Good evening.

I'm psychiatrist Jay Fawver, and welcome to Matters of the Mind.

Matters of the Mind is a weekly mental health program where you have the chance to choose the topic for discussion.

So if you have any questions that I can answer on the air, you may write me a via the internet at MattersoftheMind - all one word - @WFWA.org That's MattersoftheMind@wfwa.org.

And if you're able to do so, you may call me or you may text me.

All we ask is that you leave a first name and let us know the town from where you're calling.

So with that being said, let's start with our first email for tonight.

Our first email reads Dear Dr.

Fawver, does creatine help with mental health?

Could it be taken with medications like Effexor and Wellbutrin?

Creatine is a is a product that is used to structure muscles.

Creatine is a combination of three amino acids.

It's a combination of methionine, arginine, and glycine.

And basically it's what bodybuilders will use to bulk up their muscles.

It's specially helpful for bulking up the powerful muscles, so people who are sprinters and bodybuilders will often use it.

Creatine is different from creatinine, but creatine is often used as a supplement to bulk up and help with muscle development.

Now, as we get older, we tend to have less creatine, and it's thought that maybe that's why people over 50 years of age tend to lose about 8% of their muscle mass per decade.

So as we get older, we tend to gradually lose muscle mass.

So it's thought that people, as we get older, we need to do more resistance training and more weight work, but we also need to maybe possibly add some creatine.

What's that have to do with mental health?

Well, creatine does help with muscle development, but it also goes to the brain.

And it's thought that it might stimulate this particular receptor called dopamine type one receptors.

There's five different dopamine receptors.

If you stimulate dopamine type one receptors you can potentially have improvement with memory concentration and attention span.

So maybe creatine would actually help with mental health.

There's no evidence that it would be deterrent to mental health in general.

So it can be used with Effexor and Wellbutrin.

And it can be used to possibly help people stabilize their mood and keep them out of the depths of depression in general.

Now, I want to give you a little caveat here concerning creatine.

You don't want to take creatine before your annual blood tests because creatine turns into creatinine.

So creatine turning into creatinine.

Think of creatinine as being kind of like a waste product of creatine.

If you take creatine supplements within two weeks before you get your blood test, well, the blood tests that you often will will have on a routine physical will be a renal function test, which includes creatinine.

The higher the creatinine, the higher the waste, and creatinine as a measure, not uncommonly, that's used to determine how well the body is able to get rid of its waste and how well the kidneys are working.

So creatine supplements will increase creatinine.

And you don't want to do that before a blood test.

It's not thought to be creatine.

It's not thought to be toxic to the kidneys.

It's just that it can increase the waste that's associated with the measurement for kidney function.

Thanks for your email.

Let's go to our first call.

Hello, Paula.

Welcome to Matters of the Mind.

Paula, you want to know how does Cobenfy compare with previous antipsychotic medication for schizophrenia?

Paula, Cobenfy is a medication.

It's a combination of two medications and has been studied for decades for various conditions.

But Cobenfy is xanomeline which is a medication specifically will stimulate muscarinic type one receptors.

What's that mean?

It's basically going to increase acetylcholine in the front part of the brain, and indirectly decrease dopamine in the middle part of the brain.

And schizophrenia, one of the problems will be you have trouble with concentration and paying attention to things.

That's a frontal lobe function, and you have trouble with hallucinations and delusions.

That's a function of the side part of the brain and the limbic system over here in the temporal lobe.

So if you use Cobenfy, you're going to be using a medication called xanomeline.

What's the biggest side effect of xanomeline all by itself.

Xanomeline can cause you to have increased acetylcholine, but that can cause you to have difficulty with gastrointestinal problems, nausea, diarrhea.

It can slow down your heartbeat.

So people, what do they need to do?

They need to take a medication that's not going to block acetylcholine in the brain, but just a block acetylcholine in the rest of the body.

That's where trospium comes in.

Trospium does not get into the brain itself.

It stays in the rest of the body, so it'll block all those acetylcholine effects in the rest of the body and thereby decrease the likelihood of you're having nausea and vomiting and diarrhea, and the difficulty with heart rate.

And that's the biggest side effect that I'll often hear about with Cobenfy - for those kind of nauseating problems.

And trospium is available by itself.

It's a very inexpensive medication.

You can add on extra trospium under your clinicians supervision, but that's the biggest issue there.

With Cobenfy, it's a medication that's entirely unlike the traditional medications that have been available for schizophrenia for the past 70 years.

The past 70 years, we've been using medications that primarily will block dopamine.

