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Good evening live from Fort Wayne , Indiana.

Welcome to Matters of the Mind.

I'm psychiatrist Fauver and Matters the mind has been on the air for the past twenty five years so if you have any questions concerning mental health issues give me a call here at PBS Fort Wayne by dialing in the Fort Wayne area (969) to seven to zero and if you'd like to call me coast to coast you may dial toll free at 866- (969) 27 two zero nine on a fairly regular basis.

>> We are broadcasting live every Monday from our spectacular PBS Fort Wayne studios which lie in the shadows of the Purdue Fort Wayne campus.

>> If you'd like to contact me with an email question that I can answer on the air concerning mental health issues, you may email me at matters of the mind all one word at a dot org that's matters the mind at FWC Dog and I'll start tonight's program with a question I received over the past week.

It reads Do not a favor.

I know that there are different types of medication to treat attention deficit hyperactivity disorder also known as ADHD.

>> What's the difference between something like Vyvanse or Adderall and Concerta or Ritalin?

Does one kind treat specific symptoms better?

>> Does it just depend on the person?

I think I can answer that pretty succinctly basically with attention deficit hyperactivity disorder medications the stimulants you have the amphetamine class and you have the methylphenidate class also known as the Ritalin class, the amphetamine class sometimes will give you more side effects such as increased heart rate and more of an energizing feeling and unfortunately that's why more people will abuse that class if that classes prescribed in the short acting formulations where people get a really quick hit of the dopamine and norepinephrine and then it wears out really fast.

We prefer to use the longer acting formulations the methylphenidate class that's Concerta that's metadata CD methylphenidate known as Ritalin those that those are the the kind of medications you use to have fewer side effects basically from a comparative standpoint the amphetamines tend to push out more dopamine and norepinephrine whereas the methylphenidate class tends to block the vacuuming back in of dopamine and norepinephrine to a bit lesser degree overall.

So if you think about the two classes, the amphetamine classes is a bit more potent and that's why it has more side effects overall you can use that class of medications in a long acting formulation long term they will typically work right away.

>> But I always remind people that the stimulant medications are like eyeglasses.

>> You dose them to the extent that you need them to be dosed.

If you need eyeglasses you might need a really thin lens.

You might need a really thick lens but if you have to thin of a lens or to think of a lens for you you'll tend to have worsening vision.

>> So we try to adjust the dosage of stimulants just right and we start low typically and we'll go higher.

Going higher and higher does not help with focus and concentration for everybody more and more just like going thicker and thicker on your eyeglasses lens won't always help people's vision.

So you find the strength that works the best for you if you go to high on a stimulant dosage you'll get an energizing effect that's kind of a side effect.

>> You might even get a decreased appetite.

>> That too is a side effect but that effect will not be sustained and you'll have to go higher and higher and higher.

Some people don't like the effects if they go a little bit higher on the dosage and they'll get difficulty with a racing heartbeat shakiness sometimes nausea, sweatiness and that means you've gone too high on the medication.

So we try to dial down the medication when we hear about those side effects.

There is a medication used for depression called Wellbutrin or bupropion.

It has about half of the potency of the stimulants so we'll often use Wellbutrin or be appropriate for attention deficit disorder.

It's called off label use where it hasn't been studied because Wellbutrin was FDA approved for depression back in nineteen eighty nine so it long ago lost its patent status.

>> So there's not a brand name Wellbutrin that is is typically used.

>> There are availability, there's availability of the brand name Wellbutrin but very many times the generic version will be used.

So that's why a drug company is not going to study Wellbutrin or bupropion for the purpose of ADHD.

There wouldn't be any advantage to that.

>> So for that reason we will use Wellbutrin to be appropriate at very low doses initially going higher and higher for the purpose of trying to help with ADHD because it has about half the potency of a stimulant.

So we'll use that typically as a foundation to help people morning, afternoon and evening for their focus attention span and for some people that's all they need.

