A (7:54)

Of course. Thanks so much for having me.

B (7:55)

Dr. Amy okay, so let's start with what made you get into the brain? What made you specialize in psychiatry and neuroscience? What fascinated you so much to dive into this area?

A (8:10)

I mean I think the short answer is that I've always for in my older adult life like and by I shouldn't say older adult life, I should say starting around high school, I was a high school athlete. I played most sports but you know, specifically like ice hockey, tennis, soccer, volleyball, things like that, baseball and I love playing athletics. And I realized that there was a very interesting relationship between stress and performance and recovery. And I noticed that inside in my own body. I also noticed that my friends and I was always fascinated with dreams from my early childhood. But that Dreams are really hard to study, so they kind of seem like a far off, like science fiction for me. But chronic stress was really interesting because stress shapes the way we see reality and the way we approach stress. Whether we approach it as, like, why me? What's wrong with me that I'm dealing with all these challenges right now? And why is all this happening to me right now versus this stress? This challenge I'm facing is another opportunity for growth. Let's get it on right. Let's do this. Let's adapt and see it as a learning experience. That perspective shift is. Was really interesting. And when I looked at. As I started to get into my medical training and started to work with elite athletes, elite military and veterans who would come back from service and really struggle after having gone through so much basic training and military training, train their bodies and their minds to function under extremely high levels of stress. Many of these folks would get back to our regular life in civilian life and really struggle. And so this became very interesting to me. And I'm trying to figure out, like, what makes a Michael Jordan, right? Like, can we have more than one Michael Jordan? Do any of us or Bruce Lee, right. Do any of us have the capacity to reach that level of extraordinary performance? And ultimately, what kept coming back was this idea of our mindset and perspective and how the way we think about stress and the support that we get from our community and our role models after we experience challenges or hardships are two incredibly important factors that I notice were often being overlooked. And I especially saw this in our military veterans who were really struggling to recover when they came back. And so working with those people, we were doing what we were told to do, right? We're prescribing the medication, psychotherapy, all these different techniques, many of which, for most of these folks, were not working. And people were basically dealing with symptoms day in and day out for their entire lives that were really significant to the point where they couldn't work. And they struggled to interact with their families and have normal social interactions, it was really, really hard for them. And so I started to just look outside the box to what else worked. You know, what about meditation, mindfulness, yoga, Eastern and tribal indigenous practices to address trauma? What do they have to teach us that Western medicine isn't teaching our trainees? Right? Like me, what did I miss? Because I wasn't getting the Eastern and tribal approach to healing and trauma in my medical education. You know, I went to a standard American medical school, and our curriculum is basically the same in every American medical school. So that being said, as I'm looking for these other tools and techniques, I actually in 2012 had a colleague of mine in the psychiatry world who said, Dave, you know, you should really look into the research going on in psychedelic assisted therapy, because this is treating people who have been severely affected with depression, ptsd, that have had no relief from any treatments, but they're getting better in just a few doses of psychedelics with highly structured therapy. So she sent me 10 papers of the top papers that were published at that time, and I went back and stayed up all night reviewing them. And I was just blown away by the quality of research and the findings that were coming out of these studies. And the overarching theme was that these medicines are working to accelerate, like, remaking of meaning around past traumatic events and what those mean about us. And as I saw that, I was like, holy crap. This is like a medicine, a drug that induces a waking dream state that allows us to reshape the way we think about stress in real time and then rewire our brain brains to have long lasting outcomes and in the case of patients, remission from symptoms that we've never seen before. And so that really is. As soon as I read those papers, I was like, definitively, trauma psychiatry is for me. And studying the way that alternative therapies and psychedelic medicines in particular work and what they have teach us just became the most fascinating passion for me in my life.

B (13:01)

Gosh, I wish more docs going through that, like you said, the rigmarole of medical school would expand their minds, no pun intended, but expand their minds like you did, to really say, hey, these are very interesting and not studied enough areas that can really impact people's lives. So I'm just blown away. And I love the fact that you branched out and really wanted to go deep in the study of neuroscience. Okay, on that topic, can we become Michael Jordan and Bruce Lee or what's the secret sauce there?

A (13:35)

I mean, I think that the evidence in modern neuroscience says that we are much more capable of tremendous achievement of that level than we previously thought. But it starts with figuring out what we are good at and removing the limitations from ourselves. Like, if you can imagine that, and you probably can relate to this, that we are grown up being told stories about what we're good at and what we're not good at. Right. And I know I was, I know most people I know were. And those stories were told to us by other people, like our parents or teachers or whoever, friends. And if we continue through our whole lives believing those stories to be true based on our childhood selves and what people told us back then, Then what happens is our curiosity about what we're capable of and what I would argue the meaning of life is, which is to self discover what we're capable of in this life gets completely suppressed or repressed and it doesn't even become a thing that we think about. And so to answer your question, I would say yes, absolutely. We have the capacity to reach Bruce Lee or Michael Jordan level performance in our specialty area that we were born to excel at. I think the challenge is that we're stuck in the box of I am only capable of and good at these things. So that's all I'm going to do. And I'm not going to be curious because curiosity could result in failure. And failure is scary, right? But we have to fail. We have to make mistakes to be able to grow. That's literally the growth process for all living things, but especially for humans. And we all know unchallenged humans don't become very good at many things. You have to be challenged to become developed skill sets. And so I ask people this question, which I think is a very important question that we all need to ask ourselves, which is, is it possible that what we were taught that we were capable of is not the full story?

