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Good evening.

I'm sorry.

Good evening.

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

Welcome to Matters of the Mind now in its third year matters the mind is a live call in program where you have the chance to choose the topic for discussion.

So if you have any questions concerning mental health issues ,give me a call here at PBS Fort Wayne by dialing in the Fort Wayne area (969) 27 to zero or if you're calling any place coast to coast you may dial toll free at 866- (969) to seven to zero now on a fairly regular basis I am broadcasting live every Monday night from our spectacular Fort Wayne studios which 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 all one word at WFA dot org that's matters of the mind at WFA a dot org and I'll start tonight's program with a question I recently received.

It reads Dear Dr. Fauver can anxiety and depression in a person be caused by underlying attention deficit hyperactivity disorder?

How can this be identified?

Anxiety and depression often will be concomitant with ADHD.

>> They go hand in hand and it's usually the ADHD that starts first now ADHD by definition needs to start in childhood.

You don't all of a sudden get ADHD when you're 35 or 45 years of age that's due to depression, hypothyroidism, diabetes, low ironer and in the case of women when they get in their late 40s and early 50s they can have trouble with ADHD symptoms because they have menopausal symptoms.

But true ADHD occurs in childhood and it's persistent.

It's day by day by day and it's characterized by difficulty with inattentiveness and frequently distractibility and hyperactivity.

So when you have trouble with inattentiveness you have a hard time with focusing on things you're forgetful, you tend to be absent minded, you're inefficient in what you're doing.

What happens is you get behind on things and you start to misplace certain items.

>> You start to get distracted as you're leaving out the door .

So you're typically always late and you're getting behind if you're in school you're getting behind on your assignments because you procrastinate in the workplace.

It's taking you ten hours to get an eight hour day done so it causes a lot of anxiety and anxiety will often cascade into having difficulty with sleep.

So there's this cascade of anxiety that gives you difficulty with sleep with difficulty with sleep night by night that leads to depression.

So it starts here in this anxiety part of the brain called the amygdala as that gets more fired up, you get more anxious, you get more scared, you get more fearful.

That leads to difficulty asleep which affects the front part of the brain.

The front part of the brain affects judgment and and the perception of the world around you as that gets distorted you get more depressed because you perceive that other people feel badly about you as you do and you perceive that you are not as good as other people and that you want to give up and that you're not loved and all these different dimensions of depression that can often go hand in hand with ADHD.

So when we see somebody who has symptoms of ADHD and depression will often actually try to treat the depression first.

And as you treat the depression often you will find that the depressive symptoms can overwhelm the ADHD symptoms so so that when you have depression it might cause you to have poor concentration depression then can cause you to a worsening insomnia depression.

>> You can have a hard time with self-esteem.

You put all these together ADHD symptoms will be worse so will often try to treat the depression and get that under control and see how much ADHD problems will be there.

We might try to knock down a couple of birds with one stone.

For instance, if you have depression and ADHD we might use medications that can work for both such as bupropion also known as Wellbutrin or Vaud Occitan also known as Trend Telex.

Those medications can work typically by themselves for ADHD but they also are mainly FDA approved for depression.

So we'll try to use one medication to help with depression as well as a difficulty with focus and concentration.

What we don't want to do is treat someone for depression and indirectly inadvertently make the ADHD worse and this is why it's very important to try to identify if somebody has depression and ADHD because some medications can help with depression and even help with anxiety but they can make ADHD worse.

Those medications typically are the serotonin medications such as Prozac, Lexapro, Celexa, Zoloft and Paxil.

These medications predominantly are increasing serotonin which can be good for depression or anxiety for a lot of people.

But when you increase serotonin you can indirectly decrease dopamine.

Well, a decrease in dopamine is part of the problem that you'll see with ADHD.

So with ADHD we're trying to increase Obama and the serotonin medications can indirectly decrease that.

So sometimes we'll hear about people who are noticing that they're calmer they're less depressed on their serotonin medications but they're perceiving their concentration their focus might not be that much better.

