.

>> Good evening, I'm psychiatrist Jeff Offer live from Fort Wayne , Indiana.

>> Welcome to Matters of the Mind.

Now in his 10th year Matters of 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 here in the Fort Wayne area by dialing (969) 27 two zero or if you're calling a place coast to coast you may dial toll free at 866- (969) to seven to zero.

>> Now on a fairly regular basis we are broadcast live every Monday night from our spectacular PBS Fort Wayne studios which lie in the shadows of the Purdue Fort Wayne campus.

>> And if you'd like to contact me with an email question that I can answer on the air, you may write me via the Internet at matters of the mind all one word at ECG that's matters of the mind at WFA ECG and I'll start tonight's program with a question I recently received it dirt and if I had a tough time the past few years but I'm hopeful things are on the upswing a much happier than I have been.

>> But there's still a bit of anxiety and depression several days of the week all of this has me wondering if good mental health equals happiness.

>> Is that a fair expectation?

Well keep in mind that happiness, anxiety, sadness, anger, apathy those are all normal emotions that should occur based on your life circumstances.

Otherwise if you're perpetually happy and joyous, why you wouldn't appreciate the downswings you'd be constantly on the high and you wouldn't appreciate the downtimes and the downtimes kind of help us remember what it's like to have the good times and it gives us a gradient of the mood valence so to speak.

So yeah, it's expected we're going to have some good days and bad days and again it's usually based on life circumstances where it's a problem with a mental health issue will be if it's causing you functional impairment and if the moods are unnaturally up or down angry whatever on a day to day basis no matter what the circumstances and that's what we call functional impairment.

>> Functional impairment will be where it gets in the way of your work, your socialization, your marital relationship and you're actually having problems on a day to day basis getting out of bed, getting things done, doing what you need to do so having some anxiety, having some depression here and there.

>> It's really OK. Anxiety is a matter of fact can be very motivating.

It's good to have anxiety for instance as a student before an examination because anxiety will fire up your thinking part of your brain and help you kind of get through that exam and studying process necessary to do it.

So if you have something as an expectation coming up having some anxiety around that expectation is fine.

>> It actually fires you up feeling sadness periodically.

Well, that's really OK. too.

>> If it's something you're grieving or something where you're disappointed in how an outcome might have evolved, it helps you realize that you might not be in control of things yourself, helps you kind of re-adapt your goals and your thinking and gives you a point and maybe in a different direction.

>> So having moods that might not be comfortable temporarily is really OK having those kind of moods and having that experience is fine.

It's just that if it's there more often than not that's where it's becoming a problem for people.

>> Thanks for your email.

Let's go to our first caller.

Hello Dan.

Welcome to Mary's Mind.

>> Dan, you want to know about my thoughts on eliminating ADHD medication?

Are there actual solutions or exercises to help with for focus what I think about ADHD, Dan, I often think about nearsightedness.

Some people need eyeglasses all the time because it corrects their vision.

>> You mentioned helping with focus.

I don't think talking about how big the focus for vision if you need eyeglasses to correct your vision on a day to day basis now they can be very, very beneficial if you don't need eyeglasses on a day to day basis and you only need them for reading.

>> Yeah, maybe you can just use them every now and then.

ADHD is a similar phenomenon.

It's where people since childhood on more days than not will have trouble with attention span focus distractibility, getting things done, prioritizing things, having vigilance in getting something started then getting done.

>> People with ADHD will often be fairly impatient you know from a behavioral standpoint ADHD would be fine if you're a hunter because as a hunter you're going to notice things other people might not notice so it can be very adaptive in certain situations.

So ADHD I think is controversy whether it's a disorder or not, it's probably a character trait where some people will have more difficulty in some areas and others people with ADHD often will do very well in exciting, challenging, innovative kind of situations firefighting, law enforcement, computer programing sales these are people people will often be in those kind of areas with ADHD because things are happening very quickly and when they do a whole different part their brain will kind of kick in.

So what kind of things can you do naturally for ADHD without the medication if the medication is necessary?

>> OK, make sure you get on the right medication fine.

Tune it as well as possible because the problem with ADHD medication could be if you get too high of a dosage or too low of a dosage it won't work so well.

>> So it's like eyeglasses.

You got to get the right lens strength on eyeglasses to get the proper visual focus with ADHD medications you also have to get the right dosage strength on those.

