But good evening, I'm psychiatrist Jeff Alver live from Fort Wayne , Indiana.

>> Welcome to Matters of the Mind.

Now in its 10th 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, you may call me here in the Fort Wayne area by dialing (969) 27 two zero or if you're calling any place else coast to coast you may dial toll free at 866- (969) 27 to 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 e-mail question that I can answer on the air, you may write via the Internet at matters of the mind all one word at WFYI dawg that's matters of the mind at WFYI Dog and I'll start tonight's program with a question I recently received.

It reads Do not a favor.

>> I think my son may be starting to show signs of attention deficit hyperactivity disorder ADHD.

>> Is there a certain age where it's more beneficial to see a psychiatrist?

Could it be too soon or could he grow out of it?

Well, the bad news is that if people have ADHD as children and it's a valid diagnosis, about 90 percent of them do take the condition into the later years as an adult often in a different way.

In other words, as a child you'll often have more hyperactivity, impulsivity, more difficulty controlling your actions and you say things and do things you shouldn't be saying and doing later on in life that often will fade and settle down some.

But you'll often still as an adult have trouble with concentrate and focus especially if things are not interesting, challenging or novel or exciting so you can have different types of ADHD symptoms going into the adult years.

What is a start?

Typically by the time you're in middle school as a general rule of thumb, twelve years of age is the baseline where you need to see ADHD more often than not before you call it ADHD later on in the adult years.

How young can you go?

I would defer that to my pediatric colleagues as well as child psychiatrists depends on how impairing it is now if you think about ADHD being like visual impairment with visual impairment, people sometimes have nearsightedness to the point where they need to have eye glasses all the time.

Other people have vision disturbances where they only need to wear eyeglasses upon reading so they just use them periodically.

That's kind of how ADHD can go.

You can have very severe forms where it can be impairing and I think impairing for your child would be where he or she is having difficulty in the school environment academically and socially.

So a lot of children with very severe ADHD they don't get invited to sleepovers so they have trouble really maintaining friendships and being able to socialize.

You don't want that going on year after year after year necessarily.

You also don't want to get them behind academically.

So it's all a judgment call on the degree of impairment with ADHD and also take a look at the family members, the father, mother, brothers or sisters for that matter.

Did they have ADHD?

Was it impairing for them?

How did it affect them and how were they treated with medication or with behavioral techniques?

So not only does ADHD strongly run in families, it's the second most highly prevalent medical genetic condition there is psoriasis, a skin condition of psoriasis is the number one genetically transmitted medical condition we have but ADHD number two so it's highly genetic and I'd want to know how family members did when they were younger when they were a similar age and how they were treated and how to if any to what degree it did impair them.

>> Thanks for your call.

Let's go to our first caller.

>> Hello, Robert.

Welcome to mastermind Robert.

You mentioned the high blood pressure runs in your family and you've recently been prescribed Quincy.

Could you be should you be concerned obvious medication that can increase the blood pressure when you're taking it in about one out of ten people nine out of ten people won't have the increased blood pressure.

Why do you have increased blood pressure with cogency quite simply because Corbino is a combination of two medications, one of which had a million which will directly stimulate two receptors.

>> They're called muscarinic receptors and in doing so they work entirely differently entirely differently than any antipsychotic medications we've ever had.

The antipsychotic medication we've been using for the past seventy years primarily have blocked dopamine and that's how they worked and doing so they gave side effects and they worked some but they didn't work the way that both benefit does benefit works more on acetylcholine.

So they normally Xenome Melling is a medication that was specifically for that purpose.

>> Here's the problem is Elmaleh and it will increase the COLENE and doing so indirectly will decrease dopamine but it also by increasing acetylcholine can cause people to have horrific nausea and diarrhea.

So how do you get around that?

Trust me on me is a Amnicola energy medication.

It's Bloks acetylcholine just in the body but not in the brain.

That's the beauty of it.

So doesn't interfere with the good effects of Zanele muling in the brain but terrorist and will block all the peripheral body side effects that people can have.

So in that way you don't have diarrhea, don't have nausea.

However by blocking acetylcholine at the heart level yeah you can have a faster heart rate and sometimes as associated with higher blood pressure so it could exacerbate or worsen blood pressure in about one out of ten people.

But nine out of ten people it doesn't.

