.

Cameron Psychiatry.

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

More information available at CameronMCH.com.

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>> Good evening.

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

Welcome to Matters of the Mind.

Now in a 20 down as 26 year matters, the mind is a live call in program where you have the chance to choose the topic for discussion.

So if you have any questions concerning mental health issues, give me a call here in the Fort Wayne area by dialing (969) 27 two zero or if calling any place else coast to coast you may 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 the mind at WFA a dog that's matters of the mind at a dog and I'm seeing an email come in already it reads Director Fovea with all the new medications available for depression, is there any role for therapy?

Should all people be in therapy?

Well, I often describe this with my patients as well as with various clinicians wondering what is the role for therapy.

>> We've had twenty six oral antidepressant medications become available over the past 60 years so we have all these medications we've been using and the medications historically that we've used for the past 60 years primarily affect serotonin, norepinephrine and dopamine.

>> But for the past four years we've had a couple treatments bravado and novelty that are primarily affecting glutamate and then you have this other chemical called GABA.

>> So when we talk about the medications for the treatment of depression, we're talking about the ones that affect glutamate GABA dopamine, serotonin and norepinephrine.

>> So where do all those chemicals fit in?

Think about a car analogy.

Glutamate is the accelerator in the car so your right foot on the accelerator right or glutamate regulates all this outside gray matter of the brain outside gray matter the brain is the thinking part of the brain, the emotional aspect of the brain, the part of the brain that helps you pay attention.

>> That's the outside part of the brain and it's regulated by glutamate the accelerator which is offset by Gabb the brake.

>> So you got glutamate pushing on the accelerator Gabb pressing on the brake so you got the accelerator brake accelerator brake going back and forth to balance things out.

So that's glutamate GABA and these newer medications bravado the nasal spray ketamine is used off label I've many times for the past twenty five years for depression.

It also affects glutamate and then you have all valide an oral antidepressant medications that is affecting glutamate so they are directly affecting the accelerator of the brain.

>> Serotonin, norepinephrine and dopamine originate from the brain stem brain is shaped like a giant cauliflower and in the stem of the brain you've got the origin of serotonin, norepinephrine and dopamine and they were spraying up to the gray matter giving advice to glutamate the accelerator and gabb the brakes.

>> So serotonin, norepinephrine and dopamine are coming from the middle part of the brain spring up to the cortex on the outside so what's the role of serotonin, norepinephrine and dopamine there more in a consultative role they are giving advice to glutamate and GABA on terms of their balance overall.

So think of serotonin norepinephrine dopamine as being like the passengers in the passenger seat and they're advising glutamate and GABA to now speed up or slow down respectively.

So that's the role of serotonin norepinephrine or dopamine and many of your antidepressants have had that role in the past 60 years.

>> So you've got the Zelzal and you got the break with Glutamate and Gabb respectively.

>> You've got serotonin, norepinephrine and dopamine coming from the brainstem giving an advisory role to glutamate and sort of therapy fit in well therapy is kind of like the driver the driver training teacher when you are learning to drive you need somebody there with you to kind of help you learn how to steer and where to steer.

And as an example your car might be functioning pretty decently but if you've never driven on the interstate before, be a good idea to have somebody with you when you get out there on the interstate to help you about who help you with lane changes and ways to get on the on ramp and the off ramp.

>> So you need somebody to try to help help you steer in the proper direction.

>> That is the role for therapy.

Now what if somebody simply has difficulty with your accelerator, they have trouble with their braking system, get to get those fixed first and foremost, that's what we're doing when we're prescribing medications.

We're trying to biologically normalize the brain so to work better.

But if you've not had life experiences, if you had the ability to learn how to cope with certain situations, that's where you need the wrong analogy of the driver's training teacher to be right there with you.

>> That's the therapist.

So the therapist is helping you steer where you need to go once your brain is properly functioning now now back in the 1980s when I was first in training much, much of our training in the 1980s was primarily on psychotherapy because we didn't have that many medications.

We had a few medications the older ones that affected serotonin, norepinephrine and dopamine.

But they only gave so much effect and they gave a lot of side effects to a lot of people.

So we often focused our treatment back then on the steering and helping people navigate.

