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>> Good evening.

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

Welcome to Matters of the Mind.

Now as twenty fifth 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 dialing (969) 27 two zero or if you're calling any place coast to coast you may call toll free at 866- (969) 27 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 question that I can answer on the air, you may write me a via the Internet at matters of the mind all one word at org that's matters of the mind big and I'll start tonight's program with a question I recently received.

>> It reads Your Fauver what are the newest developments in psychiatry?

Well, there's a lot of new things going on in psychiatry where the direction of psychiatry has changed dramatically over the past two decades.

We used to talk a lot from a neurochemical standpoint of serotonin, dopamine and norepinephrine and those chemicals make up a very small percentage of the brain.

>> Most of the brain has the chemical transmitter.

>> Glutamate involved in glutamate is balanced by this other chemical called GABA.

So between glutamate and GABA that's how you kind of have do the balancing act with your brain and that will prevent you from having seizures, psychosis ,anxiety and depression.

Well, the issue is with psychiatric disturbances that disturbance of Gabin glutamate will kind of get a little off center and we've used serotonin, dopamine and norepinephrine a kind of fine tune and glutamate.

But now we have medications coming out just over the past two or three years that actually do some direct work on glutamate and GABA how how that important is that with serotonin, dopamine and norepinephrine it would take several weeks to get the full benefit in relief for depression with the newer medications that we have on hand you can get benefits sometimes within one or two doses so it's quite a bit different.

>> We're looking more at the scaffolding of neurons now where they will grow more and more branches.

Little neurons have anywhere between ten thousand and one hundred thousand branches.

Each individual neuron has all these different branches so it's like a very extensive tree branching that will have and when you get depressed, when you get anxious, when you get psychotic for that matter, all those branches start to shrivel up the tree still there.

The neurons not dying.

It's the branches that kind of shrivel away and with these newer medications affecting glutamate and GABA directly you're going to get more branching and that's seen within a matter of 15 minutes up to four hours or so.

People will notice that under the microscope you can get this extensive branching occurring that quickly.

So it's a whole different world in psychiatry at this point.

We've heard about blocking dopamine receptors over the course of time for schizophrenia.

Well, now we're going to be talking about all different types of pathways for helping people with schizophrenia that don't affect dopamine blockade when you block dopamine you can have side effects such as stiffness and you can have tremors and you can have a difficult with concentration blocking dopamine will give people long term effects like tardive dyskinesia where they have hard blinking in their mouth and on their shoulders.

They can have a lot of shrugging.

So if you get away from just blocking dopamine with schizophrenia you can get a different mechanism of action that won't go cause those kind of side effects and perhaps help people in entirely different ways.

>> We used to use benzodiazepine medications extensively for anxiety Xanax, Klonopin, Valium back in nineteen seventy nine Valium was the number one used medication of all medications in the entire country.

So Valium in nineteen seventy nine that's when I came out of pharmacy school that was the number one medication of all medications and now we've gone an entirely different direction in terms of helping people with anxiety we can enhance their serotonin system a little bit to calm down anxiety we use the various antiepileptic medications like Gabapentin also known as Toronto to help with anxiety and we can use some of the newer medications that are coming down the pike here that will affect glutamate to decrease anxiety.

>> So from a neural pharmacology standpoint, it's a whole new world for us.

>> There's a lot of a lot of changes occurring right now.

A transcranial Kenendy stimulation it used to be everybody got who who got TMS always got the left front part of the brain.

>> Now there's ways to actually center where the magnetic stimulation should go in these stimulations occurred in the matter of just a minutes, a few minutes sometimes just a few treatments on an inpatient setting can be done but you give magnetic stimulation to certain parts of the brain for the purpose of helping people recover from illness.

So that's something that's going to be seen over the course of time psychotherapies they're evolving over the course of the past few years we've heard a lot about eye movement desensitization and reprocessing that's also known EMR a very nice treatment for a lot of people with post-traumatic stress disorder symptoms we've had dialect and behavioral therapy that continues to expand and that's more for people with borderline personality disorder who have moodiness that's triggered by interpersonal conflicts or just stresses that happen in general .

So DBT is something that's used for a lot of people as well.

So we're finding that there's different treatments and all these different areas that will continue to expand over the next five to ten years.

So it's going to be an exciting time in psychiatry.

>> Thanks for email.

Let's go to our first caller.

