Why Women’s Mental Health Is Different — Dr. Brittany Booth

So I want to welcome you to our podcast. This is Dr. Brittany Booth. She's a reproductive psychiatrist here in Westlake Village and has become a friend and colleague of ours. And I'm just really excited to have you here because I've learned so much from you. I'm so excited to be here. Thank you. In the short time that I've known you, you've taught me more about my own body and the people around me. And it has, it makes a huge difference to understand what's going on, number one, to understand that, you know, when to worry and when not to worry. And also it's so refreshing to have a doctor who really focuses on women's health and women's, the way women are, because many of us, including myself, have had a lot of experiences where maybe I feel misunderstood or not taken seriously. And it's quite refreshing to have somebody who is like, you know, I feel like you're a real advocate, not just a piece of knowledge and you share your knowledge, but you also advocate. And I think that is so awesome. So, you know, let's see where the conversation leads us today. There's a lot to talk about. But I'm just excited to sit with you as I always am. And I know you, you are trained at UCLA. Yeah. And you continue to work there and add a really cool program that I also want to know more about. But let's start with the basics because I feel like, you know, the term reproductive psychologist, psychiatrist, sorry. I didn't know what that meant. Not a lot of people do. So would you mind just starting there so our listeners can understand where you're coming from and what your specialty is? Yeah. I mean, I'll even just start with that, like the difference between psychology and psychiatry, right? So a psychiatrist is some, you know, a medical doctor that prescribes medication. Sometimes we do a little bit of therapy, re-throw in therapeutic techniques, but, you know, at least in my own practice, I kind of stay in my medication management lane, you know, to treatment health conditions. And that's because... Which is a big lane. It's a big lane. And I did get some therapy training and I do incorporate, you know, some techniques. But I just know that, you know, there are a wealth of much better trained, amazing psychologists around who are much better able to do that work. So... Well, the cool thing is to work together. Exactly. And collaborate. But even in med management, like you said, it's still a big lane. And so reproductive psychiatry is a subspecialty or a niche of psychiatry that focuses on the intersection of hormones with mental health. And then, you know, women's mental health is sort of, you know, related but not quite the same thing because reproductive psychiatry could also incorporate, you know, hormones when folks are transitioning genders, right? But women's mental health, which is what I really focus on, is what is the mental health and the experience of mental health of women specifically? Like, what does it mean to be a woman in this country, in this world, in this society, and treating mental health through that lens? Because something that might get pathologized elsewhere just might be, you're just a woman and there are things that are working against you and the fact that you're feeling sad or anxious or angry might be just a normal human reaction, right, to something that's going on. Yeah, which, by the way, just that what you just said is, I feel like, is so corrective for so many women to give permission for the fact that, yes, we feel those feelings. But society kind of, yeah. Postpartum rage, I think, is one of the best examples of this. It's a chief complaint for a lot of people who come to seek treatment for it. This is something that's wrong with me. I need medication or I need help with this. And sometimes that's true, right, when it gets to a certain severity or if it's coming out in physical behaviors that are unsafe or whatever. But a lot of the time it's just, oh, no, you're just expected to handle way too much, manage your emotions and the emotions of everybody around you, have a complete lack of support both from your own relationships and just structurally, societally. And you're angry about that, you're just paying attention and you're at a live breathing aware human being. Yeah. I mean, I can tell you from my own experience that I experienced postpartum rage, but I didn't know there was a term for it. I just thought exactly that it's just all these other things. And when I learned there was a term for it, it's like it turned everything upside down. It turned my experience upside down. I had to rethink about my experience. Yeah. Because it was not until way later that I learned about that term. It's really something. I'm in this field. I'm aware. I keep up with things. And I did not know about that until you told me about it, actually. Or maybe I saw it on your Instagram. Oh, maybe. It's possible that that's the first time I really understood what was going on with me. But again, this was years after the fact. Yeah. So I had to replay it all and try to understand what was going on. Yeah. Yeah. And I just think so many women when you're in it, there's all these reasons that we could come up with. But what about just the fact that that's your situation and it's reasonable to feel those feelings? Yeah. So that's like permission that I think people need. So a lot of women come to you postpartum? What about also before like trying to get pregnant or just no pregnancy related? Just coming for hormones? How do they know? How does someone know they need a reproductive psychiatrist versus a regular psychiatrist? So reproductive psychiatrists really come into play when there's reproductive transitions or hormonal transitions. So we think about the menstrual cycle, right, which is just this monthly cycle of hormonal transition, right? And some people struggle with their mood and the time leading up to their period, right? There's a disorder called premenstrual dysphoric disorder, which is essentially a really very severe version of PMS where their relationships or their ability to work or ability to function is actually impaired. So that's a disorder that reproductive psychiatrists treat. The perinatal period, right? And that can include conceiving if you're going through fertility treatment, you're getting hormone treatment, right? When you're pregnant, your hormones do all sorts of fun things. When you're postpartum, you know, same exact thing, right? You're hormones during pregnancy, you're rising steadily, steadily, and then literally in a matter of days just drop off a cliff. And so the postpartum, and then they, you know, they have to recalibrate, re-regulate. And then we also think about menopause, which is another huge time where hormones are changing. And all of these various times can affect mental health, right? There's studies that absolutely show that women or people who are assigned female at birth go through these different transitions and they are at much higher risk for mood disorders. During the transition times? During the transition times. So there's really interesting graphs that show young kids, like up to age 10 or whatever, the risk of depression is essentially the same between girls and boys, like the lines on the graph completely overlap. As soon as you hit the time of puberty, they split. And then until the time basically of menopause, like 40s, 50s, the line for women is just consistently higher than men and it spikes around perinatal period and then right around menopause it kind of starts to... I mean, I think that makes sense. Yeah, exactly. Having been pregnant twice and just going through monthly changes I think that makes sense. But why isn't this more