Good evening, I'm psychiatrist Jay Fawver live from the Bruce Haines studio in Fort Wayne , Indiana.

Welcome to Matters of the Mind now in its 10th year are 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.

The Fort in area by dialing (969) 27 two zero or if you're calling any place coast to coast you may dals toll free at 866- (969) to seven to 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, you may write me via the Internet at matters of the mind all one word at WFYI eg that's matters of the mind at WEF Big.

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

It reads Your daughter Fauver I have ADHD.

>> What's a difference between Strattera and Kalbarri?

Strattera is Adam Occitan Cloudberries of Eloxatin.

>> My nurse practitioner is recommending either of those Satara versus Kalbarri.

Strattera has been out for a couple of decades now.

Strattera is a medication as specifically and selectively will increase norepinephrine in the front part of the brain.

>> So part of the problem with attention deficit disorder is that you don't have enough transmission of norepinephrine and particularly in this left frontal part of the brain that's used for focus, concentration, attention span blocking out outside distractions and people with attention deficit disorder have about a five percent decreased activity in this left frontal part of the brain.

>> What you're wanting to do is fire that part of the brain up.

How do you do it?

You can increase norepinephrine.

How do you increase norepinephrine while Strattera or Atabaki Sateen is one way of doing that if you increase norepinephrine it can fire up this part of the brain.

>> Wist Atara it's a medication that will give you about a 90 percent increase blockade of the norepinephrine.

>> Now when you say blockade norepinephrine you might think well gee I just heard you say you're increasing norepinephrine.

What you're doing here is you're blocking the vacuum of norepinephrine into the firing neuron.

So if you think about the neurons as being like shotgun's, they're firing norepinephrine pellets.

These pellets go to several different receptors in the periphery then they get back in to the firing neuron.

What Strattera is doing, it's blocking the vacuum the vacuuming of norepinephrine back into the firing neuron about 90 percent blockade at that with usual doses of Strattera Wilbury on the other hand, is blocking about fifty percent of the norepinephrine block.

But it's also doing something very importantly it's blocking two serotonin receptors one a serotonin receptor type to be as in boy and one of serotonin a receptor type seven.

>> What that's going to do is not only give you some increase in norepinephrine here but it's also going to increase serotonin in the front part of the brain.

Why would you want to do that?

A lot of people with attention deficit disorder will have difficulty with focus and concentration but they also have a lot of anxiety because they're always procrastinating.

They're getting behind on things.

They're not getting stuff done.

They're worrying about all these different obligations that they're overlooking and they're finding that they're not completing because they don't have enough vigilance.

>> Well, because of that they have a lot of anxiety.

So if you block serotonin receptor seven and to be indirectly you increase serotonin transmission in the front part of the brain and by doing so can decrease worry and anxiety.

>> It's not that you'll be less motivated to do things.

It's just that you don't have the degree of obsessive rumination that you might have if you didn't have that on board.

So Westbury, on one hand the phylloxera vaccine is the generic and for that cooperation medication that does increase norepinephrine like the Strattera but it also will give you a little bit more of an antianxiety effect.

>> Strattera are adamant eighteen is a medication more specifically and selectively just increases norepinephrine Castlebury is brand name.

It's newer so it's going to be more expensive for many people it will require not uncommonly a prior authorization with many insurances.

Satara Adam Occitan has been around since boy about twenty five years now so it's been around for a long time so it's very easily acquired at this point.

>> Thanks for your question.

Let's go to our first caller.

Hello Phil.

Welcome to Matters of Mind.

>> Phil, you had mentioned that you started a day patch for ADHD Trona is methylphenidate.

That's a Ritalin type product.

You started it for ADHD and you've noticed a decrease in your appetite.

>> Is that normal?

It's can be a side effect.

Phil, if you take day Trauner, you're taking a slow release version of Ritalin methylphenidate and in doing so it's related to the dosage but you can't have a decrease in your appetite now it's not a problem for a lot of people unless it's problematic and you're decreasing your appetite to the point where you're losing weight that you don't want to lose.

>> Now many people like the weight loss and they get disappointed because the decrease in appetite and the weight loss will often diminish as time goes on.

So many people say I need to increase by dosage because I'm not having the weight loss anymore.

Well, that's a side effect and side effects with many medications will diminish over the course of time.