>> Other people will need a little bit of a stimulant on top of the bupropion or Wellbutrin as a means of being able to stay sustained attention span decreased distractibility and get things done more efficiently overall.

>> Now will everybody respond to a stimulant?

No, no more than everybody would respond to wearing eyeglasses.

>> If you need eyeglasses and you were eyeglasses or corrective lenses, sure they'll help tremendously with your vision and that's wonderful.

>> But if you don't need eyeglasses, wearing eyeglasses won't further improve your vision.

>> If you don't need ADHD medication all you'll notice will be the side effects such as the higher energy and perhaps decreased appetite.

And for many people they say that's great.

>> That's what I want.

The problem is if you don't have ADHD to get those same kind of effects you typically need to go higher and higher on the dosage.

Next thing you know you're hearing about people who are taking a stimulant with Xanax or Klonopin because they're feeling so anxious they need the Xanax to calm them down and that's a big red flag whenever I hear about that for people and not uncommonly when individuals are taking a medication like Adderall which is a mixed sort of an amphetamine has for amphetamine salts in it when people are taking Adderall they'll often need Xanax because they feel so anxious with it and they also notice that when it gets out of their system they crash and they feel worse.

So they have this updown feeling all day long.

That's why instead of giving them medication like Adderall even in the extended release version we give a long acting version of a medication.

It's an amphetamine such as Vyvanse or My Daises are more common medications we use as amphetamines.

So with attention deficit disorder it is a condition that affects about eight or nine percent of people to some degree at some time in their lifetimes.

>> So it's something that does need to be addressed.

Basically with ADHD you have decreased activity is left front part of the brain up here and when you have decreased activity that part of the brain you typically will have trouble with being able to focus and sustained attention and block out outside distractions for prolonged periods of time unless you're interested in something if you're interested or challenged by something you can focus for long periods of time.

But if you're not that interested in something, your brain's just all over the place and people will often say they have racing thoughts and it's as if their mind is on a television channel changer and going from one station to another to another.

They can't focus on different topics for long periods of time and many times these people are mistaken for having bipolar disorder which is a mood disturbance because when people have bipolar disorder, when they get the manic highs they'll have trouble with racing thoughts and they won't need to sleep and they'll be impulsive and they'll talk really quickly going from topic to topic to topic.

Well, that's bipolar disorder when you're on the high side.

But unlike ADHD, those people with bipolar disorder will crash and they'll have depression where they become socially withdrawn and they get very, very slow down.

People with ADHD will have very consistent symptoms day by day by day similar to people with nearsightedness, people nearsightedness every day they'll have trouble, focus and concentration.

>> That's kind of how it is with ADHD.

Thanks for your email.

Let's go to our first caller.

Hello Amy.

>> Welcome to the mind.

Amy, you want to know how do you know if you have seasonal affective disorder?

>> Seasonal Affective Disorder is also known as winter depression for many people because for most people they notice more depression in the winter.

Occasionally it's fairly rare people get more hyped up in the winter time and more depressed in the spring and summer.

But that's quite rare.

Most people with seasonal affective disorder will notice that the seasonal disturbances where they have winter depression springtime comes around April May they notice that they start getting a little hyped up and by June they're flat out manic sometimes .

>> So with the mania they don't need to sleep.

There are very, very impulsive.

They're very hyperactive and it's just the opposite of what they had in winter depression with winter depression they were slowed down significantly.

>> They were eating too much usually carbohydrates.

They were sleeping more.

They were socially withdrawn.

They couldn't concentrate and with seasonal affective disorder it does affect women four times more than men for some reason probably due to the hormonal status status prior to menopause.

But it does affect women more than men and it typically starts with the winter depression around October November and it goes all through the winter.

It doesn't have as much to do with the cold the great days it has do with the darkness of the day.

So the darker the days the shorter the light during the day that's when you're going to have more winter depression and that's why as you go higher on the latitude of the earth you get more winter depression.

