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

Welcome to Matters of the Mind now in its 24th 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 Fort Wayne by dialing in the Fort Wayne area (969) 27 two zero or if you're calling coast to coast you may dial 866- (969) 27 two zero now on a fairly regular basis we are broadcasting live every Monday night from our spectacular PBS Fort Wayne studios which are 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 Big that's matters of the mind at WFYI org and I'll start tonight's program with the first of several emails I received recently.

>> It reads Do not a favor can stuttering be treated with drugs?

I read an article that said the use of Xanax and Lexapro could help.

>> STUTTERING is a neurological condition and we look at it not as a psychiatric condition but more as a neurological condition.

It's a condition that is worsened by anxiety and that's why historically it's been treated under the domain of psychiatry.

It's basically a condition where the basal ganglia circuit inside the brain here kind of gets stuck and you end up having a hard time getting the words out and that's what causes the stuttering.

>> So it's a neurological condition.

It's not a an anxiety condition even though it's worsened by anxiety like so many conditions are.

>> For instance, even epilepsy can be worsened by anxiety and lack of sleep.

>> You can have other conditions such as chronic pain that can be worsened by anxiety.

So it's worsened by anxiety and that's why it sometimes gets treated with something like Xanax or Lexapro.

>> I'd rather see it treated more directly and a good friend of mine, Jerry Maguire, he's a psychiatrist at the University of California Irvine and he historically has been the a leader in obsessive in stuttering research and instead of research research he has conveyed that the antipsychotic medications also known as the dopamine receptor blocking agents are the best medications to use for stuttering because there seems to be some disturbance in that basal ganglia with a dopamine system such that excessive dopamine causes the stuttering to occur and people have a hard time getting their words out and they will have difficulty getting started with different words.

>> STAMMERING is one thing stuttering is another is another and it's a very subtle distinction but stuttering itself seems to be a dopaminergic problem.

Blocking excessive dopamine transmission can be helpful now the old medications like Haldol would help with stuttering but they would cause so many side effects it would cause intolerable difficulty with concentration and and be unable to keep a person's minds on mind on things.

So nowadays more medications at low doses can be used such as Zyprexa Sarfaraz versus getting used Lietuva I think they're dabbling with that some so the newer antipsychotic medications that are not only used for schizophrenia and bipolar disorder now they're used for a lot of other conditions now outside of the original intentions and stuttering is one of them.

I doubt you'll ever find a medication approved by the Food and Drug Administration for specifically stuttering just because of the population that would be served as a very limited number of people and stuttering is kind of difficult to assess because as I mentioned, people get more anxious.

>> They study said more how would you measure the stuttering improvement for people?

Many times people just know when they come back to my office that they're stuttering is decreased.

So we're using various antipsychotic medications to decrease stuttering as opposed to simply treating the symptoms of anxiety that can go along with stuttering that will make stuttering worse when people get anxious and they're in a social situation, they're speaking in front of a large group of people.

They might have difficulty getting the words out.

They might stutter at that time and that's where we often will use a low dosage of an antipsychotic medication to treat that Lexapro.

>> We use that a lot for obsessive compulsive disorder perhaps at a higher dosage.

We used it for anxiety depression.

We use Lexapro sometimes for premenstrual symptoms where a woman is having irritability prior to her periods every month but wouldn't necessarily use that for whatever reason.

Matter of fact I could potentially see how that could possibly worsen stuttering in some ways so I wouldn't want to go that direction.

I'd want to go with more of the low dose antipsychotic medications for stuttering.

Thanks for your question.

Let's go to our next question.

>> Our next question reads Dear Dr. Farber, I've heard that the DSM that's the Diagnostic and Statistical Manual website has some self diagnostic checklists, is trying to diagnose yourself with a mental health disorder like depression or ADHD something you would recommend as a first step a lot of clinicians would say you shouldn't self-diagnosis but I would have to differ in that opinion.

>> I think self-diagnosis is OK as long as you follow up with a treating clinician.

In other words you can self diagnose various reasons why you might have difficulty with a cough and you might figure out well maybe I have a cough because of asthma.

I have a cough because I bronchitis I have a cough because I have stomach problems with a reflux.

