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 get to choose 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 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 during this program, you may text or call me with a question.

Let's start with a caller from Mary from Fort Wayne by the name of Mary.

Hello, Mary.

Welcome to Matters of the Mind.

Mary, you had said that you Zoloft for anxiety, but it didn't seem to work.

What anxiety medication would be best to take?

Well, Mary, the first question I would ask would be what type of anxiety are you experiencing?

How long it's been going?

Has it been going on, and what else have you tried for anxiety?

Number one, what kind of anxiety might be there?

There's different types of anxiety, Mary.

There's a kind of anxiety where you worry and that's called generalized anxiety disorder, where people feel tense, they dwell on things.

They're worried more about the future possibilities as opposed to past events.

And they have a lot of doubt.

They will often get various physical symptoms as well.

That's a day to day phenomenon that occurs over the course of at least six months.

Then you have post-traumatic stress disorder as an anxiety condition, Mary.

PTSD as a condition where you've had some kind of traumatic experience and it will cause you to be jumpy, you're on guard, and you often have nightmares and even sometimes flashbacks of the bad events occurring.

Whole different type of anxiety.

Social anxiety is where you get anxious, specifically in the presence of others when you're in social situations.

You can have what's called panic disorder, where you get a blast of anxiety.

It comes out of nowhere and people often feel like they're going to die.

They're getting really dizzy during panic attacks.

They will peak within a matter of five minutes or so often last just a few minutes.

And you have obsessive compulsive disorder, OCD, where people will think about things over and over and over again.

They know they're illogical, but because of those obsessions, they will then do things over and over again to try to prevent the obsessions.

And those are called compulsions.

So obsessive compulsive disorder is another type of anxiety.

We will treat all those different types of anxiety differently, Mary.

So I have a few questions for you.

Right off the bat, I first want to know what kind of anxiety you are experiencing.

Secondly, I want to know how long it's been going on.

Can you trace it back to something more recent or has it been ongoing?

Thirdly, I'd want to know.

Okay.

Outside of Zoloft, what, if any, medications have you tried over the course of time?

Then I want to know what your family member is, if any first first degree relatives, especially mother or father, brother or sister, any first degree relatives who have responded particularly well to certain medications.

And finally, but very importantly, do you have any medical conditions that might be potentially exacerbating the anxiety?

For instance, we'd want to evaluate you for something like a pulmonary embolism.

We have a blood clot in your in your lungs that can cause you shortness of breath and anxiety.

Some people can have difficulty with high thyroid.

They can have difficulty with blood sugar disturbances.

It will cause a lot of anxiety in a lot of cases.

Some people will notice anxiety when they're having a condition called sleep apnea, where they're snoring at night.

They're not getting enough airflow.

At night.

They'll wake up sometimes with anxiety.

But even with sleep apnea, you can periodically have difficulty throughout the day having anxious symptoms.

Supplements and foods can sometimes bring on anxiety.

Obviously, caffeine and high amounts can bring on unnatural anxiety, but sometimes even supplements can do that for some people.

I've heard a lot of good feedback about ashwagandha as an herb, but for some people, they hate it because it will affect their hormones in such a way that they feel more anxious with it.

So what I often do with supplements is I'll have people go back to when they started the supplements.

Was it two months ago?

Was it four months ago?

And then when did the anxiety start?

If the anxiety started, especially after they started taking the supplements, I'd want them to do away with that supplement.

I do hear about people having gluten intolerance still.

Those are people who are sensitive to wheat products.

So a gluten intolerance sometimes can cause anxiety in various other food.

Food food intakes can cause anxiety.

It all comes down to trying to track down what caused the anxiety to start.

And when did it all start for you?

So there's a lot of different things we'd assess.

Zoloft is one of several different medications we use for anxiety.

Some people with generalized anxiety, for instance, will do well with Buspar or Buspirone twice a day.

That helps with worry.

It doesn't help so much with panic attacks or post-traumatic stress disorder or even social anxiety.

But Buspar can help with worry or generalized anxiety disorder if you have PTSD or post-traumatic stress disorder will often recommend a medication like Prazosin or guanosine.

Those medications can sometimes settle down the jumpiness or the hypervigilance that can still be occurring for post-traumatic stress.

Gabapentin, also known as Neurontin is a medication people can take as needed for situational anxiety.

And if Zoloft is not helping that much, I'd want to know.

