Latest / The Dr Louise Newson Podcast / 52 – Why psychiatrists must start thinking about hormones

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52 – Why psychiatrists must start thinking about hormones · The Dr Louise Newson Podcast

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Today on my podcast, I've got Doctor Gareth Jarvis, who is a
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psychiatrist who prescribes hormones.
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There's not many of those around.
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He's learnt a lot from his wife Rachel, who actually works with
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us in the clinic, and he talks about how important it is to
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think about hormones and mental health.
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Think about how important it is for us to be diagnosing properly
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in psychiatry and thinking about the important roles of hormones
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in our brains. So Gareth, thank you so much for
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coming today. It's always great having
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somebody who, like me, didn't really know about hormones at
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medical school and has just sort of seen the light almost.
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But you are a psychiatrist And I really enjoyed psychiatry.
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I did it in North Manchester with a very deprived area, but
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it was a really good unit, actually very cohesive.
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The, the doctors really worked together well.
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You know, my other students were really quite jealous that we
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were there in, in at the time we had eight weeks, which isn't
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long, but it is quite a good chunk of time compared to like
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one week of ophthalmology. I think that I did, but I've
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used a lot of my psychiatry training throughout, especially
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being AGP, but I never thought about the association of
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hormones and mental health. Whereas every day I think about
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it now. And you, you think about it more
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now, don't you? I do and I, I, I guess probably
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worth me saying Full disclosure right up at the top of the, the
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vodcast that my, my wife Rachel is AGP works for, for, for
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Newson Health. And she, she's amazing.
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And, and she's really helped bring me towards the evidence
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base around menopause. Because I'll admit, Louise, that
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I, I, I kept myself woefully poor, not up to date in this
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area for, for, for many years. It was, it was, it was a
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footnote at medical school when, when I was up there in
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Edinburgh, we, we maybe had a day on it.
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I do, I can't really. It's, it's so it's so much back
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in the midst of time now and through throughout my psychiatry
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training again, at best a footnote at any point was
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menopause discussed. And yet I, I, I look at it now
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and think, I can't believe that we haven't, we've done how
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little attention was paid to it throughout that, that time.
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I mean, if I, I look back at medical school, that was around
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the time that the, that the Women's Health initiative study
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was, was out. And so that, that message just
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came through of, oh, oh, hormones cause cancer and stay,
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stay away from them. It's HRT is dangerous.
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Was, was basically the only message I can remember receiving
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about it. And I don't think I'd really
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updated my knowledge since then because it wasn't my specialist
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area. It wasn't sort of specifically
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what what I was focused on within my training, though.
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I didn't have a single supervisor and knew about it or
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wanted to talk about it. And that's such a key part of
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how we train as medical professionals.
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You learn, you learn on the job a lot, don't you?
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And also what you read is dictated and shaped by your,
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like you say, your supervisors, your peers, any guidelines?
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So if it's, if it's not on your radar, it's really difficult,
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isn't it? And, and I, I mean, I trained
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before the WHI so I graduated in, in 1994 and then I became
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AGP in 2000. So the WHI study came out in
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2002. But I was writing evidence based
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articles every week for GP magazines.
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It's a free magazine, went to every GP.
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So I wrote key, key topics in various things that I could
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choose. And actually I, I found them
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recently. So I, I wrote one on in 2001
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about HRT and then I wrote another series.
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I did 4 because he'd only had was a small column.
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And there's a lot to talk about obviously with hormones in 2002.
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And actually it's interesting because in 2002 I say, oh, this
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is study that's come out doesn't show us anything that we didn't
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know might be a slightly greater risk of breast cancer.
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But again, that's with older types of hormones, but but it
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definitely helps with bone protection, helps people feel
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better. And we can should continue, but
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obviously involve the patient in your decision making.
