Good evening.

I'm psychiatrist Jay Fawver.

Welcome to Matters of the Mind, a weekly mental health program where you get to choose the topic for discussion.

So if you have any questions concerning mental health issues that I can answer on the air, you may call me, you may text me, or you may email me at MattersoftheMind - all one word - @wfwa.org.

That's MattersoftheMind@wfwa.org.

And upon contacting me.

Let me know your first name and from where you're watching makes it a little bit more personal that way.

Let's start tonight's program with an email I recently received.

It reads Dear Dr.

Fawver, I am currently 70 years young, 70 years young.

I've been treated for depression since I was 30 years old.

I take Effexor, also known as venlafaxine, bupropion, also known as Wellbutrin and Spravato also known as esketamine.

I also enjoy a beer or cocktail with supper.

What are your thoughts about mixing alcohol with medication?

Well, Effexor, Wellbutrin, Spravato those are medications used for depression.

And when you use medications for depression, the general rule of thumb, as a psychiatrist will be if you have one drink, it's going to feel like three.

Now you have to take the use of alcohol with medications in context, because if you're also taking other sedating medications like narcotics, you have to be really careful with any alcohol at all.

If you have a prior history of alcohol use disorder where you've had trouble with alcohol in the past, you probably want to stay away from alcohol.

And specifically with this combination Wellbutrin, Effexor, and Spravato.

If you use alcohol within about 12 hours prior to your next Spravato treatment, because what's provided treatments, as you're aware, it's a nasal spray tree, but where you have to sit in a supervised setting for two hours at a time.

If you have alcohol within 12 hours of your Spravato session, you can have more sedation than you would expect and even more side effects during the treatment itself.

So I'd recommend definitely don't drink any alcohol at all within 12 hours prior to having this Spravato treatment.

Talk it over with your clinician about the pros and cons of having a drink.

As you'd mentioned, a beer or cocktail every now and then.

Being aware that with Effexor, with Wellbutrin, you might feel a little bit more loopy than you might expect it compared to if you use the alcohol alone.

Thanks for your email.

Let's go to our first caller.

Hello, Larry, welcome to Matters of Mind.

Larry, you had mentioned that you don't really want to take any medications.

What are some things you can do to help with anxiety in general?

Larry, one of the best things you can do for anxiety overall is resistance training or weight training.

Now for many people they think, my goodness, I haven't lifted weights since I was a kid.

Well, if you have a trainer or a coach, somebody can guide you through the process of weight training.

If you can imagine when you have anxiety, you're kind of tensed up, not uncommonly, and it'll give you difficulty with feeling tired.

And that can sometimes even influence your sleep pattern.

If you use resistance training, we're talking about 20, maybe 30 minutes of weight training or resistance training of some type three times a week that can, in many cases, cause you to tense your muscles while you're doing a resistance resistance training, but then you'll feel more relaxed thereafter.

So resistance training is very good for anxiety.

Another means of exercise it can be very good for anxiety or depression for that matter, will be aerobic training.

So we're talking about brisk walking, running, if you're able to do so, elliptical training, bicycling.

Resistance training can help with anxiety, but aerobic training where you're getting your heart rate up, that can be very helpful as well.

And the nice thing about aerobic training that can help you with exercise.

What else can you do to help with anxiety?

Try to look at the source of your anxiety.

If you're worried about things in the future and you're brooding about things that might happen and you have a lot of doubts and you're thinking, what if, what if, what if?

Keep a worry diary.

In other words, write down the worries that you're experiencing, and write down 5 or 6 worries at a time.

Try to do so earlier in the evening as opposed to later in the evening, and just write down the worries and give it some thought in terms of what you can do about them or what you can't do about it.

If you're worried about international events, you personally probably can't do anything about that, so keep that in mind.

The nice thing about writing down your worries, Larry, is when you look back on your worries three months later, you'll often find all that stuff you were worrying about really never came about.

So it's very reassuring for you to write down your worries.

So exercise, writing down your worries.

Try to identify the source of your worries and do something about it, and identifying what you can do and what you cannot do about those particular worries.

Larry, thanks for your call.

Let's go to next caller.

Hello, Charles.

Welcome to Matters of the Mind.

Charles, you want to know about using Depakote for anxiety and does it work?

