Making It Through Your To-Do List But Still Feeling Miserable? You May Have High Functioning Depression, Says Dr. Judith Joseph
Show Snapshot:
Are you experiencing stress, overwhelm, chronic worry? Are you making it through your to-do list but still feeling miserable? You may have high-functioning depression, says psychiatrist Dr. Judith Joseph. Midlife mental health issues can run a gamut – ranging from the blahs to feelings of overwhelm, from anxiety to debilitating depressive disorders. Dr. Joseph decodes the range of struggles that impact mental health and breaks down innovative tools beyond therapy to boost mood and improve emotional regulation. We also cover the menopause / mental health link, the role of sleep, and why the ability to say no is a critical mental health boundary. Gift yourself more mental peace by tuning in!
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Quotable:
People use work, they use being busy to cope with their pain. So, they don’t process their pain…if you don't feel the feels, then you don't begin to heal. They are really not feeling what they are feeling. And instead, they use other things to distract…they just work, work, work, work work, and then they're depleted.
Transcript:
Katie Fogarty 0:03
Welcome to a certain age a show for women who are unafraid to age out loud. I'm your host, Katie Fogarty beauties. You do not need me to tell you we live in challenging times. times that are challenging our mental health like never before. depression and anxiety are either weekend visitors or constant companions. Throwing the hormonal roller coaster of menopause in midlife, and feeling stable and solid can be tricky. And those modern holy grails of productivity and positivity will some days they feel about as attainable as a subprime mortgage. If you want new tools and fresh ideas for tackling stress burnout, and addressing midlife mental health issues head on. Please stick around for today's show with my marvelous guest. Dr. Judith Joseph is a psychiatrist, researcher, mental health thought leader and a massively popular Tik Tok star and Instagrammer Yes, you heard that right. Not only is Dr. Judith social media's favorite psychiatrist, she is a practicing clinician and holds both a medical degree and an MBA from Columbia University. She runs a first of its kind research labs studying high functioning conditions such as high functioning depression, ADHD, anxiety, PTSD, and more. Let's talk mental health few days because we can all use some new tools. Welcome, Dr. Judith,
Dr. Judith Jospeh 1:27
thank you for having me. I'm excited to be here to talk about these things.
Katie Fogarty 1:30
I am super excited because I've had the pleasure of hearing you speak we first connected at some of the menopause events that took place in New York. This past October around world menopause month, I am very excited to explore challenges to our mental health across the spectrum. I also want to get into the link between menopause and mental health. But I would love to start more generally. Right now we're sandwiched in the holiday season, which is a time of celebration, but also stress. You know, if we are feeling mad, if we feel like it's our to do lists, the depressing news? What are your ideas for sparking more joy in our lives?
Dr. Judith Jospeh 2:09
I think that that math feeling is something that a lot of people deal with and can identify with. And I think it's an interesting because when you think of the word math, you really don't know what it is. And for many, we walk around or busying ourselves, and we don't really even take the time to think about what we're feeling. We don't even take the time to feel the feels. And when we do that, we end up not being able to identify what it is that we're emotionally experiencing. So a lot of us just go, you know, and many times we'll say, people ask, how are you doing? And we'll say, I'm okay, everything's okay, when it couldn't be further from the truth. So I recently did an article and an episode on an ad had Donia. Anhedonia literally means the lack of joy, lack of pleasure, and really explains what that is, especially around the holidays, a time when we're supposed to be joyful, we're supposed to be happy. But most of us feel rundown, we feel exhausted, and we feel like we're burnt out. So the holidays can be especially challenging for people. Because when they're trying to find happiness and trying to find pleasure and joy, they just don't make space for it. And they don't even make space to understand how they're feeling.
