.

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

Welcome to Matters of the Mind now in its 25th year are Matters of the Mind is a live Call-In program where you have the chance to choose the topic for discussion.

>> So if you have any questions concerning mental health issues, give me a call here.

>> PBS Fort Wayne by dialing in the Fort Wayne area (969) 27 two zero.

>> If you're calling any place else coast to coast you may dial toll free at 866- (969) 27 two zero now on a fairly regular basis I am broadcasting live every Monday night from our spectacular Fort Wayne studios which lie in the shadows of the Purdue Fort Wayne campus.

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

>> You may write me via the Internet at matters of the mind all one word at WSW a dot org that's matters of the mind at f a dot org and I'll start tonight's program with an email I just recently received.

It reads Dear Dr. Fauver my sleep rhythm has not been very good.

I stay up far too late which makes it difficult to wake up in the morning and I need to get to work often I'm up until one or two a.m. What's a good way to try to get back into the habit of being in bed at a more reasonable time?

>> I'd recommend several different things for you.

No one set an alarm to get yourself thirty minutes or an hour earlier every day to try to get back on track.

>> Now if you're going to work off and you have to get up no matter what but on your days off try to get up and keep your routine the regular basis also discipline yourself to try to get to bed earlier now granted your if you didn't wake up until 10:00 or 11:00 a.m. for instance, you might not want to go to bed 10 p.m. or so.

>> So you want to get in the same sleep cycle night by night by night ideally keep an eye on what you're doing at night because if you're doing frivolous things that are just keeping you more awake that can be a factor for you.

For instance, a lot of people will watch late night movies, they'll watch basketball games, they'll go to different social media sites and they'll look at different things that keep them up and the next thing you know well you've lost that instinct to go to sleep.

So many people will notice that about every hour and a half they get kind of sleepy and if you fight or your instinct to go to sleep at a particular time, you'll stay up for another hour and a half and you can fight his way through that throughout much of the night and step until 1:00 or 2:00 a.m. Now that works fine if you're a second shift or even third shift or where you can get up whenever you want.

But many people want to try to get up early in the morning because they work a day job.

>> Another thing you could do would be to exercise in the morning.

We're talking not an hour workout, just maybe a thirty minute workout, get some physical activity as soon as you get up before you have the first cup coffee .

Now many people will drink coffee in the morning but if you can delay that first cup of coffee to a little bit later in the morning that actually might give you a more of a boost for the rest of the day and give you less of a crash in the afternoon.

So if you can exercise some brisk walk whatever it takes for about twenty or thirty minutes and warning that wakes you up often better than coffee does anyway.

>> And something is sometimes people are in the wintertime especially it's dark when we get up if you're getting up in the morning for a day job.

>> So some people in the wintertime are using light boxes.

>> Light boxes will be a natural means of awakening the brain.

It's a bright light that's a high intensity light.

>> You sit in front of it for about twenty or thirty minutes in the morning maybe the start of your workday but you do it first thing in the morning as a means of waking up your brain, waking up your brain in the morning sometimes will reset your circadian rhythm so that you'll go to sleep later at night.

>> So if you can consider the possibility of looking at your sleep hygiene, figured out what you don't need to be doing at night to keep you up trying to get up a little bit earlier each day exercising and using lightbox those are ways that you can maybe change around your circadian rhythm a little bit to try to keep you awake earlier in the morning.

Now I mentioned caffeine briefly and using caffeine a little bit later in the day.

If you use caffeine, just be aware that you don't want to use it passed about 4:00 p.m. or 5:00 p.m.

Many people drink caffeine into the evening and that can keep them awake.

>> So if you're drinking caffeine past a certain hour and that's keeping you awake a little bit late later into the evening, that can be a factor as well.

>> Thanks for your email.

Let's go to our first caller.

Hello Ted.

Welcome to Matters of Mind.

>> Hey, Dr. Farber.

Hi Ted.

How are you?

I'm doing OK. >> How are you doing, Ted?

Well, not too bad.

Here's my question.

I'm a 68 year old man who suffered a back to back case last summer of long covid which manifested itself in anxiety and that was in July followed by heart surgery in August which had been scheduled to repair not replace repair my mitral valve.

