Good evening, I'm psychiatrist offer live from the Bruce Haines studio in Fort Wayne , Indiana.

>> Welcome to Matters of the Mind now in its 10th 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 the Fort Wayne area by dialing (969) 27 two zero or if you're calling that place coast to coast you may full toll free at 866 (969) 27 two zero now on a fairly regular basis where broadcasting live every Monday night from our spectacular PBS Fort Wayne studios that 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 a via the Internet at matters of the mind a drug that's matters of the mind all one word at WFB again and I'll start tonight's program with an email I recently received Fauver My mental health concerns have become more stressful lately and are impacting my daily life more than they have in a long time.

It does cause myself and other loved ones stress.

>> Here's the thing to me going to the doctor is also stressful for me.

How can I get over the issue becomes if the stress and irritability and anxiety evolves into insomnia often you have this cascade of stress leading to anxiety which leads to insomnia that leads to depression and that becomes a health problem for you.

>> So somehow some way it would be nice for you to use telehealth.

>> It would be nice for you to see a primary care clinician who would be trusted for you to be able to help you at least have accurate assessment on what's going on for you right now.

>> Sure, counseling can always be helpful if you'd rather not see somebody in the medical field so you could start with your pastor, you can start with a rabbi priest, anybody with whom you have a religious affiliation and sometimes people can simply refer you to local counselors.

>> It can be helpful for you because if you're just dealing with stress and putting up with stuff you want to catch it before it cascades into severe anxiety, insomnia and depression because when you start having a lot of problems and a lot of different ways so you can always talk to a counselor to be able to help you with that.

>> So stress is something we all endure.

Stress is basically a change in your life and the problem with stress we need to have stress.

>> We need to have stress to literally keep us sharp.

>> But when you have unmitigated stress that leads to difficulty with coping with it and that difficulty of coping with it causes you to start to brood and ruminate and stay up at night.

That's where it becomes a problem and it can physically make you sick.

I mean people with chronic stress are more likely to develop diabetes, strokes, heart attacks.

I mean they can have more of a likelihood for obesity.

So if you have anxiety that leads to insomnia and depression, that leads to a lot of medical problems that otherwise wouldn't be there.

>> So keep an eye on how that how that goes for you.

Let's go to our first caller.

Hello, Sam.

>> Welcome to Matters of Mind.

Sam, you want to know is there an over-the-counter alternative to congested medicine that when the congestion medicine says don't take if you're taking antidepressant medications and what's the danger of over-the-counter medications for congestion with antidepressants?

What's the drug interaction?

There's a lot of different cold medications and there's a lot of different antidepressant medication.

So the cold medications and the presence that are most concerning will be for instance, dextromethorphan.

>> That's the DSM which is a cough suppressants been around for sixty five years but DSM Dextromethorphan has a mild serotonin effect very mild but it's enough sometimes to give you side effects if you're already taking a medication that affects serotonin such as Zoloft, Paxil, Prozac, Lexapro, Celexa these are all medications that predominantly increase serotonin.

So if you increase serotonin with dextromethorphan a cough suppressant on top of an SSRI I like I just mentioned yeah.

You can have some difficulty with fast heartbeat sweatiness, headache, diarrhea and have some side effects from the serotonin aspect.

There are medications out there that have decongestant as oral medication sort of pseudoephedrine.

These are kind of medications that will give you vasoconstriction.

Other words they clamp down on the blood vessels in doing so decrease the congestion.

>> They should be used only for a short period of time.

But those very medications can increase the blood pressure and if you use them with a medication as an antidepressant that can also increase the blood pressure that could be problematic.

So there's medication will be the serotonin norepinephrine reuptake inhibitors like Cymbalta Paxil I'm sorry Cymbalta Plastique, Effexor, FIDs Zema these are medications to increase serotonin and norepinephrine and they can give you high blood pressure.

Wellbutrin bupropion can also give you higher blood pressure with the oral decongestant medications whereas antihistamines out there antihistamines and cold medicines will kind of help you sleep and decrease some of the congestion themselves.

But the antihistamines can also make you tired if used with sedating medications such as mirtazapine also known as Raemer on and the old tricyclic antidepressant medication.

So it all comes down to looking at which particular medication you might be using for a cold medication and which one you'd be using as a medication for depression.