>> But we found that a lot of people had a lot of trouble with navigating through life's difficulties because they had trouble with motivation, energy, concentration, sleep.

They had all these biological problems that we later found could be remedied with tolerable antidepressant medications.

Prozac or Fluoxetine came out in nineteen eighty seven and thereafter about seventeen more medications came out and over the course of time they became more and more tolerable so people could take them and they could biologically help their brain function better.

>> So the role of psychotherapy is mainly there to help you steer in the proper direction where the role of the medications will be to biologically help you accelerate or break Cordingly to help you get to your destination.

Thanks for your email.

Let's go to our first caller.

Hello Diane.

>> Welcome to Of Mind.

Well Diane, you want to know is it possible for depression to go on its Goodwill's own or does it require medications?

Diana usually depends on how many bad depressive episodes you've encountered.

If you are going through a real big stress and for the first time in your life you're having trouble with sadness, lack of enjoyment with things motivation, energy, sleep problems.

You're having all these depressive symptoms go on day by day by day for a couple of weeks and it's the first time you've ever had depression and you don't have anybody in your family who's had depression.

>> Pretty good chance you might come out of that particular depressive episode if you've never had it before.

>> If you don't have a lot of other stuff going on in your life and you don't have family members who have had similar depressions, you'll likely come out of that depression as long as the particular stress is no longer found to be overwhelming for you.

In other words, you've learned how to cope with it or the stress is no longer problematic for you.

So for those people they'll often have the one and done type of depression.

>> Some people will navigate through their depressive episode if they do have psychotherapy as a means of helping them with coping and that's where we're talking about helping them steer and the proper direction and get them where they need to go.

The role of medications will be if somebody is having biological disturbances which are often characterized by fatigue, difficulty with concentration, sleep disturbed says you know, if you start having sleep disturbances it's kind of like a vicious cycle where the more sleep disturbances you encounter the worse your anxiety depression can get because the role of sleep in our brains will be to allow this front part of our brain to rest and with the front part of the brain the thinking part, the brain, the decision part and part of the brain without resting adequately night by night by night you're able to think more clearly the next day if you don't sleep the thinking part of your brain doesn't get to rest at night.

So it's kind of like going through the day with a poorly charged battery on your cell phone.

It just doesn't work properly and eventually doesn't work at all.

So that's the role of sleep.

It helps your brain recharge and the thinking part of your brain recharge is that thereby allows your memory part of the brain down here the hippocampus to to recharge and you're allowed you're thereby going to be able to remember things a lot more clearly.

>> Diane, thanks for your call.

Let's go next caller.

Hello Sharon.

Welcome to Mars.

Mind.

>> Sharon, you mentioned that your teen has diagnosed anxiety and you saw a recent article about a rise in suicide rates.

Should you be concerned and what signs should you evacuate with teenagers?

>> We saw a tripling of the suicide rate during the covid pandemic restrictions.

And when I say that I'm referring to the social isolation that adolescents and young adults especially had to endure and were affected by because they went to Isla running, they weren't allowed to socialize.

They weren't allowed to congregate in large groups.

So the social restrictions were devastating for adolescents and young adults during the covid pandemic restrictions that we endured.

>> And why was that?

Well, loneliness is a predictor for depression and loneliness is a predictor for suicidality.

So that's why we saw the depression rates triple.

We saw the escalating suicide rates with alcohol use and opiate use disorder which we often see with adolescents and young adults.

That was problematic as well.

So a number one concern I would have for the adult adolescent would be at the adolescent is all of a sudden having a deterioration in his or her grades if they're becoming more socially isolated and they're becoming lonelier over the course of time and they've had a change in their overall demeanor, especially if they're not sleeping and if they're getting more and more anxious anxiety is a risk factor for suicide.

For some people looking at past histories of suicide attempt can be a predictor.

It's it's a misnomer to think that if somebody tries to attempt suicide again and again and again they're just trying to get attention and they're not really at risk.

They actually are the more times you attempt suicide and play with the idea, the more likely you complete it.

So that's something we have to consider now how about self injurious behavior?

This often is very, very concerning for a lot of parents where somebody cuts at themselves or they do things to injure themselves.

