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>> Good evening, I'm psychiatrist Fauver live from Fort Wayne , Indiana.

Welcome to Matters of the Mind.

Now in its twenty second year are matters of the Mind is a live call in program where you have the chance to choose the topic for discussion.

So if you have any questions concerning mental health issues, give me a call here at PBS for Wayne by dialing in the Fort Wayne area (969) 27 two zero or if you'd like to call coast to coast toll free you may dial 866- (969) 27 two zero now on a fairly regular basis we are broadcasting live every night from our spectacular PBS Fort Wayne studios which lie in the shadows of the Purdue Fort Wayne campus.

And if you'd like to contact me with an email question that I can answer on the air, you may write me via the Internet at Dout Matters the mind all one word at a dog that's matters of the mind at WFYI a dot org and I'll start tonight's program with a question I recently received.

It reads Dear Dr. Fauver, are there any prescriptions that can help with eating disorders ?

>> Eating disorders are difficult to treat.

There's different types of eating disorders.

There's the type of eating disorders where you restrict your calories.

You naturally perceive that you're overweight and fat and that's called anorexia nervosa.

These people can have electrolyte disturbances and have severe medical problems often involving the heart and is a very dangerous situation will often use low dose antipsychotics for those people because it's truly a loss of reality testing.

>> You have a difficult time perceiving reality such that you envision yourself as being overweight when you're becoming more emaciated.

So that's anorexia nervosa.

But most people when they talk about eating disorders, they're talking about binge eating disorders or the possibility of bulimia where they're making themselves vomit after bingeing on large amount of food or some people just over overeat.

So what can you do about this population who has binge eating or over overeating?

There are several medications that can be used with some success.

The most popular have been Prozac or Fluoxetine has been around since nineteen eighty seven and Fluoxetine has actually been studied and approved for the treatment of bulimia often at higher doses than what we'd use for depression was we go up to 40, 60, even 80 milligrams a day for bulimia.

>> It has an effect not only on serotonin but it does have some specific receptor effects in the brain that might decrease the tendency to want to eat excessively.

>> Secondly, over the course of the years we've used a medication called ADAPTIX or Phentermine.

Phentermine is a medication that can be used for weight loss.

We use it very carefully if we have somebody on antidepressant medication just so we don't it neurotransmitter interactions there where somebody can have a hypertensive crisis but at a picture Phénomhne has been used basically is what it's doing is it's increasing the transmission of dopamine and norepinephrine and in doing so it can suppress the appetite.

So there's a stimulant used for ADHD called Vyvanse.

It's actually been approved by the Food and Drug Administration specifically for overeating and binge eating disorder so Vyvanse can be a medication stays in your system for about eight to 12 hours typically and not only for ADHD but also for binge eating.

So people typically take about fifty milligrams of that a day .

Topiramate is a medication has been around for a long time.

The trade name is Topamax often used for migraine headaches but when they study them for migraines they found that as a side effect it decreased the appetite significantly.

So topiramate or Topamax tends to really suppress the appetite for a lot of people.

We use it for folks who are more inclined to eat excessively in the evenings so we have them take the Topiramate or Topamax around 7:00 p.m. so they'll decrease the appetite or the decrease the excessive eating in the evening and those are the main medications will often use for binge eating or possibly for anorexia.

But a best behavioral means that I've ever seen for binge eating will be carefully doing intermittent fasting where you keep yourself from eating eighteen to twenty hours a day now during those four to six hours that you are eating again you have to be careful that you're not binge eating during that time but what it does it disciplines not to overeat in the evening hours when more people who are prone to binge eating are susceptible to doing so.

>> The appetite center is right next door to the sleep center in the brain it's in the hypothalamus us and the hypothalamus is in the middle part of the brain right there.

>> So the sleep center, an appetite center, a side by side as you get sleepy and tired in the evening off instinctually you'll want to increase your appetite and increase your eating because your brain mistakenly thinks you're actually hungry when you're just sleepy.

So a lot of people will have difficulty with eating excessively after 7:00 p.m. when they're getting more and more tired.

And for those people Topiramate can be helpful but especially intermittent fasting where they specifically quit eating at a certain time each evening 6:00 pm, 7:00 pm and they just commit that's it for the rest of the day.

>> Then they then they skip breakfast the next morning.

