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>> Good evening.

I'm psychiatrist Jeff Olver live from Fort Wayne , Indiana.

Welcome to Matters of the Mind.

Now its 24th 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.

PBS for Wayne by dialing in the Fort Wayne area (969) 27 two zero or if you're calling any place else coast to coast you may dial toll free at 866- (969) 27 two zero.

>> Now on a fairly regular basis where our broadcast live every Monday night from our spectacular PBS Fort Wayne studios which lie in the shadows of the Fort Wayne campus.

>> And if you'd like to contact me with an e-mail question concerning mental health issues that I can answer on the air or you may write me a via the Internet at matters of the mind all one word at W f w a drug that's matters of the mind at WFYI Edgar and I start tonight's program with one of a couple of questions that I received over this past week.

This reads Dear Dr. Fauver is multiple personality disorder the same as split personality?

Split personality was a term that was used years ago for people with schizophrenia and it didn't take a lot of sense because basically a split with schizophrenia was a split between the emotions, the emotional expression of how somebody feels and what they were actually thinking and was thought to be a split with schizophrenia.

>> There is a problem with expressing emotion, difficulty with processing thoughts, information, difficulty with motivation and initiative and being able to concentrate and also the classic hallucinations and delusions which are the fixed false beliefs that people will often have schizophrenia multiple personality disorder is quite different with multiple multiple personalities or somebody and it's commonly a woman has been traumatized in some sense and during that trauma she adapted by dissociating or removing herself from the situation and in many cases going into a different personality as a means of coping.

>> And what happens if somebody has been traumatized in early childhood?

They will continue this coping technique later in life when they get under any stress so the slightest stress comes can sometimes trigger a person to go into this personality and it's typically a childlike personality.

Another personality might be more of a domineering personality.

You might have a more seductive personality.

You have all these different types of personality on the average there might be three personalities but some of the more dramatic cases such as the the case of Sybil that was made into a movie years ago that was based on a novel and a true story she had several different personalities.

So these different personalities in which people will dissociate are kind of blank out and go into will be personalities where they don't realize they're doing it until they come out of it later on they realize there in a different spot they're in a different place and they can't recall what they've been doing for the past six minutes or in some cases even hours.

So people have these little spells were under stress.

They forget what they've been doing and they go on to a different type of personality.

People will say that they have different voices during those time they will have a different expression of their voice of a different intonation.

They'll have a different volume to their voice.

They might be more assertive, they might be more passive but there's a distinctive change in their personalities.

So with multiple personality disorder also known as dissociative identity disorder that's a more common term.

Now that's a very rare phenomenon particularly occurs with women who have been traumatized is where they go into one personality or another and it's quite different from split personality which is an old outdated term for schizophrenia.

>> Thanks for your question.

Let's go to next email.

Our next email reads Dear Doctor Father, my wife is taking Lexapro and is having negative sexual side effects.

She doesn't want to take something else because she has no other adverse reactions than the sexual side effects.

>> Is there a way to treat the sexual side effect while staying on Lexapro, Lexapro mainly is increasing a chemical called serotonin and serotonin will affect selective parts of the brain but indirectly if you increase serotonin transmission and you specify hit fourteen different serotonin receptors which is what Lexapro will do a couple of those receptors will dampen down the transmission of dopamine.

Now increasing serotonin can help you with calming effect, make you not so emotional.

Increasing serotonin can make a person less depressed.

We've seen over the years that increasing serotonin can actually help women with premenstrual symptoms so there's a lot of benefits with increasing serotonin for a lot of people.

>> But if you increase serotonin you can indirectly decrease dopamine.

>> If you decrease dopamine you can sometimes have a sense of emotional blunting where you don't feel happy, you don't feel sad, just kind of feel blah.

>> If you decrease dopamine you can also have the sexual disturbances that you've described as your wife.

Experiencing those sexual disturbances can be difficulty with arousal sex drive pretty much the whole scope of the gamut.

>> So why do you do if that's occurring?

>> Well, number one you question how well is the medication working well in your wife's case she is doing fine except for those side effects you can sometimes decrease the dosage under your clinician's supervision to see if that makes a difference.

