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>> Good evening.

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

Welcome to Matters of the Mind now as 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 here in the Fort Wayne area by dialing (969) 27 two zero.

>> If you want to call me long distance you may dial toll free coast to coast at 866- (969) to seven to zero now and a fairly regular basis.

We are broadcasting live every Monday night from our spectacular PBS Fort Wayne studios 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 all one word at WFYI dot org that's matters of the mind at WFA org and I'll start tonight's program with an email I recently received.

It reads Dr. Fauver how does post-traumatic stress disorder and depression interact?

Do they often go hand in hand?

>> They actually will and when we talk about post-traumatic stress disorder we're talking about a particular traumatic event that caused you thereafter to feel really jumpy and feel on edge and expect something bad to happen in the future.

>> People with post-traumatic stress disorder will often have difficulty with nightmares.

They might have flashbacks.

They might have these feelings as if the past traumas happening all over again and that often will lead to avoidance of situations or people that may remind them of the past traumatic events.

Now when that goes on you can become demoralized and it can indeed lead to depression where you have difficulty enjoying things you feel sad more often than not and you have trouble motivation, energy levels, concentration and sleep especially.

And when we hear about people phaving difficulty, the anxiety that cascades insomnia that can thereafter lead to depression.

>> So we often hear about PTSD depression.

>> We will indeed occasionally use medications that try to address both types of conditions such as Zoloft has been around for a long time.

Medications that increase serotonin might dampen the hypervigilance or the jumpiness that goes on with PTSD and amid some of the anxiety but also depression disassociated not uncommonly with PTSD.

So we often hear about them going hand in hand now all often ask people OK, the post-traumatic stress symptoms, when do they start and what was the nature of them because adverse childhood experiences will often cause somebody to have PTSD later in life .

>> If you had over four bad childhood experiences and they're defined by this adverse childhood experience skill that's a ten item scale over four of those particular items will be predictive that you're going to have more depression in later life .

>> So if you had bad childhood experiences before especially the age of eight years of age where you had a family divorce ,you had a parental divorce or separation, you had a lot of family trauma, you had emotional abuse, sexual abuse, physical abuse.

>> You might have had somebody in the family with a mental illness.

Somebody went to jail.

These are all traumatic events for a small child and those traumatic events can kind of prime the pump for the hardwire of the brain and make you more likely to have depression later on.

And we find that if you've had over four of those particular events in your early childhood, you might not respond so well to the serotonin medications like Zoloft in those particular situations if you had early childhood trauma you might not do so well with a serotonin medication like Zoloft, Lexapro, Celexa, Paxil, Prozac those are all medications commonly used but people don't respond so well to them if they had that early childhood trauma because the hard wiring of the brain changes when that's all occurring.

>> So if you have PTSD and depression related to bad childhood experiences, we might go a little bit different direction with the counseling treatment of choice for PTSD is eye movement and desensitization and processing eye movement desensitization and processing MDR like the term sounds I mean you follow somebody's finger and change your eye movements and in doing so it actually changes the processing of information in the brain.

>> It's very effective.

It sounds very simple but it's very effective.

>> Thanks for your email.

Let's go to our first caller.

Hello Karen.

Welcome to Matters of Mind.

Hi.

Thank you for having your show.

I love it.

Thank you Karen.

Here's my here's my deal tonight.

My father in law who's almost 93 has dementia.

He's recently moved into a new care home this weekend when they asked him to turn off the TV he said not nice cusswords and acted like he was going to slug them.

This is nowhere in anything he's ever done.

He doesn't say bad words.

He doesn't he's never been aggressive.

I see these commercials for things saying oh, the hands that used to sing you are that used to pat you and sing you a lullabies are now saying nasty things.

That's what that is that the dementia is making him mean or a different person and what do we do it to your awareness does your father in law have frontotemporal dementia, Alzheimer's dementia, vascular dementia?

>> Do you know the type of dementia he might have?

Lewy body dementia doesn't come to mind.

>> My mother in law had Alzheimer's for twelve years and we always assumed he was going to be the strong one.

But in the past year and a half his dementia has come on fast and and whatever but we haven't had it officially diagnosed.

I got you.

Well there are different types of dementia.

There's a type of dementia called frontotemporal dementia .

It is a type of dementia that will affect the front part of the brain, especially and as the front part of the brain shrinks down, it will cause you to have difficulty with aggression, personality changes even before the memory disturbances become prominent now with Alzheimer's dementia is affecting more of the side part of the brain on the east side of the brain is shrinking down the side of the brain.

