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

Welcome to Matters of the Mind now as twenty seventh 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 the Fort Wayne area by dialing (969) 27 two zero or four calling any place else coast to coast you may 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 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 WSW ECG that's matters of the mind at WFYI Dog and I'll start tonight's program with an email I recently received.

>> It reads Your daughter Fauver is it is there a better time of day to take vitamins and supplements with medications for that matter?

>> Is it better to take them all at once or separate them throughout the day?

>> I take my vitamin supplements and Lexapro also known as escitalopram 10 milligrams altogether in the evening.

>> Well if you ask five physicians about taking medications with or without food at different times you're going to get five different answers.

>> So as a general rule I would suggest that if you take a vitamin that is fat soluble that is vitamin A, D, E and K fat soluble vitamins and preferable preferably take them with food I'll be the first to admit and I always tell my patients and I don't tell them do anything I don't do or I don't tell them to not do something that I do but I take vitamin D myself and I don't usually take it with food so ideally you theoretically want to take it with food now can I can I determine definitively that taking it on an empty stomach versus food makes that much of a difference?

No, but theoretically since they're fat soluble they get into fat, they get absorbed there they get possibly better absorbed.

>> That's when you want to take them with food.

Now there are certain medications that you certainly want to take on an empty stomach and are certain medications you will certainly want to take with food.

Lexapro is not one of them.

Lexapro you can take on an empty stomach and you might think well wait a minute, my doctor told me to take it with food initially you take Lexapro when you first start taking it with food because well 90 percent of your body's serotonin is in the gut.

Lexapro is increasing serotonin transmission and if you take Lexapro in an empty stomach init, it'll make you more nauseated and possibly give you more diarrhea.

So we recommend that people take Lexapro with food initially to decrease the noise in the possibility of diarrhea but generally gets absorbed just fine on itself by on its own.

>> You can take it with vitamins and with supplements typically but you want to talk it over with your clinician concerning which supplements you might be taking.

>> For instance, CBD, which is a common supplement for many people.

It will interact with many, many different medications.

So you don't want to be taking CBD if you're taking various medications that are out there.

There are medications like Levothyroxine also known as T for Levothyroxine needs to be taken at least an hour before or two hours after you've eaten.

In other words, Levothyroxine does not get absorbed well if you have any food or any other medications in your stomach it's very anti-social in that regard.

>> It doesn't like to be around other medications or other food for absorption.

So Levothyroxine needs to be taken on a totally empty stomach.

There are other medications like Geodon also known as the president for instance that have to be taken with food to get absorption.

So if you have a medication that you're taking and you're told to take it with food for absorption, you need to ongoing glowingly take it with food.

But if you're taking a medication with food initially mainly to prevent the nausea, then perhaps later on you would need to do so.

I hope that helps.

>> Thanks for your email.

Let's go to our first caller.

Hello Derek.

Welcome to Matters of Mind.

>> Derek, you had a question about Benadryl also known as diphenhydramine.

You wonder about it being linked to dementia in the news is that only if you abuse it if you take it diphenhydramine or a Benadryl, there is a medication that has a strong antihistamine component and it also has a so-called anticholinergic component.

>> What that means it blocks a particular chemical called acetylcholine.

Acetylcholine is what you use in your brain to help you with your memory and it's thought that one of the factors underlying Alzheimer's dementia is you have a decreased amount of acetylcholine.

>> Colene comes from the front part of the brain called the nucleus of Meinert and it gets sprayed out through the brain.

>> Well, Bennetta or diphenhydramine will block acetylcholine and in doing so it will mimic the symptoms of dementia.

>> And I remember twenty years ago hearing about studies where people would take diphenhydramine or Benadryl at bedtime as a sleeping aid and it does help with sleep.

>> But if they did driving studies on them up to noon the next day they were impaired in their driving.

So we often recommend that people don't take diphenhydramine or Benadryl at bedtime as a sleeping aid.

>> There are better alternatives even over the counter.

I would certainly suggest docs el-amine also known as UNISOM as a prescription medication hydroxyl Zeine is another antihistamine does not have as much of an anticholinergic component to it and we often use other medications like low dose stocks happen.

>> We use gabapentin, we use Trazodone.

We use a lot of other medications for sleep that are not addicting and for which you do not become tolerant.