But what can you do otherwise you can identify the areas where you really struggle if it has to do with paperwork which is a big problem for a lot of people with ADHD get the paperwork done, make a list list making is wonderful for people with ADHD because it helps them prioritize.

You're not going to do anything else until you get the first thing on your list you don't want to do it.

>> It's boring.

It's not challenging but you've got to do it so get yourself the mindset that you're going to take have a list and you're going to prioritize things on those lists and don't go on to the second third things until you get the first thing many people with ADHD will get started on something fight a not so challenging or get kind of bored.

They go to something else, they go to something else.

They'll have four and five different things going on at the same time but nothing is getting done so make a list of things and challenge yourself to get get it done.

Secondly, you can physically exercise your physical exercise is remarkable for ADHD and in some schools years ago they took away recess and with recess you know it's time for kids to go out and have some physical activity that was devastating for a lot of these children with ADHD because they couldn't basically burn off some of their extra energy.

>> So with ADHD it does help to exercise.

It calms the brain and can help a person focus a little bit more adults.

What can you naturally do on a regular basis?

You can make the list.

You can stay more physically active and check in with other people based on to determine how you're coming across and don't be the first in the room to give suggestions if you're in a meeting for instance, I often recommend people with ADHD to have a cup of water or some kind of beverage in front of them and before they want to blurt out something because they know what everybody's thinking presumably try to take a sip to think for a few seconds they're don't blurt out something even though it comes to your mind because people with ADHD not uncommonly like people with autism will often have a different networking in their brain.

They think differently, be aware of that and try to compensate accordingly.

>> Dan, thanks for your call.

Let's go next caller.

Hello Jill.

Welcome to the mind.

Joe, you want to know is there any relationship between bipolar disorder and hoarding not a direct relationship between bipolar disorder and hoarding?

Hoarding is where you collect things unnecessarily.

Bipolar disorder is where you'll have unnatural highs that can be characterized not only by euphoria or really happy feeling.

Sometimes people have irritability and they have the highs but those highs will go on for several days.

They'll don't need to sleep so much during that time they'll be more impulsive.

>> It could be vaguely related if you become more impulsively hoarding during that time but you usually don't hear that direct connection hoarding used to be a thought to be a characteristic of obsessive compulsive disorder.

Now hoarding is kind of in a category of its own where people are unnecessarily keeping things.

They have trouble throwing them out.

They kind of have an emotional attachment to all these different things they've collected so they don't want to get rid of things bipolar disorders where people will have the highs and then lows lows will be where they don't want to get out of bed.

They socially withdrawal.

They're very, very sad during that time.

So there's a highs on where they go to the mountain top and the lows where they go in the valleys with the mood hoarding is entirely different.

>> Thanks for your call.

This our next caller.

Hello Sally.

Welcome to Matters of Mind.

>> Sally, you're mentioned you're going through menopause and you're having a lot of brain fog.

Is there anything you can do or take for a mental clarity?

>> Sally, brain fog is very common during menopause because this little area here called the hippocampus it's the memory storage center of the brain that's studied with little estrogen receptors and when you are going lower on your estrogen as you go into menopause average age used to be a fifty one.

It might even be younger than that now.

But when you go into menopause your estrogen level is going down, down, down, down, down with less estrogen you have these little receptors just starving for estrogen.

They don't have so you can't think so clearly so mental fogginess will be a common characteristic.

What can you do naturally I wish I could tell you to take this or that supplement doesn't work that easily.

Physical exercise does help for anybody with a mental health issue but taking natural supplements may or may not help from a medication standpoint if the brain fog is significant with depression which sometimes will accompany menopause we're having particularly good luck with medications.

They're kind of more activating and energizing perhaps like trend Wellbutrin also known as Bupropion Antioch's also known as Vaud Oxytocin.

Those are the main medication we're using right now for menopause.

They're activating and energizing but they do seem to fire up the ability to concentrate.

>> Keep your mind on things a little bit better.

Thanks for your call.

Let's go our next e-mail question our next e-mail question dear Dr. Fauver, I have had several hobbies and activities in the past that I often enjoyed lately I find that I am much less excited about these things.

I would rather just watch television most evenings.

Is this a sign of depression or other mental illness?

You've got to be careful about kind of withdrawing and watching television into the evenings even if it's PBS because you got to maintain hobbies and interests.

You've got to maintain pleasurable activities because a risk factor for getting depressed we're talking about sustained depression, unnatural depression day by day by day for at least a couple of weeks a risk factor for getting depressed will be not having pleasurable activities.

