?

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

Welcome to Matters of the Mind now in that's twenty second 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 yeard 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) 27 two zero now on a fairly regular basis I am broadcasting live every Monday night from our spectacular PBS Fort Wayne studios which lie in the shadows of the Purdue University Fort Wayne campus here in Fort Wayne .

>> 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 a dot org that's matters of the mind at WSW Edgar and I'll start tonight's program with a question I recently received.

>> It reads Dear Dr. Fauver does cough medicine help with the mood to some of my friends drink a lot of it and feel better cough medicine that has dextromethorphan it's the D.M.

that you often see and cough medicines dextromethorphan has a mood altering effect in the problem you get into with cough medicine will be you sometimes need higher and higher amounts of that.

>> So it's not a good way to really improve your mood.

>> Dextromethorphan has a unique property.

It doesn't last very long but it has a unique property and it in the sense that it will block these little receptors called NMDA receptors NMDA receptors if you block them basically glutamate won't stimulate them and glutamate will go around these NMDA receptors and stimulate the AMPA receptors in doing so can fire up the front part of the brain and stimulate brain growth by firing up this chemical called brain derived neurotrophic factor BDNF and that helps the brain grow makes the brain more fluffy and makes you less depressed.

>> So yes, cough medicine with dextromethorphan can at least temporarily help with a mood but the problem will be that people have to take higher and higher amounts of it.

People can get a bit of a high from that.

It's not a safe way to try to help with the mood.

There is a medication being developed right now.

It's a combination of dextromethorphan with an antidepressant.

It's been around since nineteen eighty nine called Wellbutrin.

Wellbutrin is also known as bupropion and Wellbutrin will inhibit the breakdown of dextromethorphan such that you'll get higher blood levels of dextromethorphan and it will last longer in the system.

It'll be a prescription product.

It'll be available probably in the next two or three years once it gets FDA approval which I would expect that would do because both of those medications are very well established.

They've been established for their safety individually but again with dextromethorphan using it for mood altering effects you'd have to take higher and higher amounts of it to get the good effects.

And that's what the Wellbutrin can help you do over the course of time.

So I wouldn't recommend using cough medicine for the mood.

Talk to your primary care clinician about alternatives for that.

>> Thanks for your question.

Let's go to our first caller.

Hello Renee.

Welcome to the mind.

>> Yes.

As it is first off as sensory processing disorder, consider a mental health condition and as so what are some of the best ways to treat it?

>> It actually is not considered a mental health condition, Renee.

The best means of treating sensory processing disorder would be to go through a neuropsychologist or a neurologist.

They tend to take care of those kind of conditions mental health conditions, Renee, will often involve the mood, the ability to concentrate the reactivity to different situations, a sensory processing disorder is like the name sounds where you have difficulty well processing information so it can be due to something you're born with.

It can be developmental in that sense it can be related to having a stroke.

It's often typically a neurological kind of condition neuropsych allergists are very good at helping you reprocess how you receive that information and what you do with so it's often a training mechanism by which neuropsychologist can help you but it's primarily a neurological condition.

>> Renee, we psychiatrists don't typically treat sensory processing disorder.

>> Thanks for your call.

Let's go to our next I think we have another email.

Let's go our next email.

>> Our next email reads Dear Dr. Fauver, I have always thought normal when I took a narcotic.

>> Why don't doctors prescribe narcotics for depression?

This was something that was asked of me boy twenty five years ago where some patients would say I feel normal when I take morphine, I feel normal when I take a narcotic and why can't you prescribe me a narcotic and back in the 1990s it was not uncommon for some psychiatrist to prescribe methadone a long acting narcotic for the purpose of helping with the mood and there were a lot of articles and reputable academic centers that were advocating the use of narcotics not what narcotics will do you somewhat uniquely as they stimulate these little receptors called MUE Receptors IMU and if you stimulate the receptor you can have a sense of bliss, fullness and happiness and contentment and it will do something more for you than the traditional antidepressant medications will do the ones that primarily increase norepinephrine, dopamine, serotonin, the narcotics will give you the sense of bliss, fullness and people will say it gives them a unique sense of euphoria or happiness.

