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>> Good evening.

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

Welcome to Matters of the Mind.

Now in his twenty sixth 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 any place coast to coast you may dial toll free at 866- (969) to seven to zero now on a fairly regular basis we are broadcasting live every Monday night from our spectacular PBS Fort Wayne studios which lie in the shadows of the Purdue 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 org that's matters of the mind at WSW Edgard and I'll start tonight's program with a question I recently >> It reads Your daughter Forfar is gabapentin effective for anxiety?

What are your thoughts?

>> Gabapentin is also known as Neurontin been around since the 1980s or early 1990s around for a long time.

>> Gabapentin was originally approved and studied for seizure disorders but it was readily discovered especially by psychiatrists.

It was a very nice medication not only for anxiety but also for restless legs tightening of the jaw.

We call that bruxism where people kind of grind their jaw but was also very good for sleep because it tends to normalize the sleep architecture such that it gets out of your system within about eight hours.

>> So very early on psychiatrist started using gabapentin for reasons other than it was for which it was approved and that's perfectly egal.

>> It's moral ethical.

>> You can still do that and we continue to do that to this day.

There's a lot of studies coming out on gabapentin right now.

>> It's not going to get FDA approved for any additional indications because it's now generic.

The company that made gabapentin Neurontin Pfizer they no longer have the patent on it so anybody can use it for various purposes Lhasa's established treatment.

>> So there's a lot of papers out there on using gabapentin for alcohol withdrawal, sustained alcohol, abstinence.

That's where people have difficulty with a dry drunk period for instance, and they have trouble with ongoing anxiety even though they've been off alcohol for two or three weeks.

>> We use it quite commonly for people who have been on marijuana a lot people who use marijuana for recreational purposes will say eventually they're using it because it helps them feel normal.

They don't feel stressed out.

They feel calmer with marijuana takes away your motivation and especially as a younger adult it actually compromises your ability to think and affects your memory and concentration.

>> Gabapentin does not now because gabapentin be used for everybody and this is where there's always exceptions people who take opiate medications, narcotic medications, pain medications, those kind of medications if they take gabapentin it will amplify the effect of the narcotic and potentially give a higher risk for respiratory suppression and dying of stopping breathing if you're under the influence of a narcotic.

Klonopin, Ativan, Valium, the traditional benzodiazepine medications.

>> Gabapentin works differently and it won't suppress it won't accelerate the effect of the narcotics as much as the benzodiazepine medications will but it can still be a problem.

Roughly two percent of people based on one study out of New Jersey two percent of people will abuse gabapentin to give them a high and those are the people who will take higher and higher amounts of it.

>> But a vast majority of people will not rarely do we hear about people taking more and more gabapentin as a means of trying to get the sustained effect.

>> We hear that all the time with Xanax, Klonopin, Ativan, the benzodiazepine medication.

So what's the difference?

The benzodiazepine medications work more on this particular receptor called GABA and it works directly on the Gabo receptor itself.

>> By contrast, gabapentin even though it has the name the the term Gabb in it Gabapentin works more on calcium channels and it's called a calcium channel modulator.

>> In other words, it decreases the itchy trigger finger that calcium channels can have and if a calcium channel has an itchy trigger finger it's firing too much and it can make you anxious and make you more prone to seizures, make you more prone to restless legs and give you all these difficulties too which I previously referred in which we use the gabapentin.

So if you gabapentin you're not affecting the Gabba receptors directly and that's where the addictive potential can come.

You're affecting more of the calcium channels and gabapentin as a chemical cousin called Pregabalin also known as Lyrica and those medications can help not only with seizures but with restless restless legs, fibromyalgia, bruxism, sleep disturbances and anxiety.

So we're commonly using gabapentin for a lots of different people now again you can abuse it.

>> It will be abused in some cases we have to watch out for those folks.

>> But you know, a common dosage will be 300 milligrams three times a day for pain and many people will say that's just too much.

So for anxiety will often prescribe 100 mg capsules having people take one or two the capsules twice a day just as needed and then two or three capsules a bedtime for sleep knowing that we can be a little bit flexible on the dosage.

>> What are the main side effects?

If you get too much gabapentin you can feel tired and some people for some strange reason we don't know why will sometimes get swollen ankles so they'll get a little puffy and some people will notice they have some weight gain because of the fluid retention but that's the main side effect you'll hear about with gabapentin.

