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

>> Welcome to Matters of the Mind.

Now in his 26 year matters, 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 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 to zero.

>> Now on a fairly regular basis I broadcasting every Monday night live 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 e-mail question concerning the 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 at WSW ECG that's matters of the mind at WFYI EDG and I'll start tonight's program with an email I recently received.

It reads Dear Doctor Father, do those struggling with eating disorders need to continue treatment throughout their lives if they're treated in their youth, should they continue to check in with a specialist as an adult?

>> Does the type of disorder influence this?

>> I'll answer the last question first.

The type of the type of disorder does influence the type of treatment as well as the severity of the disorder itself.

>> It's thought that many teenage girls especially have a very high incidence of eating disorders and we talk about eating disorders.

>> We're talking about functional impairment.

>> They're having a hard time with their dietary intake that leads to their difficulty with socialization going to school, being able to have a normal life and with the anorexia type they're restricting you the bulimia type of problems where people will binge eating many occasions and make themselves vomit there may be people who have extreme preoccupation with their dietary intake and that's an eating disorder of a self.

>> So there's a lot of different types of eating disorders.

Eating disorders rarely occur in a vacuum.

>> There's always other things going on.

For instance with bulimia where people will binge eat and then they'll make themselves vomit out of guilt and out of shame.

>> Those people often have depressive disorder so we often will be looking for other kind of conditions, other type of issues that might be going on when we hear about people with eating disorders, the eating disorders, it's not usually about food with anorexia for instance where people will be restricting their food.

>> It's not so much about food.

>> It's more about power and control and you'll hear about those type of things when deal with these patients with in therapy.

So the key with eating disorders is to try to sort out what's the underlying issue and what could be influenced in that regard now how long will it go on for some people it is very transient.

It might be for six months or a year when they're going through a tough patch.

It might be for instance, a young prepubescent girl who's just starting to get her hormones going.

She's very intimidated by the biological development that she's feeling and seeing so she might be restricting her dietary intake because of that.

That's a whole different issue then you might hear about with a 17 or 18 year old who's having an eating disorder.

So you have to sort out what's the underlying disturbance that might be there?

>> Will it go into the adult years?

Many times it does not but sometimes it does and I have indeed seen a few people over the course of my thirty plus year career who had eating disorders going into their 30s and 40s and really into their 50s.

But it can occur sometimes and here's what happens.

You'll hear about somebody for instance who under stress they resort to pass coping mechanisms so they might be under stress, they might be going through a lot of change and they realize that in the past when they forced themselves to vomit after eating a very, very large amount of carbohydrates, they felt better very briefly and now that's a key it's very brief.

People will feel better.

They get somewhat of an emotional high from vomiting because they get a surge of norepinephrine and dopamine gives them a brief high but it's very brief and then they crash.

>> It's not unlike somebody using cocaine who gets this brief rush of a high after they vomit but then they feel real depressed and the more times a person will make themselves vomit over the course of time they can get physical changes.

It's interesting that many people who have bulimia and they make themselves vomit actually start to gain weight.

Their body metabolism changes.

They get puffy cheeks because they're parodic glands.

Their cheeks start to puff out a little bit and if they're doing it as a means of weight control, it's a horrible means to end up gaining weight.tend- They'll have menstrual irregularities as women and many times they'll have disturbances with their insulin levels because of that.

>> So the first key will often do is address is try to sort out what the underlying problem might be then a lot of it will be education to try to help of coping than the eatingans- disorder itself.

That's a very, very brief synopsis overall some people will have an eating disorder as an adolescent or young adult and then they'll still have the depression later on.

So we'll be addressing the Depression and trying to address biological means or even psychological means of helping them with coping later on as an adult.

So an eating disorder is typically more of a symptom of underlying things going on and those underlying things might persist into the adult years.

>> Thanks for email.

Let's go to our next caller.

Hello Candice.

Welcome to Mastermind Candice.

>> You wondered about having vivid dreams where you were you wake up crying.

>> Why does your unconscious feel so real if you're awake and crying Candice it might not be that you're in the dream state you might be an dream state is where you're in rapid eye movement sleep.

