Latest / Connect Call / EP23 - It’s Not Just Anxiety: What Most Doctors Miss About Hormones, Part 2 | Dr. Carly Snyder

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EP23 - It’s Not Just Anxiety: What Most Doctors Miss About Hormones, Part 2 | Dr. Carly Snyder · Connect Call

• 0:00
  [SPEAKER_00]: I do also want to address those women out there that are going through parry menopause and menopause.
• 0:06
  [SPEAKER_00]: Yeah, you know, because when you kept talking by the way about sleep, I literally was tromping at the bit, because Dr. Slider are not sleeping.
• 0:14
  [SPEAKER_01]: Yeah, I'm getting progesterone.
• 0:17
  [SPEAKER_00]: I'm doing progesterone, I have estrogen, I get my testosterone patch, pellets, and I doing magnesium, I take melatonin at night and every two hours I am waking up and have these hot sweats.
• 0:33
  [SPEAKER_01]: So, um, two things that can, the hot spots, but I also had a hysterectomy, like four months ago.
• 0:40
  [SPEAKER_00]: Okay, it doesn't matter.
• 0:41
  [SPEAKER_01]: No, well, no, that actually does make a difference because getting the right estrogen dose on your patch is not so easy.
• 0:49
  [SPEAKER_01]: Okay.
• 0:50
  [SPEAKER_01]: And it becomes a bit of a pain in the ass.
• 0:52
  [SPEAKER_01]: So you kind of have to, it's a little more of a dance.
• 0:55
  [SPEAKER_01]: Once you get that, but I have to tell you,
• 1:02
  [SPEAKER_01]: all the difference in the world.
• 1:03
  [SPEAKER_01]: Oh my god.
• 1:04
  [SPEAKER_00]: Yeah, because I'm just passionate about my REM cycle is just jacked.
• 1:10
  [SPEAKER_00]: And I'm going to speak for the majority of my girlfriends.
• 1:13
  [SPEAKER_00]: We all like literally are getting up at like three in the morning for more like all it's like this.
• 1:19
  [SPEAKER_00]: And we are all trying everything.
• 1:22
  [SPEAKER_00]: How do you get?
• 1:23
  [SPEAKER_00]: Oh, so it's a circle through your psychiatrists.
• 1:24
  [SPEAKER_00]: You have to get
• 1:28
  [SPEAKER_01]: So it is, yes, I mean, you could get it through anyone, but the problem is that other people don't know about it.
• 1:34
  [SPEAKER_01]: It, you know, I'll preserve 25 milligrams.
• 1:38
  [SPEAKER_01]: And that will be good enough, but a lot of interns will be the goal.
• 1:43
  [SPEAKER_01]: That's a associated with metabolic syndrome.
• 1:46
  [SPEAKER_01]: Yes, if you're taking 250 milligrams, it is at 25, it's not.
• 1:50
  [SPEAKER_00]: Got it.
• 1:51
  [SPEAKER_00]: Interesting.
• 1:52
  [SPEAKER_00]: All right, I'm going to bring that up.
• 1:53
  [SPEAKER_00]: So, yeah, because I think the focus again or we're talking about because we're seeing it.
• 2:01
  [SPEAKER_00]: Uh, with, uh, you know, extreme circumstances with maternal mental health, but just with women who are, you know, going through the changes as they call it.
• 2:11
  [SPEAKER_00]: I mean, it's it rocks you with your concentration.
• 2:15
  [SPEAKER_00]: It rocks me with everything every day.
• 2:18
  [SPEAKER_00]: Yeah, like I always think of men had to deal with this.
• 2:21
  [SPEAKER_00]: They would.
• 2:23
  [SPEAKER_00]: freak out.
• 2:24
  [SPEAKER_01]: It's not, you know, it's like it's then had to deal with it.
• 2:27
  [SPEAKER_01]: We'd have a phenomenal treatment for it.
• 2:31
  [SPEAKER_00]: It's so true.
• 2:32
  [SPEAKER_00]: It's so sad.
• 2:33
  [SPEAKER_00]: And it's it's so true.
• 2:35
  [SPEAKER_00]: But so so that's the other thing.
• 2:37
  [SPEAKER_00]: So, you know, as a woman,
• 2:40
  [SPEAKER_00]: Do we, what do you recommend for women, you know, going through menopause or going through parry menopause when we're gonna go back to the maternal mental health?
• 2:47
  [SPEAKER_00]: But if, you know, like, are there any other doctors they can go to if it's not maybe mental?
• 2:55
  [SPEAKER_00]: I feel like everyone's mental health gets a little jacked during menopause.
• 2:59
  [SPEAKER_01]: I mean, a lot of people do.
• 3:00
  [SPEAKER_01]: I mean, it's also beyond the hormonal shifts.
• 3:04
  [SPEAKER_01]: If you look at where someone is in their life, obviously depends on their age,
• 3:08
  [SPEAKER_01]: Life changes, right?
• 3:10
  [SPEAKER_01]: If you're in a partnership.
• 3:12
  [SPEAKER_01]: Um, you know, it's life crisis.
• 3:14
  [SPEAKER_01]: Exactly.
• 3:15
  [SPEAKER_01]: Also, if you have kids, often people's kids are getting older, they may not be leaving the house yet.
• 3:21
  [SPEAKER_01]: Maybe they are.
• 3:22
  [SPEAKER_01]: But it went all the sudden.
• 3:24
  [SPEAKER_01]: Yeah.
• 3:24
  [SPEAKER_01]: Right.
• 3:25
  [SPEAKER_01]: Your relationship is kind of in a spotlight because now you have the kid to talk about.
• 3:29
  [SPEAKER_01]: Right.
• 3:30
  [SPEAKER_01]: And that all seems to coincide with
• 3:40
  [SPEAKER_01]: You can't stay in your partner who knows, not always, but it's a lot, Dr.
• 3:45
  [SPEAKER_00]: Senator.
• 3:45
  [SPEAKER_00]: It's a lot.
• 3:46
  [SPEAKER_00]: We a lot of us out there can't stand our partners.
• 3:49
  [SPEAKER_00]: No, and I love my partner, but we often say my girlfriends, and I, if we could all still live in a compound together and like just like the next door, do we each other and sell our spaces?