B (15:40)

Ooh, that's good.

A (15:42)

When you.

B (15:43)

And when you think in for a minute.

A (15:44)

Yeah, right. And when anybody asks themselves that question, the answer, of course is yes. When you really listen, right? It's like, of course it's possible. Is it guarantee? No, but of course it is possible. I have a saying that I like, which is that if you ask yourself the wrong questions, like the why me Questions, you'll get the wrong answers. But if you ask the right questions, you'll get the right answers. And so the questions we ask are really important. So that kind of questioning, which we call like self inquiry, is it you're asking a question of yourself. Is it possible that what I was taught is about myself or about the world is not the full story? And we answer honestly, which is yes, it is possible. Then all of a sudden, curiosity and self discovery are unlocked, right? And then we can start going down those paths and actually growing and learning at a much more rapid rate than we were possibly taught we were capable of.

B (16:38)

Okay, so, Dr. Dave, you're sparking my brain here. We'll get to the menopausal brain in a second. But now I'm thinking mainly about my patients that have had hypothyroidism, Hashimoto's for a long time. You know, now we see in the clinic, these are patients that have been through the conventional system, maybe drop thousands, if not tens of thousands on functional medicine. But the people they were working with were not thyroid hormone experts. So they really have, they've been through the gamut. So let's say you have that person that has been misdiagnosed, have been mistreated, and in their minds they have created such an embedded story of I'm so sick, I'm such a tough case, nobody can help me, no one's ever going to help me. I'm such a tough case, no one can help me, no one's ever going to help me, I'm such a tough case. And that loops so many times in their head. Do you see that belief system literally keeping people stuck, that it's kind of like, well, you're right, because you believe that you will never attract a true helper into your world, nor will you be open to that person when they show up.

A (17:44)

Yeah, absolutely. Nor will you necessarily take the actions that result in the change in your life that you want, because your belief is contrary to the possibility of that being a reality. Right. So that's 100% true. And we have a word for that. It's called self limiting beliefs.

B (18:04)

Yeah.

A (18:05)

Right. And the other word for that in scientific trials of medicine is called these. The opposite of placebo, it's called nocebo. Right. So we don't talk, we don't talk about this that much outside of the medical world, but people need to know these words because there's a tremendous amount of research around this that is highly confirmatory of this concept that self limiting beliefs reduce efficacy not just of the medication you're taking, but of yourself. Right. So if you're doing something like say you're trying to learn something new to playing a sport, to doing the work that you do every day or your taxes or whatever, if you go into that activity, even taking a medicine, if you go into that activity and you believe that there's no way this can help me, like I'm a lost cause. Right. It has like a 50% less chance of working.

B (18:58)

Wow.

A (18:59)

Right.

B (19:00)

Wow. 50. Now, I knew there was an impact, but I didn't think.

A (19:02)

Well, it's. Yeah, I mean, it varies depending on the study. In mental health cases, we see that the placebo effect accounts. So the placebo is a medical term for describing the belief effect that a treatment will work or the expectation effect. So if we believe that a sugar pill is going to Help us because we were told that it will and our beliefs are aligned with the outcome that we want. It works 30 to 50% better in mental health cases if we believe the opposite, which is that it won't work. It's like a 40 to 60% chance that less likely that it will work for you to give you your desired outcome. So it brings up two things that I think are fascinating that we don't talk about enough, which is, number one, that belief matters. Right? Belief matters is actually a real thing that has real outcomes on our lives. And number two is that if we want to achieve anything in our lives, even just basically like being like healing and being in a good state in our bodies, we need to align our belief with our goal outcome. If we identify, hey, I want to get to position B, but my belief is I will never get there or I'm not capable of getting there, then we're not going to get there or we're going to be that much less likely to get there. Does that make sense?

B (20:20)

Oh, 100%, absolutely. Yeah, that totally makes sense. So when we use the term psychosomatic, because we've definitely had patients in the practice where my nurse practitioners are looking at the labs, they bring them over to me, they're like, can you look at these? I'm looking at them. Everything on paper says that this person is perfection. But they'll still complain about one or two symptoms that we're like, we don't see any connection. I mean, even, you know, reaching into the depths of functional medicine and functional medicine testing, we're not seeing the connection. Is it possible that people can literally think their way into a symptom when no evidence is present pointing to that particular symptom or system that we be connected to the symptoms?

