?

>> Good evening.

I'm psychiatrist Jeff Olver live from the U.S.

studios in 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 two zero (969) 27 two zero.

However, you can also text me live during this program where I can see your text by texting two six zero (969) 27 three zero and let me know give me a name to which I can refer you and also give me the town where you might be from where you may be calling on a fairly regular basis where we're broadcasting live every Monday night from our spectacular PBS Fort Wayne studios which lie in the shadows of the Purdue foreign campus.

And if you'd like to contact me with an email question they can answer on the air.

>> You may write me a via the Internet at matters of the mind all one word at WSW Edgar that's matters of the mind at WSW Edgard and I'll start tonight's program with an email I recently received.

>> It reads During the fovea and restless leg syndrome patients may have reduced brain iron, low ferritin and low dopamine.

>> Is it possible that high ferritin yields higher brain dopamine, even amyloid beta plaques and neurofibrillary tangles or other psychiatric consequences?

>> A very sophisticated question there.

So let's review some of this low iron will give you low fare to not uncommonly iron is coming from the food that you are eating and it gets absorbed ion carries oxygen in the body through hemoglobin.

>> Ferritin is a protein that carries and stores iron so ferritin is often a nice way of determining if somebody is low on iron ore overall and low ferritin can be a key for determining why somebody might have restless leg syndrome.

>> So when somebody has restless leg syndrome low iron will be a factor and restless leg syndrome is also associated with low dopamine transmission .

So what we often try to do with restless leg syndrome is enhance dopamine transmission many times doing that indirectly through medications such as beta blockers such as propranolol which indirectly will increase dopamine.

So we'll consider those kind of factors you'd mentioned high ion that's not good either.

High iron will be levels over three hundred generally men tend to run higher ions higher ferritin levels than women.

>> But when you have a high ferritin level determining that you have high iron stores that will give you difficulty with weakness.

>> It'll give you difficulty with thinking concentration the iron can kind of accumulate in these little amyloid plaques and basically what you describing there the amyloid plaques, the neurofibrillary tangles those are just gunky things in the brain that will cause you to have memory disturbances and high iron levels can contribute to that so high iron why do people have high iron inflammation can do that chronic alcohol use liver disease, certain kinds of cancer thyroid disturbances can all give you high iron levels and that's not good for the brain either.

>> So high iron can give you high ferritin levels which are the storage product overall.

>> So we want to get the iron level just right for people to be able to allow them to function appropriately.

Thanks your email.

Let's go to our next look.

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

Our next e-mail question reads here it is disruptive however is it possible for someone to experience post-traumatic stress disorder for the first time many years after a triggering event?

>> I feel as though I'm experiencing anxiety from an event many years ago.

It can happen now.

Not always will people have an abrupt sense of anxiety after a traumatic event.

It can be delayed sometimes for months if not years and that can occur sometimes based on a smell, a sound, a sight that reminds you of a past traumatic event.

>> You think where that come from many times it'll be manifested by a dream that people might give them a recollection but sometimes a sight sound and a smell.

The smells are really triggering for a lot of people who have experienced post-traumatic stress, your brain naturally will try to suppress a really bad memory.

The hippocampus here is the memory center of the brain.

>> When you have an intense trauma occur that intense trauma can fire up the amygdala right up front here.

That's the anxiety, anger and anxiety volume control and if the amygdala gets fired up really excessively, your brain in a protective mode can sometimes suppress that memory for a while until maybe later on you let your guard down.

Maybe you haven't dealt with the triggering event that adequately and the memory can come back in the form of anxiety.

Many people with post-traumatic stress symptoms will have a sense of feeling really jumpy.

>> They'll be on high alert of things happening around them.

They sometimes will have this sense of depression and despair and they don't really know why.

So post-traumatic stress symptoms can occur at a later date.

>> Let's go to our next email question.

Our next email question reads Here we go.

>> Dear Dr.

Fauver, I am a therapist who periodically encounters clients who believe they are furries.

>> Should I affirm their beliefs or confront them?

Is this a delusion that can be treated with antipsychotic medication as well as therapists?

