Dr Louise Newson: [00:00:02] So welcome to the podcast Sue, you're a consultant psychiatrist in New York. So we're recording this remotely and I love talking to psychiatrists who are interested in women and the health of women and hormones, so welcome.  [00:00:15][13.2]
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Dr Sue Varma: [00:00:16] Thank you. Thank you so much for having me and exciting to be here and all the great work that you're doing. And so I love following you on social media and you're empowering people. So grateful to have this conversation.  [00:00:25][9.7]
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Dr Louise Newson: [00:00:25] Oh, thank you. Well, I'm quite insightful and I'm very honest. Honesty is really important. I've brought my children up to be really very honest because it's important. But I'm also honest about things that I haven't got right as well because you learn by your mistakes and some of those mistakes are harder than others. And I don't think, it's not necessarily mistakes that I've but I hadn't had the information that I have now, and I feel like... You know, I'm 55 now, I wanna make up for lost time and I can't go back to my patients from 20 years ago and to say, look, I am sorry, I didn't know about hormones and like I'm sorry I gave you antidepressants and I should have maybe spoken about your surgical menopause or whatever. But what I do feel like you say is just empower women so they have knowledge, a lot of them have as much knowledge as I do about hormones, which I think is great because it's about empowering people so they can become better patients and better advocates. But I really enjoyed psychiatry when I was training as a doctor, but I never learned anything about the role of hormones in the brain.  [00:01:29][63.5]
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Dr Sue Varma: [00:01:29] Nobody does. I mean, we don't get any information about, like, we look at it as, like hormones are means to an end for reproduction and when your purpose is over in that department, then you don't need it anymore. But we don't realise the impact of estrogen on the brain and in terms of, with the memory and dementia and your bone health and your muscle mass and fat distribution and insulin regulation. So these are far more than reproductive hormones or hormones for life, for living, for brain health, for cognitive benefits.  [00:01:58][28.6]
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Dr Louise Newson: [00:01:59] So the same for you with your training of psychiatry, you weren't really taught about it? [00:02:03][4.3]
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Dr Sue Varma: [00:02:03] Not at all. And, you know, if anything, we were taught, okay, there are things that happen to women when there are fluctuations. So, okay puberty, you might see, you know, the rise of anxiety or depression or body image issues or eating disorders. And it was never known, is it about societal factors, is it about hormonal fluctuations. You know, one thing I often get called to speak on either in the media or I see with my own patients is fluctuations of hormones around pregnancy and postpartum or antepartum. But you know, I think one of the hardest things is how do we tease out lifestyle and changes that are happening in the world in your family. So like when a woman is pregnant, she's saying, you know I'm scared. Is my partner really going to be able to hold their share after I deliver? I'm not sleeping. So it's so hard to tease apart. You know, is the woman's depression in those months afterwards a relate change in my identity, in my body, in hormones, in relationship with my partner who is helpful and meaning, wants to help but really can't. Is it the sleep deprivation. Is it that fact that I can't see my friends, the fact that i'm not able to see my colleagues at work. So it's so hard and we have to look at every piece of this and I love how you said, we were talking about hormones, you said it's like the foundation. Yes, you still need the yoga, yes, you need the supportive partner, yes, you need the diet and nutrition, but if you don't have the basics to then build upon, it's not, is it a hormone issue, is it social, psychological factors, it's all of it. It's yes and... [00:03:31][87.6]
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Dr Louise Newson: [00:03:31] Yeah and I was reading some notes actually of a patient of mine, they were notes from the psychiatrist over several years and she'd been labelled as having schizoaffective disorder, bipolar, treatment resistant depression but actually one of the notes did talk about her postnatal depression but she's in her 40s and that had sort of been hidden really. And it's really quite difficult to know because there are so many factors. This lady was also a big drinker. She was well known to the services. She had lots of paranoid ideas. And when she turned up, it was often in a crisis so the last thing they're gonna sit down and talk about is her periods. But actually, when I spoke to her and just said to her, what were you like when you were pregnant? And she said, oh, just amazing. Like it was the best time of my life. You can't ignore hormones. Do you know what I mean?  [00:04:27][55.4]
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Dr Sue Varma: [00:04:27] Absolutely.  [00:04:27][0.0]
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Dr Louise Newson: [00:04:29] It's, but we didn't ask. And it takes like, I don't know, 10 seconds to say how did you feel when you were pregnant.  [00:04:34][5.1]
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Dr Sue Varma: [00:04:35] Yes.  [00:04:35][0.0]