So if the day trying to patch at this dosage, the first question you need to ask yourself is is this dosage really helping my concentration, my focus, my distractibility?

Is it helping me be more productive on getting things done?

Am I getting completed?

Am I overall calmer because I'm more focused and I'm more aware of my task at hand.

>> On the other hand, if they Trona is not giving you that much benefit yet you have decreased appetite.

>> You probably way overshot the dosage you need because if you take too much of a methylphenidate product like they Trona it's like getting eyeglasses that are too thick and often make this analogy fill when you have poor vision you get eyeglasses or corrective lenses that have a certain strength and you start at a lower strength and you go higher and higher and higher and you find the strength that works for you.

But like with many corrective lenses, if you go to thick on the lenses you actually see worse.

The same is true with a day Trona Patch or methylphenidate there's that fine line between efficacy or how well it works versus side effects and you want to get the best benefits with a few side effects as possible.

>> But sometimes when you overshoot on the medication a little bit you don't get as much efficacy.

>> It doesn't work as well and you get more side effects and one of the side effects can be decreased appetite.

>> So the first thing I would often consider if they try to give you a lot of difficulty with appetite is number one.

>> I'm going to wonder how well it's doing for your concentration and focus.

>> But many times we might decrease the dosage or not a notch to this for the determination if it's giving you the same benefit that you might have otherwise.

So we're always trying to find that right dosage going higher on a medication like a stimulant is not always going to give you better efficacy any more than getting thicker and thicker eyeglasses are going to give you better vision.

>> You've got to find that fine tuning point for you not necessarily what works for somebody else but you got to find the fine tuning point for you at what dosage works best for you for efficacy.

>> I was at work and in doing so not giving you as many side effects as you might have to find intolerable.

>> Phil, thanks for your call.

Let's go to our next caller.

Hello Jacob.

Welcome to Matters of Mind.

Jacob, you've been taking an antidepressant for two for four weeks but you haven't noticed any significant improvement should you continue taking it or stop it because it doesn't seem to be working.

Jacob a rule of thumb with antidepressant medications generally will be at two weeks.

>> You should get at least 20 percent benefit and then at four weeks you should get about 60 to 70 percent benefit.

That's kind of out of work six weeks to eight weeks is where you get the full benefit from an antidepressant.

So the question you had for weeks OK number one, you're going to know it's four weeks if you're having difficulty with side effects because antidepressants side effects often will be seen within the first two to four weeks.

You'll see that very quickly and then the side effects if anything start to diminish over the course of time you should get a little bit of a benefit from an antidepressant is 20 percent or more is a good sign at two weeks but at four weeks you should be getting a much better benefit than what you're describing.

>> So if you're not if you're not finding that the medication is helpful for you at four weeks, talk to your clinician about the possibility of number one increase in the dosage always considering the pros and cons of increasing the dosage knowing you could have more side effects if you increase the dosage.

>> But number two , is it the time to add other medication to it?

>> If you're getting a 25 to 50 percent benefit from a medication for instance, you're considered to be a partial responder or a responder or someone who gets a 50 percent or more benefit a partial responder or somebody who's getting a twenty five to fifty percent benefit on a medication.

>> If that's the case and you're getting a little bit of benefit, sometimes we add something to it like Cap Leida we might add Abilify or exalted.

>> We add other things to OP if you're getting a little bit of benefit from the medication at at 25 to 50 percent at the four week mark we often will consider if somebody has an alternative kind of mood disturbance like bipolar disorder if you have bipolar disorder you might be having some subtle highs and lows.

>> You need a mood stabilizer in those cases whereas in antidepressant medication might be the not be the best thing for you and obviously we're always going to be looking at medical conditions like thyroid disturbances, ion disturbances, glucose sleep apnea all those kind of conditions can cause an antidepressant medication to not seem to be beneficial because we're kind of chasing up the wrong tree for the wrong particular fruit we're trying to acquire.

So if we're trying to treat somebody with an antidepressant they actually have low thyroid.

Well, we need to go a different direction and if you treat the low thyroid with thyroid supplement or whatever they may may need that will often give people better outcomes.

>> Thanks for your call.

Let's go next e-mail question.

Our next e-mail question reads another favor is it true that autistic people have lower levels of oxytocin in their bloodstream?

>> What could some mental health treatments affect oxytocin levels negatively leading to more emotional problems?