Katie Fogarty 3:28
So we feel like it's ironic, because it's like the pressure to be joyful actually produces stress. So if we're if we're looking to sort of feel the feels appropriately Is it is it giving ourselves time to acknowledge how we're feeling? Do you what are some mechanisms that you might recommend for people to sort of process their feelings so they can open up and experience some of the positive things that they would like to be filling. As
Dr. Judith Jospeh 3:56
a psychiatrist and therapist that treats children and adults, I find this especially interesting because children are taught and, you know, as as young as preschool age, how to identify feelings. We've all probably seen that feelings chart where you see the different faces, making different expressions, and then that's how children learn to identify how they're feeling. And the reason that we have that is because it's so important for us as human beings, to be able to identify emotions. Why? Because if we can identify emotions, then we can understand the thoughts and the thinking behind those emotions. What led to that we can understand what's happening in our bodies, right? Like we we tell little children, you know, if you're feeling that your tummy hurts, or you're uncomfortable, that means you have to go to the bathroom, right? How many times have we power through our lunch break? Not, you know, drank enough water, not gone to the bathroom, even though we were bursting because we just had to do what we're doing in the moment, right? How many times do we invalidate ourselves? Yet we tell our children, make sure you feel the Fit wheels, make sure you see your bodies, but we don't do the same. So I think it's important to think about how we feel to give space to acknowledge how we feel. Because if we're able to do that, then we can actually do something about it. And research actually tells us that if we can name our feelings, if we can name how we feel in that moment where we're feeling something, we just don't know what it is. But if we can name it, then that in itself, the naming process is therapeutic. Why? Because you liken it to being in a dark room, right? You're in a dark room, you know, there's something there, you don't know what it so you're freaking out. So you're swinging every way. But if you turn the light on, and you see what you're dealing with, then you know, oh, I know what I'm dealing with. I'm less anxious automatically. And the first step is being able to name how you're feeling to acknowledge how you're feeling. And so what I tell my clients to do is, you know, if you're feeling rundown say it, I feel rundown, I feel stressed, I'm feeling anxious, actually feel depressed, you know, those things are so powerful, because they tell our brains and our bodies that we matter, that our emotions matter, that our emotions matter so much that we can give it a name. And that's the first step to actually doing something to address it.
Katie Fogarty 6:21
I absolutely. So agree with this, because the naming is so powerful. I've observed that from this recording the show, you know, we talked about on the show about topics way beyond mental health, we talk about, you know, painful sex or urinary incontinence, sort of loss of intimacy, and midlife. And when you name these things, you can get help and tools and support from people who have you know, solutions, or even just have a sense of solidarity with people who are going through things. And I've observed that in my own life. You know, when I talked about some of the things that I struggle with, when menopause came on, it just felt so much better to feel connected. And it also put me in places where people were able to give me some solutions. And so that that is so powerful. I love how you talk about how children are able to do this, because we support them in doing it and that it becomes harder as we get to be adults, a lot of things get in the way. How would you help an adult patient who is is not able to do this? I mean, we have, you know, masks, we have pressures? What how does becoming an adult, sometimes compromise our ability to access tools that serve our mental health? That's an it's a big question.
Dr. Judith Jospeh 7:41
I mean, there are many ways and let's start with the basics. We know from psychology and psychiatry, that the brain operates in very different ways compared to other organs, we have something called the unconscious, or the subconscious, and then the conscious. And a lot of times when we're busy, because we take care of families we're working, we take care of households, we have 1,000,001 things to do, we kind of go on autopilot. So naming the feeling is our way of presenting our underlying emotions to our conscious brain, right. So like the unconscious, the conscious, and we're basically presenting to ourselves, this issue. And so what I ask is very little for my patient for my patients, my clients when we're first starting this, because you'd be surprised, you could be a high powered exec with like ivy league degrees, but you don't take the time to name how you feel. And so, I'd say simply wake up in the morning, right. And this is the first bit of homework I'm gonna give you, I want you to take your time to drink some water slowly. So you so you're slowly taking the sips you're practicing mindfulness, which is an Eastern philosophy that has been heavily incorporated into a lot of the tools we use, such as Dialectical Behavioral Therapy, a specific therapy aimed at, you know, mood regulation, amongst other things, but drink that water slowly and I want you to think about how does that water feel going down your throat? How does it feel? So that someone was a wet? Cold? Okay, how does it taste fresh, you know, can be minimally, you know, does it have a smell? Some water does have a smell, believe it or not. So we're going through all the senses, what are you hearing, I encourage people to use glasses, not like paper, plastic, but actual glass so that they can actually have this experience. So you hold this glass, you may, you know, describe what it sounds like when you're when your nails you know, like touch the glass. And you know what you're doing and this simple act that we all take for granted every day. You know, drinking water is your being present in the moment. And that one or two minute exercise says so much to a person who who's always busy, who doesn't make time for themselves? It keeps them in the present so that they can actually reflect on how they're feeling. And so then I'll ask them to say, Well, how do you feel? After you're done? You know, you're a couple of sips, how do you feel, and then many of them will say, you know, I'm actually feeling a bit depressed. Or they may say, I'm actually feeling a bit energized, I'm actually feeling you know, just name the feeling. So that little practice that someone does every day, if you do it consistently, every day, what you're telling your brain, what you're retraining your brain to do, is to be present. And being mindful. And paying attention to one thing, if it's an if water is not your thing, it could be a deep breathing a deep diaphragmatic breathing exercise. It could be something like relaxing and tensing your shoulder muscles, like paying attention to that, that does so much for an individual who's busy, who doesn't make the time and space to acknowledge their feelings. And that is really the first step. And I think that when you acknowledge how you feel, it may even go a step further, you may realize that, you know, I am stressed, I am tired, because yesterday, I didn't make time to even eat lunch yesterday. You know, I was up helping my kids with their homework yesterday. I said yes to a project that I probably shouldn't have taken on. Why did I do that, you know, like, so little moments of making space and making it a practice, to be mindful, goes such a long way. And it's baby steps, because that couple of minutes a morning may turn into a couple of minutes, you know, during your lunch break, there many times after my first set of morning patients, I'll just sit there and I'll practice deep breathing just to, you know, ground myself because your work can be hard. And it's okay. And sometimes I say to myself out loud, work be hard. You know, like, that was a tough session, you know, like, oh, giving my myself permission to feel to process to be because I am worthy of that I'm worthy of acknowledging my feelings, and my feelings are worthy of being heard. But if they're not heard by me first, and why would anyone else listen to it? I would
