good evening.

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

Welcome to Matters of the Mind Now in its 10th year matters the mine 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 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) to seven to zero now on 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 WFYI dot org that's matters of the Mind at WFYI starts tonight's program with a question I recently received.

>> It reads Durata VA VA Is there a connection between long term psychiatric medication and being off balance not just once?

>> I'm to the point of having to use a walker my goodness.

>> I would certainly recommend that you talk to your clinician about that because you could be taking too high of a dosage of whatever you may be taking in.

>> There are some medications at too high of a dosage will make you unsteady and give you difficulty with balance and it can be due to there are neurological disturbances as a side effect but they also can be due to your having lightheadedness upon standing.

That is not an expected side effect.

That is not something that you should have to tolerate.

I'd certainly talk to your clinician about that now if you notice are having more neurological disturbances as you get older with prolonged use of the medication that can be a phenomenon with some medications called tardive dyskinesia medications a blocked dopamine they used to be called the antipsychotic medications.

Now they're called the dopamine receptor blocking agents.

But these medications by blocking dopamine will increase the budding of more dopamine receptors and sometimes give you more difficulty with unsteadiness, tics, twitches in the facial area, shoulder shrugs, movements and things like that.

So either way, my goodness, I'd certainly talk to your clinician about that and see if something can be done about the current medication you're taking if that appears to be attributed or attributable to the medication that you are taking now, you always have to go back to how you were feeling before you took that medication and over the course of time how it's helped you or how it's not helped you so much and possibly given you that side effect of unsteadiness.

>> Thank you so much for your email.

Let's go to our first caller for tonight.

Hello Craig.

Welcome to Mariza Mind.

>> Craig, you mentioned that you're currently taking Zoloft or a search plane at fifty milligrams every day and you feel like your anxiety has been under control but your doctor wants to raise the dosage.

>> Is there a reason for the change if you're managing well, that's your call basically Craig.

If you're managing well and you are saying the anxiety is a good control, then the question might be with Zoloft at least would be easier to oppression under good control 50 milligrams is a relatively low dosage for sertraline or Zoloft, Zoloft is typically dose between 50 and 200 milligrams every day.

>> So 50 milligrams a day is a relatively low dosage but it's a common dosage for many people who primarily have anxiety and the types of anxiety that we often address to be generalized anxiety which is a fancy term for worry.

Then you have obsessive compulsive disorder which is often treated at a higher dosage post-traumatic stress disorder phobias, social anxiety, panic disorder those are all forms of anxiety so based on the type of anxiety you're experiencing, the Zoloft 50 milligrams might be enough but certainly enough.

Zoloft is also used for the treatment of depression and maybe your clinicians is identifying either with specific outcome metrics like a Q nine for instance where you get a numerical score on your depression or maybe in talking to you there might be some means of identifying that you might need a little bit more of a dosage of Zoloft.

>> But quite frankly if somebody in my practice is saying they're feeling really well on their current dosage of medication, I'm thrilled to keep them at a lower dosage if need be.

So you're certainly entitled to be able to ask your clinician the rationale for the higher dosage.

So might be some good reasons there that you might not be aware.

Thanks for your call.

>> Let's go next caller.

Hello Pam.

Welcome to Mastermind Pam.

>> You're having issues focusing on tasks as you get older.

Is that normal?

As we get older it is normal to forget names more commonly is it normal to have difficulty focusing on tasks?

>> I wouldn't accept that necessarily because as we get older our body kind of breaks down and as our bodies break down we can have things happen that can affect our focus and concentration.

And as a clinician I always want to assess those possibilities.

No one that comes to the top of my list will always be sleep apnea.

>> Sleep apnea will be where somebody's snoring, they're pausing and they're breathing.

They're not getting enough air flow to their lungs and they're by not getting enough oxygen to the brain.

So sleep apnea increases its likelihood as you get older and your throat kind of collapses down in your airway as you're sleeping.

>> Sleep apnea will make you tired and less focus the next day.

>> That's the first thing will often try to address.

Secondly, we'll look at thyroid disturbances as we get older especially women will have lower thyroid and low thyroid can certainly give you difficulty with focus as you get older.

>> Sometimes you can have gastrointestinal bleeds where you can have a subtle little bleed in your iron can drop when your ion drops you can have difficulty the focus you can be fatigued.

