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>> Good evening.

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

Welcome to Matters of the Mind.

Now in his twenty sixth year 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 if you're calling long distance 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 that I can answer on the air or you may write me a via the Internet at matters of the mind all one word at WFA that's matters of the mind at WFA EDG And let's start tonight's program with an email I received this week.

>> It reads Do Dr. Fauver is religious trauma a recognized condition?

>> I've had trouble finding therapists who understand both my background and safe ways to integrate my current faith.

I'm not sure I trust faith based therapists.

>> Any advice what you're talking about religious trauma which I believe refers to evil deeds committed by men and or women in the name of God and a religious community.

Now that's something that can cause people to be very traumatized later on because they have trust and faith in these people who are doing their deeds in the name of God, the ultimate authoritarian figure.

>> So is kind of like being abused by a parent in that regard.

You have a lot of trust in these people and here they are sexually, emotionally or physically abusing you and that's the kind of trauma that can lead to have people having post-traumatic stress disorder where they later on feel very, very anxious and hyper responsive when they get in that kind of environment and they start having an unwillingness to maintain their faith and it can significantly impact your relationship with God.

So with that in mind, what's the first thing you can do?

Try to find people who have had a shared experience as Eurus and that's sometimes difficult to do but try to find people who understand the faith that you were previously the faith community in which you were previously engaged and who have endured similar experiences.

>> I don't want to go into details and I'm not going to mention names of therapists who you could see but there are therapists and people in particular religious communities who have indoor word trauma and they've gone through the type of experiences as you've described.

>> So that's a good start if you have difficulty with through post-traumatic stress disorder where you're hyper vigilant, you're always on edge, you're having nightmares to this day, you're having difficulty with avoidance of people in situations and it's affecting your relationships with others.

>> That's post-traumatic stress disorder and is warranted for particular kinds of individual therapy toward those particular symptoms as well as certain medications that we will use.

>> But finally, you know, should you go through faith faith based therapy, faith based therapy would be for the purpose of trying to bring your back to objectify your relationship with God.

Don't don't relate how you are in a relationship with God based on your experience with these particular people who are obviously in a very bad situation providing exhibiting evil deeds in the name of God and that puts them in a position where they're going to be accountable themselves.

>> But for you it's important that you maintain a good healthy relationship with God despite what you've gone through in the past.

>> Let's put our next caller.

>> Hello, Dawn.

Walking to matters of mind.

>> Well, Don, you want to know if environment is a big cause of mental health disorder?

Dawn it's estimated that the environment itself is probably anywhere between 30 and 60 percent related to mental health conditions for depression, for instance, is thought to be about 70 percent environment for bipolar disorder where people have manic depressive conditions that can be responsible for maybe 40 percent environment can be responsible for about 40 percent of that condition for ADHD that's thought to be about 20 percent environmental but there are genetic factors but the environment goes back to childhood now when I say going back to childhood we're talking about going back to before eight years of age.

So before eight years of age people can be very influenced by sexual of emotional physical abuse.

And your relationship with your parents at that time is a very, very strong we'll have a very strong impact on how you relate to others in your life .

Authoritarian figures as well as interpersonal relationships.

So prior to eight years of age your brain is very much still growing and you're getting hard wired for how you'll be able to adapt to stress.

>> So yeah, early on we are hard wired with our genetics but your genetics can be strongly influenced and molded in those very early vulnerable years and this is why with the previous email, you know we have to talk about how trauma within a religious community can be so impactful for somebody later on and how they can trust authoritarian figures and even have a trust in their faith in God.

So it's important for us to understand that those early childhood environmental traumas can be a big factor on how we cope with things later on.

So as we learn to cope with traumatic situations that can actually strengthen you over the course of time, people who have never learned how to cope with traumatic experiences can sometimes be crippled with similar traumatic experiences in the future.

If you've dealt with experiences in the past you've overcome them.

It gives you confidence and a any knowledge of an awareness of how you're going to be able to respond in the future.

>> So genetics will be a factor early childhood experiences can be a factor.

