.

think Tony Romo is really good .

>> Good evening.

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

Welcome to Matters of the Mind now in its 26 year Matters of the Mind is a live call in program where you have a chance to choose the topic for discussion.

So if you have any questions concerning mental health issues, you may call in the Fort Wayne area by (969) to seven to zero.

>> If you're calling coast to coast you may dial tone rate 866- (969) to seven to zero.

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

And if you'd like to contact me with an email question that I can answer on the air, you may write me a via the Internet at matters of the mind all one word at WFA egg that's matters the mind at WFA Egg and I'll start tonight's program with an email I received this past week.

>> It reads Dear Dear Father, what's the difference between panic disorder and a phobia?

I worry I'm going to pass out every time I drive.

It feels very real and causes great distress.

Would cognitive deletion be an effective treatment?

>> Medications haven't helped except for the benzodiazepines.

There's a lot of material in that question so let's get to work.

>> Panic disorder is often an unprovoked sensation that emerges over the course of five or ten minutes and it gives you a fast heart rate sweatiness, diarrhea.

>> You feel dizzy, you feel like you're going to pass out, you feel like going to die or go crazy.

Many people with panic attacks will have tendency to hyperventilate and they can have nausea.

>> So you have all these physical symptoms emerge over the course of several minutes.

Now a phobia is where you have an unrealistic fear and thereby avoidance of something.

Now you mentioned driving the phobia can be related to driving.

Looking back, you might have had a panic attack that was unprovoked, that happened to occur while you're driving so there's a lot of different things that could be going on there.

So we often got to sort out is it a phobia related to driving itself now if it's a phobia related driving, we'd always going to go back to asking the why how did it start?

>> And you mentioned cognitive deletion.

Cognitive deletion is really a variant of cognitive behavioral therapy.

I prefer the term cognitive restructuring because cognitive deletion kind of infers that you're deleting or eliminating certain memories and that's not really how the brain works.

>> You will restructure how the brain works and how that occurs is you can think different thoughts and have different perspectives on a bad experience that occurred in the past.

So if you had a catastrophic type of perspective on a bad experience in the past, your brain physically restructures and rewires in a sense that will well basically emphasize that that was a catastrophic experience and become more and more fearful and more worried about it.

On the other hand, if you are able to understand that that was an experience that had occurred but it's not likely to occur again, the odds are against it you can restructure the brain so you wouldn't be so anxious and so fearful not not s fearful in that case.

>> So if the phobia is causing the panic symptoms that could be addressed by cognitive behavioral therapy trying to examine what really happened you had mentioned benzodiazepines are tend to be helpful for your symptoms.

Benzodiazepines include the medications Ativan, Xanax, Valium, Klonopin these are all medication that basically to put it lightly will just tranquilize the brain and make you not care so much.

>> They will go straight to this part of the brain right here called the amygdala an almond shaped body in the front part of the temporal lobe.

It's the yellow part of the brain.

It's the brain looking at you right there.

pThe amygdala will get calm down and that's amygdala is the volume control for anxiety, fear and anger and you can dial down the anxiety volume control very quickly with Xanax, Ativan, Valium, Klonopin, the benzodiazepines in doing so to problematic factors can can be scene number one.

>> You might notice you have to go higher and higher to get the same effect over the course of time but more problematic and more subtle it will be the difficulty with processing information the benzodiazepines will cause you to have basically in your brain slow Internet speed.

It'll slow down your ability for your brain to process more information over the course of time.

>> So that's always been my biggest concern about the benzodiazepines.

>> Many people will argue that they've been on them for twenty, thirty years and they've been doing fine.

Why should they have to come off of them at any particular time as we get older, especially over that magic age of 65 years of old years of age, you tend to have more difficulty with speed of processing anyway and rouble with recent reca.

>> So as you take benzodiazepines that can make all those type of conditions worse so you want to do all you can to release the brake on your brain's ability to function especially as we get older now going along with panic attacks especially you mentioned panic attacks fast heart rate lightheadedness.

I always want to make sure that we're not talking about some underlying medical condition that can cause those symptoms because we psychiatrists were really good at looking at some of these past experiences.

We're very good at identifying past traumas.

For instance, women especially are more susceptible to sexual physical emotional abuse especially as children.

And if you're traumatized in that way as a child, whether you're male or female, you can have a higher likelihood of having anxiety later on in life .