So if you enjoy doing certain things, try to get yourself back into doing those certain things even though you might not feel like it in Indiana we don't embrace winter like they do up in Norway and Denmark where they try to get more active and they try to get more excited about different winter activities and then they look at winter is as a time where you can be more relaxed in getting things done.

There's not as much yard work to do.

You can get more reading that you can do hobbies in the winter you probably wouldn't have time to do in the summer.

So we need to embrace that in the wintertime as opposed to getting depressed because it's winter.

>> So it's important to maintain some kind of pleasurable activities.

I will often ask about pleasurable activities for many, many people because I find that when people get depressed they give up having fun, they give up their pleasurable activities.

>> If you watch television it's a very passive type of activity.

You're watching there.

You're not really using your brain a whole lot.

You're not thinking so much when you're watching television because you're not interacting with the television.

So you have to be careful about that passive type of activity not only as Dolz but for young adults, adolescents and children at all ages passively watching television can be problematic in terms of really exercising the brain.

>> Thanks for your email.

Let's go to next caller.

Hello Ben.

Welcome.

The mastermind then you'd mentioned your nursing and energy or nursing and injury and your prescribed steroid medications.

Will that interfere with your anxiety medication?

So as a side effect of the steroids can be jitters?

>> It depends, Ben.

Some people myself included if I take a steroid I don't need to sleep so much.

It's kind of an energizing revved up feeling so I always am careful not to do anything financially when I'm on steroids for a back injury or something like that.

So it's different for different people.

Some people get more depressed with steroids.

Some people do get anxious with steroids.

You have to kind of play it by ear.

It can be dose related if the steroids are causing you more anxiety, your clinician can give you medication temporarily that will actually help with the anxiety related to the steroids if you already have anxiety and then you take steroids, you have to be very careful.

Are the steroids kicking up the anxiety or the steroids provoking an underlying condition called bipolar disorder where some people won't have big highs or big lows unless they're on steroids?

So if it's doing that, sometimes a mood stabilizer is necessary.

So talk your clinician about the possibility of you taking a medication to offset the side effect the steroids steroids can be phenomenal for back injuries, for discontinuations, for skin conditions, for asthmatic conditions.

So they're very, very helpful.

Fortunately they typically are just used for a short period of time.

But if you do have side effects or in that time talk to your clinician about giving you some rescue medications to take care of those extra side effects from the steroids themselves.

>> Thanks for your call.

Let's go next caller.

Hello Sharon.

Welcome to Arizona.

Mind Sharon, you mentioned your grandmother's having has bipolar disorder now as is experiencing dementia.

>> What's the connection and should you be concerned about developing that when you're older?

Sharona's two conditions there.

Bipolar disorder is a mood disturbance where people have highs and lows.

There's no direct connection between bipolar disorder and dementia.

However, Sharon, if you have untreated depression which is the valley of bipolar disorder, untreated depression can increase the risk of dementia after sixty five years of age by four times.

>> So if you have untreated depression it can increase the likelihood of dementia by over four times.

What's the connection between bipolar disorder and dementia if you have untreated highs and lows?

Yeah it can be somewhat stressful to the brain.

We see the same thing with psychosis where if you have psychosis you have an excessive amount of this chemical called glutamate too much glutamate can be problematic and too much glutamate is like putting too much salt on your food.

>> It just causes more problems and it helps.

>> So to us glutamates like having too much fertilizer in your lawn it can actually cause damage.

So excessive glutamate can occur when people are having manic episodes, when people are having psychotic episodes in those kind of situations it can precipitate dementia.

>> Bipolar disorder itself is about 10 percent genetic 90 percent not genetic if you have a grandmother with bipolar disorder but your mother and father or brother and sister don't have bipolar disorder, you're less likely to have bipolar disorder yourself.

Dementia has a genetic component but the number one risk for dementia is getting older.

So as we all get older our risk for dementia increases.

>> There is a particular genetic risk factor called an apolipoprotein E two , three and four gene and if you have a particular configuration of those genes it can put at a greater risk for dementia if you have apolipoprotein E for an E as two genes that put you at a higher risk for dementia compared if you have three or E two .

>> So yeah, there's a genetic component.

What can you do to prevent dementia?

>> Try to stay physically active?

I think it's a third time I've said that this evening so staying physically active can decrease your risk of dementia, staying intellectually active, trying to learn new things.