>> So for that reason narcotics can help some people with their moods and they'll notice that they feel better on that than anything else.

>> The issue with narcotic is they get that same effect.

>> Typically you have to take higher and higher amounts and that's called tolerance or taqi full access and when you take those higher amounts with a narcotic, you know, eventually you'll get to the ceiling effect where you stop breathing and that's what will kill people when they use excessive amounts of narcotics they just shut down their breathing and they die and that's why we have various means of trying to reverse that very quickly with nasal sprays and injections and so forth.

>> But that's the issue with narcotics now there have been narcotics that are kind of all week effects.

>> They have weeks effects on these receptors and there have been medications that have been proposed to try to offset that kind of an effect where you wouldn't have the difficulty with having the respiratory depression and that's being steady right now where they look at different pieces of narcotics all these molecules out there that are used for pain, for depression, for anxiety these molecules have pieces to them.

They have a left side of peace and right side of peace.

And supposedly if you use a left sided piece of something like methadone, you might notice that you'll have fewer side effects and less of a likelihood to have difficulty with shutting down the breathing.

>> So for that reason, yeah, there there might be unique effects like that.

People sometimes ask me though, you know, why do we need all these medications for depression?

Why can't people just try to enjoy their lives, exercise more, eat well?

>> Well, you could use that same kind of argument for any medical condition.

>> If it's diabetes, for instance, why can't people just eat well with diabetes and exercise and watch their diets and cut back on their carbohydrates?

>> Well, it becomes a medical condition with the medical condition.

Part of diabetes will be that you have a tendency to crave carbohydrates and it becomes a vicious cycle where it's difficult to manage a condition where your body naturally is rebelling against the means of treatment.

That's what happens with depression.

When people get depressed it becomes a vicious cycle because they become less socially active.

>> They have less energy to exercise.

They don't maintain a conscious conscientious effect to they don't maintain a conscientious effort to try to eat properly and it kind of goes downstream from there where they get more and more depressed.

It'll affect their sleep, it'll affect their energy level and that's why there's treatments for depression just like there's treatments for other medical conditions like diabetes.

>> So the reason we have medications for depression will be these are the types of depression that are causing people to have functional impairment where they're having a difficult time getting things done.

They can't socialize, they can't go to work.

They just can't function in society.

So much anymore.

And it's not unlike diabetes or other medical conditions like heart disease, lung disease and so forth.

>> Let's go to our next caller.

Our next caller is Jeff.

Hello, Jeff.

Welcome to Matters of the Mind.

>> Well, Jeff, you have what feels like a social fear fear you're afraid to engage in group conversations.

>> What exactly is this and how can you treat a group settings make you extremely uncomfortable.

The best way to get over any fear, Jeff, is to well expose yourself to that fear.

>> So in your case try to socialize with small groups initially to the best you can to try to interact periodically.

But the worst thing you can do is avoid social gatherings the more you avoid a fear the more ingrained that fear becomes.

So if you want to overcome any fear it's called desensitization.

You want to be able to expose yourself to that fear and the best way to get over any social anxiety and especially public speaking anxiety is to volunteer to get in those kind of positions and often encourage young adults to do this because if you didn't learn how to speak in middle school and high school, if you weren't somebody who was going to be in front of the class and you weren't on a debate team or you weren't really learning public speaking skills in high school, it's good as an adult to try to pick those up and to volunteer to speak in certain settings.

>> So you know, if you if you keep avoiding public speaking and keep avoiding social settings, that's going to make the fears all the more worse.

Now we do use medications for some people to get him started and medications will often use for overwhelming social anxiety will be so-called beta blockers as long as you don't have asthma, beta blockers can be very safely used.

Beta blockers or medications like propranolol metoprolol, atenolol these are medications that basically block adrenaline and in doing so they decrease the shaking is the sweatiness, the fast heart rate, the trembling voice.

These are medications that help you get started with these kind of social anxieties that are also known as performance anxieties.

>> And once you do it again and again and again, the anxiety tends to be diminished.

So it's like any fear the more you expose yourself to the fear and the more you confront the fear itself, the less likely you're going to experience that.