Eventually it will affect the front part of the brain.

But the reason people with dementia will have disturbances with aggression is because their judgment part of the brain is deteriorating and it sounds like he might be having some frontotemporal type of dementia where it's causing the frontal lobe to be shrunk shrunken in such a way that's causing personality changes and we hear about that not uncommonly caring people who had never said any word of profanity in their entire lives will all of a sudden start using profane remarks and be aggressive, angry, total personality changes.

It's sad to watch but we haven't seen that now what kind of medications can do can help with that one medication.

It's appears to be effective and well studied and now FDA approved for aggression associated with dementia is result result as Brexit alone.

It's a medication that's been out for moods stabilization and as an add on for depression has on for a few years now and it's >> We use very, very low doses of it for people but it's a good start for helping someone with dementia.

Sometimes people will respond well to the dementia medication such as Namenda, Aricept, Exelon.

These kind of medications can actually help increase acetylcholine and sometimes help with a memorium and indirectly it might help with the irritability.

We do use antiepileptic medications not uncommonly the safest of the bunch probably being gabapentin also known as the Rensin.

Using that as needed can give people a calming effect so there are a lot of medications that we will use to help with the aggression related to dementia.

>> Now one of the most important factors for somebody with dementia care and to decrease their irritability and aggression would be to try to keep the sameness of their environment.

>> People with dementia will have trouble not unlike somebody with autism.

They'll have trouble with change and if you change the environment they'll forget what they've been doing, where they've been keeping photographs of loved ones in the room is a great idea.

You'll often see in memory care centers for instance, they always have big challenge calendars on the wall to remind people what day of the week it is, what month it is, what year it is and to try to keep them reoriented but they need structure.

They need the sameness of their environment.

Now Karen, many people with dementia you try to keep them at their home environment as long as you can.

>> But there comes a point where it's very difficult to manage them at home.

So that's when they get into more structured assisted living type of situation or memory care centers to try to have the help around that.

>> But there are various medications available now that weren't available for aggression or irritability related to dementia.

They're available now and they weren't in years past.

So there's a lot of hope that that your father in law could have better managemet of that aggression.

>> Karen, thanks for your call.

Let's go to our next caller.

Hello, Phyllis.

>> Welcome to Matters of Mind.

Well, Phyllis, you had mentioned that you have you have neuropathy in your knees.

Teams intends to travel to your feet.

Is that really happening?

Is it possible for neuropathy to travel and Phyllis, that would be more of an orthopedic surgeon or probably a neurologist per say question?

>> I'm a psychiatrist so as a psychiatrist I'm dealing with brain conditions and we hear about neuropathy occasionally especially as we're hearing about pain.

But neuropathy is basically have pain, numbness or tingling going on your legs and it sounds like it could be a sciatic nerve disturbance that could be a focal vocalized in your lumbar area.

So that's something where you'd want checked your with your primary care doctor try to get a start on what kind of disturbance might be there for the neuropathy but neuropathic pain signals.

Yep, they go up and down the leg and you can have disturbances in the feet and the knees and it's typically emanating from the sciatic nerve which is on the back side of the hip and it goes right down the leg and it can be from a pinched nerve.

>> Phyllis, thanks for your call.

Let's go to next caller.

Hello Randy.

Welcome to Matters of Mind.

>> Randy, you had mentioned that you're on one hundred milligrams of Trazodone a night and you've Trazodone does help you sleep but you want to get off the track known and you wonder if melatonin is a good substitute ocean.

>> Well, I'll tell you this, Randy.

No one I'd want to know why would you want to go off the Trazodone if it's working well for you?

>> I mean it's great if you don't need it anymore.

If Trazodone is working well for you, it's helping you get a deep sleep.

It's giving you a good quality of sleep overall Trazodone has its advantages in the sense that it gets out of the system after about eight hours now why would anybody want to go off a Trazodone?

>> It's because sometimes people have a stuffy nose.

If you have a stuffy nose that could be a reason to go off of it.

It's dose related so we'll often want to decrease the dosage if that's the case, Trazodone is not addictive.

In other words, it's not affecting the Gabba transmission the brain GABA is gamma amena nitric acid GABA transmission affected if it's affected it basically knocks you out.

