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

Welcome to Matters of the Mind.

Now in his twenty sixth year Matters of the Mind is a live call in program where you have the chance to choose the topic for discussion.

So if you have any questions concerning mental health issues, give me a call here in the Fort Wayne area by dialing (969) 27 two zero or if you're calling any place coast to coast you may dial toll free at 866- (969) 27 two zero nine a fairly regular basis.

>> We are broadcasting live every Monday night from our spectacular Fort Wayne studios which lie in the shadows of the Purdue Fort Wayne campus.

And if you'd like to contact 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 WFA Weygand I'll start tonight's program with a question I recently received.

>> It reads Dear Daughter Father how can I keep divorce and shared custody from affecting the mental health of my children?

>> Sounds like you already are recognizing the potential issue that can occur there if you're having shared custody with children and you're bickering among each other as husband and wife, former husband and wife, mother and father, you will have an effect on the children because the children will notice that you're bickering and that'll be the biggest impact.

So the best thing you can do is maintain a healthy relationship between each other.

So you know, keep an eye on the children, make sure that they're having adequate time with each of you and it's certainly going to be quality time that you want to have.

But the main thing is to maintain your relationship with your spouse.

>> So that's healthy interaction in front of the children because the children will be watching that.

Thanks for your email.

>> Let's go to our first caller.

Hello Jeff.

Welcome to Matters of Mind.

>> Jeff, you know what you can do about being so difficult for me to be in crowds?

>> What steps can you take to feel less isolated?

>> The first thing you want to do if you're feeling stressed out and anxious about being around crowds is to try to expose yourself to small groups of people periodically for brief periods of time.

>> It's like dealing with any phobia.

It's actually called social phobia.

It used to be called social phobia.

Now it's called social anxiety disorder but it's where you have difficulty being around crowds of people and some people will notice that they just feel overwhelmed and they get the experience panic attacks.

>> We always want to know what the source of that anxiety might be because for some people, for instance, if they have attention deficit hyperactivity disorder with ADHD they'll hear all the conversations at one time and untreated ADHD will cause you to feel extremely anxious in crowds of people because it's it's like you're hearing all these voices all at the same time and you can't discern one conversation versus another.

>> So with untreated ADHD, unfortunately many people when they go into social gatherings they will they will gravitate toward the alcohol and they'll have a few drinks to calm their nerves as a means of relieving the anxiety.

>> So untreated ADHD will be a factor there if somebody has low self-esteem and that somebody well feels like when they go in the crowd everybody's watching them feeling it poorly about as poorly about them as they feel about themselves.

They will have difficulty getting into crowds.

>> We want to know the reason why people are having difficulty with social anxiety but as with any phobia you want to have brief time, limited exposure to the actual source, the fear and that can be just getting around crowds every now and then small groups of people you can go into a shopping mall perhaps and just go there for a little while and the idea will be to desensitize you from having those kind of fears because in the brain on the left side of the brain especially more so than the right side you have this anxiety fear center here called the amygdala excuse me the amygdala being right here that's the fear center, the anxiety center, the guilt center, the rage center that controls a lot of the emotions and that's right beside the memory center of the brain.

And you might have memories of being around a lot of people where you feel ridiculed.

>> You have a hard time discerning what the conversations might be and that causes anxiety when you have anxiety it can hijack the logical part of the brain, the front part of the brain.

So the front part of the brain is the logical part of the brain.

That's the decision making part of the brain and you want that part of the brain to work and allow you to make good decisions.

>> Well, if your front part of the brain is hijacked by your emotions it's called bottom up type of responses bottom referring to the amygdala having an effect on the upside of the brain the logical part of the brain that will cause you to not act logically and not think through your different decisions.

And in that case people will often act instinctually and they'll act based on their emotions and you typically don't want to allow your emotions to get in the midst of and really direct your decision making.

You want your decision making to be based on the front part of the brain where you can look at past circumstances.

You can look at your past ability to cope with different changes.

You can decide is this a good idea?

Is this a bad idea?

That's all the front part of the brain doing that now the front part the brain continues to grow until you're about twenty five years of age.

