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

Welcome to Matters of the Mind.

Now in his twenty fifth 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, give me a call here at PBS or Wayne by dialing in the Fort Wayne area (969) 27 two zero or if you're calling any place 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 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 via the Internet at matters of the mind all one word at WFA ECG that's matters of the mind at WFA org and I'll start tonight's program with an email that received it reads Dear Dr. Farber, is it true that everyone has a certain level of dementia meaning that as we age at a certain point we're all gradually taking on a certain level of dementia increasing until we die?

>> Well, here's what happens as we age as you get over sixty five years of age, 70 years of age.

>> Seventy five years of age.

Yeah.

Your risk factor for true Alzheimer's dementia or vascular dementia will increase with each passing year.

But natural aging is often accompanied by a slower speed of processing.

In other words you can process information and you can come up with a solution to a problem but it just takes you more time.

So as we age it takes us more time to be able to think through problems and think through solutions on things.

>> Now naturally with some aging difficulty, remembering people's names will be part of natural aging as well.

Now what's not part of natural aging, what is considered to be the disease state of dementia that's where you have geographical disorientation, where you forget where you are and you have momentary lapses of getting lost going to a familiar place like the grocery store you might have geometric disturbances or you're trying to draw things and you're asked to simply draw a circle and put the numbers in a clock numbers which should be and you might have difficulty with that if you have Alzheimer's dementia you might have difficulty naming things even given enough time.

>> But with neuropsychological testing as we get older we should be able to get things figured out if we're given more time.

>> So the thinking now is if we can help people with the speed of process processing of information with certain medications that might actually delay any deteriorating cognition which would involve memory and attention span as people get older for instance, there's an antidepressant medication called Trents and Toronto is medication that affects serotonin in such a way that it improves speed of processing for people who have delayed or slowed speed of processing with depression.

>> So when you have depression not uncommonly it's like having slow Internet speed and it just takes longer to get information processed that happens with depression.

>> It happens with aging.

So the thinking is if the trend talks can help speed the speed of processing with depression, could it also do so as we naturally age that's going to be something is going to be examined as time goes on.

We also have some newer medications coming out now that are making the neurons more fluffy as we age.

It's thought that our little neurotic branches are less fluffy.

>> It's like a tree that's kind of shriveling up and having fewer branches on it.

If you can increase the branching on the trees or in this case the neuronal branches you can hopefully get improve concentration and memory in those cases do.

>> Thanks for your email.

Let's go to our first caller.

Hello Diane.

Welcome to Matters of Mind.

>> Diane, you wondered you've been taken to Fluoxetine that's also known as Cymbalta and your vision has been blurry.

Is that a side effect or should you be concerned Cymbalta or Delux is a medication.

It and dilate the pupils and in dilating the pupils it can make your vision a bit blurry, especially if you're looking from a distance to things closer to you and you can have difficulty with what's called accommodation where you're trying to read things and it's because a dilation of the pupils when you enhance serotonin and to some degree norepinephrine you can have The Daily Show the pupils people sometimes notice that your eyes look darker in those cases it's not a dangerous side effect unless you have what's called narrow angle glaucoma or angle glaucoma as a phenomenon where you're ducked the fluid ducts in your eyeball just doesn't drain out adequately and you get increased pressure in your eyeball that can give you pain and blurred vision and sometimes blindness.

So if you have acute angle glaucoma you shouldn't take antidepressant medications until you get the neurological glaucoma treated because you don't want to dilate the people because that can further close off the duct.

>> But the difficulty blurred vision with some antidepressant medications will be an annoyance but it won't necessarily be dangerous unless you already have glaucoma.

Hope that helps.

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

Our next e-mail question reads Durata father my husband has sleep apnea and it is contributing to his depression .

However, insurance won't cover AC pap it's called continuous positive airway pressure machine for six months.

>> Are there any temporary remedies to help you?

The best treatment for sleep apnea for a lot of us can be simple weight loss.