>> It does not seem to compromise the ability to think to the degree that the benzodiazepine medications like Xanax and Klonopin and Valium will do and it will certainly help with anxiety more efficiently than will marijuana or alcohol for that matter.

>> So we do use gabapentin for anxiety.

Thanks for your email.

>> Let's go to our first caller.

Hello Robert.

Welcome to Mary's in Mind.

Hi, Dr. Fowler.

I was a caregiver for my mom with Alzheimer's for about the past ten years and she passed away last Monday.

Um, I I'm a recovering alcoholic and subsequently I had a relapse and went to PVH and was discharged.

My question is I'm a I'm a long term naltrexone user, a long time Citalopram user and I was wondering when I go to talk to a nurse practitioner Friday should I request a change in medication is or should I just stay on my medications and work through the grieving process?

You know what I mean with what the medications that I have or I guess I'm wondering if like you know I mean some a pill to relax me or something.

I don't know if that would be counterproductive to my grieving not natural grieving process.

>> Yeah.

Robert, let's just pretend you're seeing me right now during an office visit you're coming off the grieving.

>> Unfortunately your mother passed Jiya about a week ago so I'd want to know how are you doing right now?

>> Granted you went into the hospital due to a relapse with alcohol but how are you feeling right now?

>> You should be grieving.

You should be sad.

>> You should miss your mother.

But overall, how are you feeling right now?

You know, I feel a lot better than I thought I would you know, I bounced the naltrexone really helps you bounce back from relapses.

I was sober two years prior to that, you know what I mean?

And I've gone through long nights of sobriety but I think, you know, Mom's death mixed with that alcohol relapse.

I was just wondering, you know, would a change in medication just be throwing more onto the fire or you understand I don't know.

I guess what I'm asking is should I should I like I feel good, you know?

I mean I'm where I'm working.

I'm eating I'm sleeping good.

I've cleaning cleaned out her house, you know what I mean?

And I'm I feel very productive good at this point, Robert.

>> I don't know if I change anything based on what you're describing because I want to do anything I could to help you from not relapse again.

>> Naltrexone is fantastic.

Naltrexone comes in a pill called Ravier.

It comes in an injection called Vivitrol.

So Naltrexone is basically an opiate receptor blocker that decreases the basically enjoyment and craving for alcohol.

So I'm a big fan of Naltrexone in various forms so Naltrexone won't make grieving a lot worse.

>> Significantly the grieving process itself I'd want to make sure that you were not self medicating for insomnia, appetite, anxiety if you were self medicating and feel like you need to have a drink of alcohol as a means of getting over those rough patches by all means I'd probably give you this medication to which I referred earlier called Gabapentin.

>> Gabapentin can be safely used even during the grieving process.

>> Now you rightly noticed, Robert, that if you take a tranquilizing sedating medication for anxiety like Xanax, Klonopin, Valium, you can maybe to get you through the funeral and things like that very briefly.

>> But you're exactly right, Robert.

If you take a a tranquilizing medication for a long period of time as you're going through the grieving process, it does simply delay.

>> It'll hold you over to get you through some obligations but you don't want to take a sedating tranquilizing medication long term.

>> So if you're eating you're sleeping all these things you already mentioned you're doing things you're not experiencing complicated grief, complicated grieving which leads to what we call major depression is where you're not sleeping or not eating.

>> You're not getting out of bed.

You're not going any place you want to die yourself.

Those are all symptoms of complicated grieving.

But my goodness, Robert, it sounds like you're hanging in there for the time you're getting the obligations done that you need to do Citalopram Naltrexone.

They've been your friends for a while.

You might want to stick with them for the time being.

>> That sounds good because you know I mean I was two days ago if you'd asked me I'd say oh please give me the pill, you know, but today it's like now I really do want to kind of like you know what I mean?

>> It's fantastic, you know, stay the course.

Yeah.

Midwifes yeah.

>> And from my perspective I would say OK, if you're feeling like you have a drink you need to have a drink let me know because I can give you something to offset that craving and I don't want to know why do you feel like you need a drink is because you're anxious is because you can't sleep.

>> Are you drinking alcohol to try to help bring some joy back.

