.

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

Welcome to Matters of the Mind now going on as 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 you may call me the Fort Wayne area by dialing (969) 27 two zero or if you're calling long distance you may dial toll free at 866- (969) 27 two zero.

>> And we're also available live on YouTube now on a fairly regular basis every Monday night we are broadcasting live from our PBS Fort Wayne studios which lie in the shadows of the Fort Wayne campus.

And if you'd like to contact me with an email question that I can answer on the air, you may write me via the Internet at matters of the mind all one word at the Beltway dog that's matters of the mind away dog.

And I'll start tonight's program with an email I recently received.

It reads Do not a favor.

I've been suffering from anxiety and insomnia since before my husband's death 11 weeks ago.

I started ten milligrams of trend telex last week but that left me staggering and unable to walk.

I now take five milligrams of talks at bedtime and a half milligram of Ativan three times a day.

>> Is it safe to increase the Trantor dosage?

Could either of these medications affect my eyesight or in talks and Ativan are entirely different medications .

>> They don't usually affect the eyesight but as I always tell people, if you start a medication and all of a sudden you notice some unusual changes in your physical well-being or anything at all for that matter, it might be due to the medication itself.

>> Talk Talked is a medication that like any antidepressant medication can dilate the pupils and if you're prone to having glaucoma such that you might have blurred vision or a painful eyeball, your pressure in your eyeball is too high.

Any antidepressant medication can dilate the pupils and give you a worsening glaucoma.

>> If the trend is dilated your pupils you might notice you have a visual change there because if you do that the pupils you might have difficulty with being able to read things or see things in a distance either way so it could be the Trantor giving a little bit of difficulty with eyesight and talks doesn't usually make you unsteady on your feet whereas lorazepam or Ativan does and especially when somebody is grieving you don't want to be taken Ativan or Lorazepam for a long period of time because it can actually complicate the grieving process.

The good thing is you're only taking a half milligram of Ativan three times a day.

It's a low amount but it's enough to make anybody over 55 years of age especially have problems with unsteadiness.

>> So that's probably the medication giving you the unsteadiness between the Trinity and the atavism talk over with your primary care clinician or your prescribing clinician concerning the increase in the doses of treant about one out of six people will stay on EntreMed at five milligrams a day.

>> Three out of four people will get up to ten milligrams a day and then other people will go further to twenty milligrams a day.

>> Everybody's a little bit different sometimes we can determine based on a person's genetics if they're going to get by on a lower dosage or a higher dosage.

>> But most people do go to ten milligrams a day.

I'd suggest trying to back off Lorazepam but talk that over with your clinician.

>> Thanks for your email.

Let's go to our first caller.

Hello Peter.

Welcome to Matters of Mind.

>> Peter, you had asked logically speaking why can't we as a society find common ground on conflict?

>> Peter, you could also be known as Plato because that's what Plato thought Plato thought if we just used logic we can all pretty much agree on the best decisions politically and as a society.

>> The problem is Plato didn't take in consideration as part of the brain.

>> It's in the inside part.

Here's the front of the brain or the inside part part of the brain called the ventromedial prefrontal cortex is right inside here.

The ventral MediaMath medial prefrontal cortex will filter information coming into the brain and interpret what the brain is perceiving based on your overall emotional state.

>> In other words, when you receive information and you're receiving logical information it has to go through an emotional filter.

>> So Peter, what you'll notice is that people will have certain beliefs often with a emotional overtone associated with those beliefs and it's called cognitive dissidence where you will have cognitive dissonance, dissonance where you'll have a particular ingrained belief and then you might have outside information coming in that might conflict with that belief.

>> It causes a lot of anxiety because you're pretty set in your ways with your beliefs based on your emotional state.

>> So you'll have this emotional valence that will influence what you're perceiving with the information coming around you.

We see this sometimes with disorders such as bipolar mania, even with schizophrenia, with psychosis is where especially with bipolar mania for instance, if you're really hyped up and your thoughts are racing a mile a minute, you might be be pulling in information that can be interpreted differently than you would interpret it if you were of a normal mood.

Same with depression.

You will hear about people being very depressed so they are more pessimistic on things and again they're bringing in information that they're interpreting from emotional standpoint and thereby not using logic to make the best decisions.

>> Plato thought we could pretty much run our society on logic if we just had all the information in front of us.

