Session 450: Reproductive Psychiatry

Welcome to the Therapy for Black Girls podcast, a weekly conversation about mental health, personal development, and all the small decisions we can make to become the best possible versions of ourselves. I'm your host, Dr. Joy Harden-Bradford, a licensed psychologist in Atlanta, Georgia. For more information or to find a therapist in your area, visit our website at therapyforblackgirls.com. While I hope you love listening to and learning from the podcast, it is not meant to be a substitute for a relationship with a licensed mental health professional. Hey y'all, thanks so much for joining me for session 450 of the Therapy for Black Girls podcast. We'll get right into our conversation after a word from our sponsors. Reproductive health is often discussed in terms of our physical bodies, but what about our mental and emotional well-being across the reproductive lifespan? In today's conversation, I'm joined by Dr. Mimi Sanders, a board-certified psychiatrist specializing in reproductive psychiatry to help us better understand the unique mental health needs that can show up during menstruation, pregnancy, postpartum, fertility challenges, pregnancy loss, and menopause. We explore what reproductive psychiatry is, why it's especially important for Black women, how mood and anxiety disorders can show up during major reproductive transitions, and what it looks like to advocate for yourself when navigating mental health care during these seasons. Dr. Sanders also breaks down common myths about medication during pregnancy and postpartum and shares what supportive, culturally responsive care should look like. If something resonates with you while enjoying our conversation, please share with us on social media using the hashtag TBG in session, or join us over in our Patreon to talk more about the episode. You can join us at community.therapyforblackgirls.com. Here's our conversation. Well, thank you so much for joining us today, Dr. Mimi. Oh, thank you for having me. I'm excited. Yeah. So you had such a unique career journey thus far. So tell us about your career as a psychiatrist and on reality television. And I think this is always interesting for the sisters in the community who may be exploring medicine. How did you choose psychiatry as a career path? Yes, very unique. I often tell myself, hey, you never know what is going to be around the corner. So just be prepared to pivot. I'm originally from Alabama. I went to undergrad at Tennessee State University. and at that time I wanted to be a pharmacist and I was doing like my chemistry and all the prereqs but then I discovered hey I you know I like kind of medicine as well what does that look like and I entered into like a program after undergrad and it was for just those who were just wanting to do more medicine but not necessarily had really fully not necessarily committed, but I want to explore. And so I entered into this program during the summer after I graduated from Tennessee State University at Ohio University. And it was my first time being exposed to what a doctor of osteopathic medicine was. And it was really focused on general practitioner and those of like primary care. And so I kind of fell in love with really, okay, I really like to know everything about the person and also behavioral health kind of fell in that as well. So I entered into Ohio University for a medical school and stayed there. And it was just different experience. I was coming from a historically black university and now I am in Appalachia. So I'm like, okay, Lord, you're giving me all types of experiences in my life. And then just from there, just met really good like friendships and just really had a really good experience. And I left there and went to Cleveland Clinic. And from there, that did my residency. And at that time, I had decided on psychiatry. And your question was, how did I decide on that? And it was not until maybe one of my last rotations as a medical student, I'm like, hey, I don't like surgery. I'm not necessarily a person that wants to do a true specialty like of dermatology. I really wanted to explore more, yes, of my primary general practitioner kind of experience and background, but I found myself in my clerkship of my rotation in psychiatry on an inpatient ward. On that ward, I saw a lot of persons of color. And I didn't see at that time where I was doing a rotation of a lot of those in those crisis situations of the majority. So I didn't see a lot of those who are Caucasian. And I was wondering why was that? And when I went from an inpatient setting to the outpatient setting, then I saw more of those who were Caucasian and really exploring those preventative measures of their mental health and emotional well-being. And that is kind of where I fell in love with psychiatry. And I'm just like, you know what? I really know that I can relate to a lot of individuals because of my background and because of my life experiences. But I really want to be a representative of that Black community, of a psychiatrist that we necessarily don't have to see someone in crises. We can have that particular representative as an outpatient and really work on what is proactive in my own mental health. I have someone that I can relate to. I can talk about these things. They understand my spirituality and