And that goes for social fears, public speaking, any kind of fear is out there.

It's important to gradually try to get yourself to encounter it again to as we say, get back on the horse so that you don't have the fear that maybe something previously made you really scared or fretful about it.

>> You're able to confront it directly.

Thanks for your call as your next caller.

Hello Michael.

Welcome to Meyers mind.

>> Well, Michael, you want to know how effective are these selective serotonin reuptake inhibitors in treating eating disorders and in particular binge eating Prozac or Fluoxetine way back in the early nineteen nineties got to be studied and eventually approved for binge eating for people bulimia specifically and Fluoxetine increases serotonin.

It also has some secondary effects that are thought to affect serotonin.

Has these effects on this particular receptor a serotonin called Toussie and in doing so can diminish binge eating for some people.

>> So the SSRI by increasing serotonin can make you feel kind of full now most SSRI will allow you to have a decreased appetite Prozac being the most prominent with that Zoloft to some degree Lexapro is kind of neutral.

Paxil sometimes will cause people to gain weight over the course of time.

So the SSRI is a bit different in terms of how likely we're going to be using them for specific eating disorders.

But the medications that are used the most now for binge eating will be medications such as Prozac.

You can use Wellbutrin to suppress the appetite to some degree Wellbutrin is increasing dopamine and norepinephrine but even more powerfully as a medication that it is FDA approved for binge eating called Vyvanse.

It's a medication it's used for attention deficit hyperactivity disorder.

It's called Venlo.

It's called dexamphetamine.

It's called lists amphetamine and is less amphetamine.

It will decrease binge eating by increasing norepinephrine and dopamine.

So it is an amphetamine but it tends to last the whole day and it's been found to be a very effective around fifty milligrams a day for helping with binge eating.

>> Where we'll use Vyvanse basically specifically will be for people who have ADHD but secondarily have binge eating disorder.

>> So they have the we will try to knock down two birds with one stone when we treat with Vyvanse Topiramate Topamax has been around for a long time.

It's a medication that tends to dull the appetite as a side effect.

Make soda pop taste really weird because it's a so-called carbonic carbonic ANHYDRASE inhibitor and in doing so the sleaziness and the soda part of part a soda pop not get metabolized adequately and it tastes really weird when you drink something like soda pop but topiramate is an anti seizure medication also used for migraine headaches but it just dulls the appetite.

So we'll use that occasionally at IPEX or Phénomhne is a medication used by itself can be very safe in terms of dulling the appetite good long term data on that and does tend to help decrease the appetite for a lot of people.

>> So there are medication treatments for binge eating and for excessive eating in general one of the best behavioral approaches we've seen over the past 20 30 years has been intermittent fasting where you intentionally don't eat for longer periods of time during the day 16, 18, even 20 hours a day you don't eat you drink fluids but you don't eat during that time and you limit your eating to maybe four to six hours at a time.

>> You have to be careful and balance that out.

You don't want to binge during that four to six hours.

But in my experience in recommending that to people I find that people have a harder time bingeing when they're eating in a small period of time like that because they can only binge so much during that time.

>> But you have to balance that out with people having behavioral disturbances with binge eating and tending to excessively eat when they do have the chance a bit intermittent fasting has been very helpful for lots of people where they only eat during a four to six maybe an eight hour window each day.

>> Thanks for your call.

Let's go our next caller.

Hello.

I want to welcome to matters of mind.

Yes, Doctor.

I. I have two questions related.

First of all, dementia and memory loss that is associated with aging other several diagnoses for that.

And then the second related question is there treatment on when somebody has memory disturbances and an adult?

>> There's mainly three well three different types of dementia we talk about the most we talk about Alzheimer's dementia which is the most common Alzheimer's dementia is related to age head injury, hypertension, diabetes, depression and it's where the side parts of the brain literally are shrinking and as we get older we're more prone to having that problem.

>> It's where people have difficulty with remembering where they are.

>> They'll have trouble with short term memory.

They'll remember what happened twenty years ago but they'll forget what they had for breakfast that morning.

