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>> Good evening.

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

Welcome to Matters of the Mind now as 24th 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 PBS Fort Wayne by calling in the Fort Wayne area (969) 27 two zero or if you're calling any place coast to coast you may dial toll free at 866- (969) 27 two zero.

>> Now on a fairly regular basis we are broadcasting live every Monday night from our spectacular PBS Fort Wayne studios which lie in the shadows of the Purdue Fort Wayne campus.

>> And if you'd like to contact me with an email question that I can answer on the air, you may write me a visit via the Internet at Matters of the Mind all one word at WFA a dot org that's matters of the mind at Weygand.

>> I start tonight's program with a question I recently received.

It reads Dear Dr. Fauver I have recently started taking Lexapro .

>> It's also known as Escitalopram and noticed that I now have dreams every night.

>> Does this mean that the prescription is working its variable sometimes with dreams sometimes people will notice that when they take Lexapro they'll have a suppression of dreams and that's not all bad because some people with depression moderate to severe depression will notice that they dream so intensely that they awaken periodically throughout the night and some people can even have nightmares.

>> So on one hand the antidepressant medication can actually suppress dreams to some degree and you'll have less dreams now other people will notice that as a side effect of medications like Lexapro it actually worsens their dreams and that's a side effect that you'll often hear and that's because if Lexapro is taken in the morning, it's kind of its blood level is kind of decreasing a little bit in the evening and as the blood level of Lexapro is decreased and you get this rebound effect where you have more intense dreams.

>> So if we hear about a side effect from Lexapro, for instance, where somebody is having increasing dreams, sometimes it's because you're taking the medication the morning and will simply have people take it the medication in the evening taking the medication that evening will often suppress dreams.

But if the dreams are bothering you, that's where you might want to do that.

If they're not bothering you, if you're noticing that you're experiencing some dreams, that's OK.

Older folks who are having difficulty with dementia and they're having trouble with memory impairment will often gradually have a loss of dreaming and dreaming is actually good for the brain.

>> Dreaming is affecting this part of the brain here called the hippocampus and it's the memory center of the brain.

>> When people dream it actually helps rebuild and fire up that center of the brain.

If you start having fewer and fewer dreams, that can be one of several different indications that you might be having some difficulty with memory impairment over the course of time when we treat individuals for dementia with medications like Aricept, Exelon rhapsodized these are medications that increase acetylcholine and in helping with increasing acetylcholine the idea is to preserve the memory.

>> But a side effect can often be increased dreaming.

>> So these are people who many times if they've had memory impairment they've not had dreams for years and all of a sudden they're dreaming again and they'll be somewhat disturbed by having these dreams.

They're not nightmares but they just have dreams at night.

But a lot of people with with depressive conditions will have excessive dreams and these dreams will be somewhat persecutory.

Sometimes they can be related to nightmares they awaken them periodically throughout the night.

I always tell people dreaming is perfectly fine unless it's awakening you and it's causing you to be upset upon awakening.

>> Now dreams are like a puff of smoke if you don't really think about them so much upon awakening you tend to forget what you dreamt about.

So dreams will be there for a few minutes after you're awake and in terms of being able to recall them but after a few minutes go by and many people will forget their dreams unless they actually remember them now a an approach that will often use in psychotherapy and this was done historically with psychoanalysis especially is where you write down your dreams first thing in the morning you record what you remember dreaming and try to write them down to really think about them and figure out how the dreams might relate to your day to day activities as you go to sleep you tend to have your first set of dreams about an hour, hour and a half after you go to sleep and then you'll have more frequent dreams as the night goes on and it's thought that as you have more dreams as the night goes on early in the morning you'll have dreams that are more related to current or recent day phenomena.

>> So sometimes people will be able to correlate the symbolic type of messages circuiting the dreams and put that together in terms of the different types of things that might be upsetting them during the day.

But we always have to remember that dreaming is very symbolic.

It's very abstract.

You can't take it at face value.

It represents different things happening in your life but it does not necessarily mean it's a predictor for something that's going to happen at least in today's day and age in terms of Lexapro, suppressing dreams is more common than Lexapro.

>> Increasing dreams if it's increasing dream is probably because you're taking the Lexapro early in the morning and you're getting a little bit of a rebound effect.

Thanks for your email.