they understand that, hey, I'm not necessarily having a psychosis if I am talking to the Lord. And so it was just that particular experience and me wanting to fill in that gap or that void and be truly a representative of this is what it looks like or what it could look like for proactive, preventative mental health and going to see a psychiatrist. But funny story also, my mom, when I told her I wanted to be a psychiatrist, her being from the deep South of Alabama, she was like, so you go into medical school and you're not going to be a real doctor? And I said, mom, mom. And so just knowing that, and now she's very well educated and she knows all things about mental health and going to see someone and medications and just knowing that that is how we were. It's gotten much better now, but that's how we thought about going to see a psychiatrist. So that is kind of where I fell in love with it. To be honest, I don't like to get down and dirty in terms of physical exam. Like I really love talking to people. I love doing that particular type of examination. So that's how I landed. Yeah, I appreciate you sharing that story because I think that that can pop up in lots of different ways, right? Like not just stigma around like medical specialties, but also I think the stigma related to mental health in some ways, right? And I think that is deep seated for a lot of our families. Absolutely. Yeah. Yeah. So is the focus on prevention that you saw what led you to develop your private practice, intercommunity health? Yes and no. So my practice, intercommunity health, It started back in actually in COVID. So it was a virtual practice. And so I was working while in COVID as an employed psychiatrist, as well as now self-employed doing my virtual practice. And usually during this time, I had a lot of women reaching out because we were all confined and we're like, okay, I can't set these particular boundaries that I thought I had in terms of work and life and children and husband and cooking and now working again. And I had a lot of women reaching out and say, hey, I need some help. I have not navigated this before. And I said, well, let me just open up my schedule and let's just see what this looks like. And it was, again, mostly women. And during that time, also as an employed psychiatrist, I was working in Cleveland Clinic's Women's Mental Health Department. And not necessarily knowing what that was, but I just knew that I was drawn to women that had these life experiences, whether it was pregnancy loss, postpartum, postpartum depression, as well as anxiety, and them really wanting to come to the office and really say, hey, I have a place to go. I have someone that understands me. And also me going through my own particular journey in motherhood really made me gravitate. So just disclosure, when I graduated residency, I was going through my own particular transition. Like, okay, I'm attending now. What's next? Got married during that first year. I lost my grandmother during that first year out of residency, and I had a miscarriage. And so going through all those particular life transitions and not knowing where to turn. So here I am as a psychiatrist telling my clients or patients these coping strategies, what to do, and I'm really not practicing what I'm telling them. So I'm not practicing what I'm preaching. And if I do want to have help or search out that particular individual, I did not know where to go. I knew myself because I need to go to someone that I can receive this information from. I needed to go to someone that I can feel that I can relate to. And that is why I think ultimately, hey, where is this place or how can I develop this space, this place where I as a mother, I as a woman will want to go to and not go to a particular place where it's not conducive to my mental health. Like my provider perhaps doesn't get me. Or like the physical location is kind of like dim and not conducive to my mental health. It's not inviting or giving me aspirations. And so that is what I wanted to create for my women. I wanted to create a space that I know that I would want to go to, that I will feel comfortable. And I know that I'm getting the necessary tools that I know that I needed at that time of my life. Yeah. So you have further specialized in reproductive psychiatry. Can you say more about that specialty? So reproductive psychiatry is basically a specialty in psychiatry where we follow the woman throughout her reproductive cycle. So that can be whether it is challenges with infertility, whether it is miscarriages or even elective or even spontaneous abortions, those who are pregnant or desiring to get pregnant, those who have had their child. And now maybe I going through something that is further than the baby blues Maybe I having some postpartum mood or anxiety symptoms or even psychosis And then also traveling with that woman when you go through menopause or perimenopausal symptoms. So really understanding that we're very complex and we have hormones. We have other challenges as relates to all the many things or people that are pulling on to us. And so just following her throughout her cycle, her journey, just as a woman. And have you found that this reproductive kind of spectrum is where many women actually turn to wanting to have some mental health support? Are there