• 3:57
  [SPEAKER_00]: Yes, we do it.
• 3:58
  [SPEAKER_00]: But my question, I think, because I remember one, my girlfriends and I were driving on a trip together.
• 4:03
  [SPEAKER_00]: and we were discussing some of our symptoms and I think it's just like what I try to do on this show is to give people these tangible steps and tips.
• 4:11
  [SPEAKER_00]: So as a woman, if you are displaying mental health symptoms during let's say menopause, right?
• 4:17
  [SPEAKER_00]: What is the, who's the first doctor to go see or who's the first person to go see if you're the first one.
• 4:23
  [SPEAKER_01]: And I mean, go see your OB-GYN because depending on where now you can check hormone levels in terms of Perry Metapods that is absolutely something we can do and also they can go in ultrasound see how many follicles you have or don't have or whatever right.
• 4:39
  [SPEAKER_01]: They can put you on either a low dose birth control, depending on where you are.
• 4:44
  [SPEAKER_01]: That means enough or HRT.
• 4:47
  [SPEAKER_01]: He is God sent for most people who need it.
• 4:50
  [SPEAKER_00]: Yes.
• 4:51
  [SPEAKER_00]: And that is hormone replacement therapy ladies and gentlemen.
• 4:54
  [SPEAKER_01]: Thank God for that.
• 4:56
  [SPEAKER_00]: Thank God.
• 4:58
  [SPEAKER_01]: It got a really bad rap because of what was actually a really poorly done study several years ago and in fact, you know, it said there was increased risks of this and the other such of cancers and such not true.
• 5:13
  [SPEAKER_01]: In fact, you know, if you the way that I conceptualize it is this and it's as women are fitness.
• 5:23
  [SPEAKER_01]: is defined and meant too, but our fitness or speak is defined by having a child, right?
• 5:30
  [SPEAKER_01]: Evolutionarily, not, right?
• 5:33
  [SPEAKER_01]: But from an evolutionary standpoint, we are not no longer needed once we are menopausal.
• 5:40
  [SPEAKER_01]: Men can have kids until their god knows how old we can't.
• 5:44
  [SPEAKER_01]: So from an evolutionary standpoint, we can't spread our, you know, can't.
• 5:48
  [SPEAKER_01]: be fruitful and multiply after men of us.
• 5:51
  [SPEAKER_01]: So our bodies aren't actually optimized to function after men of us.
• 5:59
  [SPEAKER_01]: So our bones break down our cardiac function goes away, you know, like this is depressing.
• 6:03
  [SPEAKER_01]: It is.
• 6:04
  [SPEAKER_01]: It's completely depressing.
• 6:06
  [SPEAKER_01]: And it's totally depressing, but it's totally true.
• 6:09
  [SPEAKER_01]: Also, right, like our bodies said, I mean, for, look, every animal, right, reproduction is the only way
• 6:18
  [SPEAKER_00]: Right.
• 6:18
  [SPEAKER_01]: He sees continues.
• 6:20
  [SPEAKER_00]: Yep.
• 6:21
  [SPEAKER_01]: But we, despite the fact that obviously every grandmother out there is like screw you, that's not true.
• 6:28
  [SPEAKER_01]: But it is, right?
• 6:29
  [SPEAKER_01]: Like we obviously are needed, but purely biologically speaking, our bodies are not equipped.
• 6:41
  [SPEAKER_01]: Right.
• 6:41
  [SPEAKER_01]: From the point of average 53 years older or so, older.
• 6:46
  [SPEAKER_01]: So we need to give ourselves hormones back.
• 6:49
  [SPEAKER_00]: Exactly.
• 6:50
  [SPEAKER_00]: And that's the point.
• 6:51
  [SPEAKER_00]: It's like I was saying that to my girlfriends.
• 6:52
  [SPEAKER_00]: Like for men too, they're they're depleting.
• 6:55
  [SPEAKER_00]: And so you need to get a balanced right to feel better.
• 6:58
  [SPEAKER_00]: And let me tell you something.
• 6:59
  [SPEAKER_00]: And every woman will agree with me on this.
• 7:01
  [SPEAKER_00]: When you're HRT is
• 7:05
  [SPEAKER_00]: hitting from all sockets good like man it's a game changer you guys it's such a game changer like even you know for women your sex drive goes down or this goes down or like your energy goes down my concentration when my levels are good like you just feel you feel healthy you do feel like I remember it's like vaginal dryness right I have sex if you have
• 7:33
  [SPEAKER_00]: that nobody on you.
• 7:34
  [SPEAKER_00]: Nobody, Dr. Slater, so nobody.
• 7:36
  [SPEAKER_00]: Fix that, you get some topical esters, and oh my God, right?
• 7:39
  [SPEAKER_00]: But you have to, I think the theme of this and ladies out there, and this is what I talked about on the last episode, is you really have to advocate for yourself, you know?
• 7:49
  [SPEAKER_00]: I think it's ingrained in us for some reason that, you know, oh, we're sitting in front of a doctor, like, and even me, you know, when I had a great guy in my college, it's a two here in Atlanta,
• 7:59
  [SPEAKER_00]: who were like, you're crazy, you go back to the psychiatrist, you're crazy, you go back to the psychiatrist.
• 8:04
  [SPEAKER_00]: And I don't fault them, but I also think to myself, like, we need that we need to start changing the education around this, and I even remember,
• 8:15
  [SPEAKER_00]: Uh, when I was in the UK taking care of my mother when she, uh, she had terminal cancer, it was during COVID and we, you know, I was treating my PMDD and all this kind of stuff, but abroad.
• 8:26
  [SPEAKER_00]: I was in the UK and even the pellets weren't available at the time.
• 8:31
  [SPEAKER_00]: I was literally having to do the patch for HRT or gels.
• 8:34
  [SPEAKER_00]: It was a nightmare, but what was even more of a nightmare was I was in front of a lot of providers.
• 8:40
  [SPEAKER_00]: You know, where I had to like the doc in the box, tell a health to get my prescriptions and with that they would make me go over all my diagnosis and with that there I remember there was two or three doctors that changed me for my PMDD because they didn't understand what it was and remember this one doctor in particular goes.
