good evening psychiatrist Jay Fawver live from Fort Wayne , Indiana.

Welcome to Matters of the Mind Now in its 10th year Matters of the Mind as I 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, you may call me in the Fort Wayne area by dialing (969) 27 two zero or if you're calling coast to coast long distance you may dial to six (969) 27 two zero on a fairly regular basis.

We are 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 have any questions that you'd like me to answer on the air, you may write me a via the email at Matters of the Mind all one word at WFYI Big that's matters of the mind at WFYI Dog and I'll start tonight's program with a question I recently received.

>> It reads Dear Dr. Fovea, what are the steps I can take if I want to do the following three things I want to stop smoking.

>> I want to quit drinking and improve my overall mental health .

I take bupropion also known as Wellbutrin and it seems to work well for me.

I feel like I'm at a place where I can take on the smoking and drinking that's fantastic and smoking and drinking are addictive.

>> They're modulated somewhat by dopamine and that's why I'd be increasing.

Bupropion will increase the transmission of the brain especially the frontal lobe, the thinking part of the brain of dopamine and norepinephrine and indirectly that's what smoking and drinking are doing when you smoke a cigaret you have nicotine.

>> It goes to the nucleus accumbens in the middle of the brain here which sprays out dopamine gives you an energizing feel good effect.

>> Yeah, nicotine does that alcohol for some people will do the same.

So I think the question would be what residual symptoms you might be experiencing when you try to abstain from nicotine and when you try to abstain from alcohol.

>> And my biggest concern early on would be any chance of withdrawal if you're having withdrawal that needs to be addressed if you drink alcohol to the point where you start getting shaky, you get headaches, you can't sleep, you get sweaty.

>> That means you're going through alcohol withdrawal and that needs to be addressed over the course of five to seven days.

>> Typically it can be done as an outpatient but occasionally it's done in a hospital setting if it's very serious alcohol withdrawal, nicotine withdrawals, more settle, people can get irritable and angry and annoyed very easily as they're coming off nicotine.

That's where bupropion can be helpful.

But sometimes we'll use a medication like Chantix which has been around for twenty years now as a means of easing the nicotine withdrawal and quite frankly nicotine withdrawal can be modulated by using nicotine patches, nicotine gum and the whole idea there is by by using less and less and less nicotine to allow yourself to taper off.

>> So now that you're ready to tackle smoking and drinking and trying to go off of those, talk to your primary care clinician about the possibility that you might have withdrawal and different means by which you can taper off of each of those you might want to do one thing at a time but if you're all ready to go for alcohol in nicotine withdrawal and discontinuation as fantastic, we want to encourage that.

But sometimes will encourage people to do one thing at a time so they don't lose heart.

>> There are different medications that can be used for the so-called prolonged abstinence syndrome that can occur.

In other words when people are off of nicotine, when they're off off off of alcohol for several weeks and several months, they can still have that craving.

So there's different ways that we can address that craving is as well.

For instance, many people as they come off of alcohol four or five months down the line they might still have difficulty with sleeping anxiety ,irritability.

We'll give them medications that now have a lot of research backing them such as gabapentin, also known as Neurontin.

Another one is topiramate also known as Topamax.

And you might have heard about the clip one agonist the glycogen like peptide type one agonist basically to stimulate the Glik glycogen like peptides and in doing so not only do they help with weight loss and modulating blood glucose is in the periphery, they will go to the insulin receptors in the brain and have some pretty significant effects if beneficial effects and it's thought that they can significantly impact addictive behaviors.

>> A lot of research going on with those now.

So here's a medication that was originally developed for Type two diabetes and then it got used a lot for weight management and now we're talking about the possibility over the course of the next five years maybe of using the clip one agonist quite a bit in psychiatry for the purpose of addictive behavior as you're describing.

>> Thanks for your email.

Let's go to our first caller.

>> Hello Margo.

Welcome to Matters of Mind.

Margo, you are an old broken heart syndrome, a type of depression.

Broken heart syndrome is a phenomenon that occurs where a spouse dies within a matter of months up to a year following the death of their other spouse.

So broken heart syndrome is thought to be a cardiovascular condition where for due to stress due to high levels of cortisol due to high levels of Derrinallum following the loss of a spouse that leads the heart going into a cardiac arrhythmia where it doesn't beat properly and basically starts quivering, quivering and then you die suddenly and it's called broken heart syndrome.