particular challenges that you found that pop up during this period that make somebody more likely to seek out services? I have found that some women or just general population don't know that we exist. And once they find out that we exist, and we are a place where we can really relate to each other. And hey, yes, I'm not sleeping and I'm 45 or I'm close to menopause. Is that something? Yes, we can really think about that. Also having some cognitive or brain fog. Yes, that may be associated with perimenopause. So really educating others and letting them know that we exist and there is help. And so I do say, yes, reproductive the psychiatry, but it's just in general women's mental health. And whatever that means to you, that if we don't have it here, we can provide resources, whether it is for therapy, management groups. So really understanding that we exist and educating the population that this is a specialty in psychiatry. Dr. Mimi, one of the things we talk about on the podcast, and that I feel like lots more women are talking about and getting diagnoses for things like PCOS and endometriosis. And so we know that there's like the medical kind of symptom side, but what are some of the mental health challenges that come up with something like a diagnosis like PCOS? Well, with PCOS, and this is like, as we can just generalize it as some type of ovarian challenge or ovarian failure. And so there's a lot of symptoms that may come with that, whether it's physical symptoms of like acne, excessive hair growth, infertility, or problems conceiving. And so that can really play a part in someone's mental health journey, whether it is self-esteem, whether that is some type of guilt or shame, and just anxiety. If you are family planning, what does that look like for me? And providing that support to the client, as well as providing that support if you're working with your OBGYN, I think is very necessary. Those patients or clients that I have with those particular diagnoses, they deal with the uncertainty. And so that uncertainty of me wanting to have a child, that uncertainty of what are these medications that my OBGYN has put me on, whether it is some type of birth control pill, what type of pill that is, is that going to cause me to have some mood swings? So really supporting that patient through this journey of whatever she chooses. Hey, I'm on this to regulate any type of physical symptoms that I may be experiencing. I'm on this medication to make sure that I'm putting myself in the best chance to conceive or have a family plan. Just knowing that, hey, we see you, we understand what you may be going through. There's some resources here. And it goes far beyond just medications. It can just be, okay, I'm here to listen. I'm here to listen for your concerns. And what are your goals so we can have a treatment plan all together? Hmm. And what is your approach to medication management for somebody who may be struggling with something like anxiety and depression if they are also kind of on a fertility journey? Right. So maybe they are taking fertility medications. What's that approach? so to be honest my ladies come in apprehensive they come in okay i don't know about these medications and i heard about you psychiatrists you guys going to prescribe me these medications and i tell them no it's individualized and i'm going to tell you my recommendations i'm going to also communicate to you that hey this is what i am hearing from you in terms of any impairment whether it is in your sleep, your mood, your appetite, just in any impairment in your quality of life. And my job as a psychiatrist is to let you know your options. And so if you are going on your fertility journey, and I can understand why you are a little bit hesitant of adding another medication, I can say, hey, there is limited research. And that's just the nature of it in terms of you dealing with women of infertility or pregnant women. We have limited research, but there is some out there. But there is some reviews saying that, hey, even if you're on medications like an SSRI, a selective serotonin reuptake inhibitor, and those different parameters in terms of your ability to conceive, it has not shown any particular detrimental effects of you in your inability to conceive while you're going on this journey. But everything is individualized to you. So we have to weigh out all risk and benefits. As a psychiatrist or a medical doctor, I work closely with the OBGYNs to make sure I know all the medications that you're taking. We're doing drug interactions, making sure my stuff is not missing with her stuff. And it's really having that necessary collaborative care to make you feel comfortable and let you know your options. But I'm going to let you know, hey sis, like we need to make sure that you are good because when you do conceive that, hey, we are reducing our particular risk of low birth rate or preterm labor, we're really looking at the risk and benefits for you as well as the baby. It's a team effort and understanding that at the center of the team is you as the client and the patients. So I'm going to tell you my recommendations. The OBGYN is going to tell you her recommendations, and we're going to all work together and make sure you feel heard and seen. You know, another place where this often comes up around, do