>> So if you have a family history of blood pressure disturbances that is not a warning and precaution on Zanele million or a benefit for that matter in terms not using it, you can go ahead and use it if the problem arises, it can be it could be managed that time.

>> Thanks for your call this Gore next caller.

Hello Terri.

Welcome to Of Mind Terri.

>> You ought to know about irrational fears.

Why do you have them?

Well, irrational fears it sounds Terri is where you have fears that don't make a lot of sense.

>> Many times we there's phobias and there's worries so there's different types of fear.

So let me talk about phobias first.

Phobias will be an irrational fear of something in the environment and it can be a phobia of flying.

It can be a phobia.

Snakes can be a phobia of all sorts of different things instinctually we are supposed to have fears of things that can be dangerous in our environment but sometimes you can you can exaggerate how dangerous a situation can be.

>> So an example being if you were to fly in a jet and you're going off to New York City and you're flying yeah.

For some people could be dreadfully frightening because they think about the what if of the plane crashing but we all now know that flying to New York City is a lot safer than driving in New York City.

I'm just talking about the transportation itself.

I'm not talking about what happens when you get there but flying is a lot safer than driving in general.

So if you can think through those different fears and think through the reasons why you might have phobias that can often be a star many people have worries about things that don't make a lot of sense and those are worries that sometimes it can be obsessional where you know it doesn't make any sense and if it's an obsessive compulsive disorder that could be related to a past childhood history of a lot of strep infections, some women after you deliver a baby will develop OCD obsessive compulsive disorder where they have obsessions about especially cleanliness and goes over the top to the point where it becomes impairing and that can go on for several months after delivery.

>> So there's different type of irrational fears where you can have phobias where you're afraid of something in particular often it's because you've had some exposure to that in the past and you've kind of made up in your mind that it's very dangerous.

>> You can have worries where you can have fears about the future though.

What if what if what if where you have a lot doubts many people will be fearful of things happening in the future that well quite frankly they look back on it and nothing ever happens.

And for those reasons I'll often recommend to those people that they keep a diary of their main fears on a day to day or week to week basis.

Write down what your main fears might be then go back and look at those fears three months, six months, even a year later and you'll often find the things that you were finding fearful today.

Well, that doesn't amount to much in the future that you overcame them.

>> They kind of dissolved and went away on their own or they just didn't come about.

So then you have those kind of fears and then you have the fears whether it's called obsessive compulsive disorder where you have these irrational thoughts that go through your head, various reasons for that.

>> But because of a circuit in the brain getting a little bit off kilter and the best way to get rid of those kind of particular fears is to talk yourself through them the obsessional fears that people can have where they are just totally irrational thoughts kind of talk yourself through them and verbally tell your brain to stop.

>> You don't want to do it necessarily out loud when you're in public but if you have an obsessional thought that's just going round and round and round there's something that happens to the brain circuitry that's really interesting if you just say out loud stop you can sometimes get the needle back on the groove where it needs to be because for a lot of these people when they have obsessions it's like the needles getting stuck and they just have the thought going round and round and round and if you can verbally say stop kind of in a quiet private area that can often throw that obsession off.

>> Thanks for your call.

Let's go our next caller.

Hello Cindy.

Welcome to Matters of Mind said do you want to know what kind of things should you avoid that would worsen your depression?

Ralph about that I'm thinking alcohol.

Anything you're trying to do to self medicate your depression can often make it worse.

You want to still get your sleep so if you're having depression you don't want to step night and watch late night movies and we've had the basketball tournament going on recently.

>> You don't want to stay up watch late night basketball game so you don't want to do anything that's going to interfere with your circadian rhythm when you're going through a lot of changes and you're starting to have depressive symptoms.

It's a fine line but I'm always warning people don't make too many changes in your life at one time if you're going into a depressive episode.

So depression can be triggered by a lot of changes, changes that are difficult in which to manage by definition will be stress.

So stress is basically where you're having trouble with a change and you're having trouble coping with it.

So you want to be careful about too many changes going on at one time if you're going into an episode of depression itself ,you want to be very careful when you're going through an episode of depression of what you're eating, you're going to crave carbohydrates.

There's a biological reason for that if you blast your brain with carbohydrates it will increase the influx through the blood brain barrier of tryptophan.

Tryptophan goes to the brain, creates serotonin.

Serotonin gives you a little bit of a calming effect and you feel better.

