Good evening.

I'm psychiatrist Jay Fawver and welcome to Matters of the Mind.

Matters of the Mind is a weekly mental health program where you have the chance to choose the topic for discussion.

So if you have any questions concerning mental health that I can answer on the air, you may write me a via the internet at MattersOfTheMind - all one word - @wfwa.org.

That's MattersOfTheMind@wfwa.org and if you're able to do so during the program, you may also call or text me.

So let's begin tonight's program with a text I recently received.

And the text that I recently received is from Pat from Fort Wayne.

And Pat asked, what causes feeling hot and off balance, having dizziness, when anxiety gets higher?

Is this a medication that needs adjusted?

Possibly.

I also feel a little motivation to do anything when this keeps happening.

Well, when you feel hot and off balance and you're dizzy in the midst of anxiety, my first question is going to be, did this occur before you took the medication to which you're referring?

Has it been a longstanding issue?

Because I want to know, okay.

Is it a side effect from the medication that happens to be worse when you experience anxiety?

Or is it a symptom of anxiety itself?

Because when people have anxiety, they can have a palpitations.

They can have difficulty with tremulous, they can have difficulty with gastrointestinal problems, they can get headaches.

You can have all sorts of physical problems when you get anxious.

And if this is a manifestation of the underlying anxiety, where the medication sure needs to be adjusted or changed, that's a whole nother issue.

So I'd want to know is it a symptom of the underlying anxiety?

Is it related to when you start the medication?

Maybe you go to need to go to a different type of medication.

Are there other medical issues that might be problematic?

For instance, people can have anxious symptoms when they have diabetes, low iron.

They can have trouble with anxiety symptoms when they have thyroid disturbances.

Even sleep apnea can give you a lot of physical symptoms.

So I want the broad overview.

But as you go back to your treating clinician, you might want to talk about these particular problems.

But be prepared to be asked, Pat, when the symptoms started.

And were those symptoms related to when you took the medication initially when you adjust the medication or had they been there previously?

Pat, I wish you well.

Thanks for your text.

Let's go to our first caller.

Hello, Lilly, welcome to Matters of the Mind.

Lilly had mentioned that you're taking Wellbutrin.

That's also known as.

And your doctor said there's a low risk of seizures as a side effect.

Should you be worried?

Well, number one, Lilly, your doctor probably wouldn't have prescribed Wellbutrin had you already had a significant seizure risk.

Now, significant seizure risk is where you've had recent seizures, or if you're undergoing withdrawal from alcohol or the so-called benzodiazepines like Xanax, Valium, or Ativan.

Those medications can give you a higher likelihood of going into a seizure as you're coming off of them very quickly.

Taking that all aside, what's the risk of having a seizure from Wellbutrin?

Well, if you dose it up to 450mg a day and the seizure risk is related to the dosage, the higher the dosage, the higher the higher the seizure risk, up to 450mg a day.

The seizure risk is one out of 200.

And they actually looked at people who overdosed on Wellbutrin and studies out of Arizona and California, and they found that even if you overdosed on Wellbutrin, took exceptionally high amounts, your seizure risk was about one out of four.

So even with an overdose, it wasn't that everybody had a seizure.

But the seizure risk is there, especially at higher doses.

So the seizure risk related to Wellbutrin, Lilly, will be related to the dosage.

If you take the higher dosage, it gives you gives you a one out of 200 chance of having a seizure if you've not had recent seizures overall.

So those are the kind of things that we have to take in consideration.

Lilly, thanks for your call.

Let's go to our next email question.

Our next email question reads Dear Dr.

Fawver, how often should I see my treatment provider's regarding my depression and anxiety conditions?

I have a family doctor, I have a psychiatrist, and I have a therapist who I regularly see.

I think it really depends on the nature of your problems currently and the severity of them and how you're doing.

If you're doing really well, maybe you can see your therapist even as needed.

Sometimes many people will see their therapist weekly as they're working through some problems.

Sometimes in the old psychoanalytic type of model of treatment, you'd see a therapist 2 or 3 times a week.

But with the therapy that's done nowadays, usually once a week, once every other week will be adequate to address the needs at hand.

Your psychiatrist, who you see your psychiatrist, will try to stabilize you on a medication to help you be able to put up with your current life circumstances and get stronger, and your responses to various challenges that are occurring in your life.

So the medications will be there, but usually the medications get kind of tuned up and you might be on the same medications for every three months, every six months, and you go back for a follow up primary care doctor.

It depends on what kind of medical issues you might be experiencing.

