.

Good evening.

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

Welcome to Matters of the Mind now in its 20th year matters the mind is 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 coast to coast anywhere you can call toll free at 866- (969) to seven to zero.

Now on a fairly regular basis we are broadcasting live from our spectacular PBS Fort Wayne studios which are 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 of the either via the Internet at matters of the mind all one word ECG that's matters of the mind at WFB, ECG and during this program if you would like to text me live with a question that I can answer the error you may text me by texting two six zero (969) 27 three zero that's two six zero (969) 27 three zero.

We just ask that you provide us a name and the city from where you're texting.

>> With that in mind, let's go to our first email tonight our first email derivative favor can Zyrtec for really or any really Balaji medication make depression worse?

>> Zyrtec is one of those medications then only about 10 percent of it gets across the blood brain barrier so some antihistamines will get across the blood brain barrier if you block histamine in the brain it'll make you tired and depressed because histamine is what I'm using and hopefully what you're using right now to keep yourself awake.

>> So histamine is skyhigh when you're awake, if you block histamine that's how you go to sleep and that's how you will be tired on an antihistamine that gets across a blood brain barrier.

The antihistamine that's predominantly gets across the blood brain barrier is diphenhydramine.

The trade name used to be Benadryl and diphenhydramine is over the counter.

It is about 50 percent across the blood brain barrier Desertec maybe no more than 10 percent.

So some of the antihistamines will get across the blood brain barrier and those will be more sedating, make you more depressed, make you more tired and sometimes give more difficulty with concentration.

Whereas other antihistamines such as Zyrtec don't get across the blood brain barrier so much and they'll be marketed as non sedating or less sedating antihistamines.

So that's the reason why you'll see that Allegra is one that doesn't get across the blood brain barrier so much.

>> Let's go to our first caller for tonight.

Hello Tim.

Welcome to Matters of Mind.

Tim, you had mentioned you take Prozac also known as Fluoxetine for depression at nighttime.

However, the exact time varies each night.

Would it be more effective to take it at a consistent time each night with a lot of antidepressant medications him we'd say yeah, you want to take it at about the same time every day Effexor known as Venlafaxine and Paroxetine known as Paxil or two antidepressants by golly you need to take those about the same time every day because you know some withdrawal from them Prozac, Gruffalo Occitan on the other hand lasts for about six days after you take it.

As a matter of fact there was a formulation of Prozac twenty five years ago called Prozac Weekly.

It packed in a whole week's worth of Prozac in one capsule such a you can only take a once a week and as because it lasts a long time in the system.

>> So Prozac is something where you would need to take it necessarily the same time every day many people take Prozac every other day they'll they'll triple up on the doses every third day.

You can always talk to your clinician about the possibility of taking Prozac at a higher dosage but more spread out.

But Prozac is something where you would not need to take it at the same time every day as you do with many other antidepressant medications.

>> Tim, thanks your call.

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

Our next e-mail question reads Dr.

Farber, what can you do to help an elderly parent who lives independently but is beginning to have more frequent memory issues?

This particular elderly parent would likely be reluctant or receiving medical attention.

Well, you always want to assess any medical issues with memory problems within the capacity of the elderly person wishing to do so.

>> So you want to make sure the elderly person doesn't have difficulty sleep apnea, thyroid disturbances, glucose, glucose abnormalities those are obvious reasons why you can have memory problems if there are at least receptive to seeing a primary care clinician, that would be a great place to start.

What can you do from a behavioral standpoint to try to help them with her memory, make sure there's a calendar in the room, make sure there's a very visible clock in the room when you come in talk about day to day activities, remind them of the day of the week.

Have a schedule on hand where they do certain things on certain days.

>> In other words, the best thing you can do for anybody having difficulty with memory especially as we get in the older years is to have a routine and mind the problem with assisted living.

Sometimes as many people will be left to their own devices and they won't have specified things to do if there's activities in the illness in the assisted living facility that's fantastic.

But they need to have some kind of schedule not unlike when you're at the workplace, when you're at the workplace.

>> The wonderful thing about being at work is you're you're having meaningful, productive activities day by day and you are around people every day.

>> Those are the two factors that will keep your brain alive and active being around people and having things to do.

You want to have that kind of capacity in an assisted living environment because that will actually help with a memory.

