Speaker 1 (00:00:14):
Okay, we're doing the thing. Hello, Charlotte. So excited to see you. Good to see you again. Maybe there may be people joining us as we talk, but we're recording this. We're going to put this out on the podcast, and we're going to put this conversation into our community where we have almost 400 people. Amazing. So there's going to be hopefully a lot of this message getting out to a lot of us. But to get started, I want to go ahead and introduce you, Charlotte. And then I want to give a little bit of a preview of what we're going to be chatting about. We can chat and then we can answer any questions. Charlotte and I can talk for a long time, so we're going to try to keep this to an hour. We have a lot to say, but this is such a juicy topic, one that is really close to both of our hearts. So if we can't get to everything, we might be able to bring you back, Charlotte, and continue the conversation. Okay.
(00:01:15):
So today we have Charlotte Herring with us. She is a board certified nurse practitioner, holistic health coach, registered yoga teacher, and a mindfulness practitioner. She's currently the lead nurse practitioner for outro health. This is the first service for safe and evidence-based antidepressant tapering. Prior to outro, Charlotte worked in a number of healthcare roles over 12 years in telemedicine, psychiatry, integrative, and psychedelic medicine, primary care, humanitarian outreach, and emergency response. She has trained in integrative modalities such as mind body medicine, reiki, and psychedelic assisted therapies, and is particularly passionate about the intersection of western medicine with consciousness and spirituality. So we're so lucky to have Charlotte here with us today, and we're going to be diving into topics around SSRI withdraw, and how many of the symptoms of SSRI withdraw overlap PMDD symptoms. It's very interesting conversation. We're also going to be talking about informed consent, what it is and why it matters in the context of just health in general, but specifically also in the context of PMDD when we're seeking diagnosis and treatment.
(00:02:37):
We're also going to talk about the lack of education around coming off of these medications safely. And hopefully we'll have time as well to dig into the creation and genesis of the PMDD diagnosis and its addition into the DSM five. Very interesting conversation. And we have a couple of other points here that we wanted to dive into around western medicine and the need for more proactive and preventative solutions as a first line, rather than jumping straight to strong psychotropic medications. We also want to talk about the lack of women's health research in general and the desperate need for more of that. And then a really interesting conversation we wanted to touch on as well was the diagnosing journey that often accompanies de-prescribing coming off medications, and the process of having to rediscover yourself through the journey that is getting a diagnosis, being treated, working to heal your symptoms, and then moving on with your life. So thank you for being here, Charlotte. We're so lucky to have you and we're so excited to have this conversation.
Speaker 2 (00:03:49):
I'm so excited to chat with you again, Jess. I can't wait.
Speaker 1 (00:03:53):
Where do you think we should start? We have a lot on our plate here.
Speaker 2 (00:03:57):
I'm wondering if we should start at the top with this creation of PMDD and how we got here in the first place, the genesis of this diagnosis, as you mentioned, and I know you shared with me initially some really fascinating research about how this diagnosis came to be, and I'd love to talk about that to start maybe how does that feel?
Speaker 1 (00:04:21):
Yeah, I love that. Yeah, I think it makes sense. It's the logical progression. How did we get here to start? And I do have a research study. I'm going to link in the chat. You'll be able to find this in our community classroom in the resource center. I have A-P-M-D-D research log, and I have a section around PDD DSM five controversy. And so I'm going to drop the most interesting research study a link to that in the chat so you can all look at that later. And remember, you can come to the classroom and access it in the research log as well. But yes, where should we start with this part of the conversation? Do you have,
Speaker 2 (00:05:09):
Yeah, I think just for a little bit of background, my practice was traditionally in western medicine and I was kind of taught, I'm doing a postmasters right now at Johns Hopkins in psychiatry, and we're taught to use the DSM as this bible of sorts to guide all of our clinical decision making. And as I've dug more deeply into integrative medicine and looking at root cause and where this evidence comes from and the funding behind the evidence, it's like the deeper you go, the more there is to uncover. I was really surprised about the diagnosis of PMDD and the idea that it was a diagnosis that was largely pushed in many ways by the pharmaceutical industry who funded and participated in a consensus meeting on the definition of PMDD, which helped the FDA convince them of diagnostic validity and which led to the approval of antidepressant prescribing. It was a really fascinating revelation for me as a prescriber.
Speaker 1 (00:06:07):
Had you heard about this before our conversation?
Speaker 2 (00:06:11):
I had heard, I think I had been on a longer journey for a bit more background, I had worked at the VA hospital. I had worked in major large medical systems, and I had also worked in telep psychiatry. So I was doing primary care psychiatric medication management, so a lot of SSRI prescribing really, really quickly without a lot of nuance around how that was happening. And at that time, I remember having sort of a WTF moment, I was like, wow, we are throwing these medications out like candy and starting to dig into a bit more of the research behind how we got here with throwing these medications out like candy. So I knew that the P MD diagnosis was a newer one. I didn't quite realize the full genesis of it until we talked earlier this year.
Speaker 1 (00:07:00):
So it's one of those things that to me sounds like, oh, this must be conspiracy. But then you dig a little deeper in, you're like, no, this is just how the world works in some ways. And so basically what was happening was Prozac was coming up on their, what is the word? Their patent? Patent, yes. And they needed a new market for their drug. And there was a big lobbying push from Eli Lilly who owned that drug. They actually rebranded Prozac into what was called Sera Fme at the time. They packaged it in pink and purple packaging, and then they lobbied essentially to have SSRIs named alongside hormonal contraceptives as a treatment for PMDD. This was all started, I think, around 2000. But it's really interesting to dig into that history. And I didn't know about this. I had lived with PMDD for lots of years before I actually got an official diagnosis in 2017.
(00:08:17):
And I had been treated, diagnosed, all of this. I didn't learn about this until I was doing a research project on the history of PMS and PMDD that I uncovered this. And this was only a year or two years ago. So I had even been in practice working with people for a long time before I uncovered how controversial this actually was. And it was controversial from many physicians, psychiatrists from many in the feminist movement. So there's a lot of literature out there. You can read and dig into this a little bit more, but it just makes you question, ask more questions and asking more questions is always good. Yeah.
Speaker 2 (00:08:57):
Yeah. The slogan, think it's PMS, it could be PMDD, these awareness campaigns that were created to push this agenda by the pharmaceutical industry. And I think we see that over and over this kind of overrepresentation of the pharmaceutical industry in the way we practice as clinicians and as prescribers. And I think, yeah, it brings up this much larger issue of our tendency to go straight to a prescription medication rather than asking more, I think more creative questions, more comprehensive questions around a treatment plan. And yeah, the deeper you dig, the more you find. I think it's the pharmaceutical industry is a beast. I get a very David and Goliath vibe whenever we talk about this.