It used to be thought that breakfast was the most important meal of the day.

Now we're realizing is probably the least important meal of the day.

If you skip breakfast and go an extended period of time and not break the fast or have breakfast for that matter, you're more likely to be able to sustain your weight and decrease the risk of diabetes and obesity.

>> Thanks for your email.

Let's go to our first caller.

Hello Karen.

Welcome to Matters of Mind.

>> Did you say Karen?

I said Karen.

Hello, Karen.

Well, there you go.

Is it OK?

Here's the deal.

My 87 year old mother in law she's been diagnosed with Alzheimer's for like ten years ,gone fairly slowly till recently.

But because I'm a doctor well I'm seeing lately I'm thinking Lewy body dementia maybe getting into it.

She's sleeping a lot.

She's starting to see little animals and it's and that's not really a problem.

I mean we say aren't they this when yellow or what color and blah blah blah but Friday then she was like no cognition at all.

I mean there was no light in her eyes.

She couldn't figure out up or down when she tried to eat she couldn't like even seemed like maybe spacially she couldn't figure out where her food was to stab it with her fork and was just wall and asleep and whatever and I'm telling my father-In-law we need to get her in and having trouble finding words and I'm saying we need to get her in.

He's now we're realizing he's slipping some so like we need to just take charge so the next day I said OK, we're taking charge and we're getting him.

But she was better basically the next day.

Yeah.

I mean she you know I mean you know, she knows something you're saying right at that moment a minute later she doesn't know what but for that minute she's but she wasn't on Friday she was just I mean there was nothing happening in her brain so I'm thinking Lewy body dementia if it is what do we do?

>> You could have both Alzheimer's dementia and Lewy body dementia.

Karen with Alzheimer's dementia is basically a condition where the side parts your brain where my hands are slowly shrink over the course of time and it'll affect your ability to retain short her memories and have geographical orientation.

You'll have difficulty with naming things over the course of time and difficulty even drawing a clock which is a classic type of test for Alzheimer's dementia.

>> Lewy body disease is a condition where you'll have these little speckles of Lewy bodies all over the brain.

>> Now normally an older brain should have no more than point five percent of Lewy bodies and the gray matter outside part of the brain when people have Lewy body disease that percentage increases dramatically and under the microscope with a particular red stain it looks just like orange jello, a little bit of speckles of orange jello all over the brain.

And what that will do, Karen, is exactly what you've described.

It'll cause people to see small furry animals.

I don't know why they're furry and I don't know why they're small and they also see children they often refer to these babies or toddlers running around the room and many times they won't be bothered by these visual hallucination but they're often small furry animals and small kids who they see.

>> Secondly ,as you describe Karen, they'll have fluctuations of their cognition.

It'll come and go and sometimes they'll be perfectly alert on the times they'll be kind of tired and going along with that fatigue they'll often sleep excessively.

People with Lewy body disease will often get more sleepy as the time goes on.

Many times Lewy body disease is associated with Parkinson's disease and Parkinson's disease is basically a condition where this middle part of the brain way down here, the substantial nigra slowly decreases in its activity so you get less than forty percent less than 30 percent activity there.

That is part of the brain that will secrete dopamine and in doing so it allows you to have smooth movements so people with Parkinson's disease will have a difficulty with not only a tremor but they'll have trouble with a shuffling shuffling gait and they won't have much facial expression a lot of times.

>> So you'll often hear about Lewy body disease going concomitantly with Parkinson's disease.

>> But as you described, Karen, you can have both you can have a combination of Lewy body disease, Alzheimer's disease and even small vessel disease that would give you vascular dementia.

>> So the key with any of these kind of conditions is to be able to diagnose it properly and know what you're treating if it's Alzheimer's disease.

OK, you guys a few medications out there that are being used now Aricept Excelon Rhapsodize Namenda is being used as an add on medication so those are used specifically for Parkinson's disease where a few months away from having an injection I'm sorry there's a use for Alzheimer's disease.

We're a few months away from having an injection where for 30 minutes you have an injection of a medication that physically shrinks down the plaques that are associated with Alzheimer's disease and these little plaques are thought to be part of the reason why people have Alzheimer's.

>> The problem with the studies with this injectable infusion is that it didn't show that people actually had improved with memory and overall functioning.

But the question is will that change over time as people start using this medication in the real world?

