Good evening.

>> I'm psychiatrist Jay Fawver live from the Bruce Haines studio in Fort Wayne , Indiana.

Welcome to Matters of the Mind now in its 20th 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 (969) 27 two zero or if you're calling a place long distance you may dial toll free at six six (969) 27 to zero and on a fairly regular basis we are broadcasting live every Monday night from our spectacular PBS Fort Wayne studios and if you'd like to contact me with an email question and I can answer on the air you may write me via the Internet at matters of the mind all one word WFYI dot org that's matters of the mind at WFYI Edgar I'll start tonight's program with an email I received this past week.

It reads Do not a favor.

Can you explain pseudo dementia?

Does that mean that I will get dementia?

>> Is this from long term psychiatric medication pseudo dementia as a name kind of implies is kind of like a fake dementia.

>> It's gives you the symptoms of dementia such as memory impairment and difficulty with attention span and concentration.

But it's not real dementia that is a progressive condition like Alzheimer's disease, Lewy body dementia, vascular dementia and so forth.

So pseudo dementia is where typically a person is getting older and as they get older they have trouble with memory and concentration but it's related to depression, untreated depression will give you memory impairment and especially as you get older you can notice that so people when they get in their 60s and 70s, if they start having memory problems related to depression, it's a term has been around for a long time but it's been called pseudo dementia where they don't really have the true aspect of dementia.

It's related to depression which is a very treatable form of dementia.

Other treatable forms of dementia can be related to sleep apnea, low thyroid glucose disturbances these and low iron BWV disturbances.

These are all reasons why people can have symptoms of dementia but they are treatable and they can reverse the whole process.

>> Now a secondary question you had was with psychiatric medications do they in turn give you a higher likelihood of having dementia?

>> Some might for instance, if you're taking medications to offset the side effect of some of the older antipsychotic medications such as Kunjin Artane these are medications that are so-called anti cholinergic medications.

They block acetylcholine and in blocking acetylcholine acetylcholine is necessary for memory concentration.

>> But if you block acetylcholine you can give somebody difficulty with short term symptoms of dementia and possibly even long term dementia.

Another aspect that can be problematic for some people will be if they take alprazolam clonazepam diazepam a lorazepam these are all the benzodiazepine medications.

If you take a benzodiazepine medication for anxiety long term that indeed possibly can give you long term aspect or long term repercussions with dementia.

And that's why we're very, very cautious in giving those kinds of medications to people who are over 65.

They can give you cognitive or memory disturbances for the time that you're taking them.

>> But for some people actually have been shown to have long term memory disturbances even after they go off of them.

>> The controversy is always there.

Do the medications like the SSRI, the antidepressants, the mood stabilizing medications do they actually cause dementia?

>> Well, it's kind of a chicken or the egg type of phenomenon.

If you take a medication long term for the treatment of a condition that is associated with dementia, is it the actual condition associated with dementia or is the treatment itself for instance with long term depression if it's untreated depression as you get older you have a five times higher risk of having Alzheimer's dementia.

In other words with long term depression holding up my brain here this is the temporal lobe over here, the hippocampus aspect of the brain is right there.

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

It'll shrink down as you get older.

It can naturally shrink down but when people have Alzheimer's dementia it'll shrink drastically such that instead of having perhaps fifty thousand connections on each individual neuron you might only have 30 or maybe twenty thousand connections on each individual neuron.

It's the branching that often shrinks when you have dementia or long term cognitive impairment.

Well depression will do that as you get older and long term depression puts you at a higher risk for Alzheimer's dementia itself.

>> So untreated depression puts you at a risk for Alzheimer's.

Well, you can imagine if somebody gets treated with an antidepressant medication maybe it'll help some with that but it might not help all the way.

So that's where the controversy has always been.

People who take antidepressant medications might have a higher likelihood of long term memory problems not because of the depression itself but perhaps because of the subtle damage that might be done while they had spells of untreated depression.

So we emphasize to people that untreated depression is damaging to the brain.

If anything, the antidepressant medication tend to downstream stimulate the natural brain fertilizer it's called brain derived neurotrophic factor.

There's one called mTOR mammalian target of rapamycin.

These are natural brain fertilizers and if you stimulate those it's like firing up your your lawn with some fertilizers.

