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 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 via email at MattersoftheMind - all one word - @wfwa.org.

That's MattersoftheMind@wfwa.org.

if you're able to do so, you may call me by dialing 260-969-2720, or during the program, you may text at (260)969-2730.

And if you call or text.

All we ask is that you leave us a name and the city from where you are viewing.

So let's start tonight's program with an email question that I recently received.

It reads Dear Dr.

Fawver, what are the most what are you most looking forward to for the future of depression or anxiety treatment?

Are there any newer medications that stand out for you?

I think over the next few years, we're going to be hearing about a lot of medications that affect this neurotransmitter called glutamate.

Glutamate is the accelerator on the gray matter of the brain, the outside part of the brain, the thinking part of the brain.

And right now we have a medication.

It's FDA approved.

It's a nasal spray called Spravato nasal spray.

It's been on for about eight years now.

Spravato nasal spray is a means by which people can get very rapid relief from depressions.

Twice a week treatment for the first month, once a week, the second month, and every other week or once a week thereafter.

So Spravato was the first of the bunch that got FDA approved for the treatment of depression.

And now we have Auvelity.

We've had Auvelity available for about five years now.

Auvelity is a medication that is an oral medication that will also affect glutamate.

So again, if you affect glutamate you're going to get fast relief and rapid onset of action with an antidepressant medication.

And we're getting away from the medications that exclusively affect serotonin, norepinephrine and dopamine.

Think about glutamate as being the accelerator of the brain.

Gaba is the brake on the brain, so glutamate and Gaba in the gray matter of the brain are kind of like a teeter totter.

And they've got to be in balance.

On the other hand serotonin, norepinephrine, dopamine they're coming from the brainstem part of the brain down here.

So they're kind of giving advice to glutamate and Gaba, whether they should enhance their actions or dampen them down.

So, norepinephrine, serotonin and dopamine have their roles as well.

People frequently ask me, well what's the role of psychotherapy?

Talk therapy.

We're always talking about these medications.

We'll keep in mind psychotherapy or talk therapy acts as the GPS for your daily activities.

When you go to an unfamiliar city, you're often going to use your GPS, and that little personal GPS machine is going to be telling you, turn right, turn left.

Keep going another mile or so.

It's giving you direction in an unfamiliar area.

That's what psychotherapy does.

If you have little experience in a particular stress in your life in which you're enduring, if you don't have coping skills to deal with that stress, psychotherapy is there for the purpose of giving you direction to reach your eventual treatment goal.

So as we talk about medications for depression anxiety, I think there's going to be a lot of emphasis on glutamate.

You're going to hear a lot about the psycho stimulant medications like psilocybin.

Psilocybin.

A tiny microdosing can be helpful for people with severe depression and post-traumatic stress disorder with maybe one dosage.

I just saw a recent study showing that one dosage of psilocybin in a controlled environment did give people dramatic relief with suicidal thinking.

Now what psilocybin is doing, it's affecting a chemical in the brain, a particular receptor called serotonin, two way receptors.

And if you affect that specific receptor, serotonin two way receptors, it's one of 14 different receptors for serotonin.

But if you affect that simple receptor, you can kind of get the brain out of the funk, where if you have depression, it's a severe depression with suicidal thoughts.

It's thought that you have a kind of an idling going on in the brain where you can't get out of the idling.

What you need to do is get it gear and get going.

But when you have severe depression, you can't get it out of that idling and you idle with ruminative thoughts, past regrets.

You think about suicide.

So what do you do?

You address it by stimulating the serotonin to a receptor very abruptly, but very briefly.

And in doing so, that's how the psycho stimulant medications can be effective for depression and post-traumatic stress disorder.

We're here in the same type of efficacy with some people with medications like LSD, which has been around for 70 years now at tiny, tiny, tiny microdosing.

My hope in the future for the treatment of depression and anxiety, however, will be that will have measurable means of determining if our treatments are working in the everyday population.

In clinical trials, we're getting symptomatic relief, which is great, but I want to see us actually have measurable means of determining if somebody is getting their lives, their lives back.

Now we have some functionality scales where we're determining if people are getting back to work, they're socializing, they're enjoying things.

That's great.

We need to do that.

But I think we need to step it up a notch and figure out how much people are able to able to get their lives back once they get out of the out of severe depression.

So I'm hoping that will be the case as well.

Thanks for your email.

Let's go to our next email question.

Our next email question reads, Dear Doctor Fawver, with so many medications available, how does a person overcome side effects despite the medication being effective?

