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>> Good evening.

I'm psychiatrist Jay Fawver live from Fort Wayne , Indiana.

Welcome to Matters of the Mind now in its 25th 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 in the Fort Wayne area by dialing (969) 27 two zero or if you're calling long distance coast to coast you May 866- (969) 27 two zero now on a fairly regular basis we are broadcasting live every Monday night from our spectacular PBS forty nine thirty nine studios which lie in the shadows of the Fort Wayne campus.

And if you have any questions for me that I can answer on the air you may write me via the Internet at matters of the mind at WFB Dog that's matters of the mind at a dot org and I'll start tonight's program with an email question I recently received.

It reads Your daughter Fauver My adult son takes seventy five milligrams of Trazodone as a sleep aid if he has any alcohol after seven p.m. he has dreams that people are chasing him down to kill him.

Is this interaction common or is this just our son's body chemistry?

He now avoids alcohol every evening.

Good for him.

>> He should avoid alcohol in the evening.

Alcohol in the evening doesn't tend to last very long and back to the old days people used to drink alcohol as a means of getting to sleep.

>> Alcohol will put you to sleep but it rapid gets metabolized and gets out of your system such that you'll have what's called rebound dreaming and sometimes rebound nightmares where you put that on top of Trazodone.

>> Trazodone is very good for helping a person get to sleep and giving them a deep sleep, a deep sleep on the EEG or the brain waves will be a very high and low and wide waves overall it gives you a deep very, very relaxing sleep.

If you get awakened during a deep sleep you'll tend to be very surprised and you will be somewhat disoriented for just a couple of seconds then you come out of it that is different from dream sleep.

>> So what you're getting with Trazodone is more deep sleep and then it goes in a dream sleep thereafter.

>> Well the problem with alcohol is it will cause you a rebound increase in dream sleep so you put that on top of the Trazodone and you put alcohol on top of the Trazodone and you can get more vivid, more intense dreams.

So that's what your son was was recognizing there alcohol in the evening.

Yeah.

After about seven p.m. it can help you get to sleep as he does for some people but they'll get that rebound effect now the problem with using alcohol as a sleep aid is no one, it can cause you to have some memory impairment overall and actually interfere with the sleep architecture won't give you as good of a quality of sleep.

It knocks you out but it tends to interfere with your deep sleep and will sometimes give you that reversal where you get more vivid dreams and excessive REM or dream sleep.

So ideally you don't want to drink alcohol after about six or seven p.m. That's when many people do.

But if you take a medication like triacetone that can be more amplified overall so alcohol tends to have a very short half life .

It gets in the system very quickly gets metabolized relatively quickly and it gives you that rebound effect at nighttime.

I remember twenty twenty five years ago in nursing homes they used to give alcohol in the form of beers at bedtime to help the residents sleep.

They readily found out that was not good for their memories and it wasn't good for the quality of their sleep because people who are already having memory problems often have impaired sleep where they don't get enough dreams sleep and with alcohol you'll suppress dreams, sleep early on for those first couple hours and you get a rebound and sometimes you get a worsening of the dream so it just doesn't help the quality of sleep overall.

>> Thanks for your question.

Let's go to our first caller.

Hello Jack.

>> Welcome to Matters of Mind Jack.

You want to know about sensory processing disorders the same a sensory overload basically sensory processing disorder, Jack, is a condition where your brain doesn't filter out outside stimuli.

>> Now as we sit quietly, we're going to be bombarded by lights, by sounds, by things that we can feel and this inner part of the brain called the thalamus right in there is the central operator for the brain and it kind of filters out all the extraneous stimuli and then we have a little area above it called the in the limbic cortex that will further help you sort out anterior cingulate gyrus that will help you sort out outside stimuli that you don't need to use at that time.

But people with sensory processing disorder will have indeed sensory overload because they get too much of an influx from light sounds any the touch of their clothes can be uncomfortable for them.

They'll be very sensitive to smells so the sensory overload can cause them a lot of anxiety and irritability.