A (21:08)

Absolutely. And this is, I think, again, speaking to the power of the mind and speaking to the power of the mind body connection. Right. Which is that if we believe ourselves to be sick, and again, this is one of the topics that, that my book is about that I think you'll really enjoy that's coming out in the spring, this idea that if we believe ourselves to be sick, even if all the tests come back showing that we're not sick, we can still manifest symptoms of illness that are unexplained by any core, what Western medicine calls organic biology. There's no, like, molecular disruption. There's no direct organ system issue. There's nothing that you can track from measurement that is confirmatory of the fact that you are ill. And that's where we get into this concept of psychosomatic because the psychosomatic disorder is like a mind body disorder where we believe ourselves to be sick because maybe somebody we trust, a parent, a doctor, somebody we look up to or looked up to at one time said you are sick or you have this diagnosis, it has no cure. Mental health is like notorious for this because most of our diagnoses have no cure and doctors hand them out left and right and that actually does damage to people. When we like when insurance companies now over the last 10 years, I'm sure you know this, but most patients don't realize this, that when you have health insurance and you go to a mental health provider or your family doctor for them to get paid, they now have to report a diagnosis. And if they report a mental health diagnosis and they tell you that, then you have just been given a label of something that generally speaking in mental health has no cure. Right. There's only, there's basically like adjustment disorder is like the only thing that goes away all other mental illness. Like you're basically stuck with it for life in the current western psychiatry model. And you have to take medication for life to address that. So the that leads up to something that we often talk about as like illness identity disorder or illness anxiety disorder, which is a psychosomatic disorder that's not actually like there's something wrong with your body that you were born with or developed. It's that you believe yourself to be ill because you were told that's what we were taught. And then it's up to us to actually amass the evidence. And this is the work we do in our clinic is like, how do we help people amass enough mo current up to date evidence that supports your well being. Right, right. That you're good to go. Like when. How many tests do we need to do if we're doing tests or how many proof points do we need to realign your inner story to? Not one of I'm sick and there's nothing that can be done, but I'm well and everything is okay. Right. And then I can grow from there. And so that creates a sense of safety and security in the body. And which is where all change and growth comes from. It comes from security, comes from safety. And if we don't feel safe, our autonomic nervous system that governs our entire stress responses in our body, which is also hormonally regulated, gets completely shut down. And so change building new habits like eliminating old bad habits, rewriting stories, all of that. We're just like meh that's too hard and scary right now because I'm already so stressed out and unsafe. So I'm just going to stick with what's familiar and known to me. And in our Western culture, I would argue that, like, it's almost like a Munchausens at scale because people are being taught that you are not worthy of receiving care and love and affection and acceptance for your community unless you are ill. Right. Unless there's something wrong with you, get back to work. Right.

B (24:49)

Yeah, yeah. And, well, and then you have the medical gaslighting going on where people are being told, well, you know what? This is all in your head. Like here. Okay, I hear that you're depressed and anxious. Here's an antidepressant or an antipsychotic or a benzo. But all of this is in your head, Susie. So here you go. And now she's handed a pill which just perpetuates the whole placebo, nocebo effect of, well, okay, I thought I maybe had a hormone problem, but my doctor just told me I'm depressed and gave me a medication for it. So now I have the label and the pill. And that just further ingrains it.

A (25:31)

Exactly. Yeah. It just provides further confirmation that your suspicions that there's something wrong with you, especially in the in. And I don't know how much this has been updated, and I don't think it has been updated that much because it's something that I lecture on frequently and people often, the clinicians I teach had not been caught up on the evidence. But that this idea that there's a neurotransmitter imbalance that you were born with if you have mental illness is not proven out. Like, this is a hypothesis that has actually been disproven in the last five years in massive studies, massive meta analyses, that there's no. For. For like 99% of mental illness. There is no genetic inborn guarantee that you have it and that there's something wrong with you because you were born wrong. That's not true. So if we understand that, then we understand that a lot of the symptoms, the illness, the behavior, a lot of that is learned behavior. It's learned coping mechanisms to cope with a very, very challenging modern life that we were not given instructions about how to do. We're just trying to figure it out on our own and look at our role models and this and that. And oftentimes we don't have great role models to role model, like how to deal with complex emotional situations. Right. Or to give us like complex language for, or accurate language for emotional identification and processing. Like we have to go to therapy most of the time to get that information. And many of us don't go to therapy because it's stigmatized. So it's very tricky. And so what I try to bring it back to is think about, be mindful of the thing that we can do on a daily basis is to be mindful of the words we choose to describe ourselves. Right? Like describing how we feel in the moment is really important. But describing how we feel in the moment with the wrong words that then apply to the past and the future can actually put us into a really bad spot. Because if you say you're sad right now, then we can deal with that. But if you say I'm depressed and you believe you always were and you always will be, it's a lot harder to address those issues. And medication can be like the Western medicines can often be very helpful to stabilize people when they're in a really bad spot. But they don't treat the source of the problem, they don't get to the root, and they often have a lot of negative side effects when used long term just to stabilize somebody for life. So while those medicines are helpful, they are not particularly useful for long term treatment and addressing the core of the what's causing the symptoms. They just kind of like help stabilize people by taking the edge off, but they're not solving the problem. So we're kind of going, in modern society, modern psychiatry, that psychedelic medicines are very helpful to teach us is that we can get to the root cause. And if we can get to the root cause, we can prevent the problem from coming back, even if it requires stabilizing someone in the short term. If we get to the root cause, whether it's through just psychotherapy or whether it's through psychedelic assisted therapy or technology assisted therapy or whatever it is, if we can get to the root cause, we can prevent the problem coming back. And I think that's really the most exciting part about modern psychiatry, that in the era that we're in right now, well, that's huge.

