Good evening.

I'm psychiatrist Jeff Alver live from Fort Wayne , Indiana.

Welcome to Matters of the Mind.

>> Now in its 10th 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 in the Fort Wayne area by dialing (969) 27 two zero or if you're calling any place else coast to coast you might call toll free at 866- (969) 27 two zero.

>> Now on a fairly regular basis we're broadcasting live every Monday night from our spectacular PBS Fort Wayne studios which lightly shadows of the Purdue Fort Wayne campus .

And if you'd like to contact me with an email question that I can answer on the air, you may write me via the Internet at matters of the mind all one word at big that's matters of the mind at WFYI or and let's start with tonight's program with an email I recently received.

>> It reads You wrote a favor please explain transient global amnesia.

>> Is it preventable and can it occur this the process this is a phenomenon that I first encountered way back in my residency in the 1980s and I've always been intrigued by a I've probably seen maybe a dozen cases of transient global amnesia over the course of my career and it affects people particularly women a little bit more than men between the ages of 50 and 70 years old.

>> And it's a phenomenon where you have several hours of just missing downloading material into your brain so you have trouble with recent memory what you're doing currently you remember who you are but you might not remember where you were you've been what you're doing.

>> It basically affects this part of the brain called the hippocampus BACE the hippocampus is this yellow part of the brain brain's shaped like a boxing glove.

The thumb part of the brain is the temporal lobe.

Hippocampus is right on top of that.

This is where you store your memories and for whatever reason there's decreased blood flow and decreased glucose metabolism when somebody is having an episode where they totally forget what they've been doing or where they've been and it goes on typically for six, 12 hours no more than 24 hours it's different from a stroke.

It's different from a transient ischemic attack in those instances there's there's distinctive damage that can be done the brain with a transient with transient which by nature of the name means that just short term global meaning all over the brain it affects your entire memory and amnesia and refers to the memory itself.

>> But it'll affect the memory center for a matter of hours and then it totally goes away.

>> You do an MRI, everything's normal, you do an EEG looking at brain wave tests, everything's normal.

>> So what caused it?

Well nobody knows for sure but the suspicions will be number one emotional stress can influence and that's why psychiatrist or sometimes brought in somebody who's had recent emotional stress that can be an influence.

Number two , if you've had a lot of physical activity, recent physical activity can be an influence.

Number three, if you've had a history of migraine headaches, migraine headaches sometimes as an episode of migraine can give you that overactive surge of this chemical called glutamate and when glutamate is overactive in the brain it can short circuit this hippocampus on each side of the brain and it's not unlike having a surge of electricity in your electrical system at home where you're a circuit breaker just pops.

>> And what are you doing in a circuit breaker Pops?

You go into the circuit box and you flip the little switch and it all comes back in the case of transient global amnesia that the effect of that overloading of the circuit and getting that circuit breaker popping goes on for several hours afterwards we perfectly fine.

Now here's the good news with transient global amnesia, the the risk of it ever occurring again is anywhere between one out of 20 and at the most one out of four three to four chance you're not going to have it occur again.

There are some people that have it occur again.

>> Secondly, you don't treat it.

You do not treat it.

You don't give somebody aspirin.

You don't give people Alzheimer's medications.

You certainly don't give people antipsychotic medications are antianxiety medications so you don't treat it.

>> You just kind of sit back and wait and observe.

You don't drive for 24 to 48 hours typically after it happens but you don't treat it with any medication neurologically or psychiatrically.

And the very, very, very good news it does not predict future stroke now transient ischemic attack which is where you have difficulty with stroke like symptoms for several hours are going on for up to a few days.

A transient ischemic attack can predict a future stroke transient global amnesia where you're mainly affecting your memory that does not predict future stroke at all and very significantly the very good news is transient global amnesia does not predict your likelihood of having dementia no relationship to dementia at all.

>> So when you think about transient global amnesia basically a better term would be hypo functioning of the hippocampus but that would be too long of a term to remember.

>> But basically it's this outside part of the brain just shutting down briefly and it's not unlike your cell phone you're trying to record something on your cell phone and your record button gets stuck for several hours.

>> So during that time you can't get access to your data on your cell phone.