>> Your ability to cope will be a factor and then as you go through life what's happening around you can be somewhat of a factor after you've been hard wired with genetics with early childhood experiences and early coping experiences as you go through life you can have stuff happen now stuff happening means it's a stress if it's if it's any change in your environment it's a stress now there are good stresses.

We want to have good stresses that keeps us keep us strong and keep us alert.

We don't want to go through every day where every day would be exactly the same that would actually make us kind of lachsa days ago and it wouldn't make us very interested and excited about going through life every single day was the same.

So we expect new things to happen day by day and by definition that's a stress.

The question is is the stress overwhelming for you?

If the stress is overwhelming for you and cripples you, that's where it can cause you to have clinical symptoms of depression or anxiety and that's what we'll often treat in the psychiatric field when somebody is crippled by the disturbance in their mood, their anxiety due to environmental stresses that are often occurring now as you go through life and you have more episodes of depression and you have ongoing difficulty with anxiety, less stress is necessary to kick you off into another mood or anxiety disturbance.

So as you go through life you'll notice that if you've had difficulty with more of these mood and anxiety disturbances you're more likely to be vulnerable to stresses in the future.

So for that reason it's important for us to help people cope with stress and cope with changes and that's the whole concept of psychotherapy.

>> But the the underlying treatment with from a medication standpoint, from a biological standpoint is very important as well.

>> And I often describe a scenario where if somebody's driving a car somewhere, if you're driving a car you're pushing on the accelerator and you're pushing on the brake.

The accelerator is like this particular neurotransmitter that's the gray matter of the brain.

The outside of the brain glutamate glutamate is the accelerator.

GABA is the brakes 70 percent of GABA is attached to glutamate.

So you got brakes attached to your accelerator so you're getting acceleration in the brain, you're getting braking in the brain and then you have these three chemical serotonin ,norepinephrine and dopamine which come from the brainstem down here they project to the outside part of the brain and you've got the glutamate which is accelerator the gabbers, the brakes, serotonin, norepinephrine and dopamine are kind of sitting in the passenger seat giving advice and telling the brain to either speed up or slow down serotonin being more prone to telling the brain to calm down a little bit dopamine and norepinephrine being more prone to get the brain more fired up.

>> So the neurotransmitter serotonin, norepinephrine and dopamine have their roles and we've been focused on those particular neurotransmitters for the past six decades.

But now we're talking more about going directly to the gray matter and affecting dopamine or I'm sorry affecting glutamate and GABA for that matter.

So serotonin, dopamine and norepinephrine are influencing glutamate and GABA but glutamate and GABA are the accelerator and the brakes respectively.

Now what's the role of therapy?

What's the role of the talk therapy itself to talk therapy is actually helping you steer in the direction of your ultimate navigation now from a navigation standpoint we all need a purpose.

We all need an eventual intense of where we're going in life .

>> We need to be navigated there.

The idea of talk therapy or psychotherapy is very important because it is helping you with steering.

>> So when you're in driver's training and you're learning how to drive a vehicle, you're taught how to accelerate, you're taught how to slow things down.

You've got the driver's training teacher beside you or might be your parent but they're actually giving you advice on speeding up or slowing down.

But very importantly they're helping with the steering.

They're helping you navigate the particular road and get to where you need to be.

And the ultimate goal is what we all need if you lack purpose and if you lack goals in life , you're more likely to get depressed and you're a lot more likely to have trouble with just having a sense of purpose .

We all need that eventually.

But the idea of talk therapy or counseling is to help you with the steering of getting where you want to go.

>> Thanks for your call.

Let's go next caller.

Hello Shauna.

Welcome mastermind Oshodi asked Is there an alternative to alternative to risperidone that used to be called Risperdal as a brand name medication risperidone is a medication that blocks dopamine and has a lot of other effects as well.

>> You're mentioning that with risperidone you're sleepy during the day and you can't sleep at night.

Well in that case it might not be the best medication for you if you're having those kind of troubles you can always talk it with your primary care clinician or the prescriber who's giving you the risperidone but risperidone is medication.

It came out about nineteen nineteen ninety two or so nineteen eighty four.