>> Thanks your email.

Let's go to our next caller.

Hello Pamela.

Welcome to Mastermind Pamela.

You want to know about Lyric?

A lyric is brand name for Pregabalin so Lyric has been out for a while for old fibromyalgia and for pain.

You want to know about Lyrica?

Is there any long term effects that you need to worry about especially when it comes to dementia?

Lyrica is a chemical cousin to gabapentin.

Gabapentin is also known as Neurontin so Lyrica and Gabapentin are frequently used for pain because they will decrease the firing of the itchy trigger finger in the nerves that nerves have a little trigger finger called a calcium channel and what Lyrica and Neurontin will do is they'll kind of modulate or dampen down the itchy trigger finger in the nerves itself.

>> So with that being said, if you take Lyrica or Neurontin with a narcotic or with an opiate medication that can give you more difficulty sometimes with over sedation and falling episodes.

So you want to be careful and take an Lyrica with an opiate medication.

It's controversial whether Lyrica itself causes more memory problems or long term dementia.

>> Is that a side effect from Lyrica because again it's slowing down the firing of the neurons.

>> Is that a side effect or is that more permanent?

I've heard debates either way.

What I would suggest with Lyrica is now be careful if you're taking it with the narcotic that's where you're going to get the most trouble and be aware of what kind of side effects you might be experiencing from it if you are indeed experiencing the side effect of memory disturbance with Lyrica, chances are you could take a lower dosage, find the lowest dosage you can take.

Lyrica is typically dose twice a day Neurontin I mentioned previously it's typically dose three times a day but Lyric can dose at 25 milligrams twice a day.

>> I've seen doses three hundred milligrams twice a day for some people but you find the dosage that helps you while giving you the lowest number of side effects possible.

>> Thanks for your call.

Let's go to our next text.

>> Hello David.

You're texting me from Huntington and you want to know what does creatine how does creatine help the brain and does it help with Parkinson's?

Creatine can help with muscle development.

Creatine supplements are thought to be helpful for many people to give them energy get up and go and actually muscle strength creatine is often dosed at five grams every day.

It's a teaspoon full of a powder typically people will take and it's thought to be a fairly safe supplement to take but you don't want to take it within two weeks of getting a blood test for your kidneys because your creatinine can be increased by creatine.

It's not damaging the kidneys.

It's just going to give you a false impression that you're you're having damage with kidneys because creatine will break down into creatinine and creatinine levels will rise.

Your clinician will think you have renal or kidney damage.

So if you take creatine as a supplement you don't want to take it within two weeks of getting a kidney test.

>> So that all being said, does it help with Parkinson's?

I don't know.

I mean it can give you enhancement with brain functioning.

It's thought that a lot of older people tend to lack creatine.

>> It is in Red Beatson.

Older people might lack creatine so it's sometimes recommended for older people under our clinician supervision to take creatine supplements if you take the creatine supplement with caffeinated coffee it'll actually get higher absorption.

So many people will take the first thing in the morning with caffeinated coffee but it can be something for muscle development which quite frankly a lot of older people are losing as you get into the older years especially after thirty five years old, you start to lose the capacity to maintain muscle mass creatine can help with that.

I will warn you however, creatine as a supplement not uncommonly will give you weight gain.

It's going to give you more fluid retention muscle mass increases.

People can have five to ten pounds of weight gain from taking creatine supplements over the course of six months to a year.

But using four specific brain disturbances like Parkinson's I don't know it probably wouldn't hurt but I haven't heard of it used specifically for Parkinson's disease before.

David, thanks for your text.

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

>> Our next e-mail question reads Do not have over are there any reasons for an adult to be tested for autism if they are functional and not in distress?

Well, that's the key there.

If there are functional if they're functional, that refers to their being able to get things done and they're able to socialize, are able to do the work they're able to have a meaningful quality of life and they're able to be around other people appropriately.

>> There's all sorts of different degrees of autism and I don't want to to overgeneralize it such that people are getting diagnosed with autism unnecessarily.

So autism is a condition where basically you might think outside the box you might have a different perspective on the world that other people around you you might have somewhat unique social interactions.

So it's thought that when people have autism one of the things that's lacking will be the so-called mirror neurons on the right front part the brain mirror neurons allow you to mirror the behaviors and social interactions with others.

