>> Good evening.

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

Welcome to Matters of the Mind now and its third year are 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 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- nine six 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 Purdue Fort Wayne campus.

>> And if you'd like to contact me with an email question that I can answer on the air, you may write me via the Internet at matters of the mind all one word at WFA ECG that's matters of the mind at WFYI Big and I'll start tonight's program with an email question I recently received.

>> It reads Dear Dr. Bovver, what's the difference between obsessive compulsive disorder and obsessive compulsive personality disorder OCD versus OCD?

>> Well, that's a common question because they sound so similar and I don't like the terminology because they sound so similar for completely different conditions.

OCD or obsessive compulsive disorder is basically where you have these thoughts that don't make any sense to you that you know they don't have realistic sense but you can't get them off your mind and it's like the old record players where the needle would get stuck and from a circuitry standpoint the networking in the brain is such that those thoughts will go around and around and around in the front part of your brain and it's difficult to do something about them now we all have odd and unusual thoughts every now and then but they typically are like a puff of smoke and that puff of smoke is there briefly and it goes away and it's an odd thought that make a lot of sense to you goes away.

People with OCD can't get rid of that thought and it starts to consume them and it gets to the point where it's distracting and affects their ability to socialize and get out around other people and be able to work.

And those obsessions which are thoughts can turn into actions which are compulsions.

>> Sometimes people have the compulsion to do things over and over and over again as a means of trying to relieve the anxiety created by the thought.

For instance, if you have a thought that you're contaminated bugs all over you or that you're contaminated in some way you might Washington wash and wash and some people will have raw hands from washing excessively.

>> They know they're washing excessively but they can't get away from the sink.

Other people will check and recheck and recheck and they'll go and check their stove.

>> They'll check their their ion.

They will check the door locks, they'll check the windows, all sorts of things.

>> It's not that they're paranoid.

They just can't convince themselves that it's already been checked enough and they'll know it consciously that they did check already but they got to go check it just one more time and that goes on sometimes for over an hour a day for these people.

So obsessive compulsive disorder is a circuitry disturbance that affects serotonin and this particular receptor called a sigma receptor, a sigma one receptor and a sigma receptor will be affected in such a way that if it's treated appropriately you can relieve the OCD.

So we treat OCD with medications that affect serotonin and the sigma receptor but we also use talk therapy.

Talk therapy can be the type of behavioral therapy where you basically train your mind to say to itself stop and some people have to stay say stop out loud where they will audibly say stop to try to get those thoughts to get back on course and it's just a means of trying to get things on the right track.

>> Now that's OCD, that's obsessive compulsive obsessive compulsive disorder, obsessive compulsive personality disorder is the old type A personality where people are perfectionists.

They got to do things their way .

They can't delegate.

They get very annoyed by other people try to do the work because they know how to do it themselves.

They tend to be very precise.

They keep lists.

They're extremely organized and they tend to be individuals who are going to recheck things but they reject them because of their perfectionism.

>> They don't recheck them because the lack of checking creates anxiety.

What happens with OCD is it's a condition where it often interacts with your social interactions or interferes with your social interactions and it will cause you to have difficulty getting along with other people because you're annoying to other people when you have obsessive compulsive personality disorder.

OCD is an anxiety disorder OCD obsessive compulsive personality disorder that's a personality condition itself.

>> Thanks for your question.

Let's go to our first caller.

Hello Donna.

Welcome to Matters of Mind.

>> Hello, Donna.

Hey.

My question is different but here here it is.

>> I've got chronic lung problems so excuse me if I cough no problem.

>> I have veteran friends who have been taken off of all their pain medications and they're not even on the registered ones or not on active Kodo or any of the Percocet and I know that there's one called Tramadol and they have they were on that not having any trouble, no problems and then they started weaning them off of them.

They took them off those I don't know why but then I saw my they're both veterans and I saw my friends you know, they're self medicating.

They they want to alcohol and it's really bothersome because one of them we've already buried and now I have another one and I see him doing the same thing.

He keeps falling.

He's had brain surgery because he keeps falling because he never drank that much alcohol but they took him off the pain medication that he needs to just dull the pain so he can get through his days.

And I'm getting really, really terrified for all those folks out there anyway.

What can you could you help us?

Could you tell somebody we have a problem out there?

>> It's not that they're they're not over medicating anything.

They just can't get a pain medication at all.

>> Donna, there is a specially called pain management that deals with that kind of issue including the Veteran's Administration.

>> But Donna, the pendulum has swung to the other extreme.

I remember in the late 1990s it was thought that anybody and everybody with any kind of pain at all should get an opiate and opiates were highly promote in the late 1990s and it went overboard to the extent that we have what's now called an opiate epidemic where there was an epidemic of people dying from opiate overdoses often inadvertent.