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But I was in my little GP practice then and I had no idea
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externally the rest of the world HRT prescribing had just fallen
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off a Cliff. And for, for, for the likes of
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you little bit younger, not having that anywhere in your
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radar. But when I was taught it was
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literally like you say a day or so, but it, or in a few hours
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really, but it was more about flushy sweat.
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So there's something it wasn't really nothing about the mentor
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house. And, and also, you know, as you
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know, well, Rachel, the scene, a lot of our patients have PMS and
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PMDD. And for those women actually, so
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premenstrual dysphoric disorder is about one in 20.
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So it's really common. And you know, patients say to me
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it's like light and day. You know, they they said as the
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light goes out, the whole personality changes those days
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before their periods. And I I must have seen it in
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general practice and psychiatry. But if you don't ask about a
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change throughout the cycle, and you only see the women in their
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crisis, if you like you, you don't build up the big picture,
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do you? And that's The thing is that so
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as psychiatrists, we're always trained to be really holistic in
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the way that we think about someone's health.
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And so, so we, we, and we've got the luxury of an hour to spend
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with someone really trying to understand fully what's going on
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with, with their lives. Can we actually figure out
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what's gone through the, the life course and that and that's.
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So what's so often one of the distinguishing features we're
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looking for is actually at what point in their life cycle did a
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change happen? But at no point was this sort of
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brought into my sort of thinking around actually focusing in on
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what, what happens on menopause. Yeah.
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You, you look at things that we, we, we know already about.
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So as we know in about for decades, when does suicide peak
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for women? It's between 45 and 54.
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And what's happening around that age.
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And, and I, I, I kind of almost sort of feel a little bit sort
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of shameful now sort of looking back of like, why wouldn't I
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have paid that more attention to actually focus in on the changes
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that happened for women at that time?
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And, and I, and I'm the same, but also when you read a stat,
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you don't always think what's behind it.
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And you might know that we've funded APHD student suicide
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prevention with Liverpool John Walls University.
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And she's just got her PhD and she's going to come and work
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with us actually full time in research, which is wonderful.
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And, and, you know, we've had some really interesting
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publications already about that, but also, you know, one of the
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publications, a lot of quotes from women whose lives we have
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saved with hormones. And one lady quoted to say, you
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know, if I had taken my life, I would just be another statistic.
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No one would have known I was perimenopausal.
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And this is a problem, of course, isn't it?
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And for many centuries, really, women have been dismissed and
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gas lit and, and being told, well, it's their stress, it's
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their circumstances. And I don't know if you know,
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but I was doing some volunteering in prisons.
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You know, a lot of people in prisons have a lot of mental
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health, all sorts of things that have gone on in the past.
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But they also, a lot of them have early menopause because of
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their drug abuse, because of what's gone on in the past, you
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know, and a lot of them are on heavy duty psychiatry drugs.
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So a lot of them are on quetiapine, a lot of them are on
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pregabalin and gabapentin, some of them are on lithium, a lot of
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them have implants for contraception.
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And the reason I'm saying all these drugs is because they will
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not have their own natural hormones in their body.
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So a lot of them have physical symptoms.
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So a lot of them were having very itchy dry skin, a lot of
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cystitis, urinary tract symptoms, palpitations, and they
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weren't having periods. So I was going just to educate
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about what hormones are and do talking to some of the younger
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ones about PMDD because we've known for many years people are
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more likely to commit a crime when they're angry and irritable
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these days for the periods. And a lot of them, it was a
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light bulb moment and they were like, Oh my goodness, that's me,
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that's me. But they couldn't get access
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hormones from their GPS or the, the doctors in, in, in prison.
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And, and I actually got reported to someone in the prison service
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because the doctors weren't happy I was there.
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And they reported me to my responsible officer who does my
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appraisal. And they said that I was saying
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that all mental health was due to hormones.
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And like, it's just crazy because it's so many things that
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affect our mental health. Absolutely.
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But if we ignore hormones the whole time, we're never going to
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get people completely well, I don't think.