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Dr Louise Newson: [00:04:35] And I think what's happened often is that we're trying to find another reason. So with this lady's notes, there was a lot of sitting down talking and I, because I could read the script, asking about, you know, she denies any abuse as a child. We've asked her again about her relationship with her father and it's like, hang on, and this was repeated many times because she had so many admissions and It was almost like they were trying to get something out which would then go oh so that's why she's like it and often it can be like that in psychiatry as you know there is something that happens in our lives that can tip the edge or affect us or cause trauma or stress or whatever, but actually I thought gosh if they'd spent less time asking her about her relationship with her father and her sons and her partner and actually just asked her about periods or did a hormone blood test.  [00:05:28][53.2]
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Dr Sue Varma: [00:05:29] Yes.  [00:05:29][0.0]
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Dr Louise Newson: [00:05:32] It might be a bit more revealing...  [00:05:32][0.5]
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Dr Sue Varma: [00:05:32] You know, I love that you bring that up because it's almost as if they want to be able to look at something in the past that would explain everything in the present, that would in theory dictate everything in future. And so it's like our hands are done, this one unmodifiable factor. You know I remember seeing a patient and it was interesting she was in her 60s and she was very depressed and she tied her depression and low functioning and not being able to reach her milestones in life to her relationship with her mother. And I said, you know, is your mother still alive? And she said, no. And I was like, okay, well then how are we gonna change things? She's like, I can't, it's over. And I'm like, unless we're going to get you, direct your mother's spirit, you know, and have you converse with her, to pin your entire life's 'lack of' to something that we can't permanently change, is while it might be true. It's also doing a disservice because you're negating all of the agency that you have in the present, you know. And the other point that you're bringing up that really speaks to me is when I see patients do a thorough medical evaluation in conjunction with their primary care doctor, I say, okay, these are the labs that would be important to me and please share this with them or I might pick up the phone and have a quick chat with the doctor and say I'm interested in thyroid hormone and vitamin D, vitamin B12. And even low normal can, like, I have a lot of patients who have vitamin B12s in the 200s or 300s, and ideally we want to see 400-600. So something as simple as that, that, wow, you can just start taking supplementation, you know, similar to what you're saying about the hormones, and sure, we want to look at trauma and tragedy and loss and all of these things that have happened to us in early childhood and beyond. But if there are very simple things that you can do that explain that people who have diabetes are more likely to have depression, stroke is correlated to all of these medical problems. So that's why I think if people can even do one visit with a psychiatrist and there's so much stigma around that, oh, no, that's for really people who are crazy, just getting a thorough evaluation or having a conversation with your GP specifically for mental health. Because I hear a lot of these like doorknob conversations where a patient goes to see a doctor. Your annual visit, they have 10 minutes. And the doctor's looking at diabetes, cholesterol, you know, medical issues, obesity. And then at the end of the session in 10 minutes, the doctor has their hand on the doorknob, they're about to leave and then the patient's like, oh, and by the way, I'm depressed and I don't wanna get out of bed. And then they get an antidepressant prescription without getting a thorough evaluation because depression is a symptom, insomnia is a symptom, anxiety is a symptom. It is not the actual diagnosis. So having a session that is saying, I'm just coming for my mental health. Let's go through all of the symptoms, the differential diagnosis, because your depression could be hypothyroidism. It doesn't mean that, you know, so like looking into the medical cause is a big part of getting a proper mental health evaluation.  [00:08:25][172.3]
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Dr Louise Newson: [00:08:25] And it's so important because we, we get quite confused, I think, as in we in the public, but also we as doctors about depression, what it is and what it means. And, you know, when I was a medical student, Prozac was only just coming out. You know, so we didn't really have much to treat depression. It wasn't really around so much. When I was just finishing a few years ago as, as an NHS GP. It was so easy to prescribe antidepressants because someone comes in, like you say, you've got 10 minutes. It's very hard. And when you look at the questionnaires for depression, most of us have been probably severely clinically depressed at some stage. And I know when I had my children, they kept asking me about depression and really quizzing me and there have been times in my life at various times where I've been very, very dark, but it's usually been due to something. But... I've been lucky because I can speak to people, but there was one point particularly a few months ago where I reached out to somebody who's a psychotherapist