.

The Honeywell Center presents Annie, November 2nd.

The inspiring story of an orphan who looks for the good in every situation.

Annie - a musical for the ages.

Ticket Information at HoneywellArts.org.

89.1 WBOI delivers the story behind the story.

Fact based local, state and national news for Northeast Indiana - on the radio, at WBOI.org, and on the mobile app.

It's WBOI for the How and the Why.

.

>> Good evening.

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

Welcome to Matters of the Mind now in its twenty sixth year, 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 here on the Fort Wayne area by dialing (969) 27 two zero or if you're calling long distance 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 by the shadows of the Purdue Fort Wayne campus and if you'd like to contact me with an email question that could answer on the air, you may write me via the Internet at matters of the mind all one word at WFYI Big that's matters of the mind at WSW after tonight's program with an email I recently received Judit Evolver Can Dehydration Cause Symptoms of depression?

I have an older relative who might not be getting appropriate nutrition.

You bet.

If somebody is dehydrated especially we see this in the summertime and they have potassium, potassium or sodium disturbances it can make people fatigued.

>> The Meydan give them day to day disturbances with with depression in the sense that they might have trouble with concentration that might be periodic and once they get their electrolyte disturbance address with some hydration that and often that will often improve.

>> So yes, dehydration can cause mood disturbances with some people.

So that's something we will examine.

We hear about this more commonly with people on water pills, diuretic medications whether using medication to blow off extra fluid as a means of decrease in any puffiness in the ankles, helping them with any heart conditions or decreasing their or decreasing their blood pressure.

>> Thanks for your email.

>> Let's go to next email.

Our next email reads Dear Doctor Father I have a nine year old daughter who has some special needs in the morning.

She is often well-behaved and cooperative and by afternoon she can be defiant and even lash out at others.

Can it be fatigue at the end of the day can a young person sunset the end of the day?

You know, I'm not a child psychiatrist.

I see particularly adolescents on but I can say with a nine year old child you can have these kind of disturbances somewhat in a pattern of a circadian rhythm where they get fatigued.

>> They are needing to be fed at certain times they get bored, they get restless, they need to sleep.

So in those cases you can see that kind of circadian rhythm happening with a younger child as well as with the older older child.

When we talk about sundowning or sun setting we often are referring to older adults who get more agitated if they already have some disturbances with their concentration and maybe they have dementia.

Older adults will have trouble with more irritability sometimes in the evening when the sun goes down they can get more confused during that time.

>> So we hear about that a lot with older adults, with younger kids it's a little bit different phenomenon.

>> Let's go to our first caller.

Hello Megan.

Welcome to Matters of Mind.

Megan, you want to know are there any medical tests to help determine the outcome of psychiatric medications?

>> When we determine how we're going to use psych psychiatric medication, the first thing we want to do is look at some of these overall symptoms and it's ideal to accumulate as much information as possible even before we see somebody.

>> So in the case of my practice, for instance, I'll use a lot of questionnaires.

I give a couple a couple of days worth of time periods for people to fill out questionnaires online.

So I want to know a lot of aspects about their past history and the current symptoms.

>> So the first thing we always have to determine is what are we treating?

So it's like any medical condition whether it's heartburn, if it's weakness you've got to determine what the actual diagnosis is and direct your treatment toward that particular condition itself.

>> So that's the first thing we'll often do.

Secondly, you need to system emphatically look at what kind of mediation treatments have been tried before Megan So if a person's been on six or eight medications previously for similar symptoms, we need to determine what worked, what didn't work and why and how they didn't work or did work.

>> So we want to look at that very thoroughly.

Also want to look at somebody overlapping medical conditions so people can have medical conditions that can affect how they're feeling.

A caller mentioned earlier the possibility of dehydration being a factor.

Yeah, that can be a factor itself.

So we want to look at medical conditions such as thyroid conditions and diabetes and so forth.

We also want to look at someone's family history of treatment responses.

So if you have a mother, father, brother or sister for instance who had depression and they responded poorly or well to certain medications, we want to know that.

>> So that'll be predictive on how a person might respond themselves to medications for similar symptoms.

We do genetic testing but it's not deterministic.

>> It's probabilistic but it's not deterministic.

What that means is you can't just do genetic testing on somebody and determine exactly precisely what medication they need just on the genetic testing you have to put all these other factors in mind so genetic testing will help us tip the scales on what medication we might use and whether we will go high or low on the dosing.

