The following program on PBS, Fort Wayne is made possible in part by Cameron Psychiatry, providing counseling and care for those that may struggle with emotional and behavioral challenges.

More information available at.

Good evening.

I'm psychiatrist Jay Fawver and welcome to matters of the mind.

Matters of the mind is a weekly mental health program where you have the chance to choose the topic for discussion.

So if you have any questions that I can answer on the air concerning mental health issues, you may write me via the internet at matters of the mind, all one word at wfwa.org.

That's matters of the mind at wfwa.org.

And if you're able to do so, you may text me or call me during the program.

And all we ask is that you leave a first name and let us know the town from where you are viewing.

So let's begin tonight's program with our first email question.

Our first email question reads dude, out of order with all of these medications available nowadays, is psychotherapy useful for anybody?

How is psychotherapy any different than talking to a friend or a family member?

Medications are helping with the mechanism of the workings of the brain.

So it's kind of like thinking about an automobile.

Your automobile needs to have proper engine tune ups.

Your accelerator needs to work, your brake needs to work.

You need to have proper steering for it to get to where you need to go.

However you still need to know how to get to where you need to go.

That's the whole role of psychotherapy.

Think of psychotherapy is kind of like being a GPS for your brain.

In other words, when you're going to an unfamiliar area and you're driving someplace like Chicago, in my case, I don't understand where I'm going when I go to Chicago.

If you drive into Chicago, you have the GPS on and you can listen to the GPS tell you to turn right or turn left, go up two miles and take a certain exit.

So you're getting instruction from the GPS because you're an unfamiliar area in which you have little experience.

Life kind of works that way as well.

Sometimes you have life circumstances that hit you by surprise.

You don't have adequate coping skills with these particular experiences.

You don't have a lot of support perhaps at the time, and you're kind of stressed out.

What happens?

Psychotherapy or talk therapy kind of guides you in an objective manner, giving you some ideas on what direction to turn based on what you're enduring at that time in your life circumstances.

Why can't you just talk to a friend or a family member, a friend, or a family member will not necessarily give you objective, meaningful advice that you need to hear.

A counselor or a psychotherapist is not emotionally engaged.

They don't care if you get mad at them or not.

They might even expect you to do so.

And they're going to tell you some things that are important for you to know that might kind of, be somewhat of a surprise for you.

Your family members and your friends might treat you more with kid gloves and might not be as direct and as interventional with you as a therapist might.

So the nice aspect of a therapist, it's a non-emotional objective outside observer who's trying to give you basically advice as you'd get, directions from a GPS on an automobile.

Thanks for your email.

Let's go to our first caller.

Hello, Tina.

Welcome to Marriage of Mind.

Tina, you want to know, can severe levels of anxiety cause someone to develop a personality disorder?

Anxiety.

Tina does not usually cause a personality disorder.

A personality disorder is a condition that typically has its underpinnings in early childhood development, typically based on relationships with parents and close family members and caregivers, and then, over the course of time, the personality disorder, whether it be avoidant personality disorder, borderline personality disorder, narcissistic personality disorder.

Based on the life circumstances, you can have anxiety cropping up from the underpinnings of the personality traits themselves.

So usually you'll hear about a personality disorder that's been ongoing and generally trending, and that will often create anxiety when things aren't going as you would expect.

Tina, thanks for your call.

Let's go to our next email question.

Our next email question reads Dear Doctor Father, with help, I think I just there we go.

Dear, dear father, why do people with depression seem to develop symptoms of attention deficit Disorder?

How can your mood affect your ability to concentrate?

Well, basically, when you have depression, you'll often have difficulty focusing on things that you need to focus upon based on their significance.

And in the brain you have three networks.

The networks are the default brain network, the fault mode network, the salient network.

And then you have the executive mode network, three networks.

The default mode network is the network of the brain.

It's kind of in the deep dark recesses of the brain.

That's the part of the brain where you're not really thinking about a whole lot as you're driving down the interstate.

Yeah, you're paying attention, but you're kind of daydreaming.

You're thinking about your past, you're wondering about what you might do, but you're not really thinking very intensely on something.

And it's actually called highway hypnosis.

It's not something that's pathological, but highway hypnosis is where you've driven several miles and you don't remember much about where you've been driving.

That's not dementia at all.

That's how whipped highway hypnosis is, because your brain is in default mode.

Now, let's say you're driving down the highway, and all of a sudden somebody brakes really hard in front of you.

Then your salient network kicks in and gears you into the executive mode network.

