.

>> Good evening.

I'm psychiatrist Fauver live from Fort Wayne , Indiana.

>> Welcome to Matters of the Mind.

Now in its 10th year matters the mind is in is a live call in program where you have the chance to call directly here in the Fort Wayne studios by dialing in the Fort Wayne area at (969) 27 two zero or if you're calling coast to coast you may dial toll free at 866- (969) to seven two zero on a fairly regular basis.

>> We are broadcast live from our spectacular PBS Fort Wayne's Bruce Haines studio right here 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 dot org that's matters of the mind at org and I'll start tonight's program with a question I recently received.

>> It reads Your daughter Fovea My workplace offers six free sessions for mental health counseling.

Should I try to space them out or use them all at one time?

>> It really depends if you're having some specific problems that you want to address sooner rather than later such as interpersonal problems, difficulty with coworkers, difficulty with administration or management especially within the workplace.

You might want to address that sooner rather than later and maybe have weekly sessions to try to get through some of those initial problems.

>> However, if you just want to check in every now and then you could maybe spread those sessions out if you don't have any particular concerns in mind for the time being you could maybe just do a mental health check in every few weeks or every few months for that matter and use those six sessions in that manner.

>> Thanks for email question.

Let's go to our first caller.

>> Hello Dylan.

Walking to matters of mind.

Well, Dylan, you want to know when does bipolar disorder start to manifest itself in a person and what are the signs it usually will typically occur with depressive episodes early on and it may occur as early as in the adolescent years and it is typically will affect men equally and prevalence to women early signs can be decreased need for sleep, impulsivity, saying things and doing things you ordinarily wouldn't say or do.

>> You might talk really fast and go topic to topic to topic and those are some of the symptoms of mania and course people can then crash into lows but not everybody crashed the lows but most people do now typically you know you have bipolar disorder if you have those kind of symptoms, especially if you have family members who have experienced similar symptoms and they have bipartisan as well because bipolar disorder is considered to be 65 percent genetic.

So there's a genetic link there and if you have those symptoms typically they're going to occur late adolescence or early 20s for most people rarely do I ever hear about bipolar disorder having its onset in the 40s or 50s if that's occurring?

I'm always looking for other types of conditions for women for instance, maybe they're having moodiness related to menopausal challenges for men.

Maybe they're having moodiness due to their drinking.

Maybe they have sleep apnea.

There might be something going on if you have the onset of those symptoms in the later years but usually bipolar disorder has this onset in the adolescent years or in the early 20s.

Thanks for your call.

>> Let's go to our next caller.

Hello Brett.

Welcome to Matters of Mind.

>> Brett, you had mentioned you forgot your anxiety medication which was Zoloft on vacation for a week.

Could pick up your normal dosage as a backup and contact your clinician and make sure that the clinicians on board of what you're doing typically if you were taking 50 milligrams or less on Zoloft you could pick it right up and take 50 milligrams if you were taking a hundred milligrams or even 200 milligrams is off, you might want to start with a lower dosage and slowly go up.

>> Why?

Because there is a possibility you might have some diarrhea and some gastrointestinal problems if you start on a higher dosage right off the bat you can always talk it over with your clinician just being aware that a higher dosage will be more associated with more side effects.

>> Thanks for your call, Brant.

Let's go to our next caller.

Hello Jane.

>> Welcome to Matters of Mind.

Ben, you want to know if long term lithium treatment causes brain damage you'd have to be really toxic levels being free to get brain damage from lithium lithium if anything is beneficial for the brain.

>> Matter of fact, we've got these little caps on the end of our chromosomes called telomeres and it's been identified that lithium at low dosages can actually increase the length of telomeres which actually is good for the brain and it increases longevity.

So low dose lithium is actually good for the brain and the rest of the body in a lot of ways be very careful with the dosing because it can cause hair loss, thyroid disturbances and kidney problems at too high of a dosage.

>> So you want to you'd want to adjust lithium and be treated with lithium under medical supervision.

