GOOD EVENING.

I'M PSYCHIATRIST JAY FAUVER LIVE FROM FORT WAYNE, INDIANA.

WELCOME TO MATTERS OF THE MIND NOW IN ITS TWENTY SECOND 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 AT PBS FORT WAYNE BY DIALING THE FORT WAYNE AREA NINE SIX NINE TWO SEVEN TWO ZERO OR IF YOU'RE CALLING LONG DISTANCE COAST TO COAST YOU MAY DIAL TOLL FREE AT EIGHT SIX SIX NINE SIX NINE TWO SEVEN TWO ZERO NOW ON A FAIRLY REGULAR BASIS WE'RE BROADCASTING LIVE EVERY MONDAY NIGHT FROM OUR SPECTACULAR PBS FORT WAYNE STUDIOS WHICH LIE IN THE SHADOWS OF THE FORT WAYNE CAMPUS.

IF THAT CONTACT ME WITH AN EMAIL QUESTION THAT I CAN ANSWER ON THE AIR YOU MAY WRITE ME VIA THE INTERNET AT MATTERS OF THE MIND ALL ONE WORD AT BIG THAT'S MATTERS OF THE MIND AT WFA ECG AND I START TONIGHT'S PROGRAM WITH A QUESTION I RECENTLY RECEIVED.

IT READS DEAR DR. FAUVER MY GRANDSON TAKES ADDERALL AND ATIVAN.

I AM CONCERNED ABOUT HIM TAKING TOO ADDICTIVE MEDICATIONS.

IS THERE A PROBLEM WITH THIS COMBINATION STRATEGY CAN TALK ABOUT WITH YOUR GRANDSON'S CLINICIAN?

ADDERALL IS A MEDICATION THAT IS A STIMULANT AND IT'S USED FOR ATTENTION DEFICIT DISORDER WHERE PEOPLE HAVE DIFFICULTY WITH ATTENTION SPAN BUT THEY ALSO HAVE DIFFICULTY WITH DISTRACTIBILITY AND WITH ADHD HAVE THREE TO FOUR PERCENT OF THE CHILDREN IN THE UNITED STATES HAVE ADHD SYMPTOMS AND IT DOES CARRY ON TO THE ADULT YEARS AND ABOUT 40 OR 50 PERCENT OF THE CASES AFTER THE AGE OF TWENTY FOUR YEARS OLD ADDERALL IS A STIMULANT MEDICATION THAT IS A MIXTURE OF FOUR AMPHETAMINE SALTS AND IT'S A MEDICATION THAT YOU HAVE TO BE CAREFUL IN USING.

IT IS VERY INEXPENSIVE SO IT'S OFTEN VERY HIGHLY PROMOTED BY PEOPLE WHO ARE PAYING FOR THAT MEDICATION BUT IT'S MEDICATION.

IT CAN MAKE SOME PEOPLE MOODY, IRRITABLE AND CAUSE HIM TO HAVE SOME MOOD SWINGS AND IT CAUSES ANXIETY AND A LOT OF CASES AND I'M TAKEN ABACK THAT YOUR GRANDSON'S ALSO TAKEN ATIVAN BECAUSE WE FREQUENTLY SEE THAT COMBINATION ADDERALL AND ATIVAN IS COMMONLY SEEN BECAUSE ADDERALL WILL MAKE PEOPLE ANXIOUS AND IRRITABLE AND MOODY SO OFTEN CLINICIANS WILL ADD ATIVAN AS A MEANS OF CALMING DOWN THAT MOODINESS.

THE PROBLEM IS ATIVAN WILL SUPPRESS THE ABILITY TO CONCENTRATE AND CAUSE YOU TO HAVE DIFFICULTY WITH THE ATTENTION SPAN AND MEMORY.

THAT'S WHAT ADDERALL IS TRYING TO TREAT.

SO IT'S KIND OF LIKE PUSHING THE ACCELERATOR WITH ADDERALL AND PUSHING ON THE BRAKES WITH ATIVAN NOT A COMBINATION.

I LIKE TO SEE.

SO I'D WANT TO TALK TO YOUR GRANDSON'S CLINICIAN AND ASK OK, IS THERE A WAY WE CAN GET HIM OFF THE ATIVAN AT THE VERY LEAST AND POSSIBLY LOOK AT A SMOOTHER ACTING, LONGER ACTING MEDICATION FOR ADHD THAT'S GOING TO BE A LONG ACTING MEDICATION AT POSSIBLY YOUR GRANDSON COULD TAKE FIRST THING IN THE MORNING AND SLOWLY RELEASE OVER THE COURSE THE WHOLE DAY ADDERALL EVEN IN THE EXTENDED RELEASE FORM TENDS TO GET IN THE SYSTEM REALLY FAST AND THEN HE GETS OUT OF A SYSTEM FAST SO PEOPLE TYPICALLY NEED TO TAKE A MINIMUM TWICE A DAY DOSING AN ADDERALL QUITE FRANKLY IS PREFERRED AS A STREET DRUG BECAUSE PEOPLE GET THIS EUPHORIA, THEY GET THIS BOOST OF DOPAMINE WHICH IS THE FEEL GOOD CHEMICAL THE BRAIN DOPAMINE GETS RELEASED FROM THIS LITTLE AREA OF THE BRAIN IN THE MIDDLE HERE CALLED THE NUCLEUS ACCUMBENS.

AND WHEN SOMEBODY TAKES ADDERALL AND THEY GET THIS QUICK RELEASE OF DOPAMINE, THEY GET A EUPHORIC FEELING.

THEY TEND TO GET ENERGIZED.