It is more prominent with men 70 percent more likely with men 30 to 40 percent more likely with women within three to six months typically after the loss the spouse.

So you'll hear about this occasionally where a spouse dies and then within six months to a year perhaps the other spouse dies and that can be from the stress of the loss of the spouse.

>> Is it thought to be related depression kind of indirectly?

>> I always am very, very careful about watching an individual after their after their spouses died because I want to make sure they get some sleep many times when a person loses their spouse they have trouble with sleeping.

>> They realize the spouse is not there at night.

They feel lonelier and they start losing sleep if you lose sleep that increases the stress response the body and that increased stress response can be further exacerbated by the loneliness and the sadness and the grief that can go on during the day.

So some of us related to a depressive phenomenon.

A lot of us related to the stress and the hormonal effect of that following the loss of your spouse.

>> Thank you for your call.

Let's go to our next caller.

Hello Dale.

Welcome to Matters of Mind.

Now you want to know how is nightmare disorder treated and how impera you during the day basically if you're having recurrent nightmares at night, Dale, we want to try to understand the reason behind that.

Quite frankly, nightmares are related to the left front part of the brain which is the reasoning part of the brain not adequately shutting down nightmares occur during REM or dream sleep and they can be very intense.

They can awaken you on occasion and your brain is very, very active during nightmares.

We'll often look back to see why somebody might be having nightmares if it's related to a past traumatic event, that's your brain's way of kind of holding onto that memory.

The past traumatic event is processed in the hippocampus that's part of the brain and the thumb part of the brain here and it's a memory some of the brain and the hippocampus and keep the brain awake to try to process those memories more at nighttime from a medication standpoint we use medications that are also known for as hypertensive medications such as Want Forseen or Clonidine.

>> We might use prazosin.

These are medications that decrease the excessive adrenaline release that indirectly will affect the brain with Northbourne Effron which is a chemical cousin to adrenaline and allow that front part of the brain to kind of relax at nighttime if that front part of the brain is overly active, it'll cause you to have nightmares and sometimes we'll just use medications that quite frankly will suppress dream sleep nor tryptophan is an old antidepressant medication has been around for a long time by the name of Pamela and it will specifically suppress dream sleep.

>> So the old antidepressant especially will suppress dream sleeps.

That's another means of of addressing it.

And quite frankly if you're having nightmares related to past traumatic events we'd want you involved in psychotherapies such as such as rapid resolution therapy, eye movement desensitization and reprocessing also known as MDR.

These are specific types of treatments that can help with past traumatic memories that might be trying to nudge in and give you a troubled night time with nightmares.

>> Dale, thanks for your call us call our next caller.

Hello Catherine.

>> Welcome to Mastermind.

Hello Catherine.

>> Well, Catherine, you want to know his nightly use of Benadryl also known as high diphenhydramine is related to memory loss if you're over the young age of fifty five years old, Catherine sometimes that can indeed be the case nightly use of diphenhydramine it will block histamine and if you block histamine in the brain it makes you sleepy.

So right now my histamine or histamine hopefully is skyhigh and when histamine sky high in your brain you're wide awake when histamine starts to go down you get more sleepy and you can block histamine with antihistamines like diphenhydramine also known as Benadryl.

>> The drawback of Benadryl is it also has a second component to it is also blocks acetylcholine if it also blocks acetylcholine that's blocking acetylcholine and in doing so it gives you memory problems and they've actually done studies on older adults with driving test who took diphenhydramine a nighttime Benadryl and they took it to nighttime for sleep and they did driving up until noon the next day finding that up until noon the next day they had memory problems leading to driving difficulties on computerized simulations.

So diphenhydramine are Benadryl can be problematic for older people can be done.

>> Can it be used for younger people?

Yeah, adolescents and young adults can use diphenhydramine or Benadryl for sleep quite safely.

>> It's just that the next day they might have a little bit of a dry mouth and some people will notice a little bit of an increased appetite from any antihistamine.

>> But I don't care for antihistamines.

So much for sleep or anxiety.

>> I just don't like the the theory behind him and terms of just blocking histamine making you sleepy.

I don't like that idea.

So blocking histamine to me is a means by which you just making somebody tired you're blocking a chemical that keeps you awake.