And directly they can increase dopamine in the front part of the brain.

But their main mechanisms of action, with a couple dozen different antipsychotic medications we've been using over the past 70 years, their main mechanisms of action have been blocking dopamine in the temporal lobe and thereby helping with hallucinations and delusions.

Cobenfy will do that, but in a different way, thereby not being not as likely to cause you such conditions as tardive dyskinesia, where you have twitches in the face and jaw movements and truncal movements, you're less likely to have shakiness and stiffness.

Those are the kind of side effects people can have from the medications that particularly block dopamine.

Thanks for your call.

Let's go to our next text.

Hello, Jason from Marion.

Jason.

He had asked in my practice, do I ever find patients with faith or religious beliefs having higher success or easier time overcoming depression?

Having strong faith or religious convictions, Jason, can certainly be advantageous for mental health.

Duke University, over the past decades has studied this finding that people who have a strong faith community and that includes not just church attendance, but also having fellowship within the church that can enhance your mental health.

And there are several reasons for that, Jason.

Number one, it gives you a sense of it gives you a sense of purpose and meaning.

It gives you a sense of direction in your life.

Number two, it does give you the social connection, having meaningful relationships from a fellowship standpoint.

And it gives you some idea of what your eventual purpose in life might be.

So it gives you direction in life overall.

So there are a lot of advantages from a mental health standpoint for people who have the the purpose and meaning and the direction and the fellowship that they often will encounter with mental health issues.

Thanks for your text.

Let's go to the next text.

Hello, Dave.

Dave from Huntington.

You'd asked about psilocybin mushrooms.

Can they help with mental health?

There's going to be studies done on that over the course of Dave.

Of course, the next five years, Dave, where you're going to be hearing about psilocybin possibly being used for post-traumatic stress.

Now, psilocybin can be used in a sense that it's going to affect serotonin transmission.

It's going to be microdosed.

And that's the key.

You just don't want to go out there and find it on the street.

It's going to be done in a very strict supervision.

It's thought that with psilocybin, there's always debate whether people should have psychotherapy during that monitored visit or not.

But there's a lot of discussion now about the possibility of psilocybin being used specifically for the purpose of post-traumatic stress.

I'm hearing it being used possibly for depression treatment as well, but certainly for post-traumatic stress.

It might be a treatment that people can use at microdosing, but it needs to be closely supervised.

As with many of these medications being developed in psychiatry now, you don't want to just haphazardly use them.

You want to be able to closely supervise how they're being used.

Thanks for your text.

Let's go to our next email question.

Our next email question reads, Dear Dr.

Fawver, are there any issues or concerns with Prozac - that's also known as fluoxetine - as a regular treatment option for mental health conditions?

Prozac has been around since 1987.

Also known as fluoxetine, it was the first of the selective serotonin reuptake inhibitors to become available.

Since that time, we've had over a dozen of them, over a dozen of these newer medications become available.

But the nice thing about Prozac, back in 1987, it was one of the, if not the first antidepressant medication.

It was actually tolerable for people, so people could take it without feeling overly sedated.

They didn't have the weight gain, they didn't feel lightheaded, they could tolerate it, whereas the prior medications were often very intolerable.

So Prozac was tolerable.

If it worked for people, great.

It tends to work in about one out of three people.

In terms of giving them some benefit.

Its somewhat energizing, can decrease the appetite, but if it's effective, you can literally take it for decades.

So it's a medication that can be safely used for decades, not known to cause liver or kidney problems.

The biggest issue with any medication that is a serotonin reuptake inhibitor, such as Prozac, is that it can possibly give you some bone thinning as you get older, especially in the wrist and in the hips.

A slight decrease in bone thinning.

It's called osteoporosis.

And you can have osteoporosis.

Because if you think about how these serotonin reuptake inhibitors work, they basically will block the vacuuming of serotonin into the firing neuron.

So if you think about a firing neuron, like being like a shotgun, the shotguns firing off the serotonin pellets, the serotonin pellets go to 14 different receptors.

And then the serotonin gets vacuumed back in to preserve bullets back into the firing neuron.

And if you block the vacuuming of the serotonin into the firing neuron, the serotonin bounces around for a longer period of time.

Well, the serotonin reuptake inhibitors will also block calcium from getting into the bones.

So how do you get around that?

You can certainly take a calcium supplement on a regular basis, but I would say the biggest long term issue with fluoxetine or Prozac can be the possibility of the bone thinning and having a higher risk for fractures, especially in the wrist and the hips.

But if that's not an issue with DEXA scanning and close monitoring, you could still take the Prozac or fluoxetine long term.

