.

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 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 AT FORT WAYNE BY DIALING IN THE LOCAL AREA NINE SIX NINE TWO SEVEN TO ZERO OR IF YOU'RE CALLING LONG DISTANCE YOU MAY DIAL COAST TO COAST AT EIGHT SIX SIX NINE SIX NINE TO SEVEN TO ZERO.

NOW ON A FAIRLY REGULAR BASIS WHERE OUR 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 THAT I CAN ANSWER ON THE AIR, YOU MAY WRITE ME A VIA THE INTERNET AT MATTERS OF THE MIND ALL ONE WORD AT A DRUG THAT'S MATTERS OF THE MIND AT FEBRUARY DOG AND I'LL START TONIGHT'S PROGRAM WITH ONE OF A FEW E-MAILS THAT WE RECEIVED OVER THIS PAST WEEK.

THE FIRST VERSION FIRST ONE READS DIRECTOR FAUVER I HAVE STRUGGLED WITH FIBROMYALGIA FOR 20 YEARS WITH LITTLE TO NO LUCK WITH FINDING HELP FROM A MEDICAL DOCTOR OR CHIROPRACTIC TREATMENTS IF FIBROMYALGIA PAIN IS CAUSED BY THE BRAIN RECEIVING EXAGGERATED SIGNALS SHOULD THIS BE TREATED BY A MENTAL HEALTH DOCTOR?

WELL, THAT'S A VERY GOOD QUESTION FROM MY PERSPECTIVE I THINK FIBROMYALGIA IS MORE OF A NEUROLOGICAL CONDITION BUT IT'S INDEED TYPICALLY TREATED BY PRIMARY CARE CLINICIANS AND PSYCHIATRISTS TO SOME DEGREE MANY PSYCHIATRISTS WON'T STEP OVER THAT BOUNDARY OF MENTAL HEALTH CONDITIONS TO WHAT THEY WOULD CONSIDER A MEDICAL CONDITION LIKE FIBROMYALGIA.

BUT BASICALLY WHEN YOU THINK ABOUT FIBROMYALGIA YOU HAVE A COUPLE OF FACTORS GOING ON THERE.

NUMBER ONE, YOU'VE GOT AN ITCHY TRIGGER FINGER AT THE NERVES.

LITTLE CALCIUM CHANNELS IN THE NERVES ARE PRESUMABLY FIRING TOO MUCH SO THE NERVES HAVE AN ITCHY TRIGGER FINGER AND THEN YOU HAVE THIS EXCESSIVE AMOUNT OF SOMETHING CALLED SUBSTANCE P P IS IN P SUBSTANCE P IN THE BRAIN AND IN THE SPINAL CORD FLUID AND THAT MAKES YOU MORE SENSITIVE TO SENSATION OF PAIN, PRESSURE, TOUCH AND AND MANY TIMES PEOPLE WILL EVEN SAY THEY CAN HAVE INCREASED ODOR SENSITIVITY WHEN THEY HAVE FIBROMYALGIA.

SO THERE'S TWO MEDICAL TREATMENTS FOR FIBROMYALGIA.

NO ONE WILL USE ANTIDEPRESSANT MEDICATIONS THAT SPECIFICALLY INCREASE BOTH SEROTONIN AND NOREPINEPHRINE AND THAT'S PROBABLY HOW PSYCHIATRISTS KIND OF START TREATING FIBROMYALGIA AND A LOT OF CASES BECAUSE THE TREATMENT FOR FIBROMYALGIA INCLUDES MEDICATIONS THAT WE TYPICALLY USE FOR DEPRESSION.

BACK IN THE OLD DAYS AMITRIPTYLINE WAS NOT UNCOMMON.

COMMONLY IT INCREASES NOREPINEPHRINE AND SEROTONIN.

BUT MORE RECENTLY WE'VE BEEN USING CYMBALTA ALSO KNOWN AS DELUX TEEN AND A MEDICATION THAT ALSO CAN BE USED FOR FIBROMYALGIA IS SAVOLA SEVELE IS A MEDICATION INCREASES NOREPINEPHRINE PROMINENTLY MORE SO THAN SEROTONIN AND THESE ARE MEDICATIONS THAT BASICALLY ARE PUTTING THE BRAKES ON THE PAIN IMPULSES COMING UP THE SPINAL CORD SO YOU DON'T HAVE AS MUCH PAIN COMING UP THE SPINAL CORD.

SECONDLY, THE TREATMENT FOR FIBROMYALGIA FROM A MEDICAL STANDPOINT WILL BE THE USE OF CERTAIN ANTI SEIZURE MEDICATIONS THAT SLOW DOWN THE FIRING OF THAT LITTLE CALCIUM CHANNEL IN THAT OPENING OF THE CALCIUM CHANNEL SO THEY DECREASE THE ITCHY TRIGGER FINGERS AND THOSE MEDICATION WILL BE LYRICA, ALSO KNOWN AS PREGABALIN AND ONE CALLED NEURONTIN, ALSO KNOWN AS GABAPENTIN.

THESE MEDICATIONS AFFECT THE CALCIUM CHANNEL VERY SPECIFICALLY AND DECREASE THE EXCESSIVE FIRING AT THE NERVE CELL ITSELF.

SO THOSE ARE THE MAIN MEDICINAL TREATMENTS FOR FIBROMYALGIA.

MANY OTHER TREATMENTS FOR FIBROMYALGIA CAN BE HELPFUL.

FOR INSTANCE, SWIMMING IS MARVELOUS DOING SOME DEGREE OF EXERCISE BUT NOT OVERDOING IT IS GREAT.

THE KEY WITH FIBROMYALGIA IS TO TRY TO KEEP MOVING OTHERWISE YOU'LL BE LIKE THE TIN MAN AND WIZARD OF OZ WHERE YOU TO STIFFEN UP THE MORE INACTIVE YOU BECOME.