Katie Fogarty 12:07
love that yourself. Yeah, tear yourself. Listen to yours. First of all, when you walk through the process of how one drinks water, I felt myself relax. Because I was listening so intently to everything that you were saying. I almost felt like I was experiencing that. That was that's so interesting. Dr. Judith, we're going to head into a very quick break. But when we come back, I want to keep this conversation going. And I'm also curious to hear you help share with our listeners what the differences between anxiety and depression because I know you you treat both. Dr. Judith, we're back from the break. When we went into it, you offered up a piece of homework, some tools that we can use to ground ourselves to the start of our day, or to take breaks in between maybe stressful moments at work that really allow us to be present. This is a wonderful jumping off point. I want to ask how we might apply that tool and other tools to manage sort of what I think of as modern ILS and maybe their old old fashioned ILS and I don't know it have anxiety and depression, I know that you have a practice that really focuses on high functioning depression, high functioning anxiety, and I would love to start by having you share with our listeners, what's the difference between the two?
Dr. Judith Jospeh 13:23
It's really interesting because anxiety and depression often go hand in hand. A lot of the FDA and approved medications for depression anxiety are similar. And a lot of the evidence based treatments, such as cognitive behavioral therapy can treat both. However, they are two distinct conditions, even though they travel together. And as a researcher, developing new modalities and novel sometimes medications to treat anxiety, depression, I've found myself really having a hard time putting people into quote unquote boxes. So like the DSM five is the Bible for psychiatry that we use to diagnose patients. And so symptoms of depression major depressive disorder, such as low mood, low interest, which is Anhedonia. Low appetite or changes in appetite, changes in sleep, changes in energy changes in you know, concentration, all those things. They a lot of things have to be met in order to meet criteria for a major depressive disorder or a major depressive episode. But what I was finding after the pandemic was that a lot of my patients were having some symptoms of depression, but they weren't impaired. They weren't necessarily experiencing a significant reduction in functioning. It was actually the opposite. They were at their highest performance level. So, you know, as a researcher and a clinician, I was like, how, you know, what's going on here? And what I found was that people were you Using work, they were using being busy to cope with their pain. So they weren't processing their pain. We talked about this earlier in this discussion that like, if you don't feel the feels, then you don't begin to heal, right. So they were really not feeling what they were feeling. And instead, they were using other things to distract, for example, you see this a lot in working mothers, they put their kids first they put their job first, you know, if they if a kid is sick one week, they'll take on more work to because of internalized guilt and shame, because they had to take care of a sick kid. I mean, how ridiculous is that, but this is society. Sure. And then they were just work, work, work, work work, and they're depleted. So they weren't necessarily saying I'm depressed, they were saying things like, you know, I'm tired all the time. And I, and I'm not sleeping well. And, and, you know, I don't really enjoy my hobbies that much. And I don't make time for them. And I'm not eating as well, or I'm eating too much. Or, you know, like, they were having all these bits and pieces of what looks like a depression, but they weren't meeting criteria, because they were actually very high functioning. And so I thought, you know, I wonder how much of this is happening outside of my practice. And this is before I really started posting different types of social media. So I, you know, I said, let me just do a little montage on this. And what I'm seeing in my practice, I put together a reel and dropped it on Tik Tok. And then my social media manager was like, You got to open it, tick tock, and I was like, I can't, I'm with patient. Okay, but open it. And it was like millions of views. And people were like, That's me. Do you have a camera following me? You know, how do you know what I do every day. And it's like, wow, I'm onto something here. This is not just my practice, this is something that's happening out there, you know, people are pushing through their pain, they're pushing through their trauma, they're pushing through their struggles, and they're working, they're working, and they're working. And then they just don't feel happy, but they can't stop because God forbid, they stopped just for one minute, they would, they may actually break down, right. And so, you know, I started looking into this and researching it, along with the other things that I reached out, I research PTSD, ADHD, dementia, schizophrenia, but I really wanted to focus on these individuals who appear to have it all together, they're like, super mom, Super Dad, super person, you know, super boss, you know, super athlete, but they're not really finding joy, they're actually running on empty. And that's been the focus of my, my current work, and how to help people through this. Because if these people have the talents, to do what they're doing, you know, without acknowledge of feeling, and with all the struggles that they're having, internally, then they have the talent to create change. And, and so I'm hoping that, you know, with the things that I developed through my research, people can have a better life. And with high functioning anxiety, it's the same thing. So you look at the symptoms of generalized anxiety disorder or other anxiety conditions. And a lot of times they have somatic symptom, somatic is just a fancy way of saying body symptoms. So they may feel that they're the, they're tense, their muscles are tense, they may have to make, you know, frequent bathroom breaks, because they're, they have stomach upset, they may have this tightness in their chest, they may hold a breath, you know, but you'd be surprised at how many patients don't even acknowledge it. It's only when I go through the questionnaire. And I'm like, do you do this? And they're like, nope, but I'm like, but you're doing it right now. You're holding your breath right now. And they're like, Oh, I never noticed that. Well, yeah, you don't notice it. Because you don't have the language for it, your unconscious brain buries it deep. Maybe it's cultural reasons that, you know, maybe you come from a culture where talking about these things isn't really, it's a bit taboo, you know, like, or there are other explanations for it, maybe from a spiritual religious background, you explain it differently. But, again, it's important to work with clinicians who are skilled in this to identify symptoms, because identifying is so important, it is literally the first step to changing your life to recovering you know, to making meaningful, sustainable transitions to a better life.