You're not recording and then for whatever reason out on its own spontaneously after about six or eight hours everything works.

But that time of recording didn't happen.

In other words, when you're trying to record something during those several hours nothing process.

>> So when you've had a transient global amnesia episode you won't remember what you did over the course of those several hours when you were having that spell where you weren't processing information you can do you can still do things perfectly well because you're using a different part of your brain when you're functioning on a day to day basis.

I often hear about people having transient global amnesia episodes when they're driving and they get to their intended destination unlike people who have a early onset dementia, when people have early onset dementia they'll gradually have day by day by day difficulty with memory impairment.

They'll have geographical disturbances where they get lost and that's happening more often or not and it gets worse over the course of time with transient global amnesia.

>> It's a one time occurrence.

It occurs very abruptly out of the blue.

Yeah, we're still going to do blood tests and neurological work ups but generally we treat it and it does not predict future neurological disturbances.

>> I hope that helped out and you can probably follow up with a neurologist in a few weeks typically is what they'll have you do but they will not treat it because it's a phenomenon where your brain's been overloaded.

>> You've had a short circuiting during that time and there's no necessary treatment.

>> Thanks for your call.

Let's go to our first caller.

Hello Trisha.

Welcome to Matters of Mind.

>> Trish, you want to know about self-esteem?

What can you do to boost your self-esteem and how does low self-esteem trigger mental health disorders?

I think Tricia and we talk about self-esteem you have to determine what is your baseline for self-esteem?

How are you comparing yourself to others because that's often the source of self-esteem.

So determining what you would define as your self-esteem often will relate to how you compare to other people in your own mind.

So what are you what are many people do in the twenty first century?

Well, they'll look at social media and their self-esteem will be determined by likes by how other people in her peer group are doing with their lives and often social media can be quite distorter and how they depict somebody's life .

So I think right off the bat you have to determine what your baseline is for self-esteem.

What can you do what people off will do when they try to evaluate their accomplishments or their failures is they focus on the failures.

They focus on things that didn't go right.

Some things sometimes things don't go the way you want for a purpose and you end up going a whole different direction.

So I think the focus for you should be maintaining gratitude diary in other words a gratitude diary would be considering on a day to day basis or maybe a week to week basis all the different things in which you find gratitude.

>> What are you grateful for happening in your life and what are you grateful in terms of the things you're able to accomplish at this point?

>> And another thing is the sitter keeping a diary diary.

I recommend this to a lot of people where I recommend that they write down the things that are really worrisome for them and then look back on those worries maybe several weeks or several months later and they'll often find the worries they had today were not so problematic for them as time went on.

It gives you reassurance that, you know, things work out and sometimes they work out for the better even though you wouldn't expect them to go that direction.

>> Thanks for your call.

Let's go next caller.

>> Hello Chuck.

Welcome to Mastermind.

Chuckie had asked about Springboro.

Are you able to use bravado for depression with over-the-counter allergy nasal spray?

Yes you are an allergy nasal spray if you're using Salvato as you're aware Chuck, it's a nasal treatment for depression.

You go into the clinic two times a week the first month one time a week, the second month every week or every other week thereafter and you sit there after receiving a nasal spray of ketamine, a left sided piece of ketamine and bravado gets absorbed in peak blood level about forty minutes and then you have to be monitored for a total of two hours.

You can't drive or operate machinery the rest of the day but it's a treatment for depression for treatment resistant depression know people ask can they use an over-the-counter nasal spray?

What we recommend is that people don't use it that morning and maybe they skip that dosage or at least use it later in the day.

But what you don't want to typically do was bravado is use the nasal spray for allergies right before going in to getting this bravado a trauma can affect its absorption.

>> So I'd recommend you using the nasal spray after the treatment itself or skip the dosage on that day.

>> Thanks for your call.

Let's go next caller.

>> Hello Jason.

Welcome the mastermind Jason, you've mentioned you've tried a lot of different medications to treat anxiety, depression.

None of them seem to work.

Any advice, Jason?

The first thing I consider is do you really have depression or anxiety in the traditional sense?

What's the source of depression or anxiety and kind of step back?