actually and I had a really good session with her and it made me think very differently. But I have often reflected on that time because I was quite scared of my thoughts and it really troubled me and it was awful and I didn't want to tell my family. But if I had not known this person, I would have gone to a GP. And I know they would have given me antidepressants and I know it wasn't the right thing to have antidepresants. But I just think we need to be using our brains in different ways. And I know that's your sort of specialty as well really is how do we overcome difficult times and how do not be so reactive because I think we live in a fast environment, you know, I knew my feeling would pass. I knew I would keep going, I knew, I wouldn't, you know, do anything silly. I've got lovely family, but at that time it can be very, very overwhelming. And I'm very good at telling patients but it's harder to tell yourself. But those tools that how, how we talk to our brain, it sounds a bit crazy, doesn't it?  [00:10:32][127.0]
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Dr Sue Varma: [00:10:33] No.  [00:10:33][0.0]
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Dr Louise Newson: [00:10:33] It's so important.  [00:10:33][0.3]
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Dr Sue Varma: [00:10:35] Absolutely. So first of all, thank you for sharing that because I think so many people will say to themselves, okay, she has, she's so successful and if she can also experience hard times. So this gives me permission to say, you know, first of like one of the questions I get asked, we had done in the United States, a Stop the Stigma campaign a few years ago with CBS News and it was a one month long campaign where celebrities came on and talked about their mental health challenges. And I remember getting asked the question from Gayle King. She's like, Sue, why is it so important that celebrities come out? And I think of you, I put you in that bucket of celebrities.  [00:11:08][33.5]
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Dr Louise Newson: [00:11:10] Ahh, you're very kind.  [00:11:10][0.0]
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Dr Sue Varma: [00:11:10] But why is this so important? And I said, because celebrities are not these two separate categories or these public figures, somebody who has it all together and then someone with mental illness or mental health challenges. You know, often you can have both. So first of all, let's normalise and mainstream the conversation and you speaking about it is so powerful to people. And then the second thing is, and I'm so glad that you reached out quickly, right. Because a lot of times people wait for things to get really bad or there is shame involved or I'm a doctor, I should know this, I treat so many people. So there's a humility aspect and an acceptance of this. And then also recognising that, okay, medication is not something I want right now, it's available to me, should I need it, but I wanna talk, I wanna understand, I want to process. So I really am a big believer in, because I have a lot of patients I work with that I don't give medication to, and for any number of reasons, because I really do believe that you really wanna change the framework with how you look at the world, right. Like, if you see this as, like, you know, and you bring up a good point, in pessimism, which is a slippery slope to depression, people often think that the negative feelings that they have are permanent, that the thoughts that they're having are pervasive. This is, if this is really bad in one aspect of my life, it's probably horrible in all. And they take it very personally, you know. And the flip side of that, which I talk about in my book, Practical Optimism is recognising that bad things, bad thoughts, negative feelings are not permanent, right. That they can get better. And that's really the definition of optimism, is being able to anticipate good things in the future. And so that's what you did. You said, I know that this isn't permanent, but I need to get ahead of it. And I love that you did that.  [00:12:49][99.1]
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Dr Louise Newson: [00:12:49] Oh, thank you so much. And yeah, it's so easy to dwell on negativities. Many people know I had a big trauma when I was nine because my father died. And it would be very easy to define myself as that. And I feel very strongly it's given me a superpower, actually, because nothing can be worse, losing a parent, well, there's lots of things, but not many things can be worse than what happened. But I could dwell and cry and get upset and feel very let down, or you could think, well, actually, it's given me resilience and strength and independence and everything. But one of the things that my husband gave me for my birthday in August was an affirmation diary, then my oldest daughter's...  [00:13:32][42.8]
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Dr Sue Varma: [00:13:33] Is he in mental health? Is he a psychiatrist?  [00:13:34][1.5]
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Dr Louise Newson: [00:13:34] He's a surgeon. He's a very black and white surgeon.  [00:13:36][2.4]
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Dr Sue Varma: [00:13:38] How sensitive of this man.  [00:13:39][1.2]
