.

,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, you may give me a call in the Fort Wayne area by dialing (969) 27 two zero or four calling any place coast to coast you may dial toll free at 866- (969) 27 two zero 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 concerning mental health issues that I can answer on the air, you may write me a via the Internet at matters of the mind all one word MWF egg that's matters of the mind at WSW a dog.

>> I'll start tonight's program with an email question I recently received it reads Dirt under Fauver is breakfast really the most important meal of the day?

Isn't it important to get the body off to a good start in the morning with a nutritious mostly breakfast?

Well, I'm not a nutritionist.

>> I'm not an internist but I'm a psychiatrist.

And what I can tell you is that in my experience when people started doing intermittent fasting and they skipped breakfast and they went for six even 18 hours a day without significant caloric intake, they often would feel better many people have been taught, myself included over the course of my childhood and my early adult years that breakfast was the most most important meal of the day and I've heard some endocrinologist actually say well that was mainly determined by breakfast food companies who wanted to sell their products historically.

>> So as we look at it, you can kind of skip breakfast unless you have a glucose abnormality disturbance such as Type two diabetes where you're very sensitive to any caloric intake and you need to have a persistent level of of caloric intake in your system.

But for many of us if you skip breakfast you might feel better.

>> Now a lot of people will say well I'll starve by 10 a.m. or 11:00 AM if you wait and you get through that time period and maybe have some fluids or something to to offset that hunger pang at that time you might notice after an hour or two you might have felt like you had something to eat and when you really didn't there's this particular hormone called Gerlin and Gerlin.

I like the term girland because it makes you think of your stomach growling that's your hunger hormone ghrelin will go up as you get more hungry and then if you miss a meal it starts to come back down.

>> Well the second day you do the same thing if you miss breakfast it goes up but not as much.

The third day goes up even less so Gerlin which is a hormone secreted by the stomach that makes you hungry makes your stomach grow it goes down each day that you skip a particular meal now if you have an eating disorder obviously and as I mentioned, if you have metabolic disturbances like diabetes you have to maintain your regular eating schedule.

>> But I think there's a lot of question right now whether break fast which is where you are breaking your overnight fast breakfast breaking the fast is that important now you can wait till lunchtime and go a good solid 16 hours or so in between meals and that's why for years people have been told not to snack in the evening because when we snacked in the eating evening that would that would inadvertently increase insulin levels into the night and could disrupt the sleep.

And I'm often telling people as they're having sleep disturbances be careful about what you eat after about seven p.m. Now if you eat a very, very small amount especially protein right before bedtime, it's not too bad but a high carbohydrate meal, especially a spicy meal close to bedtime can often keep you awake with gastric reflux and sometimes it just disturbs the the sleep in general.

So breakfast something I think a lot of us can give up if you do have breakfast, make sure it's a high protein breakfst with the high protein such as eggs and meat and so forth because if you have breakfast chances are you might be able to skip lunch because it can probably get you through lunch if you have a high protein breakfast for a lot of people it's just a matter of what they can do for some people at their workplace they can't really eat lunch so they will eat breakfast.

Just make sure it's a good quality breakfast, having a lot of cereal in the morning.

>> Be careful with that because it'll cause your insulin level to go sky high then you might crash.

>> And I just find that from a mental health standpoint a lot of people don't do well with eating a high carbohydrate breakfast.

>> It sounds like a good idea but in the long run often doesn't work out for people.& Thanks for your email question.

>> Let's go to our first caller.

Hello Shaun.

Welcome to Matters of Mind.

John, you want to know about personality disorders?

Are they genetic personality disorders are disorders of the personality that are functionally impairing.

In other words, they cause you to have difficulty getting along with other people doing what you need to do, being able to work or to school and get stuff done.

So personality disorders are involved involve borderline personality disorder where people can have a lot of moodiness in relationship to interactions with others.

They can have a histrionic personality disorder where they're overly dramatic people can have narcissistic personality disorder where they only think about their own needs.

So these type of disorders have a genetic propensity but no more than maybe 30 percent.

>> And how would you know that?

Well, you have identical twins.

They're separated early at birth.

They're raised by different families in different environments and that's how you study it's kind of difficult to do.

>> But looking at that kind of study, most of the personality disorders that we hear about have some kind of environmental influence for instance with borderline personality disorder where people can have the moodiness, the rage, the abandonment depression where they feel very alone and rejected when other people leave them.

