.

good evening.

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

Welcome to Matters of the Mind now in its 25th 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 call me in the Fort Wayne area (969) 27 two zero or if you're calling from any place else coast to coast you may dial toll free at 866- (969) to seven to zero.

>> Now on a fairly regular basis we are broadcasting live every Monday night from our spectacular PBS Fort Wayne studios which lie in the shadows of the 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 Warg that's matters of the mind at WFYI Doug and I'll start tonight's program with a question I recently received.

>> It reads Dear to Devolve or is there a connection between covid and anxiety and insomnia?

I've been hearing about this quite a bit just over the past couple of weeks.

I'm seeing several people who acquired covid as recently as early twenty twenty two and even mid twenty twenty two and they endured covid reasonably well with the most recent variant but then they had this residual anxiety thereafter and it seems to be unlike the covid so-called long hallers from a year or even year and a half ago the people with most recent variants seem to have milder symptoms while they were experiencing covid but after they experienced covid they had more difficulty with panic attacks and unnatural anxiety and they struggled with difficulty eventually asleep and it's often a cascade.

You'll have difficulty with anxiety.

You have worry, you have panic .

Your heart beats beating real fast.

You have shakiness, you have hyperventilation that leads to worrying what's going on with your body and just worrying in general and worrying and rumination can often lead to difficulty with sleep when you have difficulty with sleep that's going to change your whole perspective on the world around you because sleep will tend to reboot and re energize this front part of the brain front part of the brain is the thinking part of the brain that's the part of the brain that allows you to look at the world around you and be able to understand what's reality and what's not and it allows you to think through your difficulty and logically process information.

>> That part is impaired if you have difficulty with sleep so you can imagine if you have difficulty with sleep you have poor logic that will cause you to ruminate even more and you get depressed and you have difficulty enjoying things.

You have trouble motivation.

You start to become more negative and you have low self-esteem and everything goes downhill from there.

So we often hear following the covert infection with some people that they'll have anxiety those first few months and then we want to try to get that settled down as soon as possible.

>> Now what used to be done for covid related anxiety because it's the treatment of choice from a conditional standpoint of a lot of different types of anxiety are the serotonin medications like Lexapro, Celexa, Zoloft?

What I'm finding just on my personal observation is that those medications aren't helping a lot of people.

They tend to if anything to make some people worse and their health will cause some manic like symptoms with some people who have never had manic like symptoms previously.

So if you give somebody a certain medication for anxiety related to a covered long haul or scenario, it sometimes makes the anxiety worse.

So I'm trying to get people off of those medications and putting them on specific anti seizure medications such as Lamotrigine or Lamictal and another one is Gabapentin.

>> Neurontin and Gabapentin or Neurontin basically will tend to stabilize to chemicals glutamate and gabber glutamate.

>> It's like a teeter totter.

Glutamate tends to go excessively high when people have anxiety and they are recovering from covid related symptoms and Gabb tends to go to low glutamate is excitatory GABA is like the brakes on the brain so one's an accelerator, one's the brakes.

>> If you have too much acceleration you have trouble with anxiety in some cases and what we're trying to do is get that teeter totter kind of stabilized out and that's what Gabapentin does really nicely now the serotonin medications basically they're increasing serotonin in the front part of the brain in hopes that they will indirectly decrease the Gabba transmission down here in the temporal lobe or increase GABA transmission the temporal lobe and that's kind of an indirect way of treating that particular problem following Gabber related infections.

>> What we're trying to do is get the Gabba back in in control by increasing it by giving medications such as Lamotrigine and Gabapentin to stabilize it out and decrease anxiety that way.

So rather than giving somebody a medication increase of serotonin for the effects of covid related anxiety, we often want to give these anti seizure medications and it reminds me a lot of how we'll treat a traumatic brain injury if somebody has a concussion or they've had a stroke and they've have difficulty with anxiety or personality changes following that phenomenon, often the traditional medications for anxiety or depression won't help them so much will help them will be the anti epileptic or the seizure medications because it tends to give them a whole different mechanism of action in stabilizing the brain chemistry .