Thanks for your email.

Let's go to the next caller.

Hello John, welcome to Matters of the Mind.

John, you want to know, is it true that nicotine patches offer a short term improvement for depression?

A couple of things are going on there, John.

For one thing, if you're using nicotine patches, many times you're using the nicotine patches for the purpose of, well, nicotine cessation and you're trying to quit smoking.

So if you're trying to quit smoking, one of the side effects of quitting smoking can be depression, irritability, and anxiety.

And if you're using nicotine patches, that can diminish that.

Now, would I recommend nicotine patches for somebody who hasn't been dependent on nicotine previously?

Probably not.

But theoretically, yeah.

Nicotine patches can temporarily help you feel more alert, more motivated and give you the same effect the nicotine cigarettes give you.

But like nicotine cigarettes, nicotine patches, if used long term, will cause you to need more and more of them because the nicotine patches are going to this middle part of the brain.

The middle part of the brain is called the nucleus accumbens.

That's the pleasure center of the brain.

It's like the Las Vegas of the brain.

It's right in the middle here.

And if you use nicotine, nicotine will go to that part of the brain, release dopamine and give you a transient, temporarily feel good effect that last for a while.

Now the problem with nicotine, it doesn't last very long.

So you got to keep using it and using it.

With cigarettes, you got to use one after another.

The nicotine patches will slowly release over the course of time, but nicotine itself can give you.

Number one, the potential for needing more and more.

That's called addiction and also give you withdrawal if you stop them abruptly.

And finally nicotine itself, even the patch form formulation can give you a faster heart rate.

It can give you hypertension.

It can give you some of the the medical complications that you'll hear about with nicotine that you'll hear about with nicotine cigarettes.

So we'd prefer people not use the nicotine patches as a treatment for depression, but they can be useful to help you get off of nicotine in other formulations.

Thanks for your call.

Let's go.

Next email question.

Our next email question reads.

Dear Dr.

Fawver, I've been diagnosed with pseudodementia and I've been on psychiatric medications for over 30 years.

Recently, I've been having neurological imbalances issues.

Could there be a connection between pseudodementia and neurological imbalance issues?

I would say there's not necessarily a connection there.

Pseudodementia merely means that you have memory difficulties that are not related to a neurological disturbance.

In other words, you don't have Alzheimer's dementia, you don't have vascular dementia, you don't have lewy body disease, you don't have a treatable dementia where you're having difficulty related to a neurological condition.

Pseudodementia means you're having memory disturbances related to long term depression.

Now, what happens when people have long term depression is they'll have a shrinking of this area of the brain called the hippocampus.

It's in the temporal lobe here.

That's kind of the memory center of the brain.

And as the hippocampus shrinks down, you'll have trouble with memory.

And many times people will have trouble with speed of processing of information.

That's like having slow internet speed in your brain.

So when you have slow internet speed in your brain, it just feels like you can't process information very quickly.

That's what long term depression will do.

Now, separate from that, you're describing balance and neurological issues.

Otherwise they could be totally separate from the pseudodementia itself.

But if you have been on various medications used in psychiatry for the past 30 years, the dopamine receptor blockers to which I referred previously used in schizophrenia, sometimes they are also used in depression or mood stabilization treatment.

And when you use those medications, sometimes you can get twitching and tics in your facial area, your trunk.

And it's called tardive dyskinesia.

Sometimes that can give balance issues itself.

I would certainly follow up with your neurologist to determine, okay, at what point do you need to adjust your medications you might be taking for the pseudodementia use for depression, and to balance out difficulties you're having from a standpoint overall.

So talk to your neurologist and primary care clinician about that.

Thanks for your call.

Let's go.

Our next caller.

Hello Jerry.

Welcome to Matters of the Mind.

Jerry.

You mentioned that your mother has dementia and her doctor wants her to go on Zyprexa.

That's also known as olanzapine to help her with severe agitation and aggression.

Is that a reasonable approach?

Jerry, you know, we've been using olanzapine and Zyprexa for people with dementia, if they have agitation.

But you have to have consider there's a warning on all the antipsychotic medications, because 25 years ago, the psychotic medications were studied with dementia-related psychosis.

In other words, people were hearing voices and they were seeing things and they were out of touch with reality and they had dementia.

So they were given medications like olanzapine.

That's Zyprexa, risperidone.

That's Risperdal, Abilify.

That's aripiprazole.

Quetiapine was around.

That's known as Seroquel.

They were given these medications.

And there was a slight increase in heart problems and strokes and related to their take in the antipsychotic medications.

