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

Welcome to Matters of the Mind now in its 25th year, Matters of the Mind is a live call 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 at PBS Fort Wayne by dialing in the Fort Wayne area (969) 27 two zero or if you're calling any place coast to coast you may call toll free at 866- (969) 27 two 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 me with an email question that I can answer on the air concerning mental health issues, you may write me via the Internet at matters of the mind all one word at WSW ECG that's matters of the mind at WFA ECG and I'll start tonight's program with a question I recently received at Regional Evolver our mental health professionals more or less likely to have depression.

>> Are they able to handle and deal with depression more successfully than others?

How are you able to prevent yourself from becoming depressed after helping patients all day?

>> This is something we learn in training not uncommonly you you have to be able to leave the difficulties in your patients have endured at the door of your office.

It's so easy and we see this in trainee's so easy to just keep ruminating about what was said, the pain and suffering that was expressed by the patients during the workday and you can't take that home.

You can't question your decisions.

Many physicians in general will have those kind of inner ruminations and we have to let that go and let that go at the office itself.

>> So our mental health professionals are more likely to have depression.

Surveys indicate that we're actually less likely to have depression and there are some professions that have higher degrees of depression than psychiatrists.

But psychiatrists long the mental health specialists are actually pretty low in terms of likelihood of burnout and having depression based on surveys that are completed now why might that be?

I think psychiatrists might be a little bit more self aware of disturbances in their behaviors that might be causing them to have more trouble.

For instance, if psychiatrists notice they're not sleeping very well, if they're drinking more alcohol, if they're starting to withdrawal more, I think psychiatrists can be asked somewhat more insightful in terms of being aware that those problematic behaviors can cause difficulty.

However, psychiatry can get in a lot of trouble in various ways unknowingly because their psychiatrists I learn way back in my training that if you're a psychiatrist and and you're married you've got to be careful not to use your psychiatric training on your spouse because you can kind of sort through things in in the in the midst of a marital disagreement and basically as a psychiatrist you can hardly ever lose an argument because you can always put it back on your spouse's upbringing and why his or her means of beliefs and thinking at the time might be flawed.

So you have to be careful about that and not use that kind of awareness and knowledge in places outside of the workplace.

So with psychiatrists people go into psychiatry for various reasons.

Some go into psychiatry because they had some mental health problems before or they've endured or witnessed some mental health problems within their family members or with friends or in their social network over the course of the years many people go into psychiatry because they're very, very intrigued about the neurochemistry of the brain and how the brain will affect behavior.

>> I remember I was fourteen years of age and I was studying a brain and I didn't even know why that was just something I very much interested me and I always encourage people to to pursue a field that you find enjoyable to to read and invest your time and studying.

So with me it was neurochemistry and that's the it is for a lot of people psychiatry is somewhat of an offshoot of neurology.

As matter of fact, I'm boarded by the American Board of Psychiatry and Neurology.

That's the name of the board.

So psychiatry has a lot of overlap with neurology.

It's just that with psychiatry we're more focused on the mood, the behaviors of people and it's a little bit different from neurology.

So in psychiatry the challenge will always be trying to sort out difficulties people are having even though you can't see them, you can't measure them on blood tests, you can't see them on imaging.

It's kind of like trying to figure out the the source of wind.

You don't see wind, you see the effects of wind and that's what we see with with behaviors and moods and anxiety disorders.

We see the effect of disturbances in the brain that can come across as mood and behavioral disturbances.

So it's an interesting field in that way and I think as people who go into the mental health field appreciate that if they can always keep their focus on how they can help their patients, that's going to allow them to not be burnt out and not absorb not allow the kind of behaviors and flawed thinking of their patients permeate toward them.

Now as a young trainee that's easy to to to see occur.

But as you get more seasoned and experienced, you realize the patients will have their own difficulties but it does not have to become yours personally.

>> Thanks for your email question.

Let's go to our first caller.

Hello Bill.

Welcome to Marries the Mind Bill.

>> You have a wife who's been on Provigil.