THEY FEEL REALLY GOOD WITH THAT AND THAT'S WHY A LOT OF PEOPLE WILL SAY AFTER A FEW WEEKS ADDERALL QUIT WORKING BECAUSE AS A SIDE EFFECT OF ADDERALL YOU GET HIGH ENERGY DECREASED APPETITE AND THIS REALLY BOOST OF HAPPINESS AND OVER THE COURSE OF TIME THAT SIDE EFFECT WILL SUBSIDE SAYS THAT YOU NEED A HIGHER DOSAGE TO GET A REASONABLE EFFECT.

MOST PEOPLE WITH ADDERALL DO FINE AT TWENTY MILLIGRAMS A DAY IF THEY'RE TAKING IT FOR ATTENTION SPAN AND CONCENTRATION.

BUT TO GET THAT EUPHORIA TO GET THAT ENERGIZED, THAT TO GET THAT EFFECT THAT PEOPLE INADVERTENTLY ARE TRYING TO PURSUE, THEY NEED TO GO HIGHER AND HIGHER.

AND I'VE SEEN SOME PEOPLE GO UP ON ADDERALL UP TO DOSES OF ONE HUNDRED AND TWENTY MILLIGRAMS A DAY BECAUSE THEY'RE ALWAYS CHASING THAT HIGH AND THEY HAVE TO GO HIGHER AND HIGHER.

BUT WHEN YOU GO HIGHER AND HIGHER LIKE THAT YOU OFTEN NEED A MEDICATION LIKE ATIVAN, VALIUM, KLONOPIN, XANAX TO CALM YOURSELF DOWN.

SO IT'S A COMBINATION WE COMMONLY SEE ADDERALL WITH A SO-CALLED BENZODIAZEPINE MEDICATION FOR THE PURPOSE OF CALMING DOWN THE ANXIETY AND NOT A COMBINATION I PREFER TO SEE.

SO I PREFER PEOPLE NOT TAKING A MEDICATION LIKE ADDERALL WITHOUT OR XANAX OR KLONOPIN.

SO I'D RECOMMEND YOU WERE YOUR GRANDSON'S CAREGIVER.

TALK TO THE CLINICIAN WHO'S PRESCRIBING THAT COMBINATION.

THANKS YOUR THANKS FOR YOUR QUESTION.

LET'S GO TO OUR NEXT EMAIL.

LET'S GO TO OUR NEXT E-MAIL.

OUR NEXT E-MAIL IS DEFINITIVE OVER HOW DO YOU KNOW IF SOMEONE IS GOING TO DO BETTER ON CYMBALTA OR WELLBUTRIN?

THEY BOTH SEEM TO HAVE SIMILAR EFFECTS.

CYMBALTA IS A MEDICATION THAT SPECIFICALLY IS INCREASING NOREPINEPHRINE AND OPEN AND NOREPINEPHRINE SEROTONIN WELLBUTRIN INCREASING NOREPINEPHRINE AND DOPAMINE.

THEY WORK ENTIRELY IN DIFFERENT WAYS ALTHOUGH THEY HAVE SIMILAR EFFECTS IN TERMS OF HELPING WITH MOTIVATION GET UP AND GO AND EVEN CONCENTRATION.

SOME PEOPLE DO BETTER ON WHAT SOME PEOPLE DO BETTER ON ANOTHER.

NOW WE THINK WE'RE GETTING A LITTLE BIT BETTER IDEAS BASED ON GENETIC TESTING.

WHO'S GOING TO BE DOING BETTER ON CYMBALTA VERSUS WELLBUTRIN AND VICE VERSA?

THERE'S A PARTICULAR GENE CALLED COMTE KATIKA OR METHYL TRANSFERENCE.

SEE OMT HAS A MET TYPE OF LITTLE ALEO AND IT HAS A VOWEL L'OEIL IN.

THE BOTTOM LINE IS YOUR MOTHER YOUR MOTHER GIVES YOU ONE, YOUR FATHER GIVES YOU ONE AND YOU PUT THE TWO OF THEM TOGETHER.

IF YOU HAVE THE MEMET COMBINATION THOSE PEOPLE TEND TO DO BETTER ON CYMBALTA IT SEEMS IF YOU HAVE A VOWEL PET OR A VELVEL COMBINATION ON THAT PARTICULAR ENZYME YOU TEND TO DO BETTER WITH WELLBUTRIN.

SO WE'RE TRYING TO SORT THOSE OUT FOR A LOT OF PEOPLE BUT IT SEEMS TO HAVE SOME VALIDITY TO IT.

IF YOU HAVE A MEMET GENOTYPE OF CMT WILL OFTEN FIND THAT IF YOU TAKE WELLBUTRIN ABOVE ONE HUNDRED FIFTY MILLIGRAMS A DAY YOU'LL GET IRRITABLE, IMPATIENT, KIND OF ANGRY AND SOMETIMES LISTEN TO A PERSON'S PAST HISTORY OF TREATMENT RESPONSES THAT THEY REPORT TO ME AND I TRY TO GUESS WHAT THEIR GENETICS MIGHT BE AND THEN WE DO GENETIC TESTING AND THEY COME BACK OFTEN IT AFFIRMS THAT YEAH, THAT'S WHY THEY HAD THAT DIFFICULTY WITH IRRITABILITY AND ANGER AND MOODINESS AND SOME KIND OF AGGRESSION WITH WELLBUTRIN.

IT'S INADVERTENTLY THOUGHT THAT THESE PEOPLE WHO HAVE MORE IRRITABILITY ON WELLBUTRIN ACTUALLY HAVE BIPOLAR DISORDER.

BUT I THINK IF YOU LOOK AT THE GENES AND YOU LOOK AT THE GENETIC PROFILE FOR THOSE PEOPLE, THERE IS ACTUALLY A GENETIC REASON FOR THEM HAVING THAT AND THAT'S SOMETHING THAT'S GETTING MORE AND MORE STUDIED OVER THE COURSE OF TIME.