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Dr Louise Newson: [00:13:39] Well, my eldest, daughter, who's very sensitive, actually helped him buy this present. But it's quite interesting because I have to write down three things every morning that would make my day good, sorry, yeah, three things that make my day good, three thing that I'm pleased for, and then just something, an affirmation. And then in the evening, I have to say three things, that did make my day good. But sometimes these three things that I'm grateful for, have just been like alive and having the skill of kindness and it's very, it's become quite narrow, my diary, rather than... You know, I'm happy because I've got a nice car and I've got a garden and you know it's become very, a lot more about my emotions. And I do have wobbles quite a lot in the day and I'm like, and sometimes I just write, I am happy that I've kept going. I'm happy that I can see the future. I am happy that I've got a mission. I've had some good meetings. I have met lovely people. It's just reminding myself of the little things and we should do it all the time, but somehow I've told my family, I am going to do it for a year and I don't want to let them down. So I do it every morning and every evening. It takes me two seconds, but when I look back, you can really see how your days go. [00:14:54][75.2]
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Dr Sue Varma: [00:14:56]  That's so interesting. So, you know, just the ability to anticipate good things creates in your mind a certain neural pathway. Like they've done studies where they've asked people, they've given them neutral, like a photo, think of like one of those Rorschach tests where you know. So they gave somebody a neutral scene, like let's say, like what looks like it could be a car crash, but not really, and you don't know and they're like, okay, go ahead and project something onto this. Project something positive. And they've done fMRI scans where they see that the brain lights up in the left side of the brain anticipating something positive. And what we do know is that, like, you're basically asking the person, imagine the best case scenario, which is an exercise, an optimism exercise. It's an intervention. And that's what you're doing, you're doing this optimism intervention is fortune-telling good things in your life. By the same token, if you asked a person to imagine the worst case, this car crash, the people don't survive. This could happen to me. The right side of the brain which is linked to more fear in the amygdala. So there actually are key neural pathways that get lit up in the brain by asking you what can you anticipate, good things happening in the brain. So believe it or not, you can train, you can coach every morning when you wake up, which direction am I going to go in. And this doesn't mean, you know when they've done studies, people who naturally are positive thinkers, they don't necessarily have any less adversity in their life. So, all of us, right, will have the relatively same number of good and bad. I mean, obviously, in your case, this was an extreme loss at a very early age. So that is not typical but for the most part, people will have the same number of negative experiences. But when you look at success in their life and longevity with health, it's correlated with how quickly do they able to shift that adversity into Where can I find the silver lining? What am I going to do? Because like you were saying, I could have decided to dwell in negativity and passivity that this happened to me as a victim, or I can thrive and give back to others. And sometimes both, sometimes you're allowed to be miserable and say, why did this happen to me and more, right and that's not a one-off, one-time thing. It's life-long.  [00:17:13][137.4]
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Dr Louise Newson: [00:17:13] It's great that you say that because I think it is important that we can not celebrate but we can be positive about sadness as well because if we don't experience sadness we can't experience joy but actually it's a normal emotion and this is where sometimes I worry that there's too much medicalisation of emotions and a lot of people I see who on antidepressants and they tell me that they don't think they were depressed but they weren't given anything else, but they say, I don't feel sorrow, but I don't feel joy either. I'm just going through life flat lining. And that's not normal either, is it? [00:17:51][37.6]
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Dr Sue Varma: [00:17:52] No, it's not, and you know, for the vast majority, I've certainly heard that like for people who experience a very broad range of emotions and they can feel extreme sadness, I'm not talking about bipolar disorder, I'm just talking about like within the range of what might be considered normal, but that there are large dramatic shifts where like on a certain day, I always ask my patients, you know tell me subjectively on a scale of one to 10 if one is your lowest mood where you don't feel like you wanna get out of bed and 10 is, you know, I've won the lottery or whatever the best thing is, where's your mood most days. And depending on where a person says their mood is, if they say, you know I'm below a five, then I get a little bit concerned. If your mood is a three out of a scale of 1 to 10. And you know when we look at depression, low mood for two weeks or more, you know in terms of the criteria for major depressive disorder, low mood for, you know, two weeks more plus fatigue, concentration difficulties, not wanting to get through the day. Low energy, hunger, appetite might be too much, too little, sleep might be too much too little. Feeling guilt, feeling worthlessness. So it's a constellation of symptoms. But there's certainly people who after getting, taking an antidepressant, they say that my mood is in a tighter range. So instead of fluctuating from like a three to an eight or three to