You know, whatever it is, I'm going to explain it to the rest of our viewers.

A furry is basically where a person is wearing a costume or they take on the identity of a furry animal so it could be a cat, a panther, a lion and they'll take on this identity often in community with other people who have the same kind of beliefs or ideas that they may be furries as well.

So it's often a community event and it's not unlike a gang.

>> All right.

So why do people join gangs?

>> People join gangs because they have a sense of belonging and they have a sense of community and many people who join gangs will have difficulty with a feeling as if they fit in to the rest of the community so they will join a furry community for because these people have common beliefs now like a gang if you try to get out of the furry community, people can get very upset with you and people can be very threatening if you say hey, I don't want to be a furry anymore, they can be very upset about that because again it's like more like community of them.

>> You likely didn't hear that much as a therapist about furries ten years ago I don't think you're going to be hearing much about for ten years from now.

>> I think it's a social contagion.

It's not a delusion.

>> A delusion is very personal.

A delusion is a fixed false belief and you might think gee, if somebody says they believe they're a dog that's fixed if you can't talk them out of it and it's a false belief because it's not true.

>> Well that's kind of true.

However, a social contagion is where people are doing so as a means of having a better sense of belonging to other people.

It's usually you hear about it with adolescents and young adults.

You typically don't hear about somebody who's 55 years of age all of a sudden believe in the river.

All right.

So if something is occurring with younger people, they're trying to become more socially connected with those around them and in doing so they will have these feelings that and they might truly believe it for the time being.

But it's not a delusion.

And I say that because your question was would would they respond to the antipsychotic medication?

No one, they likely wouldn't take an antipsychotic medication because their community around them wouldn't accept that.

>> And secondly, an antipsychotic medication is going to work anyway because it's not a neurobiological stirbois a psych psychosis which is where somebody loses touch with reality will often have a delusion accompanying it as a symptom.

A delusion is a fixed false belief.

The delusion it's thought that it's affecting this center right close to the hippocampus where you truly believe something that can't possibly be true.

OK, so if somebody believes that there are a cat they don't have the genetics for a cat.

They don't have the physical make up for a cat.

They're not a cat but they believe they are because it gives them a sense of community with those with whom they're involved.

Now the problem with the perception of being a furry is you'll often find those people will have difficulty communicating and socializing with people who are outside of that spectrum of belief so it becomes their entire identity.

What I think you can do as a therapist is to really try to emphasize of that person their identity is not in being a furry, their identity is being who they are.

>> So their identity is based on their attributes, their past experiences and their potential.

>> It's not based on their being a furry furry.

So you need to try to focus on their attributes outside of this community involvement which is a social contagion of being a furry because quite frankly there's a good likelihood in ten years from now that person is now no longer going to identify as being a furry and that could even occur next year to five years.

They're not going to have that identity have them focus on their own personal identity and their attributes.

>> Thanks for email.

Let's go to our first caller.

Hello Tyler.

Welcome to Matters of Mind.

Tyler, you had asked Ken a vitamin deficiency caused depression.

There's a particular type of vitamin deficiency that can cause depression.

It's mainly vitamin D D and dog deficiency.

>> They did studies in Denmark.

They have a vast a vast database of medical records in Denmark and they found that in Denmark which is where they have darker winters than we do here in Indiana but in Denmark with the darker winters they're more prone to having lower vitamin D levels because vitamin D is a hormone that's in the skin and upon exposure to sunlight it converts into a means it becomes active and vitamin D itself if it's deficient under twenty five is the level many times we try to get above 50 on the level but if it's deficient it tended to have a higher likelihood people getting depressed and going into the hospital because of depression.

So it was found that in Denmark that low vitamin D levels could be predictive of depression.

>> So that's the one vitamin I would suggest could be problematic.

Now if you have a particular genetic mutation called methylene Phare methylene tetra hydro folate reduc tace if you have a deficiency in that gene of GFR you're not going to adequately be able to break down folic acid.