SO THE BOTTOM LINE IS CYMBALTA VERSUS WELLBUTRIN WHICH ONE WOULD WORK BEST FOR YOU?

THAT'S WHERE YOU'D HAVE TO GIVE IT A TRY IF YOU GOT GENETIC TESTING THAT MIGHT GIVE SOME CLUES IN ITSELF BUT A BIG TIP OFF FOR A LOT OF PEOPLE WILL BE HOW IS YOUR FAMILY MEMBERS DONE ON EITHER MEDICATION?

SO IF YOU HAVE A FIRST DEGREE RELATIVE A MOTHER, FATHER, BROTHER, SISTER, SON OR DAUGHTER WHO HAVE BEEN ON WELLBUTRIN OR CYMBALTA AND THEY'VE HAD A GOOD OR BAD EFFECT THAT'S PREDICTIVE THAT YOU'LL HAVE A SIMILAR EFFECT.

SO WE OFTEN TAKE A LOT OF CREDIBILITY INTO ACCOUNT WITH HOW YOUR FAMILY MEMBERS HAVE DONE ON SIMILAR MEDICATIONS FOR SIMILAR PROBLEMS.

CYMBALTA IS A MEDICATION THAT IS BROKEN DOWN BY ONE PARTICULAR PATHWAY AND WELLBUTRIN IS BROKEN ANOTHER PATHWAY, ANOTHER ADVANTAGE OF GENETIC TESTING.

IT'LL SHOW IF YOU'RE A FAST METABOLIZE, A SLOW METABOLIZE OR ON THOSE PARTICULAR PATHWAYS AND THAT CAN GIVE US A CLUE ON WHETHER YOU NEED A HIGH DOSAGE OR LOW DOSAGE.

NOW IN TERMS OF THE MEDICATION SPECIFICALLY CYMBALTA IS A BIT BETTER FOR ANXIETY AND FOR PAIN.

CYMBALTA INCREASES NOREPINEPHRINE AND SEROTONIN.

IF YOU INCREASE BOTH OF THOSE CHEMICALS IN THE BRAIN YOU CAN ACTUALLY PUT THE BRAKES ON THE PAIN COMING THE SPINAL CORD SO YOU'LL HAVE A LITTLE BIT OF A SUPPRESSION OF PAIN COMING UP THE SPINAL CORD THAT WAY WELLBUTRIN DOES NOT HAVE THAT EFFECT.

ON THE OTHER HAND, WELLBUTRIN BY INCREASING DOPAMINE AND NOREPINEPHRINE CAN SPECIFICALLY HELP PEOPLE WITH ADHD.

I SAW A MAN TODAY EARLIER IN MY OFFICE WHO IS ON WELLBUTRIN AT 300 MILLIGRAMS A DAY DOING QUITE NICELY JUST ON WELLBUTRIN FOR THE ADHD.

IT ALSO HELPS WITH DEPRESSION BUT IT CAN BE USED SPECIFICALLY FOR ADHD.

CYMBALTA CAN BE USED FOR ADHD FOR SOME PEOPLE BUT IT'S ONLY GOING TO HELP ABOUT ONE OUT OF FOUR PEOPLE WITH ADHD BECAUSE YOU HAVE TO HAVE THAT CERTAIN GENETIC MAKEUP FOR IT TO BE BENEFICIAL SPECIFICALLY FOR ADHD.

BUT CYMBALTA AND WELLBUTRIN ARE ENTIRELY DIFFERENT MEDICATIONS IN TERMS OF HOW THEY WORK FOR A LOT OF PEOPLE BUT SOME PEOPLE DO GREAT ON ONE.

SOME PEOPLE DO BETTER ON ANOTHER ONE.

THANKS FOR YOUR QUESTION.

LET'S GO TO OUR NEXT E-MAIL QUESTION.

I BELIEVE WE HAVE ANOTHER EMAIL HERE WE DO.

HERE IT IS.

DEAR DR. FOVEA, WHAT ARE SOME LONG TERM EFFECTS OF FEELING?

INTENSE STRESS, INTENSE STRESS WHEN I HEAR ABOUT THAT STRESS IS BASICALLY A CHANGE AND A CHANGE IN OUR ENVIRONMENT IS SOMETHING THAT BY DEFINITION IS GOING TO GIVE YOU STRESS AND STRESS IS GOOD FOR US.

IT KEEPS US SHARP I THINK WOULD BE VERY BORING EVERY DAY IF EVERY SINGLE DAY WAS THE SAME.

BILL MURRAY DID A MOVIE ABOUT THAT LONG TIME AGO CALLED GROUNDHOG DAY WHERE EVERY DAY WAS PREDICTABLY THE SAME AND I DON'T THINK WE'D WANT THAT KIND OF EFFECT HERE IN INDIANA WE DO KIND LIKE THE CHANGE IN THE IN THE WEATHER ON A DAY TO DAY BASIS SO IT GIVES YOU SOME VARIETY AND THE SAME CAN BE HAPPENING IN YOUR LIFE WITH YOUR LIFE YOU SHOULD HAVE CHANGES OCCURRING DAY BY DAY.

NOW THE KEY TO HOW YOU DEAL WITH THOSE CHANGES WILL BE YOUR PAST EXPERIENCES.

HAVE YOU EXPERIENCED CHANGES IN A SIMILAR MANNER IN THE PAST?

SECONDLY, HOW HAVE YOU LEARNED TO ADAPT OR COPE WITH THOSE CHANGES?

AND THIRD, WELL HOW MUCH CHANGE ARE YOU OR ARE YOU EXPERIENCING NOW COMPARED TO IN THE PAST IN SUCH A WAY?