Provigil goes by the chemical name Modafferi.

She's been on Provigil for ten was on Provigil ten years ago but says now the Modafinil isn't working.

>> What would you recommend?

So she's been on the Provigil for about ten years.

Provigil is not known to cause a tolerance.

>> It has a slight stimulant effect because it can slightly increase dopamine provincials kind of interesting though Bill, because it will increase the transmission of histamine in the front part of the brain .

There's also a chemical called C Phos that's increased in the front part of the brain so it's a chemical that will cause the brain to be more awake when histamine increases the brain, your brain can be more awake and that's how our brains days a week naturally all of us have histamine that gets released naturally in our brains and that keeps us awake and that's why antihistamines such as diphenhydramine or Benadryl can be used as a sleep aid doc it's Doc Sillerman is something that's also known as UNISOM by trade name that's also used as an antihistamine to help people fall asleep.

So a lot of the over-the-counter sleep medications block histamine to help you get sleepy.

Provigil and its chemical cousin Nuvigil will increase histamine in the brain and keep you more awake.

>> Why would Modafinil after ten years not seem to work presumably for wake wakefulness Bill maybe there's other things going on.

In other words, your wife might be getting tired and sleepy because of other conditions she's been ten years well over the course of ten years, ten years stuff happens.

You can develop sleep apnea that might not have been identified before or maybe if your wife is being treated for sleep apnea with CPR or BiPAP or auto Pappe, those type of things to keep the airway open.

Maybe it's not as effective now as it was before.

So that could be a factor.

Perhaps your wife is having low thyroid at this point.

Low thyroid will make you sleepy where you weren't sleepy before and now you are so low thyroid so factors you want to get that checked out occasionally you'll hear about somebody having low iron.

Low iron will make you tired and I hear about that.

I saw that today for instance with a young lady who was a vegetarian and she was having some heavy periods so a vegetarian who's having heavy periods will often have low iron and by golly she did so low iron can be a factor if you do have low iron a tip off that will be restless legs so you'll have restless legs and that'll be particularly in the evening where you have jumpy legs and sometimes you carry that into sleep.

So that's low iron.

That can be a factor in making you tired if you're getting older sometimes you're going to have lower V12 vitamin Twelve is one of the dozen B vitamins out there and low B twelve can be caused by your stomach just not having enough opportunity to be able to transport vitamin B 12 to the small intestine so the stomach has these little busses in that that will pick up V12 and these little busses are called intrinsic factor.

They're released from parietal cells in the stomach as we get older sometimes we have a thinning of the stomach lining and we have less bridel cells and you get less of the bus transportation to the small intestine for V12 and you don't get V12 absorption.

>> So that's why people need V12 injections.

V12 can be taken under the tongue but lobi twelve could make a person tired so I'd suggest if the Modafinil is no longer working take a look at all the other medical factors that could be going on and only once that's done.

Yeah if V12 is no longer working in the sense that your wife is feeling tired and doesn't have motivation perhaps she's not enjoying things and feeling more sad and having low self-esteem that can be depression.

But as a psychiatrist yeah I treat emotional disturbances and difficulty with anxiety and cognition where people have trouble thinking but I'm always trying to think about the other medical reasons that can be causing trouble with fatigue and that might be why the Modafinil is no longer working .

Modafinil as I mentioned before goes by the trade name Provigil Provigil has a right sided piece called our Modafinil and our Modafinil is a little bit more potent than the right side of peace is a little bit more potent than the left side a piece of modafinil.

So sometimes changing to Ahmedzai phenyl can help a bit more but I think it all comes back to questioning.

Yeah.

Why was the Modafinil being used?

Was it being used mainly for energy wakefulness?

Some people will use Modafinil as a means of helping with depression and it's a remarkable means of adding on to an antidepressant because it'll make antidepressants work better and now that Modafinil is getting less expensive that can be more commonly a tactic that can be used.