I take medication? Do I not? Is actually after somebody has given birth, right? And maybe they're breastfeeding. And so there may be still some like anxiety, depression symptoms that medication actually could be really helpful for. But I think a lot of new moms are very concerned, like, oh, is this going to be harmful to the baby. Can you talk a little bit about some of the considerations of taking medication, like when you're breastfeeding? So if we're dealing with like depression or anxiety, my go-to has been Zertuline. And that's just how I have been trained. They have those parameters you look for. Okay. Is this safe in lactation? Yes, it is. How does this work with when I'm pregnant? And do I have to taper off my medications when I get pregnant? Again, it depends on how you are doing and making sure that we're weighing risk and benefits. Have I had clients that have done great on this medication? Oh, you're pregnant. Awesome. How are you feeling? What are your concerns? And Dr. Sanders or Dr. Mimi, I'm good. Keep me on my medication. Okay. I'm going to let you know that we're going to be seeing each other a little bit more frequently. I'm going to be monitoring your mood and sending you all types of screenings to your portal more frequently. And so I'm your extra set of ears and eyes and you tell me how you're feeling, whether it's once a week. So really having that communication. But there's research saying that, hey, staying on this medication is good for you and the baby, especially if you have experienced depression in the past prior to pregnancy. We know that you're at greater risk and we want to make sure that we're making an environment from a pregnancy standpoint, from a postpartum standpoint that is conducive for you and the child. Yeah, yeah. More from our conversation after the break. So in addition to like conversations around medicine, we've already talked a little bit about like unpacking the stigmas that are sometimes related to things like fertility or just kind of I think mental health in general in the black community. What does that look like when you were working with your clients to help them kind of unpack some of these stigmas? So considering that there perhaps would be some type of going on a fertility journey, and depending on how long you've been on it, there can be some issues around your womanhood. And this is what I grew up of wanting to, I'm able to produce. This is how I grew up. People around me, this is what we were made for in terms of women in order to have a child. And if I'm having some type of challenges or barriers, what does that mean for me as a woman? And so I look at that and we challenge those thoughts. We challenge those thoughts and say, okay, what do you believe in terms of your womanhood? And do you know your particular options when it comes to the different types of assisted reproductive technology or fertility treatments? So really leaning into those particular thoughts that you have as a woman, how you define your womanhood, challenging any particular shame, letting you know that you don't have to go through this alone. And if you feel yourself having to hide this or feel is secretive, that here's a place that you can really be vulnerable and have a deeper dive of what that looks like for you going through this journey. And as it relates to taking medication, you taking medication does not mean that you are weak. Does that mean that you need a little bit extra push? No, it just means that, hey, this is the right treatment option for me in this season. And do I have to be on medication for the rest of my life? No. But if you want to, I have patients say, don't touch anything. I'm doing fine. I am operating. I'm living the best quality of life. I really love how I feel. And so it's really looking at that person or the client, making sure that I hear you, I see you, I'm not devaluing your concerns, but I want to educate you as much as possible and let you also challenge any of those false beliefs that you have had about what womanhood means to you and not what the expectations have been placed on you. So, you know, Dr. Mimi, I feel like we've had growing conversations around things like postpartum depression, postpartum anxiety, but what kinds of things do you feel like we still need to talk more about as it relates to the postpartum period in a woman's life? So when we hear postpartum, automatically, I've seen that patients think postpartum depression. And we really are not leaning into postpartum anxiety, which I see more in my clinic is that postpartum anxiety and that separation anxiety that the new mom has with her baby. I also think that we need to lean more into what does me returning to work look like? And what does this new normal look like? And is there options for me to spend more time to bond with my baby? And what does that look like? And so I have had many patients come to me and say, I'm just not ready to return to work. I fear that no one can take care of that baby like I can I feel that I going to miss out on some particular milestones when I at work And then we look at that and say okay what else do you need And so what was your postpartum plan? And have we deviated from that? If so, how are we in terms of our pivot? What are our options? And what are truths? So, yes, you are doing a great