It's where your body is paralyzed when you're dreaming it typically first occurs about an hour to an hour and a half after you go to sleep and then as you go through the night you tend to have more REM sleep and it becomes more frequent as the night goes on.

So if you're dreaming in a waking up and wake and crying you'll remember the dream and remember that the dream might have been a sad dream.

You won't typically cry while you're dreaming because while you're dreaming you won't be able to yell.

>> You won't be able to thrash around.

Normally when you're dreaming you don't move because your body's paralyzed.

>> Now there are REM sleep disorders where you have movements and you kick and you can hurt yourself when you're dreaming but in most cases people don't awake crying from dreams because they've been paralyzed from the dream itself.

>> What I suspect might be more likely Candace, would be that you were in a different phase of sleep called a non REM sleep where it's a slow wave sleep.

It's a very deep sleep when you awaken from this deep sleep number one you're often very confused for about three or four second.

>> It's very brief but you kind of wonder where you are.

You don't know what time it is.

You're very confused.

That means you awaken from a deep sleep.

This deep sleep is the sleep phase that occurs when somebody has night terrors and when people have night terrors then they often awaken crying.

They're very emotional, very confused and they have to kind of snap out of it.

But that's a nightmare.

It's during the night terror phase of sleep that people can also sleepwalk.

>> So during the non REM sleep cycle you can be more prone to sleepwalking.

What causes night terrors and what causes sleepwalking?

Well, number one, the developing brain can can do that so children are much more likely to have non REM sleep disturbances such as night terrors or sleepwalk fatigue.

>> Lack of sleep makes you much more likely to go into an abnormal deep sleep non REM sleep and fever can be another factor for a lot of people.

>> So those are the main type of things that can occur.

But awakening crying might be from a dream but it could also be from a non REM sleep disturbance.

You can always talk to your primary care doctor and maybe be checked out by sleep medicine doctor to try to sort out if it's an ongoing problem to what degree can be addressed.

But for many people basically getting enough sleep can can really help out with a lot of these sleep disturbances.

>> The circadian rhythm disturbances can be addressed by trying to go to bed at the same time every night trying to get up at the same time every morning and trying to get in that cycle where you're sleeping deeply throughout the night.

Be very careful about exercising after 7:00 pm at night if you were to bed about 10 p.m. be very careful about eating anything before you go to bed.

They can disrupt your sleep in very subtle ways.

>> Candace, thanks for your call.

Let's go our next caller.

Hello Becca.

Welcome to Matters of Mind.

Becca, you want to know why do people become obsessed with celebrities?

I think a lot of times and I'm stating the obvious you don't need to be a psychiatrist to figure this out but celebrities have a lot of influence.

A lot of people perceive that celebrities have attributes that they might not other know.

>> We've heard a lot about Coach Deon Sanders recently with the University of Colorado.

He's done a phenomenal job as a coach out there and he's been very public saying that at the end of a Super Bowl which the San Francisco 49ers I believe won he thought about suicide.

>> He was devastatingly depressd.

He was a very, very charismatic celebrity and here he is thinking about suicide.

So we always have to remember the celebrities are people as well.

But many people will put celebrities on a pedestal and they'll imagine that they have all these attributes that we don't have and it's often a means of comparison.

You could have envy towards celebrities.

You wish you had the power and prestige and the money that they had.

>> But many times these people are broken individuals and you have to just have to remember as you look at celebrities and look at other people around you for that matter realize they might be suffering inside and many times they are and unless you really get to know them personally, you have no idea what what kind of issues they might have.

It's kind of the Prince Charming effect where you assume these people have all these different attributes that they often do not and they often are very fallen and broken individuals.

>> Becca, thanks for your call.

Let's go to our next email.

Think we have another email here our next email is reading their dear father.

>> I have a friend who struggle with depression and believes that he was able to overcome it from exercise alone.

Can this be true or would someone require medication as well?

My goodness.

>> If somebody could exercise to a reasonable degree and we're not talking about a condition where you'd call body dysmorphic disorder where you have such a need to exercise that you can't get enough musculature and you can't get fit enough, those people end up hurting themselves.

We're talking about exercising to the point where you can increase to chemicals in the brain one excitatory, one inhibitory the excitatory chemicals called glutamate the inhibitory chemical is called Gabba Gamma amino battery acid .