>> So when we talk about medications that affect GABA, we're talking about Ambien, Lunesta, Temazepam these are medications that are affecting GABA and when you affect GABA they knock you out and that's why medications that affect GABA for sleep can be somewhat addicting and you get to the point where you got have them Trazodone one's main mechanism of action doesn't affect GABA at all.

>> It's affecting a serotonin receptor.

>> There's roughly fourteen different serotonin receptors out there and one of them is called serotonin type two A and serotonin receptors go by numbers and letters but to A is the one in which Trazodone will block and you block serotonin receptor two A you will have a deeper better quality of sleep and that's why it's not addicting.

It's not affecting ghab, it's affecting serotonin.

>> So it's thought that you could use it for years and years if you wish to do so, even use it during pregnancy during the third trimester for women.

>> So Trazodone is a safe medication to take and there are other medications out there like Trazodone but they might have more side effects quit typing or Seroquel has been used for a long time as an alternative to Trazodone.

It's a bit stronger for sleep but it can cause people some problems itself.

>> So as melatonin a good option for you?

Well, melatonin is an entirely different medication.

Where's Trazodone will help you get a deeper sleep, help you dream sleep last for about eight hours.

>> Melatonin is like a puff of smoke.

You take one and a half, three or maybe five milligrams of melatonin.

It gets in your system within 30 minutes to an hour and gives you the brain gives your brain the chemical signal to go to sleep and it happens with all of us.

>> Melatonin is natural.

It gets decently absorbed in the melatonin comes from the pineal body which is right in the middle of the brain a little p shaped body, the pineal gland will secrete melatonin in a pulsatile manner.

>> So as it gets dark, as it's getting closer to nighttime, melatonin levels start to go up and that gives your brain the chemical signal to go to sleep if you fight past the melatonin after about an hour and a half you'll be wide awake.

>> So melatonin is there briefly and then it's gone.

>> So it's there briefly and this gone where we use melatonin.

Randy will be for people who have difficulty with jetlag.

>> Maybe you're flying across the country and you're having a hard time going to sleep because you're in a whole different time zone.

Melatonin will artificially get your brain going to sleep a little bit easier.

>> Melatonin can be safely used in adolescents, for instance, who by nature are developing brains will want to stay up later.

>> Adolescents have what's called a delayed circadian rhythm disturbance where instead of going to bed at 10:00 p.m. they want to go to bed at midnight and get up at nine a.m. That's why adolescents have so much difficulty getting up for school.

>> Their brains naturally by the nature of their brains growing their brains want to go to bed later and sleep in later so melatonin can be used safely for adolescents three mgs is ideal at bedtime for the purpose of getting the sleep earlier but melatonin will help you get to sleep if you're having a hard time getting to sleep, if you're worrying if you're having a hard time shutting your brain off and might be a little bit more difficult for the melatonin to work but for many people they'll use melatonin for what we call middle I'm sorry that we call initial insomnia.

>> There's initial insomnia where we have trouble getting to sleep.

There's Middleton insomnia where you have trouble with waking up after two or three hours in your brain's going and going and you have a hard time getting back to sleep.

Then there's terminal insomnia where you awaken in the early morning hours and you just can't get back to sleep but you haven't had enough sleep.

>> So if you have initial insomnia that's where melatonin can be particularly helpful for you.

But it's it's an entirely different medication as is Trazodone.

So if Trazodone is working for you I'd wonder, Randi, why you'd want to go off of it if you want to cut back on it to 50 sometimes twenty five milligrams at bedtime that can be fined when you get over about two hundred milligrams of tragedy and that's where it starts to increase transmission of serotonin and that's where people will have more side effects.

>> Trazodone was approved by the Food and Drug Administration for depression believe the 1980 it's been around for a long time.

It was originally approved for depression at doses of three hundred and six hundred milligrams a day which is are huge doses.

>> But by the late 1980s it was discovered that Trazodone was a remarkable medication for sleep at low doses because at low doses Trazodone will specifically affect the serotonin receptors in such a way that basically will hone in on giving you a better quality of sleep without giving you a rebound if you go off of it without giving you a lot of side effects overall.

Randi, thanks for your call.

Let's go to our next caller.

>> Hello, Kelsey.

Welcome the mastermind Kelsey, you want to know about your teenager teenager gets extreme test anxiety.

>> Are there ways that she can use other strategies she can use to stay calm?

What I'd suggest for an adolescent who's having test anxiety, Kelsey would be number one, make sure she still takes the tests, don't get any special accommodations where she is not going to have toptak.