But there's a lot of emotional overtone with how we take in information.

>> Peter, thanks for your call.

Ask our next caller.

Hello Shannon.

Welcome to Mars The Mind.

>> Shannon, you want to know what are the benefits and side effects of coal fee for patients with schizophrenia and how can your doctor help you with identifying and setting goals in your treatment plan?

Well, in terms of setting goals for your treatment plan, I think that's something that you need to identify.

>> How would you want to feel better?

I ask every patient of these kind of questions what are your three main goals of treatment?

How would you want to feel better overall?

>> Secondly, what would be a game changer in your not wanting to take medication?

What would be the reasons for which you would not want to take medications?

We get that on the table right off the bat so it's a matter of you partnering with your clinician to try to identify what your goals of treatment should be and will be if you have your clinician just tell you what the goals might be, they might not align with your beliefs so with that being said, Koban FICO benefit is a medication that has been manufactured and researched by Bristol-Myers Squibb came out about a year ago.

It's an entirely revolutionary medication for schizophrenia and we've heard outstanding results from it.

It's not affecting dopamine directly.

It's not blocking dopamine as all of our antipsychotic medications have done for the past six decades, seven decades now my goodness it goes back like seventy years we've used antipsychotic medication starting with Thorazine that blocked dopamine and that's how antipsychotic medications worked.

If you block dopamine you will block this excessive dopamine transmission in the limbic system also known as the temporal lobe here.

But the problem with schizophrenia you have too much dopamine transmission here but you have not enough dopamine transmission in the frontal lobe.

The frontal lobe is where you think and that's where you concentrate.

So the atypical antipsychotic medications that were developed starting with clozapine or Clozaril in nineteen ninety nineteen ninety three nineteen ninety one they started coming out I believe it's been a while but clozapine blocked dopamine here but a block serotonin transmission in the front part of the brain blocking serotonin type two a transmission in the front part of the brain increases dopamine in the front part of the brain.

>> So we had some help in that way.

>> But they still have their drawbacks with the atypical psychotic medications blocking dopamine in the limbic system and increasing dopamine in the frontal lobe.

>> So confi is a medication that was researched for Alzheimer's dementia years ago by Lilly which is out of Indianapolis.

Lilly researched Cabined Research, the active ingredient and Cobban fee for Alzheimer's dementia because it was increasing transmission of muscarinic receptor activity muscarinic receptors have stimulated will increase acetylcholine.

>> If you increase acetylcholine you indirectly decrease dopamine and thereby decrease dopamine in the limbic system where it's overactive schizophrenia.

But if you increase the muscarinic transmission and increase acetylcholine especially in the frontal part of the brain, you will thereby improve concentration motivation and get up and go.

>> So co benefit as a medication that will specifically stimulate two of the five different muscarinic receptors that stimulates muscarinic receptor number one and number four if you stimulate those receptors you can improve concentration memory and indirectly decrease dopamine and decrease hallucinations and delusions and the problems that we often hear about with schizophrenia.

>> So why wasn't the active ingredient in fee approved for or researched further for dementia?

>> It's because when people took that particular drug they had nausea and diarrhea because if you increase acetylcholine it goes to the gut.

>> It'll fire up the gut.

>> It'll cause you to have bladder problems where you have difficulty with bladder retention you'll have difficulty or bladder difficulty with incontinence.

>> You can also have difficulty with a slow heart rate if you will tend to block just or attempt to stimulate the muscarinic receptors.

So what they did is they added a second medication in Koban.

You in that second medication in the body itself will block acetylcholine transmission that offsets the side effects that people have on their heart, in their gut, in their bladder.

So for that reason Koban is more tolerable and it was found to be a really good medication for schizophrenia might someday be used for Alzheimer's dementia.

But it wasn't tolerable for Alzheimer's dementia for schizophrenia it's much more tolerable.

>> It's taken twice a day with or without food and gradually titrated for people that are really nice medication for a lot of people with schizophrenia with the biggest side effects being nausea and diarrhea that are perpetually there.

And if you have any difficulty with bladder retention, having any difficulty with going to the restroom and urinating, that can be a problem for people who are on Koban Feet.

But that's all side effect.

The side effects are dose related.

Thanks for your call.

>> Let's go to our next caller.

Hello Tiffany.

Welcome to Matters of Mind.

