.

>> Good evening.

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

Welcome to Matters of the Mind now entering its 20th year matters the mind is a live Call-In program where you have the chance to choose the topic for discussion.

So if you have any questions concerning mental health issues, give me a call the Fort Wayne area by dialing (969) 27 two zero or if calling long distance you may dial toll free at one 866 (969) 27 two zero.

Now on a fairly regular basis we are broadcast 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 WFA org that's matters of the mind at WFYI Organo Start tonight's program with an email I recently received.

>> It reads Dakotah Fovea Can Screentime on phones have a negative effect on mental health even if you don't have social media?

>> Is it possible to be addicted to your phone?

Is that just slang or just a danger for younger folks?

No, it is a danger for all of us and social media is something that is particularly troublesome especially for younger people because it can impact their self-esteem.

>> However, what if you don't use social media?

What if you're just going to different sites and you're looking for brief clips on this brief clips on this there are algorithms that are established when you watch different sites on the Internet and the algorithms will know what kind of things interest you and they keep you engaged in that way.

>> No.

One, it can affect your sleep.

And that's one thing I warn even older adults about.

>> You need to have a time where you're not going to use any more any more use of the Internet or the media that night that you're trying to go to sleep.

>> So it needs to be ten thirty 11 pm at some point it's there's got to be a time where you put the phone down.

>> Secondly, if you do use the screen at night sometimes you can have blue light sensitivity where it's keeping you awake from the blue light of the phone itself there are blue lights blockers on certain phone apps and that can be somewhat helpful.

But the screen brightness can many times keep people awake.

Yes, you are trying to get sleepy.

It's nice to have a darker room and the best way to try to go to sleep is to read a book that has chapters in it or at least breaks in certain areas where you read to a certain part and then you were able to put it down.

>> But my biggest concern about the use of the phone and the different apps that are available will not only be insomnia but it's also decreasing your productivity.

>> It takes away time where you could be involved in other things.

>> So that's the biggest concern I see with the use of the Internet, the use of the cell phone to screen times that people are using.

>> They're going from one topic to another to another and it does indeed engage you.

>> And if you're using social media, yeah, it will actually affect your dopamine responses such that when you're getting the likes and you're getting approval to what you're saying, you can get a little bit of dopamine surge and that's where it can be addictive for a lot of people.

>> But just looking at one site and another and another and another can sometimes get you a degree of excitement and actually keep you awake and it makes you less productive overall.

>> Thanks for your email.

Let's go to our first caller for tonight.

Hello Abby.

Welcome to Matters of Mind.

>> Abby, you had mentioned you've been diagnosed with bipolar disorder and attention deficit hyperactivity disorder also known as you don't want to have bipolar disorder.

>> How do you convince your doctor to treat you for ADHD only?

>> Well, Abbie, I'll tell you what if you have a condition that needs to be treated, it needs to be treated if you have a call for instance, Abby, if you have a cough it'd be nice to simply be diagnosed with viral bronchitis because you probably known in viral bronchitis never call for a few days and it goes away on its own.

>> You don't want to have a cough associated with lung cancer if you have lung cancer, OK, you need to get it treated but you don't want that diagnosis.

>> You'd rather have a different diagnosis because you've heard about better outcomes with a different diagnosis.

>> The same can be true with bipolar disorder and ADHD.

You need to have a diagnosis to direct the clinician to which direction you need to go now bipolar disorder and ADHD I don't know if they've been diagnosed concomitantly with you or they've been diagnosed a different nose but they have overlapping symptoms with both bipolar disorder and ADHD.

You'll notice there will be a disturbance in sleep architecture and bipolar disorder.

People will get by with less sleep with ADHD people have a hard I'm going to sleep with both ADHD and bipolar disorder.

People have trouble with attention span.

They will have trouble with what they call racing thoughts but with bipolar disorder when they're in the manic episodes they will have racing thoughts where their thoughts are going so fast they can't keep track of them and it happens episodic bipolar disorder is a condition where the mood fluctuations occur and then they'll go away and they occur intermittently and episodically with ADHD.

>> More often than not the symptoms are there every day so you have a disturbance with sleep.

>> It's not uncommon the distractibility impulsivity can be an issue for people with both conditions.

>> When people have ADHD and bipolar disorder they will often do things say things they ordinarily wouldn't do or say.