HOW WELL ARE YOU DEALING THOSE CHANGES?

SO A CHANGE THEREBY A STRESS IS NOT ALWAYS ALL BAD.

IT'S IT'S AN OVERWHELMING CHANGE OR AN OVERWHELMING STRESS.

THAT'S WHERE YOU START TO GET STARTS TO GET TO YOU.

YOU'VE GOT THESE LITTLE ADRENAL GLANDS THAT SIT ON TOP OF THE KIDNEYS AND THESE ADRENAL GLANDS WILL PUMP OUT CORTISOL.

CORTISOL IS THE STRESS HORMONE AND CORTISOL CAN INCREASE YOUR LIKELIHOOD FOR DEPOSITING FAT AROUND THEIR BELLY.

CORTISOL CAN GIVE YOU AN HIGHER RISK FOR DIABETES.

CORTISOL CAN MAKE YOU AT HIGH RISK FOR HEART DISEASE.

BUT OVER THE COURSE OF TIME CORTISOL CAN KIND WELL AND IN A WAY DISSOLVE AWAY AND SHRINK THIS AREA OF THE BRAIN CALLED THE HIPPOCAMPUS.

SO WITH CHRONIC LONG TERM UNMITIGATED UNMITIGATED STRESS IT CAN ACTUALLY SHRINK THIS HIPPOCAMPUS IN THE BRAIN AND THAT'S THE PART OF THE BRAIN THAT YOU USE FOR YOUR MEMORY.

SO THAT'S WHY PEOPLE WITH LONG TERM STRESS, LONG TERM UNCONTROLLABLE ADAPTATION, THEIR ENVIRONMENT, THEY CAN HAVE DIFFICULTY WITH HAVING MEMORY PROBLEMS AND THAT CAN CAUSE THEM HEALTH PROBLEMS AS WELL.

SO THAT'S A BIG LONG TERM PROBLEM OF UNCONTROLLED STRESS.

LIKE I SAID, CHANGE IS OK AS LONG AS YOU CAN ADAPT TO IT.

WHAT WE'RE TRYING TO DO IN MY FIELD IN PSYCHIATRY IS TO HELP PEOPLE ADAPT TO THEIR CURRENT STRESS BASED ON THEIR PAST COPING STRATEGIES AND THEIR PAST EXPERIENCES WITH DEALING WITH THAT STRESS.

THERE IS A GENETIC COMPONENT FOR PEOPLE AND HOW WELL THEY CAN DEAL WITH CERTAIN STRESSES.

THERE'S A PARTICULAR GENETIC CODE CALLED SLAC 64 WHICH IS THE SEROTONIN TRANSPORTER GENOTYPE AND IF YOU HAVE A TOO SHORT A LEAL'S ON THAT AND SS VERSUS TOO LONG A LEAL'S AND L.L TOO SHORT OF LEAL'S IN THE PRESENCE OF CHILDHOOD STRESSES AND CHILDHOOD ABUSE, THAT COMBINATION PUTS YOU AT HIGHER LIKELIHOOD FOR SUCCUMBING TO STRESS AT A LATER TIME.

SO THERE IS A GENETIC VULNERABILITY TO HAVING DIFFICULTY WITH STRESS LONG TERM.

THANKS FOR YOUR QUESTION.

LET'S GO TO OUR NEXT CALLER.

HELLO SHIRLEY.

WELCOME TO MATTERS OF MIND.

HI.

HI SHIRLEY.

HI.

AND I WENT TO THE DOCTOR A WHILE AGO AND THEY SAID I HAD A MASK ON MY HEAD AND SO I I GOT TO CHECK IN.

WHEN YOU SEEN IT TODAY IT WAS LIKE FIVE OR SIX WEEKS ABOUT A WEEK AGO I HAD TO WAIT A WEEK NOW HE SAID IT'S FINE AND I JUST HAD TO HAVE BIOSURGERY SURGERY ALL CONNECTED TO YOUR HEAD AND ON THE BACK OF MY HAND I HAVE A LUMP.

HE SAID IT WAS GOOD.

IT WAS NOTHING BUT I I WAS KIND OF WORRIED ABOUT THAT A LITTLE BIT BUT HE SAID I JUST HAD TO HAVE SURGERY.

IT WAS REALLY MAJOR GOOD.

I'M GLAD YOU'RE HAVING SINUS SURGERY SURELY BECAUSE I CAN PROBABLY HELP YOU IN VARIOUS WAYS IF YOU HAVE SINUS PROBLEMS AND YOU'RE HAVING DIFFICULTY WITH AIRFLOW THAT CAN PUT YOU AT HIGHER RISK FOR HEADACHE, SLEEP APNEA A LOT OF DIFFERENT COMPLICATIONS.

SO IT'S GOOD YOU'RE GETTING SINUS SURGERY AND THAT WAS IDENTIFIED A LUMP ON THE HEAD IF YOU CAN FEEL IT.

IT'S PROBABLY NOT COMING FROM THE BRAIN THAT WOULD BE VERY UNUSUAL FOR THE BRAIN TO BE BULGING OUT THROUGH THE SKULL.

THE SKULL IS ROCK HARD AND YOU'D HAVE TO LITERALLY HAVE A HOLE IN THE SKULL FOR THE BRAIN TO BE POPPING OUT.

SO IF YOU FEEL A LUMP ON YOUR HEAD CHANCES ARE IT DOESN'T HAVE ANYTHING TO DO THE BRAIN NOW GOING BACK TO THE SINUSES.

YEAH, YOU CAN HAVE SINUS SITUS IN SINUSITIS FOR SOME PEOPLE CAN GIVE THEM DIFFICULTY WITH AN INFECTION OF THE BRAIN TO SO AGAIN THAT'S ALL THE MORE REASON TO HAVE THE SINUS SURGERY SO YOU WOULDN'T HAVE RECURRENT SINUS INFECTIONS.