The executive mode network is, you're thinking, your intense concentrating network.

So the when you think about these different networks, the default mode network, the salient network, the executive mode network, these three, these three networks are similar to going from low gear to shifting and then going into high gear.

So low gear is kind of like your salient network.

It's in the just where you're thinking about your past, in your biographical information, and you're just kind of chilling out and you might be daydreaming and so forth.

That's your default mode network.

That's the network that you're in most of the time.

But when something happens and your brain's telling you, hey, pay attention to this, it shifts you to the salient network.

The salient network is like a shifter takes you into the executive mode network, and the executive mode network is where you're constantly concentrating really hard.

How's that apply to depression and attention deficit disorder?

And both depression and attention deficit disorder?

You have difficulty with the shifter.

In other words, you can't get out of the default mode network.

Now with Attention Deficit disorder.

Yeah, you could focus on something really well.

If it's interesting, challenging, exciting novel, you can focus really well, but then you kind of lose interest with depression.

You could have difficulty paying attention to things, maintaining interest because the salient mode network is stuck in the salient mode network that gets stuck.

Is this area called the sub general anterior cingulate gyrus?

This is the single anterior cingulate gyrus around here, and the sub general meaning under the knee.

Because somebody thought this looked like a knee right here.

But under the knee there is the sub general anterior cingulate gyrus that becomes overly active when somebody has depression and presumably when they have attention deficit disorder.

Basically you get a stuck shifter.

That's where the heart of your salient network is, and you can't shift from default mode network to executive network.

So you can't focus on something that requires a lot of attention because your shifter is not working so well.

There's also something over here in the, kind of the thumb of the brain on the back side there called the insula.

That gives you a sense of self-awareness, but that also is involved in the salient network that to get stuck.

So when you think about depression and you think about attention deficit disorder, those are conditions where you have difficulty shifting from your daydreaming mode into a really intense thinking mode.

That's why people with both depression and attention deficit disorder have difficulty paying attention to things without being highly distracted, so they'll have trouble with focusing on things that might not be that interesting, but they still need to get done.

So many people with attention deficit disorder, especially, will get started on something because they're interested initially, but then they lose interest.

It's because their salient network isn't working so well.

It causes them to get stuck.

They can't shift that gear from the default network to the executive mode network, and that way they have a hard time concentrating.

People with depression will also say they feel like they have slow internet speed.

There's something that's called speed of processing in the brain, where you're trying to process information quickly and you're going from one thing to another, and you might be trying to multitask.

People with depression have a Dickens of a time doing that.

Thanks for your email.

Let's go to our next caller.

Hello, Sandy, welcome to Marriage of Mind.

Sandy, you had mentioned your grandson is overweight and autistic but doesn't want to stop eating.

What are some of the things that might curb his appetite?

That's an interesting, phenomenon that's occurring right now, Sandy.

Because I wonder in a you talk this over with your grandson's clinician based on his age, especially if he's over 18 years of age, the GLP one agonists might be helpful for somebody with autism who's having difficulty with binge eating.

Now, the GLP ones are glycogen like peptide type one agonist, meaning that they were stimulating that particular receptor of GLP ones like Ozempic, medications that are very popular right now.

They're used for obesity, they're used for type two diabetes.

But the area where we're seeing a lot of benefit for those particular medications, the GOP ones, will be for people who are binge eating, overeating.

And it's thought that has something to do with, helping them lose weight.

Although their weight loss might predominantly come from the changes in the microbiome are the bacteria in the gut, as well as how the gut is actually moving food around.

And the GOP ones make you feel full or easier.

But basically, the GLP one agonist will decrease the food noise.

So for some of the autism, I'd be curious how the GOP ones would do it with autism.

Because with autism, part of the issue can be difficulty with stress, resilience, being able to put up or stop because you get overly stimulated and you get overly stimulated because you have this area, the thalamus, which is the central operator of the brain, right smack in the middle, the thalamus can't process information adequately.

The question would be, would GLP ones help with that?

There are medications that might be able to help fire up this stress resilience in such a way that there could be a decrease in binge eating.

So there's a lot of different treatment strategies out there available, but the autism and the binge eating might go hand in hand.

The question would always be, why would your grandson be eating excessively?

Sometimes people will eat excessively because they're emotionally comforting themselves.

Some people will eat excessively because they do have that excessive food noise.

They're just getting that urge to eat and eat and eat.