Hello Joy.

Welcome to Matters of Mind.

>> Joy, you'd wondered is it something of the mind that causes restless legs or is there a cure?

Restless legs Joy will be a condition where the first thing I always want to know is what's your iron level if your iron is low and we see this not uncommonly with women who are heavy heavy men traders and they might be vegetarians for that matter if your iron is low it's going to give you restless legs.

Another factor we'll see if people have poor kidney function that will give them restless legs a rough about I want to know that from a blood test standpoint the iron is OK and the kidneys are OK if somebody who does have restless legs the first thing I want to the second thing I want to do Joyce I want to examine what medications somebody might be taking because if somebody is taking a medication that increases increase of serotonin you can indirectly decrease dopamine if you decrease dopamine that will cause you to have restless legs and restless legs typically occur more in the evening than during the rest of the day and they occur when you're trying to rest and they tend to occur when you're trying to settle down in the evening and they're miserable at nighttime you will have restless legs and also know something known as periodic leg movements in night in the nighttime and it keeps them awake all night.

>> So we want to make sure that somebody is not on serotonin medications or medications that somehow affect serotonin because that can cause restless legs very some of the medications occasionally we'll do it.

We want to take a good look at those medications and see if they might be factors now what kind of things do you do for restless legs overall?

Well, for one thing you probably want to increase dopamine and you can increase dopamine by Principessa which is a medication that specifically stimulates dopamine receptors.

>> You're basically going to address restless legs not unlike somebody addressing Parkinson's disease with Parkinson's disease.

There's there's a dampened transmission of dopamine in the brain.

So you treat people with Parkinson's disease with medications that stimulate dopamine receptors.

>> The same kind of medications can be used for restless leg.

So that's the first thing we'll do.

And obviously if there's underlying problems with ION or maybe there's a medication that might be contributing to restless legs, we want always addressed that as well.

>> But there's different ways to address this leg syndrome can be addressed basically it depends on what kind of condition the person might be experiencing.

You had a second question about a cure for severe Manero syndrome.

I'm not a psychiatrist so I tend to not see Manero Syndrome that much unless it's causing a lot of panic attacks.

>> So that's kind of how I know about Meneer syndrome.

Neuro syndrome is basically a phenomenon that was discovered by a doctor in You're a one time and Doctor Minor identified a syndrome where people would have ringing in the ears, they would have dizziness and lightheadedness and along with that sometimes they'd have hearing loss but very commonly people would have nausea.

So it's almost like having a Secich type of phenomenon.

It's got to be an inner ear phenomenon where people might have too much fluid on the inner ear but it's causing ringing the ears, dizziness and not uncommonly nausea.

>> Those are the kind of symptoms people have with Meneer syndrome.

Some people will be referred to me as a psychiatrist because along with this condition they're having panic attacks and they might have a lot of anxiety associated with I think right now the best way to approach manures disease would be to see an ear, nose and throat clinician.

Often they'll get an MRI the brain they want to see if there's a cyst that might be contributing to an inner ear problem.

They want to see if there is extra fluid there.

Many people who have difficulty with Moneris disease will indeed get antihistamines.

Medications like antifraud also known as mechanizing it has a drying effect on the ear and that's one of the reasons why it can be helpful.

So it's Mecklai or antifraud as a medication to treat it.

>> It used to be thought that people could take Xanax specifically to decrease the ringing in the ears if they had Meniere's disease but anymore it's thought that that really didn't help so much.

So I would think the best way to try to address Moneris Disease would be to see an ear, nose and throat doctor overall.

Joy, thanks for your call.

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

Our next e-mail question reads Dear Dr. Fauver, how do Headache's affect mental health ?

There's different types of headaches and we always want to identify what kind of headaches somebody might be experiencing.

>> There are cluster headaches.

There's there's chronic tension headaches, there's migraine headaches and there sinus headaches.

>> Those are the four main headaches that I'll often see as a psychiatrist and yeah, I will address those kind of conditions because if you have a headache it makes you feel lousy.

>> If you feel lousy you're more likely to have depression, anxiety and difficulty with sleep, a difficulty with thinking these are all the kind of conditions a psychiatrist will treat.

>> So let's take a look at some of those.

A cluster headache is of the ones I mentioned probably the least common.