B (28:44)

And something that you said I want to circle back on because I hear so many patients say, well, my mother had depression, it's in my family, I have a genetic predisposition to mental health conditions. But what I hear you saying, and please clarify if I heard wrong, that there really isn't, there's like a 1% chance of a genetic connection when it comes to mental health disorders.

A (29:08)

Well, I think so. The way I would Clarify that a little bit, is that people don't necessarily realize that predisposition does not mean a guarantee. Right? It does not mean that you have a genetic disorder where you have a neurotransmitter imbalance that you were born with and you're guaranteed to develop a mental illness. What it predisposition means is that because you had a parent with mental illness or addiction disorders, or maybe you had a parent or a family member that was severely afflicted with some mental health disorder, that your chances of developing a mental illness might be slightly higher than somebody who doesn't have that history. But it does not mean that you have a guarantee. It does not mean that your fate is sealed. It means that you should be extra careful in terms of how you self care. Right? And maybe self care needs to be a higher priority. Emotional hygiene, personal hygiene and physical hygiene, right. Need to be like a little bit higher of a priority for you. Especially when you're under slept and you get into and you're facing a lot of challenge and stress in your life, right? Because if you don't do that, then that's when those predispositions start to show up and it puts you at increased risk. It does not guarantee the outcome. So I think that's really where the genetic stuff and the epigenetic stuff becomes really interesting because we're not talking about, we're moving away from this idea of because your family has this, you're guaranteed to have it. That's not true. There are certain cases where that's true, but it's very, very, very rare in most people, like the 99% of us who struggle with mental health symptoms. It's in us, it's predisposition. So it's a risk, it's a risk based modifier and that's how we need to be approaching it. And then if we understand that we have an increased likelihood of getting sick if we are overstressed, over challenged, then we can prevent that by taking better care of ourselves. So there's actually a tangible, concrete answer that can change. If we really look at what's happening and you understand the word predisposition is a likelihood, not a guarantee, not a sealed fate, then we can actually do things in advance and in the time of stress and struggle and challenge to prevent our body from decompensating and resulting in constant hormonal imbalances or organ system dysfunction like we see with thyroid and adrenals and all these things when people are given are just organized, overstressed and overwhelmed all the Time we eventually start to see some of these key hormonal systems dysfunction. And so they're all really tightly related. But again, not a guarantee. It's just a likelihood. And the likelihood is actually much more educational and useful to understand what we can do than a guarantee. A guarantee makes us feel powerless, right?

B (32:01)

Yeah. Okay ladies. You know, as we get older, our bodies just change. Sometimes in ways that leave us feeling less in control. And as women, we're all navigating the ups and downs that come with aging, especially when it comes to hormones. So that's why I am super excited to share something with you that's been a game changer for me. I have been using the bioidentical hormone creams from Hormone Solutions by Karen Martel. Dear friend, dear colleague, some someone I trust tremendously. And let me tell you, I'm a little bit obsessed. So these creams are unlike anything I've tried before and I am a an anti aging junkie, skincare junkie. They're clean over the counter. They contain USP grade hormones which means they're high quality and effective without any harmful ingredients. And the best part is you don't need a prescription to get them. Karen's creams are designed to help with the symptoms of perimenopause and menopause loss. And I have noticed a real difference in how I feel and how my skin looks. So the Estro 2 rejuvenation cream, my favorite in particular, has been a little miracle for my skin. Not only does it help to balance hormones. Bonus. But I've been using it as a face cream and research shows that estrogen on the skin can actually reduce fine lines, shrink pores, even help build collagen. So it's like a mini facelift in a bottle. And it's totally affordable too. So what I love about Karen's products is they are all about helping women reclaim control over their bodies because let's face it, we deserve to feel good as we age. So these hormone creams are just like hitting the reset button, going back in time, giving you that sense of balance we all crave. So if you're ready to take back control, feel your best. I highly recommend recommend trying Karen's creams. She has Progesterone Estradiol, the E2 my fave. They come with a 30 day money back guarantee so there's nothing to lose and you can even get 10 off your first purchase with my code, Dr. Amy D R A M I E so check the link in the show notes. We are going to Give you a personalized link, but you got to use the code Dr. Amy for 10% off. And I hope you get them all and tell me what you think. Yeah, exactly. And by no means am I negating the experiences of people with depression and anxiety. How they feel is real. Even if it is a perception, it's creating that chemical imbalance, that feeling of that tight chest lumping your throat, the whole thing. But where I want to go is, now let's say someone has that predisposition. Not a guarantee that it's going to show they have that predisposition. Now, you layer upon that a hormonal or endocrine system issue. Hypothyroidism, the changes in hormones, in perimenopause as a woman transitions to menopause. We know that that all affects the brain. So it's not that someone has a Prozac deficiency. It's that they have something going on in their body that is affecting what mood? That is affecting cognition and brain performance. So let's transition and talk about. Let's start with hypothyroidism. What do you see is actually occurring when someone with a thyroid disorder is experiencing increased levels of depression? Anxiety. That's not related to a situation, the inability to handle stress, all of a sudden.