SINUS INFECTIONS WILL GIVE YOU AN INFLAMMATORY STATE IN AN INFLAMMATORY STATE OF ANY KIND SURELY CAN MAKE YOU MORE PRONE TO HAVING DEPRESSION, IRRITABILITY, ANXIETY WITH AN INFLAMMATORY STATE YOU CAN HAVE INCREASED INFLAMMATORY PROTEINS SUCH AS INTERLEUKIN SIX WHICH IS A COMMONLY DISCUSSED INFLAMMATORY PROTEIN WITH HIGHER LEVELS OF INTERLEUKIN SIX FROM ANY INFLAMMATION THAT'LL GIVE YOU DIFFICULTY WITH FEELING ACHY ALL OVER FATIGUED.

YOU HAVE DIFFICULTY WITH SLEEP FOR SOME PEOPLE YOU CAN HAVE TROUBLE WITH DEPRESSION.

SO IT'S GOOD THAT YOU'RE GETTING A SINUS SURGERY.

SURELY THE LUMP ON THE HEAD THOUGH.

YEAH, IF IT'S NOT THOUGHT TO BE ANYTHING THAT IS THOUGHT TO BE PROBLEMATIC FROM ANY BONE CANCER OR ANYTHING LIKE THAT THAT'S A GOOD THING SURELY.

THANKS FOR YOUR CALL.

LET'S GO TO OUR NEXT CALLER.

HELLO.

WELCOME TO MATTERS OF MIND.

YES DOCTOR.

THANK YOU FOR YOUR PROGRAM THIS EVENING I SAW THE NEWS WHERE THERE'S A GROUP OF SCIENTISTS IN INDIANAPOLIS STEWART DUMPING A BLOOD TEST FOR PREDICT BIPOLAR AND DEPRESSIVE SYMPTOMS BY USING BIOMARKERS IN THE BLOOD.

I WONDER IF YOU MIGHT COMMENT ON THAT FOR A MINUTE AND AND INTERESTING THERE ARE A LOT OF BIOMARKERS.

ONE OF THEM I JUST MENTIONED INTERLEUKIN SIX.

THESE ARE INFLAMMATORY PROTEINS THAT CAN POTENTIALLY YEAH.

PREDICT THE LIKELIHOOD OF YOU'RE HAVING DEPRESSION OR HAVING A WORSENING OF DEPRESSION.

WE WOULD LOVE TO HAVE MORE BIOMARKER GRUSKIN TO BE ABLE TO DO A BLOOD TEST AND DETERMINE FROM THAT BLOOD TEST ARE YOU CURRENTLY SIGNIFICANTLY SUFFERING DEPRESSION VERSUS BIPOLAR DEPRESSION?

NOW THERE'S A BIG DIFFERENCE THERE AND HOW WE'RE GOING TO TREAT THAT KID WITH BIPOLAR DEPRESSION.

YOU CAN COME IN WITH THE EXACT SAME SYMPTOMS OF DEPRESSION BUT WE PUT YOU ON AN ANTIDEPRESSANT WITH BIPOLAR DEPRESSION.

ALL OF A SUDDEN YOU GET WORSE, YOU GET MORE ANGRY, MORE IRRITABLE, MORE MOODY.

SO IF YOU HAVE BIPOLAR DISORDER ,WE HAVE TO CAREFULLY LOOK IN YOUR PAST HISTORY AND ALSO IN YOUR FAMILY MEMBER IS PAST HISTORY FOR ANY MOOD SWINGS.

IF SOMEBODY HAS BIPOLAR DEPRESSION THEY'LL HAVE MAYBE TWO, THREE, SIX, SEVEN DAYS OF FEELING KIND OF HYPED UP AND WHEN THEY FEEL HYPED UP THEY DON'T NEED TO SLEEP.

THEY'RE MORE IMPULSIVE.

THEIR THOUGHTS ARE RACING AND THEY'RE TALKING REALLY FAST AND THEN THEY'LL HAVE THESE FEW DAYS OF HIGHS LIKE THIS CAN THEN THEY CRASH WELL WHEN THEY CRASH IF YOU GO IN AND SEE THE CLINICIAN WHEN YOU'RE CRASHING AND YOU SAY I HAVE ALL THESE SYMPTOMS OF DEPRESSION, YOUR CLINICIAN MIGHT INADVERTENTLY SIMPLY YOU FOR DEPRESSION WITHOUT TAKING INTO CONSIDERATION THE BIPOLAR TENDENCIES YOU'RE EXPERIENCING THE ADVANTAGE OF BIOMARKERS IT CAN GIVE A HIGHER LIKELIHOOD OF PREDICTION IF YOU HAVE BIPOLAR DISORDER VERSUS DEPRESSIVE TENDENCIES, IT'S A FINE LINE THERE BUT MAINLY THEY'RE LOOKING AT INFLAMMATORY PROTEINS FIRST AND FOREMOST IN THE BRAIN THERE IS A PROTEIN CALLED ESSL THAT'S A I THINK IT'S SLC ONE HUNDRED BUT THERE'S THIS INFLAMMATORY PROTEIN IN THE BRAIN THAT INCREASES WHEN SOMEBODY IS MANIC.

SO WHEN YOU'RE MANIC YOU WILL TEND TO HAVE THIS INCREASED INFLAMMATORY PROTEIN IN THE BRAIN AND MEDICATIONS LIKE LITHIUM, DEPAKOTE AND VARIOUS ANTI PSYCHOTIC MEDICATIONS CAN DECREASE THAT PARTICULAR INFLAMMATORY PROTEIN.

