,good evening, I'm psychiatrist Jeff Alver live from Fort Wayne , Indiana.

>> Welcome to Matters of the Mind now in its 10th Year of 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 in the Fort Wayne area by dialing (969) 270 zero or if you're calling any place coast to coast you may dial 866- (969) 27 two zero and on a fairly regular basis I am broadcasting live from our spectacular PBS Fort Wayne studios every Monday night.

And if you have any questions concerning mental health issues that I can answer on the air, you may write me via the Internet at matters of the mind all one word at WFYI Dog that's matters of the mind at FWC And I'll start tonight's program with a couple of emails I just recently received.

>> They are somewhat related.

The first one reads Dear dear father, my 42 year old son is bipolar.

He takes medication and has regular psychiatric visits.

>> What long term effects from the medications are expected?

His grandmother was bipolar and eventually had dementia but she also had quite a few bipolar disorder is basically where somebody will have unnatural manic highs and those highs can be manifested by feeling on top of the world or irritable and sometimes people will notice having one or the other type of mood or both.

>> But a lot of times when people are on those highs they will not need to sleep and they'll go for days, sometimes weeks with not needing to sleep and you might think well gee that sounds great.

Well, the problem is you get into trouble there because with lack of sleep you start to diminish the ability of the judgment part of the brain to think so you start to have more impulsivity and you do things and say things you ordinarily wouldn't do or say that gets you into trouble.

People with bipolar disorder are quite more likely to lose their jobs and have more difficulty in marital relationships.

So there's consequences with manic highs and you can have the depressive lows where you have the depressive symptoms themselves and you don't want to get out of bed.

You're too sad to be able to leave the house.

You're more socially withdrawn.

So that's a condition of having manic highs and depressive lows .

>> So with bipolar disorder the condition itself is somehow related to epilepsy with epilepsy there is these imbalances of glutamate and gabber glutamate say excitatory neurotransmitter the brain gabbers, the brakes on the brain.

So you have this imbalance of glutamate and GABA and that's what happens with seizures.

That's what happens with bipolar disorder.

>> So untreated bipolar disorder where you have manic highs especially as well as depressive lows when you have the highs and lows you can have a damaging effect on the brain.

>> What damage your effect might that be while there's roughly fifty twenty thousand to fifty thousand branches on each individual neurons in the brain the is loaded with all these little neurons you should have between 20000 and fifty thousand branches on each neuron and when you have manic highs and lows it has a neurotoxic effect and it doesn't kill the neurons but it makes them shrivel up.

>> So you'll have kind of like a neuron that looks like a shriveled up Bush and that's what happens when you have highs and lows that are unnatural.

It's not the medications that are causing the damage in that regard.

It's related to the highs and lows and the mood disturbances themselves because similar seizures which can be toxic to the brain manic highs and depressed flows are also toxic to the brain.

The medications are trying to correct those imbalances and many of the medications we're using nowadays actually show evidence that there is improvement in these branching in the brain with proper treatment.

Now what medication side effects can you have?

Some medications are more toxic on the liver.

I'll give you an example Depakote Depakote can increase liver enzymes for some people really related to the dosage so we have to watch the dosage and keep the dosage as low as possible to Depakote also known as dy valproic can give you liver problems.

Lithium is a very safe medication to take particularly if you use the extended release version and dose it all at bedtime.

>> It's easier on the kidneys but with lithium we have to make sure that the kidney functions are adequate and that the thyroid functioning stays in reasonable range.

>> When somebody takes lithium because lithium is a salt it does go to the thyroid and it could be somewhat toxic on the thyroid that can be corrected with thyroid hormone if need be.

So there's ways to get around that.

But many people have the misperception that the medications are toxic on the brain.

It's more of the effect of the underlying condition bipolar disorder itself if not treated being toxic on the brain.

>> Thanks for email.

Let's go our next email because it's somewhat related.

Our next email reads Your daughter Fauver My husband has been diagnosed with bipolar disorder in the past seven years.

>> His mother at first refused to believe it but is slowly realizing the truth.

What resources can we use to help her understand his illness?

He just doesn't understand.

She's just as understanding referring to the mother.

The best resource I'd recommend for any family member of a loved one with a mental illness would be the National Alliance on Mental Illness NAMI, the National Alliance on Mental Illness NAMI has been around oh my goodness for decades now and it's a very good support organization for family members who have loved one with mental illness.

