good evening.

>> I'm psychiatrist Jeff Alver live from Fort Wayne , Indiana.

Welcome to Matters of the Mind now going on his twenty eighth year Matters of the Mind is a live call in program where you have a chance to choose the topic for discussion.

So if you have any questions concerning mental health issues give me a call.

The Fort Wayne area by dialing (969) 27 two zero or if you're calling any place coast to coast you may dial toll free at six six (969) to seven to zero now on a fairly regular basis we are broadcasting live every Monday night from our spectacular PBS Fort Wayne studios which lie in the shadows of the Purdue Fort Wayne campus.

And if you'd like to contact me with an email question that I can answer on the air, you may write me a via the Internet at matters of the mind all one word at WFYI dot org that's matters of the mind at WFYI ECG and I'll start tonight's program with an email question I recently received.

>> It reads Dear Dr. Farber I've been off Effexor for three and a half weeks.

>> It's been terrible.

How long can this last?

I've been on it for nineteen months at seventy five milligrams once a day.

Everybody has different sensitivities to discontinuing a medication like Effexor.

It's actually called the discontinuation phenomenon where when you stop it abruptly or even taper off a little bit too quickly you can have zings and zaps in your hands and feet.

You can have a dizzy spinning feeling in your head.

My goodness when it first came out in nineteen ninety five in the immediate acting formulation people when they missed a dosage thought they were having a stroke and now it's all in the extended release version so the effects the slower the better and for some people they do need to take a medication like flu Occitan or Prozac along with it as they taper off that tends to ease the withdrawal but the slower you taper off of it, the easier it becomes.

>> You just happen to be one of those people who is very sensitive in coming off of it.

So talk to your clinician about strategies for tapering off of it even slower than you are adding something like flu vaccine to ease some of that withdrawal.

>> Thanks for your email.

Let's go to our first caller for tonight.

>> Hello Ted.

Welcome to Mars The Mind.

Ted, you mentioned that several years ago you visited Auschwitz in Poland after the visit you had no appetite and experience nightmares.

Is that a physical reaction that's normal after a traumatic experience?

Yeah.

If you have no appetite nightmares following a traumatic experience that can be quite common.

What's happening when you experience that, Ted, is your emotional center of your brain is what was getting fired up.

>> Here's your brain looking at yeah, that's the left side of the brain on the inside part of the brain you've got this emotional volume control is getting fired up and then the amygdala is the actual area of the brain, the temporal lobe that is the volume control for anxiety, fear, anger and what happened when you visited Auschwitz?

>> This emotional volume control got really fired up and in the center of your brain is where you also have areas that regulate appetite and regulate all of the physical type of phenomenon going on your body.

So your emotional response affected you physically during that time what you want to do after experiencing any kind of physical type of phenomenon related to trauma Ted is to talk about it this is why soldiers coming back from World War Two didn't have as much post-traumatic stress as did the Vietnam soldiers who came back from Vietnam because when the soldiers came back from World War Two they came back on a long trip on a ship typically and they debriefed with their buddies and they talked and talked and talked about their experiences.

>> When you talk about your experiences, the experiences centered more in your logical part of your brain, the front part of your brain and it takes it away from the emotional part of the brain.

>> That's why techniques such as eye movement desensitization and reprocessing therapy are so effective because basically they take the emotional valence of the experience to a thinking part of the brain and another type of treatment is rapid resolution therapy where you're doing nonsensical things as you talk about the past experiences and in doing so you take away the emotional influence and put it into the thinking part of the brain.

So yes, say physical manifestation can be quite common following a traumatic experience because the physical part the brain is deep inside the brain.

It's a very primitive part of the brain and that's not a not uncommon Ted, thanks for your call.

>> Let's go next caller.

Hello Macy.

Welcome to Matters of Mind makes you want to know if there's a condition that makes remembering faces difficult.

There is a condition where you don't recognize faces so well.

Maybe it's called prosopagnosia and this is a condition where it can be something that you experience from childbirth or can happen after a stroke particularly in this area right .

The temporal lobe let's see the temporal lobe on the right side here as I pick up the brain is the brain looking at you to pick up the brain, the temporal lobe on the right side here it's called the fusiform gyrus and that's the part of the brain that's particularly prominently going to remember faces for you the hippocampus, the memory library center is right up here, the hippocampus but it's right below that part of the thumb of the temporal lobe is the fusiform gyrus and if you damage both sides that can be particularly problematic.