Katie Fogarty 19:09
And so for high functioning, depression and anxiety, and I really relate to what you shared about how people are, you know, performing at the peak, you know, I think that people use work or sort of pot, you know, things that are on the surface positive, you know, achievement, and education, achieving at work things like exercise, things that seem virtuous, you know, there's a good addiction, there's a good addictions, you know, in contrast to like alcohol and drugs, and you know, like, you know, but just bad choices or whatever people are making and so it is easy to sort of sublimate your the harder things by just sort of pouring yourself into things that normally look great. So you know, for people who are not into themselves right now are saying My shoulders are tense and I do you know, I feel the symptoms of anxiety kind of vibrating through my life or I do feel that I have what you talked about with sort of some of these depressive sort of qualities where I feel like sort of lack of joy or it's hard to be motivated. You know, I know that there are so many ways of addressing this. What might be a, is the starting point to find a therapist is the starting point to, you know, keep a journal to figure out what's going on. What are some tactical tips that you I know, you don't give medical advice on podcasts, you know, but what what are some tactical tips that a listener might use to start to, to manage or dress these, this depression and anxiety they might be experiencing? It's
Dr. Judith Jospeh 20:35
always wonderful. If you can find a therapist. There are there are great resources like Psychology Today, you can type in your zip code, you can type in your insurance information, you can find people who you know, who are in your area who who accept the benefits that you have.
Katie Fogarty 20:52
And there's telehealth, too. Now, there's like tele telehealth services there
Dr. Judith Jospeh 20:55
is there's telehealth. And not everyone is ready for therapy. I say this all the time, because, you know, we all say therapy stances therapy, but not everyone's ready for that, you know, some people have had bad experiences with therapy, some people were dragged to therapy by their parents or had, you know, terrible experiences with therapists, and they just don't want to do that just yet. And that's okay. Right, we want to validate how that feels and say out loud, I'm afraid of therapy, because of a bad experience. Right? That's very powerful to acknowledge how you feel. And so for some people, you know, they're a therapist is the way to go, because therapists can keep you on track, right? Like, they can help support you on your journey. For a lot of my clients, we do cognitive behavioral therapy, where we try to understand what that core belief is, for some, the core belief is that if I stop working, you know, things will fall apart, right? So then we slowly challenge that thought, and we say, Okay, well, let's, let's Whittle things down just a little bit a week, right? Let's say no to one thing, and let's see if everything falls apart. And then you know, believe it or not, they're like, Wow, nothing fell apart. Right? If the
Katie Fogarty 22:03
earth the earth keeps spinning, right, it just things stay on their access.
