.

>> Good evening.

I'm psychiatrist Fauver live from the Bruce Haines studio in Fort Wayne , Indiana.

Welcome to Matters of the Mind now that's twenty seventh 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, call me in the Fort Wayne area by dialing (969) 27 two zero or if you're calling any coast to coast you may dial toll free at 866- (969) 27 two zero nine 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 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 Waygood that's matters of the mind at WFA Edgar and I'll start tonight's program with a question I recently received due to defer my job as super stressful.

So when I come home I need ten minutes of quiet before engaging with my family.

Is there a better way to deal with stress so I can feel more present at home?

That's a great start.

>> At least you're giving yourself 10 minutes to be more present with your family because when you come home it's very difficult to do but it's exceptionally important to shut off all messages from work to try to oh allow yourself to process what happened at work and then be done with it.

So what what do people do if you have a little bit of a bridge between work and home that often helps and that bridge can be something as simple as going to the gym, working out for thirty minutes, going for a walk for twenty minutes sometimes as a way of kind of winding down before you go home.

But I think what you're doing already is fantastic.

You're allowing yourself ten minutes to kind of chill out and then have that bridge to be able to engage with the family.

>> It's so important to do because many people will keep their email up at night.

They're still texting their coworkers at night.

They're still working through problems at night and that's not healthy for the family.

Obviously I had to learn this when I was in psychiatric residency because when I would go home I would often keep patient care on my mind and ruminate about decisions that I had made throughout the day and it was very difficult to become more engaged with a family because you're still thinking about things.

>> You have to find that bridge to allow you to get home and for me sometimes it is watching a 30 minute sitcom with my family.

>> As soon as I got home and that was sometimes the bridge just to get me to disengage from work.

So I use that bridge like you're doing ten minutes is great if you need thirty or even forty minutes that's even better for a lot of people.

>> Thanks for your email.

>> Let's go to our first caller.

Hello James.

Welcome to Mars The Mind game.

You want to know what's the difference between bipolar one disorder and bipolar disorder?

>> Well, it's a subtle but important difference, James and I'm going to make a comparison here bipolar disorder is a mood disorder disturbance where people can have highs and lows in their mood and it's a subtle distinction because you're going to treat them differently.

>> So bipolar one is treated differently than bipolar disorder not unlike headaches.

>> If you have a headache you want to know is it a tension headache, a cluster headache, a migraine headache, a sinus headache?

What kind of headache is it?

Because those four different types of headaches, even though they're all headaches will be treated entirely differently.

>> The same with bipolar disorder.

Bipolar one disorder is where somebody is experienced a manic high and that means for at least seven days or at least seven they've experienced racing thoughts.

They talk really fast.

They are doing things impulsively.

They don't need to sleep.

They are saying things and doing things they ordinarily wouldn't say or do.

They're butting in on conversations and they can be very annoying to other people.

Bipolar one patients often and frequently will crash into lows but not always some of the people who are very difficult to treat only have manic highs.

>> Then they come down to a normal mood people who only have manic highs and going in a normal mood often don't find themselves really having a problem.

Other people do but they don't.

Many people will present to us clinicians when they're experiencing depressive episodes.

So some of the bipolar one disorder more often than not won't come to see us when they're having a manic episode.

They come to see us when they're having these depressive episodes because they've been to the mountaintop now they're crashing in their mood and often they're suicidally depressed.

So it could be very devastating for a lot of people.

Bipolar two disorder is where people will have little highs, little highs that aren't as functional comparing with a mania going on for at least seven days typically that'll be functional and pairing a hypomanic episode will occur between four six days.

>> It's not highly functional comparing to in those days but people will crash into those for at least two weeks.

So with bipolar to disorder by definition you have little highs that aren't highly problematic.

Then you go into these really deep lows for two weeks for those people we're going to certainly treat them with mood stabilizing medication and we will often use them and use an antidepressant to help them with bipolar one disorder.

