.

>> Good evening.

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

>> Welcome to Matters of the Mind.

Now as 24th year or 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 at PBS Fort Wayne by dialing in the Fort Wayne area (969) 272 zero or if you're calling any place coast to coast you may dial toll free at 866- (969) 27 two zero now on a fairly regular basis we are broadcasting live every Monday night from our spectacular 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 WFYI that's matters of the mind.

>> You have a dog at tonight's program with some questions I recently received.

>> The first question reads Dear Dr. Fauver, I have heard about this new nine eight eight emergency phone number.

>> How is it different from nine one one nine one one's been around for quite some time and nine one one involves emergencies involving fire.

>> You need the police need a medical emergency.

You need an ambulance nine eight eight is quite different.

>> I need is more for a mental health crisis or when you're feeling suicidal.

So it's specifically for a mental health purpose.

So when somebody calls nine , eight , eight they're calling because they're suicidal.

They're having panic attacks and they don't need an ambulance as much as they need somebody with whom to speak right away and try to determine their needs at that point because the misconception about people who are suicidal will be if you're talking about suicide, if you're reaching out to others, expressing your possible motives that you're not really suicidal and that's a terrible mis misconception because people who are suicidal often have that glimpse of ambivalence and it's thought that most people who actually commit suicide had been talking about doing so with others prior to prior to their committing suicide.

>> If you look back on the historical track record so it's important that we try to reach out to these people with suicidal thinking and some graphics here 24/7 crisis and support.

You get a live person on the on the call and the idea the strategy behind all this will be to divert the calls from nine one one over to nine eight eight four suicidal and mental health crises.

>> So these people aren't going to necessarily to an emergency room that particular night.

>> They're not summoning an ambulance.

They're getting the kind of needs they specifically need and we have a suicide crisis occurring in our country right now.

So this is something that I think is well overdue.

>> But again, the strategy is to divert the calls from 911 one over to nine eight for the mental health crises.

>> The logistics are still evolving and I think they will evolve quite a bit over the next few years because you have to determine on that line is the person who is calling expressing suicidal intentions where they need immediate inpatient treatment for their safety and there's ways to sort that out as you're talking to somebody.

So you have to be able to figure that out as you're on the line with somebody who is suicidal, people with suicidal considerations will often lose all hope and the suicide hotline operator needs to be able to dissect what kind of hope they might have, what kind of reasons they might have to to still live.

>> Do they have family?

Do they have people still counting on them?

They have to be reminded of how people around them might respond.

Now sometimes people will want to commit suicide as a means of retaliation toward others and you have to sort that out to determine if the motive behind the suicidal thinking overall.

>> So so the suicide hotline number was seven digits.

Now it's really simply nine , eight , eight and hopefully we can be able to redirect these people to more appropriate types of setting as opposed to simply having a police car come out picking them up and taken to the emergency room where they were then assessed these people who call nine eight eight will be assessed a little bit more proactively over the phone and hopefully it'll be less intrusive, intrusive overall and more comfortable for people to know that they can have that means by which they can get help.

>> Thanks for your email question.

Let's go to our next question.

Our next question reads your doctor Fauver does p o it s portable neuromodulation stimulator device have a use in the treatment of dementia?

We've been told it may but I have not found supporting evidence or studies.

>> You are absolutely correct.

Neuromodulation basically is where the brain gets a very mild degree of stimulation on the outside there's no side effects to speak of and it's where it's not like ECT.

>> Electroconvulsive therapy affect your providing an electrical impulse typically to the right front part of the brain but you're providing electrical impulse to the degree that it actually provokes an electrical seizure in the brain.

>> What electrical seizure occurs in the brain?

>> A lot of stuff happens from a chemical standpoint when you apply electricity to the brain just to the outer part of the brain for a few millimeters of depth where you're not provoking a seizure, you're not necessarily going to have a lot of impact.

>> And that's what we've seen so far with with electrical stimulation on the surface of the brain.

>> It's you'd think gee, that should be able to change the brain functioning right?