Speaker 1 (00:09:44):
Yeah, yeah. Well, it's interesting because this was a crossroads where PMS and PMDD were previously a physiological, a medical condition, and were treated and evaluated as that there was more testing. It was approached differently. Once this all happened and PMDD was out to the DSM, it then became a psychiatric condition. So this created a gap where many of us are falling through, where you go to your gynecologist and it's like, oh, I am going to refer you to counseling or refer you to psychology. And then you go to your psychologist and counselor and like, oh, I'm going to refer you to the gynecologist. And there's really no one doing the work to look at, okay, what are some of the clear physiological drivers behind some of these symptoms? It's just, oh, it's a mental health condition, and then here's an antidepressant. And a lot of us are, there are reasons behind these symptoms. And when it's just put into a mental health condition box, it is crazy how within psychology and psychiatry, and it's changing, I hope, and maybe you can speak to this more, but there isn't a digger digging deeper into, and what else? What is leading to this? The brain, the mind is connected to the body. So
Speaker 2 (00:11:05):
Yeah, absolutely. My sweet alma mater of the school I'm at right now, Johns Hopkins talks about what is PMDD? What's it caused by? And their answer, we don't know. We don't know. It could be an abnormal reaction to normal hormonal changes. I hate the abnormal normal paradox of these two things, but that happens with menstrual cycles. We think it might have to do with the progesterone and its metabolite, allopregnanolone, I can never say that word, and it's rise in the luteal phase. And that there's potentially some contribution of that in women with PMDD that this temporary rise in the drop may cause symptoms. But it brings up that we don't know. And I think that in most psychiatric conditions, unfortunately, and this is something I'm learning and it's kind of blowing my mind, we just don't know. We don't know why things are the way they are.
(00:11:57):
We don't know the genesis of many depression, anxiety, PMDD, we don't know the etiology of where they're coming from or what's causing them. And we also don't know exactly how the treatments we prescribe work, which I think is just a really interesting thing because as clinicians and prescribers we're taught to have this authoritarian model where we sit behind the desk and we prescribe you something and we tell you what's right to take and what you should be taking. I also hate shoulds. And I think that there's something to be said for this need for intellectual humility in medicine of we don't know largely why SSRIs work for some people, for example, we don't know what PMDD is caused by definitively, and there's a lot we can speak on that, but I think this need for clinicians to step back and be like we don't know is so important. And so I see that so underrepresented in healthcare.
Speaker 1 (00:12:53):
Yeah, well, we don't, the discomfort of not knowing, right? We don't like that. I don't think there's any humans that are like, oh, I love the discomfort of not knowing. And then when you're in a practitioner role where you do have an authoritarian, it's a directive. Western medicine takes a very directive stance in the way that they operate. I think there's an idea of it doesn't look good, so we're just not going to acknowledge that and we're going to say, this is the protocol. This is what we do. And that's that. And it leaves so many of us just feeling hopeless because we were told, these are your options. Birth control SSRIs, what if those make my symptoms worse? What if I can't handle the side effects? What if all these what ifs? That's it. I have so many clients and students that have been told, I can't help you if this isn't working for you. That's it. And then we believe because of lack of education that those are actually our only two options when it's No, those are your only two options that practitioner can offer you. There's so much more to the story.
(00:14:06):
Yes,
Speaker 2 (00:14:06):
Absolutely. Absolutely. And before this call, I was looking up at just refreshing my memory with the American College of Gynecology or ACOG's guidelines around PMDD treatment. And it's so interesting because in their statement on premenstrual disorders, they talk about pharmaceutical agents like SSRIs and combined hormonal oral contraceptives as the first two kind of frontline treatments. But they speak in their recommendations in the same sentence about the need for psychological counseling like CBT or cognitive behavioral therapy, complimentary and alternative treatments like acupuncture, exercise, nutritional therapies, self-help strategies, and patient education. Many patients may benefit from a multimodal approach. And I think that's beautiful. And I was also just scratching my head because how many times do we actually see that play out when we walk into the doctor or the nurse practitioner and we go to see them about our concerns? How many times are we getting a multimodal treatment plan with more than what you suggested? I haven't seen it very often in practice. I dunno.
Speaker 1 (00:15:14):
Yeah, it's quite rare. And I think that's in some ways it has to just be a lack of education on the practitioner's end. They're not up to date. They don't know what to do. A gynecologist is a surgeon, they're not a dietician, they're not a nutritionist. They're not even really a hormone specialist. So I think it's again, just like a dead end of, Hey, this is what's in your scope and that's it. But then that's not communicated. And I think that falls into the informed consent. But here we're really talking and touching on our point that we wanted to talk about of we need preventative solutions. And it's fine that those medications are offered and they do help many people. But why is that the first thing?
Speaker 3 (00:16:02):
Yeah,
Speaker 2 (00:16:03):
Yeah, absolutely. And I think, again, we practice in this time limited as clinicians, pharmaceutical industry dominated climate. That is the way it is right now, especially in western medicine. I say this, I was a primary care clinician for eight years. I'm now transitioning full-time into psychiatry. We are constantly being asked as clinicians to do more with less time. It is not sustainable. And I think that eventually we're going to see, we're already seeing the need for a massive overhaul in our healthcare system and how we operate. Because when you have, let's say as a primary care clinician or even an OB, GYN, you have 10 minutes to see a patient and what you learned at your in-services, which are oftentimes paid for by drug companies, what you've learned in your clinical board exams, which are oftentimes universities receive funding from the pharmaceutical industry, you are pushed more towards these treatments that are quick, that they're easy to reach for. And the way our society is set up as well, not to get into an existential discussion about our societies, but
Speaker 1 (00:17:12):
We want to,
Speaker 2 (00:17:14):
But it's so important to note, we operate right now in a society of wanting the quick fix. And I say it all the time at outro, we want the one magic bullet. We want the one thing that's going to fix us ASAP, so we can get back to work, back to our schedule, back to our linear productivity and our movement and our growth and this as quickly as possible. And so all of these factors kind of amalgamate to create a scenario where clinicians who again, are burned out, who are oftentimes in many cases, suffering from mental health needs themselves who are under-resourced. You could sit down and do motivational interviewing and talk with your patient who has PMDD or your patient who has anxiety, and you could talk with them for a half hour, but that's not going to be reimbursed by insurance the same way as prescribing something, getting in, getting out and seeing three patients in that time is. And so there's this systemic pressure that I think clinicians are put under as to why we're not always turning towards the alternative. And I see that hopefully changing with functional medicine becoming more mainstream with this shift around critical thinking around where does this evidence, I learned in nursing school, evidence is everything. And the higher the level of evidence, the more studies of studies there are on something, the more you should prescribe it or recommend it. Where does that come from? Pharmaceutical industry? There needs to be more of that critical thinking. So I see this changing, but I think it's a major problem.