So for those people will often change them over to Wellbutrin, maybe Trin talks at the very least we I put them on a medication like Cymbalta which increases serotonin and norepinephrine because about one out of four people with ADHD will do better with the neuro norepinephrine enhancers as opposed to the dopamine enhancers.

About three out of four people do well with the dopamine enhancers and those people will be the ones that do well on Wellbutrin the stimulants higher doses of Trin Telex and then you get the one out of four people who do better on the norepinephrine medications.

They do better on medications like Strattera and sometimes Cymbalta as well which can be used as an antidepressant medication that also helps with ADHD.

How do you predict who's going to do well on the dopamine versus norepinephrine medications for ADHD?

Well number one, you always look at someone's family history.

You look at the family history of treatment response.

You look at the mother, father, brother, sister if they've been treated for ADHD with certain medications and done well or not done so well, that'll be a predictor on how somebody might do.

Secondly, you look at the patient's past treatment response to medication if a patient has previously been on a stimulant or two or they've been on Wellbutrin as I saw a patient today been on stimulants and Wellbutrin, that patient that person did very poorly with their ADHD, those medications that was a clue to me that I need to get away from the dopamine side and go over the norepinephrine side and that person I put on Strattera instead and a third way of kind of predicting who's going to do well on medications or even Wellbutrin for that matter will be to look at genetic testing.

There's two particular genes that can predict if somebody is going to do well on a stimulant.

One is called OMT Caraco or Methyl Transferee C OMT has these different codes.

There's met code and there's a vowel code .

>> These codes are called illegals and if somebody has a Velvel code for instance, they can often do well with a stimulant especially if they have this other gene that's called a adrenergic to a gene and adrenergic to a gene can predict if they're going to do well on a stimulant as well.

So if they have those two genes together, add energy to the CMT gene and they both match up well for a stimulant that can be a good predictor.

But if they don't match up so well for a stimulant we'd often go another direction.

About one out of four people don't do well with a stimulant.

We used to think years ago that pretty much everybody with ADHD is going to respond well to a stimulant.

Now we know that some people just don't do so well and these are the people who will take a stimulant and they'll feel energetic and they might feel good from that but they feel irritable and they feel kind of hyper and it's kind of like having somebody who does not have poor vision wear eyeglasses.

If you don't have poor vision and you wear eyeglasses, your vision actually gets worse.

These people on stimulants who are not predictably good responders to stimulants will often have worsening concentration.

They have more energy but they have worsening concentration and more distractibility when they get on a stimulant.

So we have to sort those people out and try to look at their pattern of treatment response to determine we don't want to give them yet another stimulant if they've already had poor responses to one or two or three thanks to your email.

Let's go to the next question.

Our next question is also an email regiona revolver.

>> I have a New Year's resolution and I hope it will stick.

I'm sure I'm not the only one but after more than ten years of smoking I am hoping to quit.

I have an appointment with my family doctor.

What's the next step after that?

Your family doctor will give you some options now I certainly believe it's admirable that you're trying to quit smoking.

Many people will try to do so as the New Year is starting.

So what I'd first suggest you do is take a look at how many cigarets you're smoking is a three packs a day as a one pack a day or is it just a few cigarets a day?

They used to be called Chipper's people who would just smoke three or four cigarets a day are to really considered to be physically addicted but they're kind of using them every now and then in a means that it can be habit forming.

We always want to get people off cigarets it's entirely for their best benefit the nicotine and all the different toxic chemicals and cigaret smoke can be very hazardous to a person's health and second hand so the smoke can be hazardous as well.

So I would suggest from your perspective no one write down all the reasons why you want to quit smoking and that can not only include your own physical health but the physical health of those around you because secondhand smoke can have detrimental effect to those loved ones around you.

Secondly, look at all the ways that smoking can is affecting your social life now in the 21st century there's a lot of buildings you can't walk into and smoke you can't smoke on airplanes anymore.

I remember used back in the old days they actually had smoking section on airplanes.

>> You can't even smoke on airplanes anymore.

