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>> Good evening.

I'm psychiatrist Jay ForFour live from Fort Wayne , Indiana.

Welcome to Matters of the Mind now in its third year are Matters of the Mind is a live call in program where you have the chance to choose a 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 any place coast to coast you may dial toll free at 866- (969) to seven to zero.

>> Now on a fairly regular basis I am broadcasting live from our spectacular PBS Fort Wayne studios every Monday night 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 at FWC dot org that's matters of the mind have a dot org and ordinarily I'd go right to my email questions but I have a caller on the line already.

>> Hello Frank.

Welcome to Matters of the Mind Frank.

You know the difference between ADHD and ADD ADHD refers to hyperactivity.

>> That's what that refers to hyperactivity or impulsivity whereas 8D refers to somebody not having hyperactivity and impulsivity.

>> So how is it different with ADHD and they share the commonality of having difficulty with sustained attention.

>> So it's this front part of the brain that's a little bit underactive and when you have the front part of the brain that is a bit underreact you can have difficulty with maintaining attention and sustaining attention on something that's not that interesting.

>> So if it's interesting you're going to be all over it and you're got to be able to focus on it.

But it's not that interesting.

>> You're going to lose your attention.

You're going to go to thinking about something else and you'll have difficulty getting things done because you're hopping from one thing to another to another.

Now people with ADHD without hyperactivity aspect will also have difficulty with impatience .

They'll have irritability.

They often lack tact tact because they will blurt out things and they get in trouble and social type of interactions because they'll have trouble with saying things that they later regret.

>> So people with ADHD will have that more of that impulsivity.

They will often have difficulty with saying things before they are really thinking about them.

They'll do things before they think it over.

They might even buy things impulsively.

Now you have to be careful because with ADHD versus bipolar disorder there's a huge difference how we're going to treat that condition.

>> They share the commonality of often having racing thoughts that they share the commonality of at least difficulty getting to sleep in many cases and they'll have trouble with impulsivity and buying and spending and and often getting in trouble with with their words.

>> Now the difference will be with ADHD or add it started technically when you're a child often before twelve years of age and with your ADHD it's a day to day to day phenomenon where every day you have a similar type of difficulty with your focus and concentration and your distractible pretty much every day now the difference between that and bipolar disorder bipolar disorder is a mood disturbance where you'll have these manic highs that might last for days or weeks and just during those manic highs you'll have the racing thoughts, difficulty with sleep and impulsivity and then you might have crashes into lows where you want to sleep all the time and you're very withdrawn with ADHD or ADHD you have those kind of symptoms day by day by day.

>> They're they're off more often than not on a daily basis and they've been there since you were a child.

>> So I often compare ADHD or ADD with nearsightedness where if you have difficulty seeing things at a distance you don't have good days with your vision and bad days with your vision.

>> Typically every day you need your vision corrected.

That's the way it is with ADHD or 8D Every day you need that correction with your focus distractibility because it's getting you into trouble every day and it's you're finding that you're less efficient on a daily basis.

So people with ADHD, they've learned how to cope .

They might take longer to get things done and they make lists and with our electronic devices nowadays it's easier for them to make lists and prioritize what's most important and they will try to really focus on that top of the list type of item to get things done that are most important and then they go to the second thing and third thing many times people with ADHD or ADD will have a lot of things going on and they will not find that they get things about 75 or 80 percent done but they just don't get things completed and that's why a lot of people with ADD are on entrepreneurs where they have the ideas for setting up businesses or new projects but they have other people around them to get the things actually completed because they need the assistance to get the details done and to take care of the the fine tuning of different things.

>> Frank, thanks for your call.

Let's go to our first email for the night.

>> Our first email for the night reads Dear Dad Evolver, I've been taking a number of antidepressants and that are no longer effective woodshedded mean be a good alternative option.

>> How is it different from ketamine or answer the first part of that first ketamine is the left sided piece of ketamine so ketamine comes in two sides.

The left side of the right side is ketamine as the left side of ketamine.