Depakote has been around for a long time, Charles.

Been around since the 60s or 70s.

Depakote is also known as valproate or valproic acid.

It's a medication.

It was originally used for seizures.

It's been used for migraines and it can be used for anxiety.

In my experience, Charles, it's kind of harsh because it can give you elevated liver enzymes over the course of time.

And we have to watch for liver enzymes for people on Depakote.

It can in some cases give side effects such as weight gain over sedation and even difficulty with concentration.

So we have a lot of other options out there for anxiety at this point.

Charles.

We typically don't recommend benzodiazepines such as Xanax, Klonopin, Ativan, Valium.

Long term, we will often recommend medications like antiepileptic medications that can be used for shorter term for anxiety.

And I'm talking about medications such as gabapentin, also known as neurotic and pregabalin, known as Lyrica.

Many times we'll use Trileptal, also known as oxcarbazepine.

These are medications that are more tolerable than a medication like Depakote.

But Depakote does work and it actually can be very profound for some people.

It's just that we don't use it so much now.

We often wouldn't use it for women, Charles, because women can if they're of the age where they can still have babies.

That can be fairly transgenic or problematic during pregnancy.

And that's why we often don't use Depakote for young women, but for men, we just have to be aware it has a lot of side effects to it.

You do have to monitor the blood levels occasionally as well as the liver tests.

Charles, thanks for your call.

Let's go to our next caller.

Hello, Tom.

Welcome to Matters of the Mind.

Tom, you want to know about measuring neurotransmitter levels before being on certain medications.

We don't measure neurotransmitter levels.

I know that's been promoted over the course of time.

The bottom line is the neurotransmitters are in the brain.

We're talking about serotonin, norepinephrine, dopamine, Gaba, glutamate, all there's about 60 different neurotransmitters.

By the time they get to the brain, to the bloodstream, they're going to be broken down.

It's not going to be clinically meaningful when they get in the bloodstream.

And we have genetic testing.

Genetic testing can look at the the degree to which you will metabolize or break down various medications.

But genetic testing typically will not predict which medication specifically will work for you for certain conditions.

That's where we have to use our clinical judgment.

So there are some certain genetic tests.

And they go by the name of SLC6A1 looking at serotonin transmitter.

There's COMT, Catechol-O-Methyltransferase.

That gene will look at how quickly you're breaking down norepinephrine and dopamine in the frontal lobe of the brain.

But in general, when we look at genetic testing, we're often looking at situations where, we're trying to figure out how quickly somebody breaks down various medications and thereby determine if somebody needs a high dosage of medication or a low dosage of medications.

But we are not recommending that people get neurotransmitter levels.

And I've heard over the, oh, 20 years ago, people would get saliva tests for neurotransmitters.

And course that was found not to be really valid.

So I wouldn't recommend that at all.

Thanks for your call.

Let's go to our next text, Ted from Fort Wayne, welcome to Matters of Mind.

Ted, you want to know if Xanax is the best medication for anxiety ever invented?

I remember with Xanax, also known as alprazolam, it came out in about 1983, and it was thought to be a non addicting medication that was going to replace Valium.

Valium.

While I was in pharmacy school, when Valium was the number one medication of all medications.

Valium also goes by the name diazepam, and in 1979, Valium was the number one medication prescribed of all medications in the United States.

So Valium was highly prevalent back in 1979.

Okay, a few years go by, Xanax comes out.

The difference between Xanax and Valium was that Xanax was less sedating and Xanax was actually thought to be useful for people who had agitated depression.

And it calm them down.

What people love about Xanax will be it works within a matter of minutes and it'll typically last about eight hours.

What Xanax does.

It goes right here to the anxiety volume control.

Its called the amygdala.

Amygdala in Latin means almond shaped.

And it's right there in the front of the little boxing glove thumb.

The amygdala sits there.

That's the volume control for anxiety, anger, irritability, rage that turns down that volume control very, very quickly.

Now you might think, well that's wonderful.

Well, here's the problem with long term use of Xanax or alprazolam.

You can sometimes need more and more and more, and then you get to rely on it where minor anxiety spells are minor instances which should provoke anxiety, become problematic for you.

So we don't use the benzodiazepines like Xanax.

