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 the chance to choose the topic for discussion.

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

That's MattersoftheMind@wfwa.org.

And if you can do so, you may call me or text me during this program.

And all I ask is that you give me a first name and let me know the town from where you're viewing.

Let's start tonight's program with an email question that I just received for this past week.

It's reads Dear Dr.

Fawver.

Is it possible to have more sun sensitivity while taking generic fluoxetine versus brand name Prozac?

Direct sunlight and heat bother me more since I started taking the generic form.

I'm finding the generic causes sun burning or skin burning and lightheadedness at a faster rate.

The generic fluoxetine compared to brand name Prozac, generic fluoxetine can have a bioavailability between 80% to 125%.

So what I'm wondering is the possibility if you're getting a higher bioavailability and you're actually getting a higher dosage than you might expect.

For instance, if you're prescribed 20mg of brand name Prozac and you're taking a generic Prozac, maybe you're getting 12.5mg instead of the ten milligrams of bioavailability with a brand name Prozac.

So what that means is you're getting a little bit more Prozac, perhaps in the generic formulation, and doing so that might tip the scales and give you more sensitivity.

How's that pertain?

Well, if you have ultraviolet light, type A and B hit the skin, Prozac or fluoxetine.

And for that matter any and depressant medication can then create a substance that's inflammatory.

And it can give you somewhat of a rash looking appearance on the skin.

So how do you get around it?

Well, you can wear long sleeve shirts.

You can make sure you don't get out in the sun between 10 a.m.

and 2 p.m.

when it's most intense.

You can use sunscreen, which is probably the best advice.

Going to another antidepressant might not be the best option, because other antidepressants might cause similar difficulties as well.

So, with, generic fluoxetine, that can be an issue versus brand name fluoxetine and when talking about, sun sensitivity to the skin, the the medication that was worse in terms of causing some sensitivity was Saint John's wort.

Saint John's wort was really popular back in the 1990s, and a lot of people were taking Saint John's wort.

It's a mild monoamine oxidase inhibitor, which basically means that it was enhancing norepinephrine, serotonin, and dopamine to a mild degree.

Many people took it and they had to take it three times a day, and they noticed that they did have more sensitivity.

And, they got sunburned very easily, more so than medications like fluoxetine.

And I remember hearing a report back in the 1990s that cows were getting sunburned from eating Saint John's wort, which is a flowering yellow plant that would grow along the fence line.

And cows were eating that and they were getting sunburned.

I thought, how do you know if a cow got sunburn?

Well, cows can get sunburn on their mucosa, around their mouths and their noses, and they can get the sunburn there.

So by eating Saint John's wort, which is a pretty, very pretty yellow flowering plant, you can actually get the an antidepressant effect.

But you can also get a pretty nasty sunburn.

Let's move on from talking about cows with sunburn.

Let's go to our first text.

Hello, Erica from Marion, you have a question about, serotonin reuptake inhibitor medication?

When patients get put on an SSRI and they get better, let's bring that text on back up there.

When a patient gets placed on an SSRI and they get better, I there we go.

Can they come off of the medication or they do they need to stay on them for the rest of their lives?

Erica, that's a question that is being asked among many clinicians, because we've known for a long time that generally when you're taking a selective serotonin reuptake inhibitor as an antidepressant medication, if it's your first episode of depression ever, and with the first episode of depression, it was brought on by a significant stress.

And let's say you don't have any family history depression, but it was a bad enough depression that you needed a medication.

Generally, if it was your first episode of depression, you don't have much family history of depression.

You could try taking the medication for about a year, and then weigh the pros and cons of coming off the medication at that time, based on your life circumstances after that one year.

However, if you have a strong family history of depression, if you've had more than three episodes of depression, really bad depressions in your life, if you had maybe a severe depression where you might have lost your job, it got you in trouble with your marriage, you might have even made a suicide attempt.

In that case, you might want to stay on the antidepressant medication longer than you otherwise might want to do.

But if you're in total remission from depression, you're feeling great, you're doing wonderfully, and you've been doing great for several months, and you don't have significant life stressors in your life right now.

That's where you talk about the pros and cons of coming off the medication with your clinician at that time, where your clinician would continue to to monitor you over the course of time.

But there's an old rule of thumb with antidepressant medications, and that will be three strikes and you're on.

In other words, if you've had three bad episodes of depression in your lifetime, you probably want to stay on the antidepressant long term.