We can tweak your medications a little bit to try to address those individual problems that might be drawing you back to alcohol use because nowadays we look at alcohol use disorder is not just a disease.

State of alcoholism itself is usually an underlying reason why people are drinking alcohol.

So I want to always address those reasons that would draw you back to relapse and it sounds like Citalopram and Naltrexone are holding on for you for the time being.

>> OK, well thanks a lot.

You know I'll go on Friday and I'm pretty much going to express that I think I can stay the course.

>> Fantastic changes.

OK, thanks.

Good luck to you Robert.

Take care.

OK take care now.

>> Bye.

Let's go to next caller.

Hello John.

Welcome to Matters of Mind John.

>> You want to know is there a psychiatric component to rheumatoid arthritis?

That's an interesting question ,John, because there's a particular protein called Interleukin six.

>> It's and it's associated with rheumatoid arthritis, the flu and some are certain forms of depression.

>> So when people get depressed sometimes they all have specific symptoms that are thought to be related to inflammation and those symptoms can include lack of enjoyment of things, people feeling really slowed down and moving slowly, having difficulty with sleep and having trouble with concentration and just losing all happiness.

>> So those are all inflammatory kind of symptoms.

So you can have rheumatoid arthritis thereby releasing inflammatory proteins which then can give you all these depressive symptoms and it kind of goes hand in hand and I I would predict that another five or ten years from now we're going to have that down where we can figure out based on your symptoms, based on certain lab tests, looking for specific inflammatory proteins what medication we can use not just for depression but also for the inflammatory component itself.

But for many people, John, they'll notice that as they're getting treatment for rheumatoid arthritis they mood will improve because if you have less inflammation from that rheumatoid arthritis, you will thereby have a better mood.

>> So it kind of goes hand in hand.

John, thanks for your call.

Let's go to our next caller.

Hello, Dave.

>> Welcome to Matters of Mind.

Dave, you had mentioned you have vertigo.

How do you treat it?

Verdie grows and is an ear, nose and throat difficulty.

>> Dave and I will sometimes hear about vertigo as a psychiatrist because vertigo is a sensation that things are spinning.

>> And when I hear about vertigo, the first thing I'm going to ask people will be do you also notice that you have nausea and these also have ringing in the ears because this triad of vertigo spinning dizziness, the triad of vertigo with nausea and ringing in the ears called tinnitus that triad is a phenomenon that can be called Manyara syndrome.

A doctor by the name of Dr. Banir discovered that and studied and the near syndrome is treated best by the ear, nose and throat folks they will assess people the medical shin that's often used for vertigo and dizziness will be a medication called antivirus antivirus a medication that goes by the generic name Mecklai Zeine and Mechanizing will kind of dry up the inner ear fluid and sometimes relieve dizziness and vertigo that way.

>> But it's important that we differentiate vertigo from just lightheadedness.

Lightheadedness is where you stand up real quickly and you feel kind of loopy and you feel like you might pass out and things are starting to go back on you.

Vertigo is where you see this spinning round and round and ound and first thing I often think about when I hear about that Dave will be you've got an inner ear and infection.

You've got congestion in the inner ear.

Something's happening there to cause that balance disturbance.

That's the first thing you always want to want to examine.

Psychiatric medications don't usually cause vertigo itself.

A lot of psychiatric medications will cause lightheadedness.

>> So when somebody says they're dizzy, I'm always trying to sort out is it spinning which is vertigo or is it lightheadedness?

>> And the lightheadedness can often be relieved by taking the medications at certain times, lowering the doses and sometimes considering a different type of medication if it's causing lightheadedness.

>> Dave, thanks for your call.

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

Our next e-mail question reads Dear Dr. Harvey, you mentioned the new medication for depression.

Is it a Engeneic?

If not, how do you listen?

>> Ingenix work it differently.

I believe I mentioned a medication for depression last week that came on the market fairly recently called Youssouf Zoove Zoove also known as Aran alone.

>> It got approved by the Food and Drug Administration in early August of 2003.

>> So it's a medication it was approved by the FDA for postpartum depression.

It's a 14 day treatment.

You take this medication 50 milligram amounts to the twenty five milligram capsules in the evening and you can't drive for twelve hours after you take it so roughly you'd take it maybe six p.m.

