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>> Good evening.

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

Welcome to Matters of the Mind.

Now in his twenty fourth 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 the Fort Wayne Area (969) 27 two zero or if you're calling coast to coast you may toll call toll free at night 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 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 a talk that's matters the mind at WSW a dog and I start tonight's program with a question I recently received.

>> It reads You're not a favor.

Can painkillers like Ibuprofen and Tanel be taken with Lexapro, ibuprofen, aspirin, different nonsteroidal antiinflammatory medications, Advil, Aleve, those type of medications?

>> They can inhibit the stickiness of the platelets as can Lexapro and the way Lexapro will do it when platelets get sticky what they're doing is they are vacuuming and serotonin the platelets so the platelets get sticky by vacuuming and serotonin then they get sticky.

>> If you block the vacuuming of serotonin into platelets they don't get a sticky and you have well less ability to bleed or or less ability to clot your you're bleeding and you bleed more.

>> So people on Lexapro for instance are Zoloft, Paxil ,Prozac, Celexa.

These are medications that all can have this same effect on blocking the vacuuming of serotonin into the platelets as well as the neurons and that's how the medications work in the nerve cells they block the vacuuming of serotonin back into the firing nerve cell allowing serotonin to bounce around longer in the periphery of the brain and thereby increasing transmission of serotonin at the platelet level.

>> They will block the serotonin being vacuumed into the platelet making the platelets less sticky.

And that's why some people as a side effect from these so-called serotonin antidepressants like Lexapro as a side effect they can have petechiae where they get little red spots on them or they get Brous ability and some people can have difficulty with GI or gastrointestinal bleeding and they get ulcers and things like that because they don't clot or bleeding.

>> Ibuprofen works on prostaglandins as does aspirin and the so-called nonsteroidal antiinflammatory medications you often get over the counter not so much for Tylenol, Tylenol or acetaminophen doesn't work in that similar way.

>> So comparatively the nonsteroidal anti influenza nonsteroidal antiinflammatory agents and aspirin for that matter will will inhibit bleeding to some degree by working on prostaglandins so you can have a little bit of an interaction there.

It's not a horrible interaction.

There's always different degrees of interactions.

>> Sometimes you absolutely positively never want to take two medications together so you would never want to take a medication like a monoamine oxidase inhibitors like Nardil Pronate Marlan these are old medications have been around for a long time.

You don't want to take those with antidepressant medications because you could have a potentially very toxic interaction that way.

>> Aspirin you've got to be careful with aspirin if you take it with Advil and you take it with Aleve and the nonsteroidal antiinflammatory medications like that because those medications can increase the lithium levels not as bad of an interaction as the other one with monoamine oxidase inhibitors but some interactions you just need to avoid more than others.

It wouldn't be absolutely positively contraindicated or inappropriate to use something like ibuprofen with Lexapro.

Just be aware you might have more bleeding with that if you notice that it's easier to bleed or you have a little red spots on onon.

>> Worse yet if you're vomiting blood or throwing out blood that means you are not getting adequate clotting of the of the little blood vessels in the stomach and that would be a reason to go off of the ibuprofen at that time.

Thanks for your email.

Let's go to our next email.

>> Our next email reads Director Fauver, what are some options for pregnant women who are dealing with anxiety and depression the best option for pregnant women dealing with anxiety depression will be to have talk therapy or counseling get some kind of some kind of support especially from their families to be able to exercise the best they can within their abilities and capabilities, physical and emotional while they're depressed and anxious during pregnancy.

We do use medications during depression when you're depressed and anxious during pregnancy, what are the safer medications out there for anxiety, depression during pregnancy and actually during breastfeeding?

And we always consider breastfeeding period as well will be Zoloft.

Zoloft is also known as virtually has been around since nineteen ninety two .

It's been well studied during pregnancy and during breastfeeding and found that during pregnancy you have less in five during pregnancy it does not seem to cause any difficulty with long term problems with the baby's development and during breastfeeding it's less than five percent excreted from into the milk from the blood.

So it's thought to be very safe during pregnancy and breastfeeding for that matter.

So Zoloft is probably where we'd start.