>> You might notice some restless legs which can be from low iron.

So as the ion drops that can give you difficulty the focus as we get older we're more likely to have type two diabetes where you have increasing insulin but it's just not working so well for anymore and you have gradually increasing blood glucose as as blood glucose levels go up and down that can also give you difficulty with focus.

So we want to look at all these different medical reasons why people might have difficulty focusing.

>> I certainly seen some people with depression, clinical depression as they get older they're having more trouble to concentrate and they wonder if they're having dementia.

But as we look through their various symptoms specifically looking for the symptoms of depression, we'll find that that's an issue.

>> We treat the depression.

The focus can improve.

So I wouldn't say difficult with focus is necessarily normal.

>> I'd want to look at a whole spectrum of medical conditions that can be possibilities for why a person is having difficulty with focus as that person gets older.

>> Thanks for your call.

Let's go our next caller.

Hello Kim.

Welcome to mastermind Kim.

You mentioned that your partner gets more depressed around the holidays ever since his mother passed.

How can you support him and what advice do you have?

>> I'd say over the holidays, Kim certainly reminisce about your partners mother and talk about the memories because holidays will often remind us of fond memories of our loved ones and it's great to reminisce and have a remembrance of the of the loved ones during those times and reminisce during that time and also focus on other things.

Sometimes when you lose a loved one you have to kind of refocus your attention on other tasks and it's a new chapter in your life .

But I'd certainly start with reminiscing about your partner's mother and and talking about the fond memories and getting through those times to be able to help with that.

Always reminding your partner that there are other memories that you can create that will be new and exciting as life goes on.

>> Thanks for your call, Kim.

Let's go to next caller.

Hello River.

Welcome to Matters of Mind Forever.

>> You'd mentioned that someone told you that a rubber band would help you with picking and you still have that urge you.

>> What else can you try?

Yeah, rubber band is something it's a distraction for annoying little habits that a person might have you flick yourself with the rubber band you're thinking about the little sting from the rubber bands to distract you from the picking itself.

Picking is called neurotic dermatitis and that's a condition where somebody is picking up their skin as a means of having anxiety so no one be aware that you're doing it.

>> So what you do there is you identify the areas where you're picking maybe cover those areas up.

Some people back in the old days would wear white gloves.

I don't see many people wearing white gloves anymore of at least the white gloves would keep you aware of what your hands were doing and would inhibit the picking itself.

Yeah, there are medications people take for picking the one that comes to mind is one called inacceptable i nossiter is a B derivative of a vitamin B derivative and and at six grams twice a day can be helpful for picking.

I'd want to know what the circumstances would be if somebody is picking some people will pick it themselves when they get anxious and nervous.

So I want to know what that's all about and have them distract themselves from the picking of doing something else.

>> So when you're starting to pick at yourself you feel like you're kind of getting tense.

Do something such as three push ups, some burping or some jumping jacks just for a few seconds to try to distract yourself than picking itself but try to identify the reason for the picking itself and some people will pick up themselves because they have true germinal geological Legian so they have skin lesions of various type and they're always picking up the lesions themselves and dermatologists can help people without there's an old treatment for picking at the skin that's a tricyclic antidepressants medication tricyclic in an oppressive medication called Dock's Upon the trade name used to be called Synacthen or Atropine and it's a medication that will increase histamine or it'll decrease histamine transmission and by decreasing histamine transmission theoretically will decrease the urge to itch in the skin.

>> Now picking it yourself and itching at the skin is one thing if you're cutting it yourself because you're frustrated and we often hear about this with adolescents they'll get frustrated and they'll start cutting at themselves when you're cutting yourself out of frustration, it's not a good coping strategy obviously but there's a physiological reason why people do it in the skin.

There's natural opiates and when you cut it yourself, when you're frustrated, you're angry.

>> It releases these opiates that are in the skin and naturally you have this feeling bliss when the opiates go to the brain.

So it's kind of like an indirect way of taking endogenous opiates.

It's not a healthy coping mechanism whatsoever but there's a physiological reason why adolescence especially will cut of themselves when they get frustrated.

The point there is and the same with picking tried identify the situations where you're picking or cutting and try to do something about those situations themselves.

>> Thanks for your call.

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

Our next e-mail question reads Dear Dr.

Fauver, what is an SSRI?

