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>> Good evening.

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

Welcome to Matters of the Mind now in its twenty sixth 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, give me a call here in the Fort Wayne area at (969) 27 two zero or if you're calling any coast to coast you may dial toll free at 866- (969) to seven to zero.

>> Now 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 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 a via the Internet at matters of the mind all one word WFA dot org that's matters the mind at the dog and I'll start tonight's program with an email I received this week.

>> It reads during a favor Is the microbiome in the gut connected to mental health changes in my digestive health give me anxiety physiologically and not just psychologically.

>> Yes they can.

A lot of studies are going on right now concerning gut bacteria now there are some gut bacteria that enteric bacteria size Longo's lines.

There's certain bacteria that are inflammatory.

So you have these gut bacteria and they will cause inflammation.

>> It's very important to have a fine balance of the good bacteria and the bad bacteria.

People will often notice that when they take an antibiotic for a few weeks and all of a sudden they have diarrhea.

>> The diarrhea is there because the good bacteria is getting killed off and away to alleviate diarrhea.

>> If you're if you've been on an antibiotic, a medication will be to take a probiotic or a prebiotic which is a precursor to the good bacteria.

So there's ways to get around that by giving yourself more good bacteria.

We're hearing about more studies with the gut bacteria and depression and mood disorders in particular because there are certain bacteria that are associated with depression and mood disorders, especially bipolar disorders not so much for anxiety although there is some speculation or anxiety and anxiety.

We're not yet at a point where we can recommend specific probiotics or probiotics for specific mental health conditions because it's very, very complicated.

But what we can do is recommend a high fiber diet, a high fiber will often give you more of a promotional gut environment for the good bacteria.

>> So you want to have a high fiber diet because that's going to be more healthy for the gut overall.

But we're not quite at a point where we can recommend this particular strain of bacteria or this strain for particular mental health conditions.

But we might be in the next five or 10 years because every year I'm seeing more and more article come out talking about the effect of certain bacteria on the gut.

The biggest question now is what do we do about it and how do we address it?

>> Thanks for your email.

Let's go to our first caller.

Hello Barbara.

>> Welcome to Matters of Mind.

Barbara, you had a question about your daughter being unneurotic and you had the question last week I'm so sorry I didn't get to it because I want to make sure I got ample time to be able to to discuss NorTech Neurotic is a migraine medication and its chemical name is RMG about I forgot the name is a megabyte or something like that but anyway it's considered a Khalsa Tonin related peptide blocker and as a consultant in a related peptide blocker it's a medication that works in a specific way for migraines it's different from a triptans you might have heard about the Sumatriptan medications like that they will affect serotonin receptors and by affecting serotonin receptors the triptans can give you chest pain and chest tightness as a side effect.

>> This this class of medication in which Desertec belongs related to the chalcedon in related targeted peptides.

>> They do not give you that kind of side effect.

>> The biggest side effect NorTech can give you will be nausea.

Now that's interesting because nausea's a side effect of migraines.

>> People will have episodic migraines and they can have nausea, difficulty with bright lights.

>> They can have sensitivity, sensitivity to sound.

They can have trouble with dizziness and sometimes they can feel the migraines coming and that's called migraine with aura migraines occur episodically.

>> They are by definition incapacitating for a lot of people retests have to go lie down.

That's different from a tension headache where you just have a dull achy headache and you kind of work through it as the day goes on.

A migraine headache can be incapacitating.

Ngarkat Tech is used as an early disintegrating tablet.

Put it under your tongue it works very, very quickly and it's only to be used no more than maybe 18 times the entire month.

>> So about half the time you can use it.

The long term studies beyond that have not been established.

So with NorTech it can be safely used with the main side effect be a nausea which you have to remember is a manifestation of having migraine headaches so nausea can be a side effect of NorTech otherwise it's very well toleratd by a lot of people.

>> But the other key is to not use it more than roughly half the time throughout the entire month can be used up to 18 times a month.

>> My understanding Barbara, thanks for your call.

Let's go next caller.

Hello, Tony.

Welcome to Matters of Mind.

>> Tony, you mentioned that you're 72 years of age and you're taking Lexapro.