A (35:31)

That's a great question. And I think there's a lot of misunderstanding around this, because in those situations, we as psychiatrists are all trained and as general medical practitioners should all be trained to assess things like thyroid levels first. Before we start treating symptoms of a mental illness, we need to assess. Is there a reason why, biologically, a simple reason why this person might be having the symptoms they're having? Hypothyroid is very interesting because it can mimic the symptoms of anemia, it mimics the symptoms of depression, it can mimic the symptoms of many other different kinds of illnesses. Because the thyroid is so critical to our functioning in every way. It's one of those super hormone organs, and without it, we are really not in good shape when it's not working. Right. And so to your point, I think when we have people come into the office, we always ask first, have you had. If they have symptoms of depression or anxiety or other things? Like, have you had your thyroid checked in the last year? Right. And if they have and it's normal, then we know, okay, let's run through all the other labs. Like, have you had your blood levels checked? Have you had some of your vitamin levels checked? Like, maybe you're undernourished in certain areas, you're not Getting enough vitamins and minerals, you're not getting enough nutrients to feed your body, not getting enough sleep. Right. There's all these things that can impact your symptoms. And thyroid is one of the lowest hanging fruit to understand because it's so broadly reaching across the body. So when we people come in, we always check thyroid levels first to make sure that they don't. That's the obvious thing, right. If they have thyroid dysfunction, the beauty of that is you can just treat that. You don't need to give them any SSRIs or any mental health medication. You just treat the thyroid issue. And usually in the gross majority of these cases, most people just get better, like their mental health systems, completely clear, by just addressing the core biological dysfunction. And it's the same with anemia, it's the same with vitamin and mineral and nutrient deficiencies. So like. And even sleep can be one of those core things where if people aren't getting enough sleep and for years, they can start to have symptoms of mental illness that manifest. So that's always the first thing we look for. And then once we've ruled out that there's any hormonal imbalance or organ system dysfunction that is biologically traceable, that could be the causing your symptoms, then we know, okay, it's time to start looking at your mental health symptoms from a truly mental health perspective. Does that make sense?

B (38:14)

Oh, yeah. No, totally. And just for my listeners, when you say that you test the thyroid, you do more than tsh, right? Dr. Dave?

A (38:21)

Oh, yeah. You have to do. You have to do like T4 free thyroid, T3 to do like a full thyroid panel.

B (38:27)

Beautiful. That makes me happy to hear that you're not just relying on TSH as being normal. So I wanted to pick your brain on that. Okay. And then we have. The lady is transitioning into perimenopause, which we know perimenopause can be a long time. I mean, women can start getting mental health symptoms in year one when their hormones start to shift and progesterone starts to decline. That's our calming hormone. Or they can ride the wave through perimenopause. And as soon as they transition into menopause, estrogen plummets, testosterone's in the toilet. That's when they're basically being put on SSRIs as a band aid instead of treating the hormones. So talk to me about what's going on in a woman's brain when those hormones are changing.

A (39:15)

I mean, it's a few things going on and on the biological level Your body, the woman's body was in a. Prior to menopause or perimenopause, a woman's body is in a very much production ready mode, right? Everything is about output, reproducing. The whole body is centered around that reproduction cycle for a woman. And that's a cycle that changes the hormonal balance of a woman's body slightly every single day of the month. It's a much more rapid cycle than men are on. And so I think in a lot of ways that's why women are so much more somatically attuned, like so much more in tune with their bodies. Because a woman's body often feels slightly different every day, whereas a man's body is basically the same most of the time. And we have much longer cycles, I think. So I think like, one of the things that happens that's really important on a biological level to not forget is that women will get used to having and feeling a certain way most of the time. And then because they get comfortable with a certain level of progesterone and estrogen in their bodies, all of a sudden those levels are completely different. And when those levels are different, your entire hormonal, what we call like the hormonal milieu or like the soup of hormones that is usually inside of us, that is of certain reliable, semi reliable levels, is now completely different. And so that is a major biological transition to get used to. And I think that actually from the latest evidence coming out, is alone contributory to a lot of the symptoms that women talk about in menopause. And so we encourage healthy, safe hormonal supplementation and lifestyle change often before we jump to antidepressants or mental health medication in women going through menopause. Because if it's hormonal and you could treat it with something like transvaginal estrogen that has almost, almost no or no side effects versus an SSRI that has a lot of side effects, then let's go for the least invasive thing that has the best likelihood of success. And let's treat the problem in the body. And if we treat the problem in the body, then it can solve all the problems in the mind. And transvaginal estrogen is starting to show really great, as one example, really great results for women who are going through these life changes. I think the other piece that we don't talk about enough is psychologically is the role transition. So going from being in like a state where your purpose is reproduction and creation to a state where you're not really sure what your Purpose is because society has told us that women who are over a certain age, who are in menopause, are less valuable in Western society than women who are able to reproduce is a really wild role transition to go through. And in Western society, because our society is so bent and focused on rewarding productivity, when women are no longer in a productive phase of life, biologically, we relegate them as to be less valuable. So there's a psychological piece going on in interpersonal therapy. We call it a role transition. It can happen when you're kids and any major role transition in life, when your kids are first born, when your kids leave the house, you're empty nesting for the first time. Like any number of, like changing a job, changing a role, a parent role of any kind, right? So like that actually has a very powerful effect on a woman's mental health entering these phases of life. And so it's really up to us to, as the clinicians, when we're doing our jobs properly, to assess what percentage of this woman's symptoms would we guess, based on really well conducted interviews and evaluation to understand like what percentage of this seems to be hormonal? And let's address that first and then what percentage seems to be cognitive, psychological? Because this person may not feel as worthy now in society. And I think there's a really interesting perspective shift on this that we in Western sight need to adopt, which is the indigenous perspective and the tribal perspective around menopause, which is that a woman goes from a productive part of life into a receptive part of life in menopause. So it's not that women are less valuable, it's that they're going from production part of life to receiving part of life. And receiving means receiving of knowledge, spirituality. They become elders, they become wisdom keepers. Right? There's a certain very powerful way to think about this process of aging that is not. What's the word? It's not like diminutive. It's not about making you feel bad for being old or if making you feel like you're less than because you're older. It's about helping women understand. This phase of my life is meant to be different than my previous phase. And that's all okay. Right. It's inevitable. We can't avoid it. So. So we might as well figure out how to interpret it. And in many of these tribal cultures, I think it's very beautiful, they talk about how women are moving into this elder role and this wisdom keeper and very spiritual receiving of spirit role and become leaders of societies. Ancient Societies and even modern tribal cultures when they start to move into that menopausal phase, which I think is really important on the psychological front because it helps them understand, hey, there's nothing wrong with you. You're not less valuable. You're as much or more valuable than you were before. And by helping teach women and kind of restructure the story and the narrative around menopause, that helps to combat some of the psychological assault from Western society.