But there is a slight dependency risk on Modafinil because it does have a little bit of a surge of dopamine release and anytime you have increased dopamine release you can have this little stimulation in this middle part of the brain called the called Lacasse release and the locus release is right in the middle part of the brain and that's a part of the brain that will affect the transmission of norepinephrine and dopamine release from the TEG Menom here and dopamine will be the feel good effect give you the feel good effect of the brain so you start stimulate those areas of the brain and you can start feeling more energized.

>> You can have more motivation ,feel more happiness and when you have those kind of things happen sometimes you can get used to that feeling and need higher and higher doses of medication.

That's where addiction comes from by stimulating dopamine to some degree norepinephrine so provigil modafinil can have some of those effects but is not as likely to cause dependency as a true stimulant like Adderall or Dexedrine or the Ritalin products which people will use for energy and motivation and enthusiasm.

In some cases they will give you a short short term bursts of dopamine release and that's why they can be addictive.

They don't last very long.

You need to have more and more of them get the same kind of effect.

So that's why with stimulant medications will often use longer acting stimulants that last for eight, ten, even fourteen hours in some cases for the purpose of giving you a smoother release.

The people who are addicted to stimulants will often want to take the immediate release stimulants that only lasts for about four to five hours because they want that very high blood level of a stimulant to give them a surge of energy and a surge of motivation.

Modafinil doesn't work that way.

Typically Modafinil will typically last eight nine hours for a lot of people and if that's not strong enough for some people at least early on we change our Modafinil or Nuvigil.

So talk to have your wife talk to a clinician about other options in terms of treatment options if that's the point.

But make sure she's getting an evaluation for how and why the Modafinil may no longer be working for her because there might be some other medical reasons there that can that can be factors overall Bill, thanks for your call.

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

Our next e-mail reads Dear dear father, I'm a teacher and I sometimes have students that may have some mental health issues.

Are there signs I should be watching for and how do I have that conversation with the child's parents as a teacher you have a very unique perspective.

For instance, for instance, on one hand you're with the child throughout the day and that child is there in a very structured setting where they're supposed to be learning and a structured setting they have to pay attention.

They have to sit still.

They have to interact with other people.

So you are in a very real world setting where you can assess their mental health functioning.

So from your perspective you might notice a child's behavior changes as the year goes on.

A change in behavior is a big tip off of the child become more withdrawn if the child becomes more easily irritated with child becomes more reclusive if the child becomes less prone to want to interact and talk with the other children that can be a tip off.

So as a teacher, if you see a change in behavior as the year goes on, that can be a warning sign overall we'll hear about adolescents and children as young as being in the fourth and fifth grade using marijuana nowadays is becoming much more socially acceptable use marijuana and marijuana for a child will cause them to have more difficulty with focus and concentration because it's it physically will suppress white white matter growth in the brain so their brain is not growing at the rate it should when they're using marijuana.

So you'll see some of that but mainly marijuana you'll just find these kids just don't care and apathy is a very significant factor in terms of an after effect of marijuana.

So if you see a child having more apathy, not having that drive, that can be a factor.

Yeah, we do use grading systems in school still and if you see that child go from A and B student down to a C and D student over the course of several months, that can be a tip off.

What you can do as a teacher is simply state your observations to the parents.

You're not in the role of having to diagnose them but you can certainly be in the role of recommending that they have further assessment.

Teachers are often in a great position to identify a child having ADHD attention deficit hyperactivity disorder and many times teachers are very good at that and there are teacher assessments for instance on a Vanderbilt assessment it's a means of having a teacher do a checklist on what kind of behaviors they're seeing with the child.

But often the teachers will notice the part of the ADHD that's particularly common with boys because boys will have the H or the hyperactivity and the impulsivity part of ADHD girls are more prone to having the quieter attention deficit disorder.

Well they'll DRé daydream.

They'll be distracted.

They won't be able to focus very long but they don't cause any trouble because they're very quiet so they often get overlooked with their aid but boys are more prone to having ADHD and that's what the teachers notice.

Well, do you medicate all of them?