And it's something that gives us some extra clues on what medications we might use in the future.

>> I'm talking maybe 10 or 15 years from now there may come a time because the technology now exists where we scrapes themselves off of our skin or you take what's called stem cells from other parts of your body and you store those in a little petri dish.

>> It's well nourished and based on the kind of condition you might be experiencing the medications that are available can be tested on your stem cells in a little petri dish.

So if you have a serotonin disturbance, a dopamine disturbance, you can test medications on your cells in a petri dish.

In other words, you don't have to try them out yourself.

You can have the cells actually in a petri dish determine what's going to work for you or not.

We might be about 10 and 15 years away from that.

>> But I find it intriguing that the technology now exists for that possibility.

Megan, thanks for your call.

Let's go to our next caller.

Hello Cheryl.

Welcome to Matters of Mind.

Sherry, want to know my opinion on electroconvulsive treatment, electroconvulsive therapy or ECT has been available for over sixty years now and it was originally found that people who had epilepsy with depression if they had seizures there were not adequately controlled once they had a seizure they felt better later on it was found that if you can actually induce seizures by giving people insulin and throw them into insulin disturbances where they have glucose disturbances to the point where they have a seizure, they too would feel better.

>> So there is something about the electrical activity of the brain that mimics a seizure that can help people with depression.

>> And what happens in those cases, Cheryl, is the front part of the brain gets fired up.

You get an increased amount of brain derived neurotrophic factor that's released.

That's the brain's natural Miracle-Gro that makes all the neurons more fluffy.

You get an increased activity of what's called C for C. >> S C force increases in the front part of the brain when awakening, a more alert type of effect and it's considered CT considered one of the best biological treatments even to this day for depression you need to have the initial treatments typically Mundey and in Friday for anywhere between six and maybe 12 treatments for a lot of people and some people will get them on a maintenance basis on down the line you get general anesthesia during ECT you get ventilated because they give you a medication, shuts down your breathing during that time you get a muscle relaxant.

So when somebody has electroconvulsive therapy it's not like what you saw on television several decades ago when they depicted ECT as being almost torturous people who have now are under general anesthesia, their bodies very relaxed and the seizure itself goes on for anywhere between 30 and 120 seconds for people.

So it's something that activates the brain in such a way that a lot of the medications might do eventually.

But will do it very quickly.

So many people with can have very significant recovery very quickly.

It's not considered to be primitive even in 2023.

It's something that can still be done and is available typically in a lot of communities.

>> Cheryl, thanks for your call.

Let's go next caller.

Hello Glen.

Welcome to Mastermind Glen.

>> You notice faces in non-human objects is that normal?

Glen it's most commonly you're going to most commonly have visual illusions.

It's not a hallucination.

It's an illusion.

>> An illusion is where you see things in objects where they're not really the face of themselves but it's an illusio.

>> A hallucination is where you see a distinct image when >> But if you see a particular pattern or a shape and you see something in it that can be an illusion.

Now what might cause that, Glenn?

Some people will notice they have more illusions either visual or auditory.

Auditory illusions will be where they kind of hear things in background sounds and people will often hear hear those background sounds or they'll see those kind faces in and shapes that might mimic faces to some degree those are called illusions don't have those kind of experiences when they're fatigued.

>> So fatigue will cause you to have a lot of perceptual disturbances with fatigue if you're not getting enough sleep that'll be a key factor in your having difficulty with these visual illusions or auditory illusions.

>> They're not considered to be pathological unless you're an adolescent and you're having auditory illusions where youor- see things in different shapes and patterns, you hear things in background noises.

If you also as an adolescent have a lot of anxiety or socially withdrawing you're having difficulty concentration.

These are a cascade of symptoms that we call pre morbid psychotic symptoms that don't develop necessarily automatically into schizophrenia.

>> But it's something that we see with some people who will develop schizophrenia later on.

So if you have an adolescent who's having this cascade of a lot of different symptoms including visual illusions or auditory illusions, we will certainly take a look at that.

But even when people have these pre morbid symptoms of schizophrenia as adolescents about one three of them don't develop schizophrenia anyway.

But it's something we watch very carefully, especially with adolescents.

But for an adult, if you're seeing things in background type of images and you're seeing faces could be from fatigue.

>> No to occasionally they can be if you're under the influence of alcohol you're coming off alcohol.

Sure.

Anything that distorts the brain chemistry can be a factor.