So look at all the social deterrents you have for smoking overall and as I said, look at the amount you're smoking to determine your degree of physical dependance if you're physically dependent on cigarets and that means over about one pack a day you might need a nicotine replacement as a means of helping you come down off the cigarets themselves.

We have a lot of different means of nicotine replacement nowadays to help people get off cigarets.

We have patches, there's gums, there's lozenges all those different types of means of getting nicotine in your system where ideally you can get on the lesser and lesser dosage over the course of time so you won't have the horrible nicotine withdrawal.

Now some people will say they were smoking three packs a day.

They went cold turkey.

They felt miserable for a week or two .

They got off of it that way.

Good for them.

But it doesn't work for everybody that if you need nicotine replacement as a means of coming down off the nicotine, there are means of doing that and your family doctor can give you some ideas there.

But we also have other medicinal means by helping people get off of nicotine.

I mentioned earlier Wellbutrin also known as bupropion the combination of Wellbutrin which is an antidepressant medication enhances dopamine and norepinephrine the combination of Wellbutrin and Chantix Chantix has been around for a long time now and Chantix is basically a medication that goes to this little area of the brain called the nucleus accumbens right smack in the middle of the brain and it makes the brain kind of think you're smoking so it kind of stimulates those nicotine receptors to a degree and it releases about a third of the dopamine.

The nicotine would release.

So it makes your brain kind of think you're smoking but you're not.

And even if you do smoke while using Chantix, you won't get as much of an effect out of it.

And if you use the Chantix in combination with Wellbutrin which also increases dopamine and norepinephrine, you can get a pretty nice effect in terms of not having nicotine withdrawal and in doing so you can come off cigarets a little bit easier now when you use Chantix you want to continue to smoke for a week or two to allow the Chantix to get into your system and the same with using Wellbutrin with Chantix you want to use a Wellbutrin Chantix while you're still smoking for a week or two to let the medication start to go to effect.

So using Chantix and Wellbutrin can be a nice midship medicinal way.

And also in talking to your family clinician, the family clinician can refer you to a lot of different smoking cessation groups and activities.

There's lots and lots of different ways to help people quit smoking in the 21st century.

So kudos to you that you're trying to get off of the tobacco products in the 21st in 2022 because in the 21st century we have so many more ways of getting people off of tobacco products compared to 20 years ago.

>> Thanks for your call.

Let's the next caller.

>> Hello Baz.

Welcome to Matters of Mind Obeys.

You'd wondered what's it mean when people see fluffy little creatures when you see fluffy little creatures usually when somebody says that right off the bat I'm thinking a condition called Lewy body dementia LSW why body dementia Lewy bodies are these little speckles that are in the gray matter of the brain and generally older people might have no more than point five percent of their gray matter having these little speckles but when you get Lewy body disease it becomes very prominent and under a red dye under a microscope for people who have this kind of condition upon their death and they do the autopsies and they're able to examine their brains.

>> These little Lewy bodies looked like little cherry blobs of jello under what's called an egocentric eosinophil stain.

But they look like these little red and cherry yellow blobs that are in the brain and what that will do is it causes people to no one see small creatures and small people and many times people will describe these small people as being babies.

I've heard a lot of individuals say that they will have babies in the rooms and they're kind of concerned the baby has been abandoned and sitting there and when people see these little small people or small creatures often they're not too distressed by them once in a while every now and then you hear they are distressed.

But it's interesting a lot of them will say they're not too upset about their being there.

They just observe that these small fluffy little creatures are these small little people or even babies are in the same room with them and it goes along Lewy body disease what also goes along with Lewy body disease conditions such as memory disturbances as well as a fatigue people with Lewy body it is of dementia get really sleepy and they get really tired.

It can go hand in hand with Parkinson's disease when people have Parkinson's disease they can have trouble with tremor.

They can have trouble with a shuffling gait.

They might drool a little bit there.

They don't have a lot of facial expression.

Parkinson's disease and Lewy body disease can often go hand in hand for a lot of people.

But the main characteristics of Lewy body disease will often be the difficulty with seeing small animals, small people and they're often fluffy and furry for some reason the animals that being the fatigue and sleepiness and a third characteristic will often be lower blood pressure upon standing.