>> Thanks for your email.

Let's go to our first caller.

Hello Barry.

Welcome to Mars The Mind Aubury you had mentioned your neighbor has some mental health problems.

How do you help an acquaintance with mental health issues basically bury the first thing you need to do is develop some trust with your neighbor, get to know your neighbor and try to understand well what's important to your neighbor and how your neighbor has been doing and from that trust you can kind of talk about some personal issues where you exchange information.

So on one hand if your neighbor has some mental health problems, it's difficult to go over there and just start pointing out the mental health problems he or she might be experiencing.

It's important for you to develop some trust, get to know your neighbor first and then start talking about different things going on and as you develop trust in a relationship, that's where you can exchange some information.

You can talk about perhaps some struggles you've experienced in the past and maybe share some of those with your neighbor and your neighbor neighbor could acquiesce and share some of the difficulties back and we often will encourage people to see their primary care clinicians sooner rather than later when they're having mental health problems simply to rule out and try to determine if there's any medical issues going on.

Many people with mental health problems will have something along the lines of we're hearing now with the covid related infections causing anxiety, many people with mental health problems will have a long standing difficulty with attention deficit disorder.

They didn't realize not really not knowing that it was treatable.

Many people with mental health problems will have fatigue and poor concentration we now understand will be related to sleep apnea.

So there's a lot of medical kind of conditions that can lead to mental health problems and many people are more receptive to those kind of medical conditions and getting treated for those.

We have so many different treatments now for mental health problems that just weren't available ten years ago I talked to a young man this morning who was apprehensive about taking any medication because he remembered that when he took a medication or two ten years ago it gave him all these side effects.

Well, we have a lot different more more mechanisms of action now we have different medications now than we did ten years ago and there's a lot of different options and opportunities and for some of the younger people, the young adults, they're getting excited about the possibility of recreational marijuana becoming legalized in their states because they think marijuana is going to be the answer for them.

But if you're under 24 years of age, marijuana has been well established to slow down the white matter in the brain white matter development as if you're under 24 years of age your brain is still growing and the white matter is the natural insulation on your brain slows down the growth of the national and natural inflammation or insulation.

>> So when you have difficulty with ongoing use of marijuana you're using it to relieve anxiety or really using it to help with sleep and you're really having difficulty stopping the marijuana and using it on a day to day basis.

It's slowing down the brain development especially when you're under twenty four years of age.

So it's not a good long term used to treat anxiety and depression.

We have a lot of other options at this point so I would recommend simply getting to know your neighbor right off the bat and developing some trust.

Let's go our next caller.

Hello Walter.

Welcome to Matters of Mind.

>> Walter, you want to know if I have any recommendations for a mental health self-help books?

I couldn't really endorse one or two , Walter.

>> There's so many different types depending on the problems.

So for instance, there's different types of mental health books for attention deficit disorder, for depression, for bipolar disorder, for family members dealing with loved with schizophrenia.

And I would recommend that you have a particular type of topic in mind in seeking those type of self-help books.

Quite frankly, the best self-help books I've seen that reach a wide range of topics will be the self-help books that are published by National Alliance on Mental Illness NAMI NAMI is a family support organization Action where family members with loved ones with mental health issues will align and he's done a nice job in helping educating families and individuals with mental health disturbances on different psychiatric conditions.

>> So it's like with any medical condition, Walter, you could you get a self-help book on asthma, on diabetes, on emphysema, on kidney problems?

>> Yeah, you could.

But first and foremost you want to know what the problem is to begin your journey and looking for ways to improve those kind of conditions and that's what the self-help books will we'll start for a lot of people.

So lots of different ideas out there concerning how you could improve your overall health and wellness.

>> We often recommend to many, many people they try to maintain social connections with people.

That's one of the best ways of maintaining your overall mental health .

Secondly, exercising having some kind of physical activity on a day to day basis not only helps your physical physical health but also helps your mental health keeping yourself intellectually stimulated, learning new things, trying to be aware of how much time you're wasting, looking at computer games or things that just are not exercising your mind adequately.