>> Typically if it has gone forseen Energon forseen loosens up the mucus as a matter of fact as a brand name of physical Musan so Gwon seem would be fine with the antidepressive medications but quite frankly if you have congestion nasal congestion I learned from an ear, nose and throat clinician a long time ago the best thing to do is just simply use the old fashioned neti pot in any pot is where you use basically a steam pot.

>> Obviously you don't want it to hot going up your nasal passages but you want to moisturize your nasal passages by using distilled water in a steam pot that allows you to decrease the congestion.

That's probably the best way to take care of it anyway.

But if you do need to use medications Guan Forseen is probably one of the better ones to use.

Drink a lot of fluids with it because that helps loosen the mucus that way.

>> Thanks for your call.

Let's go our next caller.

Hello and welcome to Matters of Mind and you want to know why does Coffey or other statements sometimes have the opposite effect on your energy and alertness?

>> We'll hear about coffee sometimes having the opposite effect for some people because they are just drinking a lot of coffee.

So if you drink a lot of coffee eventually it can just kind of backfire on you and make you kind of tired.

Well it's a safe amount of coffee 200 to 400 milligrams a day.

So we're talking about maybe two double espressos a day if you drink more than that, sometimes it can make you feel more tired because you might consume the coffee within an hour or so you're crashing and you might interpret that as the coffee making you tired when it's actually you're just rebounding so quickly.

So that's causing you to feel tired in self coffee does have caffeine and caffeine will go to these little receptors in the brain and they will knock off adenosine from the receptors and when Dinnerstein is on the receptors it makes you tired.

>> So as you're going through the day adenosine is kind of like the exhaust fumes in your brain.

>> So is your bauk in your brain and you've got all this energy going in your brain.

It's you've heard of maybe ATP or ATP goes to ADP.

The an ATP means adenosine adenosine fumes and your brain make it more and more tired as the day goes on.

What caffeine will do is it knocks the adenosine off as a receptors and will for a while help you feel less fatigued or more alert so it can help you in a lot of different ways.

>> But when you get over about four hundred milligrams a day it can sometimes not work so well because your brain gets used to it.

So keep it at 400 milligrams or less of caffeine every day is going to be your ideal dosing and it shouldn't cause you to become dependent on it.

>> Higher doses can if you feel fatigued after coffee if you have a headache in between coffee consumption that means you're probably getting a bit much you want to back off of it just a little bit in those cases.

>> Thanks for your call.

Let's go our next caller hello Carla.

Welcome to matters of mine.

Carl, you are wondering about dissociative identity disorder that's used to be called multiple personality disorder you'd mentioned is often depicted negatively negatively in the media.

>> But can you discuss how it's a protective response from childhood?

It is a protective response but it's not considered to be a healthy protective response.

Carla, so what happens in childhood if somebody's been traumatized and curse for whatever reason more commonly with women than men?

If you've been traumatized repeatedly in childhood, what happened?

Your brain kind of goes off and zones out and that's the dissociation part of a dissociation means detaching yourself from reality so you kind of become well the lamp you're just become something else as you endure the trauma and it's called dissociative conditions when that occurs, dissociative identity disorder is where as a coping mechanism as you go through your adult life if you have any kind of stressful situation, your brain unfortunately inadvertently will short circuit and it's kind of like an electrical short circuit where short circuits end into dissociative identity where you become a personality for a matter of seconds, minutes or sometimes a couple hours but you become a different personality that might be empowered, might be more childlike.

It's a different personality and during that time pit typically people will forget they went into that personality.

People with dissociative identity disorder will often have spells where they just lose track of time and they're in one room for a while and then all of another all of a sudden a few seconds a few minutes go by.

They're in another room and they have no idea how they got there.

It might have been it's something as simple as their coworkers or their bosses raising their voice toward them.

Something very simple might have set them off into that dissociation.

So it is a means of the brain protecting itself from the trauma because it's your brain's trying to forget the trauma and go off into a different place while it's occurring.

But it's a poor means of the brain coping later on because obviously dissociative identity is not productive in your day to day life .

>> Thanks for your call.

Let's go next email question.

>> We have another email here.

Here it goes here it says derivative over what's the difference between Prozac and Zoloft.

>> Those are two very old serotonin medications.

I mentioned both of them earlier.

They're serotonin reuptake inhibitors.

