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

>> Welcome to Matters of the Mind now in his 10th year are 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 coast to coast you may dial toll free at 866- (969) 27 to zero.

>> Now on a fairly regular basis I am broadcasting live from our spectacular 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 a via the Internet via the Internet at matters of the mind all one word at WSW Egg that's matters of the mind at WSW ECG and I'll start tonight's program with a question I recently received.

It reads Do not a favor I feel like my mind is always racing and is always full of so many thoughts.

Is it normal and is there anything I could do to calm my mind?

>> Your mind racing can be from a lot of factors if its all the time and has been occurring since childhood that could be a condition called Attention Deficit Disorder ADD also known as ADHD if you have hyperactivity and impulsivity as a phenomenon where your mind will go from one thing to another to another and you can be highly distractible but you can be on the other hand fairly focused if you are interested, challenged or find something new and exciting so your mind might be racing on day to day issues and people will say it's like a squirrel going from one thing to another to another that that's from ADHD.

>> So if your mind is racing more often than not day by day and it goes back to childhood before the age of 12 years old, well that could be ADHD.

>> It's a treatable condition.

It's the type of thing where the question always is what severity of ADHD or AIDS would somebody have?

Do they need medication?

Do you need coaching techniques to try to help with that?

Secondly, you could you could have your mind racing form what's called generalized anxiety disorder.

>> Generalized anxiety disorder is where your mind races due to worry and your ruminating in your asking what if what if, what if and you have a lot of doubts and you're always apprehensive about the future that too will cause your mind to race and that can be a phenomenon that needs to be addressed ideally with talk therapy.

>> Rarely does somebody need medications specifically for generalized anxiety or severe worry.

But talk therapy is very good at addressing the worry because one of the best ways you can address worry would be to keep a worry diary write down your main worries and apprehensions about the future.

>> Keep them in a diary right beside your worries what you can do about them if anything and the things in which you don't have any control let them go look back on your worries from three months ago, six months ago and you'll often find that the things in which you were most worried three months and six months ago resolve themselves.

They really didn't come about wasn't a problem.

There's another type of racing thoughts people can have besides ADHD or generalized anxiety and that's where you have bipolar mania when you have bipolar mania and means you episodically just once in a while have spells where your mind will be going really, really fast.

>> You don't need to sleep typically you'll be very impulsive.

You'll do things and say things you ordinarily wouldn't do and say that's a condition where you need a medication for mood stabilization.

>> Can I get cruise control for a car because if you have those highs where they're just occurring once in a while a few days here, a few days there you're more likely to crash into big lows and with the big lows that's where people have difficulty with functioning day to day.

They have trouble getting out of bed.

They are very fatigued.

They want to withdraw from everybody.

So it really depends on the nature of the problem that would cause you to have racing thoughts.

But there's a lot of different reasons why people could have racing thoughts in my field I often find it's attention deficit disorder, generalized anxiety or perhaps a condition called bipolar disorder.

>> Those are the three main ways that I've seen people experience racing thoughts.

>> Thanks for email.

Let's go to our first caller.

Hello.

Hello darling.

Welcome to Matters of Mind darling.

You mentioned that your anxiety often spikes in your blood pressure causes spikes in your blood pressure.

>> What's the connection between anxiety and high blood pressure when you're highly anxious?

Darlene or Lotus that your heart gets racing?

>> Basically it's a chemical cousin of adrenaline getting fired off their norepinephrine when norepinephrine goes up when you're highly anxious that gets you more alert and that's a good thing.

>> So high anxiety makes you more alert and helps you focus on the things upon which you need to focus.

>> But that high norepinephrine can cause you to have a racing heartbeat and sometimes constrict the blood vessels that thereby can increase your blood pressure.

So for that reason many people who have anxiety directly leads to high blood pressure will be put on a medication for instance like a beta blocker, a beta blocker will be a medication like Metoprolol, propranolol, atenolol.

>> These are medications that will block adrenaline and they block the receptors for norepinephrine and in doing so they can decrease your heart rate and thereby decrease your blood pressure and also relaxation techniques are very common for people deep breathing techniques where you're focusing more on exhaling than inhaling how to do both but take fewer fewer seconds inhaling than you do exhaling So you might take four seconds inhaling eight seconds exhaling When you exhale you actually give your brain and your whole body a so-called parasympathetic effect where it slows down the heart so if you focus on relaxation techniques they could be very helpful in helping you with the high blood pressure directly related to the anxiety.