You might have it kind of figured out but you need to follow up the reasons for that cough.

The same is true if you have symptoms of irritability you can go to the DSM five which is the fifth version and we're coming up with a newer version over this next summer.

>> But you can go to the DSM five and find all sorts of symptoms that might match you but you also have to figure out what symptoms you don't have and you have to rule out other conditions but a very key factor and it's often overlooked you can have those symptoms in the DSM five but if they do not cause you to have functional impairment, that's not a psychiatric condition.

All the conditions in the DSM five by nature of you having a disorder you have to have impairment socially work.

>> It has to get in your way and and be able to get your life fulfilled the degree that you might and these kind of symptoms are are a barrier to you in those ways.

So irritability, anger, happiness, joy I mean those are natural emotions.

>> But if they become problematic where they get to the point of mania for instance, that's where it's problematic.

So I'm a big believer in people getting educated with the DSM five we routinely prior to each appointment for a new assessment we give people a lot of questionnaires and these questionnaires are check lists looking at different symptoms and it's trying to help us be guided by what direction we should go and for instance, you can have symptoms of impatience, difficulty with concentration racing thoughts, problems with sleeping, feeling impulsive and immediately OK just those symptoms you can say I have bipolar disorder because those are indeed symptoms of bipolar mania and during mania you can have those kind of symptoms.

But with bipolar mania the symptoms are episodic.

They aren't there every day and it's the type of symptoms you might be having.

It's very subtle but having difficulty asleep is one thing having difficulty getting to sleep is another and then having a decreased need for sleep is quite another situation.

>> So just having trouble with sleep is just kind of touching the surface of things.

As a psychiatrist I'm going to go into the different nuances of the kind of difficulty with sleep you might be experiencing and that's what we tend to sort out.

I love it when people have done a little bit of a self-assessment assessment before they come in and they have some ideas on what kind of conditions they might be experiencing.

And what I will do is ask certain questions such as do the symptoms come and go?

Are they there all the time?

How much problem problems are they giving you and your in your life ?

>> Have other family members had similar symptoms?

If so, were they treated and were they if they were treated where they treated treated successfully or did the treatment make them worse and we're going to go all down this road of of trying to sort out the different nuances of the condition itself because it's like any medical condition and if you have a cough you want to know why you're having to cough and treated accordingly if you're having trouble with irritability moodiness, if you're having trouble concentration, you want to know the specific precise reason for that so you can treat it with greater personalization.

>> Thanks for email.

Let's our first caller hello Larry.

>> Welcome Marilyn not I tell her I'm doing well thanks.

How are you?

>> I have a question for you.

Yeah I'm trying to get off alcohol.

Sure.

>> And prescribe this lithium for me OK and it's not do no good lithium is a salt Larry and it's a salt.

>> It does a great job if you have mood swings and bipolar disorder.

So if people have mood swings that are causing them to drink alcohol as a means of self medication, lithium can be fantastic.

>> So perhaps your clinicians are thinking that lithium is a natural salt which is a remarkable antiinflammatory medication for bipolar mania that can help with decrease in a need for self medicating with alcohol.

>> Now Larry, did you do that?

>> Did you tend to drink alcohol as a means of self medicating mood swings?

No, I to feel the pain pills and that's what it was.

That's what happened.

>> OK, so you started out using pain pills?

Yeah.

That led to drinking alcohol .

>> Yeah.

Gotcha.

Often happens so it's very innocuous sometimes you have pain someplace and especially ten fifteen years ago clinicians would quite liberally prescribe pain medications because they're very effective.

>> And as a matter of fact I remember Larry, twenty years ago clinicians were encouraged to treat the fifth vital sign of pain and treated aggressively and make sure to get it under control and and opiate medication were being prescribed left and right.

>> The perception was that they were very safe.

Now I was a former pharmacist and I remembered well, I don't really trust the use of opiate medications at higher and higher doses because eventually quit breathing in people who get tolerant to pain medications.

So what happens when the doctors start tapering people off the pain medications but you still get that good feeling that you you're craving from pain medications and many people will go to alcohol.

>> Pain medications like opiates will give you a feeling of bliss and alcohol for some people will give them a sense of happiness.

