.

>> Good evening.

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

Welcome to Matters of the Mind Now and its twenty eighth year 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 that I can answer on the air you may write me via the Internet at Matters of the mind at WFYI Dog but better yet you can call me tonight live and on the air in the Fort Wayne area by dialing (969) 27 two oh if you're in the Fort Wayne area or for calling long distance 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 and I can't answer the emails and I can also answer the phone calls as well.

>> So let's go to our first email for tonight.

>> The first email reads Daughter to favor how do I manage boundaries with others?

It always seems like I feel taken advantage of by family members and coworkers.

It's really a difficult conversation with friends and loved ones if you're feeling uncomfortable that's probably where you feel like your boundary is being violated so to speak.

>> It doesn't mean you're a victim.

It just means that you need to learn how to say no and you might notice that other people might be taken aback if they're used to you answering them affirmatively with any request they may make any request they may have of you in the past.

But it's a matter of you being more assertive and being assertive means being able to say no if you feel like you're a little bit uncomfortable and being honest with them and if you're uncomfortable taking on the task that they're requesting.

So it's a matter of identifying what you're comfortable doing.

Listen to your gut if your gut tells you you're a little bit outside your boundaries, you probably are and that's where you need to be assertive in saying that you're not willing to take on the task they are requesting.

>> Thanks for your email.

Let's go to our first caller.

>> Hello, Bill.

Walking to Mars the mind Bill.

>> You want to know if a transient ischemic attack a TIA in the cerebellum can provide recovery with a cerebellum's in the back part of the brain back part of the brain down here that's the cerebellum there front part of the brain is up here.

>> So the cerebellum what if you have a TIA there?

It means you have a brief decrease or loss of blood flow there that will give you no significant long term impairment.

In other words, the symptoms of a TIA will typically last for between minutes and no more than 24 hours, sometimes 48 hours.

But it's a brief transient by nature a transient scheming attack ascame it means loss of blood flow.

>> So a transient ischemic attack bill by definition is temporary.

However, if you have a transient ischemic attack it means that you're at a higher risk for a stroke so you need to get the MRI of the brain, make sure there's no damage done this time.

>> You also need to make sure you take care of yourself if you have diabetes, get that in control.

Get the blood glucose is in control.

High blood pressure can be a factor behind a stroke if you need to be on aspirin 81 milligrams a day as a means of decreasing clotting, that's something that's important.

A lot of people who are high risk for a stroke might have sleep apnea.

So if you have sleep apnea where you snore your pores in your breathing at nighttime, you need to get that corrected .

>> So bottom line is your primary care clinician or your neurologist who might be following you might want to decrease any of the risk factors that put you at a higher risk for stroke.

But a TIA by definition is kind of a warning sign for a stroke to come.

If you have a TIA the cerebellum, you can have difficulty with balance coordination, slurred speech, sometimes nausea because you get dizzy and you know, spinning sensation all around you with a tie and the cerebellum you can have difficulty with tremors sometimes and sometimes even difficulty with walking but by definition resolves within 48 hours.

Technically there's no permanent damage done but it's a big warning sign for a future stroke to come so you need to get it addressed and at the risk factors taken care of .

>> Thanks for your call, Bill.

Let's go to the next caller.

Hello June.

Welcome to Matters of June.

You all know how does buprenorphine work in your brain to wean someone off opiates?

Basically buprenorphine June as a week it's called a partial agonist of a receptor and that's just fancy language for saying it tricks your brain into thinking that you kind of have a little bit of an opiate there and it's a weak stimulant of the receptor of the opiate receptor.

>> So by itself it's not highly addictive and if you take opiates on top of that, typically you won't get as much of a high because it'll actually block the opiate effect coming in.

But buprenorphine is the active ingredient in medications to help people come off of opiates like Suboxone, Suboxone, something that can be used to help people come off opiates and buprenorphine is the major component in that to help people come off of .

>> Thanks for your call.

Let's go our next e-mail question our next e-mail question reads Dear Doctor Fauver Iman's bravado nasal spray for depression and my provider was vague about the length of the treatment plan.

>> How long I'm sorry.

Let's go to the next e-mail question here it is that director Doctor I a child who has significant anxiety about returning to school in the next few weeks last year she struggled socially and academically and isn't really feeling it.

>> Do you have any general advice for teenagers in high school this fall?

