.

good evening.

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

Welcome to Matters of the Mind now in its 25th 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 at PBS Fort Wayne by dialing (969) 27 two zero or if you're calling any place coast to coast you may dial toll free at 866- (969) to seven to zero now on a fairly regular basis we are broadcasting live every Monday night from our spectacular 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 a dog that's matters of the mind at the boardwalk and I'll start tonight's program with the first of a few emails I did receive this past week.

>> The first one reads Dear Dr. Fauver, I have severe obsessive compulsive disorder which makes reading nonfiction books for enjoyment difficult.

>> I begin writing everything down in fear that I will forget it all the anxiety builds to the point where I quit reading how do I read non-fixed in for enjoyment and take better notes without such extreme anxiety while the first thing you might consider is Gee is this really obsessive compulsive disorder or said a perfectionist quirk obsessive compulsive disorder by definition would be where you have thoughts that lead to behaviors that being compulsions that are nonsensical.

They don't make sense.

You do them over and over again.

They cause extreme anxiety if you don't do it a second or third time.

My bigger concern for you would be if you are reading nonfiction books and you had to reread and reread and reread and then repeat the lines that you were writing over and over again or you would feel like something bad would happen.

>> So you're not describing OCD in the classic sense you're describing more perfection and as something we often see for instance with college students and people who are studying because they're concerned that they're not going to retain the information for test taking what you're saying you're doing it for enjoyment.

That's fantastic.

I think in your case having yourself have a time limit on how much you read at a time and trying not to force yourself to read more than what you might feel comfortable doing but just write a general outline as opposed to the details themselves.

You're trying to remember things you know historically people used to underline they'd highlight and then go back and review different things.

But you have to be objective and determine OK, what if I don't remember every single thing I'm learning are learning in this nonfiction reading that I'm doing for enjoyment.

Is it really that big of a deal?

Write down the general concept.

It's a matter of changing the mindset from trying to identify and learn the details of what you're reading and changing over to the general outline of the subject matter itself.

So you want to get the main point.

>> The details can be important to give you the the the conclusion of what the main point might be.

>> But at the same time it might not be important for you to retain every single detail.

OCD, which would be a treatable condition is where you would stop doing those kind of behaviors.

In other words, you would only allow yourself to write down five lines per chapter and you have a certain definitive number of things you'd want to do as opposed to writing down the same line over and over and over again.

But people have OCD when they're reading and when they're writing down different observations from that reading when they will write things down over and over again and they know it's nonsense.

They know they shouldn't have to do that but they do it for fear that something catastrophic will happen so you're describing more of a quirk.

It's an annoyance but you want to get past that because you still want to enjoy things and as a matter changing your mindset from having to remember every detail to changing over to just understanding the overall point.

And I'd hope that you continue to enjoy your reading of nonfiction books always a favorite of mine but yeah, nonfiction.

But there's so much history out there to be able to read and try to comprehend the ideas to get some general ideas so that we're not condemned to repeat history.

>> Thanks for thanks for your email.

Let's go to next email.

Our next email reads Do not favor after taking Latouche to 20 milligrams a day my friends started having agitation that has lasted six months.

>> My friend is also on twenty milligrams of Cymbalta and 150 milligrams of Lamotrigine olanzapine that's also known as Zyprexa did not work for him before La Tuta.

What can be done to get rid of the agitation you might be describing an agitation that's actually known as what's called Akathisia.

Akathisia is a phenomenon where it affects the whole body especially the waist down and it makes you want to pace and it makes you want to have difficulty sitting still and you walk all around.

We can sometimes diagnose akathisia when somebody just walks in the office or even on a visit video visit.

People have to sometimes get up and down but akathisia as a side effect of a medication it's a dopamine blocker which is La Tuta and that can cause you to feel agitated and restless.

You mentioned your friend is also on Lamotrigine and maybe Cymbalta.

>> Lamotrigine is also known as Lamictal.

Cymbalta is also known as Dellucci Lamotrigine and La Tuta.

>> Our mood stabilizers and by the description of your friend being on Cymbalta I'm wondering is there a possibility of Cymbalta activating your friend to such a degree that your friend might be having racing thoughts and hyperactivity related to some underlying bipolar spectrum condition?