So with that being said, ketamine was approved by the Food and Drug Administration as an as an anesthetic agent back in 1970 and for the past twenty years ketamine has been used experimentally and so so-called off label for depression in an IV form and people found that it often relieve a depression within a matter of minutes and they felt really good.

So ketamine was developed about nine years ago.

Well, it came on the market.

They were working on it about nine years ago but came on the market about March of 2019.

So that's how long is ketamine's as ketamine is a nasal spray and what we find I've completed over 4000 treatments with us ketamine now and over one hundred patients and what we find with ketamine is it works entirely differently than any other antidepressant.

>> So I just evaluated a person today who had been on many different antidepressant medications and she wanted to be evaluated for US ketamine and she was a very, very good candidate for it and it was a type of option we had for number one.

>> You want to make sure you don't have something else that might be hindering your recovery from the Depression.

For instance, you always want to make sure somebody doesn't have sleep apnea.

We want to make sure their thyroid is just right.

>> We want to make sure they're not low on iron.

They don't have diabetes.

These are all reasons why somebody might not be doing so well on various antidepressants.

>> Secondly, we always want to look at the doses of the current antidepressants because some people can slowly breakdown certain medications and some people quickly break down certain medications and the best way to really determine that is through genetic testing.

So we love to have genetic testing on people prior to deciding on this ketamine and we've done genetic testing on over 90 percent of our ketamine patients.

So we've had a pretty good idea of how they metabolize and how they break down different medications.

>> We always want to look at what's worked for your family members and what's not worked for your family members.

So that would be a big clue on whether you could be a good candidate for us ketamine because if you've tried various medications your family members have tried and succeeded upon but you haven't maybe you'd be a good candidate for us ketamine.

>> So how does it work?

Basically as I said, it works entirely differently than anything else.

It works on glutamate system.

The glutamate system is quite different from the system of the traditional and antidepressants work upon they work on serotonin, norepinephrine, dopamine primarily but as ketamine works predominantly on the glutamate system where there's two different types of glutamate receptors, there's one receptor called NMDA and one receptor called Amapa.

>> So they go by letters and there's two different receptors for glutamate.

Well it's thought that when people have depression they have an overabundance of budding out of these little NMDA receptors and that causes some long term consequences.

>> Well, if you block the NMDA receptors with something like ketamine or ketamine, well, it's like setting a pick in basketball.

I'm from Indiana so we talk about basketball.

>> You set a pick in basketball.

What happens when the player goes around that individuals who's getting the picks at a pawn and that's what happens with ketamine.

It sets a pick on NMDA receptors so glutamate goes around NMDA receptors and goes the AMPA receptors when AMPA receptors are stimulated good stuff happens theoretically because it causes the fertilized so to speak of these little branches of neurons that cause the neurons to get more fluffy, more fluffy neurons are happy neurons and they allow for better communication and it's kind of like a tree that's able to branch out more and that allows you to recover from depression and the way that AMPA stimulation by glutamate will cause fluffiness of these neurons will be by downstream increasing in a couple different chemicals one called brain derived neurotrophic factor and another one called the mammalian targets of rapamycin rapamycin.

So if you increase the chemicals, those particular chemicals, they're like fertilizer for the brain and it's thought that that's what is ketamine or ketamine for that matter will do in the long run.

>> So they will cause the brain to be more fluffy and it will they will do so in a matter of sometimes a matter of days.

I've seen about one out of six of our patients on a ketamine get a dramatic impact within just one treatment.

Now I'd love to see it for everybody but for some people it does take two or three or four weeks for them to get that kind of dramatic impact.

But we track how they're doing with depression rating scales and anxiety rating scales.

>> So it's been something in which we've been pleased to see the outcomes and I'm hoping that there will be more clinics around the country who will be able to provide that treatment as time goes on.

>> Thank you for email question .

>> We have another caller offline by the name of Jeff.

Hello Jeff.

Welcome to Matters of the Mind .

>> You had wondered about a friend who had recovered from a severe head and brain injury and appears that his personality and temperament have changed.

Is this a permanent type of change?

It might be, but here's how this works, Jeff.

Basically when you have a severe head injury we call it a traumatic brain injury.

