.

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 Jay Fawver live from Fort Wayne , Indiana.

Welcome to Matters of the Mind.

Now in his 10th year Matters The Mind is a live call in program where you have the chance to choose the topic for discussion.

>> So if you have any questions concerning mental health issues, give me a call in the Fort Wayne area by dialing (969) 27 two zero or if you're calling coast to coast you may dial toll free at 866- (969) 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 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 WSW that's matters of the mind at WFYI Doug and let's start with a couple emails I just received this past week.

>> One reads Dear to Farber Does coffee or caffeine in general help with ADHD or is that a myth?

>> Not really a myth because I always say that the coffee shops are filled with people with attention deficit hyperactivity disorder because they're using the caffeine in the coffee as a means of mitigating some of their symptoms of inattentiveness and distractibility.

Now here's how that works when you think about caffeine is mainly for the purpose of keeping you awake and that's why people will often use caffeine as the day progresses because as the day progresses in your brain gets tired.

>> It's like these fumes are being released in your brain.

>> It's called adenosine adenosine fumes will just make you tired and sleepy and make you less motivated as the day goes on.

>> If you get a nap for about 30 minutes those fumes get released and they get eliminated or if you use caffeine caffeine to the brain looks like adenosine.

>> So caffeine will go to those little adenosine receptors and just knock them off and that gives you an awakening effect.

Secondarily, caffeine will increase dopamine and norepinephrine transmission and that's what you're trying to increase with the treatment of ADHD.

>> With ADHD you have less dopamine and norepinephrine in the front part of the brain which is the thinking part of the brain.

That's the part of the brain in which you use to pay attention and decrease distracted.

If you can increase dopamine and norepinephrine transmission in the front part of the brain you'll have improvement, concentration and focus especially if you already have ADHD.

>> So how does caffeine do that ?

What's going to increase dopamine and norepinephrine?

But it does so over the course of maybe an hour or so.

The drawback of caffeine it's a very short acting substance so the best way to use coffee or any kind of caffeinated beverage is to slowly sip it over the course of two or three or four hours trying to decrease the amount that you're consuming to the point where you're not getting physiologically dependent on it, where you are noticing a big crash afterwards or getting a headache without it the next day you want to have enough of it was doing you some good news.

>> We're talking about two or three medium cups of coffee a day.

So that's what most people are able to tolerate.

That's what works for most people.

But you don't want to knock it down in about 15 minutes.

>> You want to sip on it over the course of two hours to really help with focus and concentration.

Now there is a phenomenon called a coffee nap where people will drink a cup of coffee over the course of fifteen or twenty minutes, have about a 20 minute nap and then upon awakening they have a lot of attentiveness, focus and energy and that's something that is legitimate because the coffee might not kick in for about twenty twenty five minutes after you consume it and that's why coffee nap can be very very effective for a lot of people and that's where you drink a cup of coffee first and then you have a nap for no more than thirty minutes or so upon awakening you tend to be wide awake and very alert and have exceptionally good concentration at that time.

>> But yeah caffeine can be used used over the course of a couple hours three hours for the purpose of the concentation.

>> That's why I'm not a big fan of people taking a caffeine tablet of a one hundred two hundred milligrams at a time because it's going to work so quickly, so briefly that it's not going to do you a lot of good.

>> Thanks for your email.

Let's go to our first caller.

Hello Dustin.

>> Welcom to Matters the Mind or Dustin.

>> You want to know why do you have the same recurring dream over the years or is it a form of deja vu?

Dreams are very abstract, Dustin and dreams are not supposed to make a lot of sense to you because when you're dreaming the logical part of your brain shuts down and it makes sense that that would happen because your logical part of the brain is using a lot of glucose all day.

>> It's using a lot of energy and you're trying to think and you're kind of trying to concentrate all day and it's building up all this adenosine.

You get tired as the day goes on then you want to crash.

Well, this part of the brain needs to rest at night and when it's resting the logical part of the brain rests.

That's when you go into REM sleep rapid eye movement sleep which is dream sleep REM sleep by nature doesn't make a lot of sense because the part of your brain that you're using to try to make sense is shutting down that part of the brain is resting so dream sleep is normal.

>> Dream sleep is very effective for recharging your ability to pay attention the next day and be able to generate the ability to download memories the next day because this front part of the brain will allow you to generate memories in the middle part of the brain down here called the hippocampus.