Some people will eat excessively because they have social anxiety, and we've seen that not uncommonly, people get around, others in a social type of environment, and they want to start eating because that gives them some degree of comfort.

Other people, unfortunately, might start drinking alcohol as a means of calming down their anxiety.

So there's a lot of reasons why people might want to binge eat or overeat.

And that's why you want to always sort it out.

But with autism, you want to try to blend the treatments that where you knocked down two birds at just one stone, ideally where you take care of some of the autism symptoms while also helping with the binge eating.

Thanks for your call, Sandy.

Let's go to next caller.

Hello, Brad.

Walk in America.

Mind.

Brad, you want to know how do you convince someone to get treatment for their mental health?

Well, they don't think they have a problem.

Well, Brad, the first thing I'd recommend is you try to negotiate and find common ground.

Many people with mental health disturbances will agree that they're having one problem or another, and many times they're suffering from a particular difficulty.

Many times when people are psychotic, where they're losing touch with reality, you can't talk somebody out of a delusion, which is a fixed false belief.

You can't tell them those hallucinations that they're seeing or hearing are really occurring because they're there.

As clear as my face is to you right now on video and as clear as my voice is to you, so you just can't say it's not happening with delusions to fix false beliefs, you can't say what you notice happening around you.

Is it really happening?

So you can't.

You can cite your reality as you see it.

If you're a trusted friend or a family member, but you try to find common ground on what you can agree upon.

And quite frankly, many, many people with a mental health disturbance will have difficulty with sleep.

And that's where we start, because many people will notice that, yeah, when they're not sleeping well, they don't feel so well.

And when you don't sleep well, you have trouble with coping and you have trouble with what we call stress resilience.

Putting up with stuff, because sleeping and getting a good night's sleep will allow you to recharge this front part of your brain.

That's what we all need to sleep well.

And that's why if we don't sleep well, we're more prone to having mental health disturbances.

And later in life we're more prone to having conditions like Alzheimer's, dementia.

So you have to be able to sleep well night by night, just like you need to.

So you need to recharge your cell phone night by night for it to work.

So sleeping is often where we're going to find common ground.

And if you can get them in to see a clinician to at least help them with sleep, often with sleep improvement, other symptoms can improve and you can go step by step in terms of getting other symptoms addressed.

Many people will notice that they do indeed get in trouble because of their behaviors when they're having mental health disturbances, so they might notice that that's a problem.

Yeah, it could be other people's issues as they may claim.

But the bottom line is they get in trouble when they will have mental health disturbances, for instance, with manic behavior, when they have bipolar disorder and they get manic, they'll tend to spend more and they'll do things and say things they later regret.

They'll notice that later on you remind them of that.

With alcohol use conditions, many people, while drinking alcohol, lose judgment because alcohol, basically unnecessary, uses the thinking and the judgment part of the brain in the front.

And you don't think very well during that time and you don't make good decisions.

We will often remind people that when they last drank alcohol, this or that happens.

So you confront them on common ground based on your observations.

But what you don't do is argue with them concerning their sense of reality.

For instance, they might say, well, that's my truth.

Yet you have your truth, and what you try to do is give them, an awareness of what's real and what's not real.

You know, I'm holding the cup right now.

This is a cup.

They might say.

Well, I think it's a softball.

That's my reality.

This is a softball that right here.

So no, it's not, it's a cup.

It's obviously a cup.

No, it's a softball.

That's my truth.

So if they start arguing with you concerning their truth versus your truth, you know, you always look at the consequences of that truth.

For instance, if I drop this, a softball should be able to bounce.

If it's not a softball and it's really a cup, it's a ceramic cup.

It's going to crash and it's going to break.

So truth does have some consequences and reality behind it.

And sometimes you have to find that common ground.

Overall.

Thank you for your call.

Let's go to our next caller.

Hello Sam.

Welcome to Marriage of Mind.

Sam, you had mentioned that your son just got diagnosed with bipolar disorder and he's on medication.

How do you know if he's having a manic episode versus just having a bad day?

Usually with bipolar disorder?

Samuel, have, somebody have a bad day, one after another after another, and will often be manifested if it's a manic episode with decreased need for sleep, your son would be talking a lot faster than ordinary.

He he would go from one thought to another to another to another.

He'd be more impulsive with a, a manic episode.

Not uncommonly, people can be very socially intrusive.

And they talk to people to whom they wouldn't talk.

So bottom line is your son, during a manic episode, would have behavior a little bit over the top than what you'd expect.

A bad day?