Bipolar disorder is where people can have manic highs where they don't need to sleep.

They have racing thoughts their impulsive, their sometimes reckless hyperactive just for a few days at a time and then they crash and if you have manic highs and lows you have to be very careful in using an antidepressant medication so Cymbalta sometimes can activate the manic highs and make the cycles well more likely to cycle up and down more quickly.

The highs go higher, the lows go lower and the highs and lows are more frequent.

So we have to be careful sometimes using Cymbalta if somebody is exhibiting symptoms of manic high.

>> So that's where your friend's clinician would want to determine is this agitation from akathisia which means you could change the dosage of Cymbalta.

>> The best medications for akathisia will be Clonidine and propranolol is commonly used but we have medications to offset theCIA.

But the best thing we want to do is often back off the medication causing akathisia hopefully Lamotrigine and or for that matter even Cymbalta could do the jobs themselves if akathisia is indeed the problem for your friend.

So have your friend talk to his or her clinician to see what can be done for that agitation.

It's it shouldn't be there.

It's a side effect of battuta or is possibly related to the underlying condition itself.

>> Thanks for your email.

Let's go to next caller.

>> Hello Joyce.

Welcome to Matters of Mind.

Hi Dr. Farber.

Hi Joyce.

Hi.

I'm calling what's the best way to ease off of gabapentin because I noticed I'm getting swelling in my legs and I was taking six hundred at night and then back to 300 I started doing and then how do I ease off of it from there to be safe?

>> Sure Joyce, you're using you're using the gabapentin for what reason?

Joyce So I was using it for restless way restless legs as well as to relax me because I suffer from flight depression.

>> Oh sure.

Joyce, have you identified the reason for restless legs?

>> I mean the reason I ask that is because sometimes restless legs will be due to a medication perhaps as increasing serotonin and it can be due to low ion people will have different reasons for restless legs as the reason for restless legs ever been identified for you know and I have tried everything.

I've read everything and listen to you about it as well and I've never really found anything except it's in my genetics I believe.

>> Yeah, it's kind of like an essential tremor.

It can be genetically passed down for some people.

Gabapentin is a very well tolerated medication for a lot of people it affects as little calcium channel that will regulate how much calcium gets in and stimulates the nerves.

>> But as you've seen it happens occasionally.

But at this puffiness and the ankles and we call it edema but it is a side effect from gabapentin you can use water pills or diuretics to flesh off the extra fluid.

But the best thing we always want to do is back off the gabapentin doing so slowly is always ideal.

Now if you're using gabapentin for seizure relief which you're not but if you're using gabapentin for seizure relief we'd have to go very slowly and it's decreasing and then add on something else for antiepileptic effects.

>> But in your case you're using it specifically for the purpose of relieving restless leg so you could probably go from 300 mg down to nothing.

But if you want to play it really safely, ask your clinician to give you 100 mg capsules and go from 300 milligrams a day for a week to two hundred milligrams a day for a week to one hundred milligrams a day for a week and then go off of it that way.

My only concern if you went from 300 milligrams had nothing you could have horrific difficulty with sleep, more restless legs and trouble with some anxiousness just coming off of it a bit quickly but going down 100 milligrams at a time each week from 300 milligrams a day for a week, 200 milligrams a day for a week, one hundred milligrams a day for a week and stopping that's a real nice way to be able to taper off of it.

And as I might have mentioned on previous programs, Joyce, another way of treating restless legs will be with these dopamine agonists which are medications like Marape Ampex.

All these are medications that will increase dopamine transmission and that's often a classic way of treating restless legs as well.

Sometimes we use different types of medication in the same family as gabapentin.

>> For instance, we'll use Horizon's gray lisse are different forms of gabapentin may not give as much difficulty with the puffiness but Lyrica which is a chemical cousin of gabapentin is chemical name is pregabalin and sometimes in our experience Lyrica does not cause as much swelling in the ankles as does Gabapentin.

I don't know why Gabapentin does that but you're spot on Jois.

That is certainly a side effect from Gabapentin.

>> Joyce, thanks for your call.

Let's go to next caller.

Hello Debbie.

Welcome to Matters of the Mind .

Hello Debbie.

Are you on the line?

>> You mentioned your front your mentioned your frontal lobe is half gone since birth would be the front part of the brain up here to be there be the left side of the right side.