We get that but we shouldn't just stop there.

It's so easy for a psychiatrist is to stop and say well, you were traumatized as a child.

You're going through some bad experiences now in life .

That's why you're having anxiety.

We can't stop there if you're having a fast heartbeat periodically if you're having anxiety, if you're having headaches, we have to look the underlying medical conditions that can possibly be causing these particular symptoms such as sleep apnea, which is where you're having difficulty with snoring or pausing and you're breathing at night that would decrease the air flow to the lungs, decrease oxygen to the brain at nighttime and give you difficulty with symptoms such as mental fatigue, anxiety the following morning especially secondly, we have to make sure you don't have a condition known as Pott's postural orthostatic tachycardia syndrome.

Pott's is not uncommon for young women, women and adolescent years their 20s and 30s and posits where you'll have this abrupt speeding up of the heart and causes sometimes to pass out and the blood pressure will drop substantially and it's something we cannot overlook when somebody is having panic symptoms much more common with women than men.

But Pott's is something that is treatable autoimmune condition high thyroid let's say you're taking a thyroid supplement medications all of a sudden you've increased the dosage because your thyroid levels were seen to be a bit low.

>> Maybe all of a sudden you're having panic attacks from that.

We need to address that as well.

Some people will have difficulty with panic attacks when they are just a simple medication change and a simple medication change is something we can often trace back and identify that maybe that was the time when you started to noticing a lot of side effects such as the panic attack symptoms.

So we have to kind of review all those different things that can be factors.

There's something called atrial fibrillation where the top part of your heart starts beating really, really fast.

>> Atrial fibrillation comes and goes but it will give you all the symptoms of a panic attack.

>> And finally, if you have a pulmonary embolism, a blood clot in the lungs, you'll have shortness of breath, a fast heart rate.

You'll have all the symptoms of panic attack.

I emphasize all those medical conditions because as psychiatrists I'm a physician.

>> I can't overlook all those different medical conditions that can be symptomatic of panic attacks.

Just giving somebody Xanax isn't going to be the right approach.

We need to look those underlying factors because those underlying medical conditions can be debilitating and it's a very important we examine all those.

>> Thanks for your call.

Let's go to our first caller Sherry.

Hello Sherry.

>> Welcome to Mastermind Sherry.

You'd asked are there any long term benefits using Benadryl also known as diphenhydramine to help with sleep?

Does it cause dementia?

What's the safe option to help with sleep?

Sherry Benadryl diphenhydramine is a medication that is an antihistamine but it has a very strong anticholinergic effect now anticholinergic effect means that it's blocking acetylcholine when you have dementia gradually acetylcholine is going down, down down.

Acetylcholine helps with memory and concentration.

So basically Benadryl or diphenhydramine can cause you some memory problems No one because it has anticholinergic effects and number two it does block histamine.

The way it helps us sleep is by blocking histamine.

It makes you sleepy right now my histamine level sky high in my brain I'm doing blood measurements on that.

>> I just know it is because I'm wide awake.

So if you're wide awake your istamine level sky high if you block histamine it makes you sleepy and tired.

>> So that's the whole idea behind Benadryl or diphenhydramine.

It's very effective as a sleep medication especially for younger people.

We have to remember that even middle aged people if they take Benadryl or diphenhydramine at nighttime they can have difficulty based on studies with with memory and motor coordination all the way up until noon the next day they've done driving tests on people who took diphenhydramine a bedtime and they found that all the way up to until noon they had impairment with their driving skills going around the cones and all the things they did.

The study.

So there are other options than Benadryl for sleep and you can start with something as simple as low dose melatonin.

Melatonin at higher doses can actually cause people to have nightmares.

So we like to recommend doses of the five or even even three milligrams at bedtime as a means of helping you get to sleep if you are also having trouble staying asleep, sometimes we'll use something that's going to work through the night and there are a couple prescription medications that will help with sleeping throughout the night one being gabapentin which helps with the quality of sleep giving you a deeper sleep overall and giving you better dream sleep so gabapentin at low doses can be very helpful for sleep.

Trazodone has been around since the 1980s for depression but it didn't get used for depression much triacetone has been historically been used more for sleep itself.

It too can suppress the frequent awakening that many people will have both Gabapentin and Trazodone due to last about eight hours with Trazodone and about one out COVID 19 people giving them a stuffy nose and sometimes giving them a hangover effect the next day.