However, that's mainly speaking about the monoamine antidepressants, the one of the ones that primarily affect dopamine, norepinephrine, serotonin.

Now we're starting to use medications that primarily affect glutamate.

And these newer medications that affect glutamate might have more of a so-called healing or curative effect.

It's all speculative, but we might find that if you can cause enough branching of your little neurons and make your brain more fluffy, that might actually decrease your likelihood to need an antidepressant long term.

So I think the old three strikes and you're on rule of thumb.

That might not be true in the future, but we're going to watch and see how that does.

Thanks for your text.

Let's go to next caller.

Hello, Peter.

Welcome to Matters of the Mind.

Peter, you had mentioned you saw an article that said that LSD showed signs of helping treat anxiety.

Is that true?

LSD has been used more at microdosing.

Really small amounts more for depression.

And I think we're going to be hearing more about the use of LSD for depression over the course of the next few years.

It's getting studied right now, and with LSD, it needs to be administered in a highly monitored setting, with the possibility of psychotherapy or talk therapy occurring concomitantly with the LSD administration.

But there are a lot of a lot of possibilities with LSD.

Anxiety and depression often do go and hand in hand.

I often tell people that anxiety, insomnia, and depression often go along a spectrum where people will have anxious distress about something and they'll worry about things that leads to insomnia.

When they have insomnia, they have a hard time recharging the front part of the brain.

The front part of the brain is the part of the brain that you use for logically coping with your life circumstances.

And if your front part of your brain is not getting adequately recharged by a good night's sleep, that will often lead to difficulties enjoying things, tolerating things, having stress, resilience, were able to put up with things and that all leads to depression.

So you often hear about anxiety, insomnia, and depression.

I think LSD can potentially in a highly monitored setting at the right dose, with the possibility of psychotherapy that has potent thanks for your call.

Let's go to our next caller.

Hello, Leah, Welcome to Matters of the Mind.

Leah, you want to know if blood pressure medication can cause hallucinations?

I think you might be referring to visual hallucinations.

And the situation where I could see that happening, Leah, would be where somebody is taking a medication that causes them to lose potassium.

As your potassium gets out of your urine and your potassium level drops, low potassium can indeed cause visual hallucinations.

We would often call that delirium.

So I would wonder, if not only would you be referring to visual hallucinations, but could you also be referring to confusion and difficulty with orientation, knowing where you are, what time it is and so forth?

So if you are taking a blood pressure medication and you have visual hallucinations, that's obviously not a good side effect you want to experience and you want to talk to your clinician right away because you're probably low on potassium.

And, either need to go to a different blood pressure medication or get a potassium replacement.

Thanks for your call.

Let's go to next text.

Hello, Tom from Columbia City.

You want to know about talking to your dog.

You're mentioned that, I had a question last week about dogs.

And if talking with them is okay, going along with that question is talking to your dog actually good for your mental health?

Actually, Tom, coming from a psychiatrist, you might think that's unusual, but you can actually create a bonding hormone interaction with your dog.

If you stare in your dog's eyes, you will have an increase in this little hormone called oxytocin.

Oxytocin comes from a pituitary gland, right down here.

And the pituitary gland increases oxytocin in your brain.

But studies have shown that actually happens in your dog's brain as well.

Oxytocin is the hormone that spikes after a woman delivers a baby.

Oxytocin will spike 80 times after a woman delivers a baby, and she has this bonding experience with her baby.

Interestingly enough, the fathers of the baby, they don't have that spike in the hormone.

I don't know why, but just the women have the spike in the oxytocin.

So actually, as you look into the eyes of your dog, you get that special interaction.

And there's actually an oxytocin release with all that going on.

So as I always say, you know, you can talk to your dog as long as your dog's not talking back.

Yeah, I know there there's an instance in the Bible where a donkey talked, but generally dogs should not talk back to you, but you can actually have somewhat of a of, soothing mental health interaction with your dog where it can be a good experience for you.

Dogs are great for the mental health.

Thanks for your email.

Let's go to our next caller.

Hello, Nancy.

Welcome to Matters of the Mind.

Nancy, you want to know do SSRIs, selective serotonin reuptake inhibitors, contribute to the adolescent mass shootings?

I've heard about this in the news recently, Nancy, and I think there's a lot of questions that we need to ask.

And if you hear about adolescents who are involved in mass shootings, mass shootings by definition, I believe, involves four or more victims in a shooting.