Speaker 1 (00:18:43):
Yeah. Well, the points you're making, I'm so glad you brought these things up. These are on my mind. We often feel so victimized. Why is my doctor not helping me? We have to zoom out and be able to say, what type of help are you looking for? Because if you aren't looking for what they're offering, which is a part of their protocol, and it is a bigger systemic problem that comes down to the time and a lot of factors. But that's where we end up feeling hopeless. And I felt so victimized for so long because of my practitioners before I was able to zoom out and see they are really suffering as well. This is not what they signed up for. They want to help us. But the way the model has shifted over the last 2010 to 20 years and medicine has really gone more and more to that shorter time with each client, with each patient. And I mean, I think about the work that I'm doing with clients, it takes me at least seven hours of meeting with them, plus all of the time on the backend that I'm reviewing their labs and I'm looking at all of their health history. It takes a lot of time. And it is really sad to see the people that we really do need doing these jobs who have invested their lives in doing these jobs not actually be able to do their job because of the way the system is currently operating.
Speaker 2 (00:20:10):
Yeah, a hundred percent. And I think I have so much empathy of that feeling of victimization. I've been there myself, not with PMDD, but with generalized anxiety and with depression and feeling like I've been in that same boat with fertility treatments, with going to a provider desperate for someone to help me and someone to give me guidance. Because when we're in that state as well, it's so hard to see out. I call it. We're in the pit and it's so hard to see and it's so hard to see the light and know what path needs to be taken or should be taken next.
(00:20:48):
I know. And I have so much empathy for that position of shoot, nobody's helping me. How am I supposed to get help? And I think that, again, it's so interesting in the functional, in the integrative, in the holistic spaces, I tend to meet practitioners like yourself. All of the clinicians at outro who they got into this field because they've been there, they ran up against the wall of what Western medicine was able to appropriately and comprehensively provide to them. And then they were like, well, crap, where do I go from here? And they personally started digging into these other modalities. For me, it was finding mind body practices through the Center for Mind Body Medicine. It was doing psilocybin assisted therapy and then ketamine assisted therapy. It was these other kind of alternate at the time I was doing them fringe modalities and being like, whoa, this was so much more helpful than the Prozac that I took.
(00:21:45):
That was helpful. I'm not saying that everybody, SSRIs are the devil, or that these medications are absolute no GOs, but to your point, there needs to be more than two paths up the mountain SSRIs contraception or hormonal contraception. That's it. Right? And so I think there's just something so interesting about the acknowledgement as both patient and provider of like, wow, we really need to zoom out our thinking and zoom out how we look at comprehensive care. Because one other thing that I see a lot is western medicine kind of sticking their nose up at other modalities of care. And again, I think that might be a fear response, not to psychoanalyze, but a little bit of a fear response around this. Maybe we don't know everything, right? It's scary to not know everything. It's scary to think that maybe perhaps what we've learned in school and the evidence that we've been building our entire practice on is in fact flawed. At outro. Our founder was talking about how trying to recruit new clinicians that a couple times he's been trying to recruit new clinicians and he's gotten the response, so you're trying to take people off of SSRIs, so you're trying to put me out of a job that isn't what mental healthcare clinicians should be doing 100% of the time. But yet here we are, right?
Speaker 1 (00:23:08):
Yeah. So fun and interesting to have these more in depth conversations about all of the factors at play. And I love too, how you brought up on our end as a society, of course, we want a quick fix, right? We're human. We love comfort, we want to feel better. We all would take a magic pill if it existed and helped and didn't come with the detriment that anything can. And it also is interesting to point out that we're only one of two countries that allow direct to consumer advertising from pharmaceutical companies, which is crazy, really crazy when you learn that that is not a thing in other countries that is not allowed. And how does that play a role in all of this? And I think that I looked it up earlier, I believe in 2020, it was a $7 billion industry, like direct to consumer pharmaceutical, which actually isn't as much as I thought it would be. I
Speaker 2 (00:24:17):
Was going to say I would've expected it to be. It's probably more now.
Speaker 3 (00:24:20):
Yeah,
Speaker 2 (00:24:21):
It's bananas. And again, there's this, it's everywhere. And I think that, again, part of this journey that we're on of this coming back, I see the journey of healthcare as this boomerang. There's this back to our roots of like, okay, yes, PMDD is not a Prozac deficiency. Anxiety is not a sertraline deficiency. These things can be really helpful for some people for some amount of time. I can get into all of the nuances in a little bit about when it might be time to revisit coming off of these medications. But again, I'm not saying that these medications are bad, but when did we lose the plot of looking at the functional daily basic building blocks of what it means to be a human? I joke, we are fancy house plants with emotions. We do not get to exist outside of the ecosystem as human beings.
(00:25:15):
We are animals just like all of our mammal brethren. And we need to eat well. We need to move our bodies. We need to practice stress management. And again, I say all of these things like it's so simple. It's not that simple because we exist in a structure and a system that doesn't prioritize that. So this, it's hard work. It's rebellious work to focus and to turn back to the root of what it means to be a human and an animal on this planet and what it means to take care of ourselves from that building block root place. But there's a funny, I don't know if you've seen this before, but there's a meme or kind of a photo, and it's two goldfish in two tanks and one goldfish, it's a goldfish who is in this dirty tank, and the water is really muddy and gross, and it says, this goldfish is depressed. Would you say that they have a Prozac to fish? It's like, oh, you just need a Prozac. No, you need to clean the tank. You need to clean the environment. And again, just somewhere along the way, when did we lose the plot on that? It's kind of staggering.
Speaker 1 (00:26:23):
It really is. And there's so much, there's so much when it comes to environmental factors that's impacting these things. And it's never a part of the conversation, not never we're having the conversation, but it's rarely a part of the conversation within the western medicine paradigm. And again, not against western medicine. If I have an acute situation, if I'm in a car accident, if I break my arm, do not take me to an integrative practitioner. I want to go into western medicine. But when it comes to mental health, when it comes to preventative care, when it comes to chronic disease, they are really dropping the ball on how to address this.
Speaker 2 (00:27:06):
Absolutely. I think it's the ultimate both and which I think we can say for most things, right? Western medicine, my father has had cancer. My father in law just had a heart attack and had to have a stent placed. Thank God for Western medicine. Thank God that it exists. And when it comes to exactly to your point, when it comes to, especially I would say with mental health, more of the mild to moderate symptomatology, which is most people who have PMDD diagnoses or generalized anxiety diagnoses or depression diagnoses, we can look to other solutions before we look to western medicine solutions. And I think that that's where the, and the both and holistic medicine, integrative medicine, traditional Chinese medicine, these other modalities have such a beautiful complimentary role. And if in this new era we're able to melt the two, I see that as such a beautiful symbiosis because both have their value.