People with borderline personality disorder often have chronic guilt.

They have ongoing anxiety.

They have depression quite prevalently and they're very moody.

They have rollercoaster moods many times in relationship to what's happening around them.

>> So people with borderline personality disorder often have a parent or parents who either were emotionally detached from them or they had borderline personality disorder themselves .

They had difficulty with connectivity to other people and they have trouble with attachment as a child.

So borderline personality disorder being the most prominent personality disorder we hear about is primarily environmental but there's a small proportion of it that appears to have some genetic influence.

It has some genetic overlap with depression and with bipolar disorder which is a disorder where you have big mood swings, big highs going on for several days and then lows thereafter.

>> Sean, thanks for your call.

Let's go to next caller.

Hello Kate.

Welcome to the mind, Kate.

>> You want to know about melatonin and lavender?

You tried melatonin, lavender sprays, lavender spray smell really good but they might not work.

>> You tried it for your teen and your teen didn't sleep so well.

Is there anything else you could do?

Kate?

>> You might need to go to the next level.

Melatonin is like a puff of smoke.

Melatonin will work for about 30 minutes.

>> It tells the brain to go to sleep.

Melatonin is secreted from the pineal gland right smack in the middle of the brain is the front part of the brain here on the inside of the brain is this little pea shaped this little pea shaped gland called the pineal gland that secretes melatonin when it gets dark.

>> So when the light hits your retina the light goes the retina light gives a signal to the pineal gland.

It decreases melatonin.

>> When it gets dark it goes just the opposite might melatonin goes up and with melatonin maybe three milligrams.

Sometimes people will take more but often three milligrams at bedtime within 30 minutes or so of going to bed can help you get to sleep but if you still watch video games you're still on your if you're still on your smartphone is you still watching television?

>> It can sometimes keep you awake so you'll basically blow past that 30 minute to an hour time frame where the melatonin is trying to get you to sleep and then you stay awake for typically another hour and a half.

>> So the brain kind of goes in these hour and a half cycles where if you don't get back to sleep pretty soon when your brain wants to go to sleep you might stay up for another hour and a half until you can get to sleep.

So lavender sprays biggest issue those is if you inhale the spray excessively you can actually get a coating on the lungs and that's why vaping is so dangerous as well.

>> So might not be the best option for you .

>> There are over-the-counter options.

sleep medications merely have melatonin or an antihistamine like Dock's El-Amine.

>> A lot of the over-the-counter preparations with Doc El-Amine just have that antihistamine effect histamine raises in the brain all over the brain, especially the front part of the brain when you're wide awake.

So histamine helps you with wakefulness and keeps you alert anti histamine but like the name implies makes you sleepy, it blocks histamine.

>> So if you want to block histamine a especially for adolescents sometimes and an over-the-counter sleep medication can be safe effective in terms of blocking histamine even Benadryl diphenhydramine is the chemical name on that can be effective for adolescents in some cases but be aware that antihistamines can cause a little bit of morning sleepiness.

That's why we don't recommend it for adults on an ongoing basis for sleep because as we get older we're more prone to having more of that difficulty with memory disturbance and drowsiness even up to noon the next day might be a very subtle but people might not realize so adolescence can get by with antihistamines a little bit easier than adults.

>> And then of course if you go to a prescription medication through the primary care clinician or if you were to see a mental health clinician sometimes medications that will give you a little bit more punch for sleep and give you a little more sedation it can be helpful.

That would be low dose stocks open.

For instance, the trade name is Silin or three and six three and six milligram tablets.

>> It basically it's a stronger type of antihistamine that not only blocks the histamine receptors but it decreases histamine release.

>> So low dose occiput and can be very safe and effective for adolescents sometimes will use low dose gabapentin, low dose Trazodone.

>> These can all be other type of things can be done for an adolescent but those are prescription products.

Talk your primary care clinician and see what else can be done.

Sleep hygiene is enormous for adolescents.

>> Adolescents need to learn to try to get the bed at the same time every night try to get up the same time every morning.

It's very difficult to do as an adolescent you've got to put down the electronic type of tablets, the type of data that's coming into your head the early before going to bed.

>> If the screen is bright it'll keep you awake if you're still working on things and keeping your brain really busy late at night that can often keep you awake.