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That's it for me is that I'm, I'm not going to sort of turn
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around and say that HRT is some kind of silver bullet for all
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mental health problems, but we cannot ignore it.
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It's such an integral part of, of a woman and making sure that
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she's optimised health. That's, and it has such a big
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impact on mental state that, that, that why on earth would we
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not be exploring that and being curious about it and, and, and
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actually making sure we, we, we've got these incredibly low
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risk things that we can prescribe now for, for, for,
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for, for, for someone who's in their perimenopause or menopause
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and they've got all these other massive health benefits.
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I mean, it's one of the things that really capture my
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imagination, as I've been talking with Rachel about it, is
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that we've known for a very long, in that time now this
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enormous mortality gap we have for people with severe mental
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illness, It's 20 years and younger that you will die if you
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have a, on average, if you have a severe mental illness.
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And what are they dying from? They're dying from
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cardiovascular disease. They die from strokes, they die
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from dementia, they're dying from cancer.
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And what are all the what, what if we're looking around what's
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in our armament to really sort of try and push back about that
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holistically as as doctors working with people from
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whatever background they're coming from in medicine to help
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close that mortality gap. This is feels like such a potent
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tool to have in the box to actually support women with
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making sure that their bones stay strong and healthy, that
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their cardiovascular systems protected, that their brain is
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protected. Why wouldn't we be prescribed?
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Well, it's so interesting and I'm, I'm very interested in the
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immune regulating effects of hormones because I don't know if
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you know, I've got a pathology degree as well.
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And I spent the whole year focusing on the macrophage and
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inflammation. And the more we look at that
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neuro inflammation, so inflammation in the brain, it
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does seem to be closely associated with mental health,
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schizophrenia, depression, bipolar.
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And you know, we know that inflammation is associated with
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cardiovascular disease, osteoporosis, dementia.
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So there is a link as well, which we can't keep ignoring.
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But I'm also, I'm interested in pathology, but I'm also
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interested in history because I think that can shape a lot
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actually, especially in medicine.
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So thinking about the power of hormones in our brain, we've
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known for many years. I mean, we've only known about
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hormones since the 1930s when they were discovered.
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But even in the Victorian times before that time, there were
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lots of people going to asylums, as we know.
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But there were some really great writers of someone called Edward
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Tilt who wrote in great book in in 1888, which I've read and
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talking about the change of life, and he was talking about
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this this time. That was a real toll on mental
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health that seemed to improve with bleeding.
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So he didn't know about hormones, but he knew there was
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something that was going on. And he did talk about people
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going to prisons and committing crimes because of these
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symptoms. He talked or he wrote a lot
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about the toil of looking after children, the women, the mental
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health, you know, and, and he was alluding to it being around
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the cycle, you know, and I think then they didn't have the drugs
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that we have now. They weren't so short for time
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as we are often now. So he could really, really
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explore with patients and he was really associating the physical
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symptoms and the mental health symptoms.
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And then they discovered hormones, commercialized them
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and they went off down a different track.
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But then also the antidepressants and
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antipsychotics came out and so a way of getting people out of the
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asylums was just giving them the antipsychotics, wasn't it?
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To clear the to clear the asylums.
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And these these people maybe got better temporarily, but then
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they realised the side effects of the antipsychotics.
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And, and this is The thing is that that it's, I've, I've
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always been someone within psychiatry who's cautious about
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the prescription of, of, of psychotropic medication.
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Now it that they are really important efficacious treatments
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that we have, however they are they're patents and they come
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with with side effects. And so they have to be used to
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just judiciously and carefully and fit for the right situation
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and for the shortest period of time that we can for somebody.
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And for, for me now when I sort of, I, I look at a woman coming
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to my clinic and we're going through the history, I do want
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to stop and think about actually, if you're already on
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HRD, have we optimized it? Because there's, there's so much
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variation in the practice of its prescription because actually
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giving a woman back her own natural hormones, Why wouldn't
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we go there first before we start introducing a, a
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psychotropic medication into the system?