Okay, what dosage did you use?

How long did you take it?

Because if you took it for at least 2 or 3 weeks, you should have felt something.

If you didn't feel anything, the question would be, okay, you might be a fast metabolizer of Zoloft.

Your body chews it up real fast so you can increase the dosage and see if that helps any.

Zoloft or any medication in that class of so-called selective serotonin reuptake inhibitors should give you a little bit of a emotional dampening effect.

It's kind of called emotional numbing and emotional numbing for some people with a lot of anxiety will feel they'll be grateful for the emotional numbing.

But many people will say that emotional numbing is uncomfortable because they don't feel sad, they don't feel happy, they just feel numb and they don't feel anything.

That means typically you're taking too much of it.

But Zoloft at the proper dosage could dampen down anxiety in general, no matter what kind of anxiety you're experiencing.

But you've got to get the right fit for what's going on for you.

So, Mary, talk to your clinician about possibilities and how you could treat anxiety with medication other than Zoloft.

Even if you need a medication, possibly you could be given relaxation exercises.

But most importantly, if you have an underlying medical condition, it's causing them.

Get that fixed.

Mary, thanks for your call.

Let's go to our first text.

Hello, John from Fort Wayne.

You had asked.

Most of us don't live to see 90 years old.

90 plus is a challenge.

Are there physical challenges or changes in the human brain at 90 years old and that cannot be denied another ways to combat aging at 90 years old.

About one out of three of us, John will have what's called Alzheimers dementia or some kind of dementia when we get to be 90 years of age.

If you get to be 100 years of age, it's a 50-50 chance of having Alzheimer's dementia.

Alzheimer's dementia is basically a difficulty with short term memory, and what happens over the course of the decades will be the side parts of the brain will start to shrink up.

So where my hands are, that's the brain looking at you here.

That's the side part of the brain.

The side parts of the brain starts shrinking, and that will cause people to have difficulty with more and more memory.

What are some of the best things you can do as you get older?

Number one, I think the research is showing more and more strength.

Strength exercise is one of the best exercises you can do.

Some kind of resistance training, weight training.

It's something that older people often don't like to do.

But as you can, if you can retain your your muscle strength, if you can retain your muscle strength, it actually helps the brain.

There are chemicals released from the muscles when you're doing strength training that actually will help the brain.

Secondly, very importantly, as you get older, it's important to socialize when people get more socially isolated, which is so common as people get older.

If you can, if you become more socially isolated, you're more likely to have brain disturbances.

Thirdly, it's important to keep your brain busy.

This is why retirement for some people, if they retire in their 60s or even early 70s, they can have a Dickens of a time keeping their brain exercising.

You need to exercise your muscles in your body, but you also need to exercise your brain.

So keep your brain active somehow, some way and try to learn new things.

Learning new things will cause what's called neuroplasticity in the brain means the brain is appropriately adapting to changes around you, and it's getting more fluffy.

The individual neurons will get more fluffy with learning of new activities.

And when you're in the workplace, you're often talking to people.

When you're in the workplace, you're keeping your mind on different things.

Your brain's getting activated.

But retirement sometimes can be devastating for some people because it makes them less active to socialize, and they will not use their brain as much.

So keep your brain active as time goes on.

Those are the best things I could recommend for you.

John.

John, thanks for your text.

Let's go to the next caller.

Hello Andy.

Welcome to Matters of the Mind.

Andy, you want to know about coffee candy can help with certain mental health conditions, I believe by coffee candy.

Andy, you're referring to candy that contains not only coffee, but some caffeine.

A little bit of caffeine.

Up to 300mg a day can be safe for activating your concentration and attention span.

Caffeine, no more than 300mg a day or so could be safe in that regard.

So coffee candy.

If it contains true coffee with the caffeine, it can be somewhat helpful.

I often discourage people from taking caffeine tablets because they're just too easy to take.

You just knock them down and there's about 200mg in those tablets, and you just probably don't want to take caffeine tablets.

But if you have a lozenge like coffee candy, which is which I think you're to which you're referring, that can be helpful with a little bit of caffeine.

But caffeine can be helpful with concentration, focus sometimes making you more alert and awake.

Because what caffeine will do, it'll block these little adenosine receptors in the brain.

As you go through the day, adenosine gets released into your brain.

Adenosine as the A in ATP, which goes to ADP, and that's your energy fuel of the brain.