common knowledge? Or talked about more. It gets minimized. It just gets minimized, right? It's just hormones. You're just being crazy. It's just hysteria. You name it. Do you think that we're... It's like a way to just get... Because I think, okay, this is going to become... Who knows where... Okay. I have so much to say, but there's society, right? And we're part of society. Women are in society. So I wonder if... How much do we contribute to that exact thing of, oh well, it's just this I'll get over it kind of thing? We're the problem. Well, part of it. Yeah, we're very much culprits in this too, right? Yeah. We do it to ourselves and we can do it to other women too. We can demonize other women who are struggling or who act differently or who are louder, more out of the box, more vocal, right? It takes a lot of conscious effort, I think, to in your own life shrug off that tiny little box that we get put into and to recognize when we're doing it to other women and to stop doing it to other women too. But we can very much be the creators of our own misfortune and suffering. Yeah, and I'm thinking about when does that start? I have a daughter, she's in elementary school, and I was thinking about this the other day. When am I supposed to expect her to get her out of her period? When is this going to when does that narrative start and how am I playing into it and how can I stop playing into that? It does start so early. I have a daughter too, who's also young elementary school age. I'm always trying to notice when she's being loud and absurd and crazy to not diminish that, to encourage it. And to me at this age it's coming up so much in terms of the conversation about body image and size and I'm so much more aware of comments that are made that she's hearing even if it's not directed towards her. Family members in her life have recently lost a good amount of weight. Noticable amounts of weight and they're getting healthier. They're doing it to be healthier, which is wonderful. But she's hearing the congratulations. You look great. You lost all that weight. Wow. And that narrative of oh, smaller is better, thin is beautiful. But there are ways, because I hear you and I have the same thing, because working with kids I've worked with kids for a long time and I feel like the narrative that you put around that as a parent can really make a difference. Give context to why is this a congratulations for this person. What does this mean for them so that it doesn't exactly what you said, it doesn't extrapolate to thin is better. There's a lot of context that can really help a kid to digest what they're hearing. Because you're right, they're gonna hear that anyway. Everywhere. The part of thin is best. That's coming down the pike, no matter what. Unfortunately. But it's these pieces of, instead of saying going on a diet, you could say I'm eating things that my body needs and doesn't, not eating things that my body doesn't need. There's just very simple ways, but I think it's really hard. It's so hard. And even now being pregnant, my body is significantly changing. The conversation around that. When she started really noticing my belly and started to really show she was like, your belly is getting so big. she said it in a setting where there were other people around you, everyone else was laughing like, oh how offensive is that? And I had to be like yeah, it is. That's what it's supposed to do. I'm so happy that my belly is getting bigger. That means baby is healthy and growing. And again, just being on top of it, like okay, this is a really important moment. Let's frame this correctly. And what you say matters more than what everyone else says. Even though kids don't always admit that, but it does. Because same, I was pregnant and my daughter was asking me a lot of questions about that. Like my body changing and to be honest at the end there, I was huge. And I felt uncomfortable because of it. That was what was supposed to happen. But it was uncomfortable. I had to be very thoughtful about the words I used to describe my discomfort. And I also didn't feel good being like none of my clothes fit me. The things that even the context was very, very fine. I was very fine with that. But I was aware of, I didn't want to say like, I'm upset that, you know, I'm so big or I don't, I felt like a whale. And I remember being one time being like, don't say that out loud. Because that's not the message. But I remember thinking it. And so when you have a kid listening girl or boy by the way, I believe absolutely, we just happen to have girls. But first, you know, my both of ours happened to be girls. But if I had a son and I was pregnant, I would say the same thing. It's just I think I'm more aware of it because I just think girls get this message no matter, no matter what. Yeah. So anyway, how do we get off? We got a little off. But I think it's all related to this conversation about how do we say these things? Why are they not talked about more? I'm so glad you talk about them. So they can be more known. And then the post part in period being really also, I think an unfortunately lonely time like it doesn't need to be. You know, there's especially out here. There's actually a lot of community out here. Most people are here because so they could have kids and raise them. Yeah. And yeah, we're so isolated as moms here. Yeah, there's a lot of stuff. There's mommy and me's. There's classes. There's park meetups. We have our Mindful Beginnings class now partially because of this because we realize that yeah, there's a lot of stuff that people can connect, but it's that deeper connection that I think is missing like that vulnerability. Yeah. And I think for moms who are in the postpartum who are feeling overall pretty well. Yeah. A lot of those settings. You know, the the mommy and me groups and the library groups and things like that. It's a wonderful place for community that the moms who walk or fit moms, right? Yeah. Yeah. It's women who kind of are like feeling the same way and are and, you know, have it feeling well enough to get out of the house and get their babies out of the house and all of that. I think it's the experience of moms who are really struggling, right? We know one in five moms will suffer from postpartum depression or anxiety and it's really hard for them to get out of the house and engage in these groups and activities. Right. And even when they do kind of force themselves to get out and do that being around moms who are well feels horrible. That's what I was just going to say. I was just going to say that even if you're at these because I was there. I was just there. You know, I'm kind of coming out of it now. I have a toddler instead of a infant which is its own thing, but I actually don't know that everyone who shows up to those that is acting like they're fine. I don't know that everyone's fine. Yeah. I actually think that there's so many people that just knuckles, white knuckles through and you think, you know, maybe their hair is done and they look beautiful, but maybe on the inside they're really hurting and I think because that's what I mean that there's not a lot of room for the disheveled mom in the corner crying needing help. So I always say this I'm curious what you think and I can't remember if I said this to you maybe I have, but my grandma used to tell me because she had a lot of kids seven kids in Iran back in the day and she was not living in a village she was like in the city, you know but she used to tell me when she was little she had a bunch of siblings and she was the oldest one so she helped to raise all of them so this is a couple generations back they were in a village in Iran this was before she was a kid and she would say that all