Latest / The You Project / #2230 Women's Mental Health - Prof. Jayashri Kulkarni

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#2230 Women's Mental Health - Prof. Jayashri Kulkarni · The You Project

• 0:00
  Speaker 1: Well, g'day, team. It's You Project. It's Harps.
• 0:03
  Speaker 2: It's a bloody Friday afternoon here in the thriving metropolis
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  Speaker 2: of Hampton. just sliding towards the finish line of the week.
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  Speaker 2: I'm going to head to the gym soon and lift
• 0:11
  Speaker 2: some things. But before I do that, I've got a
• 0:14
  Speaker 2: big exercise for my brain. And that exercise is to
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  Speaker 2: try to keep up with the genius that I'm about
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  Speaker 2: to talk to, who will tell you she's not a genius,
• 0:23
  Speaker 2: but I will tell you she is because she's probably
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  Speaker 2: self-effacing and self-deprecating.
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  Speaker 1: Professor Jayshree Kulkarni. Hi, Prof. How are you?
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  Speaker 3: I'm very well and thanks for the accolade already you
• 0:36
  Speaker 3: haven't even heard what I'm going to say.
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  Speaker 2: Well I've read about you and I've read a bit
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  Speaker 2: about you and I've seen a bit of you speaking
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  Speaker 2: and I know the work that you do I know
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  Speaker 2: some of the work you do I try to do
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  Speaker 2: this is my philosophy or my and maybe it's just
• 0:48
  Speaker 2: my laziness but I try to learn enough so that
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  Speaker 2: I've got an insight and a snapshot but not so
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  Speaker 2: much that I know the answers to the questions I'm
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  Speaker 2: going to ask you because I feel that gets in
• 0:59
  Speaker 2: the way of the creativity and the flow and the
• 1:01
  Speaker 2: organic nature of what we're about to do. But again,
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  Speaker 2: that could be that I'm just lazy, but I'm going
• 1:07
  Speaker 2: to go with Freestyle Creates.
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  Speaker 1: That's my whole thing. How's your Friday been? How's your Friday?
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  Speaker 3: It's hectic as always and we're heading to the, can
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  Speaker 3: you please sort out this disaster before it becomes even
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  Speaker 3: worse on the weekend, et cetera. So, yeah, my Friday
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  Speaker 3: afternoons are always, I hold my breath thinking, what am
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  Speaker 3: I going to have to deal with? But anyway, we'll
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  Speaker 3: see what happens.
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  Speaker 1: Well, you do what you can.
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  Speaker 2: And do you allow yourself downtime on the weekends or
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  Speaker 2: are you a workaholic or what happens on the weekends?
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  Speaker 3: I would usually do some stuff on Saturday morning, as
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  Speaker 3: in work, emails, catch up on things that I'm supposed
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  Speaker 3: to write on Saturday morning, and then the rest of
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  Speaker 3: the weekend is for fun.
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  Speaker 2: Are you good at switching off or does it take
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  Speaker 2: a minute?
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  Speaker 3: No, I switch off. you know, very quickly.
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  Speaker 1: Well, I'm good at that too.
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  Speaker 2: I can go from full on in the zone, high
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  Speaker 2: kind of intensity, emotional, cognitive, da-da-da-da, to on my bed
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  Speaker 2: watching Netflix in about eight minutes. And I'm very easy.
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  Speaker 2: I don't know, maybe that's a boy thing. Maybe it's
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  Speaker 2: a personality thing. Maybe it's an anyone thing.
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  Speaker 1: Who knows?
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  Speaker 2: But I'm going to do the boring bit and then
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  Speaker 2: you're going to tell me what I left out. So
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  Speaker 2: the prof is a Melbourne psychiatrist, researcher and professor of
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  Speaker 2: psychiatry at Monash University, where I just am closing in
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  Speaker 2: on the finish of my PhD, which is nice alignment.
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  Speaker 2: And she's particularly prominent in the world of mental health.
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  Speaker 2: and the women's mental health and the relationship between reproductive
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  Speaker 2: hormones and mental illness. She's worked in psychiatry for more
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  Speaker 2: than three decades, which is amazing because she's 42, and
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  Speaker 2: is director of her center, Australia and the Multidisciplinary Alfred
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  Speaker 2: Psychiatry Research Center, say that five times fast.
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  Speaker 1: And it goes on and on.
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  Speaker 2: But Why don't you give our listeners, before we start
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  Speaker 2: diving in, just a snapshot of who you are, in
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  Speaker 2: your words, and what you do?
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  Speaker 3: Well, I mean, my title is that I'm a clinical
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  Speaker 3: academic researcher and I do have patients in my women's
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  Speaker 3: mental health clinic. I see patients in the hospital for
• 3:18
  Speaker 3: women that I set up at Cabrini Health. So they're
• 3:21
  Speaker 3: the kind of work things. I write papers, I have students,
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  Speaker 3: PhD candidates and so on. I am the very proud
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  Speaker 3: mother of two daughters and more recently the very proud
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  Speaker 3: grandmother of an 18-month-old grandson. So my husband and I
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  Speaker 3: have just come back from being grandparents because my daughter
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  Speaker 3: and son-in-law and grandson live in New York. So we
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  Speaker 3: rediscovered how much energy an 18-month-old toddler takes when you're
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  Speaker 3: looking after him. So it was fantastic. I really enjoyed it.
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  Speaker 3: And I like junky movies on, you know, Netflix.
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  Speaker 1: Yeah, gorgeous.
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  Speaker 3: You know, really people give me sort of very highbrow
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  Speaker 3: books and things to read, but I can't confess anything.
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  Speaker 3: too often that i actually still love reading harry potter
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  Speaker 3: so you know that's my wind down because my my
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  Speaker 3: world is very serious at work in yeah with a
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  Speaker 3: lot of trauma and and you know awful stories and
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  Speaker 3: so on so yes i do enjoy the comedies and
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  Speaker 3: and uh you know having a laugh.
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  Speaker 2: Kind of a departure from what you do day to day.
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  Speaker 2: It's like, I think I do, um, not what you
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  Speaker 2: do clearly, but I do coaching with lots of people.
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  Speaker 2: Sometimes it's in the exercise physiology space. Sometimes it's more
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  Speaker 2: in the human behavior psychology space, but it's definitely not
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  Speaker 2: in the brain space and the hormone space, um, that
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  Speaker 2: you inhabit. But even with me, uh, like today I've
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  Speaker 2: done five coaching sessions and which is five hours. And
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  Speaker 2: I just sometimes need to go, Hmm, How do I–
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  Speaker 2: I walk a lot, so I just got back from
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  Speaker 2: about a 7K walk and I just get out.
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  Speaker 1: Like I need a way.
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  Speaker 2: To step out of that kind of heaviness and that
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  Speaker 2: kind of deep level of psychological and emotional.
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  Speaker 1: Investment in that moment, cognitive investment.
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  Speaker 2: Yeah, I think for people who deal with a lot
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  Speaker 2: of hard stuff with other people or you being one
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  Speaker 2: of those people, of course, do you find it difficult to–
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  Speaker 2: separate yourself from that?
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  Speaker 1: Do you carry that with you? Is that a burden
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  Speaker 1: for you?
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  Speaker 2: Or because you've done it so much, can you kind of,
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  Speaker 2: not that you switch off the care, but can you
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  Speaker 2: switch off in that sense?
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  Speaker 3: Look, I think because I've been very well trained in
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  Speaker 3: the work, and I'm very grateful to the mentors and
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  Speaker 3: teachers that I've had over many, many, many years, that
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  Speaker 3: I was, you The difficulty is that maintaining a balance.
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  Speaker 3: So when I'm working with patients, I don't want to
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  Speaker 3: be and I don't think I am a sort of
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  Speaker 3: robot or a disengaged person to maintain that professionality. So
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  Speaker 3: I do give of myself in the sense of a
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  Speaker 3: therapeutic situation and So I do find that when I've
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  Speaker 3: had very heavy clinic, I'm more tired in the evening.
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  Speaker 3: And so the last thing I want to do is
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  Speaker 3: watch or read something that's again going to require, you know,
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  Speaker 3: a deep dive into some sort of philosophy or something
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  Speaker 3: like that. So it is important that particularly for junior
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  Speaker 3: therapists when they're starting off to be able to develop
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  Speaker 3: what my old teacher used to say, your own personal
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  Speaker 3: waste disposal unit, which is about being able to separate
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  Speaker 3: the important things that people are telling you, but also
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  Speaker 3: to know what your own nonsense stuff is or your
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  Speaker 3: own difficulties are so that you can then get rid
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  Speaker 3: of them and not have that get in the way.
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  Speaker 3: And that comes with experience, I think.
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  Speaker 1: 100%.
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  Speaker 2: It's funny because in exercise physiology and other things, of course,
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  Speaker 2: there's a real You know, not too much these days,
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  Speaker 2: but a focus on energy in and energy.
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  Speaker 1: Out and all of that. A lot of people don't
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  Speaker 1: realize that.