>> Well, it doesn't necessarily do that and so far I've not seen any evidence showing that neuromodulation with electrical stimulation of the brain gives any relief for dementia.

>> Now there is transcranial magnetic stimulation not electrical but magnetic stimulation to the brain that is used for depression and it is where the left front part of the brain is stimulated which is underactive with depression and that has been shown with some people to give them relief with depression itself.

>> But that's magnetic.

Has it been studied for dementia just yet?

Thanks for email question.

Let's go to our first caller.

>> Hello Bill.

Welcome to Matters of Mind.

Yes, Dr. Berger, I am calling about I've been reading about the use of lithium as a supplement like two milligrams for cognitive decline.

No, I don't know if this is actually true but I don't want to be with Don Quixote out there chasing windmills.

>> This is something that's not really something we should think about.

>> Bill, on the tips of our chromosomes we have these little caps and they're called telomeres and the telomeres get shorter and shorter as we get older.

>> So as we age a natural visual indicator of our aging process is the shortening of the telomeres and lithium is one of the few substances that has been shown to lengthen Tillem telomeres or at least to delay or prevent they're getting shorter.

So lithium at low doses would be somewhat of an anti aging strategy.

>> Now I always recommend people to people like you like yourself, Bill, to always ask their doctor or their pratchett's clinician if they are using any specific supplements and most clinicians will be open about that myself.

>> I don't use lithium as a supplement although I'm intrigued by it.

You had mentioned to grammes that a two thousand milligrams that's a pretty high dosage and I think ironically the high doses lithium causes difficulty with memory and concentration in articulating your speech and you can actually have a slurring of the speech at high doses of lithium.

>> So lithium is tricky.

You've got to use very low doses for to be probably effective as an anti aging or a as a means of helping with longevity for that matter.

>> But that's that's controversial at this point.

But I doubt it would be at those really high doses that we use for bipolar disorder.

Bipolar disorder will use doses of six hundred milligrams twice a day or maybe 900 milligrams all at bedtime.

>> Sometimes people go higher than that.

But as you go higher and higher on your lithium level, you'll have difficulty with memory and you'll have slurred speech.

>> You'll have diarrhea, nausea, tremor.

>> You'll have difficulty with walking because you'll be very unsteady.

>> So lithium toxicity at high levels when you get above oh one a level of 1.0 ML equivalents per liter and higher you start get all these side effects often there's a headache in the back of the head that people will describe.

>> So you don't want to go too high on the lithium.

A small dose of lithium can be helpful perhaps for longevity but also possibly for suicidality.

I saw a person a few hours ago who had suffered for decades with just persist and thoughts of suicide almost on a daily basis and this gentleman has been struggling for a long, long time.

>> I prescribed him one hundred and fifty milligrams of lithium.

That's something that is a prescription product that's the lowest amount of prescription capsules of lithium you can prescribe.

But prescribed him specifically and selectively one hundred and fifty milligrams of lithium because lithium has been shown to decrease the rates of suicide in various communities around the world where there's higher lithium levels naturally in the water supply.

So it's something that I found as a clinician over the past thirty five years that if people take a small amount of lithium sometimes within a week or two , all of a sudden these ongoing suicidal thoughts just go away lithium has antiinflammatory effects on the brain and that might be why you might why you might have heard about it possibly increasing longevity because by decreasing inflammation in the brain no one at can improve brain health for people who were under stress, especially if they're manic because it's thought that when people have bipolar disorder and they're manic and they're not sleeping, they're talking a mile a minute.

>> They're going from one topic to another.

It's thought that they have this particular inflammatory protein in their brain that's elevated called one hundred lithium has specifically been shown to decrease 100.

>> There's another medication it also does that called Depakote but that becomes a little bit less tolerable than lithium.

>> But lithium can decrease.

That's one hundred decrease inflammation of the brain and somehow some way it can possibly change at least in animals the telomere length and possibly increase longevity.

>> So we might be hearing about this more over the course of time.

>> Bill, you had mentioned hearing about two grams.

You might have heard two milligrams which is an extremely tiny amount of lithium that is used.