BUT IT'S A FINE LINE BECAUSE YOU DON'T WANT TO OVERDO IT.

SOME PEOPLE WILL HAVE THE SENSATION OF FEELING REALLY GREAT SOME DAYS AND THEY GO OUT AND THEY DO A WHOLE BUNCH OF YARD WORK BECAUSE THEY FEEL WONDERFUL AND IT'S SO NICE TO BE FREE OF THAT ACHING ILLNESS SENSE OF STIFFNESS AND TIREDNESS AND THEY JUST PAY FOR IT THE NEXT DAY.

FIBROMYALGIA DOES AFFECT WOMEN EIGHT TIMES MORE THAN MEN.

WE DON'T KNOW WHY BUT IT'S BEEN STUDIED MORE EXTENSIVELY OVER THE PAST TWENTY YEARS AND NOW WE KNOW THERE'S THAT NEUROBIOLOGICAL BASIS BEHIND IT WITH THAT EXCESSIVE AMOUNT OF SUBSTANCE.

IT'S NOT PRACTICAL TO DO A SPINAL TAP OR A LUMBAR PUNCTURE FOR SOMEBODY WHO HAS WHO HAS FIBROMYALGIA SYMPTOMS TO SEE IF THEY DO HAVE THESE EXCESSIVE AMOUNTS OF SUBSTANCE.

BUT WHAT WE WILL OFTEN DO IS SIMPLY ASK HISTORICALLY ABOUT THEIR SYMPTOMS OF FATIGUE, ACHINESS, DIFFICULTY WITH SENSITIVITY TO TOUCH.

THERE ARE PRESSURE POINTS OR TENDER POINTS THAT YOU CAN TOUCH AND PEOPLE WILL JUMP WHEN YOU TOUCH ON THOSE PARTICULAR POINTS AND THAT CAN BE SOMEWHAT HELPFUL FOR DETERMINING WHO HAS FIBROMYALGIA.

BUT BASICALLY IT IS A DIAGNOSIS IS MADE BASED UPON HISTORY.

THAT'S HOW WE PSYCHIATRISTS WILL DIAGNOSE MANY DIFFERENT CONDITIONS BASED ON HISTORY AS OPPOSED TO A BLOOD TEST.

NOW THERE'S ANOTHER PHENOMENON THAT'S KIND OF LIKE FIBROMYALGIA AND THAT'S WHERE PEOPLE HAVE MIGRAINE HEADACHES ALSO AFFECTING WOMEN MORE THAN MEN.

MIGRAINE HEADACHES ARE WHERE YOUR BRAIN GETS THIS HYPERSENSITIVITY TO PAIN, LIGHT, SOUND, TOUCH AND IT'S A SIMILAR PHENOMENON TO COULD BE TREATED WITH ANTIEPILEPTIC MEDICATIONS AND SOMETIMES THE SEROTONIN NOREPINEPHRINE ANTIDEPRESSANT MEDICATIONS LIKE WE USE IN FIBROMYALGIA.

THANK YOU FOR YOUR QUESTION.

LET'S GO TO OUR NEXT QUESTION.

OUR NEXT QUESTION READS DEAR DR. FAUVER, I HAVE MOOD SWINGS AND I'VE HEARD YOU TALK ABOUT WELLBUTRIN.

I'M TAKING LAMICTAL.

IS THAT THE BEST MEDICATION FOR MOOD SWINGS?

LAMICTAL IS A MEDICATION.

ITS GENERIC NAME IS CALLED LAMOTTE'S RAJIN LAMOTRIGINE AND BASICALLY STABILIZES THIS CHEMICAL IN THE BRAIN CALLED GLUTAMATE.

AND IF YOU HAVE EXCESSIVE AMOUNTS OF GLUTAMATE, THEORETICALLY YOU'LL HAVE DIFFICULTY PUTTING UP WITH STUFF.

YOU'LL HAVE MORE IRRITABILITY, MORE MOODINESS AND LAMOTRIGINE SOMETHING THAT WE OFTEN LIKE AS A MOOD STABILIZER BECAUSE IT DOESN'T MAKE YOU SLEEPY DOESN'T GIVE YOU WEIGHT GAIN AND DOESN'T MAKE YOU FEEL DULL EMOTIONALLY OR MENTALLY.

SO LAMOTRIGINE CAN BE USED FOR MOOD SWINGS.

THERE ARE DIFFERENT TYPES OF MOOD SWINGS THOUGH THERE'S BIPOLAR DISORDER TYPE ONE WHERE PEOPLE HAVE ONE WEEK OF DISTINCTIVELY ELEVATED MOOD.

THEY DON'T NEED TO SLEEP.

THEY DO THINGS IMPULSIVELY.

THEY GET THEMSELVES IN ALL SORTS OF TROUBLE AND THERE'S BIPOLAR TWO DISORDER WHERE PEOPLE WILL HAVE FOUR TO SIX DAYS OF LITTLE HIGHS AND IT'S NOTICEABLE BY OTHER PEOPLE BUT THEN THEY CRASH INTO THESE TERRIBLE TWO WEEK DEPRESSIONS AND THAT'S CALLED BIPOLAR DISORDER TYPE TWO PSYCHOTHERAPY IS WHERE YOU HAVE LITTLE HIGHS UP AND DOWN AND LOWS WHICH GO DOWN.

SO YOU HAVE THESE LITTLE UPS AND DOWNS THE MOOD THERE'S A CONDITION CALLED MAJOR DEPRESSION WITH MIXED FEATURES WHERE YOU'LL HAVE TWO WEEKS OF DEPRESSION BUT YOU'LL HAVE TWO OR THREE DAYS OF FEELING KIND OF HYPED UP AND IRRITABLE SO IT'S DEPENDS ON WHAT KIND OF MOODINESS THAT YOU'RE EXHIBITING.