>> In other words, if your husband can take off 10 or 15 pounds you might be surprised that will give you less fat around the throat and sleep apnea is a phenomenon where many people have difficulty taking in enough air at bedtime and when you take it in less air at bedtime because your snoring maybe you're pausing in your breathing you'll have less oxygen going to the brain, less oxygen into the brain at night will lead you to have fatigue, poor concentration, depression, poor motivation, low energy the next day.

And that's why as a psychiatrist it's very, very important that I think not only about the neurochemistry of brain but I think about the rest of the body and it's truly a mind body type of phenomenon where if your body is having certain problems like sleep apnea, you'll have symptoms that look just like everyday major depression or clinically significant depression.

So it's important we address sleep apnea.

OK, so what if you can't afford the C Pap machine for the time being because continuous positive airway pressure will keep your airway open open by giving you higher air pressure as you're breathing and sometimes lower pressure as you're breathing out and that would be called bipap the continuous airway pressure just keeps the airways open the whole time and bipap bipap will give you a change in the pressure as you're breathing in as you're breathing out.

So the bottom line is trying to keep the airway open.

So what can you do if you can't afford that for the time being losing weight is one factor.

Nothing you can do is simply go to your Dennis Dennis are aware of how to create a mold for the teeth that would tilt your jaw forward a little bit and if you tilt your jaw forward a little bit sometimes that will keep you keep your breathing airway more open at nighttime and that's often a pretty simple solution as well.

We try to sometimes stay away from medications that would treat sleep apnea but a kind of a back door remedy is to suppress dreams, sleep.

It's not a good remedy at all but dream sleep is very important for your memory and concentration but a temporary memory suppressant that would thereby decrease dream sleep would be a medication that would also decrease sleep apnea because much sleep apnea is occurring during dream sleep.

>> So it's not a good remedy.

It was a remedy that we had before the days of separate machines but back in the old days of people snored the whole idea was to suppress their dream sleep which unfortunately also suppressed some of their memory.

And there are medications that can suppress dream sleep and thereby would allow you to not snore as much.

But we don't like to do that because we need to have all the different stages of our sleep at night.

We need the dream sleep.

We need the deep sleep.

We need the light or sleep.

We need all these different stages of sleep to allow us to feel physically and mentally restored for the next day.

>> So the best solutions for naturally helping out with sleep apnea would be No one do all you can to lose some weight.

>> And secondly look to getting a dental device that would tip your jaw forward a little bit while your wait to see PAP or BiPAP or auto pap auto pap will automatically adjust the pressure going through the mask to your lungs as you need it and that can be a nice remedy as well.

>> So getting sleep and getting sleep apnea treated is very important not only for the mood but it can decrease your risk of heart attack and stroke and diabetes for that matter because if you don't get adequate airway air to the lungs and decrease oxygen to the brain and the rest of the body for those six or eight hours at nighttime your might be struggling with sleep apnea.

You could have a higher risk for all these endocrinology disturbing cases where cortisol levels higher because cortisol will increase because you're under more stress.

>> You can have a higher risk thereby of stroke, heart attack, diabetes, all these different metabolic conditions.

So it's very, very important that we assess people for sleep apnea.

>> Back in the old days you could only be assessed for sleep apnea if you went into a sleep medicine lab and you laid there overnight.

>> You're all hooked up with all the monitors and somebody was watching you the whole night about ten years ago.

>> There are these home sleep studies that became available.

They're called home poly sonograms and they are considered to be diagnostic for people who are appropriate to have them.

If you have a severe health condition such as a heart condition and still recommended that you go into the hospital to have the monitored sleep study done where they also can adjust you for the PAP and BiPAP right there on the spot.

But for many people they just didn't want to go into the hospital setting where they had this the sleep lab monitoring.

>> They want to have the sleep study done at home just for screening.

>> So we often find that if somebody has either snoring or they have witnessed stop witness cessation of their breathing at nighttime and on top of that they're tired or in the day those people often need to have a sleep study done.

>> Now we we want to first make sure somebody doesn't have low thyroid if you have low thyroid that will give you a lot of symptoms of sleep apnea.