In other words you don't get you don't get used to them but our diphenhydramine wouldn't be a cause of dementia.

>> It would just mimic the symptoms of dementia.

So you could have memory disturbances and trouble with concentration even up to new in the next day if you're using for sleep, especially if you're over 55 years of age now we hear all the time about adolescence and even children taken Benadryl hey, they've got more resilient brains so they can get by taking Benadryl at night time and they don't have as much trouble with memory and concentration.

>> But if you're over about fifty five years old you probably don't want to take Benadryl as a sleeping aid because you're going to have trouble with memory often into the next day.

>> Derek, thanks for your call as your next caller.

Hello Paula.

Welcome to Matters of Mind Paula.

>> You want to know why does what are your anxiety medications give you a racing pulse when you walk a short distances?

>> Paula, you're describing anxiety medications that are probably affecting serotonin now serotonin is one of the big three neurotransmitters in the brain that affect anxiety and mood.

>> There's their serotonin, dopamine and norepinephrine.

>> Serotonin also comes from a little small area of the brain and it comes from this area of the brain down here kind of in the brainstem.

So serotonin gets sprayed up into the cortical cortical gray matter and comes from the Rafina lists and it's a chemical that'll give your brain a calming effect which is always nice and it sometimes it fuzed in excessive amounts can make you feel like you don't even care.

>> So we've got to be careful how much of a serotonin type of medication we give somebody and if you take a higher dosage than what you really might need, it can give you a racing pulse that's called serotonin toxicity racing.

Paul says among those type of symptoms which also include nausea, diarrhea, headache, shakiness and sometimes chills and even hot flashes for that matter.

>> So if you're getting too much serotonin transmission going on there even though you can be help for anxiety that can give you difficulty the racing pulse and that indeed is part of serotonin toxicity.

The type of medications typically given for people who have trouble with anxiety that affect serotonin will be Effexor also known as Venlafaxine Pristina's known as does Venlafaxine and then you have a serotonin reuptake inhibitors such as to use the trade names Prozac, Paxil, Zoloft, Lexapro and Celexa.

>> So all those medications are affecting serotonin.

I might not have mentioned the one you were taking because you might be taken by Spyro McSporran is very selective on which serotonin receptor it affects but still can give you a racing pulse.

These byroade basically will affect one of the 14 different serotonin receptors.

>> It will basically fine serotonin a receptor that's called one a one a serotonin receptors are fine tuned by Bew Spirent or abuse bar but even it can give you somewhat of a racing pulse.

How do you deal with that?

Well, you ask your clinician if you could maybe lower the dosage or look for other alternatives because that can be really annoying if you're walking in you're having a racing thought, a racing pulse and especially if it's giving you difficulty with racing, if you're having trouble with shortness of breath and you're breathing faster than usual.

>> Thanks for your call.

Let's go our next caller.

>> Hello Adrian.

Welcome terrorism mind.

>> Good evening everyone.

Hi.

Yes I am dealing with the racing past the shortness of breath I'm dealing with high anxiety is what I'm going through.

I've been you know with my doctor as recent as yesterday offered some different medication to help me get through it and I'm trying to figure out on my own how do I deal with it on my own at this point my heart rate is accelerating and I'm trying to figure out how do I deal with it on my own.

>> OK, well I'm going to ask you the first question any psychiatrist is going to ask Adrian when did it all start and what might have caused it?

>> I've been dealing with it for too long like over a year now where my pulse is just accelerating through the roof.

It's over a hundred every time I go to my doctor's office is over 100.

My heart rate is over quite a bit and trying to figure out how do I deal with it and just bring it down on my own with hopefully some home remedies.

>> Yeah, well I'm wondering from a medical standpoint why would you have a high pulse?

A lot of different reasons.

You could have high thyroid, you could have a cardiac arrhythmia where you have paroxysmal atrial tachycardia some women especially will have what's called postural orthostatic tachycardia syndrome with the arrhythmia and with Pott's or a postural orthostatic tachycardia syndrome they will usually come and go.

>> You're describing a fast heart rate that's kind of always there, correct?

Yes, And it's I'm glad you mentioned that because I do I have been recently diagnosed with thyroid disease, low thyroid or high thyroid will be a factor there.