job as a mom and you have those particular safety concerns. But is that postpartum anxiety leaning more in terms of obsessiveness and you having to check that monitor a little bit too often? Now you can't take care of yourself and you're not sleeping. We're trying to get the sleep that you can on when the baby is sleeping. So just leaning more into looking into postpartum anxiety and not always thinking that it's postpartum depression. And that postpartum anxiety can lead to secondary depression. But really saying, OK, what is that anxiety? Is it interfering with me taking care of myself, therefore also interfering with me taking care of my baby in the best way I can? What does that separation anxiety look like? And what is realistic plans for me to return to work? And if I'm not ready, how can I have that conversation with my physicians or with your psychiatrist so we can have a really good plan for you and the child? So, you know, Dr. Mimi, if something is just normal, kind of especially for first time moms, right? Like, how is it different? How is just regular new mom anxiety? Like, oh, my gosh, what do I do? How do I take care of this baby? How do you know when it is crossed the line to be something that might meet criteria for anxiety and that you might need to talk with someone about it? So I asked them to give me a time period. So let's just say, OK, I'm anxious about your baby's safety. And so I ask you, well, how many times are you checking that monitor and when are you checking it? and some patients will say, I'm not even checking the monitor. I'm sleeping outside the door. Or I said, well, have we interviewed, do a daycare? Have we interviewed any particular nannies? They have this idea of the baby can come with them. She can't leave them and go to Target with her mother, which she knows is a safe person. And so I'm asking them, okay, how are you maneuvering through life? And how many hours of the day are you having to obsess over the safety, your concerns for your child? And I look at that and say, okay, out of a 24-hour period, you're spending, let's just say, this 12 hours plus really focusing on, hey, what if I did not bathe the baby right? What if they did not shake up the bottle this many times at that feeding? So just really looking into those particular thoughts and say, okay, are they rational? Were you thinking like this prior to pregnancy? And so just really having that good interview with the mom and just debunking those particular myths of no one can take care of the baby like you can. Granted, you are that child's mom and you have that particular bonding, but also you know that you have to have some support and knowing that, hey, I can trust my partner. I can trust any other family supports around me so I can take care of myself. Are you showering? Are you feeding yourself? Are you really taking care of yourself? And has those things gone neglected because of you obsessing or being very anxious about your child? So we really take a deeper dive of like, what does this look like? And is this okay? Is this rational for you? And so I'll find my lady saying, no, I should be able to not sleep outside the door. Or I should be able to leave my baby with my mom in order for me to go get me a cup of soup or something. So it's just really listening to her and allow herself to listen to her own thoughts and challenging and facilitating the challenging of those thoughts. So but really, again, lean into that postpartum anxiety, that separation, that guilt of, hey, I'm going to miss every milestone if I do return to work. No, no, you're not. You are engaged in your child's development and you will know and you will be able to experience those things. But we are not devaluing how you're feeling. We just want to make sure that you're taking care of yourself. You mentioned the baby monitor and I feel like technology has evolved so much beyond monitors. Right. So now there's a little sock the baby can wear. There's something you can put under their mattress. How do you feel about these tools? Like, do you feel like they're actually helping moms and parents to kind of manage anxiety? Or do you feel like in some ways they can kind of increase the anxiety? In some ways it's increasing it because now you have different parameters that you're trying to make sure that you're staying within. It's just a lot of noises and dings and notifications are going out. And so imagine if you're already anxious and your hormones are already all over the place. And now you're having all these apps and notifications come on your phone. And so I would tell them, hey, let's just turn off too. Let's turn it off. And then, okay, how are we feeling? We feel okay? Was baby girl, baby boy okay? Yes. We can still watch the monitor. And if you're at daycare, yes, zoom in and let me see what you guys are doing over there. But we have to make sure that we are not exacerbating our anxiety with all these developments in technology, but still understanding that, yeah, especially with first-time moms. Like, this is my first baby. I've gone through this particular journey to have this child. And so I value that. I see that. But we have to make sure, again, how are you, mom? Because we cannot neglect ourselves because we have someone else that kind of come into the picture. We also lean into