So glutamate and GABA work in tandem to give you an excitatory effect and a braking effect with exercise you can increase both glutamate and GABA when people have depression.

It's theorized that they have decreased transmission of glutamate and decreased GABA so when people are depressed they often have low energy.

>> They have trouble with motivation that trouble the concentration but at the same time they have trouble with sleep.

They feel kind of anxious, they're restless and they worry about a lot of stuff.

So that's an indication there's there's there's not enough glutamate and GABA in tandem naidus or do blood tests on those type of things you need to try to fix the underlying problem in the brain.

>> So with decreased glutamate and GABA if you exercise for about 30 minutes you'll notice that within 30 minutes after exercising you will feel more energized, more alert, more awake and actually have better concentration.

But at the same time you'll also feel a calming effect and quite frankly that evening you'll probably sleep better.

So exercising is a phenomenal means of treating depression.

Here is the big challenge try to get somebody who's severely depressed to exercise.

It's very difficult for them to do that.

They lack motivation, they lack energy, they lack initiative and you can blame them for not exercising and not following through with the plan.

But it's kind of like insisting that a person with heart failure try to get back in shape by training for a five K and getting out there and running and running and running.

At some point you might need to give them some heart medication to get them going to get him started on different things.

>> So physical therapy for cardiac patients can often be very frustrating because they physically are having a hard time just getting out the door and doing what might be advised.

The same goes with depression.

Many people with depression become so despondent with the depression because the glutamate and GABA transmission in the brain are so disturbed the brain has changed because of the depression and the longer the depression goes on the more the depression becomes or the more severe the depression becomes.

The more likely people will have brain changes that are occurring.

So you're trying to rationalize with somebody who's having disturbances with brain changes to do something their brain might not otherwise be telling it to telling them to do so part of having depression will be disturbances not only in the front part of the brain which is the reasoning part of the brain but a disturbance in the part of the brain called back here called the insula.

The insula is a part of the brain that will give you a self awareness.

So many people with depression will have difficulty with self awareness that exercise could be beneficial for them now when they do it they'll often say they feel a lot better.

>> Many people who do some aerobic exercise, they do some weight training 30 minutes is often all it takes.

But as people leave the exercise facility will often say they feel a lot better.

Why don't they do it more often then it's because they get into the cycle where they have a hard time with the motivation and the energy and the initiative to get out there to exercise but exercise rising will do the same good things to the brain that antidepressant medications will.

It's just that some people are at a point where exercise alone might not be the case.

>> What we're frequently trying to get people to do will be to have the initiative and motivation and have the cognitive wherewithal to be able to think through their difficulties and develop better coping mechanisms mechanisms and we often do that through psychotherapy and talk therapy .

But if they can exercise that can be dramatic.

People often ask me what's more important exercising or dietary changes they can work hand in hand.

I'm not going to say that you just eat this and this and this and you'll feel great.

>> It doesn't work that way.

You have to figure out what works for you.

For some people they'll say when they blast themselves with carbohydrates they can feel a lot worse.

Some people will say when they eat a lot of gluten which is the genetically modified wheat, they'll feel worse with that some time so people will have different ways that dietary the dietary influence will occur for them.

So we have to take that into consideration.

But across the board, within somebody's physical limitation, exercising can be a very, very means good means of treating depression.

And you're right, some people especially with a mild depression once they get into an exercise routine and 30 minutes five days a week usually works out pretty well.

>> But if they get into an exercise routine on a regular basis, it can be dramatically helpful.

But again, don't be too tough on somebody when they have a hard time exercising while they're depressed.

It could be a very, very difficult time to initiate that.

>> Thanks for calling your next caller.

Hello Marsha.

Welcome to Matters of Mind.

>> Marsha, you want to know about tinnitus ringing in the ears?

You know about how that's treated.

You've heard that it can affect your cognitive abilities and it can affect your emotion as well.

I sometimes will hear about tinnitus.

Marshall as a psychiatrist there's one particular medication called Wellbutrin or reprogramed that as a side effect can cause tinnitus in about one out of twelve people.

