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>> Good evening.

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

Welcome to Matters of the Mind Now in its twenty sixth 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) two six 27 two zero (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 I am broadcasting live every Monday night from our spectacular PBS Fort Wayne studios which lies 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 WFYI Bellaigue that's Matters of the Mind had to be a big exercise program with a question I recently received it reads Jarda to favor with a time change it's obviously getting darker sooner.

>> It's easy for me to see Seasonal Affective Disorder becoming an issue.

How can I get over the hump especially for these first couple of weeks following the time change?

>> Well the first thing you probably need to do is try to get up a little bit earlier than you might expect to do so and get outside in that early morning light for about fifteen minutes or so.

>> Take a coat with as it's getting colder but get outside early in the morning as soon as you can.

>> It's going to get getting darker a little bit earlier and you're going to notice you're getting tired in the evening a little bit sooner than you might expect.

>> So yeah, go to bed a bit earlier but especially get up early in the early morning hours.

Many people do use a light box.

>> A light box is a bright light that you sit oh about a foot or two away from and you find that it will help wake you up in the morning.

>> Most people only need about twenty minutes or so of sitting in front of the light box for them to get benefit but sitting in front of a light box can be very, very beneficial.

A lot of people especially as we get into the winter time will notice a mood elevating effect if they take some vitamin D do so under your doctor's supervision but vitamin D is a dog twenty five thousand units a day for some people and some people will take ten thousand units once a week in particular formulations.

Talk to your primary care clinician about your options for the vitamin D supplementation.

We can do vitamin D blood levels and many people will get those about this time of the year.

But low vitamin D is very prominent for a lot of people as we get into these winter months and it will affect your mood.

It affects the mood, affects concentration and it can affect a lot of people medically.

It's thought by some studies that individuals who had low vitamin D or the higher risk for certain types of cancers so vitamin D supplementation can be very, very helpful not only for the mood but the overall body.

>> Thanks for email.

Let's go to our first caller.

Hello Oliver.

Welcome to Matters of Mind.

>> Oliver, you had wondered about having difficulty accomplishing tasks and you find that you make a lot of lists but it feels like a mental block and it's stopping you from getting it done.

>> What can you do?

Well, Oliver, a lot of different things are going on here for you.

>> You're getting started on different tasks and then you're not able to get them done.

So the first thing you need to do is focus on the number one priority.

Keeping the lists are fantastic .

Keeping the lists are wonderful because it allows you to maintain a priority and know what you need to get done now and what can wait and devote a chunk of time to just doing the first priority the task at hand that means not looking at any television, not looking at your smartphone, not answering any emails, having radio silence basically for about twenty five minutes work on it and work on it only for about twenty five minutes with no distractions after twenty five minutes.

>> Take a break.

Hey go out play with your dog go do something entirely different than what you had been doing.

Take a break for about ten minutes and then if you hadn't completed your task get back to it maybe another twenty five minutes or so but it seems like twenty five minutes is a time period that many people who will find helpful to be able to get something done and get something accomplished and get something started.

>> Now there's certain conditions that are medical conditions like attention deficit disorder.

>> People with ADHD get very excited and they get very enthusiastic about new and challenging and novel type of activities and they will get them started but they don't persevere and they have difficulty just from a brain perspective to be able to persevere and get things done.

And that's because with attention deficit disorder the disturbances in the left front part of the brain primarily where the left front part of the brain allows you to pay attention on things that aren't very interesting and allows you to focus, focus, focus to get things done.

People with ADD have decreases in activity of this particular part of the brain.

Now that's part of the brain does grow over the course of time until you're about 24 years of age and for many people they'll notice that the attention deficit disturbances are less problematic as they get older into their 20s and even 30s for that matter because the left front front part of the brain is growing more and more and more.

>> So you may grow out of some of the symptoms, others might persist.

So if you have ADHD there are specific treatments for that but it sounds like you're already catching on to realizing you need to keep lists and on those lists you have to prioritize.

Don't let priority number five or six jump up there to number one until you get number one done.

So you have to maintain your focus on what's most important to be done right now and block out all outside distractions for those twenty five minute blocks to be able to get get your number one priority done and get it done to its completion.