If you have a primary care doctor and you're being treated for asthma, hypertension, diabetes, they might want to see a on a more regular basis perhaps every 2 or 3 months.

But it depends on how you're doing overall.

If you're really stable, believe it or not, there are some people who see their psychiatrist and even their primary care doctors just once a year.

So you can be seen yearly if you're doing really well with medication overall.

So it all comes back to how you're doing in general.

Thanks for your call.

Let's go to the next caller.

Hello, Beth.

Welcome to Matters of the Mind.

Beth, you want to know for a transcranial magnetic stimulation, would you recommend the one week treatment or the eight week treatment?

Which is better?

It really depends on what your clinician is recommending based on the nature of your current symptoms.

Number one, based on your severity of symptoms.

Number two, based on whether or not you're taking other medications that just need to be tweaked a little bit with the TMS, based on the recurrence of the depression, how long it's been going on and the severity of it, and also based on family members responses to transcranial magnetic stimulation.

So those can all be factors.

If you've previously had a beneficial effect from a treatment of transcranial magnetic stimulation and you're having only mild symptoms now, maybe you don't need treatments very often, but if you're more severely depressed, you might want to have the more frequent treatments.

So it's very individualized.

And that's the beauty of transcranial magnetic stimulation.

It can be individualized to your your particular needs.

Thanks for your call.

Let's go to our next email question.

Our next email question reads, Dear Dr.

Fawver, I'm finding that my ADHD medication helps, but it doesn't limit all my symptoms.

Are there other things that could be doing that I could be doing to help besides medication?

Well, the first thing I'd always want to know if somebody on ADHD medication I'd want to know.

Is that really all there is?

So many times ADHD will run accompanied with other kind of conditions like depression, anxiety, conditions such as social anxiety, OCD, sometimes even various spectrums of autism.

So ADHD will often not be a condition that's just there all by itself.

It will often have other conditions.

Many people will inadvertently self-medicate their ADHD residual symptoms with alcohol or marijuana, which makes the condition worse, obviously.

So I'd want to know what are the conditions might be there.

And in that case, sure, ADHD medications might not be helpful in themselves.

Secondly, I'd want to know what kind of symptoms you're actually experiencing that could be related to ADHD, because many people will have symptoms such as irritability and frustration.

Because with ADHD, if the medication is not working adequately, you're always running behind.

You're procrastinating, you're not getting things done, you're not vigilant.

You're not pursuing your different tasks at hand to their completion.

You get started on things, but you don't get them finished.

That causes a lot of frustration for people.

And I'll say my ADHD medications not working.

Keep in mind, ADHD medications can be kind of like eyeglasses.

With eyeglasses, you want to get just the right string, the strength on the lens to be able to correct your vision.

Some people need thicker lens lenses.

Other people need more thin lenses.

So ADHD medications are the same.

It does not matter what your body weight is, you might need higher doses.

You might need lower doses.

If you have a dosage for an ADHD medication that's actually too high.

It can actually worsen your symptoms of distractability and problems with focus.

So you want to make sure you get dialed in on just the right dosage for medication.

So I'd want to know what the symptom might be if you have other type of conditions, I want to make sure that your medication is where it should be.

Sure, we could always be coached on doing different tasks, different type of strategies, in terms of organizational skills.

With ADHD, the first thing I recommend for many, many people with ADHD will be to keep a calendar of your obligations.

Keep the priorities that you need to get done first at the top of the list.

Get them done before going on to something else.

Because people with ADHD are notorious for starting something, getting really interested in it, and then going to something else.

And next thing you know, they have five, six, seven tasks, all kind of partially done and they don't get anything completed at all.

And that could even go along with somebody doing housework.

They get started on a little bit of laundry, and they put their laundry in the washer, and it stays there for 2 or 3 days because they forgot to take it out, to put it in the dryer, because they went onto something else and something else and something else.

So with ADHD, the first thing I often recommend to people is to make a list of their obligations and really focus on getting the most important things done first, as opposed to losing interest and going to something else.

And I tell people with ADHD to be very careful with social media, because people with ADHD can get really engulfed in the algorithm of their interests on social media, and it'll take them down a rabbit hole where they might be stuck for hours doing things.

And it's really a thief of time.

When you think about what social media does for people, it just steals your time.

And with ADHD, you're already trying to struggle with staying on time as it is.

So yeah, medications can help to some degree, but you have to maintain those kind of behavioral strategies.

Thanks for your call.

Let's go to our next caller.

Hello, Bill.

