.

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

Welcome to Matters of the Mind now in its sixth year, Matters of the Mind is a live call in program where you have the chance to choose a topic for discussion.

So if you have any questions concerning mental health issues, give me a call in the Fort Wayne area by dialing (969) 27 two zero or if you're calling any place coast to coast you may dial toll free at 866- (969) 27 to zero.

>> Now on a fairly regular basis we are broadcasting live 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 of the mind all one word at WFYI Georg that's matters of the mind at Edgard.

>> I start tonight's program with a question I recently received.

It reads Your Evolver.

>> I heard that there are several different types of ADHD.

Can you tell me about the different types are and what the differences are?

The classic types of ADHD are the inattentive types and the predominantly hyperactive or impulsive types.

>> That's a good place to start now I don't like the term ADHD because people with attention deficit disorder often don't have difficulty with attention span in areas in which they're challenged or a third finding an interesting or if it's novel two of them or if it's exciting people with attention deficit disorder will have no trouble focusing on things that are highly interesting for them the problem they'll have is having the vigilance to get things done so they'll get started on something but they readily become distracted and they start doing something else.

So it's not so much attention deficit per say in that regard and then you have the hyperactivity type ADHD where people are more impulsive, they're fidgety, the restless and they're more they're more hyper in general and they might be more impulsive in doing things and saying things they ordinarily wouldn't do or say.

Now with ADHD or attention deficit disorder inattentive type you'll have the disturbances becoming somewhat apparent by the time you're in middle school or high school and you might not notice it that much until you get to the point where you get where you get to the point where you're challenged academically or occupationally to an extent that you weren't before.

>> So a lot of people will have difficulty with being challenged at a certain point maybe after they're out of high school perhaps they go into college and all of a sudden they're having more difficulty getting things done.

A lot of people with attention deficit disorder will compensate for their difficulties, attention span or concentration because of their high IQ and because of their high IQ.

>> They can get really interested in something and some people can even hyperfocus many people with ADHD will have a photographic memory where they'll be able to look at something and memorize everything very, very quickly.

They might not be able to apply that information but they'll at least be able to remember it and regurgitate it later on when they need to do so for examinations.

But they might have trouble remembering it perhaps three months or six months down the line.

So they have difficulty sometimes with applying the knowledge that they're gaining .

>> People with ADHD will often notice that other family members will have similar symptoms.

It's highly genetic.

>> It's almost as genetic as height.

There's a medical condition called psoriasis, a skin condition that's the most genetic medical condition there is.

>> But ADHD is right behind that.

So we'll often hear about family members having similar symptoms overall.

It's basically a condition where the front part of the brain especially is a little bit underactive.

The attention span part of the brain, the left front part of the brain here is a bit underactive.

So you have a hard time focusing in on different things.

This middle part of the brain is not functioning properly.

That's the part of the brain that allows you to not be distraced so people will have trouble with ADHD with various distractions and then this little part of the brain right over the eyeball here is the middle of the brain, the little part of the brain over the eyeballs called the orbital lateral prefrontal cortex.

That's the part of the brain that helps you with impulsivity.

In other words, it makes you think before you act it makes you think before you say things and with ADHD that part of the brain is a bit underactive and you'll often be more impulsive.

>> Now naturally the brains of boys tend to develop a bit later about a year or two behind the brains of girls so girls will often have inattentive symptoms.

They might not have as much hyperactive impulsive symptoms.

Boys will be more prominent leadin fight in childhood-becaus getting into trouble and they could be more disruptive in the classroom and socially for that matter.

>> So boys will often have trouble with ADHD symptoms were identified whereas the girls will be the old quietly inattentive individuals in the back of the classroom who might not say many things but yet they're having a difficult time reading and comprehending things.

>> So there's a different type of ADHD there for a lot of different people.

>> It used to be thought that ADHD would go into the adult years and maybe 70 percent of the cases.

There was a recent study about a year and a half ago that identified different different ways of evoking ADHD symptoms based on your life stresses.

In other words, if you are challenged academically or occupationally later in life you might have a waxing and waning of the symptoms and you'll have a worsening symptoms if you're having a hard time compensator or coping with the increasing cognitive challenges that go along with that.

