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Catherine: When I met Dr. Lauren Osborne, she told me that she probably had the most unusual career trajectory of any of the physicians that we'd speak to for this podcast, which is a lofty statement, I know. But it's true. She was a book publisher for the first half of her career, and it wasn't until she was forty years old, with three children at home, that she decided to go to med school at Weill Cornell Medicine. When I asked her why she did this, she explained that complications she’d experienced during her pregnancy with her eldest son reinvigorated an interest in science and medicine that she'd always had, and it led her to pursue a career in reproductive health. And thank god she did, because today, Dr. Lauren Osborne is a reproductive psychiatrist who is pioneering research into the origins of perinatal mood and anxiety disorders and challenging the field of medicine to take woman's reproductive health seriously.
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I'm Catherine Price and this is Advances in Care. Today, my conversation with Dr. Lauren Osborne, the Vice Chair for Clinical Research in the Department of Obstetrics and Gynecology at NewYork-Presbyterian/Weill Cornell Medicine.
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Catherine: Thank you, first of all for making the time to speak with me this morning.
Lauren: Of course.
Catherine: Normally I wouldn't start an interview by actually asking the person where they were born, but I'm wondering where were you born?
Lauren: I was born at New York Hospital before, before it became New York Presbyterian. I was born, um, at what's now the Weill Cornell Campus of New York Hospital. And every day when I go into work, you know, my, my office is in the building that has the sign on the outside that says Lying-In Hospital, established AD 1799 or something. And I'm pretty sure I was probably born in that building, so it's, it's fascinating.
Catherine: That is really funny. I also was born at New York Presbyterian, but on 68th Street, so, but that's amazing. So
Lauren: Yeah.
Catherine: So I know that you have a lot of specific focus on depression and anxiety
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in the perinatal period, so can you tell me a bit about how prevalent that is as a problem?
Lauren: It's a huge problem. I would say the exact numbers aren't known because we're so bad at detecting it, and treating it, but roughly somewhere between 10 and 20% of women across the perinatal period will experience some kind of perinatal mood or anxiety disorder.
Catherine: Wow, that's really crazy to think about.
Lauren: Mm-hmm. It is, it is.
Catherine: Okay.
Lauren: It's an overwhelming number of people.
Catherine: Yeah. That's… So that leads me to my next question, which is why have we not been taking this seriously if it's affecting between 10 to 20 percent of women in the United States alone?
Lauren: Yeah. That is such a good question and I think there's a couple of reasons that have to do with culture, um, and sexism and the way our healthcare system is set up. I think of depression and anxiety in pregnancy as a morbidity of pregnancy, just as preeclampsia, gestational diabetes, preterm birth. Those are the things we think of as pregnancy morbidities,
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but I think perinatal mood and anxiety disorders are in that category too. So I think part of the reason is that we have created this myth around motherhood that we need to be pure and self-sacrifice for our children, right? And so, you know, there are these books out there to prepare people for pregnancy that make a big deal out of ‘you shouldn't eat refined sugar and you can't have soft cheeses’ and all of these things. And I think it, it creates this culture of women thinking, ‘I can't put anything in my body or go on medication during pregnancy, I have to sacrifice anything for myself for the sake of the child.’ We have overwhelming evidence now that most of the antidepressant medications we have are compatible with pregnancy. And yet my anxious patients were too anxious to take advantage of that. And what we actually know is that not treating mental illness during pregnancy is actually worse for the child than treating it. And I think that message hasn't gotten through.
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So I think that's part of it, is that culture. You know, all of our pregnancy and postpartum care is done by obstetricians, but there's no training for either psychiatrists or obstetricians in reproductive psychiatry.
Catherine: Wow.
Lauren: It's not required in either residency, so there isn't really anybody who's, who's trained to pick up on these things.
Catherine: That's, that's amazing, and not in a good way,
Lauren: Yeah.
Catherine: Like it's 2023 and women have been all around for a really long time.
Lauren: Women have been around for a really long time in a men's world, right? And this field of reproductive psychiatry is a very new field. Not that the concepts are new, right? We had, we've, we've had identified cases of, of perinatal psychiatric illness as far back as Hippocrates. There was a wonderful, um, French neurologist in the 19th century with whom I am a little obsessed, who wrote the first treatise on, uh, you know, identifying, characterizing, um, women at times of reproductive transition. His book was called something like,
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“Of the madness of women who are pregnant or lactating.” And it, it's, it's a great, it’s a great little thing.