Welcome to Matters of the Mind.

Bill, you mentioned you're taking clonidine.

Clonidine is an old antihypertensive medications called an alpha two agonist.

You mentioned it's being used for blood pressure and you're taking it for anxiety.

Does the medication actually help with anxiety?

What clonidine will do, Bill, as an alpha two agonist.

Basically it'll go to the front part of the brain.

And what it does, it makes norepinephrine work a little bit more specifically and more cleanly, so to speak.

It directs the norepinephrine to attention and focus such that you can have less anxiety.

Clonidine is one of the classic medications out there for nightmares and for post-traumatic stress symptoms, so it can be very helpful for nightmares and post-traumatic stress symptoms because it's directing norepinephrine to where it needs to be, as opposed to allowing norepinephrine just to run wild in your brain and cause a lot of anxiety.

So it's more direct even how norepinephrine will affect you.

Secondly, clonidine can be used for the distractability associated with ADHD.

So many people with ADHD, as I just mentioned, will have difficulty with anxiety.

So if you have a lot of difficulty with anxiety and distract ability associated with ADHD, clonidine can be very helpful in those regards.

It as an old blood pressure medication.

My goodness.

It was used back in the 1980s for hypertension and that's where you have to be careful.

It can lower the blood pressure quite significantly.

There's a chemical cousin to Clonidine called guanfacine and guanfacine isn't as likely to lower the blood pressure to compare it to quantity.

Clonidine is more sedating.

Claudine is more likely to lower the blood pressure.

Guanfacine is kind of like a milder version, where it's also a so-called alpha two agonist, where it basically is stimulating these alpha two receptors associated with norepinephrine.

But it also can be helpful for anxiety, especially associated with PTSD symptoms as well as ADHD symptoms.

Thanks for your call.

Let's go to our next caller.

Hello, Tom, welcome to Matters of the Mind.

Tom, you had mentioned with with exercise being good for your physical and mental health.

Do retired professional athletes live longer?

Actually, they often don't, Tom.

A lot of studies being done on this.

A lot of professional athletes don't take so good, much good care of themselves after they retire.

They're thinking, oh, I don't have to work out so hard anymore.

And you often see these professional athletes, number one, they're kind of beat up already.

So they have arthritis.

They have some injuries that are kind of lingering.

But retired professional athletes will often have heart difficulties because they just don't have the exercise perseverance that they had previously.

So retired, professional athletes have to be very careful about that.

The exceptions are people out there like Tom Brady.

Tom Brady is just a phenomenal not only athlete, but he's actually taken retirement to a whole next level.

So he's not necessarily retired from professional athletics.

He's gone into more of a managerial and and an ownership role.

But he really takes care of himself not only from a diet standpoint.

He still exercises.

He's still a mentor for many people.

He's doing it right in a lot of different ways, but a lot of professional athletes, yeah, they don't take care of themselves once they retire, because they don't have to work out as a means of maintaining their job anymore.

Interesting question.

Thanks for your call.

Let's go to our next caller.

Hello, John, and welcome to Matters of the Mind.

John, you want to know about the difference between norepinephrine dopamine reuptake inhibitors, NDRIs and SSRIs, serotonin - selective serotonin reuptake inhibitors.

They're quite different.

Norepinephrine dopamine reuptake inhibitors are medications that, as the name implies, will increase norepinephrine and dopamine by blocking the vacuuming of norepinephrine and dopamine into their firing neurons, and the classic norepinephrine dopamine reuptake inhibitor is bupropion, Wellbutrin.

So Wellbutrin predominantly will increase transmission of norepinephrine and dopamine about half of the potency as you'll get from a stimulant that's often used for ADHD.

So norepinephrine dopamine reuptake inhibitor is bupropion or Wellbutrin.

An SSRI, selective serotonin reuptake inhibitor, is one of five medications typically to use the trade name Zoloft, Paxil, Prozac, Lexapro, Celexa and Luvox.

I guess thats six, isnt it?

But there's six SSRIs out there, five of which are used for depression predominantly Luvox is used more for OCD.

These medications, like the name, implies they're selective in increasing serotonin.

So that's why not uncommonly, we can use a medication that enhances serotonin with a medication like Wellbutrin, which enhances norepinephrine and dopamine.

And in doing so, you could increase the transmission of serotonin as well as dopamine and Norepinephrine and for some people, that's what they need to really get the best effects.

The serotonin medications for depression, they're effective at about one out of three people to reach remission, at least to a short term, whereas bupropion might be a little bit more effective than the selective serotonin reuptake inhibitors.