>> Prozac and Zoloft have been out for several decades.

Prozac also known as Fluoxetine came out in nineteen eighty seven Zoloft came out and also known as Searchingly and came out in nineteen ninety two .

I believe so they came out years ago and there was a subtle difference between the two of them.

>> Prozac has more drug interactions.

Life had fewer drug interactions.

That was one of the issues of Prozac or Flock's team typically would cause people to have more weight loss.

It affects a serotonin to see receptor in a different way as does Zoloft search Lenar Zoloft will also enhance a little bit dopamine so they work subtly differently and that's why some people will say they did better on one versus another.

However, I would discourage people from going from one serotonin reuptake inhibitors to another.

We we ask everybody what medications have you previously tried?

What do you remember about them if somebody's been on Prozac and we've got a lot of options now from which to choose where we can put them on a different antidepressant but you could try Zoloft especially if they have a lot of anxiety that's still there.

>> Zoloft is better for anxiety for a lot of people compared to Prozac but we typically don't want see people going from Prozac, Zoloft to Celexa to Lexapro to Paxil to Luvox.

Those are all medications that have a lot of similar mechanisms of action and we have so many different antidepressants from which to choose that it's often nice to go to a different class overall.

>> Thank you for your call.

Let's go to next caller.

Hello Mary.

Welcome to Mary's The Mine.

Mary, you you said that you've been taking Paxil for depression.

>> What are the side effects of Paxil and are they different for women than men with the side effects?

Paxil is a medication came out in 1994 two years after Zoloft.

So Paxil also known as Paroxetine is stronger as a serotonin reuptake inhibitors and other words it's more potent on serotonin and for that reason will give people more of a calming effect.

>> And for many people that's not pleasant.

They will feel more sedated, more calm.

The issue with Paxil approx Tene is it inhibits its own metabolism and what that means practically is if you stop it the inhibit the inhibiting of its own metabolism is no longer there so the blood levels will plummet.

>> So when people miss a dosage or stop Paxil Ibrox team abruptly they'll have withdrawal symptoms discontinuation symptoms such as zings and zaps in their hands and feet.

They'll have a burning sensation in their head.

They'll feel dizzy and it could be very, very unpleasant.

So Paxo approach team is most problematic from an adverse events standpoint in stopping or missing a dosage otherwise compared to other medications in that class it affects serotonin.

>> Broxton or Paxil is more likely to cause your weight gain.

So sedation and waking are the main side effects from a little bit of dry mouth for some people and because it's so potent on serotonin they can give you more serotonin.

>> Toxi city where people will have more serotonin the related side effects such as restlessness, diarrhea, headache, palpitations sometimes they might notice getting more of a punch of serotonin affects from Broxton or Paxil but it is used extensively for panic attacks, post-traumatic stress disorder.

It can be used a low doses for menopausal related symptoms.

So it's used for a lot of different purposes.

But you want to be very cautious in using it and if you're using Paxil approx TENE you want to make sure to take the dosage about the same time every day because if you miss a dosage for about six or eight hours sometimes you can get those discontinuations symptoms that can be quite unpleasant.

>> Thanks for your call.

Let's go to next caller.

Hello Grace.

Welcome to Martha Mine.

>> Grace, you had mentioned that you're recovering from pneumonia and you've been experiencing brain fog.

How does physical illness affect your mental health and memory and can trigger a mental illness?

>> Not so much.

It'll trigger mental illness, Grace.

But you know, mental illness in general is where you're in.

You're experiencing depression ,anxiety, difficulty, concentration, keeping in touch with reality, mood swings and gives you significant functional impairment where you're having trouble on the job with the family getting the things done you want to do you're noticing brain fog from pneumonia and what happens there, Grace, is when you have pneumonia you'll have this release of various inflammatory proteins such as tumor necrosis factor.

You'll have interleukin six.

These are different proteins that are inflammatory proteins.

They go to the brain and when they go to the brain inflammation of the brain can be manifested by brain fog, difficulty with enjoying things, fatigue and difficulty of motivation.

So when you have these inflammatory proteins going to the brain you can have those kind of symptoms.

Do they go away after a period of time typically they do but some people will notice that they need something to kind of offset the brain fog and will sometimes treat them with specific medications if they're having those kind of problems.