the women would have the babies but then all the women would take care of all the babies and breastfeed each other's babies it didn't matter who it's just the baby crying and I have milk and I'm going to feed that baby and you're going to do the same and so on and so forth and we're all just going to do this thing together and the men are going to go do whatever they're going to work or get but it was this women helping women all the time and I remember her telling me these stories and just sort of like it seemed so like a land land far away you know and then even for her she was in the city but she would say like oh yeah I remember I met this guy I was like an uncle or something and she's like oh I breastfed him like what? that's weird but it's not weird it wasn't weird for her and for them at that time that was her little crew you know her neighbors they were like my neighbors and we just all helped each other's babies and it didn't it didn't seem like it felt alone it felt like they had each other's backs and we have gone away from that and it's really upsetting to me because when I was in that postpartum period and even still now by the way I would do anything to have a set up like that because there's something that like another mom can understand that is unspoken you don't have to ask it just is and I wish we could just say that out loud I guess just missing those days even though I never was a part of those days but how can we simulate that or get like a version of that back you think I mean I think it starts in local communities like the one that we have right I mean you may not live on a street with however many other women who have babies of the same age but we live in a community where this is a family community right? people come here to have kids and so those meetups and groups where you can get together and be with each other moms can feel seen babies can feel taken care of I think sometimes in these groups if you can kind of build a cohort almost like a COVID pod where it's like the same people over and over you build that trust you develop these deeper relationships rather than a group that you drop in once in a while exactly because then you if that person comes and picks up my baby if I've met them once or twice but if it's somebody that you have really gotten to know that you've really developed a relationship with absolutely right my best friend and I just as a tangent might we have this dream of getting like basically like the Kennedy compound not necessarily Diana's but just like let's have a compound and just live that life same dream with my friends because that's what's missing and sadly what's replaced that is social media where everyone has a completely different opinion about how to parent and how to do it right major air quotes right and there's it's like simultaneously you know you feel more connected to more moms than ever before but also so much more isolated and judged yeah you know I can tell you right now like just scrolling and seeing oh everyone looks so perfect and everyone has this together and here I am the mess in the corner trying to just like you know find my shoes like that is what social media does especially when it's your first kid right and you're figuring this out like how do I keep this kid alive how do I keep you know how do I do this the way that I want to raise my kids you just go and you're scrolling through social media and you see one voice saying you know use formula it's great you know you need to take care of yourself and the next video that you see is people who use formula are evil breast milk is the only thing you should ever feed your child you should breastfeed until they're five right these two people are saying exactly the opposite things and the strongest opinion right yeah and how do you choose which voice to listen to and it's not just feeding methods it's sleep training which toys to everything yeah and sometimes it's not a choice so it's so then so then you have that piece where it's same thing with birthing like c-section or you know vaginal medicated or unmedicated exactly and there's all this opinion and opinion you know if facts and information are great I do love that about the internet like right we know more more easily and sometimes because you know more it can be a little bit more to sort through which is fine if you're sorting through it yourself I think it's really hard when you're sorting through other people's you know opinions and everything you know I mean that's an interesting point I didn't think about it like that because you're right if it's the middle of the night like with my first I didn't scroll as much in the middle of the night when I was up with her and then with my second it's just unfortunately more of it's more in the fiber of like I don't want to say who I am that sounds really bad it's more habit it's more I'm more in the habit of it like seven years later which is disturbing it's actually really upsetting because you can't be as present with what do I think what do I want for my baby what's my baby needing what's my baby telling me because attunement is such a big part of it to be honest one of the hopes we had with our Mindful Beginnings program is to create a little mini version of that what you just said like a cohort that's close that actually talks about deeper things because I think that's how people get to that place of trust and connection is when you're vulnerable so if I'm vulnerable we're in a group together and I'm vulnerable and you know about like my childhood, my attachment stuff things that I'm working through I feel a little closer to you because I trusted you with that information and hopefully vice versa and so I think that's one of the we thought that was one of the things that we're missing so we're hoping that that helps but also to not be another voice adding to the mix of well you should be doing this and you should be doing that more about just giving people permission giving people permission to think about what's just going on for you and what do you need that's it you the parent yeah and that's it's a very similar philosophy so the program that I'm in tell us about that program we're excited to know about it so it's called the maternal mental health program at UCLA so we are a perinatal intensive outpatient program so it's for women who are experiencing more severe either perinatal or postpartum depression, anxiety, OCD different diagnoses but just really struggling with our mental health so it's impacting their function it's to the point where it's impacting their function I just think it's I want to make sure to clarify that because in case someone is listening and they're like that's what I need yeah it's much more than just like a mommy and me group right it's folks who really can't function or you know they can't work they can't they're really struggling to take care of their babies they you know can't take care of themselves you know a lot of different sort of ways that that impairment can look maybe feeling like having intrusive thoughts intrusive thoughts but intrusive thoughts can happen to anybody even without you know a mental health diagnosis I had horrible intrusive thoughts when I had my baby and the only reason it didn't develop into a full-on disorder was I thankfully had already been doing this work right I knew what it was so I would have these horrible you know it was images right like intrusive um glory images when I had my baby and if I did not know what that was I would have been terrified I would have been extremely you know isolating um an anxiety producing experience thankfully I knew what it was and I could just sort of be like okay I know what that is that was a horrible thought but I'm just