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  Speaker 2: Our brain uses about 20% of our energy. Like this
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  Speaker 2: little 1.3 or 4 kilo thing in our noggin takes
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  Speaker 2: up a fifth of our daily energy requirements.
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  Speaker 1: That's very costly, isn't it?
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  Speaker 3: Well, this is why when students say things like, oh,
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  Speaker 3: I'm studying and I find myself really hungry, you go, yeah,
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  Speaker 3: go feed yourself because that's what you're doing. You're chewing
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  Speaker 3: up all the calories with all this incredible brain work
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  Speaker 3: that you're doing. A lot of women I see, particularly
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  Speaker 3: around the midlife menopause story, who are gaining weight because
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  Speaker 3: the hormones are changing, will often do things like starve
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  Speaker 3: themselves to try and lose weight. So, you know, people say,
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  Speaker 3: I feel miserable. What are you eating? What's your diet?
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  Speaker 3: I have black coffee and pretty much, you know, just
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  Speaker 3: a lettuce leaf because I'm trying to lose weight. And then,
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  Speaker 3: of course, they're feeling depressed because the fuel that they
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  Speaker 3: need for all the activities they're carrying on isn't there.
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  Speaker 3: So we do need to fuel ourselves, our brains in particular, really,
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  Speaker 3: with healthy food and good food.
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  Speaker 2: We're almost putting our brain at a disadvantage, like when
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  Speaker 2: we're like, oh, I've got to lose weight, so therefore
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  Speaker 2: I'm going to eat, you know, a glass of air and,
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  Speaker 2: as you said, a lettuce leaf and a coffee, and we're–
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  Speaker 2: we're not making things better at all. One, all you're
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  Speaker 2: doing is hijacking your metabolism, which is pretty much going
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  Speaker 2: to shut down if you stop eating. But two, your
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  Speaker 2: brain just doesn't work. No wonder you feel worse, right?
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  Speaker 3: Absolutely. And even the MIT did a study looking at
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  Speaker 3: the fad when people were chucking out carbohydrates completely from
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  Speaker 3: their diet. And that, in fact, led to quite significant
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  Speaker 3: serotonin changes, which led to depressions. So there's quite a link,
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  Speaker 3: and that's one of the things that I think in
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  Speaker 3: women's mental health I've learned is you have to have
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  Speaker 3: a holistic understanding because it is what's going on in
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  Speaker 3: the entire person's environment, their biology, their brain, their psychology,
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  Speaker 3: their past challenges, their current context. Otherwise, you just can't
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  Speaker 3: really move forward.
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  Speaker 2: I want to ask you before we start talking about
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  Speaker 2: your research, and by the way, you'll find this interesting, 75%
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  Speaker 2: to 80% of my listeners are females and a lot
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  Speaker 2: of them in the age group that this is highly
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  Speaker 2: relevant for.
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  Speaker 1: Do you have.
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  Speaker 2: Are you aware of your optimal times for doing certain things?
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  Speaker 2: Let me explain that. So I find if I've got
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  Speaker 2: to do stuff that's heavily, that requires heavy focus, concentration, presence,
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  Speaker 2: you know, cognitive.
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  Speaker 1: Load, I'm pretty good. In fact, I would say I'm optimal.
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  Speaker 2: Between 6 and 12-ish for me, like 12 to 8.
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  Speaker 2: I am.
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  Speaker 1: I am.
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  Speaker 3: Sorry.
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  Speaker 1: Yeah, yeah, yeah. But I go to bed early. I'm
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  Speaker 1: the boringest bloke in Hampton, right? I don't smoke. I
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  Speaker 1: don't drink.
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  Speaker 2: I'm like a hush puppy, right? I'm so boring. And
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  Speaker 2: then kind of midday till six, not bad, but not amazing. Like,
• 11:02
  Speaker 2: all right, I can function, but... especially at the moment
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  Speaker 2: because I get up around five and then do stuff.
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  Speaker 2: And after maybe seven or eight, I think my IQ
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  Speaker 2: drops by 100 points.
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  Speaker 1: So I need to figure out.
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  Speaker 2: When am I going to work out, when am I
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  Speaker 2: going to walk, what are the things that I need
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  Speaker 2: to do today that requires my brain a lot and
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  Speaker 2: when am I going to put that in. I can
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  Speaker 2: do that thing at three because that's not real super
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  Speaker 2: heavy stuff. Do you– Do you have the opportunity to
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  Speaker 2: do that? Do you do that or do you not
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  Speaker 2: have that luxury because work just happens when it happens?
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  Speaker 3: So the writing work would be the equivalent of the
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  Speaker 3: brain work. So having to synthesise data, put it together,
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  Speaker 3: write it in a way that makes sense and put
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  Speaker 3: it out for publication. That I would say is probably
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  Speaker 3: heavy brain work. I mean the other heavy brain work
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  Speaker 3: is developing a research project And interestingly, I'm the opposite
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  Speaker 3: to you. I'm a night owl. So I have always
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  Speaker 3: kind of done a lot of heavy brain work from
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  Speaker 3: about 8, 9 p.m. to 1 a.m. And as a student,
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  Speaker 3: as a medical student and then later on specialising in psychiatry,
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  Speaker 3: I did most of my study then. Now, it could
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  Speaker 3: have also been because when I was doing my specialisation
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  Speaker 3: and I did my PhD, I had little kids. So
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  Speaker 3: I was with them when I could be and waited
• 12:37
  Speaker 3: till everybody was off to sleep before I could start
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  Speaker 3: doing the studies. It's also deadlines for me. You know,
• 12:45
  Speaker 3: it depends on when the deadlines are. I'm still doing
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  Speaker 3: the terrible student thing, which is stuff around, stuff around,
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  Speaker 3: and then at the last minute get a burst of
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  Speaker 3: creative energy and just get it done. So the old
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  Speaker 3: habits of adolescence, you know, still there. Yeah.
• 13:05
  Speaker 2: It must be a professor thing because my professor, my
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  Speaker 2: senior supervisor, Professor Christian Rotaru, shout out to the prof,
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  Speaker 2: he's great. I get emails from him at 3 o'clock
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  Speaker 2: and I write back. I'm like, what are you doing?
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  Speaker 2: Go to bed.
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  Speaker 1: So I'm like, dude, I'm in the middle of my
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  Speaker 1: REM moment at 3am.
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  Speaker 2: How do you even think I can barely get out
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  Speaker 2: of bed to go to the bathroom once or whatever
• 13:32
  Speaker 2: it is? I read this interesting term that I'd never heard.
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  Speaker 2: I've heard of psychoneuroimmunology. In fact, I talk about it
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  Speaker 2: with people, but I'd never heard of psychoneuroendocrinology.
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  Speaker 1: What is that?
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  Speaker 3: So if you break it down, it's psycho, which is the– well,
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  Speaker 3: not psycho as in Alfred Hitchcock, but as psycho as
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  Speaker 3: in psychological. Neuro as in neurological, which really refers to brain.
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  Speaker 3: And endocrinology, which is the study of hormones. So it's
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  Speaker 3: pretty much the study of hormones in the brain that
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  Speaker 3: lead to behavioral impacts or mood or cognitive impacts.
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  Speaker 2: Okay.
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  Speaker 3: It's the hormones in the brain causing depression or anxiety
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  Speaker 3: or other mental health expressions of the changes in the brain.
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  Speaker 1: Right. I had a guy on recently. This is, I
• 14:30
  Speaker 1: don't know, I could get in trouble for this. You
• 14:32
  Speaker 1: might be tired. You know when you think, oh, shit,
• 14:34
  Speaker 1: should I ask this question?
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  Speaker 2: Anyway, he's also a psychiatrist, medical doctor, researcher, And he's
• 14:44
  Speaker 2: all about.
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  Speaker 1: Metabolic psychiatry.
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  Speaker 2: He's normal psych and he's not against drugs, but he
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  Speaker 2: spoke about.
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  Speaker 2: You know, using nutrition and sunlight and lifestyle variables and
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  Speaker 2: exercise and that as I guess interventions or, but even to,
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  Speaker 2: so these kind of non-drug options to help people is,
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  Speaker 2: and I know this is a new area. Do you
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  Speaker 2: have any vague thoughts on that?
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  Speaker 3: Well, like I said, it's a spectrum of particular interventions.