>> Some medications that are antihistamines though don't last as long and they don't affect acetylcholine so much.

>> Dock's el-amine is the active ingredient in some over-the-counter sleep medications you might have heard of UNISOM Doc Sillerman seems to be OK.

It will work for sleep at night.

>> It'll block histamine but it won't give you the acetylcholine effect the next day hydroxy Zeins sometimes use during the day for anxiety against blocking histamine but it has less effect on acetylcholine so the medications like diphenhydramine strongly block acetylcholine.

Those are the ones that can be most problematic for memory loss.

It's not the antihistamine effect itself that's so problematic is blocking acetylcholine it causes the memory loss Catherine.

>> Catherine, thanks for your call.

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

Our next e-mail question reads Your daughter Fauver can an antidepressant ever stop working?

I have been using flu vaccine for a few years but lately it seems to be less effective.

Fluoxetine is also known as Prozac.

It came out in nineteen eighty seven and we noticed shortly after it came out that it worked really well for a lot of people for several months.

Then it kind of faded in its effects and it didn't work so much and I at the time talked to some of the researchers out about Lilly who manufactured and researched and created Fluoxetine and they said well you just need to increase the dosage.

>> We found that that was not what we needed to do.

What happens is that if you increase serotonin with a medication like Flock's a team you can indirectly decrease dopamine.

>> When you decrease dopamine you feel emotionally blunted.

>> You don't care about things.

You don't feel happy or sad.

You kind of feel emotionally numb.

And for many people they will perceive that's kind of recurrence of the depression itself.

>> There was a study done twenty five years ago called the STATI Study where everybody in the study three thousand people got serotonin a medication called Citalopram Syndrome Celexa and they found that of the one third of them who had a really good response if you follow them over the course of a year or two out of three of them got depressed again and on the average they is so in about three months.

So the medications that affect serotonin and sometimes norepinephrine they can fade in there their effects over the course of several months and the dopaminergic medications like bupropion and telex also known as the vaccine are less likely to fade and their effects over the course of time.

But yeah, antidepressants medications can stop working number one based on their mechanism of action.

Number two , they can seem to stop working because you don't really have just depression if you have a condition called bipolar disorder where you're having highs manifested by decreased need to sleep racing thoughts, impulsivity, doing things and saying things ordinarily wouldn't do or say if you have manic highs periodically then they're going to lows the highs and lows will lead to your having the perception that you're getting depressed again because when you have the highs you run out of gas and then you have the lows.

>> Those people need a mood stabilizer.

We always look for underlying medical conditions that might contribute to somebody having relapses of depression, sleep apnea, low thyroid diabetes, low iron ore just some of the conditions we'll examine when people are having recurrence of depression itself.

So I want to make sure that you're on the medication is going to give you the best mechanism of action.

We want to make sure that you've been properly diagnosed so you don't need a mood stabilizer or something with the antidepressants.

We also want to make sure you don't have medical conditions that might be contributing to your getting depressed again, thanks for your email.

>> Let's go to next caller .

>> Hello Fred.

Welcome to Mastermind Fred.

>> You want to know what are some of the healthy coping strategies that you can use when you feel overwhelmed?

No one to keep the feelings of overwhelmed being overwhelmed in perspective.

And I mean what I mean by that is keep a diary of what's really bothering you right now and keep a diary and note what you can do about those particular concerns and what you can't do about them and things you have to let go.

>> So if you can't address those particular concerns yeah.

Don't procrastinate.

Do something about those particular concerns you can address if you keep a diary you can look back on the particular concerns you had three months ago, six months ago, even a year ago and find you're going to find out that those particular problematic concerns at that time they took care of themselves.

You were able to overcome them.

They worked out so if you think about the stuff that really bothered you a year ago and even more so five years ago, you're going to figure out that it all got worked out.

So a coping strategy to help you with day to day worries will be to keep a diary on a daily basis or a weekly basis just writing down the things that you're noticing now and you can look back on those particular concerns six months from now, a year from now and think, huh, I got over that stuff.

So that's the first thing to do Fred.

Fred, from a coping strategy standpoint when you feel overwhelmed exercise, exercise, exercise is fantastic going for a brisk walk, getting some movement especially outside with some fresh air as it's getting warmer.

Try to go early in the morning or later in the evening as long as it doesn't keep you awake at night.

