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Welcome to the Clinical
Center Grand Rounds,

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a weekly series of educational
lectures for physicians and

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health care professionals
broadcast from the Clinical

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Center at the National
Institutes of Health in

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Bethesda, MD.

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The NIH Clinical Center is the
world's largest hospital totally

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dedicated to investigational
research and leads the global

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effort in training today's
investigators and discovering

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tomorrow's cures.

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Learn more by visiting us online
at http://clinicalcenter.nih.gov

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I'M PLEASED TO INTRODUCE OUR

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SPEAKER TODAY SAMANTHA MELTZER

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BRODY, MD MPH, INTERNATIONALLY

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RECOGNIZED PHYSICIAN SCIENTIST

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IN PERINATAL DEPRESSION. SHE IS

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ASSAD MEYMANDI DISTINGUISHED

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PROFESSOR AND CHAIR DEPARTMENT

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OF PSYCHIATRY, UNIVERSITY OF

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NORTH CAROLINA OR UNC AT CHAPEL

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HILL AND IS DIRECTING THE UNC

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CENTER FOR WOMEN'S MOOD

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DISORDEDISORDERS. BORN AND RAISN

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CAN TON, OHIO, SHE COMPLETED HER

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BACHELORS DEGREE IN BIOLOGY

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PSYCHO YES AT THE SIMMONS

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COLLEGE BOSS TUNED EARNED

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MEDICAL DEGREE NORTHWESTERN

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UNIVERSITY MEDICAL SCHOOL IN

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CHICAGO, ILLINOIS. SHE PURSUED A

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RESIDENCY IN PSYCHIATRY FROM THE

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DUKE UNIVERSITY MEDICAL CENTER

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AND BECAME CHIEF RESIDENT AT THE

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DURHAM VA MEDICAL CENTER. DR.

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MELTZER BRODY FOUNDED UNC

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PERINATAL PSYCHIATRY PROGRAM IN

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2004 AND BECAME CHAIR IN UNC

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DEPARTMENT OF PSYCHIATRY IN

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OCTOBER 2019. HER WORK FOCUSED

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ON DEVELOPING A INTEGRATED

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CLINICAL AND RESEARCH PROGRAM IN

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WOMEN'S MOOD DISORDERS ACROSS

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THE REPRODUCTIVE CYCLE OF LIFE.

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LIFE CYCLE. SHE HAS INVESTIGATED

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THE EPIDEMIOLOGIC AND BIOLOGICAL

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PREDICTORS OF PERINATAL

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DEPRESSION GENETIC

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NEUROENDOCRINE BIOMARKERS AS

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WELL AS IMPACT OF ADVERSE LIVE

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EVENTS. DR. MELTZER BRODY HAS

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BEEN ACADEMIC PRINCIPLE

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INVESTIGATOR FOR NOVEL CLINICAL

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TRIALS DEVELOPING EFFECTIVE NEW

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PHARMACOLOGIC TREATMENT FOR POST

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PARTEM DEPRESSION CALLED

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BREXANALON (PHONETIC) NOW FDA

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APPROVED. SHE IS CO-PI OF A

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LARGE PATIENT CENTERED OUTCOMES

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RESEARCH INSTITUTE GRANT TO

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STUDY PSYCHOLOGICAL

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INTERVENTIONS INCLUDING TRAINING

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NON-MENTAL HEALTH SPECIALISTS

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FOR PERINATAL DEPRESSION.

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FOUNDER AND LEAD OF THE

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POSTPARTUM DEPRESSION ACT

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TOWARDS AND TREATMENT

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CONSORTIUM. AND SHE IS CO-PI ON

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A SMART PHONE APP NOW REBRANDED

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AS MOM GENES THAT IS A LARGE

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SCALE INTERNATIONAL GENETIC

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STUDY OF POSTPARTUM DEPRESSION

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AND POST PARTEM. LASTLY, DR.

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MELTZER BRODY HAS BEEN

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COLLABORATING IN PERINATAL

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DEPRESSION INITIATIVES IN SUB

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SAHARAN AFRICA, MALAI AND ZOOM

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BEEIA. SHE IS A PASSION ANALYST

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ADVOCATE FOR TRANSFORMATION

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MENTAL HEALTHCARE AND LEADERSHIP

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ROLES AND PHYSICIAN HEALTHCARE

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WORKER MENTAL HEALTH AND WELL

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BEING IN THE SCHOOL OF MEDICINE

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AND UNC HEALTH. AND SHE RECEIVED

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THE 2020 MAX GARDENER AWARD A

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UNC SYSTEM AWARD FOR HIGHEST

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FACULTY HONOR. SHE'S ALSO

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RECIPIENT OF THE 2019 AMERICAN

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PSYCHIATRIC ALEXANDER SIMONS

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AWARD IN WOMEN'S MENTAL HEALTH.

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SHE RECENTLY NAMED TO THE 2021

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FORBES VISIONARY LIST OF WOMEN

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OVER 50 FOR SHAPING THE FUTURE

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OF SCIENCE TECHNOLOGY AND ART

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AND THE FORBES LIST OF WOMEN

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OVER 50 WORKING TO IMPROVE LEK

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COLLECTIVE MENTAL HEALTH. SHE IS

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ALSO RANKED IN 2021 BY EXPERT

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SCAPE AS NUMBER ONE EXPERT IN

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THE WORLD FOR POSTPARTUM

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DEPRESSION. MOST RECENTLY IN

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JUNE 22 SHE WAS NAMED TO FORBES

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LIST OF 16 HEALTHCARE INNOVATORS

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YOU SHOULD KNOW. SO THE TITLE OF

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DR. MELTZER BRODY'S PRESENTATION

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IS FROM BENCH TO BEDSIDE

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TRANSLATIONAL APPROACH TO

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INNOVATION IN RESEARCH AND

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TREATMENT OF PERINATAL

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DEPRESSION. WELCOME AND

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CONGRATULATIONS. 

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>>THANK YOU VERY MUCH FOR
THE

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GENEROUS INTRODUCTION.  IT'S

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BEEN A GREAT PLEASURE AND HONOR

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TO SPEND TIME HERE THE PAST FEW

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DAYS AND TO MEET WITH THE

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FANTASTIC PEOPLE THAT MAKE UP

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THE NIH. I REALLY ENJOY MEETING

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WITH THE TRAINEES, THE FELLOWS,

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THE CLINICAL FELLOWS AND THE

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MEDICAL STUDENTS TODAY AS WELL

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AS ALL THE INVESTIGATORS. IT'S

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BEEN A REAL PLEASURE AND

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PRIVILEGE. I HAVE BEEN TO THE

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NIH BEFORE BUT NOT TO THE

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CLINICAL CENTER. SO REALLY

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THRILLED TO BE HERE. I THINK

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THAT YOU WALK INTO THE CLINICAL

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CENTER AND THE THOUGHT THAT YOU

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ARE AT THE NIH, THIS IS A PLACE

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WHERE WE CAN TRANSFORM CLINICAL

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CARE TO DECREASE SUFFERING

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BECAUSE OF VERGE IS VERY

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POWERFUL AND THAT PROMISE OF

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THAT TO THOSE OF US THAT DON'T

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WORK HERE, IS AN INSPIRATION SO

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IT IS A GREAT HONOR TO COME AND

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A GREAT HONOR TO BE ABLE TO GIVE

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A TALK CALLED GREAT TEMP TALK

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WHEN ONE WANTS TO RISE TO THE

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OCCASION TO DO THAT. AS

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DEPARTMENT CHAIR, I FEEL THAT A

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LARGE PART OF MY JOB IS TO BE AN

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EDUCATOR AND TRY TO INSPIRE THE

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NEXT GENERATION TO MAKE

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IMPORTANT CONTRIBUTIONS SO THANK

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YOU FOR THIS GREAT HONOR AND

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OPPORTUNITY TODAY.  I WANT TO

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ACKNOWLEDGE MY DISTHROW INSURES 

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I WAS DISCLOSE INSURES I HAVE

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EXTRAMURAL GRANTS FROM NIH AND

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PCORI. I HAVE DONE CLINICAL

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TRIALS WITH SAGE PER

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THERAPEUTICS AND SERVE AS

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CONSULTANT FOR WEB MD AND MODERN

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HEALTH.  SO TODAY I'M GOING TO

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TALK ABOUT PERINATAL DEPRESSION.

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I'M GOING TO SPEND A LITTLE BIT

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OF TIME TALKING ABOUT THE

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TRANSFORMATION WE HAVE WITNESSED

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OVER THE LAST THROUGH YEARS TO

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TELEPSYCHIATRY OR JUST ELECTR

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ELECTRONIC VIRTUAL

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COMMUNICATION, I UNDERSTAND MANY

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PEOPLE AS WE EXPERIENCE AT UNC

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MAYBE WATCHING REMOTELY. AND THE

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WAY WE COMMUNICATE NOW IS VASTLY

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DIFFERENT. OUR ABILITY TO

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INCREASE ACCESS AND REACH

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PATIENTS IS VERY DIFFERENT THAN

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IT WAS. I WANT TO TALK ABOUT

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GENETIC SIGNATURE OF POSTPARTUM

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DEPRESSION AND THE MOM GENE

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STUDY, THE AT BASE STUDY. AND

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THEN TALK ABOUT PRECISION

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PSYCHIATRY AS APPLIED TO THE

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PERINATAL PERIOD USING THAT AS A

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MODEL. THEN END WITH THE WORK

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THAT'S BEEN DONE ON NOVEL

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TREATMENTS WITH BREXANALONE.

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HOPING TO GIVE A STORY THAT

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ILLUSTRATES POWER OF TEAM

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SCIENCE. AND WANT TO ACKNOWLEDGE

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THAT ALL OF MY WORK HAS BEEN

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DONE BECAUSE OF OUTSTANDING

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COLLABORATORS ACROSS A BROAD

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RANGE OF DISCIPLINES, I LOVE

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WORKING ON TEAMS.  I LOVE

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WORKING ON MULTI-DISCIPLINARY

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TEAMS AND BRINGING TOGETHER

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PEOPLE WITH VERY DIFFERENT

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BACKGROUNDS AND AREAS OF

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EXPERTISE TO CREATE SOMETHING

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THAT IS ULTIMATELY GOING TO MOVE

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THE FIELD FORWARD. I FEEL

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GRATEFUL TO STAND ON THE

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SHOULDERS OF THOSE THAT HAVE

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COME BEFORE ME AND HAD

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OUTSTANDING MENTORS. AND

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COLLABORATORS AND SO EVERYTHING

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THAT I HAVE BEEN ABLE TO

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ACCOMPLISH IS BECAUSE OF

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OUTSTANDING PEOPLE TO WORK WITH 

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MY INTEREST IN PERINATAL

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DEPRESSION IS BECAUSE IT IS SUCH

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A PROFOUND TIME IN A WOMAN'S

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LIFE AND FAMILY'S LIFE, AND

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INTERVENING AT THIS TIME FOR

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PEOPLE SUFFERING FROM MENTAL

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HEALTH CONCERN HAS ALWAYS BEEN

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ENORMOUSLY REWARDING. WHEREVER I

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HAVE GONE IN THE WORLD, THIS IS

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A PICTURE FROM A POSTPARTUM UNIT

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IN MALAWI, YOU SEE THAT THERE IS

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BOTH THE JOY OF A MOTHER WITH

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HER BABY, YOU ALSO SEE WHAT

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HAPPENS WHEN SOMEONE IS

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SUFFERING FROM A MENTAL HEALTH

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CONCERN. AND IT IS VERY, VERY

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DIFFICULT TO TRY TO TAKE CARE OF

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A NEW BABY WHEN YOU ARE

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SUFFERING FROM DEPRESSION. 

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POSTPARTUM DEPRESSION REMAINS

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ONE OF THE GREATEST CAUSE

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CONSIST OF MATERNAL MORTALITY

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WORLDWIDE AND SOMETHING THAT

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REQUIRES ALL OF OUR ATTENTION. 

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EVERYBODY FORTUNATE TO SPEND MY

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CAREER -- I HAVE BEEN FORTUNATE

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TO SPEND MY CAREER AT UNC WE

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OPENED THE FIRST PERINATAL

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PSYCHIATRY UNIT IN THE UNITED

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STATES, WHICH IS AN

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ACCOMPLISHMENT FOR THE UNITED

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STATES BUT CERTAINLY SOMETHING

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THAT IS ABOUT 60 YEARS LATER

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THAN THE REST OF THE WORLD. SO

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THE UK OPENED THEIR UNITS ABOUT

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60 YEARS BEFOR BEFORE. AS HAS EE

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AND OTHER PLACES. AND THIS IS

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LARGELY REFLECTS THE

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COMPLICATIONS WE FACE IN WORKING

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IN THE U.S. HEALTHCARE SYSTEM.

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AND THE FACT THAT WE DON'T -- WE

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ARE THE ONLY DEVELOPED COUNTRY

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WITHOUT UNIVERSAL MATERNITY

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LEAVE. WE ARE THE ONLY DEVELOPED

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COUNTRY THAT HAS NOT MADE

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MATERNAL MENTAL HEALTH A

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PRIORITY AND THERE'S BEEN A

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SYSTEMATIC CLOSING OF IN PATIENT

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PSYCHIATRY BEDS THAT BEGAN IN

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THE '60s AND '70s AND AT

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THIS POINT IS AN ABSOLUTE

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CRISIS. AS THE CHAIR OF LARGE

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PUBLIC ACADEMIC DEPARTMENT OF

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PSYCHIATRY, ALL OF THE EMERGENCY

256
00:09:35,880 --> 00:09:37,960
ROOMS ASSOCIATED WITH UNC HEALTH

257
00:09:37,960 --> 00:09:43,480
ARE FILLED WITH PSYCHIATRY AND

258
00:09:43,480 --> 00:09:46,480
MENTAL HEALTH PATIENTSS. THERE

259
00:09:46,480 --> 00:09:49,200
LACK OF ADEQUATE BEDS. AND FOR

260
00:09:49,200 --> 00:09:52,120
MOTHERS THAT NEED A SPECIAL

261
00:09:52,120 --> 00:09:52,800
UNIT, THERE IS AN ABSOLUTE LACK

262
00:09:52,800 --> 00:09:55,240
OF RESOURCES. SO TO BE

263
00:09:55,240 --> 00:09:56,640
POSTPARTUM AND BE ADMITTED TO A

264
00:09:56,640 --> 00:10:00,040
GENERAL PSYCHIATRY UNIT WORKS

265
00:10:00,040 --> 00:10:01,960
POORLY. WE LEARN THAT THE HARD

266
00:10:01,960 --> 00:10:04,560
WAY AND WE ARE ABLE TO OPEN A

267
00:10:04,560 --> 00:10:06,760
UNIT IN 2011. PEOPLE OFTEN ASK

268
00:10:06,760 --> 00:10:09,040
US HOW WE DID IT. AND WE HAD THE

269
00:10:09,040 --> 00:10:10,360
RIGHT PEOPLE AT THE RIGHT TIME

270
00:10:10,360 --> 00:10:12,360
AT THE RIGHT PLACE. SO ONE OF MY

271
00:10:12,360 --> 00:10:16,440
WONDERFUL MENTORS AND DEAR

272
00:10:16,440 --> 00:10:18,560
FRIENDS DR. DAVID OF RUBINO

273
00:10:18,560 --> 00:10:19,560
(PHONETIC) WHO IS HERE MANY

274
00:10:19,560 --> 00:10:21,560
YEARS AND CAME TO BE CHAIR AT

275
00:10:21,560 --> 00:10:23,840
UNC WAS TRANSFORMATIVE AND

276
00:10:23,840 --> 00:10:26,560
ADVOCATING FOR THAT. WE ALSO HAD

277
00:10:26,560 --> 00:10:28,200
THE VERY GOOD LUCK OF HAVING

278
00:10:28,200 --> 00:10:28,960
LEADERSHIP POSITIONS IN THE

279
00:10:28,960 --> 00:10:31,680
HOSPITAL THAT HAD A PSYCHIATRY

280
00:10:31,680 --> 00:10:33,560
INPATIENT NURSING SERVICES AND

281
00:10:33,560 --> 00:10:35,000
THE HOSPITAL CHIEF NURSING

282
00:10:35,000 --> 00:10:37,560
OFFICER WERE ALSO VERY

283
00:10:37,560 --> 00:10:38,560
SUPPORTIVE. IT WAS EVERYONE

284
00:10:38,560 --> 00:10:39,720
COMING TOGETHER AT THE RIGHT

285
00:10:39,720 --> 00:10:40,920
TIME INCLUDING A COLLEAGUE WHO

286
00:10:40,920 --> 00:10:44,000
WAS RUNNING THE GERO PSYCH UNIT

287
00:10:44,000 --> 00:10:45,560
THAT AGREED TO HAVE THREE BEDS

288
00:10:45,560 --> 00:10:47,480
REMOVED TO GO TOWARDS THIS

289
00:10:47,480 --> 00:10:50,240
CAUSE. LIKE EVERYTHING, I THINK

290
00:10:50,240 --> 00:10:51,560
IN ORDER TO BE SUCCESSFUL AT

291
00:10:51,560 --> 00:10:54,320
MAKING CHANGE YOU HAVE TO HAVE

292
00:10:54,320 --> 00:10:56,040
PEOPLE COMMITTED TO DOING THAT

293
00:10:56,040 --> 00:10:58,160
AND YOU NEED PEOPLE COMMITTED TO

294
00:10:58,160 --> 00:11:02,280
FORWARD PROGRESS. WE OPEN THIS.