Let's go to next email our next email reads Dear Doctor Father, can you take Prozac just during your days?

>> If so, why wouldn't you withdraw when you stop taking a Prozac also known as Fluoxetine and Zoloft also known as sertraline are two medications that were approved back in the 1990s by the Food and Drug Administration specifically for what's called premenstrual dysphoric disorder.

>> PMed premenstrual dysphoric disorder occurs with women a few days before their periods and once their periods start they feel a lot better.

>> So premenstrual dysphoric disorder is very predictably occurring a few days before the woman's period and during those days she can have difficulty with moodiness, depression, irritability, anger, tenderness, bloating, difficulty with a little bit of weight gain, carbohydrate craving during that time she will have some concentration difficulties and she might not want to be around people as much specifically during set numbers of days before her periods.

No, once her period flow starts then she feels better.

So Prozac and Zoloft were actually studied specifically for the purpose of taking them just during those days before the period and it's called pulse dosing where you just give a pulse of medication for maybe once a day four or five days before each period.

>> Now you can give the medication throughout the entire month but some women if they only have premenstrual dysphoric disorder they only need to take the medication on those days before their periods.

Why is that and how does that work?

Well, if you slightly increase serotonin transmission in the brain you can get some relief with the premise of dysphoric disorder because it's thought that that's due to the disturbances of estrogen and to some degree progesterone before the period.

>> So the woman will naturally throughout the month have increases and decreases for estrogen and progestin and as they're going up and down sometimes you can have mood shifts and that's what happens during the premenstrual dysphoric disorder time period the four or five days, sometimes a week, even two weeks before the period.

>> But that's what's contributing to the PMed the serotonin disturbances in the brain related to the shifts of estrogen and progesterone occurring throughout the month when the progesterone disturbances they're increasing increasing serotonin with just a few doses of Prozac or Zoloft can be very helpful for people.

Now if you give somebody Prozac or Zoloft, they'll get an increased amount of serotonin, their brain increased level and as soon as twenty minutes and that's adequate for premenstrual dysphoric disorder.

Now when you hear about people taking Prozac or Zoloft or depression, they need to take it not for just four or five days.

>> They need to take it for four or five weeks to really see the full effect.

They'll get some effect within two weeks but they see the full effect in four or five, six weeks on down the line and that's because when you treat depression you're not only wanting to just increase the serotonin transmission in the brain.

You're also wanting to make some meaningful changes on the little receptors on the neurons themselves.

So the nerve cells have receptors on them and it's thought that when people get depressed they have a disturbance in the numbers of receptors on the firing neurons and the receiving neurons and you need to fix that takes about four to six weeks for the protein changes the receptors to occur.

>> So you need four to six weeks of Prozac or Zoloft to really get the main benefit for the relief of premenstrual relief of clinical depression.

>> But four or five days worth for premenstrual dysphoric disorder can work now Prozac in the system for several days.

You're not going to have to withdraw from that with Zoloft also and a search you're probably not going to have withdrawal from that if you take it just for a few days.

>> If you take it for two or three weeks, you might have some withdrawal.

You have to taper off of it.

But just for taking it for a few days you probably wouldn't have any withdrawal if you stopped that abruptly after just four or five days.

But some women will take the Prozac or Zoloft day by day by day throughout the entire month and they can do that especially if they have some depression the rest of the month.

But if a woman says she only has difficulty those four or five days before her periods she might just take just during those days.

Now there are other treatments for premenstrual dysphoric disorder.

Some women take a water pill like hydrochlorothiazide they might take out Daptone or just some water pill.

It can help them blow off some of the excess fluid and for some people that's adequate.

Other people might just take something as simple as calcium.

Calcium supplements have been shown to relieve some of the symptoms of premature dysphoric disorder taking the calcium supplements about a week or two especially before the start of the period each month.

>> So calcium supplements they were studied in Taiwan a few decades ago and it was found that they were somewhat effective overall trying to stay physically active during those premenstrual days can be very helpful along with a lot of women do not want to stay physically active during that time because they feel lousy, they feel tired, they feel irritable as it is but some kind of physical activity during those days before the periods can really help out now outside of Prozac or Zoloft, the main treatments for premenstrual dysphoric disorder or premenstrual tension will be the oral contraceptive medications because basically they are dampening out the peaks and troughs and highs and lows of estrogen and progesterone.