>> But there's no evidence that lithium clinically the clinically common doses will cause brain damage.

>> Thanks for your call, Bayen.

Let's go next caller.

Hello.

>> I don't walk in American mind, Hannah, you want to know what are the signs of obsession and when does this obsession turn dangerous obsessions can become dangerous.

>> You have difficulty with homicidal thoughts or suicidal thoughts that get to the point where you have a hard time turning them off.

>> Now by definition obsessions will be thoughts that are so-called ego dystonic.

>> In other words, they don't make any sense to him.

So if you have thoughts that don't make any sense to you, chances are you're not going to act out on them as a matter fact, obsessions typically will cause you to have more anxiety and often lead to compulsions where you do things over and over and over again to try to get rid of them.

But obsessions by nature are not the type of thoughts that you're going to act upon because by nature their thoughts are very foreign to you and you don't want to do those and they make you very anxious and even irritable even an experience that the thanks for your call.

>> Let's go to next email question.

Our next e-mail question reads Discover how does my doctor know what medications work well together I am always concerned that there will be some sort of interaction that won't be good for me.

That said, so far so good my medications seem to be working well.

Well that's fantastic.

If your medications are working well you probably don't want to make any changes at this point .

But how we determine how medications are going to work together will be No one knowing what the drug interactions between them will be but secondly very importantly the mechanisms of actions of medications.

Why would we use two and three medications together?

It's not unlike in the treatment of diabetes, hypertension, heart disease, asthma.

>> These kind of conditions often will warrant the use of several medications that have different mechanisms of action.

So based on the medications having different mechanisms of action they will often work together pretty well.

So how does a clinician know what to use for you particularly number one, you've got to get the right diagnosis and know what's being treated so having the right diagnosis is a good place to start.

>> Secondly, knowing what has worked for you and what has not worked for you in the past and having a clear understanding of the different type of medications based on their mechanisms of action that have worked for you and have maybe not worked for you.

Next we'd want to look at your family family history of medication, treat responses what medications have your family members taken and how they do if they did well great if they didn't do so well we wouldn't want to go that direction necessarily.

>> We'd want to look at other medications you're taking outside of mental health medications such as medications for other medical conditions because we want to make sure there's not going to be any interactions there.

So we'll take all those and considerations if we have genetic testing results available and that might tip the needle a little bit one way or another because genetic testing and influence treatment decisions.

>> But basically we're going to put medications together to have different mechanisms of action and I'll make a big difference.

>> Thanks for your call.

Let's go our next caller.

Hello Leslie.

Welcome to Mastermind Leslie.

>> You want to know where in the brain is drive created and there are certain diseases that can affect the drive or off the bat the front part of the brain is the decision making part of the brain.

>> If you have difficulty motivation, initiative, getting things done, persevering on things, typically it's because his left front part of the brain called the dorsolateral prefrontal cortex it's underactive and that's kind of making you not care about things so much.

>> There is a pleasure center part of the brain right in the middle called the TEG mentum to take mentum will spew out dopamine and give you a feel good effect, get you all fired up about doing things but it's got to fire up that front part of the brain to get you motivated to really do things.

>> So when people have depression oh when people have attention deficit hyperactivity disorder often there's decreases in transmission in this left front part of the brain and that will cause them to have difficulty getting things done especially because they just don't have that sense of needing to get things completed overall.

>> Leslie, thanks for your call.

>> Let's go our next e-mail question our next e-mail question reads dear to is there any is there such a thing as being too busy?

It seems like my body shuts down.

Is that my brain needing a break or is it a physical thing?

It could be.

I mean you're going to have so much bandwidth in your brain where you're going to have so much cognitive energy and for many people when they're working during the day it's not uncommon they might need a little bit of a nap in the afternoon and that actually resets I just mentioned the dorsolateral prefrontal cortex right up here when you nap for 20 to 30 minutes it actually resets and energized that thinking part of the brain.

So you might notice that you're just wiped out after a certain number of hours of thinking really, really hard.

