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>> Good evening.

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

Welcome to Matters of the Mind now in its 10th 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 in the Fort Wayne area by (969) 27 two zero or if you're calling any place coast to coast you may dial toll free at 866- (969) to seven to zero and on a fairly regular basis we are broadcasting live every Monday night from the 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 dot org that's matters of the mind at WFA eg I'll start tonight's program with a question I recently received.

>> It reads to the father My child has AIDS HD is putting him or her in a team sport like soccer a good idea?

Actually a team sport can be very very beneficial for a child with ADHD because especially if the H is their hyperactivity and impulsivity they can burn off some of that extra energy and getting them involved in a team sport can help them be able to focus work with others and they're involved in a challenging new and exciting and novel kind of experience.

>> So when children have ADHD, when they're doing something that involves a lot of activity, a lot of a lot of new experiences, they can often pay attention much more clearly.

>> And it's called hyperfocus focusing if they do so to the extent where they really, really hone in on something and have a hard time paying attention to much else.

The very famous Olympic swimmer by the name of Michael Phelps has been very open about his mother getting him involved in swimming because he had severe ADHD as a small child and he put a lot of his extra energy into swimming and the physical activity involved with it.

>> So a lot of children with ADHD are more kinesthetic learners.

In other words, they learn better when they are moving around so they often have a difficult time sitting in a crowded classroom at a desk all day long listening to a teacher or a professor in college lecturing to them.

>> They like to move around.

They like hands on learning not uncommonly and the same is true with team sports.

Now I'm going to get involved if I'm going to get involved in baseball I don't want I'm not necessarily in right field where they can kind of look around and have difficulty paying attention.

I want them in an active position on the infield preferably if they're in baseball soccer I don't know much about soccer but I want to make sure they're getting the ball kick to them every now and then so they can pay attention.

A goalie can be a great role for a child with ADHD as long as they don't lose track of where the ball is when it's going to the other end of the pitch I believe it's called so depending on the sport itself.

But I think physical activity involving other people can be a great outlet for children with ADHD.

>> Thanks for your question.

Let's go to our first caller.

>> Hello Ned.

Welcome to Matters of the Mind.

Ned, you don't know about the effect of someone being misdiagnosed with ADHD and being prescribed with Adderall and what if they really have anxiety and they don't have ADHD?

A lot of people will have anxiety as a component of ADHD because and when you have ADHD you're always anxious about what you misplace, what you forgot, what you precedented porn you're always running behind.

It's a very anxiety provoking situation.

So you'd think OK, if you give somebody a stimulant and they have ADHD it should help with anxiety, right?

It can however how about if you don't have ADHD and you take a stimulant like Adderall?

>> It's like wearing eyeglasses when you don't need them.

>> Let's say you have 20/20 vision and you wear your friend's eyeglasses think and you're going to have twenty fifteen vision.

>> You got phenomenal vision if you wear glasses on top of having normal vision already.

Well what happens when you wear somebody else's glasses?

>> They often don't fit you properly from a focus standpoint and your vision actually gets worse if you take a medication like a stimulant such as Adderall and you don't have ADHD you're going to have more energy and you might even like that energy for a while you might notice you don't need to sleep as much you're doing a lot of things but you might not be highly productive doing them.

>> They've actually done typing tests with stimulant medications for people who didn't have ADHD, for people who did have ADHD.

>> Everybody got a stimulant.

They did typing tests.

The people who didn't have ADHD who got a stimulant typed a lot faster but they made more mistakes than before the people who had ADHD and took a stimulant type faster but they made fewer mistakes.

In other words they're more productive so if you have ADHD you have this this deficiency of activity in the left front part of your brain primarily this part of the brain is involved with focus distractibility and it's involved in paying attention to things that require a lot of vigilance and they might not be so interesting for you.

This part of the brain is underactive just by a slight percent when somebody with ADHD if they take a stimulant, this part of the brain is what gets stimulated if you take a stimulant and you don't have ADHD in this part of the brain is working just fine.

>> All the stimulant will do is increase unnecessarily dopamine and norepinephrine which is what stimulants will do and you'll feel more hyper you'll get the side effects of the stimulant itself.

>> Many people will ask me why shouldn't we all just take Adderall?