>> So when people start having pless dreaming over the years they can have less difficult or less ability to download memories and have more difficulty paying attention.

So that's why it's exceptionally important that as a psychiatric vital sign we're always asking about sleep.

We want to know if somebody is able to get to sleep.

Do they stay asleep or are they awakened by bad dreams which is a whole different phenomenon called nightmares.

>> We want to know if somebody is able to concentrate do they feel awake and refreshed upon getting up?

It's OK to have a cup of coffee in the morning to get the brain kind of charged up some but overall you shouldn't feel just as tired when you get up as compared to when you went to bed.

>> So you should have a refreshing sleep.

Typically that's anywhere between seven and nine hours for most people for occasionally you'll hear about ten hours but you want to know that somebody getting a good quality of sleep but part of that good quality of sleep is being able to dream where this front part of the brain, the logical part of the brain is shutting down.

Now you remember with dreams they're like a whiteboard upon awakening unless you write down your dreams, unless you think about it, unless you talk about your dreams and try to figure out how does that relate to what I've been going through day to day unless you talk about them or think about them, those dreams get wiped off your memory really, really fast.

>> That's why now for many of us we can't remember what we were dreaming about last night .

>> Here it is in the evening.

We can't remember what we were dreaming about last night as we talked about it and the same is going to happen tonight will dream but we won't remember it because that's what happens.

>> This whiteboard gets wiped off very, very quickly upon your awakening.

>> Thanks for your call.

Let's go our next caller.

Hello Janet.

Welcome to Matters of Mind.

Well, Janet, you want to know if you need a referral from your doctor to make an appointment with a psychiatrist?

It depend on what kind of mental health clinic it might be.

Janet, for many mental health clinics my preference would always be that nobody would need a referral that you'd be able to see somebody if you talked to a scheduler they'd be able to get you set up with the right person at the right time.

>> But for some mental health clinics they do need a referral from a primary care doctor first to make sure that it's a legitimate psychiatric concern.

>> But more often than not, if you have a scheduler navigator who can get you into the right spot and have you see a therapist, have you see a nurse practitioner, have you see a psychologist or psychiatrist that's going to always be best for us.

So the whole idea of getting a referral is for the purpose to make sure you're getting to the right person the right time so you'd have to check with the individual clinics.

Janet, Janet, thanks for your call.

Let's go our next caller.

>> Hello Peggy.

Welcome to the Mind.

Peggy, you mentioned you had a stroke six years ago and now you're crying nonstop.

You never know what triggers what's a symptom.

>> Is that a symptom of stroke and what can you do about it?

Peggy, I imagine you had a stroke that affected somehow some way the front part of your brain when you have a stroke that affects the front part of the brain and sometimes the side part of the brain over here this would be called a middle cerebral artery stroke sometimes that will affect the emotional aspect of the brain itself.

>> But the bottom line is if you're crying on stop, that's a really good scenario where as long as he didn't have a hemorrhagic stroke if if it was an inclusive stroke whereas a blood clot that caused you to have decreased blood flow to certain parts of the brain, you could take a medication that's going to affect serotonin.

If you increase serotonin in the brain, it'll dampen down excessive emotions and by dampening down excessive emotions what I mean is you're not as likely to cry all the time.

>> So if you take a medication like Zoloft, Celexa, Lexapro, Paxil, Prozac, these are medications that are primarily increasing serotonin and in doing so they're dampening down the excessive emotionality some people can have following a-str.

Now that's one treatment option.

Now some people have a hemorrhagic stroke where they have a brain bleed and those people have to be careful with any medications that are prone to just increasing serotonin.

So for those people, if you have excessive emotionality, we might give them an anti epileptic or an anti seizure medication like LaMotte's or Jean Trileptal.

>> These are medications that will kind of modulate this chemical called glutamate and if you dampen down the excessive glutamate that's in the brain, you'll have a diminishing of excessive emotionality as well.

>> But when people have strokes, yeah, it will affect sometimes your emotional state of mind.

Typically that will decrease somewhat over the course of six months, maybe a year.

>> But we'll use medication sometimes to dampen down some of those excessive emotions.

>> Thanks for your call as your next caller.

Hello Greg.

Walk on terrorism.

I'd Greg you want to know how you get tested for adult ADHD and what's the treatmet plan?

>> I'm kind of particular in terms of determining when we diagnose ADHD for somebody.

>> Greg, if you have adult onset ADHD which I think is an oxymoron, that's a phenomenon where I think we need to take a deep dove and looking for other factors than the typical attention deficit hyperactivity disorder condition.

