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

Welcome to Matters of the Mind now in its third 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 here at PBS Fort Wayne by dialing in the Fort Wayne area (969) 27 two zero or if you're calling coast to coast toll free you may dial 866- (969) 27 to zero now on a fairly regular basis we're broadcasting live every Monday night from our spectacular 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 WFYI Big that's matters of the mind at WFB a dog and I'll start tonight's program with a question I recently received.

>> It reads Dear Dr. Fauver, my spouse hasn't been sleeping well for the last few months.

>> We're not sure what's causing this and have tried all of the over the counter treatments.

>> What other treatments can we try?

Well, the over the counter treatments are typically antihistamines and melatonin.

You have Doc Sillerman which is known as UNISOM the brand name.

>> You have various products that have diphenhydramine which is basically well antihistamines called BEININ also known as Benadryl.

>> Melatonin products basically act as a puff of smoke.

They work for about 30 minutes, help you get to sleep and then they're gone.

>> So melatonin helps get people's sleep cycles back on track but they don't necessarily keep you asleep.

>> So what else can you do?

Well, number one, you want to see if there's some underlying reasons keeping a person awake.

There is a phenomenon called sleep apnea, sleep apnea is often characterized by snoring and it's where you're not getting adequate air to the lungs at night during that time of your airway being shut down a bit and that decreases the oxygen to the brain and it keeps you awake because basically intermittently your brain is telling you that you're suffocating and people with sleep often have very restless sleep.

There is also a phenomenon called restless leg syndrome.

It's often characterized by having difficulty keeping the legs still and then you have periodic limb, periodic limb, limb movements in the night causing your legs to be jumpy and that can be from low iron and sometimes trouble with the kidneys.

But difficulty with restless legs is not uncommon for some people having difficulty with sleep.

So with that being said, what else do we do?

We look at sleep hygiene.

Are you going to sleep the same time every night getting up same time every day?

>> It's a big factor for a lot of people because if you think about the time you need to get to sleep is when your brain is getting tired and you want to go to sleep.

>> But if you stay up because you're really interested in that football game that might be going on on the West Coast and you're staying up late to watch it that will keep you awake and you subsequently miss the bus for the time that you need to go to bed.

You need to wait another hour and a half to get sleepy again.

So sometimes your sleep cycles go every hour and a half and if you miss the bus at that time you unfortunately stay up for another hour and a half.

Now some people will watch movies late into the evening.

>> Really you should be turning off the television maybe thirty minutes to an hour before going to bed.

The bright light from the television will keep you awake and having something to do watching your cell phone, getting on various social media outlets at nighttime will keep you awake and even though you're sleepy you can unfortunately have difficulty getting back to sleep.

So with that being said, sometimes we'll consider prescription medications.

So with prescription medication there's a lot of different options out there.

We often start with medication called Trazodone Trazodone and Old an antidepressant that came out back in nineteen eighty one is as antidepressant but we use it more now for sleep and as we use it more now for sleep it has to help you get to sleep quite nicely but it gives you a deep good quality of sleep and then it lasts for about eight hours so Trazodone is never approved by the Food and Drug Administration for sleep because it was never formally studied for sleep.

It got the market we started using it for sleep within a few years and by nineteen ninety or so it was one of the more commonly used medications for sleep out there docs happen at a low dosage works kind of like antihistamine medication where it decreases the firing of of histamine but it also blocks histamine so it actually has a very strong antihistamine effect and it doses as low as three to six milligrams a bed time.

It can do a really nice job in helping people sleep as well.

I mentioned gabapentin.

It's an old Athersys medication used for pain and for sleep and as an as a medication used for pain and for sleep we often use it at doses of three hundred maybe four hundred milligrams a bed time to help people sleep.

So there are options but here's the key for getting better sleep night by night.

>> Try to go to the bed same time every night, try to get up the same time every day.

If you are using medications use the medications for the purpose of getting you back on track and when you get back on track the idea being that you start sleep at night by night for two, three, four months and then maybe go off the medication you might be using for sleep and see if you still need it sometimes as a matter of getting that brain back on track and getting those circadian rhythms back.