I mentioned this chemical called glutamate too much glutamate.

>> It's not a good thing.

And when you have a head injury or sometimes a stroke or even a surgical procedure on the brain, sometimes you release too much glutamate and when you lose too much glutamate it can overly stimulate these NMDA receptors as I mentioned before that you don't want to stimulate so much and actually cause a toxic effect on the brain and where that is a particularly problematic Jeff will be in the front part of the brain where you can have personality changes if you affect the front part of the brain and have excessive glutamate released in that area, you can have difficulty with irritability, poor stress tolerance.

You can have trouble with impulsivity and you just kind of aggravating to other people .

So memory disturbances, concentration disturbances these are all mediated by glutamate that glutamates very interesting chemical too little you'll have too much you'll have trouble with being able to concentrate and maintaining memories and downloading memories for that matter.

But too much can cause you to be irritable and even psychotic and have seizures for that matter.

That's why a lot of the anti seizure medications will block excessive glutamate one of them that we use for people with head injuries, especially if they've had personality changes will be a medication called Lamotrigine or Lamictal.

Lamotrigine or Lamictal basically stabilizes glutamate and in doing so can help these people with head injuries and these personality changes.

So it's not uncommon we will use an A.C. your medication as a means of psychiatrically treating somebody who's had a head injury and hopefully well over time that can improve and and resolves the magic time frame oh somewhere between one and two years one and two years after somebody had a head injury typically that's when you see most of the healing occurring.

It used to be said one year but I like to say two years because I have seen some people at a year and a half and even two years get a little bit more improvement with their personality changes that have occurred due to head injuries themselves.

So the key is to keep in contact with a neurologist and see what other things they might want to do, what they need to do.

If you've had a head injury with a kind of situation that might be preventable in the future for instance, if the head injury was due to stroke and the stroke was due to hypertension, you want to make sure your blood pressure stays in good control.

>> If it was for some other reason that might be preventable, you might want to address that as well Jeff, thanks for your call.

Let's go to our next caller.

Hello, Mike.

Welcome to Matters of Mind.

Mike, you talked about what in the brain causes hoarding disorder.

>> We're not really sure about that, Mike.

We used to think that hoarding disorder was an obsessive compulsive kind of disturbance but over the past five years or so that's been disputed with obsessive compulsive disorder.

You have this circuit in the front part of the brain that kind of goes round and round and it gets stuck like a needle on old record player which would get stuck.

>> That's what happens in the brain when people have OCD and it's thought that hoarding is kind of like that but it seems to be different.

>> So hoarding is kind of in a category of its own I think from a psychiatric standpoint hoarding is thought to be related to fearing of losing possessions kind of makes kind of sense when you think about it that way you hoard things as a means of maintaining some security and some stability so that you have a sense of possessing all these different things and you want to possess more and more and more as opposed to getting rid of any and for some people getting rid of some of these prized possessions they might own that other people think of as junk.

>> Those prized possession to one person might be their treasures so they don't want to get rid of these things because they get the sense of security and comfort with having all these items that quite frankly sometimes can be a hazard because it's difficult to step around them in the household.

So people with hoarding have some of the same psychological issues as people with OCD because with obsessive compulsive disorder people have these obsessions that don't make a lot of sense to them but they can't get them off their minds with hoarding.

It's a similar phenomenon only with hoarding these people say yeah I heard because it makes a lot of sense to me.

So that's the difference there.

But with hoarding there's some psychological issues that have to do with a fearfulness of getting rid of things because those things give them a sense of comfort and security.

>> Thanks for your call.

Let's go to our next caller.

Hello Nick.

Welcome to Mariza Mind.

>> Well, Nick, you mentioned you had a friend who had a stroke at a very young age and has now come out of a coma.

He's now experiencing intermittent painful locking up on the right side of his body is Dr. appear to be a loss.

What's causing it?

What are my thoughts?

Well, I don't want to dispute or even question what their doctors are thinking.

>> But what I might speculate upon is that if somebody is coming out of a coma, remember that's a brain injury in itself and if their bodies locking up on one side or another, that's obviously due to the traumatic effect of the coma with coma there might have been a loss of oxygen to certain parts of the brain with a loss of oxygen to certain parts of the brain.