>> So just going from a latitude of Ron, Minnesota down to Sarasota, Florida for instance, you'll have a substantial decrease in winter depression or seasonal affective disorder as you go south.

>> So with that being said, it's a light disturbance apparently and the light will hit the retina by the retina also will transmit a signal to the middle part of the brain called the pineal gland.

>> The pineal gland upon exposure to light will decrease melatonin.

If you decrease melatonin upon exposure to light, you will feel more awake and alert and your mood will improve if you have increased melatonin which is what lack of light to the retina will tend to stimulate increased melatonin will make you tired, make you want to sleep all the time and make you want to overeat carbohydrates so Amy, you know you have seasonal affective disorder number one if you characteristically have a mood disturbance based on the season in other words, summer comes around, fall comes around and you feel fine perfectly fine.

It's a seasonal change occurs now what would we do differently if you had seasonal affective disorder versus major depression where you have depression any time of the year?

>> Well, number one, we might recommend a lightbox.

A lightbox is where you would sit in front of a bright light every morning for about twenty or thirty minutes two feet away from the bright light.

But the light box has a very strong light intensity.

If you look right into it it can actually give you a headache so you have it off to the side as you read or eat your breakfast or do something on the computer during that time and you only use it for twenty or thirty minutes every day in the wintertime during those dark days of winter it can have a dramatic effect.

That's the number one thing that will often recommend if somebody has seasonal affective disorder.

Number two , make sure your vitamin D level is adequate.

We like that.

We like to see the number above fifty five not uncommonly people with Seasonal Affective Disorder will have vitamin D levels in a single digits so we like to see that number above fifty five vitamin D supplementation can be made by taking a vitamin D capsule and you can take ten thousand units once a week or five thousand units every day but have your primary care clinician kind of monitor that and keep a close eye on how you're doing overall if you have seasonal affective disorder we want you to take a walk first thing in the morning when the sun is coming up.

We want you to go outside for about 20 or 30 minutes when the sun is coming up just to get some fresh or which is good for everybody but also a little bit of that early morning light exposure.

Ideally you want to exercise in the morning now these are good tips for anybody but if you exercise first thing in the morning with seasonal affective disorder you'll typically have more energy during the day 30 minutes of exercise or a brisk walk could be fine.

Ideally be nice of you to exercise outside somehow but exercise is particularly helpful for people seasonal affective disorder and finally if you have seasonal affective disorder do what you're prone to not want to do and that is socialize, try to be around people, get involved in activities, do things over the winter time it's the last thing you want to do and you have seasonal affective disorder but it's a vicious cycle because the more you're socially withdrawn the more depressed you get.

The more you give up pleasurable activities, the more depressed you get.

So try to be around people and do things actively and socially around others if you do have seasonal affective disorder but you know you have it if your mood is basically dictated by the changes in the seasons.

>> Amy, thanks for your call.

Let's go to next email.

Our next email reads Dear Dr. Fauver, why does it often feel good when a person or a loved one hugs or touches you in a kind manner?

>> It's always a good feeling, perhaps even therapeutic when my husband gives me a hug and kiss.

Well, all you have to do is look at the primate's if you look at the primates, they're grooming each other OK?

>> They're grooming each other from a hygienic standpoint but they're also doing it as a soothing for a soothing effect because when you groom hug, hold somebody's hand, what you're doing is releasing some neuropeptides little bitty proteins in the body called endorphins.

Endorphins do have an effect on the brain similar to that of opiates.

>> Now we've had this big opiate epidemic going on over the course of time.

Opiates will artificially stimulate the same parts of the brain that hugs and holding the hands will do for people.

>> So with opiates you're getting a false sense of bliss.

You're getting a false sense of calm, of a calming effect and you're getting a false sense of feeling good basically.

So to get that same effect with opiates you typically have to go higher and higher and higher.

What you're trying to do with opiates is artificially stimulate that loving feeling you get from hugs or holding hands or giving somebody a kiss.