WELLBUTRIN IS AN ANTIDEPRESSANT MEDICATION AND WE TYPICALLY WOULD NOT GIVE SOMEBODY IF THEY HAVE BIPOLAR DISORDER TYPE ONE WHERE YOU HAVE THAT ONE WEEK OF MANIA.

SO WE TRY TO STAY AWAY FROM ANTIDEPRESSANT MEDICATIONS FOR PEOPLE WITH BIPOLAR DISORDER TYPE ONE IF YOU HAVE THE DIFFERENT OTHER TYPES OF BIPOLAR CONDITIONS OR MOOD SWINGS, WE CAN SOMETIMES USE AN ANTIDEPRESSANT MEDICATION.

BUT LAMICTAL IS ONE OF MANY DIFFERENT MOOD SWINGS WE'RE USING IN THOSE KIND OF CONDITIONS LAMICTAL AND ANTI SEIZURE MEDICATION.

BUT WE HAVE FOUND THAT ANTI SEIZURE MEDICATIONS FREQUENTLY DO WELL FOR MOOD STABILIZATION IN A SIMILAR MANNER ABOUT IN A SIMILAR MATTER WOMEN ESPECIALLY WITH BIPOLAR DISORDER CAN INDEED HAVE MIGRAINE HEADACHES SO MIGRAINE HEADACHES AND BIPOLAR DISORDER CAN GO HAND IN HAND FOR THOSE PEOPLE.

WE OFTEN PREFERENTIALLY WILL USE ANTIEPILEPTIC MEDICATIONS LIKE LAMICTAL AND ONE OF THEM.

THANK YOU FOR YOUR QUESTION.

LET'S GO TO OUR NEXT CALLER.

HELLO MARYANN.

WELCOME TO MATTERS OF MIND.

HI, DR. FARBER.

THANK YOU FOR TAKING MY CALL.

CERTAINLY WE HAVE A QUESTION WE HAVE A QUESTION ABOUT WE HAVE AN ADULT SON WHO IS 45 YEARS OLD WHOSE MOTHER WAS SEVERE BIPOLAR ONE AND HE HAS STARTED TAKING STEROIDS BY IVY AND ALL OF A SUDDEN IS SHOWING SIGNS OF MANIA AND EXTREME MOOD SWINGS, ANGER, CRYING, DESPAIR, DEPRESSION, WONDERING IF THERE'S ANY CONNECTION THERE REALLY IS.

MARIANNE, TELL ME THE REASON HE'S TAKING THIS STEROIDS IVY FOR FOR WEIGHTLIFTING PHYSIQUE PURPOSES LIKE PROBABLY TAKING ANABOLIC STEROIDS PROBABLY NOT A GOOD IDEA OBVIOUSLY MARIYAM.

STEROIDS CAN EVOKE MANIC EPISODES THAT MIGHT NOT HAVE BEEN EVOKED WITHOUT SOME EXTRANEOUS SUBSTANCE.

SO IF YOU HAVE A BIPOLAR DISORDER, A HISTORY OF ABOUT A SIXTY FIVE PERCENT CHANCE OF HAVING BIPOLAR DISORDER YOURSELF SO THERE IS A GENETIC PROPENSITY THAT IS THERE AND IF YOU STIMULATE YOUR MOOD IN SUCH A WAY THAT USING ANABOLIC STEROIDS WHICH WILL BRING ON MUSCLE WITH FOR WEIGHTLIFTING IF YOU USE STIMULANT MEDICATIONS SOMETIMES THAT WILL EVOKE MANIC EPISODES.

SO YEAH, EVEN IF YOU DIDN'T HAVE A HISTORY OF BIPOLAR DISORDER OR DIDN'T HAVE IT IN YOUR FAMILY ANABOLIC STEROIDS CAN INDEED MAKE YOU MORE IRRITABLE.

MANY OF THESE WILL HAVE EFFECTS ON TESTOSTERONE.

USING TESTOSTERONE SUPPLEMENTS OBVIOUSLY CAN MAKE PEOPLE MORE IRRITABLE AND AGGRESSIVE.

SOMETIMES YOU WILL ACTUALLY HEAR ABOUT THESE TYPE OF STEROIDS MAKING PEOPLE MORE MOODY IN GENERAL.

NOW PEOPLE OFTEN ASK ME, MARIANNE, WHAT IF I HAVE TO TAKE A STEROID BECAUSE I HAVE ASTHMA BECAUSE I HAVE RHEUMATOID ARTHRITIS.

I HAVE THESE CONDITIONS THAT WARRANT THE USE OF A STEROID.

IN THOSE CASES WE WILL OFTEN HAVE PEOPLE CONTINUE TO USE THE STEROID BUT WE GIVE THEM A MOOD STABILIZER ON TOP OF THE STEROID AS A MEANS OF ALLEVIATING THE MOODINESS THEY CAN HAVE FROM THE MEDICAL TREATMENT WITH A STEROID.

SO WITH THAT ALL BEING SAID, IF STEROIDS ARE ABSOLUTELY MEDICALLY NECESSARY WE WILL INDEED USE MOOD STABILIZERS TO OFFSET THE SIDE EFFECT OF THE STEROIDS.

BUT IF YOU'RE USING STEROIDS I WOULDN'T SAY RECREATIONALLY I'M SURE THAT YOUR SON HAS A REASON FOR USING THE IV STEROIDS IF HE'S SPECIALLY ESPECIALLY COMPETING WITH WEIGHTLIFTING.

I KNOW THAT THOSE PEOPLE WILL OFTEN USE STEROIDS AS A MEANS OF TRYING TO ENHANCE THEIR PERFORMANCE BUT IT'S SOMETHING THAT CAN BE QUITE DANGEROUS IF YOU ALREADY HAVE A HISTORY OF BIPOLAR DISORDER IN THE FAMILY.