>> They've done studies on college students who didn't have ADHD and they all took Adderall.

These were college students who tended to get behind with a lot of their classes so they took Adderall and they watched what happened from their friends and it was diverted in various ways and they found that these students who were getting behind in their classes when they took Adderall to study at the last minute they actually did worse than we would be expected if they didn't take the Adderall.

In other words, the Adderall helped them stay awake for longer but they didn't do any better in their studies.

They didn't download information adequately.

>> So if you don't have ADHD and you take a stimulant, you're going to feel like you have a lot more energy but you're not going to be adequately downloading the appropriate information.

So you actually have worsening concentration and worsening productivity.

Adderall is a medication in which many people will notice they get more energy and they like that happy joyous effect they can get from it temporarily but then you have to keep taking higher and higher amounts to get an adequate amount adequate effect.

And that's why during the covid pandemic when there was a lot of telehealth medicine being administered, a lot of people got on Adderall just by telehealth and next thing you know we had an Adderall shortage.

>> Now currently the recommendations are typically to use longer acting stimulant medications that have a smoother effect.

>> But Adderall will give you that jolt of energy and that's what a lot of people like and that's why on the street Adderall is one of the more diverted or exchanged inappropriately medications out there when it's sold on the street.

So many people will take Adderall on the street as a means of getting a quick hi from it, a quick jolt of energy ,especially if they're also taking narcotics or sets or sedatives and you might think well gee, why would people take something that's going to slow them down and then have to take some Adderall to speed them back up?

Well, the things that slow them down like opiates will give many people a sense of a blissful illness and they have that sense of calming that the ordinarily wouldn't experience.

So they have that sense of calming and they might take a sedative like Xanax or Klonopin or Valium calms them down for a while but it makes them so sleepy they need something to get them going again.

>> It's a bad bad cycle in which people can initiate but if you take a sedative then you might need a medication like Adderall to hype your back up and on the street.

That's what a lot of people do.

So we're trying to get people away from taking sedatives as a way of alleviating their anxiety.

Opiates as we know, even though they will give people a sense of blissful this can lead to fatalities when they take a little bit too much and it shuts down your breathing.

>> We're trying to stay away of medications like Adderall as the exclusive medication for ADHD.

It's often promoted by even pharmacists and a lot of clinicians simply because it's really cheap .

>> So Adderall works, it's cheap but you've got to be very, very careful in its use and make sure not to keep going higher and higher and higher on it because that's so easy to do historically the primary dosage for Adderall extended release has been about twenty milligrams.

Many people take forty sixty.

I've even seen people getting up to 120 milligrams of Adderall extended release so it's easy to go higher and higher because with Adderall many people miss that Energis feeling they got from it initially and they want that same feeling so they go higher trying to achieve the side effect from Adderall.

>> If you're going to take a stimulant you want to take this at a dosage that helps your distractibility, helps your focus and actually slows down your racing thoughts.

>> You don't want to take a stimulant with the intention of getting more energy and getting the perception you're going to just have more productivity from that energy itself.

>> Long answer to a very short questionnaire, Ned, but thanks for your call.

Let's go to the next caller.

>> Hello Carla.

Welcome to Mars the mind.

Carla, you want to know what happens to your brain to cause motion sickness?

That's seasickness were you get kind of this woozy feeling when you're in the process of moving around.

It's more of an ear nose and throat question Carla.

But I will stand by.

Elaine, we don't prescribe medication such as scopolamine patches behind the ear for motion sickness in my field as a psychiatrist.

But motion sickness is mainly an ear, nose and throat phenomenon.

So you have this inner ear that's filled with fluid and as the fluid kind of gets distorted with the change in motion, people can begin to get this dizzy sensation and nausea going along with it.

So motion sickness is something that goes along with an inner ear disturbance in the process of having motion that is difficult to tolerate.

>> Thanks for your call disconnects next caller.

Hello Beth.

Welcome to the Mind.

Beth, you want to know what triggers someone to go into a catatonic state?

A catatonic state would typically be associated with schizophrenia.

Schizophrenia is a condition where people starting in adolescence typically will have trouble with hearing voices with people no long, no nobody's around their voices talking to them.

They'll have these fixed false beliefs not uncommonly where they have misperceptions of the reality around them.