I heard about it once in a while with depression not uncommonly with women who have postpartum depression, they will be able to see images in the background and sometimes even hear their baby cry when they're babies not crying so they can be a full blown hallucinations when you're hearing something or seeing something when nothing's there but illusions of where there is something in the background that's giving your brain a little bit of a stimulation.

>> Glen, thanks for your call.

Let's go next caller.

Hello Ted.

>> Welcome to Matters of Mind.

Ted, you want to know about how you can work toward unlearning a behavior that you know as a result of past trauma when people have past trauma?

Ted, it's important to try to deal with it not by repeating and experiencing the trauma again and again and again.

That's where we always have to be careful in talk therapy how much you lean on discussing the past trauma itself.

But there's different types of treatment if people have PTSD to try to unlearn the type of automatic behaviors that can come from that.

>> For instance, there's a particular treatment called MDR Eye Movement Desensitization MDR is basically where you're trying to train the frontal lobe to work more effectively.

The frontal lobe is the thinking part of your brain that's the part of the brain that you use to concentrate to pay attention to decrease your distractions and you're trying to get the frontal lobe to work more clearly again because with post-traumatic stress disorder where you've had a past event that's caused you to feel jumpy, you're more irritable, you're always on edge expecting something bad to happen.

>> You might even be reliving the kind of experiences again and again you might avoid situations that remind you of the experiences, especially smells.

People will notice that sights, sounds and smells will be will be triggers for they're having these recollections.

>> So you're trying to decrease the activity right down here in your amygdala, your amygdala is your anxiety, anger and fear center of the brain and then gets really fired up if you've had a past traumatic experience in the amygdala, if it gets excessively fired up will hijack the thinking part of the brain.

So your emotional part of your-l kind of determine what direction you go in different situations.

So in trying to unlearn those kind of behaviors, I think you're alluding to avoidance behaviors that's where you want to talk to a therapist about it and try to work through some of those kind of situations that are causing a lot of anxiety and some subsequently hijacking that part of the brain.

>> Thanks for your call.

Let's go our next caller.

>> Hello Jenny.

Welcome to Matters of Mind.

>> Hello Jenny.

You're on the air.

Hello.

Good evening.

Hi.

I'm calling to ask a question about a couple of my medications Cymbalta and Effexor.

I was on Cymbalta for several years and now I went to Effexor and I the Effexor isn't working very well.

I also take the Trudgen and Wellbutrin so I didn't know if Cymbalta might be a better medicine than Effexor or is I don't know.

>> That's what we always try to determine how the different medications have worked for you.

>> Effexor and Cymbalta are in the same class.

Cymbalta typically will increase serotonin to norepinephrine by a ratio of about eight to one Sobieraj ratio of five to one each one.

It is increasing serotonin to norepinephrine so both these medications will increase serotonin and norepinephrine in the brain.

>> Serotonin gives you more of a calming effect.

Norepinephrine helps more with energy, motivation, concentration.

>> Many times Effexor doesn't increase norepinephrine as much as Cymbalta.

However, the higher the doses go on Effexor or Venlafaxine the more of an effect you'll get on norepinephrine.

But with Effexor doses of seventy five two hundred fifty milligrams a day will give you an increase in serotonin and norepinephrine of thirty five to one so it's not as potent norepinephrine as is Cymbalta.

>> But you know norepinephrine enhancement is not right thing for everybdy will use genetic testing in those cases because there's a particular enzyme and we pick up on a gene called Kadokawa Methyl Transfer a C OMT and we can sometimes figure out who's going to do better on a norepinephrine medication or versus a dopamine medication.

>> Now Wellbutrin bupropion is indeed a medication and it enhances dopamine and to some degree norepinephrine.

>> So that's a whole different type of medication.

But then you have LaMotte's for gene that is basically a stabilizing chemical called glutamate.

Glutamate is an excitatory chemical in the brain and basically low motor gene will help stabilize a person's mood.

ut specifically we find that it helps people with stress, resilience that basically means it helps you put up with stuff better so stresses that that come will not be as overwhelming for you in those cases.

>> So for some people you're exactly right.

>> Some people will do better on Effexor primarily because they're doing better on a serotonin type of medication.

Other people will do better on Cymbalta because it will enhance norepinephrine more and we do indeed use Cymbalta with Wellbutrin even though there is some overlap there on the norepinephrine side, Wellbutrin will as I mentioned, increase dopamine and norepinephrine.