Well, he probably gets irritable.

Irritability is a symptom of manic behavior.

Some people get euphoric where they feel higher than a kite, but many people do get irritable and angry.

But think about those other type of symptoms going along with it.

There's something called a hypomanic episode where people get a little high.

And yeah, it's not highly problematic for them or people around them.

But the problem with those little highs, they often will rebound into big lows, and the big lows can last for a couple of weeks.

People hate those experiences, with a full blown manic episode.

It'll go on day by day by day for at least a week.

So, you need to sort that out.

And the idea in treating people with bipolar mania will be to try to get the mania as well as the depression under control.

So we will often give the mood leveling, medication, mood stabilizers that act as cruise controls on the mood.

They don't allow you to go too high.

They don't let you go too low.

They keep you somewhere in the middle so you don't unnaturally have a manic episode that can unfortunately rebound in to lows thereafter.

Thanks for your call.

Let's go to our next text, our next text reads, is it possible to wake up one day and feel like you have a mental issue?

I feel like I have experienced this depression, self-doubt, insecurity, low self-esteem, to name a few.

I don't feel like at that any of that when I went to bed.

It's been about almost a month now and I'm still experiencing this.

How does this happen?

Well, if you wake up one day and you unnaturally have depression, it just slam on you and it's been there for a whole month.

Number one, make sure you go see your primary care clinician.

First and foremost, you need to get checked out to see if you've had any metabolic issues come up.

Perhaps type two diabetes is emerging.

Perhaps hypothyroidism.

Perhaps you started snoring for whatever reason and now you have sleep apnea.

Maybe you have low iron because you have a slow leak of, and the gut has some blood, so low iron will cause you to feel terrible.

So get checked out medically.

See what's going on there.

Number two, what I want to know is if you ever had any of these episodes before, it sounds like you did not.

And number three, did any of your family members have similar episodes?

If so, yeah, clinical depression does raise that.

Does, tend to, run in families.

So you can have people with, a major depression having similar disturbances in family members.

But, you can have those symptoms day by day, occurring over the course of, of a month.

If that's the first episode ever, we call that single episode of major depressive disorder, and we want to treat it accordingly.

But you can awaken unnaturally, have a major depressive disorder.

Usually when people have a depressive episode, people will have something happen.

So something happens to trigger the depression.

I mean, I had bad stress, something change in your life that, you find is difficult to tolerate.

You have a hard time coping with the changes the first depression and anybody ever has usually will be brought on by something.

And then the second depressive episode.

Less stress is necessary.

Third depressive episodes, less stress still.

But in your case, have nothing going on in your life to speak of that you consider to be stressful.

And you just woke up and you just been stuck in this funk for the past month.

By all means, I do want to make sure that metabolically, physically, you're doing okay with everything.

And then, as a diagnosis of exclusion, we consider a major depressive disorder.

I wish you with the best.

Thanks for your text.

Let's go to next text.

Cindy from South Milford.

Welcome to marriage.

The mind.

You want to know, how do you get your husband to stop smoking cigarets?

That's a question many, many spouses are asking.

Cindy.

Number one, he needs to have some incentives.

Why would he want to stop smoking cigarets?

Just the cost is an issue.

The taxes on cigarets are going higher and higher, so there might be a little bit of an issue there.

Try to identify what's in it for him.

So if he quit smoking, maybe he'd have, more of his more ability to have, more physical stamina.

Maybe he'd be able to breathe more clearly when he's walking long distances.

Maybe he'd be able to go into places where he couldn't before.

So you try to look at the at the assets.

And, you know, many people want to quit smoking.

And some statistics show that four out of five people want to quit smoking, but they have trouble doing so.

So there are many, many means of helping people with nicotine replacement.

We have gum.

We have, nasal sprays, we have patches.

There are many, many ways that we didn't have 30 years ago to help people withdrawal from nicotine.

So if it's a nicotine withdrawal, that's problematic.

That could be an issue.

Maybe he's feeling like he can concentrate more clearly and he has more energy when he's smoking nicotine cigarets.

Yeah.

That happens.

We've got medications that can help offset that as well.

It used to be thought that teenagers, for instance, who would smoke cigarets were smoking to self-medicate depression or self-medicate, attention deficit disorder.

Now we know that's not necessarily the case.

But we do know is that if you start smoking as an adolescent or a teenager, you're more likely to basically set the template in this middle part of the brain for depression later on.

So you have to keep smoking cigarets as a means of mitigating or decreasing the likelihood of having depression.

