.

Cameron Psychiatry.

Providing counseling and care for those that may struggle with emotional and behavioral challenges.

More information available at CameronMCH.com.

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

Welcome to Matters of the Mind now in its 10th year Matters of the Mind is a live Call-In program where you have the chance to choose a topic for discussion.

So if you have any questions concerning mental health issues, give me a call here on the Fort Wayne area by dialing (969) 27 two zero or if you're calling any place else coast to coast you may dial toll free at 866- (969) to seven to zero.

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

And if you'd like to contact me with an email 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 Edgard that's matters of the mind at www EDG And I'll start tonight's program with an e-mail I received this past week.

It reads Do not a favor.

>> I wanted to know your suggestion on what I can do for anxiety and panic attacks been I've been going to a nurse practitioner for the past six months trying to different medications with no relief.

It's getting to the point where I'm scared to go out driving etc.

Please help.

>> Well if you're getting treated with benzodiazepine medications for panic attacks, they're very effective and these medications include Xanax, Klonopin, Ativan, Valium.

>> They work for panic attacks by going right to this little area of the brain called the amygdala, the amygdala.

And then there's the front part of the brain looking at you.

It's on the side part of the brain.

The amygdala is in this little area of the brain called the temporal lobe and it's shaped like an almond and in Latin it means almond shaped.

>> So that's the anxiety volume control.

It's the anger volume control.

It's the part of the brain that gets fired up when you get really, really anxious and have a panic attack.

Benzodiazepines like Xanax out of an Valium Klonopin go right to that area of the brain and tone it down real fast so they work quickly there are other medications typically used for panic such as the serotonin medications Zoloft, Lexapro, Celexa, Paxil being the ones most commonly used for panic attacks.

>> What they do is they work in the front part of the brain giving your brain some reassurance and giving them a calming effect such that the front part of the brain which is the awareness part of the brain and the reasoning part of the brain gets calmed down some.

So you're not having so much anticipate or anxiety expecting the next panic attack to come so it'll calm you down in that regard.

Well, I imagine that's what your nurse practitioner is using and apparently it's not working so I'd consider other options in terms of what might be causing panic attacks.

A lot of medical conditions can indeed cause panic attacks.

No one just to roll off some of the most likely conditions that can cause panic attacks, high thyroid if you're a thyroid is too high and I often see this as a psychiatrist where somebody recently had a dosage increase on her thyroid supplementation and all of a sudden they're having panic amount of Xanax or Klonopin no- sometimes will relieve that.

>> Secondly, if you have atrial fibrillation, atrial fibrillation is where the top part of your heart, the rhythm part of the heart just starts going really fast and it starts causing your heartbeat to be really, really fast and it's something that can be readily treated surgically, can be treated with ablation.

>> Sometimes they'll use beta blockers as a means of calming that down.

Beta blockers slow the heart rate so atrial fibrillation can be a factor.

>> Women are about eight times more likely to have a condition called postural orthostatic tachycardia syndrome Pott's Potts's where all of a sudden your heart races so fast that you pass out and it's much more common with the women especially young women women between the ages of 16 and about thirty five years of age.

>> Potts's a condition that can be devastating in terms of causing a lot of panic and anxiety and as a psychiatrist I will get referred people in your very situation who will say I've tried everything out there for anxiety and panic.

Nothing's getting nothing's helping me and then I go through the symptoms and I find out they're having symptoms of pots and we get them treated by cardiologists in those kind of conditions.

>> Other medical conditions can be a glucose disturbance if your glucose goes really low periodically and you have hypoglycemia that will give you symptoms of a panic attack not uncommonly more seriously.

>> Some people will have a pulmonary embolism where they have a blood clot that goes to the lungs.

They'll have difficulty with hyperventilating and it will also mimic a panic attack.

>> So what I'd suggest to you is make sure you see your primary care clinician to really get a thorough overview of what's going on in terms of what can be exacerbating the panic attacks.

Now sometimes I'll see somebody who is being treated from a psychiatric perspective and maybe they're on a stimulant for ADHD and they're stimulant medications a little bit too high.

>> It's similar to what can happen if somebody has too much caffeine.

Caffeine will aggravate panic attacks some people but if somebody is on a stimulant medication for ADHD and they had a subtle dosage adjustment recently that will often bring out panic attacks for those people.

I just saw a lady earlier today who had panic attacks predominantly occurring the five to ten days before her period's month by month by month.