Tiffany, you had mentioned that you've been slowly weaning off Effexor, also known as Venlafaxine for three months but you can go for more than 24 hours without having having withdrawal symptoms like a fuzzy head numb face.

So you then cave in and take the medication something you could do to help you get over that or are you doing the right things?

>> Effexor Venlafaxine is very difficult to taper off.

>> We have to do so very slowly and you've been hanging in there for three months trying to do a venlafaxine or Effexor is a medication that increases transmission of norepinephrine and serotonin.

But the problem is twofold.

Number one, it doesn't last very long in the system.

A number two it's only about 30 percent protein bounce so it doesn't hang on the proteins.

>> In other words, it just gets in the body and gets out pretty quickly whereas a lot of medications are over 90 percent protein balance.

So they kind of stick around for a while so they hang around on the protein Effexor gets in and out so fast it can give you what's more accurately known as discontinuations symptoms.

It's not considered to be true withdrawal.

It's more discontinuations symptoms.

So when you stop venlafaxine abruptly you can have zings and zaps in your scalp in your hands your feet can feel very dizzy and when they had their immediate release Venlafaxine which was first available in the 1990s, people would go to the emergency room if they missed a couple of doses because they thought they were having a stroke.

>> They felt terrible.

So then the R version of Effexor came out and now we have in the vaccine and the generic version we have Venlafaxine XRX and extended release versions in a capsule.

It has Bede's in it and it slowly releases over the course of a whole day what we often have to do is we will have people go down very, very slowly thirty seven point five milligram increments at a time and sometimes it will be over the course of several weeks what we're already doing that my goodness you've been trying to do it for three months.

>> So what's plan B?

Sometimes we'll add a little bit of a medication called flu Fluoxetine also known as Prozac.

Prozac stays in the system for days and Prozac can sometimes balance out or dampen down the withdrawal that you're having from Venlafaxine.

>> We hate to add a second medication to a first when when you're trying to get off the first one to begin with.

But in the case of Fluoxetine sometimes that will dampen it down.

>> But the key will be to slowly taper off piece by piece by piece off of the Venlafaxine and get that dosage down as low as you can.

The lowest doses of the vaccine is 25 milligrams.

You can go really slowly, slowly in terms of coming down off of a bit if you need something to be added to it to dampen some of the discontinuation symptoms that would be Fluoxetine ten milligrams often enough just to hold you over you take that for two or three weeks as you're coming off the Venlafaxine itself.

>> But it's a real phenomenon and it's particularly prone to occur of the antidepressants with Venlafaxine also known as Effexor and Paxil also known as paroxetine Paxil approx.

Tene is an entirely different phenomenon when he gets out of your system but both of those can give you those discontinuations symptoms.

>> Thanks your call as your next caller.

>> Hello Kim.

Welcome to Matters of Mind.

>> Jim, you mentioned that you can smell and taste the food that you're dreaming about.

Is that possible to have a dream that it really is you know, you can have sensory input when you're having dreams .

People will have the same phenomenon where they have an increased sensation of taste and smell when they're having migraines and not uncommonly when they're having seizures.

>> So what's the commonality there?

It's all coming from the temporal lobe here, the memory center with migraines, with seizures and with intense dreams.

Your your temporal lobes getting really fired up here and actually the sense of smell is one of the most distinct memories that we will ingrain if you have a particular smell from the past that was particularly meaningful for you, whether it was related to trauma, a good experience or whatever is a particularly meaningful experience for you.

That sense of smell can be easily triggered later on and in the case of dreams that also can occur and as you can imagine smell, taste, touch, sound and sight those are all our sensory inputs.

Smell and taste often go hand in hand so you might just be prone to being able to do that with intense dreams doesn't mean it's pathological at all but that is not uncommon phenomenon.

>> Thanks for your call.

Let's go next caller.

Hello Drew.

Welcome to the Mind.

>> Do you want to know how do you deal with your quick temper to when you are in conflict and how do you deal with your anger during small disagreements without feeling that you're going to be losing your temper?

>> Well, there's a lot of things going on there, Drew .

>> No one try to identify what get your temper going.

Many people will have difficulty with dealing with their anger when they feel like they've been personally slighted and they feel as if their honor has has been offended.

So somebody has challenged them and this is why in the southern states especially over 50 or 60 years ago there was a higher murder rate in the southern states because in the southern states traditionally going all the way back to the eighteen hundreds honor was very, very important.