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  Speaker 3: So it's great if you can help somebody get better
• 15:24
  Speaker 3: with talking therapy or with exercise or with changing the
• 15:28
  Speaker 3: diet so that it's better for the person. And, you know,
• 15:33
  Speaker 3: all of these things are acceptable and good. It's a spectrum, though,
• 15:38
  Speaker 3: in the sense of would you want to use that
• 15:41
  Speaker 3: for somebody who's got very acute schizophrenia and is a
• 15:46
  Speaker 3: danger to themselves or others. No, you wouldn't. So it's
• 15:50
  Speaker 3: about matching the different conditions and the different symptoms and
• 15:54
  Speaker 3: particularly understanding what is it that the person wants. So
• 15:58
  Speaker 3: many times I have this discussion with women who I'm
• 16:03
  Speaker 3: treating who have menopausal depression and there's many times when
• 16:07
  Speaker 3: people go, oh, no, no, no, I don't want– psychiatric
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  Speaker 3: drugs i don't want uh hormone therapy i want to
• 16:14
  Speaker 3: do this uh get over the depression with exercise and
• 16:18
  Speaker 3: with uh diet and so on and you think okay
• 16:21
  Speaker 3: fine let's let's give it a go and be led
• 16:25
  Speaker 3: by what she wants because she will tell you this
• 16:30
  Speaker 3: is too hard it's not working or this is great
• 16:33
  Speaker 3: um and let's just keep going so many times psychiatry
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  Speaker 3: is big and it encompasses mental health at one end
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  Speaker 3: right through to severe mental illness at the other end.
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  Speaker 3: So you don't want to be loading people up who
• 16:50
  Speaker 3: have mental health challenges that are temporary or that are
• 16:55
  Speaker 3: obviously due to something that's a difficulty in their environment.
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  Speaker 3: And you don't want to load them up with medications. Equally,
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  Speaker 3: you don't want to ignore the dangers for somebody whose
• 17:07
  Speaker 3: life is really, really becoming adversely affected by their mental
• 17:12
  Speaker 3: ill health. So it's a judgment call.
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  Speaker 1: Yeah, I would imagine.
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  Speaker 2: It's like with everything, even in exercise, there's no best
• 17:21
  Speaker 2: exercise program, but there is one for you. So when
• 17:25
  Speaker 2: people go to me, Craig, what's the best way to whatever,
• 17:28
  Speaker 2: you know, train this or train that? I go, well,
• 17:31
  Speaker 2: my best way is not your best way. It is
• 17:34
  Speaker 2: not your best way, Prof. Like, it's like, well, let's
• 17:37
  Speaker 2: do some testing. Let's find out what's going on. Let's
• 17:40
  Speaker 2: see where your body's at in terms of all the
• 17:42
  Speaker 2: stuff I measure, you know, strength and range of movement
• 17:44
  Speaker 2: and cardiovascular and everything. VO2 max and whatever it is,
• 17:48
  Speaker 2: then we'll figure out what's happening in your body and
• 17:50
  Speaker 2: then we'll prescribe based on that. But even that is
• 17:54
  Speaker 2: still an educated guess. I still don't know after prescribing
• 17:58
  Speaker 2: thousands of programs or fitness or health interventions what the
• 18:02
  Speaker 2: outcome is going to be with absolute surety. So it's
• 18:07
  Speaker 2: like we'll start here, but we'll pay attention and we'll
• 18:10
  Speaker 2: improvise and adapt. So I guess it's a little like
• 18:14
  Speaker 2: that with treatment of depression and all of the mental
• 18:17
  Speaker 2: health issues as well.
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  Speaker 3: Yeah, the term personalised medicine I think is a really
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  Speaker 3: important one and very, very important in mental ill health
• 18:27
  Speaker 3: conditions because unlike physical health conditions, we don't even have
• 18:33
  Speaker 3: proper tests that really let us have an objective diagnosis.
• 18:37
  Speaker 3: There's no ECG equivalent. So you can't do something and go, oh, yes,
• 18:42
  Speaker 3: there it is. That's exactly what you've got is major
• 18:45
  Speaker 3: depressive disorder. Here's the antidepressant. You've got to take this dose,
• 18:49
  Speaker 3: et cetera, et cetera. It doesn't work like that in psychiatry.
• 18:52
  Speaker 3: There's a very different way of working, which is to
• 18:56
  Speaker 3: understand and work collaboratively with each person and develop a
• 19:01
  Speaker 3: program approach for each person, which is, as you say,
• 19:04
  Speaker 3: it's going to be different for each person.
• 19:07
  Speaker 2: Is it hard in the field of psychiatry? I know
• 19:11
  Speaker 2: in many fields, like in exercise, like in nutrition, like
• 19:15
  Speaker 2: in there's a lot of echo chambers where people have
• 19:17
  Speaker 2: been teaching a certain philosophy or believing a certain thing
• 19:21
  Speaker 2: or having a certain model or way of doing for
• 19:25
  Speaker 2: so long that that becomes part of their identity. And
• 19:29
  Speaker 2: it's like now, oh, well, what if there's a better
• 19:32
  Speaker 2: way than what I've been teaching or doing or prescribing?
• 19:36
  Speaker 2: But my identity is tied up in that and my
• 19:39
  Speaker 2: sense of self. And is it hard to get people
• 19:43
  Speaker 2: to at least consider something different, something that maybe doesn't
• 19:48
  Speaker 2: align exactly with what they previously thought or advocated or
• 19:52
  Speaker 2: even prescribed?
• 19:53
  Speaker 1: Is it hard to.
• 19:55
  Speaker 2: Be objective about something when you truly believe your protocol
• 19:59
  Speaker 2: is the best protocol?
• 20:01
  Speaker 3: Oh, look, I think that happens all the time. Everybody
• 20:03
  Speaker 3: gets into a silo and, you know, they're the king
• 20:06
  Speaker 3: of the castle in their little silo. But that's one
• 20:10
  Speaker 3: of the good things about research. Your basic premise is
• 20:14
  Speaker 3: we don't know and we need to know more. So
• 20:17
  Speaker 3: that's what you're doing is you're going out there trying
• 20:19
  Speaker 3: to find the next thing and the next thing and
• 20:22
  Speaker 3: the next thing. So I think that helps, you know,
• 20:27
  Speaker 3: to be practising in the same way over many, many,
• 20:31
  Speaker 3: many decades, I think is saying, hang on, something's not
• 20:36
  Speaker 3: innovating here and we need to look at that. But, yeah,
• 20:39
  Speaker 3: I mean, people are people and some people will tell,
• 20:42
  Speaker 3: you know, like it's die-hard football team mentality, my way
• 20:48
  Speaker 3: or no way. But hopefully, hopefully, hopefully people will move
• 20:53
  Speaker 3: forward when they can, you know, actually have access to
• 20:57
  Speaker 3: the latest research and have a look at what else
• 20:59
  Speaker 3: is out there.
• 21:01
  Speaker 2: With that in mind, comma, prof, what have you changed
• 21:07
  Speaker 2: your mind on? I mean, you've been in the space
• 21:09
  Speaker 2: for decades, right? So I'm imagining there's quite a few things,
• 21:13
  Speaker 2: either you've just You've got new information or new data,
• 21:16
  Speaker 2: as you said, and you've done either a 180 or
• 21:19
  Speaker 2: you've changed your process or your treatment protocol or whatever
• 21:25
  Speaker 2: over 30 years. What's changed for you, but more broadly
• 21:29
  Speaker 2: perhaps as well, in the field of psychiatry, what has
• 21:33
  Speaker 2: there been a big shift on?
• 21:37
  Speaker 3: I think perhaps the biggest thing for me was to
• 21:41
  Speaker 3: encompass and incorporate understanding trauma in patients' lives. When I
• 21:48
  Speaker 3: was trained, the trauma side of things, I wasn't taught
• 21:53
  Speaker 3: how to take a trauma story from a patient. We
• 21:57
  Speaker 3: were told, you know, you just go for the symptoms
• 21:59
  Speaker 3: and this is the clinical interview and, you know, emphasis
• 22:04
  Speaker 3: placed on the mood and description if you were dealing
• 22:08
  Speaker 3: with someone with psychosis, emphasis placed on hearing, whether they
• 22:12
  Speaker 3: were hearing voices or not and so on, somewhat limited.
• 22:16
  Speaker 3: And we were even taught that if somebody had psychosis,
• 22:19
  Speaker 3: then you really weren't going to get much by talking
• 22:23
  Speaker 3: about their life, their past life, you know, their early
• 22:27
  Speaker 3: life and also other contextual things. That would be a
• 22:31
  Speaker 3: huge change because the more and more I've been in
• 22:35
  Speaker 3: this field, particularly with women, the more I've recognised the
• 22:39
  Speaker 3: importance of what has happened in childhood, what has happened
• 22:43
  Speaker 3: in early adolescence, and how that shapes the current mental
• 22:49
  Speaker 3: health problems, even in midlife or even later. And so
• 22:54
  Speaker 3: I think incorporating trauma into a better understanding of trauma
• 22:59
  Speaker 3: and how it impacts mental health is really important. The
• 23:03
  Speaker 3: other thing is... I've tried to and am happy with
• 23:08
  Speaker 3: the better integration of trauma and brain biology because there
• 23:14
  Speaker 3: was a time when the brain biology people didn't talk
• 23:18
  Speaker 3: to the people who were psychotherapists. You know, they'd be like,
• 23:23
  Speaker 3: our field's better, no, my field's better, and there'd be
• 23:26
  Speaker 3: no conversations going on there. That was a real Carlton
• 23:30
  Speaker 3: Collingwood football club sort of approach. So funny.
• 23:35
  Speaker 1: Such a good analogy.
