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>> Good evening.

I'm psychiatrist Jeff Alver live from Fort Wayne , Indiana .

Welcome to Matters of the Mind now and it's twenty sixth year matters.

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 long distance 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 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 via the Internet at matters of the mind all one word ad wfyi Doug that's matters of the mind at WFA Egg and after tonight's program with a question I recently received it read your daughter Fauver I heard about this medication for depression that women can take after having a baby for two weeks.

How fast does it work and which you need to repeat the dosage this medication chemical name is alone.

>> It's has a trade name of zero Zoove a Saux or Zoove is a medication that was approved for the treatment of what's called postpartum depression.

This goes beyond just baby blues which affects four to five women clinically depression, postpartum depression affects as many as one out of twenty maybe as many as one out of twelve women out there after they deliver a baby typically affecting them within the first three months after they deliver and it's related to progesterone levels dropping abruptly after delivery and progesterone levels dropping abruptly will diminish this particular metabolite of progesterone called pregnant alone and that will cause a woman to have severe depression.

Now why does it happen?

Is because the her GABA receptors and gabb transmission is not functioning so well.

So here's how it all works.

>> If you think about glutamate, glutamate is an accelerator for the brain.

Half of the synapses in the brain are affected by glutamate.

Glutamate is like the accelerator on the brain gabber is the brake on the brain glutamate and GABA have to be always in balance.

>> Think about when you exercise.

>> When you exercise you feel tired afterwards but emotionally you feel good.

You feel happy after you exercise typically but you also feel calm.

>> You feel good after you exercise because glutamates increased but you feel calm because Gabb has increased so you got this nice combination going on after you exercise when people get depressed just the opposite is happening.

>> When people are depressed they have low glutamate transmission, low GABA transmission.

>> What Zaranj alone or Zoove will do is directly affects Gabb and it does so very quickly.

>> Agaba transmission effects a chloride channel which will give you an inhibitory a braking effect on the brain.

How quickly will this medication work or works?

Within two days and it's totally unlike any medication we have for the treatment of depression works than two days.

You take it every day with a fatty meal in the evening if you take it with a fatty meal in the evening or triples the absorption and you can't drive for at least 12 hours after you take it now you might think well gee that's a pretty big hassle if you can't drive for twelve hours after you take it.

>> But think about it if you take it in the evening with dinner at about 7:00 p.m. you can drive in the next morning at seven a.m.

So women who take this can still go to work.

They cannot breastfeed though.

>> So for those fourteen days of taking those around alone presumably a few days later you can't breastfeed but if you have a severe depression which can be catastrophic for some people I mean there have been a lot of incidences of women getting so just desperately depressed after having a baby that they will harm their babies.

So postpartum depression is something that we need to take very seriously.

This is a treatment that works within two days.

You take the medication every day for two weeks.

Four out of five women have a pretty dramatic effect from it and four out of five women only need one treatment for the whole year.

About one out of five people might need another two week course of treatment within a year but four out of five people don't.

So it's a medication main side effect can give you some tiredness and that's why you can't drive for at least 12 hours after taking each individual dosage and for some people to have some gastrointestinal problems.

But other than that very well tolerated, it's going to be a controlled medication.

>> So that means that it's going to be like a schedule for medication in the same class as Xanax and some of the sleep medications.

But how addictive will it be?

>> Not likely highly addictive because you're only going to be taken it for fourteen days.

You're not going to get a high from but they did make a controlled because of the degree of sedation people get from it.

So you'll be hearing about that as an oral medication.

You take it every day for fourteen days after having the baby if you're in the midst of a postpartum depression there has been a related medication called Brecksville alone.

Brexit alone has been around for about four years now it's an IV medication where a woman would have to go in the hospital for two and a half days and for two and a half days she'd be in the hospital with an IV and that would bring her out of the Depression very quickly as well.

However, that came with a very high cost not only financially but also it took the women away from her baby over the over that two and a half day time period.

So wasn't real popular.

>> This will be an oral medication which a woman can take at home.

Thanks for email.

Let's go to our first caller.

Hello Diana.

Welcome to Matters of Mind.

>> Diana, you'd mentioned that every medication you've taken has caused dry mouth.

Why is that?

And there's anything you could take that wouldn't cause dry mouth as an antidepressant medication.