going to move on with my day right but when it turns into more of a disorder like obsessive compulsive disorder that's what we see in our our program or if it's not going away not going away you can't shake it yeah you start avoiding things that that image or that thought is telling you is scary and dangerous right you start avoiding stares or knives or driving or what have you um that your brain is telling you is a threat to yourself or your baby um you know that's the reason that we treat people um but yeah we have eight women at a time we're in westwood at UCLA in person three days a week about four hours a day um we welcome we want moms to bring their babies because the babies are part of the treatment right it's not just getting better on your own separate from your role as mother it's how do you get better within that context and that role and identity yeah I think that's such an important piece that women can bring their babies yeah because there are so many there are tons of these types of programs like you guys run IOPs right um and and there are lots of them around but not perinatal ones and not ones that are in person and where you can bring your baby and that can be a barrier to a lot of women in the postpartum getting this level of treatment right 100% especially if it's an in person program but it's just general depression or general mental health program um that might be great like they might get medication management and therapy and skills but if they can't bring their babies and they don't have other child care right well and attaching to the baby is part of the healing yeah right and sometimes it's you know helping them to feel more attached right if their their illness is helping or is making them feel detached right um or they're scared to attach in some way right we can help foster that that attachment and that dyad um sometimes it's kind of the opposite right it's a to it too much too much right they're they're really anxious and they can't separate so we've had women who come to our program who you know their babies might be several months old and they've not spent an hour two hours apart they don't trust anybody else to take care of them you know even they're a partner their mother you know close close people that they trust they just right that anxieties um is too intense and so part of the program for them might be you know allowing our staff like you know I'm going to take your baby just to the other side of the room right um and you can watch us and you can see us and then you know next week we're going to go just to the room next door right and practicing that that graduated well because there's a healthy attachment there right because also the baby this is what we learn in mindful beginnings is the baby understands the mom's anxiety and also feels it like there's something to be afraid of so then but doesn't know what yeah and so really I think helping people understand that is important because no one wants to give their baby anxiety and it's not like you can just give your baby anxiety it's more about being the secure base to give your baby security yes which is the like antidote right so it's not like you're giving them anxiety but if you give them security then they can hopefully handle the discomfort of being away from you and have a secure attachment know that you will come back and you will be there and you're consistent but I think a lot of the times it's our own attachment style that gets either biologically triggered or even just like environmentally triggered yeah so I will say that for myself and I know a lot of women who the moment you get pregnant and or show there starts to be all the comments and everything it starts to just be triggering to whatever it is for your story that happened right and then the baby comes out and now all that continues the comments and everyone has opinions that's kind of one thing but this reminder of well this happened to me when I was a baby or a kid or this I could have happened and I don't want this to happen I want to be different it's really loud in there sometimes and so there's an opportunity I think at that point with by the way with both parents where I know we're focusing a lot on mom but I think it's actually about both parents focusing on her son what's what does this bring up in you like when your baby cries and you can't attend to them or you can't sue them what does it mean some people say like well that means I'm a terrible parent or some people say well I'm abandoning them if I don't pick them up every single time they cry okay there's such an extreme between abandoning right and letting your kid cry but if that's how it feels for you we need to look at that you know not to change your mind but just for the adult mom or dad to understand what's going on so that they can respond in the way they want to respond today as opposed to responding to a way that maybe they would have responded in another situation that it's reminding them of yeah does that make sense absolutely like for me that brings up so much about especially sleep infant sleep and and how we think about infant sleep right you know there's so much research so much research on this on you know sleep training and what what are the things that contribute to infant sleeping longer and better throughout the night right and it all the research basically agrees that it's parental behaviors and that parental anxiety parental over involvement in getting kids to go back to sleep is what contributes to worse sleep like we in I think in this country especially we have this idea that oh you have a baby you're not going to sleep for years congratulations right it's just an automatic assumption that it's like a biological truth babies cannot sleep and it's a hundred percent not true right it's our own behaviors and thoughts and assumptions and feelings that are informing how we respond to babies overnight and that's contributing to how they're sleeping right and if we can understand what our own anxieties are and stuff is right like you know hearing my baby cry I can't tolerate it even for ten seconds I have to soothe them otherwise I you know I'm abandoning them I'm a horrible mother a horrible father and so sleep training are you crazy right right and then I see them two years down the line and they're still depressed and anxious because they haven't slept in years help either not sleeping doesn't help oh yeah that absolutely slippery slope I do I do think that well I'm a big fan of attachment I think when I learned I remember learning about attachment theory in grad school and I would just remember thinking this is everything this makes everything makes sense it you can place almost every situation into that theory of attachment and I really have never changed my mind on that I work with kids teens adults I've been a parent I've been a kid I have parents like you know secure attachments and even just like by the way it doesn't even have to be with a parental figure it could be with your partner like that was a whole another thing I learned you can have you can have terrible attachment styles a child and and still correct your attachment in in your adulthood as long as you have secure attachments with someone yeah you know anyone who's consistent so it gives you hope you know but what we're talking about and maybe the people that are listening to us talk right now are maybe newer parents or are going to be are trying to be parents or know someone who is and to me I would love for people to know this at that point in time you know when when there's an opportunity there to form really strong and healthy attachments at the beginning yeah and and knowing that strong healthy attachment doesn't mean never leaving