Lexapro is also known as escitalopram.

Lexapro typically has caused a person to have excessive saliva but you've mentioned you're having excessive saliva so you're wondering if that could be a factor.

Excessive saliva is where the product glands are specifically stimulated and it's called a particular muscarinic receptor where you're prodded, glands are stimulated.

>> Lexapro doesn't usually do that because it's if anything might give you a little bit of a dry mouth but not that much for most people.

I'd wonder perhaps what other medications you might be taking.

Some people who have Parkinson's disease for instance, will have excessive salivation.

So if you have early Parkinson's disease with a bit of a tremor, a little bit of a shuffling gait, a little bit of a masked facial expression early Parkinson's disease can have as a manifestation some excessive saliva.

Lexapro doesn't usually provoke those kind of symptoms.

It's possible.

>> But here's how you know, Tony, if you started having excessive salivation specifically when you started taking Lexapro and then you taper off the Lexapro with your clinician supervision, then you could sometimes attribute that particular problem to Lexapro but it could be other type of factors.

Take a look at your other medications with your clinicians and see what other kind of can see what other kind of conditions or medications might be contributing to the excessive salivation that you're noticing.

>> Tony, thanks for your call.

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

>> Our next e-mail question reads Detective what sleep disturbances are common during pregnancy and how would you treat them?

There are certain medications we can use during pregnancy.

The first, second and third trimesters we can use a medication by the name of mirtazapine.

The trade name is on because with pregnancy especially the first and second trimesters you can have some difficulty with sleep.

Many women will notice they have nausea and reflux with that first trimester.

So that's what we like about mirtazapine.

Ramadan is the trade name on that we'll use seven point five perhaps fifteen milligrams at bedtime.

It does a nice job in terms of decreasing stomach acidity but it'll also help give you an increased depth of sleep and if you happen to have anxiety or depression sometimes at higher doses it helps with that.

>> So Mirtazapine appears to be safe for the baby with the studies that have been done throughout the pregnancy and even during breastfeeding.

So we'll not commonly use Mortazavi for the first second third trimester during pregnancy itself if a medication needs to be used it may be in the third trimester you can use mirtazapine but those last three months you can use a medication called Trazodone.

Trazodone is a medication is very specific and selected for affecting these particular serotonin receptors.

It will help you get a greater depth of sleep and it lasts for about eight hours for most people can use it during the third trimester .

That's thought to be safe during that time.

But detox happens sometimes can be used a really small doses perhaps during pregnancy.

But that wouldn't be our first choice for a lot of people.

But there are medications that can be used during pregnancy especially with getting to sleep and staying asleep and if that reflux is problematic, that's where we're going to specifically use mirtazapine for a lot of people.

>> Thank you for email.

Let's go next caller.

Hello Alex.

Welcome to Matters of Mind.

>> OK, you want to know if testosterone levels affect the mood they can affect the mood, Alex.

And this has always been a controversy.

Should we give somebody testosterone or should we not?

If you have low testosterone you can have difficulty motivation initiative get up and go people low testosterone necessarily won't have a clinical manifestation of full blown depression but they just won't have the gumption that they might have had previously.

>> Now unlike women who have postpartum depression and they have an abrupt drop off of estrogen, they have an abrupt drop off of progesterone during that time unlike women who are going through menopause and they have the effects on estrogen and progesterone when men have low testosterone it's often a very gradual type of event so far in many cases, you know, you can use the supplements which would be the injections, the patches.

There are various ways even the gels for that matter for giving yourself increased testosterone.

It can improve your overall mood disposition.

But a lot of times we're often recommending people trying to increase their testosterone levels in a natural manner by doing some weight training to try to increase the muscle mass the best they can.

>> But testosterone can improve he mood.

There's always a back and forth in terms of the pros and cons of using it and you can always talk to an endocrinologist or your primary care clinician to look at the look at possibilities for should you take testosterone, should you not?

>> And what would your obligation be in using testosterone supplements?

>> Alex, thanks for your call.

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

Let's go the other it is our next e-mail question reads Dear to devolve or I have a teen who struggles with autism and selective mutism.

One thing that always makes me worry is introducing my teen to other adults.