Those are two options.

A third option could be low dose stocks been expensive, been around as an antidepressant since the 1960s.

That dose is between 50 and 150 milligrams a day but a dose is a three to six milligrams at bedtime.

Tiny little doses it to can work on suppressing histamine release in a different way than what Benadryl or diphenhydramine does.

>> But the the doctor pain can actually decrease histamine firing and doesn't have a strong of an anticholinergic effect that these tiny tiny doses of three to six milligrams of bedtime's so for many people that can be more tolerable but quite frankly scary for a lot of people we simply have them go back and look at their sleep hygiene.

>> What time are you going to bed at night time?

What are you doing every night?

>> When do you get up the next morning.

Do you exercise in the morning?

Exercising in the morning can be phenomenal for helping with sleep that night drinking any caffeine after about five or six pm for some people can keep them away and be very careful about eating much if anything toward bedtime because you can have gastric reflux keeping you awake.

And of course I mentioned earlier the whole phenomenon of sleep apnea.

If you have sleep apnea that will be a key factor on why a lot of people are staying awake at night because they're basically smothering they're gasping for air.

They don't realize it necessarily and they're having a hard time going back to sleep after Sherri, thanks for your call.

>> Let's go our next caller.

Hello, Keri.

Welcome back to the Mind.

Keri, you mentioned that you take Abilify also known as Eric Pipas Oil and you recently saw that it's also used for stress.

>> How can this be effective for multiple conditions basically carry Abilify is a medication that it does affect dopamine receptors but it also affects serotonin and norepinephrine receptors in different ways.

But the way that it works for Tourette's Tourette's is basically a condition where you have the dopamine in the middle part of the brain called the basal ganglia get my brain apart and it means a little bit too jumpy and it causes you to have grunt's and twitches and sometimes people will use& profanity and do things very impulsiely.

That's thought to be a disruption of the middle part of the brain with the front part of the brain, the front part of the brain being the udgment part of the brain.

>> But Abilify can help by blocking dopamine transmission and kind of settled down a lot of this overactivity of the middle part of the brain that's causing a lot of those symptoms of Tourette's Abilify as are many other medications kind of in that class.

They have a lot of different receptor activities and many times you'll hear about them being used for many, many other conditions.

>> We not only use Abilify for psycho cases for instance, but we use it for bipolar mood stabilization.

We use Abilify to augment or help a depressant if it's not working so well for depression.

So we use these medications for lots of different reasons because they have a lot of different receptor activities.

>> Carrie, thanks for your call.

Let's go our next e-mail question our next e-mail question reads your daughter Fauver what's the difference between an SSRI and SENTRI, an SSRI, a selective serotonin reuptake inhibitor as serotonin norepinephrine Riptech inhibitor is an necessary so an SSRI basically fairly selectively will increase serotonin fluoxetine or Prozac being the first of the bunch back in 1987 that came out and since that time using the trade names we have Paxil, Celexa, Lexapro and Zoloft.

So Luvox is also another SSRI that's used more for obsessive compulsive disorder but the SSRI are increasing serotonin now here's how that works.

>> If you increase serotonin you'll have somewhat of an emotional dampening.

In other words, you'll have a sense that your emotions aren't so out of control you'll have less crime.

>> You'll feel a little bit emotional numb if you get too uch of a necessary but you'll find that your emotions are just kind of settled down a little bit.

>> So a selective serotonin reuptake inhibitor by increasing serotonin will dampen the emotions.

Now the drawback of that is sometimes it can damage it to dampen it too much and you can have a sense of feeling emotionally where you don't feel happy, you don't feel sad, you just kind of feel nothing.

>> I mean you're getting too much also the selective serotonin reuptake inhibitors can cause you to have a little bit difficulty with concentration because by increase serotonin you can indirectly affect dopamine and to some degree norepinephrine and dampen those down so you don't want to do that.

>> Selective norepinephrine reuptake inhibitors include using the trade names once again Fed Zema, Cymbalta, Effexor and Prestige.

>> These are medications that are increasing serotonin but to some degree increasing norepinephrine.

>> Now the old tricyclic and a presence were serotonin norepinephrine reuptake inhibitors such as Topher Nhill Dock's but I mentioned that before Ellisville Amitriptyline these are all medication sit around for a long time but the older medications from the 1960s and 1970s would have all this extra baggage with them causing people to have a dry mouth weight gain lightheadedness and they didn't like to take those medications.