B (45:04)

Well, I love you for that. My listeners love you for that because you just took a huge stress load off of them just with that statement alone. And to expand on that, I think women deserve to be receptive in that stage of life because they've already gone through taking care of the whole household, birthing children, taking care of the kids. Yeah, the dad's helped too. But you know what? She's taking care of you too. You're like a third child. So. So if we're all honest, I mean, women have busted their ass through their life. Once they get into menopause, they deserve to sit back and receive a little bit.

A (45:40)

I love that.

B (45:41)

I love that. Now there just is that.

A (45:44)

It's a powerful reframe. Right. The mind is so powerful. And really, like, I think this is what we talk about is like perception shifting. Like, we have the ability to shift our perspective and how we make meaning at any time. And so if, as long as we're open to the idea that there are other equally valid perspectives out there. Right. About the world and our experience, then we can start to. To build a more complete story that's resonant with who we know ourselves to be. It's not dissonant. It doesn't make less of us because of what's happened. It just is. And then here's how we can interpret it and understand it by taking in all the information available to create like an actual fortified, structured sense of self that allows us to still be functional and still be worthy and still be meaningful just in a different way, in a different face.

B (46:37)

Oh, I think that's so powerful. If we could reframe that and change the perspective across the board. So it would have to be media, society, medicine, and lay people across the. We need a. A massive perspective shift in the country, basically, to. To help women transition into this stage more gracefully without beating themselves up.

A (46:59)

Yeah, agreed.

B (47:01)

So is there a time, Dr. Day, where you would bring in an antidepressant, even if it is short term? Is there a time and place for these medications that affect our brain chemistry?

A (47:15)

Absolutely. You know, Many of the current western mental health medications that we use were designed to stabilize people. So I think I mentioned this a little bit earlier. Stabilization is extremely important and useful when someone is actively unstable. And by actively unstable, what I really mean is that they are not able, like they went from working and functioning highly in their lives to all of a sudden being like non functional, not working, maybe not being able to socialize, not being able to hang out with their families, not being able to carry on a conversation, not being able to get out of bed. We see the whole gamut and I think to the point where people are just so down and out that they can't even like take, they can't even like shower or feed themselves, right? Like these things actually happen. And so when we see people in those kinds of states or in suicidal states, that's when stabilizers like SSRIs or other antidepressants or even benzodiazepines used cautiously can be very, very effective. The slippery slope is that those are not medications meant to be used long term. They're meant to be used for, on the case for benzodiazepines once in a while to stabilize an immediately unstable situation, but not every day. And SSRIs and tricyclic antidepressants, MAOIs, these are really helpful for day to day use to stabilize somebody over the course of like 6 to 12 months. But then the goal is, in psychiatry of the past, and I would argue psychiatry of today, we're starting to come back to this idea that the goal is to get people to independent functioning without reliance on medicine or the system. Because we don't have enough money as a medical system or country to support every single person on medicine or therapy for the rest of their lives. It's just not possible. It's already bankrupting our healthcare system and therefore our country. So what we have to do is get back to this concept of that the source of all healing comes from within the person seeking to be healed, right? Which is Hippocratic, it's Hippocrates, right? It's thousands of years old. The source of, I'll say it again because it's that important. The source of all healing comes from the person who is seeking to be healed. So if we understand that, then the medicine, the therapist, the doctor, the surgery, whatever it is, these are tools, the technology, these are tools. They are not the end all and be all of our well being or our healing. They are tools to get us to the next level. And then when we get to the next Level we don't. We shouldn't need them anymore or at least not need them as much. Does that make sense?