So if they're going if they if you take an oral contraceptive medication, it just dampens out the fluctuations in the blood levels of estrogen and progesterone.

>> Thanks for email.

Let's go to our next caller.

Hello Barb.

Welcome to mastermind Barbu on A.. >> Does Lexapro increase the chances of developing of developing dementia?

Barb what does increase the chance of developing dementia will be will be a depression if you have clinically significant depression it's left untreated after a magic age of 65 years old you have a four times greater risk of having dementia later on because we now know that depression itself will tend to fry this part of the brain called the hippocampus and that's the part of the brain that's involved with dementia and that's part of the brain that shrinks down as you are having more and more trouble with memory that leads to dementia, to dementia.

>> So untreated depression is the main source of the dementia itself.

>> Now what can Lexapro do as you get older from a detrimental perspective for women especially it can cause your bones to be a little thinner.

It's very, very slight is a clinically significant that is debatable but you can be at a slight risk for having a bone fracture as you get older if you take Lexapro that probably wouldn't be a good enough reason to necessarily stop it if it's given you benefit because there's a lot of worse things that can happen if you have untreated depression or persistent anxiety.

But the way Lexapro works, Barb, is that it blocks the vacuuming of serotonin back into the firing neurons.

>> So if you have a firing neuron that's like a shotgun and it's spraying out all this serotonin well the serotonin will then go to fourteen different targets out there in the periphery of serotonin and then come back into the firing neuron and that's how the fire neuron preserves its serotonin bullets.

>> It vacuums them back in and what a medication like Lexapro will do, it will block the vacuuming of serotonin back into the firing neuron allowing serotonin to bounce around longer in the periphery and hit its targets.

>> It will do the same thing Lexapro do the same thing with calcium so it can decrease the vacuuming of calcium back into bones so that can potentially make a woman about a 12 percent higher risk for bone fractures especially of the wrist or the hip.

So that's a slight risk.

It's not the it's not a good enough reason to take older adults off of Lexapro necessarily.

>> But that is the main risk that we're concerned about once in while we're here about somebody with who is having gastrointestinal bleeding and if you have a tendency to have gastritis or bleedings, Lexapro will also make platelets less sticky because serotonin will also block platelets pumps from in serotonin and the way platelets get sticky is they vacuum in serotonin.

When they vacuum in serotonin they get stickier and if you block the vacuuming of serotonin you platelets don't get a sticky and if you already are prone to a gastrin bleed that can make it more likely.

So sometimes we'll hear about that if somebody is having trouble with blood in their stool, they are having trouble bloody vomiting.

Those type of things will certainly want them off of the medication like like Lexapro but specifically from a dementia risk.

>> I'd say that Lexapro likely decrease the risk of dementia if you have depression or even anxiety conditions more so than increase the risk.

>> So we're always weighing benefits versus risks looking at every individual for their particular risk factors whether they have a tendency toward having depression, anxiety.

Do they have difficulty with osteoporosis already nassauer they take any medication for that because quite frankly you can take supplemental calcium and you can take various medications to make the bones stronger to offset some of that risk for the bone fractures.

If you're taking a medication like Lexapro and you're over 65 years of age and that's something you can always consult with your primary care clinician to what degree would you be at risk for having thinning of the bones also known as osteoporosis?

If you take a medication for like Lexapro in your older years?

>> Thanks for your call.

Let's go to our next email question.

Our next e-mail question reads derivative over what's the difference between a normal grief reaction and a clinical depression when somebody has a normal grief reaction they should feel sad.

They should miss their loved one with a normal grief reaction.

>> People find this to be unusual but it's not unusual to see their loved one who passed on to see them every now and then and it's kind of our brains way of kind of letting go of the passing of a loved one and people will sometimes perceive that experience as being that they see a ghost but your brain will kind of adapt to the loss of a loved one by actually seeing that loved one periodically you might see the loved one in a mirror or in the faint shadows of the darkness not uncommon and it does not warrant the use of an antipsychotic medication.

It is not necessarily pathological if you see a loved one, a normal grief reaction would be where you might have a little bit of difficulty sleeping but it's not causing you so much difficulty with sleeping that you're feeling tired the next day you're having trouble with concentration.