>> So as this part of the brain grows, you can we call it maturity but that's actually from a neurobiological standpoint your front part of your brain growing to allow you to have better decision making.

>> So the first thing the first part of the brain to fully develop is the fun center of the brain.

>> The nucleus accumbens is right down here in the middle part of the brain by twelve years of age you know how to have fun.

>> You are enjoying life and you're having fun in all different ways.

Unfortunately it takes thirteen more years for the maturity and the decision making part of the brain fully developed.

So that's why it's very important that we keep an eye on adolescents and young adults as they're maturing because we want to make sure they're not making decisions that can have lifelong consequences as an adolescent or a young adult and that includes the use of marijuana.

I know I've mentioned that several times but if people use marijuana before the age of twenty four twenty four twenty five years of age they're very prone to having suppression of the growth of the brain, particularly the decision making part of the brain and they can actually lower IQ points by using marijuana before especially the age of twenty four twenty five years of age.

So that's why it's so dangerous for our youth to be recreationally using marijuana because even though decreases their anxiety it will help their anxiety for a while.

But the bottom line is when they go off marijuana in their 30s or 40s they'll have that maturity that that really never emerged and really never developed or blossomed.

So they often have the maturity of an adolescent when they finally try to go off marijuana in their thirties and forties.

So it's important for adolescents to experience anxiety.

>> It's important for adolescents to go through the awkward teenage years and by going through the awkward teenage years you learn coping strategies.

>> You you learn how to get through things and that includes interacting with people.

>> I'll often hear Jeff about people having trouble with social anxiety because they started using they started using marijuana at a young age and marijuana was the only thing that allowed them to cope with social environments and anxiety and they used it as a means of self treatment.

Well, here they are now in their twenties, their thirties, even in their 40s and they're still having a lot of anxiety.

So it appears that marijuana will tend to promote that kind of anxiety ongoing and it's difficult to get rid of that.

>> Jeff, thanks for your call.

Let's go to our next caller.

>> It's Walter.

Hello, Walter.

Welcome to Matters of the Mind.

Good afternoon.

Good evening.

I as long as a possible to be diagnosed with anxiety but actually have an inner ear problem having that balance problems and I just wondered.

>> Yeah, Walter, there's something called Moneris Syndrome where people will have ringing in the ears dizziness and spinning we call vertigo and they also have nausea and that's called Moneer Syndrome with Monir syndrome it creates a lot of anxiety.

>> I'll see patients occasionally who have tinnitus nd the first thing I often want to do is rhythm of any medication.

It might be contributing to tinnitus tinnitus being ringing in the ears that could be caused by an antidepressant medication not very commonly but it can cause it in the name of with the name of Wellbutrin or bupropion Wellbutrin which has been around since nineteen eighty nine but is an odd side effect and about one to twenty people it can give you ringing in the ears ringing the ears for some people will cause some anxiety as you can imagine Walter dizziness spinning vertigo will give you anxiety and even nausea can give you anxiety and if that's something that you've noticed as a cascade and as a as a as I continuum of symptoms sure that could cause you anxiety and that could be a reason to get that worked up inner ear problems typically can be treated either by addressing the drug problem if there's a cyst in the inner ear ,perhaps the ear, nose and throat doctors can address that but sometimes they'll use a medication called necklacing also known as anti avert.

The brand name is Anna Mechanizing as an antihistamine that has special features in the sense that it appears to be able to dry up excessive fluid on the inner ear.

So you'll often see mechanizing used in those types of different situations.

But what we don't want to do necessarily is give somebody a medication merely for anxiety if there's an underlying problem of an inner ear disturbance that needs to be addressed.

Walter, thanks for your call.

>> Let's go to our next caller.

Our next caller is Claire.

Hello, Claire.

Welcome matters of mind, Claire, you want to know if your reoccurring nightmares are a sign of stress if you have recurring nightmare is the first thing I always want to know is when do they start and what might have been associated with them.

People can have recurring nightmares for instance, if they take certain cardiovascular medications like beta blockers, if you take a beta blocker, Inderal propranolol being a very common one for instance, metoprolol being another and also known as Prall.

>> These are medications that will block norepinephrine.

All right.

