.

>> Good evening.

I'm psychiatrist Jeff Alver live from Fort Wayne , Indiana.

Welcome to Matters of the Mind now on the air for the past 27 years, 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 in the Fort Wayne area by dialing (969) 27 two zero or you can call any place coast to coast 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 land 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 WFA org that's matters of the Mind at WFB.

>> Org and I'll start my program tonight with the first question from an email and that question raised your daughter Fauver My job is stressful and I feel like I take some of that stress home with me.

Are there any tips on how to wind down after a shift and how not to take the stress with me when I get home to my family?

>> That is a very important important point that you make because you don't want to take the stress of your work home with you realizing there's only so much you can work out there.

So if you are able to do so, No one try to document and write down maybe in a diary before you go home or before you start the evening with a family that your main source of stress and what you're going to do about him the next day or what you can't do about it because sometimes you can't do about anything about anything so you can debrief very briefly and have a particular time period where you debrief maybe with your spouse or a trusted family member immediately upon going home.

>> But then it's a matter of cutting all of that off and trying to relax for the rest of the evening and part of that can be going for a walk.

Having some light exercise in the evening is often very, very important but it's extremely important for people to have that definition between their work and their work stress and their home life .

>> But what many people as you had mentioned, will go home taking the work stress with them thinking they're going to work things out overnight.

Do you ever really do that?

I mean does it really help to stay awake and ruminate about all the stuff going on at work?

>> It usually doesn't.

So writing the sources of stress down your worried and as I often recommend having a worry diary put down the write down the things that bother you the most and write down immediately before you leave work when you get home right off the bat and then put that aside and get to it the next day because you'll notice that those worries get themselves worked out.

No one but also it doesn't really help you to continue to ruminate about them the entire evening.

>> Now some of that can be related to an anxiety or depressive disorder when people start getting clinically depressed there's three network modes in the brain.

There's a default network, there's the salient network and then there's executive mode network.

So the default network is where you're just thinking about different things.

You're ruminating about the past.

>> You're don't really focus on anything in particular.

It's the network that your brain is often in as you're driving down the highway.

>> They call it highway hypnosis but it's basically your brain being in the default network.

>> You're aware and you're awake enough to be able to function but you're not really having to concentrate really intently now if somebody pulls out in front of you or you know, you're starting to slide a little bit on the eyes all of a sudden you're salian that works put you into the into the executive network which makes you very, very attentive and very, very focused.

So at home when you're starting to worry about work things unfortunately you get kind of in the ruminative default network.

It's important to try to get out of that do something else with the family, read something as totally unrelated a book, get like a book.

>> So get your brain entirely off the work related type of things and get yourself distracted as soon as possible.

>> Thanks for your email.

Let's go to our first caller.

Hello Jerry.

>> Welcome to Matters of Mind.

Jerry, you asked are there different medications for agoraphobia?

That's where you have a hard time getting outside, getting around to other people or open spaces.

You said you're on amitriptyline that's also known as Ellisville or end up ended upsets your stomach.

Amitriptyline is an old medication that's been around since the 1950s.

It primarily increases serotonin and norepinephrine and then it also will block histamine and block acetylcholine and it can kind of make people kind of calm.

But agoraphobe is where you're having trouble those open places and getting outside the house so much I'd want to know the source of the agoraphobia.

>> When did it start and is that associated with panic attacks?

Maybe it can be when people are having panic attacks go off and be reluctant to go out in the open area so they've had a panic attack in the past.

They felt like they were incapacitated with anxiety and here they couldn't do anything about it.

So if you're having panic attacks, OK, let's take it one step before that and determine why you're having panic attack.

>> So if you have a panic attacks, is it due to thyroid disturbances, fluctuations in glucose?

I saw a woman today was having panic attack due to her having what's called pots postural orthostatic tachycardia syndrome and Potts's where your heart rate just out of the blue starts going really, really fast, lowers your blood pressure when you stand up and you can pass out that gives people symptoms of panic attacks.

>> Another person I've seen in the past, they had intermittent arrhythmias in their heart so their heart would be really, really fast that would give them panic attacks because the rest of the body's kind of asking what's going on?

>> So if you're having panic attacks that will cause you to have more agoraphobia and you'll have trouble getting out.