295
00:11:02,280 --> 00:11:04,200
OUR UNIT AS MUCH AS WE CAN WE

296
00:11:04,200 --> 00:11:06,200
TRY AND HAVE IT FEEL

297
00:11:06,200 --> 00:11:07,840
COMFORTABLE, DESPITE JOINT

298
00:11:07,840 --> 00:11:11,600
COMMISSIONS BEST EFFORTS TO HAVE

299
00:11:11,600 --> 00:11:14,560
IT NOT BE AGAIN WITH BEST OF

300
00:11:14,560 --> 00:11:16,000
INTENTIONS WITH RISK BUT ENDS UP

301
00:11:16,000 --> 00:11:18,560
MAKING PSYCHIATRY UNITS

302
00:11:18,560 --> 00:11:20,880
INHOSPITABLE. WE WORK TO HAVE

303
00:11:20,880 --> 00:11:22,240
OUR PSYCH NURSING STAFF HAVE

304
00:11:22,240 --> 00:11:24,520
TRAINING IN PSYCHIATRY AND OB

305
00:11:24,520 --> 00:11:27,720
RELATED ISSUES AND TO HAVE

306
00:11:27,720 --> 00:11:29,640
MULTIPLE WAYS TO HAVE BABIES

307
00:11:29,640 --> 00:11:31,360
VISIT, THEY CAN ONLY BE ON THE

308
00:11:31,360 --> 00:11:33,320
UNIT WITH ANOTHER ADULT WHO IS

309
00:11:33,320 --> 00:11:34,680
NOT THE PATIENT BECAUSE WE DON'T

310
00:11:34,680 --> 00:11:36,680
-- THEY ARE NOT ABLE TO STAY

311
00:11:36,680 --> 00:11:38,000
OVER NIGHT LIKE MOTHER BABY

312
00:11:38,000 --> 00:11:40,160
UNITS IN OTHER PLACES. BUT THIS

313
00:11:40,160 --> 00:11:42,280
IS PROVIDED AN OUTSTANDING PLACE

314
00:11:42,280 --> 00:11:43,680
TO CONDUCT NOVEL RESEARCH

315
00:11:43,680 --> 00:11:45,600
PROTOCOLS.  CERTAINLY HERE AT

316
00:11:45,600 --> 00:11:47,000
CLINICAL CENTER YOU ARE ABLE TO

317
00:11:47,000 --> 00:11:50,560
DO THAT TOO. WHILE THIS UNIT WAS

318
00:11:50,560 --> 00:11:51,440
DEVELOPED FOR CLINICAL TREATMENT

319
00:11:51,440 --> 00:11:54,320
WE HAVE BEEN ABLE TO USE IT TO

320
00:11:54,320 --> 00:11:56,640
DO RESEARCH, I WILL EXPLAIN MORE

321
00:11:56,640 --> 00:12:00,960
ABOUT HOW THAT HAS WORKED.  SO

322
00:12:00,960 --> 00:12:02,120
POSTPARTUM DEPRESSION WE HAVE

323
00:12:02,120 --> 00:12:04,760
LOOKED AT IT AS MORE HOMOGENOUS

324
00:12:04,760 --> 00:12:07,360
FORM OF MAJOR DEPRESSION.

325
00:12:07,360 --> 00:12:08,600
PREVALENCE ESTIMATES WE ARE

326
00:12:08,600 --> 00:12:11,960
USING OF 10 TO 15% GENERAL

327
00:12:11,960 --> 00:12:13,840
POPULATION OCCURS IN

328
00:12:13,840 --> 00:12:14,800
REPRODUCTIVE AGE WOMEN. THIS IS

329
00:12:14,800 --> 00:12:17,200
A MAJOR DEPRESSIVE EPISODE SO

330
00:12:17,200 --> 00:12:18,840
WHEN YOU SAY DATA THAT SAYS ONE

331
00:12:18,840 --> 00:12:20,760
IN FIVE OR ONE IN FOUR WOMEN

332
00:12:20,760 --> 00:12:23,200
HAVE WHAT IS NOW OFTEN TERMED

333
00:12:23,200 --> 00:12:25,320
POSTPARTUM MOOD AND ANXIETY

334
00:12:25,320 --> 00:12:26,240
DISORDERS THERE IS AN EFFORT

335
00:12:26,240 --> 00:12:27,840
FROM THE PUBLIC HEALTH COMMUNITY

336
00:12:27,840 --> 00:12:30,640
TO BE VERY INCLUSIVE IN TERMS OF

337
00:12:30,640 --> 00:12:32,280
HOW WE DO POPULATION BASED

338
00:12:32,280 --> 00:12:34,120
SCREENING FOR ANY KIND OF

339
00:12:34,120 --> 00:12:35,880
MATERNAL MENTAL HEALTH ISSUE.

340
00:12:35,880 --> 00:12:37,320
AND THAT GETS A LITTLE BIT

341
00:12:37,320 --> 00:12:38,480
CONFUSING IN TERMS OF ARE WE

342
00:12:38,480 --> 00:12:40,000
TALKING ABOUT MAJOR DEPRESSIVE

343
00:12:40,000 --> 00:12:41,720
EPISODE OR ARE WE TALKING

344
00:12:41,720 --> 00:12:43,640
ANXIETY DISORDER AND SORT OF

345
00:12:43,640 --> 00:12:45,560
LUMPING EVERYTHING TOGETHER. SO

346
00:12:45,560 --> 00:12:47,760
I'M GOING TO BE TALKING ABOUT

347
00:12:47,760 --> 00:12:48,920
POSTPARTUM DEPRESSION, TALKING

348
00:12:48,920 --> 00:12:51,880
ABOUT WHAT WE SEE AS A DSM

349
00:12:51,880 --> 00:12:53,800
DIAGNOSIS OF A MAJOR DEPRESSIVE

350
00:12:53,800 --> 00:12:56,440
EPISODE THAT IS OCCURRING WITH

351
00:12:56,440 --> 00:12:57,920
ONSET VERY PROXIMAL TO

352
00:12:57,920 --> 00:12:59,440
CHILDBIRTH. THAT IS IMPORTANT IF

353
00:12:59,440 --> 00:13:02,240
WE THINK ABOUT UNDERLYING

354
00:13:02,240 --> 00:13:04,120
PATHOPHYSIOLOGY AND EFFORTS TO

355
00:13:04,120 --> 00:13:05,240
DEVELOP INTERVENTIONS SPECIFIC

356
00:13:05,240 --> 00:13:07,760
TO THAT TIME. WHAT CAUSES IT? IT

357
00:13:07,760 --> 00:13:09,720
IS UNKNOWN, IT IS LIKELY

358
00:13:09,720 --> 00:13:11,360
MULTI-FACTORIAL. IT'S BEEN

359
00:13:11,360 --> 00:13:13,960
LINKED TO HISTORY OF DEPRESSION,

360
00:13:13,960 --> 00:13:15,200
INFLAMMATORY SIGNALING

361
00:13:15,200 --> 00:13:17,040
FLUCTUATIONS AND PERINATAL

362
00:13:17,040 --> 00:13:18,640
HORMONES DISREGULATION OF STRESS

363
00:13:18,640 --> 00:13:21,200
PATHWAYS SUCH AS THE HPA AXIS,

364
00:13:21,200 --> 00:13:23,000
GABBA SIGNALING DYSFUNCTION

365
00:13:23,000 --> 00:13:25,360
INCLUDING ALTERED GABBA RECEPTOR

366
00:13:25,360 --> 00:13:27,760
REGULATION. CERTAINLY PETER

367
00:13:27,760 --> 00:13:30,160
SCHMIDT, DAVID RUBINO AND THEIR

368
00:13:30,160 --> 00:13:31,840
TEAM AND OTHERS HAVE HAVE DONE

369
00:13:31,840 --> 00:13:33,680
PIVOTAL WORK FOR MANY, MANY

370
00:13:33,680 --> 00:13:35,920
DECADES LOOKING AT THE

371
00:13:35,920 --> 00:13:37,680
DIFFERENTIAL SENSITIVITY OF

372
00:13:37,680 --> 00:13:39,880
WOMEN'S REPRODUCTIVE HORMONES SO

373
00:13:39,880 --> 00:13:41,920
THE NIH INTRAMURAL PROGRAM HAS

374
00:13:41,920 --> 00:13:43,960
PLAYED A POWERFUL ROLE IN

375
00:13:43,960 --> 00:13:47,440
ADVANCING SCIENCE IN THIS AREA. 

376
00:13:47,440 --> 00:13:50,360
WE HAVE SEEN IT IS MORE

377
00:13:50,360 --> 00:13:51,600
HERITABLE THAN NON-PERINATAL

378
00:13:51,600 --> 00:13:54,760
DEPRESSION SO THIS WAS USING

379
00:13:54,760 --> 00:13:56,080
SCANDINAVIAN SAMPLES AND SEEING

380
00:13:56,080 --> 00:13:57,640
IF YOU LOOK AT THE PERINATAL

381
00:13:57,640 --> 00:14:00,080
PERIOD THERE WAS UP TO 54%

382
00:14:00,080 --> 00:14:02,520
HERITABILITY COMPARED TO

383
00:14:02,520 --> 00:14:04,760
DEPRESSION OUTSIDE THE PERINATAL

384
00:14:04,760 --> 00:14:06,160
PERIOD. SOMETHING UNIQUE ABOUT

385
00:14:06,160 --> 00:14:09,560
THIS TIME. WHEN IT HITS IT IS

386
00:14:09,560 --> 00:14:11,160
OFTEN DEBILITATING WITH A BROAD

387
00:14:11,160 --> 00:14:13,080
RANGE OF CLINICAL SYMPTOMS, YOU

388
00:14:13,080 --> 00:14:15,840
WILL SEE LOW MOOD, DECREASED

389
00:14:15,840 --> 00:14:19,960
INTEREST OR ANHEDONIA, MOMS

390
00:14:19,960 --> 00:14:23,680
UNABLE TO ENJOY THE BABY,

391
00:14:23,680 --> 00:14:26,680
CO-ANXIETY OCCURRING AND UNABLE

392
00:14:26,680 --> 00:14:29,040
TO SLEEP WHEN BABY IS SLEEPING,

393
00:14:29,040 --> 00:14:30,240
STAYING UP ALL KNIFE WATCHING

394
00:14:30,240 --> 00:14:32,560
THE BABY BREATHE FOR FEAR OF

395
00:14:32,560 --> 00:14:33,840
SIDS ALL CAN INTERFERE WITH

396
00:14:33,840 --> 00:14:36,200
MOTHER INFANT ATTACHMENT. MOTHER

397
00:14:36,200 --> 00:14:39,720
BABY RELATIONSHIP, HOPELESSNESS

398
00:14:39,720 --> 00:14:41,440
OR THOUGHTS OF SELF-HARM IS

399
00:14:41,440 --> 00:14:43,040
COMMON WHICH IS WHY REMAINS ONE

400
00:14:43,040 --> 00:14:44,840
OF THE GREATEST CAUSES OF

401
00:14:44,840 --> 00:14:46,680
MATERNAL MORTALITY. YOU END UP

402
00:14:46,680 --> 00:14:48,760
WITH GREAT DISRUPTION IN THE

403
00:14:48,760 --> 00:14:50,840
FAMILY UNIT WITH LONG STANDING

404
00:14:50,840 --> 00:14:52,360
NEURODEVELOPMENTAL DELAYS IN

405
00:14:52,360 --> 00:14:55,200
CHILDREN WHOSE MOTHERS HAD

406
00:14:55,200 --> 00:14:56,440
UNTREATED DEPRESSION OVER TIME

407
00:14:56,440 --> 00:14:58,560
AND NUMBER OF STUDIES THAT

408
00:14:58,560 --> 00:14:59,840
KNOWED PEOPLE LONGITUDINALLY UP

409
00:14:59,840 --> 00:15:02,200
TO AGE 18 AND BEYOND AND YOU SEE

410
00:15:02,200 --> 00:15:03,520
DIFFERENCES MAJOR STRESSORS ON

411
00:15:03,520 --> 00:15:05,200
FAMILY WHICH IS WHY IT IS ALWAYS

412
00:15:05,200 --> 00:15:07,720
BEEN TO ME SUCH AN IMPORTANT

413
00:15:07,720 --> 00:15:10,000
TIME FOR INTERVENTION. SO I WANT

414
00:15:10,000 --> 00:15:11,320
TO TALK A LITTLE BIT ABOUT

415
00:15:11,320 --> 00:15:13,560
TELEHEALTH.  EARLIER TODAY WHEN

416
00:15:13,560 --> 00:15:15,120
WE WERE MEETING WITH THE MEDICAL

417
00:15:15,120 --> 00:15:17,240
STUDENTS, THE PANDEMIC HIT, THE

418
00:15:17,240 --> 00:15:19,000
PAYERS DECIDED THEY WOULD PAY

419
00:15:19,000 --> 00:15:21,720
FOR VIRTUAL CAR AND WE RAN

420
00:15:21,720 --> 00:15:23,720
AROUND IN TWO WEEKS AND LAUNCHED

421
00:15:23,720 --> 00:15:25,440
VIRTUAL CARE BROADLY.  THIS IS

422
00:15:25,440 --> 00:15:26,880
BEEN AMAZING WAY TO INCREASE

423
00:15:26,880 --> 00:15:28,960
ACCESS AND IN MENTAL HEALTH AND

424
00:15:28,960 --> 00:15:30,880
PSYCHIATRY AND BEHAVIORAL HEALTH

425
00:15:30,880 --> 00:15:33,360
IT IS HERE TO STAY, I THINK

426
00:15:33,360 --> 00:15:35,080
WHATEVER REGULATIONS ARE ROLLED

427
00:15:35,080 --> 00:15:37,360
BACK IN OTHER AREAS, THIS IS

428
00:15:37,360 --> 00:15:39,400
GOING TO BE ONE PLACE WHERE IT

429
00:15:39,400 --> 00:15:41,480
REMAINS IN THE MATERNAL MENTAL

430
00:15:41,480 --> 00:15:43,040
HEALTH SPACE IT'S BEEN VERY,

431
00:15:43,040 --> 00:15:44,520
VERY POWERFUL. IF YOU THINK

432
00:15:44,520 --> 00:15:46,160
ABOUT A NEW MOM HAVING TO COME

433
00:15:46,160 --> 00:15:47,080
IN AND HAVE A MENTAL HEALTH

434
00:15:47,080 --> 00:15:48,640
VISIT AND YOU HAVE TO BRING THE

435
00:15:48,640 --> 00:15:50,280
BABY OR KIDS YOU HAVE TO TRAVEL,

436
00:15:50,280 --> 00:15:53,640
YOU ARE ON THE BUS OR THE TRAIN

437
00:15:53,640 --> 00:15:55,920
OR DRIVING HOURS, THE ISSUES

438
00:15:55,920 --> 00:15:58,040
AROUND ACCESS, AROUND GAS,

439
00:15:58,040 --> 00:15:59,320
AROUND ECONOMIC FACTORS, IF YOU

440
00:15:59,320 --> 00:16:02,160
CAN DO A TELEHEALTH APPOINTMENT

441
00:16:02,160 --> 00:16:04,200
ASSUMING YOU HAVE A SAFE PLACE

442
00:16:04,200 --> 00:16:06,040
IN BROADBAND INTERNET ACCESS IT

443
00:16:06,040 --> 00:16:09,800
REALLY CAN DECREASE BARRIERS. SO

444
00:16:09,800 --> 00:16:12,040
ONE OF THE QUESTIONS THAT IS

445
00:16:12,040 --> 00:16:14,440
RAISED, IS IT AS GOOD? IS

446
00:16:14,440 --> 00:16:16,280
TELEHEALTH AS GOOD AS IN PERSON?