>> Well, the oxytocin blockers are used pregnancy by the obstetricians basically if you block oxytocin in pregnancy you block an early delivery.

>> So if somebody has they go into premature contractions when they're trying to deliver a baby oxytocin which comes from the pineal gland.

>> Right.

Not the pineal gland.

The pituitary gland which is right smack in the middle of the brain kind of hangs down the bottom here.

It comes from the pituitary gland and oxytocin goes sky high just at the time of delivery that releases the calcium necessary to cause the uterus to contract.

>> If you're going into premature contractions sometimes oxytocin blockers will be given so medicinally.

>> That's where oxytocin blockers will be given.

>> Now what does oxytocin what's its role in autism?

It's thought that people with autism lack oxytocin and thereby they have less activity in their mirror neurons and the right front part of their brain in a particular mirror neurons as the name implies help you mirror the social behaviors of people around you so mirror neurons help you kind of connect with other people and so-called read the room if you read the room you're understanding what kind of emotional valences there and how you should respond to certain situations.

>> Is it a happy joyous type of environment?

Is it more of a solid environment?

You know, you go to a funeral probably not a good place to to tell a joke kind of read the room and know what kind of social context you're in.

>> Oxytocin helps with that bonding and helps you read the room in that regard.

>> So with that being said, people with autism often have a disturbance early on in their lives, especially with decreases in oxytocin.

For years there have been studies being done not yet approved for oxytocin intranasal intranasal formulation because if you take a pill of oxytocin it's a peptide, it goes to the stomach, it all gets broken down.

>> It's meaningless.

So for oxytocin to get to the brain you have to formulate it in such a way that it goes it bypasses the so-called first passed effect.

It goes through the liver and it goes right to the brain and you can do that from an intranasal formulation not yet approved.

So what kind of things lower oxytocin levels outside of the oxytocin than blockers that I mentioned earlier when pregnancy alcohol if you drank alcohol heavily it can increase oxytocin.

And I think it's an interesting concept because think about it if you drink a lot of alcohol it can affect your interpersonal relationships and it can certainly affect your marriage and a lot of different ways.

>> But if you block the bonding hormone oxytocin is the bonding hormone.

It's the hormone of love.

It's the hormone of romance.

When you first fall in love, when you have sexual experiences, oxytocin goes sky high.

It bonds you to the other person.

So if you drink alcohol it dampens down oxytocin, it decreases oxytocin levels so it can certainly affect your ability to bond with your loved ones.

>> So alcohol can decrease oxytocin levels.

>> Another medication that can block oxytocin some levels will be narcotics or opiates, narcotics, pain medications.

If you use opiates for pain, if you use opiates recreationally for the purpose of feeling bliss, you're going to have often less bonding with other people because it will decrease oxytocin levels themselves so medicinally the medications block oxytocin effects will be the medications used for preterm labor or early contractions during pregnancy, alcohol and opiates.

>> Those are the three things that mainly will dampen down oxytocin levels and as you'd mentioned, autism can be a condition where there's is a disturbance in oxytocin levels early on giving people difficulty with that ability to bond with others.

>> Thanks for your call.

Let's go to our next caller.

Hello Leo.

Welcome to Matters of Mind.

>> Leo, you had mentioned your friends say that you have obsessive compulsive disorder due to your anxiety and tendencies to want to clean all the time.

Is that something you should look into OCD obsessive compulsive disorder is a condition where you can have ruminative thoughts that don't make any sense to you.

>> They're called ego dystonic thoughts.

>> They don't make any sense to you.

Those thoughts you can't get off your mind.

So if you have a thought concerning contamination and you know it's illogical, you know, it doesn't make a lot of sense but you have these thoughts it go around and around your brain about contamination and being dirty and having germs all around you.

>> What's happening there?

This front circuitry of the brain is going round and round.

>> Usually we'll have a thought about contamination.

We'll say oh that's icky and then and the front part of the brain it stops further thinking about it and you move on you stay away from the icky type of thing that you're around so your brain has a natural way of sorting out OK, is this a danger to me or not?

>> So OCD will start typically with a thought that goes round and round and round and you can't stop it because your orbital lateral prefrontal cortex which is right here above the eyeball there's no work so well the orbital lateral prefrontal cortex will often stop the circuitry and allow you to move on.