Catherine: Oh my god, right.
Lauren: But, but we've had those glimmers, but the field of reproductive psychiatry has really been a field that has exploded in the last 20 years, partly because we've had an explosion of women going to medical school, women getting interested in these things. So I think that's, I think that's part of it. And you know, I remember when I was deciding to do a psychiatry residency, one of the reasons that I thought this was the field for me is that there's so much that we don't know and that the recent advent of things like brain imaging and a bunch of other scientific techniques have suddenly opened up this field for research that maybe can get us some answers and I, and I think it's still, you know, it's, it's not a high prestige field within medicine, right? I remember when I was preparing to go to medical school and I talked with a friend of mine who had also made a decision later in life to go to medical school.
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And I said I was gonna get involved in doing some contraception and abortion research, and my friend looked at me, he said, ‘well, why would you wanna do that? That's not gonna get you into med school.’ And I'm like, ‘but it's interesting…’
Catherine: Right. Wow.
Lauren: Um, so this is not a, a high prestige area of medicine, and I think it's not a high prestige area because it's about women's bodies, and that's not something that traditionally we've cared about. I mean, for example, for other psychiatrists, most people, if they have a woman present in her forties or fifties with anxiety or depressive symptoms, they don't even ask about her reproductive cycles, and I, I don't see how you cannot, but it's just not part of our training.
Catherine: Wow. Wow. I wanna ask you about, um, how you got interested personally in the connection between perinatal depression and anxiety and inflammation.
Lauren: Yeah. I, I would say going into residency, I had an intellectual curiosity about the immune system but it wasn't very well formed. It was just, oh, the immune system's kind of interesting and kind of cool, right? And then I, I did my residency up at, up at Columbia,
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and I had the great fortune to spend my fourth year in an elective year doing their women's mental health fellowship with Betsy Fiddleson, who's the amazing director of the women's program at Columbia and I had my own cases assigned to me who were all reproductive psychiatry cases, all pregnant and postpartum women, with mental illness. And I happened to get a cluster of cases who all had something going awry with their immune system. So I had four patients all around the same time, all of whom had, um, either an immune abnormality or some kind of physical health symptom that was causing disruption in their immune system. And they all presented with relatively similar symptoms of really severe anxiety, some depressive symptoms. But what was more compelling to me was the anxiety so that just really interested me that there seemed to be this clinical phenotype and again, it was only four women, but I happened to have them all at the same time and it, so it got me curious about what is going on with the immune system
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and women who present with these severe anxiety and some depressive symptoms in pregnancy, and could there be a biological link there?
Catherine: Hmm. Well, it's really interesting to think that that cannot have been the first time in the history of that particular program that there had been women in there with the similar symptoms and similar kind of preexisting conditions, but that you were one of the first people to notice and follow up on that. So I'm wondering if you can tell me a bit more about what you did next in order to start trying to unravel the mystery of what was happening.
Lauren: Yeah, absolutely. And I think, you know, I think the reason it sort of came together for me in that moment was that I was predisposed to be thinking about a biological connection. When I encountered patients, I was always thinking about what's the biology behind it, as opposed to somebody who came from a different background, who might have encountered those four women and thought, well, what, what went on in their childhood that disposed them to these kinds of symptoms? So there'd just be a different, a different sort of angle to it. But what I did in response to it was I, I had those, um, those four patients
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and said, you know, ‘I really wanna have a better understanding of what's going on with the immune system and perinatal anxiety and depression.’ So I looked at all of the literature that currently existed about the immune system and perinatal depression and anxiety. And we wrote this literature review and said, ‘okay, here's what we know. Here's what we need to find out.’ And that was kind of the spark that got me going. And I have to say, one of the things that came out of that, the most important thing that came out of that was that I read a paper in my preparation for that, uh, that had been done by a group at Mount Sinai. It had nothing to do with depression and anxiety, but it was about, um, immune responses to influenza vaccine during pregnancy. And I happened to know one of the researchers and I called her up and I said, ‘this is a really interesting paper, I'm trying to learn about this topic.’ And she knew that I was a psychiatrist. And she said, ‘we have all these depression anxiety measures in that study, but we didn't do anything with them.’ And so she very generously said,
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‘you wanna look at the data, go for it.’ And uh, and that became the project I worked on during my research fellowship.