So sometimes people will try to eat their way through depression with a high carbohydrate diet that makes them feel worse in the long run but temporarily gives some kind of a soothing effect.

So be careful with alcohol marijuana.

Be careful with the changes going through your life day to day.

Try to stay physically active because when people get depressed they want to withdraw more and be very careful of your diet when you're going through depression itself and try to eat more of a high carb.

We sometimes call it a ketogenic diet.

It's where you're eating more high protein diet I mean a high protein diet, low carb diet.

It's called ketogenic diet is where you're trying to limit your carbohydrates and increase your protein and fat consumption for that matter.

That's often the best type of dietary means of treating depression.

That's what people often don't want to do when they're depressed, when people are depressed, they want to kind of binge out on carbohydrates and that's why they often gravitate toward junk food often makes the depression much worse when people have depression especially in the winter time and as we go into the springtime try to get outside some and get some sunlight periodically.

Sunlight is remarkable for the brain.

It helps wake the brain up.

If you stay inside you're more occlusive.

The dark days of the house can be more depressing for a lot of people.

Thanks for your call.

Let's go next caller.

Hello Stan.

>> Welcome to Matters of Mind.

Stan, your mention that you're having trouble waking up too early in the morning and it's causing that brain fog.

Is there anything we can do to help sleep through the night?

Brain fog is a phenomenon where you have a hard time thinking and you have a hard time processing information quickly and it can be due to a waking awakening to early.

>> So well I'd want to know OK, what might be exacerbating or contributing your awakening to early it's called terminal insomnia when people have terminal insomnia can be an underlying symptom of depression.

When people have a clinical depression many times they will awaken to early in the morning it's because as you go through the night you tend to dream more and more in your dreams are more intense.

So as your dreams get more intense sometimes in the early morning hours you'll wake up because whether you know it or not you're having pretty intense dreams can be a symptom of depression itself.

>> So that's something in which you could be assessed.

You can always check with your primary care clinician to see if there's anything you can do to sleep through the night for something going on.

For instance, if you smoke cigarets nicotine very typically you'll have your last cigaret close to bedtime after two or three hours the effect of the nicotine is wearing off and you wake up because you're a nicotine withdrawal.

So nicotine withdrawal will contribute to early morning awakening.

>> Same with alcohol.

Some people will have a drink or two before they go to sleep.

It'll put them to sleep but it gives you disruption in the efficiency of your sleep itself and that includes awakening early in the morning.

Sometimes you have to look at your surroundings.

Well, do you have a neighbor who has a barking dog in the early morning hours that keeping you awake so certain little things like that might be a factor?

Yeah, we do use medication to help people to sleep throughout the night if we don't identify these other factors Gabapentin, Trazodone, these are medications commonly used for people.

>> They work for about eight hours so they don't just work for two or three hours like a medication like Ambien or zolpidem will do.

They'll work throughout the entire night.

So sometimes people need to do that.

>> You're exactly right.

You can't have brain fog by not getting enough sleep.

I'd also wonder if you're having difficulty with sleep apnea.

Sleep apnea is where you're snoring, where you're pausing and your breathing periodically at night.

If that happens, you're not getting enough air flow to the lungs and thereby not getting enough oxygen to the brain sleep apnea gets worse when you're dreaming.

So as the night goes on many times as people get more dreams, sleep in the middle of the night and in the early morning hours they'll be snoring more intensely and they'll have less airflow that sleep apnea will actually wake them up and it's not uncommon that people will say they awakened at four and five in the morning.

They don't want to get up till seven a.m. or so but they awake and they have a little bit of gastroesophageal reflux so they have some heartburn and they notice that they almost feel nauseated.

They have some difficulty with brain fog because they didn't get a good night's sleep.

>> But the brain fog is also due to the sleep apnea because sleep apnea will give you a brain fog.

So a lot of different things in which you could be assessed talk about some of your symptoms to your primary care clinician.

>> I think he or she can kind of go through different options for you.

Thanks for your call.

Let's go next e-mail question.

>> Our next e-mail question reads Dear Dr. Farber, my family has a history of schizophrenia is something that can be passed down.

>> Are there certain things I can look out for schizophrenia is about 50 percent genetic.

>> So if you have an identical twin twin with your exact same chromosome is living in the same environment or even living in different environments, about a 50 percent chance of you getting schizophrenia if your identical twin has schizophrenia.