• 23:37
  Speaker 3: But over time, and in particular in women's mental health,
• 23:42
  Speaker 3: what I've realised is that actually everything is integrated. So
• 23:46
  Speaker 3: what trauma people have experienced as a girl in early
• 23:51
  Speaker 3: life does change the brain biology, the brain hormones, and
• 23:56
  Speaker 3: it is a driver of, say, for instance, premenstrual depression.
• 24:02
  Speaker 3: or postnatal depression can be contributed to by all these experiences.
• 24:07
  Speaker 3: So it isn't just the, oh, yeah, that's nice, we
• 24:12
  Speaker 3: can get to know the individual, that is important, but
• 24:14
  Speaker 3: it's also, yes, it's nice we get to know why
• 24:17
  Speaker 3: the brain biology is reacting differently in this person to
• 24:22
  Speaker 3: the current stress.
• 24:24
  Speaker 2: And I think I read that you said, something like
• 24:28
  Speaker 2: psychiatry historically hasn't paid enough attention to the biological differences
• 24:34
  Speaker 2: between men and women. It's all kind of in the
• 24:37
  Speaker 2: one bucket. And so that is really just because of the,
• 24:43
  Speaker 2: I'm asking, I don't know the answer, but this is
• 24:46
  Speaker 2: just because men and women clearly are very different hormonally
• 24:49
  Speaker 2: and that manifests or presents itself psychologically And in terms
• 24:57
  Speaker 2: of mental health, it presents differently.
• 24:59
  Speaker 1: And, yeah, that's the worst question ever. But you know
• 25:03
  Speaker 1: what I'm saying.
• 25:04
  Speaker 3: Yeah, when I look back and I think, hang on,
• 25:08
  Speaker 3: you know, we were just given gender-blind treatment protocols. So
• 25:13
  Speaker 3: it didn't matter whether you were dealing with a 45-kilogram
• 25:17
  Speaker 3: woman or an 85-kilogram man, you were still treating the
• 25:24
  Speaker 3: symptoms of with the same medication and the same dose. Really? Yeah, yeah. No, absolutely.
• 25:33
  Speaker 1: Did nobody think? Sorry to interrupt.
• 25:35
  Speaker 3: It's crazy. It's just crazy.
• 25:36
  Speaker 1: She's 45 kilos.
• 25:38
  Speaker 3: Yep.
• 25:38
  Speaker 1: She's half his weight.
• 25:39
  Speaker 2: Yep. I mean, surely you don't need to be any
• 25:42
  Speaker 2: kind of doctor to figure out, well, that's probably not great.
• 25:45
  Speaker 3: Well, no, the prescribing guidelines, and even today, if you
• 25:48
  Speaker 3: look at the prescribing guidelines, up to the age of 12–
• 25:52
  Speaker 3: they are very careful prescribing guidelines for children you know
• 25:56
  Speaker 3: you've got to give a certain say just take panadol
• 25:58
  Speaker 3: you've got to give a certain milligram per kilogram of
• 26:01
  Speaker 3: the child's weight makes sense yes but it all stops
• 26:04
  Speaker 3: at at about 12 and then um it's like well
• 26:08
  Speaker 3: you know now everyone's the same so just prescribe the
• 26:12
  Speaker 3: same dose for everybody regardless and the first thing that
• 26:16
  Speaker 3: I started to hear was when I was working in
• 26:18
  Speaker 3: the women's only ward back in the day in Royal
• 26:21
  Speaker 3: Park Hospital when it was the asylum in Parkville. Wow.
• 26:26
  Speaker 3: Women were telling me about the side effects that they
• 26:29
  Speaker 3: were experiencing, a lot of side effects. And I thought, well, yeah,
• 26:35
  Speaker 3: you would. If the dose, you know, and then you
• 26:37
  Speaker 3: look at where the clinical trials for these drugs had
• 26:40
  Speaker 3: been done, they'd been done in the Veterans Affairs hospitals
• 26:44
  Speaker 3: in the US, which are, of course, for war veterans,
• 26:47
  Speaker 3: mainly male, in fact, predominantly male back in the day.
• 26:52
  Speaker 3: And then those doses were translated across to everyone, every adult.
• 26:57
  Speaker 3: And so this just was, it just struck a chord as,
• 27:01
  Speaker 3: hang on, this doesn't seem right at all. And especially
• 27:05
  Speaker 3: when many women intuitively were doing things like they were
• 27:09
  Speaker 3: taking half the dose they were prescribed or so on. And,
• 27:12
  Speaker 3: you know, intuitively they got it right. It just made sense.
• 27:17
  Speaker 3: So that was one thing. Then it was the hormones
• 27:20
  Speaker 3: that also was another thing. Like, yes, there's a whole
• 27:24
  Speaker 3: hormonal difference. And the hormones are not just about having babies. Estrogen,
• 27:29
  Speaker 3: progesterone hormones are not all just about ovulation etc it's
• 27:34
  Speaker 3: about they're all neurosteroids they're brain steroids they influence they
• 27:40
  Speaker 3: modulate they determine all sorts of brain chemistry so of
• 27:45
  Speaker 3: course it's going to be different for the expression of
• 27:49
  Speaker 3: depression or psychosis or whatever in uh women and men
• 27:54
  Speaker 3: so this is another reason why i started thinking about
• 27:57
  Speaker 3: you know hang on we've got to do this better
• 28:01
  Speaker 3: That was back in the 90s. So it wasn't like,
• 28:05
  Speaker 3: you know, 500 years ago that people were thinking about this. Wowza.
• 28:10
  Speaker 3: I know. It's been quite an overlooked, ridiculously overlooked area.
• 28:14
  Speaker 3: And now, you know, we wouldn't dream of just saying, look,
• 28:20
  Speaker 3: here's a thing, just use it regardless of the weight, height,
• 28:24
  Speaker 3: size of the person in front of you.
• 28:27
  Speaker 2: And it seems so wildly unscientific to give very different people.
• 28:34
  Speaker 1: The same thing. Like, yeah.
• 28:37
  Speaker 2: Well, I'm glad you and people like you rocked along
• 28:40
  Speaker 2: and jumped up and down a bit and started researching
• 28:44
  Speaker 2: and figuring out more. So could you, I know you
• 28:47
  Speaker 2: work with women pretty much exclusively.
• 28:50
  Speaker 3: I mean, I still see men in the clinical trials
• 28:53
  Speaker 3: that we're working.
• 28:54
  Speaker 2: So let's say a man and a woman, let's say
• 28:57
  Speaker 2: they both weigh 70 kilos, right, for example. Let's eliminate the–
• 29:01
  Speaker 2: but even then, there's different body composition and hormones and
• 29:04
  Speaker 2: all that. But they rock up to you with– pick
• 29:10
  Speaker 2: an issue that somebody would come.
• 29:12
  Speaker 3: Depression.
• 29:13
  Speaker 1: Okay, depression. So there's a guy, there's a girl. They're
• 29:16
  Speaker 1: both 40, right? Yeah.
• 29:19
  Speaker 2: What, what, how might you, like, might, where might you
• 29:23
  Speaker 2: go with the lady versus the man or vice versa?
• 29:27
  Speaker 1: Like, what I'm trying to do is to go, yep,
• 29:29
  Speaker 1: this makes sense. This makes sense. And I'm, I'm always
• 29:33
  Speaker 1: thinking of my listeners who, God bless them. They're great.
• 29:36
  Speaker 2: But a lot of my listeners are uh just gorgeous
• 29:41
  Speaker 2: smart people but not necessarily with academic backgrounds so okay
• 29:45
  Speaker 2: you got a guy you got a girl what might
• 29:48
  Speaker 2: you do differently one.
• 29:50
  Speaker 3: Of the first things to do is um to find
• 29:53
  Speaker 3: out why is this person what are they why are
• 29:56
  Speaker 3: they presenting now Yes. And what is it that I
• 30:00
  Speaker 3: often say to people, what's at the top of your
• 30:02
  Speaker 3: list of issues? What's the main thing they're working on?
• 30:05
  Speaker 3: And that's where you often find a difference because you
• 30:09
  Speaker 3: find different things will bother different people of differing types
• 30:15
  Speaker 3: and severity. So you've got to go with the person
• 30:18
  Speaker 3: in front of you and you collaborate with them throughout
• 30:21
  Speaker 3: the taking to understand what is their world like, who
• 30:26
  Speaker 3: is in their world, Where are the conflicts for them?
• 30:29
  Speaker 3: What are the stressors? And what's the biology? So the
• 30:33
  Speaker 3: 40-year-old woman, I would go into a big history about
• 30:36
  Speaker 3: premenstrual stuff. I'd find out if she's on a contraceptive,
• 30:41
  Speaker 3: if she's had kids. And at 40, she may still
• 30:46
  Speaker 3: be wanting to have more children or not. And that's important.
• 30:50
  Speaker 3: And so it is for him as well. So we
• 30:52
  Speaker 3: need to also be thinking about, you know, what are
• 30:54
  Speaker 3: their employment, what's their employment situation, what's their living situation.