My goodness, we hear about that.

Not uncommonly, medication is really working for you, but you're getting side effects from it.

The first thing we'll typically do is lower the dosage.

We're always trying to ideally idealize or optimize the dosage of a medication.

It's not unlike going to an ophthalmologist who's giving you different lens strengths.

And you're trying to look at the eye chart and figure out which lens strength on the little lens in front of you.

It works the best.

That's what we're often doing with medications, and I'm frequently asking people, if you take a medication at a certain dosage and you're at 50mg when you increase this 100mg, did it work any better for you or did you feel any differently?

And if they say not and feel it differently, or if they say I felt worse going up to the higher dosage, that's kind of a no brainer.

Drop it down a little bit to the lower doses, because a lower dosage might be more efficacious, might work better than the higher dosage, with fewer side effects.

So we're always trying to find that lower dosage.

Now we can do genetic testing.

Genetic testing won't tell you everything, but it will give you some clues if somebody is a fast metabolize or a slow metabolize.

In other words, how quickly do they chew up the medication?

So if somebody chews up a medication really quickly, we need to give them a higher dosage.

If they're a slow metabolized and they slowly break down a medication, we need to give them a lower dosage.

And we'll see that with genetic testing.

So that can help us to some degree.

But quite frankly, just talking to people and asking them, how do you feel when you went to the higher dosage versus when you're on the lower dosage?

So we're trying to optimize that.

A second thing we can do when a medication tends to work really well, but it gives intolerable side effects, is we might try to find a chemical cousin to that particular medication that works in a similar manner in terms of its mechanism of action, but yet doesn't have the same side effects.

So we might find a medication that works on serotonin, norepinephrine, in such a way that it's working well, but it's causing too many side effects.

We might find a chemical cousin to that medication that won't cause the side effects overall, so there are ways to get around that.

Rarely do we want to add on another medication to the first medications that's causing side effects.

But sometimes you can do that where you if somebody, for instance, has diarrhea from one medication, but they feel really good, well, drop the dosage.

That's the first thing you're going to do if you tried.

Another medication has similar mechanism, but it doesn't work as well.

Okay.

You come back to the medication, you find that dosage and it's working really well, but doggone it, they're still having diarrhea.

What do you do?

You give a small dosage of another medication that also maybe can work for the same kind of symptoms, but it's mildly constipated.

So sometimes we'll intentionally pair medication together because they have opposing side effects.

Don't like to do that, but sometimes it's necessary.

Thanks for your email.

Let's go to our next caller.

Hello, Judy, welcome to Matters of the Mind.

You want to know what is the difference between PMS and PMDD?

A lot of acronyms there.

Premenstrual syndrome is PMS.

Premenstrual symptoms is often used as that term.

Premenstrual symptoms are symptoms that occur in about four out of five, maybe nine out of ten menstruating women, and it occurs about five days before the periods month by month.

Very predictable.

And it can have emotional symptoms such as irritability, depression, sadness.

It can have physical symptoms such as bloating, breast tenderness, sometimes headache, and they'll notice them very characteristically for about 4 or 5 days, maybe seven days before each period.

And then once the menstrual flow starts, the symptoms stop.

That's PMS.

The difference between PMS and PMDD.

Premenstrual dysphoric disorder is PMDD.

PMDD is functionally impairing.

In other words, when you have PMDD, you don't have underlying depression throughout the month.

You just have really bad symptoms of PMS.

Those 5 to 7, maybe 14 days before each period and then once a period starts to feel better.

But during those days of the premenstrual days, you're feeling just terrible.

You can't function, you don't get along with other people, you have trouble going to work.

You have trouble going to school.

Perhaps you have trouble getting things done in your life.

That's PMDD.

So if PMDD, premenstrual dysphoric disorder is functionally impairing, premenstrual symptoms are annoying.

They're present, but they're not impairing in such a way that you're not able to get stuff done.

You might notice them, but you can still get stuff done.

The difference being with treatment, PMDD has a couple treatments that got FDA approved Food and Drug Administration approved about 25 years ago, called Zoloft, also known as sertraline and fluoxetine, also known as Prozac.

These two medications were FDA approved where you could take them every day of the month if you wanted, but you could actually take them just on your premenstrual dysphoric disorder day.

So if you felt really badly, functionally-impairingly badly for 5 or 7 days a month, you could take a medication like sertraline or Zoloft just on those days and go off of the medication when you start your menstrual flow.