Celexa would be another option Celexa and Zoloft or the so-called serotonin medications are so certain Riptech inhibitors so they both work in a similar matter by increasing serotonin in the system and they can help you get a calming effect that way.

>> A medication we might use especially if a woman is having a lot of difficulty with sleep and anxiety and even moodiness and irritability will be Seroquel also known as quote typing Seroquel is a medication has been around since about nineteen nineteen ninety eight I believe it came out and it's been well studied again during pregnancy well steroid study during breastfeeding so that's an option for us as well .

If you have anxiety and depression and it's related to difficulty with concentration focus or maybe you have a long track record of attention deficit disorder we might use a medication like Wellbutrin, Wellbutrin, bupropion that too is very safe during pregnancy and breastfeeding.

Wellbutrin is a medication doesn't have any serotonin effects but it has more norepinephrine and dopamine effects and thereby can help more with energy get up and go.

It can help with concentration attention spans.

We'll use it for people who have a very tired blah feeling of depression and they specifically can't concentrate during practice, during pregnancy and thereafter breastfeeding.

So those are for medications will often Zoloft, Celexa, Seroquel and Wellbutrin.

They all appear to be safe during pregnancy and breastfeeding and that's where we'll often start will first examine if someone has taken those medications in the past if they've worked for you previously, chances are they'll work for you again and that's where we'll often start and we look at the pros and cons have taken having a woman take any medication during pregnancy.

Ideally we want a woman not to take anything during pregnancy especially the first three months the first trimester that's when the baby's body is developing and that's especially when the brain is is developing.

>> So we'd like to keep people off the medication the first three months but we recognize that a woman who is depressed is going to be more likely to have a baby with a smaller head and a smaller brain.

So depression itself is transgenic or dangerous to the baby.

So we don't want a woman being depressed during pregnancy.

Thanks for your email.

>> Let's go to our first caller.

Hello Karen.

Welcome to Matters of Mind.

Hi.

Hey.

I know you say take vitamin D and I have for years and however much you said I should but I threw my stinking bottle away and I forget how many milligrams that I'm supposed to be by and I know you said a minimum of something or I don't know what years ago but yeah I threw my bottle of wine.

>> I soak it in.

Well the good thing here and it's getting to be spring time so you might not need as much vitamin D as the year goes on.

I take five thousand units every day throughout the entire year.

That's a little bit on the heavy side there are two thousand units is perfectly safe for almost everybody.

My goodness.

Always talk to your primary care doctor about that to see what doses might be best for you.

>> But here's how it works Karen.

You can get a blood level.

We don't give blood levels so often any more on vitamin levels.

I always liked it when I could get a blood level.

But insurance often don't cover the blood levels now because quite frankly up here in northeastern Indiana a lot of people are low on vitamin D especially in the summertime.

Now if you go out into the sun shine in the summertime for no more than twenty or thirty minutes my goodness you can get a blast of vitamin D of about twenty thousand units right there by being out in the sun.

So if you go out in the summertime and get some sun exposure you can get quite a bit of vitamin D levels there.

>> But the problem is when you get that exposure to the sun there is that slight risk of getting skin cancer.

>> So that's a big problem in itself.

So it's easier just to take a very inexpensive supplement vitamin is actually considered to be a pro hormone where it actually it breaks down into another hormone.

We call it a viable vitamin but it's actually a hormone.

>> It's manufactured in the skin upon exposure to ultraviolet light.

>> But in the pill or a little beed capsule form you can get adequate amounts but two thousand units every day is perfectly safe for a lot of people.

If you have a vitamin D level of twenty five let's say if you take two thousand units theoretically that'll take you up to forty five on the vitamin D level ideally we want that level around forty five fifty five or more so we want that vitamin D level at least forty five if not fifty five for a lot of people when I checked vitamin D levels for a lot of my patients I found that a lot of them are in the single digits and the winter time and those people not uncommonly they'd get this dosage of fifty thousand units of vitamin D once a week for about eight weeks or so to get their vitamin D level up quickly.

But if you just want to have something year round a real safe dosage is two thousand units every day.

Like I said five thousand years every day is a little bit more the aggressive side and I certainly recommend that for people in the wintertime.

