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>> 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 of matters of the Mind is a live call in program where you have the chance to choose the topic for discussion.

So if you have any questions concerning mental health issues, give me a call here in the Fort Wayne area 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 are these shadows of the Fort Wayne campus.

>> And if you'd like to contact me with an email question that I can answer on the air, you may write me via the Internet at matters of the mind all one word at WWA org that's matters the mind at W Egg and I'll start tonight's program with an email question I recently received reads a favor I have started taking advantage of started taking an antidepressant and I'm suddenly having trouble sleeping.

Is there a correlation?

Yeah I always tell people if you're having side effects try to relate and correlate when that side effects started.

So if you started taking a medication of any kind and all of a sudden you started noticing that yourself feeling differently, feeling untoward effects in any way.

Yeah, it might be related to that medication and early on medication side effects can be worse than later.

>> So what we typically will do if somebody is having uncomfortable side effects of any kind from any medication early on will have people take a lower dosage some anthe depression medications can give you a worsening of your sleep because they're activating sometimes they're affecting chemicals like serotonin.

>> They can give you difficulty going to sleep nightmares all sorts of different side effects concerning sleep and if that's the case we will typically have people lower the dosage.

We might have people take the medication in the morning rather than the evening but that can be a side effect.

>> Be reassured usually those kind of side effects and involving sleep are not long lasting.

Sometimes sleep will just need normalize over the course of time.

But I don't like people to have those uncomfortable kind of side effects.

I'd prefer people lower the dosage under your clinician's supervision and try to see if you can write out the early effects of the medication that might be causing you difficulty with insomnia.

>> Thanks for your call.

Let's go to our first caller.

Hello Mason.

Welcome to Matters of the Mind Mason, you want to know how does Lexapro treat major depressive disorder and what are the side effects of Lexapro?

>> Lexapro is also known as Escitalopram Mason it came out about twenty years ago and Lexapro is a medication.

>> It's very selective in what it does.

It will block the so-called reuptake of serotonin.

What does that mean?

Well, if you could think about how your serotonin network is working in the brain, serotonin comes spewing out from this inner area of the brain and from that inner ear of the brain it will go to the outer cortex of the brain.

It is valves in about one percent of all neurotransmitters in the brain itself.

>> So serotonin comes from the Rafet nucleus and it gets it's gets sprayed up here to the outer cortex.

Now the way that works is if you can think about your serotonin neurons as being like shotgun's and they're firing out little serotonin bullets when those bulls get fired out they will stimulate 14 different targets and these different targets are known by numbers and letters serotonin one A serotonin A, one B and so forth.

They have different letters and numbers associated with them but there's 14 different types of serotonin targets out there.

Serotonin will go out and stimulate various targets and then to preserve serotonin the brain knows where those shotgun's to value go back into serotonin, back into the firing neurons.

So it's like a shotgun vacuuming back in its little pellets.

>> It's just shot so it goes back into the neuron to preserve the serotonin.

Well, if you will block the reuptake or block the vacuum of the serotonin more serotonin stays around and bounces around and hits those targets again and again and again.

And that's one of the ways that the serotonin reuptake inhibitors such as Lexapro will work.

So basically when you think about Lexapro, it's enhancing serotonin in the brain now for many people that will give them somewhat of a blissful feeling.

It often works well for anxiety is over a dozen different indications for serotonin reuptake inhibitor for anxiety.

So you'll often find these serotonin medications being very helpful for anxiety.

They can decrease crying, they can decrease rumination and brooding so they can have a calming effect.

But two out of three people who take a medication like Lexapro might not feel well.

>> They feel better but they might not feel well.

So we have to be creative sometimes on what we might add to the Lexapro or another medication we might use.

>> Alternatively IT side effects can be number one.

You can feel so emotionally dull you don't feel happy, you don't feel sad, you just feel kind of blah.

That's one of the biggest complaints we hear about the serotonin medication and key there will be to often decrease the dosage.

Secondly, you can have difficulty with restlessness where you have a hard time sitting still and then you have the common side effects that are due to serotonin overload such as headache, nausea, fast heartbeat, diarrhea, shakiness.

>> Those can all occur if you get too much of a dosage.

So we're often watching very carefully about the kind of effects you're getting from a medication like Lexapro.

Yeah, we want you to feel calmer.

We want you to feel less anxious and less ruminative.

>> We want you not to cry as much.