It gets much better absorbed with a high fat meal.

So you take it about six p.m. You don't drive until six a.m.

So it's not too big of an inconvenience but you take it at home whereas the previous medication for postpartum depression it was somewhat of a chemical analog you had to take it as an IV for 60 hours two and a half days in the hospital setting and it had to be closely monitored wasn't alone or Zoozoo they you can take it at home for fourteen days four to five women get a significant response out of just 14 days of treatment with or without another antidepressant.

>> But four out of five women got a significant response in the clinical trials Wisner's of Zoove for just fourteen days of treatment and then four out of five of them did not have to require another treatment for the rest of the year.

One out of five of them did but four out of five of them did not so that one treatment was all they needed.

Remarkable medication.

>> We're getting away from antidepressant medications that just affect serotonin, norepinephrine and dopamine.

>> Those have been the type of medication we've had for the past 60 years that's been the main mechanism of pretty much all antidepressant medications we've had for the past six decades.

>> Now we're talking about medications that affect one chemical called glutamate and another chemical in the cases of zoove that's affecting Gabb.

So are working in different ways and the reason why Zoove is controlled and reason can't drive for twelve hours after you take it is because it can make you kind of sedated, a little bit lightheaded and itself but otherwise it tend to be tends to be very well tolerated for a lot of people.

So it's a medication that should be available on the market within the next month or two when the medication gets approved it usually takes a month or two before it actually get on the market.

>> But right now it's approved specifically for postpartum depression which affects as many as one out of five women and it can affect them pretty significantly about three to four months after they deliver the baby.

Now 90 percent of women get the baby blues or they feel a little bit depressed, a little bit teary eyed but they don't get a full blown depression that postpartum depression women will experience where they don't want to care for their baby.

They withdraw significantly.

They don't want to eat.

They have trouble sleeping.

Zoove works very quickly within a matter of two or three days and then you take it every day for fourteen days and then that's so it's kind of like an antibiotic in that regard.

>> It's remarkable how it works so quickly and it seems to give a sustained effect even though you only take it for fourteen days.

So the pharmacotherapy of postpartum depression has dramatically upgraded with zoove that came out in August of twenty twenty three.

>> Thanks for your call.

Let's go to our next caller.

Hello Janet.

Welcome to Matters of the Mind.

>> Janet, you notice that your daughter is pushing things around on her plate, pushing the food around on her plate I presume instead of eating.

Should you be concerned?

I wouldn't be concerned, Janet, unless was evolving into an eating disorder where she wasn't eating or she was vomiting after eating the usual type of eating disorder type of phenomenon.

Sometimes children will pick up their food.

You can hear about kids who will say they don't want their food to touch.

>> They want to eat in a counterclockwise or clockwise manner that's not considered to be pathological unless it's causing what we call functional impairment whether or not getting nutritional value with their with their eating habits themselves.

>> So pushing around food on the plate is not considered to be pathological and wouldn't warrant a referral to a psychiatrist or psychologist for that matter.

>> Janet Janet, thanks for your call.

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

Our next e-mail question reads Your daughter Fauver what's the likelihood that someone will continue to have attention deficit disorder as an adult if they had as a child?

>> If you had asked me that maybe a year or two ago I would have said about sixty five seventy percent likelihood of taken attention deficit disorder into the adult years compared to the childhood years.

But we've since come to realize that that data looked at certain points of reference.

>> If you look at the symptoms of attention deficit disorder specifically you'll find that you'll have about 90 percent of adults still having AIDS if they had it as a child.

>> So if you had AIDS by the time you were 12 or 13 years of age where you had trouble with attention span concentration, distractibility, difficulty with procrastination, getting things efficiently done to a greater degree than you'd expect, about 90 percent of people will take those symptoms into the adult years now up until the time you're twenty four years of age, the front part of the brain here are still growing attention deficit disorder is basically a phenomenon where the front part of the brain is a little bit underdeveloped, about five percent underdeveloped but because it's five percent underdeveloped you can have trouble with attention span which is affected by the left front part of the brain here and you can have trouble with impulsivity, doing things and saying things you ordinarily ordinarily shouldn't do or say causing you to have a lack of tact.

That's this front part of the brain called the orbital lateral prefrontal cortex right above the eyeball.