They'll have difficulty associating their thoughts and they'll have trouble with kind of being socially withdrawn and being very socially anxious in environments where there's a lots of people now some people will get in go into catatonia catatonia where part of the brain will basically shut down and they kind of freeze up.

>> So it's kind of a fight or flight phenomenon for many people.

The anxiety volume control is right in the front part of the thumb of the brain.

This is the temporal lobe of the brain, the yellow part front part the amygdala.

That's the fear, anxiety and anger center of the brain that part of the brain will get overactive and somebody goes into a catatonic state and they'll basically shut down.

It's kind of like the brain freezing up but it's associated typically with schizophrenia which is a psychotic condition itself.

>> Thanks for your call, Beth.

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

We have another email question here.

It reads Dear Dr. Fovea, I have some new responsibilities at my job that is putting a lot of pressure on me causing me to feel a lot of stress.

Is there anything I can do to help not bring this stress home with me in the evenings?

Yes, there is.

There's several things you can do number and make sure you're getting enough sleep.

>> So many people when they get under a lot of stress a job on the job site, they will not sleep adequately and if you don't sleep adequately that part of the brain in which to which I referred concerning ADHD doesn't get recharged.

So with ADHD the problem is you get under activity of this left prefrontal cortex here if you don't sleep adequately that part of the brain doesn't get fired up.

That causes you to be irritable and you have trouble processing information.

So getting adequate sleep is very, very important.

>> Try not to take your work home with you and do work at home.

I know that's sometimes difficult for people to not do but do the best you can not to take documentation and not to take phone calls after hours try not to continue to continue with your work related activity after hours if at all possible.

At some point you've got to turn it off and you turn it off at a certain time if you can.

Secondly, if you're taken if you're if you're having to still think about the job situation in the evening, make sure that you're putting some boundaries on that.

If you have to take calls, if you have to do documentation, try to get away from the family at some point, try to have some kind of time frame where after 7:00 p.m. after 8:00 p.m. or whatever it may be, you're not going to be doing any work related activity.

So what can you do to kind separate that many people will do a brief workout at a gym or in some kind of environment where you can exercise for maybe twenty or thirty minutes after work.

So it's kind of a means by which you're putting a wall between your work and your home.

So going for a walk exercising weight lifting or resistance training is wonderful for stress related to work activities but some people will do a brief workout go for a walk is get away from it all in the evening to try to put that wall between your job situation and your home situation.

But it's it's very important to try to put that boundary there between your work and your home life .

>> Thanks for email.

Let's our next caller.

>> Hello, Jennifer.

Welcome to Matters of Mind.

Jennifer, you mentioned that you're constantly noticing flaws in your appearance and it's causing you to be late with that body dysmorphia and what are those symptoms you describe some of the symptoms of body dysmorphia there, Jennifer, where you're so preoccupied with a perceived flaw that it caused you to have what we call functional impairment.

Functional impairment is where it gets in your way of socializing, gets in your way of being on time.

It gets in your way of doing the kind of things you want to do because you're focused on that one little flaw and many people focused on such a flaw will go to a plastic surgeon and the plastic surgeon will work on that particular floor until you find another floor and then the plastic surgeon works on another floor.

So plastic surgeons have to be very careful about how aggressive they become and trying to correct these perceived flaws by people who have body dysmorphia but body dysmorphia is indeed a condition where you have the perception that there is a flaw that might be present that other people might not notice to be that big of a deal.

We all have these God given attributes but we all have these God given flaws in our physical appearance and at some point we have to accept that that's who we are.

But many people will get really preoccupied with a particular flaw and they will be late going to events and will get in their way with social activities.

So that would be considered to be body dysmorphic disorder or body dysmorphia.

That's a condition I'm aware of .

The perception of the flaws will get in your way of trying to get things done.

>> Jennifer, thanks for your call.

Let's go our next caller.

Hello Dale.

Welcome to Matters of Mind.

Dale, you want to know are there any mental diagnoses associated with the spring time like April May I presume springtime is often more associated with people getting on the high side of the of the manic side.

The suicide rates are highest in October and April.

Now October you can kind of figure that out in October it's starting to get dark and people are noticing that the skies are getting more gloomy and yellow depression rate can go up as the days get a little bit shorter with light.