SO THOSE ARE THE KIND OF BIOMARKERS BEING EXAMINED BUT BASICALLY A BIOMARKER IS A CHEMICAL SIGNAL IN THE BLOOD.

TYPICALLY THAT'S TELLING OR GIVING US SUGGESTIONS THAT PEOPLE MIGHT HAVE SOME DIFFICULTY WITH DEPRESSION VERSUS BIPOLAR DEPRESSION AND WE'RE ALSO USING THEM FOR SOME PEOPLE VERY MUCH IN THE EARLY STAGES RIGHT NOW FOR ALZHEIMER'S DEMENTIA AND THAT'S WHERE IT GETS REALLY EXCITING CAN BECAUSE A LOT OF OLDER ADULTS WILL START HAVING MEMORY PROBLEMS AND THE QUESTION WILL ALWAYS BE ARE THOSE MEMORY PROBLEMS NORMAL OR ARE THEY ASSOCIATED WITH NORMAL AGING OR ARE THEY RELATED TO DEPRESSION BECAUSE A LOT OF PEOPLE WHEN THEY GET TO BE 70 YEARS OLD, 80 YEARS OLD, THEY'LL START TO HAVE MEMORY PROBLEMS AND DIFFICULTY REMEMBERING THINGS.

BUT THEY'RE ACTUALLY EXPERIENCING DEPRESSION AS A PULSE AS OPPOSED TO ALZHEIMER'S DEMENTIA.

SO WHEN YOU EXPERIENCE DEPRESSION, WELL THAT'S GOING TO GET BETTER A FEW YOUR MEMORY IS GOING TO GET BETTER IF YOU ARE ABLE TO TREAT THE DEPRESSION ITSELF WITH ALZHEIMER'S DEMENTIA, IT'S TYPICALLY MORE OF A PROGRESSIVE PHENOMENON WHERE WE NEED TO USE CERTAIN MEDICATIONS TO SLOW DOWN THE PROGRESSION OF THAT.

SO WITH BIOMARKERS FOR DEPRESSION, BIPOLAR DEPRESSION OR ALZHEIMER'S DEMENTIA, IT WILL HELP US KIND OF DIFFERENTIATE THOSE KIND OF CONDITIONS AND A WHOLE IDEA WITH BIOMARKERS CAN IS TO GIVE PEOPLE MORE OF A SENSE OF PRECISION TREATMENT WITH PRECISION MEDICINE.

WHAT WE'RE TRYING TO DO IS NOT ONLY LOOK AT THE SYMPTOMS THAT SOMEBODY IS EXHIBITING THAT'S CALLED PHENOTYPE BUT WE'RE ALSO LOOKING AT THE FAMILY MEMBERS PAST TREATMENT RESPONSES TO MEDICATIONS.

THIRD, WE'RE TAKING A LOOK AT SOMEBODY'S GENETIC TESTING A LOT OF CASES AGAIN THAT'S PRECISION MEDICINE WHERE WE'RE TRYING TO BE MORE PRECISE AND PERSONALLY FOR THAT PARTICULAR INDIVIDUAL AND IF WE CAN ADD BIOMARKERS TO THAT, THAT'S FANTASY BECAUSE BIOMARKERS WILL GIVE US THAT EXTRA LEVEL OF PRECISION NOW WITH CAN WITH ANY OF THESE DIFFERENT DIMENSIONS OF PRECISION MEDICINE, NONE OF THEM WILL BE DEFINITIVE.

SO EVEN THOUGH THOSE BIOMARKERS CAN BE OBTAINED, I BET YOU OVER THE COURSE OF TIME THEY'RE NOT GOING TO BE DEFINITIVE.

THEY'RE WHAT THEY'RE DOING IS INCREASING THE PROBABILITY THAT A CERTAIN TREATMENT APPROACH MIGHT WORK BETTER.

SO THE SAME WITH GENETIC TESTING.

GENETIC TESTING IS NOT DEFINITIVE CONCERNING WHAT TREATMENT APPROACH WE'RE GOING TO USE.

WE HAVE TO LOOK AT ALL THESE OTHER DIMENSIONS, SUCH AS YOUR PAST TREATMENT RESPONSES TO MEDICATION, YOUR CURRENT SYMPTOMS, YOUR FAMILY MEMBERS RESPONSES.

WE PUT ALL THOSE TOGETHER.

GENETIC TESTING IS JUST ANOTHER DIMENSION OF GIVING US SOME PROBABILISTIC OPTIONS AND THE SAME IS TRUE WITH BIOMARKERS IT'LL GIVE US MORE CLUES CONCERNING WHAT DIFFERENT TYPE OF TREATMENT APPROACHES MIGHT BE BEST FOR THAT PARTICULAR PERSON.

AND THAT'S WHAT'S EXCITING ABOUT PSYCHIATRY FOR ME NOW.

I MEAN I GUESS I'VE BEEN A PSYCHIATRIST FOR OVER THIRTY YEARS AND IT USED TO BE THAT IT WAS KIND OF A SHOT IN THE DARK.

I MEAN YOU LOOKED AT SOMEBODY'S SYMPTOMS AND IF THEY WERE AGITATED OR ANXIOUS OR THEY COULDN'T SLEEP, YOU GIVE THEM A SEDATING MEDICATION IF THEY'RE TIRED ALL THE TIME, YOU GAVE THEM MORE ACTIVATING OR IN ALERTING MEDICATION.

WELL, FORTUNATELY WE'VE GOTTEN A LOT MORE SOPHISTICATED NOW BUT SIMPLE TYPE OF STRATEGIES SUCH AS LOOKING AT SOMEBODY PAST TREATMENT RESPONSE AND CATEGORIZING THEIR PAST TRAUMA RESPONSES BASED ON THE KIND OF MEDICATIONS THEY'VE TAKEN, HOW THEY'VE DONE ON THOSE MEDICATIONS IN TERMS HOW THE MEDICATIONS WORK, WHAT SIDE EFFECTS THEY HAD, HOW LONG THEY TOOK THE MEDICATION, WHAT DOSE THEY TOOK OF THE MEDICATION.