We're going to mainly use a mood stabilizing medication and be very, very, very cautious in using any antidepressant medication because if you use an antidepressant medication when somebody has a bipolar one disorder, you need to make sure they're not going to go into highs because you can trigger that high with an anti antidepressants with be careful about that bipolar one disorder more common with with bipolar disorder it's pretty much equal for men and women.

>> Bipolar disorder type two is more common with women compared to men and with bipolar disorder type two you're going to hear about the comorbidity of migraine headaches especially for women.

So women who have bipolar disorder will be more prone to having migraine headaches so often for those women we'll give them a mood stabilizer that also will address the migraine headaches like Lamotrigine also known as Lamictal Trileptal also known as ARC's Cabaser p.m.

gabapentin also known as Neurontin will use some kind of medication that's going to address the moodiness swooshes bipolar disorder but also addresses the migraine headaches.

>> Thanks for your call.

Let's go next caller.

>> Hello Diane.

Welcome.

The mastermind Diane, you want to know is there an effective cholesterol medication?

It does not cross the blood brain blood brain barrier and rob the brain of a central fat.

Yeah, there are some medications that will be more prone to crossing the blood brain barrier.

I think you need to work that out with your clinician.

You know, there's a medication that can lower cholesterol by them a well call that doesn't really have an effect on the blood brain barrier as affecting resorption.

More often than not there are some of the statin medications, some of which don't cross into the blood brain barrier as much as other atorvastatin also known as Lipitor does very little has very little crossing into the blood brain barrier.

So it's the type of thing you talk over with your primary care clinician.

>> The key, Diane, will be if you take a statin medication and all of a sudden notice you're more depressed and you have difficulty with thinking and concentration if it started when you started that medication, you might want to go back to your primary care clinician, your cardiologist, whoever might be prescribing and say I felt like this, this and this after I started that medication.

So even though you might take certain medications that do cross the blood brain barrier and can affect the lipid lipid constituency in the brain, they might not give you those problems.

But there are some medications like I said, atorvastatin Lipitor is one medication.

It doesn't cross the blood brain barrier so much and is less associated with those difficulties such as the cognitive impairment and the depression and the fatigue.

So the key will be upon starting any medication for cholesterol, observe how you're doing thereafter and go from there.

>> Diane, thanks for your call.

Let's go to next caller.

Hello Timothy.

Welcome.

The mastermind Timothy.

>> You want to know why in commercials do with medication are there so many potential side effects?

That's because the Food and Drug Administration will force the pharmaceutical companies to put all those side effects on their because they potentially can occur.

So you can have a commercial with a smiling person and everybody looks happy and they look like they're enjoying their medication and then you have this scrolling side effect profile on there.

So the government perceive that if you're going to see a commercial concerning a medication you have to know of all the possible side effects.

The key about those side effects, however, will be that people will often not experience them.

Their possible side effects, side effects of any medications no one are often related to the dosage.

>> The higher the doses the more likely you have side effects and the many times are time related.

You'll have more side effects early on when you initiate a medication and side effects often subside thereafter so you have to keep the side effects in perspective.

Those side effects do not occur for everybody if you have a side effect occurring and one with one out of twenty people typically that side effect will be listed in those kind of commercials.

So when you see the small print, the fast rate of speech of somebody talking on the commercial about the different side effects often conveying the side effects that can occur with over five percent of the people.

So you might have one out of ten even one out of twenty people having a side effect but the rest of the people don't have that side effect that's going to be a reported on the commercials themselves.

So it's the type of thing where I always wondered why a pharmaceutical company would want to have the so-called direct to consumer ads director consumer ads is where you're actually advertising to the general public.

>> I think what they want to do is get the name of their medication on the mind of the patients who might have these particular conditions such that when the clinician refers to these medications as a possible option, the patient has the name recognition already kind of like a politician having the political ads out there just getting the name recognition.

So I think the pharmaceutical companies want to have the name recognition but from my perspective I always wondered the strategy behind that.

There must be some reason for it kind of like with negative ads with politicians.