Adolescents will often worry about the next day so it's important they talk things out before they go to bed and not be worrying about those type of things as they go to bed.

So sleep hygiene is very, very important for an adolescent and that's where we'll often look even prior to a medication.

>> Thanks for your call.

Let's go our next caller.

Hello Phillip.

Welcome to Matters of Mind Phillip.

>> You don't know you want to had attention deficit hyperactivity disorder as an adult.

>> What are the symptoms when you have ADHD?

By definition it's their day by day by day giving you different degrees of severity on some days based on your obligations and expectations.

>> But with attention deficit hyperactivity disorder it's more prominent in children because the children especially boys will have more hyperactivity, impulsivity and they have a hard time sitting still girls as young girls will often have more difficulty with inattentiveness where there are quietly and passively inattentive but you might not notice it so much.

>> They're just not getting things done as you become an adult over 90 percent of the people it appears still will have some of those symptoms going into the adult years.

But as an adult you're not having to sit in a classroom eight hours a day and try to keep your mind on things as an adult you're often doing a little of this, little this and you're moving about so many people.

>> It's not that they grew out of their ADHD, it's just that they have a different environment.

>> So the ADHD is not so problematic for them with ADHD it's like your brain needing eyeglasses.

>> If you needed eyeglasses you had nearsightedness, you need eyeglasses.

You put the eyeglasses on you can see and you can focus with ADHD you it's like you can't focus pay attention anymore more distractible and if you get the proper medication treatment or the proper tools pwith coaching you can keep your mind on things for longer periods of time.

So it all comes down to expectations.

If you're in a work environment where you can have the residual ADHD symptoms that are there, it might not be problematic for you.

>> But if you do need to pay close attention, stay on task, don't procrastinate, get things done sometimes that's where treatment comes in.

So what are the symptoms of adult ed or off the bat inattentiveness, difficulty with procrastination, absent mindedness, having three things going on but not getting any of them done.

>> People with ADHD will often be listening to three and four different conversations at the same time and not comprehending any of them.

People with ADHD will not uncommonly finish the sentences of others because they're thinking ahead and they already know what you want to say so they want to just finish your sentence for you so they come across sometimes as tactless, they come across as impatient, sometimes as irritable and sometimes just somebody who doesn't really care about what anybody else thinks and some people will perceive them as having narcissism on that basis.

>> So with ADHD people can they're often smarter.

They often are the entrepreneurs.

They're the ones that have the ideas for getting things done but they don't have the ability to finish things.

>> They need people around them to actually get things done.

Thomas Edison being a great example.

Thomas Edison in the first grade was told by his first grade teacher he never amount to anything was sent home to be home schooled by his mother for the rest of his schooling.

And of course we all know Thomas Edison became a famous famous inventor.

But even as an inventor he got the inventions started but he had assistants around him to get them completed.

So he had the ideas and that's where a lot of people with ADHD will find that they'll have the ideas and they'll want to have do all these things.

They have the they have the intention to get things done and they might get things started but they don't have the perseverance to get them done.

And again, it's a brain disturbances disturbance where they left front part of the brain is a little bit underactive and that's the part of the brain that you focus on things that aren't highly interesting for you.

>> The middle part of the brain is somewhat disrupted as well.

The middle part of the brain is going to help you with focus and decrease the distractions and help with impulsivity that's disrupted as well.

>> So we look of ADHD as being a brain disturbance rather than a behavioral problems.

So for say it's a brain disturbance that can be corrected.

>> We use medications such as stimulant medications.

There are many nonsteroidal medications now becoming available but they all have in common the ability to increase dopamine and norepinephrine to some degree many people with ADHD will have a lot of anxiety and the way you can treat anxiety is to dampen down the anxiety with a little bit of a serotonin medication like Lexapro or Zoloft Prozac these are all serotonin medications.

>> They'll dampen down the anxiety and give you some symptomatic relief with the anxiety.

>> But many people with ADHD have anxiety because they're always behind they're always misplacing things.

>> They can't get things done efficiently and it creates a lot of worry and anxiety and they often stay up at night late into the evening worrying about different things or trying to catch up for what they didn't get done during the day.

If you give them a serotonin and antidepressant that can decrease anxiety on one hand it'll decrease anxiety, make you feel better but it won't help the underlying problem.