Catherine: So what, what did you find when you looked into the data on the influenza vaccine?
Lauren: Yeah, so it was, it was really interesting. These were patients who did not have diagnosed mood or anxiety disorders, so they were people from the general population. They were from a low income, probably highly-stressed population, so we expected there would be some symptoms, but there was nobody with known mental health conditions. And what we found was that in this population, women who had higher depressive or anxious symptoms had what I called then a, a, an innate immune burst at the third trimester. So we saw that the women with high and low symptoms, their, peripheral cytokines, which was how we were measuring immune function, in the beginning of the pregnancy, they weren't very different depending on whether you were high or low symptoms, but once you hit the third trimester, there was this burst of pro-inflammatory cytokines
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in the women who were more depressed or more anxious, and we didn't have that burst in the people without symptoms. And that stayed elevated through six weeks postpartum. And we actually had data from six months postpartum, and it wasn't even quite back to normal at six months postpartum. So that led me to think that, that inflammation, or at least immune dysregulation seemed to be associated with higher depressive and anxiety symptoms. And again, it was in a non-clinical population. But that got me thinking about, well, what if we designed a study to look at this in people who had clinical levels of anxiety symptoms?
Catherine: Hmm.
Lauren: So that led me down this path where I blithely assumed that this meant that all women with depression and anxiety had elevated inflammation.
Catherine: Okay.
Lauren: And I designed a study, um, to look at this exact, this exact same question, immune function across pregnancy and postpartum, but in two carefully selected groups: people with high symptoms of, you know, high clinically significant symptoms of anxiety and people who didn't have any anxiety.
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Um, and I was very clear that I wanted to study with anxiety alone because those were the patients that I had so much difficulty treating. My depressed patients would take the medications I gave them. My anxious patients were too anxious to do it, and so my, the whole driving for the, the kind of research I do is I wanna figure out what's going on. So maybe we can design treatments that are more acceptable to those women to take.
Catherine: I see. So walk me through that study -- what were you measuring?
Lauren: I looked not only at those peripheral cytokines, but I also wanted to look a little deeper into the immune system because peripheral cytokines are just floating around in your blood and there are lots of things that could affect them, so they may not be the best marker of what's actually going on in the brain.
Catherine: Okay.
Lauren: So we also looked at immune cells and what, whether the population of immune cells changed across pregnancy and postpartum. And I discovered a couple of interesting things. First of all, I discovered that really thinking about the population that you're studying makes a big difference.
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The population I had in the Mount Sinai data was largely Black and Hispanic. They did not have known psychiatric illness. By contrast, the population that I recruited in Baltimore, was a largely White and a population where about half of them had significant psychiatric illness. And I discovered a completely different immune pattern than what I had in the Mount Sinai group, which was fascinating.
Catherine: What was the difference?
Lauren: Um, so the difference was that in this, in the population in Baltimore, I actually found more immune suppression during pregnancy rather than that activation at the third trimester, and so that was really interesting to me. We also looked at these immune cell populations and again, discovered numerous differences between the anxious and less anxious, but not fitting into that clear pattern of saying, oh, it's inflammation. And that study, which just came out last year was the, that was the first time somebody had looked in a longitudinal way at immune cells and cytokines across pregnancy and postpartum in a population with anxiety.
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So it's the very first step in trying to figure out what's going on with this immune dysregulation.
Catherine: Wow and in that research, what were some of your conclusions and also what did it make you continue to wonder?
Lauren: Oh, it made me to continue to wonder so many things. Um, the major things that we found were that we saw different patterns, right? So that, for example, cytotoxic T-cells: those levels in women with anxiety were elevated during pregnancy, and those things shouldn't be elevated during pregnancy, right?
Catherine: Uh huh.
Lauren: They, they, those are the things that we're trying to damp down, so as not to kill the fetus. So in our, in our women with anxiety, they were elevated during pregnancy and then in the weeks following childbirth, they came down. In women without anxiety, the level of those cytotoxic T-cells declined in pregnancy and then continued to decline after birth. So that's a very different pattern, right? We also noticed that those pro-inflammatory cytokines, as I mentioned
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in the women with anxiety, were suppressed during pregnancy and then rose after childbirth, while healthy women exhibited the opposite pattern. So it's not enough information for us to say, ‘oh, we have figured out that there's this thing broken in the immune system and we can treat it and fix it,’ but it's enough to show that we're seeing different patterns across time when women have psychiatric symptoms and when they don't. And we need to do more research to figure out which is the chicken and which is the egg, and then to design treatments that will affect that. There are a lot of treatments, for example, non-pharmacologic treatments that work on, um, on inflammation. But if inflammation isn't the cause, but rather immune dysregulation, are those the treatments we need? We need more research to figure that out.