• 8:57
  [SPEAKER_00]: P.M. whatever you want to call that, and I literally stopped him, and I said, listen, I'm just going to say this as polite as possible.
• 9:05
  [SPEAKER_00]: It's okay that you are not familiar with this diagnosis.
• 9:09
  [SPEAKER_00]: It's okay that you are not educated on this struggle for me and for so many other women, but what is not it is okay is then to make me feel stupid, because I have a diagnosis that you have no knowledge of.
• 9:22
  [SPEAKER_00]: That's on you, bud.
• 9:23
  [SPEAKER_00]: You know what I mean?
• 9:25
  [SPEAKER_01]: One of the best things about a doctor is when they know what they know and they know what they don't know and they're honest about it.
• 9:30
  [SPEAKER_00]: Yes, and there's no ego.
• 9:33
  [SPEAKER_00]: Like that's what I loved about my guy in a college just handling psychiatrists.
• 9:36
  [SPEAKER_00]: When I said it was going to see you, they were like, how aluya?
• 9:39
  [SPEAKER_00]: Yeah.
• 9:40
  [SPEAKER_00]: You need, I always say a good clinical team, a good provider, you want in your life, or those that want to collaborate with the other providers and also don't think they know everything.
• 9:53
  [SPEAKER_00]: And I love my psychiatrist, but what you do is so specific and I was going to ask you, how did you get into this work?
• 10:03
  [SPEAKER_00]: It's a good question.
• 10:04
  [SPEAKER_01]: Okay, man.
• 10:05
  [SPEAKER_01]: I'm going to make I'm going to make what is a long story so much for it.
• 10:09
  [SPEAKER_01]: I was going into plastics in medical school.
• 10:11
  [SPEAKER_01]: That was my thing.
• 10:12
  [SPEAKER_01]: I really wanted it.
• 10:13
  [SPEAKER_01]: Well, is it plastic, plastic surgery?
• 10:15
  [SPEAKER_01]: I like
• 10:19
  [SPEAKER_01]: at the time I was dating and then I married a neurosurgeon so, you know, it seemed like kind of cool.
• 10:25
  [SPEAKER_00]: Your husband's a neurosurgeon and you're reproduced by psychiatrists.
• 10:29
  [SPEAKER_01]: Yes, my late husband's here, yeah, my late husband is a nurse, but yes, he, so.
• 10:35
  [SPEAKER_01]: We would joke that we was like brains and boobs that was going to be us.
• 10:40
  [SPEAKER_01]: Anyway, so fast fast fast forward and I'm I graduated and she's doing a fellowship in Toronto.
• 10:47
  [SPEAKER_01]: So I know I'm going to take a year off.
• 10:49
  [SPEAKER_00]: Right.
• 10:50
  [SPEAKER_01]: Med school residency and I'm pregnant and all of a sudden my my hands are going
• 11:04
  [SPEAKER_01]: And it encouraged me looking backwards that when I was a medicine, I used to wear double glove and my hands always thought that the gloves were too small.
• 11:13
  [SPEAKER_01]: Right.
• 11:14
  [SPEAKER_01]: Because my dexterity wasn't great.
• 11:16
  [SPEAKER_01]: As it turns out, no, it was an auto-mute thing.
• 11:19
  [SPEAKER_01]: But in that moment, I was like, oh my god, I can't be a surgeon who can't feel my hand.
• 11:24
  [SPEAKER_00]: Right.
• 11:25
  [SPEAKER_01]: So I had this weekend where I freaked out.
• 11:28
  [SPEAKER_01]: And I had had, so I decided I didn't want to go into medicine
• 11:34
  [SPEAKER_01]: for any number of reasons.
• 11:37
  [SPEAKER_01]: And my dad's a psychiatrist.
• 11:38
  [SPEAKER_01]: I love my dad to death.
• 11:39
  [SPEAKER_01]: I was like, okay, cool, I'll go into psychiatry, whatever.
• 11:42
  [SPEAKER_01]: It was really like I had not focused on it.
• 11:45
  [SPEAKER_01]: It was not a field that I had thought about.
• 11:47
  [SPEAKER_01]: That being said, I was always yelled at for talking to the patients too long, pre-operatively.
• 11:54
  [SPEAKER_00]: We love a psychiatrist like you.
• 11:56
  [SPEAKER_01]: Well, but like, you know, all the I used to ask the women how they were doing, bubble and you're not supposed to do that.
• 12:01
  [SPEAKER_01]: I didn't.
• 12:02
  [SPEAKER_01]: Anyway, so I started in a psychiatry residency.
• 12:04
  [SPEAKER_01]: My son was a year old.
• 12:06
  [SPEAKER_01]: I hated it.
• 12:08
  [SPEAKER_01]: I was miserable because it really wasn't my thought process at all.
• 12:13
  [SPEAKER_01]: It wasn't my speed.
• 12:15
  [SPEAKER_01]: And I went.
• 12:17
  [SPEAKER_01]: And so I was like, this is not for me,
• 12:25
  [SPEAKER_01]: in the middle of my first year, it's about six months.
• 12:28
  [SPEAKER_01]: And they knew me as the psychiatrist who actually could put in a central line.
• 12:34
  [SPEAKER_01]: I was the psychiatrist who knew, had it.
• 12:36
  [SPEAKER_01]: So I was on what's called the code team.
• 12:38
  [SPEAKER_01]: I would just go to people's codes like when they were, their hearts stopped.
• 12:41
  [SPEAKER_01]: I did that for four months.
• 12:42
  [SPEAKER_01]: It was really fun.
• 12:43
  [SPEAKER_01]: I was like, oh, this is what I'll do.
• 12:45
  [SPEAKER_01]: Then I switched to pediatrics.
• 12:48
  [SPEAKER_01]: And there was a woman who came in.
• 12:49
  [SPEAKER_01]: Her baby was admitted.
• 12:52
  [SPEAKER_01]: Because he had intractable seizures from the day he was born and he was dying and they knew he was dying was just a question of like they were kind of timing it out and he was on the epilepsy unit and I sat and talked to his mom a lot.
