Good evening.

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

Welcome to Matters of the Mind now in its twenty seventh 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 call in the Fort Wayne area by dialing (969) 27 two zero and calling coast to coast.

>> You may dial toll free at 866- (969) to seven to zero.

>> Now 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'd like to contact me with an email that I can answer on the air, you may write me via the Internet at matters of mind all one word at WSW that's matters of the mind at WFYI dot org and I'll start tonight's program with a question I recently received.

>> It reads Durata Fauver I have been prescribed Gabber Paignton it's also known as Neurontin.

I also use antidepressants when I read about gabapentin it mentioned serotonin syndrome.

What is that?

Well, gabapentin has no relationship to serotonin syndrome.

Gabapentin is working on the little calcium channels basically it's decreasing the firing of itchy trigger fingers on the nerves so gabapentin thereby can decrease the nerve transmission for pain and it can also help with anxiety and tends to give people a better quality of sleep overall.

Now when you talk about serotonin syndrome, you're talking about medications that are increasing serotonin and thereby causing serotonin toxicity.

In some cases those medications would be the serotonin reuptake inhibitors like Prozac, Paxil, Lexapro, Celexa, Zoloft.

>> They'd be the selective serotonin norepinephrine reuptake inhibitors such as Cymbalta Presti, Effexor, the domain name a few of them.

>> And if you increase serotonin you can have headache, fast heartbeat sweatiness, shakiness, nausea, diarrhea and if it gets really serious which we don't see very commonly if it gets really serious you can get really confused.

>> You can have difficulty with sleep.

You can have even seizures with severe serotonin syndrome itself.

>> So gabapentin would typically not have a direct drug interaction with any of these medications because gabapentin is metabolized and excreted by the kidneys so it doesn't go through the liver, it doesn't interfere with the metabolism of other medications and gabapentin has no effect on serotonin itself.

So Gabapentin would not have a relationship with serotonin syndrome.

>> Thanks for your email.

Let's go to our first caller.

Hello William.

Welcome to Matters of Mind.

>> William, why don't you want to know about the signs of alcoholism, alcohol use disorder and what are the symptoms of alcohol withdrawal on a body and brain?

>> You know you're in trouble with alcohol, William.

>> If you are hiding it, you're lying about it to other people you're hiding physically hiding the alcohol so that people can find it.

You know you're in trouble with alcohol if you're lying about it in other words, maybe your wife asked you how many beers you had and you said three.

>> We actually had seven.

>> So when you're lying about it, when you're hiding it, when you're trying to kind of pass it off and minimize the use, that's where you probably know you're in trouble with alcohol.

Now a key tip off in terms of predicting who's going to have trouble with alcohol later on will be as a young adolescent or a young adult for that matter if you had your first drink and you didn't just feel buzzed, you thought really happy.

I've read where that's a bad sign.

That's a sign that you might get in trouble with alcohol later on.

So if alcohol makes you extraordinarily happy, especially happy, that can be a sign that you're one of those people where alcohol can have a special effect on the brain where it's affecting opiate receptors, dopamine and thereby giving you joy and happiness unlike what it does for a lot of people work calms them down.

So if alcohol makes you feel especially happy, that could be a warning sign.

Now obviously other signs of alcoholism will be when you're drinking more and more and more and you got to have something to drink first thing in the morning to decrease the shaking because the shaking is indeed a symptom of alcohol withdrawal.

>> Alcohol doesn't last very long in the body.

Many people will drink alcohol at bedtime to try to get them to sleep.

>> It'll help knock you out, go to sleep but then it gives you a horrific sleep efficiency where your quality of sleep is very poor thereafter and then it wears out so if somebody needs an eye opener in the morning to get them going in, they've got to have a drink.

>> Ralph, about that's a sign of alcoholism as well.

If you do abruptly stop alcohol that can be dangerous.

The worst case scenario would be that you'd have a seizure, maybe a heart attack.

So you want to withdraw from alcohol and a supervised type of environment or at least supervised structured plan with your primary care clinician.

It can be done very carefully as an outpatient.

But many times people with severe alcohol use disorder need to be in the hospital for three to five days for alcohol detox toxification there.

>> But if you stop alcohol abruptly, you can have tremulousness, you can have nausea, you can have headache, severe insomnia.