a nine, it's more around a six or seven. And they say like, at least I don't feel the low lows. So there are people who say that I feel muted or I want to cry so badly, but it just doesn't come out. And that I don't love, right. But for the most part, you know, and this is why I think it's really important to go to a doctor that offers multiple modalities, that can offer psychotherapy, talk therapy without medications. Like that saying, if all you have is a hammer, everything is a nail, something like that, right. To be able to talk to somebody and because I do think that medication can be life-saving and life-changing for people who need it. But keep in mind, like you have to change the circumstances of your life as well. So asking yourself, what can I do? And I'm a big believer in what I call the four Ms of mental health. And these are like science-backed daily habits, movement, mindfulness, mastery and meaningful engagement. And I would say, you know, if you want to maybe add that into your diary, I don't want to give you more homework, but you know, you do all of this every day, you know, you're experiencing mastering the work that you do with patients, with advocacy, with your lectures and talks, with your podcast. So there's, your day has all of that. The meaningful engagement I'm already hearing between your husband and your daughter and probably friends or colleagues, right, that are invested in you and you're invested in them and your patients. And then movement, you mentioned yoga, are you?  [00:20:28][155.9]
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Dr Louise Newson: [00:20:28] Yeah, I get up every morning actually and either do yoga or free weights, usually yoga because, then I do a longer session on a Wednesday, I do the whole primary series of Ashtanga and that definitely keeps me physically and mentally active.  [00:20:41][13.0]
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Dr Sue Varma: [00:20:41] Yes, that's beautiful. And then for mindfulness, what do you do to take a break and centre? [00:20:45][4.2]
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Dr Louise Newson: [00:20:46] Well, I actually meditate quite a lot, actually, and I meditate myself to sleep because I have so much going on. And actually, about 20 years ago, I was trying to teach myself to meditate and I was reading all these books and I found that I was thinking so much about how to do it that I couldn't actually do it. So I found my own way and I basically just empty my brain and visualise that I have a cement around my brain, and no thoughts are allowed in and no thought are allowed out. I just clear my brain. And that's really important. And I do a Shavasana obviously after every yoga practice, so I often meditate in the day as well and it's very powerful. [00:21:27][40.3]
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Dr Sue Varma: [00:21:27] I love that. I'm going to try using that next time when I'm having trouble falling asleep, the cement. My mom had given me a funny, and I'll never forget it, towards the end of her life, my mom would wear dentures, and so she would put the teeth outside into a box. She said Sue, if you're ever having trouble sleeping, think of my dentures and every night I take them out, I put them, they're done. So you think of your negative thoughts in a little box, and you close them and you're done for the day.  [00:21:54][26.6]
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Dr Louise Newson: [00:21:54] Yeah, it's hard because your mind, your mind, our minds are so powerful and controlling. And, you know, I know when I was perimenopausal, I was often waking in the early hours with very negative dark, like intrusive thoughts, but also ruminating a lot over thinking and catastrophising, which is a lot, happens with women when their hormones are naturally dropping in the middle of the night or the early hours, and it can be very disconcerting and I, it didn't ruin my life, but there's lots of women who say, well, I can't drive anymore, I can't go out. I can't, I'm even worrying about packing a suitcase for the holiday that I've been dreaming of going on. And they know, but they've got insight, so they know that it's not normal behaviour, not normal for them. And actually, you know, then you talk about hormones and they're so worried because of these perceived risks that they've read about, but once they're on their hormones, they can then unpick a lot that's been going on and some of those thoughts are thoughts that they probably need to deal with themselves because I do think it's important to deal with negative things rather than just push them away, I don't know what you think? [00:23:02][67.8]
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Dr Sue Varma: [00:23:03] Yes, no, and there's a lot of science behind the dangers of suppressing your emotions. So I have a lot to say about suppressing emotions and how not to. So we do know that people who have a tendency to suppress, like when they follow them for four years, there's higher mortality rates of people who, for heart attacks, for strokes, specifically anger, and I feel like for both men and women, for different reasons, right like, anger is a difficult emotion. I think women end up internalising and crying and blaming themselves that they have a hard time expressing it. And what they find is that in couples, people say, oh, you're fighting and that's not a good sign. In fact, women who are more verbal in their marriages are happier, right. So this is a big push to say figure out how to express yourself and I give people like a four-step plan. You know, in my book, I talk about practical