What's a good way to make other adults comfortable with the situation?

Let the other adults know that your son has autism.

A lot of people have a better understanding of autism now and by definition autism is where somebody will have difficulty making in connection with other people's emotions and with autism you have a disturbance especially in this right front part of the brain because people with autism lack these particular neurons that are called mirror neurons, mirror neurons basically help you mirror the emotional valence or the type of attitude that you might be encountering with other people.

So as you're in a conversation you can kind of pick up when somebody is kind of sad and somebody' happy when somebody is kind of excited and you can kind of mirror or mimic their behaviors in some way and it allows you to have a greater connection with them during the conversation itself.

When people have autism they often can be kind of in their own worlds when they're speaking with other people.

The selective mutism in which you referred I presume you're referring to the difficulty with speaking with other people but they'd still be able to speak within the household and they have the selective mutism in the sense that they have trouble speaking to strangers.

The best thing you can do is keep your son exposed to those kind of environments to allow him to be more and more comfortable as time goes on because practice will help with those social encounters.

The last thing you want to do is protect him or restrict him from having those kind of social encounters because any of us will become less and less anxious as we encounter certain situations.

And for some with autism that can include having conversations with other people just in a social environment.

>> Thanks for your email.

Let's go to next caller.

Hello Pam.

Welcome to Matters of the Mind.

Pam, you had mentioned you take ten milligrams of Lexapro for anxiety.

>> How do you know you need to increase it is us a new drug and is it better than Celexa and Prozac?

Well, just to go through the history there, you mentioned three medications Prozac came to nineteen eighty seven.

>> Celexa is a medication.

It works kind of like Prozac but yet it's a bit different.

They both work on serotonin Celexa.

I'm going to do the best I can to recall when it came out it came around around 2000 and I think Lexapro came out around 2004.

Celexa is has a chemica name Citalopram.

Lexapro is the left sided piece of Celexa.

So as the left side a piece of Celexa it might work a bit better than Celexa and might have a few a few less side effects compared to Celexa.

>> So the comparison of Prozac, Celexa and Lexapro will be they all will increase serotonin the way they do that they're called serotonin reuptake inhibitors and basically how that works you have a serotonin neuron that's firing out like a shotgun serotonin bullets and these individual bullets will go to fourteen different receptor targets in the periphery to keep the bullets bouncing around on the targets.

You block the vacuuming of serotonin back into the firing neuron with a medication like Prozac, Celexa or Lexapro.

>> So they're blocking the reuptake of serotonin.

That's why they're called reuptake inhibitors.

They're blocking the vacuuming of serotonin back into the fire neuron serotonin is just floating around longer periods of time and the cases of Lexapro, Celexa and Prozac, they're they're affecting they're stimulating all 14 different serotonin receptors so they're not highly specific in the serotonin receptors they hit some people do better on one or another.

But quite frankly, if somebody has not done so well on one serotonin reuptake inhibitors, I probably won't put them on a second or third or a fourth.

About one out of three people will do really well on a serotonin reuptake inhibitor now Lexapro ten milligrams it's a moderate dosage.

Twenty milligrams is the maximum dosage.

So with Lexapro you could go higher.

But I'm always telling people see how you feel from going from one dosage to another.

Some people do better on a lower dosage.

Some people do it better on a higher dosage.

Lexapro is metabolized to a particular enzyme called Toussie 19 to see 19 to the letter C in the nineteen to nineteen is an enzyme in the liver that breaks down Lexapro and Celexa and if you're a slow metabolize you're on to see nineteen.

>> You want to go with the lower dosage five and no more than ten milligrams.

If you're a fast metabolize you're on two to see nineteen and your liver metabolizes things really fast that go through to nineteen.

You probably want to go with a higher dosage of Lexapro or Celexa.

Prozac goes to see nine a different enzyme so it's an entirely different enzyme so you can adjust your dosage accordingly that way so I'll tell people find the dosage that works the best for you and if they go from ten to twenty milligrams a day I'm going to ask do you feel any better because if you don't feel any better going from ten to twenty milligrams a day on Lexapro you want to go back down and then determine if you're getting at least a 50 percent improvement, you know, kind of a rule of thumb as if at least a 50 percent or more improvement.