But brain fog is related to inflammation.

Inflammation can occur from pneumonia.

We heard a lot about this grace when people were were enduring the covid-19 infections.

>> Many, many people had brain fog, had mood swings.

They had all sorts of things happening following a covid-19 infection and sometimes it'll be persistent if they have more irritability and moodiness.

We too often treat them with a medication like Lamotrigine or Lamictal if they had more difficulty brain fog the main medications we would use would be Trin Telex also known as Vaud Octane once in a while bupropion also known as Wellbutrin.

Sometimes we'd use authority which has been out for the past four years now but these are the kind of medications we're using to decrease the inflammation.

>> They can be really related to brain fog.

Thanks for your call us our next caller.

Hello Tom.

Welcome to Mastermind Tom.

Did you have a question Tom?

You want to know about the treatment plan for OCD and hoarding OCD and hoarding are entirely different phenomena, Tom.

>> OCD is a condition where you will notice that you have difficulties with thoughts that don't make any sense to you that go round and round and round your head and they're annoying and they don't want don't warm the house or they don't make any sense.

>> So OCD obsession with OCD are not simple, brooding and worrying about things.

There are thoughts that don't make any sense concerning the contamination counting things that just don't make any sense to you and what happens from neurobiological standpoint will be that those thoughts are going around and around and around in this front part of the brain and it gets stuck and when they get stuck you can't get them off your mind and sometimes you will then follow through with with compulsions.

Compulsions are where you start counting or you do things very methodically to try to get the thoughts off your head to try to give you some relief.

So for instance, if people are very concerned about contamination, they might wash their hands over and over and over again to the point where they have their skin sloughing off their hands.

I mean they get terrible skin conditions because they're washing their hands so much is because you had the thoughts of contamination so obsessions can lead to contamination.

>> That's OCD.

That circuitry to knock that kind of off the circuit can be alleviated from a medication standpoint by either having some SICHEL simple talk therapy where people are told to think or at least say out loud very quietly the words stop as a means of stopping the round and round circuitry.

It sounds like a very simple behavioral technique but that's a technique that can be used.

But from a medication standpoint we use high doses of the serotonin medications which I've discussed on several occasions tonight.

The high doses of serotonin medications tend to calm this excessive circuitry and it's like the old record players where the needle's getting stuck.

The high doses of serotonin medications tend to alleviate much that I've seen OCD occurring predominately after people have had a strep infection like they have a really bad sore throat as children when you have a bad sore throat as a child it can inadvertently the antibodies for the strep will inadvertently attack the front part of the brain and when the front part of the brain gets attacked it can throw you into the circuitry.

So even later on with a delayed response you can have OCD occurring as adult as an adult if you had recurrent strep infections as a child I've seen OCD occur not uncommonly when women have babies.

So when you deliver a baby you're going to have the mother bear instincts and you're going to want to protect your baby and keep things clean.

>> But I've seen some women have that mother bear instinct where they start cleaning excessively and it becomes a problem and they know they're cleaning excessively and that's the key with OCD.

Most people have good insight and they're aware that they're doing things excessively but they just have a hard time stopping.

What do they do when they try to stop the compulsions or stop the thoughts?

>> They get more anxious and that will cause them some time to think about it more hoarding ,entirely different phenomenon hoarding is where you keeping things unnecessarily and hoarding is less understood but it used to be thought to be part of OCD.

It's entirely different even in terms of the brain circuitry with hoarding is more of a sense of your own identity when you get rid of things that you might have acquired over the course of time you look at those as part of your own possessions and when you get rid of them you feel like you're getting rid of some of yourself or if there are important aspects of something from family or friends, some something that you've been given you just have a hard time getting rid of it and that could be something something as simple as a magazine or something where you perceive that if you get rid of you're going to lose a part of yourself.

So hoarding is not something that's medicinally treated.

It's something that people are going to try to treat from a counseling standpoint to try to help them piece by piece by piece and clutter what they actually don't need and give them some reassurance that and getting rid of those things they'll still have their own self identity.

>> Thanks for your call.

Let's our next caller.

>> Hello Seth.

Welcome to Matters of the Mind .

>> Seth, you want to know where do thoughts come from?

Thoughts come from their part of your brain to articulate the thought you have to think about words.

All right.

So the front part of your brain is where your thoughts are are gathered so your thoughts are gathered by words.