So I would often go back to the source of the panic attacks themselves but overall medications won't help that much for the agoraphobia component getting out and about medications can help with panic in the underlying anxiety.

So if you need a medication like Alprazolam also known as Xanax, Klonopin also knows these EPAM you can use them short term or just on an as needed basis to get you out the door once you get the door with any phobia or any fear for that matter, the more you practice doing the more that fear or phobia will mitigate or diminish in its intensity.

So doing things again and again that you initially found to be fearful or anxiety provoking can actually help you public.

Speaking of good example, many people will have that fear of public speaking well volunteer to lead a Sunday school class, volunteer to lead a discussion with other people, volunteer to just talk in front of other people and you'll find that over the course of time public speaking is not that big of a deal.

So that type of fear it's just a matter of getting out and doing very gradually.

But again, it's like fear of flying.

For instance, sometimes we have to give people Zanuck's just to get them on the plane but once they fly a few times they have less anxiety related to that.

>> Thanks for your call.

>> Let's go our next caller.

Hello Bill.

Welcome to Matters of the Mind Bill.

You want to know can magnesium be used for depression?

Kind of Bill.

There's a particular genetic genotype genotype that's called Katika or methyl transference Gene.

And if you have a genotype of met met it's thought theoretically that magnesium at a dosage of about 400 milligrams once a day can be somewhat helpful for that particular genotype.

Not that I've actually highly recommended that for people because I haven't found to be that helpful.

They usually will need another medication along with it.

But magnesium can help if you have a particular genotype.

The way you determine your genotype is by getting genetic testing for OMT and CMT.

>> It regulates dopamine primarily and the lesser degree norepinephrine but it actually regulates how quickly dopamine and norepinephrine are broken down and magnesium can be helpful if you have that particular genotype with some people now magnesium as a side effect for some people that would give them diarrhea because magnesium could make the bowels go a little bit faster and that's why some of the some of the medications for constipation like magnesium citrate have magnesium in them.

>> So that's the biggest side effect that people might find troublesome magnesium though as is particularly good between 200 and 400 milligrams at bedtime if you're having trouble with sleep so magnesium can be helpful as a supplement, you can always talk to your primary care clinician and see if it's a good supplement for you.

I wouldn't use it necessarily by itself for depression but as an add on type of supplement it can help with sleep and if you're having some trouble with constipation certainly can help with that Bill.

Bill, thanks for your call.

Let's go next caller.

Hello, Jane.

>> Welcome to the mind.

Jane, you're asked if your mental health facility is closing down.

What are some resources to find another facility?

I would start, Jane, with your primary care clinician who typically was aware of all specialty resources in their area.

So that's a best place to start with your primary care clinician for your area if you have a therapist, usually a therapist would know but I'd start with primary care clinician.

Now if you have a psychiatrist, you have a mental health clinician by all means.

>> You know we start with them.

But primary care clinicians usually keep a pretty good idea and keep a pretty good handle on the mental health facilities in the area that are open.

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

Our next e-mail question Regidor revolver how do we as a family confront a loved one who really needs help to deal with a serious alcohol problem?

Subtle hints and positive encouragement has not really helped the situation.

I think it's time for you no longer to have the subtle hints and just have a flat out intervention.

You might have heard about those type of things but in my experience an intervention where you get as many people around your loved one who has trouble with alcohol use family friends let them know what they see is problematic in their behavior.

>> So if they're having trouble with doing some very irresponsible things while drinking these people in their presence during that time need to point that out to them in a very loving manner.

But you can't be subtle.

>> You can't be so you have to actually talk to them and say I'm seeing this this and this and this and I'm concerned about you for these reasons.

>> So alcohol use is a condition where it can affect the frontal lobe judgment.

So the judgment center of the brain is the frontal lobe.

Alcohol shuts that part of the brain down.

So these people who are drinking excessively and drinking to a problematic degree and getting themselves into trouble, they don't realize it's a problem and the more you drink, the more you need to drink to get the same good effect you're trying to achieve.

>> So many people drink and alcohol just don't realize it.

So if you have a loving intervention around them but it can't be settled, you have to be direct.

You have to be specific and let them know what you're seeing.