>> Thanks for the email question.

Looks like my mom's on the line.

Hi Mom.

How are you doing?

Hello.

Hello Mom.

You're on the air.

>> You have you have thousands of people watching you right now.

Well, I just want to wish you happy birthday 65 and I hope I help you live as long as I do.

>> Sixty five.

Well, let's see if you're sixty five that makes me a lot younger so that that math works out really well.

>> So yeah I mean as long as if I have I'm a hundred and one.

>> OK well thanks for pointing that out Mom we have milestone birthdays and you know you have milestone birthdays when you're sixteen when you're twenty one thirty years of age is a big birthday for a lot of people.

>> Sixty five is another birthday because at each milestone you're finding that you hope to have accomplished certain things.

You have certain plans for the future.

So you know when you get to be sixty five years of age you start thinking about gee should I retire or should I continue to work and I'm having those discussions with people all the time where they're asking for my from a mental health standpoint should I still work beyond these years or should I not?

And I think you still have to think OK, if you're not working and you are going to this new chapter in your life and you're going into retirement, what are you going to do with your life and how is it going to be different?

I think for all of us physically we're going to be slowly breaking down.

>> We can't help that our bodies are only made to last so long.

>> But what we hope to be able to do is oops, I lost a microphone there.

What we hope to do over the course of time is to enhance our emotional well-being and and strengthen our spiritual wellbeing because we realize that we can't do anything about our physical breakdown overall .

>> So Mom, thanks for calling.

Let's go to next caller.

Hello Louis.

Welcome to Mars the mind Allouche you wondered about hypnotizing someone, Louis I used to hypnotize people not uncommonly oh back in the 1980s we just didn't have that many medications back then we did a good amount of counseling so we tried hypnosis for a lot of people.

Where did hypnosis work?

The best hypnosis worked the best for people who had the need to stop something and that's why it did not help though.

>> Well, for somebody who is trying decrease their appetite and decrease their food intake and use it for weight loss hypnosis is good for somebody trying to stop something abruptly and stay off of something.

So it was decent for smoking and I have used hypnosis way back in the 1980s I think maybe early 1990s to help people quit smoking.

You do not want to use hypnosis for post-traumatic stress to have people relive the experience no matter what you see on television shows and movies you don't want to use hypnosis as a means of having people relive those kind of traumas.

But you can use hypnosis as a means of helping people with performance anxiety and being able to relax in such a way that you know, if they're if they're working on their golf game they can work on hypnosis before a golf game and be able to get themselves to the point where they can block out outside distractions.

So there are benefits to it.

It's not used so much now because I think we have better counseling techniques.

We have for post-traumatic stress disorder for instance something called rapid resolution therapy in which I'm very interested but it doesn't have a tremendous amount of research yet.

What has more research for post-traumatic stress is eye movement desensitization and reprocessing MDR we have dialectic behavioral therapy DBT these are better studied types of treatments for post-traumatic stress disorder so hypnosis probably doesn't rank up there as being one of the better treatments for a lot of different conditions where we might have used it back in the 1980s.

But it's something that's been around for a long time.

I've had the key was hypnosis as you want to learn self hypnosis I've been able to use self hypnosis for something as simple as going on television way back when when I was first doing television as a means of relaxing and walking out outside distractions so it has its benefits but it's not used quite so much anymore now Lois, thanks for your call.

>> Let's go our next caller.

Hello Michael.

Welcome to Mars Mind.

Michael, you had mentioned you have a friend suffering from serotonin syndrome.

What is it and how it can be?

How can it be treated serotonin syndrome, Michael is where somebody basically is taking a medication or two or three and they're getting excessive serotonin in their system.

>> When that happens they can get shaky, they can get sweaty, they can get a fast heartbeat.

They can have difficulty with confusion.

>> Diarrhea is not uncommon and it's basically where they're getting too much serotonin overall.

>> So there are various medications that are associated with higher amounts of serotonin.

We hear about the medication like Celexa, Lexapro, Prozac, Paxil and Zoloft.