So whether you realize it or not when you're interacting with others you are mirroring some of their mannerisms as a means of connecting with them.

So with autism they have difficulty mirroring the connections of with other people and with autism not uncommonly.

>> We'll talk and talk and talk and talk and talk.

That's called a bit pedantic speech where they will talk to such a degree that they will kind of get on the nerves of other people because they are talking excessively.

So when you have autism the whole idea is to try to train that person to have a give and take with social interactions.

But there's different degrees with autism just like there's different degrees with the nearsightedness.

>> You know, some people have horrific distant vision and they have to wear glasses all the time or corrective lenses.

Other people just on occasion do they have to wear eyeglasses?

So with autism I would say there's no reason to be tested for it unless you intend to treat it.

I would say that with any blood test, with any kind of neuropsychological testing when you're doing any kind of testing you want to ask OK, if a test comes back a certain way or another, am I going to do something about my lifestyle ?

I got to do something about my training to overcome that particular condition.

But the key term you use there is without functional impairment if you don't have functional impairment as we say in Indiana, no harm, no foul.

>> I mean don't worry about it if it's not causing you to having difficulties in your day to day living now where we will consider something a mental illness or something that we're going to treat will be where we notice that there is somebody is having trouble socializing, getting their work done, getting school work done and getting there their relationships in order where they can interact with other people.

That's functional impairment when you have those kind of difficulties not uncommon with people with more severe degrees of autism.

>> Thanks for your call.

Let's go our next caller.

Hello Leo.

Welcome terrorism.

I'd leave you want to know can alcohol abuse mimic bipolar disorder lya it's very common that bipolar disorder will have a component with it of of alcohol use disorder because many people with bipolar disorder they're having manic highs and they don't need to sleep.

They have racing thoughts.

>> They're irritable, they are doing things the same things they ordinarily wouldn't do or say.

Many people having was manic highs will drink alcohol as a means of self medicating so it often goes hand in hand.

>> So alcohol abuse well alcohol use, alcohol abuse, alcohol dependance they're often used interchangeably but with the alcohol use itself you can have a disinhibition of your front part of your brain.

In other words, it's alcohol use will make you sometimes do things and say there are things you wouldn't ordinarily do or say alcohol use itself can sometimes disrupt your sleep.

I think that as a clinician you could probably tell the difference between a manic episode and somebody who's intoxicated with alcohol.

There is a distinctive difference one way or another but what we often see will be the two conditions kind of overlapping where somebody has bipolar disorder but they also have alcohol use disorder.

And I remember seeing people when I was working in the hospital settings they'd come in the hospital and we have alcohol dependance.

>> They were drinking two pints of hard alcohol every evening and I asked them, OK, I get it that you're needing alcohol at this point.

>> But what got you started drinking alcohol many times they'd say well I started drinking alcohol because I couldn't sleep.

>> Why couldn't you sleep well, my thoughts were racing.

>> I didn't need to sleep.

I was going and going and going and then I crash after three or four days so I needed alcohol to sell my brain down.

Well, retrospectively that person was probably using alcohol as a means of treating their manic episodes and that's where we'll often see alcohol overlapping with bipolar disorder.

Thanks for your call.

>> Let's go to next email question.

Our next e-mail question reads out of order I have recently been prescribed bupropion.

It's also known as Wellbutrin for depression.

What's the best way for me to monitor my progress?

What are the signs that the medications are working or not working as a general rule of thumb with a so-called monoamine antidepressants these are antidepressants that affect serotonin, norepinephrine and or dopamine bupropion is a medication and predominantly will affect dopamine and norepinephrine.

>> It has about half the potency of a stimulant so it's not addictive but it will enhance the transmission of norepinephrine and dopamine if you have difficulty with depression that warrants the use of a medication like bupropion, you bet it's can be something that can be effective in helping you with energy concentration, focus, get up and go and it can be very effective in treating certain types of symptoms of depression.

>> How do you know what's working as a general rule of thumb with a monoamine antidepressant medications will be if you have 20 percent improvement a two weeks it's a good sign now how do you measure 20 percent improvement in two weeks?

Well, we have certain scales that we use like the patient health questionnaire nine questions called a Kunai.

>> We will use the best depression inventory.

There's scoring we can use for the objective symptoms of depression to determine to what degree they are.