And for her I'm going to address the hormonal premenstrua type of disturbances that can occur because those premenstrual hormonal disturbances not uncommonly will cause panic attacks for her.

>> So as estrogen is going down prior to the periods that will sometimes bring out the panic attack.

>> So there's a lot of different things out there that can be done besides just merely using benzodiazepine medications and medications that merely increase serotonin.

You have to look at the whole picture to really sort out what's causing panic attacks once in a while, you know, you'll hear about somebody having panic attacks for psychological reasons.

>> In other words, they started having panic attacks.

>> When you're in a situation where they felt like they're back to the corner, they didn't have any way out by based on their perspective and they felt like they were backed up into a corner where they didn't have any solution to a particular situation and they'd have this blast of panic where their heart would race and they'd get sweaty and they get shaky.

>> Those people from a psychological perspective sometimes will have recurrent panic attacks thereafter and it all started with being in a situation where they felt as if there was no way out.

>> And for those people they do very well with counseling to try to give them a different perspective on life .

Thanks for your email.

Let's go to our first caller.

>> Hello Joy.

Welcome to Mars the Mind.

Hi, Dr. Farber.

I'm wondering if antibiotics affect your dopamine or your serotonin and will probiotics fix that?

>> You answered your question, Joy.

You bet.

Antibiotic medications can sometimes kill off the good bacteria in the gut.

We have good bacteria in the gut with some bad bacteria.

The good bacteria actually can influence the brain.

There's a lot of there's not a lot known about this Joy.

>> But we do know there is some important gut bacteria that can have an effect on serotonin and dopamine.

It's not to the point where in twenty twenty four we are actually using probiotics as a means of treating depression or anxiety.

But if you notice that you're taking an antibiotic and you feel differently, many people will notice it with a manifestation of severe diarrhea.

>> But if you feel differently physically or emotionally, you might notice that probiotics especially during that time and maybe for a month after you take the antibiotics can be helpful with probiotics are basically bacteria that are good for you and they help with the gut health and indirectly they do affect the brain chemistry.

Thanks.

>> Thanks for your call, Julie.

Let's go to next caller.

Hello Diane.

Welcome to Matters of Mind.

Diane, you want to know how does a brain recover from a stroke?

>> Diane There's a couple of different types of strokes.

There's a hemorrhagic stroke where somebody has a bit of a brain bleed and then there's a occlusive stroke where they have a clot that causes a decrease in blood flow to certain areas.

Number one, depending on how massive the stroke is and what part of the brain it affects, you're going to treat it in different ways.

Some people will do well with physical therapy, occupational rehabilitation.

They will have this ongoing rehabilitation over the course of six months to a year typically after a stroke.

How does it recover?

Well, when you have a stroke there's an excessive amount of glutamate release.

Glutamate is an excitatory chemical that is toxic to the brain.

So whether you're having a seizure, whether you're having a stroke, you could have excessive glutamate and thatpgin cause further cell loss.

What we sometimes will do when people have emotional disturbances related to a stroke is will give them medications that modulate or stabilize glutamate.

So we always will look at that possibility but frequently will depend on where the stroke is located and what kind of rehabilitation somebody will have as you mentioned six months to a year as the typical time frame where we expect people to have the most dramatic improvement following a stroke.

>> Diane, thanks for your call.

Let's go next caller.

Hello Shannon.

Welcome to Mastermind Shannon.

>> You want to know about the mental health risks of loneliness?

What advice would I give to anybody who's an introvert?

Loneliness is a prominent risk factor for depression.

Shannon and this really came out during the covid lockdown down restrictions that we saw these past years when people were locked down and there was more and more loneliness that drastically increase the likelihood of depression and even suicidal risk factors especially for the young adults people up to about 30 years of age between adolescent years and 30 years of age is more difficult for the younger people.

>> The younger generation now is the most digitally connected generation we've ever had in history but they're the most isolated from a social social standpoint because they're not interacting with each other as they did before.

Loneliness will give you a risk factor for depression even if somebody's been treated for depression Shannon and they're starting to feel better if they don't get out doing things and finding pleasurable activities and especially if they don't socialize, that will be a risk factor for their relapsing back into depression.

Older adults, people over that magic age of 65 years of age if they're are more socially isolated which is so common they're more likely to develop depression and dementia.

So social isolation for an older at all is a big risk factor for depression and dementia.

