>> Good evening.

I'm psychiatrist Jeff Overlie from Fort Wayne , Indiana.

>> Welcome to Matters of the Mind now coming on its twenty third 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 here.

>> PBS for Wayne by dialing in the Fort Wayne area (969) 27 two zero or if you're calling any place else coast to coast you may dial toll free at 866- (969) to seven to zero.

>> Now on a fairly regular basis we are broadcasting live every night from our spectacular PBS Fort Wayne studios which lie in the shadows of the Fort Wayne campus.

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 a dog that's matters of the mind at WFYI a dog and I'll start tonight's program with a question I recently received.

>> It reads You're doing a favor.

>> What's the difference between a psychiatrist and a counselor or a psychiatrist like family doctors that do counseling?

>> Not quite psychiatrists first and foremost our physicians are medical doctors and following medical training.

>> Then we go into a residency program where we learn about diagnose take assessments, we learn about counseling and most importantly in today's world we learn about how the brain works from a neurochemistry standpoint and how we can treat that brain condition with medications and such procedures such as electroconvulsive therapy, transcranial magnetic stimulation, bravado whereas ketamine treatments or ketamine treatments for that matter.

So a psychiatrist first and foremost as a medical doctor who has extra training in the neurochemistry and the neurophysiology of the brain itself, we also get training in neurology as do neurologists at some training in psychiatry.

So it kind of goes back and forth that way.

We are trained to some degree in counseling as a matter of fact, when I was in my psychiatric training way back in the 1980s I was told that my pharmacy background which I had would be a waste because in psychiatry you don't use that many medications.

Well, that's what I was told back in the 1980s.

Now we use over 100 hundred different medications and we use them in various combinations so that pharmacy background for me did help out because it gave me a better understanding of how medications work and what kind of doses you should use based on how people metabolize those medications and we can look at their genetics that way.

>> So a psychiatry as being a medical doctor who can do counseling in the twenty first century most psychiatrists are mainly doing diagnostic assessments for individual and determining if they need medication and if they do what medication would be best suited for them.

And as psychiatrists we are often working with nurse practitioners with whom we are aligned and often the nurse practitioners will oversee the care of our patients after we set a treatment plan for them.

A counselor basically is there for the purpose of helping you establish a perspective on what's happening around you and they do so in a different way than your family members or your close friends might do because they're giving you objective input.

>> So a counselor helps you mainly fire up this front part of the brain which is the reasoning part of the brain.

Now what we often find in psychiatry is the anxiety center, the part of the brain over here on the left side here it's called the amygdala.

>> That part of the brain can sometimes well overrule the thinking part of the brain and in doing so it can kind of hijack your thinking part of the brain and your logical part of the brain.

>> So when you're highly anxious, you're highly depressed, you're very fearful, you're angry, you often don't think clearly.

>> So for that reason sometimes we'll use medications for the purpose of allowing you to think more clearly.

Then we get you into counseling for the purpose of helping you gain a perspective on what's going on around.

So in the twenty first century we look at psychiatric conditions as not be an attitudinal problems or basically just behavioral problems.

We look at them as being neurochemical problems where that the neurochemistry of the brain can be altered thereby affecting your judgment, your perspective on the world around you giving you difficulty with concentration and processing information so we often see people with depression and anxiety having slow processing speed to their brain not unlike a computer with slow processing brain, a slow processing a computer with slow processing will be very frustrating to choose from to go from screen to screen.

It takes a long time to do that and we have to wait a few seconds to wait for the screen to change over.

That's the way it is with our brains.

When you get depressed and anxious you have slower processing speed so it's difficult to think and maintain conversations and to remember the kind of things you're trying to do day by day.

So these are all neurochemical chemical problems that we find with a brain.

They're not just add attitudinal problems and in doing so we will treat psychiatric conditions like we would with any medical condition.

Now as a medical doctor, as a psychiatrist, we also are looking at overall medical conditions.

>> For instance, in psychiatry we often find that people have medical conditions that are affecting their mood and their anxieties and their ability to concentrate so will often look at sleep apnea.

>> Low thyroid will occur, glucose disturbances, low iron all these kind of conditions can contribute to psychiatric problems and if you overlook those kind of conditions and try to deal with somebody's perspective on things, sometimes they just don't get better.

