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>> Good evening.pI'm psychiatrir live from Fort Wayne , Indiana.

Welcome to Matters of the Mind now in 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 in the Fort Wayne area by dialing (969) 27 two zero or if you're calling any place coast to coast you may dial 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 via the Internet at matters of the mind all one word at WFB vague that's matters of the mind at WFYI Borg and I'll start tonight's program with a question I recently received reads Dear Dr. Fauver, what can I take or do to help ease my fear of flying?

>> Well you you'd mentioned you'd like to take something if you're to take something we will give people as needed for temporary use medications like Xanax also known as alprazolam.

>> Sometimes people are given lorazepam or out of Albats that might be a little bit more sedating for some people so we often will use maybe no more than a half a milligram, maybe point to five milligrams-of Xano take prior to getting on board what we like about it it's fast acting.

You take it at the boarding area as they're preparing to board your plane and then you get on the plane.

>> Many people when they have the fear of flying will have difficulty with turbulence and they interpret turbulence as being something that's highly dangerous.

Well, it can be upon taking off and landing but there are so many safety features nowadays compared to 30 years ago that it's not so much of an issue for people but that's the thing you could take and you could get that from a prescribing clinician.

>> But overall try to educate yourself about the whole process of flying, try to understand what turbulence is all about, what it means turbulence is basically airflow making your the fuselage of the jet kind of a little bit more shaky.

It's not unlike going over bumps if you're driving down the road and going over a pothole here and there.

So a bumpy road is kind of like turbulence in the air.

Also understand the noises that are occurring with the plane.

I hear about a lot of people getting anxious when they hear the wheels going getting pulled up and going down and they think that that's there's something wrong with the plane.

>> So educating yourself on the whole process of flying is very helpful.

But the main thing you should do to get over any fear is to do it and to keep the more you fly the less likely you'll have difficulty with anxiety related to flying because you'll have those experiences but try to get educated on it, get some experience with flying and over the course of time you'll typically diminish a lot of the difficulty you're having with flying overall.

But short flights are fine the longer flights yeah you can always get the perception and the fear that you're in this tightly bound metal object is called the fuselage and the plane itself.

But try to get enough sleep on the plane if you can sleep on the plane but try not to drink any alcohol.

That's the last thing you want to do before getting on a plane because alcohol for many people even though it can make you calm initially it actually can make you more anxious over the course of the flight and cause you to not really think reasonably so I recommend that people not use alcohol prior to getting on a plane but the main thing you ought to do is keep flying and keep getting yourself self scheduled for more trips.

Thanks for your email.

>> Let's go to our first caller.

Hello Angela.

Welcome to Matters of Mind.

>> Did you say Angela?

I said Angela.

Hello Angela.

Thank thank you kindly.

I'm fine thanks so if you say take a 13 year old boy he aders quickly with the parents is polite in school and with thers what I guess what's your first thing that comes to mind if it's not too broad of a question as a psychiatrist it's okay.

>> That's a broad question but there's and that's what we will often do.

Angela will look at all the different possibilities and Ralph the you're saying he's getting along well.

>> Sorry.

Go ahead.

Apologize.

I also have a second part of the question.

Yes, The sorry I just lost my thought.

Oh, and what's the best tactic to the child in therapy to convince the child to go to therapy and go sure.

>> Yeah.

Stay still if you'd like because the first thing I'd wonder if he's having trouble with authoritarian figures but he's getting along with his peers.

OK, that sorts out a lot of different possibilities that could be even more problematic but it could be something it's called oppositional defiant disorder where he's having trouble with authoritarian figures and yeah, that's going to be mainly addressed through psychotherapy or talk therapy if he's having difficulty the to the point where he's having problems in school and possibly even getting to the point of being expelled due to lack of respect, it comes down to having a trusting therapist to be able to kind of coaching through some of those difficulties but also having a trusted friend who can point out with in a very safe environment with with him that you know, it's not working out so well for him.

So a thirteen year old having trouble in school and having trouble with authoritarian figures at some level knows that's a problem 13 years old of age you're not often thinking about the future so much but at some point a trusted friend or a mentor is somebody who would be somebody to try to help him look toward the future.