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It's it just feels not like. You know, if I said to you,
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look, you've got an iron deficiency and you're quite
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tired, Yeah, tiredness is a symptom of depression.
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But I wouldn't give you an antidepressant.
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I would try you an iron first, yes.
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Yes, yes. It's it's all quite simplistic
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medicine, isn't it? And, and the same, you know, we
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know that progesterone, estradiol, testosterone are made
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in the brain. They're newest do, yes.
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So they have a role in the brain.
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And, you know, there was, there's even randomized control
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studies from the 1980s, women with severe mental illness who
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are in a psychiatric hospital given either placebo or estudiol
14:15
in conjunction with their other medication.
14:17
And the results are staggering. Thanks so much for listening to
14:23
my podcasts. Did you know that if you prefer
14:25
to watch rather than just listen, my podcasts are
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available on YouTube every week. You'll find full episodes and
14:32
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14:36
Women's Health, all grounded in science and real clinical
14:39
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So if you want to stay up to date, revisit episodes or share
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them with others who might benefit, make sure you subscribe
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to my YouTube. But the other thing about
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antipsychotics that I I never realised because I didn't think
15:05
too broadly that antipsychotics affect metabolism.
15:09
So we know that people on them long term, there's an increased
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incidence of heart disease, diabetes.
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People usually have the blood tested for their cholesterol,
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they have their blood pressure quite rightly done, but we know
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that they can increase prolactin.
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So if they increase prolactin they can switch off or suppress
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FSH and LH2 hormones in our brain.
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So basically give people a chemical menopause.
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We've known for many years that people on these antipsychotics
15:36
long term have amenorrheas, a stopping of periods.
15:40
But I've been trying to work out guidelines and I've been in
15:43
touch with your Royal College of Psychiatrists in case I've
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missed them. But they've confirmed to me
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there aren't guidelines that we have to be testing or
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psychiatrists should test for hormones in women who are on
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psychiatric medication long term.
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And it doesn't make sense really.
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Absolutely. I, I think this is where we get
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into some of the barriers that, that, that are there for
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psychiatrists in trying to sort of their, their, their practice
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and stepping into thinking about perimenopause, menopause.
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I know as an, as an NHS consultant that it can be really
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challenging to do blood testing as, as, as a, as a psychiatrist
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is. We're, we're often not well set
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up within the average psychiatry clinic to actually just turn
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around and say, oh, hang on, I'll just take a blood test off
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you. And we, we're quite often having
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to ask our GP colleagues to help assist us with that, or we're
16:30
having to try and book in through one of our depot
16:32
clinics. And it's complicated and
16:33
challenging. So it's, it's so the systems
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just aren't really well set up for us doing blood testing on a
16:37
regular basis. And I'm, I'm not meant to be an
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excuse, it's just a reality of it, isn't it?
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Because I know for my own practices, I've been starting to
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try and sort of build up the way that I'm working here.
16:48
And, and I read more into the evidence and read more of the
16:50
guidelines around how you can practice in this area.
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I sort of realise that, oh, I'd be really nice to actually know
16:54
what the whole main levels are. So I've got a sense of, of, of
16:58
where we're at. It's certainly inhibits me from
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wanting to go above the, the, the licence limits, even though
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I hear all the time from Rachel just how much success that she
17:11
has within the Newson Health Clinic of actually knowing for,
17:14
for women who are poor absorbers of estradiol that actually, if
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you've not had success in this sort of lower levels, it
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probably because they're a low, a poor absorb there.
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There was a CPD module that I completed a couple of years ago
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that so I noticed you, you assisted in writing the news,
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which, which is fantastic. I found that a really helpful
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module that's available on the Royal College website for, for
17:35
our, our Co and CPD training. And that really got me over the
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line actually in feeling confident about prescribing
17:42
because it just, it just really helped me understand exactly
17:45
what. Yeah.
