.

>> Good evening.

I'm psychiatrist Jay Fawver live from 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 dialing (969) 27 two zero or if you're calling long distance 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's Bruce Haines studio and if you have any questions concerning mental health issues, you may you may write me at matters of the mind all one word at WFB dot org that's matters of the mind at WFYI Agag and start tonight's program with an email I recently received a regional director for my pharmacist told me that brand name Prozac is no longer being produced by the manufacturer or other pharmacies told me the same thing.

I've been taking this medication for twenty eight years now and I don't like being forced to stop it.

>> Please help.

Well I understand the reference to what you're describing because Taiwan produced most of the bran name Prozac until December of twenty twenty four so we've been without brand name Prozac for the year since the year of twenty twenty five.

Lilly originally researched and promoted and manufactured Prozac back in 1980 seven that's how long it's been on the market and then it was handed over to outsourcing in the international countries after it went generic boy in the early 2000s I believe so it's been generic for quite some time now generic Prozac or generic flu vaccine versus brand name Prozac.

>> What's the difference?

A generic medication can give you about eighty percent to one hundred twenty five percent the bioequivalence of the brand name.

>> Now what that means if you've been taking twenty mg of brand name Prozac and it says it right there on the bottle if you take a generic version you could get as little as sixteen milligrams.

So how do you get the extra four or five milligrams where you can be creative with a generic assuming you're getting the lesser amount in the generic and quite frankly most people when they use a generic are getting the lesser amount they're getting more toward eighty percent as opposed to the one hundred and twenty five percent that they could be allowed to brand name Prozac.

What you've been taking spot on right at twenty milligrams very consistently but the generic fluoxetine that you would have available you might be getting the equivalence of maybe sixteen milligrams of Fluoxetine for a twenty milligram dose.

>> So how do you make up the extra four milligrams.

What you can be creative about it and you really want to talk this over with your clinician and find a generic version.

It works the best for you but if you're finally finding that a generic version of twenty milligrams just isn't doing the job for you, you could still possibly use that generic version and you'd have to be creative in how you would use it.

For instance with Prozac it has a long Half-Life that means it stays in the system for days so you wouldn't have to take a consistent dosage every day to get a steady blood level.

So with Fluoxetine or Prozac you could take twenty milligrams on Monday, twenty milligrams on Tuesday, twenty milligrams on Wednesday and then forty milligrams on Thursday.

>> So for one day out of four days you could take a forty milligram dosage that would give you an average of one hundred milligrams over the course of four days which is 25 milligrams.

>> That's how you get a twenty five milligram dosage of generic flock's team that might equivalent be somewhat equivalent from a bioequivalent standpoint to brand name Prozac.

>> Twenty milligrams so there's ways we can get around that.

>> So that's one option you could stay on Fluoxetine that way and Flock's is subtly different than from the other selective serotonin reuptake inhibitors and the rest rise you have Zoloft, Lexapro, Paxil, Celexa, Luvox these are all s rise and they all have subtle differences and that's why some people will do better on one versus another.

>> But if you've done well on brand name Prozac either Trigiani Prozac knowing that you might need to take a higher dosage in some cases or go to another SSRI Zoloft, Celexa, Lexapro, Paxil, Luvox, go to another SSRI to see if that would give you similar effects one way or another and that would be assuming the generic Fluoxetine or the Prozac would fail.

So there are a lot of options out there.

Yep, I've heard the brand name Prozac is no longer available in the market.

>> Thanks for your call.

Let's go to our first caller.

Hello Margo.

Welcome to Matters of the Mind .

>> Margo, you want to know what causes stress related headaches?

What's happening to your brain when you have stress?

Margo, it'll cause your muscle tension not uncommonly and some people get neck aches, back aches and you can get a headache because we've got this skull that surrounds our brain .

>> Our skull is thick, it's hard and it's not going to move.

So when you're a little thin muscles all around the scalp clamped down and they get a little bit tight.

You're going to get a headache and a headache with a tension headache.

It's like a headband.

It goes around the forehead, around the sides in the temple areas like a headband and it will come on with stress if you exercise especially resistance training or weight training that is particularly good for stress related headaches.

>> Now there are headaches that are related to high blood pressure, whole different phenomenon high blood pressure headaches can be dangerous because you can well you can have a hemorrhaging of a blood vessel that's never good.

So high blood pressure would always need to be controlled.