optimism, there's eight pillars, and processing your emotions is a key one. So the pillar starts out, the first pillar is about purpose. What is your intention? And it could be big P, purpose in life, or little p, purpose in this moment. And the last P, last pillar, is practising healthy habits. But really it's just, it could be any goal or the execution of anything that you want to achieve. So you start with intention, purpose, and you end with execution, practising healthy habits. And in between, it's all of the obstacles, both in your mind and in the real world. And I say that at any given time, we're contending with two battles. The battles within ourselves, right, between, did I do something right, the self doubt, the anger, the rumination. And then, problem solving is another pillar of, okay, how do we emotionally regulate and then execute. Because if we're stuck in our brain and we're paralysed, we'll never be able to execute. And in that emotional, how to not suppress your emotions, a four-step plan that I give people, and it's called, name it, tame it, claim it, and reframe it. So name the antecedent, and the people can get really granular, and that's where I feel like journaling is very helpful, that if you can be very granular and specific about what upset you that day, because a lot of times people will say, I'm fine and I have no problems, I have no anxiety, and then I say, well, how do you sleep at night? And they're like, yeah, not good. You know, and I think that sleep as a window into your mental health, and that tells me a lot that when your head hits the pillow, that's when the ruminations begin, or many people say I fall asleep immediately because I'm running around all day and I'm tired, but then I wake up at three in the morning and then the rumination starts. So naming the antecedent, more emotional granularity, those people are far healthier. They can be very specific, and if you know the problem, you're more likely to be able to solve it. Taming it is about, how do you self-soothe? And the way you do that is by first claiming it. Where in the body are you feeling the tension? A lot of people will have it in their jaws or in their neck or in their shoulders or GI problems, insomnia. And I see a lot of mental health issues present, as you know, as medical problems and psychosomatic. And the body expresses what the mind cannot. And I share my own sort of blind spots of how during a very challenging time in my life, all of a sudden I started to feel weakness in my leg, so severe to the point that I can't walk. And I talk about how when we take permission to express our feelings, to assert, to ask for what we need, we're less likely to manifest with a hundred different medical problems, headaches, unexplained. The average person will go to five medical specialists before they end up with the psychiatrist. They're going to the GI doctor, they're ending up in the ER for panic disorder because they think they're having a heart attack. And I always say, by all means, please get medically checked out. But it shouldn't take five to 10 years and five medical specialists. And that's a reason why there's the mental health symptoms cost, at least in the United States, $1 trillion a year from presenteeism, which is showing up to work, but you can't function because of mental health problems, absenteeism, you're missing work and then the cost to the health care system, which is unexplained medical symptoms. So naming it, what's the antecedent. Claiming it, where in the body are you expressing or holding onto this tension and how is it manifesting medically. Taming it is what are you doing for the self-soothing. So I love the meditation that you talk about, yoga, all of these things, journaling. So three things that you do, which is amazing, but all people should do. And journaling can take place in many forms. There's something called, that I learned from my own therapy when I went through this challenging time, is a worry diary. And the worry diary is you write down for 10 minutes everything you're worried about. And I remember when my therapist told me this. I said, worry diary, you want me to write all the things I worry about? I'm trying to run away from my worries. Why would I start telling you, like telling my diary about them and invoking them all over again and suffering all over again, she said trust me, do this, do for a week. And I saw her the next time and I'm like, I'm not 100% sure where we're going with this, but I'm going to trust you on it. She's like, keep going, keep doing. So three weeks later, she goes, look back and reflect and tell me if you've picked up on anything. What I found was two things. One was I was worrying about the same thing over and over again, right. And it was a time when my mom had been diagnosed with stage three breast cancer, and she wasn't able to get chemotherapy because she had underlying heart disease and the chemotherapy was gonna put her into heart failure. So nobody wanted to treat her. So all of these ruminations of, oh my God, my mom is gonna die. She'll never get to walk me down the aisle. She won't meet my partner. I want her to meet everybody. All of these catastrophising, what we call the worst case scenarios. And then I realised that the things that I'm worried about, aren't actually happening, and that there's studies behind that. I later learned that 85% of the time, the things that we worry about don't happen, and 15% of time when they do happen, we're better equipped to handle it than we think that we are. And so then she said, okay, well, the other thing is your worry diary helps you separate productive worry from unproductive