>> What I like about NAMI with the resources is they're not politically biased.

>> Many associations where I'm reading on the websites are very politically charged right now and I wouldn't recommend going to those because you have to keep digging and digging to find the information you really need to get past the politics that they're trying to convey.

NAMI is not doing that.

NAMI gives you very good information on speaking to family members with various mental illnesses, especially bipolar disorder.

They give you resources giving you easy to understand complexities of bipolar disorder itself, how it's treated, why it occurs and what are the genetics and the likelihood of another family member experiencing it and what you could do as a family member.

Now if you go to the website you can also find that there may be a NAMI group that meets on a periodic basis in your area.

So if you can attend a Anami group that's free of charge is something that is across a lot of communities in the United States.

But that would be the best resource that I'd recommend for a loved one with bipolar disorder.

>> Thanks for your email.

>> Let's go to our first caller.

Hello Olivia.

Welcome to Mars The Mind Live.

You want to know what are the what are spring bipolar manic episodes when somebody has what's called seasonal affective disorder seasonal affective disorders where people will have mood disturbances based on the season now about four to five people that have this condition will know as they get more depressed in the winter time and more hyped up in the spring and that's what you're describing.

>> Some people will get more hyped up in the winter and more depressed in the spring.

It's quite rare.

Only about one out of five people with seasonal affective disorder will have that.

But most people get more depressed in the winter usually from October until about April around April till July or August they can get more manic.

So it's where people will distinctively have manic episodes in the spring and early summer.

And while these manic episodes how are these manic episodes characterized decreased need for sleep impulsivity, racing thoughts, fast rate of speech and generally doing things and saying things they ordinarily wouldn't do or say and the problem they'll often experience is periodically they will crash into WLOS is not like somebody who's using cocaine .

If somebody uses cocaine they'll feel really hyped up and energized for a while but then the is crash your brain can only function on that much high activity for a while so bipolar mania is where if somebody's sky high and it's thought that when people have seasonal affective disorder they're more sensitive to the sunlight.

So in the wintertime if they have winter depression typically they will get more depressed in the winter time because there's less sunlight and then in the spring they're more sensitive to that sunlight and they'll get more hyped up and more energized during that time it is treated sometimes with mood stabilizing medication.

I'm not going to recommend that people stay out of the sun in the springtime if they have spring manic activity that is a contributor.

I'm going to recommend somebody get on a mood stabilizer if they're having spring manic activity and what's it mean?

>> I mean when you're manic in the spring, shouldn't we all feel more energized and more enthusiastic in the springtime?

In summer we should because yeah, it's nicer weather.

We're typically more physically active.

>> We're more socially active at least here in Indiana in the spring and summer.

So we tend to be around people more and that's a good thing.

>> So you don't want to mitigate that in any manner.

But if somebody is having manic episodes to a problematic degree where they're getting in trouble with spending and doing things and saying things they ordinarily shouldn't say, that's where they will benefit from.

A bit of a mood stabilizer and a mood stabilizer is basically a cruise control on the mood to keep them from going too high, keep them from going too low and just allowing them to have the normal fluctuations which are called vicissitudes of the mood itself.

So you should feel happy when you have happy circumstances occurring.

You should feel sad when disappointing circumstances are occurring.

So you should have these normal fluctuations of mood that are there that's perfectly fine.

>> It's where they're unnaturally high, unnaturally low and they're getting you into trouble.

>> That's where they're problematic.

Thanks for your call.

Let's go our next caller.

Hello Paul.

Welcome the mastermind Paul you are can a high caffeine levels cause panic anxiety attacks as I take a sip of my caffeine high caffeine levels were there too high?

>> You they can cause you to have an increase in dopamine and norepinephrine and by doing so with some people if you go a little bit over the top in terms of where you should be getting the norepinephrine and dopamine that will make you kind of shaky and hyper and irritable sometimes will give people headaches while they're using the caffeine.

Sometimes when they're withdrawing that can be the factor the main purpose of caffeine for people if they use it at appropriate amounts under 400 milligrams a day typically would be that it allows your brain to be awakened as you go through the day you're brain will give off this these exhaust fumes called adenosine when adenosine is released more and more and more goes to adenosine receptors and it makes you slowly more tired.

>> What caffeine will do do is go to the dentist and receptors and fool the adenosine receptors thinking through adenosine and basically blocking the receptor so that you feel more awake and more alert.