Now, it's controversial whether the antipsychotic medications like Zyprexa caused the medical complications, because some of those people also received as needed medications called benzodiazepines, such as Ativan.

And that will increase the likelihood if you're having neurological complications as well.

So with that being said, just a week or so ago, there was a medication called Auvelity that was approved by the Food and Drug Administration specifically for agitation related to dementia.

We're going to be hearing more about that, but that's brand new information.

Auvelity is a medication that's a combination of two medications.

Dextromethorphan, which is an old cough suppressant, has been around for over 65 years.

Dextromethorphan and Bupropion as an antidepressant medication been around since 1989.

Bupropion is in Auvelity, for the purpose of increasing the dextromethorphan level by over 30 times and extending how long it lasts by over three times.

So the whole purpose of Bupropion is to keep the dextromethorphan in the system for a longer period of time.

If you have difficulty with agitation and irritability related to dementia, those high levels of dextromethorphan can be advantageous in a way entirely different than the antipsychotic medications like Zyprexa.

So Zyprexa has been used very carefully with people with agitation related to dementia.

But the good news is I think we're going to have better options as the years go on.

I'll be in the first and as of late April 2026, that was approved for dementia-related agitation.

So we look forward to hearing about that.

Thanks for your call.

Let's go.

Next email question.

Our next email question reads.

Dear Dr.

Fawver, I'm in my 40s.

I've had a history of chronic trauma, abuse, neglect, gaslighting, etc.

I am frequently in fight or flight mode with intrusive thoughts and rumination.

My nervous system can't tolerate most medications and talk therapy can only do so much.

What are some treatments on the horizon for people like me?

On one hand, sure.

We talked earlier about psilocybin.

That could be something totally outside of the box for the possibility of helping somebody with post-traumatic stress that haven't hasn't been helped with anything else.

But I think you need to always consider the five pillars of mental health, the first being genetics.

You can't do anything about your genetics, but we are all are.

We are all are genetically prone to having anxiety, depression and having a certain degree of resilience.

So there's genetics number one.

Number two would be stuff that happened to you, especially at an early age, before the age of eight years old.

If traumatic things happen to you, especially at an early age, that can actually trigger your genetics because you're going to have genetics for anxiety and depression.

But like a light switch, they need to be turned off or on as a means of helping you get through life and having any any difficulty with mental health problems.

So stuff that happens in your life can turn that light switch and the genetics on and off, appropriately or inappropriately.

The third pillar of mental health, outside of genetics and things that happen to you in your past, will be your ability to cope based on your experiences, based on your resilience, how well you're able to put up with stuff so your ability to cope will certainly affect your mental health.

Fourthly, it would be lifestyle.

And lifestyle is often thought to be just diet and exercise.

But when I talk about lifestyle, I'm talking about maintaining social socialization.

As I mentioned earlier, having those religious convictions, having purpose and meaning in your life, doing enjoyable things, lifestyle can have a significant impact on your mental health overall.

And fifthly would be your overall medical state.

Mental medical mental health issues can be worsened by medical conditions, but sometimes they can actually be caused by medical conditions.

They can be worsened by medical conditions because if you have a particular medical condition, that's very frustrating and discouraging for you.

That will affect your mental health.

But some medical conditions can actually cause you to have inflammation of the brain.

Some health conditions can actually mimic difficulties with fatigue, poor concentration, depression.

So if you have sleep apnea, for instance, you can have all the symptoms of depression because you won't be able to think very clearly.

You won't be able to cope very well.

You have difficulty with energy and motivation throughout the day.

You got to get the sleep apnea treated.

The same with low thyroid, iron difficulties, thyroid difficulties.

As I mentioned before, diabetes.

Those can all be factors that are related to medical conditions that can cause mental health problems to be worse.

So when you consider the five pillars of mental health genetics, past life traumas, coping abilities, the lifestyle that you're currently enduring, and finally, the medical conditions.

Those five pillars are something that will always assess and try to address accordingly.

If somebody is just not feeling like they're getting any place in treatment, and a lot of people are looking for that next big thing like psilocybin, that might help.

But I think we always have to keep in mind your those five pillars of mental health in general.

Thanks for your call.

Let's go to our next text, Pam from Fort Wayne.

Welcome to Matters of the Mind.

Pam, you want to know about certain thoughts making you sneeze?

Is that a thing?

I'm not aware of thoughts making a sneeze, Pam, but that might be something that ear, nose and throat doctor could tell you about.

I do know that you can sneeze from exposure to sunlight.