So we have to be very vigilant about the overall health of the body in terms of determining how by changing the overall health of the body we can affect somebody's mood and anxiety levels.

>> Thank you for your email.

>> Let's go to our first caller.

Hello Jeff.

Welcome to Matters of Mind.

>> Well, Jeff, you made a resolution to quit drinking.

Good for you.

How long does it take for the brain to adjust to the absence of alcohol?

>> Excellent question, Jeff.

The textbooks will tell you three to five days and in three to five days you can go through a detoxification program and perhaps use Valium Librium out of and there's some of the medications used to help you detox off of alcohol and you can do that in three to five days.

That's what the textbooks will tell you.

But in the real world, Jeff, I'll tell you often it's a prolonged process based on how much you've been drinking and how long you've been drinking.

>> So as a general rule of thumb, if you've been drinking for five years, it might take you five weeks to kind of gradually adapt to getting off of alcohol and you'll hear about the acute withdrawal process which is occurring over the first week but then you have them prolonged so-called dry drunk period that's also known as prolonged withdrawal where you'll still have craving or still feel anxious.

You have some difficulty with sleeping but you're not having the high blood pressure and the fever and all the stuff that goes along with acute withdrawal.

So when you look at an alcohol cessation program where you quit alcohol, the first week can be kind of tough and that's where you go through the withdrawal and that's where we give people medications on the outpatient or inpatient side depending on how bad the withdrawal might be.

But we'll give you medication to help you through that first withdrawal then after that time there's a lot of different things we can do to help you with craving, to help you with the anxiety, to help you with sleep.

Medications will often be used during that time and it can be things like Gabapentin Lyrica, Trazodone can help with sleep topiramate or Topamax is an old antiepileptic medication that for some people based on their genetics we often find can be helpful in decreasing cravings and then we use medication specifically for alcohol related cravings like a Campero state.

Sometimes we use naltrexone.

Naltrexone comes at a shot called Vivitrol and there's the medication that you sometimes can use to give you a bit of a safety that called Antabuse.

>> It's kind of harsh but if you drink alcohol under the influence of Antabuse you can get physically sick and vomit and it makes you not be able to metabolize alcohol to its entirety and it makes a very sick because it backs up a byproduct called acid aldehyde and that makes you physically sick if that's getting backed up in your system.

>> So Jeff, as a rule of thumb for every week for every year you've been drinking takes that number of weeks to kind of gradually get off of it.

We want you to get to get involved in Alcoholics Anonymous support groups as a means of helping you get through this those few weeks.

But I've seen people who have been drinking for 20 years and for those people might take 20 weeks for them to get through the cravings and the anxiety and the kind of prolonged withdrawal they can sometimes experience.

And it's not unlike when people have been on Xanax, Klonopin, Ativan, Valium for years and years as well.

Jeff, we see the same phenomenon and we use the same rule of thumb.

If you've been on Xanax or Klonopin for ten years, we might do a 10 week tapering process knowing that you're going to have a lot of craving and anxiety during that time and we don't want you to suffer during that time because if you do you're going to crave the alcohol.

Are you going to crave Xanax and want to go back to it and you're going to find it any way you can.

>> So we want you to medically and physically be able to get through the withdrawal process itself.

But we also want you to have the proper support and that's where Alcoholics Anonymous just as a remarkable job in terms of helping people have that support to help people realize they're not the only ones going through the alcohol withdrawal process that other people have gone through it as well and it's a great means of support.

But Jeff, one thing that people often will struggle with will be the insomnia related to the withdrawal.

That's a prolonged withdrawal.

So you want to make sure you get the insomnia and under good control.

There are a lot of non-addictive medications out there that are very safe to take long term even if you've been prone to drinking alcohol.

So it's important to talk to your primary care clinician, your mental health clinician about the possibility of getting something for insomnia because if you don't sleep this front part of the brain is impacted.

>> Lack of sleep will affect your judgment.

Part of the brain and that's the front part of the brain.

>> If you don't sleep you'll tend to have difficulty with concentration, will be more impulsive, you'll be more impatient.

>> You just won't be able to think clearly and lack of sleep night by night by night will get to people and that will cause people to have mood and anxiety disturbances.

People often ask what's the cascade between anxiety, sleep, depression?

Often what happens people do have some anxiety where they're worrying about things or trying to get off alcohol.