Dr. Judith Jospeh 22:08
Yeah, people keep peopling, you know, so like, what I tell them is, like, you got it, challenge those cognitive, those core beliefs that are negative, those automatic thoughts that are negative, and we slowly see them changing, right? Change is slow, however, it is possible. And so we set realistic expectations in therapy. And we say, you know, because you're a joke, I call it high functioning AF, because you're a high functioning, AF, you're going to want to see changes right away. This is a process, we're going to do this slowly together. And then, and then when we when we create these changes, we're going to acknowledge them, because we're going to acknowledge that this is something you did that you did with hard work, right. And then that tells your brain that this is a positive thing that we're moving in the right direction, we got to keep on going. For those who don't want to start therapy, there are wonderful, positive people out there on podcasts, right, there are people who write books, you know, some some self help books address some of these behaviors. So there are places where you can start where you feel more comfortable. You know, if you're not ready just yet for for therapy. For others, it could be teaming up with a buddy, right and saying, like, you know, we both kind of do this, let's remind each other to slow down, right. So, you know, it could be someone who is in the parent circle that you're in, or in the work circle that you're in, just like making sure that you're looking out for each other so that you make time for yourself. So there, there are different ways that you can go about it. For some people, they're connected to their faith leaders to their faith communities. And it could be you know, making time to sit still to just, you know, be be in your, your faith space and not be busy, you know, like, yeah, to be careful, because some people do carry some of this high functioning behavior into their, their faith circles, and they're the ones running all the events, they're, you know, calling everyone up, they're busying themselves there, when when you were supposed to connect to your spirituality, to find peace, not to add more work to your plate, right. So, you know, for some people who aren't ready for therapy, there are other options. But there are options. And that's the thing to realize that change is possible. Change doesn't look the same for everyone. So know, you know, the change that fits you that fits your pace that fits your life and fits your, your cultural beliefs,
Katie Fogarty 24:31
you get so many wonderful recommendations, I would love to ask you a little bit about, you know, when you talked about this, this sort of the busyness and running all the things to you know, I don't want to make gendered assumptions. Obviously men run things and men are busy and you know, men have struggles as well. But I feel like women definitely take a lot of a lot of this on you're busy. You know, the data shows that you're, you know, if you're working even in a corporate job that you are you tend to have more responsibilities at home like you meet your you're caring for sort of the emotional health of the family, you're doing maybe more caregiving work around either children or parents, you know, people have, there's a lot of social obligations that women have. And women even carry some of these social obligations at work, they're expected to do like the the team building things and all that kind of stuff. So women do experiences. And I know that a lot of women start to sort of experience a lot of mental challenges when they hit menopause because things change, right, like menopause, can roll into town like a freight train, it brings hormonal changes, it brings physical changes that that are really challenging to grapple with, is this something that you see in your own practice to women who have not had issues when they're in their younger days come to you because they are experiencing challenges with mental health and mood due to things that are related to physical and hormonal changes? Absolutely,
Dr. Judith Jospeh 25:58
and for many women, they'll have their first depression, you know, the, or they identify their first depression in midlife. And if you think about this, if your identity was so wrapped up, and being the go to, and multitasking and doing all these things, and like not feeling your feelings, and then suddenly your body says, Hold on, changes are coming. And maybe you feel like, oh, wow, I'm not able to do these things, the way that I used to, like, I'm forgetful, I'm about to say a word, and I can't remember it, it's called the tip of the tongue, right? Or, you know, like, my, my mood is so irritable, and up and down, and like, I'm having a hard time regulating it, or my sleep is off, and I'm drained, I'm exhausted. All of these things, you know, that you used to call your identity feels like they're suddenly changing and you have no control. So a lot of times, I'll have someone come to my office in midlife and say I just, I just feel like I don't know who I am anymore. And, and I like to educate my patients, the way that I do my, the medical students that I work with, and I tell them to look out for the ties, the T i e. S, between mental health and menopause, the T is the thinking. So thinking is a fancy way of saying thinking and thought processes cognition. So the cognitive changes that happen during the peri menopausal period, can look like what we call brain fog, right? You're forgetting things, you misplace things. Planning is more difficult, more challenging. And for many people, this is very problematic, if they're the go to if they're the multitasker because they feel like well, the one thing that made me special is gone, right, which is not true. It's not the one thing that made you special, but you just forgot who you are for a while because you were taking care of everyone else. So then what we do is we challenge that a bit. And we support that a bit. And because I treat children, a lot of the children that I treat, have ADHD, an attention deficit condition that looks at you know, issues with executive functioning, a lot of the executive functioning things during the pre menopausal period mimic what looks like an ADHD, right, like you're forgetful, you're not planning things, as well. So we use something called organizational skills therapy. And it's a type of behavioral therapy that we use in ADHD and also conditions like some some dementia, but we help clients to feel supported in their organization. So for example, sometimes we use things like a launch pad. So you'll put a designate a part of the office or the area of the home, to put things that are essential. So like keys, wallets, things that you spend a lot of time looking for reading
Katie Fogarty 28:45
glasses, reading glasses need to go in there, we're gonna put them all
Dr. Judith Jospeh 28:50
in one place. And we're going to practice putting them in one place so that you don't spend 510 minutes looking for them. Other things that we'll use is sometimes we go back to color coding. So like, because we've gotten so accustomed to putting everything in our brains, because we're super woman, we don't use things that maybe could be helpful, because when these hormonal changes happen, sometimes your brain doesn't, you know, fire the way that it used to, you know, it's temporary, but we know what happens and and many women, most women, this, this happens. So it's not just you. So we use kind of older systems like color coding systems, file file systems that I use every day with the children that I treat with ADHD to help keep them on task to keep them organized. So that they have one less thing to think about. You know, we could also use other things like pruning away the thing, the excess, so like clutter. Clutter is really problematic. I'm embarrassed to look in my purse right now because they're probably receipts that don't belong there.