worry. You're ruminating about your mom. I get it, there's a lot on the line, but what can you do about it? So the productive worry is who are you going to call? What appointments are you going make? Which doctors are you, how are you going to get her the treatment, because otherwise, your wheels are stuck in the mud. There's motion, but there's no acceleration. So this helped me 10 minutes a day, park my worries in one place, get them out, recognise that I have more agency and more control than I think that I do. The things I'm worried about, they have a theme. They are something consistent. It's about loss. It is about grief. It s about relationships. And it's about lack of assertiveness, because I was so afraid, I was in residency and I was working at as part of the programme, it was a very rigorous programme, very prestigious programme. But they told us, you check your personal life at the door when you start this programme. Your hours, we own you for the next four years, essentially. I was working 100 hours between five hospitals. And you don't have a personal life. So if you're ready for that. So I felt like how could I ask for time off, you know. And you know, in medical training, like there's a hierarchy and you're a peon. You're like the bottom of the, you're sick. You have 104 fever, put your IV pole on and come in, right. And you're expected to get to work,you don't have a life. So I didn't feel like I could ask for time off. I was expected and you know in the medical profession, you're fine, nobody, you don't need it. You're here to serve. So that's a four-step plan. Name it, claim it, tame it, and reframe it. And the last one is reframe. How can I look at this challenging situation differently. And when I was working with 9/11 survivors, this was a big part of trauma recovery. And one thing I learned was that there are gonna be some instances where you're not gonna be able to find a silver lining because my patients would say, Dr Varma, where is the silver lining in this mass tragedy that we experienced? And I would be crazy to tell them that there was one. So this is something I learned from my eastern upbringing and my parents would always say this to me growing up and I never thought I would using it in this context. But they would say, when you're worried about something and you're ruminating over and over and over again and you can't find a solution, ask yourself this one really important question. Is this a problem to be solved or a truth to be accepted? And I realised that big tragedies and big losses, sometimes it's about acceptance. And unfortunately, we equate acceptance with resignation and giving up, but really sometimes surrender can be an act of positive conscious deliberate choice that is actually giving you more agency.  [00:31:12][489.9]
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Dr Louise Newson: [00:31:14] I love that, it's so important. My mother often talks about the three As. So it's to acknowledge, accept and adapt. And I think that's really important. So what a lovely way to end because I hope this is just giving people something different to think about and to share with others because everything we've talked about is not pertinent if you're only a perimenopausal, menopausal, hormonal woman. Children, adults, everybody should be taking something from this podcast. So before I end, just three take-home tips. So there's lots to think about there, but if someone's listening to this and they're having a wobble, they're have a time where they just can't see a way out and feeling the dark cloud over them, what three things do you think they should be concentrating on? [00:32:01][47.6]
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Dr Sue Varma: [00:32:02] Yeah, so, you know, to give your mom a lot of credit, right, the acknowledgement of what you're going through, right, like, that's really, I think, important. And I want to really encourage people to seek professional help, even if it is just a few sessions. Like, I'll say that I went to cognitive behavioural therapy, and it changed my life, right. And not only were we encouraged to go as psychiatrists, like to be able to be on both sides of the couch, it's a really big part of training that you be a patient yourself. But what it taught me was life skills that changed my life, right. So seeking professional help, because sometimes no matter how much you want to think your way out of it, you just can't. And it's a medical problem sometimes, depression. Get a full battery of medical evaluation tests, right, to make sure it's not your thyroid, vitamin B, hormones, all of that. And I would say the other thing is like small daily micro habits, the four Ms of mental health, movement, mastery, meaningful engagement and mindfulness. And then think about, in the book, Practical Optimism, I give people a quiz in the beginning. There are 40 questions, and it allows you to see, where do I fit in? Am I an optimist? Am I a pessimist? Am I realist? Am I something in between? And how can I adopt and practise? It's like yoga. It's a yoga practice. Some days it's a five-minute practice. Some days, it's longer. But how can, through very actionable, tangible tips, change the way that I look at the world? Because when you change the you look at world, you change the way the world reacts to you. Perception is king.  [00:33:30][88.8]
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Dr Louise Newson: [00:33:32] So important, so thank you ever so much for your time. I've really enjoyed it. Thank you.  [00:33:37][5.1]
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Dr Sue Varma: [00:33:37] Thank you. [00:33:37]