Speaker 1 (00:28:11):
Yeah, I think it really has to start with us. We're saying this division between the two sides of practitioners, we need to rely and come together. And it is crazy to think western medicine dates back like 2,600 years. All of these alternative medicine realm therapies like Ayurveda, Chinese medicine, I mean 60,000 years, as long as humans have existed, we have used alternative forms of medicine. So it is interesting to study that and to see, oh, but that is considered alternative compared to western medicine. Maybe let's get into, do you feel like moving into the informed consent conversation fits here?
Speaker 2 (00:29:00):
Oh, hell yeah.
Speaker 1 (00:29:01):
Okay. So can you explain what informed consent is? Because I don't think people are very familiar with that term or idea.
Speaker 2 (00:29:09):
Yeah, absolutely. So when we think about practicing medicine or providing care, and we think about a informed consent, we're thinking about the need to comprehensively talk about the risks of a treatment and compare that with the benefits of the treatment. And ideally, this is done in a totally non-biased way. That's what true informed consent is as being able to talk about both in a neutral way, so that shared decision making or SDM, because we love acronyms in medicine can be utilized. So we want to utilize shared decision making by giving the full picture of what might happen. And so for example, with a new medication, and I'd love to maybe take this moment to talk about SSRIs and kind of what SSRIs or antidepressants or elective serotonin re-uptake inhibitors or a class of antidepressants that we have thought historically work by increasing levels of serotonin at the synaptic junction.
(00:30:08):
So the space between our neurons, we have thought that depression and anxiety, PMDD fill in the blank, it has been as caused by a serotonin deficiency. And so by giving back the serotonin, we fix that deficiency and we fix our mental health condition. Beautiful concept, except that it's not true. We've done many, many meta-analyses that show that there is actually, in fact, no true chemical imbalance, which is kind of the theory. This was the chemical imbalance theory. There's no evidence to support this on a large scale. So what happened with SSRIs is that this chemical imbalance theory was purported. It was widely shared and underscored by the pharmaceutical industry. And so as clinicians, we were taught, I went to a wonderful nursing school and I was taught that SSRIs almost immediately should be prescribed. If somebody has a P hq, which is a depression screening or a GAD, which is an anxiety screening over a certain number, I should be immediately recommending these medications.
(00:31:09):
And again, what you do, you combine shorter visits, less time, more stress, a education system that's backed by the pharmaceutical industry. And what happens is there's a very rushed conversation around SSRI prescribing. So Jess, let's say you came into the office and you're like, I'm having some symptoms, X, Y, Z. And I said, okay, I think that Prozac would be a good medication to start. What true informed consent looks like is sitting down with you, which probably would take more than 10 minutes, more than the entire visit. And talking about all of the risks and benefits, and we can get into those in a minute. What ends up usually happening is this rushed discussion about how the medication will benefit you. And it almost mirrors those pharmaceutical ads that you mentioned where it's talking all about the positives and then in really, really fast speech that you can barely understand.
(00:32:01):
It's like may cause and it keeps going and going and going. So that's what we see play out in clinics. Oftentimes there's an overhype of the benefits and an underhar or not any real nuanced conversation around the potential risks. So what happens is people get on these medications. One of the major things around informed consent is that when you talk about starting someone on an SSRI, you need to talk about how some people can't come off when they're ready to come off or they really struggle. They have major side effects, and we'll get into that more in a second. They have withdrawal symptoms is really hard. And people come to outro and they say, no one ever told me this. No one ever told me that it was going to be hard to come off of my Prozac when I was ready to come off of it. And so true informed consent would be talking about that before you start, and being able to comprehensively make a decision based on the full picture rather than just the little bit that oftentimes ends up happening in practice.
Speaker 1 (00:33:06):
Yeah, and I think too, with the informed consent topic here in SSRIs, something else that isn't included is you need to have a strategy and be taught in a way to monitor your side effects or your symptoms improvement or exacerbation of your symptoms alongside that medication. Because what is rarely communicated and probably would potentially reduce some of their prescribing kickback that the physicians are getting would be, Hey, there's a black box warning on SSRIs for increased suicidal thoughts, behaviors, and actions in young people. And hey, you have A-P-M-D-D diagnosis and one of the most detrimental symptoms of PMDD is suicidal ideation. But yet never was that ever communicated to me. And I have worked with thousands of clients now, and when we have these conversations, yeah, they say, I didn't know that. And it's like, oh, it's so interesting that you're going to seek health for suicidal ideation. You're put on a medication that has a black box warning for suicidal ideation. Just very scary.
Speaker 2 (00:34:23):
It is really scary. And there's all of these symptoms that aren't talked about that can be directly related. These side effects directly related to the drug, and some of these are things that are like an increased risk of GI bleeding, a bone mineral density loss, and an increased risk of osteoporosis, low sodium, which is called hyponatremia in medical speak, elevated blood pressure, especially with SNRIs like venlafaxine, overheating, hyper hydros or excessive sweating. A couple of the side effects are things that I think can have a direct impact on our mood, which are sexual side effects, which are found in at least 50% of patients. And one study from 2006 showed that 96% of female patients and 98% of male patients experienced at least one aspect of sexual dysfunction when they started SSRIs. So if weight gain and emotional blunting are also two side effects that can be majorly impactful on our mental wellbeing, so gaining weight and then which that can lead to metabolic side effects like diabetes or sleep apnea or high cholesterol emotional blunting, which is probably the most common side effect after sexual side effects that I see at outro, which is the inability to feel the joys of the world as well as maybe the inability to feel the hard stuff.
(00:35:42):
There's something to be said for the numbing effect. That's one of the hypotheses of where we think SSRIs are actually working is by numbing and blunting that emotional range. But so if you're putting someone on a drug, exactly to your point, that makes it impossible to feel the joys that you can't have sex or can't have an orgasm, that you gain weight and that your increased risk of suicidality, especially if you're under the age of 25, we're not talking about that and we're not talking about the direct impact that can therefore have on our mental health and on the diagnosis that we came to seek treatment or get help for.
Speaker 1 (00:36:19):
It's so interesting too, because when these medications do help and they help many, rather than viewing it of, okay, let's use this time to now bring in some of those lifestyle and diet changes that you didn't have the capacity to make before, but you're feeling better now to counteract this whole experience. It's just like, no, that's the solution. You're going to be on it for the rest of your life. It rarely is the solution because even if it helps symptoms for a while, I see with many clients it doesn't after time.