So when people have long term depression it's like an unfertilized lawn.

That's how your brain kind of acts with long term depression.

It's you need some fertilizer.

You need some watering.

That's what antidepressants can do.

Some of the older antidepressant medications that affected serotonin, norepinephrine and dopamine did that to some degree.

>> But we have these newer antidepressant medication such as ketamine also known as bravado.

We have authority which is a combination of dextromethorphan and bupropion.

>> These medications are affecting glutamate and within a matter of hours they are profoundly increasing the brain fertilizing with hormones that tend to stimulate that branching and they do so very, very quickly.

>> Thanks for your email.

Let's go to our first caller.

Hello Jerry.

Welcome to the Mind.

Jerry, you want to know what's the best way to prevent Alzheimer's disease or slow the process number one, a couple of things you can't do, Jerry.

You can't stop getting older and that's the number one risk factor for Alzheimer's as we all get older.

>> Yeah, we're at a higher risk for Alzheimer's.

Secondly, we can't do anything about your genetics.

It is partially genetic.

Alzheimer's has a genetic component but it's not always guaranteed.

So what can you do to prevent it?

Well, number one, keep exercising if you exercise aerobic or resistance training either one or good.

>> So any kind of exercise can decrease the likelihood of of Alzheimer's disease.

Secondly, keep your weight down .

Obese people are more likely to develop Alzheimer's thought that's thought to be because obesity itself the fat releases inflammatory proteins which can thereby cause damage to the memory parts of the brain.

Thirdly, don't drink any alcohol and I'm saying any alcohol as you get over fifty five years of age we used to think I could have a drink here and there and maybe red wine would actually be better for you.

>> Well that's the red wine.

The aspect of it you can probably get from Welch's grapefruit fruit juice to give you a brand name of a grapefruit juice there or maybe purple grapes.

>> But the alcohol in any quantity seems to be damaging to the brain especially for older adults.

So be very careful about any alcohol consumption.

So so exercising eliminating alcohol try to do something about any underlying medical conditions.

Many, many people who were having memory disturbances that can lead to Alzheimer's dementia have underlying diabetes.

So if you have blood sugar disturbances, get those under control.

Secondly, if you have thyroid disturbances, get those under control blood pressure, high blood pressure worsens the likelihood of your having Alzheimer's dementia and very importantly as you might have heard me say, many times on this program, if you have snoring or a pausing in your breathing in nighttime and you have sleep apnea, sleep apnea is a drastic risk factor for Alzheimer's dementia.

So you need to get the sleep apnea under control where you're not having the pausing, you're breathing, you're not snoring and you're using CPR auto perhaps some kind of means to regulate the sleep apnea itself.

So those are medical conditions that need to be addressed to decrease your likelihood of Alzheimer's dementia.

Another thing you can do to decrease the likelihood Alzheimer's dementia is socializing.

There's something about socializing where we interact with other people on a regular basis somehow some way that seems to decrease the risk of Alzheimer's dementia as well.

And finally learning new tasks, keeping your brain active, keeping your brain busy, doing something with your brain, with reading not just some passive activity like watching television even if it is PBS you've got to keep your brain active and in doing so you need to be actively engaged with conversations, with puzzles, with doing things where you're actually having to think and you can do those things online and computerized games are fine but passive activity like watching old sitcoms on television not going to be good for the brain for older adults and so many of us as we go into retirement that's what we often end up doing have something to do that's meaningful and productive on a day to day basis as you get older, especially going into semiretirement and retirement, have us a quasi schedule on a regular basis with some ideas on what you're going to be doing day by day by day.

Thanks for your call.

Let's go to our next caller.

Hello Beth.

>> Welcome to Matters of Mind.

Beth, you heard me mention bravado a few moments ago.

You want to know how it works and our medication has taken the Asprey more effective.

The key was bravado.

It's the left sided piece of ketamine.

So ketamine has been around since nineteen seventy as an anesthetic and it has some benefits as an anesthetic.

Ketamine was developed by an organic chemist in at Wayne State University up there in Detroit and ketamine has been around since nineteen seventy used on a regular basis.

Well it was found about twenty five years ago that when people use ketamine IV they could also have improved with depression very very quickly.

So it actually got used for treatment resistant depression but it was so-called off label so you'd have to pay out of pocket.