But if you have a stroke, for instance on the lower right side particularly of the temporal lobe and affecting that fusiform gyrus that can cause you to have difficulty with facial recognition.

So what do people rely upon when they meet and greet other people when they can't remember their faces they rely on their oh their clothes they might have been wearing previously their tone of their voice they might even be triggered by different mannerisms.

>> The other person might be might see but they won't recognize their face itself.

It's a true neurological condition that can be seen from childbirth or from brain trauma itself.

>> Thanks for your call.

Let's go next caller.

>> Hello Darlene.

Welcome to mastermind Darlene.

You want to know how does being anemic affect your mental health ?

You might have heard me mention that before Darlene because when we think about the common the common medical reasons why people will have mental health issues, the things we don't want overlook there will be things like blood sugar abnormalities, high or low blood sugar or sleep apnea where you pause in your breathing or you snore at night that will cause mental health issues, thyroid disturbances, high or low thyroid can cause you to have mental health issues but low iron and anemia can give you mental health difficulties and be manifested by fatigue, poor concentration and some people will just say they feel really depressed and blah.

So when people have low iron we have to consider that why would somebody have low iron?

We can have a woman who's heavily menstruating, maybe somebody who's a vegetarian.

They're not getting enough iron .

Somebody has a slow gastrointestinal bleed.

It's very subtle.

Older adults especially with slow gastrointestinal bleeds can have low iron.

So as a psychiatrist I will not uncommonly look for low iron and you know, a symptom that seems kind of unusual when something has low iron will be restless legs, they'll have fatigue, they'll have difficulty with depression and they'll have difficulty with various other mental health systems symptoms but they'll often have restless leg.

>> So if somebody has restless legs we sometimes will think in the back of their minds.

Huh.

I wonder if they have low iron because low iron will cause restless legs.

So if you correct that with iron supplement usually will it'll be done so with a pill depending on what kind of the problem might be we can often correct that so low iron can give you mental health difficulties.

>> That's why as a psychiatrist I am a physician.

As a psychiatrist I have to consider that when somebody telling me their fatigue they have restless legs they can't concentrate.

We will think about low iron that will often go along with the more obvious signs where somebody is pale.

We'll often ask a woman who's in her 20s or 30s if she's heavily menstruating women who have uterine fibroids will be heavy.

is not uncommon and they'll have low iron as well.

So we we can't overlook that and simply give somebody and energizing anti depressant or a stimulant to try to bring out and bring them out of that we have to look at the underlying problem so it's important that we try to treat that problem.

>> Thanks for your call.

Let's go our next e-mail question.

Our next e-mail question reads Durata favor Is it ideal for my psychiatrist to work with my family practitioner ?

Will I have a better outcome if I'm seeing both my psychiatrist and my family doctor?

I have this scenario all the time.

>> My psychiatrist, the family clinicians will be treating people for underlying physical health problems like hypertension, hyperlipidemia, diabetes, asthma and I will look at their medications.

They'll look at my medications.

But as a psychiatrist they are often referring to me to get somebody presumably the right medication from a mental health standpoint.

But I have to take in consideration what medication the primary care clinician will be using so will often be on the same electronic medical records which is a phenomenal tool.

We've had a readily available since about 2005 where it's pretty standard practice now where clinicians and specialists such as myself can communicate very readily back and forth and let each other know what we're doing and if we have questions if we're on the same electronic medical record as many of us are will simply ask a question in real time and we can communicate by text messaging back and forth right in the middle of the day.

>> Thanks for your email.

Let's go our next caller.

Hello Markus.

Welcome to Arizona.

Mind Marcus.

>> You want to know if I can explain contamination obsessive compulsive disorder or contamination OCD when your friend can't remember opening a bottle they'll just throw it away if they can't remember if they opened it already or not contamination OCD Marcus is a condition where somebody has intrusive inappropriate thoughts concerning contamination and inappropriate, inappropriate, inappropriate thoughts that are intrusive are considered to be obsessions.

Compulsions are where you do something to carry out that obsession so in your friend's case your friend is inappropriately concerned that a bottle might have already been opened.