Those symptoms are problematic for you.

Another way of determining of your subjective perspective on depression will simply be to ask somebody on a scale of zero to 10 zero being you're getting no help at all from the from your medication, ten being you're feeling fantastic.

It's not going to NorthPark you love how you feel.

How are you doing?

And if somebody says they would score themselves at a two or three that means we're getting a twenty or thirty percent Bruma So subjectively the notice got a bit of improvement.

So a predictor for a long term response and remission with an antidepressant will be that early to week improvement.

>> Just twenty percent at two weeks can tell us that it's might give you some good outcomes over the course of time.

>> Secondly, when you look at using an antidepressant medication it all comes down to the whole concept of functional outcomes which I mentioned earlier.

Are you doing the things you'd like to do?

Are you interacting with people like you were you'd like to interact?

>> I'll often ask people their very first appointment what pleasurable activities would you pursue if you felt good?

In other words, if you didn't have depression, what would you do that you're not doing now?

Pleasurable activities will be a key predictor for somebody getting back on track.

>> So sometimes people have to be nudged into getting involved in those pleasurable activities again.

But if you can get involved in pleasurable activities and do things that are enjoyable once again that's a predictor that you're going to get well and stay well.

So be appropriate and kind of get you out of a funk from a neurobiological standpoint by firing up the brain in certain ways.

But you also need to take that next step to try to make the lifestyle changes the best you can to try to get involved in pleasurable activities.

>> Once again, thanks for your call.

Let's go to our next caller.

>> Hello Matthew.

Welcome to Of Mind.

I got a question for a couple question for you.

You bet you I want to know I take metformin metformin for sugar diabetes and have you ever heard of Mandorah?

Yes, I have a brother who takes that and he's lost a lot of weight from it and I want to know if my medical taking my medications would interfere with that.

>> I will stay in my lane here at this point, Matthew, I'm a psychiatrist but we do encounter people who take metformin.

>> Metformin is typically given 500 to a thousand milligrams twice a day.

It comes on a long acting version where people can take a once a day.

Metformin basically is decreasing the absorption of glucose in your gut and also decreasing the glucose production in your liver.

>> So in other words it decreases glucose very indirectly, very safe medication for a lot people as long as you don't have any kidney problems for Manja as you'd mentioned is a glycogen like peptide type one agonist longsword there.

They call it a glib one but that's working in an entirely different way.

People do indeed take the two of them together.

But again, I want to stay in my lane.

That's more of a gastrointestinal issue overall.

>> But we have seen that combination being used.

You know, there's discussion in psychiatry about people taking clip one medications for psychiatry and psychiatric reasons, especially if they have addiction .

But I think the jury's still out on that from my perspective, I'm being very cautious in recommending that people take up one agonist for for the brain health simply because the problem with clip one agonist number one they can decrease muscle mass and number two , they can cause you as medications.

The clip what agonists like Bandura can cause you to have some trouble with lack of enjoyment with things and lack of motivation.

Those are my biggest concerns about that kind of medication.

However, obesity and itself is a big problem for a lot of people.

If you have obesity, the fat cells will secrete inflammatory proteins.

Inflammatory proteins go to the brain you feel depressed so if you decrease the obesity in your body that can help you too.

>> So there's pros and cons with the clip one agonists like the Mandurah but it's something where you can discuss with your clinician especially using it in combination with metformin.

>> Thanks for your call, Matthew.

Let's go our next caller.

Hello Tony.

Welcome to Mastermind.

>> Hello Tony.

You had a question about your product gland being removed.

You take testosterone to help with the removal.

Is this going to affect you in a long term and can you still drink coffee ?

A lot of different things going on there, Tony.

You've had your parotid gland removed.

The main issue you're going to have there will be the possibility of you're having trouble with calcium metabolism so there will be some other issues.

>> There's the parathyroid there, Pirot, a lot of different things in that area.

So the question is going to be at what point do you need to have any hormonal supplementation overall?

Can you still drink coffee ?

I think that really comes down to the affects of your adrenals on all that.

But with your product gland that's a little bit gland that oh let's see here it hangs down in the middle part of your brain and the product and will help you with the metabolism of cortisol.

>> It will secrete testosterone that will affect growth hormone has a lot of features in itself.

>> So you might have to have supplementation in different ways.