You know, all of that went well but I suffered through September, October , November with anxiety and depression and which I have never dealt with before and it has since lifted the doctors put me on a combination of Buspar own bu Propylene and Citalopram and recently one of the doctors you know has you know, now begun to de-escalate.

My question is what is what are your thoughts about the de-escalation of those drugs now thank God that I'm feeling better and thank God you are feeling better Ed because you went through one one heck of a twenty twenty two .

>> I mean that was a tough year for you.

Looking back, had you ever experienced significant depression or anxiety in the past prior to twenty twenty two before all this all these stresses came upon you?

>> No no I had a fairly high stress job and never had anything like this.

>> Nothing at all.

Fantastic question number two did you have any family history of depression or anxiety?

Mother, father, brother, sister or anybody in the family have any trouble with depression or anxiety?

>> Well, probably my I think my mother who died of Parkinson's probably suffered from depression.

Her father I believe suffered from depression.

>> So yes.

OK, so might be some depression.

The family background question number three would be do you anticipate any bigger stresses in 2023 2024?

I mean we all have our time anticipating things that will happen in the future.

But can you anticipate you're going to make a big life change with the type of expectations that you might be doing on a day to day basis?

No, I don't think so.

I don't you know, we hope to have a pretty well we'll just call it a quieter 23.

>> Yeah.

And God willing we all will, Ted.

So we've all been through a lot over these past few years.

So yeah.

In terms of chipping away at the medication I'd go one by one.

You're taking abuse biron abuse babi appropriate also known as Wellbutrin and Citalopram also known as Celexa they work in different ways.

The Celexa or Citalopram primarily increases serotonin which gives your brain a calming effect.

Bupropion is Wellbutrin.

It increases norepinephrine and dopamine so it's an energizing activating type of antidepressant and then you take and be Spirent Abuse Bar which is giving you a thermos at effect on one of the 14 different serotonin receptors.

Bottom line is if you have too much serotonin in the system it blocks it.

If you have too little serotonin in the system it'll stimulate the receptor.

So bottom line is they'll work different ways.

I would chip away one by one now a general rule of thumb, Ted will be evaluate OK, do you have recurrent episodes of depression?

>> The rule of thumb is three strikes you're on if you've had three bad spells of depression in your life now you want to probably stay on that medication.

>> Number two , you would look at what might have brought on the Depression for for you .

My goodness it was medical conditions of long covid after having a covid infection.

We've seen this with many people dead .

They can get anxious, they can get moody, they can in some cases get depression.

Some people have difficulty with thinking and concentration after experiencing covid.

So that's a real factor.

And of course you had the stress of having a very vulnerable surgery of a heart surgery.

>> So a heart surgery even though that might have come out just fine any time somebody is operating on your heart it just makes you aware of your own mortality and it makes you feel very vulnerable to life and death kind of conditions and reminds us all that we only have so many days on this earth when somebody is working on your heart.

>> So we had all these things going on.

>> With that being said, Ted, I'd say if you've had three or four good months you could start chipping away at the medication.

>> The eventual goal typically is one year of feeling well, not just better but well one year.

>> So that's the eventual that's the usual goal in any treatment.

But in your case you had very specific very specified medical conditions that led to your having these conditions.

So I would think in your situation I'd want to chip away start with one medication, chip out all the way off, start with another medication, the second medication take that all the way off and to take the third medication off as well.

>> Now which medication do you start to taper?

Well, typically you'd taper with the medication where the symptoms are best under control.

>> So if you're worried if your anxiety, if your nervousness, if you're rumination is best under control at this point the boost byroade be the first to go Zilzal a pram or Celexa by increasing serotonin would be the next to go if you notice that your energy level, your focus, your concentration and motivation are on great control right now while the bupropion would be best tapered first so many times people will taper one medication after another after another.

>> But considering how your medical conditions distinctively elicited these type of symptoms of depression anxiety yeah you could probably chip away at them for a lot of our covid patients the patients who had experienced on Koven we will start tapering off their medication after about six months or so.

So after they're doing much better over the course of six months it kind of runs its course.

