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

>> Welcome to Matters of the Mind now as 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 a call.

The Fort Wayne area by dialing (969) 27 two zero or if you're calling any place else coast to coast you may dial toll free at 866- (969) 27 two 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 WFYI Eigg 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 Durah to favor my father recently moved to a nursing home how do I get him to be more active there?

>> He has shown little interest in taking part in various activities offered he has been depressed and remained in his room.

Well you might want to make sure that your father does see his primary care clinician.

He may indeed be getting depressed.

It's a vicious cycle when somebody gets clinically depressed they do withdraw more.

>> They sleep not uncommonly more.

They don't eat as well and if a change of environment that can be extremely stressful for somebody and that can contribute to depressive symptoms.

So considering that he may have some depression, OK, talk therapy can be useful but sometimes we use medications as a means of helping people have a little bit more neurobiological joy and happiness from that perspective and allow them to get out of that funk.

Sometimes when people are going into a nursing home we have to identify any medical problems they might be encountering.

For instance, if your father has undiagnosed sleep apnea, diabetes, low eyer and various medical conditions can contribute to him feeling more depressed.

>> But obviously he needs to socialize and find purposeful, meaningful activity.

The best way possible is an adjustment.

A stress by definition is a change and an overwhelming stress is where you have difficulty with coping with that change and he may be enduring that right now.

So make sure to contact his primary care clinician to try to see what kind of options would be available at this point.

>> Thanks for email.

Let's go to our first caller.

Hello Shannon.

Welcome to Matters of Mind.

>> Well, Shannon, you want to know is the need to change clothes constantly between inside and outside where a form of OCD?

In other words, you're going inside the house.

You're going outside the house or changing clothes upon going outside inside.

Is that a form of OCD?

Well, any psychiatrist is going to ask you why are you doing that now if you're going outside and you're dealing with some livestock and you're getting dirty?

Sure it makes sense to change clothes when you get inside if you're going inside, you take off your shoes, put on slippers for the purpose of not dirtying up the floor.

>> That makes a lot of sense.

However, if you know that you're changing clothes inappropriately, that's where it can be considered to be OCD .

Now OCD obsessive compulsive disorder is where somebody will have thoughts in the case of changing clothes that you may be contaminated unnecessarily and when they have those thoughts you have this loop in the front part of the brain that's the front part of the brain here is the inside of the brain.

This loop goes round around around and you can't get that thought off your mind if you know the thought is illogical and you know that changing the clothes doesn't make sense.

>> You don't need to change clothes.

You just took the dog out and came right back in.

You felt like you need to change your clothes.

>> That can be an anxiety condition called OCD.

So that's OCD.

But on the other hand we're always going to ask somebody why are they doing what they're doing?

And secondly, do they perceive that that behavior is unnecessary?

>> So if you realize that that changing of the clothes and coming back inside is unnecessary, that could be a problem.

That's an obsessive compulsive disorder.

Merely changing clothes going from outside inside is not considered to be psychopathological for that for that perspective now a lot of people did develop OCD like symptoms after the covid pandemic because they were very fearful of germs.

So when they got around other people they'd want to come back to their home and take a shower and and change your clothes because they were fearful of something and specifically along the line of covid it became for some people it almost incapacitating anxiety but that wouldn't really qualify as OCD yet.

But it could get to that point if it got to the point where it was illogical.

>> Shannon, thanks for your call.

Let's go to our next caller.

Hello, Doug.

Welcome to Of Mind.

>> Doug, you want to know if motion sickness is a mental or physical condition as a psychiatrist I'm going to hear about motion sickness occasionally, Doug, because motion sickness will have a symptoms nausea, cold chills, maybe a fast heartbeat.

>> And when you have those kind of symptoms, people sometimes wonder am I having a panic attack?

>> So they get referred to a psychiatrist such as myself and I'm finding that when they have those kind of symptoms they're specifically in a situation such as an automobile, maybe an airplane, even a boat or a train or something where there's motion involved and they have those kind of symptoms.

Motion sickness is indeed a physical condition and as a physical condition basically your sensory input is getting overwhelmed in those cases you've got this central operator in the middle part of your brain called the thalamus.

So it's the front part of the brain here is the middle part of the brain.

Thalamus is right there so the thalamus is the central operator and if it gets overwhelmed with conflicting sensory input where things around you sights, sounds, even feelings for that matter don't line up.