Some of them can have behavioral disturbances because they haven't learned the discipline within the household to be able to sit still and pay attention when authority figures are speaking.

>> Sure, that can always be a factor but that's where a careful assessment can be very important because as a teacher if you identify ADHD or you can perhaps change that child's tire trajectory of their academic career because some children have a difficult time getting through school and even graduating from high school due to their attention deficit disorder.

Others will get through but they have to study three times harder.

But they'll still get that roadblock when they get into college or a higher level of academic expectation and that's where they will struggle.

I've seen some people not being diagnosed with ADHD until they got into graduate school or they got into their job market where they finally were academically challenged to the point where they couldn't keep up so well through school they kind of coasted because children with ADHD are often have higher IQ so they can get by and they can often be the ones that have the photographic memories.

They can remember things quite well and do what they need to do to pass the tests.

But in terms of learning and being able to retain information over the course of time that might be a bit a bigger problem for them.

So as a teacher you're in that unique position to be able to identify these kind of behaviors.

But the first thing I do is try to get to know the children early in the semester when you're seeing them and get to know them as you follow them over the course of hopefully half half the year or the entire year you're able to be able to comment if there's any change in their behaviors and you're going to be in that position where you can really see how they interact with their peers.

There are particular symptoms for schizophrenia that are called pre morbid symptoms for instance and you see it occurring around the age of 12 or 14 up until 18 or 19 years of age when they start develop symptoms of schizophrenia.

But these pre morbid symptoms of schizophrenia are very subtle but that's where an adolescent will become more socially isolated.

They will hear things in the background that nobody else can hear.

They will have kind of unusual thoughts.

They have extreme social anxiety.

So these can be the children who are having a lot of difficulty being able to get up in front of the class and speaking in in front of their peers, people with pretty morbid schizophrenia are the primary symptoms of schizophrenia can often have difficulty sleeping poor concentration.

Their hygiene goes downhill really fast and it's thought that there's a good possibility that those children can go on to develop schizophrenia later on if not caught in and dress.

But about twenty twenty five percent of them do not.

So it's a risk factor but it's not determining that they're going to have schizophrenia later on if they have these these oddities in their behaviors as an adolescent.

But again as a teacher you're going to be able to identify those type of things.

You can always work through the school counselor in terms of trying to get them the best resources for further assessment.

But that's the key and I say the same thing to law enforcement officers that I will train and crisis intervention treatment.

It's not your role to diagnose and even determine what treatment somebody needs.

Jarrold identify there's a problem and if there's a problem I'll try to get them into some kind of help and try to at least direct them sooner rather than later the kind of treatment they need.

Thanks for email question.

Let's go to our next email.

Our next email reads Dear dear father I'm worried about my friend who feels guilty and selfish when taking a break from stressful situations.

How do I help my friends see that it's not really healthy for her to neglect her needs.

>> I'm afraid she's going to have a nervous breakdown.

I had a similar type of question is this last week in terms of addressing the needs of a family member or a friend who's just not taking a break for for mental health reasons and just kind of muddling through their problems and feeling overly stressed.

And I think it's important to emphasize to people that from your perspective and that's what you have to maintain just state your perspective, say what you notice one way or another.

Now the first thing you need to do with any kind of friend or acquaintance before you confront them concerning mental health problems is trying to get a relationship with them, get a trusted relationship with them as opposed to somebody who doesn't really know their circumstances, don't know their background and just come in and start barking out ideas and suggestions for them.

Nobody wants to hear that you need to have some kind of willingness to form a relationship with them, have a give and take conversation with them.

Don't come and just lecture, listen to them and sometimes the best thing to do is just to be quiet and hear what they have to say and hear what their concerns are.

Establish some empathy, try to understand what they are going through but be careful about how often you say I know what you're going through because you probably don't you might have had some similar situations but we all have unique backgrounds.

We all have unique coping mechanisms.

We all have unique current lifetimes lifetime situation.

>> So you don't know exactly what someone is going through.

So yeah, go easy with the platitudes when somebody is expressing their concerns.