your support. So instead of those notifications, if you are fortunate enough to have that family support, lead into that instead of, you know, the technology and notifications. So speaking of support, like what kinds of things would you say to partners and other family members about how to support somebody who is kind of in the postpartum period and maybe how to recognize like when they need to escalate and talk to somebody else? I recently did a recertification in my perinatal mental health class, and we talked about a postpartum plan and sharing that plan, of course, with your supports prior to the birth of the baby. And during that conversation or during that dialogue with your support, letting them know and also being educated as the patient of what this does look like if I am having some type of irritability, mood, anxiousness. And so if I do start to exhibit some of those particular signs and symptoms, then this is how I wish for you to communicate to me about what you see. And I'm very open for you to communicate that to me. Because once I give birth, I know that I'm going to have some fluctuations in my mood, some fluctuations due to my hormones. And so I may not be able to recognize that within myself. So during my postpartum plan that I'm doing pre-baby, I really need you to let me know how I'm doing. Encourage me to take care of myself. Make sure that I have meals because my focus will be whether it is breastfeeding or feeding that baby. So make sure that you're taking care of me as I'm trying my best to take care of my newborn. So having that conversation pre-baby, setting a postpartum plan with your family members of that loved one or that partner, I think will be very, very helpful. And then also, hey, if I get to a point where I'm unable to receive from you, who's backup? Who's your backup that can communicate to me? And also making sure that you, if it is my partner, how are you going through this process? And I don't want you to neglect your needs, partner. So you make sure that you have your own particular support. So having a postpartum plan pre-baby, I thought it was a very good advice that they were giving us to tell our clients. Let's develop it, but also not be so rigid that we have to stick to it. And so we know areas where we can pivot, but hey, please let me know if I am not having the quality of life that you know that I should have. So making sure my basics, my eating, my social connectivity, my sleeping. So help me out because we're not going to get the sleep that we did, but what does this look like now for me to make sure as I have gone through this experience of giving birth, making sure that I am sleeping good. And then again, well, you're not exercising, but when I can, and if that's something that I used to like to do, encourage me because that also has its added benefits. Are there any resources in particular that you know of Dr. Mimi that are specifically for men to support the women in their lives around reproductive psychiatry? So there's a website and it's Postpartum Support International. And so on that website, it has different tabs. And it's also, they have support groups for partners that you can kind of put in your zip code, figure out where you could go, whether, and also if it is virtual for your partners and they can have male groups and then also other partner relationship groups. groups. And I believe that was a really good website. And also on that website, it's a directory for those who are reproductive psychiatrists or how to find a provider. And so that is kind of a website that I give my clients. If you're looking for support groups, if you're looking for other providers, therapists, other psychiatrists, just other resources when you're going through this perinatal journey. Thank you for that. More from our conversation after the break. So earlier in our conversation, you talked a little bit about, you know, we spent a lot of time talking about like the fertility journey, postpartum, kind of pre postpartum, but also perimenopause and menopause, right, is another part of the cycle that women go through. You mentioned like brain fog and like some cognitive concerns. What are some of the particular mental health kinds of symptoms that we see kind of in this perimenopause menopause stage? Well, and just self-disclosure, like I'm freezing the whole house out in terms of hot flashes, insomnia, brain fog. So the mental health, it could just be mood swings because your hormones are literally swinging. They're decreasing. And so mood swings, irritability, low libido, and also just physical symptoms of whether it is vaginal dryness that can also contribute to your low libido. So just for perimenopause or just going through menopause, look it out for those symptoms of, yes, you hear hot and cold flashes, but also that cognitive slowing or that brain fog. Hey, I'm not as quick as I used to. Okay, just give me some time. But mood swings, that irritability and that snappiness, sometimes it can lead to depression. So again it different for ladies all ladies So also you can ask if you have a mom that you able to ask okay when did you go through this How was your experience Because it may be similar to hers And so you can be on the lookout of those particular symptoms but mood symptoms of just anxiety depression irritability