I recently started taking Flock's team that's a necessary correct are there is side effects that I might encounter as serotonin selective serotonin reuptake inhibitor that's SSRI selective serotonin reuptake inhibitor.

They started coming out in 1987 with Prozac or Fluoxetine being the first of the bunch and now we have five six SSRI we have Fluoxetine or Prozac.

We have Celexa or Citalopram Lexapro or Escitalopram Paroxetine or Paxil Zoloft researcher Lane and Fluevog Simien or Luvox I guess or R6.

So these are medications that will selectively and specifically block the really take of serotonin.

>> So what's that all about?

Well if you think about your serotonin neurons which are in the front part of your brain and they are released in the roffey nucleus which is kind of in the middle part of the brain, the front part of the brain looking at you Roffey Nucleus is right there in the middle part of the brain and that spews out serotonin.

>> So think of serotonin neurons being spewed out to the front part of the brain and various other parts of the brain as being kind of like a shotgun.

A shotgun is like the neuron, the serotonin is like the shotgun pellets that are being distributed and these pellets go to 14 different receptors all over the brain in these fourteen different receptors for serotonin do different things.

So what you're getting with an SSRI is a blockade of the pellets getting back in to the serotonin neuron.

So it's kind of like kind of like preserving your bullets by your shotgun, being able to vacuum in the bullets after they hit their targets.

>> So that's what our neurons do because you just don't want to keep manufacturing more and more and more serotonin your brain couldn't keep up so your brain has this remarkable recycling ability to vacuum in serotonin and thereby fire it again at the different different targets SSRI or selective serotonin reuptake inhibitor will keep the serotonin bouncing around and hitting the targets for a long period of time by blocking the vacuuming of the serotonin back in.

So you get the serotonin bouncing around for longer periods of time that can help with anxiety, can help with depression, can help with premenstrual symptoms, can help with post-traumatic stress.

A lot of different things that increasing serotonin can do if you increase serotonin with any of those six SSRI eyes you can have a sense of calming effect .

>> So that's why Accessorize have an FDA approved indication for I think eight different anxiety conditions.

>> They also have an FDA approval for depression but they have FDA approval for a lot of different anxiety conditions overall and it's because increasing serotonin can give you a calming effect and somewhat of a feeling of bliss.

>> Now the side effect of the as a surprise increasing serotonin can indirectly decrease dopamine.

>> So the bad effects of it SSRI is you can feel like you're emotionally blunted.

You feel no happiness, you feel no sadness, you just feel emotionally blunted.

Now for some people who have experienced uncontrollable crying, that can be a blessing they feel Oh thank goodness I'm not crying in public.

I used to go into a grocery store and just break down crying in there no longer experiencing that because they're on a serotonin reuptake inhibitor that's calming them down and not allowing them to cry so that it can be a benefit.

But it also can be a detriment because people will say they can't cry and they can't express emotion as they could previously.

Another common side effect from the serotonin reuptake inhibitors will be that if you increase serotonin you decrease dopamine and you can have sexual disturbances in some cases.

>> So that's a common side effect that we see with the SSRI.

>> SSRI typically have been for the past three or three decades first line treatment for depression.

>> But we have come to find that over the past couple decades that if you use SSRI as your first line treatment for depression you've got about a two out of three chance of there not working.

>> Now about one out of three people are really good candidate genetically and from a family history standpoint for unnecessary but they just don't work for depression for everybody.

>> They tend to work really well for anxiety for a lot of people for depression kind of so so so if you're not getting adequate relief from Prozac or Flock's team, we used to think oh we just need to increase the dosage.

Well, we found that increasing the dosage just increased serotonin transmission even more and it made people feel even more emotionally blunted and that was actually detrimental to their treatment.

So sometimes we just need to go to different mechanisms of action and we have several other antidepressant medications we can now use.

So we have over 20 new developments with antidepressant medications that have come upon the market from the past 25 years or so.

We have a lot of other options outside the SSRI but that's a good place to start for some people if it works well.

But keep in mind takes four to six weeks for them to give you the full effect.

>> But if they don't get the full effect you will often ask people on a scale of zero to 100 percent what percentage improvement do you have with us if somebody gives me a score north of fifty percent and they say the SSRI is helping me 60 percent 70 percent, I might keep them on that and add something else.

>> But boy if they're only getting about a twenty or thirty percent improvement I might bail out on that SSRI and go to something else with an entirely different mechanism of action.