>> So I've got good news for you if it's related to the thyroid that's treatable now you want to get just the right amount of thyroid if you get too much thyroid.

Yeah, that can give you a racing heart rate as well.

But if you get too lower thyroid I've seen people have high heart rate even with too low of thyroid that could be the factor that would be the way that you could address that overall.

Sure.

you could do relaxation exercises.

>> What people will often do is take a deep breath in over the course of two counts blow out over the course of four counts if you blow out when you exhale that actually brings down your heart rate breathing in increases your heart rate a bit.

>> So a little bit of an inhalation maybe hold it for just one second.

>> But if you can blow out and hold for a more extended period of time that is a real simple technique that people use to sometimes help themselves relax and you don't want to hyperventilate.

Hyperventilating would be where you breathe in, breathe out, breathe in, breathe, breathe out and you might me take a deep breath but sometimes you can blow off too much carbon dioxide that way and that'll make you even more anxious and give you a higher heart rate but a natural way.

>> Yeah just breathing exercises and different relaxation techniques that are available out there.

>> But I'm thinking Adrian, the first thing I'd want to do if I was you is get that thyroid addressed if you have been diagnosed with thyroid disease off the bat, that's a pretty easy fix.

I've seen the same kind of phenomenon with other medical conditions such as anemia where people how are low iron?

I've seen people have GI pulmonary embolism where they get a fast heart rate and they're short of breath so there's a lot of medical reasons out there but it sounds like they've at least identified for you a thyroid disturbance that is treatable and usually once you start getting treatment for your thyroid they can improve the heart rate within a matter of two or three weeks.

Now there are medications that specifically will lower the heart rate because if you have high heart rate, Adrian makes you tired I mean physically and mentally tired because your heart's going so fast all the time.

OK, there are so-called beta blockers that will slow down the heart rate physically metoprolol is one of them.

Propranolol is another one.

But these are medications that will slow down the heart rate just from a medical standpoint and for you hopefully it would just be a short term fix so much because I do also suffer from low iron as well.

So you just hit that right on entailed there.

>> So I don't want to keep going.

We're we're clicking off too many things here but OK, we got we got a thyroid disturbance that needs to be fixed.

You got low iron needs get be fixed.

Do you snore at night time by chance?

>> Yes I do.

Are you treated for sleep apnea?

No I have not been OK might want to get that checked out to sleep apnea is where you're not getting enough air flow into the lungs and thereby getting inadequate oxygen to the brain.

And if you have sleep apnea it's because you're snoring or you might pause in your breathing at nighttime you would know that.

But other people sleeping with you, would they just notice you quit breathing every now and then sleep apnea is a very treatable condition and if you have sleep apnea you can be tired the next day it's more likely that you're going to put on weight especially around the belly if you have sleep apnea you have trouble with concentration but I've seen sleep apnea also the next day cause people to have nausea especially in the morning and a fast heart.

In other words, when you have sleep apnea your brain gets the interpretation that you're smothering at nighttime and you're getting these releases of cortisol which is the stress hormone that will increase your heart rate and just make you anxious overall the next.

Adrian, you've got a whole bunch of reasons to get feeling better so thanks for your call.

>> Let's go to next caller.

Hello Jason.

Welcome to Matters of Mind.

Jason, you want to know can you be born with anxiety?

You can be hard wired for anxiety and I I ask this of patients I see all the time who and your family has similar symptoms if you have anxiety for instance, do you have a mother, father, brother or sister with anxiety?

OK, we could be hard wired to some degree for anxiety.

It's about 30 percent genetic now here's what happens based on past life stressors especially before the age of eight years old, you're going to be more prone to having anxiety if you had a lot of traumatic experiences interacting with your parents, peers, friends, family members before you eight years of age, a lot of trauma before of eight years of age will give you a greater likelihood of having symptomatic anxiety and depression at the later years.

Does that mean you're automatically predestined to have anxiety?

No, because if you learn coping strategies after eight years of age, if you go through some things that you overcame that can decrease the likelihood you're going to have anxiety so you can be genetically wired for anxiety but you learn good coping strategies and you've endured some bad events in the past that could make a really good therapist for that matter later on because you can help other people.

But yeah, to some degree we're hardwired for anxiety.