And this is a phenomenon that we often see with conditions such as autism spectrum disorder where people get very irritable with changes in the environment but also with bright lights, flashing lights, loud sounds.

They have to get away from those type of things with children with their developing brains.

We'll often see that as well.

It's not diagnostic of them having autism spectrum disorder but as a little thalamus inside their brain is still developing.

The operator of the brain is just not able to filter out those extraneous stimuli.

So it's the thalamus, it's the anterior cingulate gyrus.

All these parts of the brain are in the middle of the brain and they're being used for the purpose of helping filter out.

So you've got the thalamus here, the anterior cingulate gyrus on top there and those parts of the brain are working properly should help you sort out what's really important to pay attention to and what's not and with sensory processing disorder that could be problematic.

Jack, thanks for your call.

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

>> Our next e-mail question reads Dear Dr. Fauver, are there any indicators that someone might be predisposed to post-partum depression?

Any good warning signs to look for after the birth?

>> The biggest predictor for postpartum depression would typically be if a woman was previously depressed prior to her pregnancy.

So if she is depressed already prior to pregnancy, she's more likely to have postpartum depression.

So that's indicator number one.

Indicator number two would be if a woman had a postpartum depression with her prior baby, she's more likely to have a postpartum depression with subsequent babies.

Now I always tell women have as many babies as you want it just even if you did have postpartum depression because we have ways of treating the postpartum depression so we don't want to get in the way of any planning they have for future children based on the depression.

>> We want them to allow to have allow them to have children.

>> It's just that we know that with each subsequent pregnancy and delivery there can be a higher risk for depression.

But we have a lot of ways of treating that now if you have a family history of depression, especially postpartum depression, you'll be more likely to have postpartum depression.

It's thought that if a woman has very serious premenstrual symptoms in other words the four or five days before her periods she gets really irritable and depressed.

She might have a greater likelihood of postpartum depression thereafter if during the pregnancy she's abandoned by her loved one, the father of her child that and put her at a higher risk for postpartum depression because social stressors during the pregnancy can be a factor and complications during the pregnancy itself.

>> Let's say she's bedridden.

Let's say she's having really high blood pressure.

She's having hyperemesis Gravett era where she's having vomiting during the pregnancy herself.

She has all these complications going on during the pregnancy itself that can put her at higher risk for postpartum depression now after delivery once she does deliver again if she's a single mom and she doesn't have much support that will increase the risk for postpartum depression as well as difficulty with maintaining the ability to take care of her child that can increase the risk but that's thought to be a lesser risk compared to the prior ones.

>> Now how do we treat postpartum depression the number one treatment and the most effective treatment is Brexit alone as an IV drug that's used in a very controlled setting over the course of three to four days in the hospital setting to have the IV being infused day by day by day and that can relieve postpartum depression very dramatically, very quickly.

It's not used very often because it's highly regulated.

We have a newer medication that we hope to see available on the market in August September by the name of the ZAREENA alone and Tsarina loan is a medication that is an oral version of the same type of mechanism of action.

These medications are working on the so-called GABA receptors and in doing so they seem to be reversing the effects of the steroid induced depression stories.

We're talking about estrogen.

We're talking about progesterone during pregnancy estrogen and progestin are sky high with delivery those hormones will drop abruptly and that's thought to contribute to postpartum depression for women who are prone to having postpartum depression.

>> Now the postpartum depression I'm not talking about the baby blues.

About four out of five women will have the baby blues so about 80 percent of women out there will have the baby blues where they feel a little bit sad.

They feel a little bit teary.

There are more emotional for the first month or two after delivery.

Postpartum depression tends to peak at about six or eight weeks after delivery and these women can often be incapacitated.

They don't bond with their babies.

They don't sleep well, they don't eat well.

They have difficulty with enjoyment.

The things are very sad and very depressed and it's causing them functional impairment where they not only cannot care for their baby but they can't care for themselves.

That's postpartum depression.