Okay, so if you have a mass shooting and it's by an adolescent, the mass shootings to my understanding, are typically committed by white upper class to upper upper middle class males who are fairly socially isolated, somewhat socially awkward, and they have a lot of grievances.

So imagine this scenario where you have a young man who's angry.

He's discontented about a lot of things, a lot of grievances, angry about interaction with other people, not necessarily paranoid.

He's not psychotic, but, he's an angry, discontent young man.

What do you do?

You bring him to a clinician.

The clinician might try some psychotherapy.

And in desperation, a prescriber for that individual might prescribe a medication like an SSRI.

Lexapro, Celexa, maybe Zoloft, or the most common given to adolescent males.

The question I have about the mass shootings is will be, number one, is there a higher likelihood of the mass shootings that we've heard in the reports, higher likelihood of them being on SSRI compared to the rest of the population of adolescents out there?

My understanding is there's not.

Number two, if you prescribe Lexapro, Celexa, Zoloft to an angry, discontented young man who doesn't even want to have treatment, who's angry that he's not even seeing you, what's the likelihood he's going to take the medication?

So being prescribed medication is one thing.

But were these adolescent mass shooters, were they actually taking their medications?

Did they do blood tests?

Did they do forensic studies?

I haven't heard of those, but I'd want to know that.

So that's a question needs to be asked.

Because if their blood level was zero for the SSRI, that means they weren't taking the medication.

Were they taking it?

Then they stopped it abruptly.

There's no evidence that we're hearing about that.

So there's a lot of different questions that need to be asked.

But I think what happens sometimes in the news media with politicians, they get emotionally involved in all these different interactions and they say, we need to stop prescribing SSRIs to adolescents because it's causing people to shoot innocent victims.

And I don't know what the evidence of that really is.

So I think it's something where we need to ask a lot of questions.

When statements like SSRIs might cause mass shootings, where that comes up, it would be easy for me to comment on a condition in which I'm not being treated.

For instance, I don't have type two diabetes yet, I don't have I haven't had a heart attack yet.

Thank goodness I haven't had a stroke and I can lose a few pounds, but I'm not considered to be morbidly obese.

But how about if I was?

What if I had a heart attack?

What if I had type two diabetes?

What if I had morbid obesity?

I'd want to take a GLP-1 based on what I hear.

But let's say, okay, I don't have these problems.

So what if I go out there and start telling the public you shouldn't be taking GLP-1s because you know, they can cause this side effect, this side effect.

And next thing you know, you got the attorneys getting involved and they're doing class action lawsuits, say, and people, taking GLP-1s can have this side effect or this side effect or this side effect.

I think we have to be careful in terms of saying that this treatment or that treatment causes all these problems out there, because we're doing a disservice to people for whom those treatments really help.

So for me, I don't take a GLP-1.

I do the best I can to exercise and eat reasonably well.

I did have a hot dog coming over here from a gas station, but that's one of my vices.

I just love gas station hot dogs.

But if you if you can watch your lifestyle to some degree, sure you might be able to control your weight.

Here's the problem with obesity.

Obesity, the fat, the adipose itself will will secrete hormones that actually make it more difficult to lose weight.

So when have adipose tissues you're releasing inflammatory hormones.

You're releasing, disturbances that cause disturbances in leptin.

All these appetite hormones out there, it's a vicious cycle.

So with the obesity, you have a hard time losing weight and you have a hard time exercising with obesity.

You're going to have trouble with motivation, initiative, and exercise.

I get that those are the reasons why all these people out there are taking GLP-1s, because they're trying to address the obesity epidemic.

So I don't think we should be at a point where we're saying we need to get back to diet and exercise and get everybody off these GLP-1s No, that's that's not responsible.

And you're really doing a disservice to the people where the GLP-1s might be lifesaving.

I think the same thing could be said with SSRIs.

We need to leave that between the patient and the patient's clinician.

Thanks for your call.

Let's go to our next caller.

Hello, Gene.

Welcome to Matters of the Mind.

Hello.

Hi, Gene.

You're on the air.

Oh, yes.

I had a question about, different, medications.

And also about, so I'm trying to get my TV down here.

I was wondering about, vertigo and, a couple different medications and also about pulse rate.

Would anxiety cause that to be down in the 60s, jump up to 150 and break out in the sweats and also, like what?

What you recommend for, sleep insomnia issues?