We often used to warn people about how long they watch television but now it's not so much they are watching television they're watching they're actually actually engaged in computer games and that can be activated to the brain to a degree but eventually it kind of numbs you out.

Now many people will zone out in watching television or they'll watch the same kind of reruns they've seen before and they do that to relax and that's understandable.

But to do that on a day to day basis, hour after hour after hour can be problematic for some people because they're just not engaging their brains, they're not exercising their brains and we need to exercise our brains just like we need to exercise the rest of our bodies.

>> Many people will wonder at what point should you seek psychiatric treatment or actual medical treatment for psychiatric decisions as a means of trying to get some help and that line is always crossed when you get to the point where you can't sleep, you can't concentrate, you can't do the things day to day that you'd ordinarily want to do.

So when you get to the point where because of depression, because of anxiety, because of difficulty with concentration, if you get to that point where you just can't function and you can't do the things you need to do, that's where you can seek out mental health treatment either from a counseling standpoint or from a digital treatment itself.

But a lot of people will have trouble with depression anxiety.

They get disappointed.

They will have trouble with not caring about certain situations.

But it's not problematic to the degree that they need to seek help.

It's just a normal day to day experience and if it's one day here, one day there and it's not a problem, it's not getting you behind in your work obligations.

It's not affecting you socially, it's not affecting your marriage.

Great.

I mean that's it's not so much of a difficulty but it affects their day by day more days than not rule of thumb is generally two weeks at a time is problematic for a lot of people.

But if it's there more days than not, that's where you want to seek mental health treatment overall.

Thanks for your thanks for your call.

Let's go to our next e-mail.

Our next e-mail reads Dear Doctor Fauver, I have recently come to realize that better physical health seems to have a positive effect on my mental health .

>> I'd really like to lose weight and quit smoking should I prioritize one over the other or try to both lose weight and quit smoking they will go hand in hand.

>> Interesting enough when you're starting to quit smoking you'll notice that initially you're going to be coughing up a lot of phlegm.

>> You're going to be coughing a lot and you'll notice that you're really short of breath and it's an interesting phenomenon if you start exercising and quit smoking at the same time you'll notice you're really short of breath and you'll really struggle but you're going to cough up a lot of stuff and you'll you'll have all this congestion.

>> You'll kind of wonder if you're feeling worse because you might even have some shortness of breath because you're coughing up excessive phlegm that's related to the cigaret smoke because cigaret smoke itself will kind of paralyze these little silly eye that are are fanning your phlegm up and when the little cilia are paralyzed they don't move the phlegm so much and when you quit smoking they start working again.

>> So the phlegm starts coming up easier and if you exercise on top of that you really notice it.

So if you start exercising yeah, I think it's probably not a bad idea for you to try to quit smoking at the same time I'm always one to try to knock it out of the park and take care of as many symptoms as soon as possible as early as possible.

>> But you might need to use a nicotine replacement like nicotine gum, nicotine patches ,something to help you get off the nicotine or at least taper off of it.

Nicotine as you're likely aware is highly addictive.

So if you stop it cold turkey, it's not life endangering.

It's just that it makes you feel miserable and you have a lot of nervousness and tension and sometimes difficulty with sleep because you're getting off of the nicotine itself.

>> So you might need some nicotine replacement.

You could always see your primary care clinician for the purpose of getting some ideas because they're always very receptive to anybody coming into their office saying they want to quit smoking and try to give you some ideas on that.

>> But if you exercise you can actually in some ways motivate you to quit smoking because when you're exercising that shortness of breath will motivate you to want to get off the cigarets because the cigarets will be hindering you from being able to breathe not uncommonly.

>> Thanks for your call.

Let's go to our next caller.

Hello Ken.

Walk into Mary's mind, can you I know is dementia hereditary there are types of dementia that are hereditary.

>> For instance, Alzheimer's dementia has a genetic component to it and apolipoprotein E gene is a predictor for Alzheimer's if you have a particular configuration of apolipoprotein genes and in your brain and that's the hereditary component but there are a lot of other factors involving the genetics of Alzheimer's with Alzheimer's dementia you can you're more likely to develop at the older you get.