>> Those people often do not mean to kill themselves.

>> So self injurious behavior isn't a direct predictor for a suicidal outcome.

>> You might think well gee self injurious behavior if they're cutting themselves they must be thinking about suicide.

Not necessarily.

People will often cut it themselves, especially adolescents who lack the coping abilities to get through life's problems.

>> Adolescence especially will cut of themselves as a means of relieving stress and relieving frustration.

>> When you cut it yourself you relieve you release some natural opiates that are in the skin.

We've got some natural narcotics that are in our skin so that's a protective standpoint.

You cut yourself accidentally, you get some relief off about from from pain and you don't hurt as much.

Well, if you cut yourself intentionally you're releasing some natural opiates from the skin.

>> That's not a good way to cope with things because basically you're just taking opiates as a means of helping with anxiety.

So if you have anxiety and you have difficulty tolerating stress to the degree that you'll have difficulty with wanting to cut yourself or needing some help with that, that's where starting out with a primary care clinician, a pediatrician, a mental health clinician can help you out in terms of looking at other means of coping in that kind of stress.

But anxiety, agitation, lack of sleep are often big predictors for individuals who might make a suicide attempt.

Thanks for your call.

>> Let's go next caller.

Hello Zach.

Welcome to Matters of Mind.

Zach, you wondered why you stutter when you feel anxious or stressed.

Zach stuttering is a neurological condition that originates in the middle part of the brain and the middle part of the brain is an area right here in the middle here that's the area of the brain that when people stutter it's considered to be a neurological condition and you have a hard time articulating the first phrases of a lot of words and when you get anxious it will make that worse.

>> Now there are various medications that can be used for stuttering them once the blocked dopamine are often the best at preventing stuttering and for many people they can learn through speech therapy techniques to decrease stuttering when you get anxious it will affect your stuttering pathway and again that's a neurological pathway and it gets worse and when you when you get anxious and we see that go hand in hand with a lot of people who have stuttering Zach, thanks for your call.

>> Let's go our next caller.

Hello Jan.

Welcome to Matters of the Mind.

Jan, I wanted to know if I could if if you can tell a difference between someone with a bad attitude or someone with intermittent explosive disorder a bad attitude, Jan basically is where somebody might be negative Vesty pessimistic.

They tend to have a hard time get along with other people.

Somebody with an intermittent explosive disorder is an entirely different phenomenon with an intermittent explosive disorder for no necessarily provoked reason.

>> Somebody has an episode of rage now the first thing we're always going to assess in the kind of situation again will be if somebody has a seizure disorder there are certain types of seizure disorder, especially the ones that affect the temporal lobe that will be manifested by anger and rage just out of the blue.

So that could be a factor in itself.

So bad attitude is more of a personality disturbance or a personality trait for somebody intermittent explosive disorder like the name kind of implies will be episodes of rage for no particular known reason although we do have to look for various medical conditions that might be precipitating that.

>> Jan, thanks for your call.

Let's go next e-mail our next e-mail reads Dear Dr. Fauver, how often should someone see a therapist we're talking about therapy earlier.

Can't intensive therapy more than once a week be helpful?

It depends on your situation and terms of the frequency of seeing a therapist.

When I was in my training back in the 1980s I saw an owl and that was an analyst for psychoanalysis twice a week over the course of two and a half years.

That's not the type of treatment we'd typically do for people nowadays.

I did it back then because I was interested in psychoanalysis and I wanted to see the what the process was like and wanted to experience it myself.

But nowadays typically people will have a more intensive therapy early on, especially if they're having a lot of life difficulties.

So if you're having trouble on the job and you need to take off work, you just can't function on the job.

For instance, that's where intensive outpatient treatment where you go in to a group therapy setting maybe three days a week can be helpful as a means of keeping you out of the hospital setting.

>> When people go into a hospital setting such as a psychiatric hospital, they'll be in group therapies day by day several times a day not uncommonly whereas intensive outpatient treatment will be three times a week and that will often be decreased in frequency over the course of time after typically four to eight weeks and then people will be seen perhaps once a week, twice a week you and your therapist can negotiate how often you need to come in.