>> These are medications that specifically fairly selectively will increase serotonin transmission among some others.

So here's the key, Michael, about two out of three of us just aren't real good candidates for those medications if we get depressed or anxious just because our genetics aren't really good fits for them.

And on top of that you might have genetics where you slowly break those kind of medications down in one way or another.

>> They're broken down by different pathways.

And if you have those kind of genetics, Michael, you can get these high blood levels of the medications and thereby get high levels and they're shrivel in the central nervous system of serotonin.

>> So you have those kind of symptoms going on.

What happens initially, Michael, we always try to have people lower their dosages of the serotonergic medications .

We might even have them go off of it in the midst of having all these terrible type of symptoms.

You might be having a serotonin syndrome.

We will recommend a particular antihistamine called Cipro Hebridean also known as reactive very active is an old antihistamine but it has specific effects in relieving some of the symptoms of excessive serotonin and serotonin toxicity and serotonin syndrome can be treated with that particular antihistamine.

So we will often go that route.

Rarely does anybody have to go in the hospital to get treatment for that but once in a while people can have seizures or a really extreme fever and have some severe neurological outcomes from that.

But that's usually if somebody's not caught for a long, long time.

Michael, typically people are caught at a very early stage and we'd call that serotonin toxicity.

But the syndrome itself is where people are getting seizures and fevers and that's where they often need to be brought in the hospital get that settled down.

But Michael, it's basically related to getting too much of a medication.

>> It's increasing serotonin.

That's why we warn people not to take oh herbs and don't take supplements while they're getting treated for depression.

>> For instance, if you take five HTP which is a commonly used supplement, it basically is a building block for serotonin.

Add that to a medication like Zoloft or Lexapro or Paxil that can dramatically enhance the effects of serotonin and can give you a serotonin toxicity where you have all those neurological symptoms.

So you want to be careful about taking any supplements or herbs without talking to them over with your clinician first we rarely hear about serotonin syndrome with medications like Trazodone or abuse Spierer.

>> They do affect serotonin in some way but we rarely hear about serotonin syndrome with those medications because they're much more selective on the particular receptors and affecting serotonin.

>> Thanks for your thanks for your call, Michael.

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

Our next e-mail question reads Dear Dr. Father, I have always had problems with authority and I'm finding out that this is affecting my relationship with my manager at work.

>> Are there any methods to manage these feelings so that it doesn't affect my job or even cost me my job, my job?

>> I love the fact that you're asking about what you can do about your problems with authority because so many people will say I hate my boss, I can't stand it, I can't stand being around him or her.

>> What do I do about it?

And you're taking the responsibility of recognizing that your issue here is how it works as we interact with other people and it can be colleagues, it can be friends.

It can be bosses as we interact with other people were often interacting with other people based on the perspective of our life experiences and that can be our life experiences with our parents, our brothers, our sisters, our past friends, past coworkers, past bosses were all looking at our current relationships in the lens of how we interact with other people in the past.

>> So with that being said, you're recognizing that this is your issue which is great.

So why do you do about it?

>> Well, the first thing you always have to remember is realize that you're not in charge and you have to accept that and there's a lot of biblical commands that are instructing us to to submit to our authority figures even though we might not agree with them.

>> Now if they're doing something immoral or dettman or dreadfully against your values, that's a whole nother issue you really can't go along with that.

>> But basically in terms of doing the day to day job of getting the work done at your place of employment, yeah, you have to submit to authority figures now how do you get around that?

>> What you learn from the authority figures you try to allow yourself to be taught by them.

You gain experience on the job that you're currently involved in doing and basically have to learn to not blurt out what you're thinking at times and realize that your opinion might not be most appropriate at various times.

>> So you need to kind of stay a bit passive in that regard but learn as you observe and then over the course of time well yeah, you could be promoted to higher positions but the ideal situation for a lot of people who say they can't deal with authority figures is to start your own business and that's a great situation for a lot of people who can't deal with authority figures or they find it difficult to do so keeping in mind that when you start your own business that's a 24/7 job.