But you had that extra condition there Ted, where you had the mitral valve surgery and that probably threw you for a little bit more of a loop and for that reason you might need to stay on the medication a little bit longer.

But tapering off one by one would be perfectly reasonable at this time of the medications.

Bu Spyro and you can come off of that pretty quickly Citalopram you want to probably taper off over the course of a week or two and bupropion or Wellbutrin you can come off of that pretty quickly to six days or so so those medications should not give you a lot of trouble with withdrawal or discontinuation syndrome symptoms if you have a discontinuation symptoms from the Taliban the most likely discontinuations symptom would be zings and zaps your hands or feet maybe a dizziness, lightheadedness feeling.

Sometimes people will get a little bit of nausea when they're coming off Citalopram but that's when they're coming off Citalopram too quickly if you come off of it over the course of six days or so typically that's not a big problem for you.

Ted, I wish you well.

You've had a big year here but I'm hoping these next couple of years will be much, much better for you.

Thanks for your call.

Let's go to our next email our next email read Dear Doctor Father, I have been taking Venlafaxine also known as Effexor for over thirty years.

It came out about thirty years ago.

My sleep doctor thinks it's likely causing my sleep movement disorder.

This disorder can lead to Parkinson's multiple system atrophy and Lewy body dementia.

>> Should I take a different antidepressants to prevent these diseases?

Well to my awareness if you're taken venlafaxine by it increasing serotonin it can give your restless legs periodic limb movements and sometimes jumpy legs that are called parodic leg movements.

>> So those are the type of things you can have and you can have a particularly at night time when you hear about those type of symptoms.

>> Number one, I'm always going to check the iron level for somebody because if you have low iron you can have restless legs and restless legs are a phenomenon where you feel like you need to move your legs but particularly in the evening and especially at nighttime.

And it's actually a reason why some people will have difficulty asleep and that's often discovered and identified by the sleep movement, the sleep medicine doctors.

They often will pick up those nighttime movement disorders like that.

So if you've been diagnosed with a periodic periodic limb movement at nighttime, Venlafaxine is predominantly increasing serotonin at lower doses.

But when you get above one hundred and fifty milligrams a day it's going to be increasing more norepinephrine.

>> So the question I would have would be number one, why are you using Venlafaxine if you're using it for depression you could easily move over to one of seventeen other oral antidepressants that are now available and they have variable effects on serotonin.

Number two are using it for anxiety in that case there's a lot of other non-addictive medications that could be used for anxiety.

If you're using it for anxiety I bet you you're using it under one hundred fifty milligrams a day and again it's very serotonergic at the lower doses that will give you the right glim movements three using it for pain people will use venlafaxine for pain for those people we often move them over to a medication like Fluoxetine or Cymbalta or if using it for pain we often move it over to a medication like Gabapentin or Lyrica.

Those are medications that have no effect on serotonin and as a matter of fact they tend to decrease periodic limb movements or restless leg.

So there's a lot of different options out there for you to my awareness usually it's not a chronic degenerative kind of condition where you're causing yourself more and more physical damage if you're on Venlafaxine it's usually a side effect of venlafaxine such that when you come off of it and go to something else, the symptoms ,the limb movements or the movement disorders at nighttime will typically diminish and often go away entirely if you go to something else that does not affect serotonin so much.

>> Thanks for your email.

Let's go to next caller.

>> Hello Dean.

Welcome to Matters of Mind.

Hello Dean.

>> Hello.

Yes are you there?

I am here.

You're on the air Dean OK, I had a question about my anxiety gets higher.

I get like real itchy feeling outside and about like I didn't know some of my medications because of the frequent urination I take the Xanax, Gabapentin, Lexapro, testosterone cream or gel I should say didn't have any of those because the worse I have obviously really bad too.

>> So then what was the first medication you mentioned?

I'm sorry I didn't catch that Xanax testosterone gel and they have apparently got you government and what was the fourth one?

I've tried the whole I know I'm drawing a blank on here about the Cymbalta.

>> Oh yeah.

Those are medications that do not typically worsen itchiness unless you notice that as soon as you started a particular medication you started getting more itchy.

>> So itchiness is something that can be caused by some medications.

It does not mean your or allergic necessarily.