It goes on for at least a couple of weeks and it needs to be treated very aggressively now the medications we've historically used for postpartum depression will be medications based on the woman's ability and unwillingness to breastfeed if the woman is breastfeeding will preferentially give a medication like sertraline or Zoloft or maybe bupropion also known as Wellbutrin.

These are traditional so-called monoamine or antidepressant medications that in the case of Zoloft increases serotonin in the case of bupropion or Wellbutrin it increases dopamine and norepinephrine.

>> They work on those particular chemicals to try to get a woman out of depression typically within four to six weeks.

>> On the other hand in alone as working Ivy on the hormonal imbalance that's occurring with with the women and again it tends to bring a woman to depression really, really quickly.

So we have treatments for postpartum depression.

We do watch for it very carefully as a woman's in our last trimester those last months of pregnancy you can give certain medications during those last months of pregnancy that would not be harmful to the baby.

And if you choose to breastfeed we'll be very selective on which antidepressant medications are continued now if a woman chooses not to breastfeed, we can use any medication we desire at that time that would be safe and effective for her because we wouldn't have to worry about harming the baby.

Some medications get in the milk, some not so much.

So the ones that don't get the milk typically if it's less than 10 percent of the drug getting in the milk will be able to safely use the medication.

But if medications get in the milk more than 10 percent, that's where we'll be somewhat apprehensive about giving those kind of medications.

But with postpartum depression it's a phenomenon that we've known about for a long, long time.

It's something that we will OBGYN doctors will tend to monitor it very carefully as a woman is proceeding through the Depression.

We know that if a woman is depressed when she has a baby in the, the baby's brain does not develop as it should in the brain.

The baby's brains will be smaller.

>> The baby's brains will be more prone to having a tendency toward having irritability after delivery.

Smaller brains will often contribute to more depression for the baby as the baby goes through life .

So we know that a depressed mother when the baby's in the is not safe for the baby, him or herself.

So we want to get a mother depressed as soon as we want to get the depressed mother treated as soon as possible when she's having depression during pregnancy itself.

>> Thanks for your email.

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

Our next e-mail question read your daughter Fauver do essential oils actually help with mental health or is it a placebo effect we're talking about I believe you talk about omega three and omega six oils.

These are oils that omega six can give you an inflammatory effect omega six in excess which is what's available in trans fatty oils can give you more inflammation overall omega three is what you want more so you want more omega three than Omega six.

So Omega three theoretically can decrease inflammation in the entire body and even in the brain and that's sort of with some types of depression they're prone to being caused by inflammation.

So they did studies over in Japan years ago with women who had delivered babies and it found they found women in Japan had a fifty fifty times decreased likelihood of having post-partum depression and the thought behind that was because they eat so many fish.

So if you eat a lot of fish and have a lot of fish, well you're less prone to having depression.

So for the past 10, 15 years it was very common for psychiatrist to prescribe fish well to their patients.

But then over the past five years or so it was found if people took fish oil versus the ones who didn't take visual, there wasn't a big difference in the outcome.

The bottom line is with fish oil as long as you don't have any difficulty with bleeding and any difficulty with coagulation in general you'll tend to be OK with taking fish oil.

It tends to be pretty safe for some people they can have some trouble with nausea, gastrointestinal problems with fish oil.

Sometimes people can have some burping and some people can have some diarrhea with it.

But overall fish oil seems to be safe to take.

It's probably more impactful for the heart that it is the brain but both the brain and the heart health can be impacted by fish oil and again it's an omega three fatty acids that tend to be more helpful for giving the good health for the brain or the the heart themselves.

People ask all the time what is the best supplement you can take and I usually try to put them in order a fish will be down the line a little bit.

I think from a psychiatric standpoint the very best supplement you could take would be vitamin D D as in dog vitamin D it's often seen as D3 on the on the counter but vitamin D two thousand units a day sometimes 5000 units a day can be recommended at two thousand units a day for all of us can certainly be helpful for a lot of people.

Thanks for your email.

Let's go to our next caller.