>> Cymbalta increases serotonin and norepinephrine so you get some overlap with the norepinehrine itself.

>> Now Cymbalta compared to Effexor Cymbalta typically is a little bit better for pain.

People will take Cymbalta do Fluoxetine for aches and pains.

It's approved by the by the Food and Drug Administration for fibromyalgia so Cymbalta can work better for pain than Effexor.

Effexor is specifically used for women for instance who are taking a medication called Tamoxifen Tamoxifen is used as a estrogen receptor blocker so it's used for cancer.

The reason Effexor is specifically used is because it does not interact with other it doesn't the effects will not interact with Tamoxifen.

Tamoxifen needs to break down to its acte biproduct to work to its acte biproduct.

It won't work and it won't block the estrogen receptors Effexor has no interference with the breakdown of tamoxifen whereas Cymbalta could so that's a reason why some people use Effexor versus Cymbalta.

So we look at the drug interaction aspect.

We look at the so-called pharmacodynamic aspect where we look at if somebody needs more of a serotonin effect, more of a norepinephrine effect and you look at other medications in which you're using so Effexor and and bupropion or Wellbutrin get along just fine as do the Cymbalta but they work a little bit differently for people.

So Jenny, what I would typically do is have you take a deep dove and take a look at how you've really done on Effexor although I don't know what kind of dosage you took people on effects typically take between seventy five milligrams up to two hundred twenty five milligrams.

Some people go higher than that just knowing the higher you go on Effexor the more that effect you get on norepinephrine.

Well now that we have Cymbalta we often don't need people to go higher and higher on Effexor.

The drawback of Effexor is that if you miss a dosage you feel terrible, you feel like your head spinning.

You feel zings and zaps in your head, your hands, your your feet so the higher the dosage on the Effexor you go you will have more difficulty with missing a dosage and when you come off of Effexor you have to come down very gradually over the course of not uncommonly three or four weeks with Cymbalta.

Yeah, you have to come off of that gradually as well but you come off of it a little bit more quickly and it doesn't give you quite as much withdrawal when you're coming off of it.

It doesn't mean you're addicted to Effexor or Cymbalta because you get these side effects and coming off of them.

It's just a discontinuation phenomenon where you get these things and zaps and it's lightheadedness.

So you're not physically dependent on the medication as much as it's merely the medication getting out of your system.

Effexor gets out of your system very, very fast and that's the reason why you'll have some discontinued phenomena withpEff0 percent bound to protein in your body.

So when it gets out of your system it gets out real fast.

Cymbalta on the other hand is about 90 percent down to protein in your body in the bloodstream.

So it hangs on a little bit longer and it gets out of your system a little bit more slowly.

But in your case I'd look at what medications work the best for you, how they worked.

>> How did you feel when you took Effexor a certain dosage, how you take how did you feel on Cymbalta at various doses and also importantly, do you have any other medical conditions like if you had chronic pain for instance?

I'd certainly want to I certainly favor Cymbalta for chronic pain and looking in any family members who might have taken medication for depression anxiety if you had family members do particularly well on Effexor Cymbalta that would also tip the scales as well.

But it sounds like you've already realized that Cymbalta is working better for you than Effexor.

>> So the combination of Cymbalta, Wellbutrin and Lamotrigine or Lamictal can be a really nice combination for a lot of people and is a safe combination to take long term.

>> Gennie, thanks for your call.

Let's go to our next email question.

Our next email question reads Dear Doctor Father I'm an older adult.

>> What are the main ways that I can prevent dementia?

What's the difference between dementia and Alzheimer's disease?

Alzheimer's disease basically is a form of dementia.

So it's like a brand name of a of a of a tissue.

So Alzheimer's is a type of dementia.

Dementia is basically a condition where you have gradual brain shrinkage or brain disturbances give you short term memory impairment, personality changes and difficulty with processing information.

So dementia is something that does typically emerge as we get older and there's different types and most people who have dementia symptoms have various types.

We will say they mainly have Alzheimer's dementia which is asically the side part of the brain where I put my hands will gradually shrink down with Alzheimer's.

Dementia is predictable as you get older there is a slight genetic component but like with all genetics the genetics are not deterministic.

>> It's not guaranteed you're going to get Alzheimer's dementia based on your having a certain genetic profile but with Alzheimer's dementia you can't have the word finding difficulties the geographical disturbance where you get lost but then you can have a condition called vascular dementia where people have tiny little strokes and tiny little strokes all over the brain as you can imagine can give you disturbances themselves.