>> You were saying Angela I'm sorry.

He's he's doing fine in school .

Oh, that's wonderful.

So that really narrows that down as well.

It comes down to the oppositionh authoritarian figures, correct?

>> Correct.

Does he have a mother and father at home?

Yes.

Wonderful.

So having a mother and father at home it probably comes down to encouraging him to have family therapy and that's where the mother father the the 13 year old boy does he have any brothers or sisters?

>> Yes.

Bring them all in and I think that would be that would take more of the pressure off of him if you make it more of a family environment.

So that's what I would certainly do to try to convince him to go into therapy.

I think it's wonderful that he's getting along with his peers and he's doing well in school.

That's fantastic that if he's having difficulty mainly with just authoritarian figures OK, that's part of growing up but thirteen years of age, Angela, his brain is not fully developed and I point this out to a lot of young adults under twenty four years of age and especially adolescence I might see an adolescent occasionally sixteen, 16, 17, 18 years of age and I'm telling him look, your front part of your brain is not fully developed.

You're not making good decisions because your brain is not grown when you get to be twenty four twenty six years of age I think a lot of these things people are telling you now are going to start making sense to you but I try to make them aware of that their brain is not fully developed and that's not going to allow them to make the best decisions.

>> So at 13 and 14 years of age the things your parents might be saying to you don't make a lot of sense because your brain can't conceptualize what they're trying to say.

You will later on.

So there's a lot of ways that you can talk to them about that.

But I'd certainly suggest getting them involved in talk therapy.

Individual therapy is fine but it sounds like he's having trouble particularly just with authority figures doing fine in school.

He's having good relationships with peers.

Those are good signs overall.

Does he have attention deficit hyperactivity disorder?

It doesn't sound like a people with ADHD often will have difficulty with peers at some level and have some type of difficulties in school, especially with academic kind of work.

But I certainy suggest that he get involved in family therapy to try to understand the dynamics around that but also give him some time.

He's thirteen years of age.

He has a lot of grown up to do some of that's immaturity at this point.

>> Angela, thanks for your call.

Let's go to our next caller.

Hello Lee.

Welcome to Matters of Mind.

>> Lee, you had mentioned that you're currently prescribed two antidepressant medications Prozac and Wellbutrin.

Is it necessary to be on both?

Wouldn't one be sufficient?

Well, I imagine that you started out taking one particular medication either Prozac or Wellbutrin and it only did so much for you and that's the reason probably a second antidepressant was added.

>> Prozac predominantly will increase the chemical by the name of serotonin.

Wellbutrin predominantly increases norepinephrine and dopamine.

They work entirely differently.

So it's kind of like salt and pepper if you're going to make a casserole, do you really need the salt and pepper?

>> Couldn't you just use one?

Well, that might not taste as good that way and that's the way the brain kind of functions when you think about what serotonin does, serotonin will give you this calming effect and for many people it will help more with anxiety serotonin projects from the middle part of the brain and goes to the outer cortex and it gives the brain somewhat of a braking effect.

It calms down excessive emotionality decreases excessive crying.

>> It'll make people feel less panicky and they often will have less traumatic experiences that way.

So serotonin has its role and that's what Fluoxetine or Prozac will do.

>> Bupropion has the potency about half the potency of a stimulant.

So bupropion is a medication that increases dopamine and norepinephrine.

Those are two activating energizing chemicals of the brain and they can help with concentration energy get up and go motivation.

They work in a different type of so-called phenotype than serotonin will.

>> So the phenotype will be the symptoms in which we will try to examine for people and some people will have the phenotype where they might do better with a serotonin medication.

>> Some people might have a so-called phenotype where they do better with the dopamine and norepinephrine medication.

So putting the two together makes a lot of sense.

>> So Prozac and Wellbutrin work entirely differently.

Think about them as being different seasonings for a casserole in terms of helping the brain function better now wouldn't one be in your persons better interest if it works?

>> Yeah that's great but sometimes you just will find that one medication won't work so well and you have to add on another one to get a little bit of a secondary effect.

>> Thanks for your call.

Let's go our next caller.