MARY, THANKS FOR YOUR CALL.

LET'S GO TO NEXT CALLER.

HELLO MATT.

WELCOME TO MARS THE MIND ON MATT.

YOU MENTIONED YOU WORK AT A VERY HIGH INTENSITY JOB.

YOU DO A LOT OF RUNNING AROUND.

YOU'VE GOT TROUBLE SLEEPING AT NIGHT BECAUSE YOU CAN'T TURN OFF YOUR BRAIN.

YOU'RE CONSTANTLY THINKING ABOUT THE THINGS THAT NEED TO BE DONE THE NEXT DAY.

HOW CAN YOU CALM DOWN YOUR BRAIN AT NIGHT SO YOU CAN SLEEP NO ONE.

MATT, YOU PROBABLY WANT TO BE CAREFUL ABOUT ANY EXERCISING LATE AT NIGHT SO YOU WANT TO NOT EXERCISE ABOUT FIVE HOURS OR SO BEFORE GOING TO BED?

HARD TO DO THAT SOMETIMES WHEN PEOPLE HAVE A VERY PHYSICAL JOB BUT THAT'S ONE THING YOU WANT TO CONSIDER EXERCISING IS FANTASTIC FOR THE SLEEP BUT TRY TO DO IT EARLIER IN THE DAY IF AT ALL POSSIBLE THE BEST TIME TO EXERCISE IF YOU CAN REALLY DO IT AS FIRST THING IN THE MORNING.

SECONDLY, BE CAREFUL ABOUT EATING ANY SPICY FOODS IN THE EVENING AND IF PREFERENTIALLY I WOULD SUGGEST YOU GO OUT TO EAT AND EAT ANYTHING AT ALL FOR ABOUT FOUR OR FIVE HOURS BEFORE GOING TO BED IF YOU EAT SOMETHING BEFORE GOING TO BED SOMETIMES THAT WILL KEEP YOU AWAKE.

BUT MATT, YOU'RE DESCRIBING HAVING DIFFICULTY TURNING THE BRAIN OFF AT NIGHT AND I'D SUGGEST YOU KEEP A JOURNAL AND YOU WRITE IN THAT JOURNAL THE THINGS THAT BOTHER YOU THE MOST, THE THINGS ANNOY YOU THE MOST.

AND WHEN I SAY RIGHT, I'M USING MY HAND LIKE A PEN USE LAPTOP AND JUST WRITE IT DOWN ON A LAPTOP.

THAT'S HOW WE OFTEN DO THINGS NOWADAYS OR EVEN A SMARTPHONE.

JUST WRITE YOURSELF SOME NOTES ON THE SMARTPHONE AND HERE'S WHAT YOU WANT TO DO, MATT YOU WANT TO WRITE DOWN THE THINGS THAT ARE AFFECTING YOU OR BOTHERING YOU THE MOST AND THEY'RE ALMOST ON YOUR MIND.

TAKE A LOOK AT THOSE THINGS AND THERE MIGHT BE FIVE OR SIX THINGS EVERY DAY AND THEN TRY TO SORT OUT WHAT YOU CAN OR CANNOT DO ABOUT THEM.

MANY TIMES WE TEND TO RUMINATE ABOUT THINGS THAT WE DON'T WANT TO FORGET.

WE WANT TO TRY TO PROCESS THAT INFORMATION AND UNFORTUNATELY WHEN THE LIGHTS GO OUT AT NIGHT WE TRY TO GO TO BED.

WE'RE STILL TRYING TO PROCESS INFORMATION AND FIGURE OUT PROBLEMS.

WHAT YOU WANT TO DO, MATT, IS GIVE YOURSELF SOME TIME AND SPECIFICALLY DEVOTE TIME TO WORKING OUT THE PROBLEMS DURING THE LIGHT OF DAY, PREFERABLY SOONER RATHER THAN LATER.

NOW MANY PEOPLE THAT LAST HOUR BEFORE THEY GO TO BED THEY WILL READ SOMETHING THAT'S TOTALLY UNRELATED TO THEIR WORK.

THEY READ SOMETHING JUST ON A RECREATIONAL BASIS.

I OFTEN RECOMMEND PEOPLE READING SOMETHING IN CHAPTERS BECAUSE IF YOU READ A NOVEL YOU MIGHT NOT PUT THE BOOK DOWN.

YOU KEEP READING AND READING AND READING.

YOU WANT TO READ SOMETHING IN CHAPTERS WHERE THERE'S A PARTICULAR STOP STOPPING POINT AT CERTAIN SECTIONS WE TEND TO HAVE THESE CIRCADIAN RHYTHMS WITH OUR SLEEP MAP WHERE IF YOU CAN KEEP YOURSELF AWAKE PAST A CERTAIN TIME CHANCES ARE YOU'LL STAY AWAKE FOR ANOTHER HOUR AND A HALF AND IT'S LIKE CATCHING A BUS IF YOU TYPICALLY GO TO SLEEP AT AROUND TEN THIRTY OR SO BUT YOU'RE REALLY INTERESTED IN SOMETHING YOU'RE WATCHING AN EXCITING BASKETBALL GAME NEXT THING YOU KNOW YOU'RE GOING TO BE AWAKE TILL TWELVE O'CLOCK AND THEN IF YOU'RE AWAKE AT TWELVE O'CLOCK YOU MIGHT NOT BE ASLEEP UNTIL ONE THIRTY.

SO THERE'S THESE ONE AND A HALF TO TWO HOUR CYCLES THAT WE GO THROUGH.

IF YOU TEND TO KEEP YOURSELF AWAKE BECAUSE YOU'RE INTERESTED IN SOMETHING AND YOU GO PAST THAT PARTICULAR TIME WHERE YOU TYPICALLY WOULD GO TO SLEEP, YOU'RE GOING TO STAY AWAKE LONGER.