• 30:59
  Speaker 3: Have they had past depression? Some of it will be
• 31:02
  Speaker 3: the same questions like, you know, what's past depression and
• 31:05
  Speaker 3: tell me about your past story. But, of course, the
• 31:07
  Speaker 3: menstrual cycle stuff and the kid stuff is going to
• 31:10
  Speaker 3: be different. When it comes to formulating a plan of management,
• 31:16
  Speaker 3: If I'm going to suggest an antidepressant, and I always suggest,
• 31:20
  Speaker 3: I don't go, you must. It's always I suggest that
• 31:24
  Speaker 3: an antidepressant might be useful for you if that's the
• 31:26
  Speaker 3: decision that we've made. Then the next thing that we've
• 31:31
  Speaker 3: got is capacity to do a blood test. Pharmacogenomic testing
• 31:36
  Speaker 3: has been around for about five or six years or
• 31:39
  Speaker 3: a bit longer. It doesn't have a Medicare rebate, but
• 31:42
  Speaker 3: you can do a blood test. And you get an
• 31:45
  Speaker 3: individual report for that person about what enzymes they have
• 31:50
  Speaker 3: in their system that will best suit a certain type
• 31:54
  Speaker 3: of antidepressant, for example. And it'll tell you, use this
• 31:59
  Speaker 3: in this dose range because this person's metabolism requires that,
• 32:04
  Speaker 3: whereas the other person might need a different medication at
• 32:08
  Speaker 3: a different dose. So that's another thing that we've got
• 32:11
  Speaker 3: better at. Wow. But a lot of the time when you,
• 32:16
  Speaker 3: you know, it's this very interesting thing that human beings do.
• 32:19
  Speaker 3: Science comes in with, here, here's an innovation. And the
• 32:23
  Speaker 3: first thing that happens is all the knockers come out
• 32:25
  Speaker 3: of the woodwork and go, nah, nah, that's not going
• 32:27
  Speaker 3: to work. Why should I do that, et cetera, et cetera.
• 32:30
  Speaker 3: So a lot of the time we do meet with
• 32:32
  Speaker 3: people who go, my doctor doesn't believe in this. And
• 32:37
  Speaker 3: so you just sort of go, well, hang on, let's
• 32:40
  Speaker 3: have a look at what your particular enzyme systems are
• 32:44
  Speaker 3: showing us because that will guide us. It will guide
• 32:47
  Speaker 3: you as well because you can have this record for
• 32:51
  Speaker 3: your life because your enzymes aren't going to change. So
• 32:54
  Speaker 3: you always know that, for instance, Prozac is a terrible
• 32:57
  Speaker 3: medication for you, whereas Zoloft is great for you, just hypothetically.
• 33:04
  Speaker 3: So it's important to utilize the latest of what is
• 33:08
  Speaker 3: available out there, including excluding other causes of depression. I mean,
• 33:14
  Speaker 3: you know, is there a thyroid problem that is playing
• 33:17
  Speaker 3: up here? Is the person in pain of some sort
• 33:21
  Speaker 3: that's going to make it worse? is there another medical
• 33:24
  Speaker 3: condition that's mimicking the depression? It's not a psychological depression
• 33:28
  Speaker 3: at all. So you've got to think about all that
• 33:31
  Speaker 3: stuff as well. I have very long consults with my
• 33:34
  Speaker 3: patients in the clinic at the Alfred. It's, you know,
• 33:37
  Speaker 3: up to an hour and a half, two hours sometimes
• 33:39
  Speaker 3: because we go through all the bits and pieces.
• 33:43
  Speaker 2: You're the unicorn that we've been looking for. You're the
• 33:46
  Speaker 2: medical unicorn that doesn't do eight-minute consults.
• 33:50
  Speaker 3: Yeah, but I'm in a prestigious position in terms of
• 33:53
  Speaker 3: I'm at the Alfred, I'm doing a tertiary, you know,
• 33:56
  Speaker 3: clinic that's a specialist clinic. The general practitioners, I think,
• 34:02
  Speaker 3: are the ones that are the heroes of the health profession.
• 34:05
  Speaker 2: Yeah, it is.
• 34:06
  Speaker 3: They're there at the front line and they don't have
• 34:09
  Speaker 3: more than their eight minutes, you know.
• 34:10
  Speaker 1: Yeah, I know.
• 34:11
  Speaker 3: That's how the structure is, yeah.
• 34:13
  Speaker 1: Yes, yeah, that's not their fault, of course. What is, you.
• 34:21
  Speaker 2: Did some work around, was it estrogen, the relationship with
• 34:27
  Speaker 2: estrogen and psychosis?
• 34:29
  Speaker 1: Yeah, that's where I started. Yeah, and what did you
• 34:34
  Speaker 1: discover in that?
• 34:35
  Speaker 3: So it was very interesting in that I, again, because
• 34:39
  Speaker 3: I was working in the women's only unit at Royal Park,
• 34:43
  Speaker 3: it was the back ward, horrible, Dickensian facilities, and that
• 34:49
  Speaker 3: also made me think one day, and I very luckily
• 34:52
  Speaker 3: got to do what I wanted, which was to set
• 34:55
  Speaker 3: up a modern, nice place for women.
• 34:58
  Speaker 2: Anyway.
• 34:59
  Speaker 1: Was that at Cabrini?
• 35:01
  Speaker 3: Yeah, we opened in 2021. I've got to design that.
• 35:05
  Speaker 3: you know, with interior designers and everything. But, you know,
• 35:08
  Speaker 3: back in the day, it was dark, it was dingy,
• 35:11
  Speaker 3: it was horrible, awful. But what I got to do
• 35:15
  Speaker 3: was listen to the stories from the women. And many
• 35:19
  Speaker 3: times the women would say things like, I was okay
• 35:22
  Speaker 3: until I had my second child, third child, first child,
• 35:26
  Speaker 3: and I'd never... to being myself ever again, either through
• 35:31
  Speaker 3: because of depression that went on and on and on
• 35:33
  Speaker 3: or because of psychosis. And in Royal Park there were many,
• 35:37
  Speaker 3: many women with psychosis at that point, long admissions back
• 35:42
  Speaker 3: in those days, which was not good. And so I
• 35:48
  Speaker 3: was reading in the various journals that I was reading
• 35:52
  Speaker 3: and there was one in 1990 about that put together
• 35:56
  Speaker 3: a hypothesis from animal work saying that in the brain
• 36:00
  Speaker 3: of the rats that were being studied, estrogen had antipsychotic
• 36:05
  Speaker 3: properties because it was working on the particular chemical system, dopamine,
• 36:10
  Speaker 3: and was actually acting like an antipsychotic. So I thought, well,
• 36:15
  Speaker 3: if this is the animal basis research, maybe we could use,
• 36:21
  Speaker 3: because the pill has been around since the 60s, And
• 36:25
  Speaker 3: it's estrogen largely. Maybe we could use a variation of
• 36:29
  Speaker 3: the pill and see if that actually helps. And that
• 36:33
  Speaker 3: was the first trial that I conducted in women with schizophrenia.
• 36:37
  Speaker 3: And lo and behold, you know, we got some spectacular
• 36:40
  Speaker 3: results from some of that early work. And then, you know,
• 36:46
  Speaker 3: it was really gratifying to see. I remember one patient
• 36:48
  Speaker 3: in particular who had been in the hospital for 12
• 36:51
  Speaker 3: years and Wow.
• 36:55
  Speaker 2: Yeah.
• 36:55
  Speaker 3: Wow. Long hospitalisations and her life had just, it was
• 36:59
  Speaker 3: just awful. You know, every, she hadn't seen her, she
• 37:03
  Speaker 3: came in after she'd had her second child and with
• 37:08
  Speaker 3: postpartum psychosis and had never got better. And so she
• 37:12
  Speaker 3: was hearing voices all the time. Her husband had left
• 37:17
  Speaker 3: and taken the kids and she hadn't seen the children
• 37:20
  Speaker 3: and You know, she was completely psychotic a lot of
• 37:23
  Speaker 3: the time, had all these paranoid ideas, couldn't really look
• 37:27
  Speaker 3: after her daily care, like brushing her hair and things
• 37:31
  Speaker 3: like that. So she had pockets of lucidity, interestingly. And
• 37:37
  Speaker 3: in one of those pockets, I said, would you like
• 37:39
  Speaker 3: to try a hormone treatment? And she said yes. And
• 37:44
  Speaker 3: so we went ahead and the voices stopped within three
• 37:48
  Speaker 3: days of her starting the estrogen.
• 37:50
  Speaker 1: Oh, my God.
• 37:52
  Speaker 3: That was just remarkable for everyone to see. The nurses
• 37:57
  Speaker 3: in the ward rang me up excitedly going, what have
• 38:01
  Speaker 3: you done because her voices have stopped. So that was great.