Darlene, thanks for your call.

Let's go to our next caller.

Hello, Jessica.

Welcome to the line.

Jessica, you want to know about I think you're talking about rant alone Zoove for postpartum depression ABRAXANE alone is used for it's a medication called a result.

>> Brexit alone is a medication that is used for post-traumatic stress.

It's used as an add on for depression.

It's used for schizophrenia and even bipolar mood stabilization.

But I think you're referring to Zoove also known as Zaranj alone for postpartum depression.

>> So Zurin alone is a is a 14 day treatment.

You have postpartum depression which can be treated within one year after delivery.

It's where you are incapacitated with severe depression and it's directly related to delivering the baby.

>> So Zurin Ilona's or Zoove is a medication that works entirely differently than any other medication that we are using for depression.

The typical medications for depression affect serotonin, dopamine, norepinephrine and the newer ones affects glutamate.

Zavala's are included primarily effects gabb so it's thought that when people have disturbances in Gabb following delivery they can have severe depression.

>> It's basically a 14 day treatment with a medication that as its main side effect will give you difficulty with sedation that typically people will be dosed in the evening with food gets absorbed better with food.

So you take it around dinnertime you don't drive for at least 12 hours after taking Zuffa it's not excreted significantly at all in the milk so it's thought to be safe during breastfeeding.

But Xavier's reign alone is being used for postpartum depression.

We've seen in our clinic give people dramatic benefits within a matter a couple a couple of days in many cases about one out of three people might need another dosage by the end of the year about about two out of three people don't.

>> But it's a 14 day treatment not unlike an antibiotic.

But in this case it's a 14 day treatment for depression.

>> Thanks for your call.

Let's go next caller.

Hello Milton.

Welcome to Mary's Mind.

>> Milton, you want to know if is hoarding a form of obsessive compulsive disorder or anxiety and what's the difference between hoarding and simply collecting?

>> Hoarding used to be thought to be an OCD type, Milton, but now it's thought to be a kind of an a class of its own.

It's probably an anxiety condition.

True hoarding is where you will collect things unnecessarily to the point of the environment around you being unsafe.

>> In other words you're hoarding and you're collecting so many things as basically filling up your house and that's where you know it's a problem and it's a it's a problem where you feel anxious upon attempting to get rid of this or that now simply collecting that's fine if there's a if you're collecting a something as a hobby that's not necessarily hoarding when you're collecting you have a purpose behind it.

>> You're trying you might even trade to get different collections but with collections there's a purpose and there is meaning behind why you're collecting with hoarding you're just keeping stuff and you just haven't hard time throwing things away and you get actually anxious when you attempt to clean things up.

So with hoarding it can be an unsafe, unsanitary and sanitary and unhygienic type of environment and that's where hoarding becomes a problem and it's thought to be somewhat of an anxiety disorder.

No no longer thought to be a subtype of obsessive compulsive disorder.

It's a different type of variant than that.

>> Thanks for your call.

Let's go next caller.

Hello Carey.

Welcome to Mary's mind.

Kerry, you want to know about borderline personality disorder and when did the symptoms occur?

Basically Kerry borderline personality disorder develops in childhood as basically related to you having difficulty with attachments with your parents and the old psychodynamic literature.

>> It was primarily the mother maternal attachment that was problematic.

But I think it can be any parent or even grandparent, any caregiver where you're having difficulty with interpersonal attachment because of their not being interested in you or kind of having their own issues in which they're dealing so they don't really form that bond which is particularly important before the age of three years old.

>> It's called reproach from psychoanalytical standpoint but by the time of your three years old you should be able to be more attached to a caregiving figure if you're not over the course of the years you can have symptoms often occurring in adolescence but they're very notable as an adult because many adolescents will have a lot of symptoms of borderline personality disorder.

>> That's part of immaturity.

>> That's part of growing up.

That's part of the front part of the brain growing because the front part of the brain as is growing you'll get over such difficulties as moodiness, impulsivity, difficulty with rage, anger you'll be able to control your temper more.

>> That's a frontal lobe hyper disturbance people with borderline personality disorder not only have difficulty with attachments and very needy needy clinging relationships but so often have trouble with mood, anger, irritability, depression.

>> Many people with borderline personality disorder are inadvertently diagnosed with bipolar disorder but when you ask them when they notice the mood swings it's typically after they felt rejected or they feel very alone.

