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

Welcome to Matters of the Mind now and 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, you may call me in the Fort Wayne area by dialing (969) 27 two zero or if you're calling any place coast to coast you may dolittle free at 866- (969) to seven to zero.

Now on a fairly regular basis we are broadcasting live from our spectacular PBS Fort Wayne studios which lie 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 WSW Edward that's matters of the mind at WFB EDG and I got several email questions this week.

>> Let's get started with our first one.

It reads Do not your favor.

Is there a link between fibromyalgia and ADHD?

Can Ritalin help for fibromyalgia fatigue and brain fog if my primary care doctor doesn't think it will help but I'm still curious what are the next steps I would take?

Well, if your primary care doctor is kind of vacillating one way or another you could always check with the rheumatologist.

>> Rheumatologist typically are the experts in fibromyalgia from a rheumatologist specialist to whom you could be referred but ADHD and fibromyalgia they're entirely separate phenomena.

>> ADHD by definition starts when you're a child.

The diagnosis of adult onset ADHD is an oxymoron.

>> It doesn't happen that way if you have ADHD symptoms that occur as an adult and have their onset as an adult typically it's related to some other phenomenon such as menopause, depression or hypothyroidism.

Something else is causing you to have trouble with this with distractibility and attention span.

So ADHD is something that occurs since you are a child and it's there more days than not it's going to be more prominent when you're undergoing times of cognitive challenge such as academic stress, new job expectations and so forth.

>> So ADHD is one phenomena fibromyalgia is an entirely separate condition that affects women eight times more than men.

It's something that we've known about for several decades now.

It's better understood because now we know that with fibromyalgia there's a particular chemical called substance p p is in pain substance P increases in the brain the side parts of the brain where sensory input is perceived and with higher amounts of substance p it just gets your nerves that itchy trigger finger and you have more aches and pains if you will fatigue and I'll give you this mental fogginess that goes along with it.

So what are the FDA approved medications out there for fibromyalgia?

Well we just this month had a brand new FDA approved medication that's been around for several years but it got FDA approved as a sublingual under the tongue medication called Cipro.

>> Bensedrine and Sikelel Bensedrine is a medication that we've known for years as a muscle relax and called Flexeril.

Flexeril is a tablet five to ten milligrams every day we've used it off label for fibromyalgia but Flexeril is sikelel been supreme and you would take it at nighttime.

What it does it better normalizes the sleep.

It gives you better sleep efficiency with fibromyalgia typically have less efficient sleep.

They don't go into a deep sleep and when they lack a deep sleep they're more sensitive to pain the next day and presumably the higher amounts of substance in the brain.

So Sikelel Bensedrine allows you to have a better quality of sleep overall and that's why it's now used for fibromyalgia on a regular basis.

>> A second medication it's FDA approved for fibromyalgia is Pregabalin also known as Lyrica.

Lyrica will dampen down the effect of substance p but it also decreases the itchy trigger fingers of the nerves themselves.

Pregabalin has been around for a long time as well and is now generic.

A third medication that's FDA approved for fibromyalgia is Cymbalta Dellucci team.

>> It will increase serotonin and norepinephrine in the spinal cord and in doing so block the pain impulses coming up the spinal cord and in doing so give you less sensation of pain.

And then finally we have the last of him which is Savola that is a medication that also increases serotonin and a little bit more norepinephrine than Cymbalta.

But in doing so it is more energizing activating now off label medications that have not been approved for the fatigue to which you referred related to to fibromyalgia will be medications like Modafinil or also known as Provigil.

>> That's a medication that will tend to be activating energizing it's increasing norepinephrine and I'm sorry norepinephrine and dopamine in the frontal lobe also increases histamine and allows you to feel more awake Nuvigil as its chemical cousin.

Those medications are wakefulness medications.

They can be used when people have sleep apnea and when people have sleep apnea.

The best way to treat sleep apnea is by mechanically enhancing the airflow into the lungs.

But if you still have residual sleepiness you can use medications like to use the trade names Modafinil or Provigil as well as Nuvigil.

So these are medications that are often used as well for fibromyalgia related to low energy and they can help with the concentration and focus somewhat as well.

>> But fibromyalgia is still something is getting well studied.