>> So the Food and Drug Administration is looking at so for art's Alzheimer's disease, there's various oral medications.

There's a possibility of injectable medication and for Lewy body disease if it's associated with Parkinson's disease, you can treat it with medications that specifically will stimulate dopamine receptors.

Medications like Preme PEX all these are medications that specifically will stimulate dopamine receptors or sentiment that's been around for a long time levodopa caba dopa is the name of that medications to medications and one but that will increase the activity of dopamine in the brain and keep it working for longer periods of time.

But if it's truly Lewy body disease we do use a medication that's that's FDA approved for psychosis associate with Parkinson's Disease called New Plays a new plays has been around for a few years now and we use new plays it for people because it tends to be a medication that will tend to specifically block these receptors called serotonin 2A receptors and serotonin 2A receptors.

They're blocked with psychosis and that seems to be a mechanism by which they help with psychosis.

But it's thought that with Lewy body disease you specifically have an overabundance of serotonin 2A receptors.

It's thought that there's 14 different types of serotonin receptors and they go by a number and a letter there's serotonin a one a there's one to see two as I mentioned serotonin three.

These are all the different type of receptors for serotonin .

They all do different things and for whatever reason people with Lewy body disease tend to out and they grow more serotonin 2A receptors and with an excessive amount of serotonin 2A receptors people will get psychotic, they'll have trouble with concentration and they'll see things that the other people can't see.

So if you block those particular receptors with a medication like new plays that that can be helpful.

There's another medication.

It's come out as an antipsychotic medication for schizophrenia called Cap Leida and Coprolite is a very interesting medication.

It seems to block serotonin 2A receptors more than the so-called dopamine receptors by a factor of sixty.

So it seems to be a good medication known for psychosis with very few side effects.

But I am thinking that for people with with Lewy body disease it might also be helpful in the future as well because it's specifically dealing with the pathology associated with Lewy body disease.

>> So there are treatments one way or another.

Karen, I'd certainly suggest that you get your mother in law seen by a neurologist to try to sort out the proper diagnosis and with any proper diagnosis, you know, that's how we direct treatment.

>> So I always give the analogy if you have a cough that cough could be because of peanuts caught in your throat.

It could be because you have asthma, you could have bronchitis, you could have pneumonia, could have lung cancer.

A cough could be related to stomach acid where you're having acid reflux you can have congestive heart failure where you're having trouble with a cardiac problem giving you a cough.

So there's all different reasons for a cough and the key with treating that cough is to figure out what's causing the cough and based on what's causing the cough you apply the appropriate treatment the same is true with trouble with memory, trouble with seeing things especially as we get older we're more prone to having these neurological conditions.

So you got to figure out what's going on.

Then you prescribe the the appropriate treatment.

>> People ask me all the time, you know, how many different types of dementia are there?

>> Well, there are several different types.

There's Alzheimer's dementia, Lewy body disease, there's vascular dementia, there's all these different types of dementia.

>> But the key will be is you do treat them a bit differently.

So having dementia where you have short term memory loss doesn't necessarily mean you're going to always use the Alzheimer's medications like Aricept or Razo Dinora.

Excellent.

You might use something else depending on what kind dementia it is.

For instance, if you have vascular dementia, the first thing you always want to do is to make sure the blood pressure is well controlled because vascular dementia where you have little mini strokes and you have these little small strokes all over the brain, well that's often related to excessive blood pressure also it can be something going hand in hand with diabetes.

So you want to get the blood pressure, the diabetes, all these other medical conditions under good control for the purpose of trying to control that stepwise progressive deterioration with dementia itself.

Karen, thank you so much for your call.

>> I wish you the best.

Let's go our next caller.

Hello Mary.

Welcome to Matters of Mind.

>> Hello.

Hi, Mary.

Hello.

Hello Mary.

You're on the air.

OK, I have a question I seem to get very nervous when I expect to go to a meeting or go see a doctor or when I decide I'm going to go somewhere so I don't know what to do about that.

>> Some anxiety when you're getting ready to do something, Mary is actually good for you.

>> Anxiety is a normal emotion to degree now anxiety, happiness, sadness, anger, apathy, all normal emotions and there are described as being part of the vicissitude of life experiences.

Otherwise we'd be robots.

Mary so you want to have emotions and those emotions can motivate you to do certain things.