>> In other words, if you're in your 30s, if you're in your 40s and all of a sudden the past few years you notice you can't concentrate your distractible you have poor attention span, poor memory.

I'm going to want to know OK, what's your thyroid status?

>> How is your glucose doing?

Do you have snoring or pausing in your breathing at nighttime because that could be sleep apnea.

>> There might be other reasons why you're having trouble with attention span and focus and concentration as an adult I'm going to look for depression many times people with depression will have difficulty with their speed of processing.

It seems as if their brain has slow Internet speed and are having a hard time going from one type of topic to another.

>> So depression will do that.

Greg, you know if you haveion,- chest pain we've got to figure out as the chest pain due to a stomach problem, heart problem, a lung problem, what's causing the chest pain?

>> We're going to treat it accordingly if you're having trouble with focus and concentration as an adult, we want to know, OK, how long have those symptoms been there?

What's the course of them?

And I'm not going to give away all my trade secrets in terms of how we diagnose ADHD because much of ADHD diagnosis will be based on a person's history and their current presentation.

>> So how do we treat ADHD?

>> It's not always with stimulants.

Many people will say I have this symptom, this symptom, this symptom of ADHD so I need a stimulant.

>> It doesn't always work that way.

Stimulants are like eyeglasses.

Not everybody will do well with eyeglasses if your brain needs eyeglasses for the purpose of correcting your vision so that your vision can process the visual images in the back of your brain.

>> Great eye glasses can be great for helping you focus your vision if you have poor vision in the same way stimulants are but are yet one treatment if they're not the only treatment or a treatment for ADHD we'll use some on medications for some people.

Many people will do best with a medicaton use for depression like bupropion also known as Wellbutrin or Vaud Oxendine also known as Trenta Alex these medications are used for depression but they also have to do a good job for focus and concentration and processing speed especially if somebody does have some underlying depression.

So there's a lot of different factors out there.

But with ADHD by definition it starts when you're a child and it's there more days than not.

>> And if you take a medication as like a stimulant for ADHD, you really don't have ADHD.

>> It's like somebody wearing eyeglasses who doesn't really need the eyeglasses.

>> Your vision will be worse if you don't need eyeglasses.

If you start wearing them, you don't have supervision, you start wearing eyeglasses.

If your vision doesn't need to be corrected and you wear eyeglasses, your vision's worse.

pThe same is true in many cases with ADHD treatment if you take a stimulant you'll feel some energy and you'll think hey this is great.

>> But the problem is your energy is a side effect from the stimulant.

The stimulants can make your focus and concentration somewhat worse.

You can be more irritable, more jumpy, you'll make more mistakes that's actually been studied.

People who take a stimulant who don't have ADHD typically have a tendency to make more mistakes in their cognitive processing.

So we've got to get the diagnosis right and we've got to find the right fit of the medication for you as well as a dosage.

>> Not everybody does really well with high doses of stimulant medications or ADHD medications in general some people need lower doses.

It's all individualized and it needs to be very carefully assessed by a clinician.

>> Thanks for your call.

Let's go next caller.

Hello Shannon.

Welcome to the Mind.

Shannon, you want to know why does stress and anxiety mess with your short term memory?

Shannon There's three major networks in the brain that we now understand.

We used to talk about serotonin ,dopamine and norepinephrine all the time.

Now we're talking about these three network Thursday the default mode network.

There's the salient network and then there's the executive network.

So let's start with the default mode network.

>> The default mode network just has you chill out.

You're thinking about your past life .

You're not thinking about a whole lot.

>> The default mode network is what many people will actually use as you're just sitting around the house or actually when they have what's called highway hypnosis and they're driving for long periods of time not thinking about anything in particular and all of a sudden they realiz they're ten miles down the road and they have no idea how they got there.

It's a normal phenomenon but you're basically your brain is kind of like in this default standby mode where you're not thinking about a whole lot of stuff.

>> However, in that standby mode you are often thinking autobiographically about stuff.

>> It's happened in your life and you're kind of daydreaming about things and it's in that default mode that many people will get stuck brooding and they start dwelling on stuff and past regrets and past misgivings.

>> The salient network is like a means of shifting from the default mode network to the executive network.

>> If you've ever driven a manual shift we used to have manual shifts where you'd have the gear going from first gear to second gear and you have to change gears.