Neuropeptides are released in those kind of instances which lead to endorphin release in the brain and the endorphin release and a brain goes to this part of the brain called the anterior cingulate gyrus right in here and that's the part of the brain that gives you that nice calming effect overall it's associated with physical physiological pain and emotional pain.

But you can reverse that by by stimulating with endorphins in the case of giving somebody a hug if they're going through a tough time, you give them a hug.

What you're doing is giving them a neurobiological effect on the anterior cingulate right there and makes them feel better.

>> So a hug is a good natural way of giving somebody the same good effect emotionally there's something like an opiate would do.

Thanks for your email.

>> Let's go to our next caller.

Hello, Suzanne.

You have a couple of questions for me as I get my brain together.

Hi.

Hi, Suzanne.

I'm turning down my volume right now.

I have a few questions for you.

One regarding my own medication and that's why I'm on eighty milligrams of Prozac and one hundred fifty milligrams of Wellbutrin.

But the past year and a half has been extremely stressful including amputation of my right leg having to move and been living alone for six months and unable to even get off my driveway and so I turned to my emotional eating but I was wondering I'm feeling blue out quite a bit of the time and just really down a fair amount at the time and how do I go about being someone about getting my medications examined?

>> Yeah, I'll give you some ideas about where you could go to have somebody take a look at your medications first go to your primary care clinician again and quite frankly ask to get another assessment on the current medications either in that office or get a referral to a mental health clinic to get your medication examined.

You're taking Prozac and Wellbutrin and if I may offer some ideas here when you went to the higher and higher doses of Prozac, Suzanne, Prozac is also known as Fluoxetine.

When you went from 20 to 40 to 60 to 80 milligrams, did you notice an improvement with your mood with a higher dosage by chance?

>> Yes, things definitely became more manageable.

OK, so the higher dosage did help you to some degree and I'm going to imagine here the Wellbutrin was added at some point when you're increasing the Prozac or when you're already on Prozac.

>> Eighty milligrams.

Yes.

OK, how did the Wellbutrin do for you when it was added on?

>> Did you notice any effect on when life wasn't throwing lemons constantly?

I did OK but as things got worse its effect I kept me in a better frame of mind.

>> Gotcha.

So the big question is Susanna's right now if you could feel better in a couple of ways what were those couple of ways be?

How would you want to feel better than you are now or considering that you're on Prozac eighty milligrams a day and Wellbutrin hundred and fifty milligrams a day.

How do you want to feel better if you could feel feel better in a couple of ways.

It's a loaded question as it is I am currently in rehab because a month ago my rotator cuff split in half and they had to do a reverse shoulder replacement because I kept dislocating my shoulder and but I in losing weight I lost twenty five pounds in the last month.

>> And did you intend to do so, Suzanne?

Yes I did good right there right and I want to see my left arm get strong again so that I can stand up on my one myself again and finish going through the process of getting a prosthetic.

>> Got you.

Well Suzanne, you mentioned you had a amputation of your leg, your had rotator cuff tear.

>> How much pain do you experience now?

It varies a lot not from the operation.

I'm still tethered to my body for another two weeks of non movement but I am my pain is primarily in my right shoulder which is just about as bad as the left shoulder was.

OK and my remaining mean that they're being overstretched to help compensate and so I'm getting a fair amount of pain from them many days in the six to seven category.

But over this weekend I didn't take any Tramadol at all and I have four so my brain's going to blink oxycodone.

Yeah.

Available to me if I ask for it but I avoid it as much as possible because I don't like the effect that it does.

>> Sure.

And I don't want to become dependent on it.

Well that's a great idea considering you do have some pain at this point you might want to consider if they've not suggested it already had they suggested a medication that increases serotonin and norepinephrine like Cymbalta Presti Effexor has Zema have any of those medication names then any of those ring a bell for you know you're on Cymbalta eighty milligrams a day going higher and higher on Cymbalta will increase more and more and more serotonin when you increase serotonin substantially indirectly it can decrease dopamine transmission and in doing so make you feel a little bit dull for that reason.