Yeah.

I'll try to answer all.

I'll try to answer all three of those.

Gene, differ recommendations for sleep.

The first thing we always want to address will be sleep hygiene.

To try to get somebody to go to bed the same time every night.

Get at the same time every day.

Don't look at your cell phone within 30 minutes of going to bed.

Try to not worry about things as you go to bed.

Get the worry out of your system by using a writing in a worry diary.

By 6 or 7 p.m.

at night.

Don't write in the worry diary as you go to bed.

Be careful with caffeine.

Be careful of any, things that you might be eating right before going to bed.

So sleep hygiene is where we're going to start with sleep.

Medications for sleep.

Now there's a so-called Z drugs like Lunesta, Sonata, Ambien.

We've been using those short term for some people, but I prefer other medications that are used.

It's called off label where you use medications like gabapentin.

Pregabalin is another one Trazadone and low dose doxepin but these are all medications that can be used for sleep long term, as opposed to the so-called z drugs which are used or they're used short term.

You'd asked about difficulty with, heart rate when you get anxious.

Yeah.

You can have a heart rate that's slow.

It might be in the 60s.

All of a sudden you get anxious with a surge of adrenaline, and your heart rate can get very fast.

I always wonder, especially with younger women you hear about this is called paroxysmal orthostatic tachycardia syndrome, where they have, a very fast heart rate and they pass out because their blood pressure drops.

But for a man, Gene, I would say you want to be assessed by a cardiologist or a primary care clinician with an EKG where they might want to monitor you 24 hours and see if there's a, a, type of cardiac condition where your heart naturally is speeding up.

And there's different names for those kind of cardiac conditions.

So you want to make sure you don't have an underlying cardiac condition causing that, because that can actually cause you to have panic attacks where your heart rate speeds up periodically like that.

And it can be very miserable.

The anxiety and, dizziness, well, dizziness itself is modulated by this, cranial nerve number eight.

It comes right down there.

It's called the vestibular nerve.

And if the vestibular nerve gets irritated, you can have dizziness.

And for some people, if they have dizziness or vertigo, okay, there's a condition called Ménières syndrome where you have ringing in your ears, dizziness, and nausea.

It's kind of a triad that way.

And, that's an inner ear problem.

You can also have dizziness sometimes from medications.

And if the medications are causing dizziness, what we try to do is have people look at a distance, look at something close up, look at a distance, look at something close up.

Do that for about three minutes.

And that can kind of reset your vestibular nerve, which is regulating the dizziness itself.

So there's different things we will often, discuss with people about that, Gene.

So talk it over with your primary care clinician and see if they can address some of these individuals individual issues.

Gene, thanks for your call.

Let's go to our next caller.

Hello, Shane.

Welcome to Matters of the Mind.

Hello, Shane.

Hello.

Oh, Shane, you want to know if cognitive enhancement therapy really does work?

Well, Shane.

Cognitive enhancement therapy is a means by which you're basically reframing your current life situations.

And the purpose is to try to help you with resilience and objectively, the keyword there objectively assess your situation while getting your emotions, out of the way.

Now, what often happens, Shane, is people will have difficulty with their emotions just taken over their thinking process.

So this little amygdala right here, the amygdala is your center of your brain for anxiety, anger, fear.

And that gets really fired up in some situations.

And when that gets fired up, it hijacks the frontal part of your brain.

The frontal part of your brain is the thinking part of the brain.

That's a logical part of the brain, the thinking part of the brain.

And if the amygdala gets fired up too much, the thinking part of the brain kind of shuts down.

What cognitive behavioral therapy, cognitive enhancement therapy will do is basically help you with the thinking part of the brain, allowing you to think through your life difficulties as opposed to emotionally reacting.

So it's something that's Aaron Beck first talked about cognitive behavioral therapy back in the 1970s, I believe, and it's a technique that works.

If you've got your amygdala adequately under control and you've got it reined in well enough, where you can control your anxiety and anger and, and irritability as you're thinking through your life circumstances as they occur.

Thanks for your call.

Let's go to our next email question.

Our next email question reads, Dear Doctor Fawver, what can you tell me about the de-prescribing trend in psychiatry that I'm hearing about in the news?

This is not really a new trend.

I'm hearing it pop up every now and then.

I guess it's it's been popular on social media, but the trend of de-prescribing is basically where we clinicians, as we should look at patients, individual medications one by one by one and try to determine, is this really helping you?