Sinus headaches are usually associated with fever and congestion and if you tap, tap, tap, tap, tap, tap over certain parts of your head you'll notice particular pain.

Migraine headaches will often be on one side or another and they are incapacitating migraine headaches often have an aura where you'll notice them coming.

>> You'll feel them coming off and then when you have a migraine headache you just can't do anything light sensitivity sound any kind of movement can bother you and not uncommon when people have a migraine headache they just need to lay down.

>> There are other types of headache but those are the main ones that people will experience.

>> But a tension headache is basically the thin muscles around the actual skull itself clamping down and they're not incapacitating but they can be really, really annoying.

>> Thanks for your call.

Let's go our next caller.

Hello Gary.

Welcome to Mastermind Gary.

>> You mentioned that you take Bew Spyro and you wonder if you could take blood pressure medication with that.

The easy answer is yes.

You can take blood pressure medication with you.

Byrum be Spyro is a medication.

It's very selective in what it does.

It will give you a thermostat like effect on a particular type of serotonin receptors.

>> There's 14 different types of serotonin receptors.

>> These borrowing is working on serotonin receptor number one A and if you stimulate serotonin one A receptors or block it accordingly based on the amount of serotonin in the system can help with worry and anxiety.

So be Spirent is we're helping with worry and anxiety but it has no effect on the blood pressure.

>> A side effect of abuse byroade can be early on dizziness and sometimes double vision but that's a brain phenomenon.

That's not a blood pressure phenomenon.

So if you're taking blood pressure medications that would not typically interact with B Spirent and B Spirent would not be affected affecting the blood pressure itself.

>> Thanks for your call.

Let's go to next caller.

Hello Clare.

Welcome to Mastermind Clarey.

>> You'd mentioned your daughter is on Zoloft but she went to camp, did not take it the whole summer.

>> Now you want to know should you resume her dosage or do you need to contact your provider?

Well, the safe answer is always to contact the provider and talk this over as opposed to some psychiatrist on TV like myself.

But I'll give you some ideas here.

The first question I want to ask is does your daughter still need the Zoloft?

>> Why was the Zoloft being used?

Was it due to depression, irritability, anxiety, anything incapacitating that was really relieved with her Zoloft when she went off of that, how did she do so you always have to weigh the need for the Zoloft over the course of this fall.

She goes back in the school year now if she does need it for social anxiety, she needs it for panic attacks, obsessive compulsive symptoms, whatever may have been there before the Zoloft was used, you could always resume the Zoloft and again with your provider's direction depending on the dosage she was taking, if she was only taking 25 milligrams a day she could go right back on 25 milligrams a day.

>> Usually if somebody is on fifty milligrams a day you want to go 25 milligrams a day for about six days and go to fifty milligrams same the 100 milligrams you are slowly titrate the Zoloft where she would take 25 milligrams a day for six days fifty milligrams a day for six days and go up to 100 milligrams every day thereafter.

>> So you want to gradually move into it if you start taking Zoloft at fifty or a hundred milligrams a day right off the bat sometimes get stomach upset and diarrhea.

>> It's not harmful just that it's really uncomfortable.

So with Zoloft especially early on, typically people will take a lower dosage often with food because that'll decrease a lot of the gastrointestinal effects.

>> Thanks for your call.

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

Our next e-mail question reads Dear go out of favor with high school sports starting up again, is are there any concerns for athletes who also take medications for depression, anxiety or mental health conditions?

It's still hot outside.

I'm wondering might there additional risk for heatstroke or dehydration?

>> Are there side effects?

There are certain medications that might give you more difficulty in the hot weather than others and in playing sports particularly if you're on psychostimulant for attention deficit disorder, you can still play play sports.

>> As a matter of fact, if you're a point guard on the basketball team, if you're a quarterback on the football team, if you're a shortstop on the baseball team, you might actually perform better taking a medication like a psychostimulant if you have severe ADHD that's causing to have difficulty paying attention to instructions so you can take it the key with any psychostimulant medication for ADHD is to make sure the blood pressure or the heart rate will not be too high.

>> Some people will need to take lithium for mood stabilization.

Lithium has a misperception that you can't sweat while you're taking lithium.

That's ridiculous.

You can sweat while you're taking lithium.

It's just that you want to replace your electrolytes so if you're taking lithium you can sweat it just that you want to take some electrolytes every now and then there are electrolyte drops people can take.

