The Dr Louise Newson Podcast - 92 – Hormones, mood and mental health myths Dr Sue Varma

Episode Date: August 13, 2026

Psychiatrist Dr Sue Varma joins Dr Louise Newson to unpack why hormones are so often left out of mental health care and what gets missed as a result, from puberty to postpartum to perimenopause.Dr Varma is a board-certified psychiatrist and was the first medical director of the World Trade Center Mental Health Program, treating 9/11 survivors and first responders.Sue and Louise discuss why psychiatric training leaves out hormones' role in the brain - memory, mood, dementia risk - and why a proper medical work-up (thyroid, B12, vitamin D, hormones) should come before a psychiatric label. They talk about the stigma around seeking help, the risk of over-medicalising ordinary emotions and Sue's practical tools for difficult periods such as the "four M's" of mental health, the worry diary and her four-step framework - name it, tame it, claim it, reframe it.Sue closes with three take-home tips for anyone having a difficult time right now.Let’s connect👉 Track your mood symptoms with the Balance app: https://bit.ly/4yZty5A👉 More from Dr Louise Newson: https://linkin.bio/drlouisenewson👉 Link to Dr Sue Varma's book : Practical Optimism https://a.co/d/ekTvcfq

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 health of women and hormones. So welcome. 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. Oh, thank you. Well, I'm quite insightful and I'm quite, well, I'm very honest. Like, 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 made. But I hadn't had the information that I have now. And I feel like, you know, I'm 55 now. I want to make up for lost time. And I can't go back to my patients from 20 years ago and to say, look, I'm sorry, I didn't know about hormones. And like, I'm sorry, I gave your 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. it. But I never learn anything about the role of hormones in the brain. 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 realize the impact of estrogen on the brain and in terms of with memory and dementia and your bone health and your muscle mass and fat distribution and insulin regulation. So these are

are far more than reproductive hormones or hormones for life, for living, for brain health, for cognitive benefits. So the same for you with your training of psychiatry. You weren't really taught about it. 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 antipartum. 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 women's depression in those months afterwards, a real change in my identity, in my body, in my hormones, in my relationship with my partner who is helpful and meaning wants to help but really can't. Is it the sleep deprivation? Is it the 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. We have to look at every piece of this, you know, 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 basic 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. Yeah, and I was reading some notes, actually, of a patient of mine.

There were notes from the psychiatrist over several years. And she'd been labeled 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 going to 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, it was just amazing. Like, it was the best time of my life. You can't ignore hormones.

Do you know what I mean? Absolutely. But we don't ask. And it takes like, I don't know, 10 seconds to say how to you're pregnant. Yes. 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, because I could read the script, asking about, you know, she denies any abuse as a child. We've asked her again about 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 her periods or did a hormone blood test. Yes. You know, I think they were more revealing, you know? 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 the future. And so it's like, our hands are done, this one unmodifiable factor. You know, I remember seeing a patient and, you know, 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 going to change things? She's like, I can't. It's over. And I was like, unless we're going to, direct your mother 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, where I might pick up at 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 300, and ideally we want to see four to 600 to 600. So something like 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, you know, 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 or 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 is 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 want to 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 from 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 causes is a big part of getting a proper mental health evaluation. And it's so important because 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 an NHSGP, 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'm 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 was 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 antidepressants. 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 we not be so reactive? Because I think we live in a fast environment. You know, I knew my feeling would pass and 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. of those tools, how we talk to our brain, it sounds a bit crazy, doesn't it? No. It's so important. Absolutely.

So first of all, thank you for sharing that because I think so many people will say to themselves, okay, she has so successful and if she can also experience hard time, so this gives me permission to say, you know, first of all, 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 Gail 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 celebrity. Oh, you're very good. But yeah. But why is it 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 normalize and mainstream the conversation and you speak. 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's shame involved or I'm a doctor. I should know this. I keep so many people. So there's a humility aspect and an acceptance of this. And then also recognizing that, okay, medication is not something I want right now. It's available to me. Should I need it? But I want to talk. I want to understand. I want to process. So I really am a big believer in, because I have a lot of 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 want to change the framework with how you look at the world, right? Like, if you see this as, 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. 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 recognizing 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. Oh, thank you so much. And yeah, it's so, it's so easy to.

to dwell on negativities. You know, 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 than losing a pet. Well, there's lots of things, but not many things can be worse than what happened. But I could have 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. Is he in mental health? Is he psychos? He's a surgeon. He's very black and white surgeon. How sensitive of this man?