• 13:09
  [SPEAKER_01]: Um, there was nothing I could do for this baby.
• 13:11
  [SPEAKER_01]: There was nothing anyone could do, but like there's mom.
• 13:14
  [SPEAKER_00]: Yeah.
• 13:14
  [SPEAKER_01]: Who had a completely normal pregnancy.
• 13:16
  [SPEAKER_00]: Yeah.
• 13:17
  [SPEAKER_01]: Who was married to like this, uh, gorgeous man.
• 13:20
  [SPEAKER_01]: Like they were this perfect couple.
• 13:22
  [SPEAKER_01]: Everything.
• 13:23
  [SPEAKER_00]: Yeah.
• 13:23
  [SPEAKER_00]: Right.
• 13:23
  [SPEAKER_01]: And this baby looked perfect, but he had in track of seizures.
• 13:27
  [SPEAKER_01]: And for reasons I don't honestly, I can't.
• 13:31
  [SPEAKER_01]: I couldn't even identify then, but I
• 13:34
  [SPEAKER_01]: I connected her with a grief counselor, even though he was still alive, who happened to work across the street from her office.
• 13:42
  [SPEAKER_00]: Wow.
• 13:43
  [SPEAKER_01]: And then there's church, whatever.
• 13:45
  [SPEAKER_01]: Several months later, I saw his, the baby's neurologist who told me that it was transformative for this woman that she had someone to talk to and that they had established in the epilepsy, the pediatric epilepsy.
• 14:00
  [SPEAKER_01]: and across his practice that if someone's baby was dying, they were going to connect them with the, oh, okay, appropriate mental health care.
• 14:08
  [SPEAKER_01]: Provided beforehand.
• 14:09
  [SPEAKER_01]: And the fact that that, that I could make that difference, that I was amazing to me.
• 14:16
  [SPEAKER_01]: So one of my senior residents said, oh, you should talk to my wife.
• 14:19
  [SPEAKER_01]: She's a reproductive psychiatrist at Cornell and I was like, the hell is that?
• 14:24
  [SPEAKER_01]: I'd never heard of it.
• 14:27
  [SPEAKER_01]: And I was like, oh my God, I love this.
• 14:31
  [SPEAKER_01]: It blends medicine.
• 14:33
  [SPEAKER_00]: It totally does.
• 14:34
  [SPEAKER_01]: And it's like, high tree.
• 14:36
  [SPEAKER_00]: Perfect for you.
• 14:37
  [SPEAKER_01]: It was great.
• 14:38
  [SPEAKER_01]: And so I ended up doing an elective at Cornell.
• 14:41
  [SPEAKER_01]: I joke I just never left.
• 14:43
  [SPEAKER_01]: I came attending.
• 14:45
  [SPEAKER_01]: I go, I still go to Browns.
• 14:46
  [SPEAKER_01]: I read it.
• 14:46
  [SPEAKER_00]: It was a medical journal from Cornell or something.
• 14:48
  [SPEAKER_00]: Yeah, I know it's coming back to me.
• 14:50
  [SPEAKER_01]: And basically, I figured out that classical psychiatry
• 14:57
  [SPEAKER_01]: You know, men, you know, men, you know, with these intractable illnesses that are hardship, they weren't, it was not my thing, but women, the shared connection was really important to me.
• 15:15
  [SPEAKER_01]: Fast forward again and I was doing this work, but I thought I understood the anxiety that came with
• 15:23
  [SPEAKER_01]: you know, motherhood.
• 15:25
  [SPEAKER_01]: But I was pregnant with twins and I lost them and I subsequently went through my own episode of incredible, intractable, intrusive thoughts about the two kids that I had.
• 15:39
  [SPEAKER_00]: Really.
• 15:40
  [SPEAKER_01]: And I was petrified that something was going to happen to them.
• 15:43
  [SPEAKER_00]: Yeah.
• 15:44
  [SPEAKER_01]: And it was a very, very much
• 15:48
  [SPEAKER_01]: It was a transformative period for me as a physician and as a person, because it really, I always knew no one wants that anxiety, but the pain that it came with it and the fear and the knowing that the thought you're having isn't real.
• 16:06
  [SPEAKER_01]: You're not going to do this.
• 16:08
  [SPEAKER_01]: It's not going to happen, but having this paralyzing degree of fear that what if.
• 16:15
  [SPEAKER_00]: Right.
• 16:16
  [SPEAKER_01]: And it was really, really, I mean, it was terrible time for me, but it turned out it turned into a very useful time.
• 16:24
  [SPEAKER_01]: And I think I became a better doctor for it because I Yes, see and feel my patience more so then even before.
• 16:31
  [SPEAKER_01]: Um, so all of those things got me to where I am.
• 16:42
  [SPEAKER_01]: I've been fortunate not to experience it, but I've had so many patients who do.
• 16:47
  [SPEAKER_01]: And you...
• 16:50
  [SPEAKER_01]: There's nothing like seeing a woman who has untreated PMDD, who then gets appropriate treatment.
• 16:56
  [SPEAKER_01]: They're like, oh my God, my life.
• 16:58
  [SPEAKER_00]: It's like when you, it's the me too of me too.
• 17:01
  [SPEAKER_00]: Like I'm telling you, when they told me that I had this thing called PMDD, or I was reading on Reddit, which I don't recommend either.
• 17:10
  [SPEAKER_00]: I don't recommend it.
• 17:11
  [SPEAKER_01]: But yes.
• 17:12
  [SPEAKER_00]: But other women talking about, I think that, and that's the, there's something else, sorry, I just,
• 17:18
  [SPEAKER_00]: I always talk about the stigma about mental health still and the stigma, but what makes me so sad is as women, we are not talking to each other about this stuff, you know what I mean?
• 17:31
  [SPEAKER_00]: And as moms definitely, but just as women, and I'd love to your story, you know, I always ask my guests, you know, what brought you to being a helper, you know, and a game changer.
• 17:41
  [SPEAKER_00]: with so much respect to all the people that have been on and providers.
• 17:44
  [SPEAKER_00]: There is something to be said, and I, again, don't have a clinical background, but I think why I am good at the work that I even do is why my depression when it was at its worst, I was in front of the wrong doctor, and I unfortunately was put into a 1013 hole that a unit in a hospital for eight days.
