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

Welcome to Matters of the Mind now in its 10th year, Matters of the Mind is a live call in program where you can decide on the topic for discussion.

So if you want to ask me a question in the Fort Wayne area ,you may call me by dialing in and (260) 969-2720 but we also have the option for you to text me at (260) 969-2730 R 27 three zero because the 27 three zero text allows me to get your text directly.

>> All I ask to make it a little bit more personable is that you leave a name and tell me where you're from and that will get right back to you and hopefully talk right ahead on the program now on a fairly regular basis we are broadcasting live every Monday night from our spectacular PBS Fort Wayne studios which lightly shadows of the Fort Wayne campus.

>> And if you'd like to contact me with an email question, I can answer on the air.

>> You may write me a via the Internet at mattersofthemind all one word @WFWA.org that's Matters of the mind at WFWA.org and I'll start tonight's program with an email I recently received.

>> It reads Your daughter father my doctor prescribed phentermine vitamins also known as ADAPTIX and Fast and then are made for weight loss.

It's giving me a lot of energy and helps with my mood but another doctor said I couldn't take it with an antidepressant.

>> How does it work?

Well you can and you can't take it with an antidepressant.

It depends on which antidepressant you're using.

Phentermine is a medication if it's pushing out norepinephrine .

If you think about your little neurons there's 80 billion neurons in your central nervous system.

If you think about your neurons being like shotgun's, they're firing out pellets of neurotransmitters and you have these neurotransmitters like norepinephrine firing out the shotgun and then we have antidepressant medications that will block the vacuuming of those neurotransmitters back into the firing shotgun and those are called reuptake inhibitors.

So a lot of antidepressant medications work by blocking the vacuuming of neurotransmitters back into the firing shotgun when a case of Phénomhne it's firing out.

It's pulling the trigger so to speak, more frequently on norepinephrine.

So you're increasing more norepinephrine to a lesser degree.

>> It will fire out more serotonin and dopamine but to a lesser degree.

So if you're going to use an antidepressant medication with phentermine, you probably don't want to use one that's going to inhibit the vacuuming of norepinephrine because then you'd be firing out more norepinephrine and in hindering the vacuuming of norepinephrine out of the surrounding area and that would give you possibly norepinephrine toxicity such headaches fast heart rate sweatiness, tremulousness, diarrhea, a lot of bad stuff from the higher amount of norepinephrine.

If you're going to use a depressant with Finnerman, you're probably wouldn't use the medications like the serotonin norepinephrine uptake inhibitors such as Cymbalta to use the trade names Presti Effexor Fed Zema these medications would likely interact with Fantome more potently because they have more effects on norepinephrine.

>> You could cautiously use the serotonin reuptake inhibitors such as Prozac, Paxil, Zoloft, Celexa, Lexapro those are commonly used.

Be careful though because again Sanamein can increase serotonin some and you know you want to avoid medications like Wellbutrin also known as bupropion because that's going to inhibit the uptake of norepinephrine and dopamine so those type of medications would interact.

If you're going to use an antidepressant medication, just be very cautious in which one is used to talk it over with your clinician keeping in mind Phénomhne by itself has antidepressant features.

If you increase the transmission of norepinephrine you're going to have more energy and your mood is going to be better.

Maybe that would be all you would need.

The issue that I've heard with Thinner mean for some people will be after several months its appetite suppressant effects can start to subside.

But you do have to watch out to see if you have any evidence of norepinephrine toxicity like higher blood pressure and higher heart rate so your clinician will likely monitor for those.

>> Thanks for your email.

Let's go to our first text for the night.

Hello Jess.

Welcome to Matters of Mind.

>> Jess, you had mentioned that your child has been diagnosed with anti-social personality disorder at the age of eight years old.

>> Do I have any medication thoughts about that or is therapy the answer?

>> I'm not a child psychiatrist.

Yes, but I do know that my social personality disorder can show traits of oppositional defiant disorder and disruptive mood dysregulation disorder.

These are childhood diagnoses that will often have traits of antisocial personality disorder.

>> Antisocial personality disorder is basically something that you'll often see developing after the age of 16 years old.

Twenty four years old more commonly but in the early adult years you hear about people who just don't care about the rights and the boundaries of other people.

>> It's all about them.

>> They will intentionally lie.

They have no empathy toward other people.