So it's about 50 percent genetic if you have a parent, a mother or father with schizophrenia, your chance of having schizophrenia is 12 percent if you have a brother or a sister with schizophrenia ,your chance of having schizophrenia is eight percent.

So the good news is if you have a mother or father with schizophrenia yeah.

Your chance of having schizophrenia is 12 percent chance of not having schizophrenia is 88 percent.

What can you do to break the cycle?

It's very important No.

One try to maintain socialization and a healthy social environment in the in your childhood environment and going through your adolescent years.

Very, very, very importantly and I emphasize this for quite commonly to people who are adolescents who have family members who have schizophrenia never, never, never smoked marijuana.

I know it's getting legalized.

It's getting recreationally legalized in many, many states.

But don't touch cannabis.

Cannabis is a major trigger for the onset of schizophrenia for people who quite frankly might not have developed it.

It's not the cannabis all by itself will promote schizophrenia but it will sometimes provide the spark to create the psychotic symptoms for somebody who is prone to developing schizophrenia.

Other words, if you have a a can of gasoline in your garage that can gasoline is perfectly fine sitting there unless you throw a spark or a match at it and then it can explode.

>> OK, having genetics for schizophrenia well that could be very latent for you.

Those genetics might actually eventually extinguish because nobody's developing the symptoms over the course of time.

>> If you have anything that's going to provoke or exacerbate schizophrenia symptoms, that's what you want to try to avoid.

So maintaining a healthy environment, trying to be assessed for anxiety and depression as an adolescent if that's an issue, the sooner we can start to treat people with so-called pre morbid schizophrenia symptoms the better.

So the the key will be to try to jump on any possible symptoms of anxiety, social awkwardness, hearing things in the background.

Those are all called pre psychotic symptoms and we try to address those as soon as possible.

>> Thanks for your call as your next caller.

Hello events welcome to America.

Mind Venz you just started taking Dellucci Dean also known as Cymbalta.

How do you know if your symptoms are getting better?

Cymbalta became approved by the Food and Drug Administration back in 2002 I believe for major depression it's since been approved for fibromyalgia so it's basically increasing serotonin and and norepinephrine at a ratio of about six to one roughly.

So it's increasing both serotonin and norepinephrine and in doing so it can help with depression and it can help with fibromyalgia and aches and pains.

>> How do you know if you're getting better?

It depends on what symptoms you're being are being addressed.

On one hand you can subjectively just try to scale yourself on a scale of zero to 10 how you're feeling Tenby Best zero being no help at all.

How is the Cymbalta doing if you can think about how you felt before you took the Cymbalta and then go up the scale of up to ten in terms of how much better you feel with a that's a subjective assessment.

>> We do use questionnaires very, very commonly looking at very specific symptoms so we look at symptoms of depression, anxiety.

These questionnaires give us a numerical score on how you're recovering.

>> So as clinicians if we use questionnaires we can sometimes gauge just how you're doing.

But your subjective response itself where you've identified OK, what are your goals for treatment based on those goals Del Occitan was prescribed to you?

How are you doing in terms of addressing those goals?

>> And it's basically a subjective experience but we have ways to objectively assess it with the questionnaires.

>> Thanks for your call.

Let's go our next caller.

Hello Kim.

Welcome to Matters of Mind.

Kim, you had mentioned that last month you had a mental health crisis.

What are some some of the things you can do outside of therapy to support your recovery with the mental health crisis depends on the nature of the mental health crisis.

Kim, if it was a serious psychosis that's like having a seizure, you want to get that assessed and get that settled down typically with medication so medication can help with functionally impairing symptoms such as psychosis a manic episode, a severe depressive episode that was frankly impairing you don't want to allow that severe mental health crisis to linger because you can be less resilient.

>> In other words, you have more difficulty putting up with stuff in the future if you don't get that under control.

Therapy is an option.

Talk therapy is an option.

What can anybody do in terms of trying to help with their mental health ?

As I mentioned before, try to be careful about your carbohydrate intake with more of a ketogenic diet where you have a low carb, high protein, high higher fat type of diet.

Mediterranean diets have been discussed for a long time eating like they do on the Mediterranean so your diet can be a factor there and exercising staying socially active is often very, very helpful.

Maintaining a diary of your mental health symptoms can be very helpful.

You're going to a mental health crisis.