Is this really helping you?

Is this really helping you?

Now sometimes I'll see a patient for the first time and they're on 4 or 5 different medications.

I might chip away at one at a time, if the patient is unsure if something is helping them.

So I'll ask patients individually, with this medication.

With this medication, when you started it, did you notice an appreciable benefit?

Sometimes they noticed something, sometimes they don't.

And the only way you can really tell is by tapering off the medication.

Now, I say taper off because some medications that lasts for about a day or even less, you have to taper off very, very slowly over the course of 2 or 3 weeks.

So medications like Prozac I mentioned that before, one called Trintellix.

These are medications that tend to stay in the system for days.

So you can stop them abruptly sometimes.

So some medications you have to taper off over the course of 2 or 3 weeks.

Some medications can stop abruptly because they stay in the system for a long time.

So de-prescribing is just a means of trying to determine is this really helping you?

Is this really helping you?

We heard about that a lot.

When we find a medication that just knocks it out of the park and somebody doing great on a certain medication, well, what do you do then?

You have to take them off all the other medications they might have been on before, because they might have been on an antidepressant with lots of seasonings before, the seasonings being antipsychotic medications, anti-seizure medications, all these other medications.

We're trying to help the main antidepressant work.

Maybe you don't need that antidepressant anymore since you got another antidepressant that's really helping now.

So we will typically slowly taper off people from medications.

And I think it's something that's being discussed now because it's more in the news and it's more on social media.

But it's something we should have been doing all along.

Thanks for your call.

Let's go to our next caller.

Hello, Philip from Waterloo.

You want to know about, mood stabilizers?

What part of the brain uses the mood stabilizer?

A mood stabilizer, Philip, is basically a medication that can be an anti-seizure medication like Depakote, Lamictal, gabapentin, Lyrica.

These are medications that, stabilize the current of the brain.

And you.

Lithium is another one.

Lithium as a mood stabilizers, has been around since 1949.

Basically has an anti-inflammatory effect.

They primarily will affect the front part of the brain to help you be able to think more clearly than than reacting.

And specifically, they can affect the front part of the brain, the thinking part of the brain, but they also affect the limbic system.

Over here on the side part of the brain, the limbic system will affect emotions and mood and what they're doing.

Mood stabilizers are basically, whether they're anti-epileptic medications, lithium antipsychotic medications that have dopamine receptor blocking agents.

These are all basically stabilizing the the transmissions of the electrical transmission in the brain.

And in doing so, you can think of mood stabilizers as being like a cruise control in your automobile.

So a cruise control in your automobile keeps you from, well, going too fast and keeps you from going too slowly.

It kind of keeps you level.

We should all have certain fluctuations to our moods, but they shouldn't be out of control where they're unnaturally higher, unnaturally low.

That's what mood stabilizers are doing.

And that's what people will need use for bipolar disorder.

Thanks for your email.

Let's go.

Our next email.

Our next email reads Dear Dr.

Fawver in the original Star Trek, do you think that Spock had a different structured brain than the rest of us?

You know, it's interesting you mention that because Spock, I think Spock was very logical.

Okay, so that was Leonard Nimoys character in the original Star Trek, if you remember, way back then, and if you remember in the original Star Trek, you'd have Doc and you'd have Scotty freaking out about something, and Spock would be very calm and controlled.

Spock was the go to guy to logically think through a very difficult situation.

I think Spock was missing an amygdala.

Amygdala, it would be amygdala would be right here.

As I mentioned before, that's the volume control for anxiety, fear, rage.

That's where your temper gets flare it up, and that all fires up.

If you don't have an amygdala, you will be able to think more clearly, and you'll be able to think through your life circumstances.

You'll have kind of a, flat demeanor, somewhat like Spock did.

He didn't have a lot of emotions.

And Leonard Nimoy, actually acted that out very nicely because he acted as if he didn't have an amygdala.

As he was doing his character, Spock.

So the amygdala is the anxiety and emotional volume control.

You take that out either by having a tumor, by having some kind of damage to that part of the brain, you'll have more of a Spock demeanor where you'll have more logical thought and, sometimes think more clearly in certain situations.

Thanks for the email.

Unfortunately, I'm out of time for this evening.

If you have any questions concerning mental health issues, you may write me via the internet at MattersoftheMind - all one word - @wfwa.org.

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 again next week.

Thanks for watching.

Good night.