They really can't put themselves in other people's shoes and they often cross a lot of boundaries.

>> Difficult to really make that call when somebody is eight years old.

So I'd say at eight years old therapy's probably going to be the more the answer there to try to help with that interpersonal engagement to help with empathy itself.

Medications for children, adolescents or adults wouldn't help with antisocial behaviors for adults it's more of a moral issue for many of them just trying to get an understanding of how they can serve others as opposed to expecting others to serve them.

You might think well gee that sounds narcissistic.

Well, the problem with antisocial personality disorder is they actually get into to the point where they start breaking rules and they often become and involved with breaking the law and things like that and that's where a lot of criminal behavior obviously will be related to people with antisocial personality traits.

Thanks for your text.

>> Let's go next to Jenny Jenny from Fort Wayne .

Welcome to Mars.

Mind you asked what are my thoughts about somebody wanting to come off of all medications while struggling deeply with all diagnoses so that the best context I can Jenny, in terms of coming off all medications if you're doing well you could do so under the thoughtful oversight of your clinician.

>> But the question would be what kind of condition do you have?

Is that something that potentially is reversible?

Is it something is no longer problematic because you're not in a similar type of life circumstance as you were before ?

>> So if the medications are working for you really well, I would applaud that.

I think that's great.

But the question would be how many spells of these episodes if you had in the past what your family history of having any similar psychiatric diagnosis if you have a strong family history of mental health issues, it's more likely you're going to have these underlying underpinnings that would cause you to need to be on the medication for a longer period of time.

So there's a lot of different considerations we will we will make now on the other hand, you might have asked that question in the context of you've had a lot of diagnoses and you've taken shots at was diagnosed with various medications and they're not working.

>> OK, I get that in that case it really comes down to having the right diagnosis.

So for instance, if a person has chest pain you want to determine if that chest pain is from heart disease, stomach upset lung problems, gastrointestinal problems with small intestinal problems.

>> Is it from a liver problem?

You want to determine what's causing that chest pain and if you just throw medications at it that have different mechanism of action, you might not get the right etiology and you might not find the appropriate treatment.

So first and foremost you need to have a thorough diagnostic assessment looking not only in your own symptoms but also having the clinician examine your family member's symptoms that they might have endured over the course of time because we have to remember that psychiatric conditions often are quite genetic.

>> It's not guaranteed but if you have a mother, father, brother or sister with similar symptoms of mood anxiety or cognitive problems, they can often mirror what you're going through and it gives us a lot of clues on what might be going on for you.

So for instance, if you've been treated with antidepressants or antidepressants after antidepressants but underlying your condition will be trauma with post-traumatic stress you might have underlying bipolarity where you're having mood swings.

>> You might have trouble with attention deficit hyperactivity disorder or you might even have something like thyroid disturbances or sleep apnea, something entirely medical and not psychiatric such that if you address the medical aspect of the symptoms that might take care of a lot of things.

So it really comes down to getting a thorough diagnostic assessment and really targeting the medication toward that.

We often are asked why do we have to label somebody with a diagnosis?

>> Well, again, going back to the analogy I gave with a chest pain before, if you have congestive heart failure or you have gastric reflux, those are quite different in terms of how are you going to treat those conditions.

>> So if you have congestive heart failure you're going to treat that with cardiac medication.

If you have gastric reflux you're going to change your diet and maybe use the medications for your stomach entirely different treatments for similar symptoms.

We have the same phenomenon occur in psychiatry where you can have symptoms of feeling depressed and have difficulty concentration and it can involve a myriad of different conditions that we might address.

So it's very important that we do target our treatment toward the underlying condition as opposed to randomly giving people medications based on the symptoms they might be presenting.

>> Thanks for your text.

Let's go to our next text.

Hello Gary from Fort Wayne .

Welcome to the Mind.

You had asked what's the best medication for memory loss?

Well, the best medication for memory loss is the one that's going to treat the underlying condition causing the memory loss.

>> So you know, if you're eighty years old and you're having trouble with what we'd consider to have Alzheimer's dementia, well, you're going to use a medication that's going to increase acetylcholine and we have some specific medications that might be used for Alzheimer's dementia nowadays.

But you want to have a neurologist really determine what type of medication you might need for that underlying dementia.

>> Well, let's say you're fifty two years old and this wouldn't apply to you necessarily.