I always tell people that going into retirement can be detrimental if they're not going onto a new chapter in their lives where they're doing more things and trying to learn more things are still socializing.

They're still around people.

They're still active in terms of their thinking on the day to day basis.

So staying intellectually active will often be helpful.

Be careful to keep your blood pressure and blood sugars in check because high blood pressure, high blood glucose over the course of time can actually be a risk factor for dementia.

>> So you know, you can't do anything about your genetics but you can do all you can to try to decrease the likelihood of those genetics being problematic for you later on.

>> Sharon, thanks for your call.

Let's go next email question.

Our next email reads Dear Dr.

Carver, if someone stops taking antidepressants because they don't feel like they need them anymore, will that person have withdrawal symptoms?

Well, let's talk about those two questions in one there.

OK, let's talk about the withdrawal symptoms first.

Certain medications can give you withdrawal symptoms because they get out of your system very fast.

You can have worsening withdrawal in order I'd say probably paroxetine or Paxil could be the worst followed very closely by Venlafaxine or Effexor and then probably the Venlafaxine known as Stik.

If you go off of that too quickly and to a lesser degree the so-called SSRI Lexapro also known as escitalopram Citalopram known as Celexa they can give you some difficulty with withdrawal to some degree the medication is less prone to giving trouble with withdrawal to use or trade names would be true until Prozac although it probably wouldn't that much so there are some medications that get to your system more slowly so it depends on which medication you're taking to determine how slowly you come off of it.

>> If somebody is on Prozac or or perhaps all Valide I might have them go off the medication abruptly if they wanted to stop it for whatever reason but on Effexor or Venlafaxine I might taper them off over the course of three weeks just to make sure they don't have withdrawal.

What's the withdrawal like?

It's like experiencing zings and zaps in your hands, feet and scalp.

>> That's the most troublesome aspect of the withdrawal.

Many people can get dizzy when they are going off of an antidepressant so quickly they can feel kind of buzzed in their head.

So we'll have them slowly back off on how quickly they're coming down the medication.

>> So that's the second part of your question.

The first part is if you're feeling well you can you go off your medication.

>> It depends on how many recurrent spells of depression and how problematic they were in the past.

>> If you've had just one or two spells of depression and they came on when something really bad was going on in your life but the spells of depression went on for a week or two and they didn't cause you to lose your job or have a lot of problems with people around you.

But they were there and it was annoying.

>> You might be a candidate to go off the antidepressants, stay off the antidepressants if you've been doing really well for a long time, if you're only doing partially well and you're responding to the Depression but you're doing better but not well, you're more likely to have a relapse into depression and going off of it.

>> So if you're doing well, you had fairly mild episodes of depression in the past and especially if you don't have anybody in your family who's had any depression ,depression is about 30 percent genetic.

>> So if you have something in your family with depression you're more likely to endure recurrent depression.

>> So that's the bad news.

The good news is we do have some medications coming out now that are affecting not just serotonin, norepinephrine dopamine which come from the brainstem of the brain brainstem like the stem of the big old cauliflowers.

>> That's the brain looking at you.

The inside of it looks like this the stem is down here and norepinephrine serotonin and dopamine come from up there come from down here and they spray up to the gray matter of the brain at the top that affects your mood.

No ability to think.

Now we do have medications now that directly affect the gray matter of the brain where they affect glutamate.

So these medications are ketamine as ketamine also known as bravado.

>> We now have all Velarde and a lot of medications are coming out in the future that are going to directly affect the great matter of the brain.

>> What are they doing while they're basically fertilizing the brain without causing the toxicity that could be caused by some other medications?

>> So these medications that are coming out might just work over the course of time and give you more of a persistent almost curative effect for depression.

We've seen that with postpartum depression, with a medication called Zeren Alone also known as a it's a medication that you just take every day for fourteen days for postpartum depression.

You've had a baby sometime within a year if you have a lot of depression and it's directly related to the delivery and the pregnancy itself and here you are with a new baby and you're really, really depressed.

>> You're not able to get things done.

You can't you can't get out of bed.

You just can't function so well zubaz a medication it can be very effective and just over the course of fourteen days and that's it and most people just take it for the 14 days and that's all they need.

>> So I think in the future we're going to be hearing about medications that are going to work fairly very quickly and they're working now very quickly but they might be more curative as opposed to giving symptomatic relief as we saw with medications we've we've been using historically for the past 60 years.