>> Now there's ways of checking to see if it's already been opened obviously.

>> But if your friend just knows it has probably not been open but throws away anyway.

The compulsion aspect of that is discarding the bottle itself even though your friend knows that it shouldn't have to be discarded.

So obsessive compulsive disorder will will be manifested by sometimes aggressive obsessions where you have thoughts that come to your mind checking obsessions where you just feel like you need to check things over and over again and the care you carry that through by checking door handles and checking the floors and checking the locks and things like that, people are going to have different obsessions such as having obsessive doubt doubting that something didn't go right.

They'll have obsessions about their health , knowing they don't have to think that hard about their health .

So obsessive compulsive disorder is basically where in your front part of your brain you have a little bit of a loop here that's going on here and it loops round and round and round like an old record player with a needle get stuck.

So you have this obsessive thought you can't get off your mind and just keep going and going and going and you struggle with letting it go and it sounds like you that's certainly a big of a deal for people.

But it is it can be very, very empowering when they have these thoughts they can't get their mind and it'll cause them a lot of anxiety and sometimes impair their ability to think so OCD or obsessive compulsive disorder will often be treated with the serotonin medications.

Luvox being the first on the list because Luvox also knows Luvox imeem has this added benefit of being a very strong antiinflammatory medication will stimulate this particular receptor called a sigma one receptor and in doing so can decrease inflammation so Luvox or flu vaccine is used for OCD but it's also used for various types of inflammation.

It was medication that was used quite predominantly during the covid pandemic when people would have an infection of their lungs.

They would take Luvox or flu vaccine as a means of treating not OCD but treating the infection of their lungs so flu vaccine can help with OCD symptoms.

>> But it's thought that maybe OCD has a component of inflammation accompanying it and based on that inflammation, Luvox can be particularly helpful for people in that way.

>> Thanks for your email.

Let's go to next caller.

Hello and welcome to Matters of Mind and you want to know why does your attention deficit hyperactivity disorder cause you to hyper focus on certain foods while ADHD can cause you to hyper focus on a lot of different things and this is where people will have a misperception about ADHD because I'll say attention deficit.

>> Why am I able to focus on computer games?

Why am I able to focus on certain aspects of history?

>> Some people with horrific ADHD are phenomenal mathematicians.

It's because if you're interested or challenged or you find something exciting or novel you can focus on those particular areas of interest to the point where you can almost get so involved.

>> You forget to eat, you forget to go to the bathroom for a while.

>> You just are there for hours focusing on that particular topic.

So in your case and it sounds like you are hyper focusing on foods and I presume that means you're hyper focusing on the preparation of foods as opposed to bingeing on foods but if you are preoccupied bingeing on foods, it's an interesting phenomenon that we've seen that people with ADHD are more prone to being binge eaters anyway and it has to do with dopamine when you fire up dopamine as you can do with binge eating, you're also helping with a concentration on a good way to do it.

>> But when people binge eat and they blast themselves with a bunch of carbohydrates, they can indirectly give themselves a little kick of dopamine and a little kick a dopamine will help you concentrate better briefly.

>> It's like a puff of smoke.

It doesn't last very long so it's not uncommon people will binge eat and have ADHD.

>> There is a medication that we use for both phenomenon called Vyvanse five ANSYS list dexamphetamine and list dexamphetamine will be a medication that will help people with ADHD and binge eating.

It helps with both conditions because the clinicians who research that particular product realize that those conditions went hand in hand not uncommonly and thanks for your call.

>> Ask our next caller.

Hello Ben.

Walk on matters of mind Ben you all know is creating fakes scenarios in your head normal or could that be a sign of a mental disorder?

>> It would only be a sign of a mental disorder.

Ben, if the fake scenarios in your head are causing you functional impairment, are you having a hard time getting your job done?

>> You have a hard time socializing because you've got these fake scenarios going on in your head.

But fantasy is fine.

Fantasy is perfectly fine.

It is a way for people to cope in some ways as long as you don't sell maybe express your fantasies out loud excessively to the point where you're not realizing what's real and what's not real and other people around you are sure what you're really talking about and they might be assessing your integrity about the kind of things you're discussing.

>> So scenarios or fantasy you're in your head that's not uncommon.