>> You had to clutch and then change from one year to another.

The salient network is like the clutch.

>> It allows you to go from the default mode network the kind of the ruminative brooding autobio graphical network where you're not really thinking about a whole lot of stuff to the executive network where you're really thinking carefully about things and you're focusing, concentrating and you're paying attention to things you've got to shift you've got to engage that clutch with the salient network to get to the executive network when somebody's under stress now stress is OK.

Stress just means a change in your life .

Stress is all right.

I mean it keeps our lives from being boring but stress in which you have difficulty coping with the overwhelming stress, the overwhelming change occurring in your life .

That's where it creates anxiety and when you have anxiety your little amygdala up here in the front part of your brain gets set off and that's your anxiety, fear and anger center of the brain that sets off and hijacks the ability of your brain to go from the default mode network to use that clutch of the ceiling network to get to the executive network so you can't go from the default gear to the ceiling to the executive gear because the clutch isn't working so well so you get stuck in ruminating dwelling about things.

>> You have paralysis of palpitations and fear and anxiety and you just can't get things done and you can't concentrate worth a darn because your front your brain's not working and that's where the executive network lies.

>> So when you're under a lot of difficulty with stress that you in which you cannot tolerate that will cause you to have the inability to get into that gear of the executive network and that's where will often try to recognize that for people to allow them to basically grease that clutch a little bit and that's what medication will often do.

The medication will often allow your clutch to work better to get you from that default mode network, the thinking network, the executive network because that's frequently seen with people who have a lot of stress and a lot of anxiety.

>> Thanks for your call.

Let's go our next caller.

Hello Alex.

Welcome to Matters of Mind.

Doctor, I had a question for you.

Certainly Alex was wondering hyperactivity though is that something related to anxiety?

Is it a blood thing?

Is it a brain thing or I remember being younger and our parents try to diagnosis with hyperactivity but I just never got happy when Candy was around and stuff and I didn't even know if I was really hyper.

I don't think I'm hyper now.

>> What do you think?

Thanks a lot Dr. Alex.

That's how it all works out and sugar.

Yeah, sometimes parents will insist that sugar will certainly affect the demeanor of their children and give them more hyperactivity and that could be some effects on insulin the actual glucose levels themselves.

>> So yeah, that can be a factor and that's why it's very careful to to try to regulate how much sugar intake especially the refined sugars children are getting.

>> Boys are more likely to have hyperactivity related to attention deficit disorder compared to girls hyperactivity where it's problematic and detrimental is where it's something it probably could or should be treated.

>> So if you're disruptive in a classroom you can't socialize.

You're never invited to stay overnight with friends because you're so hyper and so distracted disruptive that could be problematic for you.

And where that is a particular problem, Alex, is where people get into trouble when they're in their teens and young adult years.

>> Half of the people who are in prison systems nowadays have what's considered to be attention deficit hyperactivity disorder.

They on their having poor decision making, impulsivity and lack of regard for others in some cases will go along with that.

>> But it's thought that ADHD will contribute in some cases to poor judgment, even criminal behavior for some people, not everybody.

The thing about ADHD people with ADHD typically have higher excuse compared to people without ADHD so they tend to be smarter.

>> It's just they just don't make good decisions.

Now you had mentioned you hyper as a as a kid, Alex, and now you're not.

That's fantastic because that's what happens as you go through life many times the hyperactivity the impulsivity will decrease signify but you might have still difficulty with attention span and focus.

>> It's not an issue unless causing you trouble on the job or your worth with your relationships now many people will have difficulty attention span and focus if they're doing things that are not challenging, interesting or novel or exciting and if they can stay involved in something and really be engaged you're going to be fine.

So if you're in a work environment that's very stimulating for you and it's allowing you to pay attention and on top of that you're getting along with your family members, your social relationships and the difficulty conversations is problematic.

That's not an issue for you.

So there's different degrees of attention deficit disorder for some people is highly problematic.

They need treatment where it's causing them impairment on the work force and school with social relationships.

>> But for other people they notice it's there but they can adapt and they're able to work around any symptoms that might be lingering.

>> But the hyperactivity will often decrease as somebody gets older.

>> Alex, Alex, thanks for your call.

Let's go next caller.

Hello Peggy.

>> Welcome to Arizona.

Mind Peggy, you wanted to know about medications for stroke symptoms and are they available over the counter?

Is there anything you can do to stop the crying itself?