Hello Mary.

Welcome to Matters of Mind.

Mary, you want to know what are the white flares in the front part of the brain?

What does that mean white flares?

I'm not really clear what your might be you're referring to there, Mary, but I'm going to take my best shot here.

You might be referring to the front part of the brain be in the front cortex and they will have white flares if you look at it in a magnetic resonance imaging of the brain or even a CAT scan of the brain.

The white flares are basically myelin sheets.

These are the projectiles of the nerves themselves.

They're called axons and they're coated with myelin and myelin is the insulation of the individual neurons and myelin.

It will give it a white appearance so the myelin insulation on the individual projections of the nerves will give this white appearance.

>> You'll see it on the front part of the brain but you'll see it in all different areas of the brain well as well that's how the brain is communicating from one part to another.

>> Now when we talk about myelin, Mary, you know we're often talking about the difficulty people have when they are shrinking down the myelin as they will do especially in the front part of the brain if they use marijuana as an adolescent and young adult on a regular basis, regular basis being three times or more a week.

>> So if you use marijuana especially under 24 years of age, it actually will diminish the myelin or insulation in your brain.

>> That's the white matter and that will give you difficulty later on with concentration, attention span memory and it's been shown that if you use marijuana earlier in your life you'll have more difficulty with thinking and concentrating and keep your mind on things later in life even 20 years later.

So that's why we're often emphasizing to people to not use marijuana, especially if you're under 24 years of age because of that white matter that mile and especially in the front part of a brain where you use your judgment and try to make good decisions.

Thanks for your call.

Let's go next caller.

>> Hello Matthew.

Welcome to Mastermind Matthew.

>> You mentioned that you have obsessive compulsive disorder and depression and you feel that medical marijuana helps you bring joy in life .

>> So you want to know my opinion about medical marijuana, Matthew, right now with medical marijuana it's very important to have a prescriber who understands it very well and understands the risks as well as the benefits of medical marijuana does have a lot of different features and it has a different different effects on the brain.

You need to understand the potency of it.

That's the whole idea of having a marijuana card that you can as a prescription where you can have somebody take a good look at it whenever anybody dispenses you medical marijuana they need to understand what risks you may have for it.

So they need to understand the potency the ratio between THC and CBD in those type of factors will come into mind.

>> So the question is, OK, if you've tried various other medications other than medical marijuana, how have they done for you?

But with medical marijuana, medical marijuana right now my biggest concern will be the long term safety of it has been studied for long term.

No, I mean when you have a medication come out that's approved by the Food and Drug Administration, that medication has to be studied very, very extensively versus placebo on over one hundred people for at least a year and over 300 people for at least six months.

And I've not yet seen that kind controlled specific data with medical marijuana and that's what we need.

I want to see merit medical marijuana, get more studied and get more extensively studied and I want the Food and Drug Administration to treat it like any other proprietary medication.

>> But yet they have not done that because it's something that it's processed by the Department of Agriculture and it's overseen in an entirely different way.

Thanks for your call.

Let's go our next caller.

Hello, Mark.

Welcome to the Mind.

>> Mark, you had mentioned that you have a lot of anxiety, depression and you drink a lot of alcohol to level off.

So I think you can take to smooth how you feel and stop drinking.

Mark, I just talked to a man earlier today with this very issue.

>> He was having trouble with alcohol and oh hi Mark.

I understand your life .

What on my mind.

>> Yeah.

Hi.

Good to hear from you.

I was here some of your question already but you tell me well that you're yeah.

I struggled with you know, the first and I struggle with anxiety and I think my drinking the answer there by my drink you know helps I know that but what is there in the United States to help me?

>> Lots of things you could take to help you, Marc.

And thanks for even considering that because many people they start drinking heavily and they just lose hope and they don't expect themselves to ever have a different quality of life.

>> So the bottom line is, Mark, when you had your first drink of alcohol, maybe when you were younger, how that first drink of alcohol make you feel?

>> You remember when I was younger I guess remember?

>> Yeah, some people do.

I mean some people will remember when they first started drinking alcohol it made them feel really good and they felt happy and they felt joy and they felt energized.