>> So they have trouble with short term memory with Alzheimer's dementia a second type of dementia is vascular dementia own and that's where people have little tiny strokes and we sometimes call them mini strokes but they have these tiny little strokes and it causes a stepwise progression of memory impairment where they're doing OK for a while then they just have a sudden drop off of their memory and attention span.

It's related to hypertension, hemorrhagic strokes and so forth can cause that.

But having little tiny strokes can cause you to have a stepwise progression with your memory.

>> Some people with Parkinson's disease will have a type of dementia called Lewy body disease and Lewy bodies are these little speckles under the microscope when you put a particular strain on them they look like cherry jello but little speckles all over the brain generally we only should have about point five percent of our outside part of the brain having these little speckles but with Lewy body disease you can have a significant proportion of the outside the brain having these little Lewy bodies all over and that will cause you over the course of time trouble with memory as well.

So those are the main types of dementia we often hear about.

>> Oh and when I hear about an older adult having difficulty with memory I always want to look for very treatable conditions.

>> So we always want to check thyroid glucose, make sure they don't have sleep apnea.

A lot of people who are older have sleep apnea where they are not getting enough air flow to the lungs at night.

They're snoring.

They're restricting or breathing.

They don't get enough oxygen thereby to the brain that will give you memory problems as well as we want to always look these treatable conditions.

I see people all the time as a psychiatrist O1 who have depression and they're in their 60s, 70s, 80s.

They have depression.

The depression is causing them to have all these memory problems so depression especially will give you what's called thought processing disturbances where you have a hard time process information quickly.

So it's kind of like having a slower computer speed in your brain where you just don't process information quickly and that will cause you to have memory problems and a lot of cases as well because you can't download new information.

>> So we want to take care of all those treatable conditions.

If you do have a condition like Alzheimer's dementia OHAN for the past twenty years we primarily been use the medications to increase acetylcholine such as Aricept Exelon rhapsodized these are medications that indirectly will increase acetylcholine and if you increase acetylcholine you can maintain your memory.

It's kind of like putting a rust proofing on your patio furniture.

>> It won't stop the progression of the disease but it will slow it down.

So if you rust proof your patio furniture it won't stop the rusting of the patio furniture.

It'll slow down the progression of it.

That's what the traditional medications for Alzheimer's disease will do.

>> A second treatment will be something called Namenda also known as Memantine.

>> This is a medication that will block NMDA receptors not unlike what dextromethorphan will do which I mentioned earlier and cough medicine.

But it lasts longer than dextromethorphan and that can be added on to a medication like Aricept not uncommonly to get a dual effect again to slow down the progression.

And more recently just over the past couple of months we've had this FDA approval of a medication that is an injectable medication.

It's infused over the course of thirty minutes and it's infused once a month and it's first the specific purpose of kind of shrinking up or dissolving some of the little amyloid plaques in the brain.

>> It's thought that when people have Alzheimer's dementia they have all this gunk in the brain that's amyloid plaques, protein plaques, same kind of amyloid that is in the pancreas when people have type one diabetes.

>> So with that being said, it's a very expensive treatment .

Hopefully we're going to see insurances be able to cover it for people but it actually decreases the volume of the amyloid plaques that issue their own is in the trials that were submitted to the food Drug Administration there was not found to be an improvement in a person's functioning concentration or memory in using these injections.

>> However, there was a substantial decrease in the amyloid plaques so there was physical evidence of these plaques shrinking and between amyloid plaques and what's called tau proteins which are little fibers that are excessive.

Those are the two main problems with Alzheimer's disease.

You have too much amyloid plaques and you have all these tau proteins in there and these fibers and tangles and all that type of thing.

But at least with the injection it showed that it dissolved and decreased the volume of the plaques themselves.

>> So that's going to be studied more and more over the course of time.

We're going to actually see in real in the real world how much dissolving those plaques will have provided a meaningful benefit for people.

>> So I look forward to seeing that with Alzheimer's dementia.

It's it's something that's kind of been static in its treatment for the past twenty years.

We haven't had a lot of new treatments or innovations over the past twenty years.

We would have liked to have seen more of it, a lot of studies out there on it and it's still being studied quite extensively.

>> Owen, thanks for your call.