It will affect this particular chemical that I've mentioned already a couple of times a night glutamate with excessive amounts of glutamate.

You can have a toxic effect in certain parts of the brain.

So I'd wonder for that individual how their MRI might look at their brain to see what physical damage might be there no to what their EEG or electro encephalogram might appear because with an EEG sometimes which shows seizure like activity that can be problematic for some people there's something called electro myelogram and EMG that looks at muscle conduction and nerve connections to muscle in on my show that there's certain damage to certain parts the body because I've heard with some people with comas if they've been laying on one side of their body for a long period of time in advertently, it will actually cause muscle damage and they can have contractures and tightening other muscles in that area not usually a psychiatric problem, more of a neurological issue that people will have to address.

>> Nick, thanks for your call.

Let's go our next caller.

Hello Lance.

Welcome to Matters of Mind.

Lance, you had mentioned you suffer from hypomania.

That means little highs and you wondered if sleep deprivation can be the cause of that.

Actually sleep deprivation will often be a result of hypomania but sleep deprivation can throw fuel on the fire if you are prone to having hypomania.

So hypomania goes hand in hand not uncommonly with two weeks or more of depression, a little hypomania and two weeks or more depression we typically call that bipolar disorder type two .

There's a type of bipolar disorder called cyclic Thania where people might have hypomania for one, two or three days and then they go into WLOS for a few days and they go back and forth back and forth.

But hypomania typically will be followed by depressive episodes and when people come out of depression if for whatever reason you're losing sleep, we sometimes hear about this war with people who are working second or third shifts.

They get their sleep cycle thrown off.

Their circadian rhythms are disturbed.

They tend to stay up late at night doing this or that and throws off their sleep rhythm.

Yeah, that can throw you into hypomania itself but if you're not prone to hypomania, lack of sleep by itself wouldn't usually cause you to have hypomania.

Now how could you be prone to having hypomania number one if you've had hypomanic episodes in the past that can be an issue but also if you have a family history of bipolar disorder, how would you know that a family history of bipolar disorder would be especially a first degree relative a mother, father, mother, brother or sister who had highs and lows with their mood they may or may not have been treated and sometimes people who have highs and lows with their moods will have a difficulty with drinking too much alcohol.

>> They might use marijuana.

They might use various means of self medication to calm their nerves.

I talk to a person today who drinks alcohol heavily a couple of times a week and he does that because he's going into these spells where he's getting real riled up and he can't sleep and he's getting well what we call hypomanic.

>> So alternatively I gave him a mood stabilizer, a mood stabilizers sets the cruise control on the mood.

>> It doesn't make you a robot.

You can still feel happy, sad, anxious or angry if you need to do so and if the situation is appropriate for it.

But what it does it sets cruise control so it doesn't allow you to get unnaturally high and decrease the likelihood of you going unnaturally low.

So it kind of levels things out like that and then when people have hypomania that's what we often want to give them.

But as I mentioned before, hypomania can be provoked if you have a tendency toward mania provoked by going without sleep for whatever reason but then when you go out go without sleep it's just throwing fuel on the fire for hypomania.

So it's very important we get people sleep cycles under control when they're having these highs and lows.

>> Thanks for your call.

Let's go next caller.

Hello Mark.

>> Welcome to Marisela Mind.

Yes I was wondering if alcohol consumption has anything to do with like restless leg syndrome twitching of the arms and legs, things like that.

Is there any correlation there or yeah.

>> Markka the first thing we often think about with restless leg syndrome will be low ion so low iron we get low iron tests for people with restless legs and secondly we will look at any difficulty with kidney functioning once in a while we'll see somebody low kidney functioning that can be a factor with restless legs and then we look at any medications they might be taking certain medications that increase serotonin like Lexapro, Prozac, Zoloft, Paxil, Celexa these medications by increasing serotonin can inadvertently causes a side effect restless legs and even twitching muscles.

So that's one thing we'd always consider.

>> However, alcohol it does affect this particular chemical called GABA Gamma Ametov butyric acid GABA is the chemical breaks on the brain.