So October you can kind of figure out where the suicide rates would be a little bit higher at that point.

>> But April, they're also why April it's because people have gotten through the entire winter and now here it is April now the taxes are due in April.

That's a bit of a factor.

But I think that the main reason you'll have these higher blips of suicide in April is because people were waiting for winter and early spring to go of get behind him.

>> The days are getting brighter or they're noticing the weather is getting better but yet they still might feel depressed.

>> So if you still feel depressed in April when you've been kind of hoping that you'd be coming out of a by the that could be very demoralizing.

Second thing that happens in April is you can get more energized when people who have a chronic depression for weeks and weeks all of a sudden get more energized, they can become more suicidal.

But the specific issue that we hear about particularly people prone to having bipolar disorder the particular issue that we'll hear about in the spring will be them getting manic.

>> So the days are getting a little bit longer with light.

They'll notice that they are more active in general they might not need to sleep as much.

>> They have racing thoughts during that time they might have been depressed throughout the winter but in spring they start to get really fired up and if they're prone to bipolar disorder that's when the highs will often occur.

So we hear about a lot of people exhibiting manic symptoms in the springtime.

Now some people might not mind those manic symptoms because my goodness they've been depressed all winter.

They're feeling really fired up now they're getting by with two hours of sleep.

They're having racing thoughts.

They want to go talk to everybody.

They want to buy a lot of things that might be OK in their minds.

But unfortunately with those around those around them, their friends and family, they'll notice there's problems and when the manic episode subsides they realize they made a lot of mistakes.

They said and did things they ordinarily wouldn't have said or did.

So they get in trouble with finances.

They get in trouble with social interaction.

So the manic episodes get them into trouble in some cases and those can be manifested particularly in the spring if somebody is prone to having bipolar disorder.

>> Thanks for your call.

Let's go next caller.

Hello Sammy.

>> Welcome to Mastermind Sammy.

>> You mentioned that you notice that when you have an episode of Vertigo which means spinning around to cause you to feel anxious, is there a connection between vertigo and anxiety to some degree because when you are spinning and you have this vertigo sensation where things are going round and round and can create a lot of anxiety, does anxiety by itself cause vertigo?

Not usually directly.

Vertigo is a phenomenon that once again is somewhat of an inner ear issue and there's a phenomenon called manures syndrome.

Maneer syndrome is where people have ringing in the ear.

They'll have vertigo a spinning sensation and they also have nausea so they have that triad of tinnitus or ringing in the ears vertigo the spinning and they'll have nausea.

>> That triad can be due to an inner ear problem.

>> So ear, nose and throat clinicians will often see that particular phenomenon.

I'll hear about it because people will come to me as a psychiatrist saying they're having these episodes of spinning and the nausea sometimes associated with the ringing in the ears.

So I will often refer them to an ear, nose and throat specialist to see if they have a cyst on the inside of the inner ear.

Sometimes they have a fluid disturbance where they need a medication like necklacing which is kind of an antihistamine but it does make Wlezien also known as Antifa also does a very nice job of drying up the excessive fluid that occurs in the that is thought to be contributing to Vertigo itself.

>> Samii thanks for your call.

Let's go our next email question.

>> Let's go to our next e-mail question here it reads Judith Evolver I have severe fear of dogs that comes from some childhood trauma.

Is there a way I can overcome my fear of dogs?

I think the best way you could overcome your fear of dogs or any phobia for that matter is exposure to in a non dangerous type of environment where there could be dogs present for instance, if you wanted to go to the local shelter perhaps you could perhaps interact with some dogs assuming those dogs are not going to be ones to bite you or be aggressive toward you and the people who work at the shelter should know and maybe you could even do some volunteer work to shelter or even better yet if you have some neighbors who have nice dogs and are nice dogs out there, if you have neighbors who have nice friendly dogs you could certainly interact with them but with any phobia or fear it's usually elicited by a bad experience sometimes not sometimes it's an unrealistic holistic experience.

>> But if you had a bad experience with dogs or animals or any particular episode in general, on one hand a phobia is unrealistic fear but a post-traumatic stress response can be a realistic fear.

>> So what you need to do if you've had a bad experience previously and now you're fearful of encountering any thing or anybody related to that bad experience, the best thing to do is try to extinguish that fear by exposing yourself to that particular fear that would be safe in a sense.