>> Now why would vitamin D be recommended?

No one it has a lot of mental health benefits.

They did a big study in Denmark years ago where it gets really dark in the winter time and they found that people who are admitted to the hospital in the winter time especially had by nature lower vitamin D levels.

So they actually correlated low vitamin D levels with more depression in Denmark.

So as a psychiatrist, yeah, I see that as a factor.

>> Also attention deficit disorder people with ADD or ADHD where they have trouble with focus, concentration, attention span, distractibility they typically can be benefited with a couple supplements vitamin D being one of them but also zinc zinc for some reason and will help somebody with vitamin D will help with ADHD and zinc at fifty milligrams a day can be helpful for those people but vitamin D recommended for people with ADHD and it's also thought that if you have adequate vitamin levels you'll have decreased risk for cancer and a lot of other medical conditions.

So vitamin D is a very safe vitamin also known as a hormone to take long term you can get vitamin toxic if you just take ridiculous amounts of it and because vitamin D is a fat soluble vitamin vitamin D and E are the are the fat soluble vitamins.

They go to the liver, they can build up and accumulate.

>> So you don't want to take really extraordinarily high amounts of vitamin D daily but at least twenty minutes every day would be adequate.

A lot of the multivitamins only have 400 international units of vitamin D and so for a lot of people it's just not enough to take a multivariate and people say well gee what about the vitamin D in milk a very slight amount.

What you really need is consistently twenty five thousand units every day and for some people I've seen it help their mood.

>> I mean some people who traditionally will get winter depression and every winter they're down the dumps and they're predictably depressed from October until about April those people benefit significantly from vitamin D and a lot of cases so we'll often recommend vitamin D No.

One, we recommend exercise of the people with winter depression.

We recommend a light box where they sit in front of really bright light a couple of feet away from really bright light box every morning for about twenty minutes day by day by day of the winter that'll help with winter depression and socializing being around people and doing things, being socially active, interacting with people can be very, very helpful for people with winter depression in addition to vitamin D exercise the lightbox that's a good way to get around the winter depression for a lot of people.

I always enjoy going up to Minnesota or Wisconsin in the wintertime because when I've gone up there it's just amazing how they embrace their winter times with social and physical activities.

>> They're having festivals up there in the wintertime.

They really embrace winter events as a means of getting through their long winters and their winters are darker as well because the farther north you go the darker it gets and that's why some people can go south and they go to Arizona, they go to New Mexico, they go to Florida, they go to Texas and they migrate south during the wintertime as a means of dealing with the darkness of the winter because with winter depression it's thought that it's not the vitamin D levels exclusively.

>> It could be the brightness around you so and the dark days of winter you have less light getting to your eyeballs and your eyeballs are right up here in the front of the brain and the middle of the brain is this little pineal gland right smack in the middle of the brain.

>> It's like a gland and the pineal body of the pineal gland will secrete melatonin and when it secretes melatonin you get tired and sleepy and that's why melatonin for some people can help them get a sleep.

>> We get excessive melatonin released in the winter time when it's dark outside because melatonin is known as the vampire hormone.

>> It goes it it goes up when it gets dark and it goes down when it gets bright.

So I guess getting up when it gets dark makes it the vampire hormone but the higher melatonin levels in the wintertime tend to make people more tired.

They more sleep, they want to socially withdraw and some people in the wintertime can get really depressed.

>> Depression in the wintertime occurs in about four times more so than women than men for some reason.

>> So women are really prone to having winter depression but a way to get around that is to take vitamin D. >> It's a simple supplement.

It's except only unusual to get any side effects from vitamin D simply because it's something that you naturally would get secreted in your skin upon exposure to the sunshine.

>> Karen, thanks for your call.

Let's go to our next e-mail.

Our next e-mail reads Deirdre over how do you know when a person is getting over a mental illness?

I've been I've had depression for several years and seem like I'm getting stuck.

>> A way to measure depression will be the outcome metric scales that we often use.

>> For instance, it's free it's online as an outcome metric.

It's nine called a Q nine .