>> Now not everybody but I always warn people, Larry, when people are having they notice when they're at a young age and they drink alcohol and they feel especially happy as opposed to just calm and getting a buzz, they feel especially happy those people are at the highest risk for getting in trouble with alcohol.

>> So what are some medicinal treatments for alcoholism?

Well, lithium is going to be good if you have highs and lows and you know, I'm always looking for the underlying reasons why people might have gotten started on alcohol.

Some people just started drinking as an adolescent or an early adult if they went next thing you know, they're drinking six and 12 beers every night or they're having bottle of wine every day and off they go.

>> So sometimes that happens but other people are having difficulty with trying to sleep so the only way they can get the sleep is by drinking alcohol.

Alcohol gets to sleep because it gives them a horrible sleep architecture because it gives you terrible sleep quality as the night goes on.

But the specific medicinal treatments will use for alcoholism will be a medication for instance like Acamprosate, Acamprosate is also known as Campral.

>> Campral basically stabilize the yin and yang of the chemistry of the brain.

>> There's a chemical called glutamate.

There's one called Gaba.

Glutamate is stimulatory, GABA is inhibitory and they need to balance themselves like a teeter totter.

Acamprosate or Campral will help that balance occur and be less likely to have a dry drunk period.

Now you use that after somebody detoxed detoxified from alcohol Larry.

So if you're having shakes and you're feeling nervous and you're having nausea and headaches and difficulty dizziness and you're getting off alcohol, we'll use medications like Valium, Ativan once in a while Klonopin Liberum used to be used back in the old days so the so-called benzodiazepine medications are often used to help people get off alcohol.

But once they're off alcohol for the next three to six months, many people will have some underlying anxiety and they might even have some cravings.

>> Acamprosate or Campral has been a way to get around that some people will have trouble with anxiety just ongoing.

They used to call it the dry drunk period.

Now we call it the prolonged abstinence period.

>> But it's where for the first six months after quit after you quit drinking your physical physiologically detoxed from alcohol, you just need something there to help you get through the next few months will often use Neurontin or Gabapentin.

I've done that for probably fifteen years with people but there's a lot of research just coming out over the past year or two validating that so 300 milligrams 600 milligrams three times a day of gabapentin or Neurontin has been shown to be effective for helping with that underlying anxiety and difficulty with sleep that often occurs two , three, six months after you're off the alcohol.

So that's a factor will sometimes use naltrexone naltrexone as an opiate blocker and it comes to a shot called Vivitrol and it's a medication that can do a nice job with just decree's the effect of alcohol when people drink alcohol it's thought that somehow they have some internal release of opiates.

We all have these natural opiates in our bodies and it's thought that when some people drink alcohol they get a little bit of a high from the opiates inside their brains and it gives you a sense of fullness and joy.

And as you mentioned, Larry initially took narcotic medications for some pain relief.

>> Next thing you know you're drinking alcohol.

Well, alcohol can indirectly affect opiates in your brain so in a sense you're trying to get the same kind of effect.

>> So naltrexone is a means of of decreasing the likelihood that's going to occur for a lot of people.

So Vivitrol as a shot can be administered.

>> Erevia is the trade name for Naltrexone but Naltrexone came out about twenty two twenty three years ago so it's been around for a long time so now we just give it naltrexone.

So Naltrexone is a medication, it's an opiate blocker so you can't take a narcotic with it because you do the narcotics not going to work so well.

>> So that's a common treatment as well.

Another treatment from a medicinal standpoint for alcohol use, Larry, will be a medication called Antabuse.

You might have heard of that we don't like to use it that often because it makes a person dreadfully sick if they drink alcohol basically stops the breakdown of alcohol in its middle steps so alcohol breaks down to acetaldehyde which breaks down to acetic acid will get stuck in the acid aldehyde breakdown.

And if you get stuck in breaking down alcohol, it makes you dreadfully sick.

You get hot all over, you get get to the point where you feel very nauseated.

>> You have vomiting.

It's a dreadful feeling to experience but is is something that will be used for some people who no one or under court order to not drink.

So the courts will actually order the use of Antabuse.