Don't put things off now granted when people especially with put things off they have to use a whole different part of their brain when you're trying to accomplish a task using the left front part of your brain.

>> But when you're under pressure there's a whole different part of the brain that kicks in not necessarily in a good way but the excitement part of the brain, the nucleus accumbens part of the brain starts kicking this middle part of the brain starts doing more of the work at that point because you're under pressure to get things running, you're basically getting things done running on your adrenaline.

>> The problem with that is yeah, you'll get things done but it might not be the kind of quality you would have wanted to do.

>> It's ideal to get your deadlines done a week or so in advance and then that last week kind of think over what you did and that's where you'll make revisions.

You kind of think in your mind what you might have done differently but give yourself plenty of time before your deadline to get things done.

Difficult to do because of the deadlines not still a ways off.

It's easy to just kind of back off on it and not worry about it.

But that's where you'll often get in trouble with procrastination procrastination you have to get things done because you're under under pressure at that point.

>> Thanks for thanks for your call.

Let's go our next caller.

Hello Dale.

Walking to matters of mind, Dale, you want to know how can you become a better listener?

>> Your family and friends are tired of me of you interrupting them.

>> It sounds like Dale, you're not listening so much to what are the people saying and that's why you're interrupting now that's a classic symptom of what I just mentioned attention deficit disorder with attention deficit disorder people often think three steps ahead of everybody else.

They will finish the sentences others because they already know what they want to say.

So why are you waiting for them to go ahead and talk?

You just go ahead and talk for them.

Well, that's what happens with aid gets to be very annoying.

You lack tact and you can have very the perception of having a lot of of impatience when you come across like that and people often are going to get tired of you interrupting them in that way.

>> So with that being said, Dale, I think that no one try to determine if you do have attention deficit disorder or not.

That is a treatable condition where aid is kind of like needing eyeglasses for nearsighted severe nearsightedness.

You can accommodate all you can by squinting and sitting closer to things and get by with poor vision.

But if you get the vision corrected with a proper lens strength on corrective lenses you can have a better quality of life.

>> That's way aid is or is different severities of attention deficit disorder.

Some people have very mild aid where it only gets their ways when they're having difficulty with challenging very complex project that might be unusual for them to be trying to accomplish.

>> Other people have severe aid where they hardly can't get out of bed without having something for the aid to be able to focus just to get to the bathroom and do what they need to do.

>> So there's different varieties of aid.

It's like there's different severities of poor vision so it's important to try to get them treated the best way possible but becoming better listener I think you've already kind of figured it out Dayle.

Your friends and family are tired of you interrupting them .

With that being said, you need to be aware of that particular problem.

Have something in your hand to drink as other people are speaking and when you're wanting to really say something ,take a sip and instead of talking take a sip, be conscious, be conscious of how much you're speaking, wait for the pauses.

Try to try to back off of that temptation to to finish what other people are saying because it's tempting to just jump right in there and finish their sentencs.

But it sounds like you do have the awareness that other people are getting annoyed by you're interrupting them.

So that's the first step.

The next step is to do something about it and that will be to make sure to sit back and not say anything until maybe you're asked or until there's a long pause in the conversation.

People with AIDS often have difficulty with silence.

If you're a teacher, for instance, and you ask the classroom a question if there's a little bit of a pause of a silence there is the people with aid that will often be the ones to blurt out the answers whether well it's something they know about or not because people they don't like pauses, they don't like silences.

>> They like to keep things moving and they can be very impatient.

So if you have had to talk to your primary care clinician about possibilities for getting that treated if you get assessed for if that's the issue but you know, some people are poor listeners by nature and that's just a social skill that needs to be learned and the main thing you need to do is be able to know when to be quiet and know when to say something and you'll notice the people more people listen to you if you say things that are more meaningful as opposed to just filling in the blanks.

So be aware of how people are saying that you're coming across to them.

>> They'll thanks for your call.

Let's go to our next email.

Our next email reads during a revolver I just started Trazodone and noticed some big changes in my digestive system with its level our should I call my doctor?