So with that in mind, when a recess people with ADHD they found that as many as 90 percent of people did have ADHD symptoms or symptoms going into the adult years even though some people don't.

But 90 percent carried into the adult years they might manifested differently many times when you go into the adult years you don't have as much hyperactivity or impulsivity but you can still have trouble with attention span especially when you're presented new tasks.

>> We treat ADHD and add with medications that help the front part of the brain get fired up a bit more.

>> It's not unlike wearing eyeglasses if you have poor vision the same way we use medications that can adequately help with the focus and concentration with the inattentiveness and the distractibility.

>> Thanks for your question.

Let's go to our first caller.

Hello Bridget.

Welcome to Matters of Mind.

Hi.

Hi Dr. Fowler.

My name is Bridget Hanson and I have bipolar and I have personality disorder and I have PTSD.

I was diagnosed with this just about a month ago and I am just depressed and I'm on different type of medicine.

I lost my son four years ago and every time I can take a lot but death is really hard for me and my son my sister in the bathroom when she was gone and she was 59 and it just really bothers me and I like to know what you think of of a good medication I take so laxative and Trazodone and burst blah and then this other pill I think it's Eloxatin ten milligrams.

I'm trying to find it but I don't see it anywhere here right at this time and it's like a ten milligram this kind of helps you but it doesn't seem to help it.

I think you're mentioning a medication called olanzapine ten milligrams at that time that's often used for a mood stabilization and for sleep fluoxetine you'd mentioned that's a medication used for depression abuse byroade abuse spar's a medication that helps with worry and ruminating and dwelling on things and of course thousands of very good medication for sleep.

What it all comes down to bridges number one identifying the problems that you had.

It sounds like you've had the diagnosis of bipolar disorder which means that a person can have a few days of manic highs where they don't need to sleep.

They are more impulsive on those days they have thinking that goes really, really fast.

They have racing thoughts during that time and then you can crash in low.

>> So that's the highs and the lows of bipolar disorder.

It's about sixty five percent genetic so it does run in families.

Unfortunately you've had some tough losses in your life , Barbara, with your sister, with your child when those type of things happen it sometimes can be overwhelming with somebody no matter how strong or coping mechanisms are now we all are wired a bit differently, Barbara, and it all starts with our genetics.

So we're all hardwired to some degree upon our birth.

So we have genetics that will make us more predisposed to succumbing under a different stresses.

But then you have the early life experiences up until about the age age of eight years of age you can have traumatic life experiences that can rewire your brain.

In other words physically rewiring your brain so early childhood stresses can be highly traumatic for people and then as you go along in life while you're trying to learn coping strategies and into trying to learn coping strategy when stress stresses hit you you're able to overcome them based on past experiences.

>> But here's what often happens this middle part of the brain right about in here it's on the inside middle part the brain that's the front part of the brain here, the middle part of the brain it's called the ventral medial prefrontal cortex.

That part of the brain doesn't work so well when people have chronic stress.

They've had overwhelming incapacitating anxiety.

That's the part of the brain that allows the connectivity of the front part of your brain, the thinking part of the brain to the emotional part of the brain.

>> The emotional part of the brain is over here on the side and the thinking part of the brain in the front is connected by that ventromedial prefrontal cortex.

When you get depressed, when you get anxious normally what should happen, Bridgit, is you're thinking part of the brain should override the anxiety part of the brain.

But what happens is your anxiety part of the brain when you have what we consider to be anxiety disorder or depressive disorder, the anxiety part of the brain is hijacking the thinking part of the brain.

So that's the role of medication overall.

Bridget, there right now.

Seventeen different oral antidepressants that have become available since nineteen eighty seven.

So we have a lot of different options out there.

You want to take a look at what's helped you the most in the past?

>> What's not helped you so much in the past?

You also want to consider if you have any family members who have been on medication what has helped them and what hasn't helped them.

We do genetic testing and genetic testing is not definitive.

I cannot emphasize that enough.

It's not definitive but it helps us kind of tip the scales in terms of what direction we go with the medication we choose but very much so genetic testing is influential and helping us determine how high or low of a dosage we should use with individual medications .

That's where it's extremely helpful for a lot of people.