Well, my oldest 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 things 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 those three things that I'm grateful for, just being, like, alive and having the skill of kindness. And it's very, it's become quite narrow, my diet, rather than, you know, I'm having 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 sometimes I just write, I'm happy that I've kept going. I'm happy that I can see the future. I'm happy that I've got a mission. I've had some good meetings. I've met lovely people. It's just reminding myself of those 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. 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 tasks where you're up. 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 and 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 a same number of negative experiences.

But what different, 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 a life. And I think 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 are 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 scaring through life, flat, And that's not normally either, is it?

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 sanity, 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 want to 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 one 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 a major depressive disorder, low mood for, you know, two weeks or 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 taking an antidepressants, 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's saying, if all you have is a hammer, everything is a nail, something like that, right? Like, so to be able to talk to somebody, because I do think that medication can be life-saving and life-changing for people who need it. But keep in mind.

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 M's 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 So 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 in your patients. And then movement, you mentioned yoga. Are you? Yeah, I get out every morning actually and either do yoga or free weights, usually work yoga. And then I do a longer session on a Wednesday. I do a whole primary series of estanga. And that definitely keeps me.

Physically and mentally active. Yes, that's beautiful. And then for mindfulness, what do you do to take a break and center? Well, I actually meditate quite a lot, actually. And I meditate myself to sleep. Do you? Yeah. Because I have so much going on.

And actually, like, 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 visualize that I have it. a cement around my brain and no thoughts are allowed in and no thoughts are allowed out. So I just clear my brain and that's really important. And I do a shabasna obviously after every yoga practice.

So I often meditate in the day as well. And it's very powerful. I love that. I'm going to try using that next time when I'm having trouble falling asleep, the cement. You know, my mom had given me a funny and I just, 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. So she said, too, 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 the little box and you close them and you're done for the day. 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, overthinking and catalymp. It's a lot happens with women, but in their hormones and naturally drop in the middle of the night or the early hours. And it can be very disconcerting.

And 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'm even worrying about packing a suitcase with a holiday that I've been dreaming on going on. And they know, but they've got insights. So they know that it's not normal behavior or not normal for them. And actually, you know, then you talk about hormones and they're. so worried because they've 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. Yeah. 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, you know, we do know that people who have a tendency to suppress, like, they will, when they follow them for four years, there's higher mortality rates of people who, for heart attacks, for stroke, 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 internalizing and crying

and blaming themselves, they have a hard time expressing it. And what they find is that in couples, that people say, oh, you're fighting. That's a, 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 practicing 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, practicing 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 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 paralyzed, 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 anteceded and the people who 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 of 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 damn tired, but then I wake up at three in the morning and then the rumination starts.

So naming the antecedent, more emotional and 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 say 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 100 different medical problems, headaches unexplained. And the average person will go to five medical specialists before they end up with the psychiatr. 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 presenteism, 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 on to this tension and how is it manifesting medically. Taming it is what are you doing for the self-soothing so that I love the meditation that you talk about, yoga, all of these things, journaling, to three things that you do, which is amazing, but all people should do. And journaling can be, can take place in many forms. You know,

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 it. I'm trying to run away from you. from my worry. Why would I start telling you, like telling my diary about them and invoking them all over again and suffering all over again. She's, trust me, do this, do this 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 going. 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 going to put her into heart failure. So nobody wanted to treat her. So all of these ruminations of, oh my God, my mom is going to die. She'll never see me, she'll never get to walk me down the aisle. She won't meet my partner. Like, I want her to meet all of these catastrophizing what we call the worst case scenarios. And then I realized 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 the 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. It's, it's, there's a lot of, there's a lot on the line, but what can you do about it, you know, so the productive worries, who are you going to call? What appointments are you going to meet? Which doctors are you going to, 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, recognize that I have

more agency and more control than I think that I do. The things I'm worried about, they have a theme. There's something consistent. It's about loss. It's 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 as part of the program. It was a very rigorous program, very prestigious program. But they told us, you check your personal life at the door when you start this program. 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 a 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 going to be some instances where you're not going to be able to find a silver lining.

because my patients would say, Dr. Barma, 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 be 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 realize 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 active, positive, conscious, deliberate choice that is actually giving you more agents. I love that. It's so important. My mother often talks about the three A's. 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 having a time where they just can't see a way out and feeling the stark cloud over them, what three things do you think they should be concentrating on? 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 that. 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 behavioral 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, you know, 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 a realist? Am I something in between? And how can I adopt and practice?

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 I, through very actionable, tangible tips, change the way that I look at the world. Because when you change the way you look at the world, you change the world, the way the world reacts to you. Perception is so important.

So thank you ever so much for your time. I've really enjoyed it. Thank you. Thank you.