>> It's not leaving you overall functionally impaired people with a normal grief reaction will still be able to eat.

They'll have enough energy to get around and do things.

They will cry periodically.

They'll miss their loved ones and that's perfectly normal but they won't be functionally impaired where they can't take care of themselves.

>> Now when you cross over and have the difficult major depression that's where it becomes significant.

People with major depression will have trouble with sleeping to the point where it's starting to affect their concentration the next day they can't focus.

They're preoccupied with guilt perhaps that they're still alive.

People who have major depression following the loss of a loved one will often want to be dead themselves and they'll it'll be a desire to be dead even to the point of even thinking about suicide because they don't want to be around anymore and when those people are having that experience, it's this front part of the brain that's being affected because the front part of the brain is the reasoning part of brain.

This part of the brain will shut down when you're having more and more depression and when it's getting shut down you won't reason quite as readily.

>> And years ago was found that when people had completed suicide when they did the autopsies they found they had less serotonin in the front parts of their brain.

So it was found that the possibility was there that maybe suicidality was a serotonin disturbance and offsetting the normal serotonin transmission was somehow increasing likelihood for suicidality.

>> So for people who were suicidal, it was found that antidepressants could help them in various ways.

>> Now people often wonder why is there a warning for antidepressant medications for individuals under 24 years of age for the possibility of increasing suicidality or increasing suicidal thinking if they're taking antidepressant that occurs early on in the treatment and it's related to them getting too much of a dose too quickly and might have something to do with their becoming more agitated.

But we have to remember that people under 24 years of age still have growing brains and as you have a growing brain you're more likely to have more sensitivity to medications that are changing the brain chemistry.

So that might be a factor for individuals under 24 and why we have to carefully watch how we dose them for antidepressant medications and how they're doing with them.

>> Thanks for your question.

Let's go to next caller.

>> Hello Miriam.

Welcome to Matters of the Mind .

Miriam, you want to know about a recent diagnosis of serotonin syndrome and what's that mean for you?

Serotonin is a chemical that it's in the brain one of 80 different chemicals that are used to create chemical messages between one nerve cell and another nerve cell.

So serotonin is a chemical in the brain and it can modulate mood and anxiety conditions and if you get too much serotonin by using medications in combination or medication it too high of a dosage it can give you what's called serotonin syndrome.

Serotonin syndrome is manifested by having difficulty with the fast heart rate pounding heart rate.

You can be shaky, sweaty, you can have nausea, diarrhea.

Some people will get a fever and when it gets really bad you can actually have a seizure.

So serotonin syndrome is basically a phenomenon where you're getting excessive amounts of serotonin in your system.

Now when I've seen people with serotonin syndrome it's not typically due to the medication they're actually taking.

It's due to the supplements that they've added on.

>> So if you add on supplements when you're already taking medications that increase serotonin, sometimes those supplements can kind of tip the scales and cause you to have serotonin syndrome.

And a good example is that of that is a very commonly used supplement called five five HTP is a precursor or a building block for serotonin and if you take as a supplement five HTP on top of a medication like Lexapro, Zoloft or Prozac I've mentioned those already this evening you can have serotonin syndrome.

It's something that starts out with symptoms of serotonin toxicity was serotonin toxicity.

>> You just don't feel right.

>> You get a bit of a headache.

You might get the fast heart rate, you might have some diarrhea and that's just an indication you're starting to get too much serotonin in your system.

But as time progresses, full blown serotonin syndrome would be where you get dilated pupils the fever headache you feel terrible and it's sometimes require hospitalization.

>> More often than not we're going to give somebody a medication and can kind of reverse the serotonin syndrome symptoms and one of those medications would actually be an old antihistamine called Cipro Hebridean also known as reactive.

It's an antihistamine but it does have serotonin blockade effects and it can reverse the symptoms of serotonin syndrome very, very quickly.

So that can sometimes be given even as an outpatient for people if an individual's blood pressure heart rate are in reasonable good control and they don't need to be in hospital in the hospital but will give medications sometimes to offset those symptoms, does that mean you can never take a serotonin type medication again?

No, because I'd want to go back and look at step one.

Number one, it'd be nice to see your genetic testing because some people based on their genetics we can kind of tell who's going to be at higher risk for having side effects from serotonin medications and or not.