>> So if somebody offended you or your loved one you were expected to retaliate and they would have duels and then as time went on, OK, they didn't have duel so much anymore but they would tend to fight if they felt like their honor had had had been offended in any way.

>> So no one consider the source of your anger why you're getting angry.

>> Secondly, people will often feel like they're getting angry because they've been victimized and again it goes to goes back to somebody else influencing your emotions.

So whether you feel like your sense of honor has been betrayed or you've been victimized, it all comes from an outside source.

>> So the first thing I would suggest you do if you're having trouble with anger and conflict is try to identify why are you getting so upset about things?

Why are you allowing other people to set your emotional tone because that's what's often happening now if you have an underlying pathological condition where you're having trouble with anger, OK, we get that people with bipolar disorder where they're having manic episodes will often have anger as associated with the bipolar episodes.

>> Men especially can get really angry when they get depressed.

So if you're noticing you're quick to get angry because you're depressed, especially if you're a man that can be a factor.

People with ADHD there's certain types of ADHD where people were going to be more prone to being more impulsive hyperactivity and they too can have a quick trigger on their anger itself.

>> We can treat those kinds of conditions.

But I'd go back to the original source of your anger is you're getting angry because you feel like you've personally been offended by somebody or do you feel like you're being victimized by somebody else?

Those kinds of angers can be alleviated by getting your your perspective changed on your personal responsibility as opposed to having other people dictate what your emotional toll tone will be.

>> Thanks for your call.

Let's go next caller.

Hello David.

Welcome to Matters of Mind.

David, you want to know what are some thoughts on memory and brain supplements and what what's the safety issues and measures and using melatonin and can you can I recommend both melatonin has been around for a long time, very safe to use and you can use a long term typically people don't need to use more than three milligrams or even five milligrams which is a common dosage over the counter.

So five milligrams of melatonin is often plenty unless a sleep specialist is recommending that you take ten or fifteen milligrams for whatever reason.

But many people who take 10 and 15 milligrams of melatonin will have nightmares and they'll have more problems with taking a higher and higher amount of melatonin will not give you a deeper or better or more efficient sleep.

>> Usually three to five milligrams is all you need at bedtime.

>> You take it about thirty minutes before you intend to go to bed.

Melatonin is like a puff of smoke.

It's there very briefly and then it gets metabolized very quickly.

>> Melatonin is doing one thing it's giving your brain a signal to go to sleep.

Our brain naturally will do that as we get exposed to darkness at nighttime.

So as you're exposed to darkness the melatonin levels go up.

>> That's why you need to be careful with any screen time at nighttime .

>> Is that bright screen on your computer or your cell phone is going to keep your brain awake so melatonin will be suppressed with bright light.

>> But melatonin is the vampire hormone in the sense that it goes it gets up when you when it gets dark outside.

>> That's why it's called the vampire hormone.

So melatonin can be safely used long term and it's often used for younger people, even adolescents who have a sleep wake cycle that's a little bit delayed in the sense they like to go to bed later at night.

They like to sleep in longer in the morning if you can get them to bed a little bit earlier, especially during the school year that can be helpful with three to five milligrams at bedtime of melatonin fairly safe to use now what supplements use for memory or or decreasing Alzheimer's dementia for that matter?

>> I would recommend any based on what we know right now the supplements I highly recommend do a lot of people on a day to day basis will be the possibility of using vitamin D on a regular basis and magnesium magnesium whisenant is very well absorbed so magnesium 400 milligrams at bedtime can be very, very helpful if people were to check their magnesium levels especially if they're under chronic stress, if they're depressed, if they use alcohol, they're magnesium levels will often be lower than expected if your magnesium level is lower than expected, it can often give you difficulty with fatigue and even feeling more depressed and having difficulty concentration.

So a magnesium supplement vitamin D can often be helpful.

There are other supplements that you can ask your primary care clinician what he or she might take.

I always tell people to ask their clinicians what they take and see if you get any ideas from that.

But supplements specifically for dementia or to prevent dementia and improve your memory.

>> I know there's been a lot of them touted but they just don't seem to have really good placebo controlled outcomes that I could certainly recommend.

I remember back in the 1990s a real popular supplement was ginseng ginseng.

To ever hear anybody talking about using ginseng anymore?

No, it was a fad back in the 1990s it was thought that ginseng would help with memory.