People can sometimes notice that when you're withdrawing from alcohol they will even see things that other people can't see.

>> So that's called delirium tremens and with delirium tremens they can have the sense of visual hallucinations and they can get very confused.

So that's why alcohol can be life threatening upon withdrawal.

So it needs to be sometimes monitored if you've been drinking heavily, if you notice withdrawal symptoms thereafter.

>> William, thanks for your call.

Let's go next caller.

Hello Karen.

Welcome to Of Mind.

>> Karen, you want to know about the difference, the kind of the signs of dementia that might be out there?

>> What's the difference between dementia and Alzheimer's disease and how does it affect your memory over time?

I'll answer the second question first.

>> Dementia is like saying you have an automobile.

Alzheimer's dementia is a type of the automobile.

So Alzheimer's disease is kind of like a type of dementia.

It's kind of like the model of an automobile itself.

So dementia is the overall category.

Dementia means you're having difficulty with memory concentration, attention span and then the Alzheimer's dementia is a type of dementia itself.

So what are the symptoms of dementia?

Basically you're having memory disturbances.

That's a hallmark symptom and often it will start very subtly with naming things naming fruits, animals, naming towns.

That's a typical test we'll give people where they try to name as many fruits, as many animals, as many colors and as many towns as they can where off the top of their heads and if you're having trouble naming that can be a sign of dementia.

>> Now forgetting names a lot of people get really freaked out about the they're forgetting names that's considered to be normal aging so normal aging not uncommon.

It can be forgetting names but if you're getting naming things that can be another factor itself.

Now another issue that people will often notice with early onset dementia early signs of dementia will be they have trouble getting lost.

They are all driving around.

They're simply going to the local grocery store.

They take a wrong turn and they have no idea where they are.

So geographical disorientation ,difficulty with naming will be factors and then kind of forgetting what you've been doing over the past day, people dementia will remember what they did ten years ago.

They'll have a very clear memory of forty years ago but they'll forget what the past day.

Now you don't want to go into too many details there because there's a phenomenon in our brain that is called apoptosis.

>> Apoptosis is where you your brain is intentionally kind of pruning away certain neuron branches that aren't necessary in other words or off top of my head I don't need to know what I did yesterday at two p.m. if you think about it, what did you do yesterday at two p.m. you can think about it but maybe it wasn't that important.

Maybe you're just sitting around after church.

You wouldn't you don't have to know every single thing you've been doing day by day by day.

>> So your brain will process those memories but they're if they're not necessary your brain just knows to prune them away.

So it's like pruning away dead branches so that more important memories can be preserved.

Now looking at other memories, do you remember what you were doing the day of 9/11 most of us do remember what we did on 9/11 2001.

Do you remember what was going on the day of your wedding and the details about that?

You bet.

Those memories are well preserved and they're preserved branching in your brain.

But just knowing what you're doing day to day, hour by hour sometimes that's something you're not going to necessarily preserve unless it was important enough to do so.

>> Thanks for your call.

Let's go to next caller.

>> Hello Alex.

Welcome to Matters of the Mind .

>> I'm sorry, Alexis.

Hello, Alexis.

You had mentioned it's allergy and asthma season.

How does taking antihistamine affect anxiety and can and can you take an allergy medication if you're on a prescribed anxiety medication?

The anxiety medications often do include antihistamines so a common antianxiety medication will be a medication called hydroxyl Zeine also known as Visceral or Radack's and it's basically blocking histamine now when you're wide awake histamine is sky high in your brain right now.

Histamine should be skyhigh in my brain if you're awake histamine is increasing your brain histamine keeps you awake.

If you block histamine it makes you tired.

That's why four years Benadryl also known as Dief Hydrazine has been used as a sleeping medication for younger people adolescents especially young adults it can be fine as you get older the diphenhydramine anticholinergic or acetylcholine blocking effect can give you more difficulty with memory the next morning especially so it's not something that prevert preferred for older adults but diphenhydramine or Benadryl can be used for younger people so commonly see a medication like Hydroxides Ambien used which has less effect on memory and less effect on blocking the acetylcholine antihistamines can give you a calming effect and they do so by making you sleepy.

Not my preferred route for trying to treat anxiety for people in general because I just want to make I'm sleepy.

I want to get get the core symptoms of their anxiety under better control.