They feel like they don't have any strong relationship and in their life at that time.

So people with borderline personality disorder will have moodiness in a relationship to their environment or interpersonal reactions.

So it'll be directly related that you treat it sometimes symptomatically with medication for mood stabilization based on what the symptoms might be.

But the best treatment for borderline personality disorder will be a therapy called dialectic behavioral therapy in my opinion DBT is a therapy that helps you focus on the here and now you're not going back into your past and reliving all those things.

You're focusing on the here and now and you're learning coping mechanisms do go from this day forward.

Many people with borderline personality disorder do have a history of emotional, sexual or physical abuse and if that's the case there might be a component of post-traumatic stress there.

If that's the case, the best counseling treatment would Ibou.

But in desensitization reprocessing also known as MDR so MDR is very good for PTSD that could be related to borderline personality disorder.

But the key is from a proper diagnosis standpoint it might be considered to be a variant of bipolar disorder but it's a type variant of bipolar disorder where the moodiness is related to people and situations.

So that's a big, big differentiation there.

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

Our next e-mail question reads Dr. Fauver can a bad diet cause you to feel more depressed or anxious?

I'll give you a definitive answer there.

It depends if you notice that when you eat gluten, when you eat a high carbohydrate diet, you feel really lousy tracked back to OK, what did I eat?

>> When did I eat it?

When did I start feeling lousy?

It's different for everybody.

Some people can tolerate certain types of foods and others cannot read wine.

I've seen some people have horrific responses to something like red wine whereas other people do fine with us.

So I think it really, really depends definitively I'm not going to prescribe a diet for every single person out there because everybody's different but it really depends on what works for you.

>> So if you find that when you eat really good biscuits at a particular restaurant and you feel lousy about three hours later, that could be the gluten in those biscuits and you might have a gluten intolerance when a gluten intolerance is really bad and you have gas and diarrhea after eating those type of things that's called celiac disease if you have certain testing that confirms that.

But many people will have gluten intolerance without the full blown celiac disease itself and gluten intolerance is basically where you feel really lousy after eating wheat products.

>> Thanks for your email.

Let's go next caller.

Hello Phenix.

Welcome to Arizona.

Mind Phenix.

You want you want to know what are some of the coping mechanisms that you can use to help with trichotillomania to avoid pulling out your hair?

No one Phenix be aware of your doing it.

Some people will notice that they're pulling out their hair and back in the old days people would be told to wear white cotton gloves.

>> You don't see that so often anymore.

But white cotton gloves are a means by directly treating these cattle ammonia if it's socially appropriate you can wear white cotton gloves in the public but many people will just wear them at home because if you have the thin gloves on you at least know where your hands are and what you're doing .

>> But many people will have the hair pulling occur and it's totally unconscious.

They just have no idea they're doing it.

>> I would suggest having something else in your hands when you're at home fidget little mechanism's there's all sorts of different things you can have but have a pin in your hand have been holding something more often than not in each hand most people will tend to pull their hair with one hand or another and it's a habit they get into and if at hand sets are left hand that's pulling your hair the most, make sure to always have something in your left hand.

Yeah, we use medications for trichotillomania in acetyl has probably been the most effective treatment I've ever seen.

>> It's a supplement people will use and sometimes people will use serotonin type medications like Zoloft or Paxil or Lexapro.

They're kind of OK with trichotillomania.

But the bottom line is I find that from a behavioral standpoint that's what's most effective knowing what your hands are doing and keeping that in mind.

>> Thanks for your call.

Let's go next caller.

Hello Elizabeth.

Welcome to Matters of Mind Libbers as Elizabeth you had mentioned that you know someone who's a recovering drug addict but was just prescribed medication from a psychiatrist.

It's a controlled substance.

Would they get her?

Why would they get a controlled substance?

It depends on the situation and the reason behind that, Elizabeth, if somebody is recovering drug addict, we have to go back to square one.

>> I saw a person today with a similar type of situation.

>> If they are using drugs of abuse, why did they start to use drugs of abuse and if they started using drugs of abuse because of anxiety or depression or difficulty with focusing, you want to go back to the original reason why they started using the drugs of abuse because they've been possibly self medicating.

>> Many people will do that with alcohol, opiates, narcotics for that matter of opiates or narcotics.

>> They'll they'll self medicate underlying symptoms.

So what we're often trying to do is OK, we're aware that we don't want to exacerbate or create any craving for them for the substances that they used to abuse.