>> Folic acid is a B vitamin and folic acid should break down into Elmsford late and far as that enzyme will be the enzyme that does that if you have a genetic deficiency in that activity of far and the only way you know that is through genetic testing that could give you more of a likelihood for depression, even anxiety disturbances.

The only way to test for that enzyme mutation may be to do genetic testing.

About one out of four people will have that particular mutation work could be helpful for them to take elemental folate in the active form.

It's like going to a turnstile if you imagine going to a stadium there's a turnstile there.

Folic acid is on the outside.

Folic acid to get inside has to go through the turnstile.

Turnstile is far enzyme if if the enzyme is working adequately the turnstile moves and you're able to go inside.

Getting inside Israel for so many people will recommend that will simply give them all methyl folate as the active form of folic acid and that's what a lot of women are doing nowadays when they're pregnant because when you're pregnant you want to make sure you have adequate methyl folate in your system and the prenatal vitamins now have LMI methyl folate in them.

Why?

Because if you're inadequate on all methyl folate and you're pregnant, you're at a higher risk for miscarriage.

>> So the higher risk for miscarriage during pregnancy, the higher risk for depression and anxiety if you're older and you're having trouble with different things in your lifetime at that time.

>> Thanks for your call.

Let's go next caller.

Hello Peter.

Welcome to bear in mind Peter, you mentioned that you started taking Zoloft also known as certainly it be addictive.

>> Will there be any withdrawal side effects if you stop taking it?

Peter, Zoloft is a medication has been around since nineteen ninety two .

It's also known as sertraline as a medication that's fairly selectively will increase transmission of serotonin and secondarily can enhance transmission of dopamine.

Zoloft is something that is not addictive in the sense that it's not going to be making you high.

>> You're not going to crave it.

You're not going to have physical withdrawal from discontinuing it but you might have discontinuations symptoms and that might sound like an oxymoron.

>> Well, discontinuations symptoms will be that it's not that your body is craving it upon your stopping it.

>> It's just that if you stop Zoloft at one hundred 150, 200 milligrams a day abruptly you can have tingling and dizziness and you can have kind of a brain brain zaps are described by some people.

So what we'll typically do is Zoloft is tapered over the course of six to twelve days not uncommon especially over time if you're on the higher doses.

But Zoloft is not thought to be addictive.

We've been using it again since nineteen ninety two .

It does enhance dopamine transmission but not in a way that will make you crave it or want to take higher and higher amounts of it.

Addictive medications the type of medications that will cause you to need to take higher and higher amounts of them and eventually over the course of time they might not work but they'll give you a feel good effect where you feel kind of high and euphoric early on but then they fade in their effects that Zoloft can make you feel good and help you with feeling emotionally blunted in a good way where your emotions aren't so profound especially early on.

>> But over the course of time we want to make sure the dosage is just right because if you take too much Zoloft you can feel kind of blah and we call it emotional blunting but where you don't feel happy, don't feel sad is feel kind of flatlined in your emotions.

That's not an addiction.

That just means you're getting a bit too much Zoloft and maybe it's not the right medication for you.

>> Peter, thanks for your call.

Let's go our next caller.

Hello Chris .

Welcome to Matters of Mind.

Chris , you want to know about what happens to untreated attention deficit disorder as an adult untreated ADHD as an adult?

It depends on the severity, Chris .

If you think about ADHD, attention deficit hyperactivity disorder, if you think about ADHD as being like near-sightedness all right with nearsightedness you might have trouble seeing things at a distance and with nearsightedness sometimes people will squint and they get by and they can it's not so problematic for them that it's not a big deal.

But other people they need to have their corrective lenses on as soon as they hit the ground in the morning because their vision is very impaired and they have trouble without any corrective lenses.

>> So they need to wear that corrective lenses all day long.

If you think about ADHD with adults it might not be as problematic as it was when you're younger now it used to be thought that ADHD was only a childhood and adolescence condition.

Then about the year 2000 it was discovered that the brain scans and the brain images of adults who had ADHD symptoms looked just the same as the children.

>> So now we realize that ADHD does have its onset typically in childhood and early adolescence you notice it it's a day to day phenomenon specifically as it involves challenging involves challenging type of activities were the thrill of initiating the activity has no longer pertinence.