Clearly benefits for being in a routine and returning to school a lot of there's there about children, about adolescents getting in the routine going back to school.

So let's start with the easiest part of that first.

Yeah, you need to get back in the routine probably a week before going back to school, going to bet the usual time try to get up at the time you need to get up for school because you don't want to have that circadian rhythm disturbance occurring where some children are all of a sudden shocked into having to get up early and go to bed a little bit earlier.

So maybe a week prior to going back to school kind of go through a practice run and a lot of children and young adolescents are very apprehensive about going back to school, talk to them about it.

What are they apprehensive about?

Were they bullied previously?

Were they having difficulty academically?

Were they having trouble with change and going from one environment to another?

Are they going to a new school?

Let him talk about the anxiety and why they're having it and don't discount it.

Remind them that you undoubtably had some anxiety yourself if you're the parent, the grandparent or even a friend, let them know that when you were that age you had anxiety and reassure them that you were able to endure.

>> But anxiety is normal when you're a child or adolescent when you're going into a new situation but reassure them that OK, they get through it and they will recover and remind them come November December if they're much more comfortable in school especially remind them that they were anxious back in August and they overcame and reward them for doing that with teenagers going back to high school a whole different type of question.

What's the best advice I can give to teenagers?

They give a lot of advice to teenagers.

Obviously as you've heard me on this program many, many, many times I've said if you're an adolescent, if you're a teenager, do not ever, ever use marijuana at least until you're in your late 20s.

Maybe not even after that.

I'm still not seeing any significant benefits on the brain with marijuana people can always tout the benefits of pain relief and other factors but especially with the growing brain of the 24 years of age, marijuana is extremely destructive about with the brain development and there's more and more studies demonstrating that so no one's off marijuana but has some more practical advice for a lot of adolescents will be don't be afraid to be challenged with an opportunity even though you feel like you're underqualified to do it.

Don't be afraid of failing.

Don't be afraid of looking bad or awkward in a situation if you have a God given opportunity given given to you am I going to go after it?

Go ahead and get involved with it especially you have if you have an empathetic mentor who's involved in your challenging opportunity that's been presented so with adolescents I'm frequently encouraging them to not be afraid of being a feeling of underqualified.

>> Go ahead and take off on an opportunity itself and another piece of advice I give adolescents is I remind them they have growing brains when you have a growing brain the last part of your brain to develop is the judgment and the insight part of the brain which is in the front don't do things at the age of 16, 18, 20 years of age prior to the age of 24 years old which is the date of the age of brain development completion.

But prior to the age of twenty four years of age don't do things that you're going to later regret in your life because you're going to make some stupid decisions.

>> Listen to your parents, listen to your grandparents, listen to these these older mentors who are trying to give you advice as you're growing up because typically they're on the right track.

Your brain hasn't developed to acquire that kind of insight or judgment just yet.

So be aware your brain is still growing.

Don't make impulsive decisions as an adolescent or a young adult that you might regret later on.

>> Thanks for your call.

Let's go next caller.

Hello Rita.

Welcome to Matters of Mind or you are Rita.

You had mentioned you're bravado nasal spray for depression and bravado nasal spray by the way, as is ketamine.

It's the left sided piece of ketamine.

It's an angel spray that people use twice a week for the first month and once a week a second month and then every other week or every every week thereafter Assoc.

bravado nasal spray is used for depression and you mentioned that your provider was very vague about the length of the treatment plan.

How long is the average treatment you've been on this provided treatment plan since the spring of twenty twenty ?

I've really read it in my experience we in my clinic we use bravado for patients for six years starting in twenty nineteen until 2020 late twenty twenty four and during that time we found that a lot of people did best if they stayed on bravado but yet in a less frequency now it was studied over the course of six years.

>> We've got a lot of data on it.

It was studied every week or every other week.

A few people decreased every month in the long term studies but most people stayed on every week or every other week long term it's indicated or approved for depression for people eighteen years of age and older who have treatment resistant depression.

They've tried a couple of antidepressants previously and they did not work adequately as ketamine.

His bravado is working on an entirely different chemical to brain than the traditional antidepressants which primarily affect serotonin, norepinephrine and dopamine.

So bravado is primarily affecting glutamate.

>> Glutamate upon stimulation will downstream in the brain enhance the natural brain fertilizer.

So it's like giving your brain a shot of Miracle-Gro every time you get your bravado treatment.