Speaker 2 (00:36:56):
Yeah. There's a poop out effect we call it, which is a very technical sounding term, but this idea that eventually over time these medications become less and less effective. And exactly to your point, these drugs also weren't studied over years and decades. They were studied. The clinical trials are very short term over, I think many of them are over eight weeks. So I struggle with this because yeah, the way I see and practice that these medications could be helpful. We talked about being down in the pit, feeling like it's impossible. Again, when your symptoms are a 10 out of 10 and your PMDD or your anxiety or your depression feels debilitating, and I've been there, I call it the dark cloud that descends or the fog that descends going and getting your morning sunlight with a 30 minute walk and making the healthy food and doing the this and the, that feels impossible.
(00:37:50):
That feels unattainable. And getting out of bed feels hard, brushing our teeth can feel hard. Taking a shower can feel hard. So these medications can help us pull ourselves up enough to start to bring in these different practices. And then after six months or after nine months, or at the most after a year, there needs to be a reevaluation of efficacy, a reevaluation of what is the long-term treatment plan. And at the very beginning, there needs to be built in a game plan to your point of, okay, we're going to start this medication to help get you kind of pull you up, and then we're going to bring in these interventions. And that's why I love so much the work you do of looking holistically at like, okay, what other things can we look at to tackle and to work on to optimize your health over the long run?
Speaker 1 (00:38:42):
It's so important. I mean, we're going to keep living. Life's going to keep happening. And so what are we doing here? They were actually designed correct for only six months to a max a year to be used. And yet though physicians are not trained in this, physicians are not trained in, we'll get into helping you come off, there's just a total gap in education around these medications and the physicians that are prescribing them in my I correct here.
Speaker 2 (00:39:14):
Absolutely. Absolutely. And again, we have this huge, huge population of people, and this isn't specific to SSRIs, but I think it's important to talk about 'em in this context. We saw this with PPIs, proton pump inhibitors, so things like Nexium or over the counter medications or prescription medications for acid reflux, people just get put on them. You go to a doctor, you go to a nurse practitioner, somebody puts you on them, and then they just keep refilling them. And before you know it, five years, 10 years, 20 years have passed. And there's never been what's called a medication reconciliation or a review of like, Hey, has anybody talked to you about these medications and checked in to see if you really still need them? And so, yeah, there's not any real discussion on coming off of these medications. And so I think of my mom, who's somebody who's been on sertraline on the max dose of sertraline.
(00:40:11):
She's like, yeah, somebody put me on it in 2001 when I was actively in alcoholism and I've been sober for forever and nobody's asked me if I should come off of it now that I'm not drinking anymore. We've had this beautiful conversation of, yes, there were very different circumstances surrounding the initiation of this medication, and somebody should have been monitoring that regularly and checking in to say, Hey, do you want to try coming off? And the last point I'll make on it is the coming off process. There is such a lack of research around at Hopkins we talk about, I don't mean to slam Hopkins in this podcast at all. It's a great school, but I think I've had a total of three sentences about how to take people off of antidepressants. I've had thousands of pages of reading on how to put them on and why to put them on. So again, a systemic problem that shows up in our individual medical histories and practice.
Speaker 1 (00:41:15):
Yeah, it's so wild. And I think these conversations are so important because we just don't know. There's a lack of education from both a practitioner standpoint, but also there's such a lack of education for us around self-advocacy and what that actually entails and what that looks like and the reality that the hard truth and reality that I had to wake up to when you had to wake up to Charlotte that no one is coming to save you. No one is responsible for your health. No one cares about your health as much as you do no one. And it's really hard to stomach that. And it's really hard to step into that autonomy when you're suffering very badly, which many of us are a lot of the time that we're in these situations. But it's so wild how little, I mean, I don't know who would educate us on these topics, but we as humans, as consumers of medical care and different medications have to be informed.
(00:42:18):
Right now, I'm going through the Charlotte with my thyroid medication. I'm working with a naturopath. He put me on thyroid medication. Well, I had already been on thyroid medication. He upped my thyroid dose. He's just been refilling it without testing my thyroid. This is a different conversation than SSRIs, but you got to test your thyroid every six months when you're taking a hormone medication like that, a hormone, thyroid hormone that's regulating so many of your metabolic functions. If I didn't know that, I would be in a completely different situation where he might, this could go on for years, and this has just happened with my mother where her practitioner was doing this for her and her thyroid got completely off and she really, really, really was suffering. And there wasn't anyone to be like, what's going on with your thyroid medication? No one is thinking about that. Right? My dad wasn't thinking about that. The practitioner isn't thinking about that, who was advocating for her me, but at the end of the day, it's like, what if she didn't have me? Right? Most of us just have no education around these things. And it's wild, the damage that is being done in the context of trying to help people and to help ourselves.
Speaker 2 (00:43:33):
Absolutely. And I think we're seeing the shift as we're talking about. I think that historically medicine has been this very authoritarian, again, like we talked about, I said, behind the desk, I give you a prescription. You listen to the good doctor, the good clinician, and go on your way. And I think that we have generations of individuals who that was kind of the framework that operated right, and we don't know what we know until we know it, we were doing the best we can. I think clinicians are doing the best they can with the resources they have and the knowledge they have until that knowledge shifts. And I think that as patients, that's also a lesson that was really hard for me to learn of. And I think a lot of us women too, we're people pleasers where very much, we don't want to rock the boat.
(00:44:20):
We don't want to push back. We don't want to snap or yell or get angry or be bitchy or fill in the blank with our provider. And that advocacy is so important because true medicine should be a bi-directional relationship of this shared decision making that we talked about earlier. And I think that that movement towards us advocating, we have so much more knowledge now than we did even 20 years ago. We have the ability to become so much more informed than we used to be. And so I think that to your point, we do. We know our bodies better than anyone else, and I try, I always talk about this. We go by how you are feeling above all. I can be here and I can talk to you about the neurobiology and the drug curves and the this and the that, and the side effects and withdrawal symptoms, and I'm here as a resource, but you ultimately know your body better than anyone else ever on this planet. And so why would we not use your internal and external symptoms and signs and your knowledge of yourself as a critical part of your treatment? Doesn't make sense. Make it make sense.
Speaker 1 (00:45:34):
Right? Make it make sense. Well, like I said, Charlotte and I can just chat for days. Something that we definitely want to touch on before we wrap up tonight is what are the withdrawal symptoms of coming off of an SSRI and how do those overlap PMDD symptoms?