You can always call your clinician if you have any questions and nowadays it's easier to contact clinicians because you can text your clinicians and most type of health organization.

So feel free to contact your clinicians if you have any questions.

But Triacetone is a medication that at low dose is under two hundred milligrams at bedtime will primarily block this particular receptor called serotonin 2A receptors.

There's 14 different serotonin receptors.

If you block serotonin 2A receptors you can notice that you'll get a better night's sleep and it's a better night's sleep in terms of having more dreams and a good way and having a deeper sleep.

And it's thought that Trazodone can actually be a medication that older adults can use at low doses 25 or 50 milligrams at bedtime typically to get a deeper quality of sleep.

And that's important because if you don't get a deeper quality of sleep you're more prone to having Alzheimer's dementia a risk factor for Alzheimer's dementia will indeed be lack of deep sleep and specifically by blocking certain 2A receptors can give you a deeper sleep now as you go higher on the dosage of Trazodone you can start affecting serotonin in a generalized way so that serotonin starts to affect other receptors such as serotonin receptor three which can give you nausea and you can have some diri because 80 percent of your body serotonin is in your gut.

So if you're stimulating serotonin in your gut and you're getting more serotonin have diarrhea.

>> Will it go away in most cases it does diminish over the course of time.

But the first thing will typically do when we hear about somebody having gastrointestinal problems with Trazodone is will start to drop the dosage down a little bit because usually the dosage is too high for what you need and it's often a medication that at very low doses can be a very effective for giving you that deep good quality of sleep.

Rarely for sleep does anybody need to get above 200 milligrams a bedtime now transit Trazodone was first approved by the Food and Drug Administration for the for the treatment of depression back in the early 1980s.

>> It's been around for a long time and it was approved for depression at doses between 300 and 600 milligrams a day because as are the doses that people would need to increase serotonin to relieve depression but for sleep it was found in the late 1980s, early 1990s it was a very good medication for giving people good quality of sleep without giving them a tolerance and without giving them a dependency over the course of time people can take Trazodone for a long, long time now why wouldn't everybody take Trazodone to give them a better quality of sleep?

>> It can make you overly groggy into the next morning if you get too much of it and about one 18 people who take Trazodone will get nasal congestion.

They'll get a stuffy nose and that can be kind of uncomfortable for some people.

But that's only about one of the eighteen people if you dose Trazodone just right for many people it can be very effective.

>> Thanks for your call.

Let's go to our next e-mail.

Let's go to next caller.

>> Hello Sheila.

Welcome to Matters of Mind.

Hello Sheila.

You had mentioned that your maternity leave is running out coming to an end next month but you don't feel ready.

How can you deal with the separatio anxiety I'm taking?

>> I'm take it that there's a separation anxiety from your baby that's always difficult, Sheila and the different workplaces have different strategies for that.

>> Some workplaces allow you to be able to breastfeed and go home periodically.

Many places when they have people going back to work they're allowed to do so remotely.

So you're still in the household and you can be there with the baby periodically.

But the separation anxiety is not something I consider to be pathological when you have separation anxiety as a young mother that's expected that's your oxytocin which goes sky high.

Oxytocin is a hormone that comes from the pituitary gland and it's called the bonding hormone.

>> Oxytocin comes from right there in the pituitary gland as a bonding hormone.

>> It not only makes you fall in love and allows your bond other people but after a woman delivers a baby the oxytocin level goes up by like 80 times .

>> Now interestingly enough for the fathers of the babies, the oxytocin level does not go up.

>> We don't know why but for mothers the oxytocin level goes sky high.

So what you're experiencing is not a pathological separation anxiety is very difficult to go back to work after you've had a baby.

So it's a matter of being able to find some means of transition to be able to do so and be able to spend some quality time with your baby and especially when you're at home to be able to spend as much time as possible.

>> Sheila, thanks for your call.

Let's go our next caller.

Hello Phillip.

Welcome to Matters of Mind.

Phillip, you had mentiond that you feel burnout at work and lately can't sleep.

You feel nervous going in the job.

Is there anything you can do you can't afford to quit your job?

>> I agree with you, Philip.