But it's based on your past experience with the medication.

To some degree, it's based on your symptoms.

I mean, the SSRI are more effective for for anxiety for a lot of people, whereas bupropion or Wellbutrin is going to be better for energy and helping you with cognition and thinking and concentration.

So they have different means in which they can help people, but we do indeed often use them together.

There are genetic factors that can influence which way you might want to go.

There's a particular gene called SLC6A4 that will look if somebody has a long so-called gene genotype, it's called an L genome type standing for long or a short genotype.

The short genotype is S which stands for short.

So you've got the long and the short genotype.

If somebody has two short genotypes for SLC6A4 and they have early childhood traumatic experiences before the age of eight years of age, that genotype with the early childhood experience will predict that they probably won't do so well with a selective serotonin reuptake inhibitor.

So we look at different factors like that as a means of determining which medication to choose for a person.

So we choose a medication that's going to affect more norepinephrine or dopamine, or we're going to choose a medication that's going to affect more serotonin.

We do look at the symptoms.

We look at the genetics.

We often look at a person's personal family history of treatment responses.

If I hear about somebody who's had a phenomenal - whose family member had a phenomenal effect on Pristiq or they've had a phenomenal effect on Mirtazapine or Remeron, my goodness, I might think about those medications for that particular patient.

If that particular patient I'm seeing is having similar symptoms as did their loved one.

So if their loved one had good or bad effects from a medication or two, I'm going to consider that good or bad effect for the patient I'm seeing.

So yeah, we can do genetic testing, but a bigger impact and a bigger factor that I think is something to take into consideration is how a family member did on certain medications.

Thanks for your call.

Let's go to our next email question.

Our next email question reads Dear Dr.

Fawver, for with all the things happening in society nowadays, how do I keep my grandchildren protected from stress and disappointment?

I don't think you want to.

If you are protecting your grandchildren from stress or disappointment or failure in any way, shape or form, you're not doing them any favors.

And I think a lot of well-meaning parents and grandparents for the past 50 years have thought that if we could protect our children from any disappointment in life, that we could actually help them deal with stress and anxiety later on, it actually makes it all worse.

So here's how that works.

If you are encountering a challenge to your thinking, a change, a disappointment when you're a late adolescent or an early adult, maybe you're going into college, maybe going into the military, maybe you're going into some early relationship.

If you haven't learned how to deal with disappointment and and losses in your life already without being overwhelmed, you're going to be more overwhelmed later on, as a as a young adult.

You want to learn how to deal with disappointment and failure early on in life.

Now, your responses to disappointment failure as a young adult can be where you're extremely fragile and you just fall apart with any change or anybody perhaps challenging your way of thinking.

Or perhaps they don't like something you did, or they don't like something personal about you.

You can be overwhelmed, and that's called a fragile response.

A healthier response would be one of resiliency, where you can deal with the challenge or failure at hand, but it doesn't overwhelm you, but you can at least deal with it.

And the best response would be that of what we call neuroplasticity.

Neuroplasticity is where not only do you are you able to handle the particular problem or failure or challenge at hand.

Not only are you able to handle, but you get stronger from it and you learn from it.

So we call that neuroplasticity.

And what happens in the brain with neuroplasticity is with your ability to learn from challenges and failures and disappointments.

When you learn from those, you actually grow more branches on your individual neurons.

Our brain has 80 billion individual neurons, and each individual neuron has between 30,000 to 50,000 branches.

So if you think about your neurons being like trees, the individual neurons have branches on them.

And when you are getting more and more stressed and the stress is unmitigated, you're not able to cope with things.

Those little branches on your neurons just start shriveling up.

That's not a good thing.

It causes you to be more likely to have depression.

You have more of a tendency toward inflammation of the brain.

You don't enjoy things.

You lose your motivation.

You can't concentrate.

What you want is to learn from past failures and disappointments.

And when that happens, learning itself will help branch out the individual neurons.

And that's called neuroplasticity.

That's what you're trying to achieve.

So the best advice I would have for you as a grandparent is to mentor your children and tell them, okay, you've got some challenges ahead of you.

You're going to have times where you're going to have disappointments.

That's okay.

And emphasize to them that losing is going to happen.

They're not going to be the best at everything they do, and we can't give everybody a trophy for all their small victories.

We have to let them know that some people are going to be better than they are.

And that's why I'm always frustrated when I hear about the Little Leaguers not keeping score.

Now, the kids on the bench, they're keeping score, but the parents are not.