>> But if you're getting to a point where you find the therapy is not really helping that much anymore and you're able to cope with life circumstances a lot better on your own, that's a good sign.

That means you can often decrease the frequency that will often be discussed between you and your therapist in terms of how often you need to be seen.

>> Thanks for your call.

Let's go our next caller.

Hello Greg.

Welcome to Mastermind Greg.

You want to know how are people easily persuaded by cult leaders with cult leaders?

>> They give you a sense of belonging.

Many people have a detached sense of of belonging and they don't feel a connectedness in many of these people have conditions such as borderline personality disorder.

They have difficulty with bonding and they've not had within their families within their relationships a sense of belonging or connectedness.

>> We see the same type of manifestations with gangs where people want to belong to gangs because they feel cohesive to the gangs.

The cult leaders can be very influential because they call leaders and give you a sense that you are special and that they have ideas that are intriguing and they have abilities to allow you to become more connected.

You become connected to the other cult members and you become a big family and it's it's something that's very exciting for a lot of people and that's why cult leaders will give you that sense of belonging and be very successful gathering large groups of people together even though their ideas might not make a lot of sense to people who are not in the cold.

But when you try to leave the cult they'll make it very difficult for you.

It's as if you're abandoning the family so the whole idea of a cult or a gang will be to give you that sense of belonging and really meaningfulness.

>> People in a cult will often get a whole different sense of meaning and purpose in life that's very appealing to them at the time because previously their life might have been an empty void and they didn't really care for the direction they were going.

>> Thanks your call.

>> Let's go next caller.

Hello Paul.

Welcome to Matters of Mind A Paul you had mentioned that your brother in law cannot keep a job.

Is that a sign of depression or another mental disorder?

It depends.

Paul, based on your brother in law's history, does your brother in law, for instance, have a history of losing jobs and what's the reason behind the job loss?

>> Is it because he loses interest?

>> He has mood changes that lead to his being very productive on the job and then not even showing up?

Does he have trouble interpersonal problems?

Does he have trouble bosses you want to look at all those reasons why somebody might not be able to keep a job now if somebody had a job for three decades and all of a sudden they're not able to go to work, they're not able to get along with anybody that could be a sign of depression or another mental health problem.

So I think it just a matter of getting all that assess.

Paul, you might want to start with encouraging your brother in law to at least see the family clinician for the purpose of determining are there any mental health issues or psychiatric problems going on?

Are there any medical problems going off?

And if the problem keeping a job is more recent, not uncommonly we'll hear about medical problems such as diabetes or sleep apnea causing people to have difficulty getting up day by day and they just don't feel good.

Sometimes people will have fibromyalgia symptoms where they have overall fatigue.

>> Their body feels like a dead weight and they can't get up and around.

These are medically treatable conditions that can frequently compromise a person's ability to stay on the job.

>> Paul, thanks for your call.

Let's go next e-mail question our next e-mail question reads Dirda to favor a shopping too much and being constantly over budget a mental disorder.

This has caused some worries at the end of many months from my college child while shopping too much being constantly over budget you want to look is it occurring in episodes or is occur all the time if it occurs in episodes there is a condition called bipolar disorder.

With bipolar disorder people can have manic episodes where they don't need to sleep.

They talk a lot faster than they ordinarily would do.

They will tend to in on conversations.

They're very impulsive and they spend a lot of money during that time and it's just when they're on these really high moods now many people on the hand will shop more when they're depressed and they will try to get a little bit of a dopamine rush.

>> Dopamine is the feel good chemical.

The brain they get a little dopamine rush when they buy something or they're out shopping so they shop as a means of treating depression itself.

So we always want to sort out OK, is it because they're having trouble with mania is because they're having trouble with depression and some people have a hard time with their budget and understanding the source of money as people are are getting funded by outside sources.

They might be somewhat irresponsible with how they use that money mentioned a college aged child with a college child is getting money indiscriminately from various sources they might not be so conscientious about using it people when they get into a work environment and they start making their own money, they are much more aware of wherepth.

Thanks for your call.

Let's go next caller.

Hello Hilary.

>> Welcome to Matters of Mind here.

Are you want to know why do you fidget and find it difficult to control your tapping when you're nervous?