And many people would say, well, my goodness, Prozac and Zoloft for depression and anxiety.

You have to take those every day for them to even work, and it takes them up to six weeks to go to work.

Well, with premenstrual dysphoric disorder.

It's a little bit different phenomenon because with premenstrual dysphoric disorder, what you're trying to do is increase serotonin in the brain.

And after taking a search relief dosage or a fluoxetine dosage within 20 minutes, you're going to get search whirling enhancement in the brain.

So you're going to notice a very quick relief with that on the premenstrual disorder day.

So that's called pulse dosing.

Pulse dosing - P-U-L-S-E.

Pulse dosing is where you only give the medications on the days where you have the symptoms fairly fairly unique phenomenon.

But it also tells us that premenstrual dysphoric disorder is different from depression or anxiety that we often treat on a day to day basis.

Judy, thanks for your call.

Let us go to our next text message.

It comes from Bailey.

Hello, Bailey.

You had mentioned that you have a lot of anxiety with random people talking to you in public.

You get scared easily by them and yell at them when you're have anxiety from strangers in public.

I'd wonder, Bailey, about the context behind that.

If you're getting overly stimulated from a lot of people in public, okay, that could be a phenomenon where your brain is having a difficult time filtering out extraneous stimuli.

So extremely, extremely stimuli are filtered out by this operating center right in the middle of the brain called the thalamus.

So when you get all this sensory input coming in, the thalamus is like the central operator that sorts it all out.

Some people, for instance, with autism, some people with ADHD will have difficulty filtering all that out, and they have trouble feeling really anxious because there are filter isn't working so much and there central operator just gets overwhelmed.

So what will often do is first identify what's the issue itself.

Now be aware that when you get in the presence of a lot of people, you don't want to start yelling at them because that's going to get you in trouble.

So be aware of the social consequences of how you react in those situations.

Okay, you might need to avoid the situations until you get the underlying issue treated.

But you could have autism.

You could have ADHD.

There's a phenomenon called social anxiety disorder.

But the issue usually isnt from overstimulation.

With social anxiety disorder, it's where you feel, as the name implies, really anxious.

In social settings, it's often a self-esteem issue.

You're afraid of embarrassing yourself or doing something that you'll later regret.

That's social anxiety itself.

If you're having difficulty with overstimulation with people and it just comes and goes, that could be a mood disturbance like bipolar disorder, where if you're in a manic state, all the input comes in a really, really fast and you can feel readily overwhelmed.

So I'm thinking diagnostically, you could have a condition like autism, ADHD, you could have bipolar mania, you could have possibly social anxiety.

But with any of those conditions, we're going to treat them entirely differently.

But that's why I think it's a good idea for you to get assessed, to make sure those conditions get in good control and hopefull in a small incremental manner you gradually get out and you're out more and more people as time goes on.

Thanks for your text.

Let's go to our next text.

Hello, Tom from Columbia City.

You have a question about adopting a dog helping with mental health.

Yeah, that's a really good idea, Tom.

Many people will want to have a means by which they can adopt a dog and thereby not have to pay rent in a, or able to take the dog in public.

As an emotional support animal, I want to get away from even discussing that.

That's a whole different level of need.

Many people with post-traumatic stress disorder, many people with autism in which I mentioned earlier will need that emotional support animal.

But just in general for your mental health.

Dogs are fantastic because dogs have what we consider a soul.

Now, not all animals or insects have souls.

A dog has a soul, and when an animal has a soul, it means you have reciprocal back and forth.

Okay, so the dog will look you in the eyes a dog I've heard dogs can understand up to 200 words.

I think my dog Winnie can understand 300 or 400 dogs because he's he's exceptionally smart.

But she was adopted from a shelter.

And when he has been around for with me for seven years.

And dogs are fantastic for your mental health.

They greet when you get home.

Dogs will be very non-judgmental of you.

Dogs will listen to you when you're having any difficulties.

They will go out and walk with you.

They're always willing to play.

There are so many advantages with dogs.

Now cats, I've had cats, too.

Cats, so that's a different level of engagement.

And I know a lot of cat people versus dog people.

They'll have a lot of debates on what's the better pet.

But the bottom line is, I think having a shelter animal that has that soul and has that reciprocal back and forth with you can be very helpful for the mental health in general.

Now, if you have a mental health condition such as autism, ADHD, post-traumatic stress disorder.

Yeah, I think there's some treatment advantages.

And having an animal, a emotional support animal in those cases as well.

Thanks for your text, Tom.