Speaker 2 (00:45:58):
Yeah, absolutely. So when we think about coming off of the drug in traditional medicine, there's oftentimes what we call a linear taper. You have your medication, then you have it again. So if you're on a hundred milligrams of Zoloft, your doctor will say, well, just take 50 for two weeks, then take 25 maybe for two weeks, and then just stop it and you'll be fine. We find many people have withdrawal symptoms because of that. And there was a study from, I think it was 2023 that showed that about one in eight people are estimated to have some sort of withdrawal symptomatology when they come off of their SSRIs withdrawal symptoms have a huge and varied constellation of different types of symptoms. There's physical symptoms, there's mental symptoms, there's emotional, mental or cognitive symptoms. There's emotional symptoms. So this can be things like worsening insomnia, worsening anxiety, worsening depression.
(00:46:48):
It can be more physical symptoms, dizziness and brain zaps are two, or body zaps are two of the most common things that we see, but are very clearly withdrawal symptoms because we don't see those when we start the medication, but we see it when we pull off of the medication. Other more serious symptoms that can come up are things like suicidal ideation. There's a phenomenon called akathisia, which is an inner restlessness. It oftentimes manifests as a need to pace, a need to a feeling of wanting to get out of our skin or feeling like we can't settle down or calm down. That's a really debilitating, I would argue, one of the most debilitating symptoms that can come up. And so there's this big question because when people would come off of their antidepressants or their SSRIs, and let's say they would start to have panic attacks, Western medicine says, oh, well, you're just relapsing from your original condition, so we need to put you back on the medication.
(00:47:43):
There's a lot more nuance that needs to be explored around what a withdrawal symptom is versus what relapses, and that's a lot of the work at outro is teasing out the time course of when the symptoms started. Right? And so if symptoms started immediately after dropping your dose, let's say, of your SSRI or coming off of or stopping the SSRI, it blends us to maybe think that maybe this could be a withdrawal symptom. The time course is really important to keep in mind around when we come off of the medication and when these symptoms crop up. Another thing that's really important to note is that with withdrawal symptoms like let's say anxiety or depression, one thing anecdotally I've seen with, I would say off the top of my head, 80 to 90% of our patients at outro is we've seen this shift of people coming in after they've come off of their antidepressant or tapered down their SSRI, and they've said, I have this new onset X, right, this new onset depression, this new onset anxiety, these new onset nighttime panic attacks, these new onset insomnia symptoms that don't feel anything like the thing that I was started on the antidepressant for.
(00:48:57):
So that's another clue, right? If you were started on an antidepressant for depression symptoms and then coming off of the medication gives you horrible new onset anxious symptoms that you've never experienced previously, that's not a relapse of your original condition. So it's really important to tease that out and to your point, sit down and take the time to go through that symptomatology. So things like mood swings, maybe we talk about the overlap with PMDD, mood swings or a widening emotional range and hypersensitivity, that's another really common thing we see coming off of antidepressants. And again, there's a patient, God bless her because I use this analogy over and over and over, but she described it beautifully. She said, when I started my antidepressant and it got to a therapeutic level, I felt like I was sitting at a piano and I could see all of the keys of my emotional range, but I couldn't play the high keys and I couldn't play the low keys.
(00:49:53):
I could see them, but I couldn't access them coming off of my antidepressant. When I tried, suddenly it felt like suddenly I had access to the entire keyboard and it was really overwhelming. And so when we think about coming off in a stepwise slow manner, like hyperbolic tapering, which we'll talk about in a second, I'm sure that it's like putting, giving us back one key at a time in helping to expand that range. Because when we come off especially quickly and we have withdrawal symptoms, mood swings, emotional liability, emotional dysregulation, those are major withdrawal that can come up and be really debilitating, and I think can overlap a lot with PMDD and anxiety and depression symptoms as well.
Speaker 1 (00:50:36):
Yeah, it's hard to tease out because so many of them are the same, but I love what you're pointing out here as that withdrawal is not the same as relapse. These are two very different things. And can you speak a little bit also to the difference between, it's not that SSRIs are addictive, it's that they create a dependency. And again, those are, I see that language thrown around. It's like SSRIs are addictive. It's like that's not really the right language. They create a dependence. Can you speak to that?
Speaker 2 (00:51:11):
Absolutely, absolutely. And this is something that even in psychiatry, even in western medicine, we see all the time, these two terms are confounded. So physiologic dependency happens with long-term SSRI use because the body with anything is, I joke, it's obsessed with homeostasis or maintaining the status quo. So when you are adding an exogenous neurotransmitter cocktail into your body, the body adapts with that. And the way that the body adapts with SS RI usage is by what's called downregulation or making less of your serotonin receptors. So when you pull off of the medication or you come off of the medication, the brain has essentially this WTF moment of like, wait, I've been getting this exogenous serotonin or this exogenous norepinephrine, where did it go? And so this physiologic dependence happens simply in relation to long-term medication use that the brain adapts to those changes. That's what dependence is talking about.
(00:52:10):
Addiction is we can have addiction and dependence, but addiction is more of that psychological aspect of craving, of wanting more, of feeling like there is a need. Your life is being affected by the need to seek more of this medication. And so benzodiazepines, for example, another medication, we have been over-prescribing like candy, and up until very recently in western medicine, not revisiting the importance of reevaluation of if you need it anymore. Benzodiazepines have caused physiologic dependence as well on a different pathway, but they also cause addiction over time. There's this need for more and a craving for more in many people. And so that's important to note when we think about this because yes, SSRIs people are not craving Prozac. They're not like, Ooh, I need to get my hands on Prozac. And their marriage is not blowing up, and they're not robbing a bank to get their hands on Prozac, but that doesn't mean there's not physiologic dependence.
Speaker 1 (00:53:09):
Yeah, I think that distinction is so important for people to understand as they're dipping their toes into understanding this whole conversation around SSRI, informed consent withdrawal symptoms. Do you have time to go a little bit over? I really want to be respectful of everyone's time here. Okay. Tell us a little bit about outro and what hyperbolic tapering is.
Speaker 2 (00:53:36):
Yeah, absolutely. So hyperbolic tapering is essentially a fancy way of saying that as we taper off of medication, we taper with smaller and smaller dose reductions. And so for a little bit of background, this hyperbolic tapering methodology was proposed by Dr. Mark Horowitz, who's one of our co-founders in 2019, but was utilized by peer support groups for many years before this. So peer support groups like surviving antidepressants, Cymbalta Herz, worse again, these communities that developed in the gap that you were speaking about of lack of access to any way to come off of these medications, many of these drugs, the commercial formularies, there's not ways to get down to smaller and smaller doses of medication over time. So again, these groups were critical to the work that outro is doing now. And so what hyperbolic tapering is in a little more detail is while linear tapering, right, what we talked about with the Zoloft, you have the medication, then you have it again, then you stop, involves a fixed amount of dose reduction over time.