However, when people have bipolar mania it's during that phase when they're on the high side they will have that occur with ADHD.

>> It can occur on a day to day basis.

>> Bipolar disorder is highly impairing, extremely impairing people bipolar disorder when they're having the manic highs and big lows they're much more likely to get divorced if they're married and they're much more likely to lose their jobs because they'll have days where their highs, days where their lows and it's very disruptive to the work environment.

>> People with ADHD will have their own issues with interpersonal relationships and in their marriages and they'll have trouble in their own ways on the job.

But they're not as likely as people with bipolar disorder to get divorced or to lose their job because the underlying condition itself so there are different symptoms but yet overlapping symptoms with bipolar disorder and ADHD there are different degrees of functional impairment concerning jobs marriage but there's just different networking in the brain.

The treatment is entirely different for ADHD versus bipolar disorder ABIE so you want to make sure you're getting the proper diagnosis just like if you have a cough you want to make sure you're properly diagnosed for the cough so you can do something about it with ADHD versus bipolar sort of those racing thoughts that distractibility that impulsivity is related to bipolar disorder is that ADHD?

The networking in the brain is entirely different and the treatment is entirely different.

I saw a person just a few hours ago who had been diagnosed with bipolar disorder for years and she had been getting mood stabilizing medications as you would do for bipolar disorder.

Nothing was working and more recently we've been treating her for ADHD and it seems to be working better because it appears that she had ADHD instead of bipolar disorder.

>> You can have both and if you have both bipolar disorder or having the highs and the lows with a mood and then you're having additional day to day ADHD, you always need to get the mood stabilized first and then will then treat the underlying ADHD symptoms for whatever remains.

>> So to make a to give you a short answer on that, I'd certainly number one make sure you have the right diagnosis in which you're being treated.

If you have bipolar disorder that's one treatment.

If you have ADHD, that's another treatment that's the most important aspect of it.

Yeah, there might be a social stigma about having bipolar disorder but if you get treatment properly that stigma can be resolved such that people wouldn't even know that you had an underlying mood disturbance.

Bipolar disorder is a mood disturbance where you can have big highs and big lows.

ADHD is more of a cognitive disturbance as a developmental disturbance that's been there since you're a kid and with ADHD is there more day to day?

>> The treatments are entirely different.

Thanks for your call.

Let's our next caller.

>> Hello Davonte.

Welcome to Mars the Mind Doctor.

How are you doing today?

Doing all right.

>> How are you doing?

Davonte know that I have two full time slots question about number one it's kind of a deep issue because you got the ADHD and bipolar stuff where so here's the first question I think a lot of people are out there might be some bipolar don't know it.

That's kind of a question I'm posing.

And then the second full part is how do you like encourage somebody that seems kind of depressed and shabby act and about running the track or working out when you know in reality by exercise and then running you get done, you feel a lot better.

Your attitude is so and how could you encourage somebody like that?

No, just turn this volume back up.

Let's take over.

>> Thanks Doctor.

Thank you.

Did you hit the nail right on the head?

I'll answer the second question first how do you encourage somebody to exercise when they're depressed?

They have low energy and they don't have the motivation to do it.

>> Rarely will you ever hear somebody say I worked out for thirty minutes and I feel terrible, OK?

>> They can feel terrible because they're out of shape but from a mood mood perspective exercising is remarkable because when you exercise you're increasing two very important chemicals in the brain.

You're increasing the transmission of an accelerating chemical called glutamate and you're also increasing transmission of a breaking chemical called GABA.

So glutamate and GABA as they both increase you have more energy, you have more motivation but at the same time you feel calmer exercising has a remarkable effect on the mood and I think that's one thing that you could do with your friends who you have well you know, as depressed when people are depressed they don't want exercise giving them gentle encouragement, going with them and having them go with you and encouraging the just do something real simple for maybe ten minutes and that can be a simple walk.

Rarely does anybody feel worse by just simply going for a walk unless they need joint replacements or some other type of things.

>> Doing any kind of exercise outside the fresh air does help with a mood and physical activity does help and there's actually as I said, a neurobiological reason why exercise can help with the mood.

>> But here's the here's the challenge Davonte when people have difficulty with depression they lack motivation.

They don't enjoy things and they have difficulty being able to anticipate feeling better.

>> In other words, they're pessimistic and they can't imagine feeling better in the future and that's where the exercise can help out.

>> So how do we get to that point?

