>> Good evening.

I'm psychiatrist Jay Fawver 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 the 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 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 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 WFA that's matters of the mind at FWC org and I'll start tonight's program with the first of a few questions I received.

>> It reads Dear Dr. Fauver, how do you determine someone's genetic makeup and their treatment needs?

>> Should everyone have genetic testing prior to medical treatment?

The only way to know someone's genetic makeup is to test them for genetic testing and determine what kind of genes you can find and try to fit those genes to the best model of their dosage needs and what mechanism of action might work best for them.

>> When we look at genetic testing we're primarily looking at the genetics on how quickly somebody breaks down a medication and what kind of mechanisms might be best for somebody should everybody have genetic testing?

>> Well, in a perfect world I'd love to see genetic testing on every single patient I saw if it was free.

For some people it's financially not realistic for them so they might have to wait later on.

The nice thing about genetic testing is unlike a thyroid test, a glucose test ion test, genetic testing will always stay the same.

It will never change.

So if you get genetic testing in twenty twenty one that same genetic result will be there 10, 15, 20 years from now.

>> The rest of your life .

>> So what we don't understand about genetic testing results now we may better understand five to ten years from now.

So we're always learning more about genetic testing and the only way you can determine somebody's genetics will be by doing the testing itself.

Now genetic testing is not deterministic.

In other words, it doesn't determine exactly what you should do.

Now I know that sounds weird to people because they think well gee, if you do genetic testing you know all about my genetics.

>> You know, how about how my body works?

You should know exactly what medication to give me.

>> That's not how it works.

Genetics will give you the hardware coating of how your body will work but yet things will happen to reveal certain parts of that hardware in different way.

>> So it's actually a four dimensional type of structure.

So it's not just the depth height and width we're talking about at the genetics are able to move around in such a way the DNA is able to move around based on stuff that happens in your life .

>> So if you're under stress and you're going through a lot difficulty with coping right now, your genetic makeup might actually shift in such a way such that some genes are activated inappropriately or turned off inappropriately during those times of stress.

The same thing thing can happen during a medical illness.

We've seen this happen not uncommonly with use of alcohol or substances of abuse.

It'll reveal disturbances in your genetics that might not have been revealed otherwise.

So there's stuff that can happen in your life that will make your genetics change in such a way that the actual hardware doesn't change.

But the way it's expressed will change and we call that epigenetics.

Epigenetics will be a reflection of how stuff in your life will actually influence your genetics because some people can have the exact same genetic coding on certain areas.

They don't get anxious, they don't get depressed.

>> What's going on?

Well, they had a different childhood upbringing.

A childhood upbringing is a huge, huge predictor on how genetics will be expressed.

There's been a lot of studies out there showing that if you had childhood emotional, physical or sexual abuse prior to seven years of age especially you're more likely later on in life to have depression and anxiety if you have certain genetics now if you have those same genetics and you didn't have significant childhood trauma, well chances are you're going to be OK later on.

>> So that's why there's a lot study of childhood trauma now you're going to be hearing about this questionnaire.

It's a ten question questionnaire called the Adverse Childhood Experiences Questionnaire.

>> It's called Ace ACEEE and ACE is a means by asking if you had difficulty with parental environment where you struck as a child.

Did you have emotional abuse as a child?

Simple questions and the ace is a screening question that children, adolescents and adults are now getting as a means of just screening them for childhood trauma.

It's called Adverse Childhood Experiences Questionnaire and you're going to be seeing that more and more over the course of time.

We're not looking for definitive post-traumatic stress.

We're not trying to determine if those allegations of childhood trauma are valid or not.

All we're doing is trying to figure out did you have the perception of the experience of childhood trauma and perhaps that's affecting your later mood and anxiety disturbances that might be there.

So genetics are something that it is hard wiring but they have to be expressed they're expressed by stresses, stuff happening trauma, medical illnesses all of these things can express genetics in an abnormal manner such that you can have symptoms of depression or anxiety thereafter.

Thanks for your email question.

Let's go to our maybe not let's go to our next email.

>> We don't have a first caller get our next email reads Dear Dr. Fauver, I have had trouble falling asleep for a long time and have started using Z Cuil is there a concern that taking an over-the-counter like this can make me dependent on medication to fall asleep going forward?

