing excessively people will often take medication like Pregabalin also known as Lyrica or Gabapentin also known as Gabba Gabba and also known as Neurontin.

>> Those will basically decrease the firing of the itchy trigger fingers on the calcium channels that are excessively firing and causing the pain and tingling.

And you can also take a medication that dampens the transmission of the pain up the spinal cord and that will be a medication that increases serotonin in combination with norepinephrine.

Abiomed medication like Effexor Presti Cymbalta fizziness of Savelli those kinds of medications well to various degrees dampen the transmission of pain.

Coming up, the spinal cord in a non-narcotic means of decrease in the pain itself so when you have pain yeah, you can't have anxiety because you often feel like you have to pace around some so pain can give you some degree of agitation.

>> The pain itself doesn't usually increase the heart rate but you're absolutely right anxiety when you feel anxious you can't increase heart rate.

So when you are feeling like you're getting a lot of anxiety, a symptom of anxiety can be what we call tachycardia where your heart rate goes from sixty or seventy up to maybe 90 or 100 and many people when they pace around a lot will notice the heart rate even increases further.

>> Thanks for your call.

Let's go our next caller.

Hello Jane.

>> Welcome to Matters of the Mind.

Hello Jane.

Are you there?

Um, hi Jane.

Hi.

I have a big problem Dr. Farber with an adult son.

Yes.

Yeah.

Sixty years old six years ago he had stage fright.

I was cancer.

He's not been able to eat solid food since that time.

He he lives alone.

He never married.

He drinks boost an instant breakfast and lately, you know, he's just withdrawn from all of his friends for several years now and for about five years he's not gotten around out and I'm like you always assumed he was a graduate from Purdue and had a good job could do built bridges.

Well, he's just his very depressed right now and last week he started having some bleeding from his nose and mouth but he still refuses to go get medical help.

And I've been there a couple of times and you know, he just gets so frustrated when I try to deal with him.

It's like I told your receptionist I said and I once facilitated a depression support group for six years but I can't help my own son.

>> What can I do, Dr. Farber?

Sometimes it's difficult for a family members to actually intervene because you have that emotional connection and sometimes you'll need to hear clinicians or outside opinions in terms of what he can do for his health .

>> But I'm really curious.

>> He mentions he's 60 years old and he had thyroid cancer.

What was done for that thyroid cancer?

>> What was I'm sorry, what treatment did he have for the thyroid?

Just chemo and radiation and let yeah.

He didn't let us know until the last day of radiation.

A friend of his knew but he saw that person to silence.

Otherwise we would have really tried to look for the best doctor and he said that's why he didn't let us know.

He said Mom I knew you would be looking for the best doctor I said yes would that's what moms are for .

>> Yeah, thyroid cancer is very treatable now how is his mental health before the thyroid cancer versus after he had an alcohol problem before?

>> But but you know, he seemed to have that kind of nipped in the bud was able to control it but at one time he could not.

Yeah.

So but I'm kind of so concerned he just sits his you know, muscle tone is gone.

He just he lives alone and doesn't really help but then he has things that he needs help so he kind of reaches out and pulls back.

>> We had mentioned that he had an alcohol problem before.

He's getting in better control.

I was wondering though, Jane did the thyroid cancer following it's in the aftermath did that worsen his mental health ?

>> I think because he was he was ashamed to let his friends know he had cancer.

He didn't want anybody to know but it seemed like the alcohol was hey, no problem, you know.

Yeah.

So but yes, he didn't want anyone to know that he had cancer.

>> I ask about the thyroid cancer because after thyroid cancer usually you're going to receive thyroid replacement.

>> He is receiving thyroid replacement now the thing no.

You sure?

Yes.

OK, because that could be a tremendous factor in itself.

>> OK, so you get chemotherapy on your thyroid you might have a so-called ablation or thyroid usually.

OK, they're going to check thyroid levels afterwards and thyroid levels depending what they did may warrant the use of thyroid medication in to either suppress the thyroid itself because if you take pills of thyroid it'll decrease the functioning of thyroid itself and that's a good thing.

You want to take thyroid supplements to suppress the thyroid functioning so the cancer won't be reactivated sometimes they will destroy the thyroid with chemotherapy, radiation, whatever in which case you need thyroid supplementation.

So Jane, if you can identify much of disturbances with mental health might have followed the thyroid cancer and its treatment, you can maybe encourage him to see a clinician because if you have low thyroid or even high thyroid for whatever reason and taken too many supplements but if you have thyroid disturbances it can make you severely depressed and you won't want to eat.