Sometimes people who exercise after 7:00 p.m. will have difficulty going to sleep, try to get some exercise in somehow some way because that's one of the better ways that you can exercise.

Also, Fred, if you're getting overwhelmed by something, try to get interested in something that doesn't involve that something in other words, if you're feeling warm about your work related activities, try to develop a hobby, a reading group, something that's entirely different than your day to day work like environment.

The medical students who I've taught recently say they have a reading group going and they read things that have nothing to do with medicine.

It's a wonderful coping strategy for a lot of people and along with that I recommend to many, many people late in the afternoon maybe mid afternoon and try to take a 20 minute nap no more than thirty minutes if you can avoid it.

If you take a brief nap mid afternoon or late afternoon, it recharges the thinking part of the brain to which I referred earlier the thinking part of the brain is the front part of the brain.

>> A brief twenty to thirty minute nap can do a remarkable job in resetting this front part of the brain and allowing you to download more information more efficiently.

So a coping strategy would be to get a brief nap in Einstein did this they call it power nap and you do it for twenty no more than thirty minutes or so every afternoon on a regular basis.

A coping strategy for feeling overwhelmed also would be quite frankly on a related note getting adequate sleep trying not to stay up late at night, doing extraneous things like watching television or looking at social media.

>> Try to get to a sleep hygiene pattern where you get sleepy at a certain time and you go to bed at that certain time.

Now you might think well gee I have certain things I do before I go to sleep.

That's OK.

I mean if you read try to read a chapter here, a chapter there but be careful about using any social media or going to the Internet late at night because the algorithms with the Internet, they know what interests you and they'll keep you engaged and unfortunately keep you awake later at night if you go to bed a certain time night you should get up without an alarm.

>> You should if you get an adequate sleep you should be able to get up without an alarm.

>> Now if you really need to have that alarm there because you have to be at work or at the airport or whatever at a certain time by all means have the alarm.

There is a backup but you know you've had adequate sleep for the night if you don't need it alarm you automatically wake up at a certain time and you want to do that night by night where you go to bed about the same time and get up about the same time.

>> I mentioned that Fred because many people who over get overwhelmed don't have the coping strategies because they don't get adequate sleep.

>> When you sleep at night you are recharging the thinking and the logical part of your brain in the front.

>> So if you don't get the logical and the thinking part of the brain recharged adequately, you can't cope with different things.

>> And when we talk about coping strategies, we're talking about being able to deal with stresses that you have difficulty encountering now stress is OK. >> Stress just means a change in your day to day life stretches stresses all right.

It's when you have overwhelming stress where you can't cope based on your past life experiences based on your difficulty with managing those particular stresses, based on your having lack of control over those things that are happening.

I mean the first thing about dealing with stress is understand what you can control and what you can't but if you have inadequate sleep that can be a factor.

Some people, Fred, are influenced by their diet.

I've known several people who are significantly influenced by the least amount of gluten.

They don't have the full blown celiac disease which is a gluten intolerance itself and they have diarrhea and bloating and all sorts of different things.

But a lot of people have gluten sensitivity where they'll notice if they have meat products which contain gluten typically they will notice they feel foggy.

They can't think clearly the more irritable and they have trouble with memory disturbances.

So something as subtle as a gluten intolerance for some people can be problematic.

Other people who might be prediabetic may notice that with their blood glucose fluctuations if they eat candy or sugars they'll notice they have a lot more trouble with their coping abilities in those cases.

And what do people do, Fred, when they feel overwhelmed they want snack on carbohydrates.

It's instinctual because when you snack on carbohydrates your insulin level in your body does go higher.

When insulin goes higher it actually will increase the transport of tryptophan into the brain.

>> Tryptophan is a building block for serotonin.

And then briefly you can have a little bit of an emotional blissful feeling if you blast yourself with carbohydrates.

It's very comforting.

But in the long run you feel worse.

>> So that's why it's not recommended that people eat a whole bunch of sweets and refined carbohydrates when they're really depressed because in the long run the insulin levels will go up and down and then you'll feel lousy when you're crashing.

So I'd recommend Fred keep the diary exercise, try to maintain things in perspective, watch your diet over the course of time and be aware of what you can control and what you cannot control.

And if you have any difficulty with particular environmental stresses themselves, Fred, you can talk to a counselor now people tell me all the time you know, I talk about medications, I talk about the brain chemistry and everything.