And if you block norepinephrine and you suppress norepinephrine excessively in the left front part of the brain during the night time, you can have nightmares normally at nighttime are thinking part of the brain right here it's called the dorsolateral prefrontal cortex.

>> This the part of the brain that used to think the focus to concentrate pay attention that part of the brain shuts down at night and it shuts down by having exceptionally low norepinephrine transmission.

But if you do so excessively and have exceedingly low norepinephrine transmission in the brain, you can have nightmares and people will have nightmares related to blocking norepinephrine that we can see with beta blockers like propranolol or Inderal so often going to look at any medication somebody might have if they're having ongoing nightmares.

>> Stress can give you nightmares especially if it's a type of stress is associated with post to a post traumatic stress disorder.

PTSD is a condition where somebody has experienced a traumatic event and because of that traumatic event they have a disturbance of norepinephrine in their brains and they will have difficulty with nightmares, flashbacks sometimes feeling like they're experiencing the traumatic event all over again .

They'll be jumpy.

We call it hyper vigilant but they're always on guard and they're always expecting something bad to happen.

>> They will avoid situations that remind them of the past traumatic episodes and sometimes they will just have a smell and they'll hear something or see something that will trigger the memories of the past traumatic events.

So when people have post-traumatic stress nightmares can be a factor associated with that day to day stress.

While I often hear about with that will be people having difficulty with sleep because if it's day to day stress which by definition means it's a change in your life circumstances but when people talk about clinically significant stress they're talking about stress that's overwhelming for them and it exceeds their ability to cope with the stress.

>> We call it disturbances with stress resilience and in that kind of situation you'll often have difficulty with getting to sleep and staying asleep because you're worrying about things and you're still processing things in the darkness of the night.

So with those kind of situations will often hear about people having sleep deprivation, sleep deprivation sometimes will give you a rebound on more intense dreaming and more intense dreaming can sometimes be associated with what's perceived to be as nightmares.

But you can also have a deeper degree of sleep.

But sometimes if you're not getting enough sleep and you're not getting quality sleep, you'll have a rebound and have exceeding exceedingly more dreams in general and that will give people a lot of disturbances with their thinking ability the next day and their ability to focus on things.

So with nightmares will sometimes hear about people having difficulty with their ah medical treatments for them.

But the first you want to do with nightmares is try to get adequate sleep hygiene, try to get to bed the same time every night, try to get the same time the next day, try not to drink any alcohol at nighttime or at least after five p.m. because alcohol even though it knocks people out they can get them to sleep.

People who drink alcohol will have a rebound in the insomnia and sometimes they can come back as nightmares and the night.

>> Thanks for your call.

Let's go our next caller.

Hello Milton walk nomadism mind Milton.

>> You want to know do you need to have an issue to see a psychiatrist or do you recommend a visit with a psychiatrist as part of a yearly wellness check?

Milton, I would say, you know, you could see a psychiatrist if there were plenty of psychiatrists.

>> Psychiatrists are medical physicians who specialize in neurobiology.

They have board certification in psychiatry and neurology and psychiatry will be difficult to find just to see on a routine visit unlike many other specialists, some specialists aren't that available as well.

So whether it be a cardiologist or a gastrointestinal doctor, you need to have some reason to be able to see them and a psychiatrist wouldn't be that much different in that regard.

So it might be difficult to obtain a psychiatrist just or a yearly check and for a yearly wellness.

I think what you might be referring to Will Milton will be just seeing a counselor and having maybe a life coach, a life coach or a counselor who you could see on a regular basis just checking in every now and then would be not a bad idea.

Many employers have what's called employee assistance programs where you can see somebody as a counselor within the organization for maybe six or eight visits and have some immediate assessment's treatments and they can determine if you need any further follow up from there.

But to see a psychiatrist, a medical physician, you're probably going to need to have some kind of symptoms for the psychiatrist to be able to address.

>> Milton, thanks for your call .

Let's go to our next caller or next email for that matter.

The next email reads Your daughter Fovea.

I'm experiencing a crawling sensation on my skin.