17:47
All it actually did was reconfirm everything that I'd
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heard from Rachel before and had and had all the papers put in
17:52
front of me by her. And we'd gone through and I'd
17:54
read through a couple of the books.
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But actually then finally having the Royal College stamp on it
17:57
helped get me over the line of feeling like, OK, I I feel
18:00
comfortable and confident now that that my practice is being
18:02
backed. Yeah, and I, I wrote that with
18:05
some colleagues, but it took me a good two years because I got a
18:08
lot of pushback to say surely the evidence isn't this good,
18:11
Surely there's more but but fair play.
18:13
And, and, and actually I paid some of our money so that it
18:16
would be free access because it was really important for me that
18:20
it was free access. And then I did get a, a prize
18:22
because it was the most downloaded module and, and I
18:25
went up to Edinburgh to, to receive it and which was great.
18:29
And every psychiatrist I spoke to DSP realised this is problem.
18:33
But most psychiatrists are not like you and they don't
18:35
prescribe any hormones at all. And I find that really quite
18:40
frustrating because as AGP, I'm expected to prescribe most
18:44
things and hormones are safer than, yeah, most other drugs,
18:48
you know? I I, I, I guess the, the, the
18:50
thing for me that I, I, I've always been really lucky this,
18:53
that I've had Rachel on tap this whole time.
18:55
That, that, that who I, I, I can sit and debate cases with over
18:59
the dinner table and, and then and just say, you need to
19:01
describe that woman HRT. But but also that Rachel's she's
19:09
given me permission to talk about this openly.
19:11
Is that that that she's been going through her own
19:12
perimenopause. And so we've had our own
19:15
personal experience of sort of going through that journey and
19:19
we we started to notice lots of changes with with with Rachel
19:22
that she was, she was getting much more tired.
19:25
She was, I mean, Rachel is just the most organised person you've
19:29
ever met in your life. She's on top of everything all
19:31
the time. And, and it just found that that
19:33
we, she wasn't just quite on top of things the way she used to
19:35
be. And then we started to find that
19:37
there's lots of mood swings started coming in and there'd be
19:39
these moments of explosive anger that would come out of nowhere.
19:42
And I'd be thinking, Oh my God, what have I done now?
19:45
And because I'm the kind of person who just internalised
19:47
this stuff straight away. And I was thinking, oh, I'm, I'm
19:50
a dreadful husband. I'm doing terrible things and,
19:53
and, and it, and it starts to become this real sort of, it was
19:56
a difficult point in our relationship where we were
19:59
having these sort of flash points of, of argument.
20:02
And then she started to really get, get into the, the world of
20:06
understanding perimenopause and menopause and has been able to
20:10
be prescribed. But she's a poor absorber and,
20:13
and, and 100 microgram patch was not enough for her and she had
20:16
to go up and, and she's on, she's on 400 micrograms now.
20:19
So she she puts on 4 patches a day and.
20:22
And, and, and that's been, that's finally got to the point.
20:24
And it's a world of difference where, where and she, she, she's
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a she, she says, I've got my energy back.
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My mood is, is great again. I'm able to function.
20:35
And so having, having that personal experience of and the
20:38
confidence to see that, that, that that's made all the world a
20:43
difference for her and, and for us.
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I, I, I think that's definitely made me want to go more.
20:49
Women should have the chance to, to, to, to, to, to feel this.
20:52
Good. And I mean it's the same.
20:54
I mean I've been on HRT for 10 years, but I don't absorb well.
20:58
And I was on 100 micrograms, it did nothing and going up to 200
21:02
and I was perimenopausal then. So now I'm higher than that.
21:06
But if I don't I it's I get migraines really badly anyway
21:10
and they just get a lot worse and I get joint pain.
21:12
But my mood was terrible at times.
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But I've I have managed to persuade a few psychiatrists to
21:18
to prescribe. There was one of my patients.
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It's really sad actually. She was doing really well on HRT
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and then there was an HRT shortage a few years ago.