>> Not everybody does best on the higher doses of Lexapro.

Some people actually do better on lower doses of Lexapro.

>> Perhaps they are individuals who are fast metabolism of Lexapro.

>> They might need a higher dosage but other people might be slow metabolism of Lexapro.

It goes to this particular enzyme called to see nineteen if you're a slow metabolism Lexapro maybe you can get by on five milligrams a day so some people will be on twenty milligrams a day and they'll have all these side effects we realized that we overshot.

We need to go to a lower dosage is not unlike fitting somebody for eyeglasses.

Getting thicker and thicker lenses for everybody will not give everybody benefits.

So going on a higher and higher dosage of a medication like Lexapro does not help everybody and some people will get more side effects as they go the higher dosage.

>> So that's one option under her clinician's supervision possibly decrease the dosage once in a while.

The medication that actually increases dopamine will be added.

It's kind of a trick that's been used for the past two decades.

>> It's kind of so so in terms of how effective it might be.

But adding a medication like bupropion sometimes can be helpful because bupropion is a medication that will increase dopamine and norepinephrine in doing so sometimes will offset those sexual side effects from Lexapro that sometimes helps.

>> There has been a study that was was completed in about three years ago and it's now in the package insert of Trin Telex Trin talks chemical name is already Austine Trin Talks has been around for about nine years now and is not yet generic but it's a medication that will increase serotonin as does Lexapro.

But it will also affect very specifically five of the 14 different serotonin receptors.

Some of it will some of them will be blocked, some will be stimulated and in the bottom line is you'll have fewer sexual side effects from that.

>> So the if I heard about somebody doing well with Lexapro, they liked how they felt but they had that annoying sexual side effect from it.

I'd probably want to taper them off the Lexapro and put them on Tranel talks again is doing all the same good effects as is the Lexapro but much less prone to causing sexual side effects and that's actually in the package insert for Trin Telex and that is an advantage of talks right now over Lexapro.

>> Thanks for your question.

Let's go to our first caller.

Hello Deb.

Welcome to Matters of Mind.

Well Deb, you had mentioned that you're taking Gabb Paignton and Trazodone.

Is absence of dreams a problem?

Antidepressive medications Deb can sometimes suppress dreaming and you mentioned two specific medications that will enhance non REM sleep.

In other words, they will enhance the deeper sleep we call it theta waves, the delta wave sleep.

These are the this is the kind of deep sleep that we all need to get our battery recharged and to allow us to feel physically more awake and alert the next day.

>> So by enhancing and increasing deep wave sleep it can make you feel more rested.

So we do indeed not uncommonly use Gabapentin and Trazodone to get somebody to a deeper sleep without causing them to have difficulty awakening the morning because both those both those medications typically last about eight hours or so.

So they typically get on the system by the next morning Gabapentin and Trazodone are not generally addictive.

>> They don't cause you to require more and more on the dosage and they don't generally give you withdrawal if you stop using them.

They last about eight hours and are gone so you can use them as needed in many cases gabapentin is also particularly helpful for people who have aches pains.

>> Some people have knee pain, hip pain, pain wakes them up at night.

So Gabapentin pences nice a nice medication to use between three hundred even six hundred milligrams at bedtime for the purpose of helping with aches and pains.

>> Gabapentin can also help with restless legs.

Trazodone at higher doses can give you restless.

>> You have to be careful there so we often try to dose triacetone at 50 100 maybe no more than 200 milligrams a bedtime because if you go higher than a 100 or 200 milligrams of bedtime it can sometimes give you restless leg .

>> So we have to kind of be careful with that.

But Gabapentin and Trazodone do enhance deeper sleep now will that thereby decrease dreaming to some degree possibly.

But a problem with people with depression, Deb, will be when you have depression you tend to dream more and it's one of those phenomena that have been identified for decades when people are having depression they have more REM sleep, they have more rapid eye movement sleep, they have more dreams, sleep.