>> Thanks for your call.

Let's go to our next caller.

Hello Jeff.

Welcome to Matters of Mind.

Jeff, you had mentioned that you often feel on edge and turned to having one alcoholic beverage to help you with your mood.

Is that normal?

Are there long term effects?

Well, that was a common self medication for anxiety 50 and 100 years ago, Jeff.

>> That's what people have done for many, many years to deal with anxiety if you on edge.

>> So what do they do?

They have a drink.

What does alcohol do?

It goes to the little GABA receptor on the chloride channel in the brain and calms me down.

>> Unfortunately it can make you impaired to the point where it makes your front part of your brain not work so well and that's why people do stupid things when they're intoxicated with alcohol because of basically anesthetizing they're thinking part of the brain.

The thinking part of the brain is in the front that's the part of the brain that helps you make good judgments to allow you to to weigh the pros and cons of different behaviors and to be decisive in what you're doing alcohol and exercise that part of the brain so it's not a good means to help you with anxiety.

>> We have many other ways of helping with anxiety if you're having trouble with irritability, if you're having trouble with situations that are causing you to have excessive stress.

>> Yeah, No one counseling can always help with those situations to try to talk you through them because what are you trying to do in counseling is make the front part of the brain work better and the way you try to make the front part of the brain better is by reasoning through the different situations and trying to think about your options before you act on them.

But many people have such overwhelming anxiety that their little amygdala up here it's on the left side and the right side of the brain the amygdala is and his temporal lobe, the yellow part of the brain the front part of the yellow part of the brain has the amygdala as a little ormonde like structure and that's the part of the brain that's responsible for anxiety, anger, fear, rage and that part of the brain can get really hot if you are out of control with your anger if it gets to that point, if irritability is overtaking you, it can hijack the thinking part of the brain so you don't think through your current situation adequately now what will make that worse?

>> Insomnia.

>> So I'm often telling people that they need to be able to sleep well if you don't sleep well, you're more likely to have a compromised effect on how the front part of your brain is working.

So you have to get a good night's sleep to recharge the front part of your brain to allow it to work alcohol again.

It's like having a poor night's sleep you're front part of your brain's not going to work so well.

>> So I would certainly talk to your clinician about other possibilities on how you could get some relief like you're kind of temporarily getting with alcohol but something that would be more efficient and helping with your concentration and helping you get through the situations you're enduring.

>> Thanks for your call.

Let's go to our next caller.

>> Hello James.

Welcome to Matters of Mind.

James, you want to know what kind of medication a prescription or over the counter would I recommend for ADHD Attention Deficit Hyperactivity Disorder?

An example would be if your mind wanders when reading a book.

Well, the first thing you want to do, James, when talk about prescriptions for ADHD, over-the-counter medications for ADHD, if your mind is merely wandering around that might be not symptomatic of ADHD itself.

>> It might be that something else could be going on.

So I'd want to number one, make sure you have a good clinical assessment and the best way to really diagnose PhD will be if somebody is having and getting a questionnaire.

>> There's an adult ADHD self scale self rating scale that you can actually get online and that's what we often use.

We want a thorough questionnaire, a thorough assessment of the problem hand because we want to know what we're treating.

I mentioned earlier sleep apnea, low thyroid ayanda disturbances, diabetes those all can give you difficulty with your mind wandering over the course of time.

>> So with ADHD we want to did those problems start when you're a young child and have they gone on persistently day by day now granted your focus and difficulty with concentration can be worse on the situation in which you're trying to concentrate upon.

So if you're having difficulty with something that's not new or challenging and it's kind of boring.

Yeah, that can make your mind drift a little bit more so is that clinically significant for ADHD over the counter type of treatments for ADHD?

>> The number one thing that many people have used for many years is quite frankly caffeine.

>> Coffee shops are often loaded with people who have ADHD.

>> If you're going to use caffeine, be careful about the caffeine because doses over about 400 milligrams a day can be problematic for a lot of people where they get the shakes fast heart rate gastroesophageal reflux you can have side effects.

>> You should get the higher amounts of caffeine but it's quite frankly a way in which many people self medicate their ADHD.

The key with caffeine use is to use small doses over the course of several hours so don't take a 200 milligram tablet and you get a surge of energy and you might get a little bit of relief from ADHD for an hour or so but then it will be gone .