So what you do is you just say here's what I'm noticing about you and as a trusted friend you can often say that because if you've known them well enough over the course of time you can say to somebody who is a trusted friend you look tired now would you necessarily walk up to a stranger on the street and say you look tired?

No, because you don't know them.

That might be how they always look.

So if you just state what you notice and state what you can observe based on your perspective, that's a good start and that's after you've developed some kind of trusted alliance with somebody.

The second thing you do is you can't express what you've gone through but again don't use that as the sole example.

I've gone through this so I think you need to do the same thing I've done.

You can sometimes express that as a suggestion but you have to be really carefully aware and you need to be very knowledgeable of their current situations to be able to really relate to that.

>> So you can give some examples of how you've coped with certain situations and that's always a good idea.

But to simply state after hearing there are difficulties for about 30 seconds what you think they ought to do based on what you've done be careful without getting them into a trusted professional, whether it be a family doctor, a counselor, somebody who you might know can always be helpful for them but you have to do it again on their terms.

You have to see what that person who's having the difficulty with anxiety and stress, you have to see what they're willing to do and they they have to be able to identify how they perceive their current life circumstances as being problematic.

In other words, when somebody Cicotte often when they're psychotic the front part of their brain just isn't working so well and when you're psychotic and you've been you're out of touch with reality.

You're hearing voices talking to you.

You have these delusional thoughts which are basically fixed false beliefs.

You're not gonna be able to reason with that person.

But what you can do is you can identify look, you're pacing back and forth here that doesn't look like it's very comfortable, looks like you feel miserable.

You can cite that they don't look like they've been sleeping very well and you can and they'll often express to you that they haven't been sleeping and even a person who's psychotic will at some level realize the lack of sleep and pacing all about really normal behavior and it can be exhausting for you over the course of time.

So again, as a trusted friend you can make observations based on what they're telling you that gee, if you're not sleeping, if you're having trouble with a lot of anxiety, you're worrying about things, you're stressing out about this or that could be a reason to be able to seek treatment.

So that's kind of how we'll suggest to people to get treatment as opposed to saying you've got this symptom, this symptom, this symptom.

I think you need to see a psychiatrist and many people perceive the suggestion to be to be seen by a psychiatrist as a fairly hostile suggestion.

Sam, be very careful how you present that to people.

I prefer that primary care clinicians and people who refer individuals to me as a psychiatrist to say that psychiatrists are specialists in medications that affect the brain and we try to do so in a safe manner used to be psychiatrists did a lot of counseling but there's not enough of a psychiatrist nowadays to do all the counseling and needs to be done .

So we have a lot of people in the community who are able and very competent to do counseling to whom we recommend our patients.

But psychiatrists nowadays are going to do a careful assessment of the why somebody might be having difficulty with fatigue and difficulty with sleep and pour energy and those different things and will often be able to seek out medical causes.

But we will use medications on occasion to try to normalize the brain chemistry because of the brain chemistry is flawed.

It's just like any organ of the body, whether it be the heart, lungs, kidneys, liver.

I mean if they're not working so well you're going to feel sick and that's what happens to the brain.

So we look at the brain as being a part of the body that can influence behaviors.

You're thinking your insight, your awareness and if the brain has some disturbances you're going to have a hard time thinking through your problems and that's why it's you can't tell somebody who's severely depressed just think happy thoughts because the awareness of their having the disturbed thoughts that they're experiencing is often lacking and they don't have the awareness that they're having difficulties and a lot of cases .

So that's where the medication will at least normalize the brain chemistry so they can think clearly they can have less distractions and they can focus on what they need to do at that point.

Thanks for your email.

Unfortunately I'm out of time for this evening.

If you have any questions about mental health issues that I can answer on the air you may write me a via the Internet at matters of the mind all one word at WFA a drug.

I'm psychiatrist Jeffrey, you've been watching Matters of the Mind on PBS Fort Wayne God willing and PBS willing.

I'll be back again next week.

>> Thanks for watching tonight