So typically when people are depressed the idea will be to try to suppress some of that dream sleep because they're dreaming too much and if you're having more REM sleep you're not having enough deep sleep and the deep sleep is what Gabapentin and TriZetto promotes.

>> So yeah, you can have a lessening of the dreams with gabapentin and triacetone is that problem?

>> Well it's hard to say because a lot of people will dream and they don't realize that you put EEG on their head electroencephalogram actually look at the brain waves.

>> You realize hey, they are sleeping and they're dreaming during the sleep and a lot of people won't even realize that they'll perceive they are awake all night and they didn't dream at all when indeed they were sleeping all night and they were dreaming more than what they realized we tend to dream more as the night goes on.

Our first dreams typically occur about an hour and a half after we go to bed.

>> We initially go into a real deep sleep and then we go into dream sleep about an hour and a half after we go to bed and then we tend to dream more and more and longer as the night goes on such that by early morning you've probably doing more dreaming than what you had earlier in the night.

So with with depression you tend to have more intense dreams and longer dreams earlier in the night so often a goal and dream depression is to suppress some of the rapid eye movement sleep the dream sleep anyway.

Now how about lack of dream sleep long term if you truly are not getting REM sleep yeah that can be a hazard because dreams sleep helps enhance this area over here called the hippocampus is on the side part of the brain and it helps the hippocampus grow.

So we need dreams sleep to help us with memory so we want to have dream sleep to help us with memory when people have Alzheimer's dementia and they start to have a shrinkage of this hippocampus area, they tend to have less dreams and with less dreams is thought to be related somewhat with difficulty with short term memory.

>> When we treat people with Alzheimer's dementia with medications like rhapsodizing excellent Aricept they tend those medications tend to increase dreaming and for some people they'll be kind of apprehensive about taking the medications because they'll tell you they're having nightmares when they're actually just having regular dreams but they haven't had any dreams for years so they're kind of scared about having dreams when they haven't experienced them for quite some time.

So dream sleep is important for the memory.

We don't want to suppress it entirely but if you've had depression you've probably been dreaming too much.

>> Thanks for your call.

Let's go our next caller.

Hello Jill.

Walking to Mars the mind.

Well, Joe, you want to know how do you assess someone struggling with suicidal thoughts?

Jill the number one thing you always want to do if somebody is struggling with suicidal thoughts will make sure they get assessed by a clinician.

A primary care clinician is a good place to start.

A mental health clinician is going to try to really dissect out when somebody is having suicidal thoughts are they thoughts of death where they don't want to be around anymore?

Are they thoughts of actively wanting to take their lives?

There's a huge difference there, Joe, because in both cases, as you can imagine, these people typically have depression.

When people have depression they start to have thoughts about death.

It's a classic symptoms of depression.

When people have depression they think they don't want to be around anymore.

They want to give up on life and when they have that sense of hopelessness, hopelessness is one of the biggest predictors for somebody ending up committing suicide when they lose all hope.

So the first thing you want to do, Jill, is try to get this person in to see a clinician and try to get them adequately assessed and get them treated for depression because suicidal thoughts and depression go hand in hand.

Now many times jail people will gravitate towards substances of abuse and if they use alcohol or opiates they're much more likely to actually take their lives because those kind of substances of abuse will tend to suppress the functioning of the frontal part of the brain.

>> The front part of the brain is underactive when somebody has suicidal thinking and depression.

So if you can imagine here you have difficulty with logic which is where the the part of the brain where the logic originates.

You've got this neurobiological disturbance in the front part of the brain.

Your brain's not working quite properly.

That will cause somebody to have depression and suicidal thoughts if you put on top that alcohol or opiates that can further suppress the functioning of the front part of the brain and that can unfortunately cause somebody to end up taking their lives.

>> So we want to keep these people away from alcohol, alcohol dramatically increases the likelihood of somebody taking their lives.

>> Opiates will be a means by which people will use opiates to try to help with depression.

>> Narcotics or opiates will give you a sense of bliss fullness and you'll feel this bit of a joy and you won't care about things so much.

But the problem is as you take higher and higher doses which is often necessary to get the same effect you can eventually shut down your breathing and that's how people die of narcotic or opiate overdose.