Because when you talk about different medication, keep in mind, Jason, there's over 60 different antidepressant medications and there's over 20 different mood stabilizers, the mood stabilizing medications that we use and sometimes we put these medications together so it's like a vegetable soup with vegetable soup.

You know, you can have a whole bunch of different vegetables in the vegetable soup or you can just have potatoes so often with the treatment of depression, not unlike the treatment of asthma, depression or asthma, diabetes, hypertension, all these kind of conditions often warrant multiple medications that have different mechanisms of action, especially if they're more difficult to treat now the first thing I want to do is try to sort out do you have major depression?

>> Do you have recurrent depression?

Do you have depression with mixed features anxious distress, psychotic symptoms?

>> We want to know what kind of diagnostically symptoms you have that we're trying to target with medications.

>> So it's not unlike if you have chest pain, if you have chest discomfort you want to know she has a chest discomfort from a heart attack.

Is it from gastric reflux or is it from pneumonia bronchitis?

>> What's causing the chest discomfort?

It might just be that you're choking on a peanut.

I mean you're going to treat all those different ideologies of chest discomfort entirely different ways.

The same can be true in treating depression anxiety.

We want to know is the depression associated with certain features?

Is the anxiety associated with OCD post-traumatic stress disorder?

Is it a social a social anxiety generalized anxiety panic disorder?

We're going to look at all these different types of anxiety that might be problematic and based on the type of depression, based on the type of anxiety which often do overlap, then we're going to determine what medication might work best for you.

That might be a combination where you're going to affect norepinephrine serotonin and or dopamine.

>> Sometimes we bring in the antipsychotic medications which are now being used in entirely different ways than just for psychosis where they're using their mood for mood stabilization.

If you have difficulty with putting up with stuff and we call that stress resilience all will add medications like Lamotrigine or Lamictal sometimes Trileptal also known as orks carbamazepine.

So we've got a lot of different combinations of medication we might consider.

>> I'd very much want to know what kind of treatment responses you've had in the past.

Often we're going to look at your medication from a category categorical standpoint and look at mechanisms of action and see which medications might work better or worse than others and put that picture all together and there were no one to know what kind of responses if any, your family members have had with medications for depression and anxiety.

That could be a huge tip off often overlooked by a lot of clinicians.

But a simple question of have you had a mother, father, brother or sister have similar symptoms and have they been on medications having good or bad effects from any medication?

>> That's a big, big clue for us.

We do genetic testing.

Genetic testing is not definitive but it might just kind of tip the scale a little bit to help us determine if you need a high or low dosage on medication and what mechanisms of action might do better for you.

>> Now if you've been on various medications for depression and anxiety, most likely they're primarily affecting norepinephrine serotonin and dopamine.

Those have been the mechanisms of action of medications that we've been using for depression and anxiety predominantly for the past 60 years.

But now we have mechanisms that will affect glutamate.

>> And you heard earlier possibly that the the use of bravado is bravado is the left sided piece of ketamine and Prado's a nasal spray bravado is going to affect glutamate.

>> So it's a nasal breath and glutamate.

We now have a an oral medication as a tablet called All Valide of it is basically two medications that have been around for a long time in combination.

Bupropion is there.

That's also known as Wellbutrin.

It's bound since 1989.

It's there for the purpose of increasing the blood level of the second medication that's dextromethorphan.

Dextromethorphan has been available as a cough suppress and since the 1950s.

So it's been around for a long time high levels of dextromethorphan in this particular mechanist mechanistic way can increase glutamate transmission in a way that you won't see with lower levels of dextromethorphan.

So we have a lot of different mechanism of action from a medication standpoint and quite frankly some people will have depression anxiety quite frankly because of stuff happening in their day to day lives.

Now back in the 1980s when I was trained we would always start with psychotherapy with somebody and consider as a last resort the possibility of medication.

Now we have a much more sophisticated means of examining the effects of medication and knowing how they might respond to people.

So now will often start with medication for the purpose of allowing a person to have a normally functioning brain so they can think and concentrate and focus and in doing so they often do better in counseling.

But some people will have past traumatic experiences and they will need counseling to deal with the trauma itself with such techniques as eye movement desensitization and reprocessing MDR Eye Movement Desensitization and reprocessing MDR is very good for PTSD obsessive compulsive disorder.

