Session 94 Today's guest is Dr. Carly Snyder, a reproductive psychiatrist, a specialty which is probably something a lot of people don't know about. In fact, she didn't know it existed until she was in her psychiatry residency. She talks about her journey, what she likes about it, and what she doesn't. Get a glimpse of what her world looks like. Maybe this is something you're interested in too. Also, please be sure to check out Meded Media for more podcasts as you're looking for resources to help you along this journey towards medical school and residency. [01:30] Interest in Reproductive Psychiatry Carly didn't know reproductive psychiatry existed when she started residency. As a psychiatry resident, she did 4-6 months of medicine and pediatrics. Throughout that period, she kept on questioning psychiatry as she didn't like inpatient psychiatry. She found it depressing and it wasn't how she imagined her career would be. While on the pediatrics floor, she met a 3-month-old boy who suffered from seizures since he was born. Having a baby boy at that time as well, she identified with the mom that she had a very strong drive to help her. The child eventually died but the mom was doing well for having a strong support network already in place. They then decided they were going to set up a program where every woman who's baby or child was dying was going to be connected with a counselor or therapist who will focus on the moms. This was an aha moment for her that she could actually affect change and help women. At that time, one of their senior residents' wives was doing reproductive psychiatry. Eventually, she took an elective at Cornell University where they had a women's mental health program. It had a perfect mix of women's mental health and medicine. You think about the baby and the family system. You also have to consider whether there was a medical issue going on. After residency, she was given the directorship of women's mental health program. "It's a huge transition in life. And to be able to support women through that process is incredibly rewarding." [06:45] Types of Patients She sees women throughout the reproductive lifespan. Her practice is limited to adult women. The vast majority of her patients come to see her for 4-5 times who have history in depression, anxiety, bipolar disorder, or some psychiatric illness. They may or may not be on medication but they're looking towards a planned pregnancy. They want to figure out how to optimize their mood and keeping them stable. At the same time, they strategize on how to minimize risk from either exposure to medication and/or exposure to untreated illness. You have to weigh both sides of it. "A fair number of my patients are in fertility treatment and they're all referred by reproductive endocrinologists." Moreover, some patients come to see her when they're pregnant because they're experiencing mood symptoms, and sometimes women in their postpartum. Carly finds is fun and rewarding to see women's families grow and see their lives unfold. She also has a group of patients with severe PMS called PMDD where they come to see her every month for a variable number of days. Their mood changes to a degree that their ability to function has been impacted. [10:05] Traits that Lead to Being a Good Reproductive Psychiatrist "One needs to have empathy in any specialty." Empathy tops Carly's list. Think about your patients' lives, not from a standpoint of that specific medication and that's it. But you think about it from a standpoint of their family structure. Think about their future plans and their past. Think about the big picture. That being said, you also have to consider multiple factors. Make sure there's no underlying medical illness going on that's masking or feeding into a psychiatric illness. Additionally, you can't be dictatorial where the way you think is the way it should be. You, as a physician, may have a very rational approach to why you'd recommend xyz. Their anxiety mean