>> I mean vacations are far and few between when you're running your own business and I always have a tremendous amount of respect for the private businessmen who not only work during the work week but typically is working on the weekends as well if not the actual business site itself doing the paperwork, the personnel bureaucracy that has to be done and just getting done with the accounting and all the things that have to be done.

So the advantage of working with other people and working for an employer is that you don't have those directly responsible.

But if you're really at a point where you think I can do this a lot better myself, I have better ideas and I don't like to work with authority figures that's OK.

Going to a private business start your own business even then remembering that you're going to have governmental regulations overseeing you so you'll never be able to get away from the authority entirely.

>> You'll have the governmental regulations overseeing you but it'll be a little bit different on a day to day operation.

The decisions you make in a private business are the ones that you have to abide by and well that's that's how you eat.

>> If you make bad decisions you don't make money and you don't have as much money for food that that and that's always the dilemma of a private business.

Ma'am, if we saw this a lot during the covid season where a lot of businesses were dreadfully affected by the covid restrictions and a lot of them had a hard time staying in business if they were on their own.

So it's a risk but there are factors involved.

But I think the wonderful thing based on how you asked your question was that you recognized that you're dealing with authority issues is your problem and not your boss's problem and that's that's a very, very good place to start.

>> Thanks for your thanks for your question.

Let's go next caller.

Hello Susan.

Welcome to Matters of Mind.

Hi, Susan.

Hello.

I appreciate your talking to me.

And my question is if a person is bipolar and doing well on lithium, is it possible that they can remain on lithium their entire adult life ?

>> Yes, that's the quick answer to that, Susan.

Lithium is a medication that oh about one out of twenty people it can slightly suppress the kidney functioning if that many you can get around that quite a bit by number one dosing lithium entirely at night time number two using the lowest effective dosage that works so not pushing the dosage higher and higher in a lot of cases the number three using the controlled release or long acting formulation of lithium.

So there's ways we can get around the difficulty that people might have with their kidney functioning once in a while.

And again, it's fairly rare people can have a suppression their thyroid functioning because lithium does go to the thyroid and can suppress thyroid release and sometimes thyroid levels will go down.

>> So every three to six months we check kidney test and we check for thyroid tests.

But you can stay on lithium long term if it's providing mood stabilization now lithium was something that was discovered back around nineteen forty nine and it's a salt it's in the same category on the periodic table as sodium and that's why if people all of a sudden start eating a high sodium diet lithium levels go down and if they all of a sudden decide to go on a low sodium diet lithium levels will go up.

>> So we have to be aware of somebody's sodium intake on how it's changing if they do start lithium.

But lithium is something it's merely a salt and it's very unique in what it does.

Susan, it's one of the few medications if I can't think of any or medications but one of the few medication known to mankind that actually lengthens and enlarges the telomeres telomeres are these little caps on your chromosomes and they're associated with aging.

And as we get older, Susan, as we heard earlier from this young lady who is 101 years old, telomeres get smaller and smaller and your chromosomes start getting more and more lithium actually enhances the growth.

>> And I'm wondering from a longevity standpoint, Susan, it's not being recommended yet.

Otherwise I'd be taking lithium myself for that purpose.

But the possibility would be could we take a small amount of lithium for the purpose of enhancing our longevity and actually lengthening our telomeres in some cases that's something that might be a possibility.

But when people talk to me about how lithium might be detrimental to them, OK, I get it that sometimes can cause you problems with your kidneys.

Sometimes it can suppress your thyroid functioning.

But overall there's a tremendous number of benefits with lithium including an anti aging effect.

>> And if you do have a bipolar condition, Susan, you can use lithium as a means of a very strong anti a manic effect by decreasing inflammation.

We've treated a few patients over the course of the past year who had covered infections, who got a bit manic during the recovery from the current infection and lithium was dramatically affected because basically lithium will suppress the inflammation that's occurring in the brain during mania and possibly following a covert infection if people have mood disturbances during that time.

So that's something that's going to be studied quite a bit over the course of the past or the course of the next few years.