Catherine: Wow, so that must have been so satisfying to get this data back and realize that way back when you were doing your fellowship and saw those four patients with high inflammation -- and you had this hunch that their anxiety might be tied with their immune response - that you were actually right!
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So I’m wondering, moving on a bit, if you can tell me a bit about what I heard is your favorite hormone, which I believe is allopregnanolone.
Lauren: Excellent, excellent job. So the reason we're so interested in allopregnanolone is that it is, um, an allosteric modulator of the GABA A receptor. GABA is the major inhibitory neurotransmitter and that's the receptor that is responsible for calming anxiolytic effects, and we have 20 years of basic science research looking at the role of allopregnanolone in mood and anxiety disorders showing that in a lot of people, for example, with chronic depression, allopregnanolone is lower in those people than it is in people without chronic depression.
Catherine: And that’s true for men and women?
Lauren: For men and women, and then there's been a lot of work looking at allopregnanolone in perinatal mood and anxiety disorders. It's a natural thing to look at because progesterone and its products change drastically across the menstrual cycle and change
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even more drastically across pregnancy and postpartum. There are lots and lots of studies that have not found anything in terms of differences when you look at estrogen and progesterone and women who suffer illness across pregnancy and postpartum, but there is compelling data that there's something awry with allopregnanolone and some of the other metabolic products of progesterone. What that something awry is, is complicated because allopregnanolone most likely acts in a sort of inverted, U-shaped curve so that if you have really low levels of allopregnanolone, that's bad. If you have really high levels, that's bad, and there's a kind of sweet spot in the middle.
Catherine: How did allopregnanolone become your favorite hormone, personally?
Lauren: Okay, so, um, so when I was designing that study I mentioned before, uh, on the immune system, um, I got interested in doing my research to prepare for that study. I was thinking, okay, well what if there is immune dysregulation in these women with anxiety?
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Why? Why would there be immune dysregulation? And I thought of two other systems in the body that are closely linked to the immune system that might also be changing across pregnancy and postpartum. One system is stress reactivity. The other system was allopregnanolone, and the reason I thought of that is that we know that there's literature shows when allopregnanolone is low, inflammation is high and vice versa because the two can affect each other. And so when I designed the study, I said, ‘Well, what I'm really interested in is the immune system, but let me collect blood and also look at these other two systems to see how they relate to each other.’ I had a wonderful mentor at Johns Hopkins, Dr. Jennifer Payne, who had some blood left over from her K award and she said, ‘Do you wanna do something with it?’
Catherine: I love that you guys just have, like, blood lying around. You're like, Hey, you wanna take some of this?
Lauren: Yeah!
Catherine: Like, check it out.
Lauren: Well, well, and I think, I think it's actually a really important lesson about how collaborative this field of research is
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that, you know, it's precious to get those samples. It's hard to do this research and we have to make use of the samples we have to try to get the answers. So she had this blood sitting around and she hadn't had the funding to run additional samples beyond what she had done with her, her own original study, and so we decided to look at allopregnanolone in that blood leftover from her, her K award. And what we discovered by looking at that was that in that population, the lower your allopregnanolone level was in your second trimester, the greater your chances of developing postpartum depression in this high-risk sample. And so for every additional nanogram per milliliter of allo in your second trimester, you reduced your odds of developing, um, postpartum depression by 63%.
Catherine: What?!
Lauren: So that's a lot, right?
Catherine: Yeah, that sounds like a lot.
Lauren: Yeah. But it's clearly not something that's ha, that's immediate, right? Second trimester allopregnanolone. Postpartum depression.