But if you're having side effects from the medication we have many, many other options at this point.

>> Thanks for your call.

Let's go to our next caller.

Hello Ted.

Welcome to Matters of Mind.

Hey Robert.

>> How are you?

I'm doing all right, Ted.

How are you?

Watch you every week and I really appreciate everything you have to say.

Oh, thank you so much, Ted.

Here's my question.

You know, you often talk about how important it is, you know how important sleep is and you know, you say it's good to you know, go to bed and to get up at the same time every day.

But a couple of weeks ago you said but if you had to just do one or the other you said that it's really important to get up at the same time every day if even if you don't go to bed at the same time every day, why is that?

>> You listed very well, Ted.

>> The reason you're doing that is you're trying to get your your brain in a circadian rhythm such that you're getting a wake every every morning at the same time even though you still might be tired now you might say well my goodness, I only had five hours of sleep I couldn't get to bed till one a.m.

Well that's OK.

You want to try to get the same time every day to try to get your homeostatic rhythm, your circadian rhythm, all these rhythms going on in your brain you want to get them set at the same time now you might need a thirty minute nap or maybe a forty five minute nap at the very most midday to get you through the day but you want to get your brain into this very set clock where you're getting up at the same time every morning people will say they have a hard time doing that because they like to sleep in on the weekends there is a phenomenon called sleep debt.

It's a real phenomenon.

It was controversial twenty years ago but sleep debt is where you slept five hours on Tuesday night.

>> You slept six hours on Wednesday nights, seven hours on Thursday night, three hours on Friday night.

So you're kind of behind in your sleep all week and then sleep twelve hours on Saturday or maybe Sunday and so that's OK so you can kind of catch up but ideally in a perfect world you want to try to get up at the same time every day to get yourself on track.

What your brain doesn't really like is where you're getting up some days at seven a.m.

and other days at 10 a.m.

I'm some days until not till noon think about an adolescent.

That's what they often do.

They'll have their circadian rhythm all over the place.

>> Ideally your brain wants to get the same routine or the same rhythm where you're getting up the same time every day and thereby you will get tired at the same time every night.

>> So in the perfect world from a sleep hygiene standpoint you want to get up every morning let's say 7:00 a.m.

and then you'll get tired or sleepy at a certain time in the evening at 9:00 pm or 10:00 p.m.

you want to go to bed when you start getting tired.

>> You do not want to try to fight through that because it's like trying to catch a bus is coming by every hour and a half.

>> If you don't catch that bus when you're tired at 10:00 or ten thirty pm or whatever time out might be if you don't catch that bus next thing you know you're not getting tired till an hour and a half later.

>> So you want to try to take advantage of that time when you're starting to feel tired.

You don't want to take a look at your cell phone.

You don't want to check your email or start going through social media or looking at YouTube, those type of things while you're going to bed.

>> Many people will do that out of habit.

It's very dangerous to do that because you can stay awake for a much longer period of time and it's often like missing that bus for trying to get to sleep at that time that answer your question, Ted, thanks so much.

>> Is there such a thing as too much sleep for somebody over 70 if you're over 70, Ted, I encourage people to sleep the best they can.

>> Now what you don't want to do is sleep two hours during the day because if you do that that really messes up your sleep at night.

>> But sleep is so important as we get older.

I remember thirty years ago and even forty years ago when I was in training it was thought that older people weren't supposed to sleep so much.

That's a fallacy because older people need to sleep just as much as younger people not a little bit more because it's good for our brains.

>> So as older folks we need to fire up that front part of our brains and good quality sleep and lengthy enough sleep is actually good for your memory center.

So a risk factor for dementia for us older folks will be if you're not sleeping adequately.

So that's why in psychiatry we look at sleep disturbances like as a psychiatric vital sign we're always talking about sleep if you're getting sleep if you're staying asleep, do you feel refreshed when you get up?

Do you feel like you have to take a long nap during the day?

>> And we're always looking as you might have heard me say many, many times before, we're always looking for this phenomenon called sleep apnea and as we get older we're more prone to having sleep apnea.

We're not getting adequate airflow to the lungs at night because you're snoring.

You're pausing your breathing.

That is a big factor for waking up frequently and feeling sleepy during the day.

>> So we're looking at these other type of factors that might be associated with sleep disturbances.

>> Ted, so much.

My pleasure, Ted.