She needs to take the tests because that's part of going through school.

She still needs to do that.

But I would say do a practice test that's one of the best ways to get over any kind of anxiety practice, practice, practice and to relieve any phobias or any performance anxiety itself.

The best way to get around it would be to do practice situations.

>> So if you're having a lot of performance anxiety with playing the clarinet for instance, maybe play the clarinet in front of a few family members, then a few friends and a few neighbors and do a little brief performances in that way if you're having test anxiety, write out a few questions yourself as a parent and have have your child take a few test questions.

>> Just get the practice and get the routine of doing that.

Many people will have trouble with test anxiety because number one, they don't know the material the best way you get over test anxiety do know the material.

Secondly, they get under they feel like they get under pressure for getting the test questions done so it's important for them to read the test questions.

You know, the rule of thumb always is your first instinct on the answer is usually the best when you go back and start erasing things more often than not you're going to be wrong.

But it's OK to go back and check your work to make sure you didn't misread something.

But more often than not try to read through question by question by question.

>> But many people feel anxious when they get into the gun.

We don't like to give medications like Xanax or alprazolam for medication as medications to help people test anxiety.

We'll do that in desperation sometimes for college students.

But my only issue with alprazolam and Xanax for test anxiety yeah, it'll chilly out and help you feel calm.

>> But the problem is Xanax or alprazolam can affect your ability to remember things and slow down the processing your brain so we try not to give Xanax unless that's the only thing that allows somebody to get in the room and get through the day itself because once they get started often they're going to be better and we hope not to use those kinds of medications Xanax which is lining's a pain.

>> We'll use that for older children or young adults if you use those medication we usually will use them short term but the idea of using them is medication will be to get them in the door.

>> But Kelsi, you can always have your adolescent see a counselor as a means of just looking through looking at some at some practice situations and some techniques to decrease some of that anxiety.

>> Sometimes simply doing some practice test questions is a really good place to start.

Kelsey, thanks for your question.

>> Let's go to our next caller.

Hello, welcome to Matters of Mind Show you want to know how do you know if you have seasonal affective disorder and what are the signs?

>> Seasonal Affective Disorder.

She comes around October every year and is predictive that it's going to occur during certain months for most people when you have seasonal affective disorder you feel fine throughout most of the year.

>> It's just that certain seasons most commonly winter, the fall and winter can be tough for people and it happens because there's less sunlight.

>> So with less sunlight it's not stimulating the retina as much and if it's not affecting the Regnier much as much, the Retin-A are not giving a chemical signal to the pituitary gland which is where melatonin lives that I mentioned earlier that earlier with less milk, with higher amounts melatonin you'll have more tiredness, you'll have more difficulty with sleepiness you want to feels like you want to sleep in.

>> So with lower amounts of the light you'll have a higher amount of melatonin so light will decrease melatonin darkness will increase melatonin.

That's why melatonin is called the vampire hormone because darkness makes it rise so with the higher amount of melatonin and in somebody's brain they'll often have difficulty with overeating.

They don't want to socialize, are more tired and you know you& have seasonal affective disorder if it's predictive to predictably happening particularly on darker days in the fall and winter and then it goes away once the days become brighter typically around April you start feeling better.

April, May, June, July, August, September often are fine for people with winter depression.

Rarely do we hear about somebody with seasonal affective disorder where they have more problems in April and May but there's a particular type of seasonal affective disorder that's characterized by people getting more manic in April and May and that's when manic episodes tend to peak when it's getting brighter it's it's becoming nicer weather.

>> But Seasonal Affective Disorder is highly determined by the brightness of the skies.

So in the morning when the sky is bright, the first thing you want to do as soon as the sun's coming up you want to get out and maybe go for a walk for twenty, thirty minutes.

Exercise can do a really nice job with seasonal affective disorder sitting in front of a bright light box and you can talk to your doctor about acquiring one of those but there's bright light box that people can quietly sit in front of a light box for about twenty minutes or so every morning throughout the fall and winter.

It's one of the best treatments will be out there for seasonal affective disorder.

Many people will say it's life changing.

We do use medications for seasonal affective disorder Wellbutrin to be appropriate actually has been approved by the Food and Drug Administration for depression related to seasonal affective disorder.

But the best things you can do will be a light box exercise socializing and be aware of how many carbohydrates you're taking in.

Many people will go into a hibernation mode in the fall and winter and that will actually worsen the seasonal affective disorder and cause them to even feel more reclusive and kind of feel blah.