>> It's been around for about thirty years and it's a medication that blocks dopamine but it also has effects on serotonin and to a lesser degree histamine and it effects various other neurotransmitters but it's a it's different from the older medications like Haloperidol or Haldol which primarily just block dopamine but risperidone is used for a lot things.

It's used for psychosis but it's also used for mood stabilization with bipolar disorder sometimes people will use that as a very small dosage is an add on to help somebody be able to help them with her mood with an antidepressant medication risperidone can also be used for something like stuttering so risperidone has a lot of different features and it can do a lot of different things.

>> But if it's causing it to be sleepy during the day and you can't sleep at night, yeah, you might not find that it's going to be a good medication for you.

Now if you said you were sleeping at night and you're sleepy during the day, I'd certainly say just off top of my head you could probably benefit from a lower dosage of it.

But I take it you're trying to use the risperidone at bedtime to sleep and you can't sleep at night but it's causing you to be awake during the day now sometimes risperidone as a side effect will cause something called a akathisia.

Akathisia is a phenomena where you have a hard time sitting still.

So when I see somebody in my bed I've seen something in my office in the past with Akathisia they'd be pacing the whole time and they couldn't sit still even with telehealth where I'm treating people now with telehealth they're often having a hard time sitting still during the interview and that's called akathisia.

It's a horrible feeling to endure and it's due to tight dopamine receptor blockade when you tightly block dopamine receptors you will cause you to have a hard time sitting still and sometimes people misinterpret it as anxiety.

>> So what do they do?

They increase the dosage of risperidone or haloperidol or whatever is causing them to be restless and anxious.

That's the worst thing you can do because that'll typically make the Akathisia worse.

So you have to identify is it akathisia or is it nervousness from anxiety because both can come across pacing but with akathisia people will say they don't feel anxious emotionally .

It's just that they can't sit still and that's a side effect of risperidone.

I bring that up because sometimes people will say they can't sleep at night time because they're so restless and they have that akathisia phenomenon from the risperidone and then they're pacing all night and then because they didn't sleep very well at night they're sleepy the next day.

>> So there are different reasons why somebody might not be sleeping from risperidone but yet they're tired the next day there are so many different medications from which we can choose nowadays though Risperidone was one of the first newer medications to come out that didn't just block dopamine.

Clozapine was the first one that came out then the risperidone was the next one came out in the 1990s.

The nineteen ninety six we had Zyprexa or Olanzapine come out nineteen eighty eight we had Kutya Pain or Seroquel walking out and then we had other medications since that time and they work in different ways so depending on the nature of your problems for which the risperidone is being used you could try a different type of medication to talk it over your prescribing clinician.

Shawna, thanks for your call.

Let's go to our next caller.

Hello Maratha Mary Cynthia, welcome to Matters of the Mind Mary Anthea Mann Mary Anthea, you had mentioned the traumatic brain injury.

If you have a traumatic brain injury, is it possible that a prescription will not work treat mental health disorders?

>> It depends with a traumatic brain injury if the traumatic brain injury was the cause of mental health disorders or if a person already had mental health disorders then they had a traumatic brain injury.

>> We've seen some people who have endured a covert infection quite frankly and after the covert infections, their medications for depression or anxiety might not work as well.

And we consider that somewhat of a traumatic brain injury, a traumatic brain injury by nature that injury to the brain where well you think about a concussion for instance, where the brain having the consistency jello kind of bounces around this thick skull of ours and kind of gives you a brain bruise when you have a brain bruise you have this exceeding amount of glutamate.

>> I mentioned that earlier glutamate being the accelerator or brain exceeding mouse of glutamate can cause you to have trouble with irritability, moodiness and poor concentration so you don't want too much glutamate in your system.

>> So what do you do while you give medications that might stabilize glutamate and do so in a different way than the traditional serotonin medication?

So we might give an anti seizure medication like Lamictal or Lamotrigine which stabilizes glutamate following a traumatic brain injury.

Now if somebody had covid specifically and that's why clinicians rolfing often asking did you feel worse after you experience covid most people have experienced covid at some time so we're asking them did you feel emotionally and physically and even mentally worse?

Did you have more trouble thinking after you experienced covid if that was the case?