• 38:06
  Speaker 3: She went on to actually make a good improvement and
• 38:09
  Speaker 3: then we continued her estrogen therapy. in the form of HRT,
• 38:14
  Speaker 3: and she did really well. But, you know, then, of course,
• 38:17
  Speaker 3: she had to rebuild her life once she was discharged
• 38:20
  Speaker 3: from hospital because she'd lost all that.
• 38:24
  Speaker 2: Yeah, then you're stepping, even with that newfound kind of
• 38:28
  Speaker 2: perhaps lucidity and confidence and competence, then you get out of,
• 38:32
  Speaker 2: because through no fault of anyone's, but she's been institutionalised
• 38:36
  Speaker 2: for 12 years in a spot, then you go, and
• 38:39
  Speaker 2: now you're in the world.
• 38:40
  Speaker 3: What? Yeah.
• 38:41
  Speaker 1: I mean, that would be hard for anyone, you know.
• 38:45
  Speaker 2: Some women in their kind of 40s onwards now are
• 38:53
  Speaker 2: being prescribed testosterone cream using low-dose, as their kids call it,
• 38:59
  Speaker 2: low-dose tea.
• 39:02
  Speaker 1: Whatever that means. What's that about, Doc?
• 39:04
  Speaker 3: Okay. So and in the UK, the various menopause clinics there,
• 39:11
  Speaker 3: so menopause, let's go back a bit. Menopause begins in
• 39:14
  Speaker 3: the brain and it starts in the early 40s. So
• 39:19
  Speaker 3: it's not the old women's condition. It starts in the
• 39:24
  Speaker 3: early 40s and the transition time from being reproductive fertile
• 39:31
  Speaker 3: to post-menopause is about 12 to 15 years. So this
• 39:35
  Speaker 3: is a long process beginning in the brain in the 40s.
• 39:40
  Speaker 3: And some women, not all women, and I wouldn't even
• 39:43
  Speaker 3: say most women, but some women really experience terrible post-menopause
• 39:49
  Speaker 3: cognitive and mood and anxiety problems in the stages, even
• 39:56
  Speaker 3: beginning in the early stages of menopause. So this is
• 39:58
  Speaker 3: in the 40s. So the women who experience really awful
• 40:04
  Speaker 3: changes in their mental health early on in the UK,
• 40:08
  Speaker 3: if they were in the UK and went to a
• 40:09
  Speaker 3: menopause clinic, they would be given three hormones. They'd be
• 40:14
  Speaker 3: given estrogen, progesterone and testosterone. Now, we don't do that
• 40:20
  Speaker 3: as a routine. In fact, we're still struggling with trying
• 40:25
  Speaker 3: to get people to understand that hormones help this depression.
• 40:29
  Speaker 3: So it's still not recommended as a first-line treatment. So
• 40:33
  Speaker 3: that's battle number one. Battle number two, testosterone is not
• 40:37
  Speaker 3: provided on the PBS for this condition. So it is
• 40:42
  Speaker 3: about the sense of what is going on in the
• 40:44
  Speaker 3: brain and for the women who are experiencing awful mental
• 40:48
  Speaker 3: health stuff because of the early stages of menopause, what
• 40:52
  Speaker 3: is going on is some women are very sensitive to
• 40:55
  Speaker 3: the changes in hormone fluctuations in the brain. They're often
• 41:01
  Speaker 3: the women who have had premenstrual depression or postnatal depression,
• 41:05
  Speaker 3: and then bang, when they get to the 40s, the
• 41:07
  Speaker 3: menopause fluctuations are very big. They're much bigger than just
• 41:12
  Speaker 3: the monthly cycle fluctuation. And so their brain's reacting adversely,
• 41:17
  Speaker 3: as in the chemistry of the brain, serotonin, dopamine, these
• 41:22
  Speaker 3: chemical systems are being adversely affected by the hormone fluctuations.
• 41:28
  Speaker 3: So that's why they've got the depression, anxiety, and what's
• 41:32
  Speaker 3: called brain fog, which is where people say, I can't
• 41:36
  Speaker 3: think clearly. For those women, I have seen some great
• 41:40
  Speaker 3: turnarounds with treating with Usually estrogen progesterone is a standard
• 41:47
  Speaker 3: hormone combo, but sometimes, particularly if the brain fog is
• 41:51
  Speaker 3: really bad, then low-dose testosterone, which is a cream, and
• 41:56
  Speaker 3: it is, as it says, low-dose, so people don't develop,
• 42:00
  Speaker 3: grow beards or have husky voices or whatever because it's low-dose.
• 42:04
  Speaker 1: Yeah, gigantic biceps. No.
• 42:06
  Speaker 3: I mean, women have testosterone. So all you're doing is
• 42:10
  Speaker 3: trying to actually keep things stable rather than using big
• 42:15
  Speaker 3: doses to sort of override the normal physiological hormones. So
• 42:22
  Speaker 3: you're trying to mimic what would have been there without
• 42:25
  Speaker 3: the fluctuations.
• 42:29
  Speaker 2: How often does a woman get diagnosed with or treated
• 42:37
  Speaker 2: for the wrong thing?
• 42:40
  Speaker 3: That's the $ 6 million question. If you look at my clinic,
• 42:44
  Speaker 3: I'd say it's a terrible high statistic because I have,
• 42:50
  Speaker 3: as I said, a tertiary hospital, super specialist clinic. The
• 42:53
  Speaker 3: women I'm seeing come in saying I've been diagnosed as
• 42:56
  Speaker 3: having bipolar disorder. I've been diagnosed as having major depression.
• 43:03
  Speaker 3: I've had ECT and none of it's worked. And so
• 43:07
  Speaker 3: I'm sort of my heart sinks because I'm thinking, oh,
• 43:11
  Speaker 3: you know, this person was actually all right until she
• 43:13
  Speaker 3: got to 45 or 47 and then the wheels came off.
• 43:17
  Speaker 3: And there's the trigger. That's been the menopause. So in
• 43:23
  Speaker 3: my clinic, it happens a lot. In the general community,
• 43:28
  Speaker 3: I think it depends on who the woman goes to see.
• 43:31
  Speaker 3: If she sees a GP who's been trained in recognition
• 43:35
  Speaker 3: of menopause or even asks about the menopause or if
• 43:38
  Speaker 3: the GP's gone through menopause herself, then there's a better
• 43:44
  Speaker 3: chance that if it is due to the menopause, it'll
• 43:46
  Speaker 3: get picked up. If you go to see somebody who's
• 43:50
  Speaker 3: not interested in the menopause, has never experienced it themselves
• 43:54
  Speaker 3: or whatever, then it's not likely. Psychiatrists, still, we're trying
• 44:00
  Speaker 3: to get it on their radar and it's slowly getting there. But,
• 44:04
  Speaker 3: you know, there's a general rule. It's not part of
• 44:06
  Speaker 3: the psychiatric system. group of drugs to use to think
• 44:11
  Speaker 3: about hormone therapy. Then there's all the hoo-ha that was
• 44:14
  Speaker 3: made in the media about, oh, you know, you can't,
• 44:17
  Speaker 3: estrogen's dangerous, people get breast cancer. That's rubbish. That has
• 44:21
  Speaker 3: been debunked, but that made headlines in 2002 with the
• 44:26
  Speaker 3: Women's Health Initiative study, splashed across all the media, big news,
• 44:31
  Speaker 3: and women threw away their HRT. We have different HRT now.
• 44:35
  Speaker 3: It's much more refined. It's... the progesterone in particular is
• 44:40
  Speaker 3: more natural type of progesterone. So it's much safer, but
• 44:44
  Speaker 3: there's lots of people out there who still carry that
• 44:48
  Speaker 3: mythology with them. And that's both the general public and
• 44:52
  Speaker 3: the healthcare public.
• 44:54
  Speaker 2: It seems like, and I'm a dude, I don't know,
• 44:57
  Speaker 2: but I have worked with a lot of women. I
• 45:02
  Speaker 2: opened the first personal training centre in the country, right?
• 45:04
  Speaker 2: And most of my clients were women. And I trained
• 45:07
  Speaker 2: people one-on-one for 30 years and most of them were female.
• 45:12
  Speaker 2: So I went through birthdays, pregnancies, menopause, perimenopause, death, like
• 45:18
  Speaker 2: all of it. Yep.
• 45:20
  Speaker 1: But, and some of my.
• 45:21
  Speaker 2: Clients kind of sailed through perimenopause and menopause like they
• 45:25
  Speaker 2: had a mild cold. And other people, their life was
• 45:29
  Speaker 2: turned upside down and they were devastated. And me being
• 45:33
  Speaker 2: an alpha male bullhead, I was, you know, I was
• 45:36
  Speaker 2: probably more educated than my mates, but I was always
• 45:40
  Speaker 2: trying to, it was a very hard, problem to solve,
• 45:45
  Speaker 2: not solve, understand and navigate, I guess.
• 45:48
  Speaker 1: I was never going to solve it. But is that
• 45:50
  Speaker 1: just genetic? Is that just....
• 45:54
  Speaker 3: Why do some women say all through and others don't? Yes.
• 45:57
  Speaker 3: It's a big, big question that we're looking at some...