>> If you feel like that when you first start drinking, you're probably going to have a predictor for getting in trouble with alcohol later on.

>> So if you should have your first few drinks as a young adult or even an adolescent and it makes you feel great, that's warning sign that your brain might be kind of wired to really, really like the effects of alcohol and in trouble with it that way.

But I saw a man earlier today, Mark, who was having difficulty with alcohol use and going back he started having trouble with sleep and he found that alcohol at nighttime helped him sleep.

>> I hear about about it all the time where people will say pthey started having trouble with anxiety so they started drinking alcohol to calm the nerves and other people say alcohol makes me happy so they start using alcohol for the purpose of helping them feel happy.

The problem is alcohol is extremely toxic not only on the whole body but on the brain.

And in doing so it can affect your memory.

It can affect your judgment obviously and over the course of time you can have a tendency to need to drink more and more to get the same effect.

>> So alcohol is not something that is really a very reasonable medication to take in twenty twenty four as a means of trying to help with nerves, with sleep, with depression.

So what we often will do now is we try to mimic what the alcohol is doing with a prescription medication.

So if you're saying that you're not sleeping very well, if you're not dealing with anxiety, you're having trouble coping with things.

>> For one thing, alcohol makes that worse over the course of time.

So how do we reverse that?

We reverse them by typically giving one of three medications.

One is called gabapentin, also known as Neurontin.

There are a lot of studies done on that.

Over the past five years I've been using gabapentin prescription for patients for about fifteen years now but gabapentin is a very, very good medication to calm down anxiety and help with sleep especially when people have been using alcohol as a means of meeting those goals.

So Gabapentin or Neurontin is one option a chemical cousin of gabapentin is pregabalin also known as Lyrica.

It's now generic so it's a lot more affordable for people.

It's more potent in many ways than gabapentin but that can often help as well.

Topiramate or Topamax is a medication has been around for a long time for seizures.

It's also used for migraine headaches and for appetite suppression.

But topiramate has some really interesting effects on reversing some of the anxiety provoked feelings that alcohol can actually cause you over the course of time.

So we use those different medications.

I've heard about Naltrexone being used for alcohol use disorder that can be helpful for some people for craving but I found that it's not as helpful as gabapentin, pregabalin or topiramate.

Another medication Acamprosate eight is a medication.

It can just decrease your desire to want to drink works in a whole different types that type of of way and it's also known as Campral.

>> But Acamprosate are chemicals is medication.

>> It decreases the the desire if you're having difficulty primarily with depression and you're drinking alcohol as a means of helping with depression, I'm going to try to look at what kind of symptoms of depression you're trying to treat.

Are they more the type of symptoms where you're having trouble with enjoying things motivation initiative and we might go with medications like Wellbutrin Rintel of elitism, a medication we've used more recently.

As long as you're not drinking heavily and you're on the point of having a seizure from withdrawal.

So if somebody is drinking heavily and they're on the verge of having a seizure due to withdrawal, we're not going to use medications like Ability or Wellbutrin in those cases.

But we'll look at the underlying problems it might be there and that might have precipitated the underlying difficulty with the drinking itself.

>> There are a lot of different things you can take start with your primary care doctor to see what kind of options he or she might be able to advise and then they can always refer you to a mental health clinician.

>> Thanks for your call.

>> Let's go our next caller.

Hello Jim.

Welcome to Matters of Mind.

Yeah, I was in the hospital recently and for 16 days I had a surgery but for 16 days I couldn't eat anything and you know you can't get any sleep at a hospital.

Yeah.

And then when I get out of the hospital and it's kind of happened to me in 07 when I had colon cancer surgery after I got out of hospital about two or three weeks it seemed like I had like a post-traumatic stress event or something and my blood pressure went up and the doctor has been treating it and it was thinking that maybe they should give me something for anxiety or stress.

I just got some circulation today.

But after reading the paper here with I can cause serious side effects and all that, I'm wondering whether I should take it.

p>> I just want know if you think any particular medication in its so-called package insert will refer to many, many different possible side effects.