B (49:52)

Oh, that makes complete and total sense. That's beautiful. I'm so happy you repeated that too, because it's so powerful. So the power really is most within the person now. I'm just thinking of that woman that's listening right now. And you just literally empowered her. And yet somewhere in her mind she's still thinking. Because I literally just heard this last week from a patient. But I just, I feel like my nervous system is disregulated. Like I'm in fight orf flight. I just can't control it. I don't even know how to get help because I just can't control how I feel inside. So without telling her, you know what, you got to go buy 10,000 different supplements. You gotta go spend money on a functional practitioner. What are ways that we can calm the nervous system down, feel more stable without loading on these just overwhelming protocols?

A (50:49)

Yeah, absolutely. That's a great question. And there's so many people in that position right now. And I break it down into six core practices that I describe as the six elements of control. Because anxiety, like the world around us is pretty wild and crazy right now. It's arguably the most convenient time to be alive ever in terms of the access that we all have to things that we've never had access to before, like two day shipping of pretty much anything you want anytime, anywhere in the world. Right? Like, that's amazing. Like, we shouldn't screw that up in terms of convenience. But I think the other side of it is that there's choice overload and we're constantly overstimulated and there's so much incoming information that we don't have control over that our nervous systems are not designed to deal with. To give you an example, if you look at how much information the average human being takes in in the first 30 minutes of being awake today, when they look at their phone in that first 30 minutes, that's as much information as the average human being took in in a week in the 1950s.

B (51:52)

Whoa, whoa.

A (51:54)

Right. Okay, so we are thoroughly overstimulated. That's 1/2 hour of phone in the morning. Multiply that times six hours a day, right? And then more screens for work, et cetera. Like, and then you're not off, when you get off work, you're still like pingable on your phone, right? Like it never stops. And again, our nervous systems did not evolve to cope with that level of constant unrelenting stress. So much of the anxiety that we face is complicated because it's compounded by complete overstimulation from the environment. So the way that we help people cope with that is that it's helping understand that overstimulation triggers the fear response because there's too much uncertainty that we're surrounded by. There's too much uncertainty trying to capture our attention. And we're giant sense organs as human beings, so we're just being bombarded constantly with inbound information and we don't have the time to process it all. So if we don't have control over changing that information or changing the outcome of what we're learning about from that information, we do have control over certain things. And control is a sense, it's a feeling or a perception that we can establish by focusing our attention on things that we actually have control over. So if we don't have control over all the things that are coming in from the outside, like the news and the pings and what people think about us and our responsibilities and all that, we don't have necessarily control over all that stuff, but paying attention to it, which we do have control over. The more time we pay attention to it, then the more time each day we feel uncertain. Uncertainty is an evolutionary signal to trigger our amygdala to set off a fear response in the brain that we call anxiety. Right? And so psychologically speaking, I think restoring power is about restoring to our power as human beings is about restoring power of choice. Choice that we make on a moment to moment basis. Not tomorrow, not yesterday, not in a week, but like right now. What can I pay attention to that I have control over? Oh, I'm noticing. I'm spending all this time thinking about the news and what my friends think about me and that weird conversation I had last week when I wasn't feeling that good. Let's reorient in the moment and just direct our attention back to what I call the six elements of control. So these are intentional breathing, taking a breath in any moment. By choice, intentional listening. So listening to your body or anything you're hearing around you. By choice, not doing anything, Just receiving information and just listening to it, not judging it, not analyzing it or criticizing it, just listening. Observing intentional movement, which is just choosing to move your body, right? Like flap your lips up and down without saying anything. You can move your arms, you can move your legs and go for a walk. Like anything that you choose to do is a way of executing your sense of control, your emotions, reminding yourself that you're not under threat because you can choose to go, move, breathe, or listen right now. Then there's like singing and humming and there's sleep and there's nutrition. So when we're not actually under a real survival threat, meaning we have enough air, we have enough food, we have enough water, we have enough shelter, and we have enough sleep and connection to people around us, which most of us do most of the time, then we're actually not in a survival threat mode. No matter how much information is being thrown at us, every moment that we're in our phones or in life, we're actually not under threat. It just feels like we are. So we can literally by making a simple decision to say, okay, I notice that I'm doing X, but I'm going to redirect my attention back to the things that I know are certain. Then you're instantly creating a positive feedback loop in your brain where without spending any money, that just says, I am safe enough to do X right now under my own control and choice. And then your attention is on certainty and what you can be certain of, the six things, not on what you're uncertain of and certainty. Even if just those six things, which are, I would argue, the only things that we have certainty around our entire lives, those six things in any moment, redirecting our attention to those for more time makes us feel certain more of the time. And then our anxiety level starts to decline. And that's when you start to notice, okay, is it the hormones imbalance that I have, the life role transition I'm going through right now, or is it actually that I'm just really overstimulated and overwhelmed? Right? And then you figure out, okay, here's what I can control and here's what I can't. I can't control the hormonal imbalance right now. I'm going through a life transition. What I can control is where my attention is at any moment. And that's the real power. And for people who have tried all these things and they're struggling with them, it's not easy to start breathing techniques in these practices. It takes time, it takes a little effort. We know that. We developed a technology called Apollo that you could see me wearing on my chest. But you can get it for free if you have an iPhone that uses sound waves to instantly regulate the body's nervous system and remind us through touch that we are safe and can be safe in our body. So it reminds us of another thing that we can be certain of. So that is just another tool that we made free in 2025 for iPhone users, but the wearable works for everyone. And that is something that when you've struggled with these practices that you've heard about all the time but haven't actually been able to implement, you can actually know that you're feeling regulated. And by regulating yourself in the moment with technology now, which is really exciting.