>> It's called a patient health questionnaire nine nine there's nine questions and those nine questions basically ask you how you been doing for the past two weeks?

You're rating your scores on zero to three zero being you're doing great.

>> No problems.

Three is those kind of symptoms are there every day and a Q nine is a very simple way of assessing do you have clinically significant depression?

It's a self rating scale.

You do it yourself and if you have a score over ten especially it's probably indicative that you have some degree of depression there if those symptoms are there day by day by day for at least the past couple of weeks and that's where it's a clinically significant depression.

I will have my patients track their lives every time they come in to see me they have to fill out a canine so it's something they do on a regular basis to track the severity of their depression.

We love to see those canines in single digits ideally we want to even see them under five.

That means you're doing really well but when you get that canine above 10 it goes up to twelve but ten or more can be significant for depression.

So one way to know if you're getting better or not with your depression is by tracking your canine.

And like I said, we do have in our office and I saw a person today, for instance, whose canine went from 18 to 12 since in the past two weeks since I had seen her and she didn't know if she is any better or not.

But based on the canine that's a start.

The score itself showed that she was indeed doing better and again I'm not reading that she was reading that.

So the nice thing about Page nine , it's not my perception about how somebody is doing.

It's their own perception on how they're doing overall.

>> So the canine looks at symptoms such as any sleep disturbances, anxiety, trouble with concentration, sadness, difficulty with enjoying things just some general symptoms for depression.

Another thing will often examine when somebody is recovering from depression is their sleep.

>> The sleep is a very sensitive barometer on your overall mental health .

If you have trouble getting to sleep for instance, it's often indicative that you're having some anxiety that's still there because you're still thinking about stuff during the day.

People with attention deficit hyperactivity disorder will also have difficulty getting to sleep because they have a hard time shutting their brain off at night.

Their brain just goes and goes and goes.

If you have depression you'll often have difficulty with sleep by awakening in the middle of the night or too early in the morning, night by night by night your waking awakening at four a.m. and you mean to get up at seven a.m. that middle or so-called terminal insomnia is what we call it and that's an indication of depression in itself.

Another way to look at the sleep pattern will be if you're having nightmares, if you're having a lot of nightmares that could be related to you having a post traumatic event and PTSD people with PTSD will often have nightmares that will startle them awake now dreaming I always emphasize to people dreaming is perfectly normal.

You want to be able to dream because dreaming will fire up this part of the brain in here called the hippocampus and attacks is good for the memory.

>> So dreaming is great.

The dreaming that wakes you up screaming that's a nightmare and that's not good for you and that's where you can have post-traumatic stress disorder and for those people we actually try to suppress their dreams.

>> So one way to determine if you're getting better and recovering from depression would be to look at a conine look at your sleep overall but very importantly look at your overall functioning.

>> A huge factor and a huge measure of somebody's recovery is what kind of things you do in day to day.

Are you socializing with other people?

Are you doing things that used to be fun?

I asked that to a lot of people.

What do you used to do that was fun that you're not doing anymore that the press that you're depressed if you're giving up pleasurable activities while you're depressed you're more likely to stay depressed because giving up pleasurable activities will keep you depressed and people give up things that used to be fun when they're depressed and it's important to try to get back into those kind of activities that you used to enjoy.

And if you're starting to do those, that's a very good sign.

>> Once you start exercising again and getting more physically active now that can help you recover from depression but it's also a sign you are recovering from depression when people get depressed one of the things they'll quit doing are things that used to be good for them.

They start to eat poorly.

They don't exercise as much.

They don't stay as physically active and they kind of go downhill from there and that makes them more and more depressed.

>> It becomes tough to get back into a healthy habits again because when you're getting depressed you might you might gain some weight, you might have some sleep disturbances.

One thing leads to another you just don't want do the things that you used to enjoy doing and that used to be healthy for you.

So you start giving up on those things and that causes you to be more depressed in the long run.

>> So a factor that we will often consider in terms of somebody recovering will be their overall functional activity, their socialization, their exercise how are they eating their eating habits improving and also what's their work or school productivity like because when somebody is depressed they'll often miss a day here.