>> I remember back in the days ,you know, the controversy about should we put iodine in the salt because iodine can actually in the salt and it can affect the thyroid levels and iodine and thyroid transmission will have an interaction oh maybe lithium is doing something along the same.

It's it's not a new product has been on the ground since the beginning of time so lithium is a natural salt.

>> It's in the in the same column on the periodic table sodium and potassium and that's why if you increase your sodium level your lithium level can decrease and vice versa when somebody is taking lithium now sometimes people will want a lithium blood level.

Well, if you're not taking lithium, your lithium blood level is going to be zero.

>> So the lithium blood level is going to be negligible for most of us.

But the question is should we all be taking a little bit of lithium?

>> I think that's something that might be discussed over the years but it's not totally out of line to consider the possibility of lithium being used for conditions other than mood stability, which is how it's used now we use lithium for the purpose of stabilizing the mood with bipolar disorder.

>> That's a number one use of it.

The number to use is probably to decrease suicidality for people and just a really small amount of lithium can be helpful for a lot of those people.

>> Now the drawback of lithium and this is why not everybody should be taking it at this point without close supervision?

No one I mentioned all the side effects you can get with lithium toxicity but number two , you can have a suppression of your thyroid functioning.

>> So high dose of lithium especially in the immediate release formulation can cause you to have decreased thyroid function, decreased thyroid can cause you to have fatigue weight gain bloating.

>> You can have constipation, blurred vision with thyroid deficiency you can have some hair loss.

>> So that's not really something that people want to experience and also with high doses of lithium unnecessarily over the course of time you can actually shut down your kidneys and have renal problems so you could have problems with your kidney functioning with too high of doses of lithium.

So that's why it needs to be monitored.

>> But at the lower doses who knows it was in soft drinks a version of Seven-Up and early early 20th century had lithium in it and people would drink the the soft drink.

>> It was a citrus soft drink very similar to Seven-Up and they drink with lithium and they feel more mellow because lithium yeah it can make you feel kind of mellow.

>> That's why it helps with bipolar disorder but they found that a lot of people were getting really sick on that soft drink.

>> So if you drink too much of the soft drink with too much lithium in it you have lithium toxicity and that's when you have diarrhea, tremulousness, poor concentration and memory disturbances and trouble walking.

>> So that's why lithium needs to be monitored overall.

>> Thanks for your call, Bill.

Let's go to our next email question.

Our next e-mail question regenerative Alver can sleep concerns be symptoms of depression?

>> How can I tell whether it's depression or sleep apnea?

>> This is a very common question because sleep apnea is basically where your snoring at night or perhaps you stop in your breathing every now and then maybe your loved one will notice that you stop and you're breathing and they give you a little nudge trying to get you breathing again.

>> Well that's called sleep apnea.

When you have sleep apnea, you're decreasing your airflow every now and then sometimes for four or five or even 10 times an hour or more and when you're having difficulty with the air flow to the lungs that will decrease oxygen to the brain with less oxygen to the brain throughout the night.

>> And for some people this goes on throughout the entire night you'll have fatigue, you'll have poor concentration, you'll have low motivation and you can't have depression the next day so often as part of the routine workup I'm always asking people if they're having any difficulty with snoring or pausing or breathing and any tiredness during the day and there's actually a questionnaire that we use called the Stop Bang just like it sounds it's free so you can get it online at Stop Bang is a questionnaire assessing you for symptoms of sleep apnea.

>> So we will do routinely a stop bang on the first appointment looking for symptoms of sleep apnea and will often order an at home sleep studies call a poly sonogram.

>> You pick up the unit at a sleep medicine lab with an order and you wear overnight in your own bed and then you go in the next day take the unit back in.

They read within a week.

Typically you can have an in-house sleep study where they do the sleep study in the sleep medicine lab overnight and they used to be done all the time but now we have the home sleep studies where it's a little more convenient for some people.

>> But if you have a stroke or medical issues that are complications, they often want you to have the sleep study done in the hospital in sleep medicine lab itself.