B (57:32)

Oh my gosh, that's amazing. So people do have the power within them. And I want to know if you talk about all of these techniques in your book too, because that would be fantastic for people. That'll hold up. Amazing. Good, good, good. And we have technology. So combining the two, I think is that beautiful space where we're using our modern tech that we can use now. Like you said, like we have these conveniences that are beautiful. It's just finding the balance of that them and not overstimulating yourself because of all of these conveniences in society. So talk to me about your book. Tell people what it's about and where they can find it. And then we're going to put the links in the show notes as well.

A (58:18)

So the book is the first book of my series which is called A Simple Guide to Being Alive. And it basically I found personally and I've noticed in a lot of my patients over the years and friends and colleagues that most of us wish we were handed an instruction book about life that was evidence based because there's so many things that happen in our lives that are really, really hard that we were never taught how to deal with, including everything we talked about here. Right. And so as I went through my medical training, I started to realize, hey, I'm learning so much. And this is such incredible information and knowledge and wisdom, but it also is missing a lot. And we weren't taught anything about eastern and tribal techniques. We were taught that all psychedelic medicine is, are considered drugs of abuse. They're not in a therapeutic purpose. Right. That's like all of that is not true. So we're taught self care. Like most of the body just does its thing on its own. Right? Not true. Right. There's certain things we have to do. We call them hygiene. Right. And there's emotional hygiene and there's physical hygiene. Like these things need to be taken care of on a regular basis. And it's a way of showing love and care to ourselves. That creates another feedback loop that promotes healing and increases vagus nerve activity, which you can now track through heart rate variability. So what I really wanted to create was like a helpful, simple guidebook that is the instructions, right. It's like if you were to know nothing else about what it means to be a human being and be alive today, this is what you need to know. And if you just know this stuff, you are teed up for a happy, healthy, long life. And it's not knowing the stuff that often results in a lot of the undue suffering that we face today. And if we can help people feel even just a little bit more calm and a little bit more centered and clear and in control. Right. Like again, it's a lot of it's about hope. It's like giving people, restoring the sense of hope that you, the individual person, we in as individuals have the ability to change the outcome of our lives by changing our decisions that we make in a moment to moment basis. Also something that's not well taught. So that's the focus of the book and it's coming out this spring and you can find it on my website at drdaveio and I really look forward to getting it out because I've been working on it for 10 years and hearing everybody's thoughts.

B (60:36)

This is going to be a gift for everyone. So thank you so much for writing it. And you know what? We are going to do a part, part two because I have so many more questions for you, Dr. Dave, that we just didn't get to today, but we will be back on. We have to. We have. You're amazing. So we're definitely going to do a part two. But for now, everybody go down in the show notes, click on the link and get this book because I feel it, it's going to change your life. And if you don't feel that after hearing Dr. Dave talk, then go back and relisten to the show because you're missing something. You were paying attention, you were thinking about your health issues. So go ahead and press rewind and relisten. So Dr. Dave, thank you so much for your time today. It's been amazing.

A (61:19)

Of course, it's my pleasure. Thank you so much for having me and everyone.

B (61:23)

Thank you for listening and share this. Because there's so many women suffering if, if you're not it, think about your friends, think about your sister, think about your mom, think about your aunts. There are so many women suffering right now who don't have to. There are so many women that are being medically gaslit and prescribed band aid medications who don't have to. There are answers out there. And really it starts with this podcast. So share this episode the information shared on the Thyroid Fixer podcast is intended solely for informational and educational purposes. It is not a substitute for professional medical advice, diagnosis, diagnosis or treatment. Always consult with your physician or other qualified health care provider with any questions you may have regarding a medical condition treatment or before making changes to your healthcare regimen, including medications, supplements or other therapies. Use of the information provided in this podcast does not establish a doctor, patient or client provider relationship between you and the host or between you and any other healthcare professionals featured on the show. Any medical opinions or statements made made by guests are their own and do not necessarily reflect those of the host or affiliated parties. Statements regarding dietary supplements or health related products mentioned in this podcast have not been evaluated by the fda. These products are not intended to diagnose, treat, cure, or prevent any disease. Some episodes of the Thyroid Fixer podcast may include sponsorships or affiliate links. The host may receive compensation for discussing or promoting certain products or services. Any such sponsorships or affiliate affiliations will be clearly disclosed during the episode. All opinions expressed are those of the host or guests and do not necessarily reflect the views of any sponsors. The inclusion of a product or service does not imply endorsement by any healthcare professional featured on this podcast.