There's some physical reason perhaps they're having anxiety and that leads to difficulty with sleep because if you worry about things, if you're anxious you'll have a hard time getting to sleep and then you also have a hard time staying asleep.

>> Well, lack of sleep will then give you difficulty with your judgment and perspective on the world around you and when you have trouble with your perspective of the world around you, you often will tend to have more of a gloom and doom attitude and you won't have a realistic understanding of what's really happening.

And this is where a cancer comes in handy because a cancer can describe your reality as he or she sees it and try to give you more of an objective outlook on what might be really going on or give you some alternative ideas on what could be going on based on the perception you might be experiencing.

But you know, we look at sleep as being a psychiatric vital sign.

I know with a lot of clinicians we will actually do a a sleep scale.

It's called insomnia severity index and it's always about seven or eight questions and what it does it goes through different questions specifically relating to sleep, getting to sleep, staying asleep, getting up too early, having difficulty feeling well rested the next morning so we want to look at sleep overall but we also want to assess people for sleep apnea because if you have sleep apnea that means you're not getting adequate airflow at night because you're snoring or you're pausing and you're breathing and with lack of adequate airflow you'll have difficulty getting adequate oxygen oxygen to the brain and that will cause you to have trouble with concentration, energy, motivation, depression the next day.

>> So all these kind of things can kind of cascade upon each other and that's why we try to examine the whole person when we are talking to somebody about alcohol and trying to get them to get off the alcohol.

Many people will have medical complications from alcohol that can be residual problems for them so they can have trouble with their hearts, their livers, their kidneys and we need to get those addressed as well.

>> Thanks for your call.

Let's go to our next caller.

Hello, Claudia.

Welcome to the Mind Will.

>> Claudia, you'd mentioned your child is having night terrors.

Will he need treatment for this or will he outgrow the good news, Claudia, is typically children do outgrow night terrors.

>> Nightmares are basically the same type of sleep you get when you're sleepwalking.

>> They are not nightmares.

Big difference, Claudia.

Nightmares are basically when you're having rapid eye movement you're having dreams and nightmares are associated with dreams when so when a child is having nightmares they're scared, they're fearful .

But when they awaken they remember typically what they were dreaming about and they dream they tell you about the monsters and these things happening in their dreams and it was a very scary experience.

>> Night terrors are often related to three things number one fever.

>> So if your child does have a fever, night terrors are very highly associated fever no to just being a young child will often bring on night terrors but number three, lack of sleep will bring on night terrors and the reason you have nightmares is because you're going into an exceptionally deep sleep.

>> It's called a non REM sleep.

If you look at the brain waves are really high and deep with rapid eye movement or dream sleep, the EEG or the brain waves are really choppy.

They look like you're almost wide awake when you're having dreams or nightmares but with night terrors the dream sleep waves, EEG waves, the brain waves are really deep and high and low so night terrors typically will occur about forty five minutes to an hour after a child goes to sleep and that's where you're getting real deep sleep.

>> If you get awakened from this sleep you will be confused and not know what's going on and that's what your child is doing.

>> He's awakening from the night terrors screaming frightful he's having a fast heartbeat, undoubtably might even have some sweating and can be very, very confused until he comes out.

>> Sometimes those night terrors will occur hand in hand with sleep walking and when people sleepwalking or people are sleepwalking same things happening.

They're walking all around and if you awaken them they can be very confused and they won't know where they've been, why they are doing what they're doing.

They'll be very confused.

They won't have been dreaming but sleepwalking can be a problem for most time.

>> People do grow out of this you we use some medications sometimes to suppress that but the first thing you can do is try to get your son enough sleep, get into a regular sleep pattern.

>> A lack of sleep will often bring on night terrors and sleepwalking for some people because if you think about it, what happens if your brain is lacking sleep well off the bat.

It wants to get into this really deep sleep to compensate for the lack of sleep and that will inadvertently cause you to have night terrors or even are sleepwalking for that matter.

>> Now nightmares can be due to having trauma traumatic type of circumstances going on during the day and nightmares can be related to symbolically trying to act out things that are troubling you.

>> So nightmares are often used as a means of helping people get through therapy because in therapy they're trying to deal with stuff that bothers them.

Nightmares are very abstract, they're very symbolic and it's something that people can use as a as a tool to help them get through the day to day life circumstances in terms of what's bothering them night terrors, sleepwalking that's non REM sleep entirely different.