>> People say why do they have to be so many negative ads?

Well, the negative ads sell so the reason politicians use negative ads is because people will more be more inclined to hear negative material whether it's on the news they always talk about horrible stories on the news.

Those are the ones that get people to watch but our brains will get more engaged when we hear about bad things happening, whether it be on the news, whether it be in political ads from my perspective that might include direct to consumer drug ads with the pharmaceutical companies.

So when people are watching those ads, I would think they are going to be more prone to hearing about all the side effects from the medications quite frankly might not occur that that often.

But I'll ask people when I'm prescribing a medication have you heard of this medication?

And not only am I asking have you heard about it on commercials but have you heard about from other family members?

>> Have you heard about it because you might have taken in the past have you heard about it from friends or any social acquaintances?

Because when people hear about medications they might have good or bad perspectives on those medications.

So I want to know what's their preconceived notion about the medication before I consider prescribing it for them.

>> Thanks for your call.

Let's go to our next caller.

Hello Derek.

>> Welcome to Matters of Mind are you doing today?

>> Hey Derek.

I'm doing OK.

I was just wondering what was billed an ethanol plant in southern Indiana and my brother and I slept in this apartment next to it was a huge electrical room and we often we'd wake up at work and felt like we had a little brain twitch.

We didn't actually know if it was the electrical equipment or not because we started taking fish oil and that like brain twitch went away.

I'm going to hang up but just tell me a little bit about what you think about fish oil.

>> Thanks a lot.

But hey Derek, thanks for calling in the electrical effect on you externally.

I don't know.

It's hard to say.

I'm always prone to say what I thought twenty years ago might be differently different than what I think now.

So even though I don't know a lot about the influence of external electrical activity affecting your brain now ask me in twenty years God willing if I'm still around and I might have a different perspective but right now I don't really know about the effect of external electrical activity on a person's brain fish oil.

You bet you fish oil has the omega three fatty acids in it.

There's omega three fatty acids and there's omega six fatty acids one predominantly the omega three fatty acids.

You get an adequate amount in fish oil typically various amounts can be used.

>> Fish oil has been mostly studied on the good cardiovascular effects, good effects on the heart so fish oil can decrease triglyceride levels.

So that's the those are the types of lipids, the types of fats that will go up especially with a high carbohydrate diet so fish oil can modulate that somewhat.

Fish oil typically will be very well tolerated if you get too much sometimes we'll give you some gastrointestinal effects or diarrhea.

It's very well tolerated but oil potentially can be effective for the brain.

>> There was a study a long time ago just observing that women in Japan had less post-partum depression compared to women and various other parts of the country and I thought it was because they had more exposure to consumption of fish in Japan.

So there is thinking that maybe fish oil should be regularly prescribed for people with depression and that was commonly done about oh 20 years ago.

>> Twenty years ago people would take fish oil supplements very commonly not so popular now.

But I think if you have high high cholesterol, especially high triglycerides and you have difficulty with depression and concentration and memory, sure fish oil could be beneficial for you as long as you don't have any of the gastrointestinal side effects.

It appears to be very safe to take for a lot of people but especially the omega three aspect of it.

Omega three has a very strong anti inflammatory effect compared to Omega six.

So the omega three aspect of the fish oil can be helpful .

>> Thanks for your call.

Let's go to next caller.

Hello Anthony .

Welcome to Matters of Mind.

Well let's go to let's see we have Anthony on the line.

Well, Anthony , you got a question about gabapentin.

Gabapentin is a medication that's been around since the 1990s and gabapentin is a medication also known as Neurontin.

And your question was what does a gabapentin do?

Basically gabapentin will modulate this particular chemical called Gabba Gabba Accies the brakes on the brain and acting on the brakes on the brain.

Gabapentin was originally studied for seizures and it was a studied and approved for seizures back in the nineteen nineties and then we in psychiatry started using it for anxiety.

We started using it for pain, we started using it for sleep and we found that it had a lot of different uses.