>> There are there are sports drinks that have electrolytes in them.

But with lithium the key will be if you're sweating excessively you're lowering your sodium level when you lower sodium levels, lithium levels go higher.

So you want to have some kind of salt replacement or electrolyte drinks or tablets to be able to replace that with something like with something like lithium with some of the medications they can make a little bit lightheaded.

We don't use those medications so much anymore but a few of the medications can cause your blood pressure drop and we heard about that in times past more often than now.

But talk it over your clinician concerning what risk there might be with the hydration or playing sports, especially in the event that the blood pressure is increasing or the heart rate is increasing with physical activity.

>> Thanks for your call.

Let's go next caller.

Hello Maggie.

Welcome to Matters of Mind.

>> Meg, you want to know about Zarar Zoove also known as a Pantalone you want to know it's it's used for postpartum depression and why is it only taken for four days?

Is it a cure for postpartum depression?

>> Well, Zuhur reserva zoove or is adrenaline is used for fourteen days, Maggie.

So yeah, it's kind of like an antibiotic in that way after a woman delivers a baby, her estrogen and progesterone levels plummet.

>> All right.

So when the estrogen and progestin levels plummet you can have a loss of a particular byproduct of progesterone called pregnant alone ALAH pregnant alone mimics a Xanax or an out of an or a Klonopin or a Valium type effect in the brain.

>> No.

In other words, alopecia alone is very calming on the brain with the loss of a pregnant alone because you don't have as much progesterone you can have a lot of trouble with depression, anxiety, difficulty with sleep, poor concentration.

It can cause a lot of bad things so what Zoove is is basically a chemical analog or a chemical look alike to allow pregnant alone.

Your brain thinks it's getting pregnant alone.

You use it for 14 days in clinical trials for postpartum depression.

It has been very helpful during those times and we've used it extensively in our practice.

>> It's 50 milligrams every evening with food it gets absorbed best with you take it with a fatty meal so it gets absorbed in the evening.

You can't drive or operate machinery for twelve hours thereafter or we often recommend people take it at six p.m. or seven p.m. and the name are able to sleep throughout the night and it's out of their system by the next morning they can drive if you have little ones at home I often recommend you have somebody else kind of keeping an eye on them just in case you're overly sleepy and you can't attend to their needs after taking Zoove some people are very sedated.

Most people aren't that sedated but that is a side effect.

>> It's only for 14 days that you're taking it.

Is it a cure for postpartum depression?

>> Generally about three out of four people are going to take the two weeks of treatment for postpartum depression and that's that's it.

>> They don't need further treatment and you can take another into the present with it.

So Zoove is affecting so-called GABA receptors but other antidepressants that affect serotonin, norepinephrine, dopamine, even glutamate can be used with serves Roubaix and you might actually get a better effect in those cases.

But if you just want to take one medication for postpartum depression to try to balance out that hormonal changes occurring following delivery's or Zoove or ZAREENA alone is an option.

There is a medication has been around for a longer than that.

>> Brexit alone is an IV medication.

It's used over the course of an inpatient stay or in the hospital for two and a half days and during that inpatient stay you're getting this IV formulation.

>> That's it.

But if that was causing a lot of clinicians to find it somewhat burdensome to use, we prefer to because that's a couple of capsules of twenty five MG capsules people get it through a specialty pharmacy, they get it in the mail.

It's a scheduled medication.

It is controlled because it can give people a bit of a buzz and sedation after taking it but people take it over the course of 14 days with or without an antidepressant medication and in our experience we've had a lot of good luck with it for postpartum depression because it's actually treating the underlying condition if you don't typically have that much depression the rest of your your life but you really know you get slammed with depression after delivering babies.

>> Yeah.

So they can be a really nice option for correcting that.

Thanks for your call.

Let's go to our next email question.

Our next e-mail question reads Detective offer is therapy using psilocybin showing any promise?

>> I've been doing some reading and I'm wondering if it might be helpful to a family member.

Psilocybin is being used clinically in Oregon right now but no place else in United States.

Australia has been using psilocybin for treatment resistant depression for this past year.

Psilocybin is a derivative from mushrooms.

>> Psilocybin breaks into Selous solution solution.

I believe the the pronunciation of that is is the metabolite and that is what's affecting serotonin type 2A receptors.