>> Is this medical or is it in my mind I don't want to know what are what medications you might be taking if you're having a crawling sensation on your skin because opiate medications are part of opiate withdrawal can be symptomatic of having a crawling sensation like that.p>> So we hear about h some of the narcotics like oxycodone where you can have this crawling sensation on your skin itself can be a neurological condition where if you have a pinched nerve that can give you a crawling sensation burning numbness, tingling can be other symptoms people will have some people will have crawling sensations when they took certain medications like the serotonin medications, the medications that increase serotonin can indirectly decrease norepinephrine a Doberman and when that happens people can have restless legs.

>> They can have a restlessness where they have difficulty sitting still or standing still and they can have difficulty with sometimes crawling sensations in their skin and some medications are more prone to causing that than others.

For instance Effexor, Paxil these are medications that get in and out of the system very quickly and in doing so they can give you withdrawal and sometimes withdrawal can be characterized by having a crawling sensation itself.

So I'd want to look at the whole picture.

I wouldn't say a crawling sensation per say would be a manifestation of anxiety.

Yeah, some physical symptoms are characterized by by a certain some some physical symptoms are exacerbated by anxiety and and certainly anxious states for a stomach upset tension, headache, backaches.

>> Those are very commonly seen with people who have anxiety states but a crawling sensation and there's probably an underlying medical condition that could be going on there.

Sometimes we'll hear about vitamin B 12 deficiencies which will give people tingling and numbness often in their lower extremities and their feet and we will check the B twelve levels for a lot of people for that reason, especially as we get older because as we get older there's less absorption of vitamin B 12 for a lot of people and if there's less absorption of vitamin B 12 that'll give you difficulty not only with tingling and numbness and crawling sensations but also to have trouble with memory so low b 12 can be a factor for us older folks having trouble with the memories.

So the reason for that is because in our stomachs there's a little bus that carries the vitamin B 12 to the small intestine.

A bus is released from parietal cells and it's called intrinsic factor and intrinsic factor grabs hold of vitamin B 12 in the stomach and carries it to the small intestine where it gets absorbed as we get older our stomach lining gets thinner and that's why we're so more prone as we get older to the nonsteroidal anti inflammatory medications they will cause a thinning of the lining of the of the stomach and give you less mucus secretion.

But as we get older we have fewer parietal cells in the stomach and I'll give you a difficulty with absorbing absorbing vitamin B 12 and getting that vitamin B 12 carat carried to the small intestine.

>> Thanks for your call.

Let's go our next caller.

Hello Dirk.

Welcome to Matters of Mind.

Dirk, you had mentioned that watching the news and politics makes you more depressed.

>> Is there a way to deal with this and still stay informed?

I mean it seems pretty bad right now, Dirk.

I would suggest with news and politics the first thing you want to do is not look at it every day.

You want to look at apps that will have news clips but you don't want to sit there necessarily watching the news hour after hour.

And we now have cable networks where you can watch news 24/7 back in the old days I'm talking about the way old days Dirk back in the nineteen sixties even nineteen seventies we'd watch the thirty minute evening news and that was it and that was the news you got good or bad that was the news you received at that point some people would read the newspapers news used to come in the form of paper called newspapers and people would read that the nice thing about those kind of scenarios is you're reading text that somebody did right and granted somebody who wrote that text might have had their own opinions and you had to keep that in mind.

What's different what we see on the cable networks right now is a lot of yelling and screaming and it's really a demonstration on how not to converse and debate with somebody because you'll see people on the news networks interrupting each other, yelling over each other and that just makes a lot of us who are watching kind of depressed and anxious.

>> So Dirk, I'd suggest that to follow the news and follow the politics and we should all be following them, try to read news stories that hopefully are as free of opinion as possible.

>> That's hard to find out but try to look at objective news stories, look at different sources for stories, look at different types of sites for your news to try to get a blend of that.

But don't sit in front of the television set or in front of the computer screen just watching the news segments one after another after another because I've seen a lot of people get depressed and very anxious about that.

>> And what you always have to remember, Dirk, is you have to remind yourself of what you can control and what you cannot you can feel overwhelmed by all the things happening in the world and get depressed and angry and anxious about it.

>> OK, if you can do something about it, if there are things within your capacity to do something about those different things, great.

Go out and do something about it, start your own movement, whatever.