Gabapentin has less effect on the memory and concentration compared to benzodiazepine medications for anxiety such as Xanax, Klonopin, Valium, Ativan these are medications are going to affect your concentration and memory and they can also make you more depressed because they can kind of zap you of your motivation.

Gabapentin is less prone to doing that at lower doses now gabapentin has its drawbacks if you use gabapentin especially with a pain medication like an opiate, it can amplify the effect of the opiate and sometimes give you excessive sedation and give you a lot of side to side effects from the opiates.

So if you're not on an opiate it can be typically used with with an opiate.

Just be aware that it's going to be more amplified and its effects for the pain itself.

So it's something we are using more extensively in the state of Indiana right now Neurontin or Gabapentin it's monitored but it's not controlled medication.

It's controlled as a controlled medication in Ohio and Michigan states around us but not in Indiana.

But it is a medication that we watch for any potential abuse if somebody is using more gabapentin than they ought to be using, we are always on the lookout for that.

But they did a study in New Jersey twenty years ago looking at patients who were taking gabapentin and found that only about three percent of them got in trouble with it where they abused it.

So yeah, you can get a high on it if you take too much of it or excessive amounts.

But most people don't do that.

>> Thanks for your call.

Let's go to next caller.

Hello Anthony .

Welcome to Matters of Mind.

Anthony , you want to know is irritability a side effect of Galip Azeglio aside is one of the glib one agonists that are very popular now glyphosate aside is a medication that has been around its use for Type two diabetes.

>> It's also used for weight loss.

And is irritability a common side effect from it?

I wouldn't say it's a common side effect as it would be from any of the clip one agonists Anthony it's something that can decrease it can decrease your appetite if you have maybe collateral symptoms around it.

I take a look at your other medications you might be taking but keep in mind, Anthony , as I tell people many, many times if a particular adverse event occurred directly associated, you're taking a particular medication.

>> It's probably related to the medication itself that you're taking or the consequence of the medication.

>> So if you're getting more irritable perhaps due to a blood sugar change is sometimes people will drop their blood sugars as they can from that clip aside, if you're dropping your if you're dropping your blood sugars and in doing so that's causing you to have irritability that can sometimes be an effect but it's something you can discuss with your clinician especially at the side effects occurred shortly after experiencing the medication itself.

Thanks for your call.

Let's go next caller.

>> Hello Karen.

Welcome to the Mind.

>> Karen, you don't want to know is it possible to get psychosis from scrolling the Internet?

I think what I hear about from squirreling the Internet, Karen, will be more commonly people describing trouble with what I call a social contagion.

In other words, they have a lot of people talking about particular issues and they kind of jump on board with it.

And there's a couple of things happening in the brain there.

On one hand the brain opened up here.

The front part of the brain is looking at you on the inside part of the brain is this part of the brain called the ventromedial prefrontal cortex which gives you your identity.

>> It allows you to to know who you are and what your values are, what your morals are.

It gives you a sense of identity yourself and it's the ventromedial prefrontal cortex then just above that is the dorsal medial prefrontal cortex where your values are trying to align with people around you to fit into the herd to fit into the group itself.

>> So you've got the social aspect of it aligned side by side with your own personal identity when you're scrolling through the Internet and you're getting these ideas from other people, you can have kind of what I refer to as a social contagion where a particular idea becomes popular and as it becomes popular some people can say it gets them to thinking about things they ordinarily wouldn't believe and they start to wonder if they're losing their identity.

Well, that can happen from scrolling the Internet and seeing particular ideas or values or perspectives that might be different from your own if you see it again and again and again it can alter your your your your beliefs.

>> Now many people will hang on to their beliefs and that's what the ventromedial prefrontal cortex does on the inside there it'll allow you to have ingrained beliefs and sometimes people need to shake that loose to be able to believe otherwise.

But I think it's very important for you to always try to be objective just because you're having 10 or 20 or hundreds of people on social media aligning to a particular thought doesn't mean that you have to wholeheartedly assume that kind of belief.