You still want to try to work with that medication either by adjusting his dosage or adding something to it.

But if somebody has less than a fifty percent improvement with a medication like Lexapro, we often don't want to continue with it.

>> We want to go to something else.

Pam, thanks for your call.

>> Let's go to next caller.

Hello Mattie.

Welcome to Matters of Mind Matter.

You had mentioned that you're a new mom.

Congratulations and you're tired all the time.

Oh my goodness.

Is that normal or am I having postpartum depression?

That's a fantastic question, Matty, because I'm bringing that up with new mothers all the time because it's speculated that if you're a new mom you're supposed to be tired because you're not getting your sleep and you have a new baby and you're up and around and you should be tired.

>> Be careful with that logic.

I get it.

I understand the perspective on that.

But about one out of eight women after they deliver a baby can have difficulty with low thyroid so they can have a thyroid condition where their thyroid drops those first few months after delivery.

So I always want to make sure I check a thyroid test on any individual who's recently delivered a baby and if the thyroid is low we want to address that accordingly.

So low thyroid will give you fatigue.

You have trouble with concentration you'll have lo get up and go now what's the difference between nap and postpartum depression?

Postpartum depression will be where you're not only fatigued but you just don't care and you won't care about your baby.

>> It sounds terrible but you don't have a lot of attention toward your baby and that's where often family members have to really pick up from there and as many as one out of 10 women will have significant postpartum depression.

Now we now have a brand new medication that's an oral medication and take every day for fourteen days called Zoove Ansar's of A is a medication that you take every evening for fourteen days and that's it and it's for postpartum depression very well tolerated.

It's a medication and can give people a little bit of nausea.

People will typically take it six or seven p.m. in the evening and you can't drive for twelve hours.

>> I just mean you can't drive until the first thing in the morning but you take it in the evening can make you a little bit tired and that's the reason you can't drive for twelve hours but it's only for fourteen days.

So what's a chance is going to work about four out of five chance is going to work about an eighty percent chance is going to work for a postpartum depression and as they followed women over the course of a year 80 percent of them didn't need another dose only only twenty percent or one out of five people over the course of another year needed another fourteen days of dosing.

It should be on the shelves over the next couple of months for the women with postpartum depression.

>> It was also studied for clinical depression for men and women and it worked for that.

But the Food and Drug Administration has not yet given its approval for that particular use is only approved for postpartum depression right now.

But postpartum depression will make you fatigue.

But you don't care about things you don't want to eat so much you'll have trouble with sleeping during that time can feel highly anxious.

>> That's what's really nice about Zuby.

>> It's considered to be a neuro active steroid and as a neuro active steroid it works entirely differently than the traditional antidepressant medications.

It works specifically on this particular receptor called GABA receptor and on the Gabber receptors.

>> It basically makes it easier to open up.

It's like oiling the Gabo receptor and make easier to open up and it gives the brain more of a calming effect and in doing so it can help with depression on down the line.

So it opens up that channel and allows the brain to have more of a calming effect and works very, very fast.

A lot of medications for depression.

The traditional ones we've been using for the past sixty years will require six to eight weeks to go to work.

But Zoove is working within a matter of one or two days and there's a whole new class of medications that have now that's now available called a rapid acting antidepressants are ads and rapid acting antidepressants work within one week and working within one week.

They are separating away from placebo within one week and they tend to give people clinically meaningful effects within one week.

And those medications that we currently have that are rabbitt active antidepressants are ketamine which is an anesthetic and it's been used without FDA approval for about twenty years I've we have escaped Amenas bravado which is a nasal spray and that can be a rapid acting antidepressant.

We have a medication called Sovaldi that has dextromethorphan and a cough suppressant with a little bit of bupropion which is the anti depressant of Valide is a medication works within one week and the fourth medication is Reserva which is used specifically for postpartum depression.

So a lot of options out there that we have available there is IV injection called Brek Sinaloan which has a very similar mechanism as does or zoove a brick Sinaloan is where you have to be in the hospital and it's a 60 hour injection.

>> It's been available for a few years now but it didn't gain a lot of popularity because the women had to go in the hospital for two and a half, three days and they got this 60 hour injection.