• 18:02
  [SPEAKER_00]: And
• 18:03
  [SPEAKER_00]: Those eight days as traumatic and horrible as that was, it was a game changer for me as a professional because now I'm always an advocate for children.
• 18:12
  [SPEAKER_00]: I'm an advocate for adolescents and young adults and I'm even bigger advocate for you know, uh,
• 18:19
  [SPEAKER_00]: if we can keep kids out of those stabilization units, unless necessary, and they are gonna hurt themselves in somebody else, but when we have a kid saying, I'm gonna kill myself just because I don't wanna go to treatment.
• 18:28
  [SPEAKER_00]: Let's not put them in that because I know how shitty that is and I know how traumatic it can be.
• 18:36
  [SPEAKER_00]: And so I think why you're, you know, what it does, it just, and I think,
• 18:42
  [SPEAKER_00]: what the work that you're doing is so powerful because it's truly as women and that's why and I'm going to go back to the Lindsay Clancy Case first second.
• 18:53
  [SPEAKER_00]: This is happening.
• 18:54
  [SPEAKER_01]: You know, there was so many women who were like, I would never do that.
• 18:57
  [SPEAKER_00]: Yeah, of course she wouldn't do it.
• 18:58
  [SPEAKER_00]: Nobody would want to do it.
• 18:59
  [SPEAKER_00]: She woke up too and didn't want to do it.
• 19:01
  [SPEAKER_00]: So, so the here's my question.
• 19:03
  [SPEAKER_01]: Yeah.
• 19:04
  [SPEAKER_00]: I think it is important for families to hear a little bit more about when intervention should take place for maternal mental health.
• 19:13
  [SPEAKER_00]: You know, I talk about, you know, with my PMDD and
• 19:19
  [SPEAKER_00]: depression, I have what's called suicidal ideation and dark thoughts.
• 19:23
  [SPEAKER_00]: When I say dark thoughts or suicidal ideation for me, it's completely different than saying I want to die.
• 19:28
  [SPEAKER_00]: Suicidal ideation is I hear music playing in my funeral.
• 19:32
  [SPEAKER_00]: I may like see a day in the life of my friends in my wife without me, but I don't have a plan.
• 19:38
  [SPEAKER_00]: There's nothing, no voices in my head telling me do this now, do this now.
• 19:43
  [SPEAKER_00]: But I do know, even the suicidal ideation, I, it's an out of body experience where I see myself who, like, I see myself, that's going, that's not me.
• 19:54
  [SPEAKER_00]: Like the girl from the ring, Hannah is not me.
• 19:58
  [SPEAKER_00]: So my question is is, you know, first of all, I'm sure you can agree that these intrusive thoughts are real, people do hear voices, they are different things though for what it's worth, I would say, not when you're, but go on.
• 20:12
  [SPEAKER_01]: No, but intrusive thoughts, so the big, big piece of that which you just said, intrusive thoughts are completely real.
• 20:19
  [SPEAKER_01]: ego, what we call ego centonic or dystonic, meaning when you have an intrusive thought and you're like, this is not me.
• 20:27
  [SPEAKER_01]: I won't, what is, that's an ego dystonic thought.
• 20:30
  [SPEAKER_01]: It is doesn't run up with who you are.
• 20:35
  [SPEAKER_01]: It's not, right?
• 20:36
  [SPEAKER_01]: And that is indicative of anxiety generally, depression.
• 20:41
  [SPEAKER_01]: It is not psychotic, right?
• 20:44
  [SPEAKER_01]: There's no, now when you have an ego
• 20:48
  [SPEAKER_01]: what is ultimately an egosintonic thought, meaning that in that scenario, you think that this is actually okay.
• 20:57
  [SPEAKER_01]: That's a problem.
• 20:58
  [SPEAKER_01]: Most people when they have an intrusive thought are super aware that this is a crazy idea.
• 21:04
  [SPEAKER_01]: This is a bad thing.
• 21:04
  [SPEAKER_01]: This is never going to happen like, and they get really freaked out and I scared.
• 21:08
  [SPEAKER_01]: I'll say to my patients all the time.
• 21:11
  [SPEAKER_01]: Do you have intrusive thoughts?
• 21:12
  [SPEAKER_01]: Ah, no.
• 21:13
  [SPEAKER_01]: I'm like, well, here's some that I've heard for.
• 21:16
  [SPEAKER_01]: Stop me, if any, right?
• 21:17
  [SPEAKER_01]: Like, you can say anything to me, I've heard it all.
• 21:20
  [SPEAKER_00]: Can you give me some examples?
• 21:22
  [SPEAKER_01]: So for, what if I flip the baby in the microwave?
• 21:25
  [SPEAKER_01]: What if I throw the baby out the window?
• 21:27
  [SPEAKER_01]: What if I keep walking with the baby and I don't catch them?
• 21:31
  [SPEAKER_01]: What if I put the baby in boiling water, which is interesting because it's actually related to fairy tales, not quite.
• 21:41
  [SPEAKER_01]: Yeah, um, what if, right, because cancel and brittle, um, what if I don't love my baby, what if I had a patient years and years ago, wonderful mother, what if my baby's ugly, I think my baby's ugly, which all of these things, when you feel incredibly upset by the thought,
• 22:10
  [SPEAKER_01]: concerned about the fact that they're having against the grain of who they otherwise usually are.
• 22:16
  [SPEAKER_01]: But now they feel like it's okay.
• 22:18
  [SPEAKER_01]: That's a totally different situation.
• 22:22
  [SPEAKER_01]: And if you hear, voice is often we hear ourselves, right?
• 22:25
  [SPEAKER_01]: We hear our own thoughts, our presence, whatever, what are the voices?
• 22:32
  [SPEAKER_01]: Yeah, I mean, well, so those voices are like our internal monologue
• 22:40
  [SPEAKER_01]: either what we call command hallucinations, which is when you hear a separate voice telling you to do something?
• 22:46
  [SPEAKER_00]: Is that what happened with Lindsay Clancy?
• 22:47
  [SPEAKER_01]: Yeah, that's what's right.