THAT'S WHY I OFTEN TELL PEOPLE, YOU KNOW, IF YOU'RE ARE WIDE AWAKE AT ABOUT ONE THIRTY IN THE MORNING TWO A.M. AND YOU'RE NOT GOING BACK TO SLEEP, CHANCES ARE YOU'RE NOT GOING BACK TO SLEEP FOR ANOTHER HOUR, HOUR AND A HALF YOU MIGHT AS WELL GET UP READ SOMETHING THAT'S NOT TOO STIMULATING KIND OF IN DIM LIGHTING PREFERENTIALLY AND JUST GO AHEAD AND MAKE SOME USE OUT OF YOUR TIME WITHOUT WORKING YOUR BRAIN TOO MUCH.

BUT MATT, IT SOUNDS LIKE WITH YOU BEING IN A HIGH INTENSITY JOB AND A LOT OF STUFF GOING AROUND YOUR MIND, YOU NEED TO HAVE SOME TIME TO THINK ABOUT THOSE THINGS WELL BEFORE YOU GO TO BED AND THEN THAT HOUR BEFORE YOU GO TO BED READ SOMETHING TOTALLY UNRELATED TO YOUR FIELD.

YOU HAVE TO BE CAUTIOUS ABOUT WATCHING TELEVISION.

IF YOU'VE WATCHED TELEVISION YOU WANT TO WATCH SOMETHING VERY MUNDANE WHERE YOU DON'T HAVE TO THINK DEFINITELY DO NOT WATCH THE EVENING NEWS WHERE PEOPLE ARE SHOUTING AND YELLING AT EACH OTHER AND DEBATING HOT TOPICS ABOUT POLITICS.

YOU DO NOT WANT TO DO THAT FOR AN HOUR BEFORE YOU GO TO BED BECAUSE THAT DOES KEEP YOU AWAKE NOW THE LIGHT OF THE TELEVISION IT'S A BRIGHT LIGHT .

WE HAVE THESE BRIGHT LED PROJECTORS COMING OFF OUR TELEVISIONS NOW AND THE BRIGHTNESS OF THE LIGHT WILL KEEP YOU AWAKE AS WELL.

SO BE CAREFUL ABOUT THAT.

BUT IDEALLY YOU WANT TO WATCH SOMETHING LIKE A SITCOM SOMETHING AND DOESN'T REQUIRE A LOT OF THOUGHT AND SOMETHING IS TOTALLY UNRELATED TO WORK.

KIND OF SHUT YOUR BRAIN DOWN OVER THAT LAST THIRTY MINUTES TO AN HOUR BEFORE YOU GO TO BED.

BUT THE KEY WILL BE FOR YOU MATT TO TRY TO SHUT YOURSELF DOWN FROM THINKING ABOUT WORK.

DO NOT LOOK AT YOUR EMAIL THAT LAST HOUR OR TWO BEFORE GOING TO BED.

A LOT OF PEOPLE THEY ACTUALLY ARE LAYING IN BED LOOKING AT THEIR WORK EMAIL AND THEY'RE ANSWERING QUESTIONS AND THINGS YOU JUST DON'T WANT TO DO THAT BECAUSE YOU'RE GOING TO STILL BE PROCESSING THAT INFORMATION AS YOU GO TO SLEEP.

YOU NEED THAT HOUR OR SO BEFORE YOU GO TO BED TO TRY TO SHUT THE BRAIN DOWN AND DO SOMETHING ENTIRELY DIFFERENT AND THINK ABOUT DIFFERENT THINGS OTHER THAN YOUR WORK ITSELF.

YOU'LL FIND IF YOU DO THAT YOU'LL GET A BETTER NIGHT'S SLEEP AND YOU'LL ACTUALLY BE MORE PRODUCTIVE IN YOUR JOB THE NEXT DAY, ESPECIALLY IF YOU CAN DO ABOUT THIRTY MINUTES OR SO OF EXERCISE IN THE MORNING.

EXERCISE HAS A DRAMATIC EFFECT ON IMPROVING YOUR ABILITY TO THINK THROUGH PROBLEMS, PROCESS INFORMATION AND BE ABLE TO ORGANIZE YOUR THOUGHTS.

SO EXERCISING 30 MINUTES IN THE MORNING IS A REAL SHORT TIME WHETHER IT BE A LITTLE BIT OF WEIGHT LIFTING SOME PUSH UPS, A LITTLE BIT OF QUICK WALKING AS THE WEATHER GETS NICER HERE, MAYBE GO OUT AND GO OUT AND DO A QUICK WALK IN THE MORNING.

THAT LITTLE BIT OF PHYSICAL ACTIVITY IN THE MORNING HAS A GREAT EFFECT IN TERMS OF YOUR ABILITY TO WORK THROUGH YOUR PROBLEMS AT WORK BUT ALSO TO BE ABLE TO SLEEP AT NIGHT.

SO EXERCISE IN THE MORNING ANYWAY ANYHOW CAN BE REALLY GOOD FOR YOU.

MATT MATT, THANKS FOR YOUR CALL.

LET'S GO TO OUR NEXT E-MAIL.

OUR NEXT E-MAIL READS DEAR DR. FAUVER, I'VE HEARD THAT SOME ANXIETY AND DEPRESSION MEDICATIONS HAVE ADVERSE SIDE EFFECTS LIKE LOWERED SEX DRIVE AND LESS EMOTIONAL RANGE.

IS THIS TRUE AND ARE THERE SOME MEDICATIONS THAT ARE BETTER THAN OTHERS FOR THIS?