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So her GP said, well, you don't need it anymore so we'll stop
21:30
everything. And her mental health
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deteriorated really quickly and her husband was doing some
21:37
washing up and she, she jumped. So she fractured her, her spine
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and was in a psychiatric hospital.
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And he reached out to me and I went to go and visit her.
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Actually one Sunday. I just turned up at the hospital
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and I hadn't been to a psychiatric hospital for many
21:53
years. And she was really agitated and
21:55
she was absolutely mortified. I was there and she was like a
21:59
little Sparrow, you know, she, she was, she wasn't one of my
22:03
patients, so I didn't know what she was like before, but she was
22:05
a clinic patient and I, I just felt really sad to see her.
22:08
So she had very dry hair, very dry skin.
22:12
She was ruminating a lot. She was fixating on the
22:14
accident. She was so embarrassed that I
22:16
was seeing her. So she had insight as well,
22:18
which a lot of these people still do.
22:20
And so I can't, couldn't prescribe for her because she
22:23
was under the NHS. So I can't tune it.
22:25
So the psychiatrist had done the module and, and recognized my
22:29
name so agreed to prescribe for her.
22:33
And I saw her as a review last week actually.
22:35
And it's just amazing. She's, she's like, she's so
22:38
well. But it's, it was the
22:40
testosterone that made the biggest difference.
22:42
And a lot of people who have that poorly, the estidine and
22:46
progesterone help, but it's the testosterone and it takes time
22:49
and, you know, physically she's looks completely different that
22:53
mentally she's so different. And you know, it's, it's
22:58
incredible. But having this rapport with a
22:59
psychiatrist and actually giving them, telling them, you know, or
23:04
advising them what would be good to prescribe, looking at the
23:07
blood results with them, it's been really good.
23:09
And it's happened to another couple of patients again, who
23:12
have been inpatients. And that's really amazing.
23:15
But I, I would have even thought about it years ago.
23:18
That's what frustrates me. But now, now it's there, it's so
23:21
obvious. And a lot of psychiatrists,
23:23
well, we need more evidence. But actually there is really
23:26
good evidence, yes. Compared even to some of the
23:29
other drugs, Yeah. It's this sort of wilful
23:32
blindness really, that they're using it as a a reason.
23:37
Maybe, but but we need to change the conversations, don't we?
23:41
And, and I found that a really tricky area to navigate.
23:43
So Louise around it that, that relationship with other doctors.
23:46
Yeah. And, and, and so even as I've
23:48
sort of started making this a more regular part of my practice
23:51
of prescribing HRT for women, after we've gone through
23:53
figuring out that that feels like a right fit for something
23:55
to try. And then we've had some amazing
23:57
results where, where, where women have just come back and
24:00
said, I feel this has really helped.
24:03
You know, it's not sold my probably because, but by the
24:05
time they come to see me as a, as a psychiatrist, they, it's
24:07
usually, it's usually pretty severe and complex mental health
24:11
problems because actually the vast majority of mental health
24:13
problems is managed by general practice, of course.
24:15
And, and, and so I'm seeing the most severe end.
24:17
So it's not, as I say, not some silver bullet that's just taken
24:19
away their, their, their problems.
24:21
But they said this has helped. I'm sleeping better.
24:23
I'm not drenched in sweats. I, my, my mood just feels that
24:26
little bit calmer and I'm just able, I've got that energy back
24:29
to sort of start doing things again.
24:31
So I'd really like, you know, we said, great, let's get it
24:33
continued And I'll write back to the GP and say, you know, we've,
24:35
we've done this trial of HRT, please carry it on.
24:37
And I've had some very rude letters back from, from, from
24:40
some GPS where, where they've actually come back and said,
24:42
what do you think you're doing as a psychiatrist, right?
24:44
They're prescribing HRT or another one I had was, was a
24:49
woman who'd, she'd had a hysterectomy and she'd been
24:53
given some HRT, but it was a very, it was, it was 50
24:55
micrograms of, of estudiol and that was it.