And the way that works, Donna, and you probably are aware of this is some degree opiates when you take them over the course of time you get less and less of an effect and you take a higher and higher amount to try to get that relief of pain or to try to get the effect you're trying to get and then you get to that certain ceiling of a dosage and you stop breathing.

That's what's the opiate epidemic is all about.

It's not people necessarily shooting up with heroin although some people do that we're talking about pain medications like you're describing.

So right now clinicians are highly scrutinized and it's extremely regulated such that physicians have a hard time prescribing opiates long term for people.

Tramadol is also known as Altrincham.

It's a partial opiate agonist meaning that it will gently to some degree stimulate opiate receptors but it also has a serotonin and norepinephrine effect similar to Cymbalta plastique that Zema will do that these are antidepressant medications that can help with pain and other ways.

And the idea right now, Donna, is as a society we're trying to get away from the opiate overuse from 20 years ago.

But the pain management specialists are in that role to figure out who who will need the opiates long term and what doses they should or could use and how are there are how are they monitored because that was the problem for a lot of years, Donna.

People would sprain their ankle and they'd get a month's supply of narcotics and maybe they didn't even need narcotics but they got a month's supply so they took them home and what a lot of people are doing in the past 20 years, Donna, is they they would take a narcotic or two and they noticed this sense of bliss.

Narcotics for some people especially can give them a sense of happiness, contentment and people describe it as a as a sense of bliss fullness.

And when they get that feeling it's unlike any feeling they had before and they thought, wow, I really like this and the next thing you know, their ankle pain's gone but they start using the opiates as a means of helping their mood.

So using opiates is a legitimate way to relieve depression and there's actually been studies on various means of helping people with opiates for depression.

>> But the problem will be how do you get past that difficulty going with higher and higher doses to the point of reaching that ceiling effect where they stop breathing.

So I think what's going to happen on it in years to come is medication treatments will be developed that will help with pain at the narcotic and it means narcotics do at the so-called MUE receptor Ayumu Ta'amu receptor you stimulate that receptor and you can get a nice effect for pain.

>> There's Delta receptors, there's kapa receptors.

>> Narcotics will affect these different receptors in various ways and I think in the future we're going to find that people will be able to get some relief from narcotics without the addictive potential, without the respiratory suppression they get when they go to the higher doses born out there right now like I said, Donna, sometimes from regulatory standpoint things go to different extremes.

I remember like I said over twenty years ago we were encouraged as physicians to treat the pay and treat the pain, treat the pain.

It was referred to as the fifth vital sign where we were told we need to treat pain when we saw it and the best way to treat pain was with narcotics because they they worked and even in the field of psychiatry there were a lot of very prominent academic academicians and psychiatry promoting the use of narcotics not only for pain but also for the enhancement of mood but like I said, Donna, we got to the point where we had a lot of the population die due to the epidemic of opiates and that's why you're seeing it go to the other extreme.

There are other means of treating pain obviously physical therapy.

We use Cymbalta as I mentioned before Fitzsimon sometimes Pristina's used sevele is often used for fibromyalgia pain.

There's gabapentin also known as Neurontin.

There's Lyrica which is known as pregabalin.

There's other medications that can be used for pain but that's where you leave it to the pain specialist, the pain management specialist to closely monitor people who do need the opiates and then make sure they use them accordingly.

Now obviously if they drink alcohol with the opiates that will exclude them from being able to use opiates at all.

And I understand your concern that they're using alcohol as a means of means of self medication but that will also exclude them from being eligible for opiates.

So you have to get that alcohol use substance use condition under control before you get on opiates and opiates are to be used very, very carefully and you can't share with share them with other people.

You have to just take them yourself and yeah, there's going to be a pill count on how many you're actually using month by month by the pharmacy who tracks it and reports it to us physicians and the actual clinic where the person might be going as well.

Donna, thanks for your call.

Let's go to next caller.

Hello Jim.

>> Welcome to Matters of Mind.

Yeah, I take five milligrams of melatonin to go to sleep at night in a place where I bought on switch to ten milligrams.

Should I take them and what's the long term effects of taking melatonin?

>> I see a lot of sleep specialists recommending melatonin at ten milligrams bedtime, Jim, so I don't think it's a big problem.

Some people will have nightmares when they take the higher doses like that.

I've heard some people getting by with a half a milligram of melatonin at night but the most common dosage is three milligrams to five milligrams at bedtime.

>> But ten milligrams typically won't be a big issue.

See how you do over the course of a week or so some people will say that when they take a higher amount of melatonin it lasts into the next morning and our melatonin is another medication and to use the same analogy I use previously it is like a puff of smoke where melatonin gets in your system within about about an hour or so and then it gets out in about 30 minutes.