>> We also want to make sure you're not taking medications like antihistamines that can also make you tired overall if you're taking a stimulant medication for instance for attention deficit disorder, we typically want you off the stimulant for about one to two weeks depending on what sleep lab you'll eventually have interpret the test but one or two weeks off the stimulant would be ideal because medications even though you take them in the morning can disrupt the look of the sleep cycle at nighttime.

>> So the sleep medicine docs want us to have people off the stimulants before they have this sleep studies done.

>> Thanks for email.

Let's go to our next caller.

Hello Jenny.

Welcome to Matters of Mind Jenny had mentioned that your grandmother has lost a lot of mobility, seems to be depressed.

Do you have any advice on how you can help?

>> Well, what you want to do for your grandmother Jenny would be number one try to identify things that she still enjoys as we go through life .

I can guarantee you one thing as we go through life our bodies break down.

>> That's just how we're built.

Our bodies are made to break down and we have to accept that's going to happen.

It's considered to be one the next chapter in life as is often described.

But we have to expect that we can't do the things physically that we did earlier.

>> However, as we get older we should gain wisdom from our experiences and we should have greater stress resiliency in many ways because we put up with a lot of stuff over the course of our lifetime.

>> So you want to be able to really take advantage of that and with your grandmother identify the things that she can still do and she can still enjoy doing.

>> Now a lot of older folks, they have difficulty mobility.

They will sit in front of a television all day long.

It's a very passive activity.

No one as we get older we still need to socialize and it's so difficult many times to socialize but ideally socialize people with your who have your common interests and common experiences and that would be people typically of your same age.

>> So that's why it's so important that older people are able to get in settings where they can socialize and mingle with individuals who have common life experiences.

If your grandmother is interested in reading or playing certain games or for vision is still adequate, that can be often helpful.

>> But it's very important for her to identify things that she still enjoys doing just simply doing a life history review, having her write down a diary of her life experiences and just reviewing that and and having her share that with family members and acquaintances and people who are younger than her to try to learn from those experiences.

>> But as we get older it's still important for us to still be active and still do things until as my 101 year old mother said prior to her death she said we all have an expiration date and you just have to wait for years to run out now hers eventually did and it's a kind of perspective we all have to maintain.

We have so many days of life and we have to use them to our fullest based on the capacity that we have physically and hopefully she still has the mental capacity and she can utilize that to Jenny, thanks for your call.

>> Let's go our next caller.

Hello Saul.

Welcome to Matters of Mind.

>> Saul, you asked should adults be screened for anxiety at their yearly checkup?

>> So I think generally people are screened for depression at a yearly checkup with what's called a patient health questionnaire nine question known as a Q nine .

That's pretty standard in a lot of offices now it has a total score of twenty seven as a possibility.

>> Zero means you don't have any symptoms depression 27 means you have a lot of symptoms of depression and if you score in double digits on the Q nine and ten or higher that is usually significant for depression now within the union will be questions concerning sleep anxiety worry as well so you can pick up some anxiety just by looking at a few name.

But there's also something called a seven.

It's called a generalized anxiety disorder seven questions range eighty seven also has a total score of let's say that would be a total score of twenty one as the highest and eighty seven is something that does specifically look at anxiety and worry symptoms.

I think it's a good idea to assess people for anxiety but even more so assess people for their resiliency and there's a whole different type of scale that you can use to assess resiliency.

Resiliency has to do with your coping abilities and your ability to put up with stuff.

>> So with each yearly visit I think clinicians should ask their their patients how well are you putting up with changes?

>> How well are you putting up a stuff in general now everybody talks about stress.

Stress is OK. >> Stress is simply a change in your day to day routine stress is great if you can tolerate it.

If you can't tolerate that's where you're struggling with stress resiliency that's where you're struggling with frustration, tolerance.

>> Those are terms we use meaning that you're having a hard time putting up with stuff if you have trouble with stress resiliency, if you're having trouble with the changes that are occurring in your life , you need to consider getting further treatment for that because if you have unmitigated stress stress it's getting out of hand if you're having trouble coping with the day to day changes that are causing you to feel overwhelmed that can cause you to worry at night and a key early symptom of somebody getting in trouble with mental health issues will be with that person does not sleep very well if you have trouble going to sleep and staying asleep that will cause you to have trouble just dealing with things on a day to day basis.