• 22:48
  [SPEAKER_01]: Yeah.
• 22:50
  [SPEAKER_01]: I mean, for what we were right.
• 22:53
  [SPEAKER_00]: Look, I obviously, but this does let, I mean, without even talking about the case, this happens with women.
• 22:58
  [SPEAKER_00]: And maybe you can explain, let's take this case out of it, where we have a woman who, and this was another thing and this,
• 23:06
  [SPEAKER_00]: Again, I can't relate to any of that, but what I can relate to, and I remember like this was driving me crazy on social media too, and I had to pull myself off of it was, again, people were like, well, she didn't look depressed.
• 23:18
  [SPEAKER_00]: Well, she, you know, or like, she was functioning, she was functioning, right?
• 23:23
  [SPEAKER_00]: And I'm like, first of all, people that I know that I've, you know, the work that I've done unfortunately when we have lost adolescents or young adults,
• 23:34
  [SPEAKER_00]: You don't see it.
• 23:35
  [SPEAKER_00]: I mean, it's not that you don't see it coming.
• 23:36
  [SPEAKER_00]: They're not saying I'm going to kill myself.
• 23:38
  [SPEAKER_00]: They literally, you know, I've had kids just laughing one minute and the next minute.
• 23:44
  [SPEAKER_00]: We have found them unfortunately in their closet, you know what I mean.
• 23:47
  [SPEAKER_00]: And so I guess my question is and so I find it also very ignorant and.
• 23:52
  [SPEAKER_00]: If for anybody's out there who doesn't experience any mental health stuff, it's so insensitive.
• 23:59
  [SPEAKER_00]: It's like basically saying, I was saying to somebody on social media when this woman was like, what she didn't look depressed, I go, yeah, that's like my mom and she had cancer.
• 24:06
  [SPEAKER_00]: Well, she doesn't look like she is cancer and going through chemo.
• 24:09
  [SPEAKER_00]: It's like we wouldn't say that.
• 24:11
  [SPEAKER_00]: You know what I mean?
• 24:12
  [SPEAKER_00]: And it's just like, or they don't look like they have a cold, you know what I mean, everybody is different.
• 24:16
  [SPEAKER_00]: And I know for the majority of us, you're fighting to fake it until you make it and kind of show up and show face, but my question is.
• 24:27
  [SPEAKER_00]: for those who have experienced this like postpartum psychosis, right?
• 24:32
  [SPEAKER_00]: Where these commands are happening and they are real.
• 24:37
  [SPEAKER_00]: How does that typically show up and play?
• 24:41
  [SPEAKER_00]: Like, how would a family member know to interrupt and go, we need to get help here?
• 24:46
  [SPEAKER_01]: Because there's a great question.
• 24:48
  [SPEAKER_01]: So for one thing, for just in relation to what you were just saying about the people are much easier to find.
• 24:54
  [SPEAKER_01]: Post-partum psychosis classically.
• 24:57
  [SPEAKER_01]: Watches and weigh-ins.
• 24:58
  [SPEAKER_01]: Meaning she could find one minute and be okay with them and then not another.
• 25:03
  [SPEAKER_01]: So this idea that someone takes her kid to the pediatrician in the morning and they're fine, means that they should be fine later in the day.
• 25:10
  [SPEAKER_01]: That's not the case when it comes to post-partum psychosis.
• 25:13
  [SPEAKER_01]: It is a very unique entity.
• 25:16
  [SPEAKER_00]: And that's important to know that because that's why in the case the husband did go out and he did do his day night I think because she was showing up during the day a certain way right yeah, I can't speak to what he did You know whatever, but I was kidding, but I'm just saying general partners spouses.
• 25:33
  [SPEAKER_00]: Yeah
• 25:35
  [SPEAKER_01]: We see postpartum psychosis present within the first few weeks after delivery, but that does not preclude presentation up to a year postpartum.
• 25:46
  [SPEAKER_01]: Diagnostic criterion in practice is much more, it's a much wider period of time, then, for example, the DSM, which says, which is irrelevant, basically.
• 26:01
  [SPEAKER_01]: a year is really the point, right?
• 26:03
  [SPEAKER_01]: So this is a woman, I mean, in a classic sense, this is someone who all of a sudden is not sleeping.
• 26:11
  [SPEAKER_01]: She may at times make no sense.
• 26:14
  [SPEAKER_01]: She may be, you know, very hyper.
• 26:18
  [SPEAKER_01]: She may not be.
• 26:20
  [SPEAKER_00]: Kim, I'm sorry, can the wrong medications or high medication dosages in mid, like exacerbation?
• 26:27
  [SPEAKER_01]: Yes.
• 26:27
  [SPEAKER_01]: So a woman with postpartum say coaches should not be on SSRI, and that's by the way, for bipolar, so also, I mean, there's a lot of debate within the world of psychiatry, whether or not one can safely put someone with bipolar disorder on a SSRI, I air on
• 26:51
  [SPEAKER_01]: other interesting, very controlled from a mood stabilizing standpoint, which is totally different.
• 26:56
  [SPEAKER_01]: But so when you say medication yes, I mean, what can look like anxiety and then is treated as anxiety can then become all of a sudden is worse because of the SSRI, but that's the key is that if you put someone on a medication, like so often,
• 27:16
  [SPEAKER_01]: And all of a sudden, they're considerably worse.
• 27:18
  [SPEAKER_01]: They're not sleeping anymore.
• 27:20
  [SPEAKER_01]: They say, oh my God, I'm so recent.
• 27:22
  [SPEAKER_01]: I don't know what's going on.
• 27:24
  [SPEAKER_01]: But it's a consistent thing.
• 27:27
  [SPEAKER_01]: Then you stop that medication and you pivot and assume a different situation, a different diagnosis.
• 27:35
  [SPEAKER_01]: So yes, there are meds that can make things worse.
• 27:38
  [SPEAKER_01]: Where I think it becomes an issue when the provider who's perfect,
• 27:42
  [SPEAKER_01]: prescribing the medication doesn't listen to the patient, and instead says, oh, that's just, you know, a side effect or whatever.
• 27:49
  [SPEAKER_01]: Yeah, some, as a source can make you a little activated, but this is different from the family standpoint, if you're worried.