>> There were no regulations associated with it and then in 2000 Nineteens bravado or a women got FDA approved in other words officially approved by the government such that insurance companies would cover ketamine as the left side a piece of ketamine and as the left side a piece of ketamine.

It's four times more potent on this particular receptor compared to ketamine itself the entire molecule and if you use it intranasal it will give Zschau better.

So if you use various medications intranasal leg is absorbed and that's how ketamine is utilized.

People will be monitored for a two hour time period twice a week the first month, once a week, the second month and then once a week or every other week thereafter and then you talk it over with your clinician on how long and how frequently you use it thereafter.

But ketamine and ketamine is bravado are being used as a means of very quickly stimulating their natural brain fertilizer brain derived neurotrophic factor and mammalian target a top of myson these are natural brain fertilizers that will stimulate the branching of your individual neurons within a matter of hours and in doing so it can be they can be very, very quick and effective means of helping reverse depression because I mentioned the hippocampus a moment ago.

Fifty thousand connections per neuron in the hippocampus it's functioning properly but with long term depression, with long term unmitigated stress that you're not finding tolerable if you use alcohol women who are going into menopause they will have decreased branching of this memory center of the brain and that's only a part of the problem because the ranching here is extensive.

But all around the brain there is extensive branching that's decreasing if you have chronic stress, chronic depression and so forth.

So what we're trying to do with as ketamine is bravado is try to fire up that branching very quickly and that's why not uncommonly and it's not a placebo effect because it's been assessed versus placebo but not uncommonly within a matter of hours after somebody has their first couple treatments of bravado, they notice they feel emotionally much better and they can think more clearly.

>> Thanks for your call.

Let's go out and ask our caller .

>> Hello Karen.

Welcome to Matters of Mind.

OK, here's the deal.

Lilly has stopped making real Prozac and in 2001 I started on generic and I crashed and burned really bad.

I had to miss work for nine weeks.

I was so suicidal ideation OK and so I went on real Prozac again then like 2006 maybe my doctor switched offices and they put me back on generic which I didn't realize but I was crying every day it's like what the heck is going on until I finally realized oh I'm one generic.

So yes it's really expensive but it's worth it to me because I've seen the black hole and I'm not going back but now because you know it costs me almost sometimes depending on where I am and my insurance.

Twenty dollars a day for the real Prozac and you could get generic for two bucks so I get it really doesn't want to make it but I feel like I'm cooked.

>> What do I need to do?

There are options Karen when you change for well I'm sorry what dosage of Prozac do you take.

>> Twenty milligrams 44.

That gives me a start if you're taking forty milligrams of Prozac brand name if you get a generic fluoxetine which is generic Prozac.

Yeah you're getting perhaps as little as thirty two milligrams of Fluoxetine versus forty milligrams and a brand name Prozac because a generic formulation is allowed it's called bio availability bioequivalence actually but it's a generic formulation is allowed to have as little as eighty percent of the brand name dosage up to one hundred twenty five percent but quite frankly it's often on the lower side brand name Prozac was indeed manufactured.

>> It was formulated by Lilly back and it was FDA approved back in nineteen eighty seven.

Been around for a long time.

Lilly's out of Indianapolis and then Lilly outsourced the brand name manufacturing most of it to Taiwan so it's outsourced to Taiwan and about eighty five percent of our brand name Prozac came from Taiwan since December a twenty twenty four they quit manufacture ring brand name Prozac in Taiwan and I think it's going to be very, very difficult to find it any place because I've had the same experience with my patients.

It's very difficult to find brand name Prozac any place.

>> So here's here's the options Garran number one you could could anticipate maybe you're getting a lesser what we call bioavailability or bioequivalence bioavailable how much gets in the body itself.

>> So it's kind of similar type of terms but anticipating that you might be getting less Flock's team in that 40 mg generic formulation that you're getting, you could perhaps with your clinicians oversight take an extra 10 milligrams.

In other words take fifty milligrams of generic.

That's kind of a backdoor way of maybe getting a little bit more Luvox in your system preferably.

I think Karen, you might want to go to a different SSRI now you might have tried various other ones before but some people well can do reasonably one other SSRI it is a fallacy to believe that all SSRI is work the same.