447
00:16:16,280 --> 00:16:17,920
I THINK THE DATA COMING OUT

448
00:16:17,920 --> 00:16:19,240
SHOWS WELL IT DEPENDS ON THE

449
00:16:19,240 --> 00:16:22,480
PATIENT POPULATION. IS IT GOOD

450
00:16:22,480 --> 00:16:25,600
ENOUGH? ARE THE ADVANTAGES OF

451
00:16:25,600 --> 00:16:28,920
INCREASING ACCESS OUTWEIGH

452
00:16:28,920 --> 00:16:30,760
WHATEVER DOWN SIDES MAY BE

453
00:16:30,760 --> 00:16:33,640
THERE. BUT SOMEWHAT IRONICALLY

454
00:16:33,640 --> 00:16:36,360
WE HAVE STARTED A STUDY, THIS IS

455
00:16:36,360 --> 00:16:39,960
A $13 MILLION STUDY WITH PCORI

456
00:16:39,960 --> 00:16:42,360
CALLED SUMMIT TRIAL SCALING MA

457
00:16:42,360 --> 00:16:42,960
ATTORNEY HEALTH HEALTHCARE BY

458
00:16:42,960 --> 00:16:43,600
INCREASING ACCESS TO TREATMENT.

459
00:16:43,600 --> 00:16:44,920
I WANT TO SPEND A LITTLE TIME

460
00:16:44,920 --> 00:16:47,240
TALKING ABOUT THIS. BECAUSE I

461
00:16:47,240 --> 00:16:48,440
THINK IT IS ONE, VERY

462
00:16:48,440 --> 00:16:49,640
INTERESTING TO THE TIME WE ARE

463
00:16:49,640 --> 00:16:53,160
LIVING IN NOW. AND TWO, IT JUST

464
00:16:53,160 --> 00:16:54,440
TALKS ABOUT THE TRANSFORMATION

465
00:16:54,440 --> 00:16:56,360
TO ALL OF OUR RESEARCH PROGRAMS

466
00:16:56,360 --> 00:16:58,680
OVER THE COURSE OF THE PANDEMIC 

467
00:16:58,680 --> 00:17:02,760
SO WE STARTED THIS PRE-PANDEMIC,

468
00:17:02,760 --> 00:17:07,720
THE QUESTION WAS, IS

469
00:17:07,720 --> 00:17:11,080
PSYCHOTHERAPY DELIVERED BY

470
00:17:11,080 --> 00:17:12,280
TELEMEDICINE, AS GOOD AS IN

471
00:17:12,280 --> 00:17:15,240
PERSON CARE? AND CAN THIS BE

472
00:17:15,240 --> 00:17:17,760
DELIVERED BY NON-SPECIALISTS? BY

473
00:17:17,760 --> 00:17:19,440
TRAINING OB CLINIC NURSES TO DO

474
00:17:19,440 --> 00:17:21,480
A MANUALIZED FORM OF

475
00:17:21,480 --> 00:17:22,280
PSYCHOTHERAPY, COMPARED TO

476
00:17:22,280 --> 00:17:24,040
HAVING A MENTAL HEALTH

477
00:17:24,040 --> 00:17:25,480
SPECIALIST? SO IF YOU WILL, A

478
00:17:25,480 --> 00:17:28,360
TWO BY TWO TABLE, THE PI OF THIS

479
00:17:28,360 --> 00:17:30,680
IS AN AMAZING WOMAN NAMED DR.

480
00:17:30,680 --> 00:17:32,040
DAISY AT THE UNIVERSITY OF

481
00:17:32,040 --> 00:17:33,760
TORONTO. AND SHE REACHED OUT TO

482
00:17:33,760 --> 00:17:35,520
SAY I NEEDED AMERICAN

483
00:17:35,520 --> 00:17:36,720
COLLABORATOR. I WANT TO APPLY

484
00:17:36,720 --> 00:17:40,760
FOR A PCORI GRANT. THIS WAS IN

485
00:17:40,760 --> 00:17:41,560
2018. REALLY WONDERING HOW ARE

486
00:17:41,560 --> 00:17:43,720
WE GOING TO DO POPULATION HEALTH

487
00:17:43,720 --> 00:17:44,760
LEVEL MATERNAL MENTAL HEALTH

488
00:17:44,760 --> 00:17:46,400
INTERVENTIONS? THERE'S NEVER

489
00:17:46,400 --> 00:17:47,480
GOING TO BE ENOUGH MENTAL HEALTH

490
00:17:47,480 --> 00:17:49,480
PROVIDERS TO DO IT.  AND SHE HAD

491
00:17:49,480 --> 00:17:51,240
DONE A LOT OF WORK IN LOW

492
00:17:51,240 --> 00:17:52,400
RESOURCE COUNTRIES GLOBAL HEALTH

493
00:17:52,400 --> 00:17:54,200
WHERE YOU DO A LOT OF TASK

494
00:17:54,200 --> 00:17:55,160
SHIFTING. SHE KNEW I HAD AN

495
00:17:55,160 --> 00:17:57,040
INTEREST IN THAT TOO. AND THE

496
00:17:57,040 --> 00:17:59,120
QUESTION WAS, CAN WE DO

497
00:17:59,120 --> 00:18:00,760
TELEMEDICINE, IS THAT MORE

498
00:18:00,760 --> 00:18:02,160
CONVENIENT AND CAN YOU TRAIN

499
00:18:02,160 --> 00:18:03,480
PEOPLE OTHER THAN MENTAL HEALTH

500
00:18:03,480 --> 00:18:04,800
PROFESSIONALS TO DO THIS IF WE

501
00:18:04,800 --> 00:18:06,560
ARE REALLY GOING TO TACKLE THE

502
00:18:06,560 --> 00:18:07,760
POPULATION BASED HEALTH ISSUE OF

503
00:18:07,760 --> 00:18:11,120
MATERNAL MENTAL HEALTH? SO WE

504
00:18:11,120 --> 00:18:13,240
BEGAN THIS, WHAT IS THE

505
00:18:13,240 --> 00:18:15,320
TREATMENT AT SIX TO EIGHT WEEKS

506
00:18:15,320 --> 00:18:17,160
OF BEHAVIORAL ACTIVATION THERAPY

507
00:18:17,160 --> 00:18:18,400
WHICH HAS A STRONG EVIDENCE

508
00:18:18,400 --> 00:18:21,440
BASE. AND IS BEEN SHOWN AS

509
00:18:21,440 --> 00:18:22,840
EFFECTIVE IN TREATING BOTH

510
00:18:22,840 --> 00:18:24,800
PERINATAL DEPRESSION AND ANXIETY

511
00:18:24,800 --> 00:18:27,600
AND HAS BEEN EASY TO LEARN. IT

512
00:18:27,600 --> 00:18:29,400
WAS PICKED FOR ALL THOSE

513
00:18:29,400 --> 00:18:32,040
REASONS. THIS IS OUR TEAM,

514
00:18:32,040 --> 00:18:33,920
DAISY, RICH SILVERS AND MATERNAL

515
00:18:33,920 --> 00:18:36,080
FETAL MEDICINE DOC AT THE SHORT

516
00:18:36,080 --> 00:18:38,560
SHORE HEALTH SYSTEM CHICAGO. AND

517
00:18:38,560 --> 00:18:39,880
THEN TWO OTHER CANADIAN

518
00:18:39,880 --> 00:18:42,320
INVESTIGATORS SIMONE AT WOMEN'S

519
00:18:42,320 --> 00:18:44,400
COLLEGE TORONTO AND CINDY LEIDEN

520
00:18:44,400 --> 00:18:46,320
IN THIS.  WE BEGAN MANY

521
00:18:46,320 --> 00:18:48,320
ENROLLING IN IN JANUARY 2020.

522
00:18:48,320 --> 00:18:50,720
THIS IS VERY, VERY FUNNY, AND

523
00:18:50,720 --> 00:18:52,080
THEN WE KNOW WHAT HAPPENED IN

524
00:18:52,080 --> 00:18:55,080
MARCH. WE WERE ABLE TO CONTINUE

525
00:18:55,080 --> 00:18:56,080
THE TELEMEDICINE PART OF THE

526
00:18:56,080 --> 00:18:57,680
STUDY UNINTERRUPTED OVER THE

527
00:18:57,680 --> 00:18:59,200
COURSE OF THE PANDEMIC. IT WAS

528
00:18:59,200 --> 00:19:01,840
WILDLY POPULAR.  ONE OF THE

529
00:19:01,840 --> 00:19:03,840
THINGS THAT BECAME A HUGE

530
00:19:03,840 --> 00:19:05,760
BARRIER THOUGH IS THE NURSES ALL

531
00:19:05,760 --> 00:19:07,440
QUIT. SO WE HAVE HAD TO FIGURE

532
00:19:07,440 --> 00:19:08,880
OUT WHO WERE GOING TO BE THE

533
00:19:08,880 --> 00:19:10,920
NON-MENTAL HEALTH SPECIALISTS

534
00:19:10,920 --> 00:19:14,320
AND WE HAVE MOVED TO DULA'S

535
00:19:14,320 --> 00:19:15,800
WHICH IS HELPFUL BUT DESPITE

536
00:19:15,800 --> 00:19:17,960
THIS WE RESUMED IN PERSON CARE

537
00:19:17,960 --> 00:19:21,240
IN AUGUST '21 AND TODAY WE HAVE

538
00:19:21,240 --> 00:19:24,480
VERY HIGH RETENTION RATES, WE

539
00:19:24,480 --> 00:19:26,560
ARE 90% BEING FOLLOWED UP TO A

540
00:19:26,560 --> 00:19:28,840
YEAR OUT, BABIES BEING FOLLOWED 

541
00:19:28,840 --> 00:19:31,720
WE HAVE 50% WHO IDENTIFY AS

542
00:19:31,720 --> 00:19:35,080
BIPOC SO WE HAVE WORK TO HAVE

543
00:19:35,080 --> 00:19:35,800
UNDER-REPRESENTED POPULATIONS

544
00:19:35,800 --> 00:19:37,760
INVOLVEINVOLVED.  WE ARE NEARINE

545
00:19:37,760 --> 00:19:39,680
END OF RECRUITMENT WHICH IS 1226

546
00:19:39,680 --> 00:19:41,800
MOTHERS ENROLLED, IT WILL BE ONE

547
00:19:41,800 --> 00:19:43,600
OF THE LARGEST PSYCHOTHERAPY

548
00:19:43,600 --> 00:19:46,600
TRIALS IN THE WORLD. SO MY HOPE

549
00:19:46,600 --> 00:19:48,320
IS THAT THIS BEGAN PRE-PANDEMIC

550
00:19:48,320 --> 00:19:49,560
BUT THIS IS GOING TO PROVIDE

551
00:19:49,560 --> 00:19:52,680
REALLY INTERESTING ANSWERS TO IS

552
00:19:52,680 --> 00:19:54,040
TELEMEDICINE TELETHERAPY AS GOOD

553
00:19:54,040 --> 00:19:58,360
AS IN PERSON? AND CAN WE

554
00:19:58,360 --> 00:20:00,560
SUCCESSFULLY USE TASK SHIFTING

555
00:20:00,560 --> 00:20:02,640
MODELS TO DELIVER PSYCHOTHERAPY

556
00:20:02,640 --> 00:20:03,400
INTERVENTION?

557
00:20:03,400 --> 00:20:04,680
WE ARE GOING TO NEED TO FIGURE

558
00:20:04,680 --> 00:20:06,680
HOW TO DETAILS -- DO TASK

559
00:20:06,680 --> 00:20:08,560
SHIFTING WITH A LOT OF THINGS WE

560
00:20:08,560 --> 00:20:09,640
FACE IN HEALTHCARE BECAUSE THE

561
00:20:09,640 --> 00:20:10,880
PEOPLE AROUND THERE, WE ARE

562
00:20:10,880 --> 00:20:12,320
STRUGGLING WITH WORK FORCE

563
00:20:12,320 --> 00:20:15,880
SHORTAGES AND HOW TO MA MANAGE

564
00:20:15,880 --> 00:20:17,120
THAT, WE CAN'T SAY WE DON'T HAVE

565
00:20:17,120 --> 00:20:18,920
THE PEOPLE WE HAVE TO FIGURE HOW

566
00:20:18,920 --> 00:20:21,160
TO USE TASK SHIFTING AS DONE IN

567
00:20:21,160 --> 00:20:22,720
OTHER MODELS. ONE THING WE ARE

568
00:20:22,720 --> 00:20:24,920
DOING A LOT OF AT UNC IS LOOKING

569
00:20:24,920 --> 00:20:27,560
WHO CAN STAFF ORs, WHO CAN DO

570
00:20:27,560 --> 00:20:30,720
THINGS. THE LPNs WHO GRADUATE

571
00:20:30,720 --> 00:20:33,200
FROM TWO YEAR NURSING PROGRAM

572
00:20:33,200 --> 00:20:35,440
ASSOCIATE DEGREES, WHICH WERE

573
00:20:35,440 --> 00:20:38,120
OFTEN TRIED TO BE REPLACED WITH

574
00:20:38,120 --> 00:20:40,720
DSN NURSES ARE GOING TO HAVE TO

575
00:20:40,720 --> 00:20:42,720
CHANGE THAT MODEL IN THERE IS

576
00:20:42,720 --> 00:20:44,240
NOT ENOUGH BSM NURSES TO DO THE,

577
00:20:44,240 --> 00:20:46,640
WHO. SO WE ARE ARE LIVING IN A

578
00:20:46,640 --> 00:20:47,440
TRANSFORMATIONAL TIME BUT WE

579
00:20:47,440 --> 00:20:49,040
HAVE TO BE OPEN TO INNOVATION AS

580
00:20:49,040 --> 00:20:51,520
TO HOW WE ARE GOING TO ADDRESS

581
00:20:51,520 --> 00:20:55,840
THIS.  SO I WANT TO SWITCH GEARS

582
00:20:55,840 --> 00:20:58,040
AND TALK ABOUT PRECISION

583
00:20:58,040 --> 00:21:01,240
PSYCHIATRY. THIS IS A PAPER FROM

584
00:21:01,240 --> 00:21:04,960
2017, I THINK IT IS VERY

585
00:21:04,960 --> 00:21:05,760
RELEVANT, THIS TOPIC IS

586
00:21:05,760 --> 00:21:07,440
SOMETHING THAT'S BEEN INSPIRING

587
00:21:07,440 --> 00:21:09,800
TO ME. ONE OF MY VERY GOOD

588
00:21:09,800 --> 00:21:11,320
FRIENDS IS A BREAST CANCER

589
00:21:11,320 --> 00:21:14,120
ONCOLOGIST. AND I HAVE WATCHED

590
00:21:14,120 --> 00:21:16,960
WITH ENVY AS HER FIELD HAS

591
00:21:16,960 --> 00:21:19,640
BECOME MUCH MORE PRECISE. AND

592
00:21:19,640 --> 00:21:20,720
THE ABILITY TO RECOGNIZE THERE

593
00:21:20,720 --> 00:21:22,880
IS NOT ONE KIND OF BREAST CANCER

594
00:21:22,880 --> 00:21:24,400
HAS BEEN TRANSFORMATIVE IN

595
00:21:24,400 --> 00:21:25,880
CHANGING OUTCOMES AND LIFE

596
00:21:25,880 --> 00:21:29,000
EXPECTANCY. IN PSYCHIATRY

597
00:21:29,000 --> 00:21:30,360
UNFORTUNATELY WE ARE STILL

598
00:21:30,360 --> 00:21:32,280
OPERATING SORT OF A ONE SIZE

599
00:21:32,280 --> 00:21:34,480
FITS ALL MODEL. THEN WE WONDER

600
00:21:34,480 --> 00:21:36,640
WHY WE AREN'T ABLE TO TREAT

601
00:21:36,640 --> 00:21:38,040
PEOPLE TO REMISSION IN THE WAY

602
00:21:38,040 --> 00:21:42,000
WE WOULD LIKE.  SO PRECISION

603
00:21:42,000 --> 00:21:45,600
MEDICINE, ASPIRATIONALLY IS THE

604
00:21:45,600 --> 00:21:47,800
IDEA OF USING DIAGNOSTIC AND

605
00:21:47,800 --> 00:21:49,200
THERAPEUTIC TECHNOLOGIES THAT

606
00:21:49,200 --> 00:21:51,920
CAN BE TAILORED AND TARGETED TO

607
00:21:51,920 --> 00:21:52,920
BE VERY PRECISE TO WHAT YOU

608
00:21:52,920 --> 00:21:56,600
HAVE. WE ARE STILL FAR AWAY FROM

609
00:21:56,600 --> 00:21:58,480
THAT IN PSYCHIATRY AND IT IS

610
00:21:58,480 --> 00:21:59,680
SOMETHING WE HAVE TO GET BETTER

611
00:21:59,680 --> 00:22:02,880
AT. SO WHEN THE OPPORTUNITY

612
00:22:02,880 --> 00:22:05,440
AROSE TO ENGAGE IN A PRECISION

613
00:22:05,440 --> 00:22:07,120
MEDICINE ENDEAVOR, THAT WAS

614
00:22:07,120 --> 00:22:08,160
SOMETHING WE ARE VERY, VERY

615
00:22:08,160 --> 00:22:10,000
EXCITED ABOUT. SO I WANT TO TELL

616
00:22:10,000 --> 00:22:14,200
THE STORY OF THAT. THE

617
00:22:14,200 --> 00:22:16,680
PROGESTERONE TO ALLO PATHWAY,

618
00:22:16,680 --> 00:22:19,600
WHEN IT CAME TO UNC I DR.