>> It's all over the brain and when you enhance GABA transmission as alcohol will do, it gives the brain a calming effect.

>> But here's what happens alcohol works out really quickly for instance back in the old days so my goodness twenty or thirty years ago Mark, people used to get prescribed alcohol in the form of beer or even a shot of whiskey in nursing homes because it was thought they would help to help them sleep better.

>> Well, that's not done anymore.

Thank goodness because what alcohol does for your sleep it helps you go to sleep.

>> But then you awake and often within a couple hours and you're having these twitch these twitching sensations which can be kind of a repercussion of alcohol withdrawal.

So alcohol gets in your system very fast.

It affects GABA calms you down then you have this rebound effect.

So what happens when you have a rebound effect when the brakes of Gabeira are being released it means that you get more excitatory type of events like restless legs and twitching and sometimes people get shaky as a classic symptom of alcohol withdrawal so it could be a mild effect of alcohol getting out of your system.

>> People typically will notice when they're drinking alcohol they don't have the tremor, they don't have the restlessness, they don't have the twitching.

It's a couple hours later even maybe a day later they have all these kind of symptoms.

So it's usually an after effect of the alcohol consumption Mark, Mark, thanks for your call.

>> Let's go our next caller.

Hello, Michael.

Welcome to the Mind.

>> Hello.

Hello, Michael.

Hey, how are you doing?

I'm doing OK. How are you doing and good days and bad days.

>> OK, this let me hear about hands.

>> I had a stroke back in twenty fourteen I had a blood clot go to blood vessel in my brain and cut off into my brain and the UK hospital was in there for a while.

They said it was a you felt and they couldn't believe I lived through it since my stroke had no energy whatsoever no sleep like two hours at a time and just constant headache in this room and just no energy.

Oh goodness.

>> Where was the stroke located?

Michael I'm going to speculate is right smack namely the brain and what's called the brain stem.

>> Does that sound about right?

Well, I think it was on the right right side I'm not so maybe over on I took my brain apart here this the right side of the brain.

So maybe on the right side did it affect your your strength and your left arm and your left leg perhaps?

>> Yeah, did OK so it was on the right side the reason I was wondering if it's in the middle of the brain is because I'm wondering did it affect your sleep?

>> I mean I would have thought undoubtably they they did a sleep study right now I've never had to sleep again.

I'd back and had it back in twenty fourteen I woke up one morning and couldn't get up.

>> I had urinated on myself oh my goodness.

>> Well Michael I would certainly I would suggest if you're tired following a stroke many people following a stroke when they're tired and they have this headache and they just don't like how they feel and they feel they can't concentrate.

Many people have what's called sleep apnea.

Sleep apnea is where you might have decreased air flow to the lungs at night while you're sleeping and some people will snore and they might even pause in their breathing at night.

>> Now hopefully that's not happening for you but has that been the case for you?

>> Have you been snoring?

Do you pause in your breathing at night that anybody until now?

>> Not that I know of sleep by myself.

Yeah, I don't really know it.

>> There are apps I'm 70 years old so OK, you know well there there are sleeping apps that are free that are available on your cell phone that will actually listen to you sleep at night.

I know that sounds kind of strange but they're very effective in letting you know if you snore or not and obviously by sleeping by yourself you would know if you're pausing your breathing but if you don't get air flow to the lungs at night, you get less oxygen to the brain the next day that can make you tired.

It'll cause you to have trouble concentrating and it'll give you horrific headaches especially in the morning.

>> So the one thing I'd recommend for you, Michael, would be ask your doctor about the possibility of getting a a sonogram called a sleep study.

>> A sleep study is where you can do it at home a lot of times but many times they want to do it in a sleep lab if you've had a past history of a stroke and I'd love to hear how that how that turns out for you.

Michael Michael, thanks for your call.

Unfortunately I'm out of time for this evening.

You've been watching Matters of the Mind on PBS Fort Wayne.

>> I am psychiatrist Jay Fawver and God willing and PBS willing.

>> I'll be back again next week.

Have a good evening.

Good night