But you know you're a woman you're 52 years of age and you're going through menopause that's going to give you some memory loss because when you go through menopause the memory loss occurs right here in the hippocampus, the temporal lobe part of the brain that's studied it with little estrogen receptors and as you lose estrogen estrogen overall those little estrogen receptors are starving for estrogen.

>> That's going to give you a memory problems right here in your hippocampus so women will have trouble with memory problems around the time of perimenopause, especially if you have clinical depression, clinical depression in any age, whether you're in your 20s, 30s or 50s, any age with clinical depression can give you difficulty with processing information so your speed of processing will be altered in such a way that many people will have what they think is early dementia when they actually have clinical depression.

So we want to try to address that.

I had mentioned earlier people having thyroid disturbances, sleep apnea.

>> You can add to that low iron blood sugar problems with diabetes.

All these conditions can give you trouble with underlying memory problems.

So I think the best key would be to try to understand the underlying problem that you might be causing the memory problem.

>> Look back to how long it's been going on.

Sometimes we hear about certain medications that were started and when they a person started that particular medication maybe two months ago since that time they've been having trouble with memory even though it might not be a common side effect if we can attribute when the memory problem started to when you started a particular medication, sometimes we'll go back and say how about we have you go off that medication and see how you do otherwise?

So it really comes down to your clinician doing a thorough assessment.

But what you can do is before you see your clinician is go back and try to determine how long the memory problems there is that there every day is it there are more days than not we're all in on particular days when you're perhaps under more stress because some people will have this difficulty with what's called stress resilience and they have a hard time putting up with stuff and when they have a hard time putting up with stuff they get really stressed out and there's an excessive amount of a chemical called glutamate that gets released.

The gray matter of the brain and when glutamate gets released excessively can have a neurotoxic effect and indeed it can give you difficulty with memory disturbances.

So in those cases we want to try to help somebody deal with the underlying stress obviously with psychotherapy or whatever means are necessary and then we want to sometimes block the excessive glutamate with a medication like LaMotte's or gene that will kind of modulate the amount of glutamate and decrease the likelihood you're going to have memory problems with stress itself if you've had a traumatic brain injury that's certainly going to give you a higher likelihood of memory problems.

>> So there are many, many, many reasons for memory disturbances.

I wouldn't suggest simply randomly taken an over-the-counter supplement that says it's good for memory because it comes down to trying to figure out what's caused the memory loss and trying to address that very specifically.

Thanks for your text.

Let's go to our next email.

Our next e-mail question reads Dear Dr.

Fovea, what's the biological relationship between stress and mood disorders?

>> We all we we all have stress .

>> Oh, if we were to relieve all stress, would that take care of the possibility of mood disturbances?

Stress itself is something that's normal.

>> You don't want to have those exact same circumstances every single day if you've ever seen the movie Groundhog Day with Bill Murray from 30, 40 years ago, that gives you the nightmare of what your day would be like if nothing ever changed.

>> And that was the whole premise of the movie how much of a nightmare it was because every single day was the same you don't want to have every day the same.

>> You want to have a bit of a change.

>> You want to be able to adapt.

You want to have challenges more often than not and I say that especially to my friends who are going into retirement because when you're going into retirement you need things to do and I tell people when you go into retirement that first week or two will be great.

>> It'll be like a prolonged vacation but then you have to start sorting out what am I going to do day by day and how am I going to keep myself busy and challenged because you can still be productive despite being retired.

So with that being said, if you have difficulty with stress, the stress if it's unmitigated, if you've not if you've not been able to cope with those particular things going on that stress being just a change in your day to day environment and you're feeling overwhelmed, what can happen is that little chemical by the name of glutamate that I mentioned earlier glutamate can start to get released excessively.

Glutamate is an excitatory neurotransmitter that consists of about 80 percent of all the chemicals up here in the gray matter of the brain, the gray matter of the brain being the thinking part of the brain, the logical part of the brain.

>> If you have excessive glutamate release it can cause you to have some neurotoxicity and you can have among those symptoms inflammation as well as mood disturbances thereafter.

>> So excessive glutamate can lead to the release of inflammatory proteins, the release of inflammatory proteins are damaging to the brain.

>> So if you have a release of inflammatory proteins and they're called such names Interleukin six tumor necrosis factor alpha interleukin six for instance is the same inflammatory protein is released with influenza.