>> Our life experiences early on will flip the switch for anxiety because those flitch the switches won't even be flipped if unless you had some traumatic experiences and a lot of cases.

So environment does have a factor but very importantly your ability to cope through things and be able to endure and become resilient.

>> That's a term we use a lot in our field but resilience is basically where you're able to put up with stuff.

In other words, stresses don't get to you as much as they might otherwise.

>> So over the course of time hopefully you can learn from these past experiences and actually be a help for others.

>> Thanks for your call.

As Goyeneche Hello Gary.

>> Welcome to Matters of Gary.

You want to know are there any warnings or negative side effects when trying hypnosis for the New Year and how does it work?

>> Hypnosis is a true medical treatment.

It needs to be done with careful supervision.

It is only done if you're highly suggestible.

In other words, Gary, hypnosis cannot be completed on people who don't want to be hypnotized.

That's a big misconception I know it's been discussed for a hundred years now hypnosis and no, you can't hypnotize somebody just by looking at them or looking at somebody across a sidewalk or something.

>> It doesn't work that way.

You have you're basically the the main person involved with hypnotizing yourself as a matter of fact the best means of hypnosis if you're going to get hypnosis, make sure the hypnosis you're getting is the type where they teach you yourself either by some kind of audiotapes or some means that they teach you yourself on how to do hypnosis because hypnosis is not a one time event.

>> You do it again and again and again and you practice it.

>> So basically it's a state where you're not going into dissociation from the world around.

As a matter of fact during hypnosis your brain is very, very active.

So it's very much like a dream state in your brain but it's a state of high concentration, high focus.

>> You're highly imaginative during that time you are in control of what happens around you.

You might notice, for instance, if you're being hypnotized for pain and I have myself and I've been taught self hypnosis.

>> I've been hypnotized where I could make my hand entirely numb.

>> So if somebody wanted to put a needle in my hand for whatever reason to do it, I've I could make my hand numb.

>> There are means by which you have this will be more successful than others, one of which is smoking cessation.

>> So if you try to quit smoking the whole technique of hypnosis is to make yourself imagine that you're getting physically sick and it's a very visual type of process.

>> But with hypnosis while you're highly suggestible during that time you imagine yourself getting extremely sick while you're smoking.

>> So you actually imagine the cigaret smoke going down to your lungs what the tar is looking like that you're coughing up all this black junk that's just totally disgusting and makes you want to want to vomit.

>> In other words, what hypnosis is doing is making you feel physically sick even at the thought of smoking.

>> So hypnosis is best for helping you quit doing things.

>> Is it so good at helping you decrease your appetite?

That's been debated for decades now and quite frankly I haven't seen people get a lot of success decreasing their appetite because you still got to eat that.

I have seen people have really good success with things that they have to totally quit and smoking is a good example of that.

But I think the key with hypnosis is if you're going to do it for the new year just to make sure that you get some training techniques so you can practice it again and again and again on yourself and you certainly can.

When I first started doing television though 27 28 years ago I was terrified thinking about talking to people on live television.

>> I didn't know what I was going to say so I was terrified.

So I did actually do some self hypnosis before I went on the air a long time ago to get myself to relax and just allow me to focus.

>> But now you know, I have to drink caffeinated beverages to keep me awake in the evening because I'm so relaxed out here.

>> So over the course of time with practice you'll find that you're going to be able to do the hypnosis better and better.

>> Thanks for your call.

Let's go our next email our next e-mail reads Dear Dr. Fauver can a flu or common cold lead to depression or other mental health issues?

>> My friend had a cold last week and is better but still seems really down and not herself.

You better can.

The flu and the common cold will release inflammatory proteins called interferon proteins and these proteins go to the brain and can make you mentally depressed.

>> They can cause you to not care about things, not enjoy things, lose your motivation, decrease energy.

>> They can cause you to ache all over overdose when you have the flu you ache all over.

>> That's these inflammatory proteins being released and when the inflammatory proteins are being released it can make you feel physically and mentally depressed.

So yeah, the cold, the flu can make you feel that way and some of the treatments that are have been under development for the treatment of depression have been ones that attack these inflammatory proteins.

Interleukin six is that's an inflammatory protein I was trying to remember Interleukin six is the main inflammatory protein that seems to be released when somebody has a cold or they have the flu and interleukin six with certain types of depression seems to be elevated and it's been debated for the past ten years.