Adenosine.

As the day goes on, as it's getting released, it's like fumes of a car.

It just kind of makes you more tired.

So what you want to do is you want to block the Adenisine.

And the way you do that is with caffeine.

So caffeine can block adenosine, allow you to be more awake because it fools your brain into believing that you don't have as much adenosine around.

Now, the better way to take care of adenosine is take is to take about a 20 to 30 minute nap midday.

That is much better in terms of clearing out the adenosine.

If you block the adenosine with caffeine on the caffeine receptors, the adenosine still hanging around for a while so you can get tired again.

The key with any caffeine is to use it very gradually and slowly, because caffeine gets out of your system after about an hour, an hour and a half in general.

So you want to use it very gradually over the course of time.

Thanks for your call.

Let's go to our next text.

Hello, Steve from Fort Wayne.

You had asked.

Lots of peer reviewed research has shown that therapeutic, low carb keto diets are very effective against any number of mental issues.

Any comments on this therapy versus using a medication used recommended by the drug industry?

Steve I couldn't recommend a low carb ketogenic diet more.

Number one, it'll control your weight in many cases.

Now, some people can crash with a low carb ketogenic diet and they don't feel well.

So with supervision you want to kind of transition into it.

You don't want to all of a sudden go low carb because you can feel really, really tired initially, way, way back in the 1990s was it even made me 1980s.

Doctor Atkins had the Atkins diet.

He talked about basically a high fat, very low carb diet and had a lot of promise in as people studied it more and more, they have found that low carbohydrate, more ketogenic diet, which is releasing ketones in the body, which can give you an energetic effect, were very helpful.

A low key, ketogenic diet, a low carbohydrate diet actually was found to be helpful in preventing seizures for children prone to epilepsy over 100 years ago.

So we've known about this low carbohydrate diet.

But here's the challenge in our society we are exposed to such an abundance of different food sources.

And there's carbohydrates, there's sweets, there's processed foods all over the place, and it's hard for many people to stay away from.

But if you can have the discipline to stick with a low carb ketogenic diet, that can be helpful not only for your physical health, but also for your mental health.

Now, I've seen the same kind of good results for many people who don't have type one diabetes necessarily, but for many people, they'll get good results in a similar manner with.

With interval type of of eating, where they will wait for 12, 16, even 20 hours and not eat.

So they'll have long periods of time where they don't eat.

They drink fluids during that time, but they won't bring in calories for a 16 to to 20 hours in a lot of cases.

So for those people having the intermittent fasting, which is what the name of it is, intermittent fasting can have a similar effect for some people as a low carb ketogenic diet.

But many, many studies have been showing that a low carb ketogenic diet can be effective for various mental health conditions as well as your physical health.

Thanks for your text.

Let's go to our next caller.

Hello, Bill.

Welcome to Matters of the Mind.

Bill.

You want to want to know, can you expect to ever maintain a relationship with your brother who has antisocial personality disorder?

Antisocial personality disorder, Bill, is where an individual just really doesn't have any concern or empathy about the needs or concerns of anybody else.

Now, what causes that?

Well, it often leads to criminal behavior because as you can imagine, if you don't have any respect for the rights of others, you're going to be often prone to breaking the law.

So for those people, it's very difficult to treat the kind of condition.

Can you establish a relationship?

All you can do from your perspective is try to be empathetic and and understanding toward your brother, but you might not necessarily have that kind of relationship.

It's something that it varies from person to person.

There's different degrees and severities with antisocial personality disorder.

Some people will get in trouble with the law and they end up in prison.

Other people have a lot of difficulty with social interactions with work interactions.

If you can be the loving sibling, that's going to be your best role you can have and try to be there for your brother in the event that he inevitably has trouble with other people and and work in life situations.

Thanks for your call.

Let's go to our next email question.

Our next email question reads.

How do I deal with the anxiety I get almost every Sunday evening?

I rarely look forward to Mondays.

I think you're referring to your work situation in that Sunday evening.

People can have anxiety.

Okay, the first question you ask is why are you having anxiety concerning your work situations?

Is there something or somebody at work that's causing you to have anxiety?

Now, I'm not one to tell people just haphazardly to go out and find another job.

But you can look you can look at the possibilities of other work situations you might have.

But most importantly, I'd want to address the potential problem at hand.