So your bravado treatment twice a week the first month once a week, the second month once a week thereafter or every other week and that's how it was designed in our experience when we use bravado on our patients rather than patients going off of it after six months or a year and we have data now that showing that if you go off as bravado after is just four months.

>> If you go off his bravado entirely you're twice as likely to relapse with depression compared if you stayed on it.

So we encourage people not to go off of it entirely but we would often bargain with people to maybe go on stay on it every three weeks, every four weeks and some people would actually tell us bravado every one month, every two months, every three months and they decrease the frequency.

But if you think about what it was being like that natural brain fertilizer where it's it's enhancing the brain fertilizer itself and in doing so sometimes when you have treatment resistant depression you have difficulty with not having enough of that natural brain fertilizer.

>> It went with long term treatment resistant depression.

They've they have studies on animals and now people showing that there's less branching of the individual neurons in the brain in some areas the brain for instance, the hippocampus here and the yellow part of the brain here each individual neurons should have as many as 50000 connections.

Now you have 80 billion neurons in your brain, 80 billion in your brain and each individual neuron has between twenty thousand and fifty thousand connections in the hippocampus.

There should be fifty thousand branches on each individual neuron but when you get depressed that can go down to maybe twenty thousand thirty thousand branches.

So what we're trying to do when we treat somebody with a set amount is bravado is to enhance the branching of these individual neurons.

So again it's like going to your backyard and fertilizing a plant that's kind of looking shriveled up after a one to three weeks it starts to look better once you fertilized and watered it.

That's what we're trying to do is bravado and for some people they need less frequent watering fertilization as time goes on.

>> And we have found that for many people rather than going off of an entirely simply decreasing the frequency can be helpful.

>> And for some people they'd been on it for several years but they're only coming in every two or three months in some occasions.

Now if you do go off to Braudis bravado, the important factor will be to have your clinician continue to keep an eye on you because if you're out there at a month or two off of bravado and all of a sudden you're getting more depressed, we want you getting back on it as soon as possible to try to revamp and try to give you that boost of fertilizer in your brain once again.

So it's all a matter of talking over with your clinician to determine if you're a good candidate to go off of it or stand on it.

In our experience when people came to us with long term treatment resistant depression, it was more likely they need to be on this bravado maybe a less frequency but it was studied at once a week or every other week indefinitely over the course of now six years of data.

>> Thanks for your call.

Let's go our next caller.

Hello Saul.

Welcome to mind.

Saul, you had asked does your brain repair itself when sleeping?

What's happening to your brain during the night?

Well, during the night saw you got a couple of things going.

You go into sleep and you've got a couple of phases of sleep that are very important.

>> You've got a non REM sleep.

The non REM sleep is a very deep aspect of sleep during REM sleep is and when you're not dreaming if you happen to awake and during non REM sleep you're going to sleepwalk or you're going to have night terrors where you're kind of confused perhaps and you look around you for a few seconds and you don't know what you're doing so you'll be very confused upon awakening in non REM sleep.

>> Non REM sleep is very important because that's when growth hormones go sky high.

Growth hormone is good for the brain in the body so growth hormone going sky high during non REM sleep is very restorative to the body physically itself rem sleep as dream sleep dream sleep is where you'll notice that this left front part of your brain will shut down.

>> It's the left dorsolateral prefrontal cortex when you're in dream sleep you're dreaming.

>> Your brain is very active during dream sleep and you have a natural chemical that paralyzes the rest of your body .

>> So if you're awake and during dream sleep you might feel briefly paralyzed can be kind of scary but it only happens for a couple of seconds or so and then you able to get around but there's something called sleep paralysis that occurs when people inadvertently are awakening during dream sleep and they're still getting that paralyzing effect on their body dreams.

>> Sleep is very important for memory concentration attention span for the next day.

So if somebody's not getting adequate dream sleep they can have trouble with memory, concentration and attention span for the next day and we'll often hear about people having Alzheimer's dementia or at least having early symptoms of Alzheimer's dementia where they're no longer dreaming now very, very importantly.

So you might not remember your dreams.

Your dreams are like a whiteboard where they get erased within seconds upon awakening.

So if you write down your dreams or your record, your dreams and your smartphone for instance by voice recording exactly what they immediately upon awakening you can kind of remember them and you can sort out OK, what was that symbolic of in my life ?

So dreams are very abstract and they're intended to be very abstract.