THESE ARE VERY, VERY IMPORTANT DIMENSIONS TO DETERMINING TREATMENT APPROACHES.

SO YOU USE THOSE KIND OF IDEAS IN ADDITION TO SOMETHING LIKE BIOMARKERS THAT CAN BE REALLY HELPFUL, A VERY PRIMITIVE AND INEXPENSIVE BIOMARKER THAT SOMETIMES GETS USED.

IT'S CALLED A C REACTIVE PROTEIN CAN SEE RAKTI PROTEIN IS AN INFLAMMATORY PROTEIN BASICALLY IT CAN PREDICT THE LIKELIHOOD OF YOUR HAVING VASCULAR OR BLOOD VESSEL DAMAGE RELATED TO INFLAMMATION AND IT'S VERY INEXPENSIVE AS C RAKTI PROTEIN CAN BE USED.

WE USED TO BE THINKING THE C REACTIVE PROTEIN CAN PREDICT WHICH TYPE OF ANTIDEPRESSANT TO USE FOR INSTANCE OF A C REACTIVE PROTEIN WAS HIGHER.

YOU MIGHT DO BETTER ON A MEDICATION THAT INCREASES JUST NOT SEROTONIN ALSO NOREPINEPHRINE AND THE LOWER C REACTIVE PROTEIN LEVEL WOULD BE MORE PREDICTIVE AS SOMEBODY IS GOING TO DO BETTER ON SEROTONIN ALONE.

QUITE FRANKLY THAT HASN'T BEEN A REALLY GOOD PREDICTOR OVER THE COURSE OF TIME FOR FOR A LOT OF PEOPLE.

BUT AGAIN THAT'S A BIOMARKER.

I THINK WHAT WE REALLY NEED CAN ARE SEVERAL BIOMARKERS PUT THEM ALL TOGETHER AND IT'S LIKE GENETIC TESTING WITH GENETIC TESTING YOU CAN GET A COUPLE OF DOZEN DIFFERENT GENETICS TOGETHER AND YOU LOOK AT THE WHOLE PICTURE, YOU DON'T LOOK AT ONE GENE.

YOU LOOK AT ALL THE GENES PUT TOGETHER AND TRY TO FIGURE OUT WHAT MIGHT BE THE BEST TREATMENT FOR SOMEBODY AND ASSOCIATED AN ASSOCIATION WITH THEIR PAST TREATMENT RESPONSES AND WITH THEIR FAMILY MEMBERS RESPONSES AND THEIR THEIR ACTUAL SYMPTOMS THEMSELVES.

KEN, THANKS FOR YOUR CALL.

LET'S GO OUR NEXT CALLER.

HELLO JEFFREY.

WELCOME TO MATTERS OF MIND.

I GUESS I HAD A QUESTIONS ABOUT HYDRAZINE AND KLONOPIN.

YEAH.

AND SINCE THEN ON BOTH OF THEM I HAVE LIKE MY HEART RACES I LOOK AT ITZ MAKES ME NAUSEATED AND IN THE PAST I'VE BEEN DOING ROUTINE WORK AND I DIDN'T BOTHER ME AT ALL.

I ALSO HAVE THIS ITCHIN THAT IS ME AND MY TEETH FEEL WEIRD.

IT'S NOT A DENTAL ISSUE.

I DON'T BELIEVE THAT NOW IF YOU HAD ANY IDEAS ON THAT MY CURRENT DOCTOR SEEMS TO THINK I'M DOING FINE ON IT AND I I'M NOT I DON'T KNOW I DIDN'T KNOW IF YOU HAVE ANY IDEAS ON WHAT WOULD CAUSE THAT.

WELL, JEFFREY, JUST IN MY BRIEF INTERACTION WITH YOU, YOU'RE NOT DOING FINE ON HIM.

SO LET'S START FROM THERE.

ONE OF THE DIFFICULTY WITH THE TEETH FEELING FUNNY AND WITH THE LIGHTHEADEDNESS WHEN DID THAT START THAT PRECEDE THE USE OF THE HYDROXYL AND THE KLONOPIN OR TO THAT HAPPEN AFTER YOU STARTED THEM?

I WAS ON KLONOPIN.

THEY TOOK ME OFF OF IT AND THEY DIFFERENT MOKHTARI STARTED ME ON IT AND IN THE MEANTIME THEY USED HYDROXYL AS A I CALLED IT LIKE A FILLER DRUG BECAUSE I WAS ON XANAX AT THE SAME TIME AS I WAS ON THE KLONOPIN THE FIRST TIME.

SO IT'S KIND OF AN IS KIND OF A MESS I GUESS.

WELL QUITE FRANKLY WHEN DID YOU START FEELING WEIRD?

I CAN'T REALLY PINPOINT AND I HAVEN'T FELT REAL GOOD SINCE I'VE BEEN TAKING THE HYDROXYL I'VE TRIED OTHER MEDICATIONS BETWEEN FULL OF PROZAC, SOME OF THOSE MEDICATIONS AND NAUSEATED JUST CAN'T SEEM TO GET RID OF THE SIDE EFFECTS FROM YEAH.

THE ZOLOFT, PROZAC THOSE ARE MEDICATIONS THAT INCREASE SEROTONIN AND FOR SOME PEOPLE INCREASING SEROTONIN CAN GIVE YOU A BIT OF A CALMING EFFECT.