>> Let's go our next caller.

Hello Dean.

Welcome to Matters of Mind.

Hello Dr. Paul.

I named the different questions.

Sure.

First of all, I'd like to thank you for doing your show.

Some of my questions here tonight are I'm on hydroxy and a lot of them I have a lot of itching like in my face area and I have also was wondering about and also on my feet I was wondering also about there's something a person can do to obtain a primary care doctor and they have agoraphobia and anxiety like possibly get a doctor in there to come to the residents house calls.

>> Dana, we don't do housecalls nowadays so often you are going to hear about those so much.

>> But Dean, what you're going to hear a lot about the use will be video calls and video conferences since we've endured covid going back to March of twenty, the federal government loosened up.

>> There are restrictions concerning the use of video visits.

So a lot of people such as yourself if you have reluctance to get outside of the house, for instance, some people with agoraphobia just don't want to go outside the house.

>> You can have video of visits with a primary care clinician and you can ask your own primary care clinician clinician if he or she is doing video visits.

But I'm seeing a lot of people in my practice now by video about 70 percent of our practices video right now and we see people all over the state of Indiana.

>> There's no geographical restrictions in seeing people with video visits.

The laws are in the state where you're licensed.

So a video visit is something that gives a person the opportunity to be treated by primary care clinician without having to leave the house.

Now in terms of itching, you have to be descriptive of your symptoms.

Sometimes you can show the clinician what kind of things you're going through.

We often will have people assessed for tremor.

We have them hold up their hands.

We have them open their mouths.

We have them actually show us different things in the physical examination.

You can do some of that.

So if you're having itching in your hands or feet you can show your clinician the hands and feet on the video scream but perhaps you wouldn't need to physically come into the office.

You could be seen for for a video visit.

So you'd mentioned Hydroxy which is an antihistamine.

Some people dying when they get anxious and they get kind of fearful they will have a release unnaturally of histamine in the skin and in doing so they can feel itchy and that's why some people feel itchy when they have a lot of anxiety and that's what Hydroxy can be used and relieving hydroxyl seen has been used for a long time.

There's an old antidepressant medication.

>> It can be used at low doses called Dock's Happen.

I remember when I was in my training back in the 1980s I did work for a month with a dermatologist and I saw him use Doc's happen all the time for people that had this itching and some people that actually had hives when they get anxious and he used low doses of Doc A which is an old antidepressant medication but low doses has a powerful anti histamine effect comparable to Benadryl.

But it also gives you this added effect on norepinephrine and serotonin and it's thought to be really good for itching for a lot of people who it's due to anxiety will sometimes use even stronger medication.

My name Aquitania Peter Serik.

Well it's an antipsychotic and mood stabilizing medication but low doses can be used at bedtime to help with sleep.

>> But it's a powerful antihistamine in itself.

It can be used to decrease anxiety and decrease the sensation of itching the next day so you could use that clonazepam or Klonopin can carefully be used over the course of time but you want to be aware over the past or about two weeks you can get a tolerance to it ten years ago I would have recommended Clonazepam or Klonopin for a lot of people even with long term treatment but we've since realized just over the past few years that long term use of Klonopin can make you more depressed, give you difficulty with the speed of processing of information and cause you to have trouble with memory and concentration.

So we're getting away from using Klonopin long term but some people will use it very, very cautiously at low doses perhaps just as needed.

Sometimes we'll give people, for instance, nine tablets a month for the purpose of just putting the fire out in the case that they have tremendous anxiety in doing so we're trying to keep them out of the emergency room so they don't have to go to the emergency rooms where they're feeling overwhelmingly anxious like that.

>> So Klonopin something that could be used sparingly over the course of time using a day by day you want to be careful with it over the course of weeks, months or even years simply because you can kind of get used to it and they can kind of dull down the concentration.

>> We see a lot of people on Klonopin who have trouble with needing higher and higher amounts and it kind of resets the volume control in the brain in terms of needing more and more over the course of time.

>> Thanks for your call.

Unforeseen I'm out of time for this evening.

If you have any questions 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.

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

>> I'll be back again next week.

Thanks for watching.

Good night