Hello Sierra.

Welcome to Matters of the Mind.

Sierra you want to know if you want to know what is cognitive dissonance?

Cognitive dissonance Cara Sierra is where you have a belief in something despite not having adequate evidence to support that belief.

So in other words you're getting a belief where somebody says something again and again and again and you get enough discussion and you get enough information about this particular belief that you believe it's true even though the evidence doesn't support it .

>> So it's kind of a contrast in that way people will often it's often believe in what's called urban legends where it becomes so common to discuss something and it's thought to be a truth when there isn't the evidence to back it up and it's not considered to be a mental disorder by any means.

It's just something that we see socially occasionally where if something is said enough times it's thought to be true especially when people in authority or are saying that.

So I'm always emphasizing that we need to question the so-called well truce even though they're either presented in a reputable fashion.

>> We need to question what people are telling us and always have an inquisitive mind about why we believe what we do over the course of history.

There's been a lot of misunderstanding concerning different type of practices that we'll do a hundred and fifty years ago it was thought that handwashing was not necessary prior to even doing surgery and a hundred and fifty years ago about the time of the Civil War it was common for for surgical procedures to be done with no gloves on the hand and very little hand washing at all and it was found shortly thereafter that we do need to hand hand wash and now in the surgical suites they are as clean and as sterile as possible.

>> Sterile is you either have a sterile environment or you don't but you try to get a very, very, very clean environment in the operating room for the purpose of decreasing likelihood of infection.

But the belief over hundred fifty years ago was that wasn't necessary.

It was hand washing was just an added burden back then.

So cuddly dist.

dissident's is where there's a belief system despite the lack of evidence to support it.

>> You might have heard about that over the past several years with a lot of people talking about their truths.

>> There is no such thing as an individual's truth.

It could be an individual's belief.

>> It can be an individual's opinion.

But the truth is either the case in something or not there is no subjective truth.

It's either something is really happening or not and that's what we talk about with cognitive dissonance.

It's where opinions are formed based on individuals preventing presenting evidence that might not be true.

>> Thanks for your call Cierra.

Let's go our next caller.

Hello Julie.

Welcome to Matters of Mind.

Well, Julie, you want to know if I can define oppositional defiant disorder also known as Odie's Oppositional Defiant Disorder Julie is something we hear about with children and adolescents and it's where more than you would expect that child is oppositional toward parents but not only just toward parents, towards teachers and toward authority figures and it becomes to be quite problematic.

Now again, the best treatment for this would always be psychotherapy not only with the child, him or herself but also with the family members and the people who are in the child's close social network because the child has learned this behavior over the course of time.

>> It's not thought to be a neurobiological disturbance per say.

It's thought to be more of a learned behavior.

It's not responsive to medications.

People ask me about that all the time could be genetic.

>> Could it be genetic?

I don't know.

It's something that typically is learned based on the household and it's not unlike when somebody trains one of their pets.

If you allow your pets to basically run the show, the pet will run the show and the same can happen with oppositional defiance disorder if a child is allowed to be defiant with authority figures enough the child realizes that he or she can meet his or her needs and being defiant and that works out for them.

So the idea is to kind of retrain them and get them past that you'll hear about oppositional defiance disorder not uncommonly when the children get to school.

So this is not typically a new phenomenon.

We're not talking about oppositional behavior just toward parents.

We're talking about all authority figures.

So this kind behavior is typically been going on for quite some time by the time that oppositional defiance disorder is identified now can you have oppositional defiance disorder with other conditions?

Yeah, you kind of can but attention deficit disorder for instance ADHD will be somewhat of a separate phenomenon with attention deficit disorder people will have trouble paying attention, being able to focus, being able to actually listen to what they're being told so they can actually they don't just hear they can actually listen to what what is being said.

So with attention deficit disorder they can have trouble following and retaining instructions and they come across as being oppositional defiance but maybe they didn't process the information to to begin with.