So we'll take all those factors in consideration with bipolar disorder is bipolar disorder type one where somebody will have a week long spell of mania periodically and then they may or may not have depression.

If you have bipolar disorder type one you want to be careful with antidepressant medications like Fluoxetine.

So that's something we'd always consider.

We'd want to know what type of bipolar disorder you have with post-traumatic stress disorder.

>> There is variou talk therapies and counseling techniques that people can use such as eye movement desensitization and reprocessing MDR is a very well established treatment for post-traumatic stress disorder and you've endured that with the loss of your family members.

So you want to try to achieve some type of help with the proper kind of counseling overall you've had you've mentioned bipolar disorder.

You've had post-traumatic stress disorder.

You're having trouble with sleep and that's why you're taking the Trazodone.

But perhaps there could be a different type of medication you could take for sleep from medication standpoint Gwon Forseen Clonidine these are old blood pressure medications are basically decrease the jumpiness of the brain by blocking a chemicals activity called norepinephrine and by blocking that chemical activity you're not as prone to be what we call hyper vigilant.

We're always expecting or waiting for something bad to happen.

>> So the use of Gwon Forseen or Clonidine especially at bedtime can be very helpful to help somebody get a better night's sleep and you might consider using that as an alternative Trazodone I usually trousered bipolar disorder is perfectly fine up to about 150 milligrams at bedtime when people go higher than that they start to get more of an antidepressant effect which could be good for a lot of people.

But if you have bipolar disorder, antidepressant medications like Trazodone or for that matter Fluoxetine can sometimes cause you to cycle higher and lower and you cycle not only more intensely but more frequently so it can actually cause upcycling to occur.

>> So I think overall, Bridgit, you want to make sure the diagnoses are proper for what you're describing.

You want to look at your past history of medication treatment bosses, other family members, medication responses overall and try to sort out which medications might work for you individually.

>> Brigit, thanks for your call.

Let's go to our next caller.

Hello Peter.

Welcome to Matters of Mind.

>> Well, Peter, you want to know how to get rid of chronic fatigue?

Peter when I hear about chronic fatigue I'm always looking for the reason for it.

It's a symptom and chronic fatigue is a diagnosis but basically chronic fatigue is just saying you're fatigued.

>> OK, so why we're always looking for various reasons with for chronic fatigue and we see a lot of it in psychiatry most commonly associated with mood disturbances.

But you want to look at the medical reasons first.

The medical reasons that we describe will often be medical reasons associated with sleep apnea.

Sleep apnea is the first thing I think about when I hear about people feeling feeling tired, sleepy.

They need a nap all the time.

>> When you have sleep apnea you're basically snoring at night or you're pausing breathing at night.

You're not getting adequate air flow to the lungs thereby getting inadequate blood flow, inadequate oxygen to the brain.

So with less air flow to the lungs you're getting less oxygen to the brain, less oxygen the brain the next day will indeed give you difficulty with being able to have enough energy, have adequate concentration, be able to focus and concentrate on things you need to do and it often masks itself as a depressive condition.

So if you have sleep apnea that's something it is treatable.

>> It's something that can be addressed if you lose weight and a lot of a lot of cases that will help.

>> But the problem with sleep apnea, sleep apnea makes your brain think that you're smothering and it will cause you to have difficulty with increased cortisol increase cortisol will deposit more fat on the torso and that thereby worsens sleep apnea itself because more fat on the torso can give you more fat on the neck area and that can give you more trouble breathing.

So it's kind of a vicious cycle if you don't get the sleep apnea addressed.

What other kind of factors can be associated with chronic fatigue?

The next thing we're going to consider will be low thyroid.

If you have low thyroid that will make you kind of foggy.

You can be fuzzy, you can have trouble motivation.

It can make it very fatigued and cause you to have frequent napping.

People with low thyroid often feel cold and chilly.

They might be constipated.

They might have a lower heartbeat in some cases but many times they'll have poor concentration.

So low thyroid is a second factor for chronic fatigue.

Another factor could be low iron.

We hear about it more with heavily menstruating women or people who are vegetarians or somebody with a chronic gastrointestinal bleed.

But low iron will make you very, very tired and going along with that perhaps low vitamin B 12 we see that especially with older people because as we get older our transporter of vitamin B 12 in our stomach starts to fade away and we don't have as much transport.