There are some medications that don't cause dry mouth for depression.

The reason to get dry mouth, Diane, is to because the two neurotransmitters that might be increasing norepinephrine is the most prominently associated medication that's known to cause dry mouth and the medications have increased.

>> Norepinephrine will be the older tricyclic antidepressants like your trip to leam by vacuoles another one.

>> Then you have the newer medications.

The one that caused the most dry mouth will be medications like Cymbalta Zema Presti Effexor might Wellbutrin can some to Wellbutrin will increase dopamine and norepinephrine.

>> I think the key will be to take a low enough dose each of those type of medications if you need them now Diana, about one out of three people will get a good effect on the serotonin medications, the serotonin medications, the purely serotonin medications won't cause as much dry mouth and that's why back in nineteen eighty seven Prozac was considered to be a miracle antidepressant because it did not cause dry mouth.

It did not cause weight gain.

It didn't cause people to have sedation sedation like some of the older medications did.

So a purely serotonergic medication like Prozac, Zoloft, Lexapro, Celexa wouldn't give you as much dry mouth.

Paxil can give you dry mouth because it has some norepinephrine effect.

So I think in terms of trying to alleviate the dry mouth, look for a medication and talk it over with your clinician that would be more purely serotonin related as opposed to norepinephrine or even dopamine for that matter.

But a medication increases norepinephrine which the chemical comes into adrenalin that will give you the most dry mouth the older medication, the tricyclic medications like Ellisville, Pamela DOCSIS Senik one those medications cause dry mouth not only because they increase norepinephrine but they also had a blockade effect on acetylcholine and if you block acetylcholine that gives you a horribly dry mouth.

As a matter of fact there are ways that we can try to reverse dry mouth with other medications.

We don't like to use those medications if we can avoid it but there are certain medications we can use to actually reverse dry mouth if that was a big problem for you but not uncommonly Diana will simply recommend people to drink to choose sugar free gum and try to drink plenty of fluids that don't have a lot of sugar in them because that'll give you a trouble with a worsening dry mouth and give you more cavities.

But we try to give people or have people do real simple things like that to offset the dry mouth itself.

>> Diana, thanks for your call.

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

Our next e-mail question dear Dr. Fauver, why is Xanax addictive?

>> Xanax can be addictive because it'll give you a sense of calm and it works very quickly Xanax we'll go to this part of the brain right here called the amygdala the amygdala is almond shaped.

That's the Latin term.

Amygdala in Latin means almond shaped.

It's right there in the front part of the thumb part of the punching bag.

If you look at the side of the brain it looks like a punching a boxing glove, not a punching bag.

Looks like a boxing glove if you look at it from the side in the front part of the thumb of the boxing glove it it's known as the temporal lobe right here in the thumb and the front part of that is the amygdala.

So the amygdala is the part of the brain that will affect anger, anxiety, irritability, rage for that matter.

>> And it's thought that when people have increased depression they have increased activity with the amygdala.

So what you want to do with the amygdala is calm that down very quickly.

The problem was Xanax out of an Klonopin Valium.

The medication has been around for a long time.

They work very quickly and that's the remarkable thing about them.

They will effect that GABA receptor in such a way that is a little bit differently than that antidepressant you mentioned earlier called Zaranj alone.

But they'll affect in such a way that you'll get very quick effects and give you a calming effect and for many people that can be dramatically helpful.

But the problem those kind of medications you don't want to use them for more than a couple of weeks now I know some people have taken those medications for decades every day and for those people we need to slowly taper them off of it because if they do stay on those medications long term they can not only have trouble with difficulty with memory and concentration but they can have trouble with ambulatory or just gate to walking around.

They can have trouble with dizziness, lightheadedness and they're more so associated with the falls as we get older.

>> So with those kind of medications they work dramatically well but we want to really try to get people off of them within a couple of weeks Xanax, Klonopin, Ativan they can give you difficulty with your concentration and your coordination and to the degree that a blood alcohol level of zero point zero eight could give you and that's a level that would give you a significant buzz and cause significant impairment itself.

>> But those medications can give you difficulty your concentration to a comparable degree as a mild inebriation from alcohol.

And if you can imagine some people take those medications every day and they do so for years and it can kind of slow them down.

I've had people come off of the medications such as Xanax out of an Klonopin.