>> Not necessarily.

Well quite frankly is diphenhydramine which is a fancy term for Benadryl then drells and antihistamine as an antihistamine it does have so-called anticholinergic features.

That means that Bloks acetylcholine so you have to be careful with well or diphenhydramine because it can block acetylcholine and make you kind of fuzzy with your concentration the next day they did studies my goodness twenty years ago looking at people who took Benadryl 50 milligrams at bedtime for sleep and having them take driving test the next morning and it was found that people who took Benadryl 50 milligrams at bedtime diphenhydramine 50 milligrams of bedtime and also also known as equal if they took it at bedtime they had impairment in driving around those cones right up until noon the next day.

So it can give you some difficulty driving the next day if you're over 55, 65, even 70 years of age, you're going to be more likely to be sensitive to these changes because as we get older we're more inclined to have difficulty with memory disturbances with any medication that blocks acetylcholine as does Benadryl, Benadryl, diphenhydramine or ZUILL.

>> These are all medications.

These are all the same medication but as medication it will cross into the blood brain barrier by 80 percent by contrast, something like Alegra Alegra doesn't get across the blood brain barrier at all but Benadryl or Diphenhydramine or Zewail will get about 80 percent across the blood brain barrier can make you sleepy that way it can also cause you to have some difficulty concentration where you get dependent on it over the course of time maybe maybe you still need to maintain good sleep hygiene if you rely on an over-the-counter antihistamine such as Zequinha long term, yeah, you can kind of get used to taking something and taking something to help you fall asleep.

You can become psychologically dependent on it but they get physically dependent on something I can see well not real likely.

The main medications we hear about over the counter will be diphenhydramine which is an antihistamine that's the one sequel you might hear about hydroxyl Zeins sometimes that's also known as cataracts or Restoril and there's a medication melatonin is commonly used as a sleep medication.

The key with melatonin is try not to go above five milligrams at bedtime if you get up to ten milligrams at bedtime, you might want to do so under a doctor's supervision because sometimes that can give you a worsening sleep and even nightmares if you get too much melatonin in your system.

So there are over-the-counter sleep medications that can help you sometimes fall asleep and that might be all you need if you have to use them just every now and then if you do use them night by night by night, just be aware that you might be the starting to become psychologically dependent on them and that's where you need to follow the good sleep hygiene of trying to go to bed at the same time every night try to get up the same time every morning, try to get some exercise during the day, try not to eat anything after 6:00 or 7:00 p.m.

I definitely don't drink alcohol in the evening because even though alcohol helps somebody get to sleep in the long run it will significantly interact, interrupt their sleep architecture and have them have more nighttime awakenings.

>> Thanks for your question.

Let's go to our next caller.

Hello Jeffrey.

Welcome to Matters of Mind.

>> Well, Jeffrey, you said you had a friend who has bipolar disorder and has explosive episodes with her mania.

How can this be treated as a hope to stabilize?

And Miller who are out on one hand if she's willing to be treated voluntarily one of the best medications out there for bipolar mood stabilization especially mania will be lithium lithium as remarkable as a salt was discovered in nineteen forty nine to be effective for bipolar disorder by an Australian physician and its assault comes out of the ground.

It's in the same periodic table column as sodium and lithium is something that can be considered to be very safe if it's used in appropriate doses .

Over 100 years ago lithium was actually included in soda pop that was the original Seven-Up if you remember Seven-Up from long ago these lithium inet and people would like it because they felt more mellow after the used of lithium have some specific means of helping with inflammation in the brain by decreasing this particular inflammatory protein called one hundred.

And it's thought that when people have bipolar mania they have a spike in the quantity of one hundred in their brains and lithium specifically can bring that down.

>> It's thought that Depakote which is an anti epileptic medication used for bipolar disorder can do the same.

So lithium is the best medication if for somebody with explosive mania that they can use.

There are a lot of other medications to use.

I think the key would be that your friend not take an antidepressant medication Jeffrey Antidepressive medications for somebody with explosive mania can often make them feel worse.

So even though these people with bipolar disorder will dip into depression, be very careful in using depression for them.

>> So lithium is one class that will use one of two other classes not uncommonly for bipolar disorder.