I'm glad to hear there's a new perspective on how you can treat it with Sikelel Bensedrine being FDA approved in August of twenty twenty five.

>> Thanks for your email.

Let's go to our first caller.

Hello Jim.

Welcome to Mastermind Jim.

You want to know how does alcohol withdrawal affect the brain especially when quitting cold turkey?

When you're using alcohol, Jim, what you're doing is you're enhancing a particular chemical called Gabber now you've got this teeter totter effect in the brain.

>> You've got Gabb which is the brakes and you've got glutamate which is the accelerator and the brakes and the accelerator ought to be in balance when you're using alcohol you're particularly pushing down on the brake and in doing so it gives people a calming effect and secondarily can actually increase dopamine for some people and that's why they feel good and happy when they're using it.

However, when you withdraw from alcohol that teeter totter effect starts to reverse and there's less gabb be affected and you'll have difficulty with the enhanced effect of the glutamate itself so you can have a heavier effect on the glutamate side so to speak thinking about a teeter totter with less of the Gabba effect higher amounts of glutamate will make you agitated, can give you insomnia, sweatiness, seizures, all sorts of bad things.

So that's why alcohol withdrawal potentially can be dangerous.

It typically occurs over the course of five to seven days and it should be monitored and supervised in at least a setting where you have a clinician involved.

Sometimes it can be done as an outpatient, many times it's done in an inpatient setting depending on the severity.

But we often will use other medications that affect GABA like the benzodiazepines as a means of slowly tapering somebody off of alcohol.

We do indeed use other anti seizure medications such as Gabapentin also known as Neurontin and Topamax.

Topiramate are being used to ease the effect of alcohol withdrawal.

What did they do?

Well, again they affect glutamate or GABA in ways that will ease the withdrawal itself.

So alcohol withdrawal is related to an imbalance of glutamate and GABA and in doing so you're going to have excessive glutamate transmission with excessive glutamate transmission you can have all those activating energizing symptoms such as seizures which is a condition that can be related to excessive glutamate transmission.

>> Thanks for your call.

Let's go our next caller.

Hello Karen.

Welcome to Matters of Mind.

Karen, are you there?

Yes, I am.

Hello Karen.

Doesn't Karen I called you last week with my switched from Prozac to would you tell me tofor now I was actually recommending for you Karen several options but quite frankly my favorite option just in briefly talking to you would be the possibility of changing from Prozac to Trileptal .

>> I'm not Trileptal Trinitron tell extrinsically likes you.

I'm sorry you know I have a tension in my brain.

It is late in the day to carry my brain went for a little whatever OK so I did get that from my doctor but she gave me absolutely no instructions as to how I'm supposed to do it.

When I picked it up from the wonderful pharmacist at CBS she said Whoa well you can do drugs which you're taping and switch and kind of explain both.

But she said because Dr. Faber is so cool, why don't you ask him what he prefers?

She has what you can do but he would have more knowledge of how he has done stuff like this with his actual patient.

>> So you are the man.

Well, I could give you some general ideas about intellects coming off a Prozac in that way.

I gave you several options with that it's changing from Prozac without getting withdrawn.

You'd done so well on Prozac for so many years, Karen, so you don't want to lose that benefit.

But it was brand name Prozac as I recall that you had been getting for decades and now they quit manufacturing brand name Prozac in Taiwan back in December of twenty twenty four .

So it's just not out there anymore.

So what do you do?

Well that's where you can go with trend telex is one of the options now Intel has a long half life similar to Fluoxetine or Prozac so both of them have long half life .

What that means is that you can take the medication every day ideally but if you miss the doses you're not going to have significant discontinuation or withdrawal symptoms from it.

That's the advantage of Prozac.

That's the advantage of twenty twenty six.

I'll tell you how that works Karen.

I'll just give you some generalities here.

About one out of five people on Intel I take it at five milligrams a day about three out of five people will take it at ten milligrams a day and the other one out of five people take it a twenty milligrams a day.

When Trent was first studied, everybody in these clinical trials went right up to twenty milligrams a day.

But in our experience in my practice I just found that most people don't need to go to twenty milligrams a day that was actually excessive from a lot of people.

They got kind of irritable and overly activated.