Now if you have sleep apnea you're going to have all those problems that can overlap with depression and I've seen this over the course of the years where people had been diagnosed with depression when they actually had trouble with sleep apnea and antidepressant medications just don't work that well for them.

You can take one antidepressant medication after another after another and they just don't seem to work so well because the underlying medical issue we see the same thing happen with somebody who has low thyroid diabetes, low iron if you have a medical condition that's giving you symptoms of depression, traditional antidepressant medication and even cognitive behavioral therapy in the psychotherapies they just don't work so well.

So you have to get to the underlying problem to be able to sort out the symptoms so the treatment for sleep apnea will be airway pressure with a mask.

>> Sometimes people are able to use it more comfortably with a nasal cannula.

Some people will get throat surgery, they open up their airway, some people get sinus surgeries.

>> But the bottom line is you need the airway opened up throughout the night.

No one the snoring would stop a no to the apnea itself.

The stopping of the breathing would stop and it would no longer be problematic for you.

>> So if you treat it usually within two to four weeks you see a significant improvement with your energy level, your concentration and sometimes even the mood.

And for some people we find that they may or may not still need the antidepressant medication but some people still do.

>> But the antidepressant medication will work a lot better depression itself as opposed to sleep apnea.

>> Sleep apnea will give you a lot of them kind of physical symptoms of you're tired, you're kind of sleepy, you're kind of sluggish.

>> You don't have a lot to get up and go depression itself.

You start brooding about stuff the past.

>> So if you're brooding about all these awful things you did in the past, that's more of a symptom depression lack of enjoyment and things with sleep apnea you want to do stuff still but you just don't have the energy to still do a depression.

>> You specifically will say you don't want to do the things that were previously pleasurable for you so you have trouble getting the motivation and the enjoyment out of pleasurable activities and it's a vicious cycle because as you no longer do the pleasurable activities you get more depressed and with more depression you don't want to do the pleasurable activity so it goes back and forth that way.

>> So we often will treat sleep apnea hand-in-hand with depression but many, many, many people with depression do need to be assessed for sleep apnea to make sure that's not an issue and a place to start would be the stop bag test.

The stop being test again asks about snoring pauses in the sleep tiredness and so forth and will give us an idea as a clinician whether you might have sleep apnea.

>> Thank you for your question .

>> Let's go to our next caller.

Hello John.

Welcome to Matters of Mind.

Well, John, you had mentioned you have an adult son showing signs of depression.

How does one help an adult who seems unwilling to get mental help?

>> John, when you have a loved one who's reluctant to get mental help, difficulty is the best thing you can do is state the reality as you see it in other state what you notice about your adult son and how you noticed he might have changed compared to be for us having mental health problems.

For instance, if he's having difficulty with sleep that's where he often start John.

When people are not sleeping well they often even in the in a psychotic state will recognize that's not really normal.

>> So we often will mention their sleep pattern.

Are they up all night?

Are they they look more tired during the day.

Do they take a lot of naps during the day that's sometimes a place where you can start in terms of identifying they're having problems.

Secondly, people with mental health problems will often have trouble going to work and getting getting along with other people they'll have difficulty with her speech as a family member you can observe that you know you're having a hard time following him and all you have to do in a loving and a nonjudgmental manner is just say this is what I'm seeing.

>> This is what I'm seeing and I'm really concerned about you and I really love you and you can try to nudge him into getting mental health treatment at that point.

>> Now mental health treatment unlike twenty , thirty years ago does not mean that you're going going going to go into a psychiatric hospital for what one or two months.

>> Mental health treatment nowadays involves psychotherapy, talk therapy.

You can have group therapy medications can be helpful medications for with from a psychiatric standpoint should not change your personality as you would expect it to be.

It does not cause they do not cause you to be addicted across the board.

They are more safer to use compared to 20 years ago.

>> So we have lots of different opportunities now that we can use with medications with with medications in twenty twenty two we can actually do genetic testing and get a little bit better clue on what type of medications might work and I'm hoping that most of us are better pharmacologist now than we were twenty years ago because we we've learned so much more so a lot of misconceptions are out there about mental health treatment but I certainly encourage your adult son John to to be able to get some help and you can start with talk therapy.