So when they stand up their blood pressure drops.

So in treating people with that kind of condition we will use certain medications such as new plays it for Lewy body disease or Parkinson's related psychosis and the nice thing about it it won't tend to drop the blood pressure back in the old days we used to use a medication called Seroquel and sometimes Clozaril and those those medications can work for those kind of hallucinations.

But the drawback will be that they sometimes will drop the blood pressure and people with Lewy body disease already have trouble with blood pressure drops, people taking new plays ID less likelihood for the blood pressure drops and in the case of those kind of medications, what you're trying to do is primarily block serotonin 2A receptors.

It's thought that when people have Lewy body disease they have an excessive number of these serotonin 2A receptors.

Serotonin has 14 different receptors and one of them is called to a and when you out more and more and more of the serotonin 2A receptors you can have trouble with hallucination .

So medications like Seroquel Clozaril new plays it can specifically block serotonin 2A receptors.

We have a newer medication by the name of Carolita that is used for schizophrenia now it's used for bipolar disorder especially especially bipolar depression but it theoretically should be able to help with Lewy body disease and Parkinson's related psychosis as well.

Thanks for your call.

Let's go to our next caller.

>> Hello Sue.

Welcome to Matters of Mind.

>> Let's do you want to know how is it best to support one who someone who is showing signs of schizophrenia the best recommendation I could give you as a family member Sue Revit a loved one or a friend of somebody schizophrenic would be to attend the National Alliance on Mental Illness meeting NAMI is the name for that in a AMA National Alliance of Mental Illness is the best means of individual schools having loved ones or friends with schizophrenia to meet and to get together as a group and to learn from each other how best to deal with somebody and their family or in their community with schizophrenia because here's what happens.

So when somebody has schizophrenia they lose judgment and they lose perception of what's real and what's not real and they have a loss of self awareness and it's because the front part the brain is lacking in dopamine and it's a it's a difficult condition and treat because of schizophrenia the front part of the brain that's lacking in dopamine thereby giving you difficulty with judgment, feelings, awareness of what's happening around you.

But you have excessive dopamine in the middle part of the brain and then it's in the middle part of the brain where you have a excessive dopamine that's causing you to have trouble with Elucidations and delusions and not knowing what's real and what's not real.

So you put that combination together where there's too much to me in the middle part of the brain too little dopamine the front part of the brain.

It's historically been difficult to treat so the newer medications will block dopamine in the side part of the brain but they specifically will block the serotonin 2A receptors in the front part of the brain, thereby increasing transmission of dopamine in the front part of the brain.

So that's why the newer medications that have come out over the past twenty years by having that dual role are called atypical antipsychotics.

But I have the dual role of blocking dopamine type receptors and also blocking serotonin 2A receptors that indirectly will increase dopamine.

They can help people with concentration and focus and to some degree perhaps improve their awareness and insight into their illness.

>> Now there's as part of the brain over on the side here in the middle they're called the insula.

The insula is a part of the brain that indeed is very responsible for self awareness and it's thought that people with schizophrenia to a lesser degree with depression but especially with schizophrenia they have decreased activity in the insula and that causes them to have trouble with even being aware they have a problem.

So how do a reason with somebody who doesn't know that they have a problem when they perceive the problem is everybody else's and that's what's difficult about schizophrenia as a as a family member of somebody with schizophrenia trying to reason with them and trying to help them understand that they have an illness when their brain doesn't allow them to to understand that.

So what you try to do with somebody with schizophrenia is to try to mention a different type of things that they can't deny.

>> For instance, people schizophrenia will often have difficulty with sleeping.

They'll often have difficulty with anxiety and you can acknowledge those kind of symptoms and help them be aware that those kinds of symptoms can be treatable.

We often use the so-called antipsychotics that help with the symptoms of insomnia and anxiety but the antipsychotic medications can also have those good effects on the brain and it's challenging because the more psychotic episodes somebody will experience it's like having a seizure with epilepsy.