• 27:59
  [SPEAKER_01]: then talk to the person, but if you're concerned do something about it, I always, I'm my feeling is the worst case scenario is you overshoot and you get too much intervention and maybe the mom is a little pissed off that she didn't need this, but thank God she's fine and the baby's fine.
• 28:17
  [SPEAKER_00]: And I say that too, because I remember again with my journey, it was only
• 28:28
  [SPEAKER_00]: a provider.
• 28:29
  [SPEAKER_00]: I had at one point who I needed to get all my meds assessed and looked at and he's like let's pull your wife in and I said why he goes because Hannah you're great just naturally self reporting know you know identify patient is going to be great at that meaning like you're not going to truly you'll say maybe how you're feeling but what's even more important I feel for a provider is like when my wife was able to sit with that provider and say this is how Hannah showing up at home.
• 28:56
  [SPEAKER_00]: So they, it's a, it's a, it's a super, it's a very tight line.
• 29:03
  [SPEAKER_01]: I agree with that provider.
• 29:05
  [SPEAKER_01]: I feel strongly that my patients are their own women.
• 29:08
  [SPEAKER_00]: This was different.
• 29:09
  [SPEAKER_01]: Yeah, this is a, so this is, but I know, but at the same point, women who are very sick.
• 29:15
  [SPEAKER_01]: right or have the potential for being very sick.
• 29:17
  [SPEAKER_01]: I mean, maybe they're stable, but they have a history of bipolar disorder, pretty pregnant and whatever, they're medicated they're doing well, it doesn't matter.
• 29:24
  [SPEAKER_01]: I will still say, let's get your partner in because I want them to understand what to look for and to know me.
• 29:32
  [SPEAKER_01]: so that they can comfortably shoot me an email, be like, hey, you know, someone's so is kind of being a little weird.
• 29:39
  [SPEAKER_01]: Right.
• 29:39
  [SPEAKER_01]: See her?
• 29:40
  [SPEAKER_01]: Right.
• 29:41
  [SPEAKER_01]: Sure.
• 29:42
  [SPEAKER_01]: But also, yeah, I think partners, partners are incredibly important and in the best scenarios.
• 29:51
  [SPEAKER_01]: That's when a relationship is good.
• 29:53
  [SPEAKER_01]: Unfortunately, not everyone has that, but assuming that someone has a supportive partner,
• 30:01
  [SPEAKER_00]: And that's, and I'm sorry, it doesn't even have to go for the partner like, you know, it could be your mother.
• 30:06
  [SPEAKER_00]: It could be your friend.
• 30:07
  [SPEAKER_00]: I think I think, you know, um,
• 30:13
  [SPEAKER_00]: your people know you.
• 30:14
  [SPEAKER_00]: They know when something's up.
• 30:16
  [SPEAKER_00]: They know that you're not good.
• 30:17
  [SPEAKER_00]: They know if you're not sleeping, especially if it's a family member.
• 30:21
  [SPEAKER_00]: And so my thing is, if there's another message to send out there, it's to spouses, to families of loved ones struggling with any sort of mental health, but especially if we have a mother who's in this maternal look,
• 30:37
  [SPEAKER_00]: mental health crisis, like, please intervene, you know, say, let's go see the doctor together or let's, you know, like really get involved.
• 30:47
  [SPEAKER_00]: And it's, and again, like you just said, it could be all for nothing, but in a lot of cases, you know, I think what's, what's up so upsetting is, um,
• 31:01
  [SPEAKER_00]: more and more women are hurting themselves and hurting their children because
• 31:10
  [SPEAKER_00]: even when we have moms who are asking for help, you know, they don't have the other support coming in, getting educated, but also like it's just, it's like the same thing when you're dealing with somebody who's addicted to drugs and alcohol, someone who's struggling with their mental health.
• 31:25
  [SPEAKER_00]: I always say this 99, 99, 99, 99, 99, 9% of these people, including myself.
• 31:29
  [SPEAKER_00]: Nobody is walking into treatment.
• 31:31
  [SPEAKER_00]: Typically, they're not walking to ask for help.
• 31:35
  [SPEAKER_00]: even when I had a therapist and I was kind of in my anxiety depression crisis.
• 31:39
  [SPEAKER_00]: I remember the best thing that happened was two of my girlfriends we were at a conference.
• 31:43
  [SPEAKER_00]: They brought me into their hotel room, shut the door, sat me on the bed and said, we got to talk to you.
• 31:49
  [SPEAKER_00]: We're a little worried about you.
• 31:51
  [SPEAKER_00]: you know, and those are the people that, you know, it's like, let's come up with a plan, let's like call somebody, let's like, because I think, you know, we think we've got it, but I just think also, you know, and especially I would think, and I'm not a mother, like, you have all this guilt also leaving your child, you know, or like, what do you mean I have to, like, I deal with mothers all the time putting them into treatment, and they're like, I can't leave my children,
• 32:18
  [SPEAKER_00]: Trust me, trust me, if you have the support, the best thing you can do for these children is to go down to treatment because this blip in the in the year that of going to treatment, the long run, the payoff is just so much greater, you know.
• 32:32
  [SPEAKER_01]: One great study, there's um, there's a old study that the star detrial it showed that when women.
• 32:39
  [SPEAKER_01]: retreated for any mental health disorder, the likelihood of their child being diagnosed in the future, within the next year, with any mental health issues went down astronomically.
• 32:52
  [SPEAKER_01]: Mom's health
• 32:54
  [SPEAKER_01]: is intricately combined with child's health.
• 32:58
  [SPEAKER_01]: Like you can't have one without the other.
• 33:01
  [SPEAKER_00]: I do want to just quickly plug for a minute, postpartum support internationally, because yes, a lot of people postpartum say if you have to get off the phone with a family right now as we're ending the show, but I wanted to leave with this.
• 33:15
  [SPEAKER_00]: What is something you would want to plug and tell them?
• 33:17
  [SPEAKER_00]: If nothing else do this, go.
• 33:20
  [SPEAKER_01]: I want to postpartum.net read about it and they have a really fabulous map.