That's OK. That's the whole purpose of an appropriate use of caffeine.

When you get too much caffeine it goes beyond just blocking the adenosine receptors and it starts to affect norepinephrine and dopamine and in doing so it can give you a faster heart rate tremors, irritability and anxiety.

So that's where you going to go over the top back off on your caffeine intake if you notice that's happening.

Thanks for your call.

>> Let's go our next caller.

Hello Tim.

Welcome to Matters of Mind.

>> Tell me you to know what is antisocial personality disorder and what can you do to help your teen be more social?

>> I think you're talking about two entirely different phenomena there, Tim, because antisocial personality disorder is where as the name implies you're doing things there are directly opposed to societal norms and legal norms.

In other words, people antisocial personality disorder don't care what the consequences of their behaviors are on other people.

They're going to do it anyway so they will lie cheat, steal and they will very much violate the boundaries of other people and the social norms that we would expect and they get involved in a lot of illegal activities.

That's anti-social personality disorder.

They don't see a problem with it.

>> They get in trouble, they get arrested and it's very difficult to treat because they don't often see it to be a problem.

>> You're referring to your teen being more social.

That's not anti-social here teen might have some social anxiety adolescence.

My goodness.

it's normal to have some anxiety during adolescence not only for academics and getting through life but also you're trying to learn social nuances and you're trying to mirror behaviors of others to try to be able to connect as we all go through our adolescence, our front part of our brain is growing and growing and growing and it doesn't fully grow into you.

Twenty four years old.

So as the front part of the brain is growing more comfortable with stresses and in situations that might involve socialization and so forth because you have practiced doing it.

>> So the first thing you can do to help your teen become more sociable is to try to get your teen out and about more and more people to be able to practice those kind of social activities and also mirroring your behavior so you can go with your teen to try to do simple things and teach your teen how to shake hands.

Look at people in the eyes, greet them by name and interact with them in an appropriate way and it's a practice over the course of time and the idea will be that your team will be more sociable and be able to feel more comfortable in social environments.

Where I'm always concerned is where I see adolescents at thirteen fourteen years of age.

They're anxious about life or anxious about their academics.

They're anxious about their friends and their social situations.

They're anxious about a lot of different things where you're supposed to be anxious when you're an adolescent for one thing.

But if you start using marijuana as an adolescent you don't care and you use marijuana to socialize and you used to be alcohol but now it's more marijuana.

Adolescents and young adults aren't using as much alcohol now as they did twenty , thirty years ago.

I've seen a lot of marijuana use but the problem is marijuana use is more toxic to an adolescent brain in my opinion than alcohol because marijuana use will slow the development of that brain and they'll really lack emotional maturity.

They don't learn how to naturally feel comfortable in the presence of others so if somebody starts using marijuana as an adolescent to get through the social anxiety that they should normally endure and be able to overcome, they will notice that when they get in their 20s, their 30s, their 40s even they can still feel very, very uncomfortable in social situations because they didn't learn how to socialize without the use of the marijuana.

So I'm always warning people about using medicinal means of helping them with socialization in that manner.

>> Tim Tim, thanks for your call.

Let's go next e-mail question.

Our next e-mail question reads during the favor can you explain the uses, doses and drug interactions with a supplements?

>> Atul Gonda Berberian and NASSI and Acetylcysteine?

Well, OK, let's give it a try as I get these questions all the time as a psychiatrist because I have to be aware of drug interactions but I'll give the disclaimer that I often give many people always talk to your primary care clinician before starting a supplement to make sure it's in your best interest medically overall.

But I have to be aware of these interactions and the uses of these many of these supplements because they can affect the medications I'm prescribing.

>> So let's start with regard to actual Gonda as basically available for something for the purpose of helping you put up with stuff better.

It helps with stress tolerance for a lot people.

>> It affects people differently and I think a reason it does is because it will increase the availability of your thyroid hormone.

So if you're high normal on thyroid already Ashokan it can actually increase the activity of your thyroid and make you anxious and hyped up and give you a fast heart rate.

>> It's probably because the indirect effect on your thyroid itself it actually on to itself outside of thyroid doesn't seem to interact with other medications that we're using.

But Ashwell is dose you'd asked about the dose depends on what formulation you use but a lot of formulations it's around three hundred milligrams twice a day but it's something that is used for the purpose of helping some people with stress tolerance.