I think it's important for you to look at the underlying reasons why you might feel burnout at work if you're not sleeping now and that's because you're worrying about stuff and when you're worried about stuff you can't sleep.

Unfortunately that will lead to inevitably people having difficulty with depression.

So what I'll often tell people when they're having that much stress about their work environment is to step back and take a look at their work environment and look at different options about what might be available to them.

It's very empowering to know that maybe there's a different type of work environment that would be more suitable for you and just being able to keep your options open.

>> Granted, I don't recommend to people to people that they quit their jobs when they're having trouble with their job, job or work situation.

>> Don't quit until you have something else lined up.

Once you have something lined up that's when you can step away.

But you might want to start looking at other options now what often happen will happen, Philip, is when people start bouncing from job to job to job, maybe it's not the job.

Maybe it's something's going on with you where it's just not working out for you to be able to go in these kind of work environments.

So take a good honest look at yourself.

Many workplaces do have employee assistance programs where you can look at what kind of difficulties you're having for some people.

Well, maybe they had difficulty as a child getting along with authority figures and they've always had trouble with authority figures and no matter what job they go to that can be a problem for them.

>> Other people have a mood disturbance up like bipolar disorder.

Bipolar disorder is where you'll have these manic highs and then you get these depressive lows.

Well, people who have bipolar disorder are four times more likely to lose their jobs or quit their jobs because of their mood disturbance.

So the mood disturbance can be a factor.

So there's all sorts of different possibilities out there.

But I'd certainly recommend you talk to somebody within your organization with employee assistance to try to determine why you might be burnout on the job.

>> Maybe it's not challenging enough for you.

Maybe you're having difficulty with the interpersonal relationships with others around you.

Look at the reason why you might be having trouble on that job and in going to another job try to be aware that you don't want to get into the same rut and you don't want to go into a worse situation that you had before.

So again, I don't recommend that you quit a job because you're not happy there and you're getting stressed out but look for other opportunities that might be more suitable for you.

>> Philip, Philip, thanks for your call.

Let's go our next caller.

Hello Tiffany and welcome to Matters of Mind.

Well, Tiffany, you had mentioned that your teen is in their first relationship showing some obsessive traits.

How can I allow their freedom to tone down the obsessive traits themselves?

Well, Tiffany, as a parent that's always difficult to do.

But keep in mind you are the parent you are the one in charge and be aware that you're not a friend to your teen.

You are their parents.

So it's difficult to make those tough decisions sometimes when you're talking about the first relationship showing obsessive traits when you're a teenager.

>> Tiffany, my brain is falling apart here.

When you're a teenager you'll find that as a teenager your fun part of the brain, the joy, the joy part of the brain is fully developed by the time you're twelve.

So if you look deep inside the brain here, I'll just take out this middle part of the brain that's easier.

Take out that middle part of the brain, the joy center the brain is this part of the brain called the nucleus accumbens.

The nucleus accumbens is the fun center of the brain.

It's the pleasure center of the brain is Las Vegas of the brain of the brain in the sense that it's where you go for the purpose of just hedonistic happiness that's fully developed by the time a person's 12 when you first get into a relationship in the early adolescent years you have this surge of Vcsi Towsend it gets released oxytocin I mentioned earlier as the bonding hormone goes sky high after a woman has a baby but it also is sky high especially when you're early in a relationship with somebody adolescents will get this combination of their pleasure center getting fired up and oxytocin getting fired up especially with some kind of romantic relationship early on.

Here's the problem as an adolescent their judgment center the brain.

The front part of the brain is not fully developed and it won't be fully developed until they're about twenty four .

So as you're going through the adolescent years, your oxytocin is getting fired up.

You're getting the bonding hormone going, you're getting the pleasure center fired up with these early romantic relationships.

But your judgment center part of the brain is not fully developed.

So what I have found Tiffanie, when I've seen adolescents over the course of the years in my office, I've told them about total structure of the brain and how this all works and they seem to get it at a lot of it at some level they seem to get it because they understand that maybe if their brains are not fully developed they shouldn't be making these kind of decisions that they're making.