• 33:28
  [SPEAKER_01]: that you can put in where you live and it will give you providers within a however many mile radius, who have been appropriately trained in, you know, perinatal metholine.
• 33:41
  [SPEAKER_01]: And if you're in crisis, you call them.
• 33:44
  [SPEAKER_01]: They have, there are a lot of phone lines.
• 33:46
  [SPEAKER_01]: Yes.
• 33:46
  [SPEAKER_01]: I mean, I mean, I was on the board many years ago.
• 33:49
  [SPEAKER_01]: I'm on the advisory committee now.
• 33:51
  [SPEAKER_01]: I'm very proud of the work they do.
• 33:54
  [SPEAKER_01]: We have, it is truly fabulous for the whole system for women, their families, everybody.
• 34:01
  [SPEAKER_00]: We had, I had on the last episode, and I'm gonna do it on the episode as well, it's not only obviously your website and MD for moms, which is your Instagram social media.
• 34:13
  [SPEAKER_01]: My Instagram, yes.
• 34:14
  [SPEAKER_00]: Yes.
• 34:15
  [SPEAKER_00]: And we'll be plugging Dr. Snyder for a couple of weeks because we're gonna make this a two-parter, but we're definitely gonna have that website up because I think that is so important that you're seeing the right providers.
• 34:25
  [SPEAKER_00]: So I think this is a valuable, valuable free website that you can just jump on
• 34:31
  [SPEAKER_00]: so much education.
• 34:32
  [SPEAKER_00]: I would think for women and for families and it's a good start, you know, name mean rates are the other place I would look when you have questions.
• 34:41
  [SPEAKER_01]: Yeah.
• 34:42
  [SPEAKER_01]: I mean with all to respect to Reddit, my view is the only thing I apologize for even saying.
• 34:46
  [SPEAKER_01]: But I want to well, the only people who go on Reddit are those who are disgruntled, right?
• 34:51
  [SPEAKER_01]: You don't get the full story.
• 34:52
  [SPEAKER_01]: True.
• 34:53
  [SPEAKER_01]: But women's mental health.org.
• 34:56
  [SPEAKER_01]: is Mass Generals Women's Programs website and they have a fabulous blog that reviews research, not only in Paranatlemental Health but PMDG, Par amenopause, basically everything that I do, they do and they review the research for providers and late people.
• 35:20
  [SPEAKER_00]: So, when we end this, if you can send me that blog that or I can find it just on the women's, I'm going to have that on those show notes as well because I want everybody to access that.
• 35:31
  [SPEAKER_00]: And, you know, you know, Dr. Snyder, I can't thank you enough for being here.
• 35:34
  [SPEAKER_00]: I mean, we could be doing this for hours by the way.
• 35:36
  [SPEAKER_01]: Well, I was going to say, by the way, if you want to do a part of your back off.
• 35:39
  [SPEAKER_00]: Yeah, I'm happy to do a part of your back off.
• 35:40
  [SPEAKER_01]: Yeah, I'm happy to do a part of your back off.
• 35:43
  [SPEAKER_01]: Yeah, I would like anything else, but like that's a top of waiting,
• 35:47
  [SPEAKER_01]: Yeah, yeah, there's there's so many questions that they can get them to.
• 35:50
  [SPEAKER_01]: You know what to me.
• 35:51
  [SPEAKER_00]: We're definitely going to have Dr Carly Snyder back on the show.
• 35:54
  [SPEAKER_00]: So again, if you're in New York City, that is where her offices, but you can also access Dr Snyder for an assessment and everything virtually.
• 36:01
  [SPEAKER_00]: She and you and also I just want to say one other plug about you what I what I loved about working with you as well is we you just we have that assessment, but at any point.
• 36:12
  [SPEAKER_00]: I emailed you over the years with a question or a need of a referral.
• 36:17
  [SPEAKER_00]: You were always right there for me and I just can't thank you enough for that, isn't it?
• 36:22
  [SPEAKER_01]: I think my, my job, my role is obviously to help people in the moment, right?
• 36:28
  [SPEAKER_01]: I also, I am, I look, I have resources.
• 36:32
  [SPEAKER_01]: I am happy to share them and, you know, and I tell my patients all the time, email me.
• 36:38
  [SPEAKER_01]: I have the same thing if they're concerned about something.
• 36:40
  [SPEAKER_01]: I'm like, email me, best case scenario.
• 36:42
  [SPEAKER_01]: I tell you it's normal, it's nothing to worry about.
• 36:44
  [SPEAKER_01]: Right.
• 36:44
  [SPEAKER_01]: And otherwise, I say, come and let's talk about it, but like, don't say quiet.
• 36:48
  [SPEAKER_00]: Yes, so thank you for that.
• 36:50
  [SPEAKER_00]: And then I just want to thank everybody for another episode of Connect Call.
• 36:54
  [SPEAKER_00]: Uh, tune in next week.
• 36:55
  [SPEAKER_00]: Make sure you get on uh, Apple and Spotify and YouTube and subscribe and download all that fun stuff and follow us on Connect Call podcast on Instagram and anyway, we will be seeing Dr. Snyder soon.
• 37:07
  [SPEAKER_00]: Thank you again.
• 37:08
  [SPEAKER_00]: Um, and see you next week.
• 37:11
  [SPEAKER_00]: Thank you for tuning into this episode of Connect Call.
• 37:14
  [SPEAKER_00]: As we conclude, remember that insights shared are intended for informational and educational purposes only and should not substitute professional medical advice, diagnosis or treatment.
• 37:24
  [SPEAKER_00]: We strongly recommend consulting a qualified medical health professional or health care provider for personalized advice tailored to your unique needs.
• 37:33
  [SPEAKER_00]: Your mental health journey is important and having the right support is essential.
• 37:37
  [SPEAKER_00]: If you're experiencing a mental health crisis or require immediate assistance, please reach out to a mental health provider or emergency services in your area.
• 37:46
  [SPEAKER_00]: We're grateful to have you as part of our community and your well-being remains our priority.
• 37:51
  [SPEAKER_00]: So follow us on social media to stay connected and be sure to catch one of our episodes on our YouTube channel.
• 37:57
  [SPEAKER_00]: We're here to support you every step of the way.