So what I would suggest quite frankly with Delux start five milligrams a day for a couple of weeks that's what we would often do and the goal dosage being ten milligrams a day if you're pretty good at ten milligrams a day, fantastic if you need to go to twenty milligrams a day that's OK. >> So ten to twenty milligrams a day is where most people will be and in doing that switch Karen, what you would do is you could abruptly stop the flow of steam.

>> You might think oh my goodness, how could you abruptly stop any medication?

What with a flu vaccine you can abruptly stop it and it will slowly get out of your system over a couple of weeks.

The reason I mentioned Treinta is being used at five milligrams for a couple of weeks is you have to account for the Fluoxetine or Prozac still being in your system because both Prozac and intellects have similar mechanisms of action on serotonin.

>> It's just a true intellectual also positively affect five of the 14 different serotonin receptors.

>> And for you you had mentioned having attention deficit disorder.

I think for you you might actually notice that trend will be more preferable for you than the brand name Prozac was because it's going to help some of the symptoms as well.

So I would certainly suggest five milligrams a day for a couple of weeks and going to ten milligrams a day thereafter maybe for a month and then possibly going to twenty milligrams a day.

Keep in contact with your primary care clinician to overview to oversee what kinds of things you're doing with that biggest side effect early on with Trentham can be a little bit of nausea.

Peanut butter is one of the best ways I've ever heard of getting over that nausea goes on for a week or two typically then people get used to the nausea is also dose related.

So the higher the dosage the more nausea you can have that's are often early on and within about two or three weeks it often will subside.

>> I wish you the best care and thanks for calling.

Let's go to our next caller.

Hello Craig.

Welcome to Matters of Mind.

Craig, you want to know what are the signs of someone is a psychopath and when you should be concerned.

>> Basically a psychopath is somebody who enjoys another person's pain, OK?

>> They're very selfish.

They're very self-centered but they don't it's not that they don't care about other people's pain.

>> They actually enjoy watching people suffer.

Now there's been a lot of speculations on why this happens from a neurobiological standpoint.

The brain because they don't seem to have a connection with other people.

>> They can't empathize with other people and there's certain parts of the brain involved in empathy where you can actually have that emotional connection with somebody else and understand how they might feel.

>> But the thing about people with antisocial personality disorder and what we call psychopaths will be that they have decreased activity, not increased activity but they have decreased activity in the amygdala.

The amygdala is in the front part of the brain here on the temporal lobe that's the part of the brain where you have anger, fear, anxiety and it's actually dialed down.

>> So these people get less anxious, less fearful when they are perceiving that you might be in compromising consequences because in many ways it's a pathological condition but they pathologically enjoy the perception of a watching another person's pain and I think it's certainly a mental health condition of some type.

>> I think for many people who have that type of personality disturbance, they have traumatic childhood experiences going back to one before they were eight years of age.

I mean when you're in early childhood your early childhood experiences can certainly shape your personality later on, especially with your bonding.

So these people who are psychopaths or they have antisocial personality disorder which are somewhat connected, they often have a lack of strong relationship with their mother or father.

And you can look at some of the more famous psychopaths throughout history they often have little connection if any with their parents and that has a big impact on them because if you don't have much of an impact, much of a connection with your parents at an early age, you then don't develop empathy and bonding with other people later on.

So there is a carryover effect like that.

Your brain is as hard wired to a great degree prior to the age of eight years of age.

So if you have traumatic experiences for eight years old it can really hardwire you and make you susceptible to later problems.

So that's why it's very important we watch out for kids who are at risk when they're young children.

Thanks for your call.

Let's go to our next caller.

>> Hello MARD walking to Mars the mind module mentioned that your granddaughter confided in you that she feels paranoid that everyone's out to get her any suggestions or medical avenues to pursue.

However, maybe keep in contact with her primary care clinician if she's under 18 years of age would be a pediatrician if she's between the ages of 16 and twenty four more and she's having those kind of feelings, I'd certainly want to get her in to see a mental health clinician.

Schizophrenia is a condition has as pre morbid symptoms of paranoid thoughts about other people.

People with schizophrenia will often have deteriorating hygiene as adolescents they will have social anxiety that's crippling.

They will have difficulty with concentration or academic performance will deteriorate their social interactions will tend to go downhill.