Now keep in mind that with alcohol use disorder now the ultimate goal is total absence from all alcohol.

>> But I think we can get some benefits with harm avoidance type of strategies where you're just trying to get them to cut down significantly on their drinking.

So if they are at a social event and they have one drink they got to keep it at one preferably they have no drinks at all, no alcohol in his drink soda pop or salsa or water or whatever.

>> But if they feel like they need to have one drink because of social pressure okay keep it to one and have somebody to whom they can be accountable to make sure they keep to one.

But the problem with alcohol use disorder for many people they have two drinks, three drinks and off they go and they're having excessive drinks and then they say things and do things that get themselves into trouble.

Thanks for your email.

>> Let's go our next caller.

Hello James.

Welcome to Matters of the Mind.

James, you mentioned your son has a problem talking to people in a social setting to the point where he gets visibly upset.

>> Is that a phase or something else?

I think you're describing his having some social anxiety where he's having difficulty interacting with other people now is that a phase?

Sure.

I mean young children four or five, six, seven years of age can go through a phase where they're very apprehensive about other people and quite frankly I noticed that to be particularly problematic following the covid restrictions.

>> I think one of the big catastrophic mental health consequence is of the covid restrictions where everybody was wearing a mask.

>> They couldn't be around people.

You had to be at least six feet away.

>> What was catastrophic about that was the effect on young children who were trying to develop their social skills and retrospectively I always wondered if that was going to be a problem once they got to be adolescents or young adults because they could interact with social media but they couldn't interact face to face.

>> And I was wondering would that affect their comfort level interacting with people face to face so that could be an issue there.

How do you get over that having practice?

>> I mean with adults there's a fantastic organization called Toastmasters that basically helps people interact and speak in public settings.

So as an adult Toastmasters is good but as a child or adolescent young adult get it and get your son in a situation where he can interact with people in a non-threatening environment and maybe talk through what he's learning with a specific homework projects now asking him merely how school go and in a very nonspecific way what you learn at school today that's might not do it.

But if he has if he's learning something specific that you know about and it's a history or something in literature, have him talk to you about it and with that practice within the family, the intention is for that to be extended as you get outside the family.

So if you go to a restaurant, make sure he in a very non-threatening manner maybe orders his own food.

>> Little things like that to practice often will be very helpful.

But going through childhood and adolescence you're learning social skills and yeah, that's the face and you have to learn them.

And with the covid pandemic, with the restrictions that were placed on our children, it was catastrophic for many of them and I found that a lot of them have extreme anxiety in social situations.

>> I'm hoping everybody gets over that but it's something that could be catastrophic for years for many people.

>> Thanks for your call us our next caller.

Hello Alex.

Welcome to Mars the mind molecule is there a sleeping position is better for your brain while you sleep, not for your brain.

I mean if people are pregnant their sleeping positions that are better for their hearts but not for your brain.

Alex, here's the exception though and it's a kind of an interesting exception if you have sleep apnea you shouldn't sleep on your back.

>> Sleep apnea where you're sleeping on your back can close off your airway easier if you have sleep apnea where you're snoring or you're pausing and your breathing at nighttime with sleep apnea you'll get less air flow to your lungs at night while you're snoring or pausing your breathing with less air flow to the lungs.

You'll have less oxygen to the brain with less oxygen to the brain the next day you can have depression, you can have fatigue, poor motivation, lack of enjoyment, things you can't think clearly.

I saw a person earlier today who had sleep apnea and that's those are the kind of symptoms they were having.

They came to me as a psychiatrist because they had a lot of depression.

>> Well, we can treat depression to some degree but if you have sleep apnea you need to get that treated and if you get sleep apnea treated within a month, typically you can have a dramatic effect in terms of your wakefulness, in terms of your concentration, even your mood.

You might still need an antidepressant for various other reasons but sleep apnea itself can be catastrophic for many people if they're sleeping on their back.

So that's why many people with sleep apnea, if they have it to a mild degree they can sleep on their sides and they can put a pillow behind their back and for the purpose of encouraging sleep on their sides if you do happen to sleep on your back a non in a very easy way to treat sleep apnea is to have your dentist perhaps mold you a mouthpiece that keeps the jaw tipped forward a little bit that helps with sleep apnea but again with sleep apnea if you're sleeping on your back that will compromise your airflow more.