But what I like about got it for a lot of people is that it does possibly decrease cortisol levels pretty good studies out there showing that it might decrease cortisol levels.

So when you're under stress you're having a hard time Bonalbo stuff as we're going to might be able to decrease cortisol levels and it's thought that increased cortisol can be a precursor to diabetes because higher cortisol increases blood sugars.

So if you're under stress, stress is increasing cortisol.

Astrachan might suppress that.

So that's the use and benefits and the doses of Brigada you'd asked about Burberry and Burberry is something that's been discussed for about the past five or six years now quite a bit.

It's an interesting verb in itself.

It's a yellow or in the capsule but it's something that's typically dose five hundred milligrams twice a day with food because it makes you feel to decrease the stomach motility so it decreases the emptying of the stomach.

But it has a lot of discussions in the past few years because it has some similarities to the very popular GLP one agonist the glucagon like peptide type one agonist like Zembiec that you might have heard about some glutamate but it has some overlapping effects with that in the sense that it's it's suppressing the release of glucagon in the pancreas and glucagon increases blood sugars it it increases insulin and increases insulin sensitivity not unlike metformin might do so when we talk about a supplement like Burberry and you have to be careful about using it with metformin or any other medications that are decreasing blood sugars because it might decrease blood sugar excessively.

So if you're using Berberian you might want to keep an eye on your blood sugar with a fingerstick on a regular basis to make sure your blood sugars are going to low if you feel weird or awful with Barberini it would be due to your blood sugar decreasing too much or maybe your blood pressure decreasing too much because it can also decrease your blood sugar or blood pressure by expanding the blood vessels and causing vasodilation.

So that can be a factor as well.

It can decrease your blood sugar and decrease your blood pressure and its potential uses also the possibility of partially decreasing the lipids in your system and decreasing cardiovascular risk not that it necessarily would replace statins for everybody, but that's something to be careful about.

Berberian is something that will interact with pretty much anything.

>> It can basically increase blood levels of many, many different medications.

How much is a clinically significant that's always a judgment call but it can mildly inhibit the breakdown of medications in all sorts of different metabolic pathways in the liver.

So if you're on various medications and you take Berberian the blood levels of the other medications might increase a bit and you might say well gee, I feel lousy in this way or this way it could not be it might not be the Berberian it could be the increase in blood levels of the medications and you mentioned Nick in Acetylcysteine in acetylcysteine usual dosages 600 milligrams twice a day.

>> It's a byproduct of cystine which is an essential amino acid glutathione glutathione is an antioxidant that it produces so it produces lithium.

That's a very strong antioxidant.

So it basically cleans up the junk in the body and it's thought to stabilize glutamate.

So it's thought that when people have schizophrenia bipolar disorder which we discussed earlier that one of the mechanisms for having that particular condition will be they have excessive glutamate transmission glutamates excitatory and it doesn't get cleaned up adequately in the brain.

So if you use an AC that can help clean up the excessive glutamate in the brain and also like Astroglide can help you with putting up with stuff better and it's all to help with respiratory conditions of people who have trouble breathing.

>> They can use in AC we're using AC six a.m. and grammes twice a day typically for somebody with obsessive compulsive disorder where they have these ongoing obsessions they just keep thinking about stuff and thinking about stuff they can't get them off their minds and then they will have compulsions where they do things unnaturally over and over again.

So Nasci has a lot of different uses.

>> Where wouldn't you use an AC if you have a sulfa allergy in AC is related chemically to Saffa so if you have a sulfa allergy you should not use AC.

>> You can get a rash from it if you do so that's the kind of overview with regard to Berberian and in a scope out opt out.

Let's go our next caller.

Hello Matthew.

Welcome mastermind.

>> Hey hey Matthew.

Good good to hear from you.

Yeah, I was talking about depression.

I have OCD but I've called before you know I'm taking medicine is a venlafaxine and I wanted to take Luvox.

Mervi recommended that a long time ago and my doctor won't let me take it out.

She recommends I don't want to take Venlafaxine and Luvox.

It doesn't matter.

The point is none of these medicines have ever worked.

I mean I'm depressed.

My life is over.

I mean I have a place to live.

I have food, I have medicine but I see no there's no nothing's going to change and I'm alone and I'm depressed and I think about, you know, suicide quite often I would never do that.

But I do think about it.