• 46:02
  Speaker 3: pointers to why this might happen. But you're right in
• 46:06
  Speaker 3: that this is where the community is really divided because
• 46:10
  Speaker 3: a lot of people say, well, hang on, I didn't
• 46:12
  Speaker 3: have a problem. Why is she whinging? And then you
• 46:17
  Speaker 3: get this kind of invalidation of the poor woman who
• 46:20
  Speaker 3: is really going under and And it's kind of like, well,
• 46:24
  Speaker 3: just pull up your socks and get on with it.
• 46:26
  Speaker 3: And that's not helpful. Not helpful at all.
• 46:28
  Speaker 1: Try harder. Try harder.
• 46:30
  Speaker 3: Well, it's been a particular thing, you know, in generations
• 46:33
  Speaker 3: past where the older women would say, well, just grin
• 46:37
  Speaker 3: and bear it. This is the lot that you've been given.
• 46:40
  Speaker 3: That's not helpful either. This generation of the 40s, the
• 46:44
  Speaker 3: women in their 40s, I don't know what they are.
• 46:46
  Speaker 3: What are they?
• 46:49
  Speaker 1: Gen something, I don't know.
• 46:50
  Speaker 3: Gen X, I think. They're great because they're not going
• 46:54
  Speaker 3: to lie down and just cop it. They're really saying, no, no, no,
• 46:58
  Speaker 3: do something, fix it. Why do some women experience it?
• 47:02
  Speaker 3: We think that we go back to early life trauma
• 47:06
  Speaker 3: and brain biology. So perhaps, perhaps, and we're still doing
• 47:10
  Speaker 3: the work, so this is observation that I've made that
• 47:15
  Speaker 3: many women who've had emotional trauma, whose families have been
• 47:19
  Speaker 3: divided or there's been some kind of emotional difficulties and
• 47:24
  Speaker 3: stresses and challenges in their early life, and I do
• 47:26
  Speaker 3: mean big ones, not just, you know, the usual sort
• 47:30
  Speaker 3: of difficulties that most families have, but something critical or
• 47:34
  Speaker 3: physical abuse and in particular sexual abuse in early life
• 47:39
  Speaker 3: seems too have a role to play in changing the
• 47:45
  Speaker 3: sensitivity of the brain to the hormonal fluctuations. That's one thing.
• 47:49
  Speaker 3: You're on the money when you say there's genetics because PMDD,
• 47:54
  Speaker 3: which is premenstrual depression, there has been a gene that
• 47:58
  Speaker 3: has been identified, but that gene doesn't become active until
• 48:03
  Speaker 3: there are at least two genes in the woman's life.
• 48:08
  Speaker 3: And messy child delivery, a birth that's long, complicated, painful, horrible,
• 48:16
  Speaker 3: that can be a trauma in itself, or even a
• 48:18
  Speaker 3: physical health condition has its traumas. So it's probably going
• 48:22
  Speaker 3: to end up being a combination of biological factors like genes,
• 48:28
  Speaker 3: then psychological factors like personality traits and how resilient somebody is,
• 48:35
  Speaker 3: And then social or environmental stuff, like what happened in
• 48:40
  Speaker 3: early life? Well, how much bullying was there?
• 48:44
  Speaker 2: Yes.
• 48:44
  Speaker 3: That's traumatic. I mean, all these different things will probably
• 48:48
  Speaker 3: add up to then say woman X is struggling with
• 48:54
  Speaker 3: the menopause transition, whereas woman Y is very lucky and
• 48:58
  Speaker 3: doesn't even notice. So... My point is, though, we've got
• 49:02
  Speaker 3: to go back to the individual, but go back to
• 49:05
  Speaker 3: the personalisation of the recommendations and don't invalidate the person
• 49:10
  Speaker 3: who is struggling by saying, well, you have no right
• 49:14
  Speaker 3: to suffer because I didn't. That's not on.
• 49:20
  Speaker 2: How funny is that people do that? It's like there's
• 49:25
  Speaker 2: a thing in psych called the false consensus effect and
• 49:28
  Speaker 2: people think that other people think like them or are
• 49:31
  Speaker 2: like them. And so they operate on this assumption, well,
• 49:34
  Speaker 2: I went through that and you're going through that and
• 49:37
  Speaker 2: I'm fine, so stop being a baby or, like, suck
• 49:41
  Speaker 2: it up. Yeah. Yeah.
• 49:43
  Speaker 1: Probably not a great strategy. What happens particularly.
• 49:48
  Speaker 2: During pregnancy and after childbirth that makes some women more vulnerable?
• 49:57
  Speaker 3: Yeah. So, I mean, again... you've got to look at
• 50:00
  Speaker 3: the whole spectrum of things, but there is a biological switch.
• 50:05
  Speaker 3: It's the GABA chemical system that has the switch and
• 50:10
  Speaker 3: the allopregnanolone hormone, which is a derivative of progesterone, seems
• 50:15
  Speaker 3: to be the key driver that turns the GABA system
• 50:19
  Speaker 3: on or off. And in the pregnancy, there's kind of
• 50:23
  Speaker 3: like a, in some women, the switch is faulty. And
• 50:28
  Speaker 3: so postnatally, they go into this postnatal depression or at
• 50:34
  Speaker 3: its worst form, postnatal psychosis. Again, that's the biological explanation.
• 50:40
  Speaker 3: If somebody has had previous hormone sensitivity, like premenstrual depression,
• 50:46
  Speaker 3: and maybe her brain is more sensitive to hormone shifts,
• 50:50
  Speaker 3: and there's a big hormone shift once the baby's delivered,
• 50:52
  Speaker 3: there have been high levels of of estrogen, progesterone during pregnancy,
• 50:57
  Speaker 3: and then all of a sudden it's just crash once
• 51:00
  Speaker 3: the baby's born.
• 51:01
  Speaker 2: Yes.
• 51:01
  Speaker 3: The hormones just drop very suddenly. And the brain is
• 51:05
  Speaker 3: a delicate organ. It doesn't like things to be up, down,
• 51:09
  Speaker 3: and sideways. It likes, you know, nice, smooth delivery of hormones,
• 51:14
  Speaker 3: delivery of chemicals. So that's another thing. And then, of course,
• 51:19
  Speaker 3: we have the whole issue of domestic violence and awful sex. very,
• 51:26
  Speaker 3: very awful situations that some women are living in, which
• 51:30
  Speaker 3: of course has its mental health effects.
• 51:34
  Speaker 1: Yeah, 100%.
• 51:36
  Speaker 2: When we talk about a lot of other health stuff broadly,
• 51:40
  Speaker 2: women and men, and we talk about whatever, diabetes or
• 51:46
  Speaker 2: heart disease or all the things, we talk a lot
• 51:49
  Speaker 2: about being proactive, not reactive. Don't wait till your body breaks.
• 51:52
  Speaker 2: Let's start to you know, let's organize our diet and
• 51:56
  Speaker 2: our lifestyle. Let's not be crazy. Let's not be, that's
• 51:59
  Speaker 2: probably a bad choice of words, but let's not be extreme.
• 52:02
  Speaker 2: Let's not be obsessed, but let's eat as well as
• 52:05
  Speaker 2: we can, sleep as well as we can, move our body,
• 52:08
  Speaker 2: you know, all those things, rather than waiting until we
• 52:11
  Speaker 2: get sick and then going, oh my God, I better
• 52:13
  Speaker 2: look after my body.
• 52:15
  Speaker 1: Is there any version of that when it.
• 52:16
  Speaker 2: Comes to your field where there's something that women listening
• 52:21
  Speaker 2: to this right now are healthy, they're in a good space.
• 52:24
  Speaker 2: Can they be proactive now to counter that in some way,
• 52:29
  Speaker 2: to reduce the chances of, you know, suffering to that level?
• 52:35
  Speaker 2: Is there anything we can do?
• 52:37
  Speaker 3: There are some, yes, there are. There are some things. But, again,
• 52:41
  Speaker 3: I think the preventative mode for mental health is less, then,
• 52:47
  Speaker 3: you know, don't eat a whole bunch of sugar and
• 52:49
  Speaker 3: stuff before you develop diabetes. But, you know, in mental health,
• 52:55
  Speaker 3: street drugs or taking, you know, the recreational drugs are
• 52:59
  Speaker 3: very bad for your brain. I'm always stunned by, you know,
• 53:04
  Speaker 3: how much alcohol people drink on a regular basis. Particularly
• 53:10
  Speaker 3: during COVID, we saw absolute mayhem with, the amount of
• 53:16
  Speaker 3: wine that middle-aged women consume, you know, a whole range
• 53:20
  Speaker 3: of professions, particularly who had tough time during COVID and
• 53:25
  Speaker 3: looking after kids' Bible, whatever. It was like this reward
• 53:29
  Speaker 3: was to have two bottles of wine per night. Well,
• 53:31
  Speaker 3: that's terrible for the brain. So, you know, watch the
• 53:35
  Speaker 3: drug and alcohol story. That is really important. Eating healthy
• 53:39
  Speaker 3: food is critical. So it is important to eat. healthy
• 53:44
  Speaker 3: food and eat well. So not starving and not kind of,
• 53:49
  Speaker 3: you know, overdoing the things that you know are fast-processed foods.