So as you try to finish something and persevere in getting something done with ADHD you have difficulty doing that so you'll get started on something and you might get excited in starting new and exciting and novel things.

But as you continue to try to progress and finish things that's where it becomes difficult with ADHD as an adult where does that pertain?

Well as an adult if you have severe ADHD where it's impairing and can affect you socially with interacting with people because with ADHD you'll have trouble with conversations not only not just paying attention but you'll have trouble with tact and you'll have trouble with social connections because you'll want to interrupt and you'll want to in on conversations because when you have ADHD you're often think in three cents ahead of everybody else.

>> So with ADHD I'm often encouraging people to wait a few seconds before they blurt out what they have on their minds because yeah, I get it you're thinking ahead you're like a chess player who's thinking three steps ahead of everybody else but that's not necessarily a good thing that can be really annoying to other people.

>> You can have trouble with ADHD to a severe degree as a spouse I've seen some couples where one of the couples one of the spouses in a marriage will insist that the other one who has ADHD gets treated because it's so impactful that it causes the marriage to become somewhat frazzled because the person with ADHD has this difficulty has has difficulty irritability and impatience and not remembering things and the lack of remembering different things in the absentmindedness that many people will have with ADHD comes across as being uncaring for a lot of people.

>> So with ADHD we will talk to adults about getting it treated if it's becoming impairing in your marriage, in your social interactions and on the job because if you have to learn new activities on the job you will often need to be treated for ADHD not unlike giving somebody eyeglasses.

>> Thanks for your call.

Let's go next caller.

>> Hello Danny.

Welcome to Matters of Mind.

Yes, I had a question about the one all over the social media about ivermectin either in a prescription form or the I see a lot of people are using a lifestyle course paste for different things anxiety and most cancer and different types of stuff like that.

I was wondering your thoughts on that type of stuff as far as if it actually worked for anxiety and also sort of personal detox system as far as like another cleansing for parasites and stuff like that?

>> Yeah, I've not I've not seen any studies or any case reports about ivermectin being used in depression or anxiety.

>> Now as you probably recall during the covid pandemic it was speculated as being a treatment with active covid and there was a lot of controversy about that.

But I'd like to see more studied in conditions like depression, anxiety for multiple sclerosis.

>> Another conditions it might have some utility because as you know it was originally used for horses but it might like many medications used on animals that might have more utility and if ivermectin is going to be studied with depression anxiety, I want to study not only based on its benefits but I want it studied versus inactive placebo where the researcher and the patient won't know if they're getting ivermectin or placebo and you get about at least three hundred patients together to do that kind of study and then study them over the course of six weeks.

You want ivermectin versus placebo over the course of six weeks you've got half the patients on ivermectin and half the patients on placebo and then over the course of six weeks you do two things you determine based on objective outside observers who really don't know what who's getting which objective outside observers start to score how their depression is doing in each group and very, very importantly, Danny, I want to know what the safety issues are.

>> I've heard the same thing about cannabis cannabis.

>> I love the fact that it was rescheduled from schedule one which means no medical benefit to schedule three, which means potential medical benefit but it has some addictive features cannabis can have some medical benefits but I want to study it to determine if it's what kind of side effects you're going to see.

So if a medication is schedule one, you can't even study it because it's been determined that it's not beneficial at all cannabis I want to see OK, how well does it work versus sugar pill and how well does it work in terms of not only giving benefits but side effects you're going to have that's the kind of thing we need to see with ivermectin.

>> So I think the people talking about ivermectin on social media, they've had some excitement and hearing about it being effective in other areas .

>> If they're using ivermectin, they're having good effects.

Great.

I'm hoping they're not having any side effects but like with any medication we want to know about long term effects.

>> Now the Food and Drug Administration requires any medication brought for a new indication or new purpose has to be studied for a year looking for a long term safety issues and ivermectin to my awareness has not been studied over the course of a year in humans for long term safety issues because stuff pops up over the course of six to nine months.

>> There is a medication that was developed about twenty five years ago called Vioxx.