Thanks for watching and happy New Year.

>> Happy New Year to you to take care.

Let's go our next caller.

Hello and welcome to the Mind and you want to know how do you know if you're suffering from depression or anxiety?

>> I often tell people and it's often one the same and here's what happens and many people will start having anxiety where they ruminate about the past.

They had doubts.

They have misgivings about things that occurred in the past and they think about the future.

They start worrying about what's going to happen tomorrow in the next day and they're going over and over these different things.

OK, what that often does and is it causes you to have difficulty with sleep just as Ted was mentioning when you have difficulty with sleep often you take those worries with you to bed and when you have insomnia, after you have anxiety that often will lead to depression because if you don't sleep adequately at night time your front part of your brain does not get adequately recharge.

>> So it's it's like having a really bad cell phone battery.

If you ever had a bad cell phone battery where you lose charge halfway through the day and you think oh my goodness, I can't keep the charge on this thing, that's what's happening .

You don't get adequate sleep the front part of your brain which is the thinking part of your brain, the coping part of your brain, the part of the brain that allows you to make good decisions that part of the brain doesn't get adequately recharged if you don't sleep well.

So anxiety leads to insomnia not uncommonly insomnia leads to difficulty depression and all kind of as a cascade.

>> So when we talk about depression and anxiety, if it's often one of the same throughout a for people with depressive symptoms will have anxiety symptoms.

So three out of four people with so-called depression or what we call major depressive disorder will often have anxiety symptoms as as symptoms that go along with that and the anxiety symptoms will be restlessness, insomnia, ruminative thoughts, doubts, anxiousness, worry you feel physically uncomfortable.

>> That's not uncommon at all.

>> Thanks for your call.

Let's go our next caller.

Hello Jody.

Welcome to Matters of Mind Joanie, I want to know is is MDR also known as Eye Movement and Desensitization Reprocessing so successful in treating dissociative amnesia fugere other conditions MDR is particularly effective Joanny for post-traumatic stress disorder.

What he is doing it sounds unusual but you're the therapist who's very well trained.

MDR will know that with certain finger movements and eye movements you can actually fire up the thinking part of the brain so the rational part of the brain in the front here can be fired up in a good way with certain eye movements of the eye movements will cause improvement with the front part of the brain.

It's been studied the most with post-traumatic stress disorder.

>> If you have dissociative symptoms where you're having difficulty with forgetting what you've been doing for a few seconds or a few minutes and you kind of go off into another world briefly in stressful situations that's called dissociation and it's a coping mechanism who people who have chronic traumatic experiences will often find themselves resorting to doing where they're dissociating and they're kind of going off into their own world temporarily because of stressful situations.

So if the dissociative symptoms of fugue and so forth are related to post-traumatic stress symptoms, MDR could certainly be helpful.

>> Thanks for your call.

Let's go next caller.

Hello Tracy.

Welcome to Matters of Mind.

Tracy, you want to know I was just talking to yourself.

I mean higher brain functioning.

I think Tracy some people will simply talk to themselves not because of a psychiatric disturbance at all.

>> They talk to themselves basically to keep a place mat a placeholder so to speak in their brain.

And some people are more visual learners.

Some people are more kinetic learners where they learn better by doing things and some people more auditory learners.

>> So if you can talk to yourself kind of like reading out loud so to speak, you can actually hear yourself saying things and reminding yourself of different things not considered pathological what whatsoever?

I don't think it's necessarily associated with greater intelligence so to speak, but it can be something where it allows you to think more clearly about a particular endeavor in which you're pursuing at that time.

So for some people they need a visual.

Some people need kinesthetic where they're moving around.

Some people need auditory stimulation to try to learn things for some people who talk to themselves as they're trying to think through a problem that's not considered a problem at all.

But I don't think it's necessarily associated necessarily with increased intelligence.

>> It's just saying that you're probably an auditory learner if you do that more commonly.

>> Thanks for your call.

Let's go next caller.

Hello Zane.

Welcome to Mars of Mind saying you want to know is what is schizoaffective bipolar disorder and can it be kind of be treated fee schedule effective bipolar disorder basically Zane is where you have day to day symptoms of schizophrenia that have undoubtedly been there since you were an adolescent, maybe an early adult but you'll have difficulty with hearing voices when other people are not there.

>> You might have fixed false beliefs which are known as delusions.

>> You have difficulty with social anxiety.