But an antihistamine can make a sleepy there are non sedating antihistamines that don't get to the brain so much ALEGRA be being one of them as an examples a trade name medication but you can always go to the over-the-counter isle with antihistamines and look for the non sedating ones.

>> They don't get to the brain but they will relieve the the allergies physical symptoms in the rest of your body without getting the brain without making you tired and those were actually preferred for a lot of people who have difficulty with allergies.

Now can you take a antihistamine medication with an anti anxiety medication and anxiety medications nowadays aren't the so-called benzodiazepines as as much as we used to use them in the past?

The benzodiazepines are medications like Xanax and Klonopin, Valium we don't use those so much can use an antihistamine with them.

>> You can but you're going to be really, really sleepy if you're not taking the non sedating antihistamines.

>> So the non sedating antihistamines 20 percent of those might get to the brain whereas something like diphenhydramine or even hydroxides for that matter about fifty percent of those will get to the brain so the non sedating antihistamines will get much less of an impact on the brain and thereby not make you as tired.

So if it's not sedating antihistamine you can take a traditional antihistamine with it or I'm sorry a traditional anti anxiety medication with many other medications used for anxiety nowadays are medications that increase serotonin.

>> If you increase serotonin you'll get kind of this calming effect and for many people they'll describe it as a blah feeling where they don't feel happy, they don't feel sad this feel kind of flatline and for many people with a lot of anxiety that's a good feeling.

So if you take it a serotonin medication taken that with an antihistamine shouldn't cause you any worsening problems with the exception that the antihistamine can make you feel kind of tired.

So you have to always that take that and consider if you're using the NSA to mean primarily for allergies try to find a non sedating and histamine many of them are very inexpensive now and they are over-the-counter.

Thanks for your call.

Let's go next email question our next e-mail question reads Dear Dr. Farber, my four year old goddaughter had emergency surgery and spent a few weeks in hospital.

>> Things are back to normal now a few months later.

But she's having trouble sleeping, crying at school and being extra clinging with mom.

How can her family and friends help her process with what's happening to her?

You might be assuming that it was a traumatic experience for her to be in the hospital maybe she's still having symptoms that led her to go into the hospital.

>> So the first thing I want to know is get her to a pediatrician and make sure she's not having ongoing pain or any kind of physical symptoms that might have led to her going in the hospital because children have a difficult time articulating their physical complaints.

Many times some kids get really good at it over the course of time but children have a difficult time articulating that they are uncomfortable in certain ways so they become more clingy.

They'll have crying spells and so forth.

So don't assume it's a psychological effect when a small child is clingy in such a way.

>> Now if the pediatrician perceives that physically the child is doing fine, you can always play with different dolls.

You can play with all sorts of different things objects around the household to try to help them deal with what they experience in the hospital.

So play therapy is something not only trained clinicians can do but you can do that as a parent.

So playing with them and talking about the experience itself with the within their abilities can often be very helpful for them.

>> The main thing for a four year old is to try to keep the four year old active and still doing things after they've experienced a hospital experience like that try to get them out.

You have and get around friends, make sure you have some playdates going because you don't want to isolate the four year old child after coming out of the hospital unless there's a physical reason to do so.

>> Let's go next caller.

Hello Don.

Welcome to America.

Mind Don you want to know about we govey you recently started we go over you know you want to do is lay around is that a normal reaction?

>> I'm going to leave the V question to the endocrinologist primary care doctors, the people who deal with that kind of medication more commonly Don.

Don, we go visit a location that's a glucagon like peptide type two stimulant or an agonist.

So it stimulates this glucagon like peptide receptor and doing so it can decrease your appetite.

And obviously the class about occasion's has been used for helping with Type two diabetes.

>> So you want to do is lie around you might be dropping your blood glucose in certain ways you want to talk it over with your primary care clinician as a possible side effect but like with any side effect you always want to go back to when did it start?

How long have you had difficulty with wanting to lie around?

If you notice the year one lie around you're tired even before you took we govey it might be related to something else if it happened right within the first week or so have taken we go over it might be related to that medication.

So talk to your prescribing clinician about that to see if there's any cause and effect related without Don.

Thanks for your call.

Disconnects Caller Hello Markus welcome to Mastermind Marcus.

>> You mentioned that your brother's in college stop and stop his ADHD medication and now very much isolated and he's gaining weight.