your child in fact it means leaving your child yes confidently leaving them in a trusted caregivers hands yeah and being able to project that to your child like this is okay this is safe I'm coming back and I trust that person yes and so you can trust that person right because they look to us I mean it makes sense right there this little tiny bundle of vulnerability in this world and of course they look to us to know any cue about anything yeah that what else are they going to do we are it for them where the litmus test of what's happening here so if we act like everything is not act like but if we truly believe that things are okay then they're going to truly know that things are okay in their nervous system but if we're you know trying to do all these other things they have no idea the context of why they just know something must be up because you know that nervous system is like that so my nervous system is going to match it yeah I need to in case I need to survive this thing that's about to happen which sometimes is not really significant right like to their lives like maybe if I'm dealing with something at work and I'm stressed out about it my baby doesn't know that they just know that I'm stressed out about something so the importance of managing our own nervous system is so hard like I'm saying these words while also you know dealing with it myself like I told you I know all this stuff pretty well I talk about it all day but like I was having a really hard time weaning from breastfeeding because of my own stuff I didn't want to let go of it because of my own journey to get to have my baby and there's a lot of reasons that I can understand intellectually why I was holding on to it but I could last night I understood I saw something in my child that made me realize this is me being stuck in my own stuff is hurting him it's more confusing for him now so there was a moment of clarity that again here I am talking about this stuff and yet I still am a victim of it or maybe a victim is not the right word it still happens to me too it doesn't make you immune to it thank you that's a better way that's what I was trying to say it doesn't make me immune to it it just happened and when I had that moment of clarity I understood it's going to be hard for him he's not going to understand why all of a sudden we're not doing that anymore but it's going to be way worse if I keep oscillating stretching it out so again there was clarity and I feel like a little bit better about it but it was hard because of my own projection that came with what that meant I was giving him nutrients and all those things are true and I was also confusing him and making him feel like he can't do it on his own and so then I watched him I said because usually I was nursing him to sleep that was the last thing we were doing when I say wean we were weaning but that was the one I wasn't letting go last one and he was upset and then I said do you want me to sing to you and he said yes and that was the first time ever that that has happened if I would have asked him I've asked him in the past and he's just like no don't even bother you and I both know what I want let's just do the thing and honestly it's going to work so anyway and that's the thing that I think so many parents do is I know what's going to work short term versus long term goals you need to go to sleep I want to go to sleep let's do it right now 100% 6 months later you're like that's me and the motivation was my daughter is asleep my husband is asleep let's just go to sleep but we'll just deal with it another day but last night when he said yes to me I sang to him a little bit through my tears because I was so sad but I sang to him and then I thought he was asleep in my arms but I was like let me just check and I said do you want me to keep singing and he nodded so he wasn't asleep which was really good for me because I realized he's calm exactly he's not asleep yet but he's going to go to sleep so then I sang a little bit more and then I said do you want me to put you in your bed in your crib and he went so I'm like okay this is a new beginning of a new routine that we're going to need to get into but he's learning that I'm here I'm going to sing to you check you in but we're not doing milk so anyway I think that what I'm trying to say is that my nervous system calmed down he was giving me the reassurance I needed by being able to say yes keep singing that allowed me to keep going but I think it's a reciprocal thing and I don't think we give babies enough credit sometimes they give us a lot of information but we have to be listening and watching and asking 100% we underestimate babies a lot I did not think you would give me that kind of response you know but we're on night one day and so let's I actually think it won't take long I think we'll be okay but it's mostly because I'm in a better headspace and so I guess that's what I hope people can hear too that we have to take care of ourselves whether it means taking medication that's another thing I wanted to touch on I think a lot of people including myself are very hesitant to take medication unnecessarily quote unquote that's always my term is it necessary and I know that during pregnancy especially every doctor that's not a specialist in pregnancy is afraid of everything that has to do with anyone who's pregnant at least that's my experience that's pretty spot on and I get it and I actually respect it like in one way if you don't know thank you just be cautious on me awesome but send me to someone who does know or look it up I guess look it up yeah because there's so much harm that can be done by not doing anything by not doing anything or if somebody is stable telling them to stop the thing that is stabilizing them so can you talk about that because I think a lot of women are afraid to once they're pregnant afraid to continue their meds or take meds if they need to yeah so you've put me on my soapbox be prepared do it so this is sort of the epitome of everything that I do in my practice both at UCLA and in my private practice this is the thing that I am most passionate about I know I want to hear about it this is for the listeners like get ready you're going to hear me talk for a minute because this is a harm that is done to so many women unnecessarily and it's done by doctors people in the community who are not in the medical profession it's done by pharmacists by nurses, by midwives, by so many different people right OBs, psychiatrists medical and non-medical people that there is still this assumption that you cannot take medication when you're pregnant that it's harmful to the baby in some way shape or form whether the assumption is birth defects or neurodevelopmental disorders is a really really common fear and that if you have a mental illness or a mental health disorder depression, anxiety, OCD, whatever it is that it sort of stops at your neck right it's just in your head it's a brain thing and that but if you put a medicine into your body that's going throughout your entire body right and that's an assumption that we have to break because mental health disorders actually do affect your whole body right and when you including the baby right it creates this entire environmental milieu that the baby is growing in so how can we possibly think that being depressed or anxious or psychotic or manic or whatever in pregnancy could not affect the baby and there's also this assumption that we don't have much data or evidence or literature on the meds in pregnancy or that obviously that data says it's harmful and these are assumptions that we have to break because first of all we know untreated or undertreated mental illness and pregnancy is associated with preterm labor