It can be a stress reliever for some people because it helps you kind of think about alternatives scenarios of your current reality around you.

>> Thanks for your call.

Let's go our next caller.

Hello Paul.

Welcome to Matters of Mind.

>> Paul, you want to know about the benefits of taking Paxil also known as paroxetine peroxide or Paxil came out in about nineteen ninety four so it's been around for over thirty years now and it's a medication that's a very strong serotonin reuptake inhibitors and what that means is it's going to profoundly increase serotonin in your synapse and thereby stimulate the 14 different serotonin receptors that are in the periphery.

So if you think about your little serotonin neurons being like shotgun's and they're firing out these serotonin bullets and these bullets spray out all over the synapse and then we'll stimuli 14 different serotonin receptors.

>> Some of them you want to stimulate someone some of them you don't.

Paxil will profoundly decrease anxiety and that's why it's what it's primarily use primary use will be social anxiety, OCD, panic disorder, sometimes generalized anxiety also known as worry that can be helpful with Paxil.

Paxil can be very calming for some people and it has approved at low doses in a particular formulation for menopausal hot flashes.

>> So Paxil could be used for various reasons.

You're currently experiencing weight gain from the Paxil by your report.

Yeah, that is side effect is related to one of those receptors called serotonin to see receptors the receptors go by a number in a letter and the two C receptor is one of the 14 different serotonin receptors that receptor upon stimulation can sometimes give you weight gain and that's the problem with Paxil.

>> So in taking Paxil you have to be aware it can give you more side effects than some of the other serotonin medications like Lexapro, Celexa, Zoloft, Prozac, Luvox I mentioned before.

Those are all serotonin reuptake inhibitors as well.

We kind of stray away from Paxil for that reason.

Not only can it cause weight gain and a lot of fatigue but it also can give you a lot of difficulty if you miss a dosage I mentioned earlier, the effects are discontinuation symptoms of those things and zaps in the hands and feet the dizzy feeling the feeling like you're having a stroke when you stop Effexor too quickly.

Well, the same thing can happen with Paxil and of the serotonin medications Paxil is one of the more commonly more likely medications to give you those kind of discontinue symptoms Paula.

>> Thanks for your call, Esguerra.

Next e-mail question our next e-mail questions reads Dear a favor.

>> Is there one thing that a person should do to maintain good mental health ?

There's a lot of things you could do to good maintain good mental health .

One thing the one thing people all ought to be doing is keeping an active lifestyle where they have some meaningful and purposeful rhythm to their day to day life .

>> In other words, you need to have something to get for to use some very bad grammar there but you need to have a reason to get up.

You need to have a reason to get up every day people who retire, people who are off work, people who don't have structure in their lives are more likely to have mental health problems.

>> I remember twenty five years ago there was this huge study involving thousands of people across the country with substance use problems.

All right.

So all these people have substance use problems, alcohol dependance and they look for any common type of factors that contributed to their having substance use problems and they found the one factor it was very common for all of them was they had a decent or disorganized chaotic lifestyle.

In other words, day by day by day everything was different.

So you need to have routines in your life .

You need to have a time where you go to bed, a time where you typically get up a routine in terms of what you do when you get up that can be walking your dog can be simply getting a cup of coffee, having a routine day by day by day working out is always a good routine.

You want to has some good habits in there but you need to have some kind of routine involved in your life .

There was a very famous psychiatrist's Ellen Franks I believe was her name from the University of Pittsburgh about twenty years ago who actually developed this therapy called social rhythm therapy.

>> Social rhythm therapy is basically a therapy that she developed for people with mental health issues in general where the whole idea was to hour by hour by our plan your day now that sounds very boring and too routine but having something to do hour by hour by hour as opposed to having that disorganized chaotic lifestyle that somebody with substance use disorder might experience that's very, very important.

So having meaningful, purposeful activity every day something that you feel is fulfilling and you feel like you're helping other people and doing so so there's a lot of factors there but have a meaningful purpose activity on a day to day basis going along with that social and social rhythm Ellen Franks talked about.

Thanks for your email.

Let's go next caller.

>> Hello Saul.

Welcome to Mastermind Saul.

>> You want to know are there any dangers to your main mental health when you do not reach deep sleep?

>> Deep sleep Saul is where if you're awakened during deep sleep you'd be kind of confused for a few seconds and you might not know where you are.