If that's an anxiety cluster of symptoms you're experiencing we're often going to do we're going to use specific medications that are affecting serotonin in those cases.

So we're going to try to match the medications to what the underlying condition will be.

>> Now some people might say well gee I don't want to have a diagnosis.

>> Well, again, if you have chest pain and you say I don't want to have a diagnosis of anything involving this chest pain, well how are you going to know what to treat?

Are you going to treat the heart?

You can treat the lungs, you can treat the stomach.

You've got to understand the the underlying pathology of the chest pain itself to be able to direct your medication treatment and that's what we'll do in psychiatry.

We're trying to figure out the source of the underlying problem and diagnostically that's going to direct our medications because medications have been studied and approved and used even off label for that matter for certain conditions.

>> So we're guided in the use of medications based on the condition that we're treating itself.

>> Thanks for your call.

Let's go to our next caller.

Hello Shannon.

Welcome to Matters of Mind.

Shannon, you had mentioned you have a child with obsessive compulsive disorder.

How can you positive positively, positively share the child so they don't spiral itself?

Shannon, I recommend that if you have a child with obsessive compulsive disorder, make sure the child is getting some treatment because OCD basically can be triggered by strep infections in childhood if you have a strep infections sore throat caused by streptococcus the strep bacteria, I will go to the front part the brain and the antibodies will attack the strep back to you in the front part of the brain and thereby cause this looping effect of obsessions.

Obsessions basically are where you have unwanted thoughts that don't make any sense to you at all but they're still in your mind and they cause a lot of anxiety sometimes it lead to compulsions where you do things and count things and check things over and over and over again unnecessarily and you do them to an excess.

>> So OCD goes beyond just worry.

OCD is where you have unnatural thoughts and because of this looping mechanism in the front part of the brain where it's like a little needle getting stuck on the old record players and you just can't process the information adequately.

So no one I'd want to make sure that your child is getting proper treatment for that condition and especially if the child has had any difficulty in the past with strep infections, make sure those get treated sooner rather than later, especially if they're recurrent in nature.

But there are treatments for OCD.

What can you do to reassure your child?

Well, basically try to understand OCD the best you can and learn techniques typically from a child therapist to learn techniques to be able to redirect the child when he or she is having those kind of episodes of the compulsions, the obsessions and so forth.

But from a diagnostic standpoint, if you're talking about OCD or want to make sure that it truly is OCD obsessive compulsive disorder is one thing generalized anxiety disorder where you have ruminative worries and you're dwelling on things you're worried about the future that's an entirely different process.

So the first thing I don't want to know is does the child really have OCD or is it more generalized anxiety?

>> We're going to treat those in an entirely different ways.

Thanks for your call.

Let's go next caller.

>> Hello Winston.

Welcome to the Mind.

>> Listen, my brain's falling apart here so I've got to get my brain back together.

You had asked what did how does dehydration affect the brain?

>> Dehydration can affect the brain by affecting sodium levels.

Winsted And when you're dehydrated yeah.

I can kind of make you delirious and then to the extreme extent because with dehydration you can have sodium disturbances.

You need to have the electrolyte balance in the brain itself.

Some what I've heard from the renal doctor is the kidney doctors will be we should drink to our thirst.

We shouldn't just automatically drink five gallons of water every day like some people have advocated that's going to work or kidneys really hard.

>> But we need to drink adequately to keep ourselves from being thirsty and usually that's adequate for maintaining brain functioning overall.

>> Thanks for your call wisdom.

Let's go our next e-mail question our next e-mail question reads Dear Dr.

Farber, do you treat someone or do you treat someone exhibiting depression for the first time differently than someone who has a recurrence of depression over after several years a recurrence of depression after several years?

>> Usually depression will take on a life of its own when somebody's currently been depressed for many, many years, it takes less stress to bring it out.

>> The first episode of Depression typically will be precipitated by something so it can be a work disturbance.

>> It can be a school stress, interpersonal conflict, a marital conflict.

>> Something usually kicks off the first episode of depression so the first episode of depression will often look at precipitating factors and will get people involved in psychotherapy for the purpose of trying to get them in a treatment that addresses the underlying stress itself.