Correct.

Currently exhausted after trouble walking.

Is there a connection, Debbie?

Usually the frontal lobe is more connected with thinking and concentration and there is a bit of a difference.

But if you've had a loss of one half of the frontal lobe since birth, the half that remain has probably compensated to some degree.

>> In other words, typically if the left front part of the frontal lobe is not functioning functioning so well because you've had a stroke you can have difficulty depression, impulsivity, be able to concentrate being able to focus the right side is more involved with with music.

>> It's an odd type of phenomenon because sometimes people will struggle with having a stroke on the left side of their brain but they can still sing.

They can't talk very well but they can still sing.

So the right side of the brain does different things.

>> But if you had the lack of a half of your frontal lobe since birth, your other half is probably compensate to some degree.

I would not expect you Debbie later on in life to all of a sudden having difficulty with fatigue or trouble walking fatigue and trouble walking is more associated the back part of the brain, the middle part of the brain as well.

So I don't think that necessarily be the situation now but talk it over with your neurologist.

>> Thanks for your call.

Let's go our next caller.

Hello Barney.

Welcome to the Mind Body.

We wondered if a mood stabilizer would be better than an antidepressant for bipolar bipolar disorder type one I'd mentioned bipolar disorder just a moment ago concerning the use of Lietuva and Lamotrigine in a really good combination for bipolar stabilization and then Cymbalta Cymbalta is an antidepressant medication bipolar disorder type one.

Bonnie is a condition where people will notice that for one week they have manic highs of at least one week and they can during these manic highs they don't need to sleep and they don't need to sleep.

So they're up all night cleaning.

They're rearranging furniture that might be doing outdoor projects that can be quite annoying to their neighbors.

They can be buying things, they'll say things and do things that they later regret.

So it causes impulsivity and it causes people to have extremely racing thoughts.

>> So with that being said with bipolar disorder type one, yeah, people can have the manic highs and they can have depressive episodes thereafter and the question was is what do you do during the depressive episodes?

Lamotrigine I mentioned earlier is a very nice medication for the depressive lows for bipolar disorder.

CAPELET is being used much more now as we've get more experience with that serik Eloqua Tippins been used historically so we have different options there but generally when somebody has bipolar disorder type one or they distinctly had that one week or more of mania, we do try to stay away from antidepressants and have people on mood stabilizers such as lithium.

>> We might have them on antiepileptic medications like Lamotrigine and Depakote is another one commonly used sometimes Trileptal and we'll have them on the so-called second generation antipsychotic medications also known as the dopamine receptor antagonist medications such as Abilify, Seroquel, Olanzapine, Zyprexa Carolita has some dopamine blocking effects but is primarily affecting serotonin.

That's why for many people it's much more tolerable for their bipolar one depression itself.

So the bottom line is if somebody has bipolar one disorder they're quite likely to still have highs and have the cycling back and forth if we add on an antidepressant medication I've done this for some people and you have to do it very carefully to bring them out of the lows.

I might put them on antidepressants very briefly but as soon as they normal normalize out in their mood or go a little bit high I immediately get them all three and a present.

It's very tricky to do that but you can use an antidepressant in those cases but you're only going to be using them for short periods of time just to bring people symptomatically out of their lows.

>> Bonnie, thanks for your call.

Let's go to next caller.

Hello Jan.

Welcome to Matters of Mind.

Well, Jan, you're looking for help with sleeping medications and you've had trouble with medications such as Zyprexa which cause you to have difficulty with movement conditions.

>> Another medication gave you hallucinations.

Trazodone didn't seem to work for you.

You had taken compromising Clement I mean is an old medication.

>> It suppresses a dream sleep medication.

It chemically looks like imipramine or Tofino with the chloride but it has chloride on it and it does a great job in suppressing dream sleep.

>> So for people having nightmares Klempner means very ,very nice medication but in doing so it can increase the blood pressure and that's what you apparently had and then Gabapentin only work shortly.

>> Talk it over with your clinician Jan to see what the underlying issue might be for having difficulty sleeping.

And the first thing will always do, Jan, is we want to look at somebody's pattern of sleeping disturbances.