>> Jeffrey will use a second generation antipsychotic medication and there's many of those now I believe there's twelve of them now and different formulations there's erm formulations there's oral and dissolvable formulations but these second generation antipsychotic medications are not used just for psychosis but they are used for bipolar mood.

Stupples stabilization and then the third thing will not uncommonly use will be anti seizure medications Depakote being one of them I mentioned that but we often pair a lithium with Lamotrigine or Lamictal we might use it with Tegretol or Trileptal.

These are all antiepileptic medications and it's thought that if you think of bipolar disorder as being kind of like a seizure disorder, well it's kind of like a seizure of the mood epilepsy of the mood where out of nowhere you have these highs and lows and they're brought on by lack of sleep not uncommonly and stress.

Well guess what?

Epilepsy with seizures will be often brought on by lack of sleep and with stress.

So there's a lot of similarities between how seizures occur with epilepsy and how mood disturbances occur with bipolar disorder.

And I don't think it's any coincidence that we use anti seizure medications for both conditions.

>> But there are a lot of different treatments out there.

One of the treatments strategies can be used.

Jefferey will be using a second generation antipsychotic medication in the injectable form which would last anywhere between one month to three months and that's more commonly used nowadays for people who just don't have the awareness or the insight that they really have a problem.

Many people with bipolar disorder by nature they're having bipolar disorder will lose the judgment such that their front out of their brain is just not adequately working and they'll lose judgment and insight and awareness into the consequences of their mood swings and they won't it'll be like they don't even have any awareness or even any memory of how out of control they might have been.

>> Those people will often deny that they have a problem and sometimes they do need a court ordered outpatient commitment to maintain them on their medications and we hope that we don't have to go that route for a lot of people we're always trying to educate people in their families on the nature of mood disturbances, helping them understand that it's an inflammatory condition of the brain when you go on a manic high it's an inflammatory condition of the brain and what we're often trying to do is dampen down that inflammation itself.

Jeffrey, thanks for your call.

Let's or our next caller.

Hello, Robert.

Welcome to Matters of Mind.

Robert, you had mentioned your wife is taking Seroquel that's also known as Quartier and her cholesterol shot up a hundred points.

Is Seroquel causing that increase in the cholesterol?

Possibly, Robert.

There's a chance that a second generation antipsychotic medication can somehow influence the glucose sensitivity and possibly affect lipid functioning.

>> And for that reason we are advised when somebody is all of these kind of medications long term to every now and then check their glucose levels and their lipid levels.

>> Now what do you do if you see the lipids go up?

Well, it depends on what kind of condition your wife may be treated in the use of Seroquel or Quotidien if it's being used for sleep.

We have a lot of other options out there that are safe and effective for sleep if it's being used for mood stabilization.

>> I mentioned earlier Depakote Depakote actually can decrease cholesterol levels.

>> Depakote has some very nice lipid lowering effects in itself if it's being used for schizophrenia, Seroquel is one option but like I said we have almost a dozen other options out there that can be used.

Some of them are less prone to causing lipid elevations or glucose elevations.

So Robert, I'd suggest that you contact your wife's clinician and just kind of see what other options are out there and try to determine if Seroquel is really the best medication for her for her needs right now.

Robert, thanks for your call.

>> Let's go to our next caller.

Hello, Wesley.

Welcome to Matters of the Mind .

Well, Wesley, you got a couple question number one, how is pain related to mental health ?

I'll answer that one right off the bat.

Pain and depression, Wesley go hand in hand pain, depression, anxiety, insomnia they all kind of intermix because if you have more depression, Wesley, the perception of pain is worse.

If you have pain, you're more likely to get depressed because you can't do stuff.

If you have pain, you have more difficulty with sleep, with difficulty with sleep.

It'll make you feel more anxious and with lack of sleep it actually affects your ability to maintain rational thought with lack of rational thought you get more depressed from that.

So yeah, it all kind of goes hand in hand.

So when we treat somebody who has pain and depression, pain and anxiety we try to treat both and you want to use opiates very respectfully and very cautiously.

>> But opiates are narcotics and they do have mood elevating effects in themselves because if they stimulate the so-called MUE receptor HMU that's a narcotic receptor and opiate receptor, it will help the mood.