So at some point even though people have anxiety sometimes we have to enhance their norepinephrine dopamine to try to treat the core symptoms of ADHD.

>> So thanks for your call.

>> Let's go to our next email.

Our next email reads Dear Dr. Fauver, I got through a bad bout of depression about a year ago.

>> Everything's been great since but I never seem to get my appetite back.

Why should I?

>> I'm wondering when you got depressed if you might have had covid-19 virus the covid-19 virus for many people gave them a decreased appetite.

>> Now that's a possibility.

Sometimes it takes a year and a half, two years for that appetite to come back after having a covert infection.

>> So I'd wonder about that.

Secondarily, if you had a bad better depression I'd wonder why you were depressed if it went on for weeks or even months.

>> Did you have a decreased or increased appetite while you're depressed?

>> Many people, especially women will have a greater appetite when they're depressed and they overeat.

>> They come out of depression, they start to feel good and they lose their appetite starts to decrease was doing is kind of normalizing so that can be a factor.

>> Some people will have depression and it might kind of trigger type two diabetes Type two diabetes as a symptom.

>> I can give you a symptom of low appetite.

>> Check it out with your primary care clinician.

Low appetite can be from a medical condition not only from type two diabetes, maybe from hypothyroidism.

That can be a factor.

There can be other reasons why something can have a low appetite.

>> I'd want to know OK with a low appetite are you losing weight if you're losing substantial weight you're getting weaker and more tired.

I'd want to look for various medical reasons that could be a factor there but with a low appetite like I said, if those from covid or if as a rebound low appetite from having excessive appetite while you're depressed that can probably turn around over the course of time as a psychiatrist I'm really good at giving people medication that can increase their appetite.

>> There's so many medications out there that as a side effects will increase your appetite.

So that's pretty easy to do.

We're often trying to avoid that with medications but a lot of medications we use in our field will increase the appetite so you can get that back but tincture of time often will help but also looking for other underlying causes for that.

>> Thanks for email.

Let's go to our next caller.

Hello Jeff.

>> Welcome to Matters of Mind.

Jeff, you'd mentioned that you watch everything with subtitles so much that when you turn them off it's hard for you to focus on the movie.

Why is that?

There might be a couple of reasons.

Sometimes the actual volume control on the television the speakers are so good they can be kind of distorted for some people.

>> Many people will watch BBC British movies and you need the subtitles for those because you can't understand what the English or what the English are saying when they're speaking in English.

>> You know we like to speak and Hoosier and we have a little bit different dialect than that.

You need the subtitles for that once in a while not to make this a clinical issue but once in a while, Jeff, you'll hear about somebody needing the subtitles because it decreases the distraction.

If you're reading something often you're going to pay better attention to it.

Some people are not audio learners.

They can't learn by hearing things and those people will often need the subtitles because they can follow along by reading them themselves.

So sometimes it just comes down to how you're processing information.

You process the information when you see things back in the occipital lobes, when you hear things over here in the auditory cortex on the side part of the brain, some people just process information better and that's why not everybody learns the same.

>> Some people learn things very well by listening to lectures and audio books and things like that.

But other people just need to read and then you have some people were kinesthetic learners where they need to be moving around and doing things as they learn.

>> These are the people who will do really well as they're learning their spelling while shooting baskets on a basketball court for instance, as they're doing things as they're moving around, they're actually processing information better and there's actually a neurobiological reason for that if you're moving around it'll activate different parts of the brain and for some people that helps them learn.

>> Jeff, thanks for your call.

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

Our next e-mail reads Your daughter Fauver what's the most difficult symptom to treat with depression?

>> Hands down.

It's called anhedonia anhedonia and means no hedonism means fun.

>> So any do any means you're not taking pleasure in things you're not having fun anymore even when people are feeling better with their depression they will often have residual lingering difficulty with having fun and it's a vicious cycle because if you give up things while your depression it used to be when you're depressed they used to be fun for you and now you're not doing them anymore, you're more likely to stay depressed.

You can stay out of depression if you keep socializing you're doing things you enjoyed.

You're doing things it used to be fun for you.

>> If you keep doing those kind of things you're more likely to stay committed.

But even when people are doing well, a key residual symptom that'll still be lingering there for a lot of people is just not quite having fun and enjoyment in their day to day activities like they used to do and that key symptom will be a huge trigger for the possibility of another depression.