>> For instance, if you're sad and disappointed that can actually motivate you to change your life circumstances.

>> If you're happy and you're joyous, that gives you an appreciation for life and anxiety can do the same kind of thing where to motivate you to do something about what you're going through.

>> So if you're getting anxious about going somewhere or doing something well keep in mind, Mary, any change is a stress.

People sometimes will ask me well gee, how do I get rid of stress?

We can't get rid of stress because every day things are changing for us otherwise life would be pretty boring.

>> So Mary, keep in mind that going to the doctor going to some public type of place, it can make you kind of anxious.

But look at as an adventure and try to not avoid doing those type of things.

>> People with so-called social anxiety tend to be more reclusive and the more they are isolated the more likely they're going to have more anxiety because if you stay isolated and decide I'm not going out because I'm too anxious, it convinces your brain that yes, that was a safe thing to do.

So what you want to do is get yourself out and do well little things, small steps often at the start.

>> But think of that anxiety as being just something that's naturally going to occur.

>> You're getting anxious because the anxiety is increasing some chemicals in your body like norepinephrine and even dopamine for that matter to get you fired up to go.

So anxieties is there as you're getting kind fired up and the key is to keep working on getting out the door and the more you do things like that, Mary, the less likely you're going to have that type of anxiety.

We're coming off of over a year of covid restrictions Mary and a lot of people have been isolated over the past year.

They're just now starting to get out again.

So they're kind of getting anxious about doing that.

The key is to gradually start doing it all over again.

So keeping yourself active and doing those kind of things will be in your best interest.

But look at all these different events.

Mary is being somewhat of an adventure because otherwise you if you stayed at home all the time you would get kind of bored and staying at home and staying isolated, especially staying socially isolated is a big risk factor for getting more depressed.

People get depressed when they are more alone, they're less interactive.

So think of these little adventures outside the household as being something is actually good for your mental health and keep doing it the best you can.

You can always talk to your primary care clinician initially about the possibility of having a medication available for when you get out the medications that we use to help people get out of the house and go places are often used just very temporarily to get them out the door.

Same with flying if some people are afraid of flying but they still have to fly and they have to get on the airlines.

>> So when they're in and the in the loading area so to speak and the boarding area as well from the loading areas the luggage area, the boarding areas where people stay.

>> So if when you're in the boarding area take a medication for anxiety and and get on a plane and you calm down while the second flight, the third flight, the fourth flight they're not so bad.

So that's what all people often notice when they are anxious about going places.

So Mary, the best thing you can do to get over the anxiety of going places is to go places and do so gradually over the course of time and keep yourself busy doing that.

Mary, thanks for your call.

I wish you the best.

Let's go to next caller.

Hello, Matt.

Welcome to Matters of Mind or Matt, you wanted to know about my opinion about your doctor wanting to put you on Lexapro and you're wondering how safe Lexapro is and how you and if I could elaborate on any potential side effects Lexapro that is a medication it's been around since of around two thousand five I think it's been around for a good long time and it's a medication it's very selective and specific for enhancing this chemical called serotonin.

And here's how this works, Matt.

We've got these little neurons.

We've got one hundred billion neurons in our brains and these little neurons some of them will fire out like a shotgun.

Serotonin bullets and serotonin bullets get fired out from the so-called priess adaptive neuron that's like the shotgun and the serotonin bullets will then float across this little area called the synapse and it will stimulate one of 14 different serotonin receptors out there.

And the in the case of Lexapro, it'll stimulate all the different 14 different receptors.

Now some of the receptors you want to stimulate some you don't and it's always a balance on getting somebody at the right dosage in that in that way.

Matt, in the case of Lexapro, the idea of using it will often be to give you an emotional calming and some people on Lexapro get too much of it and they'll feel emotionally numb or they don't feel happy.

They don't feel sad.

They just feel emotionally flatline.

So that's a side effect of Lexapro we don't want to see and it usually means you're taken too high of a dosage.

So we want to avoid that.

But yet with Lexapro what we want to do is dampen down the excessive emotionality.

That means if you're prone to cry at the drop of a hat you get angry and irritable for excessive reasons.

>> It just a little bit over the top.

That's where Lexapro comes in for a lot of people anxiety can be dampened down with Lexapro some people worry excessively and Lexapro can be helpful for them.