We'll give you a feeling of bliss and peacefulness and happiness and that's why people abuse it.

So be careful about that because what you want to do with pain is dampen down the pain to the extent that somebody can start to function.

Typically people don't get 30 and 60 days worth of pain medications anymore.

They get just a few days here and there just because we've realized that long term use of the narcotics really in somebody's best interest.

So alternatively, what do we do well from a medication standpoint try to keep people functioning.

We'll try to give them medications that increase serotonin and norepinephrine like double Occitan.

>> Cymbalta it was developed by Lilly came out in about 2002 and it was originally used for depression but it was readily found to be very effective for pain, especially related to fibromyalgia and it was found to be good for diabetic neuropathy in neuropathic pain a second type of medication will use will be an antiepileptic medication that will affect the so-called calcium channels.

It's thought that when people have pain they have an itchy trigger finger at the calcium channels and they're opening up too much causing you to have unnatural pain that makes you feel pain when you really shouldn't feel pain.

>> Gabapentin also known as Neurontin or Pregabalin also known as Lyrica can help stabilize those calcium channels and make that a natural pain less likely.

>> Second question you had mentioned is there are people who make fun of your panic attacks.

How can you explain panic attacks to them so they understand the best way to understand panic attacks?

Well, Wesley will be they initially brought on when you're backed up into a corner and you're in life circumstances where you either either have to flee from those circumstances or you have to fight those circumstances.

>> So it's a fight or flight phenomenon and they're initially brought on by usually life circumstances for a lot of people.

Some people will say they come on out of the blue but there's so many different reasons for panic attacks not only from a psychological standpoint, Wesley, but some people can have a condition called mitral valve prolapse.

Some people enough thyroid disturbances, some people can have hormonal disturbances.

In general women are roughly four times more likely to have panic attacks than men because they've got these hormones estrogen and progestin going up and down and that can provoke panic attacks if they get out of whack so you can have hormonal disturbances causing panic attacks.

Glucose disturbances can cause panic attacks.

And Wesley, once you've had that first panic attack, it is like a bolt of lightning.

If you've if you get struck by lightning and you survive, you're always going to be wondering when that next lightning strikes are going to occur and that's how it feels when people have panic attacks.

They have this anticipatory anxiety where they're always on edge wondering and worried about having another panic attack.

So with panic attacks we're always, always, always the Wesley trying to figure out is there an underlying medical reason for you to have the onset of panic attacks?

Secondly, we don't having more the more panic attacks you have again it's like getting struck by lightning again and again and again .

The more you have the more like you're probably going to have.

So we want to settle down the anxiety that's related to worrying about the next panic attack and try to prevent them the best way possible.

A lot of medications out there available for panic attacks.

Wesley, there's the so-called benzodiazepine, Xanax, Klonopin, Valium, Ativan.

They're used temporarily as a means of putting out the fire immediately and sometimes people need those more initially.

But over the course of time the serotonin antidepressant medications can relieve panic attacks sometimes beta blockers such as propranolol metoprolol these are medications that block adrenaline and they decrease the heart rate, the decrease the shakiness, they decrease the sweating.

There will often be associated panic attacks so they treat the overall so-called peripheral symptoms that way from a talk therapy standpoint, often people are taught to do relaxation exercises to breathe deeply while they are experiencing the panic attacks and try to go on with the usual activities.

What often will happen when people have panic attacks is they will isolate themselves and they're in in a way convincing themselves that it's not safe to go out into the world around people and because they might have another panic attack and unfortunately that kind of solidifies the belief so the best they can do is from a behavioral standpoint get out, try to do the usual things, talk to your clinician about possibilities from medication standpoint or counseling as a means of trying to get yourself through the panic attacks and explaining that to your friends.

I mean we look at panic attacks as being a medical condition nowadays that have an underlying psychological component because the more panic attacks you have, the more likely you're going to have because your brain keeps getting conditioned that these type of things are going to happen and becomes an inevitable circumstance.

>> You do have those again.

Thanks for your call.

Let's go next caller.

Hello Pat.

Welcome to Mastermind.

>> Well, Pat, you had asked is there a definitive test for Parkinson's disease?

If not, how is it diagnosed Parkinson's?