I think we need to keep score because we need to learn to deal with disappointment, and we need to deal with failure, and it makes us stronger the next time.

It's an interesting phenomenon that's called neuroplasticity, where you actually learn from your past failures and it makes you stronger in the long run.

A lot of colleges and the United States military right now, as are actually noticing that these young adults coming away from these homes where they've been very sheltered from disappointment, are having a hard time dealing with conflicting ideas and challenges that might be in which they might be encountering.

And there are not enough counselors out there in colleges to deal with these children dealing that are dealing with these childhood problems.

So I think our roles as parents and grandparents will be to help mentor them in the disappointment through the disappointments, and let them know that this is normal and it's going to make them stronger as they get through it.

Thanks for your call.

Let's go to our next text.

Hello, James.

James from Fort Wayne.

You have a question for me.

You said that you experienced a spinal cord injury, and you've had consistent nerve pain in your shoulders, arms and hands.

They put you on pregabalin.

That's also known as Lyrica.

Works some, but it makes you tired.

Gabapentin is worse.

Gabapentin is a chemical cousin to pregabalin.

And you're right gabapentin can be a little bit more sedating.

Is there a better option for pain or are there long term side effects overall?

Well, it sounds like James, they're trying to keep you away from opiates and narcotics.

That can happen.

So gabapentin and pregabalin are chemical cousins in a sense that they will decrease the firing of the itchy trigger finger of the nerves themselves.

And those are often preferred.

Number one, you want to make sure you optimize the dosage of pregabalin.

That makes you tired.

Okay?

Gabapentin is something that often will make people less tired than pregabalin, but you're more sensitive to gabapentin could simply be related to the dosage.

You can always ask your clinicians if you can try a lower and lower dosage of either pregabalin or gabapentin.

Perhaps they put you on too high of a dosage.

Pregabalin is often dosed at twice a day.

Gabapentin often dosed at three times a day.

I've seen patients on both of those medications individually at least, where they've had the sedation, and I often use pregabalin or gabapentin in my practice for sleep disturbances for anxiety, and I'll find that going lower and lower and lower on the doses can make the medications more tolerable.

When I hear about somebody saying that they tried gabapentin previously, it was a horrible experience for them, as I did earlier today when I saw a lady.

Usually it's because, number one, they were on other medications that could have amplified the bad effects from gabapentin.

Or number two.

Quite simply, they took too much gabapentin.

So it's like with any medication, if you take two high of a dosage of it for your individual needs, it can make you feel really lousy, so a small amount can go a long way.

Pregabalin and gabapentin in their own ways will decrease the itchy trigger finger of the calcium channels in the nerve.

So it's thought that when you have nerve compression and you have an irritation on an individual nerve, the nerve firing will be excessive.

So it's an itchy trigger finger.

And what's firing that little trigger finger on the nerves will be calcium going through these little channels.

If you stabilize the channels with pregabalin or gabapentin, it'll make the nerves not fire as much.

That's how it works.

Now there are other medications that can be used.

They are anti-seizure medications such as lamotrigine.

There's carbamazepine, sometimes is, oxcarbazepine.

There's there's other medications that can be used.

But they do have side effects of their own.

And that's the biggest issue.

Thanks for your text.

Let's go to our final email question.

Our last email question is from mental health standpoint what's the key to happiness?

Is it money, success or nice cars?

From a mental health standpoint, two studies in which I can refer the Harvard study that was done back in the 1930s, looking at over 700 people over the course of several decades, looked at the number one predictor for happiness, was not money, was not careers, was not fast cars.

It was social fitness.

So your relationships, your friendships, how much you're engaged with other people around you, whether that be in your immediate family with a marriage, whether that be with friends, family.

When you had meaningful relationships, that was another number one predictor from that study.

Another study was done out of Wisconsin with high school students who graduated around 1957, looked at over 10,000 high school students for several decades.

The number one predictor there was charitable giving, where not only were you giving your money or your time charitably, but you actually saw outcomes from your giving itself.

So charitable giving, whether you're with your money, whether you're with your time, that was the key for happiness.

It gave you a sense of meaning and purpose in a lot of cases.

Thanks for your email.

Unfortunately on a time for this evening, if you have any questions that I can answer on the air, you may write me via the internet at MattersOfTheMind - all one word - @wfwa.org.

I'm psychiatrist Jay Fawver, and you've been watching Matters of Mind on PBS.

God willing and PBS willing.

I'll be back again next week.

Thanks for watching.

Good night.