So we want to try to address the biochemical aspects of why your husband might be smoking, how to get him through the withdrawal of nicotine upon stopping, and particularly looking at, the assets of, what's in it for him to quit smoking at this point?

Talk it over the primary care clinician, especially if he's interested.

Thanks for your call.

Let's go to next caller.

Hello, Jennifer.

Welcome.

The members of mine.

Jennifer, you had mentioned that your house burned down last month.

I'm so sorry to hear about that.

Can you have something?

Can you have post-traumatic stress disorder from something like that?

Yeah.

You can.

Jennifer, a really traumatic experience.

It doesn't have to be physical abuse, sexual abuse, emotional abuse, a traumatic experience.

It can be a weather related event.

It can be a motor vehicle accident.

Your house burning down.

That's a huge stress.

Now, a post-traumatic stress disorder, basically would be manifested.

Jennifer, by you're having a lot of panic and anxiety related to the smell of smoke or seeing a fire in any other capacity.

If you're avoiding situations that might remind you of the fire, if you're having a lot of jumping, assume we call them flashbacks, where you can actually visualize the house burning all over again.

That could be a problem.

So if you're having unnatural anxiety and avoidance and what we call hyper vigilance, where you're really jumpy, those are all phenomena that can occur when somebody has had a very traumatic experience.

So again, talk it over to your primary care clinician to see if your primary care clinician has some ideas on where you could be seen for medication or therapy.

There are a lot of different treatments now for post-traumatic stress, but you can have post-traumatic stress even after a month following your house burning.

I'm so sorry to hear that.

Let's go to our next text.

Hello, John.

Welcome to marriage.

The mind.

John, you had text me about trazodone.

I can, it's taken for sleep and anxiety.

Can sleep disturbances.

It causes sleep disturbances with no appetite.

Can it cause a change in vision?

Because you're experiencing double vision.

Trazodone is a medication that's been around since about 1987 or 88, and it's a medication was originally used for depression.

We found within a matter of, 3 or 4 years.

A transient is a really good medication for sleep.

So many people will take strategies and at bedtime for the purpose of getting a deeper night's sleep if you get too much tragedy.

And I'd always want to take into account, John, what other medication you might be taking.

But if you get too much tragedy, yeah, you can have side effects like dizziness, double blind or a double vision.

You could have trouble with lightheadedness and so forth.

So it's likely dose related to the tragedy in itself.

So I'd want to make sure you're getting the proper amount of tragedy.

And while also looking at other medications you might be taking because they could be factors as well.

Let's go to our next caller.

Hello, Brad.

Welcome the mastermind.

Brad, you want to know what does it look like with someone with bipolar disorder when, after, as they age, usually people with bipolar disorder will have more difficulty with depression as they age.

Brad, early in your life with bipolar disorder, not uncommonly, you can have more manic episodes than you have with depressive episodes.

Makes people very difficult to treat because people like the highs.

But it gets him.

They get him into trouble.

Sometimes when people have a true manic episode, they'll have trouble with not sleeping.

They'll do things impulsively, they'll say things and do things they ordinarily wouldn't say or do, and people more on the manic side, they often don't have awareness or insight of what's going on.

As time goes on, they typically will have more depressions, depressive episodes.

So when people come in to see me, they're talking about depression, depression, depression.

They're talking about how they want to get out of the depression.

And I have to kind of dig for that information to figure out that they've been having some highs in the past or even recently.

So looking for the manic episodes later in life, Brad will be not unlike, looking for mushrooms in the forest when you look for mushrooms in the forest, you just can't look around and see the mushrooms.

You got to look under the branches, in the shadows, under the leaves, because mushrooms will hide in the dark, shadowy areas.

Well, that's kind of like manic episodes.

People don't report spontaneously manic episodes, but they talk about the depression quite a bit.

But as you get older, you typically will have more depression than he did manic episodes.

And typically people still need the mood stabilizer to keep them level.

Brad, thanks for your call.

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

If you have any questions that I can answer on the air, you may write me via the internet at matters of the mind all one word at wfwa.org I'm psychiatrist Jay Fawver and you've been watching matters of the mind on PBS.

Now available on YouTube.

God willing and PBS willing.

I'll be back again next week.

Thanks for watching.

Good night.

The preceding program on PBS Fort Wayne is made possible in part by.

Cameron Psychiatry, providing counseling and care for those that may struggle with emotional and behavioral challenges.

More information available at Cameron health.com.