WELL, YEAH, SOME MEDICATIONS FOR DEPRESSION ESPECIALLY CAN INCREASE SEROTONIN TRANSMISSION AND IF YOU INCREASE SEROTONIN TRANSMISSION ESPECIALLY EXCESSIVELY, YOU CAN HAVE A BLUNTING OF YOUR EMOTIONS AND PEOPLE WILL SAY THEY DON'T FEEL HAPPY, THEY DON'T FEEL SAD, THEY JUST FEEL FLATLINED AND THAT IS A NUMBER ONE REASON WHY MANY PEOPLE WILL WILL GO OFF OF THEIR ANTIDEPRESSANT MEDICATIONS THAT ARE ENHANCING SEROTONIN.

I REMEMBER WHEN PROZAC CAME OUT IN THE OH ABOUT NINETEEN EIGHTY SEVEN I BELIEVE WHEN PROZAC CAME OUT IT WAS A REMARKABLE MEDICATION BECAUSE IT HELPED PEOPLE WITH THEIR MOOD BUT IN MOST CASES IT DID NOT CAUSE THEM TO HAVE ANY WEIGHT GAIN OR SEDATION LIKE THE PRIOR ANTIDEPRESSANT MEDICATIONS.

BUT PROZAC WAS NOTABLY LIKELY TO CAUSE PEOPLE TO HAVE THIS EMOTIONAL DULLING EFFECT THEY DIDN'T LIKE AND MANY TIMES THAT WAS MISINTERPRETED AS BEING DEPRESSION.

SO WHAT HAPPENED?

THE CLINICIANS FURTHER INCREASED THE DOSAGE SO THEY WENT FROM TWENTY MILLIGRAMS UP TO FORTY MILLIGRAMS AND THAT JUST MADE IT WORSE.

SO IF YOU HAVE EMOTIONAL DARLING ON A MEDICATION THAT'S USED FOR DEPRESSION, THAT MEDICATION MIGHT BE ENHANCING SEROTONIN AND EMOTIONAL DARLING BY INCREASING SEROTONIN CAN INDIRECTLY DECREASE DOPAMINE AND IF YOU DECREASE DOPAMINE YOU JUST FEEL KIND OF BLAH AND YOU CAN HAVE SOME DIFFICULTY.

THE EMOTIONAL DARLING DECREASING DOPAMINE CAN ALSO BE RESPONSIBLE FOR AFFECTING SEXUAL FUNCTIONING OVERALL BUT ALSO WHAT THE SEROTONIN MEDICATIONS CAN ALSO DO IS AN ANTI EFFECT IN THE SENSE THAT THEY CAN AFFECT NITRIC OXIDE.

SO BY AFFECTING NITRIC OXIDE THEY CAN GIVE PEOPLE DIFFICULTY WITH SEXUAL AROUSAL AND SEX DRIVE AND IN MANY CASES SO THE SEROTONIN MEDICATIONS CAN BE PROBLEMATIC FOR SOME PEOPLE LIKE THAT.

NOW ABOUT TWO OUT OF THREE PEOPLE AREN'T GOOD GENETIC FITS FOR THE SEROTONIN MEDICATIONS ANYWAY SO THEY'D PREFERENTIALLY DO BETTER ON THE OTHER MEDICATIONS THAT DON'T AFFECT SEROTONIN AS MUCH MEDICATIONS LIKE WELLBUTRIN, MEDICATIONS THAT ENHANCE NOREPINEPHRINE AND DOPAMINE SUCH AS CYMBALTA EFFEXOR PRESTI THAT ZEMA TRENTA VIBERT WILL HAVE LESS OF AN EFFECT ON SEXUAL FUNCTIONING AND A LOT OF CASES SO IT CAN INDIRECTLY HELP PEOPLE WHO ARE HAVING THAT EMOTIONAL DIFFICULTY IN SEXUAL DYSFUNCTION AS WELL.

SO THERE ARE OTHER MEDICATIONS AVAILABLE.

WE NOW HAVE FIFTEEN NEWER ORAL ANTIDEPRESSANTS THAT HAVE COME OUT SINCE PROZAC BACK IN NINETEEN EIGHTY SEVEN.

SO WITH THESE NEWER ANTIDEPRESSANTS AVAILABLE IF ONE DOES NOT WORK CHANCES ARE ANOTHER ONE WILL.

SO WE OFTEN FIND THE DIFFERENT CLASSES OF MEDICATION FOR DEPRESSION CAN BE HELPFUL AND NOW WILL OFTEN ADD ON VARIOUS OUTSIDE MEDICATIONS AS WELL MEDICATIONS THAT ARE USED FOR MOOD STABILIZATION AND ALSO MAKE ANTIDEPRESSANTS WORK BETTER.

SO THERE ARE SOME MEDICATIONS OUT THERE.

THEY KIND OF WORK AS THE HAMBURGER HELPER FOR ANTIDEPRESSANTS.

THEY JUST MAKE THE ANTIDEPRESSANTS WORK A BIT BETTER AND THOSE MEDICATIONS ARE MEDICATIONS LIKE ABILIFY RESULT LATOUCHE AND A LOT OF CASES.

SO THESE ARE MEDICATIONS THAT JUST IF YOU ADD THEM ON TO AN ANTIDEPRESSANT MEDICATION THEY CAN SOMETIMES MAKE THE MEDICATION WORK BETTER FOR THEM.

THANK YOU FOR YOUR EMAIL.

LET'S GO TO OUR NEXT EMAIL OUR NEXT E-MAIL READS DEAR DR. FARBER, ARE YOU STILL DOING VIDEO VISITS OR HAVE YOU TRANSITIONED TO IN OFFICE VISITS?

I THINK I CAN SPEAK FOR MANY SIKICH TRIPS ACROSS THE COUNTRY.

I KNOW AT MY OFFICE PARTICULARLY WE HAVE EMBRACED VIDEO VISITS.

THE PATIENTS WE SEE HAVE SAID THEY REALLY LIKE THE VIDEO VISITS IS VERY CONVENIENT.