Peggy the stroke symptoms you had to which you had referred specific were the crying symptoms now for crying symptoms are medications that primarily will increase serotonin and that is if you don't have a history of having a hemorrhagic stroke, hemorrhagic stroke, Peggy is where somebody would have bleeding in the brain and that caused their stroke itself with decreased blood flow.

So we're going to look at that case individually.

But there are medications that increase serotonin that help with that.

>> So we use medications such as Prozac, Paxil, Celexa, Zoloft, Lexapro.

>> These are all medications that will dampen down the excessive emotionality by increasing serotonin.

But be careful about that because if you've had a hemorrhagic stroke where the stroke was contributed to by a a brain bleed, we'd probably want to use a different type of medication like an anti epileptic medication such as Lamotrigine or Trileptal.

Those can be medications that will stabilize the mood these medications are not available over the counter.

>> Peggie, I don't think if you've had a stroke you don't want to be taken medications over the counter for your brain.

You want to be very careful what you give your brain.

You want to go to a neurologist, a primary care clinician, perhaps a mental health clinician for the purpose of knowing that you're getting the right medication for your condition.

>> I wouldn't suggest you are taking supplements for instance, if you've had a stroke because you can actually make the condition much, much worse.

For instance, if you take something like ginseng and you've already had a hemorrhagic stroke that could be fatal for you because of ginseng can actually increase the bleeding that could be there.

So I follow your clinician's directions for the purpose of knowing how to best decrease your symptoms you're experiencng.

>> Peggy, thanks for your call.

Let's go our next email question.

Our next email reads Deardon on ever I'm experiencing heavy grief both from the loss of a family member and a breakup.

I've dealt with depression before.

What are some ways I can keep from sliding into a deeper depression in between my therapy appointments loss itself loss is a key precipitate for depression.

So if you've had a loss of relationships, loss of job, loss of a loved one, loss will often precipitate depression itself and one of the best ways to overcome a loss of a relationship like that whether it be through death or a breakup can be to maintain socialization.

Many people will get more socially isolated when they get depressed and it's a vicious cycle because the more social isolation you will endure the more likely you get depressed.

We saw this during the covid pandemic with all the social isolation restrictions, more and more depression was prevalent within the community because people were not allowed to socialize as they did before and it was a very dangerous volatile type set up that we saw and we're seeing some of the repercussions now.

>> So the best thing you can do if you've had loss of relationships, break ups, you've had deaths in the family is to try to keep yourself socially active and as always we always tell people to try to stay physically active as well.

Physical exercise is the best means of treating depression in between the therapy appointments we'll use medications for some people if we find that the medications could be beneficial for them.

But socializing and exercising are two of the best ways that you can decrease the depressive symptoms and decrease the likelihood that they'll recur.

>> Thanks for your call.

Let's go our last email and these last couple of minutes last email Regidor to daughter do people diagnosed with bipolar disorder also suffer from depression?

How are the two different bipolar disorder consists of one out of twenty five maybe one out of 50 of the cases of depression.

So when you have depression itself you have difficulty enjoying things about motivation, maybe sleeping too much or too little troubled concentration of poor energy and so forth with bipolar symptoms you can have several days worth of feeling especially hyped up, decreased need to sleep, more impulsivity, racing thoughts if it goes on for four to six days it's called bipolar disorder where it's four to six days of having little highs with two weeks or more of lows and then you can have bipolar one depression where you have over one week of sky high incapacitating mania but that could be followed by depression is very important that we as clinicians sort those out.

Now there is something called a mood disorder questionnaire MD Q thirteen question questionnaire that gives us a clue if somebody has bipolar symptoms or not, if they answer affirmatively to seven or more of the questions is suggestive the if they're occurring with a certain pattern they might have bipolar disorder but bipolar depression where somebody has little history with big highs but then followed by big lows those are the types of diagnoses that really warrant the use of a mood stabilizing medication.

The way I often describe it will be when you have bipolar disorder what you need is a cruise control in your mood as opposed to pushing on the accelerator.

>> Thanks for email.

>> Unfortunately I'm out of time for this evening.

If you have any questions concerning mental health issues that I can't answer on the air you may write me via the Internet at Matters of mind at WFYI dot org I'm psychiatrist Joffrin.

>> I've been watching Matters of mind on PBS Fort Wayne now available on YouTube God willing on PBS willing to be back again next week.

Thanks for watching.

Good night Cameron Psychiatry.

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

More information available at CameronMCH.com.