>> Thanks for your call.

Let's go our next caller.

Hello, Darlene.

Welcome mastermind.

>> Darlene, you want to know what changes to the brain go through during pregnancy?

It's mainly up in the middle front part of the brain.

Take the brain apart here little front part of the brain here the medial cortex orbital lateral, the medial orbital cortex in the middle here will tend to be dysfunctions such that people can have more anxiety and when you have more anxiety it's more difficulty with a natural anxiety.

>> You can have difficulty with sleeping.

You can feel very stressed.

People will often ruminate ruminate during the postpartum pregnancy time period especially but it's during that time you can have a condition called obsessive compulsive disorder where you tend to obsess unnaturally about things often worrying about contamination.

Now to some degree that's the mother bear effect because you're worried about contamination because you have a newborn baby coming along and you want to keep things clean.

>> Your brain can sometimes overreact in that regard and cause you to have obsessions that are persistent over the course of several years with some women Alaska when they had the onset of the obsessive compulsive symptoms, the obsessions are unnatural thoughts that keep going around like a loop and you can't get them off your mind.

You know they don't make any sense but they're there and then compulsions can be the actions or the behaviors that you do over and over again as a response to the unnatural looping thoughts.

So that's obsessive compulsive disorder for some women it will have its onset after delivering a baby and it's kind of a means by which the brain can have difficulty with networking information following delivery itself and it's related to the abrupt decrease in estrogen and progesterone following delivery .

So when you're pregnant you have these extremely high levels of estrogen progesterone from some women.

They say they actually feel better during pregnancy because those high levels of estrogen and progestin but then they crash they drop abruptly right after delivery and that can cause some people more anxiety, more depression and there's ways to treat that now.

>> Thanks for your call.

Let's go next caller.

Hello, Karl.

Walking to Mars the mind Karl.

You mentioned that you left a stressful job about a year ago and you're having difficulty going back to work.

Are you experiencing post-traumatic stress and what are the symptoms?

Post-Traumatic stress can occur in our daily lives if we've had some kind of unnatural traumatic event that occurred.

In other words, that it's an unnatural traumatic event where you got hit harder than you would usually expect with an emotional physical sexual trauma or some type of trauma that you were enduring if you went back if you had a workplace previously where you had a very abusive emotionally abusive boss, yeah, that can be some PTSD.

It can occur when people have PTSD, they might have nightmares.

They'll be jumpy we call hyper vigilant.

They'll have an avoidance of experiencing those similar type of experiences and that's where you can avoid going back to work because that type of thing people with PTSD will often have sometimes many flashbacks where all of a sudden they feel like they're reliving reliving the past events especially if they're provoked by hearing the voice of somebody or even having experiencing a smell of something that reminds you the past trauma so people can have PTSD not necessarily really related to related to sexual abuse or combat or motor vehicle accidents where we often hear about PTSD.

You can have PTSD with interpersonal connections if they were particularly traumatic for you.

>> Let's go to our last email question.

Our last e-mail question raised here to define why do some people with anxiety and depression ruminate in the past get stuck into thinking I used to really like driving the manual shift automobiles because you'd go from first to second or third when you ruminate with depression and anxiety is like getting stuck in first gear and you just can't get out of first gear.

It's almost like your brain is kind of idling during that time and you can't shift there's chemical by the name of norepinephrine that does allow you to shift a little bit easier and it takes you from the so-called default mode which is the lower gear of the brain where you're just ruminating about the past, not thinking about anything in particular.

>> You're just thinking about different things in the past.

But when you use norepinephrine to shift that gear into the Salyut mode, the salient mode then takes you into the thinking mode where you're actually making decisions, you're focusing on things and you're concentrating very intently.

The thinking mode is called the executive mode Network.

>> So if you're ruminating about the past, you just dwelling on things people with depression and anxiety will have difficulty shifting out of that ruminative gear and that's called default mode network.

So there is a reason behind that.

It has to do with the natural brain networking when we're treating people for depression anxiety we're trying to keep that in mind.

>> Thank you for your email.

It's unfortunate I'm out of time for this evening if you have any questions concerning mental health issues you can give me an email and I'll try to answer them on the air.

>> God, William Hebes willing I'll be back in next be back again next week.

I'm psychiatrist Jeff after you've been watching matters of mine on PBS for way now on YouTube, thanks for watching.

>> Have a good night