So much for people anymore, simply because you can get used to them and they can make you a little bit more cognitively dull.

In other words, they make your internet speed in your brain those slower.

So the speed of processing in your brain can be slowed with a medication like Xanax.

As we get older, we can have more trouble with memory on Xanax and even have more falling spells.

So we're trying to get people to go different directions than using Xanax long term for panic.

However, not uncommonly, we'll have people just have a few Xanax on hand in case they need to go on a flight, because you got to get on a plane and we'll tell people to take a Xanax while they're in the boarding area when their flight is announced.

We'll have people take a Xanax if they're in a situation where they're backed up into a corner, they're a panicking, they're paralyzed with fear and anxiety.

Because what happens when this anxiety volume control gets really lit up.

It'll basically hijack the front part of your brain.

The front part of your brain is your thinking, part of your brain, your reasoning, part of the brain.

And if you have overwhelming anxiety, you can be paralyzed with fear and you can't think.

That's not good.

And that's where Xanax can sometimes break that up.

But we try not to use Xanax when people have experienced traumatic situations because it appears to make post-traumatic stress symptoms worse.

We have a lot of other options in psychiatry now compared to back in 1983, when Xanax first came out.

So Xanax is something it can be very effective for anxiety, but effective, medications sometimes, even though they're effective at the time, might not be the best in the best interest long term for people.

Thanks for your call.

Let's go to our next email question.

Our next email question reads, Dear Doctor Fawver are there any other options besides, glucagon like peptide type one GLP-1 medications if I am, struggling with the mental toll of feeling like I'm addicted to eating unhealthy food.

You might be talking about food noise and food noises where you're thinking and you're ruminating, and you're obsessed with thinking about unhealthy food.

Now, GLP-1s have been used in those situations, and they tend to decrease the likelihood of food noise.

The GLP-1s were studied predominately with people who did not have mental health issues, however, so the GLP-1 medications extensively studied in over 100,000 people and dozens and dozens of studies.

They didn't show any mental health side effects.

That's a good news.

But they weren't studied in people with mental health problems.

In my experience, some people with GLP-1 treatment, if they have underlying depression anxiety, they can struggle with having the experience of feeling like they don't care, they don't enjoy things so much and they feel kind of blah.

So the GLP-1s in some people who have depression or anxiety can notice that.

So if you're noticing that you're having difficulty with craving unhealthy foods, keep in mind, okay, the underlying reason for that.

Sometimes it can be a dopaminergic issue where you're affecting your and you're needing to affect dopamine don't mean come squirting from this little middle part of the brain here called the nucleus accumbens.

Makes you feel good, gives you enjoyment and pleasure.

And some people, when they're kind of depressed, they will feel like they need to emotionally eat.

And if you blast yourself with carbohydrates, transiently blasting yourself, the carbohydrates will increase your insulin level.

Insulin will pump more tryptophan into the brain.

Tryptophan is a building block for serotonin.

So indirectly, you're self-medicating when you blast yourself with carbohydrates and sugars.

Now, many people will feel good for a while, but then they feel really lousy.

And it's not unlike alcohol in that regard, where you kind of have the rebound effect and you feel worse the day after it, experiencing carbohydrates.

So I'd certainly talk it over with your primary care clinician about the possibility of you taking a medication that might dampen the likelihood of your needing to eat unhealthy foods.

We have a lot of medications other than GLP-1s that might help specifically in that area, especially if they are going to directly or indirectly affect dopamine and possibly norepinephrine.

So we have options there that wouldn't give you the same side effects with GLP-1s, especially in the event if you have any depression or anxiety.

Thanks for your call.

Let's go to next caller.

Hello Bob, welcome to Matters of the Mind.

Caller: Hello.

Hello, Bob.

Caller: How are you,Doc?

Dr.

Fawver: Doing alright.

Good to hear from you.

Caller: Good to hear from you.

Caller: I'm just glad youre on TV.

Dr.

Fawver: Thanks.

Caller: So I was wondering, is it possible for an individual to suffer from ADHD or ADD and autism at the same time?

Dr.

Fawver: Did you have a second question, Bob?

Caller: No.

That was it.

Dr.

Fawver: l Okay.