>> You hear that all of time with fentanyl.

Fentanyl is a very is a very potent narcotic and it can kill people because of its potency.

Just a few grains of fentanyl can be deadly and it shuts down the breathing.

So when somebody is experiencing suicidal thoughts we want to go back to square one and get them assessed assessed their hopelessness, make sure they stay away from any alcohol or drugs of abuse and then basically try to have them get a different perspective on their lives.

And this is where family members and friends can come in because many people will have difficulty when they get depressed to really look at the world objectively and they see nothing but the negativity.

They see all the awful things that can occur around them and they will catastrophizing their current situations in one technique will often use as we're seeing people who are suicide lose will have them look at their current situation and allow them to imagine what's the worst case scenario that can occur.

What if you lose your job?

What if you don't do well in this particular examination and what if you get a divorce the worst case scenario based on your circumstances, what would you do?

>> And we have people try to go through step by step by step what they would do in those kind of situations.

So many people will have a catastrophic type of viewpoint and perceive that there is no hope for their situation when there indeed is I mean despite the situation being bad for a lot of people, they'll tend to lose all hope and for many individuals if they can reach handle their faith, focus and be able to think about the the bigger picture in the world and to think about their purpose on this Earth and why God put them here that can have a big impact for a lot of people.

But yet be careful there don't simply say rely on God and that's it because remember that a lot of people who are depressed, they've totally shut God out and because of the depression they've lost that ability to logically think through their current circumstances.

That's why they often give up praying.

They often end up not going to their faith based services.

They've given up on that and they've just totally blocked all that out.

It's easier for us to tell them, oh, you just need to read your Bible more and pray and go to church.

Easy for us to say that if you're not depressed when you're depressed you've totally negated all those as possibilities.

So it's better to for those people to get treatment for the Depression and as they get treatment for the Depression they start to pull out of the negativity.

Then we get them involved in the previous pleasurable activities and help them be able to cope as they did before.

But people with depression will often give up things that used to be pleasurable for them.

They'll give up things that allowed them to have motivation to get up every day and to enjoy life and they feel more and more withdrawn from society and they do the things that you really shouldn't do.

>> They give on socializing with people.

People with depression often don't exercise as much because they don't feel energetic enough to do it.

>> They feel achy and tired throughout their whole body and there's an inflammatory effect of depression that will lead to this sense that you kind of have the full body flu so you feel achy and tired and fatigued and there's certain inflammatory proteins with some types of depression will go up just like the flu will cause and these inflammatory proteins are called Interlude Lukan six proteins and these Interleukin six inflammatory proteins make you feel just like you have the flu and even though you don't have the infectious type of ideology of the flu yet you have depression.

>> So clinically significant depression is often type of depression where it's a physical phenomenon and people will feel very down and they'll have difficulty enjoying things and going long that with that will be suicidal thoughts now in their early research on serotonin back in the 1980s it was found that people who committed suicide upon doing autopsies had decreased transmission of serotonin in the front part of their brain.

>> So that's where the theory came out that well, people with depression just simply were caught low on serotonin.

So if you gave everybody medications like Lexapro which I mentioned earlier or Prozac, Celexa, Zoloft, Paxil, these medications all increase serotonin and that can help some people feel better.

But not everybody about one of the three people have a really good effect from the serotonin medications.

But about two out three people need a little bit something else.

>> But there was a theory decades ago that simply increasing serotonin could help with people with depression because it was found that people with suicidal completions had decreased serotonin in their frontal lobe.

>> I think another way to look at that would be people who complete suicide had a significant disturbance in their front part of their brain that led to their having the suicide completion obviously suicidal thoughts suicide completion is an illogical type of thing for any of us to consider because well, that's not why we're here.

We should be able to have motivation and purpose in life and that's where you have to keep people focusing on what their underlying purpose will be.

And I'll often recommend to people that they journal periodically they look at they write down their current problems and they try to take a peek at those problems that they had a month ago, three months ago, six months ago and see how they came out because many people will find that if they just write down a few lines of what their current difficulties are and they take a look at those few lines, their current difficulty and they sort out what they can and cannot do about them as they look back on their past difficulties months from now they find oh yeah that I came through that one I figured that that out some bad things happened there but I overcame it.