So when people say they feel like they have the flu, when they have depression with difficulty, concentration, feeling blah, having body aches really the same neuro same inflammatory protein that's being affected.

So with stress that can cause you to have increased glutamate with increased glutamate you can have the release of inflammatory proteins and very specifically around each individual neuron will be about ten of these little glial or micro glial cells.

>> Glial cells are the pit crew of the individual neurons.

Our brain has about 80 billion neurons in it and each individual neuron has about ten of the little pit crew members around them.

>> These are the glial cells or the microglia the the the glial cells themselves will nourish and clean up the area around each of the each of the neurons themselves if you can think about the Indy 500 where an Indy car comes into the pits and the Indy car will have seven pit crew address the car within five seconds that car gets four tires changed and a full load of fuel that's with only seven crew members.

>> Then it all occurs within about five seconds and it's a very efficient team watching the Indy 500 race.

>> Much of the excitement is watching the pit crew and how efficiently they can work.

That's how our little glial cells should be.

Our glial cells should be very efficient in nourishing the individual neurons and cleaning up the mess around the neurons.

>> Here's what happens with inflammatory proteins that are being released.

>> Inflammation will suppress the the efficiency of the glial cells.

>> So it's kind of like having an indie pit crew that's not having a very good day so they don't get the tires on properly.

>> They leave the fuel hose in too long and it's a big mess and it's a disaster as the car comes out of the out of the pit row, the same can happen in our brains if you have inefficient glial cells they are not adequately nourished and taken care, nourishing and taking care of the needs of the individual neurons.

That's from inflammation, the inflammation is from excessive glutamate transmission.

>> So you put this inflammation together.

What happened to your individual neurons start shriveling up and part of the problem with depression is instead of your individual neurons having 40 to 50 thousand branches on each individual neuron, they go down to maybe twenty thousand branches.

So it's like if you look at a at a neuron it looks just like an oak tree.

You've got the branches above the ground.

>> You've got this extensive root system below the ground with an oak tree.

That's exactly how a neuron looks extensive extensive branches and these branches shrivel up when somebody gets clinically depressed and they have mood disturbances.

>> So what we're often trying to do in psychiatry is help nourish the the oak tree itself, the neurons themselves.

>> We're also trying to destabilize the glutamate transmission so you don't have excessive glutamate transition causing that toxicity.

Now people often ask well gee, can you just take an anti inflammatory medication like nonsteroidal antiinflammatory like Moloch's cam Mobic?

Yeah, you can it may or may not help.

That was discussed twenty five years ago and quite frankly twenty five years ago I expected that by this time we'd be treating people with antiinflammatory.

But it's not that predictable.

Some people have inflammation, some people don't.

But there is a cascade that occurs from a symptomatic standpoint.

What I often hear about will be people having worry, anxiety, rumination.

They dwell on the past.

>> They ruminate about possibilities of the future and they're not even thinking about the present.

The people that dwell on the past, they ruminate about the possibilities of the future.

When you have people going through that not uncommonly they'll have difficulty with insomnia when they have trouble with insomnia all it takes is for them to stay up further looking at social media while they're trying to go to sleep that keeps them awake throughout the night with insomnia.

Lack of sleep will cause you to have a compromised functioning in the front part of the brain.

The front part of the brain is the part of the brain that you use for rationally thinking through things, coping with different situations and just being able to pay attention to things if you don't sleep well you're going to have trouble with coping and rationally thinking through your day to day challenges and and being able to pay attention.

So the whole idea is to help somebody sleep right off of bad calm down the anxiety so the front part of the brain can start to do its job again.

>> So it's a cascade of events .

>> It often starts with changes that are overwhelming for you and when you have changes that are overwhelming yeah, we call it stress but really stress by definition is just a change of any kind of thing in your environment.

Stress isn't bad.

I mean stress is just something that we should all endure day by day.

The stress is problematic is the stress that's so difficult for you to endure that you become overly overwhelmed with anxiety and you don't sleep and that will often lead to mood disturbances on down the line.

>> Thanks for your thanks for email.

Let's go to our next caller.

Hello Mildred.

Welcome to Matters of Mind.