619
00:22:19,600 --> 00:22:20,680
MOREAU, HE WAS A FILL LOW, SHE

620
00:22:20,680 --> 00:22:22,560
IS A BASIC SCIENTIST WITH

621
00:22:22,560 --> 00:22:25,920
STUDYING ALLO PRENANALONE

622
00:22:25,920 --> 00:22:27,600
(PHONETIC) TRAINED BY BOB PURDY,

623
00:22:27,600 --> 00:22:31,160
YOU HAVE A LONG HISTORY OF PEEP

624
00:22:31,160 --> 00:22:32,880
PEOPLE INTERESTED IN

625
00:22:32,880 --> 00:22:34,160
NEUROSTEROIDS AND STEVE PAUL WHO

626
00:22:34,160 --> 00:22:36,040
WAS HERE TO WORK AT HE WILL LIE

627
00:22:36,040 --> 00:22:38,560
LILY AND GET A DRUG YOU MAY HAVE

628
00:22:38,560 --> 00:22:40,280
HEARD OF PROZAC, TO MARKET AND

629
00:22:40,280 --> 00:22:42,280
HAS INVESTED IN MANY THINGS

630
00:22:42,280 --> 00:22:45,520
INCLUDING WHAT I WILL DESCRIBE

631
00:22:45,520 --> 00:22:49,000
WITH BREXANALONE. THE

632
00:22:49,000 --> 00:22:51,840
PROGESTERONE TO ALLO PATHWAY, IS

633
00:22:51,840 --> 00:22:53,280
FASCINATING. YOU START WITH A

634
00:22:53,280 --> 00:22:55,200
MOLECULE AND END UP WITH A

635
00:22:55,200 --> 00:22:56,280
PROGESTERONE IN THE MIDDLE AND

636
00:22:56,280 --> 00:23:01,120
METABOLIZED TO ALLO PREDNANALONE

637
00:23:01,120 --> 00:23:03,280
E A NEUROMETABOLITE THAT

638
00:23:03,280 --> 00:23:04,080
CROSSESSED THE BLOOD BRAIN

639
00:23:04,080 --> 00:23:09,320
BARRIER AND APHONICY COMPOUND.

640
00:23:09,320 --> 00:23:14,080
-- PHI IN THIS CASEY COM IN  YOS

641
00:23:14,080 --> 00:23:16,840
SPEC MACHINE. PEOPLE AT UNC WERE

642
00:23:16,840 --> 00:23:18,160
STUDYING IN ALL KIND OF THINGS

643
00:23:18,160 --> 00:23:20,360
FROM PMS TO OTHER THINGS REALLY

644
00:23:20,360 --> 00:23:22,440
INTERESTED IN A POWERFUL

645
00:23:22,440 --> 00:23:23,600
METABOLITE, KNOWN TO HAVE

646
00:23:23,600 --> 00:23:26,120
PRE-CLINICAL MODELS WHAT

647
00:23:26,120 --> 00:23:28,240
APPEARED TO BE ANGE SOW LYTIC

648
00:23:28,240 --> 00:23:32,920
AND ANTI-DEPRESSIVE EFFECTS.