>> We may or may not use medications with the first episode of depression knowing that if you've had one episode of depression you're less likely to have recurrent episodes of depression especially you get address the underlying stress that occurred with recurrent episodes of depression.

We're talking about two week episodes over the course of two, three, four times six times over the course of your lifetime.

>> The more episodes of depression you experience, the more likely you're going to just spontaneously wake up on a Wednesday morning and all of a sudden you feel depressed in those cases episodic episodic bouts of depression are not necessarily precipitated by stress themselves.

We want to first get sleep under really control because lack of sleep or sleep disturbances can cause you to be a higher likelihood of having trouble with depression as a cascade.

Not uncommonly people will have anxiety which leads to sleep disturbances which leads to more depression.

>> So we want to try to give the whole spectrum of the symptoms under control as soon as possible.

>> But early on I think with the first episode of depression we're going to look for more more for individual precipitant that might have brought that on.

>> Depression is about 33 percent genetic so it does run in families.

There's a genetic propensity but it's not guaranteed everybody is going to get depressed if you have a family member with depression.

>> Thank you for your call.

Let's go next caller.

Hello, Tabitha.

Welcome to Matters of Mind.

Tabitha, you want to know how does lack of sleep make people feel on edge and how can you set up a good sleep ritual?

>> Well, the main thing sleep is doing from a mood standpoint is letting the rest letting the front part of the brain rest the prefrontal cortex here, especially the dorsolateral prefrontal cortex on the left side here are predominantly that needs to rested right.

>> That's the thinking part of the brain.

That's the part of the brain that you are using to pay attention to things to focus on things.

>> Then you have the orbital lateral prefrontal cortex right above the eyeball that needs to rest at night.

>> That's the part of the brain that you're using to make good decisions and to make the final call when you've weighed the pros and cons of everything happening around you.

So this whole complex of the prefrontal cortex is resting at nighttime.

>> That's why people will dream in a very abstract manner because their dreams will make sense to them.

It's because this is the rational part of the brain, the rational part of the brain is resting at night.

You need to have a rest if you don't because you're staying up late at night for various reasons.

If you're not getting good sleep, your ability to cope and maintain stress, resilience and think through your problems will all be deteriorating and that's where you have trouble with feeling on edge and irritable.

So we often hear as I mentioned earlier, this cascade where people will start worrying about things that leads to they're staying up at night because they are trying to work out their problems.

>> They can't go to sleep and that will thereby lead to difficulty with coping and resilience and they feel more irritable and anxious the next day.

>> So that's why in psychiatry we're always going to ask you how many hours or do you sleep?

Do you have any trouble getting to sleep, staying asleep, waking up early in the morning?

Are you feeling refreshed?

The next day we're going to look for underlying sleep disturbances like nightmares, sleepwalking, sleep apnea and in doing so we're going to determine are you getting refreshing sleep that's adequately recharging your brain and sometimes we can just start with that.

How do you maintain sleep hygiene as you would ask?

Well, No one try to get the bed the same time every night when you start getting tired, go to bed.

I mean that's not a good time to pull out the social media and start looking and scrolling through different things that can keep you awake for another hour when you go to bed, go to bed and I often recommend that people read a book as opposed to having their cell phone out as they're trying to go to sleep.

If you have your cell phone out or you try to go to sleep, put a time limitation on it and insist that you're going to go you're going to turn it off at a certain time because it's so easy for a lot of people once they get on social media and they get stuck in the algorithms going from one thing to another to another, well they can be up for an extra hour or so that disrupts your sleep right off the bat and then you have to get up a certain time in the morning and next thing you know you're in sleep debt so that's not a problem.

>> That's going to be a problem for a lot of people.

Thanks for your call.

Unfortunately I'm out of time for this evening.

>> If you have any questions that I can answer on the air or you may write me via the Internet the the Internet at matters of the mind all one word at WFB Dog I'm psychiatrist Fauver and you've been watching matters of mine on PBS Fort Wayne now available on YouTube.

God willing and PBS willing.

>> I'll be back again next week.

Thanks for watching.

Good night