>> So if you get to be 90 years of age for instance, one out of three of us will have Alzheimer's dementia if you get to be one hundred a hundred years of age, one out of two of us will have Alzheimer's dementia.

So the older we get the more like they're going to get Alzheimer's dementia.

That's the biggest risk factor having a head injury as a risk factor for Alzheimer's dementia, hypertension, diabetes, high risk factors, lack of exercise, lack of socialization will be risk factors and this is always the danger with people retiring typically in their late 60s or 70s.

>> They're doing less and less and when people retire they quit using their brain as much and that's a risk factor for Alzheimer's disease.

We need to keep using our brains even when we we retire and we need to keep socializing because lack of of brain exercise and lack of socialization are too real big reasons for people developing difficulty with with Alzheimer's dementia.

So we want to try to address the kind of things that can be preventable.

There's a lot of other speculations concerning ways to prevent Alzheimer's dementia for instance, the dietary regimen that people might recommend will be a high omega three omega three fatty acid type of regimen that can potentially decrease the inflammatory effects on the brain.

Small amounts of lithium or était have been speculated 120 milligrams a day of lithium irritate at bedtime not lithium carbonate which we use for bipolar disorder but lithium irritate a very, very tiny amounts has been speculated to perhaps lengthen the telomere lengths on our chromosomes.

>> Our our chromosomes have these little caps on them and they're called telomeres as the caps get shorter and shorter and shorter.

That's how we age.

So if you can keep the caps more prolonged, it's thought that that can be an anti aging and potentially an anti Alzheimer's dementia type of preventative.

>> It's only speculative but it's looking pretty good from a research standpoint over the past twenty years.

>> So it's been identified that people with bipolar disorder who are treated specifically with lithium have longer telomeres compared to people with bipolar disorder who are not treated with lithium.

So lithium seems to be a means by which we can have this anti aging component at a very, very, very small dosage.

So there's all sorts of different foods and supplements that have been speculated upon that can decrease the risk of Alzheimer's disease but we can't change our genetics so that's why there is some apprehension sometimes for doctors sharing the genetics or even recommending genetics looking at Alzheimer's dementia because yeah, you might be a high risk Alzheimer's dementia if you change your behavior behavior based on that and you're you're more careful perhaps to wear a helmet when you're involved in bicycling and doing activities where you could potentially have a head injury.

Sure.

That's all the more reason to maybe check to see see if you are a genetic risk for Alzheimer's dementia.

But remember the genetics are a risk for Alzheimer's dementia but they're not the risk.

A lot of other risks out there as I mentioned, diabetes, hypertension, obesity, waist circumference increases the more we have on our more fat we have on our bellies, the more likely we're going to have Alzheimer's dementia because increasing central obesity is an inflammatory condition.

>> So inflammatory conditions increase the likelihood of having amyloid protein and tau proteins in your brain.

>> These are the type of that's the type of gunk in your brain that occurs when people get Alzheimer's dementia.

>> So when you have Alzheimer's dementia basically the side part of your brain, the sides over here are the part of the brain that kind of shrivel up and they shrivel up with these elements like amyloid proteins and tau amyloid plaques and and tau proteins and that's what's causing the difficulty with short term memory.

You'll notice that you have trouble with Alzheimer's dementia if you're noticing difficulty with struggling to get the right words out.

>> Remembering names is something that's not uncommon but really trying to identify words and trying to say the right things in the proper context will often be an early sign and people with Alzheimer's dementia we have to remember I have difficulty remembering what they did just a few hours ago but they don't they don't forget what they did a week ago or two weeks ago or even five years ago.

>> So short term memory is often the most difficult problem people will have with Alzheimer's dementia.

>> Thanks for your thanks for your call.

Let's go our next caller hello can walk matters of the mind well can you want to know what you can do to prevent memory loss?

>> The best thing you can do can as I mentioned before exercising, socializing, exercising your brain, trying to do things that you don't usually do from an intellectual standpoint, learning new things.

>> So it's important to try to read information, try to read new type of books and try to learn things and stay up with with the news, stay active with local social organizations.