24:59
And we said, I said, well, do you know what?
25:01
Actually, I, I think if we add in some mute suggestion because
25:04
she was really complaining that her sleep was really poor and
25:07
she's very anxious. I said, I, I just, I'm
25:09
interested to find out if this would be helpful.
25:11
And and this is this is common practice when the psychiatry in
25:14
terms of trying things out. Because they used to therapeutic
25:16
trials. Because what the medications we
25:19
prescribe normally in psychiatry that, that it's not like we're
25:21
topping up your lack of sertraline or, or whatever it
25:25
might be. And we're, we're, we're, we're
25:27
adding into the agents the body doesn't normally have because
25:30
we're trying to see if if the effects of it are helpful or not
25:33
and give some space for helping. So, so that's just normal way
25:36
that we practice in psychiatry. So I think if you can enter into
25:39
HRT prescribing in that spirit of let's try something and, and,
25:43
and again, just want to re emphasise that very low risk.
25:47
So, so why wouldn't we give it a go?
25:50
Because you can always not prescribe it again.
25:52
If actually it turns out that that that did nothing or, or,
25:54
or, or you can, we can play with it a bit more and try and see if
25:57
we can find it even better fit. But yes, so it's so right.
25:59
Back to that story, ladies had a hysterectomy.
26:02
We introduced some neutrogestan. And yes, after a few weeks, you
26:06
know, she came back a few weeks later and said, do you know what
26:08
that actually really helps? I, I'm, I'm sleeping a lot
26:10
better. I feel a bit calmer.
26:12
I'd like to continue that. I was like, great.
26:14
So we wrote back to the GP and said that, you know, we've
26:17
increased these style. We've we've prescribed to me
26:19
from you to dress down. And she, she came back and said,
26:22
well, she doesn't need you to dress down.
26:24
She hasn't got a womb. And so, so, so I then entered a
26:28
bit of a back and forth in the emails saying, well, actually,
26:31
you know, she's, she's benefiting from it.
26:33
And we know that progestion has an effect on the GABA system
26:36
thanks to your module. And, and and that's, that's
26:40
going to reduce anxiety, it's going to help with the sleep.
26:44
So why on earth wouldn't we continue that?
26:47
And she then came back again and, and, and, and I did have to
26:52
send us quite a few more materials and papers to sort of
26:54
try and reassure 'cause you should come back saying it's
26:55
gonna give her blood clots. And so it's just, there's no
26:58
evidence for that. And, and it's amazing the amount
27:01
of misinformation that's out there.
27:03
And, and I and I feel like there's no other area of
27:04
medicine that has this degree of misinformation no in it.
27:08
It's absolutely madding, isn't it, Because we're arguing over a
27:11
natural hormone at the end of the day and the patient is
27:15
central to that decision making process.
27:18
And, and actually we are reaching a stage often where the
27:20
patients know more than the doctors.
27:22
And that can be difficult. But a lot of doctors are, are
27:25
waking up and realizing because it is basic Physiology as well.
27:29
And you know, we can, we can have the psychiatric medication
27:33
alongside. It's not a one or the other.
27:35
And often the, you know, people need both.
27:37
That's fine as well. So there's lots we need to do
27:40
and I'm just really grateful that you're here talking about
27:43
it and hopefully we'll we'll change the minds of others.
27:46
Well, do you know that that thing about changing minds is it
27:49
occupies me a lot because it's, so as a psychiatrist, I, I'm
27:53
really passionate about an approach to mental health care
27:56
called open dialogue, which is really inclusive of family and,
28:00
and trying to be transparent with the people that you're
28:02
working with. So, so it's just got the
28:04
effectiveness, it's heart, it's that, it's, it's making sure
28:06
that you have all the conversations you need to have
28:08
about someone in front of them and that you include their
28:11
social system around them or anyone who's important to them.