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That's, that's a long ways away from the second trimester. And so that study just showed that correlation in this particular high risk sample, and clearly there's so many links in the chain in between. The immune system may be one of those links in the chain, right? The other link in the chain is that GABA receptor itself, and the reason for that is that we know that as the, as allopregnanolone changes across pregnancy and postpartum, as progesterone goes way up and then comes way down, those levels of allopregnanolone and other neuroactive steroids, other molecules in that class, they actually affect the way the GABA receptor itself is configured. So it's a receptor that has five subunits and which subunits go into that confirmation change across pregnancy and postpartum, so the levels of the neuroactive steroids affect that plasticity of the receptor. So maybe that link in the chain has to do with the receptor itself.
Catherine: That's fascinating. I understand why obviously you would wanna really understand the mechanisms
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why, like, why there might be this correlation but it also seems like there's a real value in just knowing that there's a very strong correlation.
Lauren: Yeah, so, I think there are two reasons that we do this kind of work. One is, can we develop a risk prediction tool? And the other is, can we develop new treatments, right? And so in terms of a risk prediction tool, it doesn't really matter if we understand the mechanism, right? If we find something that we can use a blood test in pregnancy and predict who's gonna develop postpartum depression, that would be huge, right? If we could draw a little blood or even saliva–some of these things work on saliva– and predict who's going to develop postpartum depression that would allow us to do a much better job identifying and treating people. Right now, we succeed in identifying and treating to remission only about 3% of the women who have postpartum depression.
Catherine: Wow.
Lauren: Which is shockingly bad, right?
Catherine: That’s pretty bad
Lauren: Yeah. And I mean, we identify more than 3% and we treat more than 3%, but identify, treat, and treat to remission
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– it's only about 3%. So we have to do a better job, and if we could have a blood test that would help us predict who's at risk, we have very few resources to put at this, and this would allow us to put those resources where they're needed. So I think that's one thing, and we don't need to understand the exact mechanism for that. But the other thing is thinking about treatments and going back to those four patients I had who none of them was willing to go on medication during pregnancy. They're not acceptable to a lot of women in this culture of “I don't put anything in my body during pregnancy,” right? So are there other medications or other non medications? Are there non-pharmacologic interventions that we can develop that do tackle the mechanism and that may be more acceptable to women.
Catherine: So speaking of treatments, am I right that there's actually finally an FDA-approved treatment for postpartum depression? Tell me about that.
Lauren: Absolutely. So, um, so Zulresso is the trade name for Brexanalone. Brexanalone being a synthetic version of my favorite hormone allopregnanolone,
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and the development of this drug was exciting, I think for two reasons: One, we've never had the FDA approve a drug for postpartum depression with that indication. So having that happen, that's a political victory, for those of us who believe that postpartum depression and other perinatal mood and anxiety disorders aren't necessarily the same beast as depression and anxiety disorders that happen at other times. I also consider it a scientific victory because of this 20 years of basic science research I mentioned that had showed that allopregnanolone was involved in the mechanism of mood and anxiety disorders, and particularly there seemed to be involvement at times of reproductive transition. I mean, I think that it's, it's something that everybody in the field was sort of, you know, hanging onto and we all sort of had, I think we had a group text that, that on the day of approval that went around with bells and whistles to say, ‘wow, you know, it, it's here, it's here, it happened.’ Um, and then we immediately started the process of trying to get permission
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to administer the drug on our inpatient units there. It was, um, yeah, definitely an exciting moment.
Catherine: I'm imagining the emojis you might use to celebrate, you know, like, or like sent with fireworks, but like, what's the allopregnanolone, like emoji.
Lauren: I thought about, um, going to Etsy and getting little necklaces made up with the molecule, like the allopregnanolone molecule. I didn't do it, but I thought about it.
Catherine: And then it's like a conversation starter at conferences…
Lauren: Yeah.
Catherine: You know, or it's like a little signal that you're all in the same kind of club. Maybe they have blood for you to use. You know, it's like, this is an idea.
Lauren: It is definitely an idea.
Catherine: Okay so... you've done all this incredible work to begin to actually understand what’s going on biologically with perinatal anxiety and depression. What do you plan on looking at next?
Lauren: That actually brings me to the point where I am in my research right now, which is that I have published on, remember I said there were those three systems connected, the immune system, allopregnanolone and stress reactivity. And actually just today I published a paper on the stress reactivity piece of it, and so I've now published separately
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on the allopregnanolone piece, the immune piece, the stress reactivity piece, and the next step is putting them all together, right? Putting that all together and saying, do the women who have dysregulation in the allopregnanolone system, are they also having dysregulation in the immune system? And if we look at them, not by anxiety, but by that biological dysregulation, can we see that something is tied in with their anxiety symptoms? And so that's the next step I have one of my, one of my postdocs is, is working on starting the data analysis for that right now.