>> But there's no really known position that is sleeping.

>> It helps the brain work better overall unless you have sleep apnea.

Thanks for your call.

Disconnects Caller Hello Dylan.

Welcome to American Mind.

>> Dylan, you want to know what's it mean to have the same recurring dream other methods that you can potentially manage your dreams?

>> You know, Dylan, dreams have been discussed for quite some time.

Dreams usually have some meaning and the meaning will often be symbolic of what's been happening in the past 48 hours in your life .

Now keep in mind, Dylan, that dreams in present day are not typically prophetic for most people now in some cultures they can be and I wouldn't dispute if they happened to be prophetic for people.

But generally dreams are not something that involves the people or the situations in which you're dreaming.

>> So dreams can be very symbolic and if you try to think about your dream immediately upon awakening and try to sort out what was that all about, you'll be able to sometimes figure out what the symbolism will be if you wait as little as 15 minutes your dreams are like a white erase board were the dreams will be erased very, very quickly your brain but what the dreams are are doing is basically they're allowing your front part of your brain to rest.

So when you're sleeping and you're dreaming the front part of your brain which is the thinking part of your brain them memory part of your brain, your your focusing part of the brain, the part of the brain that makes you pay attention really intently during the day that part of the brain goes to rest and at nighttime when you're dreaming that part of the brain is at rest and your dreams are very symbolic and people will often say if they don't make sense well they don't make sense because your judgment part of your brain, your logic part of the brain isn't working at nighttime and that's a good thing if you dream at night it actually fires up the library part of the brain, the the hippocampus goes down here in the temporal lobe and the library part of the brain actually gets fired up while you're dreaming.

>> So dreaming is good for the memory side of the brain.

That's why a lot of people in their early years with the Alzheimer's dementia don't dream and it's something that they just notice.

>> But part of the reason they're not dreaming is because their memory center isn't getting fired up as it should and that's why dreaming is actually a good thing for a lot of people.

>> Now what you don't want to have is nightmares if you have nightmares sometimes that can be indicative of a traumatic event the past.

But nightmares are problematic because your brain's too awake during the nightmares and they might awaken you overall and you don't get a restful sleep.

But dreaming in general is very, very good for the brain.

Thanks for call disconnects caller Hello Jose.

>> Welcome to Matters of Mind.

>> Jose, you want to know about the about the connection between seizures and deja vu seizures and deja vu can be connected with something called temporal lobe epilepsy complex partial epilepsy.

>> It's it would be a seizure disorder happening right the back part of the temporal lobe here.

>> This the part of the brain that if you have a seizure in this part of the brain electrical impulse, you can have a feeling where you know, you've experienced this kind of sensation before.

Now you don't have to have a seizure to have deja vu.

Deja vu can occur more commonly if somebody is fatigue if they haven't been getting enough sleep.

In other words, a brain hasn't been recharging and this part of the brain will kind of inadvertently fire and that part of the brain is right beside as I just mentioned, the memory center, the memory centers here on the hippocampus and if you have a part of the brain it's called the herup at the parahippocampal gyrus but that part of the brain is firing inappropriately.

It'll cause you to have a feeling and a thought that you've experienced exactly what you're experiencing right now.

>> So deja vu can be associated with seizures if it's affecting that part of the brain.

But deja vu can happen happened naturally for some people, especially if they're fatigued or they've lacked some sleep.

>> Thanks for your call.

Let's go to our next caller.

>> Hello Josh.

Welcome to Matters of Mind.

Josh, you want to know about Louis Taproom Capelet how it worked was treating schizophrenia and bipolar depression other potential side effects the side effects from Carolita 42 milligrams a day is the most common dosage tiredness.

I mean people will feel very tired with Carolita.

That's what we have them take it at bedtime typically.

>> But it's a medication that's entirely different than the other available antipsychotics antipsychotics in general will strongly block dopamine in various ways.

Capelet Aloma Barron is a whole different medication where it will go to the front part of the brain and block these particular receptors called serotonin Huai receptors.

There's 14 different serotonin receptors and one goes to a few blocks to a receptors no one you can increase dopamine in the front part of the brain.

That's the thinking part of the brain.