preeclampsia, low birth weight and neurodevelopmental disorders like that's actually what's associated with we know that, we have data about that we have tons of data that shows us that consistently and this misconception about meds in pregnancy actually comes from old data that looked at women who take antidepressants for example antidepressants in pregnancy and they compared those women to what's called healthy controls meaning women who weren't taking the medications but they weren't depressed the control group was people who are not depressed they're completely fine isn't even that's not a one to one it's apples and oranges it's apples and vegetables and so and so the old data it showed people who take antidepressants in pregnancy have associations with these bad outcomes and that's where so much of this misconception comes from so brilliant researchers figured out that we need to do these studies again but look at an actual control group that makes sense and when you control for the underlying depression when you compare women with depression untreated versus women with depression who are treated the association of all these bad outcomes with the medications completely disappears basically so it's not the meds it's the underlying mental illness so actually taking somebody off their meds it's the illness that's the issue it's the illness so taking somebody off their meds like you said it's really well in tension these doctors don't want to cause harm no one wants to be responsible for someone else having an issue and how you just put it I've never heard it said like that before but that's so clear that makes so much sense that felt very science to me so I'm glad that was clear I think the science just seems like it was off it completely was and so again we have groups of really amazing researchers now who are looking at all the different classes of medications that we have and doing this type of research controlling for underlying confounding variables and again and again there may be still some medications that there's a slightly increased risk of a one specific outcome and anybody you know about it then you weigh the risk on that situation that specific situation but you can't generalize that all pregnancy okay let me ask you a question is it like someone who has let's say diabetes and they have to take medication for that to control their sugar and to manage all that the glucose levels then to just say okay but don't take it during pregnancy but then the crazy glucose levels is going to affect the baby so right is that like a similar analogy yeah and I actually love that analogy because people don't think about they don't second guess oh I have to you know take my blood pressure medication or my diabetes medication or you know things to treat physical health maladies they don't second guess that when it's mental health it's oh I should be able to muscle through yeah because of the stigma because of the stigma and there's also you know certain misconceptions like oh but if I'm taking an SSRI serotonin reuptake inhibitor then if I'm taking that during pregnancy my baby's brain will not ever learn how to make serotonin just not true it develops normally but the fact is that you the mom's body will not be producing serotonin in the same way and mom will suffer which will affect baby yeah and for some reason people they don't question being depressed or anxious during pregnancy so much they kind of think about you know it's muscling through but people are very concerned about postpartum depression I think that diagnosis is present a lot more in sort of the ether right people are really afraid of postpartum depression or maybe you can manage your depression like ish but then when it's postpartum it's like I'll off the charts and so then it becomes more of like let me take care of this exactly and so people who come to see me either when they're pregnant or before pregnancy they may not necessarily be coming to see me because they want to treat their depression right then but they want to prevent postpartum depression that's the thing that they're really really concerned about and the conversation that I have with all of them is that yes absolutely let's get on top of that let's prevent this as much as possible what's the biggest risk factor for postpartum depression is depression during pregnancy active depression during pregnancy really I didn't know that so the biggest most impactful thing that someone can do to prevent postpartum depression if they're already depressed or they have a history of it is to continue whatever medication regimen that they're on during their pregnancy is that the same for anxiety same for anxiety same for OCD anything that makes sense again you say it and it's like that sounds very logical but why is that not common knowledge also I don't know but I have a question about I have a question it's going to take us a little bit side tangent what are your thoughts about TMS it's a really effective treatment it's being studied for postpartum depression currently but it's a good effective treatment it can be used in pregnancy just from a coverage perspective it's right now it's kind of covered I think only for treatment resistant depression it's not like something that you can just go to immediately and just for context TMS is transcranial magnetic stimulation it's a type of interventional treatment where you kind of go to a TMS center you sit in a nice comfy chair in a nice dark room with spa music playing you put on this helmet and it turns on magnets basically it's specific points on your head that stimulates your brain and that's a treatment that we have for depression so it's not a medication that's why I ask because I just wondered if what your thoughts were that versus medication but it sounds like it just again depends on is it treatment resistant is it treatment resistant how accessible is it for you if your insurance doesn't cover it it's quite accessible so similar to what the other stuff we were talking about if you were doing TMS before then keep doing TMS or if you were doing whatever it was continue to do I feel like a professional like yourself really understands the nuances and I would trust if you told me don't take that during pregnancy or don't do that during pregnancy then I would trust that it's because I shouldn't do it during pregnancy versus like just a blanket statement that you know we're going to be conservative and just assume we can't do it but I think and that's why I this is such a soapbox for me it's not just about finding a specialist I think this is knowledge that needs to be core competencies for every doctor every doctor should be keeping up to date on data about things in pregnancy even like the basics right you don't have to know the data on every single medication but to know like okay any SSRI is fine in pregnancy right another really common thing that I see is doctors saying okay fine we can treat your depression in pregnancy if we really have to but oh you know you're on Lexapro we got to switch you to Zoloft Zoloft is the safest medicine in pregnancy but now we're changing meds now you're changing meds and you're changing meds off of one that works great for this person and has the exact same safety data as this other one and so it's really just put in the body through something when it does that doesn't need to happen doesn't need to happen and again you don't need to know the data on every single medication but to just know like the basic any SSRI is fine don't switch you know just that right that's enough information yeah well I hope that they start to I don't know I don't know how the maybe OB's or I mean I'm hoping that it's becoming more integrated into you know residency