Catherine: Wow, and so this is the first time that this type of analysis has been done in this area?
Lauren: I think it is. I think it is.
Catherine: Wow. What do you think needs to happen to move the needle further? What are you looking forward to in this area of research?
Lauren: Yeah, I mean, I think a couple of things need to happen. I think I'm, it's exciting that we're in a moment where there is more funding than there has been in the past for this kind of research, and that's, uh, that's a great recognition, but there still aren't enough people doing it
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for us to be able to move it forward. I just submitted a grant right now, and one of the things you do when your grants are submitted is you obsessively look at the roster of who the reviewers were the last time this panel met and there are very few reproductive psychiatrists with clinical research expertise who are in that pool of reviewers at the NIH. So every time I submit a grant, I think, is there somebody with the appropriate expertise who's really gonna be able to, to give good peer review. You know, I still remember my first grant I submitted. Uh, one of the criticisms I got was that ‘you didn't discuss differences between women who [00:30:00] had been pregnant before and had not been pregnant before.’ And I was like, ‘But, uh, yeah, I, of course I did, I talked about parity all over the grant.’ And it was only then that I realized the reviewers didn't know what the word parity meant, because there weren’t enough people with knowledge of this area.
Catherine: Wow.
Lauren: So that’s one thing we have to do, is we have to increase the workforce so that we can appropriately, um, judge this research. And I think one of the, one of those things we have to do to increase the workforce
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is we have to change the way we're training doctors to be. Right now, as I mentioned before, neither psychiatrists nor OBGYNs have to learn anything about reproductive psychiatry. The OBGYN milestones residency milestones do say that obstetricians should be able to recognize perinatal mood and anxiety disorders, but there's no specifics for how to do that, and the psychiatry guidelines don't give any, don't have any requirements at all. And so if we don't expose people to this work, we're not gonna get people interested in it.
Catherine: One question that comes to mind is if you have any ideas for how we can convince more people, first of all, this is an area worth paying attention to, but then also get more men involved so it's not just women.
Lauren: I mean, I think that's a really great point. And in, in our field actually, some of the, many of the pioneers of research in women's mental health were men who were doing it out of a scientific interest at a time when nobody was doing this work. But in the current generation, it's almost all women, and I actually think that that is to our detriment in terms of moving things forward
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because it reinforces the idea that, well, that's a, that's a girly specialty, that's not one that I'm gonna take seriously. And I think it's, it's hard to figure out how to change that. I do think if we incorporate it earlier into education, let's make some exciting courses in the preclinical years in medical school that talk about this science. I mean, this is the coolest thing in the world, that there is a time in life where we can predict the onset of psychiatric illness, and it has to do with these transitions that affect half of our population. How is that not interesting? Right?
Catherine: I think that's a really good point in the sense that, you can't necessarily tell when someone's gonna develop some kind of psychiatric problem, but pregnancy is an area in which you know it's more likely, you have a highly motivated group of people who are probably gonna try to show up at doctor's appointments at regular intervals. It seems like a really perfect group of people to study for this particular subject, so.
Lauren: That's exactly right, and I've actually been really encouraged recently, I've, I've run into, um, a number of young
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research scientists, um, who are men who are really interested in it for exactly that reason, that it's this, it's this moment where we, it's understudied, it's scientifically interesting, and we might be able to figure something out there that then would allow us to
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make progress in other illnesses as well, and so I think, I think there's hope. We just have to move it along.
Catherine: Great. Well, thank you so much for making the time to talk with me today. This was fascinating. I'm so appreciative of all the work that you're doing and the fact that you shared it.
Lauren: Always a pleasure to talk about it. I, I can go on for days and, and I think my family thinks sometimes I do, but, you know…
Catherine: Well, you found a safe space on this podcast, so…
So many thanks to Dr. Lauren Osborne for the incredible conversation. I’m Catherine Price; Advances in Care is a production of NewYork-Presbyterian hospital. As a reminder, the views shared on this podcast solely reflect the expertise and experience of our guests. To find more amazing stories about the pioneering physicians at NewYork-Presbyterian, go to nyp.org/advances.
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