So it's not real common but it's something we'll hear about once in a while when somebody on bupropion so with that being said, I will often typically refer somebody to an ear, nose and throat clinician when they have tinnitus.

So will it affect somebody from a mental health standpoint?

Yeah, because some people can get very anxious with a ringing the whistling, the rumblings they hear in the in the ear and it can cause them to have a lot of anxiety.

So years ago people used to take a little small dosage of Xanax or alprazolam on a day to day to day basis.

It's not typically recommended so much now by the E.A.

clinicians because there's so many other treatments that are available out there.

But it can affect somebody emotionally by causing them to be anxious if it ever keeps somebody awake and caused them to have difficulty to go to sleep.

Lack of sleep, insomnia can be very, very problematic for anybody's mental health .

It can cause people to have difficulty with thinking, concentrating and making good judgment calls the next day so lack of sleep can always be a factor again.

That's where as a psychiatrist all I hear about that there's a particular triad called Moneris Syndrome where somebody will have tinnitus but they'll also have difficulty with nausea and they'll have trouble with having trouble with dizziness.

So when somebody has tinnitus with the dizziness and the nausea we'll often think about Moneris syndrome.

That's an inner ear problem that the ear, nose and throat doctors will often treat.

Thanks for your call.

Let's go our next caller.

Hello Greg.

Welcome the mastermind Greg, you mentioned that you're having issues with weight loss and you wonder if the weight part of that is disturbance with your mental health .

>> You're having issues wanting weight loss or actually with weight loss.

It can go either way if you're noticing that you're having weight loss for unexplained reasons.

Number one, I want to look to see if there's any explained reasons because some of the high thyroid for instance, will classically have unexpected weight loss.

>> People who have depression, especially men will tend to lose weight as opposed to gaining weight.

Women are more likely to gain weight when they get depressed.

Men are more likely to decrease their appetite and lose weight.

So that could be a factor.

They're going to be an adrenal abnormality that can be a factor with weight loss, unexpected weight loss.

So get it checked out by your primary care clinician now if you're having trouble trying to lose weight but you're not able to do so.

>> Yeah, if you're having trouble trying to lose weight, it's not usually an appetite issue.

It might be an underlying emotional issue.

Many people when they're gaining weight and they're trying to lose weight, they just can't do it.

They're having trouble perhaps with binge eating where they will eat unnecessary amounts of food and they don't eat because they're hungry.

They just eat because they're trying to feed their emotions.

And when you're trying to feed your emotions, many people will eat a high carbohydrate foods as a means of trying to indirectly increase serotonin because when you eat high carbohydrate foods you increase your insulin level.

>> Increasing in the insulin level will increase the transport of tryptophan and an amino acid across the blood brain barrier.

So more tryptophan gets into the brain, more tryptophan gets on the brain, more serotonin is produced.

>> So that makes you feel good for a while but then you feel lousy because you get the crash so your insulins going up feeding the brain with indirectly more serotonin and then you crash and you go on up and down.

>> So a lot of people will binge eat as a means of trying to help with their stress level itself.

I often will recommend that people try intermitent fasting which has pretty good scientific validity now but intermittent fasting is basically where somebody will intentionally miss breakfast and try to eat somewhere between maybe noon to six p.m. and just eat during that time period.

I know not everybody can do that.

Some people will say they get more irritable especially the first day or two when they're trying to miss breakfast and have a perhaps a later lunch.

Some people who already have an eating disorder with binge eating, for instance can find that to be problematic.

But other people will notice that it is a way of kind of keeping their eating more regulated and they are getting their insulin levels more more stabilized if they are only eating during a restricted part of the day.

Now many people wonder if you've restricted yourself from eating for 16 to 20 hours and you've just been having lots of fluids and trying to restrict the calories during the 16 to 20 hours.

>> Don't you come out of that so-called fast with a tremendous hunger and where you want to binge during that time most people do not most people will come out of that fast wanting to eat vegetables, fruits, proteins.

They want to eat good foods for them.

They don't want to binge on cookies and cakes.

Matter of fact, they'll still feel kind of sickly if they do that.

So that's where intermittent fasting for a lot of people can be helpful.