If there's a situation or people at work that is that could be causing you anxiety, I'd want to try to deal with those type of situations or people and work through the problem itself.

I'd also want to thank.

Okay, what is it about your work the next day?

Is it that you feel sad about going to work?

Do you feel like the work is not fulfilling?

Again, you could always look for other jobs while you're maintaining this job, because I wouldn't want you to just quit a particular job without having something else in mind.

But it's always nice to be have to have gratitude and be content with what you have, because you might have even more anxiety if you didn't have a job.

You might think, well, that's great.

I'd just live off government assistance and be basically on vacation every day.

It doesn't work that way.

Many people who don't have meaningful employment on a day to day basis, where they're getting rewarded with some kind of finances will have a lot of difficulty with depression and anxiety because there's a lot of uncertainty concerning their future.

They want to be in control.

They want to be in charge of their life future.

And the best way to do that is to maintain employment.

So I think the anxiety for the next day, I'd want to know what kind of issues might be going on that are causing that anxiety.

But I'd also try to encourage you to find gratitude in what you're doing on a day to day basis, as opposed to wishing you didn't have that kind of work situation.

Thanks for your call.

Let's go.

Next caller.

Hello, Hannah.

Welcome to Matters of the Mind.

Hannah, you want to know what is normal?

What is normal?

Well, if you're mentally and physically healthy, Hannah, you should be able to, within your capacity, physically do things on a day to day basis that will allow you to feel somewhat socially and occupational and academically fulfilled.

You should be able to do the kind of things that you'd be expected to do on a day to day basis, so you'd be able to sleep adequately.

You'd be able to concentrate well enough to get your daily duties done, and physically, you'd feel good enough to do all these things.

That means you're you're feeling normal now.

If you get sad once in a while, you get anxious.

You get angry.

That's okay if the situation calls for it.

But sadness, anger, happiness, apathy, anxiety, all those kind of emotions should fluctuate day by day based on your circumstances to some degree.

But if you're walking around and you're just always anxious and you're on edge day by day by day, that's not normal.

Especially if it starts to interfere with your daily abilities to get things done.

So normal means you're able to basically achieve your goals within your capacity.

Now there's going to be different directions you might be going in terms of what goals you might have in mind, but you should be able to keep moving forward and be able to find your life somewhat fulfilling.

And as I mentioned before, the ultimate goal of normal and for that matter, or happiness and joy will be to find gratitude in what you're doing on a day to day basis.

Thanks for your email.

Let's go to our let's go to our next email.

Our next email.

Why does exercise slow down the heart rate when perform regularly?

Is the decrease of heart rate related to improvement in mood?

Yeah, actually it is.

The improvement in mood can be related to decrease in heart rate.

You might think it's weird because when you're exercising, your heart rate increases, but eventually as you exercise on a regular basis, your heart rate starts to decrease, decrease, decrease.

And that happens with marathoners.

If you're training for marathons 26.2 mile races, you're hurry can be in the high 30s, low 40s very regularly.

So when you exercise, there's a particular peptide.

It's a piece of a protein that's released in your heart called atrial natriuretic peptide.

Atrial natriuretic peptide, ANP, is a little peptide, little protein piece that gets released from the heart is youre exercising.

And it actually slows down your heart rate, but actually has a component that will go to the brain and give your brain a good effect.

Now, exercise also not only will slow down the heart rate, but it also will increase glutamate, which is an activating chemical in the brain.

But it also increases GABA which is the brakes on the on the brain.

So you've got glutamate which is the accelerator on the brain.

You've got to Gaba, which is the brakes on the brain.

At the same time when you're exercising glutamate and GABA will rise.

So in essence, you're getting this energized effect from glutamate.

You're getting a calming effect from Gaba.

So many people, if they exercise about 35 minutes, 45 minutes typically is what people will notice.

You can feel not only energized but calm.

And that's why I always tell people getting to the gym, starting to exercise, going for a walk.

Initially, getting out the door is the hardest part.

Once you do it and after you're out there 20 30 minutes, okay, you're getting a little bit tired, but you're starting to feel better and many people will hate going to the gym.

They'll hate going out for a walk just to get out there, but once they get out there, they feel much better.

And that's the reason.

The reason will be they're getting the ANP increase from the heart that's slowing down their heart rate.

Eventually they're getting the good effects of glutamate and GABA.