>> We want to know if they're having difficulty getting to sleep, staying asleep, waking up too early or for sleeping 12 hours and they're just not getting restful sleep and they have unrestored sleep.

So we want to know the pattern of sleep disturbances.

>> Secondly, we were always going to always want to know if somebody's snoring or if they're having pauses their breathing, snoring or pausing their breathing will give people a whale of a time being able to stay asleep because if you can think about it, if you're snoring you're not getting enough air flow to the lungs thereby not getting enough oxygen to the brain.

So you awaken very briefly throughout the night.

So that's called sleep apnea.

So we want to identify sleep apnea for some people who are snoring or having positive breathing.

Occasionally people will have restless legs which also will result with periodic limb movements.

That's a sleeping disorder where people will have jumpy legs throughout the night.

That can be a factor in keeping them awake.

We want to look at somebody's diet if somebody eating spicy foods later in the evening will often have difficulty with sleeping because they're having reflux so if you're having gastric reflux the gastric reflux will keep you awake and that can be a factor.

>> So we look at all those kind of conditions.

>> Then we look at underlying anxiety or mood conditions, bipolar disorder which I've mentioned a couple of times tonight it's where you'll have manic depressive lows if you're having those kind of highs and lows we might specifically consider a medication like lithium as a means of stabilizing the mood.

Lithium is a remarkable medication in terms of helping increase dreams, sleep and give you a deeper sleep overall of the medications you'd mentioned Trazodone, Gabapentin, clomp I mean those are all common medications used for sleep.

You didn't mention one called Dock's SAPIEN.

So keep in mind there's always other options out there.

But Duckpin is an older antidepressant medication.

We're used at very tiny doses three to six milligrams at bedtime can specifically and selectively affect affect histamine and when you decrease the transmission of histamine and you block histamine which is what docs does, it makes you sleepy.

>> So right now my histamine sky high in my brain because I'm wide awake and when you're awake histamines really high when you want to get sleepy your brain will naturally decrease histamine and that occurs based on our circadian rhythms late at night well dock's pain will block histamine and actually decrease the outflow of histamine so that's an option as well.

We have a lot of newer medications that have come out over the past few years that specifically and selectively will affect different types of chemicals in the brain like or Rexon also known as Hypo Kryten and will have very specific medications that affect melatonin.

>> So there's other ways to get somebody sleeping but we always want to make sure that we understand the underlying condition that might be contributing to somebody having difficulty sleeping.

And what we do know jam is the longer you stay up and worry about not sleeping, the more likely you're not going to sleep very well and our sleep cycles go about every hour and a half or so.

>> It's like catching a bus if you miss the bus you've got to wait another hour and a half or next to come around if you're not asleep at the time they usually want to go to sleep as an example 10 p.m. Let's say that's the time you usually go to sleep if you stay up and watch a ballgame you watch a movie you are reading something really interesting and next thing you know it's ten thirty or eleven.

>> You're going to be wide awake probably until 11, 30 or so if you're awake in the middle of the night at one a.m. and you're wide awake.

Yeah.

Might take you another hour, hour and a half to get to sleep and it just naturally what the brain does it goes in these waves and cycles when you get sleepy at certain times melatonin I mentioned earlier is like a puff of smoke.

Melatonin is released from this middle part of the brain called the pineal body.

It's little P shaped body in the middle of the brain and melatonin is released when it gets dark.

>> So when it gets dark all around you melatonin is released and that's why melatonin is called the vampire hormone because it tends to get up when it gets really dark.

>> So melatonin is something that works for about 30 or 40 minutes for a lot of people it's like a puff of smoke.

>> It's there very briefly gives your brain a signal to go to sleep and then it's gone.

So melatonin is good for sleep initiation and sometimes is good for adolescents and young adults who naturally based on their brain still growing will want to stay up later at night and they need the melatonin as a means of giving them a chemical signal to go to bed earlier and that allows them to get up earlier.

So there's a lot of different ways that sleep can be assessed.

Sleep medicine clinicians will look specifically at sleep apnea.

They'll look at periodic limb movements and they'll look at other underlying conditions such as narcolepsy.

>> So you can start with your primary care clinician to look for other ideas.

It looks like somebody's been prescribing you the medications over the course of time if that's not working out so well ,they can sometimes send you to a specialist like a sleep medicine specialist or a psychiatrist or somebody in the mental health field if you're not already seeing anybody in that field because there's a lot of options out there for you.