That's the mood part of the brain.

That's a good part the brain to fire up dopamine and indirectly it can decrease dopamine transmission down here in the limbic system which is the source for the hallucinations, delusions and a lot of problematic type of symptoms that people will have with schizophrenia.

So unlike other antipsychotic medications, it's just very, very at least blocking dopamine receptors at predominantly will block serotonin 2A receptors.

That's mainly how it works.

And the reason it makes you tired is because by blocking serotonin 2A receptors a side that can be fatigue and tiredness in general so 42 milligrams is the usual dosage I call the Jackie Robinson Robinson dosing Jackie Robinson had the number 42 no, that's the main dosage of La Tuta so.

Forty two milligrams the common dosage it does come in twenty one milligram doses and lower if you need a lower dosage overall.

But 42 milligrams is the most common dosage it's used for bipolar depression where people are having highs and lows particularly when they're in the lows.

>> No, not a lot of medications that we've been able to use on label or off label for bipolar depression without having people become more moody.

So with cap light it is something it can be used especially if they're having the lows but it can be helpful for schizophrenia is predominantly being used more for bipolar depression right now where people are having the highs and lows and they're on the low side Carolita will bring them up to the normal mood without eliciting them into the highs like a true antidepressant could do.

>> Thanks for your call us your next email question.

Our next e-mail question reads Deductive often is a sense of guilt normal following the death of a loved one I may have grieved for this loved one one loved one long ago when her health started to decline.

Now that she's gone I feel like I'm doing well other than a sense of guilt because I think maybe I should still be grieving.

Grieving is different for people based on their relationship with their loved one and if you have a loved one who's had an extended time of illness, you've kind of mourned their loss as they've gone through that extended time.

>> So you have time to grieve if somebody die suddenly in a traumatic accident that's often very, very difficult.

So you shouldn't feel guilty for not grieving the loss of a loved one.

No one based on your relationship with a loved one and number two based on your ability to be able to grieve the loss of that loved one over the course of time.

>> Thanks for your email usque our next e-mail question our next e-mail question read your daughter Fauver.

>> I've noticed a lot of professional athletes discuss anxiety during performance but I thought exercise was good for anxiety.

What's a difference and how can I help the student athletes I work with exercises great for anxiety but you're the anxiety related to performance anxiety is a quite a different phenomenon.

Performance anxiety is where somebody anxious when they're in front of people and these are the athletes who will do great in practice but they get in the game when they're around a lot of people that can be very, very anxiety provoking for them.

>> So I think for you to be able to coach them or be able to take them through those situations really emphasize to to them to have fun, just have fun and also it sounds weird but this tends to work for a lot of athletes to get their minds off of all the stuff that's happening, all the stuff that can go wrong, maybe have them sing a little song or hum something as they're playing their sport.

I know it sounds weird.

I use this technique for people who had trouble with anxiety on the golf course when they're putting and they're really nervous especially when people are watching I'll have them hum The Star-Spangled Banner or just sing Happy Birthday very softly other people might notice maybe they won't basketball players when they're shooting free throws if they can get their mind off all their other stuff, what happens is it takes your mind off from the brains thinking part of the brain and if you think too much when you're an athlete you'll attentive freeze up and you won't play so well.

>> But if you just allow your muscle memory to go to work, which is a whole different part of the brain, you can play more naturally.

>> Michael Jordan was a master of this.

He wouldn't get anxious.

That's why he was always such a clutch performer because he said he'd get in the flow of things and he could block out everything else and allow his mouth muscle memory to do the job.

>> So if your athletes are particularly doing well in practice but yet when they get around other people that's another phenomenon.

>> Yeah.

Do things to take their minds off the name of the game.

>> Let him emphasize to them I hear coaches do this all the time just to go out there and have fun and enjoy themselves and imagine themselves being in a practice so that they don't think so much about the other people.

>> Thanks for your call unforced.

I'm out of time for this evening.

If you have any questions concerning mental health that I can answer on the air you may write me via the Internet at matters of the mind all one word at WSW ECG I'm psychiatrist J Forward.

>> You've been watching matters of the line on PBS Fort Wayne now on YouTube God William PBS will be back again next week.

>> Thanks for watching.

Goodnight