649
00:23:32,920 --> 00:23:33,720
ANXIOL IRK STIRKSC AND

650
00:23:33,720 --> 00:23:34,680
ANTI-DEPRESSIVE EFFECTS. HOLD

651
00:23:34,680 --> 00:23:36,440
THAT FOR A MINUTE. THE

652
00:23:36,440 --> 00:23:38,480
DIFFERENTIAL SENSITIVITY TO

653
00:23:38,480 --> 00:23:40,360
FLUCTUATIONS IN REPRODUCTIVE

654
00:23:40,360 --> 00:23:41,720
HORMONES AGAIN HAS BEEN

655
00:23:41,720 --> 00:23:43,800
SOMETHING THAT WAS STUDIED AT

656
00:23:43,800 --> 00:23:46,720
THE NIH AND CONTINUES TO BE IN

657
00:23:46,720 --> 00:23:49,440
PIVOTAL WOR WORK. PRE-MENTAL

658
00:23:49,440 --> 00:23:51,960
DYSPHORIC DISORDER AND PERINATAL

659
00:23:51,960 --> 00:23:53,600
MENOPAUSE AND PERINATAL

660
00:23:53,600 --> 00:23:56,520
DEPRESSION. WONDERING WHY IF ALL

661
00:23:56,520 --> 00:24:00,240
WOMEN, IF YOU LOOK HERE AT THE

662
00:24:00,240 --> 00:24:02,720
TOP YOUR LEFT MY RIGHT GRAPH YOU

663
00:24:02,720 --> 00:24:05,040
SEE OVER THE COURSE OF

664
00:24:05,040 --> 00:24:06,440
PREGNANCY, ALL WOMEN HAVE

665
00:24:06,440 --> 00:24:07,840
INCREASING LEVELS OF ESTROGEN

666
00:24:07,840 --> 00:24:09,480
AND PROGESTERONE. THAT IS NORMAL

667
00:24:09,480 --> 00:24:11,560
PHYSIOLOGY, YOU CANNOT HAVE A

668
00:24:11,560 --> 00:24:12,640
PREGNANCY SUCCESSFUL WITHOUT

669
00:24:12,640 --> 00:24:15,640
THAT. AT THE TIME OF DELIVERY,

670
00:24:15,640 --> 00:24:18,000
EVERYONE HAS RAPIDLY PLUM METING

671
00:24:18,000 --> 00:24:19,200
HORMONES.  EVERYONE WHO

672
00:24:19,200 --> 00:24:22,160
DELIVERS. SO WHY IS IT THAT SOME

673
00:24:22,160 --> 00:24:24,360
WOMEN END UP DEPRESSED AND

674
00:24:24,360 --> 00:24:25,680
OTHERS DON'T? IT IS NOT THE

675
00:24:25,680 --> 00:24:27,760
ABSOLUTE LEVEL OF HORMONE OR THE

676
00:24:27,760 --> 00:24:29,000
RATE THAT IT CHANGES IS THAT

677
00:24:29,000 --> 00:24:30,600
THERE APPEARS TO BE DIFFERENTIAL

678
00:24:30,600 --> 00:24:32,400
SENSITIVITY. THAT IS THE HORMONE

679
00:24:32,400 --> 00:24:34,280
HYPOTHESIS.  ONE HYPOTHESIS OF

680
00:24:34,280 --> 00:24:35,760
POSTPARTUM DEPRESSION. CLEARLY

681
00:24:35,760 --> 00:24:38,160
IT IS NOT THE ONLY THING. SO IF

682
00:24:38,160 --> 00:24:41,400
YOU LOOK AT THE CONTRIBUTIONS OF

683
00:24:41,400 --> 00:24:42,680
EPIGENETIC MECHANISMS WHICH

684
00:24:42,680 --> 00:24:43,880
THERE IS LITERATURE AROUND THAT,

685
00:24:43,880 --> 00:24:45,480
IF YOU LOOK AT SYNAPTIC

686
00:24:45,480 --> 00:24:46,680
TRANSMISSION MECHANISMS THAT

687
00:24:46,680 --> 00:24:49,560
THERE'S ALTERATIONS IN SYNAPTIC

688
00:24:49,560 --> 00:24:51,320
TRANSMISSION, OF MANY DIFFERENT

689
00:24:51,320 --> 00:24:52,360
NEUROTRANSMITTERS, IF YOU LOOK

690
00:24:52,360 --> 00:24:53,880
AT NEURAL NETWORK MECHANISMS AND

691
00:24:53,880 --> 00:24:56,360
THERE'S IMAGING STUDIES SHOWING

692
00:24:56,360 --> 00:24:58,680
ALTERED ACTIVITY IN THE AMYGDALA

693
00:24:58,680 --> 00:25:00,120
PREFRONTAL CORTEX CINGULATE

694
00:25:00,120 --> 00:25:01,600
CORTEX AND INSULA, THERE IS

695
00:25:01,600 --> 00:25:03,120
LITERATURE AROUND INFLAMMATORY

696
00:25:03,120 --> 00:25:04,880
MECHANISMS, ALTERED LEVELS OF

697
00:25:04,880 --> 00:25:07,200
IMMUNE SYSTEM FACTORS.  AND

698
00:25:07,200 --> 00:25:08,800
STEROID MECHANISMS ALTERED

699
00:25:08,800 --> 00:25:10,880
LEVELS OF ALLO AND DYSFUNCTION

700
00:25:10,880 --> 00:25:12,800
IN NEUROACTIVE STEROID SIGNALING

701
00:25:12,800 --> 00:25:14,880
AND OF COURSE DISRUPTION IN

702
00:25:14,880 --> 00:25:16,320
STRESS MECHANISMS ALTERATIONS OF

703
00:25:16,320 --> 00:25:19,720
THE HPA ACCESS. SO ALL THESE

704
00:25:19,720 --> 00:25:21,600
THINGS THERE IS LITERATURE ON

705
00:25:21,600 --> 00:25:23,760
AND AS WE TREAT WOMEN WITH

706
00:25:23,760 --> 00:25:25,040
POSTPARTUM DEPRESSION WE ARE NOT

707
00:25:25,040 --> 00:25:27,280
SPECIFIC AT ALL. SO UNLIKE

708
00:25:27,280 --> 00:25:29,160
BREAST CANCER WHERE YOU FIND OUT

709
00:25:29,160 --> 00:25:32,040
IF SOMEONE HAS HORMONE RECEPTOR

710
00:25:32,040 --> 00:25:33,600
POSITIVE OR NEGATIVE BREAST

711
00:25:33,600 --> 00:25:36,160
CANCER OR HR 2 NU POSITIVE

712
00:25:36,160 --> 00:25:37,360
BREAST CANCER OR GENETIC SIGNAL

713
00:25:37,360 --> 00:25:39,080
WHICH MARKEDLY DAY ORS TREATMENT

714
00:25:39,080 --> 00:25:41,520
AND LEADS TO DIFFERENT OUTCOMES

715
00:25:41,520 --> 00:25:42,880
WE THROW THE SAME TREATMENT AT

716
00:25:42,880 --> 00:25:44,520
EVERYONE AND WONDER WHY SOME

717
00:25:44,520 --> 00:25:45,760
PEOPLE GET BETTER EASILY AND

718
00:25:45,760 --> 00:25:47,360
SOME DO NOT. THAT IS A MAJOR

719
00:25:47,360 --> 00:25:49,560
SOURCE OF MOTIVATION FOR ME WHEN

720
00:25:49,560 --> 00:25:52,160
I SIT IN FRONT OF A PATIENT AND

721
00:25:52,160 --> 00:25:53,920
THE FAMILY AND THEY ARE

722
00:25:53,920 --> 00:25:55,480
SUFFERING TREMENDOUSLY.  IT IS

723
00:25:55,480 --> 00:25:56,680
FRUSTRATING TO NOT KNOW IF YOU

724
00:25:56,680 --> 00:25:58,760
ARE STARTING THE RIGHT TREATMENT

725
00:25:58,760 --> 00:26:00,760
OR NOT, THE GOLD STANDARD UP

726
00:26:00,760 --> 00:26:03,400
UNTIL RECENTLY WHERE THE FOR

727
00:26:03,400 --> 00:26:06,920
PHARMACOLOGIC THERAPY SSRI

728
00:26:06,920 --> 00:26:08,000
ANTIDEPRESSANTS THAT MAY OR MAY

729
00:26:08,000 --> 00:26:10,760
NOT WORK, MAY TAKE MONTHS TO TIE

730
00:26:10,760 --> 00:26:11,560
TRITE UP TO A THERAPEUTIC DOSE

731
00:26:11,560 --> 00:26:12,680
AND WHEN YOU ARE REALLY SICK AND

732
00:26:12,680 --> 00:26:14,440
THE FAMILY IS IN CRISIS THAT

733
00:26:14,440 --> 00:26:17,320
FEELS LIKE AN ETERNITY.  SO THIS

734
00:26:17,320 --> 00:26:18,680
WAS PART OF THE MOTIVATION FOR

735
00:26:18,680 --> 00:26:21,280
TRYING TO FIGURE OUT IS THERE A

736
00:26:21,280 --> 00:26:24,840
GENETIC SIGNATURE? AND PAC

737
00:26:24,840 --> 00:26:27,600
CONSORTIUM WAS STARTED IN 2010

738
00:26:27,600 --> 00:26:29,760
WORKING WITH GENETICS COLLEAGUES

739
00:26:29,760 --> 00:26:33,360
OF MINE PATRICK SULLIVAN WHO IS

740
00:26:33,360 --> 00:26:36,560
A WORLD CLASS PSYCH GENETICIST

741
00:26:36,560 --> 00:26:40,480
AT UNC AND PARTNERING WITH

742
00:26:40,480 --> 00:26:42,280
PEOPLE, YOU SEE PETER SCHMIDT'S

743
00:26:42,280 --> 00:26:44,040
PICTURE THERE, AND TEAM HERE AND

744
00:26:44,040 --> 00:26:46,840
OTHER INVESTIGATORS AROUND GLOBE

745
00:26:46,840 --> 00:26:50,320
WHERE WE SAID DO YOU HAVE DATA

746
00:26:50,320 --> 00:26:52,800
ON CLINICAL PHENOTYPIC DATA AND

747
00:26:52,800 --> 00:26:54,560
GENETIC DATA THAT WE CAN START

748
00:26:54,560 --> 00:26:55,800
POOLING TOGETHER TO TRY AND LOOK

749
00:26:55,800 --> 00:26:58,280
AT THE HETEROGENEITY OF

750
00:26:58,280 --> 00:27:00,520
POSTPARTUM DEPRESSION AND

751
00:27:00,520 --> 00:27:02,280
UNDERSTAND ULTIMATELY FROM A

752
00:27:02,280 --> 00:27:04,040
PRECISION PSYCHIATRY POINT OF

753
00:27:04,040 --> 00:27:05,280
VIEW WHAT ARE THE DIFFERENT

754
00:27:05,280 --> 00:27:06,640
SUBGROUPS AND HOW CAN WE

755
00:27:06,640 --> 00:27:09,840
ULTIMATELY GET TO MUCH MORE

756
00:27:09,840 --> 00:27:11,640
REFINED TREATMENT. PEOPLE WERE

757
00:27:11,640 --> 00:27:13,800
ENORMOUSLY GENEROUS.  WE CALLED

758
00:27:13,800 --> 00:27:15,880
IT THE PACT CONSORTIUM WHICH IS

759
00:27:15,880 --> 00:27:18,600
A TERRIBLE ACRONYM POST PARTUM

760
00:27:18,600 --> 00:27:19,800
DEPRESSION ACTION CAUSES AND

761
00:27:19,800 --> 00:27:21,240
TREATMENT AND YOU CAN TELL WE

762
00:27:21,240 --> 00:27:23,160
WERE WELL MEANING ACADEMICS NOT

763
00:27:23,160 --> 00:27:24,720
WORKING FOR A MARKETING FIRM

764
00:27:24,720 --> 00:27:30,640
THAT COCAINE UP WITH WE CAME UPH

765
00:27:30,640 --> 00:27:33,160
FORWARD FIVE YEARS LATER APPLE

766
00:27:33,160 --> 00:27:35,280
RELEASED A RESEARCH KIT

767
00:27:35,280 --> 00:27:37,320
PLATFORM. THE IDEA OF BRINGING

768
00:27:37,320 --> 00:27:39,040
SCIENCE DIRECTLY TO THE CONSUMER

769
00:27:39,040 --> 00:27:42,320
ON YOUR SMART PHONE, WE HAD AN

770
00:27:42,320 --> 00:27:44,680
OPPORTUNITY TO PARTNER WITH THEM

771
00:27:44,680 --> 00:27:46,640
TO LAUNCH A GENETIC STUDY OF

772
00:27:46,640 --> 00:27:49,800
POSTPARTUM DEPRESSION.  AND

773
00:27:49,800 --> 00:27:52,400
APPLE SUGGESTED TO US THAT PACT

774
00:27:52,400 --> 00:27:53,480
WASN'T A GREAT NAME, MAYBE

775
00:27:53,480 --> 00:27:57,360
CHANGE IT TO PPD ACT POSTPARTUM

776
00:27:57,360 --> 00:27:58,640
DEPRESSION ACTION TOWARD CAUSES

777
00:27:58,640 --> 00:28:01,040
AND TREATMENT. WE WERE ABLE AND

778
00:28:01,040 --> 00:28:03,720
USING SORT OF INTERNAL FUNDS

779
00:28:03,720 --> 00:28:06,200
LOCAL FOUNDATION FUNDS IN A

780
00:28:06,200 --> 00:28:08,000
VERY, VERY FAST SPRINT TO BUILD

781
00:28:08,000 --> 00:28:09,720
THIS APP AND MANAGE THROUGH A

782
00:28:09,720 --> 00:28:12,320
SMALL ACT OF GOD TO GET ETHICS

783
00:28:12,320 --> 00:28:14,480
BOARD APPROVAL AT UNC SO WOMEN

784
00:28:14,480 --> 00:28:17,880
COULD USE THIS FOR FREE, BOTH

785
00:28:17,880 --> 00:28:20,400
INITIALLY IOS THEN ANDROID IN

786
00:28:20,400 --> 00:28:23,600
ENGLISH AND SPANISH OVER TIME TO

787
00:28:23,600 --> 00:28:24,960
ANSWER QUESTIONS ABOUT LIFETIME

788
00:28:24,960 --> 00:28:26,640
HISTORY OF POSTPARTUM

789
00:28:26,640 --> 00:28:27,840
DEPRESSION. AMEND THEN IF THEY

790
00:28:27,840 --> 00:28:29,880
MET CRITERIA TO GIVE A GENETIC

791
00:28:29,880 --> 00:28:33,280
SAMPLE. WE PARTNERED WITH THE

792
00:28:33,280 --> 00:28:35,880
NIH AROUND THIS, THE NIH

793
00:28:35,880 --> 00:28:41,080
GRACIOUSLY PROVIDED SPIT KITS,

794
00:28:41,080 --> 00:28:43,680
FOR PEOPLE ELIGIBLE WOULD SEND

795
00:28:43,680 --> 00:28:46,800
OUT THEN THEIR RETURN TO NIH

796
00:28:46,800 --> 00:28:47,960
BIOREPOSITORY SO THIS IS PART OF

797
00:28:47,960 --> 00:28:50,360
PUBLIC DOMAIN. WE HAVE HAD OVER

798
00:28:50,360 --> 00:28:54,280
12,000 PARTICIPANTS TO DATE.  I

799
00:28:54,280 --> 00:28:55,200
WILL TELL YOU WHERE THIS IS

800
00:28:55,200 --> 00:28:58,640
GOING NEXT BUT IT IS A PRETTY

801
00:28:58,640 --> 00:29:00,600
AMAZING PROJECT. IT WAS LAUNCHED

802
00:29:00,600 --> 00:29:01,880
ALSO IN AUSTRALIA AND CANADIANS

803
00:29:01,880 --> 00:29:06,160
MADE ONE. THERE'S MODELS OF IT

804
00:29:06,160 --> 00:29:08,080
IN SWEDEN AND DENMARK ALL TO

805
00:29:08,080 --> 00:29:10,120
GAIN AS QUICKLY AS POSSIBLE

806
00:29:10,120 --> 00:29:11,640
GENETIC SAMPLES.  ASKING WOMEN

807
00:29:11,640 --> 00:29:12,880
WITH LIFETIME HISTORIES TO

808
00:29:12,880 --> 00:29:18,360
PARTICIPATE.  WHAT HAPPENED NEXT

809
00:29:18,360 --> 00:29:21,960
WHEN IT LAUNCHED IF YOU BUILD AN

810
00:29:21,960 --> 00:29:24,040
APP AND NO ONE KNOWS YOU HAVE AN

811
00:29:24,040 --> 00:29:25,160
APP YOU WON'T GET MUCH ACTION

812
00:29:25,160 --> 00:29:26,960
WITH IT.  WE WERE ABLE THE FIRST

813
00:29:26,960 --> 00:29:28,760
STUDY USING APPLE RESEARCH KIT

814
00:29:28,760 --> 00:29:30,600
TO GET A NEW YORK TIMES REPORTER

815
00:29:30,600 --> 00:29:32,160
WRITING ABOUT POSTPARTUM

816
00:29:32,160 --> 00:29:34,200
DEPRESSION INTERESTED.  THE VERY

817
00:29:34,200 --> 00:29:36,440
FIRST DAY WE LAUNCHED WE HAD

818
00:29:36,440 --> 00:29:37,440
10,000 PEOPLE THAT SIGNED UP.

819
00:29:37,440 --> 00:29:38,760
THREE DAYS BEFORE WE WERE

820
00:29:38,760 --> 00:29:43,280
SUPPOSED TO START THE NIH

821
00:29:43,280 --> 00:29:44,720
BIOREPOSITORY TOLD US YOU CAN'T

822
00:29:44,720 --> 00:29:46,240
SEND OUT SPIT KITS YOU HAVE TO

823
00:29:46,240 --> 00:29:46,840
BECAUSE OF PERSONAL HEALTH

824
00:29:46,840 --> 00:29:48,480
INFORMATION SO WE HAD TO TURN

825
00:29:48,480 --> 00:29:51,960
OURSELVES INTO A SPIT KIT

826
00:29:51,960 --> 00:29:52,640
DISTRIBUTION FACTORY, ON VERY

827
00:29:52,640 --> 00:29:53,840
LITTLE WARNING AND WE DIDN'T

828
00:29:53,840 --> 00:29:55,160
KNOW WHEN IT LAUNCHED WE WERE

829
00:29:55,160 --> 00:29:56,560
GOING TO HAVE FIVE PEOPLE SIGN

830
00:29:56,560 --> 00:29:59,360
UP BUT WE HAD 10,000 WHO

831
00:29:59,360 --> 00:30:00,360
INITIALLY ALL WERE NOT ELIGIBLE

832
00:30:00,360 --> 00:30:01,880
NOR THE GENETIC PART BUT IT WAS

833
00:30:01,880 --> 00:30:06,840
A BIT OF A WILD TIME IN TERMS OF

834
00:30:06,840 --> 00:30:09,200
HOW THAT WENT. NONETHELESS WE

835
00:30:09,200 --> 00:30:13,920
PREVAILED. AND A FEW YEARS LATER

836
00:30:13,920 --> 00:30:15,280
GOT A CALL FROM AN ADVERTISING

837
00:30:15,280 --> 00:30:20,200
AGENCY OUT OF THE BLUE IN IN LA

838
00:30:20,200 --> 00:30:23,240
NAMED WONG DUTIFUL AGENCY

839
00:30:23,240 --> 00:30:25,280
STARTED BY MR. WONG AND

840
00:30:25,280 --> 00:30:28,680
MR. DUT DUTY. THEY SENT ME AN EL

841
00:30:28,680 --> 00:30:29,960
SAYING WE WANT TO TALK TO YOU

842
00:30:29,960 --> 00:30:32,760
ABOUT YOUR APP. I ALMOST DELETED

843
00:30:32,760 --> 00:30:34,680
IT. THEY SAID WE SEE YOU HAVE

844
00:30:34,680 --> 00:30:37,480
THIS APP AND WE EVERY YEAR PICK

845
00:30:37,480 --> 00:30:39,680
A PRO BONO PROJECT AND YOU HAVE

846
00:30:39,680 --> 00:30:41,840
WON. WE LIKE TO TAKE OUR

847
00:30:41,840 --> 00:30:43,440
ADVERTISING SUPERPOWERS AND PUT

848
00:30:43,440 --> 00:30:44,840
IT TO GOOD USE AN HELP YOU

849
00:30:44,840 --> 00:30:45,960
TRANSFORM YOUR STUDY. WHICH IS

850
00:30:45,960 --> 00:30:47,480
NICE TO SAY WE THINK YOUR

851
00:30:47,480 --> 00:30:48,400
BRANDING SUCKS AND WE THINK WE

852
00:30:48,400 --> 00:30:50,760
CAN DO BETTER.  THIS COMPANY HAS

853
00:30:50,760 --> 00:30:52,760
A LOT OF WOMEN EXECUTIVES SOME

854
00:30:52,760 --> 00:30:54,040
THAT HAD POSTPARTUM DEPRESSION

855
00:30:54,040 --> 00:30:57,120
WHICH I UNDERSTAND IS HOW IT GOT

856
00:30:57,120 --> 00:30:59,520
PICKED.  AND IT WAS PREBRANDED

857
00:30:59,520 --> 00:31:02,040
AS MOM -- REBRANDED AS MOM GENES

858
00:31:02,040 --> 00:31:05,200
FIGHT PPD. THIS IS ON THE

859
00:31:05,200 --> 00:31:06,400
SATURDAY NIGHT LIVE SKIT I WEAR

860
00:31:06,400 --> 00:31:09,320
MY MOM GENES JEANS IF YOU ARE

861
00:31:09,320 --> 00:31:11,040
OLD ENOUGH TO REMEMBER. THEY

862
00:31:11,040 --> 00:31:13,120
PUMPED A COUPLE DIFFERENT --

863
00:31:13,120 --> 00:31:14,960
PITCHED A COUPLE OF PLANS AND WE

864
00:31:14,960 --> 00:31:16,440
WENT WITH MOM GENES WHICH WAS

865
00:31:16,440 --> 00:31:18,800
PITCHED BY THEIR LA OFFICE. 

866
00:31:18,800 --> 00:31:22,000
THEY HAD A SEATTLE OFFICE THAT

867
00:31:22,000 --> 00:31:24,080
PITCHED SOMETHING THAT IS

868
00:31:24,080 --> 00:31:26,960
FABULOUS BUT I CAN'T SAY PUBLIC

869
00:31:26,960 --> 00:31:29,240
WILL AND NEVER STOOD THE ETHICS

870
00:31:29,240 --> 00:31:30,360
BOARD AND I WILL TELL YOU AFTER

871
00:31:30,360 --> 00:31:32,720
IF YOU DON'T MIND PROFANITY.

872
00:31:32,720 --> 00:31:35,000
THIS LAUNCHED IN THE FALL OF

873
00:31:35,000 --> 00:31:37,080
2019 REBRANDED. IT THRIVED OVER

874
00:31:37,080 --> 00:31:39,760
THE COURSE OF THE PANDEMIC. AND

875
00:31:39,760 --> 00:31:42,000
SO WE HAD VERY DUTIFUL RESEARCH

876
00:31:42,000 --> 00:31:43,440
TEAM THAT CAME IN DURING THE

877
00:31:43,440 --> 00:31:45,920
PANDEMIC SENDING OUT SPIT KITS,

878
00:31:45,920 --> 00:31:48,240
THE LAST TRIP I TOOK BEFORE

879
00:31:48,240 --> 00:31:50,320
MARCH OF 2020 WAS A TRIP TO LA,

880
00:31:50,320 --> 00:31:51,360
SORT OF LAUNCHED THIS WHOLE

881
00:31:51,360 --> 00:31:52,640
THING BUT IT BUILT THIS WHOLE

882
00:31:52,640 --> 00:31:55,520
SOCIAL MEDIA COMMUNITY OF MOMS

883
00:31:55,520 --> 00:31:56,840
COMING TOGETHER PARTICIPATING IN

884
00:31:56,840 --> 00:31:59,160
THE APP SENDING IN GENETIC

885
00:31:59,160 --> 00:32:01,320
SAMPLES, AND SO REALLY

886
00:32:01,320 --> 00:32:02,880
FASCINATING TO WATCH THIS PLAY

887
00:32:02,880 --> 00:32:05,240
OUT OVER PANDEMIC. LEADING TO WE

888
00:32:05,240 --> 00:32:09,320
HAVE A FIRST PAPER UNDER REVIEW,

889
00:32:09,320 --> 00:32:11,640
WE JUST GOT THE REQUEST FOR

890
00:32:11,640 --> 00:32:16,440
REVISED RESUBMIT.  THIS IS JERRY

891
00:32:16,440 --> 00:32:18,400
(INAUDIBLE) WHO TRAINED IN

892
00:32:18,400 --> 00:32:20,280
BALTIMORE CAME AS POST DOC AS

893
00:32:20,280 --> 00:32:21,920
JUNIOR FACULTY MEMBER FUNDEDD ON

894
00:32:21,920 --> 00:32:28,400
NIH EXTRAMURAL K AWARD. HE WAS

895
00:32:28,400 --> 00:32:30,080
ABLE TO USE ALL THE APP BASED

896
00:32:30,080 --> 00:32:32,320
DATA AND THE PACT CONSORTIUM

897
00:32:32,320 --> 00:32:36,920
AROUND THE WORLD TO GET 70,000

898
00:32:36,920 --> 00:32:40,320
PEOPLE, 17,000 PPD CASE, 53,000

899
00:32:40,320 --> 00:32:41,960
CONTROLS:  TO LOOK AT THE FIRST

900
00:32:41,960 --> 00:32:44,240
GENETIC RISK FACTORS FOR

901
00:32:44,240 --> 00:32:45,840
POSTPARTUM DEPRESSION. THIS META

902
00:32:45,840 --> 00:32:48,160
ANALYSIS IS THE FIRST LARGE

903
00:32:48,160 --> 00:32:49,600
SCALE GENOMIC INTERROGATION OF

904
00:32:49,600 --> 00:32:52,760
THE PPD. ALLOWING US TO EXPLORE

905
00:32:52,760 --> 00:32:54,560
THE RELATIONSHIP OF POSTPARTUM

906
00:32:54,560 --> 00:32:56,120
DEPRESSION WITH OTHER GENETIC

907
00:32:56,120 --> 00:32:58,360
TRAITS AND WHAT IS OF INTEREST

908
00:32:58,360 --> 00:33:01,040
IS THAT IT IS SHOWN THIS WORK

909
00:33:01,040 --> 00:33:02,520
IMPORTANT RELATIONSHIPS OF

910
00:33:02,520 --> 00:33:04,000
GENETIC RISK POSTPARTUM

911
00:33:04,000 --> 00:33:05,760
DEPRESSION WITH MAJOR DEPRESSION

912
00:33:05,760 --> 00:33:07,680
OUTSIDE OF THE PERINATAL PERIOD

913
00:33:07,680 --> 00:33:10,120
WITH BIPOLAR DISORDER WITH

914
00:33:10,120 --> 00:33:12,120
INSOMNIA AND OTHER PSYCHIATRIC

915
00:33:12,120 --> 00:33:15,160
DISORDERS. WHEN WE LOOKED AT IT

916
00:33:15,160 --> 00:33:17,120
FURTHER OUR GENETIC VARIANTS IS

917
00:33:17,120 --> 00:33:19,120
ENRICHED FOR SPECIFIC CELL TYPES

918
00:33:19,120 --> 00:33:22,480
MOST NOTABLY GABBANERGIC OR

919
00:33:22,480 --> 00:33:23,760
INHIBITORY NEURONS IN THE

920
00:33:23,760 --> 00:33:25,920
THALAMUS AND HYPOTHALAMUS.  WE

921
00:33:25,920 --> 00:33:27,920
SAW SIGNIFICANT DIFFERENCES IN

922
00:33:27,920 --> 00:33:29,240
POSTPARTUM DEPRESSION AND MAJOR

923
00:33:29,240 --> 00:33:31,760
DEPRESSION. SO HERE IS THE DATA

924
00:33:31,760 --> 00:33:32,960
LOOKING AT THE DIFFERENCES

925
00:33:32,960 --> 00:33:36,880
BETWEEN CASES AND CONTROLS. IF

926
00:33:36,880 --> 00:33:38,720
YOU LOOK AT MANHATTAN PLOT IT IS

927
00:33:38,720 --> 00:33:42,120
NOT MAGIC. TEN TO MINUS 8, TEN

928
00:33:42,120 --> 00:33:45,400
TO MINUS 7 SO LIKE MOST GWAS

929
00:33:45,400 --> 00:33:48,160
STUDIES YOU CAN CONCLUDE LARGER

930
00:33:48,160 --> 00:33:49,480
SAMPLE SIZES ARE NEEDED.  THERE

931
00:33:49,480 --> 00:33:51,120
IS ANOTHER 5 TO 10,000 TO DUMP

932
00:33:51,120 --> 00:33:52,960
INTO IT SO WE ARE CLOSE. BUT

933
00:33:52,960 --> 00:33:54,560
WHAT IS PARTICULARLY INTERESTING

934
00:33:54,560 --> 00:33:55,840
OTHER THAN THAT TRENDING IS

935
00:33:55,840 --> 00:33:59,160
THIS. IF YOU LOOK AT CELL

936
00:33:59,160 --> 00:34:01,520
ENRICHMENT TYPE AND LOOK AT THE

937
00:34:01,520 --> 00:34:03,440
TOP, LOOKING HERE AT POSTPARTUM

938
00:34:03,440 --> 00:34:04,720
DEPRESSION VERSUS MAJOR

939
00:34:04,720 --> 00:34:07,360
DEPRESSION OUTSIDE THE PERINATAL

940
00:34:07,360 --> 00:34:08,840
PERIOD YOU CAN SEE INHIBITOR

941
00:34:08,840 --> 00:34:11,160
NEURONS IN THE THALAMUS REALLY

942
00:34:11,160 --> 00:34:13,520
SEEM TO BE DRIVING THE CELL TYPE

943
00:34:13,520 --> 00:34:16,240
ENRICHMENT DIFFERENCES BETWEEN

944
00:34:16,240 --> 00:34:18,920
THE TWO. THIS IS VERY RELEVANT

945
00:34:18,920 --> 00:34:22,200
GIVEN WHERE I WANT TO GO NEXT. 