>> You can get nauseated and can have a lot of symptoms of a panic attack but you don't want to be treated for a panic attack.

You want to be treated for the underlying motion sickness.

>> So what do you do to avoid motion sickness?

Try to get your eyes to focus on one thing off in the horizon and try to reset your thalamus in that way the sensory input.

Secondly, try to avoid alcohol when you're going to be in a situation where you might have motion sickness many people know very well not to read when they're in situations such as travel where they can have more of an inclination to having motion sickness.

>> We hear about it all the time when people go on cruises and they're on ships they can have the motion sickness there.

>> How do you treat it?

Ginger is one natural way of treating it.

Quite frankly, I think the best way to treat motion sickness is a scopolamine patch behind the ear lasts for about three days after you use a scopolamine is a medical treatment.

>> You'd get that as a prescription from your physician or your nurse practitioner.

But that's a medical treatment for motion sickness.

If you know you're going into a situation where that can occur.

>> Motion sickness is most commonly seen with children and women who are pregnant.

But for many people as they get older it's not so much of a problem anymore.

I don't know why women who are pregnant get more motion sickness, probably the hormonal dysregulation that occurs during that time.

>> Thanks for your call, Doug.

Let's go to our next caller.

>> Hello Carla.

Welcome.

The mastermind Carla you want to know is a heartbeat sound or washing in your ears a sign of stress when you're trying to sleep?

>> That's difficult to say, Carla.

Sometimes people can have symptoms of what's called tinnitus where they get ringing in the ears or squishing the ear sounds in their ears and that can be an inner ear problem.

So with an inner ear problem that's something that could be evaluated by an ear, nose and throat doctor.

>> Sometimes the sound of a heartbeat or wishing in the ears especially nighttime can be related to higher blood pressure.

>> OK, so if you're under a lot of stress and you get worried about something if you're prone to having higher blood pressure and a faster heartbeat when you get stressed out about things, sure that can come across as hearing the heartbeat or having that wishing sound in your ears like that.

So if it's related to stress, sure that could be related to the washing in the ears of the hearing, the thumping in the ears especially at nighttime.

But it might be an inner ear problem that could be assessed by an ear, nose and throat doctor, thanks for your call.

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

We have another email question there and the next email question is Dear Dr. Farber, how does alcohol use interact with common antidepressant medications ?

Are there potentially serious consequences for combining the two ?

The biggest concern we have with alcohol is with any medication will be the potentially fatal interaction between alcohol and benzodiazepines like alcohol, like Xanax, Ativan, Klonopin, Valium or we don't use the old phenobarbital type medications but they can be deadly if you use alcohol in combination with the sedative medications, if you use alcohol or some sleep medications like Ambien that can be devastating and cause you to be excessively sedated.

>> So the main concern we have about alcohol use will be the sedating effect of it and the sedating effect amplifying any sedating effect of other medications like the benzodiazepines, the sedatives, the pain medications.

>> You don't want to use alcohol with those kind of medications unless you do so with clinicians permission on how much you can consume during that time in terms of direct what we call pharmacokinetic interaction not a big problem there.

It's more of a what's called a pharmacodynamic interaction where you have symptoms that are piling on to other symptoms so will cause you more side effects.

>> And when you'd mentioned antidepressant medications, especially if somebody in the depths of depression they're really struggling, I encourage them don't drink any alcohol until we get you out of this funk and get the depression itself because alcohol is a depressant, it makes you less motivated, dulls the thinking.

>> Now some people will say well alcohol is the only thing that helps me sleep.

It'll help you get to sleep but it doesn't give you a good quality of sleep so you don't get a deep sleep.

You don't get dream sleep, you don't get all the phases of sleep.

You need alcohol actually suppresses those good phases of sleep.

>> It'll knock you out.

As a matter of fact, back in the old days I remember thirty years ago they used to prescribe alcohol in nursing homes to help the older adults sleep in nursing homes.

>> It was a terrible idea but they didn't do that anymore.

But if you use alcohol as a sleeping medication it's not a very good sleeping medication.

So alcohol is not good for depression.

It's not good for sleep.

>> So if you're currently having active problems it can actually make things a lot worse and especially makes panic attacks on anxiety worse.

>> A lot of people will consume alcohol as a means of trying to calm their nerves and help them with anxiety.