THEY DON'T HAVE TO LEAVE WORK.

THEY DON'T HAVE DRIVE TO OUR OFFICE AND THEY EVEN SIT IN THE WAITING ROOM.

IT JUST A WHOLE DIFFERENT EXPERIENCE FOR THEM.

WE SEE PEOPLE VIA VIDEO VISITS WHEN THEY'RE AT HOME, WHEN THEY'RE STEPPING AWAY FROM THEIR WORKPLACE.

YOUNGER PEOPLE ARE ARE ABLE TO SEE US AS THEY'RE GETTING OUT OF SCHOOL UNDER 18 YEARS OF AGE.

THEY HAVE TO BE WITH A PARENT BUT A LOT OF PEOPLE FIND THAT IT'S VERY CONVENIENT AND AS A PSYCHIATRIST I CAN TALK TO SOMEBODY, INTERACT WITH THEM VISUALLY AND IF WE NEED TO HAVE THEM DO CERTAIN TESTS LIKE HAVE THEM HAVE THEM SHOW US THEIR HANDS, WE CAN SEE IF THEY HAVE ANY TREMOR OR ANY TWITCHING OR ANYTHING LIKE THAT AND IT'S BEEN VERY EFFECTIVE FOR A LOT OF PEOPLE.

SO IN DOING SO WE'VE BEEN ABLE TO SEE PEOPLE FROM A COUPLE HOURS AWAY OR THREE HOURS AWAY WHETHER IN THE STATE OF INDIANA AND BE ABLE TO GIVE THEM ACCESS TO TREATMENT WHERE THEY WHERE THEY PREVIOUSLY MIGHT NOT HAVE HAD THAT ACCESS TO TREATMENT WITH THE VIDEO VISITS WE ALSO WERE ABLE TO GIVE PEOPLE QUESTIONNAIRES THAT THEY WERE TO COMPLETE WITHIN ONE OR TWO DAYS BEFORE THEIR VISITS.

SO WE CAN ALREADY BEFORE WE SEE THEM KNOW KIND OF HOW THEY WERE DOING WITH THEIR DEPRESSION OR ANXIETY, THEIR SLEEP, THEIR OVERALL FUNCTIONING, THEIR CONCENTRATION, WHAT SIDE EFFECTS THEY'RE HAVING.

THESE ARE ALL QUESTIONNAIRES WE'RE ABLE TO KIND OF PUSH OUT THE PEOPLE ON THEIR INTERNET PORTAL BEFORE THEY COME IN.

SO IT'S A MUCH MORE EFFICIENT VISIT AND IT'S OFTEN THE KIND OF VISIT WHERE PATIENTS ARE VERY APPRECIATIVE BECAUSE THEY DON'T HAVE TO MAKE THAT EFFORT TO COME INTO THE OFFICE AND THEY STILL HAVE THE THE SAME TYPE OF INTERACTION BY VIDEO.

THE VIDEO IS GOOD QUALITY.

WE TYPICALLY HAVE REALLY GOOD SOUND ON THE VIDEOS SO WE HAVE FOUND THAT ABOUT THREE OUT OF FOUR VISITS WE'RE DOING NOW ARE BY VIDEO.

SO WE'RE FINDING THAT ABOUT ONE OUT OF FOUR PEOPLE ARE STILL COMING IN THE OFFICE AND THAT'S STILL AN OPTION.

BUT ABOUT THREE OUT OF FOUR PEOPLE ARE OPTING TOWARD VIDEO VISITS NOW THAT WE HAVE THESE NEW PLATFORMS.

SO IT'S SOMETHING THAT IT WAS A CONSEQUENCE OF COVID I MEAN WITH WITH THE COVID RESTRICTIONS THAT BEGAN IN MARCH OF 2020, THE FEDERAL GOVERNMENT LOOSENED UP ON THE ABILITY FOR OUR ARE BEING ABLE TO DO VIDEO VISITS.

IT USED TO BE YOU ACTUALLY LITERALLY HAD TO GO INTO A DOCTOR'S OFFICE AND SIT THERE AND DO A VIDEO VISIT WITH ANOTHER DOCTOR AT ANOTHER OFFICE TO DO THE VIDEO VISIT.

NOW YOU CAN DO THE VIDEO VISIT FROM YOUR SMARTPHONE AND AS LONG AS YOU'RE IN THE STATE OF INDIANA WITH A CLINICIAN AS AN INDIANA LICENSE, THE CLINICIAN CAN DO THE VIDEO VISIT.

SO WE FOUND IT IN PSYCHIATRY.

IT'S REALLY OPENED UP ACCESS TO A LOT OF PEOPLE WHO PREVIOUSLY MIGHT NOT HAVE WANTED TO COME INTO AN OFFICE.

THANKS FOR EMAIL.

LET'S GO TO NEXT CALLER.

HELLO THOMAS.

WELCOME TO MATTERS OF MIND.

WELL, THOMAS, YOU HAD MENTIONED YOU'VE BEEN GENERALLY A PRETTY HAPPY GUY BUT WITHIN THE PAST COUPLE OF YEARS YOU'VE EXPERIENCED INEXPLICABLE, INEXPLICABLE PERIODS OF DEPRESSION AND THIS HAS NEVER HAPPENED BEFORE.

WHAT CAN THAT BE DUE TO?

IT'S BEEN JUST FOR THE PAST COUPLE OF YEARS YOU'VE HAD SOME PROFOUND EPISODE OF DEPRESSION.

WHAT'S BROUGHT THAT ON?

WELL, YOU KNOW, IF YOU'RE PAST THE AGE OF TWENTY OR TWENTY FIVE YEARS OF AGE, I'M WONDERING IS IT REALLY DEPRESSION OR IS IT SOMETHING THAT CAN BE MEDICALLY ADDRESSED?