>> That's the part of the brain that controls your impulses.

People with aid have those difficulties now as a child, boys will often be identified as having aid or because they have impulsivity and hyperactivity and that's called ADHD.

>> The standing for hyperactivity so boys will be readily identified.

They're the ones bouncing off the walls and getting into trouble.

>> Girls will often have kind of a silent attention deficit disorder where they have trouble with reading.

They don't get things done efficiently.

They kind of daydream a lot but they don't like causing trouble so they get kind of hidden in the in the background when you go into the adult years the hyperactivity impulsivity might not be so problematic but you'll notice that when you get to a certain degree of an academic or an occupational challenge you might notice that pass coping mechanisms you use for aid are no longer working.

>> So you can be a very good student and you can work three times harder than everybody else.

But as time goes on you can find that you reach certain hurdles that are difficult to overcome because you're overly challenged by them and for the first time ever you're thinking maybe I have some symptoms now keep in mind a woman who's perimenopausal in other words she's still have an appearance once in a while but they're not occurring frequently.

She might be in her late 30s or 40s, late 40s even where she's not at menopause yet.

>> The periods haven't stopped but she's going into the early menopausal symptoms.

You can have a worsening of symptoms when you're going into the perimenopausal time because as estrogen starts to slowly decrease this memory center of the brain over here called the hippocampus is affected significantly.

>> So if you already had add to some degree you might notice the symptoms really become prominent during the perimenopausal time.

So we'll have a discussion at that point with hormonal replacement therapy be an option if you don't have a history of cancer or anything that would be estrogen sensitive or would an adjustment on the medications be in your best interest at that time so ADT can go into the adult years but affects people differently going into the adult years?

>> Not everybody's diagnosed with ADHD as children or adolescents or young adults because they were able to overcome the symptoms of ADT they had at that time they learned how to cope with things.

It might affect you later on if you get into a close relationship like a marriage or in a job situation where you need to step it up a notch in terms of your ability to really cognitively focus on things.

>> Thanks for your question.

Let's go to next caller.

Hello Zach.

Welcome to Matters of Mind.

Um, I had a question that a family member that's dealing with Parkinson's disease, the increase of medication around two to three months ago and they hallucinate animals and different things they last week are on medication for anxiety.

Is there a way to deal with people to get them calmed down or do you think the dose could be too high or they just put it on an anxiety medication though if they said it'd take four to six weeks to kick in something we can do in the meantime or I'm not sure what to do.

>> I guess what I'm asking.

Yeah, Zach Parkinson's Disease is basically where you have this area of the brain in the middle here called the substantia nigra nigra meaning that it's a black blackened area but it starts to shrink down when that shrinks down you have less dopamine in that area.

>> Less dopamine will give you the characteristic symptoms of Parkinson's disease such as a masked facial expression, a shuffling gait, lack of our movement when you're walking and a tremor.

>> So those are classic symptoms of Parkinson's disease.

Some people might drool a little bit more.

They might have trouble with constipation for that matter and the treatment for Parkinson's disease will often be giving medications that increase dopamine Wolf.

>> You increase dopamine, Zack, you can have trouble with seeing things or hearing things that aren't aren't there now the question would be is it related to the medication increase where your loved ones did have the difficulty hallucinations or with elucidations occurring independently of Parkinson's if they were occurring ndependently of Parkinson's we might consider a condition called Lewy body dementia or Lewy body disease.

>> Lewy body disease will often go hand in hand with Parkinson's disease where you'll have Parkinson's symptoms such as a tremor but you can also have lightheadedness upon standing and you have these characteristic hallucinations where you will see littleppeopl.

>> There are certain medications that are specifically used for that for the purpose of relieving the hallucinations associated with Parkinson's related dementia such as emplacing that will decrease those kind of symptoms specifically related to that particular condition.

>> So there's other options out there for the purpose of treating that.

The idea is to try to get the fine balance between dopamine and the other neurochemicals that can be worsening the anxiety and the hallucinations themselves.

>> Thanks 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 a via the Internet at Matters of the Mind at WFYI ECG org.

>> I'm psychiatrist Jeff Olver and you've been watching Mattes of the Mind on PBS Fort Wayne God willing and PBS will be back again next week.

>> Thanks for watching tonight