>> But if you have it you are going to know what it's a condition it's often associated with having a clustering of the headaches at a certain part of the certain time of the day so some people will notice that the headaches cluster around four o'clock in the afternoon, five o'clock in the afternoon so they cluster around the same time of the day and they're more common with men who might be smokers and drink ones who drink alcohol but they're characterized by an ice pick like pain in one eye and it causes redness not eye that causes watering of that I it'll give you some nasal congestion especially on that side and it will cause you to have intense pain during that time it's treated by various kinds of medications that can relieve those kind of headaches.

It's treated by various antiepileptic or anti seizure medications.

It's used it's treated by nifedipine which is a medication you often used for blood pressure.

And interestingly enough, if you have oxygen available it can be nicely treated with oxygen inhalation during that time.

So cluster headache is not as common as some of the other headaches but it can occur in clusters around the same time every day, especially with middle aged men and it's characterized by that intense icepick like pain in one eye at certain times of the day.

>> Now the more common headaches will be chronic tension headache, a chronic tension headache as the name kind of suggests will be a headache the kind of nausea gints around from much of the day.

It gets worse often as the day goes on.

So if you're waking you often don't have a headache but as the day goes on and you do in the stress of your daily job and you're trying to get around doing different things, you get more and more of this headband like headache and the headband like headache will be characterized by this headache that goes across the front part of the brain and on the side just feels like the whole skull is squeezing in on you and that kind of headache can be extremely annoying but you can still do things.

In other words, you can still get up and around, you can still do things.

You can exercise and exercising especially various tension and aerobic exercise that can often help the headache.

So it often goes away with exercise and that's one way that people often try to treat that headache.

People often treat a tension headache with low doses of the old tricyclic and depression medications amitriptyline the most popular ten or twenty five milligrams at bedtime some people will use low doses of muscle relaxants because tension headache is because the the little thin muscles are tightening down on the skull and it's giving us this dull headache in that way the migraine headaches are in other types of headaches.

>> Migraine headaches are more common with individuals who have bipolar disorder in psychiatry.

So in psychiatry we have a condition particularly called bipolar disorder type two women who have bipolar disorder type two are more likely to have migraine headaches, migraine headaches are very characteristic because they just incapacitate you.

There are more typically worse in the morning you awaken in the middle the early morning hours with a headache and that's often a migraine headache.

My migraine headaches you will often feel them coming.

>> You see lightning bolts, you have this dull ache sensation.

We just have this foreboding feeling that is coming.

Some people will see sparkles before they come on.

That's called an aura but with a migraine headache it's a pounding one sided headache that is excruciating.

It will cause you difficulty with bright lights.

You have nausea.

You feel like you're going to vomit in some cases you do vomit and you've got to go lay down for a couple hours.

The worst thing people can do during a migraine headache is exercise.

>> Exercising actually makes the migraine headache worse but it's more common in my field with people who have bipolar disorder.

So it's not diagnostic but it certainly is associated with bipolar disorder.

>> That's why when we see somebody with bipolar disorder and they're having big highs and big lows and they have migraine headaches will preferentially treat them with the antiepileptic medications like LaMotte's Rajin Gabapentin valproic acid carbamazepine, carbamazepine these are medications that are all anti epileptics but they also act as mood stabilizers.

>> So we try to knock down two symptoms with this one medication and doing that.

So those are migraine headaches and then you have sinus sinus headaches are associated often with a stuffy nose, a little bit of a fever and you tap, tap, tap, tap, tap, tap over the various sinus areas and it makes people jump.

So a sinus headaches as the name implies is because the sinus is clogged up and it gives you a very sharp headache over that particular sinus area.

The treatment there obviously will be with decongestants or getting enough fluid to the sinuses using a neti pot which is basically where you're breathing in saline solution as a means of giving your more moisture that way.

But sinus headaches will come and go for a lot of people they're annoying but they don't cause as much incapacitation as migraine headache.

So as a psychiatrist I see a lot of people with migraine headaches.

I see a lot of people with tension headaches because tension headaches will go along with anxiety for a lot of people and the cluster headaches will occasionally be seen more often with the middle aged men who are drinking alcohol on a regular basis.

But just a couple of weeks ago I did see a man with cluster headaches and he was not a drinker.

He wasn't a smoker, just had the cluster headaches and interestingly enough he was treated not only with the antiepileptic medication but he is also treated with a little bit of oxygen every now and then which is a great way to treat the cluster headaches themselves.