Not only is it possible, Bob, for somebody to have attention deficit hyperactivity disorder and autism, but it's actually quite common that somebody could have autism first and foremost with ADHD.

And we have to sort of two symptoms apart, Bob, because with autism people will have difficulty emotionally connecting with somebody else.

With autism, you have a frontal lobe disturbance in the right front part of the brain and in the right front part of the brain.

That's the part of the brain that you use to connect with another person emotionally, cognitively, interpersonally.

There is something in the front part of the brain called mirror neurons.

And like the name implies, these neurons help you mirror the behaviors of other people.

Whether you realize it or not.

When you're communicating with somebody face to face, you're mirroring their behaviors, how they hold their arms, how their energy level, their their interpersonal interactions.

You're mirroring those behaviors.

And that's part of how you connect people with autism, have difficulty doing that.

That's why people with autism not uncommonly, will have what's what's called pedantic speech, where they talk and talk and talk and talk, and they won't pick up that social cue that maybe they should allow the other person to interject.

With autism many people will have difficulty with change.

They will have difficulty with, situations that are not consistent.

And it's interesting, Bob, because with both autism and ADHD, people can hyperfocus.

With autism, people will notice details that are so minute that other people might notice so much.

That's why in the Israeli Defense Force, they have a special unit of people with autism, specifically with autism, who are involved in intelligence gathering because they will notice details in photographs and in and data that other people don't notice.

ADHD could have a similar type of phenomenon.

People with ADHD will often have higher IQs compared to people without ADHD, but they don't get stuff done.

And that's what's so frustrating for these people with ADHD.

They're bright, but their brain is bouncing from one thing to another to another.

They're distractible.

It's like having a channel changer.

It's going from one thing to another.

So they get started on something.

They get excited about something, but they don't have the perseverance and the vigilance to complete tasks at hand.

So with ADHD, it's a cognitive disturbance.

It often leads to interpersonal difficulties because the kids with ADHD, if it's severe, they'll often not get invited to the parties or the sleepovers because they can be kind of annoying to be around.

The same with autism, they have a different phenomenon.

But with autism, it's more of an interpersonal processing.

With ADHD.

In many ways it's cognitive, but they have a lot of overlap.

And what does that mean from a clinical standpoint with autism, there are treatments to try to help with the stress tolerance.

In other words, we have treatments with autism from a medicinal standpoint that's going to help people put up with situations and be able to tolerate changes a lot, a little bit better.

With ADHD, we have treatments that are going to help with the focus and concentration.

You know, if you think of ADHD as being, kind of along a spectrum and with ADHD is kind of like nearsightedness, with people with nearsightedness.

Some people need their eyeglasses on all the time because their nearsightedness is so bad, they always need to wear eyeglasses.

Other people will just wear eyeglasses on occasion because it's not so bad.

With ADHD.

Some people will have a such severity they can't get through high school.

Other people with ADHD will have it to a milder severity where they don't need treatment or they don't notice it's problematic until they get into a challenging work environment, or they get into an environment where they have academic challenges and they might be in graduate school and for the first time they ever need a medication for ADHD.

So autism and ADHD.

Yep.

We'll often see them go hand in hand.

We will treat them differently.

But there's a lot of overlap there.

Bob, thanks for your call.

Let's go to our next caller.

Hello, Tyler, welcome to Matters of Mind.

Tyler, you want to know why are you suddenly wired after several months of severe depression?

Is that related to your ADHD or is that normal?

If you're wired, Tyler, after several months of severe depression, my first question is, does anybody in your family have similar symptoms?

In other words, does anybody in your family have any difficulty with what we call bipolar disorder?

Bipolar disorder is where you'd possibly have depression, but then you can have some days, if not a week or so, where you're not needing to sleep, you're more impulsive.

You do things and say things that you later regret.

You have racing thoughts, you will be socially intrusive and you.

But in on conversations totally unlike your usual character.

So those are so-called manic episodes.

They can follow depressive episodes and it's about 60% genetics.

So bipolar disorder runs in families.

So if you notice you're wired could be related to a mood disturbance or in general.

Now you mentioned you have ADHD.

If you're taking if you take an a stimulant for ADHD and you're feeling wired, that could be a side effect from the stimulant.

So on one hand, feeling wired after a severe depression for several months that could be from underlying bipolar disorder.