Sometimes dopamine is then enhanced by a medication like Wellbutrin and that might have been why it was added.

The question I would have is considering you're having so much pain we've got to look at the whole body here you have in some pain based on the amputation based on the rotator cuff tears there's a medication called Cymbalta that increases both serotonin and norepinephrine and in doing so it can relieve pain.

>> Now the high dosage of Prozac you've been taking and the Wellbutrin crate means by which you can suppress your appetite.

That might have been one of a couple of reasons why they gave those to you Suzanne.

>> So Cymbalta as a replacement for Prozac could be a possibility for you to not only help with mood but also maybe help you with the pain as well.

>> Talk to your primary care clinician about those kind of ideas.

If they want to refer you to a mental health clinician, that could be a possibility for you too Suzanne.

>> Suzanne, thanks for your call.

Let's go next caller.

Hello, Joyce.

Welcome to Matters of Mind.

So much for your show.

You do so many wonderful things and I appreciate it.

>> Thank you, Joyce.

And my question is on autism concerning adults how can you tell the difference between autism and if the dysfunction from neglect in childhood and is autism cure all other than medication?

>> It's actually choice from my perspective I'd say autism is preferably treatable outside a medication.

Medication is kind of OK medications that we have now for autism haven't quite succeeded in taking care of the core underlying problem which is the lack of emotional bonding and the attachment and the ability to relate to somebody else right front part of the brain here is the part of the brain that has what's called mirror neurons in it and the mirror neurons help you mirror the emotions and the feelings of other people as you interact with them so you can relate to them.

You can have empathy and people with autism will often lack that.

Now how can you tell the etiology of those kind of symptoms?

You have to go back to early childhood to determine if somebody had those kind of disturbances in the very going all the way back to the toddler days.

So the treatment we have from medicinal standpoint for autism really just takes care of the symptoms right now the moodiness, the irritability, the lack of frustration, tolerance there is a nasal spray you might have heard about it called oxytocin oxytocin is called the bonding hormone.

It's a protein it's a neuropeptide comes from a territory gland.

The problem with a neuropeptide is if you take it by mouth it goes the stomach gets all broken down.

If you use it as a nasal spray it can actually go right to the brain and there are forms of oxytocin being developed right now or different chemical variations of it for the treatment of autism I expect within the next five years.

Joyce will have a specific treatment for autism.

>> It'll take her a lot of the core symptoms that will help with the interpersonal relatedness for people.

>> But you're exactly right.

I mean if you were reared in a social socially deprived type of environment that will cause you to have social anxiety and difficulty with relating to people as well.

But autism itself appears to be a neurological disturbance that leads to those particular problems.

Joyce, thanks for your call.

>> Let's go to next call.

Hello Nick.

Welcome to Matters of Mind.

Nick, you want to know how to deal with big unwanted life changes and needing closure on things when you have a big stress, a big stress, Nick, is a particular change in which you've not previously encountered.

>> It's totally foreign to you.

You're overwhelmed by it.

You don't have the coping mechanisms and that's where you're trying to adapt.

Those big changes will lead to increase in cortisol release can cause you to have trouble concentration, sleep, irritability, anxiety and eventually on down the line depression.

So Nick, the best thing to do is try to get a handle on identifying what the stress might be and talk to your primary care clinician if becomes highly problematic for the purpose of intervening and with with counseling or even medication down the line.

But bottom line is, Nick, identify what the stress is and try to get some counseling either from family or friends first but outside counselors can help as well.

>> Nick, thanks for your call.

Unfortunately out of time for this evening if you have any questions concerning mental health issues, you may write me via the Internet matters of the mind at WFTDA dot org.

I'll try to answer them here on the air.

Thanks for watching.

>> God willing willing.

I'll be back in next week.

Good night