>> That's a good thing.

That means you're in deep sleep.

So deep sleep is what you experience when you may be not slept very well for a couple of nights because you were working you had other obligations and now you've finally got a chance to sleep a little bit extra and you have some sleep deep debt and you're catching up with it.

Well that's what deep sleep will do.

Deep sleep is where you go into this very slow wave sleep and you're kind of confused when you're awake and if you're in deep sleep you can inadvertently have sleepwalking and you can have night terrors as a child where you awaken in the middle of the night kind of screaming in your confused it's not a nightmare.

It's a nightmare.

So with that being said, deep sleep is very important.

How would you be affected if you didn't get adequate deep sleep?

Deep sleep is particularly important for our physical health so if you didn't get deep sleep night by night you'd be more prone to infection and if you didn't get adequate deep sleep you'd be more prone to heart problems maybe a lung problem.

He could have more trouble with your energy level and get up and go so lack of deep sleep can be very impactful for somebody who is having medical issues already.

So we try to get people into deep sleep and try to avoid medications that might decrease sleep.

The deep sleep is a very good thing if you get a deep sleep that's where you'll be confused upon awakening.

>> Thanks for your email.

Let's go to next caller.

Hello Nancy.

Welcome to matters of mind.

Maybe a problem that we're in trouble with.

>> Hello Nancy.

You're on the air so thank you, Steve.

And I am a friend who was injured in a truck accident with the frame of the front window.

The window of course is top of his head on their frame in the truck probably a four inch laceration on the top of his head like that.

It looks to me like it's in a red and a dark blue area on this very show on the map.

Yeah, I'm wondering what that area involves.

He claims that he has a better eyesight since the wreck is one thing that's unusual but now he's having some problems mentally remembering things.

>> I wondered if that would affect affected in there.

Yeah, if you have a head injury you can have increased sensory input sometimes not so fortunate for people but when you have a head injury basically the head the brain is weighs about three and a half pounds, has a consistency of jello inside of our skulls.

>> When you pop the top of your head it gets all squishy and gets moved around very abruptly and in doing so it can increase its chemical called glutamate.

Glutamate is the accelerating neurotransmitter or chemical the brain and increasing glutamate sometimes will cause you to have some difficulties with sensory input and sounds like in his case the I'd say lights were probably amplified .

In other words, he probably is more sensitive to lights at this point because that increase in glutamate this red area of the brain here is associated with movement the the blue area behind a kind of a purple area behind it is more associated with sensory input itself.

So No one I'm hoping he's not having any trouble with moving his arms or legs because that would be affecting the red area particularly.

>> But the blue areas where you have sensory input in your you're bringing in the sensory input itself.

>> Memory issues are not commonly seen with head injuries because of that surge of glutamate.

>> You know, it's glutamates great neurotransmitter it when it's used in the right quantity it's kind of like oh eyeglasses where when eyeglasses are just the right strength they're fantastic but too much of the too thick of eyeglasses is actually worse in your vision.

That's kind of how glutamate is of too much glutamates in the brain.

You can have seizures, memory and disturbances, irritability, anger.

So he probably has that Surjit glutamate that was there causing some of those problems that you're describing currently so that sometimes can go away over the course of a year or two .

Sometimes we need to treat that with medications to stabilize the nerve the neurochemistry.

>> Thanks for your call.

Let's go next caller.

Hello Jim.

Welcome to the Mind Jim.

>> You want to know what's a difference between Paxil and Citalopram?

They're both serotonin reuptake inhibitors.

Paxil is a lot stronger, has more side effects, has more difficulty with withdrawal upon your stopping it for that matter.

Citalopram it's very mild.

Citalopram is pretty well tolerated.

The commonality of Paxil and Citalopram will be that they both will enhance serotonin transmission about one out of three people out there who really well with serotonin and antidepressants for depressants but for depression.

>> But you know about two out of three people don't do so so well with those medications for depression, for anxiety they can do better.

>> Thanks for your call.

Unfortunate I'm out of time for this evening.

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

I'm psychiatrist Jeff Alver and you've been watching matters of mine on PBS Fort Wayne now available on YouTube God willing and PBS willing I'll be back again next week.

Thanks for watching.

Goodnight