On the other hand, if you're taking a stimulant for ADHD, maybe you need to back off on that stimulant dosage under your clinician supervision.

So talk it over with your treating clinician to see what kind of issues might be going on there.

But I'd say there's a possibility of either an underlying mood disturbance like bipolar disorder or the ADHD treatment making you wired at this point.

But those are a couple things that could be possibilities for you.

Thanks for your call.

Let's go to our next email question.

Our next email question reads.

Dear Doctor Fawver, I recently accepted a new job.

When I put in my two week notice from my old job, they fired me on the spot despite working there for three years with great relationship with all my coworkers.

This has taken a toll on me and my trust seems shattered.

What can I do to help myself?

It sounds like when you put your two week notice in they terminated your job, and that's more of a human resources type of issue, and you want to talk to your HR department about that.

Why were you terminated when you put in your two week notice?

It might have to do with your employer not wanting to have on record that somebody was, was quitting the job.

They'd rather see them terminated.

It's difficult to say it's going to affect your trust, but I would suggest go back to that previous workplace and, you know, you have a right to be able to find out why you were fired from the job after giving a two week notice and follow up with that.

Thanks for your email.

Let's go to next caller.

Hello, Julie, welcome to Matters of the Mind.

Julie, you had mentioned that you've been prescribed Xanax for suicidal thoughts.

Your partner's worried, should your partner or you be worried about the Xanax?

Xanax will help as I've mentioned previously, with anxiety very, very quickly.

And for some people, it can be helpful because Xanax is something that can help you decrease anxiety related to severe depression and a risk factor for suicide - but it's not the only risk factor for suicide - can be severe anxiety and insomnia.

So when we think about the risk factors for suicide in general, Julie, we're talking about number one, hopelessness.

When you've lost all hope in your life circumstances, it's going to put you at higher risk for suicide in general.

But other risk factors can be severe anxiety, agitation, restlessness, difficulty with sleep.

If Xanax is helping with those symptoms, temporarily at least, that can be helpful.

You probably wouldn't want to take it long term.

However, you want to find perhaps an antidepressant, medication, or other coping techniques to help you with the depression itself.

But Xanax can be very, very helpful short term to calming down anxiety.

But long term it might be detrimental for you because potentially could worsen depression for some people.

Is it addictive for people who are using it short term?

Not typically.

It can put the fire out for the anxiety for the time being, but what you don't want to do is keep it on board long term.

Because as I mentioned, it sometimes can cause you to need more over the course of months, years, or however long you might be taking it.

And it can cause you to feel kind of cognitively or mentally dull the longer you take it.

Thanks for your call.

Let's go to our next caller.

Hello, Sammy.

Welcome to Matters of the Mind.

Sammy, you had asked, about your child.

Your child's really worried after about a tornado hitting the house after all these storms, is there anything you can do to help him with, anxiety and worry?

I hear about storm worry with children, not uncommonly, Sammy.

And what I recommend you do is help your child understand storms and, allow your child to become somewhat of a mini meteorologist.

Because if you have an understanding of the storms, their patterns, get them to understand the the whole, flow of of the cloud formation when storm and what directions the storms are going, allow them to look at radars.

But very importantly, allow your child to know that there is safety that you can proactively anticipate.

You can go to the basement.

You can go to a safe environment.

But unlike 20, 30 years ago, we have radars.

We have all sorts of ways to predict when a storm might come up and where it might be hitting your house.

I think the biggest concern children will have, Sammy, when they talk about tornadoes and they are fearful of storms as they don't understand them.

If they could understand them better and understand that they can be somewhat predictable in the path they're going to go, and very importantly, you can do something about it.

You can take you can be safe, you can get in a safe environment.

You can get in an area where you have stability in the walls around you.

There are things you can do about it.

So, number one, help your children understand the nature of storms, why they occur.

It's going to be part of their lives and very importantly, help them understand there's ways to predict them and to be able to take shelter during that time.

Sammy, 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 MattersoftheMind - All one word @wfwa.org.

And as I mentioned before, go ahead and give me a first name and let me know from what, town you're viewing and makes it a little bit more personable that way.

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

God-willing and PBS-willing, I'll be back in next week.

Thanks for watching.

Good night.