programs and medical education right I do the lectures for UCLA residents on this topic and you know one of the things that I I just try to hammer home because again not every psychiatrist knows this right people who graduate psychiatry residency from really prestigious institutions don't know this information and they make these same mistakes do you think it also matters when they went to med school partially older data yeah partially I mean there are some some older psychiatrists who really are good on staying up of the data true and if it's really actually concerning if you look at data about you know residency programs and who has women's mental health experts or specialists like if they even have access to somebody who has this knowledge who is teaching them this knowledge or not and so there are a lot of people who are graduating residency like right now right now who don't know this okay so you're gonna change that right you're gonna teach everybody I'm trying my damn days okay good and maybe people who are listening today will learn this and it'll get to the right hands one thing I also I just want to add because it's like a really common question is okay so we talked about meds and pregnancy ad nauseam what about breastfeeding basically anything you take during pregnancy you can take during breastfeeding the exposure amount through placenta is about five to ten times higher than it is through breast milk so if you took something during pregnancy you can take it take it just just continue it yeah to be honest I was telling you about my breastfeeding journey and yeah I actually this morning thought what are all the things that I haven't been doing that I can be doing now yeah that I'm not breastfeeding and honestly the list wasn't long but it has somehow felt like it was such a well but I'm breastfeeding you know like we just had and it really comes from a lack of knowledge honestly it does come from a lack of knowledge we just had the flu pretty bad in our house it was brutal I'm so sorry and I felt like I was cautious and scared of what I could take because I was breastfeeding yeah and you know you got the internet you got chat GBT consulting with you which is not a doctor so that does not count but that's what that's what I had that's what everybody has you know yeah in the middle of the night just trying to understand like I have these fevers and these chills like which which thing which over-the-counter thing in my in my cabinet am I gonna take it's stressful like it doesn't need to be so I wish like we had this conversation two weeks ago yeah and I would have this knowledge since I could feel you know more comfortable but I ought you know when it comes to questions about breastfeeding and and what you can take and what you can do in breastfeeding I always recommend that people also just check with their their child's pediatrician because you think about like the pediatrician is going to be thinking about the things that the child is eating and consuming and so if the pediatrician knows okay they're still breastfeeding but they you know they're getting exposed to whatever in breast milk that's an excellent resource and most people can get ahold of their pediatrician fairly quickly good point I wish I would have thought of that too instead of just suffering through that fever that was I mean I ended up taking it was fine but but for the first night I didn't because I wasn't I didn't think to even like learn about it you know I just was like oh it's gonna be over in the morning yeah and it wasn't so and that that I think also is a opening to to say and you know I realize that this medicine is not a psychiatric medicine but I've talked about this in the past you have a fever and you're pregnant it's extremely harmful and you can and should take Tylenol it does the fever is more the fever is dangerous is more dangerous than Tylenol also called acetaminophen in in European countries that's paracetamol you know there was a big controversy hullabaloo a few months ago you know with people in positions of authority and power advising people to not take Tylenol when they're pregnant because of the risk of autism or other developmental delays so it wasn't true then there was even just a study that was published I think it was like last week or two weeks ago giant study that again again again again disprove that so if you have a fever you have the flu your breastfeeding your pregnant you can take Tylenol and not suffer yeah no no I was like every every four to six hours I was taking it because it was bad but like I said the first night I just you know this is also part of martyrdom that comes with like I'm fine and then it wasn't and I will say I've never been more appreciative of Advil and Tylenol in my entire life yeah last last week I was it was like literally on the clock taking it every couple hours for myself and my kids yeah we were struggling yeah so and and I think that's important to remember that the actual fever itself is is what's dangerous that's what's dangerous yeah and that being a martyr does not serve you or your children oh it really doesn't may I learn that one day but I'm still learning maybe we all are still learning that one I'm still learning that one and I hope to be done with that but it's just it's really hard yeah I think it comes it's ingrained in me and some really deep kind of way and I know I'm not alone in this I know that there's a lot of people out there that for whatever all our reasons like we all have good reasons yeah and yet those reasons don't need to still exist so yeah thanks for the reminder I'm I'm appreciative excuse me I'm appreciative of this conversation and I'm trying to think of what else there's so much to talk about I'm trying to think of there's anything else that you comes across your desk or you think is like a misconception about any of these topics yeah we had a couple we definitely covered some of the big ones right that that mental illness during pregnancy or postpartum is much more harmful than than taking meds if you're on a medicine that is working well you don't need to switch right especially you know specifically Zoloft nothing again Zoloft love Zoloft if that's what works for you right if that's the thing that you're on that's working for you great stay on it but that's I think one of the most common misconceptions that I see is that it's safer or the safest antidepressant to take I think people just know about it more doctors are familiar with it they're more comfortable with it even people even like a lay person everyone knows what Zoloft is they don't know all the names of all the other medicines so it feels foreign it feels foreign and it comes from this piece of data that it has the lowest transmission through the placenta that's where it comes from it's the lowest exposure but all of the other ones have I mean marginally higher exposures like tiny tiny tiny amounts and the safety outcomes are not different so right so that's assuming that the exposure increases any kind of safety outcome and it doesn't then yeah so that's why it's not safer the safest and actually switching is gonna again well there's more risk there because then doesn't if it doesn't work then you have to go now now you're making this baby work on all these other things versus just staying steady staying steady and I think about that all the time right like if if Zoloft worked for everybody then we'd all take it we wouldn't need any of these other ones we just just start everybody on Zoloft excellent point why do we think it's gonna work for every single pregnant woman because that would be easier that would be easier but that's not where we're at I think one other thing that I would want to touch on is this