• 53:53
  Speaker 3: That's not good. Regular exercise, and you're the expert here, but,
• 53:58
  Speaker 3: I mean, it's amazing how many people think regular exercise
• 54:02
  Speaker 3: is beyond them, whereas you go, well, hang on, you
• 54:04
  Speaker 3: can put on a pair of runners and walk for
• 54:06
  Speaker 3: half an hour, and that is regular exercise. So, you know,
• 54:10
  Speaker 3: do something, but do it regularly.
• 54:12
  Speaker 1: 100%.
• 54:13
  Speaker 3: So that's important as well. Connections, social connections and keeping
• 54:18
  Speaker 3: up connections is really important. We're not destined, we're not
• 54:22
  Speaker 3: meant to be solo. You know, human beings are pack animals,
• 54:27
  Speaker 3: if you like. So, you know, it's important that we've
• 54:29
  Speaker 3: got our connections in terms of keeping up good friendships
• 54:34
  Speaker 3: and good family connections. And then healthy relationships. Now, it's
• 54:38
  Speaker 3: easy said and not easy done. Yeah. But, you know, again,
• 54:42
  Speaker 3: I see a lot of women who, unfortunately, if they've
• 54:46
  Speaker 3: had a bad early life experience, then they have a
• 54:50
  Speaker 3: very often got a very poor self-esteem and they don't
• 54:54
  Speaker 3: esteem themselves and then they choose partners who really play
• 54:59
  Speaker 3: on that and make them feel even worse either there's
• 55:03
  Speaker 3: physical abuse or emotional abuse or sexual abuse so if
• 55:08
  Speaker 3: that's the situation then again getting out of that situation
• 55:12
  Speaker 3: again easy said not easy done but that is important
• 55:15
  Speaker 3: as well um and then realizing uh or having like
• 55:20
  Speaker 3: i i don't like a lot of the freudian stuff
• 55:22
  Speaker 3: by any means but one thing that i do like
• 55:26
  Speaker 3: that was freudian was there was this concept that you
• 55:29
  Speaker 3: need both work and love in order to be happy
• 55:34
  Speaker 3: and fulfilled. And work can be anything. It doesn't have
• 55:38
  Speaker 3: to be the most highly paid influential job, but it
• 55:43
  Speaker 3: is about whatever gets you out of bed and gets
• 55:47
  Speaker 3: you to do something, whether it's whatever. I mean, you know,
• 55:52
  Speaker 3: voluntary work, childcare or anything that is work and then love.
• 55:57
  Speaker 3: To have a love interest, whether that's love of a
• 56:00
  Speaker 3: child or love, a romantic love or a friendship love or,
• 56:04
  Speaker 3: you know, whatever it is, work and love is a
• 56:08
  Speaker 3: good balance to have in order to help your mental health.
• 56:12
  Speaker 2: You know, it's interesting, and I don't mean to bring
• 56:14
  Speaker 2: the tone down, but you might be interested in this.
• 56:17
  Speaker 2: So my dad's been really sick for a long time,
• 56:19
  Speaker 2: and he passed away a few weeks ago. He passed
• 56:22
  Speaker 2: away maybe three and a half, four weeks ago. God
• 56:24
  Speaker 2: bless him, Ronnie.
• 56:24
  Speaker 3: Sorry to interrupt.
• 56:26
  Speaker 1: Yeah, no, that's fine. Thank you.
• 56:29
  Speaker 2: But mum's been with him for the last, oh, forever,
• 56:32
  Speaker 2: for 62 years. But the last year or so, she's
• 56:36
  Speaker 2: been very isolated because she had to be with him.
• 56:38
  Speaker 2: So very lonely, very isolated. And she's a very social person.
• 56:43
  Speaker 2: And also she's 87 years old and exhausted, 86, and
• 56:46
  Speaker 2: exhausted and spent her life trying to care for him.
• 56:49
  Speaker 2: And it was just a bad situation. And, you know,
• 56:53
  Speaker 2: since dad passed away, obviously she's sad, but she's moved
• 56:57
  Speaker 2: into a, an old age care facility. And the energy
• 57:02
  Speaker 2: in that joint is amazing. And the people are amazing.
• 57:05
  Speaker 2: And the carers are amazing. And the nurses are amazing.
• 57:09
  Speaker 2: And I go there every Saturday, which I've renamed Saturday,
• 57:12
  Speaker 2: Mary Day. So it's Thursday, Friday, Mary Day, Sunday, right?
• 57:15
  Speaker 1: And it's bloody awesome. I want to go there. It's
• 57:19
  Speaker 1: such fun. And what is interesting, and this even sounds
• 57:22
  Speaker 1: bad to say, but.
• 57:26
  Speaker 2: while she still obviously is missing dad, of course, but
• 57:31
  Speaker 2: it's like someone's watered a plant that hasn't been watered
• 57:34
  Speaker 2: for six months. All of a sudden she's got all
• 57:37
  Speaker 2: these people. It's nice breakfast, lunch, dinner. She eats different
• 57:41
  Speaker 2: meals every day with different people. She can get her
• 57:45
  Speaker 2: hair done down the thing. There's a cafe there. It's
• 57:48
  Speaker 2: bloody amazing. And it's just that moving from isolation and disconnection,
• 57:54
  Speaker 2: social disconnection and loneliness, just that one variable of humans
• 58:00
  Speaker 2: and interaction and social connection.
• 58:03
  Speaker 1: I'm not kidding. She looks 10 years younger.
• 58:06
  Speaker 2: I took a photo of her about eight weeks ago
• 58:08
  Speaker 2: and I took one of her very recently. She looks
• 58:12
  Speaker 2: like a different woman because she's just not under this
• 58:15
  Speaker 2: enormous pressure anymore. uh and yeah it's it's bloody amazing
• 58:21
  Speaker 2: prof so yeah there's something to be said for connection
• 58:24
  Speaker 2: and not being lonely.
• 58:27
  Speaker 3: Absolutely so you know i think i think there is
• 58:30
  Speaker 3: something in the old work and love balance.
• 58:33
  Speaker 2: Yeah yeah yeah yeah hey um oh wow we're past
• 58:37
  Speaker 2: your time i could talk to you for like ever
• 58:40
  Speaker 2: um which is probably not your ideal thought, but Hey,
• 58:44
  Speaker 2: thank you so much.
• 58:45
  Speaker 1: Thank you so much. You're great.
• 58:46
  Speaker 2: And I love the way that you, uh, make the
• 58:50
  Speaker 2: complicated uncomplicated.
• 58:52
  Speaker 1: And, um, you're definitely an inspiration.
• 58:55
  Speaker 2: Congratulations on all the stuff that you've done and continue
• 58:58
  Speaker 2: to do. Thank you for being you. Thank you for
• 59:01
  Speaker 2: spending an hour and a half with patients.
• 59:03
  Speaker 1: I love that. And I know you're in rare air
• 59:06
  Speaker 1: and not everyone can afford to do that. I get that.
• 59:09
  Speaker 2: But if people want to connect with you online or
• 59:13
  Speaker 2: I should know this, have you written a book that
• 59:15
  Speaker 2: we need to promote?
• 59:17
  Speaker 3: Well, I'm trying to write it.
• 59:20
  Speaker 1: Come on.
• 59:21
  Speaker 3: Yeah, I know, I know.
• 59:23
  Speaker 2: All those free hours you've got just sitting around watching Netflix,
• 59:26
  Speaker 2: do better.
• 59:28
  Speaker 3: Her Centre Australia. So if people want to look up
• 59:31
  Speaker 3: Her Centre Australia, we put things on our website. As
• 59:35
  Speaker 3: it sounds, it's health education and research for women's mental health.
• 59:39
  Speaker 3: So that's Her Centre Australia, which is the Monash University Centre.
• 59:45
  Speaker 3: Then there's the multidisciplinary Alfred Psychiatry Research Centre, which is
• 59:49
  Speaker 3: my other centre, which is an Alfred hospital facility. based centre.
• 59:55
  Speaker 3: And then there's Cabrini Hospital for Women, which is in Elsternwick.
• 59:58
  Speaker 3: So all of them have got websites with different bits
• 1:00:01
  Speaker 3: of information if people are looking for that.
• 1:00:04
  Speaker 1: Awesome.
• 1:00:04
  Speaker 2: And the person you've been listening to is Professor Jayshree Kulkarni.
• 1:00:09
  Speaker 3: Thank you for having me on the program.
• 1:00:11
  Speaker 1: Oh, thanks.
• 1:00:12
  Speaker 2: We'll say goodbye fair quickly, but for the minute, thanks, Doc.
• 1:00:15
  Speaker 1: We appreciate you. Thanks for being on the You Project.
• 1:00:18
  Speaker 3: Thank you.