The newer medications that are more selective serotonin and norepinephrine generally allow a person to have a little bit better concentration, have more energy.

They'll be a little sharper.

They're less prone to causing a person to have difficulty with that emotional numbing to which I referred with the surprise and the serotonin and norepinephrine reuptake inhibitors do a nice job and putting the brakes on pain coming up the spinal cord so pain can be modulated by the spinal cord if you increase both serotonin and norepinephrine it kind of puts the brakes on the pain coming up the spinal cord.

>> So that's why SSRI serotonin norepinephrine reuptake inhibitors are effective for a lot of people for pain.

>> So we'll use them specifically for those reasons.

There are subtle differences.

About one out of three people respond well based on research studies about one of the three people respond well to necessary for depression now for anxiety maybe a little bit higher than that because it can dampen down the emotional overtone to things but etc.

I might give you a little bit better efficacy in some cases.

For some people that norepinephrine effect is uncomfortable for them because they feel kind of anxious and you can have norepinephrine type side effects such as dry mouth and increased heart rate which can be uncomfortable for some people.

>> Thanks for your call.

Let's go our next caller.

Hello Denise.

Welcome to Matters of Mind.

>> Denise, you want to know is Xanax effective to help with sleep?

Denise It's effective to help with sleep for about couple of weeks now you can keep taking it but over the course of time you'll probably notice that your sleep quality isn't as good and you might have to take higher and higher doses.

>> But for some people let's say you're going through a difficult time on the job.

You're having a traumatic experience.

I wouldn't recommend it if you're having post traumatic experience where you've had a catastrophic trauma recently because Xanax, Ativan, Klonopin, Valium, the so-called benzodiazepines actually make PTSD symptoms worse.

>> So depending on what kind of experiences you're going through where you need to sleep, Xanax wouldn't be the best medication for sleep.

There's so many better ones out there.

But people do use Xanax.

It might help for a week or two but after that we really try to get people off of Xanax or sleep the medications that can be used long term for longer term than Xanax for the first sleep can be medications like Lunesta for instance, the so-called Z drug it has been studied over the course of a year showing that it appears to be safe over the course of one year we might selectively use that but preferentially will will more likely use other medications that like I mentioned earlier Gabapentin Trazodone docs.

>> But we like those kind of medications because they don't cause you to eat more and more of them over the course of time and they don't affect your concentration as much as something like Xanax but Xanax is also known as alprazolam.

>> It should be used short term if you use it for a longer period of time people typically ill get kind of used to it and it can cause you to have trouble with concentration memory.

>> Today's thank you for your call.

Let's go to next caller.

Hello Mary.

Welcome to Matters of the Mind .

>> Mary, you wondered if taken additives like stevia can& destroy the brain.

>> Not that we know at this point, Mary.

If they did I would not be using those sugar substitutes myself.

Stevia appears to be quite safe for a lot of people.

I'm not aware of any studies showing specifically that a glucose substitute such as stevia is destroying the brain like with anything we should use stevia or any sugar substitutes in moderation.

As Benjamin Franklin once said, we should use everything in moderation including moderation, including moderation or something of that if that effect.

So in other words moderation will be the key for pretty much anything but stevia is something that has been around for quite some time just be aware of how much you're using it.

>> There's always the debate should we use regular sugar?

>> Should we use sugar substitutes while the pros and cons of sugar substitutes in some cases can actually increase the craving for more sweets, it can sometimes disturb the glucose levels in your bloodstream themselves.

>> You just have to be the best judge on that.

But from a brain perspective I'm not aware of any studies or any if evidence that sugar substitutes are having harmful effects on the brain.

>> Mary, thanks for your call.

Let's go to our next e-mail.

Do we have another email?

Yes, we do and it reads You're out of farmer.

What's the difference between anxiety and depression?

>> Are there differences in the brain that create differences and these emotions basically you've got three different networks in their brain that we use day by day.

>> There's the default network ,there's the executive network and then there's a salian network that's in between them.

The default network is what we use when we're not thinking about a whole lot.

We're just being a little creative with our minds.

>> We're daydreaming.

We're not concentrating really hard on anything we might be listening to music.

>> We're just kind of chilling out.

The Default Network is a network we're using throughout the day.

It's during the default network .