(00:54:36):
Hyperbolic tapering employs larger dose reductions at the beginning, followed by smaller dose reductions as your treatment progresses. And we do this because of the relationship between antidepressant dosage and its effect on the brain when there's not a lot of antidepressant in the brain, every milligram has a much larger effect because there's more available receptors in the brain for the drug to bind to. But at large doses, every additional milligram has less and less of an effect because many of those receptors are already occupied by drug molecules. And so I like the analogy, there's a couple of different analogies I use, but you can think of it like golfing. So you brain receptors are golf holes on a putting green, and in each hole you feel satisfaction as you sink a shot in and your score gets better. But once all of those holes are filled with golf balls, putting more balls into the putting green is not going to improve your score.
(00:55:28):
They're already occupied, they're already saturated. So similarly, when your brain's receptors are saturated with a drug, taking more of the drug isn't necessarily going to lead to any increased effect. And we see that in clinical trials about higher and higher doses having less and less of an effect on our symptomatology. And so this relationship between the antidepressant dose and the brain effect is described as hyperbolic because it's really steep at low doses, again, really steep as we're starting. And those receptors are open for business, and then it flattens out as the dose gets higher. And so what this means is that very tiny doses of antidepressant drugs can have an outsize effect on the brain. And that's very different than what Western medicine has purported with this idea that we have to get up to pretty high doses for many of these drugs to have what's called the minimum therapeutic dosage. We've found that that's actually not true at lower doses. There's oftentimes quite a lot of effect happening.
Speaker 1 (00:56:29):
So interesting. Thank you for sharing this with us, really getting into the nitty gritty of the differences. And this is so important because like we said in the introduction here, there are very few organizations, very few practitioners who are really at the forefront of this work. And it's so exciting to see outro come into the world and start launching in different states and to see a resource finally burgeoning of help around this because people are suffering very, very badly, and they had no idea what they were getting themselves into as they were going on. The medications are coming off of them. So to have a resource and people who have lived through this, mark came into this same kind of thing like we were talking about earlier, right? Because of his own experience,
Speaker 2 (00:57:23):
He was doing a PhD and was like, wait, I'm learning that these drugs should be so easy to get off of. Why can't I get off of them? And it's just this question of there needs to be a safer and more comfortable journey again at there's not commercially available dosages to make this journey easy or comfortable. It's very isolating in Western medicine. There's a lot of gaslighting around, we are either relapsing from your original condition or this isn't a real thing. And so our goal with this hyperbolic curve, if you think about it, we're building a staircase. We're building stairs so that it's not such a steep drop when you stop the medication. And yeah, it's been a beautiful ride to be at outro and to help build something that's not really been built before. It's also very scary as everything is in life. It's both, and it's scary and it's beautiful and exciting.
(00:58:16):
I think the most, and you can probably speak to this with her mood mentor, there's just so many people who are joining our services and they're like, my God, I have felt so alone on this journey. I have felt so isolated on this journey of tapering or of my doctor telling me that this isn't real or it's all in my head. And so it's hopefully a place that in the new year as well, we're starting to do peer support groups. We're starting to build more of that community support, which I love that you do with her mood mentor as well.
Speaker 1 (00:58:50):
Yes. Yeah, it's so fun. It's so fun to get into conversations like this and hear from others, and it really ultimately helps us do our jobs better when we hear from more and more people and their experience. It's so exciting. Make sure, if you haven't checked out outro yet, take a look at their website. They are. Where currently are you practicing? I know it's rolling out.
Speaker 2 (00:59:13):
Yeah. Yeah. So right now we are actively seeing patients in California, Colorado, and Washington in the new year, like January, most likely, fingers crossed, we will be expanding into Illinois, Florida, Texas, and New York. And then more to come from there. So we just hired four new awesome clinicians who start tomorrow actually. And so we are growing and we are to accept patients. So if you're interested, you can also sign up for our wait list and then the website is www.outro.com.
Speaker 1 (00:59:45):
So exciting. And they have an Instagram, you can get a lot of education through their Instagram and see what they're up to. Something else I wanted to throw out in this conversation is there was a recent study around pm, DD and SSRIs that showed that there wasn't really a difference in effect between intermittent use versus full-time use throughout the menstrual cycle. So you could potentially work with your prescriber to take, if you do want to take these medications to take them during the luteal phase only, which would they say in the study reduce your likelihood of developing dependence. And I thought that was really interesting. I wasn't sure if you were familiar with that study or not yet, but I was like, whoa, there's a study on PMDD and S SSRIs and it's about withdraw and reducing the risks for independence. Things are changing in the P MDV research world, which is so exciting
Speaker 2 (01:00:44):
And it's so interesting. Some people can tolerate, again, we think this one out of eight, potentially up to 50% of people have some sort of withdrawal symptoms. But one out of eight people we think are going to have a pretty tough time coming off of these medications. That's to say many people, especially with Prozac, which is used for pmm, DP, have no issue being on it part-time so to speak. And so that is also an option for treatment. And I love that there's hopefully more and more research on just feminine health conditions because we didn't talk about it too much and it's a whole nother conversation we can have about the lack of research there. So I'm glad to see that that study came out recently.
Speaker 1 (01:01:26):
So just to clarify, the risk of dependence increases with the long-term use?
Speaker 2 (01:01:33):
Absolutely, yes. So the longer you use the medication, the more likely there is to have withdrawal when you come off of it. Certain medications we think are harder to come off than others. So SNRIs, venlafaxine, Dulux Venlafaxine or Effexor Duloxetine or Cymbalta. And then Paxil or Peroxetine, which is an SSRI are quite challenging to come off of compared to other medications and then previous attempts to come off, how hard was it for you when you came off or tried to stop your antidepressant before? So those different factors we use as kind a guidepost of how challenging we think it might be for you to come off when you work with us at outro.
Speaker 1 (01:02:14):
Yeah, well please. If you are on these medications or you get on them at any and you are thinking about coming off of them, work with practitioners like those at outro who know what they're doing because this can be very dangerous, very scary. And not to fear monger here. That's not what we're trying to do, but we want that informed consent for you that doing this, I have clients who have not under my care, this is out of my scope, but they have just tried to do their own thing with their SSRI and that is very risky business. You do not want to toy around with these psychotropic medications and these withdrawal symptoms. Charlotte, am I correct to understand that this can come even from forgetting to take your medication for a couple days on your own trying to lower your dose, these withdrawal symptoms can arise even without just stopping taking the medication?
Speaker 2 (01:03:07):
Absolutely, absolutely. And that's something that we ask on intake is have you ever forgotten a dose of your medication and have you had symptoms? The medications with shorter half-lifes ak, the amount of time it takes for 50% of a drug to leave your body drugs with shorter half-lifes people oftentimes will get withdrawal symptoms even if they miss their dose or they delay it by a couple hours. So absolutely it can happen with a single missed dose for some people. Not at all. But that is something that's important to keep in mind.