FOR INSTANCE, WE OFTEN HEAR ABOUT PEOPLE OLDER THAN 25 YEARS OF AGE ALL OF A SUDDEN HAVING DEPRESSION AND CAN BE SITUATIONAL TYPE OF CIRCUMSTANCES AT YOUR WORK IF YOUR RELATIONSHIPS AND SO FORTH.

BUT FIRST THING WE ALWAYS WANT TO ASSESS IS ARE YOU SNORING?

ARE YOU HAVING ANY EPISODES OF PAUSING OR BREATHING?

DO YOU HAVE SOMETHING CALLED SLEEP APNEA WHERE YOU'RE NOT GETTING ADEQUATE AIRFLOW TO THE LUNGS THEREBY GETTING DECREASED OXYGEN TO THE BRAIN THAT'LL MAKE YOU DEPRESSED, TIRED AND HAVE DIFFICULTY CONCENTRATION.

SECONDLY, WE WANT TO CONSIDER THAT YOU HAVE THE POSSIBILITY OF LOW THYROID, LOW THYROID OR MAKE A LOT OF PEOPLE TIRED.

THEY'LL MAKE THEM DEPRESSED.

SO WE WANT TO MAKE SURE YOUR THYROID IS OK. THIRD, WE WANT TO MAKE SURE YOU DON'T HAVE ANY DIABETES AND FOURTH, ESPECIALLY FOR WOMEN NOT SO MUCH FOR MEN BUT WE WANT TO MAKE SURE YOU DON'T HAVE A LOW IRON.

THOSE ARE THE MAIN MEDICAL CONDITIONS WILL OFTEN ASSESS TO TRY TO DETERMINE IF THERE'S A REASON WHY PEOPLE MIGHT BE HAVING DIFFICULTY WITH DEPRESSION LATER IN THE YEARS.

NOW IF YOU'RE OVER 70 YEARS OF AGE, PERHAPS WE MIGHT CHECK A V12 LEVEL LOW VITAMIN B TWELVE IS COMMON FOR PEOPLE WHO GET OVER THE AGE OF 70 BECAUSE YOU HAVE THIS LITTLE BUZZ IN YOUR STOMACH CALLED THE INTRINSIC FACTOR IF IT'S RELEASED BY THESE LITTLE PRADEL CELLS AND INTRINSIC FACTOR IS LIKE A BUS WHERE VITAMIN B 12 WILL CATCH ON AND THEN THE VITAMIN B 12 GOES ON THIS INTRINSIC FACTOR BUS DOWN TO THE SMALL INTESTINE AND THEREBY GETS ABSORBED SO LOW VITAMIN B 12 WILL BE SOMETHING THAT HAPPENS WITH OLDER ADULTS BECAUSE THEY JUST DON'T HAVE THE INTRINSIC FACTOR IN THEIR STOMACH THAT THEY MIGHT HAVE HAD WHEN THEY ARE YOUNGER AND LOW VITAMIN B 12 WILL GIVE YOU TINGLING NUMBNESS, EVEN PAIN SOMETIMES IN THE HANDS AND FEET BUT IT WILL GIVE YOU DEPRESSION AND POOR CONCENTRATION.

SO THERE ARE A LOT OF DIFFERENT THINGS OUT THERE THAT CAN BE DONE TO BE ABLE TO ASSESS REASONS FOR THE DEPRESSION.

THAT'S THE FIRST THING I'D WANT YOU TO DO AND THEN OBVIOUSLY YOU'D WANT TO TALK TO YOUR CLINICIAN ABOUT THE POSSIBILITY OF YOUR HAVING TALK THERAPY OR COUNSELING IF YOU HAVE SOME SITUATIONAL CIRCUMSTANCES THAT MIGHT BE BOTHERING YOU AND COURSE VARIOUS ANTIDEPRESSANT MEDICATION THAT COULD BE USED.

THE FIRST THING WE WANT TO WONDER IF THIS IS YOUR FIRST EPISODE EVER OF DEPRESSION, DO YOU HAVE ANY FAMILY MEMBERS IN YOUR FAMILY MEMBER'S MOTHER, FATHER, BROTHER, SISTER, SON OR DAUGHTER, ANY OF THEM HAVING DEPRESSION BECAUSE WE TAKE A LOOK AT WHAT THEY MIGHT BE USING FOR TREATMENT AND CONSIDER THAT FOR YOU AND OBVIOUSLY IF YOU'RE HAVING ANY DIFFICULTY AT ALL WITH ALCOHOL USE OF MARIJUANA, THAT CAN BE A FACTOR AS WELL.

THANKS FOR YOUR CALL, WESLEY.

I'LL TAKE YOUR CALL OVER THE NEXT 30 SECONDS.

WELCOME.

MARRIES THE MIND.

WELL, HE HAD MENTIONED YOU'RE TAKING ZOLA OFF THAT CONFLICTS WITH YOUR AS NEEDED MEDICATIONS HYDROXY NAMIK WLEZIEN FOR DIZZINESS.

THOSE ARE ANTIHISTAMINES.

ARE THERE ANY MEDICATIONS IN THAT FAMILY THAT WON'T CONFLICT WITH THE ZOLOFT HYDROXYL INA MECHANIZING OR ANTIHISTAMINES AND ZOLOFT USUALLY WON'T BE A BIG PROBLEM WITH THAT.

THERE ARE OTHER ANTIDEPRESSIVE MEDICATIONS COULD BE USED THAT WOULD NOT AFFECT SEROTONIN WELLBUTRIN COULD BE ONE FACTOR NOR TRAPLINE BEING ANOTHER ONE THAT THERE ARE OTHER MEDICATIONS THAT WOULDN'T AFFECT SEROTONIN AS MUCH.

WESLEY WESLEY, 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 WWE DOT ORG.

I'M PSYCHIATRIST FAUVER 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.

GOODNIGHT