>> But if there are situations across the world that you personally can't really address and be careful about how long you stay consumed with that, it's important we are knowledgeable of it.

We need to be knowledgeable of it because that affects well who we vote for the next election that keeps us engaged with world events.

>> But you don't want to be consumed about it because as you mentioned, Dirk, you can just get more and more depressed and more and more anxious and I've seen people actually stay up late at night.

>> They can't sleep because of all the things happening in the world, many of which they have little control.

>> Dirk, thanks for your call.

Let's go to our next caller.

Hello, Paula.

Welcome to Matters of Mind.

Paula, you mentioned that you take paroxetine also known as Paxil and if you is one day you're fine but two days you begin crying.

That is a normal side effect, Paula.

That's called a discontinuations syndrome.

Paxil and Effexor Effexor is also known as venlafaxine.

Paxil came out in nineteen ninety four of Venlafaxine Effexor came out in nineteen ninety five.

>> So they've been around for a long time and what we've known about is when people stop them abruptly or they inadvertently miss a dose or two they can get some side effects and one of the side effect to be increased emotions.

>> They can have difficulty with dizziness, lightheadedness, tingling zap zings and zaps is what will be what people often describe.

They'll get these things and zaps in their scalp and their hands and their feet and it's very uncomfortable when the Venlafaxine first came out back in the mid 1990s, some people would go to the emergency room thinking they were having a stroke when they merely missed two or three doses of it.

>> So those are the two medications for whom for which we often hear about the most side effects overall.

So what we often recommend is if you're coming off of Paxil, for instance, Broxton taper off over the course of at least a week.

But for many people it might be three to six weeks in tapering off once in a while people will need to add on another medication to help with the taper and a trick we've used for many years is adding on Fluoxetine or Prozac because Prozac, unlike Paxil stays in the system for up to six weeks.

>> So Prozac or Fluoxetine stays in the system for a long time and it can offset some of the withdrawal from Paxil or Effexor.

But the best thing to do is just slowly taper off each of them depends on what the dosage somebody might be taking but it's not uncommon for Paxil or Effexor you might have somebody taper off over the course of three, even six weeks depending on how they're doing with the taper.

>> Thanks for your call.

>> Let's go to our next caller.

Hello Sid.

Welcome to Matters of Mind said you want to know how you overcome the trauma from a bad relationship.

Some people almost describe it as post-traumatic stress although you shouldn't equate that with sexual physical assault or having a motor vehicle accident.

But some people can be highly traumatized by going through a bad relationship.

I think the first thing to always do said is to say socially active.

The last thing you should do is stay at home and ruminate and be by yourself get out there be among other people now how can you be among other people a lot of ways to do it don't go into bars unnecessary and necessarily I don't want to trash tavern owners here but going into a tavern or a bar when you're really depresse and anxious be careful about that because if you do gravitate toward alcohol during that time it can make everything worse.

You want to socialize so you can socialize in various other ways so you can go to a exercise center.

>> It's always a healthy way to do it a place a place where you can have fellowship with other like believers with a religious faith that could be very helpful for people but you need to stay socially active and stay physically active as well, said so get out of the house.

Don't isolate yourself when you've you're coming out of a difficult relationship and most importantly try to look back on why that relationship might not be worked out for you.

Was it something that you want to address from your own personality in which case you could always see a counselor?

Was is it a pattern of relationships you're getting in involved with because many people going back to their adolescent years will notice they start to date and they they will engage with the relationships with similar type of problematic individuals and they end up terminating the relationship or the other person terminates a relationship with them and becomes patterns.

So you want to try to identify that pattern overall.

I mentioned alcohol a moment ago.

Many people will have trouble with relationships because of their alcohol use.

So alcohol use I've seen with marijuana use same type of thing when you're having those kind of substance use conditions many times that will have an impact on a relationship and you'll wonder gee, why did the relationship not work out?

So you have to identify the underlying issue that might be going on there and try to get yourself control with that said, thanks for your call.

Unfortunate 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 via the Internet at matters of the mind all one word at Edgar.

I'm psychiatrist Jay Farber and you've been watching matters of mind God willing and PBS willing.

I'll be back again next week.

Have a good evening tonight