So that will often be something that gets their attention and I'll mention to them that maybe they don't want to make these long term decisions when they're 14 or 16 years of age because they might compromise what happens to them later on and many times they'll understand that to a degree now as a parent you're emotionally involved with them, you're emotionally attached and they're going to get angry with you and they're going to talk about you being restrictive on them.

You have to just kind of it up and accept that for the time being because that's part of being a parent because what you often notice these same children who when they are 14, 16, 17 years of age and they were very, very oppositional to some of your mandates at the time they'll come to appreciate it when they get into their mid 20s as their brain is fully developing and judgment center starts to develop.

They'll start to understand why you said the things you did.

I find it very interesting because I'm I've been in practice now for over 35 years.

>> I see some some women who are now in their 30s.

>> I saw them as adolescents.

I saw them when they were-adolee some of their own young children and that's very interesting to see because I remember how the mother was as an adolescent when I was early in my practice now that a mother is a mother herself and she's bringing up these adolescents.

>> So a lot of times you'll see these multigenerational conflicts and what you can often cite Tiffanie, you can tell me how you felt to be an adolescent because you can say how challenging it was and I think it's very important that you empathize with them.

>> Stephanie, thanks for your call.

I believe we have another email ready.

>> Let's go to our next email.

Our next email reads as I get my brain back together here did revolver I'm pretty good with taking my medications for anxiety and depression regularly but I missed a dose over the weekend that I worry about that.

>> Do I need to take the missing dose as soon as I notice that I missed it?

>> Well, the way you're taking antidepressants medications ideally is every single day and the best way to do that is have a medication tray to remember that if you miss a dose it's not ideal at the worst when you miss a dosage of an antidepressant, just one dosage you can feel sometimes with some things and zaps on your hands and feet especially if you're taking a medication like Paxil or Effexor also known as Venlafaxine some of the serotonin medications if you miss a dosage you'll feel it within a day or so and it's kind of a way of reminding you that you need to take the medication.

But if you miss a dose I would not usually double up on it too with some medications that last a long time Fluoxetine one of them lasts for six days in your system sometimes you can double up and take extra amount the next time with thyroid medications.

I know that can certainly be the case if you miss Levothyroxine or for sometimes you can take the second dosage the next night because it lasts four days in your system but with most medications if you miss a dosage let it go until unless you feel it with 12 hours or 14 hours later than you can take it at that time if you're having some discontinuations symptoms from the discontinuations symptoms like I said the lightheadedness, the zings and zaps in the scalp and the hands It's very uncomfortable though.

But you're not going into a physiological withdrawal, just going into a bit of a discontinuation in general.

So usually it's not recommended double up on the medication dosage because if you get too high of a blood level of a lot of antiepressants in your system, you'll have even more side effects.

So generally if you miss a dosage not a big issue if you miss three or four doses in two or three or four days behind, you might want to contact your clinician to determine based on the medication you're taking, do you need to start to do a slow, gradual increase in the dosage?

Again, the medication would be most concerned about in that regard would be one called Lamotrigine or Lamictal.

If you missed two to four weeks worth of Lamictal generally you want to start from square zero and start with a twenty five milligram dosage for two weeks than 50 milligrams every for two weeks and gradually build back up.

You don't want to just go right back on the dosage you're on before because you'd get a higher risk for having a rash on the chest, neck or face.

So there are some medications where you don't want to jump right back in on the prior dosage and you have to start low and slowly go up because you're more likely to have side effects if you start at a high level of a dosage if you go back on it in some cases but again that is determined by how long the medication lasts in your system.

Some medications like Treinta for instance.

Twenty six last two and a half days so with twenty six if you-g to notice hardly anything.

>> Some people will double up on that the next dosage but it might not matter because a little bit of a drop in the blood level for a day or so is probably not going to affect you that much.

It's when people miss several days worth of their medication they'll start to notice they get more depressed and they have some discontinuation symptoms.

>> Thanks for your call.

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

If you have any questions concerning mental health issues you may contact me by writing me at the via the Internet at matters of the mind at a dog psychiatrist Jay Farber and you've been watching Matters of Mind on PBS Fort Wayne God willing on PBS willing.

>> I'll be back again next week.

Thanks for watching.

Good night