What steps can you take to calm down?

Some people will fidget and they'll get more anxious when they get nervous.

>> The best thing you can do in those kind of situations, Hilary, is get kind of some kind of physical activity.

So the best thing it can do is go out and walk around.

>> Wasn't exercising go out and exercise?

Exercising is one of the better fidgeting.

Yes.

And anxiety that kind of feels inside you so sometimes people will do what's called burping.

I don't know if you know what burps are but those are a means jumping up and down on the floor and doing a push up and just getting some intense physical activity going.

Get your heart rate going up up for a few minutes that will often decrease fidgeting and tapping and moving around a bit.

>> However you do have to remember that there is a condition called Attention Deficit Hyperactivity Disorder ADHD whereas part of the ADHD from a brain perspective you can have trouble with fidgeting.

>> It's one of the symptoms of ADHD so people not only have trouble distractibility and focus and keep it in mind on things but they have a disturbance in the way they're inside part of the brain processes information and it can give them fidgeting, fidgeting this where they have a hard time sitting still.

So if it's due to ADHD you want to be treated for ADHD specifically but if it's do more to anxiety, anxiety is something that is you can is something that you can relieve by exercising intensely just for a few minutes to calm yourself down weight training for instance.

Resistance training is a very good means of decreasing muscle tension because if you tense up your muscles just for a few seconds at a time it can give you an overall relaxing effect.

>> Thanks for your call.

Let's go next caller.

Hello Alice Walker.

Matters of mind Alice.

>> You want to know what happens to the brain during sleep paralysis?

Is there a way you can wake yourself up sleep paralysis Alice is considered to be a rapid eye movement disturbance rapid eye movement disturbance means that you're in dream sleep and during dream sleep you're supposed to have a paralysis of your body and that makes a lot of sense because if you could imagine when you're dreaming you don't want to be doing what you're doing in your dreams and for some people they'll awaken while they're still dreaming and that's called sleep paralysis.

So when you have sleep paralysis it's a means by which you're still dreaming but then you wake up but your body's still paralyzed so you can wait.

You typically will wake yourself up during that period of time when you're finding it difficult to move around.

>> But just keep in mind if you have trouble moving your body as you awaken is because you've been dreaming and often you give yourself a few seconds.

>> You come out of that now some people will have the experience where they want to scream during a dream so they're talking to somebody they're experiencing something during a dream and they want to scream scream and they can't.

>> That's a good thing because you don't wake up the whole household but your brain naturally will paralyze the body, paralyze your vocal cords while you're dreaming.

It's kind of scary when you try to scream when you're in the dream state like that but that's normal and that's natural.

>> But sleep paralysis is occurring where you have a difficult time moving around as your first awakening and that's because you're still in that dream phase of self.

>> I believe we have another email.

Let's go to our next email.

Our next email reads Dear to the father.

I'm curious about some of the newer medications that are occasionally used for weight loss.

My doctor and I have been have had conversations about Mozambique that Simek Lutie by the way and I'm considering it my understanding is that it changes the way your brain looks at food.

Can you tell me more about that?

Stay in my lane concerning some igloo tide or Mozambique.

It's class of medications that truly affects how glucose is processed in the body and it does in some way make you less hungry because it affects the brain processing of appetite.

So with many people they'll notice that they'll have a change in their gastrointestinal system.

Many people have diarrhea as an unfortunate side effect from a medication like that but it will change the way your body processes food and specifically glucose.

>> It's something that is getting more and more popular as a means of helping people with obesity and there are forms of Simeulue Tide right now that are Food and Drug Administration approved specifically for obesity.

But it's something that needs to be closely followed, closely managed by a clinician to make sure you don't have unfortunate side effects Thanks for your call.

Unfortunate I'm out of time for this evening if you have any questions concerning mental health issues I can answer on the air.

>> You may write me a via the Internet at Matters of the Mind at WFYI dot org that's matters of the mind at WFB.

>> Edgar I'm psychiatrist Jeff Offer and you've been watching Matters of Mind on PBS Fort Wayne now available on PBS willing to be back again next week.

Thanks for watching.

Good night Cameron Psychiatry.

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

More information available at CameronMCH.com.