Psychotherapy an individual or group therapy can be helpful.

Medications can be an option.

>> You can always start with your primary care clinician though primary care clinicians are often very trusted by family members, it's a good place to start and they can initially do some medical work ups to see if there's any disturbance.

>> Their sleep apnea as I just mentioned, can be a possibility in terms of why somebody might have mental health disturbances that were they didn't have them previously.

>> John, thanks for your call.

Let's go to our next caller.

>> Hello Blaine.

Welcome to Mars The mind.

Blaine, you mentioned you have a daughter who complains that noises like forks on tables and plates give her terrible headaches.

>> What could this be?

That's an interesting question .

John R. Blaine.

It's it might be an issue that's a neurological condition.

There's something called Misophonia where people will have difficulty with human noises so they just get really anxious when people are breathing other people or they can hear them breathing and they can hear other people munching on food and that's kind of a different phenomenon if somebody is so-called hyper sensitive to expected environmental noises, yeah, they might be worthwhile getting a neurological evaluation just to make sure there's not an underlying condition like migraine headaches because migraine headaches can be provoked by noises that can be triggers to bring that out.

People with migraine headaches will often have these excruciating headaches that cause them to have to go lay down for a couple hours and that's the difference between a migraine headache and attention headache.

A migraine headache is so excruciating you can't function.

It's often throbbing.

It's on one side of the head versus another whereas a tension headache is achy and it's annoying but you can still function.

So I'm wondering if noises and environmental sounds are triggering headaches.

As you had mentioned, if that couldn't be something it's triggered a migraine headache.

If it's a migraine headache we're going to treat it with migraine medications and there's so many good medications out there for migraines now compared to even five years ago and there's a lot of good treatments out there so that could be a factor.

>> So I'd recommend starting with primary care clinician to see what kind of differential diagnosis can be determined on the headaches.

But if the migraine headaches they would be treated entirely differently then tension headaches and of course then you have sinus headaches that are brought on by congestion in the sinuses and you tap, tap, tap over the sinuses and it hurts and they often have fever and congestion and then there's cluster headaches which tend to cluster around the same time every day often late afternoon more associate with men than women but it's associated with men who are smokers who drink alcohol but they have these excruciating icepick like headaches where they feel like an ice pick is going through their eye.

They get a red eye kind of blurred vision.

>> They get teary eyed and it's right over on one side or another.

But that's called a cluster headache again an entirely different type of headache.

>> So the main for headaches that I often see is a psychiatrist and I'm often trying to sort out will be migraine headaches, tension headache, cluster headaches and sinus headaches.

And if it's an environmental stimulant, it's bringing out the headache I bank on that being more of a migraine headache.

>> But I'd be curious how that works out.

>> Thanks for your call.

Let's go our next caller.

Hello Jill.

Welcome to Matters of Mind.

>> Joe, you want to know is Zoloft still considered a good medication for depression?

Zoloft came out in nineteen ninety two I believe it came out about five years after Prozac.

>> Prozac was the first of the newer and depressants came out in nineteen eighty seven.

>> Zoloft came out a few years later and you know Zoloft will increase serotonin and to some degree it increases dopamine and historically Zoloft been used for panic attacks, social anxiety, obsessive compulsive disorder.

>> In addition to depression it has been used with adolescents not uncommonly and we now use Zoloft as one of our safer medications during pregnancy and breastfeeding.

>> So Zoloft after it's been over twenty years now going on now over thirty years now it's a medication and still gets used quite extensively in psychiatry and it can be a nice option.

The nice thing we like about it it's very inexpensive and it's very easy to dose for a lot of people.

>> So a lot of clinicians are using that.

Joe, thanks for your call.

Unfortunately I'm out of time for this evening.

>> If you have any questions concerning mental health issues you may contact me via the Internet at matters of the mind all one word at a dog.

I'm psychiatrist Jeff Oliver and you've and watching Matters of Mind on PBS for Wayne God willing and PBSC willing.

>> I'll be back again next week.

Thanks for watching.

>> Have a good night