And if you stimulate serotonin to type 2A receptors you can no one kind of jarred the brain out of this funk that it gets in when people are depressed, when people get depressed they get into this ruminative stuck phase and it's called default mode network where you have you have your Celian network you have default mode network and you have the executive network and when people get stuck in the default mode network they just can't they can't think clearly.

>> They ruminate about things.

They dwell on things and want psilocybin will do is kick people out of that particular network.

It also has some nice what we call downstream effects by stimulating indirectly the natural brain fertilizer called brain derived neurotrophic factor.

So it's stimulating brain fertilizer to make the little neurons more fluffy and it does so very quickly by my understanding we might see psilocybin being FDA approved probably first for postpartum depression as early as twenty twenty seven as late as twenty thirty.

It all depends on how the studies go.

There has been a study that was successful using psilocybin with Zoloft which I mentioned earlier.

Zoloft is certainly unnecessary and it's a serotonin and depressant but using psilocybin Wisoff was successful but I think we're about a couple years away from seeing an FDA approved across the United States first for postpartum depression our first four treatment resistant depression then maybe for post-traumatic stress disorder, probably for addictions later on.

So it could be used for a lot of different type of type of treatments.

>> It's going to be recommended to be utilized in a very controlled setting.

>> So a clinician, possibly a therapist or at least somebody supervising the actual administration of psilocybin will be in the same room.

We do the same thing with bravado right now bravado is a nasal spray that's the active metabolite of ketamine.

It's bravado as ketamine and people come into the office and they'll sit for two hours after they get the ketamine spray they come in twice a week and it's a supervised setting to make sure they're not having any adverse side effects and they can be addressed with those side effects if any of them occur.

Psilocybin is the same way we're not going to give psilocybin to people and him take it home and use it on their own.

>> They're going to be using it under a very controlled setting.

Thanks for your call.

Let's go our next caller.

Hello and welcome to Matters of Mind.

>> And you'd mentioned you're looking for a cheaper substitute for the medication called Trents.

>> Are there any more cost effective alternatives for major depressive disorder?

Trent is going to be generic later this next year.

>> This next year I believe twenty twenty seven twenty six .

>> I think it goes generic so it's going to be getting cheaper and cheaper.

It's already getting more accessible and a lot of different insurance plans and so I'm having more luck prescribing trend than I had in the past.

>> So it's getting more accessible in that way to intox is probably unique.

It does have serotonin reuptake features but does affect five of the 14 different serotonin receptors somewhat uniquely.

>> So it's kind of honing in on what really needs to be affected.

So Trin as opposed to other medications that affect serotonin Trantor is going to be more likely to give you more energy, more motivation, better concentration, less weight gain, less sexual disturbances ,fewer side effects in general nausea can be the only side effect until early early on we can talk to your clinician about what you've tried, what worked and what didn't work and look for different options out there.

You can also see if your insurance plan is covering trend talks a little bit better now than it might have in the past.

So for instance, you might have tried to take twenty two years to go and you found that to be too expensive.

You might find that now it's not as expensive and also ask your clinician about the possibility of a savings card if you have commercial insurance to savings cards can be obtained online and that some can sometimes keep the cost of commercially insured patients.

EntreMed dollars down to no more than ten dollars per prescription.

So there are ways to get around that.

The trend is fairly unique.

We can't put some generic concoction together and come up with trends.

>> Alex is fairly unique in what it does and thanks your call as your next caller.

Hello Gordon.

>> Welcome to Matters of Mind Gordon.

>> You want to know can anxiety be caused by anemia?

How are they connected?

If so anxiety with anemia the best I could probably say could happen there Gordon would be if you have anemia you can feel tired, you can feel kind of foggy but a symptom of anemia can be a fast heart rate because your heart's pumping faster trying to get the blood flowing round because it realizes that you're low on oxygen because of anemia.

So if you notice that your heart's pounding faster and faster and faster that can be related to anemia.

But the main side of the main problems we often hear about with anemia will be oh such conditions as fatigue, poor concentration.

>> People sometimes will feel lightheaded but the fast heart rate is something we do hear about with anemia not uncommonly.

>> Thanks for your call.

Let's go our next caller Toby , welcome to Matters of Mind.

Toby , you had asked what can brain scans reveal about your male mental health ?

>> I wish they would reveal more, Toby .

When we do brain scans there's MRI of the brain to give you a magnetic resonance.