just some type of what we call lability in your mood not knowing how I feeling and also just I'm not sleeping as well as I used to. And what are my particular options? And I do, of course, work with the OBGYNs about this. So I leave the hormone replacement to them if they choose to go that route. And if not, we still have medications from my standpoint as relates to depression or anxiety, as well as we have medications from a psychiatry standpoint for hot flashes. So there are options and we work together. And if you are on hormone replacement therapy, your OBGYN can do that. And so you may not need as much as medications on my end for those hot flashes, for that irritability, because now you have that replacement from a hormonal standpoint. So I would imagine that all of this is kind of connected, but how do you distinguish between like anxiety and depression symptoms that may be related to perimenopause versus something that is just like maybe a generalized anxiety disorder or major depressive disorder? Or does it even matter? I would say it matters, but then it doesn't, Dr. Joy. Because the way that you would know if it's hormonal, okay, you're getting your levels checked. And if you want to elect to go to hormone replacement, okay. But it doesn't really matter because we're going to treat it the same way from my standpoint. So if you're having some depression, you're having some anxiety, you're having some insomnia, if it was not for your hormones and it was like more of a, I guess, organic type of depression or anxiety, then I'm still going to give you your treatment recommendations of, hey, this is what you can use for medications. You can use a venlafaxine. We can use a paroxetine for these symptoms. So it really doesn't matter because I'm going to treat it the same way. But if you really want the root cause, let's get some of your hormone levels. And if you elect to go this way in terms of hormone replacement therapy, you can. And if you don't, then we can lean into my medications. But if you elect to do both, we can do both. So it kind of doesn't matter. It's all connected. It's biological. It's psychological. It's got social aspects. So it's like a biopsychosocial treatment plan that we all just have to agree on and just know that, hey, we are working on your team and we want to make sure that you are living your life the way that you want to and it's the best quality. Yeah. In all stages. Right. So what would you say to a sister, Dr. Meeby, who might be listening to us and, you know, maybe she's in her 40s or 50s and feels like her mental health is kind of steadily unraveling. What kinds of things would you say to her and where should she start? I would say go see someone, okay? If you have any particular barriers from a mental standpoint saying, hey, I don't want to go see anybody. I don't want to tell anybody my business. I don't want to feel like I need some help in my emotional well-being. It just makes me feel kind of weak. Just try your best to push through it because that's the hardest part. And once you get to that person or you get to that person that you vibe with and you can really kind of say, OK, this is what I'm going through. I do feel like I'm unraveling. I mean, my mid 40s, my 50s. I know things are off. What do you got for me? And really educating yourself on your options, educating yourself on, hey, there are resources. I don't have to be on medication. I just may need someone to talk to and help me through this particular transition in my life. We have never been this particular age before. And so really giving yourself that grace and saying, hey, I may not have needed that help when I was 30. However, I have gone through a lot of things between 30 and 45. I have gone through a lot of season changes, a lot of transitions, and perhaps my resilience is not as much as it used to be. And that's okay. It does not make me weak. It makes me know that I need to lean into some support that now I know I have resources. Yeah. Any tips for advocating yourself with medical professionals? It's funny that you ask. I recently told one of my clients, I said, hey, go back to that OBGYN and let her know that you want some birth control. And so she was a patient that married, has been married for several years, but they just wasn't not at a stage where they wanted to have children. And going to see her OBGYN, she didn't bring up the fact that she wanted to be on birth control and provider didn't either because the provider automatically assumed you're married, you're in your career, you have this particular support. Why wouldn't you want to have children? And so we really had to work on that conversation in our sessions and say, no, you can really advocate for yourself and just say, hey, no, please tell me more about my birth control options. Tell me more because right now I want to do proper family planning for me. And it wasn't any particular knock for that provider. It was just maybe it was some implicit bias of like, hey, I just thought that she wanted to have children. She's married. She has this particular setup that I think, you know, is beneficial for bringing in a child. But really her and myself and the patient really having those role playing type of discussions in session and saying, no, I want to know my options. Also, I want to know if I