Let's go to our next email question.

Our next email question reads, Dear Doctor Fawver, does Red-40 and other artificial colors cause behavioral or mental health problems?

Red 40 has been around for decades now, and my understanding is in the United States, red 40, which is a food coloring, by the way.

It's going to be removed from the market in the next year.

So red 40, there's a particular condition we've talked about with the red 40, the red dye for about 40 years now.

And it's been a debate back and forth.

And it has to do with children with attention deficit hyperactivity disorder.

If you if you're a child with ADHD and you take in a red dye, you might have more difficulty with irritability and emotional meltdowns from taking the red dye.

What I tell parents, what I tell adolescents, what I tell young adults is just watch for having difficulties in your mood based on what you're consuming.

But for many people, they'll notice that if they eat biscuits or rolls from a certain restaurant, they feel really depressed and fatigued.

Okay, that might be a gluten disturbance.

So in those cases, be aware of what causes you to react.

Red 40 does not seem to cause mental health problems for people who don't already have ADHD and typically were not children.

But if you're a child with ADHD, the red 40 dye might be more of an issue for you.

Like I said, there's expectation that's going to be taken off the market by the end of this year.

But it all comes back to identifying is it causing a problem when you consume a particular ingredient or not and try to track okay, is there any pattern and you're feeling more irritable or having more meltdowns in certain situations?

And the same with children.

I mean, if you identify a child as having a lot of irritability and anger after consuming some cereal that seems to have some red dye in it.

Red dye is in foods to make them prettier and make them more appealing.

But you know that red 40.

It's a petroleum based die that unfortunately can have some mental health problems.

If you already have ADHD, if you don't have ADHD, there's no evidence that it's causing mental health problems.

But that's always up for debate as well.

Thanks for your call.

Let's go.

Next text.

Hello, Rita from Fort Wayne.

You had a text about hearing about.

One must be off of all psychotropic medications before using psilocybin.

You take four different medications and would be reluctant to take all the to stop all the medications.

You have PTSD, depression, and anxiety.

We're still trying to identify how this is all going to go down, Rita, because in the clinical trials, as you would expect in a clinical trial for depression or post-traumatic stress disorder, if you're going to study psilocybin, which is basically mushrooms, a particular part of a mushroom, psilocybin needs to be studied by itself in clinical trials.

That's how it was studied.

Psilocybin is not close to being an FDA approved because there's a lot of debate going back and forth on, okay, what's the protocol?

Because you're not going to just get a prescription for psilocybin at your local retail pharmacy and take it home and get on the magic carpet ride in your in your dining room.

It's not going to happen.

You're going to have to use psilocybin with close supervision in a clinicians office, and you'll be in there for anywhere between 1 to 4 hours.

That's all been discussed right now, but right now psilocybin is being studied all by itself.

Now, once we get it in our hands clinically, we're going to find that we can sometimes use psilocybin with other medications.

Where do I predict that psilocybin will give people the most difficulty it'll be if they're already on a so-called SSRI, because SSRI selective serotonin reuptake inhibitors.

We're talking select Paxil, Lexapro, Prozac, Zoloft.

These are medications that enhance serotonin transmission okay.

So they're flooding the brain with serotonin.

When the brain gets flooded with serotonin, you're going to be stimulating 14 different serotonin receptors all over the brain, one of which is serotonin two way receptors.

So if you stimulate serotonin to a receptors and then on top of that you use psilocybin, which is powerfully stimulating serotonin to a receptors.

You can get some side effects from serotonin toxicity which could include such conditions as palpitations, fast heart rate, sweaty this nausea, headache.

So it could cause some side effects when you put them on top of other medications.

But in the clinical trials, psilocybin typically is being used by itself because the researchers and the Food and Drug Administration are trying to determine is psilocybin by itself effective in helping with depression, anxiety, post-traumatic stress disorder specifically?

Or does it need to be used without a medications?

We might be a year or two away from determining that.

Thanks for your text.

Let's go to our next email question.

Our next email question reads.

What advice would you give someone with ADHD who is working a desk job with little stimulation?

I previously worked in a very stimulating restaurant with success, but I am now struggling with a change of pace.

Many people, when they have ADHD, they'll gravitate.

They'll gravitate toward very exciting jobs.

They will be in jobs where there's a lot of challenges, a lot of new and exciting things going on around them.

So many people with ADHD will gravitate toward information technology, computer work.

They'll gravitate toward being first responders.

Firemen and they'll be paramedics.

They'll go toward emergency room settings.