Secondly, we can look at how quickly you break down medications.

Some people will break down certain serotonin medications really fast and other medications that increase serotonin.

They'll break them down very slowly if you happen to have the genetics where you slowly breakdown medications like Lexapro, that would be a to see nineteen mutation.

Well, that just means that if you took Lexapro you'd want to take a very, very low dosage.

But the people who are at greatest risk are serotonin syndromes are the ones who aren't aren't a good genetic fit.

>> They don't have a good genetic profile for the mechanism of action for the serotonin medications.

>> Perhaps there are Sláma to Hellblazer of certain medications and that will enhance serotonin that'll make him have more sensitivity a serotonin medications or perhaps they are taken combinations of medications including supplements that might increase serotonin inadvertently.

>> Thanks for your call.

Let's go next caller.

>> Hello Jack.

Welcome to Mars.

The mind Jack.

You all know if stress can cause hair loss what medication or treatment can use to avoid it or regain hair?

>> Difficult to say, Jack.

I'd I'd refer you to a dermatologist to really get a better answer on that.

But stress itself doesn't usually cause hair loss.

But what we often see, Jack, when somebody is having hair loss unexpectedly we're going to first look at hypothyroidism and it all kind of goes hand-in-hand with stress overall, Jack, because if you low on your thyroid you'll often notice that you have a difficult time with stress tolerance or putting up with stuff and that can give you the other symptoms that go along with low thyroid such as dry skin constipation.

People can be fatigued.

They can have poor concentration.

So in my field as a psychiatrist all often hear about these different symptoms and I hear about people having a difficult time handling stress and hair loss and loss of the outside parts of their eyebrows can be symptoms of low thyroid.

So if I'm hearing somebody having difficulty with hair loss and they're under stress, the very first thing I want to do is take a look at their thyroid testing overall, make sure their thyroid is right where it should be from a supplement standpoint.

I don't want to go outside my boundaries as a psychiatrist.

I want to stay in my lane.

But there are supplements out there that sometimes are used for hair loss.

But again, I leave that to your primary care doctor or your or a dermatologist to be able to give you some idea specific on what you can do for hair loss.

But stress doesn't usually cause hair loss unless the stress is leading to your having low thyroid and we do indeed hear about that when you feel overwhelmingly depressed it can affect your thyroid functioning four times more common with women than men.

But I do see a lot of men experiencing that and sometimes their main symptom will be that they're taking more naps than usual.

>> They're a little bit foggy in their concentration.

They just aren't as sharp as they used to be.

So they get referred to me as a psychiatrist because they're starting to get some depression and one of the routine workshops that we'll do for people medically will be taking a look at the thyroid as well.

>> Some other medical conditions.

Thanks for your call.

Let's go our next caller.

Hello, Rob.

Welcome to Matters of Mind.

I have a question on Wellbutrin.

Sure.

Oh, I was wondering if I use more for anxiety or depression and they also ask if I would have an epileptic seizures or not.

Sure.

>> So that was my question.

I guess what I actually used for yeah.

>> Rob, if you have epilepsy really shouldn't take Wellbutrin and Wellbutrin is also known as bupropion.

When they did the original studies on Wellbutrin they gave it to some women who had bulimia and these women who would make themselves vomit and after overeating and then they'd binge eat again and they make us all vomit.

All these women had seizures when they got these really high doses of Wellbutrin much higher than we'd ever used.

So for that reason no one we typically restrict our dosage of Wellbutrin to a certain amount.

>> Number two , we don't give Wellbutrin to people with epilepsy because it can increase the likelihood of having seizures.

>> Does it help with depression or anxiety?

Yeah, both mainly for depression.

It's an activating energizing antidepressant.

But quite frankly, Rob, some people with attention deficit hyperactivity disorder or ADHD if they have anxiety associated with ADHD, Wellbutrin can help with that because Wellbutrin kind of is a soft stimulant in terms of how it works.

>> So we've had a lot of luck with it being beneficial for anxiety related ADHD as well as depression as an activating energizing antidepression.

>> Rob, 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 ,you may write me via the Internet at matters of the mind all one word at WWE dawg.

I'm psychiatrist Jay Fawver and you've been watching Matters the Mind on PBS Fort Wayne God willing and PBSC willing.

I'll be back again next week.

Have good evening.

Good night