Katie Fogarty 29:54
Your person is my person. Yes.
Dr. Judith Jospeh 29:56
We all have the things that we collect that don't make any sense. ends but we collect them nonetheless. decluttering is a very helpful so that can help to simplify your life to make the things that are essential, more prominent, more present so that you can find them easily. And you know, there are lists there like 50 things you could do to organize your life in organizational skills therapy. But if you don't know that these things exist, you don't know how to ask for them. Right? So then we spent a lot of time educating clients about organizational skills to help with the thought, the thinking the cognitive issues that happen with perimenopause, and then you know, I'll skip over the AI and I'll go back to the eye but the E in ties the emotional regulation, emotional dysregulation, you know, people will feel like I used to be like, so happy go lucky, like, the the person that people go to, but now I'm anxious. And now I'm, you know, I feel like I'm depressed. So, you know, I try to educate my patients to know the difference between a major depressive episode versus perimenopausal mood changes. So with a major depressive episode, you know, you're not going to have period changes. That's not in the DSM five, that Bible for psychiatry, we talked about periods don't come up under Major depressive episodes, if you're having changing periods, then it's likely due to perimenopause, a mood changes, not major depressive episode, physical changes, you don't have hot flashes, you don't have skin changes, you don't have palpitations, with major depressive episode, if you look in the DSM five, it doesn't show up there. You know. So you want to consider that, that this is not a primary major depressive episode. And then lastly, the third P is, you know, the past, right? If you've never had a past history of depression, then then you got to start thinking about hormones, right? If your family history is negative for depression, that there's no one here found that it has, you know, mental health issues, or you know, like that, that's apparent, then start thinking about this is probably, you know, the hormonal changes that cause mood disturbances and midlife. So, you know, the reason that it's important to differentiate the two is because the treatments are different. So the treatments for the perimenopause, a mood changes are things like, you know, hormone, sure therapy, things that are related to supporting you with hot flashes, physical changes, you know, like, and then with a major depressive episode, you know, their their medications, not to say that antidepressants don't help. Antidepressants are sometimes helpful in some cases. But they're not the Go To You mean for men and to treat Monoprice treatment, yes, for the menopause. Right? Right. But, but antidepressants are the treatment for a true major depressive episodes, along with other type of treatment of therapy modalities and what they may want. Yeah,
Katie Fogarty 32:50
so I love that you that you, you made it very clear if to help us distinguish between the symptoms of perimenopause and sort of the framework for a depressive episode. If women didn't have a history of depression in their past? What if they did you know, women who, who've had a history of anxiety or depression, you know, when menopause comes into town with its hormonal changes, you know, does this amplify people's, you know, mental health challenges? Does it disrupt and change what you would do in terms of medication? Yeah,
Dr. Judith Jospeh 33:25
so, so as a part of what I do, in my practice, I do a family tree. So we draw the the sides of the family that look for family history, but I also do a past psychiatric history for the patient themselves. So my patients who have had a history of PMDD, which is the premenstrual dysphoric, disorder, which which is like intense and significant mood and anxiety symptoms related to your period. Or if they've had postpartum depression, which is a major depressive episode during either the the third trimester, or right after giving birth, because of the hormonal drops that happen, those patients are more vulnerable to having another major depressive disorder due to hormonal fluctuations, they're more vulnerable. And also people who have a history of trauma, this is not talked about enough. If you've had a history of trauma, you're more likely to have you know, these type of mood issues. Not everyone who goes through menopause has these mood fluctuations. Not everyone has them, but those who have had at past history are more likely to have it and so we use things like cognitive behavioral therapy to help these patients to challenge these negative core beliefs about themselves negative automatic thoughts like oh, like I'm having having a hot flash. So flash, so I'm gonna, I'm not gonna be able to do this presentation, people are going to notice I'm going to fail. And we know that if we challenge these thoughts that the anxiety goes down, that even the hot flashes get better. So like the mind body connection is so important, it's so important. And also, you know, certain medications can help to support you why, if you consider doing cognitive behavioral therapy, because cognitive behavioral therapy takes several weeks, and it's not, it's not quick. So, you know, we don't want people to feel like, Oh, if I don't have time to do CBT, or if I don't have time to find a therapist, that there's nothing for me, there are many options. But if you don't know what you're going through, if you can't name it, then you don't know how to advocate for yourself. And not a lot of not a lot of doctors know about this, right? So that so you'll hear people starting antidepressant, starting anti anxiety things, and they're like, oh, that didn't work. Because not a lot of doctors can recognize it. So we have to educate patients to recognize it for themselves.