Are those common symptoms of stopping the medication and what other things should you look for ?

The main thing I'd want to look for in somebody stopping an ADHD medication, Marcus, would be if they're having any depressive symptoms and it sounds like your brother might be having some symptoms of depression ADHD medications typically they're stimulants and about four to five cases stimulant medications can give people an artificial energy, can give them an artificial sense of joy and happiness and it can also give them an artificial appetite suppressant effect.

So if you go off stimulant medications or your hope would be that you wouldn't have those symptoms as an ongoing problem as ongoing problems.

But if he's having withdrawal from the stimulus in that way, that could be a factor.

But if he has underlying depression by all means with the underlying depression that causes you to have social withdrawal, you don't enjoy things.

You don't have energy and motivation.

You don't want to get out so much you'll have trouble with concentration even more so than you did before.

So I'd want to make sure that your brother got assessed for any underlying depression if your brother has symptoms of ADHD with depression there are medications such as bupropion also known as Wellbutrin for dioxane also known as Trin Telex.

These medications to help with depression and ADHD secondarily.

So there are treatments that could help your brother up in different ways.

But I want to make sure that you try to figure out what's going on because if your brother was on a stimulant medication for instance for a long time they asked him what medication might have artificially perked him up to the point where he didn't have this kind of demeanor where he's socially withdrawn, has low energy and has an increased appetite.

So get him checked out by his clinician to see what's going on at this point.

>> Thanks for your call.

Let's go our next caller.

Hello Clark.

Welcome to Matters of Mind.

Clark, you want to know about dream anxiety disorder?

Is that a carryover of any other type of anxiety?

>> I haven't heard the term Clark dreams anxiety disorder at least in my field.

But you've got a couple of different anxiety disservices that can occur during sleeping now one of them does not having to have dreams but it's commonly and common experience for people to have anxiety associated with it.

It's called night terrors.

Night terrors will occur during non REM sleep.

It's during the really deep sleep where if you're awake and you'll be very confused happens shortly after you go to sleep.

It's when you first go into a real deep sleep and if somebody happens to awake you or you're awakened by something that you're outside, you'll kind of wonder for a few seconds where am I?

OK, that's non rem sleep.

Night terrors can occur where when people start to lack sleep and they have a lot of sleep debt sleep debt is where you haven't slept so well and you have been sleeping and all of a sudden you crash and sleep extremely deeply.

You'll often go in and on and rem sleep Ralph about not enough sleep can give you confusion and nightmares upon being aroused and awake and periodically non rem sleep can give you difficulty sleepwalking.

So that's where the sleepwalking will occur with non REM sleep and sometimes will be associated with anxiety.

Now there is dream sleep disturbances where people will have REM sleep disturbances, rapid eye movement sleep where during sleep itself they'll have nightmares when they're dreaming.

So during their rapid eye movement sleep you tend to have your brains pretty awake in certain areas except for this one area called the dorsolateral prefrontal cortex on the front that part of the brain when you're in dream sleep it shuts down and it's interesting that's the part of the brain that you use for judgment and making good decisions that shutting down that gives you lack of insight into what you're dreaming and that's why a lot of people will say their dreams don't make any sense was because their judgment and their insight an awareness part of the brain is shutting down.

It's giving given your rest so your brain needs to rest at night especially this part of the brain that you're using all day to focus and concentrate and keep your mind on things that part of your brain shuts down during dream sleep.

>> So dream sleep is very important for all of us and actually dream sleep is healthy for the brain and it allows you to be able to download your memories better the next day.

>> So dream sleep is actually good for the brain people who have dementia I mentioned that earlier people who have dementia will as a symptom have difficulty with dream sleep.

They don't dream as much and lack of dreaming might be a precursor to having difficulty eventually with memory disturbances.

>> So dream anxiety disorder as you'd mentioned Clark might have to do with having anxiety related to dreams themselves.

People who have sometimes post-traumatic stress symptoms will have nightmares.

However, you can't look at it from the perspective if you have nightmares, if you have a lot of traumatic brain or traumatic if you have a lot of traumatic dreams, it does not mean diagnostically that you have experienced nightmares .

>> There is a phenomenon oh 30 years ago called false memory syndrome where therapists inadvertently were telling people that if they had bad dreams they must have been traumatized as a young child and they were actually going so far as saying who was traumatizing them based on the dreams and dreams are very symbolic.