So it's a medication that's very specific and selective in what it does as from a side effect standpoint.

Well, by stimulating all the different 14 receptors of serotonin it can give you sometimes some nausea early on the first week or so especially it can give that emotional dulling effect if you get too much we can hear about some people having difficulty with sexual disturbances in some cases where they just don't have as much sex drive and they have difficulty with sexual functioning.

That's because Lexapro by increasing serotonin can secondarily decrease dopamine and if you decrease dopamine sometimes you can have difficulty with sexual functioning and that's also where you get the emotional darling effect.

It is a medication.

It's not addictive.

You can take it long term and it now comes in a generic formulation called Citalopram that's relatively inexpensive but it's one of the more popular antidepressants that have been out there over the past 15 years or so and now that it's generic it's getting more and more used now I'm mad about one out of three people are fantastic fits for Lexapro.

That's what we do genetic testing we can typically see with genetic testing who's going to be a better fit and who's not.

Some people just aren't that good of a fit for and they don't do as well with it.

So you've got about a one out of three chance of a doing really well for you overall and if you're not one of those one out of three people who's going to do really well and Lexapro well, we typically will take you to a different type of medication with genetic testing.

We'll also see who's going to be a slow metabolize or a fast metabolism of the particular ISO enzyme called Toussie 19.

That's a enzyme that breaks down Lexapro and we're all made differently.

Some of us break down Lexapro really fast.

Some of us break it down really slowly and other just break it down the way you'd expect people to break it down.

So if you have genetic testing it also tells how quickly you break it down telling us do you need a real low dosage, a really high dosage and finally with Lexapro, a big key will be that you want to make sure that you're getting the Lexapro for the right reason if you have a condition called bipolar disorder where you have in great big highs and great big lows, you want to be on a mood stabilizer and not just Lexapro by itself.

So we always want to make sure that you're getting Lexapro for the right reason but it can be used for depression, can be used for anxiety.

Typically it's very tolerable and a lot of people have used it over the past 15 years.

Thanks for your call.

>> Let's go to next caller.

Hello Dean.

Welcome to Mars Mind.

I guess I called in last week about trying to find a primary care doctor.

You said something about doing videos with them.

Yeah, I'm not able to find they do that on the first that you have any suggestions for primary care, Doctor Dean?

It's kind of outside my scope of recommendations that I can give you.

>> I'm a psychiatrist so I can speak from a psychiatric standpoint for the first visit that's entirely within the doctor's scope of comfort.

Some clinicians as a mandate will want to be want to see their patients face to face on that first visit and that's certainly their choice.

There's no legal reasons to have to see somebody's face to face on the first visit with the exception of the possibility of using Suboxone which is a medication, it's helping people get off of narcotics but that's very debatable.

I'm hearing that that's not necessarily a mandate right now.

So what I would suggest you do is talk to the contact the the overall organizations intake line, whether it's a big hospital or a big health system or a big clinic, try to contact not just one doctor's office but the entire organizations helpline or intake line for the purpose of finding a clinician who possibly could see you by video.

That first visit now where you might have difficulty with the first visit being seen by video would be if you specifically want certain medications that are stimulants if they're so called benzodiazepines like Xanax, Klonopin, Ativan sometimes clinicians will be reluctant to prescribe those medications over a video visit on the very first time.

But by law we have to be able to treat people by video if the patient is within the state in which we're licensed.

So I'm licensed in the state of Indiana for instance.

If I see somebody by video I need to make sure that they're inside the state of Indiana.

I can't be having people seen by video if they're out of state.

So if they're inside the state of Indiana I can see them for video visit.

So I think in your case as a matter of finding somebody who's willing to do video visits and needs to be done with the first visit, that's something that it has potential.

I've seen people a psychiatrist who have difficulty leaving the house because they have severe panic attacks.

They have agoraphobia or they have a hard time leaving.

And the idea is I treat them for the purpose of getting out of the house and the first few treatments often have to be by video and it works out quite nicely.

Dean, thanks for your call.

I wish you well.

>> Unfortunately I'm out of time for this evening if you have a question that I can answer on the air about mental health issues, you can contact me via the Internet at matters of the mind at WFB a dog will hopefully be able answer those on the air.

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

I'm Jeff Offer and thank you for watching God willing and PBS willing.

I'll be back again next week.

Have a good evening.

Good night