I do it so very slowly but they'll say it's like they have a new brain because their brain works more appropriately and works more efficiently efficiently off the medications themselves.

>> So the general rule of thumb is in coming off of the medications like Xanax, a general rule of thumb will be for every year that you've taken them you want to take that number of weeks and coming off of them now in the textbooks you can see that you can come off of Xanax or Ativan or Klonopin from a physiological standpoint within a week or two .

>> But for people who have been on these medications for five or 10 years, you don't want to just take them off in a week or two .

You might not have physical withdrawal but you'll have significant psychological withdrawal if you come off of them that quickly.

So if somebody has been on Xanax for five years, I want them to slowly come off of it over the course of at least five weeks and the key is to slowly come down so they don't feel uncomfortable with it.

Why is it addictive?

That's was your original question.

It's addictive because not only does it give you that unnatural peace and that calming effect that you'll experience but downstream Xanax releases the brakes on a medication by the name of neurochemical by the name of dopamine.

So on downstream Xanax actually releases the brake on dopamine.

>> Dopamine will give you a feel good effect and that's why back about 30 years ago Xanax was thought to be a very good medication for anxious depression because it did help people with anxiety.

It also seemed to help through depression some it didn't help them long term with the Depression but it gave them some early good effects and that's because not only was it giving them giving them a calming effect and helping them sleep but helping them with panic attacks anxiety.

>> But it also helped them feel happy and a sense of joy because it downstream increases dopamine release and with the increase in dopamine you can feel good and that's why Xanax can be addictive because to get that same effect you have to take more and more and more and some people will kind of chase their tail in terms of trying to get that same effect.

>> Thanks for your thanks for email.

Let's go to our next caller.

Hello Lee.

Welcome to Matters of Mind.

>> You want to know if someone's experiencing dizziness, what could be causing it and what can be done to help with ongoing dizziness?

Lee, I can I can tell you as a psychiatrist I've heard about dizziness.

I'm always going to be looking at medications.

I'm going to look at somebody's state of dehydration and I'm going to consider if they're having any difficulty with their heart condition itself.

So I'm going to look at all medications.

Some medications can cause dizziness because they caused the blood to kind of pull up in the leg.

So you stand up the blood pools in the legs and you can have trouble with getting enough blood to the head that can cause to be dizzy as well.

If you're a bit dehydrated, that's a common reason for people to have dizziness is a light headed feeling true dizziness.

>> We talk about lightheaded where you feel like you're going to kind of pass out but then there's the dizziness called vertigo and vertigo is where you have a spinning sensation.

Some people call that dizziness .

>> So if it's truly a spinning sensation called vertigo, there can be an inner ear problem.

>> There's a condition called Meniere's disease where discovered by a person by a minor.

But it's where you have the spinning sensation Vertigo but you also have nausea associated with it and you can have difficulty with ringing in the ears is called tinnitus.

So vertigo, nausea and tinnitus is what's called Meneer syndrome.

It's a classic triad of symptoms.

It's related to an inner ear problem.

So if you have a dizziness, have a clinician take a look at all your medications to see if the medications could be associated with dizziness, determine if the dizziness is from a lightheaded feeling where you feel like you're going to pass out or is it spinning sensation where you see things spin?

If it's a spinning sensation, think more along the lines of an inner ear problem which can be associated with maybe an infection in the inner ear or even with some cases not to frighten you but it can be a tumor on the inside of the brain.

But that's when a vertigo sensation and you have to get that sorted out.

What can be done about it obviously is to get rid the medication it might be causing dizziness, get properly hydrated if you're having dehydration and obviously if you have an inner ear problem, get that assessed to make sure it's not anything that would require surgical intervention.

There are medications for dizziness too.

If you do have Moneris medications like mechanizing also known as an inverted antihistamine medication that specifically kind of dries up the excessive fluid it can be in the inner ear that can be really related to dizziness itself.

>> Lee, thanks for your call.

Let's go our next caller.

>> Hello Thomas.

Welcome mastermind Thomas, you wanna know if there's a connection between headaches and depression, anxiety, headaches come in different varieties.

>> You've got your tension headache which is a muscular headache.

>> You've got these real thin band of of muscles all around your scalp and when they get tight and they clamp down, you have a dull achy headache all around the scalp and it will cause you to have difficulty with an ongoing achy headache that just goes on throughout some of the day.