Should people with depression take an anti inflammatory medication like an insect such as Motrin or Advil Mobic should they take automatically and instead to decrease inflammation?

And that's never been established that that really works that well.

But there's something about inflammation that will cause some people to have more difficult, especially if they have the flu, the cold or a depression.

But if you have that inflammatory process going on, the symptoms of inflammation in your body will be sadness, fatigue, lack of judgment with things, difficulty with sleep, body aches.

>> Those are all symptoms of inflammation and then there are due to Interleukin type six.

>> Thanks for your email.

Let's go to our next caller.

Hello Theresa.

Welcome to Matters of Mind.

>> Theresa, you want to know is it possible to to develop schizophrenia past your 30s?

It's possible but not likely, Teresa.

>> Typically schizophrenia is a condition that does indeed develop to some degree in the and then what happens?

You go through your early childhood development years and stuff happens that will flip the switches for the schizophrenia to emerge.

And that's why many people even though they have the genetic propensity to Delfs schizophrenia, they don't because they haven't had the environmental triggers to for it to develop if you have a parent with schizophrenia, one parent was schizophrenia.

Your likelihood of having schizophrenia yourself would be around eight to 10 percent.

>> But that also gives you a 92 to or ninety percent likelihood of not having schizophrenia.

So there's a lot of environmental factors associated with schizophrenia early in your adolescent years if you're a socially awkward if you have a lot of social anxiety, if you hear things kind of in the background that aren't there, if you're having trouble academically, socially and then lo and behold you start using marijuana as a means of treating some of these symptoms.

>> Those can all be triggers for schizophrenia usually on the average it develops when you're sixteen years of age as a woman and twenty four years of age I'm taking away from sixteen years of age as a man twenty four years of age as a woman it seems like estrogen protects women from getting schizophrenia to a little bit later but the average age about twenty four years of age after thirty you but I would have bet if somebody developed schizophrenia after the age of thirty years of age they did have some so-called pre morbid symptoms early on early on in other words they would have had some oddities in their thinking.

They would had a lot of social anxiety.

They would have had difficulty with processing information.

>> They might have been diagnosed at one point with attention deficit disorder or even autism.

Some of those signs would have been there to some degree already and might not have been highly recognized until after but usually on the average for men the average age of onset of schizophrenia is 16 for women is twenty four .

>> Thanks for your call.

Let's go our next caller.

Hello Kathy .

Welcome to Of Mind.

>> Kathy , you ought to know is it OK to take over the counter antihistamines to treat anxiety an antihistamine affect anxiety.

I don't highly recommend taking antihistamines for anxiety, Cassie, because here's the reason because basically an antihistamine is blocking histamine.

Histamine is what we use to stay awake.

>> All right.

So you and I if you're paying attention to me right now, histamine in your brain is sky high as my histamines sky high histamine keeps us awake.

>> So in my mind I wouldn't want to take a medication intentionally makes me sleepy during the day and that's what antihistamines do they kind of show you out.

They block histamine, they make you a little bit tired and they decrease anxiety.

>> I'd rather kind of go after the specific neurochemistry that's affecting anxiety such as norepinephrine serotonin, Gabba Gabba motor battery acid glutamate.

>> These are all neuro chemicals that are specifically causing the anxiety itself and I'd rather see that aspect of the anxiety be addressed.

>> But basically antihistamines over the counter are going to make you tired and they'll chill you out.

>> But your primary care clinician has a lot of better ideas on how best to get a hold of that anxiety, especially understanding what's causing the anxiety.

I mean there might be various causes for the anxiety that need to be addressed and that's always the best way to get past .

>> Some people will take as we talked about earlier, a short term medication for sleep to help them get through a rough patch.

But at the same time that probably needs to be short term because if you use antihistamine medications long term sometimes it could just make you kind of tired and not care.

So we don't usually recommend those long term thanks for your call.

>> Unfortunately I'm out of time for this evening if you have any questions concerning mental health issues, feel free to email me here at Matters the Mind Away Dog and I'll see if I can get to your email during the next episode God willing and PBSC willing.

>> I'll be back next week.

>> I'm Jay Fawver.

You've been watching Matters of Mine on PBS for Wayne Goodnight