Well Mildred, you mentioned that you're elderly and you've been taking anxiety medications for most of your life and most recently felt their effects starting to kind of wane down and you want to know my suggestion depends on what kind of medications you've used for anxiety over the course of your life , Mildred, because if you use the medications they're enhancing serotonin and I'm talking about the medications I mentioned earlier called Lexapro, Celexa, Prozac, Paxil, Zoloft, Luvox these are all medications that are increasing serotonin.

>> They can help with anxiety because they basically will give you an emotional numbing effect.

>> They calm down the excessive emotional overtones that people experience.

They don't usually wear off the medications that will wear off will be the the medication called the benzodiazepines such as out of Xanax, Klonopin, Valium.

>> They've been around for a long time and it used to be thought that people could take those medications long term.

But the past twenty years we've realized that especially as we get older they're probably not medications you should be on long term and might be difficult even to get a clinician to prescribe those medications to a person over sixty five years of age nowadays because number one they can cause you to have an increased risk for following following the benzodiazepine medication Xanax, Klonopin, Valium, Ativan they can also give you difficult memory problems and difficulty processing information over the course of time and they do lose their effects.

They actually will hinder your brain's ability to have normal sleep cycles at nighttime so they're not the best thing for sleep.

>> Kind of like alcohol remember thirty years ago is really common for people to have a couple drinks before they went to bed to help put the sleep.

Yeah, it might help them get to sleep but their quality sleep the other night was horrible and people who drank alcohol at nighttime often had a lot worse memory.

The next day we don't want to use benzodiazepines and people generally over 65 years of age unless we we just need to find some good alternatives.

We might use them just episodically and periodically when people over 65 years of age.

But you don't want to use the benzodiazepines on a regular basis if you're are using the serotonin medication sometimes it's a matter of going from one serotonin medication to another and trying something different .

But also it's not uncommon when somebody is elderly and they're having trouble the anxiety they might have an underlying problem that we want to address sometimes again high thyroid, high thyroid so low thyroid high that would give people trouble with anxiety problems.

Some people as they're elderly will have heart rhythm disturbances such as what's called paroxysmal atrial tachycardia where their heartbeat just starts taking off real fast and sometimes they need a what's called a coronary are cardiac ablation where the cardiologist will go in and kind of burn the aberrant nerve endings and people will come to me as a clinician say I'm I'm having trouble with anxiety when underlying the problem will be a fast heartbeat overall.

So sometimes we need to look at underlying medical problems that might be causing the anxiety as we get older we're all more prone to having sleep apnea and sleep apnea is where your snoring at night or maybe not getting enough airflow during the nighttime with less air going to the lungs you'll have less auction go to the brain with less oxygen, go to the brain naturally the next morning many people will have gastric reflux.

Maybe they will have nausea, headaches and many people if they have untreated sleep apnea will have anxiety on an ongoing day to day basis.

So we have to look at the whole picture to determine why a medication that had worked for you for quite some time is no longer working for anxiety.

Thanks for your email.

>> Let's go to our next caller.

Hello Herb.

Welcome to Matters of Mind.

Well, Herb had mentioned that you've recently stopped smoking.

Good for you.

Is there a chance of smoking of any smoking cessation aids that will affect any medications that you're currently taking ?

The main smoking cessation AIDS I think you may be referring to in this case there would be medications like Wellbutrin also known to be him as Zyban is the trade name of that.

We don't hear that trade name so much anymore but that's an antidepressant medication.

It's going to increase slightly dopamine and norepinephrine.

So if you're taking any medications that might decrease your blood pressure, sometimes Wellbutrin can slightly increase the blood pressure that might be a factor.

Nicotine replacement is very common for people who are trying to get a stay off of cigarets as well.

Just be aware that nicotine replacement sometimes can increase the blood pressure as well.

>> So those are the two main smoking cessation medication we'll talk about.

We do hear about Chantix which is a medication that kind of mimics the effect of nicotine in the brain.

Shouldn't have any really significant interactions with other medications with the use of Chantix but like with any smoking cessation aids, the intention and hope would be that you wouldn't need them for more than a few months.

>> Herb, thanks for your call.

Unfortunatey I'm out of time for this evening.

Any questions concerning mental health issues?

You may write me a via the Internet at mattersofthemind @wfwa.org and I'll see if I can get to those questions on the air.

>> I'm psychiatrist Jay Fawver and you've been watching Matters of 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