And if you take a brief nap it'll actually reset that part of the brain.

You'll probably go into a really deep sleep during that time is called Delta Wave Sleep non REM sleep is another term for it but it's where you're going to recharge that part of the brain with a brief nap and that's how you know and you just need a little bit of a break at that time I often advise medical students at the end of the end of the day toward late afternoon, early evening to try to take about a 30 minute nap if they can.

>> If you take a nap too late in the evening, you might disrupt your sleep if you take a nap for longer than about 30 minutes, it can certainly disrupt your sleep at night.

>> So you want to be careful about that.

>> Thanks for your call.

Let's go to our next caller.

Hello Adlen and welcome to Matters of the Mind.

Alan, you want to know how can you address your stress at home so you're not turning to food for comfort while people sometimes will turn to food for comfort ADLEN because they're trying to increase their insulin level if you increase insulin level there will be increased transportation of an amino acid called tryptophan from your body into your brain and when it goes to the brain it turns into serotonin, gives you a calming effect, gives you a feeling of bliss.

>> So that's where many people will be stress eater.

So how can you deal with stress eating well, the best thing to deal with stress eating is to divert your attention to doing something else such as physical activity.

So exercise is a remarkable way of helping you deal with stress resistance training where you do weight work is very good for a lot of people with anxiety.

>> If you do aerobics training where you're on the treadmill to go bicycle that's often very good for depression.

So for that reason a lot of people will notice that if they can exercise and get physically active that can help out as well from a stress eating standpoint, well the first thing you want to do is probably try to eat more protein.

It's difficult to binge on protein protein will actually give you a satiating effect and have some good effects on hormones in your gut by the name of ghrelin and leptin.

These kind of hormones affect your appetite and your cravings themselves.

Proteins tends to shut that down and shut down your cravings.

So that's where you can often have decreased craving with carbohydrates.

>> Thanks for your call.

Let's go our next caller.

Hello Winifred.

Welcome to Martha Mind Winnifred.

>> You want to know why does Adderall cause different reactions to the brain when you do not have ADHD lacks the Adderall is a medication that for anybody and everybody who takes it it's going to really blast out norepinephrine and dopamine.

>> It's going to blast out from the firing neuron norepinephrine and dopamine and does so in a very abrupt manner and also stimulates the synaptic or the receiving targets as well.

>> It's something that in the immediate release version can be very potent in terms of how it affects somebody.

>> It'll often give people energy.

It'll will also give them a very brief awakening effect and it's a good feeling for a lot of people.

Here's the problem with Adderall which is also known as mixed amphetamine salts.

It's a mixture of various amphetamine salts in taking it to get that energizing effect that so many people like and many people get an appetite suppression effect with it as well.

But to get that effect you have to go higher and higher and higher.

So the usual dosage of Adderall extended release for instance would be about twenty milligrams every day I've seen people who are up to 120 milligrams a day and they get up there quite quickly because at low doses if you have ADHD it can help with focus and concentration.

But for many people once they feel that energizing effect and that very strong alerting effect, they want to get that feeling again and the only way they can get that feeling is to go higher and higher on the dosage.

So the energizing feeling, the appetite suppression, the very strong alerting effect that's a side effect.

That's not the intention of using Adderall for ADHD.

The intention of using Adderall or any stigma for ADHD is to help with focus and decrease distractibility and allow to pay attention longer and more pervasively so you can get things done if they're not for the purpose of giving you energy.

But many people once they experience that energizing effect they want to stay on the medication.

>> They want that good effect to be able to persist over the course of time.

Thanks for your call.

Let's go to our next caller.

>> Hello Elizabeth.

Welcome mastermind Liz's Elizabeth.

You want to know is obsessive compulsive disorder a symptom of a bigger disorder or can it be a single diagnosis?

OCD quite common and can be a single diagnosis.

OCD is something that occurs because the processing part of the brain in the front which tries to sort out OK, did I think about this or not?

>> It goes round and round as a circuitry in the brain.