>> So if you have a lingering symptom of anhedonia or difficulty having fun, it's kind of like having a smoldering ember on a campfire that's smoldering ember it didn't go out a little puff of wind.

>> Next thing you know the fire gets going again.

That can happen if you have lingering anhedonia with recovery from depression, that lingering anhedonia, the difficulty having fun can be a factor for you.

So that's why as a psychiatrist I'm starting to do questionnaires for Anhedonia specifically there's a really nice questionnaire for any Dounia called the Shapps questionnaire and it's a 14 question questionnaire looking for things that you're enjoying and things you're not enjoying and trying to sort out.

>> Are you more likely to get depressed again based on you're still having trouble enjoying certain things?

I mean we're talking about simple things, simple things such as enjoying the sunset, enjoying a favorite television program of yours, being able to literally smell the flowers and enjoy the smell of the flowers, feeling good about how you might come across to other people and having maintaining that self esteem.

Those are all key symptoms of of pleasure that are often lost when people have residual depression that kind of lingers around in any donia is one of the more difficult things to treat with medication and with psychotherapy or talk therapy the medications that tend to do the best for treating anhedonia for depression will be Trin Telex as ketamine which is also known as bravado.

It's a nasal spray and we have a newer medication over the past year called Valide but those medications have the most steady in terms of helping with that symptom of not having fun anymore and they seem to do a nice job in bringing people around.

>> Thanks for your email.

Let's go to our next caller.

Hello Greg.

Welcome to Matters of Mind.

>> Greg, you'd mentioned that you had an experience in grad school and cause you have post-traumatic stress disorder, what steps can you take to get through that if you have lingering PTSD?

Greg, there's a couple treatments that are very good for one is called eye movement deep processing and eye movement processing and desensitization MDR and talking to a therapist about those type of things can help you out.

What I would not suggest if somebody had has PTSD, I would not suggest hypnosis, hypnosis can be very effective for a lot of conditions but hypnosis can actually make PTSD worse.

You have anxiety with PTSD.

I'd not recommend I would not recommend a benzodiazepine such as Xanax, Klonopin, Ativan, Valium.

Those medications give you brief symptomatic relief with PTSD.

But they appear to make the memories more intense and actually worsen them over the course of time.

>> So from a talk therapy standpoint, MDR has a lot of research behind him and then if you do use medication sometims serotonin medications such as Zoloft or even Lexapro can be helpful but then will also use these very specific medications that affect these norepinephrine receptors called prazosin also known as prazosin pronounced either way.

>> But that's a medication that can decrease flashbacks, irritability, nightmares and another medication called Gwon Forseen and its chemical cousin called Clonidine.

They affect Alpha two receptor in a whole different way.

>> So there's medications that we can use for PTSD depending on how problemas it is for you right now.

>> But you can always start with talking to your family doctor who can refer you to a therapist who has some experience of PTSD.

>> Greg, thanks for your call.

Let's go to our last caller.

Hello Margo.

Welcome to Matters of Mind Margo Margo, you had mentioned that you're afraid of confrontation.

>> How can you find your voice and stand up for yourself?

Margo I would think first and foremost that you need to expose yourself to situations where you can have some confrontation and initially simply respond in a fairly neutral manner by email or in some passive way like that.

But ideally it's always best to deal with conflicts on a face to face kind of basis where you can deal with the person individually.

Email is somewhat starer sterile in terms of how you're interacting with somebody and many people can read into messages in the email that you did not intend but at least it's a start in terms of simply stating the facts in terms of how you perceive something but the key with dealing with confrontation is to get practice doing it often say the same thing for people who have social anxiety.

Margo, if you have social anxiety, the best way to overcome it is to get yourself in a social situations.

If you have certain situations that arise as we all will or you need to you need to stand up for yourself, do it in a very subtle matter but the last thing you want to do is avoid those kind of situations similar social anxiety where people avoid social situations ,they get more socially anxious and they have more difficulty with that many people with confrontation.

>> They grew up in a home environment where there was not a lot of confronting.

>> So that can often be a factor as well.

Margot, Margot, thanks for your call.

Unfortunately 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 a via the Internet at matters of the mind at WSW Edgar I'm J.

>> J Forever and you've been watching Matters of the Mind on PBS for Wayne God willing and PBSC willing.

I'll be back again next week.

Thanks for watching tonight