Yeah, they all work on the serotonin transporter and that's their main mechanism of action but they work subtly in different ways.

So you might do better on Lexapro Zolt versus Zoloft versus Paxil versus Celexa.

I mean you could try various other SSRI that have similar mechanisms of action that then do Fluoxetine or Prozac and they might work as well for you.

Another option, Karen, would be to go to an entirely different medication that also affects serotonin but will have other other features such as a serotonin norepinephrine uptake inhibitor.

>> You can get those as through stic Effexor is kind of one that we we've used but now the Pristina's is generic.

We use it more.

Cymbalta also needs to lockshin they also can be available in a generic form but they'll be available in trade name form too.

So in other words what you'd want to do is go maybe to another medication that has a similar mechanism of action as does Flock's team doing that when you get a generic formulation fluoxetine you're getting as much as 80 percent lower dosage and that's why it might not be working for you.

>> Karen, I'm curious have you tried other antidepressants outside of brand name Prozac?

No, only brand name and I when I crash and burn in 2001 I was only on twenty milligrams and then when I crashed my doctor put me on forty which I've remained on but like I don't feel like the the less dosage is what I don't know I am going to be I am getting genetic testing because you know I watch your show to see if I'm whatever a good something I do have attention deficit OK which Prozac I feel like is good because you know sometimes I don't remember to take my medicine and it's got a three day half life right.

So if I miss one I don't feel like oh no it's all cooked because OK one day it's not going to kill me.

>> Yeah, that is the beauty of Prozac.

There's actually a formulation that was available I haven't seen it used more recently.

It's called Prozac Weekly.

It's where you take flaxseed or Prozac once a week now I don't know if I'd want to get that creative and trying to find you another version of Prozac.

>> Is it a brand name for instance?

There's Simbi Axis are out there.

Prozac Weekly used to be available but again you're looking for a brand name Prozac.

>> I don't know if you're going to find one or not but that's something you could get very creative in trying to find with your pharmacist and seeing where they could acquire something.

It's like brand that has brand name Prozac in it because that way you know.

Forty milligrams is the dosage you're getting I think as if I was your clinician I'd think about other options that also have similar mechanism of action as do Prozac.

Like I said, you've got Celexa, Lexapro, Paxil, Zoloft and Luvox.

Those are five medications that work in the same mechanism of action as do Prozac but they all do subtly different things.

But their main mechanism is they affect that serotonin pump and in doing so that's what's giving you effect.

I'll tell you right now, Karen, based on what you've already told me, I think one of your genetic testing results will be that you're going to have an L.A. genotype for this particular gene called Essl C six a four SLAC for the gene is the gene that we will examine to see if somebody's a good candidate for a serotonin reuptake inhibitors such as Prozac.

Hey, you're getting a good response on Prozac.

>> You're going to have at least we get two genes one from my mom, one from our dad and you're going to have at least one gene and probably both that are an L or an L a gene itself depending on what kind of genetic testing you get.

So we already know that other thing about genetic testing that we can identify is how quickly you break down medications so we'll be able to you would be able to to determine if you go to another serotonin reuptake inhibitor which one could you dose at a particular level or which one do you need to do is higher or lower based on genetic testing results.

So the genetic testing does help determine which direction to go.

But I think there's a lot of potential for you, Karen, to go to another type of medication that works kind of like Prozac and if you have ADHD, Prozac will help some and quite frankly we've got some really good stuff for ADHD that also act as antidepressant medications and that could be determined by your genetic testing as well.

But for instance, not uncommon people have ADHD.

They will add a medication to Prozac or take it entirely differently than the Prozac such as bupropion or Wellbutrin is often used specifically for ADHD.

But you're getting the serotonin effect from Prozac and you're exactly right.

Prozac does have a long Half-Life.

What else has a long half life ?

The work kind of like Prozac there is a brand name medication by the name of Trent Alex Trent.

Alex will be brand name for another year.

Its generic is very Hox team but we're finding that many people are getting it well covered by their insurance because it is going to go generic in about a year to Intellichoice will do the exact same thing Prozac does and at forty milligrams of Prozac you're going to need about ten maybe twenty milligrams of treinta but that's a brand name medication that's still brand name.

It does not come in the generic formulation.

Yeah.