Katie Fogarty 35:43
And so for patients who are taking medicines, you know, to help support and put a floor underneath them while they're working on things that are a slower burn, you know, that take time, like CBT, CBT? Are these medicines that they take forever? Or is it something that they just take during this period until they become stable?
Dr. Judith Jospeh 36:02
It depends, you know, everyone's different. Some, some of my patients don't need to be on medicine longer than a couple of months. Others feel like, you know, I think I probably had an underlying depression all this time. And I didn't realize it, you know, and they're like, I want to stay on it, and we'll figure it out. But it depends on the patient. And so that's why it's important to work with a provider that you trust that listens to you, that makes time for you, that validates how you're feeling that makes you feel like you're part of the treatment team, you know, because it's so much better when someone's involved in their treatment, and they're active in their treatment, the outcomes are just so much better. So you want to be be be sure that you're you're feeling heard. And I'll jump back to the eye and ties the identity because I feel like the reason I jumped back to it is because I feel like when people experience changes in their emotions, and they can't regulate. And then also they feel as if they, they can't do the things they used to do. Because of their thought processes being different. They feel like they're losing themselves. So I use mindfulness techniques from dialectical behavioral therapy for the identity issues, because I want people to start to make space and time to feel grounded. So we'll do the mindfulness techniques at the beginning of the session that I mentioned earlier in this talk about drinking water slowly and listening to how your body feels and being engaged in your senses. And mindfulness helps you to feel grounded, so that you are able to pick and choose which feelings you're going to give a pedestal and which feelings you're going to not give as much of an audience to right. So like, you can pick and choose how you feel. You can pick and choose what thoughts you want to give attention to. And by mastering mindfulness, then when you're feeling intense emotions in a moment, when you're having these intense identity crises, you can ground yourself in the moment and allow yourself to pick and choose which thoughts which feelings, you're going to give centerstage and that can be very powerful.
Katie Fogarty 38:12
So powerful. Oh my gosh, I love that so much. Just this notion, like just because you're feeling it, you don't have to believe everything your brain thinks, you know, or I don't have to allow myself to participate in every emotion that's popping up I can I can have ownership or choice and, you know, yeah, they're not steering saying true to things can be true. Like, I can be angry, but not you know, to say like, I would rather choose for peace right now. Or, or calm
Dr. Judith Jospeh 38:40
that session, and not to invalidate that you're not having the physical feelings. We don't want women to be like, Oh, it's not so bad. You know, like, yeah, so it's not, it's no two things can be true, you can be having a really intense hot lash that feels terrible. And you are also a competent human being you're also kind you're also capable, you know, so two things can be true. I love that and you can master that.
Katie Fogarty 39:08
So we've done ties we've done think for T identity for i e for emotions have we covered as are is that sleep
Dr. Judith Jospeh 39:15
is really important because we ties it all together. No pun intended. Sleep is so important. It's restorative. And, you know, I remember when I was a medical student, we used to compete about who like did the best like all nighter and that's not cute. Now that I look back. I'm like, that wasn't cute. That was not that should not have been a competition because sleep is so important. You know, sleep clears out the debris, the garbage from the brain, the toxins from the brain and the body. Sleep allows you to not you know, feel sick because your immune system is restored. And sleep also organizes your mood. And if you're not getting adequate sleep, you're not going to have you know the best mood that you can have. You're not going to have the best thought processes you can have. So sleep does impact the thinking. It impacts the emotions and thus impacts the identity. So all the ties get are really depend on sleep.
Katie Fogarty 40:12
So no, absolutely, I have done two shows on sleep the two different sleep doctors who are sleep specialist and I'm gonna put them into the show notes for this show for anyone who's listening because they offer wonderful tips and you know, sleep. I love that you fly that as being so critical because I think in our busy, busy world, you know, when we're when we're working and exercising and sort of, you know, running on these, like, we're sort of prioritizing things that are these, what we we've been trained to think of as being positive attributes that we sleep get sacrifice, but it's it's so critical. I know that for myself, personally, you know, my, my mood, and my mindset is always better when I've had a good night's sleep. And when I've done hot yoga, my family's happy when I've prioritized both. Dr. Judith, we're going to be heading into our speed round in a minute, because we're nearing the end of our time. But before we do, I want to ask you about one last thing. I said at the beginning that you are incredibly active on Tiktok and Instagram, you share really wonderful accessible content. And I love this because, you know, we hear often in the news that you know, or that that social media can sometimes you know, there are bad qualities there to it, it can be sort of toxic in nature. But I have found for myself that that I've created a wonderful midlife community on Instagram around this podcast, it's been really, really positive. I've met people through Instagram that share common interests with me in the midlife space and in podcasting, and it's been very joyful, which I think has been one of the biggest surprises for me about launching a podcast, you two have turned social media into this wonderful positive megaphone, I would love for you to share a little bit about, you know why you decided to take some of your expertise onto social media and what experience you have had in doing so.