>> Compulsions are behaviors and behaviors are often a result of the obsession.

>> So compulsions can be excessive cleaning no excessive cleaning if you're in the health care industry we're taught to obsessively be concerned about contamination and compulsively clean.

>> So in health care that's kind of an occupational hazard to have these so-called OCD tendencies.

When I was in pharmacy school before I became a physician and when I was when I as a pharmacist we were taught to compulsively count three times the number of medications that we were giving somebody and also the label of the medication.

We're always taught to compulsively check three times from the time we started filling that prescription to the time it left the pharmacy.

So we're trained to have this compulsivity even though we knew after one time OK, we're good on that.

>> We're taught to check it again and again in an airline industry right now again they're telling people to compulsively check different things even though they know they've checked in before.

Check them again and again.

So there are some construct compulsions I guess you could say.

But that's the question that comes back to if you're compulsively cleaning is it to the point where you're cleaning unnecessarily and you're cleaning even to the point where it's causing harm in other words, are you cleaning so much that your detergents or your disinfectants are damaging to whatever you're cleaning?

>> You often hear about the people who have the compulsive hand washing.

Their hands are raw if your hands are raw from compulsive hand washing because you're washing so much because you feel like you just can't get the germs and the dirt off, that's a problem.

>> So the first question would always be do you have OCD?

OCD is where it's causing the obsessions.

>> The compulsions are causing functional impairment.

They're keeping you from getting things done.

And a big question we often ask to determine if somebody has OCD will be is it causing you to be late to various obligations or appointments if you're at home rechecking your cleaning, you're doing things over and over again compulsively and it's causing you to be late to get out the door.

>> That's a big tip off that it's a problem for you now if you or somebody who go whose goes back and checks the stove, rejects the locks once not a big deal but if you're going back three and four and twenty times and it's causing you to be late to get out the door, that's where it becomes a problem now it's also a problem will be if you know you checked it or you know you clean two or three times but you've got to go back one more time and if you can't go back one more time it causes a lot of anxiety.

>> That's classic classic symptom for OCD as well where it's causing heightened anxiety if you can't do it one more time even though you know you've already done it.

Yeah, we do have medications now for OCD that appear to be affecting the medications that are most effective are the serotonin reuptake inhibitors particularly the ones that will give you a stimulant a stimulation effect at this particular receptor called Sigma one sigma one receptors if stimulated can decrease inflammation and it seems to have some kind of effect for OKd medication we use for OCD.

>> Typically the prescription medications will be Luvox, also known as flu vaccine and Zoloft sertraline.

They have a little bit of single one activity especially Luvox or flu vaccine and what they're doing is they're firing up the front part of the brain we do use in acetyl six grams twice a day.

>> I notice all is a B vitamin derivative but I nossiter is a natural derivative the people sometimes will use for OCD.

It's a powder formulation typically but it's about six grams twice a day and that's comes out to be about to be about a three fourths teaspoon full of powder that people sometimes will take and then we'll have psychotherapy techniques that can be on one hand very, very simple where you're having this obsessive thought where it's going around and round your mind.

>> You just can't get it off your mind sometimes quietly or even in your mind saying stop simply thinking of the word stop or thinking your mind are saying out loud very quietly stop sometimes you can stop the circuitry and get yourself distracted to do something else the more times you're able to do that and prevent yourself from going through with the compulsions again and again and again you can kind of retrain your brain to not have to do that and because in a compulsive manner.

>> Thanks for your call.

Let's go our next e-mail question our next e-mail question region out of favor.

>> I'm grieving the loss of of a child in pregnancy.

I'm sorry to hear that I'm hurting and I'm sad most of the time I don't know what to do.

How do you suggest you approach addressing this Will obviously grief counseling can always be helpful if you've had a child who whom you've lost during pregnancy.

There's a couple of things going on.

On one hand it's always traumatic to lose a child in the to pregnancy.

>> But on the other hand there is a phenomenon called post called postpartum depression.

If you're later of long in your pregnancy past six months or so in your nine month term pregnancy you can have postpartum depression and postpartum depression is where your estrogen and progestin has been sky high and then they plummet.

>> Now granted the loss of the child is enough to make you really depressed and be very traumatic for you.

But on top of that, if you have the drop in estrogen and progesterone that can cause you a hormonal disturbance that gives you the effect of postpartum depression and in doing so that can be corrected.