And so I would suggest trying to expose yourself to friendly nice dog with neighbors and various dogs that you could visit.

>> Pet stores often have nice friendly dogs so the more you expose yourself to the friendly dogs the more you can extinguish that fear.

I hear about the same phenomenon when people have been thrown from a horse you hear about the old saying get back up on the horse if you've fallen off.

>> Well, it's a lot of truth to that because if you get back involved in an activity that was previously traumatic toward you is more likely you'll extinguish that particular fear.

So that's kind of a post-traumatic stress response to a prior traumatic experience.

A phobia is where you have a unrelaxed fear.

>> There's no reason to have the fear.

You're just having an unrealistic fear and it's over the top.

>> It's exaggerated and it's more so than what you would expect.

Thanks for your call.

Let's go next caller.

>> Hello Jess.

Welcome to Matters of Mind.

Jesse, you mentioned your newly on Zoloft also on a search plane.

Is it better to take this medication in the morning or at night and sure you take it with food.

What are some tips to get you started?

Zoloft certainly came out in 1992.

It's a medication is specifically will increase serotonin and secondarily a little bit of dopamine.

So what it will do when you first are taking them especially a little bit higher dosage like fifty milligrams people will notice they can have nausea and diarrhea.

Now that sounds like an unreasonable side effect.

Nobody would want to have those kind of side effects.

But if you take to a lower dosage many times will recommend people taking twelve point five or maybe 25 milligrams a day for six or seven days then going the higher dosage the dosage is related to the nausea and diarrhea that you can experience taking in with food certainly helps with the nausea and to some degree helps with the diarrhea for many people will work will recommend that if they feel really tired with it definitely take it in the evening with their biggest meal and many people either biggest meal in the evening.

So if you feel a bit tired with the take in the evening most people who takes off will find really nice benefits with anxiety from them.

But it doesn't matter if you take it morning or evening it will last the whole day.

So Zoloft is there to last the whole day.

So we generally recommend people starting at a low dosage for a few days taking it with food and preferably take it in the evening because it can make you a little bit tired but it has several several uses for anxiety related conditions so many people will take it just once a day to relieve that day long anxiety.

Thanks.

>> Your call is great.

Next caller.

Hello Greg.

Welcome to mind.

Greg, you mentioned you're in recovery .

Good for you.

And you've been feeling on edge due to stress.

>> How can you unwind without falling into old habits?

Oh that's a good a good question because you want to be in a recovery .

You kind of go back and you think well why did I start using drugs of abuse or alcohol?

>> Why do I start using that stuff to begin with?

Some people will innocently start recreationally exper remaining with drugs abuse or alcohol and or fiddling with it and next thing you know they're using it more and more and more because it makes them feel good or the chills them out and next thing you know the the drug itself or alcohol for that matter.

>> Ah changing the brain chemistry where you need them and then you become addicted.

>> You've got to go into recovery .

It takes sometimes weeks if not months to go through this prolonged abstinence period is basically used to be called dry drunk period where OK you're physically withdrawn physiologically from the drug of abuse or alcohol itself.

>> But why are you still feeling anxious and on edge and having a hard time putting up with things takes the brain sometimes weeks or months depending on how much of the drug of abuse you used or how long you used it.

>> So some people need them to go through weeks or months to to really get over that difficulty with the prolonged abstinence kind of symptoms which they'll notice as anxiety, insomnia sometimes putting up with stuff so number one, you make sure you have a sponsor with whom you can speak someone who's been through those experiences before and try to help you with coping techniques.

>> But secondly, sometimes we will give people non-addictive medications especially for several weeks or several months after they've quit using drugs of abuse depending on the drug of abuse or if it was alcohol we might use different medications.

But your clinician who's following you can many times give you some kind of medication.

>> It's not addicting that can hold you over without causing you to go into relapse.

Thanks for your call.

Unfortunate we're out of time for this evening.

If you have questions concerning mental health issues that I can answer on the air you write me a via the Internet at matters of the mind all one word at the Blue Dog.

>> I'm psychiatrist Fauver and you've been watching matters of mine on PBS Fort Wayne now available on YouTube God willing, people willing.

>> I'll be back again next week.

Thanks for watching.

Goodnight