>> But alcohol doesn't last very long in the system when it gets out of the system you tend to have a rebound effect and you might even have more anxiety and more panic attacks as it's getting out of the system.

>> Thanks your call.

Let's go to our next caller.

Hello Phillip.

Welcome to Matters of Mind Phillip, you want to know our dream disorders and actual thing?

>> Can you have dreams of depression or anxiety?

If so, how does this affect you in the morning dream disorders when we talk about dream disorders themselves we're talking about nightmares, dreaming is a good thing for the brain when you dream at night nighttime.

>> Philip, what's happening?

The thinking part of your brain the tension part of your brain the it's called the dorsolateral prefrontal cortex dorsal meaning it's in the front lateral meaning it's on the outside prefrontal cortex meaning it's in this part of the brain here.

So that's a dorsolateral prefrontal cortex.

This shuts down at nighttime when you dream and that's a good thing because when you're thinking and you're concentrating all day long, this area gets really hot and it's you're focusing your working and working and working.

>> You need to shut it down.

So at nighttime when you shut that logical thinking part of your brain down, anything goes and you get all these abstract dreams.

A lot of them don't make any sense.

Some people will say it's a means by which God is talking to them when they are interpreting their dreams.

That's a whole nother matter.

But bottom line is dreaming is good for the brain.

What's not good for the brain will be nightmares.

>> Nightmares are coming from a different part of the brain known as the brain stem.

You're getting excessive norepinephrine release and norepinephrine is a chemical cousin to adrenaline.

>> You're getting all this norepinephrine release excessively and that's causing nightmares that could be from past traumatic experiences but it's not diagnostic.

In other words, if somebody has nightmares we can't say you've been traumatized.

You've had post-traumatic stress disorder because the nightmares no, it's just a symptom that we have to kind of observe and watch.

>> But nightmares will be a pathological kind of conditioned and we don't like to see night terrors.

>> People often misinterpret those as nightmares.

Night terrors are occurring in a whole different phase of sleep compared to nightmares.

Nightmares are occurring during the REM sleep rapid eye movement sleep the dream sleep whereas night terrors are where people will maybe sleepwalk they might just awake in the middle of the night be very confused often yell out that's why they're called night terrors but they forget what they're doing momentarily.

They forget that they've been sleeping.

They're very confused.

They have been dreaming.

>> Night terrors occur during the slow wave sleep so it's a different type of phenomenon.

So there are different sleep disorders but dreaming itself is not something that we would consider to be pathological for people even if they're having dreams that are very vivid and abstract.

Now you may notice that when you're dreaming upon awakening the dreams get a race just like a whiteboard very, very quickly unless you think about them or write them down.

So if you've been dreaming, if you write them down or think about them and try to think about them for a little while or even talk about what you were dreaming about to somebody else you'll be able to retain recollection of those dreams and maybe be able to talk about what they might have meant.

Typically when you're dreaming about things in a very abstract manner, you're dreaming about things that happen to you in the past 72 hours especially as night goes on you're dreaming about things that happen more recently maybe in the past 24 hours right before awakening.

So you're symbolically dreaming about stuff and many people they'll say oh yeah, that makes sense when you tell OK, I wonder if anything happened in your life over the past day or two that might have made you think about this or that in the dream itself.

But they're not necessarily interpretive of psychiatric disorders themselves but abstractly I mean that's how psychoanalysis often occurs when people are in psychoanalysis which isn't done so much anymore.

I I was in psychoanalysis myself when I was going through my psychiatric training where I laid on the couch twice a week for two and a half years on a Tuesday and Friday morning and first thing in the morning is when I did the session so my dreams were fresh on my mind.

>> But in psychoanalysis they will use dream interpretation as a means of helping you deal with any issues going in your life .

>> And it's interesting but it's not necessarily diagnostic and not so much use for treatment unless your dreams are very vivid and you're able to really think in an abstract manner and how you would interpret those dreams.

>> Thanks for your call.

Let's go next caller.

Hello James.

Welcome to Matters of Mind.

James, you want to know what is treatment resistant depression and what are the benefits of bravado that's being marketed?

James treatment resistant depression by definition and I don't like the definition but it means you failed on three or more antidepressant medication.

So if you failed on three or more different omnipresent medications that's considered to be treatment resistant depression tardies.