We need to have interpersonal connectiviy.

We need to talk to people.

Can you do it digitally to some degree and sometimes people can do that.

Some people can.

For instance, as a clinician I will treat a lot of patients with telehealth and video health knowing there are limitations on what I can do by video and how I can assess people.

So not everybody's appropriate for that but for many people they are because these are people who I treat who are still employed.

>> They're out and they have busy lives and they have a difficult time getting into a doctor's office in a timely manner.

>> So I'm trying to increase accessibility by video health in the same way if you're socializing video interactions will be better than nothing.

So it's important for people to have that social interaction one way or another because that will decrease the likelihood for depression and eventually for dementia.

>> Qiana, thanks for your call.

Let's go to our next caller and who do we have a next caller we oh let's go to our next email.

We have another email here.

Our next e-mail reads Deductively What's the peak age or age range for mental health disorders when they start to show they're a different ages for bipolar disorder?

This is where people have big manic highs and subsequently with big lows into depression, they most commonly will have their first mood disturbance occur in adolescence and as they go through life the highs get higher initially and then they have less lows.

>> But as they go through life they have more lows than they do highs.

So you often see bipolar disorder occurring in adolescents for depression that can occur based on somebody's life circumstances either earlier in life or later in life .

>> With depression there's a genetic risk about 30 percent genetic risk for depression.

But then you look at life circumstances before the age of eight years of age.

What degree of emotional sexual physical abuse, abandonment, attachment with the parents?

>> How much of that was problematic especially before the age of eight years old?

And then what coping skills has somebody developed as time goes on?

You put all that together and you can sometimes see an earlier age of onset for depression and other people some people get their first episode of depression when something catastrophic occurs later in life despite having a happy childhood and developing good coping skills.

>> So it depends what depression for schizophrenia which is a serious mental health and condition schizophrenia has the average age of onset for four boys at sixteen years old and for girls of twenty four years old.

>> Estrogen appears to protect a woman from developing the symptoms of schizophrenia and the and will delay it for eight years compared to boys.

>> So there's different ages of onset.

It's rare that you'll hear about a severe mental health condition starting all of a sudden in the 40s, 50s or 60s usually with mood and psychotic disturbances.

They tend to occur earlier.

They can occur later on related to strokes or neurological conditions or catastrophic events that occur in life .

But for most people they have some glimmering of anxiety depressive psychotic type symptoms occurring earlier in life rather than later.

Thanks for your email.

Let's go next caller.

Hello Laurie.

Welcome to Matters of Mind.

>> Laurie, you had mentioned that you're a former marijuana user and you recently quit.

That's fantastic, Laurie.

You are using it alongside with your prescription vibranium for anxiety.

What's the withdrawal symptoms of marijuana and I think it should be legal.

I've been very open, Laurie, in saying that I do not think marijuana should be recreationally legal.

I think it's a bad idea.

I'm going to get a lot of disagreement with people who are state legislators and people who are able to get financial advantages from the legalization of marijuana.

>> But I just think it's a bad idea and you have to do is look at the states who have legalized it starting with Colorado back in 2012 when they legalized it they had a and they still do have a adolescent and young adult mental health crisis because if you legalize marijuana, even though you might say it's only legal for 18 enough 21 years of age of an up whatever age restricted you want to have, adolescents are going to perceive that it's OK to use it as they would with alcohol.

But marijuana is actually more devastating for the mental health even an alcohol marijuana will physically change the brain structure in such a way that it makes it a white matter a brain not not grow as abundantly as it should white matter the brain is the insulation on individual nerve cells and there's a dramatic decrease especially in the front part of the brain.

The thinkig part of the brain of white matter development if you use marijuana prior to the age of twenty four years old so how about if you start using marijuana when you're forty five?

There's some thought even now that if you start using marijuana in middle age years you still might have some pdifficulty with concentrationpt have had otherwise.

So no one is going to give you difficulty with your IQ if you use marijuana prior to the age of twenty four years old.

>> And secondly, you know there's some difficulties people will have with anxiety and even mood disturbances with the use of marijuana.

>> Now Laura, you had mentioned you were a former marijuana user.

People use marijuana for a lot of reasons.

They'll use for sleep, they'll use it for anxiety.

But what it does it'll make you not care.

And that's where I'm always preaching to these these adolescents who are going off to college don't use marijuana when you go to college, go easy on the alcohol, lay off the alcohol entirely ideally but don't use marijuana because marijuana will make you not care.