Yeah, be careful if you have diabetes watching your blood sugars for intermittent fasting and you always want to do it with your primary care clinicians supervision and oversight to make sure it's safe for you want to drink plenty of fluids if you're intermittent fasting and for many people we're trying to lose weight.

That's the first thing I'll often tell them try to drink more fluids during the day intentionally try to drink a half gallon of water for instance earlier in the morning earlier in the day because when you drink cold water especially will suppress the appetite somewhat and for many people that's how they get through the morning without eating breakfast.

>> I remember twenty thirty years ago people were told breakfast was the most important part of the day.

Now we realize that that's the one meal you really should avoid and you'll feel better in many cases if you restrict your diet to lunch and dinner and try not to eat after 7:00 p.m. as I mentioned before after about 7:00 p.m. if you do eat often you won't sleep as well and you'll have to get up during the night sometimes to go to the bathroom more often if you are eating and drinking any fluids into the late evening hours.

>> Thanks for your call.

Let's go to next.

>> Hello Jim.

Welcome to the Mind.

I just had a question on medication results.

This was supposed to be taken for a mood stabilizer and it seems to make me more agitated I guess also I sweat a lot more since I've been taken and you kind of touch base on the weight gain thing but I didn't know if that was a side effect of the medication also.

>> Yes to all those questions, Jim, how much of a dosage are you taken at point 25 milligrams, 25 milligrams.

>> You're taking an exceptionally small dosage, Jim.

The first and often recommend is somebody who's having the difficulty with agitation we call it akathisia.

>> a.D.A is where you have a hard time sitting still and you want to pace does that kind of describe you?

It's more this agitated feeling are argumentative, agitated type feeling I guess more of an emotional agitation used I guess more of an irritability.

That's what that's what we're saltiest supposed to treat now you're having some increased sweating that can be a side effect weight gain can be a side effect at any dosage with result at point twenty five milligrams.

Boy, it's hard to go much lower than that.

But quite frankly Rizzolatti is a good medication for irritability argumentative ness.

But I will ask anybody who's starting a medication did you feel that that degree of emotional agitation was that worse after you started it or was it there beforehand?

>> It was worse after I started it but I'm on other medications along with this so yeah, Well, despite how the medication might work for a lot of people or exalt he's a very good medication for a lot of people.

Might not be so good for you from what you're describing, Jim, I'd go back to your clinician and ask OK, what other options might be out there because at that tiny little dosage you're getting a lot of side effects and if it's making you feel worse in that regard, we'll often punt and go another direction for you.

>> OK, All right.

>> Thank you very much.

My pleasure, Jim.

Result is a chemical cousin to Abilify.

Abilify has been around for a long time and Abilify is a medication.

It also can give you weight gain and for a lot of people can be used on top of another antidepressant medication for the purpose of not just stabilizing the mood but actually improving the mood.

>> People will use Abilify and result for bipolar disorder.

They're having highs and lows but for people that just have lows, these kind of medications such as Vallauri if I were salty they can be used for the lower popularity of the mood where it can be they can be added on to an antidepressant medication and in many cases they can do a really nice job in terms of giving that antidepressant medication a little bit more of a boost and helping you get out of the funk of depression.

Thank goodness nowadays we have so many different medications that we can use for depression for the past 60 years we've been using medications for depression that primarily affect serotonin, norepinephrine and dopamine and that includes result result indirectly by affecting various receptors can indeed help you feel better by affecting norepinephrine, dopamine, serotonin and that's been for the past 60 years.

Over the most recent years we've had other medications like bravado or academy and we've had all Valide we've had these newer medications coming out that aren't just affecting norepinephrine serotonin or dopamine.

They're affecting glutamate more directly so there are pushing on the accelerator.

So that's why they're these newer medications are in the class of the rapid acti antidepressants.

The rapid acting antidepressants are known as the Arad's Arad's the rapid acting antidepressant medications work within a week for a lot of people and they work primarily on glutamate or GABA more directly.

Thanks for your call.

Unfortunately I'm out of time for this evening 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 EDG and I'll see if I can get to that question next week because God willing and PBS willing I'll be back on the air next week.

>> Thanks for watching.

Have a good evening.

Good night.