Dreams are not something that can be necessarily prophetic or predictive in terms of what's happened in your past.

So that was a very bad but well-intentioned idea to try to interpret if somebody had traumatic dreams they must have had something traumatic happen to them in the past.

That's not the case.

So Clark, if anxiety disorder during sleep itself the key would be to sort out is a related non REM sleep which often means you've had deep sleep sleep deprivation.

Sleep deprivation will give you a more non REM sleep if it's dreaming.

Sometimes we try to work out things during our dreams and actually they can be very helpful but their dreams are causing your anxiety.

That's more of what we maybe would take into the possibility of your having nightmares.

Nightmares will keep you awake and cause a lot of anxiety cause you to awaken not uncommonly with a heartbeat shakiness and a lot of fear.

And if that's the case we'd often treat people with medications, would suppress dreams, sleep a bit to the for the purpose of decreasing the intensity of the dreaming overall.

>> Clark, thanks for your call us your next e-mail question.

Our next e-mail question reads Dear Dr.

Favor do blood sugars affect a person's mental health ?

>> Well, the simple answer to that is yes.

>> Insulin will go to the brain and insulin will affect the mental health of the person.

>> Insulin in proper amounts gives your brain adequate fertilizer.

Our brain needs fertilizer just like our lawns need fertilizer this time of year or so.

>> No insulin is a good fertilizer but like fertilizer on your lawn if you get too much insulin you can actually be neurotoxic so you don't want too much insulin because it can actually kill off the branching of some of the brain neurons just like too much fertilizer will cause you to have death in a certain parts of your lawn.

>> So you want some insulin to the brain.

There's some insulin to the brain is very good for giving you healthy branching and fluffiness of the brain neurons but too much is actually neurotoxic for a lot of people.

>> So for many people they'll they'll notice that if they are insulin resistant and their insulin levels are going higher and higher and higher they will have trouble with memory and concentration.

>> I remember seeing a man a few years ago where we were seeing him in our office and he was saying that he was having difficulty with concentration fatigue.

>> He was getting during the night and urinating quite a bit.

We did a blood sugar sticker on him right there in the office and blood sugar was over four hundred.

>> He had very, very high insulin levels but he also had high high blood glucose and they were giving him those particular symptoms.

So if you have extremely high insulin and you're getting insulin resistant, your body's not responding to insulin that high insulin does go to the brain and can cause a lot of toxicity the brain itself that's why a possible precursor and a predictor from a medical perspective of somebody getting Alzheimer's dementia or any kind of dementia for that matter would be Type two diabetes if you have really high levels it does have a neurotoxic effect on the brain itself.

>> Thanks for your call.

Let's go to our next caller.

>> Hello new hi.

Welcome to Matters of Mind.

>> Knew how you want to know what does autism fall under the umbrella of mental health disorder in the field of psychiatry it actually does.

It's called Autism Spectrum Disorder and we have different degrees of autism just like we have different degrees of nearsightedness.

I mean some people have mild nearsightedness.

People have severe nearsightedness where they can't get anyplace without eyeglasses.

So autism spectrum conditions you can have high functioning autism where you can do a lot of things you can socialize.

It's just that you have that autism spectrum a little bit in the background.

Should it be in a psychiatric category?

I don't know.

I mean in psychiatry there's a lot of overlap with what we're doing in neurology at this point.

So I think autism is something it kind of skews over toward more of a neurological condition but it becomes a psychiatric condition where it affects the ability to concentrate, socialize and maintain your mood.

Now a lot of people with autism when they get the more severe type of symptoms they'll have trouble with change and that's when they get extremely anxious and they get irritable and angry and sometimes will get violent with changes in the environment and that's where we in psychiatry will try to help out because we're trying to help people deal with the stress resilience, the changes that are occurring day to day to allow them to cope .

Nuha, thanks for your call.

Unfortunately I'm out of time for this evening if you have any questions concerning mental health issues that I can answer on the air, you may write me via the Internet at matters of the mind at WFYI dot org.

>> I'm psychiatrist Jeff Author and you've been watching Matters of the Mind on PBS for now available on YouTube.

Thanks for watching God willing and PBS willing.

I'll be back again next week.

>> Take care.

Good night