946
00:34:22,200 --> 00:34:25,080
WHICH IS THE STORY OF

947
00:34:25,080 --> 00:34:26,560
BREXANALONE A POSITIVE

948
00:34:26,560 --> 00:34:28,640
ALLOSTERIC MODULATOR OF GABBA

949
00:34:28,640 --> 00:34:31,320
WHICH IS INHIBITORY. SO I THINK

950
00:34:31,320 --> 00:34:32,520
THE CONNECTION OF THIS IN THESE

951
00:34:32,520 --> 00:34:34,320
FINDINGS RECENTLY ARE REALLY

952
00:34:34,320 --> 00:34:36,160
COMPELLING AND HELPING TELL

953
00:34:36,160 --> 00:34:39,400
STORY OF WHY BREXANALONE WORKS.

954
00:34:39,400 --> 00:34:42,280
SO I TOLD YOU ABOUT OUR

955
00:34:42,280 --> 00:34:44,000
PERINATAL PSYCH UNIT. WE HAD THE

956
00:34:44,000 --> 00:34:45,760
OPPORTUNITY AND WE ARE CONTACTED

957
00:34:45,760 --> 00:34:49,520
BY STEVE PAUL WHO NOW WAS PART

958
00:34:49,520 --> 00:34:51,320
OF A BRAND NEW START UP CALLED

959
00:34:51,320 --> 00:34:54,000
SAGE THERAPEUTIC. AND HAD

960
00:34:54,000 --> 00:34:55,760
REACHED OUT TO TALK ABOUT

961
00:34:55,760 --> 00:34:57,760
WHETHER WE WERE INTERESTED IN

962
00:34:57,760 --> 00:34:59,360
POTENTIALLY THINKING ABOUT

963
00:34:59,360 --> 00:35:02,000
LOOKING AT THEIR NEW PRO PRY DAY

964
00:35:02,000 --> 00:35:05,640
COMPOUND OF ALLO PREDNANALONE,

965
00:35:05,640 --> 00:35:07,840
THEY HAD A PROPRIETARY

966
00:35:07,840 --> 00:35:09,000
FORMULATION AS TREATMENT FOR

967
00:35:09,000 --> 00:35:11,960
POSTPARTUM DEPRESSION.  SO THE

968
00:35:11,960 --> 00:35:14,240
IDEA WAS COULD YOU USE ALLO TO

969
00:35:14,240 --> 00:35:16,160
SEE IF THERE WAS ANY SIGNAL? WE

970
00:35:16,160 --> 00:35:17,640
STARTED THIS WITH THE MOST

971
00:35:17,640 --> 00:35:19,120
MODEST OF EXPECTATIONS.  THEY

972
00:35:19,120 --> 00:35:21,400
HAD A PROPRIETARY FORMULATION IT

973
00:35:21,400 --> 00:35:24,160
WAS AN IV DRUG STUDIED IN

974
00:35:24,160 --> 00:35:27,920
TREATMENT REFRACTORY STATUS

975
00:35:27,920 --> 00:35:29,160
LEPTICUS AND THEY WERE LOOKING

976
00:35:29,160 --> 00:35:30,800
FOR OTHER IMPLICATIONS.  WE WERE

977
00:35:30,800 --> 00:35:32,360
INTERESTED IN ALLO A LONG TIME,

978
00:35:32,360 --> 00:35:34,160
WE HAD INPATIENT UNIT DOING

979
00:35:34,160 --> 00:35:38,000
CLINICAL TRIALS. AND I WAS VERY

980
00:35:38,000 --> 00:35:39,680
INTERESTED IN LOOKING AT NOVEL

981
00:35:39,680 --> 00:35:42,200
TREATMENTS THAT WOULD GIVE US

982
00:35:42,200 --> 00:35:43,640
SOMETHING DIFFERENT AND

983
00:35:43,640 --> 00:35:44,880
PARTICULARLY WITH THIS BE MUCH

984
00:35:44,880 --> 00:35:47,000
FASTER ACTING THAN WHAT WAS THE

985
00:35:47,000 --> 00:35:48,640
CURRENT BASELINE GOLD STANDARD

986
00:35:48,640 --> 00:35:52,080
FOR PHARMACOLOGIC TREATMENT

987
00:35:52,080 --> 00:35:55,640
LARGELY SSRIs. SO IT IS OF

988
00:35:55,640 --> 00:35:59,760
NOTE IN THE SAME TWO WEEK PERIOD

989
00:35:59,760 --> 00:36:04,520
IN MARCH OF 2019 THAT AFTER WHAT

990
00:36:04,520 --> 00:36:07,200
I WOULD SAY IS A VERY LONG

991
00:36:07,200 --> 00:36:09,160
DROUGHT IN NOVEL INNOVATION

992
00:36:09,160 --> 00:36:11,040
ANTI-DEPRESS ISN'T TREATMENT YOU

993
00:36:11,040 --> 00:36:14,400
HAD FDA APPROVE INTRANASAL

994
00:36:14,400 --> 00:36:16,400
KETAMINE AND SAME TWO WEEKS HAD

995
00:36:16,400 --> 00:36:20,320
BREX APPROVED. PBS FAST ACTING

996
00:36:20,320 --> 00:36:21,560
ANTIDEPRESSANTS FOR DIFFERENT

997
00:36:21,560 --> 00:36:24,080
INDICATIONS AND NIH CA AND HIS

998
00:36:24,080 --> 00:36:25,680
GROUP WITH KETAMINE, POWERFUL

999
00:36:25,680 --> 00:36:27,120
WORK BEING DONE BUT REALLY

1000
00:36:27,120 --> 00:36:28,600
INTERESTING IN TERMS OF THE FACT

1001
00:36:28,600 --> 00:36:31,400
THAT BOTH OF THESE TWO THINGS

1002
00:36:31,400 --> 00:36:33,240
ENDED UP BEING APPROVED IN THE

1003
00:36:33,240 --> 00:36:34,920
SAME TWO WEEKS IS AN INTERESTING

1004
00:36:34,920 --> 00:36:37,440
COINCIDENCE BUT SPEAKS TO THE

1005
00:36:37,440 --> 00:36:39,160
NEED FOR MORE INNOVATION IN THIS

1006
00:36:39,160 --> 00:36:43,720
SPACE. SO BREXANALONE IS A

1007
00:36:43,720 --> 00:36:45,600
PROPRIETARY FORMULATION OF ALLO,

1008
00:36:45,600 --> 00:36:46,640
THE FIRST APPROVED IN CLASS

1009
00:36:46,640 --> 00:36:47,960
TREATMENT FOR ADULT PATIENTS

1010
00:36:47,960 --> 00:36:49,720
WITH POSTPARTUM DEPRESSION BY

1011
00:36:49,720 --> 00:36:53,160
FDA MARCH OF 2019. AND IT WAS

1012
00:36:53,160 --> 00:36:57,040
STUDIED WE PICKED A PROTOCOL

1013
00:36:57,040 --> 00:37:00,200
WORKED ON PROTOCOL SKETCHED OUT

1014
00:37:00,200 --> 00:37:02,440
IN A CONFERENCE ROOM AT UNC FOR

1015
00:37:02,440 --> 00:37:03,760
AN OPEN LABEL STUDY TO SEE IF

1016
00:37:03,760 --> 00:37:06,680
THERE WAS ANY SIGNAL AT ALL. THE

1017
00:37:06,680 --> 00:37:10,240
IDEA WAS TO DO TEN PATIENTS. AND

1018
00:37:10,240 --> 00:37:12,640
WHAT WE WERE OVERWHELMED BY WAS

1019
00:37:12,640 --> 00:37:14,320
THE INITIAL FIRST PATIENT I WILL

1020
00:37:14,320 --> 00:37:15,880
DESCRIBE THAT BY THAT RESPONSE

1021
00:37:15,880 --> 00:37:17,120
WHICH LED US TO BELIEVE EITHER

1022
00:37:17,120 --> 00:37:18,800
THIS IS LIKE AN ACTIVE DRUG THAT

1023
00:37:18,800 --> 00:37:21,240
IS POWERFUL OR ONE HECK OF A

1024
00:37:21,240 --> 00:37:23,840
PLACEBO. SO BECAUSE WE HAD OUR

1025
00:37:23,840 --> 00:37:27,600
PERINATAL PSYCH UNIT, WE HAD A

1026
00:37:27,600 --> 00:37:28,840
WOMAN ADMITTED, SO IT WAS HER

1027
00:37:28,840 --> 00:37:31,120
SECOND BABY AND SHE HAD ONE

1028
00:37:31,120 --> 00:37:32,560
PREVIOUS EPISODE OF DEPRESSION

1029
00:37:32,560 --> 00:37:34,160
WHICH WAS AFTER HER FIRST BABY

1030
00:37:34,160 --> 00:37:36,920
WHERE SHE HAD NOT RESPONDED TO

1031
00:37:36,920 --> 00:37:38,400
OTHER ANTIDEPRESSANTS AND HAD

1032
00:37:38,400 --> 00:37:40,440
BEEN VERY DEPRESSED FOR ABOUT A

1033
00:37:40,440 --> 00:37:42,040
YEAR BEFORE IT RESOLVED.  SHE

1034
00:37:42,040 --> 00:37:45,160
WAS THEN BACK AT BASELINE NOT

1035
00:37:45,160 --> 00:37:46,760
DEPRESSED. HAD THE SECOND BABY,

1036
00:37:46,760 --> 00:37:48,520
BECAME ACUTELY DEPRESSED,

1037
00:37:48,520 --> 00:37:50,640
WITHDRAWN, NOT EATING. NOT ABLE

1038
00:37:50,640 --> 00:37:53,200
TO SLEEP. SOCIALLY WITHDRAWN,

1039
00:37:53,200 --> 00:37:55,200
HAVING SUICIDAL THOUGHTS. FAMILY

1040
00:37:55,200 --> 00:37:56,840
EXTREMELY WORRIED.  SHE HAD BEEN

1041
00:37:56,840 --> 00:37:57,880
ADMITTED TO OUR UNIT. WE

1042
00:37:57,880 --> 00:37:59,120
APPROACH AND ASKED IF SHE WAS

1043
00:37:59,120 --> 00:38:00,440
WILLING TO BE IN THIS OPEN LABEL

1044
00:38:00,440 --> 00:38:05,280
STUDY.  AND BECAUSE SHE HAD HAD

1045
00:38:05,280 --> 00:38:07,440
BAD EXPERIENCE WITH SSRIs IN

1046
00:38:07,440 --> 00:38:09,280
TERMS OF SIDE EFFECTS AND FELT

1047
00:38:09,280 --> 00:38:10,520
BOTH GAVE HER TERRIBLE SIDE

1048
00:38:10,520 --> 00:38:13,120
EFFECTS INCLUDING GI THINGS

1049
00:38:13,120 --> 00:38:14,560
PREDOMINANTLY, AND WAS NOT

1050
00:38:14,560 --> 00:38:15,560
EFFECTIVE, THEY WERE WILLING TO

1051
00:38:15,560 --> 00:38:19,440
DO THIS. AND WITHIN 12 HOURS OF

1052
00:38:19,440 --> 00:38:21,480
THE 60 HOUR INFUSION HER -- SHE

1053
00:38:21,480 --> 00:38:23,840
HAD A COMPLETE AFFECTIVE STATE

1054
00:38:23,840 --> 00:38:24,760
CHANGE WHICH WAS REMARKABLE TO

1055
00:38:24,760 --> 00:38:26,400
SEE. I DON'T THINK YOU SEE THAT

1056
00:38:26,400 --> 00:38:28,960
WITH -- UNLESS YOU ARE SOMEONE

1057
00:38:28,960 --> 00:38:31,520
RESPONDING DOCKET MEAN, SHE WENT

1058
00:38:31,520 --> 00:38:32,960
FROM WITHDRAWN FLAT AFFECT TO

1059
00:38:32,960 --> 00:38:34,080
BRIGHT AFFECT SHE WENT FROM

1060
00:38:34,080 --> 00:38:36,280
SOCIALLY ISOLATED TO WANTING TO

1061
00:38:36,280 --> 00:38:38,400
TALK TO PATIENTS. SHE WENT FROM

1062
00:38:38,400 --> 00:38:39,960
NOT BEING INTERESTED IN EATING

1063
00:38:39,960 --> 00:38:41,280
AND HAD LOSS A HUGE AMOUNT OF

1064
00:38:41,280 --> 00:38:43,320
WEIGHT RAPIDLY TO WANTING HER

1065
00:38:43,320 --> 00:38:45,600
FOOD ON THE UNI UNIT. SO SUDDENY

1066
00:38:45,600 --> 00:38:50,920
SHE WENT FROM A DROOPY WILTED

1067
00:38:50,920 --> 00:38:52,560
FLOWER OF NOT MAKING IT TO

1068
00:38:52,560 --> 00:38:53,600
BRIGHTENED UP CONSIDERABLY, IT

1069
00:38:53,600 --> 00:38:56,080
WAS BIZARRE AND FUN TO WATCH.

1070
00:38:56,080 --> 00:38:59,200
AND WE WERE LIKE WOW, THAT IS

1071
00:38:59,200 --> 00:39:00,920
SOMETHING. AND IT COULD BE

1072
00:39:00,920 --> 00:39:02,040
PLACEBO BUT CERTAINLY

1073
00:39:02,040 --> 00:39:04,640
INTERESTING TO WATCH. SO THAT

1074
00:39:04,640 --> 00:39:07,760
STORY WAS REPEATED WITH THREE

1075
00:39:07,760 --> 00:39:11,600
MORE PATIENTS. WITH VERY

1076
00:39:11,600 --> 00:39:13,080
IMPRESSIVE RESPONSE AND THEN IN

1077
00:39:13,080 --> 00:39:14,480
WORKING WITH SAGE THERAPEUTIC

1078
00:39:14,480 --> 00:39:16,920
THEY DECIDED THAT RATHER THAN

1079
00:39:16,920 --> 00:39:18,840
COMPLETING THE OPEN LABEL STUDY

1080
00:39:18,840 --> 00:39:20,880
OF TEN PATIENTS, THEY WOULD MOVE

1081
00:39:20,880 --> 00:39:23,760
TO PHASE 2. AND GET TO THE

1082
00:39:23,760 --> 00:39:25,280
BOTTOM OF WHETHER THIS WAS A

1083
00:39:25,280 --> 00:39:26,160
POWERFUL PLACEBO RESPONSE OR

1084
00:39:26,160 --> 00:39:29,240
NOT.  SO IT ENDED UP FDA

1085
00:39:29,240 --> 00:39:31,560
APPROVED.  BUT LET ME TELL YOU

1086
00:39:31,560 --> 00:39:32,720
MORE ABOUT THE SCIENCE BEHIND

1087
00:39:32,720 --> 00:39:36,160
IT.  IT IS A POSITIVE ALLOSTERIC

1088
00:39:36,160 --> 00:39:38,360
MODULATOR OF GABBA A, IT WORKS

1089
00:39:38,360 --> 00:39:41,040
INTRAAND EXTRA SYNAPTICALLY. 