Many people, myself included.

If you get exposure to sunlight, there's a reflex in your pupil that can make you sneeze.

But thoughts making you sneeze?

Nope, I've not heard about that, Pam, but thanks for texting me.

Let's go to our next caller.

Hello, Lily.

Welcome to Matters of the Mind.

Lily, you mentioned you start taking Zepbound for sleep apnea.

Well, Zepbound is a GLP one agonist, a glycogen like peptide type one agonist.

Zepbound is used to decrease fat, and it will indirectly decrease muscle mass.

But Zepbound is used to decrease fat.

You're saying that you're using Zepbound for sleep apnea?

I presume you might be using Zepbound to decrease the fat that might be in your neck, because if you lose weight in general, especially weight in your neck, you can have less snoring and less likelihood of pausing in your sleep.

And that's what causes sleep apnea.

Sleep apnea itself is something where you're not getting adequate airflow to the lungs at night, thereby not getting oxygen to the brain.

And if you're not getting adequate oxygen into the brain, you can have difficulty with concentration, motivation, energy the next day.

And it can give you a lot of difficulty with your overall mood.

So you started taking Zepbound for your sleep apnea, and you're saying you're having weird dreams, and should you be concerned about that?

I'm not aware of Zepbound causing strange dreams, but anything can happen to anybody, Lily.

You always want to go back to considering, gee, how you were doing before you took the medication versus after.

You want to look at your other medications as well.

Some medications can be started and they can initiate some difficulty with difficulty with dreams.

I'd want to know if you have sleep apnea, are you still using CPAp as a means of mechanically giving you the airflow?

Because if you quit using CPAp and now you're just using Zepbound, is that a factor in you're having bad dreams?

Because sometimes if you don't use the CPAp or auto pap or BiPAP or whatever you may be using for sleep apnea, that can sometimes be a factor in causing you bad dreams.

Thanks for your text.

Let's go to our last email question.

Our last email question reads Dear Dr.

Fawver, what's the difference between neuroscience and psychiatry?

Neuroscience is basically where it's a study of the chemicals of the brain.

There's 80 different chemicals in which we're aware.

It's a study of the networking of the brain, the anatomy of the brain.

You've got the prefrontal cortex here.

You've got the limbic system and the memory center over here.

You've got the the sensations and then the side parts of the brain.

You've got all these different areas of the brain that do different things.

The networks of the brain.

You've got the default network, you've got salient network, you've got the executive mode network.

So neuroscience is looking at how the brain functions.

Psychiatry basically we'll look at okay how that's functioning.

But also take a look at how you're functioning on a day to day level.

So with any psychiatric condition by definition for it to be a disorder you need to have functional impairment where the problems that you're having with mood, anxiety, concentration, the problems you're having in those areas are actually causing you to have difficulty, difficulty socializing, going to work, doing enjoyable things.

You're not able to be all you can be and do all the things you want to do.

So with that being in mind, psychiatry is looking at disturbances that occur in a brain.

But when we talk about disturbances that occur in the brain, we're always remembering those five pillars of psychiatry: genetics, past experiences with trauma, coping abilities, lifestyle and medical conditions.

We're looking at those five pillars and trying to determine what we can do about those, and how functionally impairing those particular symptoms might be for you.

So when we look at conditions in psychiatry, we will consider medications not uncommonly, but we'll also considering counseling.

People often ask what the role of counseling might be in with mental health problems.

Counseling will help you not uncommonly provide a little bit of a GPS for your brain.

If you're in an unfamiliar city, you're going to use your GPS and the lady or the man on the GPS going to tell you which way to turn based on your lack of experience in those big cities or that unfamiliar area.

That's what counseling will do.

It'll help you provide somewhat a GPS on your life circumstances so you can go a certain direction or another that you might not have considered because you don't have much experience in that area.

Thanks for your call.

Let's go to our last caller.

Hello, Leah.

Welcome to Matters of the Mind.

Leah, you mentioned you talk to your dog a lot, and a friend said that could be a sign of mental health issue.

Is that true?

Should you stop talking to your dog?

No.

Your dog does have.

I believe a dog has a soul, but that's another topic for discussion.

But that's perfectly normal.

Talk to your dog.

Your dog is a very good friend, and and a pet can be a very good means for helping your mental health.

Leah, 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 a via the internet at MattersoftheMind - all one word - @wfwa.org.

I'm psychiatrist Jay Fawver and you've been watching Matters of Mind on PBS.

God-willing and PBS-willing.

I'll be back again next week.

Thanks for watching.

Good night.