You often will have difficulty perceiving social cues from other people.

>> You might have trouble with a thought processing ability and when you speak you're going from one topic to another to another.

>> It might be difficult to follow those symptoms.

Are there more often than not without treatment?

That's schizophrenia affective bipolar disorder aspect of that is where periodically you'll have a few days if not a week or so of being high or low.

>> So being high means you're on top of the schizophrenia symptoms.

You're also having decreased need your sleep.

>> Your thoughts are racing really fast.

You're doing things extremely impulsively.

That's the manic episode manic episodes of schizoaffective disorder.

>> Then you might have the depressive episodes where you're more socially withdrawn, you have less motivation, you don't enjoy things.

You have low energy so you can have these ups and downs with the affected bipolar disorder.

>> Schizoaffective bipolar disorder is where you have schizophrenia day by day and then periodically occasionally you'll have changes in the mood where you're up or down can be treated with cold Benfica Bentzi was approved of by the Food and Drug Administration over a year ago for the treatment of schizophrenia.

Koban Fee is Zano Mullin and traceback to medications in one.

>> So Zano Malene is a medication that will specifically address a stimulation on acetylcholine.

>> So by stimulating acetylcholine downstream it turns off the faucet on dopamine.

>> What we've been using for the past 60 years is antipsychotic medications will be medications a block dopamine predominately and if you block dopamine it's like having a water hoses on full blast and you're trying to block the effects of it on the other end of the water hose to try to block all this excessive flow coming out well with then you're now actually going the spicket and you're turning down the volume of the water flow itself.

>> So if you think of water flows being like dopamine transmission, that's what's as doing so theoretically you bet Koban Fee could indeed be used for schizoaffective disorder having the difficulty of schizophrenia there by day by day.

>> In addition to the possibility ups and downs go benefit is not yet approved for manic depressive disorder or bipolar is or itself but it certainly could be helpful for schizophrenia symptoms and sometimes these medications that are useful for decreasing dopamine transmission somehow are also good for bipolar symptoms as well.

>> So chances are could be helpful for schizoaffective disorder.

>> Thanks for your call.

Let's go our next caller.

Hello Craig.

What can the masses of mind Craig you want to know how do you know if someone's prone to violence with schizophrenia and will medication in changes make a difference?

>> We're off the back, Craig.

I'd wonder if somebody has schizophrenia.

They're prone to violence.

>> Do they have a family history of schizophrenia that's highly predictive.

If you have an identical twin for instance, same genetics as you and that identical twin as you have schizophrenia, you have a 50/50 chance of having schizophrenia.

So schizophrenia is about 50 percent genetic if you have a mother or father with schizophrenia you have about a twelve percent chance of having schizophrenia.

>> So we're always going to be looking for any family background with schizophrenia when we think about some somebody having schizophrenia now if somebody has an extensive history for years if not decades of drug abuse, they've been using amphetamines.

>> They've and using hallucinogenics, they've been using cannabis all these different things you might have very similar symptoms as somebody with schizophrenia but you don't have the genetics that are there.

So when I hear about somebody using extensive drugs over the course of time, those drugs themselves, especially in the event of a relapse can cause I think more violence and you typically see with schizophrenia that was genetically brought on so to speak.

>> So there's different types of phenomena that can occur if somebody has a family history of schizophrenia, I think they're less likely to become violent.

But if somebody has psychosis where they're losing track of reality, they're getting aggressive, irritable, related to the history of drug abuse, the drug abuse that self might have damaged the brain of that person that would make them more prone to violence.

Now with any of these people, whether they be with schizophrenia or with any buddy with a history of drug abuse and drug induced psychosis, they need to be carefully watched as they're changing from one medication to another.

Why?

Because you're changing from one medication to another as one medication is getting tapered off.

The tapering of the previous medication sometimes will side effects such as irritability and restlessness.

We call it athleisure but that could be a side effect of coming off the previous medication while starting the new medication.

>> It might not have enough time to kick in it.

>> So it's a very sensitive time when somebody is coming off a medication starting a new medication they need to be followed very carefully because they can have some irritability and aggression during that time because the previous medication is getting out.

>> The new medication is not quite effective at that point.

Thanks for your call.

Let's go next caller.

>> Hello Denise.

Welcome to Matters of Mind.

Denise, you want to know why are some people of disorganize is it ADHD?