It often gets worse as the day goes on and exercise actually helps and obviously relaxing and getting some tension relief so tension headaches can be related to depression anxiety if you get stressed out if you're worried about stuff, you bet tension headaches can go along with that.

>> Then you got migraine headaches, Thomas women in particular will get migraine headaches, migraine headaches are excruciating.

They occur on one side of the head or another and they can be preceded by seeing flashing lights or Zig Ziglar lines.

That's called an aura migraine headaches are excruciating.

>> You just have to go lie down when you have a migraine headache not uncommonly it can go on for a couple hours or so and the more you exercise with a migraine headache the worse it gets.

You're as sensitive to light, you're sensitive to sound, you're sensitive to touch of in common with the migraine headache they are incapacitating migraine headaches are associated with bipolar disorder now the connection with bipolar disorder and migraines and migraines bipolar disorder it's not bilateral.

>> If you have bipolar disorder you could be more likely to have migraine headaches.

But having migraine headaches does not make you necessarily more likely to have bipolar disorder.

So we have to keep that distinction there.

But when I'm asking somebody about their mood symptoms and they describe bipolar disorder or they're having highs and lows, the highs manifested by speaking really fast, not needing to sleep, being impulsive, doing things and saying things they ordinarily wouldn't do, they're going to have manic highs and they can have depressive lows bipolar to means to poles of the mood.

>> So bipolar disorders where they're having mood swings, ups and downs women and particularly with bipolar disorder are more likely to have migraine headaches.

So that's why when we see some of the bipolar disorder we're going to ask them about migraine headaches and if they have bipolar disorder and migraine headaches will be particularly prone to giving them a mood stabilizer that will work on both and those mood stabilizers would be the anti seizure or antiepileptic mood stabilizers.

Depakote has been used for decades.

The problem with Depakote is that it can really, really increase your weight and give you some metabolic issues.

So Depakote is phenomenal for both migraines and bipolar disorder.

But the price you sometimes pay is the weight gain and having to keep an eye on some metabolic issues.

>> So we prefer Lamotrigine or Lamictal Trileptal Aurochs carbamazepine can be an option Tager taller or carbamazepine has been around for a long time.

Not as much weight gain with that but a lot of drug interactions Gabapentin or Neurontin can be used to some degree to help with anxiety and insomnia socially with bipolar disorder but it will not make migraines worse.

It might actually help the migraines.

We always have to remember that migraine headaches are much more associated with a lack of sleep.

So if you don't sleep very well you're much more likely to have migraine headaches so that can kind of set them off so tension headaches can be associated with depression and anxiety.

Migraine headaches the excruciating ones can be associated bipolar disorder.

>> Then you get the headaches associated.

You feel like you have an ice pick and the eyeball it's called a cluster headache.

It's called a cluster headache because these headaches will cluster around the same time of day usually in the mid-afternoon.

So mid-afternoon you get these ice pick like headaches.

It feels like an ice pick going through the eyeball.

You get a runny nose, teary eye.

The eye gets really red and those are called cluster headaches because they cluster around the same time of day usually in the later in afternoon those kind of headaches are more associated with more.

>> So men have more of those but more associated with smoking cigarets and using alcohol so they can be risk factors for the cluster headaches themselves in front of the fourth main type of headache I'll see as will be a sinus headache a sinus headache like the name implies involves the sinuses.

They get all clogged up and you get a tap tap tapping over the sinuses and they will hurt you to get a fever with sinus headaches not uncommonly you'll get congestion and you want to sneeze quite a bit and tension those are sinus headaches, tension headaches, migraine headaches, cluster headaches and sinus headaches are treated entirely differently and it's very importantly when a person comes to see us as clinicians they can talk about a headache.

We want to know what kind of headache they're having because the tension headaches and migraine headaches are very often associated with a mood or anxiety whereas the cluster headaches and they're more associated with alcohol use or tobacco use sinus headaches or totally independent of those type of factors.

>> Thanks for thanks for your call.

Let's go to our next email.

Our next e-mail dear Dr. Farber, I find that my good habits with diet and exercise slip when I am battling an episode of depression or anxiety it's hard to get out of get out for exercise and I often find myself making poor choices at drive up windows.