That's why you don't have your initial memories until you've been able to articulate words until you're about three years old.

Now some people will insist they can remember things when they infants or toddlers and that's OK.

But usually your thoughts are not downloaded until you in form words when you form words those are thoughts.

>> So if you think back to what you had for a meal earlier today breakfast, lunch or whatever you think about it, OK, you start articulating the words of the foods of what you had, OK?

Those are how your thoughts are made and it's important from neurobiological standpoint because some people will hear thoughts in their head and those thoughts are considered to be auditory hallucinations.

>> Those thoughts are as loud as your voice as my voices for you right now.

>> So when that happens you have the thoughts forming in the front part of the brain.

You have this little band of tissue called the argue it physicalist going back to the hearing part of the brain, the yellow part here and the hearing part of the brain actually if that arquit physicalness is impaired you start hearing your own thoughts and that comes across for some people as auditory sensations where they can actually hear voices talking to them what they don't realize those are thoughts they could be different voices, men, women, voices.

But what they are experiencing is they're actually hearing their own thoughts is because they have an impairment of the arcus physicalist going from the front part of the brain to the hearing part of the brain.

Now usually that argue it physicalist tells you I'm just thinking a thought right now I'm not hearing it but when you start hearing your thoughts, it's comes across as sometimes very frightening for people and sometimes those thoughts can instruct you in command you to do things you ordinarily wouldn't do.

>> Those are obsessions occurring in your front of your brain.

>> As I mentioned before, obsessions are often unwanted thoughts and they go to the hearing part of the brain when you have a condition like schizophrenia and it's because the impairment of the argument is Nicholas, thanks for your thanks for your call.

>> Let's go next caller.

Hello Keri.

Welcome to Mastermind Kerry.

You're mentioning you're having intense nightmares where you feel unsafe.

It leaves you with a lot of anxiety during the day.

Why is that happening and how do you stop it or no one can make sure you're getting good sleep hygiene the best you can.

It might be even scary to go to sleep because of the nightmares, but when you can go to sleep the same time every night, try to get up same time every morning that regular habit of your sleep hygiene and your circadian rhythm really will help.

You'll have typically more dream sleep which is the phase of sleep in which nightmares are are accompanying but increased sleep will often be there because you're having sleep debt and you're not getting enough sleep.

So try to get enough sleep, try to get better at the same time every night I get the same time every morning that's the first thing you can do.

Secondly, try to exercise first thing in the morning.

Exercise on a regular basis will give you a bit greater depth of sleep at nighttime so exercising can and give you a greater depth of sleep at night.

My nighttime dream sleep is where the REM is a REM sleep rapid eye movement sleep and that's where the nightmares originating when you're in dream sleep this left front part of your brain especially called the dorsolateral prefrontal cortex dreams sleep is letting that part of brain rest.

That part of the brain is where you use logic and rational thinking.

It's shutting down a nighttime when it shuts down a nighttime.

>> That's why your dreams might be abstract and you don't make a lot of sense and that's OK because your logical part of the brain is resting while you're dreaming what you're experiencing will be nightmares which is a combination of the resting of the dorsolateral prefrontal cortex and firing up of your anxiety center which is coming from the brain stem giving you norepinephrine.

So there's medications that we use such as Gwon forseen praises and these are medications that we'll use that affect norepinephrine receptors in a specific way that they can shut down the nightmares of people are occurring.

Many people have nightmares when they've experienced traumatic experiences in the past that's called post-traumatic stress disorder in some cases but it's not diagnostic.

Having nightmares will not be diagnostic that you have experienced bad traumatic events in the past but nightmares can occur because of lack of sleep hygiene.

I've seen nightmares occur with some people when they take a so-called beta blocker propranolol atenolol, metoprolol these are medications that will shut down norepinephrine in the front part of the brain and sometimes do so excessively where people will have nightmares as a side effect.

So I want to take a look at your medications if you're still having nightmares for whatever reason because sometimes medications will make some of that worse.

>> Thanks for your call.

Unfortunately I'm out time for this evening.

If you have any questions 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.

>> I'm psychiatrist Jeff author and you've been watching Matters of the Mind on PBS Fort Wayne now available on YouTube God willing and PBS will be back again next week.

>> Thanks for watching.

Good night