>> Lack of sleep will affect the front part of your brain here the front part of the brain is the reasoning part of the brain and lack of sleep because the reason part of the brain not to work so well because sleep especially as I've mentioned before dream sleep deep sleep the all those stages of sleep that we all need they will help your brain recharge this front part of your brain up here, the left front part of the brain it's called the dorsolateral prefrontal cortex during dream sleep that's shutting down and that's why all these dreams that you might be experiencing are illogical.

>> They don't make any sense.

It's because you're a logical part of your brain is shutting down.

It's arresting and your your brain needs to rest at night time during the dream sleep and that's why you have those wild dreams that don't make any sense.

So you need to be able to sleep to have logical thinking if you don't sleep you have less logical thinking during the day you start to get more irritable.

You have trouble putting up with stuff.

There's the stress, resilience, resiliency problem all over again and if you don't sleep you just won't be able to think through your problems so well.

>> So when therapists for instance are trying to work with somebody with counseling and therapy, what they're trying to do is get the front part of the brain working more so that the anxiety part of the brain down here in the amygdala and the temporal lobe, the thumb part of the brain, they want to make sure the amygdala doesn't hijack the logical part of the brain because if your anxiety fear, anger, impulsive part of your brain hijacks your logical part of the brain, you can't think through and you can't respond adequately to particular problems.

So you want to be able to think through your problems and think before you act.

You want to be able to think about what you're saying before you actually blurt it out and lack of sleep will be a factor there.

So this cascade that we often will hear about soul will difficulty with anxiety and stress, resiliency putting up with things that leads to difficulty with sleep and that can thereby lead to depression.

>> So as a psychiatrist I'm asking everybody about their sleep.

That's like a psychiatric vital sign.

We have to ask people about their sleep so we ask about their sleep and from there we ask about other symptoms that might involve depression and anxiety.

Now people are hard wired to have a certain amount of depression or anxiety in general.

>> As a matter of fact, depression disorders in general are about 30 percent genetic.

>> So you have this propensity for depression to begin with and then life experiences, early life experiences if if they're traumatic especially prior about eight about the age of eight years of age if you had traumatic experiences before the age of eight years of age and you have genetics on top of that for depression or anxiety, you can have more difficulty responding to the traditional antidepressive medication.

So life experiences at an early age can impact your likelihood of having depression later on and can impact your the predictability that you're going to do well on certain medications.

So we take that into account.

>> There's a certain scale that we use called the ACS scale the adverse childhood experiences scale.

The ACS scale is basically ten questions that asks about early childhood traumatic experiences and if you score four or more on the ACS scale it might be predictive that the traditional serotonin antidepressants that are so commonly used might not work so well.

In addition to that we look at genetic testing.

Sometimes genetic testing will sometimes give us a little bit of an idea on what medications might work or not work.

>> But we take all that into account.

We look at your family history of depression or anxiety.

>> We look at your early childhood experiences to see if the traumatic experiences were impactful for you, especially prior to about the age of eight years of age and then as an adolescent.

>> OK, so as an adolescent how did you cope with a lot of stresses?

Many people who I see in my practice will say they started smoking marijuana when they were early adolescence, late adolescence and that's how they cope with anxiety.

Well, the problem with marijuana is it slows down the development and the growth of the brain, especially the reasoning part of the brain and it can actually affect your IQ in later years because cannabis or marijuana will slow down the growth of the brain.

>> If you used marijuana as a means of trying to deal with anxiety or depression as opposed to trying to figure out adequate coping skills as we all needed to do as adolescents now the marijuana can be a factor in why you might be still having anxiety and depression later on even though you're not using marijuana anymore.

So again, you're kind of hard wiring the brain to have more difficulty with anxiety and even depression later on there was a big controversy about twenty five years ago wondering did cigaret smoking as a as an adolescent cause depression later on and or were people depressed as adolescents and using the nicotine in cigarets as a means of self medication?