They'll miss a day here, they'll miss two days here and they're missing days of work and a key indicator that somebody is recovering from depression will be when they're doing better in school or missing fewer days of work and they're more productive in general.

>> So those are the kind of factors will kind of examine outcome metrics, a person's exercise and dietary habits.

We'll look at kind of things they used to do for fun if they're starting to do those type of things and just how well you're doing and at work and in school and the kind of things that you're expected to do on a day to day basis to be productive.

>> Thanks for your email.

>> Let's go to our next caller.

Hello Todd.

Welcome to Matters of Mind.

Yes.

Wouldn't such teams come from where the dreams in general come from?

>> Todd where they come from is right up front here when you're having dreams at night time, Todd, what happens is this front part of the brain right up here starts to shut down so this part of the brain needs to rest at night time and that's what happens when you dream.

So whether they're one type of dream or another type of dream, they're coming from right up there now is the part of the brain, Todd, that you use to really focus on something and pay attention to things very closely and you're trying to follow something that might be difficult to understand and this is the part that's left front part of your brain.

You're really trying to hone in on that and that's highly active when somebody is trying to concentrate on things and pay attention people with depression and people with attention deficit disorder lack activity in this part of the brain.

>> So it's very, very active and very, very engaged and energized throughout the entire day.

>> So what happens?

You go to bed at night and you sleep so it takes about an hour and a half to get into your first dreams when you first go to bed about thirty minutes to forty five minutes then you're going to get into your first really deep sleep.

>> Deep sleep is known as slow wave sleep.

>> That's where you're dead to the world if you get awakened during that time you happen to wake up during the time for just a few seconds.

>> You're kind of confused on where you are because you're it's such a deep sleep.

You're awake and you're very confused on where you are.

That's your deep sleep that kicks in and about thirty minutes after you go to sleep then about an hour and a half later you'll have your first dreams and during that hour and a half you'll have your first dreams and their next set of dreams might be an hour later as the night goes on the dreams become more frequent and they become more prolonged.

>> And when you have dreams of a particular type sometimes it's related to stuff that happened during the day or particular concerns that you're having.

The key with dreams, Todd, is that they are very abstract, they're very figurative.

They will represent stuff that well might not appear to be what you think they might be just by looking at the content of them.

So when people awaken from dreams the dreams are like a puff of smoke.

>> They're there very briefly when you awaken in you remember them and then if you don't think about them for a little while longer they just kind of go away and by ten o'clock in the morning after you've been up for a few hours you think I don't remember what I dreamt about and that's because dreams you tend to forget your dreams very quickly unless you write them down or you really put some thought into what you had as a dream right when you first get up.

>> But dreams are very abstract .

>> They mean something underlying.

They usually represents what happened in the past day or so.

So as you dream throughout the night closer to morning the dreams are more about today.

The most recent events the dreams you have earlier in the night are usually about past events and you have more recent event dreams as you get closer to awakening.

But when you think about dreams ,think about how they might represent stuff going on in your day to day life and you can have different things happen in your day to day life .

>> What can those dreams really represent?

Some people get really upset if they have particular dreams about somebody in their life and they wonder of gee do I really think that way about this person it might not be that person about whom you're thinking it's who that person represents to you so that person to you might represent a father figure, a brother figure, somebody in your life .

But it's not that person specifically about whom you're dreaming.

So you always have to remember that dreams are very, very abstract.

As I mentioned earlier, Todd will sometimes give people medication to specifically suppress their dreams if they're having very traumatized dreams.

>> But as people get older and they get into some trouble with having Alzheimer's dementia, this part of the brain over here, the memory center, the brain starts to shrink and what happens is an aftereffect of that they tend to dream less so as you develop Alzheimer's dementia and start having memory problems, you tend to dream less because dreamings will tend to help download our memories.

>> Todd, thanks for your call.

Unfortunately, unfortunately I'm out of time for this evening.

>> If you have any questions concerning mental health issues and I can answer on the air you may write me a via the Internet at matters of the mind all one word at a drug.

>> I'm psychiatrist Jay Favorite you've been watching matters the mind on PBS Fort Wayne God willing and PBS willing.

I'll be back again next week.

Thanks for watching tonight