>> I still am functioning in society one way or another despite these things happening.

So if you journal some your difficulties you don't catastrophe's to the degree that you might otherwise you can remember and recall that you did overcome some of the difficulties that you at the time thought were overwhelming that gives you confidence in your coping abilities and it gives you confidence that you know, things can work out despite them appearing to be overwhelming at the time.

>> Jill, thanks for your call.

Let's go to our next email.

Our next email reads Fauver which is more cancer of cigarets or marijuana about seven cigarets a day is equivalent to about one or two marijuana cigarets a week.

So marijuana cigarets have the potential for cancer.

They are different.

There are polycyclic acyclic hydrocarbons that are in nicotine.

Cigaret and marijuana cigarets.

So there is a factor there.

But the issue will be people don't typically smoke as many marijuana cigarets as they will tobacco cigarets to get the same effect with tobacco cigarets you might have to have twenty or thirty a day in some cases with with marijuana cigarets people often limit those to one or two a day.

>> So if it comes to a one to one ratio one way or another yeah.

>> Nicotine the nicotine and the different toxic effects of nicotine cigarets probably are more cancerous compared to marijuana cigarets marijuana cigarets have problems that haven't been well studied over the course of time.

Tobacco cigarets my goodness.

If you remember back in the 1940s 1950s the old movies everybody was smoking physicians promoted cigaret tobacco cigaret smoking back in the 40s and 50s I remember as a young child hearing the tobacco cigarets helped open up your airways and you could actually breathe better with them.

>> And I think we're kind of at that stage now with marijuana cigarets as marijuana cigarets are getting more legitimized by state legalization of recreational use.

>> I think we'll hear about more and more people using marijuana cigarets recreationally and then in another ten, twenty years we'll hear about more of the health hazards of the use of marijuana.

Now right now my biggest concern about marijuana is especially with the use of individuals under 24 years of age because it suppresses the white matter of the brain.

>> It's physically suppressing the growth of the brain of individuals under 24 years of age.

>> So the people under 24 years of age are a huge risk for having intellectual difficulties and problems with motivation and even depression later on as they use marijuana at that.

>> If you start a past twenty four years of age, I think the research needs still needs to be done for people who use marijuana after twenty four years of age.

But if you use marijuana before twenty four years of age it's a huge, huge risk on the brain more so than probably alcohol and even more so than tobacco cigarets at that age.

Thanks for your email.

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

Our next e-mail question reads is do not favor is there a problem if I smoke marijuana while using Wellbutrin also are there drug interactions between alcohol, marijuana and gabapentin?

>> You mentioned Wellbutrin which is typically used for Motive's an energy concentration of depression.

>> So for that reason I wouldn't want to use marijuana with it but marijuana will cause you to have decreased motivation, low energy difficulty with concentration so marijuana would offset some of the effects of the Wellbutrin.

So that's the biggest interaction I'd be concerned about their gabapentin is often used to help people get off of marijuana.

Many people when they try to stop marijuana will have a lot of anxiety partially due to the marijuana itself.

So there is a bit of a marijuana withdrawal.

The people will encounter so gabapentin can be used to help people get off of marijuana and along with that gabapentin can help people stop alcohol and anxiety related to that.

If you use alcohol with gabapentin you'll probably be more tired but it's not as dangerous of it as an interaction as alcohol with another medication like a benzo ,a Xanax, Ativan or Klonopin or a barbiturate.

>> Jim, of course I'm going of time for this evening if you would like to call me back next time we're on the air.

I'd appreciate you doing that because I'd like to hear what kind of question do you have there about the psychological effects of testosterone cream?

I'm psychiatry Fauver and you've been watching Matters the mind on PBS Fort Wayne God willing and PBS willing I'll be back again next week if you have any questions about mental health issues that I can answer on the air.

>> Right meon matters the mind all one word at WWE dot org.

>> Have a good evening.

Thanks for watching.

Goodnight