I'm just more really depressed and I think there's no reason for me to be alive.

>> Yeah.

Barthe you have a common symptom and people will often experience with depression where they they're not wanting to kill themselves and that's what you're describing, right?

You're not want to kill yourself.

You just don't see any purpose in life at this point.

>> Yes.

Yeah.

So the first thing I'd recommend for you, Matthew, is make sure that you do have a safe environment in the event that you ever do get to the point where you actually think about suicide or carrying through, you can always contact a local mental health center, contact your therapist or your doctor if you're in that position.

>> But do you have a therapist at this point, Matthew?

No, I've tried it was meaningless.

You know, they just told me to go home and don't have OCD.

>> Yeah.

As you might want to try somebody different and sometimes people will recommend a case manager in this kind of situation.

A case manager just helps you with day to day functioning.

You have a place to live.

Yeah, we get that.

But you also need to have some kind of meaningful activities on a day to day basis.

For instance in the Fort Wayne area we have some organization called the Fort Wayne clubhouse also known as the Carriage House and it can be a very nice venue for somebody on a regular basis to attend because it gives them a sense of belonging and gives them a sense of meaningful activities, gets them around other people that might have various conditions.

So you can always contact your clinician about other possibilities venlafaxine Effexor and yeah, that helps with some people.

But keep in mind Matthew, we have my goodness twenty nine different medications we can use now for depression.

So if one doesn't work off of will go to a different mechanism of action.

Luvox Flu Vaccine is the chemical name of that show that's been around for a long time.

Very good for OCD but it does have some drug interactions where it can increase blood levels of various other medications and that sometimes will be a reason why it's not used.

But I would suggest to you, Matthew, don't give up at this point.

>> Try to contact a mental health clinician, somebody maybe you've not seen before.

Ask your clinician about other possibilities in terms of where you could who could see for talk therapy.

Group therapy can be helpful and like I said, if you're in the Fort Wayne area, the Fort Wayne Carey house or clubhouse would be a good option for you and get involved with that you'd contact a local organization like Park Center which we have here in the Fort Wayne area.

But that would be a good possibility for you, Matthew.

But like I said, don't give up at this point.

The field of psychiatry is booming right now with possibilities for people with depression.

We have all sorts of treatments now that we didn't have as recently as five years ago.

So there's a lot of reasons to have a lot of hope at this point.

Matthew, thanks for your call.

Let's go next caller.

Hello, Don.

>> Welcome to America.

Mind you this is Don.

Hello, Don.

No, I'm here so phrenic.

I've been diagnosed with schizophrenia for forty five some years and is there a cure for I've been taking matters and inveigle injections most recent and as their natural cure for because I feel I don't need to Madison anymore since the first of the year.

>> Well does that mean that you're feeling pretty normal?

You could do the things you want to do.

You can think clearly you're maybe not hearing voices.

>> Are you saying you're doing pretty well at this point?

Yeah, and I I've been monitored by part.

That's fantastic.

Well done a lot better.

Yeah.

Schizophrenia was been geared.

>> I don't need them.

Well the good news is you're doing well Don.

That's fantastic.

However you're doing so well right now quite frankly because of the medication it's kind of like somebody with epilepsy Don.

I use that analogy earlier when somebody has epilepsy and they're free of seizures, that's wonderful.

But if they had seizures previously again and again and again and they are free to seizures now they might need to stay on the anti seizure medication for the time being.

>> Schizophrenia is a long term condition.

OK, that's the bad side of it.

I mean you have to take a medication ongoing but you're taking in Vegas it's easy to use in Vegas because you just go in for your injections and that's it.

>> Now what sometimes will happen they might lower the dosage a little bit on the Enviga as you're doing well but you might be doing so well because you're at the right dosage.

So I think that's fantastic.

Darn it, you're actually doing so well.

You're wonder has this medication doing anything anything more me it probably is at this point such that you are doing well.

The risk of your going off the medication entirely, Don, would be you could have a relapse and have another episode of psychosis.

>> Don, thanks for your call.

Unfortunate I'm out of time for this amount of time for this evening.

>> If you have any questions concerning mental health issues you may write me via the Internet at matters the mind at Organized to see if I can get to your question on the air.

I'm psychiatrist offer and you've been watching matters of mine on PBS for Wayne now available on YouTube.

>> Thanks for watching.

Godwill on PBS will be back to you next.

Good night