And I think for some people that can come across kind of as a psychosis, a psychosis by definition where does your reality is distorted now if you're already prone to having a reality that's distorted?

Yeah, social media's often not going to be healthy for somebody but as a psychosis is where you can have fixed false beliefs where the beliefs are fixed, they're very tightly ingrained.

They are beliefs in which you cannot be you you will not find to be able to be disputed there false because they have no no meaningful reality behind them.

>> So a psychosis includes delusions.

Sometimes you get that perceptual disturbances with psychosis where you see things, hear things that aren't there and other people can validate that.

So a psychosis is a little bit different from a social contagion but a social contagion will be a belief that socially popular but it's a belief and it usually will fade away over the course of several years and it's something that we'll hear this popular now but years from now it won't be.

We've heard about beliefs from the 60s or 70s, the 80s that are no longer firmly held beliefs anymore because they were social contagious back then.

We have some of those now.

Thanks for your call.

Let's go our next e-mail question our next e-mail question reads during a half hour Is it important to be in psychotherapy while taking medication?

>> You know, with a newer medication we now are using its interesting how they're using how we're using them because they're working very fast.

The ones that affect glutamate will allow the branching and the root system of our individual neurons to grow within a matter of hours after taking these medications.

So in your brain itself you have about 80 billion different neurons and each individual neuron has between twenty thousand and fifty thousand branches like in the hippocampus here the memory center that is about fifty thousand branches per neuron when you have chronic depression or chronic unmitigated stress where you're just overwhelmed by things, the little neurons start to shrivel up and it's like a bush in your backyard where the above the ground of the branching is decreasing and if you look below the ground, you know the root system is decreasing.

Well that's similar to the neurons where you have the dendrites and you have the you have the axons the axons and cells are decreasing in number as are the dendrites.

It's like decreased branching.

Well, if you give somebody a medication such as ketamine's bravado also knows that's ketamine to Valide.

These are medications that we now have available for the treatment of depression that can rapidly within a matter of hours after administration increase the branching.

So it's like having a Bush that's above ground increasing its growth with the different branches and then you have the roots down below if this is occurring, keep in mind you need to keep your brain busy and stay active and that's where psychotherapy can come in.

Not only do you just take the medication but you need to be more active engaging with people socially exercising do all doing all these different things that will help your wellness itself.

So that's the purpose of psychotherapy why you're taking the medication, doing something with all that branching.

And finally, let's take our last call here.

Hello Robert.

Welcome to the Mind.

>> Well, nice to talk to you.

Hey Robert.

Good to hear from you.

Yeah, So you filled up your brain quite a bit and showed where the amygdala is on the one side.

Yeah, this is the amygdala on both sides.

It is on the right side and the left side it is it's on it's on both sides.

Robert, good observation.

This is the thumb of the brain the thumb, the temporal lobe and you've got a thumb on both sides.

That thumb thumb kind of looks like a the the brain looks like a boxing glove and the thumb is the part of the boxing glove here that's temporal lobe right in front is the amygdala now the amygdala on the left side for many people will have a greater influence because many of us are right handed but the right side amygdala can occur certainly very active as well.

So we do have an amygdala on both sides amygdala in Latin means means ormonde shape.

It's about the size of an almond.

If you dissect dissect somebody's brain and you find the amygdala you'll find it to be about the size of an arm and the amygdala is indeed responsible for fear, anger, anxiety.

It's responsible for rage.

>> It's it's basically our emotional volume control and if the amygdala gets too hot and it gets overactive, it can hijack the thinking part of the brain itself.

That's why we're always talking about the amygdala and trying to get that calm down.

Robert, thanks for your call.

I'm no 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 of the mind all one word I would say I'd like to see if I can answer those on the air I'm psychiatrist Jeff Oliver and you've been watching matters of mine on PBS Fort Wayne God willing and PBS willing I'll be back again next week.

>> Thanks for watching.

Goodnight