It'll give you difficulty the concentration next thing you know you're going to have more and more trouble keeping up with your classes and that's a key reason why people will drop out.

>> So you're using marijuana alongside with vibrate vibrate be an antidepressant medication that very specifically and selectively will increase returning transmission but secondarily affect one of the fourteen serotonin receptors that can, you know, show you out a little bit and help you with anxiety in different ways that the other serotonin medications might not.

>> So what are the withdrawal symptoms of marijuana, Lori?

Depends on how long you've been using it some people will have withdrawal where they will have more anxiety and scream extreme difficulty with sleep.

And I always remind people the long I've been using marijuana the more anxious you're probably going to get.

I see some people in their thirties, even early 40s who have been using marijuana since there are 13 or 14 years of age all of a sudden when they stop they start to have this social awareness that they didn't have previously because that's what marijuana will do to an adolescent.

It will basically dampen down the anxiety that we all should have as adolescents when we're in social interactions.

>> If you don't don't care and you go through life not learning how to maintain those kind of social interactions, you'll notice that front and center once you go off the marijuana years later.

So many times people will describe themselves as feeling like they have the emotional IQ of an adolescent when they go off the marijuana in their thirties because they never learned how to interact with other people because it dampened their emotions and their ability to care about things.

But Laurie, I think I think based on what I see around the country with the states legalizing marijuana recreationally, I see that there's a high likelihood even our state of Indiana will legalize recreationally.

I don't think it's a good idea.

The marijuana THC content today in twenty twenty four is entirely unlike it was thirty forty years ago thirty or forty years ago it was not nearly as potent.

Now it's much more potent and being more potent.

I think it can cause some other >> Laura, thanks for your call.

Let's go next to email our next email question reads Dear to Evolver I'm on Abilify that's also known as a result for bipolar disorder.

I'm starting to have instances of blurred vision.

>> Is this a side effect if you're starting to have instances of blurred vision on Abilify and you didn't have them previously, I wonder if you might not be having some blood glucose disturbances now bipolar disorder in itself it put you at risk for diabetes and blood sugar disturbances and it's not the medication by itself doing that.

>> It can be related to the actual underlying condition .

Back in the nineteen twenties there is a psychiatrist by who who is by the name of friends at the University of Wisconsin who had demonstrated in the nineteen twenties one hundred years ago that blood sugar abnormalities were more common for people who had bipolar disorder.

>> So we know that bipolar disorder itself possibly by disturbances in cortisol the stress hormone by itself I can give you more difficulty with blood group abnormalities and Abilify to some degree and it's speculative whether that by itself can cause blood or abnormalities.

But the bottom line is a symptom of blood sugar abnormalities and a symptom of diabetes will be blurred vision.

>> Other symptoms can include getting up in the night and urinating more than usual.

Other symptoms can be poor concentration but blurred vision can be a symptom of diabetes.

>> You might want to get your blood sugar checked either an agency which looks at your average blood glucose for the past three months or does the fasting blood sugar where you get a blood sugar first thing in the morning if you've not eaten or had any caloric beverages for at least 12 hours or so, might want to get your blood sugar checked if you're having blurred vision all of a sudden with a medication like Abilify Abilify like most medications will give you most of its side effects the first two or three weeks you take it many medications will give you the most side effects right up front and then later on they tend to fade.

>> If anything, you don't usually get side effects from medication after you've been taking a long term unless there are conditions like tardive dyskinesia which is a long term effect of medication, it's blocking dopamine, the so-called antipsychotic medications.

But tardive dyskinesia like the name implies tardive means later on can give those kind of effects later on.

But most medication side effects occur earlier on.

>> Thanks for your email.

Let's go next caller.

Hello Patrick.

Welcome to Of Mind.

Patrick, you had mentioned that you drool and spit a lot and a friend told you that it's a sign of anxieties.

Is there any truth to that?

Usually when people have anxiousness, Patrick, they get a dry mouth and they get a dry mouth and that's why some people when they're speaking publicly will get a dry mouth and then they get water and hydrate themselves.

>> If you have difficulty with drooling, I'd say especially if you're younger that could be a symptom of gastric reflux, gastric reflexes symptom sometimes people can drool when they have strep throat mononucleosis, some kind of infections can do that.

I'd want to check out with your dentist because sometimes if you have dental irritation that can cause drooling but with medications sometimes can cause drooling.