That made a lot of sense because nicotine is a medication that will enhance dopamine transmission.

>> Dopamine can make you feel better, make you feel happier and help you concentrate.

So it made sense that adolescents were perhaps using the nicotine as a means of treating depression theory ran for several years and then it was realized as they did further studies on people long term it was the people who started using nicotine substances as an adolescent who thereby would prime the pump for the brain to cause depression later on.

>> So now that we're thinking that nicotine is causing depression as opposed to nicotine was being used to treat depression, that's why it's very, very important that we try to educate these adolescents and young adults to 24 years of age when the brain is still growing about the the dangers of vaping nicotine now there's always the argument while vaping is safer than cigaret smoke.

Right?

Well, cigaret smoke has a lot of chemicals in it.

So does vaping.

It has chemicals in cigaret smoke doesn't have and it can be dangerous especially if they're coating the lungs and causing you to have difficulty exchanging air it adequately and getting the oxygen in and then getting carbon dioxide out so vaping has its own dangers in terms of drug toxicity on the lungs itself.

But the issue with vaping is it contains nicotine and you might be creating an environment for your brain where you're changing how the brain responds to stress where you're at a higher risk for having depression later on in life .

>> Thanks for your call.

>> Let's go our next caller.

Hello Nicole.

Welcome to Mars Mind.

Nicole, you had mentioned that you suspected your child has attention deficit hyperactivity disorder.

>> At what age is a good age to get screened?

I would say about seven or eight years of age.

I'm not a child psychiatrist but I think it's kind of difficult to assess ADHD symptoms under about seven or eight years of age four for children who were toddlers.

Many of them are going to be active.

They're going to be distractible.

They're going to have trouble with attention span.

I think ADHD will first show itself when they're in a socialized environment, especially a classroom environment, a greater predictor for ADHD will be if the parent or siblings older siblings have ADHD.

>> So if a mother or father or a brother or sister who are older have ADHD, I would think you'd want to keep a close eye on that child because not only is ADHD very treatable if you have it as a child then it can significantly improve the child's academic abilities and social abilities but it can often respond to the same medications the parents might have taken or the older siblings have taken previously.

So if a parent or an older sibling for instance has taken a medication like Vyvanse which is long acting stimulate medication that could be a possibility for a child as well.

>> So that's what we'll often take into consideration.

But I often would defer that kind of assessment to a pediatrician or a child psychiatrist.

Getting the teacher's input can be helpful but ADHD is a phenomenon that not only affects somebody from an academic perspective but it can affect their ability to socialize.

And the biggest concern I have with any child with Ph.D. will not only be their academic abilities but how well they're able to socialize because those are the kids that are often being excluded from social activities because of their hyperactivity, their impulsivity.

They tend to be very outspoken.

They lack tact and they're difficult to really manage.

Other parents don't want them have them have them over for overnights and they're often excluded from a lot of social activities.

That's where you can struggle with ADHD symptoms even as a small child now with ADHD I'm always emphasizing that OK, two out of five people grow out of ADHD when they get past twenty four years of age so some people grow out of it, some people don't.

>> So in the later years when you're in their 20s, 30s, 40s you can still have some of the inattentive symptoms that are there.

>> The hyperactivity, the impulsivity might settle down later on in life but with ADHD there's different degrees of it.

>> Not everybody the ADHD will have trouble getting through school.

Some people do fine in school until they reach a certain degree of academic challenge so they get into college, they're going to graduate school finally it's it's getting the point where they can't acclimate as well as they did before to be able to adapt to the academic challenges.

So ADHD has different degrees of severity.

You can have mild ADHD where you can adapt quite nicely in a lot of situations and then other people will have severe ADHD where they can't even go through high school.

>> Thanks for your question.

Unfortunately an amount of time for this evening if you have any questions that I can answer on the air you may write me a via the Internet at matters of the mind all one word at WWE dot org and I'll try to get to that question next time.

>> I'm psychiatrist Jeff Farber and you've been watching Matters of the Mind on PBS wane God willing and PBS willing.

>> I'll be back again next week.

Thanks for watching.

Goodnight