>> It's kind of like the old record players with a needle get stuck and you have obsessions that you don't want to have there and they just get stuck and you have these thoughts and some of them might involve contamination or harm to other people thoughts that don't make any sense to you and they make it anxious just having these kind of thoughts so having OCD can be a single diagnosis now there is some relationship between OCD and having strep infections as a child because if you have strep infections inadvertently the body will attack not only the strep but also the front part of the brain that affects the circuitry.

So the risk factor for OCD will have will be chronic recurrent untreated strep infections as a child I've also heard about some women having OCD especially after childbirth is kind of like a mother bear instinct where they will have OCD where they are very, very obsessive about contamination to the point where it's an extreme and they realize that it's an extreme.

They're washing things dozens of time even they know they're clean and that's kind of an instinctual type of phenomenon becomes a problem when you do things to an extreme and it takes extra time and it gets in your way of getting other things done.

>> Thanks for your call.

>> Let's go our next caller.

Hello Chris .

Welcome to my mind Chris .

You don't know why does your doctor want you to take food with some of the antipsychotic medication?

>> Some of the antipsychotic medication gets better absorbed with food.

One's been around for a long time, for instance.

So Prdsident or Geodon if you take the president or Geodon by itself, only about half or forty percent of it will get absorbed.

So with some medications you want to always take them with food.

There's not just antipsychotic medications but there's a medication for postpartum depression called zoove zoove has to be taken with food especially fatty food because if you don't take it with food only about 40 percent of it gets absorbed.

So it's with some medications they get better absorbed if you take them with food because they kind of piggyback on top of food and get through the stomach lining and that's how they get absorbed.

>> Thanks for your call.

Let's go to next caller.

Hello Crystal.

Welcome to Matters of Mind.

>> Crystal, you want to know how does early childhood trauma prevent brain growth and does it affect education?

You bet.

Early childhood trauma especially before the age of eight years old.

Crystal is very important for us to assess and there's a scale called the adverse childhood experience scale.

It's ten items that were identified as the ten items that are most predictive of impairment as an adult if you had these kind of experiences so adverse childhood experience scale it's not copyrighted.

>> It can be used for the general public but thought if you had four or at least four of those different symptoms or experiences on the adverse childhood experience scale, you're more likely later on as an adult to have anxiety or depressive conditions.

>> So early childhood disturbances can be problematic for a lot of people.

So what happens?

It seems to change the circuitry of the brain.

So in other words it creates a hard wiring of the brain that will cause you to have trouble with anxiety depression at a later time.

So early childhood trauma can be problematic for lots of people and it's one of many things that can be a risk factor.

But it's thought to be pretty significant with early childhood trauma and that includes difficulty with your with your parents.

If your parents had trouble with drugs or alcohol, if your parents got separated or divorced, these are all childhood traumas that can later on significantly affect you.

>> Thanks for your call.

Let's go next caller.

Hello.

Q Welcome to Mastermind.

>> Q You want to know does long term alcohol use cause psychosis and is that something that will go away with treatment?

It can cause a lot of different things.

Q When people especially women drink alcohol heavily it can fry this part of the brain called the hippocampus the hippocampus is the memory center of the brain itself and especially women are more prone to having difficulty with alcohol itself because women metabolize alcohol at about one third the rate as men so two drinks for a woman is like six drinks for a man so women women's brains will be much more prone to having damaging effects from alcohol in the brain memory disturbances will be what we hear about the most psychosis sometimes but psychosis when we hear about that that's more related to other drugs of abuse such as PCP, marijuana with high potency of cannabis that can give you a higher likelihood of psychosis.

>> Will it go away maybe sometimes sometimes people need a long term antipsychotic medications.

I think it goes a lot along the lines of if you have a family history of psychosis so if you have family members with psychotic disturbances and you use something like high potency cannabis, yeah, you're more likely to have a psychosis that might be more long lasting and might be more difficult to remit over the course of time.