>> You don't want to do anything.

>> You don't have the energy to get up and do anything.

So the thyroid cancer itself I'd suggest he's obviously going back for follow up to make sure the thyroid cancer is still in remission.

>> Correct?

Yes, as far as we know and you know, he went applied for disability because he's just anxious he was refused and he won't try again.

He always worked had a very good job but he's gotten you know, his his hygiene now is his house now and he is always very particular.

>> Yeah.

And as a psychiatrist, sure it would be easy for me to say oh he has depression.

He needs to be on this or that antidepressant medication but based on the course of his illness OK, I had alcohol problems before so that was an issue.

>> But if he got significantly more depressed and more withdrawn with greater physical disability after he had treatment for the thyroid cancer, I'd want to make sure that his thyroid cancer doctor, his primary care clinician were was aware of that and the question can be and a as a mother can certainly ask that question with his consent with his clinicians obviously.

But you know, does he need thyroid replacement?

Does he need to have something that's going to address the symptoms that he might be having currently that could be related to thyroid disturbance is now his clinician can always start him on an antidepressant medication but that might not take care of the underlying problem if it indeed is a thyroid condition.

Again, we've talked a couple of times already tonight about sleep apnea but when people have thyroid disturbances, sometimes the radiation around their throat will cause them to have a construction of the airway.

So when they breathe at night they'll snore more and sleep apnea itself will make you feel really lousy and tired and sometimes you put the sleep apnea on top of thyroid disturbances on top of a history of alcohol use and you can feel really lousy and it's important to all of those get addressed in conjunction but I would suggest, Jane, that you do the best you can to figure out who is clinicians are and simply give them a heads up.

>> They don't have to give you any information.

But if you know who is clinicians are you to say I'm I'm my son's mother and I'm concerned about this, this and this?

I know as a clinician myself yeah.

Our office would like to have the heads up if one of our patients wasn't doing so well we don't have to give them information or even admit that we're seeing their family member.

But it's good to have that kind of heads up because we can be aware he's not doing so well.

You'd mentioned, Jane, you weren't aware of his taking any thyroid replacement thyroid supplements I'd want to firm with his clinicians that OK, is he supposed to take him or not?

Because if he's not taking thyroid supplements, if he's not taking the medication he's supposed to be taking, it's important for you to let them know that you're concerned about that because as you can imagine, Jane, a lot of people will come in and see a clinician and they say, oh, I'm doing fine and that's it.

They don't say whether they're taking the medication or not.

They say I'm doing fine and the clinician might write him another prescription.

But you know, medications don't work unless people actually take them.

>> And as a mother you're you're seeing him on a regular basis and you're very concerned about how he's doing.

I try to get hold of the clinicians who are treating him told me yesterday when I was here, you know, he's just giving up.

>> He doesn't have a will to live anymore.

I was going to say that's the direction he's probably going, Jane and at that point he can be involuntarily treated in a mental health clinic when you've given up on life and you got to that you get to the point where you're emotionally and just cognitively and physically just checking out, OK, you can be involuntarily treated for the purpose of trying to come back from a medical standpoint.

So there are reasons to get people into treatment involuntarily.

But I would love to see his overall medical workup and make sure that he's doing OK if his cancer has recurred and he's having thyroid disturbances by all means he needs to get that addressed soon as possible.

>> OK, well I sure appreciate your time and all the information you gave me, Dr. Phil.

>> My pleasure, Jane.

God bless you.

Take care.

>> Thank you.

Bye bye.

Well, let's go to the next email question.

Our next email reads Dear daughter, father, how can I help my friend when she has an anxiety or panic attack?

It depends on the nature of the panic attack itself.

A panic attack is a blast of anxiety.

It occurs rather I think it'd be helpful for you to identify what circumstances that panic attack might might occur, encourage your friend to slow down the breathing because when somebody is having a panic attack they often hyperventilate.

Hyperventilating will will decrease to the carbon dioxide level in their body and make some really panicky anxious.

So have them take deep breaths, take slow breaths, just try to calm down.

At that point we try to identify what might have brought it on.

Unfortunately I'm out of time for this evening.

>> If you have any questions concerning mental health issues you may write me via the Internet at matters of the mind all one word at WFYI Dog and I'll see if I can get to your email on the air.

I'm psychiatrist Fauver and you've been watching Matters of Mind on PBS Fort Wayne now available on YouTube God willing PBSC willing.

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

Thanks for watching.

Goodnight