We're thinking about certain medications now that might be more helpful for those kind of symptoms if you have a lot of trouble with energy and concentration for instance, we're thinking about using telex or various quite a bit.

Trin talks has been around for ten years now but it's used specifically for depression.

But we have we have an observation that it helps also with speed of processing of information so it basically improve your Internet speed in your brain and it allows you to think through different things more quickly and that's something that people are often lack after lacking after they have covered if you've had covid and you have a lot of difficulties moodiness and anger and irritability and it's kind of lingering for months by month by month we might add on a medication like Lamotrigine that stabilizes glutamate.

So it depends on what kind of symptoms somebody will have.

But we've seen scenarios where somebody has a traumatic brain injury and they've had a concussion and thereafter they have trouble with fatigue, poor concentration.

They don't enjoy things.

They lack motivation.

They have trouble sadness with those kind of scenarios we're going to treat the primary problem in the traumatic brain injury first and foremost if you already have symptoms of depression or anxiety and they didn't they didn't do so well following a traumatic brain injury or they got worse then we might add on something to more specifically address the after effect of the traumatic brain injury on your underlying mood or anxiety disturbance.

>> Murietta, thank for the thank you for the call.

Let's go to our next caller.

Hello, Tony.

Welcome to Mars the mind.

Tony, you mentioned you suffer from winter depression and you take the lacrosse teen you recently heard that started having ringing in the ears and wondered if that could be a medication side effect Tony.

If you start having ringing in the ears from any medication even though it might be rare from that medication, it could be from that medication.

>> So I'll often advise people under their clinician supervision to try going off the medication for about two weeks and see if the ringing in the ears go away now with ringing the ears for winter depression more commonly we hear about that with bupropion or Wellbutrin Tony bupropion or Wellbutrin is used for winter depression.

It's primarily affecting dopamine and norepinephrine.

It's has half of the potency of a stimulant in that regard.

It's not addicting but it can give you an energizing activating kind of feeling.

But about one out of twenty people on bupropion can have a ringing in the ears.

It's kind of a buzzing HIGH-PITCHED sound and you go off the bupropion typically it goes away.

It can happen with delux team.

The good thing is, Tony, there's a lot of other options out there and even though you have ringing in the ears on Dellucci team also known as Cymbalta, you might not have ringing the beer in the ears with bupropion keeping in mind the Dellucci and bupropion are entirely different medications so you could try something else that might decrease the ringing in the ears.

But the first question would always be is a ring ringing in the ears from the medication?

>> Usually if ringing in the ears is from medications is going to be both sides bilateral it's going to be on both ears.

It's not going to be on just one ear or another if it's on one ear or another.

Typically it's from an inner ear problem or something that an ear, nose and throat clinician would be able to address.

>> Tony, thanks your call let's go to our next caller.

Hello Beth.

Welcome to Matters of Mind.

Beth, do you want to know if children benefit from seeing healthy relationships and if so, how can you model that as a single parent?

You bet, Beth.

I mean, as I've mentioned before, if you have traumatic experiences prior to the age of seven or eight years of age, that's very, very impactful for a child.

Children are going to notice how you interact with other people including other loved ones or former loved ones in a sense that if you have if you're in a single if you're in a single relationship, if you're if you're a single parent and you still have a hostile angry relationship toward the father of the children, the children are going to pick that up.

>> So you don't want to model that and you want to be able to suppress whatever anger or irritability you have toward the parent for those children themselves.

>> So the best way to model it is be maintain healthy relationships yourself and try to remember that you're always the parent and they're always watching you.

Children have a tremendous ability up to the age of twenty four to download New information and much of that is by observation.

The right front part of the mirroring behavior.

So children are like those little animals you see that are mirroring the behavior of their parents.

Children can mirror behaviors of the parents and they remember that and that's why you'll often hear about children as they become adults.

>> They take on the traits sometimes unknowingly of their parents and some of those traits they don't want to take on but they do naturally because when you're a child you will often model behaviors that you've seen as a child and you go through life and you start to emulate those kindpof behavis where you've learned them now part of the whole idea of therapy and that's the learning how to drive where you're using the steering wheel part of the idea of therapy is try to unlearn some of those behaviors and be aware that you've picked up some of those unwanted behaviors from your parent.