I don't like that term, James, because I want to know what depressants you've tried and failed upon.

>> In other words, we have twenty eight oral antidepressants from which to choose so we have a lot of different antidepressants going back to 1958 when they were first coming out.

>> We have all these different types for the past six decades we've primarily been using these antidepressant medications that predominantly affect serotonin, norepinephrine and dopamine and is considered to be treatment resistant.

>> If you haven't done so well on two or three of these different antidepressants medications norepinephrine, serotonin and dopamine are getting spewed from the brainstem down here and they go up to the cortical matter up here, the cortical matter we call it a gray matter.

That's the thinking part of the brain that's a mood part of the brain that is regulated by glutamate and GABA glutamate is the accelerator gabbers.

The brake so you got glutamate pushing on the accelerator gabbers on the brake and that's how the outside part of the brain works basically serotonin, norepinephrine and dopamine are just getting sprayed out to the gray matter and they work kind of like a in an advisory role kind of like a passenger in an automobile giving driver driver advice on whether he or she should push on the accelerator or push on the brake.

So the norepinephrine serotonin and dopamine consist of less than one percent of all neurotransmitter in the brain and they're serving more of an advisory role.

>> So what does bravado Kummetz bravado will work directly on glutamate so it's working directly on the accelerator and it works within a matter of milliseconds antidepressive medications that affect serotonin, dopamine and norepinephrine to get a meaningful effect will take off in four to six weeks.

>> Bravado is a medication by affecting glutamate people can see a difference in their mood often within a day and you I think James well that's a stimulant.

>> That's that's cocaine .

Well, it's different from cocaine .

Cocaine is primarily affecting norepinephrine and dopamine very abruptly and it gives you a pulsatile effect of norepinephrine dopamine not a good long term effect.

>> It's addicting and you crash afterwards.

It's bravado by affecting glutamate will make some meaningful changes where you can actually get increasing branching of your little nerves fibers.

>> So with your nerve fibers there is a hundred billion nerve fibers in the brain and each individual nerve fiber has anywhere between 10000 to 50000 little branches.

>> So if you're going to imagine looking at a bush in your backyard and it's getting all shriveled up, it has fewer branches on it.

>> What do you do?

>> You hit it with some Miracle-Gro, you give us some more water, you nourish the little bush as a means to get more branching going.

>> So instead of ten thousand branches it goes up to thirty or forty thousand branches.

That's what you're doing when you use bravado is bravado a nasal spray?

>> It's used typically with an antidepressant medication but as a nasal spray it's something that within a matter of 24 hours could increase is branching.

It does so by affecting this particular natural chemical in your brain called brain derived neurotrophic factor.

We refer to it as natural brain Miracle-Gro and what it does within a matter of milliseconds after exposure to a medication like bravado starts increasing the branching.

>> So based on animal studies and even some human studies are coming out now where they can actually mark in real time the branching occurring in the brain.

You're seeing results in a animal and in humans within a matter of 24 hours you're seeing these physical results of the branching occurring within 24 hours.

>> That's why many people in bravado will notice that they feel better and they have an improved mood, more motivation, more happiness within one or two treatments.

Now we treat people with bravado twice a week for a month, once a week for a month and then after two months that can be spread out to every two weeks and sometimes less than that typically with an antidepressant medication.

But it's bravado has been around since twenty nineteen now so it's been off for about five years at my clinic we had completed over five thousand treatments in the past and it's a very, very effective treatment.

But the reason it's so effective for treatment resistant depression is because treatment resistant depression typically involves the antidepressant medications that are affecting serotonin and norepinephrine and dopamine and they only do so much it's affecting a whole different chemical.

>> Thanks for your call.

Let's go our next caller.

Hello Ken.

Welcome to Matters of Mind.

Yes, sir.

Thanks for taking my call today.

I can't get a question.

Yeah, I this will follow up nicely with your previous caller.

I was on a out treatment once every three weeks for a while and became unavailable to me and then I found another provider here in town that was able to administer the treatments.

But unfortunately I went on Medicare and now he refuses to give me maintain those treatments because they don't pay enough.

Medicare does not want to reimburse them enough at any rate, what what I'm looking for is I wonder what would the next best pharmaceutical that would mimic or most closely resemble that treatment otherwise I need to go to South Bend.

It's tough to find even tougher to find somebody that will beat me on Medicare.