Well, that's where medications come in.

>> Sometimes we need the medication to be able to give them a little bit of a jumpstart to help them with enjoyment.

Pleasure, motivation, energy to get them out of that funk so we can at least get them to a point where they can start exercising.

>> Another thing that people will do when they feel depressed event is they crave carbohydrates and they will eat junk food and they eat very poorly.

>> And you think why are they doing that?

They always already feel lousy and eating junk food and basically stuff out of a box.

What does make you feel worse?

Well, they do that because their brain instinctually is wanting to be hit really hard with carbohydrates.

>> If you blast yourself the carbohydrates there's this chemical called tryptophan that gets into the brain easier.

Tryptophan is a building block for serotonin so temporarily if you crave or if you crave carbohydrates and then you blast yourself with carbohydrates, carbohydrates temporarily you can increase serotonin in the brain.

>> Increasing serotonin in the brain will give the brain a bit of a calming effect.

So people sometimes are self medicating to some degree with a high carbohydrate diet especially refined sugars when they get really depressed.

So your first question, Davonte, was do a lot of people have bipolar disorder and not know what I'd say?

Most people who have bipolar disorder don't realize that they did a study of this national bipolar group years ago and they said on the average people had symptoms of bipolar disorder for twelve years before it was actually diagnosed.

Now some of those years people weren't going to a clinician.

They were just trying to get it out for many of those years people were going to a clinician and the clinician kept focusing, focusing for whatever reason on the depressive phase and they were overlooking the highs because they weren't searching for the highs they asking about any high episodes and by golly the patient's not going to reveal those high episodes because of them.

>> That's a relief from the Depression.

So many people if they have four to six days of highs it would be called bipolar two disorder if they had the lows thereafter or if they had seven days of highs unless they got themselves in a lot of recent trouble or unless a family member came in with them, they probably wouldn't talk about the high so much.

They want you to treat the lows because they feel miserable during the lows so you can give them an antidepressant after antidepressant if they have bipolar disorder and they'll feel better temporarily.

But in the long run they feel lousy because if you give somebody an antidepressant medication when somebody has bipolar disorder it's like pushing on an accelerator with no brakes and you just have a hard time keeping the mood stable so what we try to do when somebody does have bipolar disorder is we give them a cruise control medication.

The medication it's going to keep them not unnaturally low, not unnaturally high but kind of in the middle where they can have what we call normal vicissitudes of their moods.

They can feel sad or happy when the situation calls for it.

But they're not over the top a naturally high or low.

>> Thanks for your call DeVonté.

Let's go to our next Hello Fern.

>> Welcome to Matters of Mind Fern.

>> You want to know how can you stop worrying about the world in a climate that causes so much anxiety?

>> I think Fern, the first thing we all have to remember when we hear about world events and we watch the news is to determine what you you personally can do about it, sometimes you have to leave things in God's hands.

>> But the question you need to ask yourself is what personally can you do about world events?

>> And sometimes I have to advise people to get away from the news and I like the fact that we can go to certain apps now and you can check out an app with a few news articles of another app with a few news article.

>> If you are consumed with a news and you're planning herself in front of a television set watching what we now have available 24/7 news it can create a lot of anxiety and the reason it's creating anxiety is because the news casters kind of want you to keep watching because if you keep watching you watch their commercials and their commercials help sell you products.

>> So there's an incentive for the news organizations to keep you watching with fairly dramatic news but always go back to what you can do about the world events and in many cases there's only a limited number of things now you can interact with your family, your friends and your immediate community in different ways.

>> But in terms of having a direct impact on world events, you have to be realistic on what you personally can do.

So continue to interact with your family, friends, your community at large and you can talk about the community events.

>> Sure, we live in a republic in the United States so there are ways to influence the voting that occurs if you're happy with the political climate overall so improves things you can do in that regard but be realistic in what you can do about it and what you can't do about it.

Thanks for your call.

>> That's your next caller.

Hello Lewis.

Walking to matters of mind Lewis you want to know about Gabba Gabba supplements gamma immuno butyric acid your doctor talks about gabb supplements for the brain.

What are my thoughts on those kind of brain supplements?

Garbo's supplements don't really get to the brain that much LEWIS So if you're going to affect Gabba in the brain I mentioned that earlier gabbers the brakes the brain glutamates the accelerator and it's like a teeter totter in the brain the gray matter the brain runs on glutamate which is the accelerator and gabb the brakes and the Indy car drivers.