>> You want to pick up the good behaviors but you want to do away with the unwanted behaviors.

Beth, thanks for your call.

>> Let's go our next email our next email reads Dear to the favor I've been self medicating with marijuana for my stress.

I've tried counseling and it doesn't seem to do that well what can I do?

Well, marijuana especially under the age of twenty four years of age will tend to suppress the growth of the white matter of the brain all over the brain we have this white matter white matter is known as myelin.

Myelin is basically the insulation for the individual neurons.

>> So you have all these billions of individual neuron branches out there and under the age of twenty four years of age especially your brain is still growing and if you use marijuana before the age of twenty four years old it's very likely that you'll suppress the growth of the white matter of the brain and that has been shown in some studies actually decrease your expected IQ as you get older and there's more recent debate saying that even if you start using marijuana in your middle age years, your 30s or 40s, it also seems to have an impact on your ability to think and have have reasonable memory.

So marijuana THC is something that can give you a calming effect on.

Many people will say it's great for sleep.pThey'll say it relie.

Pain does a lot of nice.

It has lots nice benefits for people.

>> But if it was to be approved by the Food and Drug Administration today with a same scrutiny as other medications are approved, it probably wouldn't pass because when medications are approved by the Food and Drug Administration, not only do they have to be shown to be effective.

Number two , they have to be shown to be more effective than other things on the market, especially in Europe.

They always have active competitors but number three, how are they do with short term safety issues and long term safety issues, long term being at least a year if marijuana was assessed to that level of scrutiny I think that the safety issues would probably make it disallowed by the Food and Drug Administration mainly because of the difficulty with cognition, the slower reaction time, the poor memory, the decreased speed of processing all these things would be hazards that would probably not allow marijuana to be approved.

Now you can always make the argument while alcohol, tobacco those are dangerous as well.

They are.

But I think we have to have that discussion when we talk about the use of recreational marijuana, is it safe or is it not?

I think we can clearly say it's not safe for people under 24 years of age.

>> So that would be a motivation for coming off of it.

So we have ways to help people get off of it when we have people get off of marijuana we'll always ask them why are you using it now if people are using just recreationally and they're using it only when they go to different parties usually it's not a problem for them and they can get off of it if they truly want to.

But many, many people will use marijuana because they'll say it's the only thing that helps me the anxiety OK, that's that's a place to start.

>> We can look for other types of medication to help with anxiety.

>> Many people when they start using marijuana as early as thirteen or fourteen or fifteen years of age have not learned adequate social skills because if you use marijuana at 13, 14, 15 years of age you get to a point where you don't care and it makes you more apathetic and you don't learn that normal social anxiety that we all have to learn as adolescents going through adolescence should be anxiety provoking if using marijuana during those years you just don't care and you go through those years not caring.

>> So I'll often see somebody in their 30s early 40s who might have the emotional maturity of an adolescent because they never learned the social skills that are necessary to overcome social anxiety that we should have all learned when we're adolescents.

So will often deal with the reasons why somebody might be using marijuana if using it more for sleep we might go with a different approach.

If you're using marijuana to help with depression, many people will say they feel depressed so they want to use marijuana for that reason that will help us decide which direction to go with medication not addictive medication.

We don't want to trade a benzodiazepine for marijuana so we don't want to give somebody Xanax, Ativan, Valium, Klonopin for the purpose of helping them get off marijuana.

We have safer means of getting around that.

So I think it all comes down to what the issue is in terms of the reason for why somebody be using marijuana and then go go from there.

Getting off of marijuana with heavy use can cause a lot of difficulty with nausea and people can have extreme anxiety and insomnia as are coming off marijuana.

So we want to be sensitive to that and help people get off of that.

Thanks.

You're well, let's go.

Unfortunately we're out of time for this evening.

If you have any questions that I can answer on the air, you may write me via the Internet at matters of the mind all one word at WFA dot org and we are also now available on YouTube in between episodes.

>> I'm psychiatrist Jeff Oliver and you've been watching Matters of the Mind on PBS Fort Wayne God willing and PBS willing.

>> I'll be back again next week.

Have a good evening tonight