So in your stomach you have this little transporter called Intrinsic Factor and it's like a little bus that carries vitamin B 12 to the small intestine where it gets absorbed and if you don't have the transporter you'll have less vitamin B 12 absorption so then you get a vitamin B injection or you can take a vitamin B 12 tablet under the tongue but low vitamin B 12 can be a factor in chronic fatigue and something that's frequently overlooked because we almost have an epidemic of Type two diabetes Type two diabetes Type II diabetes comes on often as you get older.

>> It's related to insulin insensitivity.

>> In other words your insulin level goes higher and higher and higher but your body's just less sensitive to it and that will eventually lead to higher blood sugars.

>> Higher blood sugars will make you in many cases tired and fatigued from looking at all those type of factors in a lot of cases when people say they're tired and they're fatigued and then you can always look at possibilities of us of another sleep disturbance called narcolepsy with narcolepsy people will go into REM sleep or dream sleep very quickly.

They'll be wide awake and they'll go into REM sleep sleep very quickly with narcolepsy.

There are specific treatments for that to be able to keep people more awake overall it's important if somebody has chronic fatigue to look at the medications they're taking if somebody is taking a medication that might directly or indirectly cause some fatigue that can be a factor.

So we're always trying to do no harm and get rid of any medications that are causing the fatigue during the day many people will say they're chronically fatigued when they're using a medication like Xanax or Klonopin.

>> These are medications that are great for anxiety but they make you persistently tired and they'll make you kind of fuzzy and if you offer them too quickly you feel much more anxious.

>> So that's always the challenge we have people taper off of those very, very gradually with chronic fatigue.

It's important that we try to address it directly with allowing somebody to get enough sleep if you're getting lack of sleep and you're having poor sleep efficiently efficiency, you're not getting into dream sleep, you're not getting into deep sleep, lack of deep sleep many, many times will cause you to have chronic fatigue during the day.

So it's really important to really take a full spectrum of examination over what might be causing a person to be fatigued are tired overall.

>> Thanks for your call.

Let's go to our next caller.

Hello, John.

Walking to matters of mind, John, you're mentioning that you're having some mood issues and other than medication, what are natural alternatives to help John, the best thing you can do for any mood issue I'm assuming you're alluding to depression.

Perhaps the best thing to do for depression quite frankly is exercise.

>> But here's the problem with exercise recommendations, John, from a clinician such as myself .

>> If you have depression, you're often going to have poor motivation.

You're going to have trouble with fatigue .

>> You're going to have difficulty with initiative and motivation to get out and do things.

So it's it's difficult for me as a clinician to simply say well, you need to exercise and then well you don't exercise because you're too depressed to exercise.

You come back to me and say well you haven't been exercising and you're still depressed.

>> Easy for me to say well you're not doing what I told you to do.

That's why you're still depressed.

Well, OK, we need to get past that when you have depression we need to look at it as a biological condition not unlike diabetes, let unlike asthma heart conditions where we've got to get you from a physical standpoint at a functioning level and that's where the brain needs to work properly with depression you'll have trouble with the thinking part the brain you have trouble with the anxiety and the emotional part of the brain and the middle part of the brain.

As I mentioned before, the ventromedial part of the brain right in here that part of the brain is not functioning adequately.

So your brain's getting hijacked by your emotions when your brain gets hijacked by your emotions, you just don't rationally think through things so clearly.

So the reasoning and the rational part of the brain starts to become impaired and take it one step further.

>> There's a little part of the brain over here in the back part of the thumb.

If you look at the brain from the side it looks like a boxing glove.

The thumb part of the boxing glove has a back part of it back here it's called the insula.

The insula is the part of the brain that's so she was self awareness.

When you have depression you start to lack self awareness because the insula physically is not working so well.

So we've got to normalize the functioning of the brain before we can necessarily recommend people to do different activities that they're going to have trouble with motivation and the initiative to do back in the nineteen eighties before some of these newer medications came out we always always always recommend counseling for people first it sounds like that's a very reasonable thing to do but with counseling we have to remember that if somebody is not thinking properly, if they're not motivated, if they don't have the difficulty, if they don't have the ability to have a self awareness, the counseling recommendations given to them might not work so well.