>> We had Indianapolis five in May in Indianapolis and the Indy car drivers will drive their car.

>> They'll accelerate accelerate with a right foot and they'll break with her left foot and we're always told her driver's training don't do that.

But that's what happens in the brain you've got an accelerator and a brake going back and forth at the same time and like a teeter totter it's got to be in balance if you have less gabb you can have more anxiety, difficulty with sleep and you don't have enough braking on the brain.

The problem with Gabb supplements if you take a Gabber pill it's not going to get into the brain because it doesn't cross the blood brain barrier.

So to effect gabber in the brain you have to do so indirectly typically with anti seizure medication will be how we safely will do that will use medications such as Lamotrigine and also known as Lamictal Gabapentin also known as Neurontin Pregabalin known as Lyrica Topiramate will affect Gabb a little bit so there's different means with antiepileptic medications.

>> You can't affect Gabbar.

You can affect Gabber even more directly in the anxiety of the brain called the amygdala by giving people benzodiazepine medications these medications profoundly will affect gabb transmission and what they'll do is they'll open up this chlorides channel and chloride channels opening up will give your brain an inhibitory effect and calm things down very quickly.

So Xanax that a Valium, Ativan, Klonopin these are all medications that will give your brain a calming effect going directly to gabbert's itself GABA supplements probably won't get absorbed that much into your brain self.

>> I wouldn't recommend those I see them sold on over the counter sometimes kava cava is a tea that does have some indirect effects on Gabb and kava kava is a South Pacific tea that's been around for a long time.

I do hear that that can affect people favorably if they use kava cavity and there's a particular chemical that's the ingredient green tea called Theunissen El Theunissen so Theunissen does indirectly affect Gabb and the Indians getting into the brain and getting better absorption.

>> There's just the chemical gabb itself.

Thanks for your call.

Let's go our next email question.

Let's see what our next email reads.

Our text or email reads your daughter offer.

What's the best way to help your psychiatrist when you arrive at your first appointment?

Is there a certain way you could categorize your symptoms as a psychiatrist?

I'm going to do the best I can to give people questionnaires that they can complete before they come in because I really want to know a lot of different things about people and I'll give people questionnaires before their first appointment.

>> It might take them twenty twenty five minutes to fill out online but I want to know a lot of information.

>> So the main information I want to know if you're coming in to see a psychiatrist you haven't done any questionnaires.

>> You're going to sit down from that and then from that psychiatrist you might have thirty minutes for the whole appointment.

What do you say?

Well, number one, I would say what your main goals of treatment are.

>> How would you like to feel better and if you really want to narrow it down you'll tell that psychiatry as I often ask what your main three goals will be if you could feel better with any treatment, with any medication, how would you hope that treatment in particular or that medication would help you this way?

>> This way and this so I want to know your main goals for treatment.

>> How are you feeling?

Lousy number two , I want to know how long it's been going on.

>> How far back does it go?

Did it just start six months ago that you've been having problems or have been going on for 50 years?

>> I want to know how long has been going on and I also want to know does it come and go do the symptoms you're experiencing come and go or are they there all the time?

I mentioned earlier bipolar disorder is a phenomenon where you'll have racing thoughts, distractibility and impulsivity that comes, comes and goes whereas ADHD it's there more days than not.

So I want to know is it there more days or not or is there just over now and then I also want to know how it's affecting your day to day life .

>> I'm looking for functional impairment.

How is it affecting you with getting things done everyday that you'd like to get done?

>> Is it affecting your socialization, your work, your ability to get out and do things you'd like to do is causing you to have difficulty getting things done that you'd like to get?

I'd like to know what side effects if you're going to take a medication, what side effects would be a game changer for you where you would not take that medication.

Are there certain side effects or certain fears or apprehensions that you have about medications that would prevent you from taking that medication?

>> And finally I'd want to know do any family members of yours have any similar symptoms and very importantly, have they been treated for those particular symptoms good effects, bad effects from treatment because family members will often mirror there are good and bad effects from medications with other family members.

So if you have a family member who's been on a particular antidepressant and doing great, you might want to consider taking that particular antidepressant medication.

So I'm looking for goals.

I'm looking for functional impairment side effects.

You want to avoid how long it's been going on?

What's the characteristic of come and go?