1090
00:39:41,040 --> 00:39:43,560
THIS IS IMPORTANT BECAUSE

1091
00:39:43,560 --> 00:39:46,200
COMPARED TO OTHER AGENTS LIKE

1092
00:39:46,200 --> 00:39:49,840
BENZODIAZEPINES THAT ALSO HAD

1093
00:39:49,840 --> 00:39:54,440
GABBA, THAT BREXANALONE HAS

1094
00:39:54,440 --> 00:39:56,040
INTRA AND EXTRA SYNAPTIC

1095
00:39:56,040 --> 00:39:58,320
INHIBITION. AND THAT MAKES IT

1096
00:39:58,320 --> 00:40:01,680
VERY UNIQUE COMPARED TO BENZOS

1097
00:40:01,680 --> 00:40:04,040
WHICH ARE NOT BOTH.  THAT IS

1098
00:40:04,040 --> 00:40:05,600
VERY IMPORTANT TO NOTE.  WE WERE

1099
00:40:05,600 --> 00:40:07,560
OFTEN ASKED WOULD YOU GET SAME

1100
00:40:07,560 --> 00:40:08,760
RESPONSE WITH BENZO? IF WE WERE

1101
00:40:08,760 --> 00:40:10,240
GOING TO GET THE SAME RESPONSE

1102
00:40:10,240 --> 00:40:12,040
WITH BENZOWE WOULD HAVE GOTTEN A

1103
00:40:12,040 --> 00:40:13,440
LONG TIME AGO BECAUSE WE HAVE

1104
00:40:13,440 --> 00:40:15,280
ALL THESE PATIENTS WE TREAT WITH

1105
00:40:15,280 --> 00:40:16,280
BENZOS THAT DON'T RESPOND IN

1106
00:40:16,280 --> 00:40:17,640
THIS WAY. SO THAT WAS THE

1107
00:40:17,640 --> 00:40:21,080
RATIONALE FOR LOOKING AT IT.  WE

1108
00:40:21,080 --> 00:40:23,320
STARTED WITH THIS PROTOCOL THAT

1109
00:40:23,320 --> 00:40:26,120
AGAIN 60 HOURS, WHY 60 HOURS? WE

1110
00:40:26,120 --> 00:40:28,720
HAD TO TITRATE UP AND DOWN SO

1111
00:40:28,720 --> 00:40:30,160
YOU DON'T HAVE ABRUPT

1112
00:40:30,160 --> 00:40:31,520
DISCONTINUATION. YOU HAD TO

1113
00:40:31,520 --> 00:40:32,400
REACH STEADY STATE AND WE

1114
00:40:32,400 --> 00:40:34,440
THOUGHT WE HAD TO TREAT FOR AT

1115
00:40:34,440 --> 00:40:35,680
LEAST 48 HOURS. ARBITRARILY

1116
00:40:35,680 --> 00:40:37,000
DECIDED THAT THE LONGEST YOU

1117
00:40:37,000 --> 00:40:38,800
COULD GET A MOTHER TO COOPERATE

1118
00:40:38,800 --> 00:40:40,600
WOULD BE ABOUT 60 HOURS IN THE

1119
00:40:40,600 --> 00:40:42,840
HOSPITAL. SO AGAIN JUST A SENSE

1120
00:40:42,840 --> 00:40:44,360
OF EVERYTHING WITH HOW WE COME

1121
00:40:44,360 --> 00:40:45,800
UP WITH PROTOCOLS IS OBVIOUSLY

1122
00:40:45,800 --> 00:40:47,760
THERE IS THE ART AND THERE'S THE

1123
00:40:47,760 --> 00:40:49,280
SCIENCE. THEN THERE IS THE

1124
00:40:49,280 --> 00:40:51,600
PRAGMATIC WHAT ARE YOU ABLE TO

1125
00:40:51,600 --> 00:40:52,680
ACTUALLY DO. THAT IS HOW THAT

1126
00:40:52,680 --> 00:40:55,640
WAS DESIGNED.  THERE ENDED UP

1127
00:40:55,640 --> 00:40:59,040
BEING THREE STUDIES NEARLY

1128
00:40:59,040 --> 00:41:02,440
LOOKING AT TWO DOSES OF BREX, 60

1129
00:41:02,440 --> 00:41:04,360
VERSUS 90. ALL WE KEPT THE EXACT

1130
00:41:04,360 --> 00:41:06,280
SAME PROTOCOL.  YOU COULD SAY

1131
00:41:06,280 --> 00:41:08,080
THAT WE SHOULD HAVE LOOKED AT

1132
00:41:08,080 --> 00:41:10,520
EASIER WAYS OF DOSING BUT THERE

1133
00:41:10,520 --> 00:41:11,560
WAS MOTIVATION TO SEE IF YOU CAN

1134
00:41:11,560 --> 00:41:13,200
GET IT OVER THE FINISH LINE AND

1135
00:41:13,200 --> 00:41:15,200
SLOWING DOWN AND CHANGING THE

1136
00:41:15,200 --> 00:41:17,080
PROTOCOL COULD HAVE LED TO

1137
00:41:17,080 --> 00:41:18,920
DIFFERENT RESULTS AND THE PHASE

1138
00:41:18,920 --> 00:41:21,280
2 STUDIES WERE VERY, VERY ROBUST

1139
00:41:21,280 --> 00:41:23,160
IN TERMS OF DIFFERENCES BETWEEN

1140
00:41:23,160 --> 00:41:25,280
ACTIVE DRUG AN PLACEBO. AND THEN

1141
00:41:25,280 --> 00:41:29,000
THE PHASE 3 STUDIES ALSO SAW

1142
00:41:29,000 --> 00:41:30,720
STATISTICALLY AND CLINICALLY

1143
00:41:30,720 --> 00:41:31,440
SIGNIFICANT DIFFERENCES THOUGH

1144
00:41:31,440 --> 00:41:33,480
MUCH HIGHER PLACEBO RESPONSE. BY

1145
00:41:33,480 --> 00:41:34,960
THE TIME WE WERE DOING PHASE 3

1146
00:41:34,960 --> 00:41:36,240
STUDIES WOMEN WERE COMING IN TO

1147
00:41:36,240 --> 00:41:38,400
US COMING FROM ACROSS THE

1148
00:41:38,400 --> 00:41:39,800
COUNTRY TO PARTICIPATE WITH

1149
00:41:39,800 --> 00:41:42,280
THEIR ARM OUT, I'M READY, I WAS

1150
00:41:42,280 --> 00:41:44,480
WORRIED WE WOULD NEVER SEE A

1151
00:41:44,480 --> 00:41:46,040
DIFFERENCE IN RESPONSE BECAUSE

1152
00:41:46,040 --> 00:41:48,840
PHASE 3 STUDIES HAVE BEEN THE

1153
00:41:48,840 --> 00:41:50,040
BANE OF THE EXISTENCE FOR

1154
00:41:50,040 --> 00:41:51,920
PSYCHIATRY IN TERMS OF COMBATING

1155
00:41:51,920 --> 00:41:54,040
AGAINST PLACEBO EFFECTS. BUT

1156
00:41:54,040 --> 00:41:55,880
NONETHELESS WE DID BOTH BY THE

1157
00:41:55,880 --> 00:41:57,880
HAMILTON DEPRESSION SCORE, THE

1158
00:41:57,880 --> 00:41:59,800
PRIMARY OUTCOME MEASURE, A

1159
00:41:59,800 --> 00:42:02,000
DEPRESSION SCORE, AND THE

1160
00:42:02,000 --> 00:42:03,680
CLINICAL GLOBAL IMPRESSION

1161
00:42:03,680 --> 00:42:06,520
INDEX. PEOPLE WERE FOLLOWED FOR

1162
00:42:06,520 --> 00:42:09,080
INITIAL -- THE 60 HOUR MARK,

1163
00:42:09,080 --> 00:42:12,000
SEVEN DAYS, OUT, THEN FOLLOWED

1164
00:42:12,000 --> 00:42:13,800
THROUGH 30 DAYS OVERALL. THAT IS

1165
00:42:13,800 --> 00:42:16,640
WHEN THE STUDY ENDED.

1166
00:42:16,640 --> 00:42:18,880
WE SAW YOU SEE THIS RAPID ONSET

1167
00:42:18,880 --> 00:42:21,000
OF ACTION IN THE FIRST 12 HOURS

1168
00:42:21,000 --> 00:42:24,440
AND THEN CHANGES OVER TIME.  

1169
00:42:24,440 --> 00:42:28,680
THAT ARE REMAIN. THEN YOU CAN

1170
00:42:28,680 --> 00:42:32,920
SEE THE HAMD RESPONSE. THE HAM D

1171
00:42:32,920 --> 00:42:34,960
THAT PILL TN DEPRESSION SCALE

1172
00:42:34,960 --> 00:42:36,880
GOLD STANDARD FOR DEPRESSION AND

1173
00:42:36,880 --> 00:42:39,200
IT WAS DEVELOPED AS

1174
00:42:39,200 --> 00:42:40,200
ANTIDEPRESSANT AND WE WERE

1175
00:42:40,200 --> 00:42:41,040
WANTING TO LOOK AT WHETHER IT

1176
00:42:41,040 --> 00:42:42,240
WAS EFFECTIVE FOR DEPRESSION OR

1177
00:42:42,240 --> 00:42:45,520
NOT.  PRIMARY SIDE EFFECTS ARE

1178
00:42:45,520 --> 00:42:47,440
-- WERE SEDATION AS WOULD BE

1179
00:42:47,440 --> 00:42:49,360
EXPECTED WITH A POSITIVE

1180
00:42:49,360 --> 00:42:51,320
ALLOSTERIC MODULATOR OF GABA.

1181
00:42:51,320 --> 00:42:56,040
IT WAS APPROVED WITH FDA REMS

1182
00:42:56,040 --> 00:42:57,800
INDICATION MEANING IT HAS TO BE

1183
00:42:57,800 --> 00:43:01,040
ADMINISTERED IN A MEDICALLY

1184
00:43:01,040 --> 00:43:02,560
SUPERVISED SETTING TO PREVENT

1185
00:43:02,560 --> 00:43:06,880
OVERSEDATION.  ALL THE TRIALS OF

1186
00:43:06,880 --> 00:43:08,480
BREXANALONE AND TREATMENTS

1187
00:43:08,480 --> 00:43:11,080
INCLUDING STATUS EPILEPTICUS IF

1188
00:43:11,080 --> 00:43:14,280
YOU HAD A TREMOR AND YOU GOT A

1189
00:43:14,280 --> 00:43:17,960
PUMP MALFUNCTION MORE OF THE

1190
00:43:17,960 --> 00:43:19,560
DOSE ONE PATIENT PASSED OUT.  SO

1191
00:43:19,560 --> 00:43:20,360
NONETHELESS THAT WAS THE WAY WE

1192
00:43:20,360 --> 00:43:21,880
DELIVERED IT NOW. WHEN APPROVED

1193
00:43:21,880 --> 00:43:23,640
IT WAS UNCLEAR HOW THE RESULTS

1194
00:43:23,640 --> 00:43:25,960
WOULD HOLD UP IF YOU LOOK AT

1195
00:43:25,960 --> 00:43:29,840
MORE MODERATE PATIENTS, HOW ARE

1196
00:43:29,840 --> 00:43:32,080
YOU GOING TO DELIVER THIS IN A

1197
00:43:32,080 --> 00:43:33,760
WAY WITH AN IV DRUG THAT

1198
00:43:33,760 --> 00:43:35,960
REQUIRED A MEDICALLY SUPERVISED

1199
00:43:35,960 --> 00:43:37,360
SETTING FOR PEOPLE THAT MAY NOT

1200
00:43:37,360 --> 00:43:39,680
MEET CRITERIA FOR IN PATIENT

1201
00:43:39,680 --> 00:43:41,520
PSYCHIATRY RESULTS.  WHAT WOULD

1202
00:43:41,520 --> 00:43:42,520
HAPPEN AFTER 30 DAY?

1203
00:43:42,520 --> 00:43:44,080
WOULD IT BE LIKE KETAMINE,

1204
00:43:44,080 --> 00:43:47,280
NEEDED TO BE REPEATED. NO ONE

1205
00:43:47,280 --> 00:43:49,920
KNEW. WE HAVE PUBLISHED IN THE

1206
00:43:49,920 --> 00:43:52,680
CONSULT LIAISON JOURNAL RECENTLY

1207
00:43:52,680 --> 00:43:56,200
A SERIES CASE STUDY, MY TERRIFIC

1208
00:43:56,200 --> 00:43:57,800
COLLEAGUE DR. PATTERSON, MEDICAL

1209
00:43:57,800 --> 00:44:00,800
DIRECTOR OF THE PERINATAL UNIT

1210
00:44:00,800 --> 00:44:02,320
AND REASONS THE CLINICAL

1211
00:44:02,320 --> 00:44:04,600
PROGRAM, 16 PATIENTS WHO

1212
00:44:04,600 --> 00:44:05,720
RECEIVED COME IN FOR CLINICAL

1213
00:44:05,720 --> 00:44:09,040
PROGRAM, THIS IS PAID FOR BY

1214
00:44:09,040 --> 00:44:10,080
INSURANCE COMPANIES, SAGE

1215
00:44:10,080 --> 00:44:13,200
THERAPEUTICS PRICED AT SOME

1216
00:44:13,200 --> 00:44:14,320
RIDICULOUSLY CRAZY HIGH COST

1217
00:44:14,320 --> 00:44:16,600
WHICH HAS BEEN CHALLENGING FOR

1218
00:44:16,600 --> 00:44:18,920
THEM. BUT WE HAVE BEEN ABLE TO

1219
00:44:18,920 --> 00:44:19,920
LARGELY GET INSURANCE COMPANIES

1220
00:44:19,920 --> 00:44:25,360
TO PAY FOR IT. IRONICALLY IN

1221
00:44:25,360 --> 00:44:28,000
ALSO IN THE SUMMER OF 2019 JOINT

1222
00:44:28,000 --> 00:44:30,040
COMMIT MADE MUCH MORE STRINGENT

1223
00:44:30,040 --> 00:44:31,400
GUIDELINES FOR LIGATURE RISK. SO

1224
00:44:31,400 --> 00:44:33,840
WE ARE NOW NOT ABLE TO DELIVER

1225
00:44:33,840 --> 00:44:35,920
ON PERINATAL PSYCH UNIT STUDYING

1226
00:44:35,920 --> 00:44:37,600
FOR FIVE YEARS LEADING TO FDA

1227
00:44:37,600 --> 00:44:41,360
APPROVAL WE DELIVER NOW ON A

1228
00:44:41,360 --> 00:44:43,400
WOMEN'S HOSPITAL UNIT SORT OF

1229
00:44:43,400 --> 00:44:45,160
GYN UNIT. AND WE HAVE BEEN

1230
00:44:45,160 --> 00:44:47,720
WORKING TO GET THAT BACK IN

1231
00:44:47,720 --> 00:44:49,600
GEAR, THEN THE MAKE HIT AND

1232
00:44:49,600 --> 00:44:50,600
EVERYONE WITH IN PATIENT PSYCH

1233
00:44:50,600 --> 00:44:53,880
WAS COMPLICATED. BUT THERE IS NO

1234
00:44:53,880 --> 00:44:55,880
LACK OF IRONY HOW THAT GOES. AND

1235
00:44:55,880 --> 00:44:57,520
SO IF SOMEONE IS SUICIDAL WE

1236
00:44:57,520 --> 00:45:00,360
HAVE A SITTER WITH THEM AND THEN

1237
00:45:00,360 --> 00:45:01,720
WE WERE ABLE TO WORK WITH

1238
00:45:01,720 --> 00:45:02,920
WOMEN'S HOSPITAL COLLEAGUES TO

1239
00:45:02,920 --> 00:45:05,200
DELIVER THE IV DRUG THERE. IN

1240
00:45:05,200 --> 00:45:06,600
THE CASE SERIES THAT WE

1241
00:45:06,600 --> 00:45:10,280
PUBLISHED WE CONTINUE TO SEE A

1242
00:45:10,280 --> 00:45:11,840
PERSISTENT EFFECT, MANY OF THE

1243
00:45:11,840 --> 00:45:13,120
PATIENTS STOP THIS AND ARE

1244
00:45:13,120 --> 00:45:15,440
STARTED ON AN SSRI BECAUSE THERE

1245
00:45:15,440 --> 00:45:16,640
CONCERN WHAT HAPPENS ONCE THIS

1246
00:45:16,640 --> 00:45:17,960
IS GONE. BUT WE HAVE CONTINUED

1247
00:45:17,960 --> 00:45:19,720
TO SEE A PERSISTENT TREATMENT

1248
00:45:19,720 --> 00:45:23,320
EFFECT OVER TIME. PAST THE 30

1249
00:45:23,320 --> 00:45:25,360
DAYS AND IN THIS CASE WE HAVE

1250
00:45:25,360 --> 00:45:28,520
SEEN ONGOING REDUCTION IN

1251
00:45:28,520 --> 00:45:29,840
DEPRESSIVE SYMPTOMS AND

1252
00:45:29,840 --> 00:45:33,520
FOLLOWING PEOPLE OUT BETWEEN

1253
00:45:33,520 --> 00:45:34,920
THREE AND 16 MONTHS AFTER

1254
00:45:34,920 --> 00:45:36,160
INFUSION BECAUSE AGAIN THIS IS

1255
00:45:36,160 --> 00:45:37,400
JUST CLINICAL CARE AND PEOPLE

1256
00:45:37,400 --> 00:45:38,720
COME IN AT ALL DIFFERENT TIMES

1257
00:45:38,720 --> 00:45:44,040
TO GET IT.  SO OBVIOUSLY AN IV

1258
00:45:44,040 --> 00:45:45,440
DRUG THAT NEEDS TO BE

1259
00:45:45,440 --> 00:45:47,120
ADMINISTERED ON A PSYCH UNIT IS

1260
00:45:47,120 --> 00:45:49,360
NOT CONVENIENT TO SAY THE LEAST.