Speaker 1 (01:03:36):
So fascinating even with a missed dose or a delayed dose that these symptoms can arise. And I think to wrap up here, what I see so much with clients, and I am sure you see this too working with psychiatric clients, is that we're so used to having so many symptoms and not being able to parse it all out, that we could miss a dose or take a delayed dose and we wouldn't even attribute the symptoms to that. We would just think, oh, I'm crazy, or I'm having a bad day or something's wrong with me. Right? When we don't have the education to know that actually there's more to the story, and this could be related to does this arrive,
Speaker 2 (01:04:17):
We hyper individualize in psychiatry, we feel something and we assume that it must be something that's wrong with us. And I think that again, there's this need and in so many of our patients are like, yeah, I came off the medication and then about a week later or a couple days later or a couple weeks later, I started to feel awful. And it took a while to put the pieces together until a partner or a parent or a loved one said, didn't you come off of your medication around that time? And then it's like this light bulb goes off and then people look up antidepressant withdrawal and then find us through that back channel. And so stabilization after you've come off of your medication if you're feeling like you're really struggling, is also something that we do at outro. So just want to pull a plug for that as well that if you have come off of your medication in the last couple months and you're finding yourself like, huh, things feel weird and they feel different than they did when I started this medication in the first place. That could be what we call protracted withdrawal, which is withdrawal symptoms that happen more in the long-term after you stop the drug.
Speaker 1 (01:05:25):
Well, there has to be, and we didn't really get to dive into this fully, and that's okay because we're kind of touching on it here, but there has to be a recalibration of yourself and your life. Just like anything, you graduate college, you're recalibrating, you get on a medication, you come off of it, there's a recalibration, there's a lot of, you have a baby, we have to recalibrate, right? There's so many points in our lives that require recalibration and coming off a psychotropic medication is going to be one of those. But it's rarely something that we think about in the bigger picture of who am I now without this medication? How do I process the experience of being on it? A lot to unpack as you are in your healing journey.
Speaker 2 (01:06:08):
Absolutely. Absolutely. And the diagnosing journey, maybe we can talk about that on a future, future call or something is such a beautiful process. And I think one last thing I'll say on that is I love the idea of ceremonial these steps that we take along the way. Not to minimize how painful or how challenging they can be, but to acknowledge and at the end of the year, as we wrap up the end of 2024, it's a great time. We look back on all that we've done, and this is something I'm doing with all of my patients at outro is reflecting on this journey, did you come down on your medication 10%? Did you come down 50%? Did you stop the medication? Can there be a reflection and a celebration and a ceremonial, I think that's a word of this process that you've gone on that's a big part of your overarching story.
(01:06:59):
And again, this journey of learning other maybe more long-term coping strategies and management strategies for when those big overwhelming feelings come up, when the anxiety rears its head, when those depressive symptoms come up is such a thing to honor. And I think that, again, so much of the healing journey can be so quiet in there's not always somebody there cheering us on because we historically were a chronic over Googler of our healthcare symptoms. And then we didn't Google our health symptoms today, right? We called our doctor instead of going straight to Google and getting panicked that we have something horribly wrong with us that oftentimes is such a quiet win. And so to anyone listening, I think that just the acknowledgement of those quiet wins is such a big part of healing and a big part of this self-healing, which is ultimately what we're trying to do. We're taking the power back to do our own internal healing work as experts of our own internal processes and are being here on this planet.
Speaker 1 (01:08:06):
That's so exciting. Charlotte. I love that you brought up the celebration. This is a huge part of the process and we're not, like you said, we're no one is celebrating us. No one teaches us how to celebrate those little wins. And so if you are trying to figure out how to do this, there's a resource in the community called 60 Ways to Celebrate yourself that we created to help you figure out how to do this. Because when I do this in coaching and I ask, how can we celebrate these wins that we're seeing people freeze, they have no idea what to do. They have no idea what that even means. And a big part of the healing process like we're saying here is we have to celebrate every little win. This is how we strengthen our autonomy. This is how we strengthen our motivation and our inspiration to continue healing. And it's not something that we're taught and every little win matters and just shining a light on it and celebrating it, it sounds so silly. Just like awareness. How can that really change anything? How could shining a light and celebrating these little wins really change anything? Try it and let me know what you think because it can and it does. And we need to be celebrated more. We do,
Speaker 2 (01:09:19):
Absolutely. And the brain has a negativity bias. It takes on average five positive things to counteract one negative thing. And that was like evolutionarily advantageous because when we were scanning the savanna, we were looking for the cheetah, not looking at the beautiful flowers. And so there's this constant neuroplastic process of turning towards the celebration, turning towards the gratitude. And again, one last both and if you guys aren't sick of it yet is like we're not acknowledging the challenge and the grief and the strife and the horrible symptoms and the progression and the challenge and the grief. We're not acknowledging that, but this is part of neuroplasticity or our ability to build new neural connections. And we know now that we have the ability to utilize neuroplasticity throughout our whole life, which is a beautiful thought.
Speaker 1 (01:10:08):
Yeah, you actively have to do it. It requires your focus and attention and the repetition to build out those new neural pathways and celebration is a really fun way to practice it. And it's so interesting too in the PMDD research that we have an even increased negativity bias compared to people even with PMS or people who don't have PMS or PMDD that this is even stronger. So we have to try even harder and we have to be even gentler and kinder to ourselves knowing that we have that HPA access dysregulation. We're going to be, our nervous system is more reactive. We're more in a sympathetic state. We're looking out more for the negative. We're ruminating more on the negative. So that celebration plays even a bigger role for those in our community. And it's got to do it. It's a prescription from Charlotte to celebrate yourself here, guys. The non drug descriptions
Speaker 2 (01:11:04):
Are real.
Speaker 1 (01:11:05):
Yes. Well, thank you Charlotte, so much for coming into our community for sharing outros message and vision with us, giving us hope and a deeper understanding of SSRIs, the risks, the benefits, the withdrawal symptoms to look out for. We appreciate you so much. We celebrate your work in this super important field and we hope to see more of you.
Speaker 2 (01:11:34):
Thank you, Jess. As always, it is an absolute joy and I'm so excited to just be here with you. I think you're doing incredible work and to those in this incredible community that you've built, I hope you take a moment every day to celebrate this thing that you've built and this network of incredible women. We're not alone. And if you're somebody who's struggling with this, with coming off of your antidepressant, you're not alone. So I just want to offer that one last message of hope.
Speaker 1 (01:12:05):
Thank you. Thank you, Charlotte. I'll be seeing you soon.
Speaker 2 (01:12:09):
Yes, sounds good. Bye. Bye.