>> And I always point out that if if we had a package insert for water we would find that it would have a lot of potential side effects water and excessive doses can cause you to seizures confusion you can ask sprayed on water.

>> So there's so many different things there's even water could cause you that could be problematic.

>> So keep in mind when you look at those package inserts, what's most important is how the medication is going to affect you and quite frankly I hear about a person who we start on a medication on Thursday and within two days I sat there feeling lousy in different ways and we think oh it's not supposed to do that.

>> Hey, if it's doing that for you, it's doing it for you.

So what's most important with any these medications is how it's affecting you for the bad but also the good is a medication it typically is used for people who have experienced the jumpiness, the avoidance, the so-called hyper vigilance whether on edge related to a post-traumatic stress event.

And you're exactly right, Jim.

You can have PTS symptoms after having a prolonged hospitalization.

We heard about that a lot with people who were under going the covid pandemic and having covered and having the treatments from that is very frightening experience for many, many people when they're in the hospital for a prolonged period of time.

>> So when you have PTSD symptoms, what your brain is doing, it's always on the on guard for something bad happening to you.

>> So this hippocampus part of the brain on the side here, that's the memory center of the brain.

It's right beside the anxiety center of the brain which is called the amygdala right on the front part of the temporal lobe here the yellow part and it's closely attached so that if you're having trouble with expecting something bad is going to happen, your anxiety can be sky high.

>> Zoloft also known as sertraline will increase serotonin transmission and in doing so gives the brain somewhat of a calming effect.

It gives you somewhat of an emotional blissful effect or just calms down a lot of those symptoms so it can be a very good medication.

I will tell you this Jim was circling.

We are giving it now to pregnant women and breastfeeding women.

>> So it's thought to be very safe for most people.

But sure there will be some exceptions out there where people have a horrific time with it because maybe serotonin is something in which they're very sensitive.

>> Maybe they need a lower dosage of the versus the usual typical higher dosage of 50 or 100 milligrams and some that some people take.

>> So everybody's individual.

But what's most important for you Jemma's what's the best medication for you if it's not serotonin based medications like sertraline?

Yeah.

>> If you've had PTSD and you have a higher blood pressure we're going to think about medications used for PTSA symptoms and higher blood pressure like Clonidine Gwon Forseen and Presson Clonidine Forseen and president are all medications used for blood pressure so they lower your blood pressure but in doing so adrenalin firing that's happening in the brain.

>> So in doing so they'll give you fewer nightmares, you'll have less anxiety and you'll be calm down overall Jim, there's a lot of options out there for you.

>> Thanks for your call.

>> Let's go to next caller.

Hello Darryl.

Welcome to Matters of Mind.

Hey Doctor.

Are you doing there all doing all right.

>> Thanks.

I had a couple comments one too.

I was hoping you could talk about the addictive nature of alcohol.

I a guy who you'll drink a couple shots of liquor and for you know he's on binge drinking all night and for about three or four days you don't see him then when you try to get a home he's home.

Hurting so bad is livres all tore up and that's one scenario another guy his wife gets home, she gets her for twenty four out beers and after about a beer and a half he says she just turned into a real mean devil and all night she's cursing everybody out screaming at him and by the morning she's apologizing to everybody.

I mean there's an addictive side to this thing that people drink and they they know about it.

>> They're not going to share it while they're doing it.

But why don't you explain that a little voice you described it very nicely already but basically the addict nature is with any addiction if you're having trouble with getting along with other people following something use whether it be alcohol or any other substance for instance, that means that you shouldn't be using now people will say well gee I can just get by with one or two drinks and drink socially.

Some people camp so if you can identify one or two drinks get you going and you end up binge drinking, what is doing is changing the networking the brain where the brain compels you to drink more and more.

It's truly a disease.

It's a neurobiological disturbance when people are drinking to that problematic degree.

Thanks for your call.

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

If you have any questions concerning mental health issues that I can answer on the air you may write me via the Internet at matters of the mind.

Paul one word at WSW Edgar I'm psychiatrist Jeffrey, you've been watching Matters of Mind on PBS for Wayne now available on YouTube God willing and PBS willing.

>> I'll be back again next week.

Thanks for watching.

Goodnight