But you've tried a lot of the traditional medications.

Gabapentin work shortly.

Gabapentin is also known as Neurontin.

It's a medication we very commonly used for sleep but you can use 100 or 200 milligrams a bedtime but some people go up to 600 or even 900 milligrams at bedtime.

I saw a man just recently who is taking a combination of lithium and 900 milligrams of gabapentin a bedtime specifically because he had covered related difficulty with insomnia and racing thoughts and that's what did the trick for him covid is causing a lot of difficulty with with some people following their infection with covid because they're having trouble with concentration, their mood, their racing thoughts and sleep as a classic phenomenon of an after effect of experiencing covid for a lot of people.

>> So sleep disturbances are commonly seen.

Thanks for your call.

Let's go to next caller.

Hello, Becky.

Welcome to Matters of Mind Becky.

One of my thoughts on electroconvulsive therapy ECT has been around since the late 1940s, Becky.

>> ECT is basically a very commonly used treatment and it's one of the most effective biological treatments we still have for depression.

It works fast and it's very, very effective basically ECT is firing up the front part of the brain by giving your brain a seizure but while you're having ECT, the rest of your body is perfectly calm because you're under a short term anesthetic and you're under a muscle relaxant while you're getting bagged for ventilation.

The treatments last anywhere between thirty seconds and two minutes.

They're very brief seizure activities and based on where the electrodes are placed on your brain you have no recollection of them because you're under the short term they're short acting anesthetic so ECT basically is firing up the brain in a fairly unique way.

It's increasing different chemicals in the brain that are making the brain more fluffy.

And Becky, there's so many more things now that we know about the brain that we didn't know just ten years ago.

But now we realize that each individual neuron has about ten thousand to one hundred thousand connections so one individual neuron in the brain has all these different connections and what you want to do is make the connections more fluffy.

It's kind of like a tree where you want the branching of the tree for your neurons to be more fluffy and more robust because when people get depressed the branching of your neurons start to shrivel up and you have less branching and that causes depression ECT is one of the means by which you can increase the branching of the neurons very, very quickly and it increases chemicals that are like Miracle-Gro for the brain like brain to drive neurotrophic factor which downstream will increase this chemical transmission of immature mammalian target of rapamycin and you have all these different chemicals downstream that can be affected that make the little neurons more fluffy and that's what we're always looking to do with ECT.

>> You can do that quickly.

We have other treatments that are becoming available that can also affect that fluffiness of the brain very quickly Ketamine IV has not been approved by the Food and Food and Drug Administration for depression but it was approved in 1970 for anesthesia.

So Ketamine IV has been used.

We call off label for depression Academi, which is the left sided piece of ketamine is a nasal spray where you use a nasal spray inside an office setting you're monitored for two hours.

That's a means by which you can make little neurons more fluffy and more recently we have an oral medication called All Valide which does affect glutamate in such a way that appears to have a very fast onset of action and based on animal studies appears to enhance the fluffiness the brain as well fluffiness of the brain is called synaptic genesis also known as neuroplasticity which is getting discussed a lot nowadays.

It's thought that even having happy good optimistic thoughts first thing in the morning can significantly affect your fluffiness or your brain for the rest of the day a fluffy brain is a happy brain so we're always looking to try to make the brains more fluffy.

We didn't know why we were trying to do this in years past but now it all makes sense that if you have better connectivity between individual neurons they can talk to each other more clearly.

It makes sense that you'd have better concentration, more energy level, less depression and there's evidence under the microscope this is all happening very, very quickly now.

>> So with ECT that is a way of still affecting the brain chemistry in a very quick way.

It's typically done three times a week, often Monday, Wednesday and Friday for a lot of people for a few weeks and then after you've done it for a few weeks and you're starting to feel a lot better, it's get stretched out sometimes to once a month and they call that maintenance .

>> Becky, thanks for your call.

Unfortunately out of my 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 to add to matters of the mind all one word at WWE org.

I'm psychiatrist Jay Fawver and you've been watching Matters of the Mind on PBS .

>> Wayne God willing and PBS willing.

I'll be back again next week.

Thanks for watching.

Have a good night