>> You're kind of thinking about your past wondering if did you offend somebody by that statement you made you just kind of thinking kind of about day to day different things but you're not concentrating very hard on anything and then you've got this other extreme called the Executive Mode Network where you're really focusing, you're really concentrating.

>> If you're listening to me right now you're trying to follow what I'm saying and you're really trying to focus you're using the front part of your brain up here when you're really trying to focus and concentrate on things.

>> But here's the key that salient network, the salience network is the gears in between.

>> It's the clutch that takes you from one from the default network up to the executive mode network.

>> Now here's the problem when somebody has depression they get stuck in the default mode network.

>> They get they get stuck there.

They're ruminating about the past to an excessive degree.

They're worrying about things they can't concentrate and they're stuck.

>> And if you remember the old automobiles that had the manual shift where you had to clutch to go from first to second degree to third or the second gear to third gear and if you didn't clutch properly you couldn't go from one year to another.

>> That salience network that's kind of in between the default network and the executive mode network is kind of like the clutch.

If that clutch isn't working you can't concentrate on things so somebody is talking to you, you can't pay attention to them.

You're trying to do things at work or in school.

>> You can't concentrate.

You can't focus.

That's what happens when people get depressed because they can't get into the executive network.

>> They can't concentrate, they can't process their information.

They get stuck in that anxious ruminative network.

>> So we'll often hear about people getting stuck in the anxious ruminative kind of network and they can't get out of that.

And for those people, yeah, to some degree they can effect they can get benefit from the serotonin medication to calm some of that down.

>> But more often than not we find that people have difficulty kicking in to the executive network where they're really trying to concentrate and focus and they can't do that because the depression itself so anxiety will often keep you stuck in this default mode network whereas depression will prevent you from going into the executive at work where you can concentrate.

It's often a cascade.

Many people will have anxiety and the worry and the ruminate and because of that they'll have trouble with sleep because they're having trouble with sleep.

>> Well that will affect your because sleep refreshes the front part of the brain that you use for decision making and and concentrate and decrease in distractibility and if you can't sleep that's all impaired and that keeps you out of the executive mode network.

>> So we're often trying to sort out where somebody might be in terms of struggling with these different networks and try to address our medications accordingly.

Again, if somebody is really ruminative and they're stuck in the ruminative network, we might give them something that's on effect serotonin more.

If they're having more trouble with concentration or focus, we might give them something that's going to affect more dopamine norepinephrine.

>> We're trying to sort out to what degree people are having trouble with those different networks.

>> Thanks for your call.

Let's go to our last caller.

Hello Richard.

Welcome to Matters of Mind.

Richard, you had an event occur on the highway, gave you a lot of anxiety.

You want to know how you can get more comfortable driving on the highway.

You take hydroxyl zem occasionally and you want to know if you could take this more regularly.

>> Will it help hydroxyl is than diphenhydramine or Benadryl to which I referred earlier Benadryl or diphenhydramine will have more of an anticholinergic effect.

>> Hydroxycut is better hydroxyurea as an antihistamine to keep in mind as an antihistamine it's basically blocking histamine which makes you less alert and less awake not necessarily a good means of treating an anxiety condition.

>> I know it's very commonly used because it's very safe.

It's not addicting.

It's not something that's controlled by any means.

So it's much safer than a benzodiazepine but there are other things that could be used other than hydroxy and gabapentin pregabalin be in two options bu Spyro often used for worry for a lot of people so hydroxy my only concern there would be is that making you tired that making you sleepy now what can you do to get back on the highway if you had an event occur out there try to go out there in small doses for instance often advise people to go from one exit to another just to get back on the highway and the section that makes them anxious many times people will say it's an interstate, it's a state road, it's a particular area that made them anxious because that's where the event occurred.

>> What you want to do, Richard, is restructure the wiring of your brain to get your brain convinced.

Yep.

You can have bad things happen on the highway but is not necessarily going to happen every time your brain right now is structured in such a way that it's telling you every time you get out there something bad is going to happen if you can get out there more and more you'll realize that that's not going to be the case.

Richard, thanks for your call.

Unfortunately I'm out of time this evening.

If you have any questions that I can answer on the air, you may write me via the Internet on matters of the mind all one word at a dog and remember that our episodes can be seen now on YouTube.

I'm psychiatrist Jay Farber and you've been watching PBS for Wayne Matters of the Mind with Dr. J.

>> Fauver.

>> Thanks for watching.

Have a good evening.

Can I