want to be on a monophasic or triphasic birth control pill. And so we're really knowing and educating ourselves about options and making sure that we are telling our providers what you desire and advocating and showing up for yourself and having that voice. And so I'm just the one in the background, just kind of just pushing. OK, talk to her. So, yeah, my patient, she got on her birth control. She is fine. She said, OK, I feel so I'm so less anxious. I'm so less anxious. Yeah, that's a really great suggestion. You know, role playing, right? Like how can you role play with a trusted other person? What kinds of conversations you might need to have with your primary care doctor or OBGYN or whoever? Yes. Yeah. Any other resources or affirmations that you find yourself kind of using in your practice? In my practice, I'm a psychiatrist, but I do. I said do a little sprinkle of adult psychotherapy within my sessions for each of my clients. And so I do lean in, especially with my very busy ladies and just those basic skills of mindfulness and just slowing down and practicing stillness. And so we really do those mindful exercises of just, hey, you don't have to eat at your desk at work. You could actually go to the break room and you could actually eat mindfully in the break room away from your computer. And those mindful are just those breathing exercises. So just really slowing down because we are in, I think, an anxious society because everything is so fast. It's all at you at once. And so just taking those moments to do that mindful exercise where it's eating, whether it is breathing, when we're trying to go to sleep and we're having some issues, do those progressive muscle relaxations. So just really slowing down your movement, slowing down your mind so you really can practice being in that present moment. And so I often give out mindful or DVT exercises to my patients throughout the portal and just challenging those negative thought patterns and changing our perspectives. And again, advocating for yourself in those conversations. Hey, what do you truly desire? Because we often do a lot of things for other people. hey, we are perhaps at an age now where we have poured out enough and let's sit back and let's be mindful and let's allow other support into us. But also let's teach them how we desire to be poured into. Yeah. So where can we stay connected with you, Dr. Mimi? What is your website as well as any social media channels you'd like to share? Yes. So my practice is intercommunity health. So it's I-N-N-E-R, community health, and that's intercommunityhealth.com. And you can find all information there, resources. Also, if you are a healthcare provider and you are looking for reproductive psychiatrists, nurse practitioners, therapists, we have that in-house at our practice, and you can actually click on referral, and we'll make sure that we can provide those services for your clients. We see patients or clients in Georgia, Virginia, Maryland, and Ohio. And of course, we see those who are not in Georgia virtually. But my social media handles are drmimi.care, so drmimi.care on all social platforms. But yeah, and you can also just call the practice and get with our concierge or our office manager. And that is 800-620-6950. So we just really want to be a place where this is, yes, for women, but it is just for that total person to provide that spectrum of care from whether it's individualized to group therapies, also to intensive outpatient programming that we are going to start this coming of late summer. So we're excited about that. And that's going to have a heavy focus on those that have just reproductive issues. And also, hey, we're showing active treatment. So if you do need that particular time off, then hey, this is a place where I can really get those coping strategies, those coping skills, and also be under a physician's care. So we're just excited about how we're scaling and growing and just be in that place, again, that I desire during my life transitions. thank you so much for that Dr. Mimi we should include all of that in the show notes I'm so happy Dr. Sanders was able to join us for today's episode to learn more about her and her work be sure to visit the show notes at therapyforblackgirls.com session 450 and don't forget to text this episode to two of your girls right now and tell them to check it out did you know that you could leave us a voicemail with your questions or suggestions for the podcast if you have books you'd like us to review or movies you'd like to suggest drop us a message at memo.fm slash therapy for black girls and let us know what's on your mind we just might feature it on the podcast if you're looking for a therapist in your area visit our therapist directory at therapy for black girls.com slash directory don't forget to follow us on instagram at therapy for black girls and make sure to join us in our patreon community for exclusive updates behind-the-scenes content, and much more. You can join us at community.therapyforblackgirls.com. This episode was produced by Elise Ellis, Inde Chubu, and Tyree Rush. Editing was done by Denison Bradford. Thank y'all so much for joining me again this week. I look forward to continuing this conversation with you all real soon. Take good care. This is an iHeart Podcast. Guaranteed human. Thank you.