So if you want to make an easy switch from Prozac to something that still has a brand name formulation that would be trendy so you can ask your clinician about the possibility of changing from Prozac to Tarantella.

It's what I like about that for you.

Karum 26 is metabolized in a similar manner as does Prozac.

So if you've done well with Prozac you could do well with telex.

Secondly, Prozac and intox last they have half life for three days apiece so if you miss a dosage it's no big deal there and one nice thing about twenty six twenty six does the exact same thing that Prozac does but it also will affect five of the 14 different serotonin receptors and in doing so can specifically help with ADHD symptoms.

We've actually used to tell specifically for people with depression who respond well to serotonin medications but also have comorbid ADHD so that could actually be a better option for you and it just could be an opportunity at this time of your life , Karen, to try something differently.

You've been on Prozac for many, many years.

You might be ready to go to something that works possibly even better than Prozac for you and this is kind of a backdoor way of getting you there.

But that happens sometimes.

Sometimes we just lose the availability of certain brand name medications and that's what happened with Prozac back in December.

>> Twenty twenty four.

>> Karen, thanks for your call.

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

Our next e-mail question reads Does weight loss particularly bariatric surgery have a positive impact on anxiety and other mental health issues?

I have had weight issues most of my life .

I'm wondering if a decision to have the surgery will have other fringe benefits.

>> Bariatric surgery include the gastric sleeve ruined.

Why bypass these are a means by which you're basically cutting off part of the stomach and you can don't absorb as much.

>> We have found over the course of the past couple of decades now that people who have bariatric surgery typically have less anxiety and less depression and sometimes even better ability to think and concentrate because obesity and the adipose cells themselves do release an inflammatory protein.

When you when you release inflammatory proteins you will fire up this large part of the brain here in the front of the temporal lobe called the amygdala.

The amygdala, if it's fired up will cause you more anxiety, more fear, more anger.

>> You're going to be more anxious from obesity itself by the adipose tissue firing off this inflammatory protein that goes to the amygdala right there downstream.

>> What happens is when you fire up the amygdala you will also increase activation of the anterior cingulate gyrus which is right up here and the anterior cingulate gyrus is the decision making part of the brain where you're thinking should I do this or should I not?

While people with anxiety often ruminate and dwell on stuff and they go over and over in their minds, you're firing that up when you have adipose tissue firing off inflammation.

So a lot of people who have evidence of inflammatory effects in their brain as a symptom will have a lot of anxiety.

What does anxiety do and makes you tired?

It makes you tired because if you have all this anxiety firing up the anterior cingulate gyrus up here down here in the basal ganglia, it tends to get dampened down some so it makes you physically fatigued.

>> So that's how anxiety can actually cause you to feel physically fatigued.

Many people when they have a lot of anxiety and they have depression for that matter if they have inflammatory components affecting their brain they'll feel like they have the flu and when you look at the inflammatory proteins associated with depression and anxiety, they are the same inflammatory proteins as you'll see with a flu such as Interleukin six tumor necrosis factor alpha.

These are fancy names for inflammatory proteins that are common with the flu as well as with anxiety depression and it makes you feel the same.

Many people with anxiety and depression will often feel achy all over and that's because that's where they feel like they have the flu day by day by day and they just don't feel right and fatigue, poor concentration, low motivation, lack of initiative for things.

>> These are all symptoms of an inflammatory type phenomenon occurring with anxiety depression.

>> So short story long there but if you have inflammatory fruit proteins being released from adipose tissue, you bet that can make anxiety much worse for many, many people.

>> Thanks for your call.

Let's go our last caller.

Hello Donna.

Welcome to the line.

Donna, you want to know the sour candy actually stop an anxiety attack you?

>> I think that when you consume something that's enjoyable for you maybe with sour candy if somethings enjoyable for you and it releases dopamine in the brain, it can decrease panic and anxiety and even depression for some people it's association you have with sour candy.

>> Donna, thanks for your call.

Unfortunately I'm out of time for this evening.

If you have any questions concerning mental health issues that I can answer on the air, you may write me via the Internet at matters of mind all one word Atwar dot org I'm psychiatrist offer and you've been watching Matters of the Mind on PBS what God willing and PBS willing.

>> I'll be back next week.

Thanks for watching.

Good night