Dr. Judith Jospeh 42:04
So it's like a treat. And particularly child psychiatry is such a small field that the people out there who need access to child psychiatrists are just, they're just likely not going to get it. But looking at the numbers, and also, even adult psychiatry, they're very, I think, in some studies, there's like one psychiatrist for every 50,000 people. So I just thought, you know, I'm well trained, I have a research lab, I have a great team, I teach at NYU. And at Columbia, this is a lot of knowledge that only a few people will get. And so it was a very evangelical approach to it, you know, like, I need to start putting information out there that's evidence based so that many people can learn, and especially after the pandemic, and what we know about disaster psychiatry, because a pandemic is considered a disaster, it affects so many people and causes collective trauma, people need information. And if we don't provide this information, then it's going to be provided by someone else, maybe someone who's not as qualified. You know, and I teach NYU fellows that are, there are basically young doctors, how to give press interviews, and it's a class called Meet the Press. And a lot of times they're shy, they're like, oh, I don't know if I want to do it, you know, but I say if you don't do it, someone else will. And so I had to practice what I preach, right? I'm more comfortable on television, because I have all this media training over the years, but social media was a new beast for me. I was like, Oh, I don't know if I could do that. I cringed first couple of times I did it but
Katie Fogarty 43:37
your stuff. Your stuff is your stuff is so fun, and it really is very engaging. So you know, I am going to the last thing I'm going to ask you in a few minutes is where can viewers find you but like people need to go check out your Instagram at least or if you're on Tik Tok. Look, look for doctors go to therapy because your stuff is I have learned so much. I think it's really wonderful. So I'm, I'm happy you're bringing this out into the world?
Dr. Judith Jospeh 44:00
Well, I'm sure you can relate that when you first start doing things people are like, Why are you doing that? Like it's like, don't you want to be taken seriously, as a psychiatrist? You chair the woman in medicine at Columbia, like what will they think and you know what? It who cares? Sometimes you have to show that you
Katie Fogarty 44:15
said it yourself. Two things can be true. You can have your resume and still be awesome on Instagram. Because you are rocking both. I love it. Alright, let's move into our speeder. This is super a super fun high energy way to end I just asked questions that you'll have one or two word answers to. Are you ready? Yeah, let's do it. Okay, people may be surprised to learn that this mental health challenge is more common than people think.
Dr. Judith Jospeh 44:42
Naming how you feel. Okay, great.
Katie Fogarty 44:45
This is a topic that crops up time after time in the comment section on my social media.
Dr. Judith Jospeh 44:51
Can you be my therapist?
Katie Fogarty 44:54
Struggling with your mental health, consider this lifestyle choice to better support your Mental Health.
Dr. Judith Jospeh 45:00
Cut out toxic habits and toxic people. Ooh,
Katie Fogarty 45:05
good ones. Okay, even doctors need to work on their mental health. This lifestyle choice or hack helps fuel my inner peace.
Dr. Judith Jospeh 45:12
Saying no to projects that you can't do. Okay?
Katie Fogarty 45:16
Just say no, it's a complete sentence. We love it. All right, this one's gonna be hard for you, I think tick tock or Instagram.
Dr. Judith Jospeh 45:24
Oh, this is hard tic tock though because the trends. Sometimes I do them and I'm like cracking up and I back up for minutes. The trends are just like, hilarious.
Katie Fogarty 45:34
I gotta, I gotta get myself over there I am. I'm an Instagram all the way. But you know, tick tock back ends I guess. All right. And finally, your one word answer to complete this sentence as I age I feel stronger. Nice. Nice. Nice. This has been terrific. I have learned so much. I'm super inspired. I'm inspired to maybe get on tick tock and give it a go. Before we say goodbye. How can our listeners keep following you and your work and your social media.
Dr. Judith Jospeh 46:03
My followers can sign up for my newsletter. I have a book coming out in 2025. But the newsletter provides nuggets that are really helpful, and they're fresh and they're found nowhere else. And you can follow me on Instagram and Tiktok Dr. Judith Joseph, and on YouTube, I have longer form videos that are essentially like mock therapy sessions that people can watch and they can practice it with their therapists at home. Phenomenal.
Katie Fogarty 46:30
I'll put that all in the show notes and please come back in 2025 When your book is out. This wraps a certain age a show for women who are aging without apology before I say goodbye a quick favor. I would love it. If you could take five minutes to write an apple podcast review. Did you learn something on today's show that you plan to add to your own life? Do you feel more seen and supported? If so please take five minutes to rate or review the show over on Apple podcasts. Special thanks to Michael Mann see me who composed and produced our theme music. See you next time and until then, age boldly beauties.