>> These pat is typically diagnosed by looking at somebody's symptoms and it's pretty clear for a lot of people their symptoms Parkinson's disease is caused by a decrease in the volume of this little part of the brain right in the middle here.

It's called the substantia nigra.

If it decreases down to 30 percent or less what that's doing is releasing less dopamine with a release of less dopamine to the area around it substantia nigra in the area around it.

It will cause you to have these movement disturbances and what will happen, Pat, will be that will notice that people will have a tremor arresting tremor that's they're very rhythmic and when they're asleep it does go away.

They will have a shuffling gait when you have them walk across the room and turn around they kind of shuffle as they do turn around.

People with Parkinson's disease will often have difficulty with showing any facial expressions.

They will just stare at you and they don't have much facial expressions.

Sometimes they'll even drool because of the Parkinson's disease itself.

They'll have sometimes what's called cog wheeling where when you try to have them relax their arm and you try to move the arm, it has this little cog whistling effect where it's kind of it feels like there's a little bit of resistance that's there in a very rhythmic manner.

>> So those the usual tests for Parkinson's disease is there a definitive blood test for it at this point I'm not aware of any but I do know that there's a lot of studies and a lot of research going on about Parkinson's disease.

You know, it's that's how it's diagnosed by looking at somebody.

The first thing we will always do is take a look at their various medications to see throw out a medication that blocks dopamine because if you're on a dopamine blocking medication that can cause Parkinson's disease even though so-called serotonin medications that increase serotonin for depression, Zoloft, Paxil, Lexapro sometimes you'll see Parkinson's symptoms come out of those because if you increase serotonin you could indirectly inadvertently decrease dopamine.

>> If you decrease dopamine, you get the so-called Parkinson's disease symptoms.

So we want to look at medications first and foremost and then if you treat Parkinson's it's often treated by medications that somehow enhance the transmission of dopamine either by helping manufacture more dopamine or making it work better once it's in the synapse between neurons and sometimes people will get Parkinson's disease treatment by stimulating the actual dopamine receptors themselves with medications like Reequip or Prindle role which will stimulate the dopamine receptors themselves.

So there's a lot of treatments out there.

The key will be to find any possible cause the factors behind it and try to address those the best way possible then treated accordingly for the purpose of improving function of life overall path.

>> Thanks for your call.

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

I guess we have an e-mail right here and regenerative Alver I've noticed that I have been more tired and very irritable lately and I'm not sure what the cause is because nothing in my routine has changed.

>> What could be causing these changes in mood and general negative feelings?

Could there be a prescription treatment for these symptoms if you're tired and irritable and it's come on kind of later in life the first thing we always want to ask is will anybody else in the family have similar symptoms and have they been treated successfully or not so successfully?

Have they been treated at all?

The first thing I always wonder especially for a person who's an adult perhaps would be to do sleep apnea.

So sleep apnea will be the first thing we always consider if somebody is tired and irritable.

>> Secondly, are you getting enough sleep?

What's your sleep hygiene like?

How many hours of sleep are getting night by night by night?

You know, we can always look at stresses in somebody's life and I always tell people that stress is OK. Changes in your environment day by day that's OK as long as you can cope with them.

But if you can't cope with them and they become overwhelming for you and you start losing your sleep because of that, that's going to affect your judgment and your perception of the world around you now I think wondering for his prescription for reform fatigue and irritability there can be if we've ruled out these medical conditions like sleep apnea, low thyroid diabetes, even fibromyalgia for that matter.

>> So we want to make sure medically you're in good shape overall and if if it appears that you have difficulty with depression for somebody who's tired and irritable, we want to irritability is not episodic where it comes and goes and why you're irritable if you're having difficulty with sleep just during those times and you can get by with less sleep, we might be thinking that you might need something along the lines of a mood stabilizer.

This kind of level you out more but if you need something more for depression, there's 16 newer antidepressants that have come out since nineteen eighty seven that are taken in the oral formulations.

So a lot of different options out there for you.

So bottom line is talk to your clinician about those possibilities.

>> Your primary care clinician should be able to have a lot of ideas for you on what directions to go.

Thanks for your call.

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

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

>> I have psychiatry forward.

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

I'll be back again next week.

>> Thanks for watching.

Goodnight