You have a you can't take them at face value but dreams are very important for helping you with overall concentration of memory.

People with Alzheimer's as I mentioned often will lack dream sleep when they get treated for Alzheimer's dementia with medications like Aricept which has been around for thirty years now when people are on Aricept they'll notice they start dreaming again and of kind of freaks them out.

But that's normal because they haven't been dreaming for a while and all of a sudden they're dreaming.

So dreaming is good for the brain nightmares no nightmares ,diagnostic of post-traumatic stress but when people have a traumatic experience from the past they can have nightmares not diagnostic at all.

Some people will have nightmares for various reasons.

You can have more intense dreaming and you can have more intense non REM sleep if you're in sleep debt.

>> In other words, you need to get seven or eight hours of sleep a night.

But if you're only getting three or four hours of sleep because of your you're studying at night time for school your have work obligations, you're staying up too late for various reasons and all of a sudden you've gone five or six nights not getting enough sleep.

You when you finally crash and go to sleep you're going to get a lot of non REM sleep and REM sleep very, very quickly because your brain's kind of making up for non REM sleep occurs within about thirty minutes of going to sleep for some people even faster than that.

>> But within 30 minutes you're going to Namor and sleep.

Your first dreams are going to typically occur about an hour and a half after you go to sleep.

>> However, if you're particularly tired you can start dreaming a little bit earlier than that as you go through the night you typically will dream more and more and more so the length of the dreams get to be longer and from a psychodynamic standpoint the dreams that are occurring more early in the morning are dreams that are symbolic of things you've going you're going through in the past 48 hours.

So if you can remember those dreams upon awakening and you don't let the whiteboard get a raise too quickly if you write down what that dream was right before awakening, typically it's something you've been going through for the past 48 hours.

Maybe you're trying to work it out symbolically in your brain.

It shouldn't be something in which you act upon because dreams as we know in today's world are not considered to be prophetic in most cases.

>> Keep in mind the dreams are typically abstract and they have meaning behind them.

It's just that you might forget what the dreams were but if you write them down right upon awakening that can help out.

Thanks for your call as your next caller.

Hello Tracy.

Welcome to Matters of Mind.

Tracy, you want to know about what common ways childhood abandonment will manifest itself and how can some one find healing child abandonment typically is something that occurs before eight years of age where it's going to be highly detrimental to the brain.

Tracy, there's a survey that's free to find it online is called The Adverse Childhood Experiences Gail the ACS Adverse Childhood Experience Gail has ten questions and if you have over four of those questions answered affirmatively, it can put you at a higher risk as an adult for having anxiety depression.

So those symptoms include childhood abandonment, trauma in the childhood emotional physical sexual abuse, having a parent in jail, having a parent with a drug or alcohol problem, having a parent with mental health issues.

You'll see those 10 questions laid out and if you have over five of those questions that occurred for you as a child, particularly before eight years old, that can put you a little bit higher risk for having depression and anxiety as an adult.

>> Why?

Because your brain is getting hard wired during that time if you have traumatic experiences before the age of eight years of age, sometimes it can make it more likely that those traumatic experiences will hardwire your brain to be more prone to having anxiety and depression later on.

>> Now we have a genetic influence.

So yes, there is a genetic influence on the likelihood of you having depression or anxiety but you put the genetic influence on top of childhood trauma abandonment being part of that trauma that can put you at higher risk for depression, anxiety later on.

>> No, we can't we can't erase that.

We can be aware of it and we can sometimes even choose our antidepressants based on that.

For instance, if you have genetic testing and you have an SLAC a four gene which is a serotonin transporter gene SLC six a fourth if that particular gene is a short has a short l'oeil to it and another short ordeal too it's called it Saleel if you have the SS a lethal combination in the SLC say for Gene and you have early childhood trauma traumatic experiences that combination will make it very unlikely that you're going to do well in treatment with a serotonin reuptake inhibitor for depression or anxiety.

So medications like Lexapro, Celexa, Prozac, Paxil, Zoloft might work so well for you especially for depression maybe not so much for anxiety either.

We need to go with a different mechanism of action for people that have the combination of the genetics and the childhood experiences that might predict they're not going to do so well with certain antidepressants.

So as clinicians it's something that we do take into account no, you can't reverse the past but we can help people deal with it with psychotherapy as well as choosing which medications might fit people based on what kind of experiences they had in the past.