So you don't want to take a surge of caffeine if you're taking something over the counter.

Same with coffee you want a sip it slowly over the course of a couple hours to try to help with focus and concentration.

Coffee has caffeine in general does have a remarkable effect in keeping you awake as the day goes on because as the day goes on you'll have this these kind of like natural exhaust fumes in the brain.

>> We have ATP adenosine adenosine triphosphate ATP is the energy for the brain is the gasoline for the brain and the fumes for the brain would be adenosine itself.

>> So adenosine is kind of like the exhaust fumes of the energy that we're burning in our brains as adenosine gets released it goes these adenosine receptors in the brain and makes you tired.

>> So that's why you naturally can get a little bit more tired ,a little bit more foggy around 2:00 PM, 3:00 PM, 4:00 pm as the day goes on.

So as the day goes on you can have a little bit more difficulty the focus how do you get past that?

>> The best way is to get a 20 or 30 minute nap midday late afternoon perhaps twenty or thirty minute nap is often all you need because clear away all the adenosine.

But another way to clear away the adenosine is by drinking coffee or having a caffeinated beverage because caffeine will knock adenosine off the receptors and thereby allow you to be more awake.

Caffeine also has the added benefit of increasing nor norepinephrine and dopamine just a little bit not to the degree of a stimulant but it can increase it just a little bit.

We use a medication for depression called Wellbutrin would be appropriate for depression depression treatment that increases dopamine norepinephrine can increase the efficacy of medications use first stimulants because bupropion has about half the potency of a stimulant and stays in your system for the whole day.

So we'll sometimes use bupropion or Wellbutrin as an antidepressant medication for ADHD because it stays in the system whole day and then we can use stimulants and sometimes non stimulants on top of that if need be.

There's a lot of different stimulants and non stimulants.

The key in taking a stimulant is number one make sure you do have ADHD because if you take a stimulant you don't really have ADHD.

It's going to do is give you more energy when you might think well that sounds great.

Well it'll give you more energy but that's kind of artificial energy causing you to crash thereafter.

And they've actually done studies on people who took stimulants if they didn't have ADHD and those people would have worsening concentration or worsening focus if they didn't have ADHD and they took a stimulant.

So simply taking a stimulant is not going to necessarily improve your concentration and your ability to pay attention.

>> It might increase your energy but it's not going to necessarily improve your concentration.

>> So we have to be scrutinizing on the people to whom we give stimulants versus the ones to whom we do not.

>> Thanks for your call.

Let's go to next email question.

>> Our next e-mail questions reads Dear to the father Why does Turkey make me tired?

I always feel like taking a nap after Thanksgiving dinner a classic question for many, many, many people and I think most of us know that answer tryptophan.

But let me give you a little bit detail on that.

Tryptophan is the building block for serotonin.

Turkey has tryptophan in it.

So basically when you're in and taking Turkey your increasing your tryptophan levels tryptophan is a building block for serotonin.

>> I mentioned earlier that fluence Azman as well as for the five other SSRI as are out there they are there increasing serotonin when you increase serotonin you have a sense of bliss fullness and you have a calming effect and for many people that can feel they can feel sedated.

>> Thanksgiving dinner also brings to the table literally and figuratively a lot of carbohydrates.

>> So carbohydrates with tryptophan will give you an especially tired feeling because the carbohydrates will increase tryptophan transport into the brain by increasing insulin.

>> So if you increase your carbohydrates with potatoes and there's desserts, that kind of thing, you're increasing insulin transmission when you increase insulin transmission, insulin transmission will cause the tryptophan to have an increased flow into the brain because the blood brain barrier is there that will kind of prevent things from going in at certain rates.

Insulin promotes tryptophan intake into the brain that will even give you more of a likelihood for having increased serotonin transmission.

So if you increase tryptophan within a matter of twenty minutes you can start increasing serotonin transmission the brain that's why you get tired after a turkey dinner, especially if it's accompanied by a lot of carbohydrates.

Thanks for your call.

Unfortunate 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 it matters the mind all one word at WFYI big via the email I'm psychiatrist Jeff Offer and you've been watching Matters of Mind on PBS for way now available on YouTube.

I'm psychiatrist Jay Farber and you've been watching matters of mine.

Thanks for watching.

Have a good evening.

God willing and PBS willing we'll be back again next week.

>> Take care