>> What's a good way to stay on top of this even when my mental health isn't the best kind of what I mentioned before talking about glutamate and gabber glutamate and Gabb when you're depressed and when you're anxious glutamates low gabbers low so glutamates the accelerator gabbers the brakes and they're both low and when depressed you just you don't feel like doing anything.

>> You don't have any motivation.

No get up and go.

You have no energy to do things at the same time you're really anxious and that's because both of those chemicals are low.

>> So when you exercise when you do the things you really need to do both those chemicals go up and when the glutamate goes up you feel more joy, more energy, more happiness.

When the Gabba goes up in transmission you feel calmer and that's why people after the exercise will feel happy.

But they'll feel calm and that's what you want to get back to doing that.

The problem is getting to that point where you have the motivation to do the things to take care of you.

Yeah, it is a self-fulfilling prophecy when you get really depressed you will tend to do the things that aren't good for you and because your brain instinctually is craving a chemical like serotonin when you get depressed your brain is saying feed me something is going to give me a little bit of a jolt with serotonin.

So how do you do that?

Eat a bunch of carbs.

You eat a bunch of carbohydrates temporarily and transiently.

You do increase your insulin transmission when you increase insulin transmission you'll get more tryptophan moving into the brain then more tryptophan mood moving into the brain gives you briefly a little bit more serotonin because tryptophan is a building block for a serotonin.

>> So when you eat a high carbohydrate diet, let's say you eat two or three donuts and taste great while it's going down and you feel good for a little while because the insulin is going up.

Tryptophan is going to the going up in the brain and you're making the serotonin you feel a little bit of a high from out but then you crash because not uncommonly especially if you're prone to insulin sensitivity and your have borderline type type two diabetes you could have a crash in insulin and you can have more difficulty with the mood swings that are associated with insulin going up and down.

So it's not a good way to help your depression but it's instinctually what you want to do.

Women will notice this as well when they have premenstrual symptoms they'll want to eat a whole bunch of carbohydrates because instinctually they're trying to increase serotonin the brain.

>> It'll help for a while to increase the carbohydrates but then you crash.

So the best thing to do is try to get some kind of routine by all means go workout, go exercise even though you don't feel like it.

>> It's the last thing you want to do.

>> But once you get in there exercise with any kind of exercise you wish to do if you want to go for a walk in the neighborhood that's a good start if you want to lift weights, resistance training is very good especially for anxiety depression you'll often do quite nicely with aerobic activity such as getting on a treadmill, bicycle, elliptical, those type of things.

Just 20 minutes is all you need.

Thirty minutes is great beyond thirty minutes.

>> I don't know if you're going to get that much more benefit overall from exercising but thirty minutes, five days a week, maybe three days a week is a good start but just getting that routine of doing it on a regular basis and you'll notice you'll start to want to do it and that kind of reverse of the cycle but lack of exercise it becomes a habit when you don't enjoy things if you're depressed it becomes a habit to just kind of lay around and not do much and next thing you know you're feeling worse and worse.

>> Thanks for your email.

Let's go to our last caller.

Hello Fern.

Welcome to Matters of mine.

Fern, you want to know is it normal to not remember your early childhood childhood memories?

Ferring will start when you're able to articulate words so memory start when you're about three years of age sometimes younger than that.

But usually it's when you're able to articulate words because the way you form your memories is typically by thinking of words to formulate your memories.

So your memories will often start when you start to articulate your words.

Maybe you had delayed development in terms of articulating words you maybe you had some kind of developmental delay that could be a factor some people and it's not diagnostic by any means and I cannot emphasize that enough some people do have traumatic memories as children in your brain naturally will wipe away those traumatic memories because those memories are stored here in the hippocampus, the hippocampus that's the thumb part of the boxing glove the brain.

So in the top part of the thumb that's the temporal lobe.

That's where the hippocampus lies.

That's the library for the brain and your brain will instinctually block you from bad memory sometimes and if you have bad memories as a child you might not remember those times.

>> It's not diagnostic of having traumatic events happening but it can be something that's suggestive if you can't remember much your childhood people have different reasons why they can't remember their early childhood.

>> Thanks for your call.

Unfortunately I'm out of time for this evening.

If you have any questions that I can answer on the air concerning mental health issues you may email me at matters of the mind all one word at a dot org.

>> I'm psychiatrist Jeff Oliver 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.

Good night