>> So people with pre morbid symptoms of schizophrenia can show those symptoms as adolescents.

>> Now for women the typical onset of schizophrenia can be as late as twenty four years of age from men it's often sixteen women are a bit protected by estrogen so estrogen will delay their onset of schizophrenia symptoms.

But schizophrenia is a condition where not only do people many times feel paranoid but they start being able to hear voices when there's not people around they will get delusional and have fixed false beliefs about the perceptions of others.

They will have difficulty thought processing their thoughts but they have a lot of trouble with being able to connect with other people and those are the symptoms of schizophrenia and that's something that needs to be treated sooner rather than later.

So it really depends on our age mod but I'd certainly get her to be seen by her pediatrician if her granddaughter's under six years of age between 16 and 24 years of age ideally have your granddaughter see a mental health clinician of some type to really keep a close eye on her to see if she paranoid about other people because she has some social anxiety.

It's more of a reflection about herself or is she getting to the point where she's delusional with fixed false beliefs and getting extremely frightened about the intentions of others that are unrealistic.

So I'd certainly get her assessed very carefully, especially if she's between 16 and twenty four more.

Thanks your call us your next email question.

Our next e-mail question reads dear to discover do anxiety and inflammation co-exist?

>> If so, how do they affect the brain?

It's an interesting correlation because anxiety as I mentioned is has its heart right here in the amygdala in the temporal lobe and that's the heart of fear, anxiety, anger, rage.

>> People can have that part of the brain fired up by inflammation.

Now what what are the two main factors for inflammation?

Well, the two main things that cause inflammation and a lot of this was discovered during the covid pandemic with all the restrictions but the two main things that seem to cause inflammation in the brain are loneliness, loneliness and insomnia.

>> So loneliness and insomnia are two big, big precipitous for inflammation.

So what can happen is you get in higher amounts of anxiety there and when you have higher anxiety there you get this high amount of anxiety in the anterior cingulate gyrus on the inside of the brain is the front part of the brain looking at you.

The anterior cingulate gyrus is the part of the brain where your thinking is this is a good idea, a bad idea and you're kind of weighing the pros and cons of different decisions in your life and the problem with anxiety will cause that anterior cingulate gyrus to really get fired up.

So you start ruminating and you start thinking good or bad, good or bad, good or bad, all the everything you're doing and it paralyzes you because you can't make a decision because you're so ruminative that part of the brain gets fired up when you do have inflammation and when that gets fired up this part of the brain called the basal ganglia which is down here below over here down here below the basal ganglia starts to shut down when the basal ganglia shuts down you get really tired and fatigued.

>> So symptoms of an inflammatory process in the brain will be fatigue, low motivation, lack of enjoyment with things, poor concentration.

These are all a cascade of things that can suggest inflammation.

Why is that important?

Because it might influence what direction we go with our treatments.

So if we see somebody who's fatigue they can't concentrate.

>> They have difficulty with motivation.

They don't ajoy things.

We might go with a medication that's going to more effect glutamate than it affects something like serotonin because with the serotonin medications like Lexapro, Celexa, Prozac, Zoloft, Paxil they don't affect inflammation as potently as a medication that increases glutamate might do so.

So with the medications that it has glutamate will be bravado is a nasal spray.

We use our Valide as a as a capsule for people or as a tablet for people who are trying to enhance glutamate and course ketamine which has been around as an anesthetic since 1970.

It's been used off label for the past 25 years as an injection for depression.

So bravado is a nasal spray or valide and ketamine are all means by which you can enhance glutamate transmission and enhancing glutamate transmission appears to be directly and specifically very potently antiinflammatory.

So that's why it's important for us to sort out if somebody is having symptoms of inflammation.

>> But inflammation and anxiety certainly can go hand in hand and that's how they're affecting the brain.

>> Thanks for your email.

Let's go next caller.

Hello Felix.

Welcome to Meyers of Mind.

>> Feel like you want to know is compulsive lying a mental condition or a symptom of a disorder?

It's difficult to say, Felix.

I think you'd have to look at the circumstances when people are compulsive liars.

Number one, they're trying to make themselves look good in the presence of others and they're trying to save face basically and in doing so they're trying to get out of a certain situation.