And finally there's Lewy body disease.

Lewy body disease is where how these little gel like substances more than you would expect and it can be associated sometimes with Parkinson's disease.

So there's various types of dementia but most people with dementia symptoms will have a combination all of those different things.

What are you what can you do to prevent a number one?

Yeah, we all have genetics that will make us more prone to have various conditions.

>> You can't change genetics but what you can change is your lifestyle.

No one diet the Mediterranean diet basically with fruits, vegetables, lean meats, especially fish has been very helpful especially blueberries for some reason blueberries are very, very effective apparently in decreasing the likelihood of dementia.

>> So diet is one factor.

Socializing is a huge factor and we're talking about actually interacting with people having discussions.

It stimulates your brain when you interact with people.

We saw this with older adults during the covid pandemic restrictions.

>> It was devastating for a lot of older people because they couldn't socialize anymore and if you cannot socialize that has a huge impact on your overall mental health and specifically can help or can give you an increased likelihood for dementia.

>> So diet socializing the third thing would be exercising exercising we're talking about aerobic and anaerobic aerobic exercise is where you're where you're increasing your heart rate anything that increase your heart rate.

>> A brisk walk getting on an exercise machine, anything can be very helpful there and a little bit of resistance training, a little bit of weight training to build muscle can be helpful in decreasing the likelihood of dementia.

So diet, socialization, exercise and stimulating the brain stimulating the brain is very, very impactful in terms of decreasing the likelihood of dementia where you're learning something new you're interested in something you have a passion for something many times when people retire and they lose interest in things they will have trouble with finding pleasure and being really passionate about something.

So it's important that as we get older that we continue to try to learn things and be on top of of getting new ideas and discussing these type of things as a means of socializing as well.

>> So diet socialization, exercise and intellectual stimulation can all be very helpful in terms of decrease the likelihood of dementia for people as we get older.

>> But the biggest predictor of dementia is age.

So as you get older you can have those kind of symptoms of memory disturbances coming on so it's always important that we try to do the best we can to try to alleviate those alleviate those overall.

>> Thanks for your call.

Let's go our next caller.

Hello, pick one.

Welcome to Matters of Mind.

Yes, I have a question.

I know somebody that's got bipolar OK?

Yeah and she just person can't make it OK. She OK is a relative very close has where she gets nice one minute and Right.

Be the next and she only does it to me.

>> What can I do about it.

Pasquino The first question would be if she really had bipolar disorder if she's nice one moment and she has a perfectly fine mood one moment and then she gets angry and irritable that can be a reactive type of mood disturbance.

We sometimes will call it borderline personality disorder if it is a psychiatric condition, borderline personality disorder as we were, people will be reactive and irritable based on their situation and the people for whom they associate.

>> So that's a condition where people are moody based on situations around them overall.

>> So that would be one factor.

Bipolar disorder typically is bipolar disorder one, two or three to bipolar disorder.

>> Type one is where people will have at least one week of Skyhigh mania where they don't need to sleep.

They can be grandiose.

>> They're doing a lot of different things that they later regret and gets them in a lot of trouble.

People with bipolar disorder Type one are much more likely to get divorced and lose their jobs because of their poor experiences.

>> Bipolar disorder Type two is where people will have four to six days of little highs and other people will notice a change in their personality in that regard and irritability can be a factor with that.

>> But and then crash into deep lows in those cases, however, people will indeed have the mood disturbances that affect everybody around them and then there's bipolar disorder type three where people have little highs and the lows.

>> So the bottom line is if it's only affecting her personality around you, it might be something having to do with your interactions with sense it's affecting people on their jobs and with all interpersonal relationships and give me a call next week because unfortunately I'm out of time.

>> If you have any questions concerning mental health issues, you may write me via the Internet at matters of the mind all one word at WFA dot org.

I'm psychiatrist Fauver and you've been watching Matters of the Mind on PBS for Wayne God willing PBS willing.

I'll be back again next week.

Thanks for watching.

Goodnight The Honeywell Center presents Annie, November 2nd.

The inspiring story of an orphan who looks for the good in every situation.

Annie - a musical for the ages.

Ticket Information at HoneywellArts.org.

89.1 WBOI delivers the story behind the story.

Fact based local, state and national news for Northeast Indiana - on the radio, at WBOI.org, and on the mobile app.

It's WBOI for the How and the Why.