They'll become a law enforcement officer.

So they're often gravitating toward areas where there's a lot of stimulation, very quick and exciting and challenging.

But when you get a desk job, okay, there's going to be less stress in a lot of different ways, but it just desktop job will have coming with it accounting sometimes a lot of paperwork things that might be kind of dull and mundane.

So just in general not knowing your situation particularly, but just in general, what I'd recommend for people with ADHD when they're at a desk job, it's kind of it's kind of boring and mundane in some areas.

Number one, what you're already identifying try to decrease outside distractions.

So decrease outside distractions the best you can.

I've actually seen some people with ADHD wear headphones and they'll play classical music.

Now classical music can be particularly helpful for ADHD.

I've heard a lot of people say that Beethoven is very helpful, and being able to help them concentrate and decrease outside distractions.

So decrease out distraction outside distractions.

Number one.

Number two, try to minimize getting things started but not getting them done.

So in other words, you want to prioritize what you need to get done.

First and foremost get it done.

Then the second thing get it done.

Third thing, get it done.

So you want to prioritize what you need to get done, not get started.

Many people with ADHD will have difficulty with vigilance and perseverance.

They'll have trouble with identifying what they need to get done, and they'll have trouble persevering to get it completed.

So they get a lot of things started, but they don't get things done.

So identify what you need to get done and prioritize that and get it done.

Another thing that I often identify with people with ADHD is you've got to get enough sleep.

A lot of children, adolescents, for instance, with ADHD, we'll find that it's much, much worse when they don't sleep very well.

Why do people with ADHD not sleep so well?

For one thing, you're on a bit of a different circadian rhythm where you might want to sleep in a little bit more in the morning.

But many people with ADHD, in the quietness of the night, in the darkness, as the night engulfs them, they'll notice that they want to do a lot of stuff.

So they start going to social media.

They start scrolling and be aware that social media, they care that algorithm.

It'll track what you're what you're looking at on social media.

So you've got to be aware of that.

Social media, when you have ADHD, will just capture you, and it'll be a thief of time where it just takes away so much of your time.

With ADHD, that's particularly difficult because with ADHD, you're able to hyperfocus when things are novel, challenging, and interesting for you.

So you can be on social media late at night for hours.

In the next thing you know, you've lost 2 or 3 hours of sleep and you need to get up in the morning at a certain time and you're typically sleep deprived.

Many people with ADHD will have that phenomenon occur to them, so I'd recommend decreasing outside distractions, prioritizing, and thirdly, getting enough sleep.

Those are three things right off the bat that I could invite you to try to help you in a fairly mundane desk job when you have ADHD.

Thanks for your email.

Let's go to our next caller.

Hello, John, welcome to Matters of the Mind.

John, you want to know, does Naltrexone help with obsessive thoughts?

Obsessive thoughts?

When we talk about obsessive compulsive disorder, maybe a little bit of naltrexone is an opiate receptor blocker.

As an opiate receptor blocker, it can be helpful for addictive type of behaviors.

It can help to some with some degree with binge eating and the the overthinking about food in your brain.

Obsessive thoughts maybe to some degree, but it's not something that's Food and Drug Administration approved for these thoughts.

But if somebody is saying that ever since they've been on Naltrexone 50mg, or have they been on trial injections for alcohol use disorder, by all means, if they say their obsessive thoughts or less, that's great.

I think you could have less obsessive thoughts when it comes to alcohol use, because it decreases some of the food noise or the alcohol cravings that frequently will come along with that condition.

So we'll hear about naltrexone decreasing the perseverance of the thinking about wanting to drink, wanting to drink, wanting to drink.

And we can use naltrexone either in an oral form or an enjoyable form to get around that.

We're going to be hearing over the course of time about more opiate receptor blockers that might be able to do some similar things.

I mentioned the opioid receptor blockers earlier with naltrexone.

There's another one by the name of Samidorphan.

And Samidorphan is a chemical analog or a similar kind of chemical to naltrexone.

Samidorphan can be used to decrease the likelihood of having weight gain from a medication like a Lanza pine, so we might be seeing more use of that in the future too.

Unfortunately, Im out of time for this evening.

If you have a question that I can answer on the air, you may write me a via the internet at MattersoftheMind - all one word - @wfwa.org.

God-willing and PBS willing.

I'll be back again next week.

You've been watching Matters of the Mind on PBS Fort Wayne.

God-willing and PBS-willing.

I'll be back again next week.

Thanks for watching.

Good night.