So based on the type of headaches somebody has, the treatment is entirely different.

So when we hear about somebody saying I have a headache, we often we want to know off the bat what are the specific symptoms because we have to sort out the the various signs and symptoms of the headaches and then based on those particular characteristics will identify what treatment approach we want to use.

And if we use a particular treatment approach, we want to know, OK, are we also going to help you with anxiety, with sleep, with mood swings?

>> What other kind of conditions need to be treated and we'll try to use medications that will treat not only the symptoms of the headache but also the symptoms of the mental health problem.

>> Somebody might have half now if you can imagine if you have a headache you'll often have difficulty sleeping and lack of sleep will often provoke a headache.

We see this particularly with migraine headaches.

A lot of people who have migraine headaches will indeed have difficulty sleeping and lack of sleep will provoke the migraine headaches overall so will often try to address the sleep and try to give them sleeping because if you can help somebody sleep who has headaches that's often three three fourths of the of the benefits people can get.

>> Thanks for your call.

Let's go to next caller.

Hello Nicole.

>> Welcome to Matters of Mind.

Nicole, you want to know why does medical what is menopause affect your sleep when people are going through menopause?

>> Nicole the average age is 51 years of age for women it's where basically the ovaries are just kind of no longer working.

They're kind of fading away and their activity and they're not releasing as much estrogen and progesterone as they had before .

So as the ovaries fade and their activity and their productivity of those hormones, women often will have difficulty with hot flashes.

They'll have trouble getting into a deep sleep so they get in this sleep, they freak out awake frequently awakening have good awakening if they do have hot flashes, the hot flashes where they get sweaty and hot every now and then that will keep them awake as well.

So the important aspect of treating individuals with sleep problems during menopause is to help them sleep with specific medications to address those kind of problems that are keeping them awake because we know that if you have hot flashes and insomnia as you're going through menopause, you are more likely to have day by day difficulty with depression, a lack of enjoyment things.

>> There's two reasons for that.

No one, as I mentioned just before, lack of sleep will increase your likelihood for having clinical depression and lack of sleep will also give you problems with being able to just function on a day to day basis.

You won't be able to think you won't be able to keep your mind on things and you're already going to have some of that difficulty with lack of estrogen because estrogen feeds this memory center of the brain.

It's called the hippocampus.

It's over on the thumb part of the brain is the left side brain looking at you here, the thumb part of the brain is the called the temporal lobe.

On the top of that is the hippocampus and that's just studied with little estrogen receptors.

>> So as you go into menopause you're not getting the feeding of those estrogen receptors anymore and that will cause you to have trouble with concentration of memory in some women as they go through menopause will perceive their having all sorts of trouble with memory such that they think they're getting early Alzheimer's disease.

>> Now there's a couple of things I'm always concerned about that when people are noticing they're having memory problems as they're going through menopause, I'm going to want to make sure that they're not drinking alcohol because if a woman drinks alcohol, one drink for a woman is like three drinks for a man.

Women don't metabolize alcohol as as well in their stomachs and their livers.

So one drink will feel like three four for a woman compared to a man.

So we want to make sure women are drinking alcohol because alcohol on top of menopause can be extremely detrimental to your concentration if you have two or three drinks at night that's like a man having six or nine drinks at night and what that's doing it's shrinking up this hippocampus area because not only is the hippocampus studied with little estrogen receptors, it's also highly sensitive to the toxic effect of alcohol.

>> So for a woman the alcohol might go right to the hippocampus and start shrinking that down.

The hippocampus area is one of the first areas that might start shrinking down when somebody has Alzheimer's dementia.

So that's the part of the brain we want to be very careful about when people are having menopause also as women are getting menopausal, I'm concerned about low thyroid if you have high prolactin prolactin for a woman if it's too high it's above twenty four on a blood level but high prolactin from various reasons can give you low thyroid especially if you're menopausal.

Don't know why but it can be a correlation there.

So low thyroid can give you difficulty as you get into the menopausal years.

>> In some cases sleep apnea is something we identify all the time in my office as a psychiatrist because sleep apnea is a condition where you get a little bit older and your neck muscles your neck tissue gets a little bit more flimsy and it collapses down when you're sleeping.

>> So as we get older sometimes that can be a risk factor for developing sleep apnea and if you gain a few pounds as you get into menopause, that can be a risk factor for sleep apnea as well.