28:14
And, and I've been working on that for about 10 years now with
28:18
various people in the UK. And we've been did a big
28:20
research trial around it called a Desi that we're publishing
28:22
soon. And it's, it's amazing the
28:27
amount of resistance I've had over that time of trying to
28:31
bring in a different way of working that that that there's
28:35
just this huge degree of conservatives, small see
28:38
conservatism amongst the medical profession to anything that's
28:40
new or different, this sort of level of suspicion.
28:43
Yes, it is. Suspicion isn't.
28:45
It of, of, of just, you know, that, that, but I, I, it's
28:49
amazing the sort of range of responses I'll get to it when I
28:52
start trying to explain. There's this sort of way of
28:53
working to, to, to people. The first of all, they go, oh,
28:55
that's no different to what I do already.
28:58
And then the next response is, oh, when they really get to
29:00
understand, they go, that's too radically different from what we
29:02
do already. Then it's almost too expensive.
29:05
And no, it'll take too much time and, and every excuse in the
29:08
book will come out and be thrown in the way of anything but
29:11
trying to embrace change. And I know we, we, we, we love
29:16
our old stories of medicine. And I and I often think about
29:19
the the story of Semmelweis. Oh yeah, the.
29:22
The, the, the Hungarian obstetrician who, who, who the
29:27
medical students were coming in from, from the anatomy lab and
29:30
they were, and they weren't washing their hands and they
29:32
were going, helping out deliver women's babies.
29:34
And, and, and he could see on the, the, the ward where the
29:37
medical students were delivering babies rather than the ones
29:39
where the the the midwives were that they had much high
29:41
mortality rate. And presenting that data to to
29:44
his colleagues, he got utterly ostracized.
29:46
He wasn't allowed to. Well, he wasn't allowed to
29:48
conferences. But the worst, saddest thing
29:50
about Semmelweis is that he ended up beaten to death in a
29:53
straitjacket. And in an asylum.
29:55
In an asylum and, and don't be wrong, I mean, there's many
29:57
times that I've thought about Semmelweis and thought about my
30:01
own mental health. But we need to end on a happy
30:04
note and things are changing and people are learning and we, you
30:08
know, we need to keep looking at the evidence.
30:11
We need to keep looking at basic neurophysiology because that's
30:15
often what we're talking about. South three things, Gareth, that
30:19
think, what three things do you think psychiatrist should just
30:23
know about hormones? I'm not saying about
30:25
prescribing, but just know so they can ask the right questions
30:28
for their patients. I'm so three things.
30:34
So the first thing I would say, I would really strongly
30:39
recommend the CPD module on the raw college websites.
30:43
It's really straightforward and you can get it complete within
30:47
an hour or so and it will just bring you right up to speed
30:50
really quickly. So I think show there, secondly,
30:54
I would think about how you can start having these conversations
30:59
with your, your, your, your patients in your clinic of
31:02
actually just being curious, being curious about that life
31:05
cycle and thinking about when did this change happen?
31:09
And is this woman in that sort of age range of sort of 35 to
31:13
55, somewhere in that range of actually what should I be
31:16
thinking? Hormones and the third one, we
31:20
we'd be, don't be afraid to prescribe.
31:23
You've got, you've got these really low risk natural products
31:26
that you can prescribe to women, their own hormones that you can
31:29
give back to them. And it's it's going to be part
31:34
of the solution not just for their mental health, but you're
31:36
going to be promoting their physical health as well, which
31:38
is such a core issue for us to drive forward.
31:40
Yeah, so important. So thank you so much for sharing
31:43
your wisdom and thoughts today. Thank you.
31:46
Thank you, Louise. I've got something really
31:50
exciting to share with you. Every Thursday I'm going to be
31:53
releasing an extra episode for those of you that sign up.
31:57
It's an opportunity that I can have more guests share more
32:01
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32:05
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money is going to be used to help with research, much needed
32:11
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32:14
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32:17
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