>> So alcohol not as likely to cause psychosis but it can cause significant brain damage and sometimes that will cause difficulty in interpreting the world around you will often hear about the paranoid thoughts in alcohol use when somebody is trying to come off of it and withdraw because the alcohol withdrawal spectrum itself.

>> Thanks for your call.

Ask our next caller.

Hello Beth.

>> Walking to matters of mind, Beth, you'd mentioned you're in perimenopause.

In other words you're still having periods every now and then your ovaries are still functioning some but you're not yet in menopause where you have an entire cessation of periods for several months and you mentioned you're having difficulty with multitasking are the things that you can do to help No one you can talk to your clinician, your primary care clinician about the possibility of bioidentical hormones, estrogen, progesterone as a means of trying to steady out those menopausal symptoms which so many women will have if you're getting to the point where you're having symptoms of depression, we're using two medications now in particular for women with menopausal symptoms.

Well, actually three Wellbutrin is one of them Trin telexes one and the third one's ability all three of these medications work differently than the traditional serotonin, norepinephrine and dopamine based antidepressant medications because Wellbutrin specifically does increase dopamine and norepinephrine in talks, increases serotonin transmission but also indirectly increases dopamine and glutamate whereas our abilities increasing glutamate transmission in such a way that it might they might be particularly helpful for women with menopausal symptoms with cognition itself.

What can you do?

The key will be try to keep using your brain socializr keep your brain active all the type of things we ask people as they get older as they're going into the years where they can be more prone to having dementia.

Keep your brain busy.

It's important to exercise your brain just like it's important exercise rest your body.

>> Thanks for your call.

Let's go our next caller.

Hello Greg.

Welcome to the Mind Greg.

You all know if you can send messages when you sleep to help with bad dreams, it's it's all controversial.

>> Greg, I've heard of some people saying that if you have good thoughts and you don't look at social media movies, the kind of things that can create a brain environment where you're more likely to have detrimental effects on the dreams.

So if you have bad dreams, the best thing to do is to think happy thoughts before you go to bed and think and look at movies or things on television, things on your computer or read things that are going to be more favorable to having good dreams.

But you can influence your dreams based on what you're reading, what you're watching before you go to bed to some degree.

So that's something that can be done.

A lot of cases I'd want to know if somebody is having disturbing dreams can be because you're still trying to work through some things from the day many people will have more vivid and more intense dreams when they're sleep deprived and it's a so-called sleep debt where they're just not getting enough sleep.

They go into more intense dreams at that time you have people with past trauma can have more intense dreams as well if you haven't worked those out.

Thanks for your call.

Let's go next caller.

Hello, Julissa.

Welcome matters of mind unless you want to know what does excessive screen time do to your brain?

>> Oh, I was just mentioning that it can influence your mood in many different ways.

>> They've looked at Wei especially with adolescents and young adults.

It might be affecting the way the brain is able to process information especially if it's passive screen time and you're not highly active.

>> It can affect the hippocampus your ability to store memories and we're particularly concerned about this marvelous tool called artificial intelligence and I say it's a marvelous tool because it can do some wonderful things in terms of researching background information for you.

But the problem is you're more likely to forget what that background information was because you didn't really look it up that much.

You just said you asked A.I.

to give it to you and there was so if you have to actually work to research information, you're more likely to remember it and be part of that same type of concept where if you're asked to talk about something that you've studied or researched, you're more likely to remember if you're asked to talk about it and teach it to other people so with screentime you can talk about the effect on cognition with memory and attention span.

>> But there's also an effect from a social perspective if you're mainly screen timing how you're interacting with them, you're losing a lot of social skills that you might acquire if you did so face to face.

Thanks for your call unforced.

I'm out of time for this evening if you have any questions or that I can answer on the air and you'd likely write to me by email you you may write me via the Internet at matters of the mind all one word at WFB Dog I'm psychiatrist Jeff Offer and you've been watching matters of mine on PBS Wayne now available on YouTube God willing and PBS willing.

>> I'll be back again next week.

Have a good evening.

>> Good night