>> We have a medication called the 911 Calls also known as Roubaix and we use Zoove if somebody has a post has a postpartum depression where the Depression has at its onset in the last trimester of pregnancy or any time within one year after delivery because they're zoove is correcting the hormonal imbalance that naturally will occur at the time of delivery and that can include a preterm delivery if you've had a miscarriage.

So you need to be assessed No one from a hormonal standpoint to see if that's a factor for you definitely getting grief counseling.

It's always difficult for somebody to lose a child but also there are antidepressant medications that can be used to try to help you cope and maintain your resilience to be able to still do the kind of things in life and be able to look to the future.

But that grief is very, very traumatic for many people.

I wish you well.

>> Thanks for your email.

Let's go next caller.

Hello Joe.

Welcome to Mastermind Joe.

You'd mentioned you're taking Gabapentin and Trazodone.

Can they be linked to an increased risk of dementia or the loss of balance?

Ask actually Joe, gabapentin is a medication that a lot of us older people can take over 65 years of age because it's been shown to actually deepen the quality of sleep and improve dream sleep and less deep sleep and less dreams sleep are associated with dementia.

So there's a lot of speculation now that Gabapentin also known as Neurontin originally approved as an anti seizure medication bastia back in the nineteen nineties but not for a long time.

>> It's now used repaying its use for anxiety.

It's used for sleep so gabapentin used for a lot of reasons in which it wasn't originally studied but is a medication appears to be very safe for helping with the depth of sleep and it does not seem to have that link to dementia that we hear about with medication like the benzodiazepines, Xanax, Klonopin, Valium, Ativan those medications seem to have a greater link dementia.

>> So we're safer with gabapentin.

You mentioned the following risk.

You bet.

If you take too much gabapentin you can have an unsteadiness and have falling risk not as much as you might have a falling risk with so-called benzodiazepines.

So gabapentin if used at the proper dosage could be very helpful for many people Trazodone a medication it works entirely differently than gabapentin.

Gabapentin works on the calcium channels where it basically makes the calcium channels less likely to give you an itchy trigger finger so there's less calcium influx get giving you less anxiety that way.

>> So calcium channels are affected by gabapentin on the other hand, trousered affected more by serotonin receptors.

So Intagliata mechanisms of action by affecting serotonin receptors triacetone does not seem to be giving anybody an increased risk of dementia or typically falling risk.

Now if you get too much don't like with too much gabapentin you can be a little bit lightheaded and unsteady on your feet.

>> But generally those medications are not typically related to falling risk.

Thanks for your call.

Let's go our next caller.

Hello Bob.

Walking to matters of mind, Bob, you mentioned that your friend is having some mental health problems.

How would you suggest your friend going to a therapist?

Bob, the best thing you can do is as a friend is give compassionate concern to your friend and just say hey, I've known you for a long time and here's what I've noticed in about you are OK and try to just it's an open discussion there and then the whole idea of of a friend is to allow somebody to have a GPS to help them guided to their individual life goals.

>> So in other words, if you're kind of lost on the highway, what do you do if you're by yourself?

>> You flip on your GPS and you try to figure out where you're supposed to be going and that's what the psychotherapist will do.

A psychotherapist will basically be like that GPS to give you some guidance to turn here, go this way they look at where you are right now as does GPS and then help you determine OK, based on where you are right now, you need to go up a mile and turn right.

Well, that's what a therapist does based on where you are right now.

You need to go forward this way or that way and the therapist gives you some practical ideas.

Now we do use medications, get medications will be for the role of primarily the acceleration, the braking helping the actual the mechanics of the brain work better so to speak where a psychotherapy or talk therapy gives you more of the ideas of what direction to go.

So therapy can be very, very helpful for many people, especially if you're going through life circumstances in which you've not experienced previously.

>> You haven't been able to cope with them before thereby you don't have much resilience and if you have a lot of changes going on in your life right now, that's where psychotherapy can be very helpful in providing a good direction for you.

>> Thanks for your call unforced.

I'm out of time for this evening if you have any questions 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 WFYI Dawg.

>> I'm psychiatrist Jay Farber and you've been watching Matters of the Mind on PBS Wayne now available on YouTube God willing a PBS willing.

I'll be back again next week.

Thanks for watching.

Goodnight