Are there all the time and also what family members have tried with similar symptoms?

>> I would be very, very important overall.

>> Thanks for your email.

Let's go our next caller.

Hello Jenny.

Welcome to Matters of Mind.

>> Jenny, you had mentioned you're on snap six milligrams every morning morning and telegrams and everything but it's not been effective in keeping your symptoms away.

What's the next step or next medication if APT is one of many different medications that's used for schizophrenia, we do use it for mood stabilization with some people.

Jenny for Naped is a medication that can work for some people, might not work for other people but if it's not working for you and you've been on it for at least two months at that six mg in the morning, ten milligrams in the evening dosage, you might want to go a different direction.

The good news, Jenny, is there's a lot of different directions we can go no, the first question is and that's how I kind of open the program today you got to know your diagnosis if you have a diagnosis of this or that and you actually have a whole different condition that needs to be treated, the medication that you're using for this or that's probably not going to work for something else.

>> So it's important to have an accurate diagnosis.

APT is used for schizophrenia.

It can also be used for mood stabilization, impulsivity, irritability could be used for various kind of conditions.

But maybe you need a different class of medication, a medication that has a different mechanism of action for the type of symptoms you're experiencing.

Sometimes antipsychotic medications are like antibiotics with antibiotic medications you can have different bacterial conditions and some people do great with one antibiotic for a particular bacterial conditions.

Other people might not do so well with us so they need to try a different antibiotic so in some same type of thing can happen with antipsychotic medications.

Snapped is one of several there are many different options out there but the key is if you give it a try and stay with a day by day by day for at least four weeks, eight weeks is ideal.

>> But if you've tried it and it's just not clearly alleviating your symptoms, it's time to go to something else.

>> And again you'd see your prescribing clinician with the concern that No one it's not working but very, very, very importantly say how it's not working.

What residual symptoms are you still experiencing?

>> I had severe knee pain years ago before I had a knee replacement I was given a nonsteroidal antiinflammatory drug that just didn't help me.

>> I had bone on bone knee pain and it didn't help me.

>> I took it for six weeks.

I took it for seven weeks and it just didn't help so I was a noncompliant patient.

I went off of it because it wasn't helping at all.

I get it.

The number one reason why people will stop their medication will because it will be because the medication doesn't work so you want a medication it works secondarily you want a medication.

It's going to be tolerable but you need a medication.

It works.

There are many different options out there.

Talk to your clinician about other possibilities based on the residual symptoms you're having again going back to OK, what are the symptoms you're experiencing?

What kind of treatments have worked and not worked for you in the past?

Always very important for clinicians to know.

Do you have any family members with similar symptoms?

Have they been treated with this or that in the past?

What side effects do you want to avoid?

You're going to go through that progression of thought to really help the clinician give you the best treatment you can.

>> Thanks for your call.

Let's go next caller.

Hello Carey.

Welcome to Mastermind Kerry.

>> You want to know why would someone need an add on therapy prescription instead of their doctor increasing the dosage of the current medication?

That's always a question we have to ask ourselves.

Carry no one you always want to start with one medication.

All right.

So you start with one medication and let's say it's a medication, it's at fifty milligrams.

>> It's given you so so effect but it's helping some at fifty milligrams.

So what do we do?

We'll typically go to seventy five hundred milligrams.

>> Seventy five hundred milligrams.

The first question a clinician ought to ask is do you feel any better since you went from fifty up to 100 milligrams if the answer is yes we want to know how much better if it's like ten percent twenty percent maybe that's not so much but if you feel like you're thirty percent better going from 50 to 100 milligrams that's a good option.

>> How about if you go to one hundred milligrams to 150 milligrams and we'll ask the same question do you feel any better going from one hundred 150 milligrams if you say no you say now I felt just a good one hundred milligrams we'll drop it back down one hundred milligrams keep it right there because I was your best dosage kind of like eyeglasses fighting the right lens strength and then if you don't feel quite good enough you might have an add on treatment on top of that.

So my general rule of thumb will be if somebody has a 50 percent or more improvement at a particular medication on a certain dosage, I might keep it there and then add on something to it.

>> I don't want to give up that fifty fifty percent or more improvement but I might want to add on something to give them a little bit better effect overall.

>> Carrie, thanks for your call and for some amount of time for this evening.

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

I'm psychiatrist Jeff Offering.

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.

Goodnight