When people have seizures the more seizures they they endure over the course of the years, the more difficult it is for them to treat their epilepsy, the more likely they're going to have more seizures.

The same is true with schizophrenia.

The more repeated episodes of psychosis somebody has, the more damaging effect it has on the brain.

The brain literally literally shrinks down each time somebody has a psychotic episode.

So what do we often do in 2022 we often give people long acting antipsychotic medications.

We have antipsychotic medications that last one month, three months well now we have one that lasts for six months.

So you give these antipsychotic medications as shots every few months in some cases and that's keeping the medication in their system for a longer periods of time and we should probably be using those medications earlier in the course of some of these treatment as opposed to after somebody had six or eight or ten episodes of of psychosis because they tend to work better earlier on and later on somebody becomes more treatment refractory and sometimes they have to use combinations of medications.

But the best thing you can do as a family member or a friend with somebody schizophrenia is educated on it yourself and the best means of doing that in the community is by attending a local national Alliance on mental illness meeting.

Those are available in lots and lots of communities now in northeastern Indiana we have a very, very strong NAMI organization right here in Fort Wayne where I live and it's available in a lot of different counties.

You can talk to your clinician about where it might be available in your area.

The community health centers in each county typically know where the most were the most active NAMI will be in their community.

>> Thanks for your call.

Let's our next email our next email reads directive over how does abuse in childhood increase the likelihood of depression as an adult?

>> This is something that we've noticed more frequently and we're actually doing a scale on a lot of our newer patients now called the adverse childhood experience scale.

It's basically asking ten questions.

There's hundreds of ways you can have abuse in childhood but ten questions that appear to be the most likely predictors for depression in adulthood.

There are ten different types of abuse now in childhood and if you score four or more on those questions, it's highly likely that you will not do so well with a serotonin antidepressant.

I mentioned that before the serotonin antidepressants being Zoloft, Prozac, Celexa, Lexapro and Paxil these are medications that predominately increase serotonin.

If you've had a lot of abuse or a lot of bad things happen to you in childhood, it predicts that those medications will not work later on.

>> Now why do I mention as because well, I psychiatrists if you look at the treatment guidelines we're told to start everybody with Zoloft or Prozac or Lexapro.

Those are what typically people will get with their first line of treatment.

But you know what only about one out of one out of three people do well with those medications.

So knowing that we often go a different direction, we look for predictors on who might do well and who might not do so well.

You're not going to do so well if you've had a lot of childhood trauma and abuse and the reason for that appears to be the higher likelihood of inflammation.

The brain literally gets inflamed if you had a lot of childhood abuse and the serotonin medications don't apparently do so well with inflammation such that we'll use the other types of medication as serotonin norepinephrine medications like Cymbalta Presti OK, we might use trend telex Wellbutrin.

Those medications might do better for inflammation compared to the serotonin medications and it's thought that with early childhood trauma we don't want to use the serotonin medications as much as something else and it will be a predictor for us.

>> Thanks for your email.

Let's go to our last caller.

Hello, welcome to the mind Barb.

>> You want to know what effect huffing has on the Bobbit body huffing basically quite frankly, Barb gives your brain traumatic brain injury because you're depriving yourself of oxygen to the brain.

So when people huff they are intentionally asphyxiating and decreasing the auction of flow to the brain.

Less oxygen flow basically gives you brain damage.

So the effect of huffing on the brain will be that somebody will have difficulty with concentration, focus.

We treat it as somebody would have a brain injury such as a stroke and a lot of cases.

So with huffing it can give temporary and then eventually permanent brain damage because of lack of oxygen.

The brain very much needs oxygen and glucose to be able to thrive and continue to function and huffing deprives of oxygen.

Barb, thanks for your call.

Unfortunate the amount of time for this evening.

If you have any questions that I can answer on the air concerning mental health issues, you may write me via the Internet at matters of the Mind at WFYI dot org.

>> I'm psychiatrist Jeff Farber and you've been watching matters the Mind on PBS Fort Wayne God willing and PBS willing.

I'll be back again next week.

Thanks for watching.

>> Good night