Write down what's going on, write down how you're feeling, how you're tolerating it and then the good thing about that will be you can go back three months, six months from now and look about look at how you dealt with that and look at how those stresses those circumstances were affecting you so prominently recently, how they're doing later on, how they're doing three, six months from now because you might find no one you overcame them and number two , they kind of evaporated on their own and they didn't become as big of an issue for you as you might have thought.

We all go through stresses.

We all go through changes.

We all go through tough life circumstances.

But what's very important is how resilient we are in adapting to them and how we do in terms of getting getting them under control.

>> Thanks for your call.

Let's go next caller.

Hello Jerry.

Welcome to Mariza.

Mind.

Uh, yes.

I was wondering what anxiety or anything cause neuropathy to get worse.

I'm currently I take Trazodone and Gabapentin and it it like irritated or like it's burning feeling in my feet in this area.

>> Jerry Jerry Gabapentin used for burning in your feet.

>> That's so gabapentin useful for those type of problems.

But are you say in the Trazodone or the gabapentin might be causing some of those symptoms?

>> That's what I was wondering if it could be dodgem and the answer is the answer is yes.

>> I mean triacetone breaks down into a chemical that does stimulate this particular serotonin receptor that sometimes will cause people to be restless and agitated.

>> It's not it's not a common side effect.

So it's fairly uncommon but it can happen.

And if I hear about that and I hear somebody like you, Jerry saying I you know, I started triacetone and then within a few days I noticed that a few hours after I take it I felt worse insert ways and one of the ways could be more agitation burning uncomfortable feeling it might be the Trazodone is not the best medication for you.

Gabapentin on the other hand really will cause those kind of symptoms.

OK, I take it every night the gabapentin yeah.

>> Gabapentin should be OK in that regard.

What's the dosage of Trazodone Jerry?

Uh fifty milligrams Valium usually take a half or a quarter of a good for you and every night I'm tired.

>> Hey I'll have you do a science experiment experiment on yourself Jerry just try it some nights maybe at a quarter or a half.

That's on a placebo effect.

It will work for some people it just a quarter or a half of a tablet of a fifty milligram dosage.

That's perfectly fine to do that.

But just do your own science experiment and try to figure out OK, do you have those weird feelings in your face or your feet on the nights that you take the Trazodone versus the night you don't gabapentin like I said keep taking that night by night by night because that by itself might be all you need.

Gabapentin works one way for your sleep.

Trazodone works another way but you might be having some side effects from the Trazodone and it has to do with this little serotonin receptor.

>> It's called serotonin to see and if you stimulate that receptor you can sometimes feel kind of weird.

OK, I was on again but there was another medication of someone like it before.

>> The opposite seems to be getting worse.

How about Pregabalin also known as Lyrica Jerry Yes.

That's when I was on the floor.

I don't know this started getting more severe in the last month maybe I pregabalin also known as also known as Lyrica.

>> How did that do for you compared to the Gabapentin?

It did seem to help some of the neuropathies.

I'm not sure what the neuropathies coming from.

Yeah, it's kind of hot wax burning feeling.

>> I don't know.

Yeah, neuropathy could come from a lot of sources.

It can come from an irritation of a nerve from a disc.

You can have neuropathy from vitamin deficiencies in some cases like a B twelve deficiency diabetes is often associated with neuropathy.

So yeah the underlying issue there would often be try to take care of the neuropathy itself but also try to find the best medication it can allow your life to be more tolerable.

>> Lyrica, also known as Pregabalin works a little bit differently than Gabapentin which is also known as Neurontin and sometimes people just have to find the right medication for them.

>> Pregabalin or Lyrica is now generic so it's much more easy easy for people to acquire, take and take the anxiety medication to start a new one, might it not?

>> That would make it worse or not usually.

You know, Gerri, if you get the right dosage of gabapentin or Pregabalin or Lyrica usually get the right dosage of that.

You don't need the anxiety medication itself because Lyrica and Gabapentin are Neurontin.

They work really well for anxiety themselves.

If you find the right dosage.

Jerry, pleasure talking to you and for I'm amount of time for this evening if you have any questions that I can answer on the air you may write me via the Internet at matters the mind all one word at WFB Vague.

I'm Psychiatrist Ja'far and you've been watching Matters of the Mind now available on YouTube.

God willing and PBS willing.

>> I'll be back again next week.

Thanks for watching.

Goodnight