That's related to lack of sleep.

So make sure your son gets into a good sleep pattern.

>> Melatonin can help children get to sleep.

It's a very safe means of helping with sleep three to five milligrams maybe an hour or so before going to bed is a nice means of establishing sleep on set with melatonin.

Melatonin is like a puff of smoke.

It is a natural hormone.

It comes from this middle part of the brain called the pineal body and the pineal body is a P shaped little gland right smack in the middle of the brain there and it releases melatonin when it's getting dark and at a certain time every night and ideally your brain wants to go to bed at the same time every night and ideally your brain wants to wake up at the same time every morning.

Well, we have ways of offsetting that because perhaps we want to watch PBS late at night.

>> We're really interested in a basketball game or something in a bar next thing you know it's an hour or two hours later than what we usually will establish as our sleep time and that throws off our circadian rhythms.

>> But typically your brain wants to go to bed about the same night.

That's when the melatonin is going up.

If you fight past that because you're really interested in doing something else, well, it's like missing a bus.

>> You've got to wait for the next bus bus to come around.

That might be an hour and a half or so later.

So if you don't get to bed if you don't get to sleep at the same time every night, that could be problematic.

And for children often the key will be having a routine for many children having a routine right around bedtime doing the same thing every night, reading books, going through the same type of routine night by night by night is giving their brains the the message that it's time to go to bed, it's time to go to sleep and getting enough sleep is one of the best ways to get over night terrors.

But it is something that we see especially with younger children as their brains are growing.

Our brains keep growing until our twenty four years of age but especially those first six to eight years of life the brain is growing very rapidly and during that time you need more sleep and that's when you're more prone to having nightmares and for that matter sleepwalking.

>> Thanks for your call.

Let's go our next caller.

Hello Thomas.

Welcome to Matters of Mind.

>> Oh Thomas, you're 45 years of age and you're experiencing sudden and gradual shaking tremors.

>> I presume you're concerned what could be causing that and how can it be treated?

>> The first thing I'd want to know Thomas again as a psychiatrist I don't want to be one who's going to just jump in there and say, well, you must be anxious and having panic attacks.

>> Thomas, I want to look at the whole picture here.

So the first thing I want to examine would be number one, are you having any difficulty with what's called high thyroid disease?

Some people can have high thyroid that can cause them shakiness.

Secondly, some people can have difficulty with diabetes if you have low or high blood sugar sometimes that will cause shaking as well.

>> If the shaking is kind of gradual, you're young for it.

>> But you know Parkinson's disease can give you this tremor that's there but you're a bit young for having Parkinson's disease.

We don't see it that often with people who are forty five except for the unusual cases like Michael J.

Fox, for instance, was very public publicly expressed his challenges with Parkinson's disease.

But know that's something that's been more unusual for a lot of people if you're having anxiety that can bring on shakiness and there's something called the essential tremor it runs in families but essential tremor is where you just have this tremulousness in your hands or your neck.

>> It goes away while you're sleeping but you'll have this tremulousness this throughout the day that can be worsened when you're under stress or when you're being in front of people and doing things.

So I would suggest, Thomas, talk to your primary care clinician first to see if there's some tests that could be run like thyroid glucoses.

The main ones I'm thinking about off the bat and just trying to see what kind of shakiness might be there.

>> It's not uncommon, Thomas, for some people to beat on certain medications that can cause shakiness.

For instance, some of the medications that are now using being used for depression and and mood stabilization such as Abilify very commonly used Rexall team Seroquel.

These are medications that even though they're used for anxiety they might be used for sleep in some cases they can cause shakiness as a side effect once in a while we don't hear about so often but the medications that enhance serotonin sometimes can give you some shakiness.

The medications that increase serotonin are medications like Lexapro, Celexa, Zoloft, Paxil ,Prozac.

These are medications commonly used for anxiety but as a side effect if you get them at too high doses they can give you a tremulousness because if you increase this chemical called serotonin you can inadvertant decrease dopamine.

If you decrease dopamine you can have more shakiness.

So for those people the idea would be to back off the dosage of the serotonin medication.

So there's a lot of different reasons out there for the kind gradual shaking that you're describing Thomas.

>> So talk it over with your primary care clinician.

Thomas, thanks for your call.

>> Let's go to our next caller.

Hello Ben.