>> We talked earlier about sensory processing disorder where some individuals are just overwhelmed with sensory input from light sounds, touch smells and with all these different sensory inputs coming in they have a hard time paying attention and it makes them very irritable and very angry.

Well, sometimes as a after effect you can have difficulty with paying attention to what you're being asked to do but ask oppositional defiance disorder in the extreme you'll often hear about these children having tantrums and they get very aggressive and they get very irritable and angry during that time.

Julie, thanks for your call.

Let's go to our next caller.

Hello.

>> Hello Jane.

Welcome to Mariza Mind.

Oh, we have another email.

Let's go to another email.

Next email says Dear dear father, can the brain grow when you treat people for strokes and depression?

What causes the brain to shrink when you have a stroke you have decreased blood flow to certain parts of the brain.

That's what causes of stroke.

A stroke can either be an inclusive stroke where you're getting a cutting off of the blood flow to certain parts of the brain which can be a hemorrhagic stroke where there's bleeding in certain parts of the brain but bottom line is with a stroke you're having decreased oxygen to certain parts of the brain and when that happens you can have the death of certain neurons which are the nerve cells that are spread out across the brain with strokes and with depression, sometimes with decreased oxygen.

>> In the case of strokes, what depression with increased stress you can have a shriveling up of the neurons.

The neurons are like branches of trees which should have fifty thousand one hundred thousand branches on them as you have difficulty with chronic stress or chronic depression, the branching of the trees become less or less so instead of 50 or 100 thousand branches you only have twenty thousand branches so the key will be whether it's a stroke or whether it's depression or stress.

>> You want to try to make the neurons you have remaining more fluffy and you want to get some of the branching to come back.

There are ways that we can bring back the branching if you're symptomatic for instance of depression with difficulty with enjoying things motivation ,energy if you're having trouble with stress that you just can't control and you don't have coping strategies to be able to mitigate that if you're having little mini strokes here and there with all those kind of conditions, what you want to do is preserve the brain as best you can and with depressive symptoms will often give antidepressant medications that can slowly decrease the shrinkage of the brain by bringing back the branching take some while to do that sometimes weeks if not months and it's doing so by increasing this chemical called brain derived neurotrophic factor.

It's one of 20 different brain fertilizers that we have.

These are called growth factors but we have about 20 different growth factors in the brain that act as natural fertilizers and make the brain more fluffy and make it grow.

Now are there ways to just take a pill for these growth factors?

No, because the growth factors are proteins and once they go to the stomach they get broken down to the stomach acid.

>> So the best way to really get them into the system is by giving a medication that indirectly increased the brain derived neurotrophic trophic factor or the growth factor in the brain itself and that's what will give certain medications more recently in the past 20 years we've seen ketamine being used.

Ketamine is a medication.

It was approved as an anesthetic over 50 years ago now we're seeing ketamine in the past twenty years being used IV in specific treatment protocols where it's given IV over the course of 40 minutes, maybe a couple times a week for a few weeks for the purpose of trying to bring somebody out of depression.

But what ketamine is doing is making the neurons more fluffy as soon as four hours after you receive it.

>> And we have ketamine which I use at my office for the purpose of treating people as ketamine is a nasal spray that's the left side of the piece of ketamine as a nasal spray.

The same concept is true where within hopefully four hours you're actually getting physical regrowth of the brain itself.

>> And as time goes on we're hearing about medications like dextromethorphan which is a key ingredient in this new cap and this new tablet called All Valide of audism medication and people will take as an oral pill.

They take it twice a day and it's for the purpose also of quickly regrowing the brain in the months to come.

We're going to hear about Zurin alone which is a medication that hopefully is a pill can also in an indirect way increase these growth factors.

>> So what we're trying to do with all these different treatments is to increase the growth factors of the brain to keep the brain get the brain more fluffy.

Thanks for your call on force.

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 as matters the mind at WFB a dog psychiatrist forfour and you've been watching matters of mind on PBS Fort Wayne God willing and PBS willing.

I'll be back again next week.

>> Thanks for watching.

Goodnight