other thing that kind of gets thrown around on the internet and from pharmacists and people that if you take a medicine an antidepressant during pregnancy that the baby will go through withdrawal or it can also be worded as they're gonna have a higher chance of a NICU admission and that's a one wants to hear that that's a very scary thing to hear and this is something that I talk about all the time with my patients who are considering staying on meds in pregnancy is what is this even talking about it's talking about this thing called neonatal adaptation syndrome which is something that is associated with people who take antidepressants in pregnancy we don't know that it's actually a withdrawal there's a study that really shows a lot of doubt on that where they thought if it's a withdrawal let's stop the medicine for the whole third trimester it's enough time to wash out completely and we shouldn't see this at all in the babies happen with the same frequency might be another example of something that's associated with again underlying mental health disorder versus the medication so we don't know exactly but it is basically this very short term transient difficulty with adapting to outside life right after delivery so it could look like a whole number of things it could be crying their muscle tone might look a little off either they might be a little bit floppy or they might be a little bit more rigid or tense they might have difficulty with suckling or latching initially if you think about newborns, if you've ever been around a newborn all of them look like this right? all of them look like this and so if you look in the literature it's like up to 30% of babies might experience this there's no like no 30% of babies who are exposed to these meds in pregnancy are not getting diagnosed with this the ones that do end up getting diagnosed or recognized or who need some extra support are the ones who the most severe end of this again if they have difficulty with latching or suckling at the beginning they may not be able to feed initially and some of them might which would result in some of those symptoms some of those symptoms and some of them may not cry right off the bat or they might have some difficulty with maintaining their oxygen level and so it's that very very very very small subset that might need some support with feeding and with like oxygen right where does that happen in a hospital almost always in a NICU right that's not going to happen on the regular postpartum unit it's not going to happen typically in a normal like a regular PEDS or pediatrics floor typically when a neonate right after delivery needs any kind of support it happens in the NICU what that increase rate of NICU admissions doesn't say is it's for like a few hours or a day at the most and they don't need anything to make this go away they don't need medication they don't need anything else it's just extra support a little like baby oxygen thing and some feeding for a few hours and then long-term studies have shown that they're totally fine happy healthy normal kids everything else being what it needs to be right but that this does not affect them long-term and so I talk about this to this extent with my patients because I think it it's really important to dispel this misinformation because to just say to to whittle that down to increase NICU admissions and withdrawal is horribly scary well what I what I appreciate about you Brittany is that you take that information and you explain what it means like what you just said if I was about to have a baby and you told me that that would feel very different then I can make my own decision about what I'm comfortable with right but you just explained the what is it like the warning labels or whatever you explain what that means which is so important I think to me at least as a patient as a mom as honestly as a caregiver in this community like that's what I seek when I refer to somebody is somebody who can do what you just did which is explain what that means because it does sound scary I just said it I was like oh I don't want my kid to be admitted to the NICU but then when you explained it right now okay I it just feels very different to hear that that okay a kid needing to go to the NICU because that's where these things are is very different then you hear NICU and you hear life and death you know and that's and maybe without the oxygen and without that extra support it's risky but what you just described was very different than like the warning label makes you feel definitely meaning I should say no it's not that you're that different you said exactly the same thing you just said more you took the time to understand wait a understand what it means enough to then explain it to me and that's what I really appreciate and I think it makes the difference for people to really feel taken care of I appreciate that yeah it's true I just wish there was more doctors that did that so I hope that there are you know I hope we continue to have more use that more information that we have and use it to help educate and inform people I think that's what people need right we're living in an age where all of this information is more accessible than ever before but how do you parse through it how do you interpret it how do you weigh you know okay so risk of untreated mental illness medication withdrawal NICU like how do you right combine all of this into one sort of clear picture and and to know to take that and how to and then make a decision about what you want to do right based on your factors you know yeah and and to have somebody to talk it through and you said it in late like layman's terms like you didn't you were using so much a jargon that it lost me like I followed you you were I could imagine the whole thing I was playing it out like in the hospital with the ox you know that how scary it already is to have a new baby no matter what is going on which is true I mean the moment they come out you're like all the questions is everything okay yeah and and honestly I think for the rest of their lives and yours probably you know the first few weeks I would say are just so scary anyways no matter what so add any factor to it and it just sometimes feels very overwhelming so this comes back down I think to taking care of the moms and the dads and giving them the knowledge to then make the decision that feels right for them which is kind of the point the whole point oh man we could talk forever I feel like there's always more but this was so helpful I learned so much even today thank you for having me again again I know I got on my soapbox this is the thing that I could talk forever about that's why you're here and that's why seriously that's why you're here so that more people can hear about your soapbox and know about you and hear your style and maybe reach out to you if they're thinking about like gosh I just wish I knew you before I knew you the way like professionally I think you could have probably really helped me when I was especially my first pregnancy but anyway I know you now and hopefully there's other women out there that are getting support from you that need it so and good luck on your journey thank you I am so happy for you I'm proud and can't wait to see see this little is it a girl boy I don't remember see that's another question people ask and I just did it too like people ask as if it matters like it really doesn't matter as long as they're healthy little human being healthy little human being exactly I guess in my mind and I think this is what people do is they want to sort of imagine like put more information to the picture but yeah anyway thank you so much for being here and I'm sure we'll do it again yeah take care you too bye bye hi