They often order three times a week for people but some people will have a tendency to drink heavily on the weekends.

They know it and they want to do all they can to try to prevent themselves from drinking on the weekends but they just can't control and off they go.

Those people will often ask for Antabuse just to take on Fridays, Saturdays and Sundays if they end up going to weekend activities where they're prone to drink.

So we'll use and abuse and those kind of cases.

There's more and more treatments becoming available over the course of time Larry.

So talk to your clinician if the if the lithium is not working, look for other ideas because there's a lot of things we can do for helping people stay off of alcohol nowadays.

>> Larry, thanks for your call.

Let's go to our next email.

Our next e-mail reads Your doctor Fauver.

>> How do you know if someone is going to respond well to Lexapro?

My mother has been taking it and I feel about the same.

My mother has taken it and I feel about the same as she does.

>> I think you're referring to feeling having the same kind of symptoms as she might experience.

So the first thing I'm going was going to ask when somebody says that to me will be how is Lexapro doing for your mother if she's doing really well with it?

Great.

That's kind of an early predictor that if you have a first degree relative a mother, father, brother, sister, son or daughter who's doing really well on a medication for similar symptoms as you, that's going to be a big tip off on using a medication like Lexapro.

A second indication will be genetic testing.

We do genetic testing with a good number of our patients.

>> Genetic testing will give you a clue on if a medication like Lexapro can work in two ways.

>> Number one, about a third of people out there are really good genetic fits for Lexapro either based on their pharmacodynamic genes.

That's a little gene called the serotonin transporter gene.

It's called an SLC six a four if you have this particular configuration on this gene where you got we got one ALIL from your mom that's in L.A. and one Emil l'oeil from your dad that's in L.A., L.A. L.A. give you a good predictor for Lexapro with that particular genetic testing.

So if you have that genetic makeup that's a good start.

Also Lexapro is metabolized through this particular enzyme called Cytochrome P. 452 C nineteen and if you're a normal extensive metabolism go on that OK, that could be a good predictor that you could do well with Lexapro.

>> Saw a person today who was ultra rapid metabolize are on Lexapro which meant that she chewed up Lexapro really, really fast.

>> Well that was a reason why Lexapro didn't work for her because she metabolize it too quickly.

On the other hand, some people can be slow metabolize on two C nineteen and they'll have super high levels of Lexapro causing and difficulty with serotonin toxicity where they get sweaty diarrhea, nausea, headaches, shakiness, palpitations where their heart's racing.

They don't like how they feel with it.

It's because they're a slow metabolize it and they should go to something else.

So that could be a factor as well.

Lexapro is a medication commonly used for depression and anxiety.

So I'm going to want to sort out if you're having difficulty with depression I mentioned earlier there self diagnostic assessments out there.

One of them is called the Patient Health Questionnaire nine questions a nine and if you score over ten ten or more on the Q nine and those symptoms are there day by day by day for these two weeks it's suggested that you might have depression.

Primary care clinicians are using that particular test extensive on all patients now they're using it a lot in cardiology and obstetrics and gynecology.

They're using it in all other fields outside of psychiatry.

In the rule of thumb is if somebody is getting in double figures on the Q nine they might want to consider getting treatment for depression.

So if you have depression, Lexapro could be helpful if it's not the type of depression that can be problematic with bipolar symptoms.

>> So if you have highs and lows, Lexapro by itself might be the best medication for you because an antidepressant by itself with bipolar disorder causing highs and lows can sometimes cause you to have worsening moodiness and worsening irritability and it's kind of like pushing on the accelerator without having any brakes.

So for those people if you have bipolar depression you want a mood stabilizer first and foremost then consider Lexapro thereafter.

So we'll look at those various considerations.

Another factor in terms of the question of Lexapro could work for you.

I want to know what are the medications you take and have you taken medications in the same class like Celexa which the parent compound of Lexapro Lexapro is the left sided piece of Celexa.

>> If you took selection of failed or you couldn't tolerate it, you're probably not going to do so well next Lexapro either if you took maybe Prozac, Zoloft or Paxil those are medications to do some similar things a Lexapro will do.

You probably wouldn't be a good candidate for Lexapro if you're already failed on medications in that same category.