But it's something that we take into account with the ACS questionnaire which is a very, very common questionnaire that people are using nowadays as a means of addressing childhood trauma.

Now here's the good news, Tracy.

If you had childhood trauma it doesn't mean automatically that you're going to have post-traumatic stress later on in life .

So post-traumatic stress disorder is a phenomenon that occurs because you've had traumatic experiences and there are treatments for that but not everybody will have anxiety related to the past trauma trauma happens for a lot of people but not everybody is impacted.

>> The same could be partially genetic should be could be partially past experiences house coping abilities of resilience in general how well people are able to get over things.

>> So there's a lot of factors in terms of who's going to get PTSD and who's not but it's not guaranteed you're going to get PTSD if you had early childhood experiences that were traumatic.

>> Tracy, thanks for your call.

Let's our next caller I'm sorry.

>> Let's go to our next e-mail question, our next e-mail question reader to decipher what happens when a medication is suddenly discontinued.

Is this something I should even worry about if a medication is suddenly discontinued?

Depends on what type of medication it might be if it's a medication in a class of the benzodiazepines, for instance, it can give you withdrawal withdrawal from Xanax, Klonopin, Valium, Ativan can be sometimes life threatening kind of like alcohol withdrawal work can give you tremors shakiness.

>> You can actually have seizures and it can be very serious.

>> So you want to taper off of the benzodiazepine class of medications very slowly because they can be something that can give you a lot of difficulty if you're on opiates or narcotics that's a different type of medication.

You can feel really lousy for eight to ten days and have nausea, diarrhea shakes, chills.

But stopping opiates is not life threatening by itself.

It makes you feel extremely uncomfortable for over a little over a week but you do get over it and typically no opiates for that matter are with our withdrawn very slowly.

If you're on a serotonin norepinephrine reuptake inhibitor like Effexor also known as Venlafaxine detoxifying those Cymbalta does venlafaxine those prestige you might want to taper off those relatively slowly especially with Venlafaxine or Effexor because it can give you zings and zaps in the hands and feet.

>> The scalp can feel like it's burning and can feel really dizzy with those.

So it all comes down to which medications they might be.

It's not only due to the medication class but it's also due to the duration of the medication itself.

There's a medication called Fluoxetine also known as Prozac and another medication called Vaud Occitan known as talks.

These medications stay in your system for a long time.

You're not going to have withdrawal from from those medications ERA or Abilify, another medication that typically stays in the system for days so you wouldn't have withdrawal from that.

>> So it really comes down to which medication you're taking and what medication class that might be.

>> Thanks for your email.

Let's go to our next e-mail question.

Our next e-mail question reads Did that favor how do I recognize triggers that might affect my mental health ?

>> Should I keep a journal to make connections between events and mental health concerns?

You're a step ahead of me already because yeah, to keep a journal all of us should keep a journal for various reasons because if you keep a journal you're able to maybe put some things together in terms of the stuff that's really bothering you.

Some people will do this with from a dietary standpoint they'll realize oh my goodness, every time I have the rolls at this particular restaurant I feel really cranky and irritable the next day.

Well maybe you have a gluten intolerance and the roles of that restaurant Hatamoto contain a lot of gluten.

>> So there's things like that you can do from a dietary standpoint to put two and two together in terms of how you feel.

But yeah, keep it a diary is a great idea.

>> Also keeping a diary will help you understand and recognize for the future that you can get over those particular stressors.

>> We talked earlier about adolescents feeling anxiety about getting back to school as well as children and keeping a diary and kind of reviewing what you did at certain times and realizing that you endured it and you got over it can be very, very helpful.

So what's a big tip off that you're having trouble with mental health issues?

>> No one typically will be sleep when people start having disruptions of their sleep.

That's usually an early sign.

You're having some difficulty not wanting to be around other people, not wanting to do enjoyable things.

Big risk factor itself worrying brooding about things, always questioning the brain circuitry changes when you start to get into having difficulty with pathological anxiety and depression.

>> So talk it over your clinician if you have any concerns about that.

Unfortunately I'm out of time for this evening.

>> If you have any questions concerning mental health issues you may write me via the Internet that matters the mind all one word away dog I'm psychiatrist J Forward.

>> You've been watching Matters of the Mind on PBS .

What now available on YouTube God willing and PBS willing.

I'll be back next week.

Thanks for watching.

Goodnight