What would you suggest might be an alternative to that to to get a bottle?

>> Yeah kid the challenge with Medicare is that Medicare won't pay currently now I'm hoping they do in the future but currently they won't pay for a bravado.

The nasal spray itself it's bravado is is ketamine.

It's the left side a piece of ketamine ketamine was FDA approved in 1970 as an anesthetic and ketamine has been used IV under the tongue.

It's been used in various forms off label.

In other words it was never formally approved for depression but it's been used off label.

>> It's for depression for the past twenty years.

So we've known about ketamine for a long time.

It was just never formally approved.

So if you get ketamine treatments you're going to be paying out of pocket.

>> You'll be receiving two , four, six treatments whatever won't be deemed necessary but ketamine as provided will affect glutamate in a very, very similar manner.

So that would be the two medications that would work very similarly.

We do have a medication available now as an oral medication not yet approved by Medicare and a lot of cases but I think it's times coming where it might be more accessible.

It's called Sovaldi although it is a combination of two very old medications.

Audience consists of dextromethorphan which is a cough medicine has been approved for call for the past sixty five years and bupropion, which is a antidepressant medication was approved for depression in nineteen eighty nine .

>> So they've been around for a long time.

The whole idea of ability is appropriate is there not so much as antidepressants?

Bupropion will increase the blood level of dextromethorphan by over 30 times and in doing so high levels of dextromethorphan will affect glutamate in a little bit different way than ketamine or bravado and that's why in a different way be in the people aren't as impaired.

They don't need to get the treatments under supervised setting but they can take the bravado day by day by day and that will affect glutamate.

>> So can what you're noticing is with bravado and with ketamine for that matter you're going to get these effects on that gray matter of the brain affecting glutamate that's the accelerator of the brain and it's opposed by GABA when people have ongoing depression and they call treatment resistant depression because they haven't responded adequately to various traditional antidepressants affecting serotonin, norepinephrine and dopamine.

When they have that kind of depression they need something different.

It goes directly to the accelerator and that would be glutamate.

So there's three medications available right now that affect glutamate.

Sprawl is the one that you had tried before.

Ketamine is another one used off label you'd pay out of pocket for the purpose of getting ketamine infusions in many cases.

>> But people are using the ketamine in different forms and of course although it is an antidepressant that's an oral version that will affect glutamate in a different way.

>> But keep your ears open for that.

He's been on for two years now and my hope is that Medicare will be covering that as time goes on.

But that is also affecting glutamate because of the high levels of dextromethorphan.

>> Yeah, and I actually vacuously I was my Medicare plan actually did it did pay for those provided treatments but they were paying like nine hundred dollars for a seventeen hundred dollar treatment.

>> Yeah that didn't work out so good for my hey kudo's we we traded a lot of patients was bravado over the years and we had a hard time with Medicare covering them.

They did sometimes but other times it all comes down to what plan on Medicare you might have it took a little work I bet it did several phone calls.

>> OK, well I appreciate your time this hey good talking to you again.

>> Take care.

Let's go to our last email.

Our last e-mail reads Deardorff over Can the moon have an effect on my mental health ?

>> I always feel like I am more moody when there's a full moon.

>> You talk to psychiatric nurses and OB nurses they will insist that a full moon will lead to more mental health crises.

>> In the case of psychiatric nurses and the O.B.

nurses will say there's more to liveries when there's a full moon.

>> I've seen different perspectives on that now this is something about the full moon make a difference in terms of somebody's mental health .

>> It can be there's more light out at nighttime.

So with a full moon many times people will say they don't sleep as well because it's too bright outside.

>> They need to close the blinds but they'll say they don't sleep as well.

They perceive that they can stay out later when there's a full moon and obviously lack of sleep.

>> Her increasing evening activities will give you a diurnal or a circadian rhythm disturbance where you'll have trouble with mental health issues from that perspective I've actually seen some studies though say it confirming that there were more mental health admissions during a full moon so I would not be one who says that's a fallacy.

I would say there's a possibility that a full moon might affect people's mental health but there's always a lot of different theories on why why they might do so.

>> Thanks for your email.

Unfortunately I'm out of time for this evening if you have any questions concerning mental health issues you may write me via the Internet at Matters of the Mind at WFYI dot org.

>> 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.

Take care.

Have a good evening.

Good night