>> What causes people to clutter and have difficulty focused ADHD tambe a phenomenon that leads to people having disorganization and being cluttered and unfocused and it's something that will typically occur as a child as an onset.

So if somebody has ADHD they've had those symptoms going back to childhood or early adolescence and more days than not those problems are there.

However the problems involving attention deficit hyperactivity will be worsened if you're challenged with a new project.

In other words, you might be doing fine for a long time if you've had the same routine projects and all of a sudden you have a new challenge ahead of you that can sometimes cause you to have difficulty with being able to cope with distractibility inattentiveness because of the new challenges.

So even as an adult you'll notice that ADHD symptoms might be in pretty good control.

>> But if you're what we call not not having enough cerebral bandwidth to be able to tolerate certain situations, the ADHD symptoms might be much worse for so if you're having difficulty with focus and having things more cluttered that can be a symptom of ADHD can be habit.

I think it all goes back to look in a person's personal history.

I'm more concerned about somebody who was perfectly organized for years and years and here they are.

Forty five years of age and they're all of a sudden they can't keep track of things they're having trouble focus and concentration.

So women and particularly in that and that age group can be going through some perimenopausal symptoms because if you have difficulty with paramedical symptoms, pre menopausal symptoms you're estrogen's going down as it will and the perimenopausal time when estrogen goes down you'll have difficulty getting your thoughts together in many women as they go through perimenopause and menopause.

>> Yeah, but as they go through menopause, estrogen is going down.

This little hippocampus area in the brain isn't able to function so well.

That's the library center of the brain and you'll be more scattered and more unfocused during that time.

That's not ADHD, that's more perimenopause and bioidentical hormones can sometimes address some of that women after they deliver a baby not uncommonly will have a crash of their thyroid because when you deliver a baby you can have what's called thyroid toxicity and when you have that occur you could have a decrease in thyroid functioning that will make you feel really foggy.

I mentioned earlier sleep apnea if you have difficulty with sleep apnea sometimes you'll have a lot of trouble with concentration and thinking then so as we look at somebody symptoms of being unfocussed, they're they're cluttered.

>> I want to know how long those symptoms been going on and could there be any more recent medical issue that has been exacerbating those particular symptoms.

>> Thanks for your call.

Let's go our next e-mail question our next e-mail reads Dirt on the favor.

I feel like I get overwhelmed easily which leads me to be unable to manage manage my emotions.

>> Are there some coping strategies that could help getting overwhelmed easily?

We call it resilience and psychiatry and I'd want to know OK, how long's it been going on?

>> Is it related to being around other people?

I'd want to know the causes for feeling overwhelmed in a new situation like a new job.

>> There's so many different reasons why somebody could be getting more overwhelmed.

We all have a certain degree going back to the whole concept of bandwidth but we have a certain degree of bandwidth that we can tolerate certain situations based on our life experiences, our ability to cope with those experiences.

>> If you go back to the changes occurring in your life , are you getting too many changes occurring at one time we should be able to adapt to our day to day changes that we're enduring.

>> However, if you are having trouble with feeling overwhelmed sometimes you can be somewhat paralyzing for the brain you can kind of shut down.

That's where you feel overwhelmed.

That's what we'd want to address.

So I want to know the reasons and the particular situations where that might be a problem.

Thanks for your call.

>> Let's go our last caller.

Hello Hannah.

Welcome to Matters of Mind.

Hannah, you want to know about my thoughts on marijuana being reclassified as a Schedule three drug, you know, as Schedule three drug it means it does have some medical validity and I think marijuana does have some medical validity definitely with certain types of seizures, maybe with certain types of pain.

I like the fact that it's no longer a schedule one.

Schedule one means it has no medical use at all.

I think marijuana does have some medical use so if it's a Schedule three it allows us to be able to study it good or bad.

I've said all along I'd love for marijuana to be studied like any other medication.

It comes for FDA approval looking at side effects long term effects toxicities, everything as well as how it works.

>> So I like the idea of it being a Schedule three drug because it puts it on the table, allows us to study it very extensively for medicinal purposes.

>> Hanna, thanks for your call.

Unfortunately 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 a via the Internet at matters of the mind all one word at WFA ECG.

>> I'm psychiatrist Fauver and you've been watching Matterson Mind on PBS Fort Wayne Gwilliam PBS .

Well I'll be back again next week.

Thanks for watching.

Good night