>> It also worked very, very fast, was dramatic on how it worked.

But the nice thing about Zoove is you go to the privacy of your own home.

You take it day by day.

>> You can drive after twelve hours each day but you take it for fourteen days in a row.

>> Matty, thanks for your call.

Let's go to our next e-mail.

Our next e-mail is ready and it reads Dear Fauver, what's the best way to confront a loved one who is having severe mental health concerns?

Is it better for one person to ask the person to get treatment or is it appropriate for a group of friends or loved one to go to the person?

It depends who that person is that the person has a very close friend, a close family member or a confidant.

That close friend or family member or confidant would be the best to approach that person and what you want to always consider is you want to express your concern in a loving, compassionate manner and you want to express what you noticed about how that person was doing previously a year or two ago versus now and what you're noticing they're not able to do despite the good things that they still are doing and you want to always emphasize the good that you still see and the attributes that you still see.

>> But you might notice that well, gee, you used to be really active with this or that and now you're not and that concerns me and I want to make sure we get a handle on this and do something about it sooner rather than later.

Now for some people that's better heard with a group there's the so-called intervention technique that's been used for decades, decades now with people who have substance use problems for the substance use itself is becoming problematic that being with alcohol, marijuana, opiates and it's where other people are expressing to them the concerns they have now an issue with mental health problems will be that this particular part of the brain over here called the insula it's right over here on the above the temporal lobe kind of in the corner there where the thumb would come out with a boxing glove, look at the brain.

But that particular part of the brain is the self awareness part of the brain when people have a mental health issue depending on its severity, they could have decreased activity in that particular part of the brain.

>> That's the self awareness part of the brain.

People with mental health issues might not be aware of how they're coming across to other people.

You're with yourself all the time so you might not notice the difference.

It often requires other people to be able to recognize that kind of difference for you.

However, sometimes where you can always start and we see this so commonly with mental health conditions will be the disturbance of sleep because anxiety, rumination, worrying about different things will cause you to have a disturbance in sleep.

If you have a disturbance with sleep night by night it can indeed affect your judgment and your ability to perceive what's happening around you and give you difficulty without self-awareness in which I was referring.

So lack of sleep is something that a person with mental health issues even if they're psychotic, even if they have a particular mental health problem that's severe and it's causing them psychosis if they are lacking sleep they often realize that's a bit of a problem and they will recognize a need to do something about that.

So the first target symptom will often address for people even if they have psychosis and they're out of touch with reality will be trying to help them with their sleep and from there you can sometimes work backwards and getting their sleep under better control can help their overall judgment and awareness in itself.

Thanks for your call.

Let's go to our next caller.

Hello Robert.

Welcome to Matters of Mind.

Robert, you want to know if there is a psychological aspect of being scammed and because you mentioned that you know someone who keeps falling for scams scamming it has to do with trust.

I mean and scammers are very, very authentic.

>> They're very skilled in what they were doing and they can create a sense of trust in their speaking with you and also generate fear that something bad will happen.

So the best thing to do about scammers is not necessarily take the bait that you might hear right off the bat.

Ask them if you can get back to them, talk it over with other people before you succumb to what they're doing and check out what they're actually saying with the scam itself and there are ways to research different scams and so forth.

But from a psychological standpoint it comes down to having trust in other people.

>> You know, we don't expect people to call us out of the blue if they're not authentic but they do and there's a trust that might be there and there's the fear that the scammer might convey to you if they say something bad can happen if you don't do this or that and sometimes it can even as extreme as saying if you don't adhere or comply to their request you can go to jail and that scares a lot of people but you can always get their number, call them back, check it out with other people before you.

>> It's frequently a financial type scam that they want.

>> They want a few hundred a few thousand dollars as a means of of satisfying their needs.

So you want to check that out with other people before you succumb to all that.

Robert, thanks for your call.

Unfortunately I'm out of time for this evening but if you have any questions concerning 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 ECG I'm psychiatrist Jeff Offer and you've been watching Matters the Mind on PBS Fort Wayne God willing and PBS willing.

>> I'll be back again next week.

Thanks for watching.

Goodnight