But I talked to your endocrinologist about the different issues of what you might need to do with any supplementation or what kind of problems you might have in the future.

Thanks for your call.

Let's go to our next caller.

Hello Cathy.

Welcome to Matters of Mind.

Cathy, you want to know about my recommendations for dealing with hypochondria?

We don't call hypochondria anymore, Cathy.

We call it illness anxiety disorder.

>> Subtle difference there but hypochondria kind of had a bad connotation for a lot people.

Illness, anxiety disorder pretty much summarizes what it's all about.

You have a lot of anxiety about the possibility of having illnesses.

So what the main recommendation will have for people with illness anxiety disorder previously known as Hypochondriasis will be for people to express gratitude and to think of the things for which they are grateful with their overall health .

Now you can worry and you can deliberate on the possibility of having all sorts of different health problems.

But in doing so you can create health problems from the worry itself.

I know it sounds weird but you can actually create all sorts of different health conditions by worrying about having health conditions because worry itself is a stressful event on the body so no one the worry itself would be problematic.

>> But I would certainly say, you know, look at the long term outcomes sometimes how people conceptualize OK, what's the worst case scenario you've got this a. pain the worst case scenario would be what if you had this particular problem, this physical problem, what would you do?

What would be the next thing?

And they'll say well am I die?

Well, OK, we're all going to die someday.

We all have an expiration date so we're all going to die someday between now and the time you're going to die of this condition or some other condition, what do you want to do with your life ?

>> So sometimes that's a matter of being matter of being grateful for the health that you still have and recognizing that worrying about a particular condition after getting it assessed, worrying about a particular condition is not something it's going to be helpful for your overall mental health .

>> It's not going to be good for your overall lifestyle.

So it goes along with the whole concept of generalized anxiety disorder in general when people have generalized anxiety disorder they basically have chronic worry and when you have the chronic worry you're deliberating about things that might happen that often don't.

>> Thanks for your call.

Let's go next caller.

Hello Jeff.

Welcome to Mariza Mind Jeff, you had mentioned that your wife is concerned that your son is depressed.

>> You don't see any evidence of that.

>> But should you consider taking a theory therapy anyway?

I would certainly suggest, Jeff, that if your wife is concerned that your son is depressed, there might be a reason for that.

I'm always one to always encourage people to listen to the spouses, whether it's the husband, listen the wife or the wife listen to the husband.

You'll have different perspectives on things.

Your wife must be seeing some evidence that your son is having depression based on his usual demeanor.

>> Now as young men go through adolescence, you can expect them to have differences in their demeanor or through hormonal changes.

Same with young ladies as well.

So if there's concern that there's a change in your son's usual demeanor and especially if it's starting to affect his socialization, his schoolwork, his ability to get things done, he'd like to get done.

As I mentioned earlier, that's called functional activity.

>> That would be where he could only be assessed by a therapist not a therapist could maybe see your son for a time or two .

>> I think that my goodness, when we're adolescents and young adults we could all use therapy because we're all going through stuff and a big trigger for mental illness will be the difficult body with being able to cope with unmitigated stress.

>> In other words, stuff happens in all of our lives and if you have difficulty coping with the changes and all the stuff that's happening, you're more likely to have trouble with despondency, difficulty with getting things done.

We call stress resilience but that's where a therapist could kind of help out.

So maybe if your son was seen for a session or two that might be adequate overall.

Thanks for your call.

Let's go to our next email.

Let's go next text hello to Tom.

>> You're texting from Columbia City.

Tom, you get asked why are there any current medications for your blood pressure making symptoms of are there any current medications for blood pressure making symptoms of insomnia worse sometimes a beta blocker, a beta blocker such as propranolol, a 10 alarm metoprolol, some times can cause a person to have difficulty with sleeping because they can disrupt the REM cycling and the dream sleep overall.

So that can sometimes be a factor.

Talk it over with your primary care clinician to see what other options might be available for you.

>> Tom, thanks for your text on force.

I'm on time for this evening if you have any questions that I can answer on the air or you may write me over the Internet at matters of the mind all one word at WFA eg I'm Psychiatrist Ja'far and you've been watching Matters of Mind on PBS for Wayne now available on YouTube Godwill and PBS willing.

I'll be back again next week.

Thanks for watching tonight