>> So where do where does therapy fit in?

Well, if you think about how the brain works, it's like you have accelerating chemicals, you have breaking chemicals so you got the accelerator and the brake in nice balance.

You've got all these chemicals working together to allow the brain to function from a chemical perspective.

So if you think about the brain as being accelerator and brakes on a car, it's got to be driving particular speed.

It shouldn't go too fast.

You can go too slowly.

So that's the whole purpose of the chemistry of the brain.

It's got to be working properly but the whole idea of psychotherapy will be to work as GPS for the brain.

In other words, if you have difficulty with a life circumstance where you're unfamiliar and you are taking the wrong turns and you're having a lot of anxiety dealing with going where you need to go, that's where psychotherapy can come in.

>> It's like the GPS for the brain if you're going to an unfamiliar town like a big city like Chicago, New York City and you're driving through these areas typically if you're a Hoosier like myself you're going to have that GPS on.

>> You need a GPS on when you're unfamiliar environments so you don't get lost and you don't get to the point where you're taking the wrong turn.

That's the whole idea of psychotherapy.

You don't need psychotherapy every week for the rest of your life but you certainly need it at times where you're experiencing overwhelming stress and you're feeling like you're taking the wrong turns.

Things aren't working out so well for you.

You're making a lot of errors and in the long run it can have consequences for you.

So psychotherapy can be helpful as your GPS in life to help you go the direction you need to go .

Fred, thanks for your call.

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

Our next e-mail question reads Dear Dr. Fauver, my brother has developed a nervous tic recently.

Could his antidepressant be causing this a nervous tic?

Yeah, if it's related to an antidepressant medication it would probably be a serotonin medication although the norepinephrine and dopamine depressant medications like bupropion can give some people a nervous tick as can caffeine's people will notice if they drink too much caffeine and they consume too much caffeine, they will not only get a tremor, they might get nausea, might get a headache but they can get a little twitch here and there.

>> So a nervous tick tick a twitch can be related to serotonin transmission.

You get too much serotonin in your system from medications like Zoloft, Prozac, Celexa, Lexapro, Paxil, Cymbalta, Presti, Effexor these are all medications that can affect serotonin if you increase serotonin transmission too much you can get a little twitchy and some people will actually get a little bit of a tremor from that.

>> So it all comes down to the question being when did the nervous tics start at a start after a medication adjustment was it after a medication was started when the dosage was increased?

>> Was there any relationship to that keeping in mind that sometimes the antidepressant medications actually help with those nervous tics?

>> Thanks for your email.

Let's go to our last caller.

Hello Giada's welcome to Mars The Mind.

>> Janis, you want to know about the warning signs of mental health crisis and what do you do if you experience one?

Well, Janis, one of the key warning signs of a mental health crisis will be lack of sleep, number one.

>> And number two , having people notice that you're just not quite the same person they knew recently when other people start to notice that you're having problems, keep in mind that it probably took them a lot of courage to bring that up to you.

But family and friends who noticed that you're not quite the same, they often notice it before you.

That's why I love it when spouses and family members will accompany a person to their mental health appointment because I like to get their perspective on what's changed over the course of time.

>> So when family and friends notice a difference that's an issue lack of sleep, lack obviously be an issue as well.

But when you're having difficulty getting things done that you ordinarily be able to get done, whether it be your work environment when you're withdrawing socially, whether you're having trouble concentra and keeping your mind on things, you're making more mistakes.

You're having difficulty with day to day activities such as taking care of yourself, grooming, cooking if you usually are the one to cook, if you're having difficulty with day to day activities that's called functional impairment and that's a key factor as well.

>> What should you do if you experience this type of mental health crisis?

You can always contact a mental health clinic but at least contact your primary care clinician primary care clinicians are very, very good at being the gatekeepers of our overall health care and they can identify mental health difficulties for a lot of people and get them referred accordingly.

>> Janice, thanks for your call.

Unfortunate I'm out of time for this evening.

>> If you have any questions concerning mental health issues you may write me via the Internet at matters of the mind all one word at Weygand.

>> I'll try to get your email on the air.

I'm psychiatrist Jeff Offer and you've been watching Matters of mine on PBS for way now available on YouTube God willing a PBS willing.

>> I'll be back again next week.

Thanks for watching.

Goodnight