>> Now if you get hives sure that that's called anaphylaxis especially when you get tightness of the throat and you can't breathe, that's an allergy.

But sometimes people will have what's called benign itching where it's just an irritation.

It goes away a lot of cases but we always want to be informed as clinicians if you're having itchiness from a medication will often have you drop the dosage or go off altogether depending what kind of itchiness you're experiencing.

But Cymbalta Xanax Gabapentin, testosterone gel they don't typically will cause itchiness as side effects.

Now some medications will for instance, there's an antidepressant medication by the name of telex also known as Forty Oxer Team.

It will increase histamine in the body now increasing histamine in the brain can actually make you more awake, more alert and help your thinking.

So increasing histamine in the brain can be a good thing because it makes you more awake and alert so the problem is sometimes people will get some itchiness as a side effect from increasing histamine.

The rest of the body you're exactly right then when some people get anxious more some more than others but when you get really anxious sometimes you can have this surge and release of histamine in the entire body and that will cause some itchiness and there's a condition called neurotic dermatitis that's an old term for basically just meaning due to anxiety you feel itchy and some people actually get hives when they get under stress their neck might turn red, they get itchy all over and they start itching for those people they might use a specific type of medication by the name of hydroxyl Zeine also known as visceral Radack's and Hydroxy and his medication that's pretty selective for blocking histamine but it doesn't make you really, really sleepy.

In other words, it doesn't get to the brain as much as diphenhydramine or Benadryl not diphenhydramine or Benadryl gets to the brain more so than hydroxy and so it makes you much more sleepy.

Plus it blocks this chemical called acetylcholine which can cause you to have a lot of difficulty with concentration, memory and keeping your mind on things hydroxy not so much but you have neuropathy.

>> OK, Gabapentin and Cymbalta work very nicely for neuropathy sometimes we don't know if a medication is causing itching until we try to have somebody taper off of it or taper off of another one.

But you always want to go back to wondering if a medication caused itchiness right after taking it.

So is the itchiness temporally related to the time to when you started taking this or that medication because that can be a factor and as well as I always mentioned to people, Dean, any of us can be allergic to any medication out there so any medication can can contribute to hives or itching.

There's no way to really predict it except with the exception of your having that experience before on that same medication.

>> Dean, thanks for your thanks for your call.

Let's well if you have any calls concerning mental health issues, you can give us a call at 866- (969) 27 two zero.

Let's go to our next email.

The next e-mail reads Your daughter Fauver I've been receiving regular massage therapy mostly for minor back pain in addition to relieve for that it can massage therapy help with one's mental health .

I often feel a release of positive energy during and after a massage you could say it brightens my day.

Absolutely a massage can be wonderful for the mental health .

A lot of workplaces are allowing coworkers and employees to be able to have a massage during the day.

It gives people a relaxing feeling because when people get anxious often they will carry it on their shoulders and their scalp and in their backs.

>> So if you get a massage that kind of loosens some of that up and that's why we often recommend when people are suffering from a lot of anxiety and they feel tight in the back and in there and they're getting chronic headaches because they're so stressed out throughout the day.

A massage can be helpful but doing some weight lifting can as well because when you lift weights in the yeah, you're contracting your muscles during that time these same muscles that you're tightening during anxiety you tighten those muscles but then after you tighten these muscles you'll feel more relaxed.

>> So weight lifting resistance training to the best of your ability don't overdo it because you can hurt yourself.

>> But resistance training and weightlifting can be also be very, very helpful for anxiety as well.

But massage therapy can be helpful.

We often recommend yoga for people where they are doing resistance and stretching at the same time.

Yoga is something the sun can certainly improve your balance as well and we recommend that for a lot of older people because as we get older we tend to have more difficulty with balance.

>> Thanks for your email.

Let's go to our next caller.

Hello Matt.

Welcome to Matters of Mind.

>> Well, Matt, you wondered why do you still feel tired after a full night's sleep?

Well, you're not getting a deep sleep, Matt.

>> Your brain is kind of like a cell phone battery where a cell phone battery you know, if you don't have a good charge on it during the night time you'll notice that in the morning that's only about 50 percent charge.

It didn't charge adequately.