Those are some of the best things you can do now people often ask me what kind of supplements I would recommend.

I'm very apprehensive about recommending specific supplements simply because a lot of them have not been adequately studied.

If you look at the fine print on the television commercials for a lot of these supplements that are being advertised, they'll often advocate their supplement.

But in the fine print it says they were clinically studied now clinically studied didn't mean they clinically worked.

>> Just because you've been clinically studied in a certain population for memory disturbance does not mean it is clinically effective.

So there's a little bit of a linguistic semantic type of differentiation you have to consider when you look at the fine print on those commercials .

But right now there aren't any particular supplements that I'd specifically recommend for the prevention of Alzheimer's disease.

Omega three fatty acids have been discussed.

I mentioned lithium but right now it's not the type of recommendation I recommendation I'd make on one person or another.

>> Thanks.

You're going to thanks for your call.

Ask our next caller.

Hello Maia.

Welcome to Matters of Mind.

Hi Dr. Farber.

I have a sister that has been struggling with anxiety and some possible depression.

She's kind of explained her symptoms to me and she has been to a doctor and has been prescribed Xanax but she said it's not really helping and it sounds sort of like the normal anxiety.

But she also mentioned that she just gets into these moods where she overreacts and she understands in the moment that she's overreacting to something that is not a big deal and she understands logically it's not a big deal that she gets so emotional about it and she gets frustrated then knowing that she can't stop herself from getting emotional.

So with the Xanax she is going to sort of see what other options there are.

Are there any prescription options other than Xanax or even non-prescription options that you would recommend for someone like this?

>> Yeah, Amaia, the first thing I want to understand was what the progression of the anxiety has been, how it started, what what was its course.

I'm going to treat anxiety entirely differently if somebody tells me they experienced a covert infection six months ago and they've been feeling anxious ever since because that's a type of anxiety that we're finding that the antiepileptic of the anti seizure medications are best treating with Xanax or alprazolam.

It's in the benzodiazepine class of medications, same class of medications as you'll have with Ativan, Valium, Klonopin, seracs.

These are medications that are benzodiazepines.

They work specifically on the anxiety part of the brain right here.

It's called the amygdala.

They turn down the anxiety volume control very quickly by increasing Gabber and it's not something I'd recommend for more than a couple weeks.

We recommend Xanax for very short term use for a lot of people.

So from a medicinal standpoint, a lot of options out there based on the source of anxiety we want to sort out is the anxiety related to panic disorder where there's blash of anxiety causing her to stay inside more for that kind of anxiety we might recommend a so-called beta blocker like Metoprolol Propranolol.

These are medications that slow down the heartbeat but they also will physiologically block adrenaline and the rest of the body so beta blockers can be help if helpful in that regard we might recommend as I mentioned before, Gabapentin Neurontin, which is a medication that balances the teeter totter effect of Gabb which is the brakes and glutamate which is the accelerator.

If you balance that out you're more likely to get a nice relief with anxiety and that can be used long term as long as you're not using a narcotic medication once in a while people will have ruminative anxiety where they're having difficulty putting up with stuff and they have stress and they're overreacting and we call it difficulty with stress resilience for those people a medication like Lamictal or Lamotrigine is often helpful because it's affecting Agaba.

It's affecting glutamate, it's affecting sodium and calcium channel.

>> So it's affecting a lot of different chemicals as well once in a while if people have ongoing worry and they ruminate about different things.

But Spyro Antabuse can be effective because that's affecting one of the one of the 14 different serotonin receptors and those are just the medicinal options.

Talk therapy or counseling can often help somebody take a look at their perspective on anxiety, give them redirection and give them more an objective perspective on how they can look at the world around them and try to help the anxiety in that way.

>> Maia, thanks for your call.

>> Unfortunate amount of time for this evening.

If you have any questions that I can answer on the air, you may write me a via the Internet at matters of the mind all one word at WFYI dot org.

I'm psychiatrist Jay Fawver and you've been watching Matters of the Mind on PBS Fort Wayne.

God William PBS willing I'll be back again next week.

Thanks for watching.

>> Good night