>> But we want to replace it perhaps with something that will take care the underlying problem.

>> So let's say you took opiates or narcotics and you were abusing those because you just felt depressed like the feeling of bliss that you got from the narcotics spiral means maybe we can treat the underlying condition with an antidepressant medication.

Now there are some medications that are controlled.

These medications can be prone to abuse.

I'm sure we have to be careful about using those kind of medications with people who are prone to abuse.

>> But there is a medication is controlled for instance, called bravado.

It's bravado can give people a little bit of a dissociative feeling where they kind of feel out of touch with reality for about 20 minutes after they get the nasal spray in a closely supervised situation.

It's a controlled medication.

We have found that we've been able to use that for people with a history of drug abuse because if there's a history of drug abuse was caused by depression and bravado treats depression, we take care of the underlying condition that caused the drug of abuse problems so it comes back to is the controlled medication addressing the original problem?

And number two , as you're monitoring people in that kind of situation is the controlled medication it's being prescribed exacerbating the underlying condition where they had difficulty with craving drugs of abuse.

So we're always monitoring those type of things but no one try to treat the underlying problem.

No to monitor somebody to see if they're having any craving for the drugs of abuse.

>> Thanks for your call.

Let's go our next caller.

Hello Thomas.

Welcome to the Mind Thomas.

>> You want to know about the benefits is bravado as a nasal spray as opposed to taking the antidepressant in a pill form?

Are there side effects with bravado?

I I just mentioned that my office had treated over 5000 had over 5000 treatments with bravado over the course of five years and it's a it's a nasal spray where you're monitored in the office for a two hour time period twice a week the first month once a week, a second month and then once a week or every other week thereafter or so it's a nasal spray and it used to be thought that it had to be always used with an oral antidepressant.

>> That's how it was approved for several years and just about the middle of January it got FDA approval for Drug Administration approval to be used alone and that means that somebody can take it without it on a present medication.

The analogy I often think of is eating strawberry rhubarb pie by itself versus always having it al-Hamad I always had strawberry rhubarb pie almost because of the bitterness of the rhubarb and then I started the sour is more sour than bitter I guess it is and but the rhubarb is kind of sour but yeah the strawberries opposing it with the sweetness but it's just kind of automatic.

I was always growing up always have vanilla ice cream with strawberry rhubarb pie.

>> Well now with bravado we've realized we don't always have to add that antidepressive.

You can use these bravado by itself just like you could eat the strawberry rhubarb pie by itself twice a week the first month once a week, the second month is how it's been studied and then thereafter people can use it perhaps at less frequencies.

It's bravado works primarily on the accelerator of the brain which is a chemical called glutamate glutamates out here in the gray matter.

It's about eighty percent of the neurotransmission in the gray matter and basically it works as an accelerator on the brain within a matter of hours can make the neurons more fluffy.

>> It's thought that people with chronic depression and chronic unmitigated stress they just are overwhelmed with stress.

They get less fluffy neurons those we got about 100 million neurons in our brains so we got these neurons in our brains and they can become less fluffy if you are under lots of stress or are chronically depressed.

It's not that the neurons die off it's just that become they become less fluffy.

So with the less fluffy neurons your brain doesn't focus as well.

You have trouble with motivation processing information, concentrating, fighting joy in different things.

If you can make the neurons more fluffy you can reverse the process and in the case of bravado it can do so in a matter of hours for some people such that about one out six people get a dramatic benefit with just one treatment.

For most people it takes two or four treatments over the course of a week or two but for some people they can get a dramatic improvement within just one treatment.

So we've been using Sprouter now since 2019 in psychiatry and bravado is entirely different than other medications that primarily affect norepinephrine serotonin and dopamine.

>> Now those medications that have been around for 60 years and there's twenty three of them I think they've been around for 60 years they primarily affect norepinephrine serotonin and dopamine.

If you think about norepinephrine serotonin and dopamine, they're kind of sitting in the driver's seat whereas glutamate is a celebrator and then there's a brain called GABA so glutamate and GABA are always in balance with each other and that's come like a teeter totter.

>> So glutamates the accelerator gabbers the brakes then you got norepinephrine serotonin and dopamine out here giving advice to glutamate and GABA so the medications that affect serotonin, norepinephrine and dopamine the traditional antidepressants we've had for the past 60 years yeah they have their purpose.

>> It's just that they in many cases kind of out.