In northeastern Indiana, a study done long ago demonstrated that on the average people gain about nine pounds in the wintertime in northeastern Indiana.

>> So just be aware of how much you're eating during that time.

Thanks for your call.

Let's go our next caller caller hello Matthew.

>> Welcome to Meyers of mind.

Matthew, you had mentioned you're in your 50s.

You triple check everything before leaving the house.

Anything you could do to feel more confident.

Just go grab your keys and goes yeah, just grab your keys and go Matthew.

>> I mean if you triple check everything maybe go back down to double checking.

I get it that you have a recheck certain things whether it be the stove, the back door, whatever checking once is OK. >> Checking it twice is not too bad if you check a third time and you know you've already checked twice that's where it's excessive.

Get yourself out the door.

You'll feel anxious momentarily but then you'll leave and you'll come back home realizing already checked out a couple of times everything's locked up, the stove's off, everything's in its place that gives you confidence and each time you can leave.

>> But the worst thing you can do when you're checking again and again and again is to keep checking again and again and again if you keep going back and doing it it just creates more anxiety if you don't do it several times, the best way to relieve any kind of compulsion like that, Matthew, will be to stop following through with your impulse to want to do it.

>> Just say in your mind stop you and set out why a lot of you wish to do so.

>> There's actually a technique where somebody will say stop out loud and it basically affects this front part of the brain when people have true obsessive compulsive disorder and they're washing their hands over and over again, they're checking things over and over again.

They're rethinking things over and over again.

>> There's this circuit in the brain that just goes round and round and just gets stuck like one of the old needles on the old record players and if you say stop out loud said quietly enough maybe two other people wouldn't hear you say it.

But if you say stop out loud it actually can halt that circuitry momentarily and get you away from it.

>> But be aware that you're checking maybe excessively a couple of times of checking things perfectly fine.

I was a pharmacist before I went to medical school in pharmacy school they taught us to triple check every single thing before it went out the over the counter to the patient.

So I get it the triple checking is OK and a lot of situations especially if you're a pharmacist but if you're trying to leave and checking a couple times it's probably OK. >> It's when you're going back to check where you know it's not necessary to check and that's where it's becoming problematic for you.

So you don't want to do that yet.

A third time.

>> Matthew, thank you for your call.

Let's go to our next e-mail question.

Our next e-mail question three dear Fauver, I'm taking Lexapro and experiencing nausea over the over the counter remedies don't seem to work.

>> Do you have any recommendations?

Lexapro increases serotonin in your brain and if you increase serotonin all over the brain you're going to stimulate 14 different serotonin receptors.

They go by letters, they go by numbers and the receptor that's stimulated by serotonin directly will be serotonin receptor three a and if you or three actually if you stimulate serotonin receptor three it will give you nausea as a side effect.

>> So here you get the brain getting flooded with serotonin from Lexapro.

It's stimulating in a good way.

Serotonin one a receptor is a stimulating various receptor serotonin seven is a good one to the effect.

>> So all these different receptors are getting stimulated but if it stimulates serotonin three which it will it'll make you nauseated.

So what do you do?

No one with Lexapro make sure to take it with food.

Your biggest meal the day is ideal from a lot of people.

That's their evening meal number two you could take it with an antacid but it sounds like you've tried those type of things.

We will often have people take Lexapro with a medication called On Danceteria and also known as Zofran.

Zofran does one thing it blocks serotonin receptor three so if you block serotonin receptor three that will often alleviate the nausea very well by itself.

Zofran Rons and Cetron it came out about twenty five years ago and I remember when it came out it was more expensive milligram per milligram than diamonds.

>> I mean great medication for what it did.

It's it blocked serotonin three receptors and it could be a good medication use during pregnancy during nausea related to serotonin medications.

But boy was expensive now thank goodness on dance Itron it comes on dissolvable tablets four milligrams at a time.

It's very, very inexpensive now so very cheap .

So that's a medication remedy that will often use you could with the Lexapro split up the dosing some and do this with your clinicians supervision where you take half the dosage in the morning, half the dosage in the evening.

>> But for many people if they take it with food lowering the dosage can help to thanks for your help.

>> Let's well 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 at The Hague I'm psychiatrist Jeff Oliver and you've been watching Matters of the Mind on PBS Fort Wayne God willing and PBS willing.

I'll be back again next week.

>> Thanks for watching.

Goodnight