There's a medication called closer and closer to a classi symptom will be excessive drooling with that because it's stimulating a particular muscarinic receptor.

Muscarinic receptors are the ones that are affected by acetylcholine and when you stimulate muscarinic receptor number four that will give you drooling as a side effect of some medications will affect that particular receptor and give you more drooling.

>> That anxiety not usually associated with the ruling because if you think about what happens, somebody gets anxious.

They have an increased adrenaline increase norepinephrine going on adrenaline, the norepinephrine if anything has a drying effect on the mouth.

>> So it's going to give you more of a dry mouth compared to drooling.

>> Patrick, thanks for your call.

Let's go to our next caller.

Hello, Chuck.

Welcome to Matters of Mind.

>> Chuck, you had studies overuse of Benadryl cause dementia.

Chuck it's not that Benadryl right.

And also known as diphenhydramine will cause dementia itself.

It's more that it'll give you symptoms that will mimic the dementia Dytham hydromorphone is a common sleep medication and for younger people it can be fine.

>> It will block histamine receptors but it also has a so-called anticholinergic effect where it's blocking acetylcholine.

If you block acetylcholine you'll have trouble with memory and that's one of the factors associated dementia.

>> So what we'll hear about younger people often do find a different hydromorphone adolescents, young adults.

>> But when you get over fifty five sixty sixty five years of age and you take Benadryl or diphenhydramine as a sleep medication for instance, you'll notice that you might have some fuzziness and fogginess all the way up until noon the next day.

They've done studies for driving for people where you drive around the cones and they found that people who took diphenhydramine or Benadryl at bedtime had more difficulty driving around the cones all the way up until noon the next day.

>> So when I see somebody who's over fifty fifty five years of age I'm always trying to get them off of Benadryl or diphenhydramine and getting them on something else as a means of helping them with concentration and focus.

But the good news is it's not usually a permanent phenomenon where they have permanent memory loss.

It's usually while they're on the Ben-Israel while they're on the diphenhydramine they have trouble with that.

>> Choux, thanks for your call us let's go to to your call walking there's mind you to follow up to an earlier question does marijuana cause psychosis?

>> Cassie, it's a kind of phenomenon where if you're genetically predisposed to having psychosis for instance, you have family members who have schizophrenia.

>> Yeah.

You use marijuana.

It's going to Drummy radically increase your likelihood of having psychosis.

So there is a genetic element in terms of who gets psychotic from marijuana and who does it.

But quite frankly and again we've seen this out in Colorado with the higher potency marijuana that's coming out from hybrids more so than what we saw twenty , thirty years ago with a higher potency marijuana that's now available there appears to be a higher likelihood of psychosis with not only this marijuana suppress that white matter growth in the brain but it also seems to trigger psychosis for people who might be somewhat predisposed.

There is a dose relation ship with that.

The higher the dosage of marijuana use the more likely somebody can get psychotic.

And unfortunately I have indeed seen some people who got psychotic.

They did not have a family history of psychosis and they got psychotic and I'm pretty much could attribute it to the marijuana.

Cassie, thanks for your call.

>> Let's go to our last caller.

Hello, Joy.

Welcome to bear in mind, Joy, you wondered could gastric issues trigger mental health problems if you have difficulty with gastric reflux, it can give you chest pain, joy and that can sometimes mimic anxiety and off you go.

We often hear the difficulty with gastrointestinal problems going back and forth with anxiety in other words, if you have anxiety you can have diarrhea.

Some people have anxiety, constipation so you can have gastrointestinal problems related to mental health issuese those kind of problems.

But you can imagine if you're having diarrhea related to anxiety, you can always be anxious when you go out in public and that can actually create some social anxiety that wasn't there before.

So yeah, sometimes gastrointestinal problems as a consequence can give you difficulty with mental health problems.

Joy, thanks for your call.

Unfortunately I'm out of time for this evening.

>> If you have any questions concerning mental health issues that I can answer on the air, you may write me a via the Internet at matters of the mind all one word at a dot org.

>> I'm Psychiatrist Ja'far and you've been watching Matters of Mind on PBS thirty nine now available on YouTube God willing and PBS willing.

>> I'll be back again next week.

Thanks for watching.

Goodnight Cameron Psychiatry.

Providing counseling and care for those that may struggle with emotional and behavioral challenges.

More information available at CameronMCH.com.