But lithium has been used for the past 70 years now and it's been been found to be a very, very effective medication for bipolar mood stabilization as well.

People have highs and lows of their moods so I'm frequently recommending the use of lithium but it's very important to try to dose it all at time with a controlled release version at the doses that's effective but yet not too high, not too much higher than what you really need.

>> Susan, thanks for your call.

Let's go to our next caller.

Hello Rob.

Welcome to America mind.

Yes, I have been experiencing over the last three days I'm having some muscle cramps, some itching and burning like across my forehead face hands that type area.

And also I was wondering about medication LA There are different type of medication.

It's not quite so expensive as Battuta as recommended but it's fifteen hundred dollars a month .

>> Yeah Rob the good news is that since nineteen eighty seven we've had sixteen newer antidepressants come out and of the medications that are the dope dopamine receptor antagonists of which Allatoona is one we have a dozen of those that have come out so we have a lot of different options now and many of them are getting cheaper because many of them did come out over ten fifteen years ago.

>> Solitude is a medication we use quite commonly for mood stabilization is not associated with weight gain or blood glucose blood glucose changes.

So there's a lot of advantages to Luisita but sometimes people's insurance plans won't really support them.

So what else do we use while Rob commonly Battuta is used for somebody for mood stabilization we do use it for schizophrenia but most commonly it's used for mood stabilization as a means of kind of leveling out the mood.

It's not typically used for anxiety alone.

We have a lot of different medications used for anxiety but if you're using Allatoona is typically for the purpose of enhance the mood and keeping your mood kind of level.

So why don't we use in those cases that are cheaper?

Well, we'll often use medications like LaMotte's or Jean Trileptal has some drug interactions but those two medications are in the class of the antiepileptic medications that can stabilize the mood the cheaper medications in the class that Lietuva might be in.

They have some other side effects and Lutu to might have but you know, we have Abilify which can give some people some restlessness and occasionally some weight gain.

>> We have risperidone or Risperdal which has been around since nineteen ninety two .

>> I think risperidone has been around for a long long time can be associated weight gain can give you some difficulty with restlessness and shakiness and Parkinson's symptoms where you get the stiffness in tremor.

So risperidone has been around for a long time I think with your clinician you can kind of talk about some possibilities for other medications Rob because there's a lot of different things out there not only for mood stabilization schizophrenia but also for anxiety and LANATA good medication a lot of different ways but the expense can be an issue for you if you are using it especially for mood stabilization.

We have a lot of other options out there.

I think the biggest factor is for you, Rob, will be what medications have worked or not worked in the past looking at family members who might be taking medications for similar conditions and taking a very good close look at all that.

And if you have the opportunity to do genetic testing, that's another dimension that we'll often use to try to get some ideas on what we might use.

Rob, thanks for your call.

Let's go next caller.

Hello, Melanie.

You walk in two of mind.

O'Mahoney, you one.

My thoughts about Pfizer getting the FDA approval for their covid vaccine.

I'm going to try to stay in my lane.

I'm a psychiatrist.

I'm not an infectious disease expert.

But what I can say, Melanie, is that, you know, people were wondering about the safety of the use of the Pfizer vaccine for covid and you know, when I done work in the past with various pharmaceutical companies such as Lilly, you know, we always talked about the number of patients you needed to be able to assess a medication safety and how long you typically studied it and from any medications they'd be studied over the course of six months or maybe eight months on two thousand three thousand people and that was considered to be enough data for the FDA to grant approval for medications will keep in mind with the covid vaccine that Pfizer has been using since December, I think it has been they've used on literally millions of people and they have data on each of these individuals determining determining if they had relapse and what kind of side effects they might have had.

>> So there's a lot of data out there.

That's why Pfizer got the FDA approval many thanks for your call.

>> Unfortunately I'm out of time for this evening.

I'm psychiatrist Jay Farber and you've been watching matters of the mind on PBS Fort Wayne God willing and PBS willing.

I'll be back again next week if you have any questions concerning mental health issues ,give me a email address matters the mind all one word at WWE dot org.

>> Thanks for watching.

Have a good evening.

Good night