You don't have a good connection.

>> The same with the brain.

The brain needs to have a period of time at nighttime where it goes into a deep sleep in a deep sleep is where you you awaken during the deep sleep and you're kind of confused for a couple of seconds wondering where you are.

That means you're in a deep sleep if you get awakened during that time it's called non rem sleep, non rapid eye movement sleep so you're not in dream sleep during deep sleep you're in a very, very relaxing sleep during that time.

>> During that time you're getting a full body relaxation and you're getting a full body recharge now REM sleep rapid eye movement sleep is where you're dreaming with rapid eye movement sleep you're resting this left front part of the brain especially and when you're resting that part of your brain that's why dreams don't make a lot of sense to you because this left front part of your brain is your logical part of the brain.

That's the part of the brain that you use to make sense out of the world around you.

It's getting shut off during dream sleep.

So that's why dreaming is a very abstract experience.

Things don't make a lot of sense unless you start putting two to two and two together.

The best thing to do in terms of trying to interpret dreams or figuring out why you had those kind of dreams is to write them down or think about them first thing upon awakening because our brains have this remarkable ability to just erase the whiteboard within a matter of minutes after you awaken.

So it's not uncommon after thirty minutes or an hour if you didn't really think about your dream upon getting up you totally forgot what the dream was about and then the next night goes on you have more dreams but we need two particular phases of sleep at nighttime to feel rested.

We need non REM sleep.

Where are you going to really deep sleep and you're very relaxed during that time and you're confused upon awakening and you need dream sleep where it's called rapid ibou mostly because your eyes are moving very rapidly during that time your brain is is quite active during REM sleep.

It's just that this left front part of the brain is really shut down during that time and basically gives your brain a rest and when you have REM sleep that's when you're able to have more memories the next day you're able to concentrate better the next day because we need to go into dream sleep to be able to sustain memory and concentration.

>> If you don't dream sometimes it can be a factor.

Now many people say well I don't dream but if we use a poly sonogram and put them in a sleep study they can actually see dreaming.

>> So you might not remember your dreams but you might be dreaming anyway.

People who develop Alzheimer's dementia often have fewer and fewer dreams and it's thought that's one of the ideologies behind Alzheimer's disease because they quit dreaming and when you quit dreaming this temporal temporal lobe over here starts to shrink down a little bit if you're having trouble with not dreaming enough and chicken or the egg, is it the not dreaming that led to the shrinkage of the temporal lobe or the other way around but if you don't dream that sometimes can affect your ability to remember things and retain things the next day.

>> And it's interesting when we treat people for Alzheimer's dementia with a medication like Aricept which increases acetylcholine, they actually start dreaming again and sometimes it's frightening to them because they haven't had any dreams for a long time and all of a sudden they're having these dreams that describe them as nightmares but they're actually just normal dreams.

But that's sometimes a reason why people have reluctance to take Aricept because it makes them dream again and in some cases they haven't had any dreams for years.

>> Thanks for email.

Let's go to our next caller.

Hello Dan.

Welcome to the Mind.

>> You had asked if the medication that I mentioned oh that you mentioned can cause bladder issues.

>> You mentioned Gabapentin Cymbalta Xanax and testosterone of those the symbol would be the most likely to cause bladder issues in a sense that it will decrease your ability to establish bladder flow.

>> Now why am I as a psychiatrist talking about this?

Well, you I prescribe Cymbalta so it's a side effect.

It's a medical side effect that can occur from Cymbalta, also known as Delux.

There's a chemical cousin to delux team called Atama Sateen, also known as Strattera and Europe.

>> Satara is used specifically for women who are having difficulty with stress urinary incontinence which means that they have trouble with squirting when they have attention on their abdominal area.

So Strattera or Cymbalta can sometimes cause some bladder retention and cause you to have some difficulty with initial initiating the bladder flow itself.

It doesn't usually cause increased urination but it can cause some difficulty initiating the urine itself.

Dean, 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 contact me by using the email matters of the mind at dot org.

>> I'm psychiatrist Jay Fawver and you've been watching matters of the mind God willing and PBS willing.

I'll be back again next week.

>> Thanks for watching.

Good night