So sleep apnea is where you're not getting adequate airflow to the lungs thereby getting decreased oxygen to the brain that will give you trouble with focus concentration energy level the next day.

>> And if you're snoring and you're having difficulty with getting adequate oxygen the to the lungs because of the snoring the snoring itself can keep you awake because your brain is perceiving that you're drowning and you're losing oxygen.

So it'll cause you to wake up periodically so menopause can be related to insomnia for so many different reasons.

So we try to identify very systematically one by one all these possibilities why you might be having sleep disturbances during menopause itself.

>> Nicole, thanks for your call.

Let's go to next caller.

Hello Barney.

Welcome to Matters of Mind.

>> You want to know would a mood stabilizer be better than an antidepressant for bipolar disorder type one?

Well, for the rest of our viewers, let's talk about bipolar disorder type one you likely know very well what it what it is bipolar disorder type one is where you've experienced at least a one week episode of mania at some time in your life .

>> Now bipolar disorder typically occurs in your early 20s, late teens at the latest early thirties for most people early on you can have some depressive episodes that actually having depressive episodes at least for two weeks at a time as an adolescent or young adult can be a predictor for bipolar disorder.

So bipolar disorder typically occurs.

The manic episodes typically occur by the time you're in your 20s, your early 30s at the latest it's often associated with a one first a real family history of bipolar disorder where we look at a father, mother, brother, sister who has bipolar disorder.

So that'll be a predictor itself.

So if you have bipolar disorder type one it means you've had typically recurrent one week or more episodes of mania.

>> Mania has characterized where you don't need to sleep as much.

You can get by on two or three hours a night and feel great.

You're energetic.

You're doing a little this you're doing that.

You're cleaning the house at 3:00 in the morning or rearranging furniture.

You decide on an impulse you need to buy a couple of cars.

A lot of the symptoms of bipolar mania sound pretty fun but the problem is you crash in many people with bipolar mania.

They crash into horrible depressions and worse yet when they're on the manic episodes they get themselves into trouble.

There are much more likely to lose their jobs because they say and do things they ordinarily wouldn't say at the workplace they have trouble with relationships including their marriages so they're much more likely to divorce if they have bipolar disorder.

So with bipolar one disorder that can cause a lot of difficulties vonne the main goal with bipolar one disorder will be to give somebody a mood stabilizer that acts like a cruise control on a car.

So we're trying to stabilize the mood.

We don't want them to feel zombie.

They're flatline but we want them to not feel too high or excessively low.

>> So like if you think about a speed in the car when you're manic you're going about 80 miles an hour when you're depressed going about 20 miles an hour.

What we're trying to do is get people somewhere between between 40 and 60 miles an hour and just kind of feel normal in that range.

They can feel happy when the situation calls for .

They can feel sad when the situation calls but they feel within a normal range of their moods such that that's called normal vicissitudes of the mood.

So with that mood stabilizer, that's what you want to have in place for a bipolar one disorder if you get a mood stabilizer on board but still have some depression, you might want to add a second mood stabilizers for instance, will often add one of three different classes of mood stabilizers to try to best regulate somebody's mood stability not unlike if you're treating asthma heart to heart disease, diabetes.

We often use two and three different classes of medication for those conditions for bipolar disorder we might use lithium which is very effective for bipolar one disorder because it's a phenomenal antiinflammatory medication.

It's thought that when people have bipolar mania their brain is literally inflamed so lithium can cut down the inflammation of the brain.

We might use antiepileptic medications lamotrigine and carbamazepine valproic acid or evaporate could all be effective as antiepileptic medications and a third approach would be the so-called newer antipsychotics the second generation antipsychotics which worked not only for psychosis but they also are now known to work for mood stabilization.

>> We'd prefer to use those mood stabilizers rather than adding on an antidepressant.

The risk of adding on an antidepressant Bonnie with somebody with bipolar disorder type one is you can throw them into a faster cycling where they have more highs and more lows because that Bonnie, thanks for your call.

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

I'm psychiatrist Jeff Offer and you've been watching Matters of the Mind on PBS Fort Wayne God willing and PBS willing.

I'll be back again next week.

>> Any questions in the meantime that you want to send me via the email?

You can send it to me at Matters the Mind at WFYI Dog.

>> I'll see if I can get to it this next week.

Have a good evening.

Thanks for watching.

>> Good night