>> It doesn't last very long and melatonin has extended release versions sometimes in the ten milligram doses that will last longer but most people will notice that melatonin will help them get to sleep.

So it's good for what's called sleep onset.

It's good for people who have difficulty just turning their brain off at night and getting to sleep.

But once they get sleep they're fine.

That's where melatonin is good.

It's something that will help you get to sleep and we often will use it for adolescents and young adults because adolescents and young adults by nature of their brain still growing until they're twenty four years of age will have difficulty getting to sleep now once they get to sleep they want to sleep in in the next morning and it's not that they're lazy teenagers.

That's just the way their brain has been developed.

That's the growth of the brain occurring when your brain is growing you typically have what's called delayed circadian rhythm disturbances where you go to sleep later.

Sometimes you don't want to go to sleep till midnight or one but then you want to sleep until nine , ten, eleven o'clock the next morning melati and it can help move that up a little bit.

Melatonin will help you get to sleep a little bit earlier.

Try the ten mg at bedtime to see how you feel with a gym.

It's a very safe supplement to use.

There have been some speculations that melatonin might actually improve one's longevity.

>> It's a hormone that comes from the middle part of the brain right here called pineal gland and at nighttime as it's getting darker and as your circadian rhythms are kind of kicking in, you're supposed to want to get to sleep at a certain time every night.

So in a perfect world, if you're getting into the routine of going to bed about the same time every night within about a 30 to 45 minute window, you should feel really tired at a certain time each night at that time you need to go to bed if you power yourself through it you eat something you watch something interesting on television.

Next thing you know you're wide awake and it's like you miss the bus because your brain naturally wants to go to bed about the same time every night and melatonin will help you set the clock on getting to bed at a certain time if you need it.

But ideally over the course of time you might not even need melatonin if you get to bed same time every night most people want to get up about the same time the next morning you shouldn't need an alarm to wake up if you've had enough sleep.

So naturally your brain should wake up on its own particular time in the morning.

And if that's early enough were you can get ready, go to work, maintain the kind of duties you need to maintain every day.

That's OK.

Some people need to get set the alarm if they have to get up earlier than what they might want to get up and for those people they probably haven't had enough sleep and in that case that's where you might want to use the melatonin to get you to sleep a little bit earlier.

But Jim, melatonin is a safe hormone to take.

You can take a long term.

There's no addictive potential to it, no particular brand names that I'd recommend.

It's something that I would certainly recommend the immediate release version just because you don't want melatonin kicking in all through the night necessarily if you use melatonin just at bedtime it's going to do what it's going to do typically within an hour to be able to help you get that little bit of a nudge to have the urge to go to sleep.

Jim, thanks for your call.

Let's go to next caller.

>> Hello Norman.

Welcome to Matters of the Mind .

>> Hello Norma.

Are you there?

Oh hello.

Yes I am sorry.

Oh sure I I started to take Allatoona and started off on a low dose and then got all the way up to 40.

I was doing much better with my mood but the only thing that I couldn't I started watching the clock and let's say that I'm I'm a stay at home mom so I'm I'm with my child and my husband comes home at two o'clock.

I would start to watch the clock and wait for the two o'clock.

So then the two o'clock would come and he would get home and then he would go to bed and then I would I would wait for the next step and like my legs felt like I couldn't keep up still and that I just wanted to like jump out of my skin.

So I started toning it down.

I told my doctor about it and then started feeling better.

Maybe I didn't need it because I the anxiety of being on it was just it was too much watching the clock and all that.

Now I'm completely off of it and I noticed that my moods have turned back into more of a if I get angry I will where before I would like walk away I will smack you know like smack my teenager for saying what he said to me, you know, rather than so I know that I need it but I don't know if Battuta is or why I was that way.

>> Well thank you for being forthright Norma because La Tuta is one of several mood stabilizers that we have and some people will have difficulty putting up with stuff and when you have difficulty with irritability snapping this you overreact.

Well it can cause you to need a medication.

It's going to be useful for mood stabilization attitude is one of several unlettered is typically very well tolerated but it's for some people it can give you this particular side effect that you've described very nicely called akathisia akathisia where you can't sit still and you feel like you're going to jump out of your skin.

It's related to the dosage and in twenty twenty one we have enough options now where you don't necessarily have to have another medication with the two to offset that side effect.

Back in the old days perhaps you would have gotten the medication in like propranolol Cogen perhaps Benadryl even as a means of offsetting that side effect but we don't need to do that nowadays.

>> No one Norma, if a lower doses of LA to helps you out and doesn't give you that side effect great because that side effect is related to the dosage the higher the dosage you go the more likely you get that particular side effect latu to can do that Abilify can do that to some degree or exalt a little bit less likely to do that compared to Abilify or even LUCCHITTA.