They give you a really nice picture of the brain itself.

we need are more functional MRI and they're done in research but they're not done practically functional MRI is where you're doing something.

You're concentrating on something and the researcher is watching what's happening in your brain and it gives us an idea on how the brain functions when you're performing tasks.

>> For instance, this dorsolateral prefrontal cortex up here is working really hard when you're concentrating on something that's not that interesting.

So that sometimes is something that we'll consider can SPECT scans which have gotten popular over the past twenty years, can they give you diagnostic assessments when you do a spec scan the problem aspect scan it's like watching two minutes of a two hour movie and you're just watching it very briefly and if you watch two minutes of a two hour movie you're probably not going to be able to figure out the two hour movie and that's the limitation of Speck's scans.

They're very transient in my experience.

People have had SPECT scans who have recommendations based on inspections.

They're not highly meaningful.

So when we do an MRI, the brain for instance, we are looking for tumors, we're looking for strokes, we're looking for specific pathology, maybe a cyst that might have caused problems that would be unexpected for a person's age and their family history.

>> So let's say somebody has psychotic symptoms are out of touch with reality and they have no family history of schizophrenia.

They have no drug use all of a sudden they have these symptoms that just come out of nowhere.

Yeah, you might want to get an MRI in those cases.

I find those to be most meaningful but functional MRI I think might in the future give us a little bit better direction because they are actually showing how the brain is processing information in real time SPECT scans not so much right now.

>> So right now we're not doing a lot of imaging in in the use of psychiatry in general.

>> Thanks for your call.

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

Our next e-mail question reads Your daughter Fauver I delivered my daughter nine months ago and I have struggled with postpartum depression since I have and using Zoloft since then my liver tests have gone higher.

>> This has happened with other SSRI.

>> What are my options for treating postpartum depression?

Well, Zoloft is one of our go to medications with postpartum depression because it's relatively safe with breastfeeding.

>> But if you're a liver tests are going higher on Zoloft each time you take it in with other selective serotonin reuptake inhibitors such as Lexapro, Celexa packs or Paxil Prozac.

>> Yeah, that class of medications might not be in your best interest.

So why do you take in those months after you deliver a baby you're having depression?

>> I mentioned Zoove earlier as a possibility but there are other medications such as press stik Desmond the vaccine it's the breakdown product of Effexor or Venlafaxine is kind of like a digested Effexor because it doesn't go through the liver, goes through the kidney.

So that would be a safe option.

Another safe option could be bupropion, Wellbutrin, Wellbutrin has been around for a long time and both Prestige and Wellbutrin would be safe during breastfeeding so the main medications we use in postpartum depression the traditional medications would have would would be Zoloft Presti Wellbutrin can be used dislocating Cymbalta can be used but that does go to the liver.

Wouldn't recommend that if you're having liver problems from Zoloft already but if you're having liver problems from Zoloft another SSRI as I'd probably go with something like Stic Wellbutrin or Zoove as my main options to consider is to talk that over the clinician.

>> Thanks for your call.

Let's go to our last caller.

Hello Brian.

Welcome to Matters of Mind.

Brian, you mentioned you've been self medicating with alcohol to calm down after work but you still having panic attacks.

Why does having an opposite opposite effect is because you're getting well to say it somewhat harshly addicted to alcohol because as your brain needs alcohol to get that calming effect, you need more and more of it.

So you could actually be going into some withdrawal even several hours or even a day after you drink the alcohol.

So what I suggest, Brian, is that you talk to your clinician about detoxing you from the alcohol.

We not uncommonly will use a medication like Neurontin Gabapentin sometimes Lyrica also known as Pregabalin.

These medications will dampen down the withdrawal from alcohol and help people with anxiety related those kind of conditions.

A lot of people used marijuana in the past same kind of scenario where we are using gabapentin pregabalin to help people get off the marijuana because many people will self medicate with alcohol or marijuana to calm down panic attacks but it sometimes makes them worse.

>> Thanks for your call.

Unfortunately I'm out of time for this evening.

If you have any questions concerning mental health issues you may write via the Internet at matters of the mind all one word at a dog.

I'm psychiatrist Jay Fawver and you've been watching Matters of the Mind on PBS Fort Wayne now available on YouTube God willing and PBS willing.

>> I'll be back again next week.

Thanks for watching.

Goodnight