They don't give a long lasting effect and that's why so many people go from one antidepressant to another.

They have other medications added on to try to help them out.

It's kind of like going to a steak house and getting the steak sauce added on to your steak.

In those cases the antidepressants we've had for the past 60 years just haven't done such a good job by themselves.

So now we have it's bravado as a nasal spray they can give people very, very quick relief.

>> Thanks for your call.

Let's go next email question.

Our next e-mail reads Do not a favor.

What's the percentage of people that need therapy versus the percentage of people that need medication?

It all comes down to the nature of the problem.

Now think about epilepsy, OK?

If you have epilepsy, you've had ongoing seizures.

You want to be on an anti epileptic medication, your goal should not be gee, how long do I need to stay on this?

Your goal with epilepsy is to stop the seizures.

The goal with depression, anxiety, ADHD psychosis, whatever the nature of your problem should be should not be how long we need to take this medication, how can I feel well and get my life back?

So the number one goal in treatment with any psychiatric medication is to allow you to feel well.

>> So where does therapy come in?

Well back in the 1980s despite my previously being trained as a pharmacist, I went into psychiatry and our our main treatment for depression anxiety a lot of conditions back in the 1980s was psychotherapy.

So I learned a lot of psychotherapy back in those days but I found that a lot of people just didn't do well over the course of time with psychotherapy alone Prozac or Fluoxetine came out in nineteen eighty seven.

It was the first antidepressant that was highly tolerable and at that time people could at least function better on a medication like Prozac and I found that when they could function better the medication in the brain was working.

>> They could then have better outcomes with counseling and psychotherapy.

>> So whereas before we always had psychotherapy and counseling first for several weeks and only as a last resort would be out on medication, we often will start medication now as a means of helping people process information and be able to understand the whole nature of psychotherapy itself so now we will often augment psychotherapy with medication but for some people medication might.

All they need was some people.

Psychotherapy might be all they need.

For instance, if you have difficulty with finding meaning and purpose in life and that's primarily your main symptoms if you have trouble with communicating with your spouse and other people around you and those remain symptoms maybe psychotherapies all you need but for many people they have trouble with their brain working and when your brain doesn't work you don't sleep properly.

You can't concentrate.

You don't you have difficulty with processing speed of your brain.

You have trouble with enjoying things.

You don't have the motivation to do the things that you're often coached to do in counseling.

>> So with the medication the first goal always, always always is to make you feel well .

Now will there be a time for some people where they don't need the psychotherapy over the course of time maybe.

But for many people it's kind of like fertilizer with fertilizer with your plants.

OK, you might need higher doses early on but as time goes on you still need the fertilizer but you might need it as frequently as you used it before.

>> So we'll often use medications perhaps a lower amount I don't know bravado being a medication the kind of acts as a fertilizer for the brain.

Who knows maybe people can get to a point where they don't need it as much over the course of time and that's what we often see.

But we have to remember people have different genetics.

They have different life experience.

Have you been traumatized as a child primarily before the age of eight years old you're much more likely to have depression anxiety later on compared to somebody who wasn't traumatized later on coping mechanisms as an early child will be a big factor as well.

So we have to remember that we can't pigeonhole everybody into the same box if they have similar symptoms and say well gee, he went off his medications after two years, why is he still on medication?

They had the same symptoms.

Well, they had different genetics.

They had different past experiences.

They had different coping techniques.

So we try to limit the medications the best we can.

But our first goal for everybody will be wellness.

>> We've got about a minute to go here.

I'm going to take another call here.

Greg, welcome to Mars.

The mind.

>> Greg, you've been mentioning feeling very isolated since your spouse passed away and what can you do to feel less isolated when you cannot get around very well when you mentioned cannot get around very well.

It might be because of the sadness or depression if you're incapacitated with sadness and depression see your primary care clinician because no one if you're having any trouble sleeping, that could be a big factor.

Number two , if you're having trouble with your diet because of your grief, that can be a factor when you're functionally impaired due to grief.

That's when you need to your primary care clinician to try to get out and about and doing things.

You know what you need to do?

You need to socialize around other people.

>> Thanks for calling.

I'm amount of time for this evening if you have any questions concerning mental health issues you may email me via the Internet at matters of the mind all one word at the morgue if I get your question next week.

>> I'm psychiatrist Jeff and you've been watching matters of mine on PBS for Wayne God willing and PBS will be back here next week.

>> Have good evening.

Good night