Welcome to Matters of Mind.

>> I'm sorry.

Are you talking I'm talking to you, Ben.

Welcome.

Yes, I've been experiencing some severe itching.

I'm currently taking a hydrazine.

I'm not sure if that's what's causing I'm kind of getting bounced around from my psychiatrist to my primary care doctor and once I see the other one all the time that not you any other suggestions also I've been having issues with the sleeping insomnia go three days and also weight gain but I can't seem to shake off some of the pandemic that started the pandemic has a helped has worsened a lot of people's difficulties managing weight over the course of time Ben.

>> So that's not unusual.

Ben, you mentioned a primary care doctor and a psychiatrist.

Have you seen by chance a dermatologist for the itching just started getting real bad here like three days, OK, because a dermatologist is skin doctor and that might be somebody else.

>> You perhaps want to see to look at conditions that go by the terms urticaria psoriasis these type of things that eczema is another thing you're going to be having.

>> So these are the kind of conditions they can skin conditions that can be related to itching itself.

>> Now I'm going to stay in my lane here, Ben, and tell you from a psychiatrist standpoint what I see all here about people having itching when they get really anxious because when you get anxious potential you could have this release of histamine in your skin and because that's just a neurotransmitter that's goes up in your body and in your brain when you are under anxious situations because histamine is a very awakening type of neurotransmitter.

So when you're wide awake your histamine in your brain is higher.

Well some people when they get really anxious they're histamine will get released excessively in their skin.

>> Well, histamine makes you itchy and histamine can be related to anxiety for some people.

>> So for those people yeah, hydroxyl Zina's an option relatively well less sedating antihistamine compared to something like Benadryl or diphenhydramine.

>> Some people for itching will take the more non sedating medications like Alegra, Zyrtec .

These are medications that are less sedating.

There's only about 20 percent of Zyrtec for instance that gets across the blood brain barrier.

>> None of the ALEGRA does.

So Alegra is very has very much less sedation for a lot of people.

>> But as a psychiatrist I learned a long time ago in a low dosage of a medication called Dock's Oppen helps with anxiety and itching.

>> Dock's pain is a very strong antihistamine.

It's an old old tricyclic antidepressants.

So it's been around since the 1960s.

It's been around for a long time but it increases norepinephrine and dopamine I'm sorry norepinephrine serotonin like the older antidepressants will do.

>> But it also has a very powerful antihistamine effect so it's often used at low doses not the antidepressant doses of 150 or 200 milligrams of bedtime at low doses doc pins often used at twenty five milligrams maybe fifty but definitely no more than that but twenty five milligrams at bedtime is a very common dosage and that can be useful for what's called neurotic dermatitis where basically people are having difficulty with anxiety that leads to itching itself.

>> So as a psychiatrist I would say something along the lines of Doc Span could be helpful for you if if the hydroxides working for you now if you go higher and higher and higher on the dosage of docs up and then you can have increased appetite from that.

So I think the increased weight with the pandemic restrictions is a whole nother phenomenon for to try to manage the increased weight I'd recommend obviously Abbey watch what you eat try to exercise more you you know all those kind of tricks.

But one thing I could certainly recommend that we've been advising people to do for the past couple of years especially is intermittent fasting if you're not prone to binge eating or if you can control the time periods where you do eat with intermittent fasting, it is probably the best way I've seen my past thirty plus years as a psychiatrist to help people manage their weight and manage their appetites.

Know what you do there is you basically skip breakfast first and foremost skip breakfast we've been told for decades breakfast breakfast is the most important meal of the day.

Well I think it's not if we skip breakfast and start with lunch and eat dinner and be done with lunch and dinner and you can snack in between in the afternoon, that's fine.

The bottom line is don't eat anything after dinner and skip breakfast and that gives you about six or eight hours of not eating.

You can drink all the fluids you want if they don't have any sugar in them but the idea is to try to go longer times of fasting 16 to 18 hours a day and then only eating during a specified period of time that seems to be helping most people with their weight.

Ben, thanks for your call.

Unfortunately I'm out of time for this evening if you have any questions I can answer on the air you may write me a via the Internet at matters of the mind all one word a dog.

>> I'm Psychiatrist Ja'far and you've been watching Matters in the Mind on PBS Fort Wayne God willing and PBS willing.

>> I'll be back again next week.

Have a good evening tonight