Now we always wondered back in the 1980s why so many people did not respond to counseling as we would expect and then some of the newer medications started coming out.

Prozac was first and Zoloft and on down the line we've had 16 17 all antidepressants come out.

But as these medications came out we found when people were able to become less anxious they were able to concentrate better.

They were sleeping better.

>> They were less overwhelmed with day to day stresses from a biological standpoint they could then apply the recommendations that they were receiving from counseling much more effectively and that includes exercising now going back to exercising if you can exercise on a regular basis we're talking 30 minutes five days a week it can be resistance training such as weight lifting or it can be aerobic exercise such as treadmill, bicycle, elliptical.

>> Anything that's going to get your heart rate up either type of exercise can be helpful for you and many people will exercise three days a week with weight training.

>> The other days they'll do some aerobic work as a great combination.

If you can get that routine 30 minutes each session, what exercise will do will increase both glutamate which is an excitatoy chemical and gabb transmission which in inhibitory chemical the problem with people with depression is they often have decreased glutamate and GABA transmission with decreased glutamate and GABA transmission you'll have low energy, low motivation you don't enjoy things decrease gabb transmission you'll often just not care about things and you actually can feel even more anxious with an abnormality of the Gabba and glutamate.

>> So what exercising will do it will give you a calming effect by increasing gabb but will also give you a feel good effect and an excitatory effect by increasing glutamate and many people an hour after the exercise they'll say they feel more energized, they feel happier but at the same time they feel calmer.

So that combination of happiness and energizing feelings with a calmness is a combination from a neurobiological standpoint of increasing glutamate and GABA you can do that naturally with exercise but you have to do it on a regular basis now again easier said than done if you tell a person who has chronic heart disease to just start training for a five k strengthen your heart.

>> Well unless the heart biologically gets a little bit stronger and sometimes medications are necessary to do that you're going to have a hard time getting out there to complete a five K and to exercise as you might be expected to do the same with depression.

>> If your brain's not working you're going to have the trouble with motivation to carry out these kind of suggestions people are sometimes going to ask thanks for your call.

>> Let's go.

Our next caller.

>> Hello Tom.

Welcome to Matters of Mind.

Tom, you want to know about the side effects of abuse byroade and Xanax if there are side effects from those, what can be done about abuse by our own abuse is a medication came out in nineteen eighty six and it's a medication that is very specific and selective in what it does.

>> It affects one of the 14 different serotonin receptors and by doing so it kind of acts as a thermostat for serotonin.

So if you have too much serotonin in the system it'll block serotonin if you have too little serotonin system it'll stimulate it.

>> So the bottom line is you, Spyro, can be very well tolerated.

Some people will get dizzy with it with their first few doses.

Some people might even have double vision with it with a first few doses.

But unlike a lot of other medications, it's not addictive.

>> It's not something in which you develop a tolerance you don't get used to and it's something most people will take twice a day.

>> It works best if you take it twice a day every day but ten milligrams twice a day is a common dosage.

Some people go up to thirty milligrams twice a day abuse by her own abuse bar.

It's as a medication we generally will describe as being good for overall worry.

We call it generalized anxietypy and rumination where the front part of the brain is overactive and you're dwelling on things and you're thinking about things over and over and over again.

That's where abuse byroade fits in came out in nineteen six been around for a long time.

>> Xanax or alprazolam is a medication.

It's in the class of benzodiazepines an entirely different medication Xanax and the other benzodiazepines go to this area of the brain called the amygdala and in doing so will give you a antianxiety effect within a matter of minutes lasts for about six or eight hours in some cases.

Sounds great.

The problem is you do get used to it and you can have difficulty with focus, concentration.

>> You can have trouble with memory impairment.

It's something that we don't recommend for people for more than a couple of weeks but to take one every now and then on an as needed basis can work out just fine.

But the biggest side effect was Xanax will be the long term use causing difficulty with being able to remember things and focus and concentrate.

>> Tom, thanks for your call.

Unfortunately I'm out of time for this evening.

If you have any questions concerning mental health issues that I can answer on the air you may write me via the Internet at matters of the mind at a dog I'm psychiatrist forfour and 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.

Goodnight