HOW WORKS REALLY WELL IN ABOUT ONE OUT OF THREE PEOPLE BUT TWO OUT OF THREE PEOPLE ON PROZAC AND ZOLOFT MIGHT NOT DO AS WELL AS YOU MIGHT EXPECT.

THERE'S A LOT OF DIFFERENT OPTIONS OUT THERE, JEFFREY, FOR ANXIETY.

LOOKING BACK, HOW LONG WOULD YOU GUESS YOU'VE BEEN ON XANAX OR KLONOPIN?

HOW MANY YEARS WOULD YOU SAY KLONOPIN?

I WAS PROBABLY FIFTEEN YEARS SOMETHING LIKE THAT AT A LOWER DOSE.

NOW I'M AT A HALF MILLIGRAM THREE TIMES A DAY AND THEN THEY ADDED THE HYDROXYUREA AND THEN LEFT AND HOW ABOUT THE XANAX?

HOW LONG WERE YOU ON THAT AND THE IDEA OF I WAS ON THAT PROBABLY TEN, FIFTEEN YEARS BUT I'VE BEEN OFF OF THAT FOR OVER A YEAR AND A HALF NOW.

SO AT ONE POINT YOU WERE ON THE XANAX AND KLONOPIN IN COMBINATION, CORRECT?

YEAH, THOSE ARE BENZODIAZEPINE AND YOU'D MENTIONED AT LEAST 15 YEARS YOU BEEN ON THAT CLASS OF MEDICATION IF YOU WERE TO TAPER DOWN ON THAT MEDICATION, JEFFREY, I'D RECOMMEND AT LEAST A 15 WEEK TAPER QUITE FRANKLY, IF YOU'VE BEEN ON MEDICATIONS LIKE KLONOPIN FOR 15 YEARS, YOU PROBABLY NEED A FIFTEEN WEEK TAPER.

SO WE'RE LOOKING AT ABOUT A FOUR MONTH TAPER AND SLOWLY COMING DOWN AND WHEN THEY TALK ABOUT HYDROXY AND BEING A FILLER MEDICATION, THEY'RE TALKING ABOUT USING IT AS A BRIDGE TO HELP YOU COME DOWN ON THE KLONOPIN.

THE GOOD THING FOR YOU, JEFFERYS, YOU'RE NOT TAKING OUT MUCH KLONOPIN A HALF MILLIGRAM THREE TIMES A DAY IS NOT A HUGE AMOUNT.

I'VE SEEN PEOPLE ON SIX AND SEVEN MILLIGRAMS A DAY SO YOU'RE TAKING ONE POINT FIVE MILLIGRAMS A DAY.

SO WOULDN'T BE REALLY HARD FOR YOU TO COME DOWN ON THE LONGER YOU TAKE KLONOPIN OR XANAX OR VALIUM OR OUT OF AND THE MORE LIKELY YOU'RE GOING TO NEED IT BECAUSE IT KIND OF RESETS THE ANXIETY.

I'M CONTROLLING THE ON THE BRAIN AND THAT'S BEEN THE COMPLICATION WITH THAT.

JEFFREY, TO YOUR AWARENESS, HAVE YOU EVER TAKEN THE SO-CALLED ANTIEPILEPTIC MEDICATIONS SUCH AS NEURONTIN GABAPENTIN?

ANOTHER ONE IS LYRICA OR PREGABALIN.

IF YOU TAKE THOSE TAKING THOSE TO HELP YOU COME OFF OF THE XANAX OR KLONOPIN BEEN ON THE RUN IN THE PAST, DIDN'T HAVE REAL GOOD EFFECTS WITH WHAT YOU HAVE WITH NEURONTIN.

DO YOU RECALL THEY HAD ME TAKING A NIGHT I BELIEVE AND I WOKE UP NO NAUSEATED AFTER I TOOK IT I GUESS WHERE ARE YOU TAKING IT BY CHANCE WITH ANYTHING ELSE?

PROBABLY WITH THE KLONOPIN AT THE TIME.

A COUPLE OF THINGS COULD HAPPEN OR JEFFREY, IF YOU TAKE NEURONTIN WITH A MEDICATION LIKE KLONOPIN, YOU'RE COMING DOWN THE KLONOPIN TOO FAST.

IF THEY WERE TRYING TO DO THAT, THAT'LL GIVE YOU SOME NAUSEA.

ALSO IF YOU'RE TAKING NEURONTIN WITH A SEROTONIN MEDICATION LIKE ZOLOFT OR PROZAC THAT WILL MAKE YOU NAUSEATED TO SO YEAH, THERE'S DIFFERENT FACTORS OUT THERE YOU COULD ALWAYS CONSIDER.

BUT THE BOTTOM LINE IS, JEFFREY, TALK TO YOUR CLINICIAN ABOUT DOING SOMETHING ABOUT THE HYDROXY AND KLONOPIN COMBINATION.

IT'S NOT WORKING FOR YOU SO WELL HYDROXYL ZEINE IT'S ALSO KNOWN AS ADDERALL AND IT'S AN ANTIHISTAMINE AND FOR SOME PEOPLE CAN MAKE THEM REALLY LIGHTHEADED.

IT SOUNDS LIKE WITH A HYDROXY YOU'VE YOUR TEETH HAVE FELT UNUSUAL AND NOT EVERYBODY DOES REALLY WELL THYROXINE.

JEFFREY, 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 VIA THE INTERNET AT MATTERS OF THE MIND ALL ONE WORD AT A DOG I'M A PSYCHIATRIST JEFF OFFER AND YOU'VE BEEN WATCHING MATTERS OF MIND ON PBS'S FORT WAYNE GOD WILLING AND PB'S WILLING.

I'LL BE BACK AGAIN NEXT WEEK.

THANKS FOR WATCHING TONIGHT