It really didn't it didn't play out so much so you rarely hear about ginseng anymore.

>> So why can you do for your memory what can you do to enhance it without taking supplements for that matter?

>> Well, if you think about helping with your with your memory number one you want to exercise exercising anyway anyhow whether it be resistance training, whether it be aerobic exercising, exercising increases to chemicals in the brain at the same time gabbin glutamate in doing so it can improve your memory and retain your memory over the course of time.

So exercise number one number two is maintain socialization.

>> People will get more socially isolated, have a lot of difficulty with having memory problems.

You've got to maintain social activity.

You've got to exchange ideas with people, keep your brain active as socialization overall.

>> What else could you do know?

Number three get good sleep.

You have to sleep.

I mentioned melatonin.

You better if melatonin is necessary to get your sleep, get good sleep, try to turn off your cell phone, your television within an hour of your computer, within an hour of going to bed.

Try to read something out of a paper book.

Yes, they still exist but something is not going to be a bright light.

Sleep is exceptionally important for older adults to retain their memories overall.

>> Fourthly, you know people talked about puzzles in the past.

Puzzles used to be thought to be really helpful to retain your memory back then it was found that with basically with puzzles it's it's they are basically helping you do puzzles so the puzzles themselves won't help with your memory.

>> But what can help you with your memory is trying to learn new things in general, learn new things whether it be political, different ideologies, keeping up with the news, learning a new language, reading about things you hadn't previously learned reading new things can be very, very important for a lot of people.

>> So those are the main means by which I would suggest you try to enhance your memory and bottom line is keep your blood sugar, your lipids, your blood glucose I'm sorry your blood sugar, your lipids and your blood pressure all in really good control to be or to preserve your memory as we get older.

>> Thanks for your call.

Let's go our next caller.

Hello Nicholas.

Welcome to Mastermind.

>> Oh hi Nicholas.

Could a massive stroke at a very young age look at schizophrenia later in life ?

It's hard to say, Nicholas.

A massive stroke at a young age could cause you to have irritability could cause you to have moodiness schizophrenia as a condition where you would specifically have the ability to hear voices other people can't hear.

>> You'd have fixed false beliefs, having delusions you'd have trouble with processing information processing thoughts.

You'd have trouble with being able to socialize and interact with other people so that massive stroke quite frankly if I was to speculate it would have to be in the left front side of the brain especially affecting this area of the brain called the Arquit physicalness.

The argument physicalist goes from the front part of the brain to the back part of the brain.

It goes from the talking part of the brain to the hearing part of the brain.

>> People with schizophrenia will have a disruption of that band of tissue called the argument physicalist and thereby when they have thoughts they will inadvertently interpret those thoughts as being a voice.

So I could speculate that that kind of a stroke could cause you to have psychotic like symptoms later on.

But quite frankly, Nicholas, when people have a stroke early in life , the symptoms that will persist later on will be difficulty with irritability, moodiness, concentration, focus and maybe that could be interpreted as being psychotic symptoms to some degree.

But I think it all comes down to what kind of symptoms people would have.

>> But if you had that stroke in a particular place, maybe you could have psychotic symptoms but it's not very common for that to occur.

Usually it's more moodiness and irritability and difficulty concentration and people will experience.

>> Nicholas Nicholas, thanks for your call.

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

Our last email question raised your daughter Fauver.

How long ah can long term psychiatric medication cause neurological problems?

>> I've been on Effexor Lamictal Gene present and although for a while they are working but I'm worried about long term effects.

Those particular medications would not give you long term neurological conditions but of the ones you mentioned, Ability and Effexor do have some overlapping effects on serotonin authority's main mechanism is that on glutamate but it has a little bit of a serotonin effect.

My only concern with that combination is a potent actually give you some serotonin toxicity symptoms such as diarrhea, headache, fast heartbeat sweatiness and nausea.

So be aware of that neurologically those would not give you tardive dyskinesia or any kind of antipsychotic like long term effects.

>> Thanks for your email and for tonight I'm out of time for this evening if you have any questions that I can answer on the air you may write me via the Internet at matters of the mind all one word at WFYI Eigg.

I'm psychiatrist Jeff and you've been watching Matters of the Mind on PBS Fort Wayne now available on YouTube.

>> God willing and PBS willing.

I'll be back again next week.

Thanks for watching.

Good night