It was a nonsteroidal antiinflammatory medication in the same class as Motrin and Advil and Aleve.

>> So Vioxx was a medication and came right out of the gate as a nonsteroidal antiinflammatory medication for pain and within a matter of months it was determined it caused severe heart problems.

>> So Vioxx was taken off the market since that time the Food and Drug Administration is saying we need long term studies so I'm not one right now to suggest that people take ivermectin.

>> I think we have better things and better studied medication out there than ivermectin for depression and anxiety.

>> But I'd be the first to say I wouldn't be I wouldn't be apprehensive about the possibility of its giving benefit.

>> But I just want to see the actual studies themselves before we start jumping in and recommending it to people.

Thanks for your call.

>> Let's go to next text.

Hello Mark from Chair Bosco.

>> Mark, you had mentioned you feel overwhelmed and I think that your your your text oh there it is.

>> You're feeling overwhelmed.

You had mentioned that loved ones need some mental health care and you have a drinking problem.

>> Not sure where to start.

Omak number one you can start the primary care clinician to try to sort out any medical issues you might be experiencing if you have a drinking problem.

Obviously the alcohol is a factor but many, many people will use alcohol as a means of trying to cope with anxiety and depression.

>> People ask me all the time how did people deal with depression anxiety?

One hundred years ago?

Well, there was cocaine available one hundred years ago and there's a lot of alcohol available one hundred years ago.

So we didn't have these medications that we currently are using one hundred years ago because well they hadn't been developed yet but people did self medicate with alcohol.

>> So your likely self medicating with alcohol you could start with your primary care clinician.

>> Primary care clinicians are treating medicinally ninety percent of all cases of depression out there.

There's not enough of us psychiatrists if your primary care clinician perceives that you could benefit from seeing a psychiatrist or somebody in the psychiatric field, that'd be fantastic.

>> You can always get counseling.

Counseling is something where you basically counseling is like having a GPS in your car.

You know, if you drive to let's say Chicago, Chicago, you've got roads going all over the place.

You don't know where you're going in Chicago.

You don't have a lot of experience in Chicago.

Let's say you're having trouble determining what direction to go.

You've got all these exits in Chicago.

What helps in Chicago, a GPS so a GPS is telling you turn left, turn right.

You're going to be going another five miles up the road.

It gives you guidance on what direction you should go.

>> That's the role of counseling if you're in a life situation where you don't have past experience with what you're going through, you don't have the coping abilities you need direction that's where counseling can help you out and counselors are unlike family members or friends, they're trained objectively to look for your life circumstances and give you that guidance just like GPS would do now medications for feeling overwhelmed.

>> Yeah, we will use certain ones primary care doctors can initiate some of them.

But as a psychiatrist sometimes I'll look at a person diagnostically if or if you're having depression, anxiety and basically you're having trouble with resilience and you're having trouble putting up with stuff because of what you're going through.

We preferentially want to give you non-addictive medications.

We're getting away from using the benzodiazepines like Xanax ,Klonopin, Ativan, Valium.

>> Those are medications that were very popularly used 20 years ago.

My goodness.

when I came out of pharmacy school in nineteen seventy nine before I went to medical school Valium of all the medications prescribed Valium was the number one medication prescribed for anybody back in nineteen seventy nine .

Well we're getting way away from that because the so-called benzodiazepines like Valium and they kind of double your concentration.

They kind of slow down your ability to process information so it's like having slow Internet speed in your brain.

So we're trying to get away from using those medications for helping people cope .

We're using more antiepileptic medications to stabilize the brain chemistry lamotrigine gene gabapentin carbamazepine.

These are medications that help you kind put up with stuff hopefully with as few side effects as possible but especially not having the memory disturbances that you might have with the benzodiazepines.

Thanks for your call, Unfancy.

I'm out of time for this evening if you have any questions 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 org.

I'm psychiatrist Jeff Ormerod.

You've been watching matters of mine on PBS Fort Wayne now available on YouTube Godwill and PBS willing I'll be back again next week.

>> Thanks for watching tonight