Compulsive lying means they know they are lying and in doing so it can affect your overall mental health being a compulsive liar because the problem with compulsively lying is you have to stay consistent with your story and many people who are compulsive liars have difficulty with variations of their stories.

They get called out on it.

It starts to have social consequences as well as mental health consequences.

So I wouldn't say compulsive lying itself is a symptom of a disorder as much as it's a precursor to mental health conditions because the lying itself which might have started somewhat innocently to avoid consequences of certain behaviors.

>> You know, you start to get used to doing it and the next thing you know that's becomes a way of life for you and it becomes part of your character and actually part of your reputation.

So as you're called out on the compulsive lying self, you're known from a reputable bull standpoint of being somebody who can't really be trusted.

>> So that's always problematic.

Felix, thanks for your call.

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

Our next e-mail question reads Their daughter Fovea Why has Effexor made it so much harder to reach climax during intercourse?

I love everything about it besides this side effect of this nasty side effects if I accidentally and it has nasty side effects of I actually miss a dose Effexor also known as Venlafaxine is a medication that predominantly will increase serotonin and secondarily norepinephrine as you go to the higher doses of two hundred twenty five milligrams you get more of a norepinephrine effect.

>> But that serotonin effect will dampen your sexual drive while sexual the sexual performance will be dampened.

That can go with any serotonin or medications now a way to get around that you mentioned you really, really like the Effexor for that reason for that reason I mentioned to Karen earlier there's a medication that enhances serotonin but does so in such a way that it doesn't cause sexual disturbances.

And as I mentioned to Karen earlier, trend would be a possible alternative for you.

>> So twin talks is going generic by the end of twenty twenty six.

So it's getting cheaper as time goes on but with twenty talks you're going to get the benefit of the serotonin effect that you're getting from the Effexor but yet you're not going to have necessarily the sexual disturbances that you'd see with effects or trend telex was compared to Lexapro head to head to see if it would cause the same degree of sexual disturbances as did Lexapro and it did not so true talks and clinical trials showed that it didn't cause a sexual disturbances as much of the serotonin a certain urging medication.

And secondly in my experience with patients doesn't seem to cause the sexual disturbances a trend also known as Vaud oxytocin for the oxytocin is the chemical name that might be an alternative for you.

>> Thanks for your email.

Let's go next caller.

Hello Jerry.

Welcome to Mariza Mind Jerry you want to know is what age at what age do depression symptoms start to develop and what are the warning signs to look to look out for Jerry you can have depressive symptoms as a child and starting as an early child.

>> Let's go back to before the age of eight years of age.

If you had a lot of traumatic experiences with child sexual abuse, physical abuse, parental divorce, emotional abuse, a parent was in jail.

>> A parent had mental health issues.

If you had the exposure to certain emotionally traumatic circumstances before the eight years old, you are at a higher likelihood later on to have anxiety, depression and what they did is they took the ten most likely traumatic events as children and they put them all together in scale called the ACS scale the adverse childhood experiences scale which is free.

It's something that's online and you have over four of those ten symptoms.

It puts you at a higher risk for having depression and anxiety later on.

So there are precursors for depression from a social standpoint, genetically depression is about one third genetic so it does run in families but it's only about one third genetic later on.

Well, there's different things that can provoke depression, bad stuff happening, traumatic experiences.

You bet.

Alcohol marijuana can often bring it out if it might not have been there before.

Some people don't have their first onset of depression until like women will have a baby and they have their first onset of the bad depression with a postpartum depression men can have depression at retirement because they lack purposeful meaningful activity in life so you have all these different factors that can occur so you can have depression starting on early on in the early years you can have it starting later years.

One of the first symptoms of depression I often hear about Jerry will be a little bit of social withdrawal and insomnia.

So difficulty with sleeping, withdrawing and not doing the things you really enjoy getting rid of those purposeful meaningful activities and getting more withdrawn.

Those are often big symptoms of depression.

Jerry Jerry, thanks for your call.

Unfortunate 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 all one word at a dog I'm psychiatrist favorite and you've been watching Matters of the Mind on PBS Fort Wayne God willing and PBS willing.

I'll be back again next week.

Thanks for watching tonight