And in doing so they can feel better in a lot of different ways.

Thanks for your call.

Let's go.

Our next caller.

Hello, John.

Welcome to Matters of the Mind, John.

You'd mentioned your 70 year old mother is going off clonazepam, that's also known as Klonopin.

She's going off clonazepam after 20 years.

Will there be any withdraws?

And why would her doctor want her to take her off this medication?

Well, when you get over 55 or 60, you can start having trouble with the so-called class of benzodiazepine medications.

The benzodiazepine medications include medications like clonazepam, Xanax, also known as alprazolam, diazepam, also known as Valium.

And if you're on that class of medication, what's happening is you're getting this constant stimulation of GABA, which is the brakes on the brain.

So you're getting this calming effect all the time, and you kind of get used to it.

And not commonly.

People will go higher and higher on the doses, but some people will stay on a relatively low dosage over the course of ten, 20 years.

But they're always getting this brakes on the brain.

So if you think about GABA as being like the brakes in your automobile, imagine going down the interstate and inadvertently having your left foot kind of on the brakes the whole time.

You're pushing the your right foot on the accelerator and you're wondering, why can't this car get going faster?

I'm trying to go up to 70 mile an hour and I just can't get going.

It's because your left foot lightly on the brake.

That's what clonazepam does to your brain.

It's staying on the brakes the whole time.

And as we get older and we get more sensitive to that, as I mentioned previously, as we get older, we tend to have more trouble with memory as it is.

Well, with clonazepam, you're going to have even more trouble with concentration, memory, keeping your mind on things.

And I've taken people off of clonazepam after 20 years, and they say they feel like they have a new brain.

Well, basically, I've taken the brakes off their brain by taking them off of it.

Now, here is the key with clonazepam.

Yeah, it's potentially addictive.

It can give you difficulty if memory and concentration.

It can also increase the likelihood for falls.

But the key with clonazepam, the longer you've been on it, the more likely you need to slowly come off of it.

My rule of thumb with clonazepam, Xanax or alprazolam or any medications in that class will be for every year you've been on it.

I want to take that number of weeks to have you come off of it.

Now, the textbooks will say that you can come off clonazepam after about 2 or 3 weeks.

Okay, that's the textbooks.

But in the real world, people often need about 20 weeks to come off clonazepam.

Clonazepam, if they've been on it for 20 years.

So I'd roughly say 5 or 6 months, I'd have somebody go down very, very, very slowly to try to allow their brain to readjust.

Because if your brain has had this soft braking on it for 20 years, you have to remember it's going to notice, it's going to get activated and awakened.

And you might have a tremendous amount of anxiety and difficulty with sleep if you come off of it too quickly.

I mentioned earlier a medication called gabapentin or Neurontin.

Gabapentin or Neurontin is a medication that works.

Sounds like it would work on GABA, but it actually works on little calcium channels.

It works on a whole different network of neurochemistry compared to the benzodiazepine.

So gabapentin often can help with anxiety in a different way than clonazepam and help people kind of with that withdrawal process over the course of time.

But my hope would be somebody could come off of clonazepam very comfortably, but do it very gradually over the course of time, and people often notice they feel much better once they're off of it.

Thanks for your call.

Let's go to last email question.

Our last email question reads, Dear Dr.

Fawver, what is the difference between happiness and joy?

I mentioned those earlier.

What seems to be the key to happiness, happiness and joy?

Happiness is more a day to day phenomenon.

That's affected by situations.

Okay, so happiness is a mood where you will notice that you feel happy, angry and anxious.

Sad.

You can have all these different emotions based on stuff happening all around you.

So happiness can be strongly influenced.

The mood by the mood.

Joy on the hand is related to contentment, gratitude.

Joy is more like the climate, whereas happiness is like the day to day weather, right?

So happiness is very transient.

It's here and there, whereas joy is more of an ongoing tone of your emotional state.

And that's what we're always shooting for.

What's the key to joy?

Well, a study out of Harvard from the 1930s, it's still going on after 80 years shows the number one predictor of they called it happiness.

It's actually joy.

Number one predictor of joy will be social connections with family and friends and people in your community.

So the number one predictor for long term joy won't be wealth.

It won't be your genetics.

It even won't be your physical health.

It's going to be your social connections.

Thanks for your email.

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

God willing and PBS willing.

I'll be back again next week.

Thanks for watching.

Good night.