>> But any of the medications in that class are medications that are blocking dopamine receptors can give you a theCIA a restlessness as a side effect.

>> So the first thing I wonder, Norma, would be could you go to a different class of medications that wouldn't affect dopamine for instance, you could have a medication in the anti seizure class.

We often use antiepileptic medications for mood stabilization.

They work quite nicely so we'll use medications like llamo to Jean Trileptal Tegretol.

Those are medications that can be used.

Back in the old days Depakote was commonly used a little bit stronger than those from a sedating standpoint more side effects but the anti seizure medication can be very effective for a lot of people once in a while a small amount of lithium can be helpful lithium is a salt.

>> It's been in the earth ever since the start of time so lithium lithium as a salt it's a natural substance and the 19 late 1940s it was discovered to be a remarkable mood stabilizer and lithium can be a medication.

It does not cause restlessness and in low doses it can help with irritability and a nice side effect of lithium is it seems to cause the tips of our chromosomes to get longer.

>> It's it actually increases longevity and there's a question whether we shouldn't all be using a little bit of lithium as we get especially older because the tips of the chromosome caps that are called telomeres lithium actually has been shown to help them grow more telomeres as we get older get shorter and shorter so our caps of our chromosomes actually get shorter and shorter and that's called aging.

Well, lithium actually makes them a little bit longer, which is an interesting side effect from that I would think in the case the thing the medication you would not want to take even though you might feel kind of depressed every now and then could be an antidepressant and antidepressant can sometimes aggravate irritability and moodiness in people who are prone to that kind of condition.

So be careful if you were to ever use a medication like Prozac, Lexapro, Celexa, Zoloft ,Wellbutrin, Effexor these are medications that are used for depression but for some people it will make them a lot worse.

I would think in your case from what you're describing.

Yeah.

If the lower dosage of Lietuva still is not tolerable for you, you might want to jump to a different type of class A medication one that would not affect dopamine so you can talk to your prescription, your prescribing clinician about that and kind of see what his or her thoughts are about it.

>> Thanks for your call.

Let's go next caller.

Hello Ronnie.

Welcome to Matters of Mind.

Yes, I have some questions about some medications and also about the reopening of facilities.

I didn't know if all facilities were reopening are mandatory reopening.

>> OK, I can't necessarily tell you about the reopening of facilities.

I'm a psychiatrist and as a psychiatrist I don't make those kind of determinations.

The infectious disease people the CDC, the Centers for Disease Control typically determine who gets open and how they get open.

One way or another.

But I will be happy to answer the best I can about any side effects you're having from medications.

>> As you mentioned at the I'm on Trazodone.

They tried me on a different sleep medication also and then Paxil they seem to be having bowel issues.

Why take those?

I didn't know there's something in those medications.

>> I've tried another sleeping pill that they had me on and had the same effects.

Paxil is notorious for giving bowel issues.

Paxil strongly enhances this chemical called serotonin and 90 percent of the serotonin is in the gut ronay So when you already have a lot of serotonin in the gut, what Paxil is doing is enhancing that serotonin effect and if you get an enhanced serotonin effect in the gut, you can have nausea, you can have diarrhea and you can have a lot of gurgling going on there.

So Paxil is notary's for doing that.

Trazodone will affect serotonin to a much lesser degree but some people are more sensitive to the serotonin effect effects than others.

So Trazodone is a medication that's pretty specific and selective on what it does with serotonin receptors and that's how it helps you sleep.

But it does enhance serotonin to some degree.

So the bottom line is Raddy, you might want to consider looking a different type of medication.

One would not affect serotonin so much if you're primarily needing something for sleep.

Melatonin was mentioned earlier three to five milligrams at bedtime perhaps if somebody is having trouble getting to sleep.

>> But there's other medications that we are now using for the purpose of helping people sleep.

>> Gabapentin or Neurontin is one that we're using off label as a generic very safe medication for many people just to help and be able to get to sleep.

But there's other options out there like they've gobe there's Bellson or these are medications that do a nice job in helping you get to sleep.

There are more expensive for some people but they help you sleep in a natural way by affecting this particular hormone called or Rexon also known as Hypocretin.

It basically turns the brain off and helps you sleep at night.

So we have a lot of other options out there.

Back in the old days people would get Ambien and Lunesta, Restoril, Delmon going even further back and those medications they're OK for a brief period of time but over the course of time they kind of lose their effects overall.

>> Ronnie, thanks for your call and forced the amount of time for this evening.

Sally, give me a call this next week because I hope to be back at that time, God willing and PBS willing if you have any questions for me though in the meantime you can write me via the Internet at matters of the mind all one word at a dog.

>> Ask that question hopefully next week if you get that to me.

Thanks for watching.

I'm psychiatrist Father.

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

Thanks for watching.

Have a good night