>> So we'll take a lot of those other factors into account.

Thanks for your email.

Let's go to our next caller.

>> Hello Matthew.

Welcome to Matters of Mind.

Hello Matthew.

Yeah, I'm here.

Hello.

Yes, I have a question about see you ever heard of CB oil CBD oil?

Yes.

What anxiety would that help with my medications?

>> The question is, Matthew, are you taking CBD oil with any other medications?

>> You mentioned your medications.

Are you taking it with any other medications?

Yes.

Here's my stance on CBD oil, Matthew.

If you take CBD oil by itself with no other medication hey, it's up to you if it's working wonderful.

>> However, I warn people do not take CBD oil with other medication.

It has a tremendous number of drug interactions.

It will increase and decrease various levels of other medications.

So do not add on to other medications.

I'll tell people if you want to use CBD oil do so at your own risk.

Go ahead and give it a try.

Some people swear by it and they say it's great and they wonder why we're prescribing these other medications.

>> Those people don't need to see me so I tell people if they're if you're at a point where you need to see a psychiatrist or you need to see a prescriber and you need to see a psychiatrist or a prescriber for medications for anxiety, for depression, for moodiness don't take CBD oil with it because it's going to mess up the blood levels of our medication.

So don't add that on to other medications if you're going to use CBD oil always always always use it by itself and don't take it with any other medications.

And that's not only psychiatric medications.

You don't want to use it with heart medications, lung medications don't use it with any other medication.

So that's what they don't tell about CBD oil that you're not supposed to take with other medications they focus on the value of and the effectiveness of it in various conditions.

But what they don't tell you is you really shouldn't take it with other medications because there's a lot of drug interactions with that.

So I wouldn't recommend doing it with other medications.

Matthew, I'd first want to see OK, can you get maximum benefit from the other medications first and foremost and determine if they could work better for you but CBD oil on top of the medications will typically mess everything up and you don't want to go that direction.

Matthew, thanks for your call.

I think I have another email.

>> Let's go the next email.

Yes, I do.

Next email says Dear dear father, what causes parasomnia?

>> Are there different variations of it and can it be treated?

Parasomnia is basically a sleep disturbance where you can have sleepwalking for instance, you can have difficulty with night terrors and parasomnia is occur typically because you're not getting enough sleep as an adult.

>> Now we hear about them not commonly occurring in childhood because children with growing brains can have a greater likelihood of night terrors and sleepwaking because they're getting more deep sleep and night terrors and sleepwalking for instance can occur more commonly with deep sleep.

>> Deep sleep as an adult occurs about twenty or thirty minutes after you've gone to sleep.

So if you've been awake all day, didn't have any naps and you're really tired and you go to sleep at night within about thirty minutes 20 30 minutes you're going into a real deep sleep and if somebody was to awaken you at that time you'd be kind of confused and wondered just for a couple of seconds where you are and what time it is and then you come out of it and you realize what you're doing.

>> So the problem with that deep sleep is if you stay in that deep sleep you can have a nightmare where you're very confused and it goes on for several seconds.

>> It's not dangerous to awaken somebody when they're very confused.

That's a a myth that if you awaken somebody while they're having a nightmare or a sleep terror that it's dangerous.

It's really not sleepwalking is what can be dangerous because people can stumble over something in the night.

>> But sleepwalking frequently occurs when somebody is overly tired.

It can occur when somebody has a fever.

We hear about this not uncommon and when people have fevers they can have a greater likelihood of deep sleep.

That's probably because the brain is trying to kind of get on the self mend and get into a deeper sleep that way another type of parasomnia can be restless legs, myoclonic where you have jumpy legs at night that's occurring during REM sleep or dream sleep not uncommonly so there's ways to suppress those type of things so parasomnia as or sleep disturbances that occur at various types of various phases of sleep and they can be corrected.

>> Thanks for your email.

Unfortunately 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 via the Internet at matters of the mind all one word at WFYI w8 dot org .

>> I'm psychiatrist Jeff Olver and you've been watching Matters the Mind on PBS Fort Wayne God willing and PBS .

>> I'll be back again next week.

Thanks for watching.

Goodnight