1261
00:45:49,360 --> 00:45:51,240
MOST PLACES HAVE HAD DIFFICULTY

1262
00:45:51,240 --> 00:45:52,600
GETTING THIS SET UP, MANY PLACES

1263
00:45:52,600 --> 00:45:54,280
HAVE. SO NATIONALLY THERE ARE

1264
00:45:54,280 --> 00:45:55,920
CENTERS THAT ARE DOING IT BUT IT

1265
00:45:55,920 --> 00:45:58,320
IS NOT WIDELY AVAILABLE, IT IS

1266
00:45:58,320 --> 00:46:00,800
ALSO VERY COSTLYLY. SAGE

1267
00:46:00,800 --> 00:46:04,400
THERAPEUTICS HAS BEEN DEVELOPING

1268
00:46:04,400 --> 00:46:05,840
ZURANOLONE, A NEUROSTEROID, AN

1269
00:46:05,840 --> 00:46:10,040
ORAL DRUG, IT IS NOT AN ORAL

1270
00:46:10,040 --> 00:46:13,960
VERSION OF BREXANALONE. IT HAS A

1271
00:46:13,960 --> 00:46:16,080
DIFFERENT RING HERE THIS LITTLE

1272
00:46:16,080 --> 00:46:20,840
RING ADDED. TO BOTH INCREASE

1273
00:46:20,840 --> 00:46:22,720
ORAL STABILITY AND THEN ALSO THE

1274
00:46:22,720 --> 00:46:23,960
YOU END UP WITH A MUCH LONGER

1275
00:46:23,960 --> 00:46:25,280
PATENT OF TEN YEARS IF YOU HAVE

1276
00:46:25,280 --> 00:46:27,040
SOMETHING THAT IS NOT AN

1277
00:46:27,040 --> 00:46:29,520
ENDOGENOUS COMPOUND.  THIS HAS

1278
00:46:29,520 --> 00:46:33,000
BEEN STUDIED OVER TIME AND WE

1279
00:46:33,000 --> 00:46:33,760
HAVE BEEN -- I HAVE BEEN ONE OF

1280
00:46:33,760 --> 00:46:36,880
THE INVESTIGATORS ON THE TRIAL

1281
00:46:36,880 --> 00:46:40,560
AS WELL. THE DESIGN IS A DAILY

1282
00:46:40,560 --> 00:46:42,760
TREATMENT FOR 14 DAYS. AND

1283
00:46:42,760 --> 00:46:44,560
PATIENTS TAKE THAT ONCE A DAY

1284
00:46:44,560 --> 00:46:47,160
FOR TWO WEEKS. AND THEN FOLLOWED

1285
00:46:47,160 --> 00:46:48,560
THROUGH DAY 15 IS THE PRIMARY

1286
00:46:48,560 --> 00:46:50,680
END POINT MEASURE AND THEN THIS

1287
00:46:50,680 --> 00:46:52,800
STUDY WOMEN FOLLOWED FOR 45 DAYS

1288
00:46:52,800 --> 00:46:56,080
OUT.  INCLUSION CRITERIA SAME AS

1289
00:46:56,080 --> 00:46:59,480
WITH BREXANALONE. IN BOTH

1290
00:46:59,480 --> 00:47:01,280
STUDIES THE ONSET OF SYMPTOMS

1291
00:47:01,280 --> 00:47:03,160
HAS TO BE VERY PROXIMAL TO

1292
00:47:03,160 --> 00:47:06,880
CHILDBIRTH. IF WE THINK ABOUT

1293
00:47:06,880 --> 00:47:08,960
THE PRECISION PSYCHIATRY

1294
00:47:08,960 --> 00:47:10,680
APPROACH, IF YOU SCREEN SOMEONE

1295
00:47:10,680 --> 00:47:12,840
AT SIX WEEKS POSTPARTUM AND THEY

1296
00:47:12,840 --> 00:47:14,840
ARE DEPRESSED, YOU NEED TO KNOW

1297
00:47:14,840 --> 00:47:16,000
WHETHER THEY HAVE BEEN DEPRESSED

1298
00:47:16,000 --> 00:47:17,040
FOR 20 YEARS AND YOU JUST HAPPEN

1299
00:47:17,040 --> 00:47:19,200
TO BE SCREENING AT THAT TIME

1300
00:47:19,200 --> 00:47:20,880
POINT OR YOU HAD ONSET

1301
00:47:20,880 --> 00:47:23,840
DEPRESSION PROXIMAL TO

1302
00:47:23,840 --> 00:47:25,640
CHILDBIRTH OR THEY STARTED WITH

1303
00:47:25,640 --> 00:47:27,240
DEPRESSION IN THE FIRST

1304
00:47:27,240 --> 00:47:28,480
TRIMESTER BECAUSE OF A

1305
00:47:28,480 --> 00:47:29,400
PSYCHOSOCIAL STRESSOR THAT MAY

1306
00:47:29,400 --> 00:47:30,880
HAVE TRIGGERED IT.  AND YOU

1307
00:47:30,880 --> 00:47:32,280
CAN'T PUT EVERYONE ON THE SAME

1308
00:47:32,280 --> 00:47:33,040
BUCKET BECAUSE YOU ARE NEVER

1309
00:47:33,040 --> 00:47:35,240
GOING TO END UP WITH ONE TRYING

1310
00:47:35,240 --> 00:47:37,080
TO FIGURE OUT IF SOMETHING GOING

1311
00:47:37,080 --> 00:47:39,520
TO WORK FOR THAT PARTICULAR

1312
00:47:39,520 --> 00:47:40,920
INDICATION AND OFTEN YOU MAY BE

1313
00:47:40,920 --> 00:47:44,480
MIXING APPLES AND ORANGES IN

1314
00:47:44,480 --> 00:47:46,040
DIFFERENT PATHOPHYSIOLOGY. MAJOR

1315
00:47:46,040 --> 00:47:50,280
DEPRESSIVE DIAGNOSIS DSM 5,.

1316
00:47:50,280 --> 00:47:52,080
SYMPTOMS LATE THIRD TRIMESTER OR

1317
00:47:52,080 --> 00:47:53,760
WITHIN THE FIRST MONTH

1318
00:47:53,760 --> 00:47:55,080
POSTPARTUM, VERY PROXIMAL TO

1319
00:47:55,080 --> 00:47:55,800
CHILDBIRTH THEY HAD TO START.

1320
00:47:55,800 --> 00:47:57,040
YOU CAN HAVE A HISTORY OF

1321
00:47:57,040 --> 00:47:59,160
DEPRESSION.  BUT IN ALL STUDIES

1322
00:47:59,160 --> 00:48:02,240
WE REALLY TRIED TO BE VERY

1323
00:48:02,240 --> 00:48:05,800
SPECIFIC TO UNDERSTAND THE

1324
00:48:05,800 --> 00:48:08,080
PATHOPHYSIOLOGY AND UNDERSTAND

1325
00:48:08,080 --> 00:48:11,880
HOW THIS PARTICULAR DRUG ALLO

1326
00:48:11,880 --> 00:48:14,920
PREGNAL AALO INE ALLOSTERIC

1327
00:48:14,920 --> 00:48:17,000
MODULATOR OF GABA MAYBE

1328
00:48:17,000 --> 00:48:19,880
EFFECTIVE OR NOT.  WITH

1329
00:48:19,880 --> 00:48:20,960
ZURANALONE YOU HAVE FAST ONSET

1330
00:48:20,960 --> 00:48:22,600
OF ACTION BUT IT IS NOT 12

1331
00:48:22,600 --> 00:48:23,840
HOURS, TAKES 3 TO 6 DAYS BUT

1332
00:48:23,840 --> 00:48:25,640
THEN YOU SEE MARKED REDUCTION IN

1333
00:48:25,640 --> 00:48:28,680
SYMPTOMS.  FOLLOWED OVER TIME.

1334
00:48:28,680 --> 00:48:30,440
THEY PERSIST, THIS IS IN

1335
00:48:30,440 --> 00:48:33,000
POSTPARTUM DEPRESSION. IF YOU

1336
00:48:33,000 --> 00:48:36,000
COMPARE ZURANOLONE IN ORANGE

1337
00:48:36,000 --> 00:48:38,600
WITH PLACEBO IN GRAY YOU SEE

1338
00:48:38,600 --> 00:48:39,360
DIFFERENCES OVER TIME THAT

1339
00:48:39,360 --> 00:48:44,120
PERSIST. ADVERSE EVENTS AND SIDE

1340
00:48:44,120 --> 00:48:48,400
EFFECTS YOU CONTINUE TO SEE

1341
00:48:48,400 --> 00:48:50,240
SO,OMULENCE IS PRIMARY BUT MUCH

1342
00:48:50,240 --> 00:48:52,360
LESS SEVERE WITH ORAL DRUG

1343
00:48:52,360 --> 00:48:55,480
COMPARED TO IV DRUG. THIS WAS

1344
00:48:55,480 --> 00:48:59,720
SUB PUBLISHED IN PSYCH A FEW

1345
00:48:59,720 --> 00:49:01,440
YEARS AGO. CHRISTINE (INAUDIBLE)

1346
00:49:01,440 --> 00:49:02,560
WAS SECOND AUTHOR LOOKING AT

1347
00:49:02,560 --> 00:49:03,760
THIS AND WE HAVE THE SECOND

1348
00:49:03,760 --> 00:49:05,440
PHASE 3 TRIAL PAPER COMING OUT

1349
00:49:05,440 --> 00:49:08,200
SHORTLYLY. WHICH BASICALLY

1350
00:49:08,200 --> 00:49:10,680
REPLICATES FINDINGS, THIS IS THE

1351
00:49:10,680 --> 00:49:13,120
SKY LARK STUDY, THEY USED A

1352
00:49:13,120 --> 00:49:15,320
50-MILLIGRAM DOSE WITH THE

1353
00:49:15,320 --> 00:49:16,480
SECOND PHASE 3 TRIAL AND

1354
00:49:16,480 --> 00:49:17,640
POSTPARTUM DEPRESSION COMPARED

1355
00:49:17,640 --> 00:49:19,880
TO A 30-MILLIGRAM DOSE IN THE

1356
00:49:19,880 --> 00:49:21,040
FIRST THAT WAS PUBLISHED. 

1357
00:49:21,040 --> 00:49:23,760
OTHERWISE RESULTS ARE BOTH

1358
00:49:23,760 --> 00:49:27,160
ROBUST, FAST ACTING AND EWE YOU

1359
00:49:27,160 --> 00:49:28,400
SEE CHANGE OVER TIME. THIS IS

1360
00:49:28,400 --> 00:49:30,440
WHAT THE NEWEST DATA LOOKS LIKE

1361
00:49:30,440 --> 00:49:34,680
IN THIS NEW PAPER THAT WILL BE

1362
00:49:34,680 --> 00:49:36,840
OUT SOON OVER TIME AND YOU SEE

1363
00:49:36,840 --> 00:49:39,480
14 DAYS OF TREATMENT FOLLOWED

1364
00:49:39,480 --> 00:49:42,200
OUT OVER 45 DAYS. SAGE

1365
00:49:42,200 --> 00:49:44,160
THERAPEUTICS ALSO STUDIED THIS

1366
00:49:44,160 --> 00:49:46,280
IN MAJOR DEPRESSION OUTSIDE OF

1367
00:49:46,280 --> 00:49:48,080
THE PERINATAL PERIOD WITH MORE

1368
00:49:48,080 --> 00:49:49,120
MIXED RESULTS BUT NONETHELESS

1369
00:49:49,120 --> 00:49:50,320
THEY HAVE IT FILE WITH THE FDA

1370
00:49:50,320 --> 00:49:51,920
RIGHT NOW. IT'S BEEN FAST TRACK

1371
00:49:51,920 --> 00:49:55,160
WITH THE FDA, FOR INDICATION FOR

1372
00:49:55,160 --> 00:49:56,760
BOTH POSTPARTUM DEPRESSION AND

1373
00:49:56,760 --> 00:49:58,520
MAJOR DEPRESSION OUTSIDE OF THE

1374
00:49:58,520 --> 00:50:00,360
PERINATAL PERIOD AND IF

1375
00:50:00,360 --> 00:50:02,120
APPROVED, WILL BE INTERESTING TO

1376
00:50:02,120 --> 00:50:03,320
SEE WHAT HAPPENS, HOW IT IS

1377
00:50:03,320 --> 00:50:05,960
USED. IT WILL CERTAINLY HAVE

1378
00:50:05,960 --> 00:50:07,200
WIDESPREAD INDICATION, THERE

1379
00:50:07,200 --> 00:50:11,040
WON'T BE A RIMS. AND THE

1380
00:50:11,040 --> 00:50:12,160
DIFFERENCES BETWEEN THE

1381
00:50:12,160 --> 00:50:15,240
ROBUSTNESS OF THE POSTPARTUM

1382
00:50:15,240 --> 00:50:16,400
DEPRESSION RESPONSE AND

1383
00:50:16,400 --> 00:50:18,000
DEPRESSION OUTSIDE THE PERINATAL

1384
00:50:18,000 --> 00:50:19,880
PERIOD IS INTERESTING. AGAIN,

1385
00:50:19,880 --> 00:50:22,480
SPEAKING TO WHAT IS THE ROLE OF

1386
00:50:22,480 --> 00:50:25,240
NEURAL STEROIDS DIFFERENTIAL

1387
00:50:25,240 --> 00:50:26,720
SENSITIVITY FOR THOSE THAT

1388
00:50:26,720 --> 00:50:28,880
RESPOND, ABOUT 70% OF WOMEN

1389
00:50:28,880 --> 00:50:32,200
RESPOND TO BREXANALONE, 30%

1390
00:50:32,200 --> 00:50:34,040
DON'T. WHY IS THAT? THERE IS

1391
00:50:34,040 --> 00:50:36,480
CLEARLY UNDERLYING MECHANISTIC

1392
00:50:36,480 --> 00:50:37,000
DIFFERENCES WE DONE YET

1393
00:50:37,000 --> 00:50:39,480
UNDERSTAND. SO WHAT IS NEXT? WE

1394
00:50:39,480 --> 00:50:41,080
HAVE AN OPEN LABEL TRIAL

1395
00:50:41,080 --> 00:50:42,920
UNDERWAY IN POSTPARTUM PSYCHOSIS

1396
00:50:42,920 --> 00:50:44,520
BECAUSE ANYONE WITH BIPOLAR

1397
00:50:44,520 --> 00:50:46,000
DISORDER HISTORY OF PSYCHOSIS IS

1398
00:50:46,000 --> 00:50:47,560
EXCLUDED FROM THE POSTPARTUM

1399
00:50:47,560 --> 00:50:49,440
DEPRESSION TRIALS.  DOES IT

1400
00:50:49,440 --> 00:50:51,680
WORK? IS IT DIFFERENT? IS

1401
00:50:51,680 --> 00:50:53,160
POSTPARTUM PSYCHOSIS A DIFFERENT

1402
00:50:53,160 --> 00:50:56,200
DISORDER THAN MAJOR DEPRESSION?

1403
00:50:56,200 --> 00:50:58,080
FOR POSTPARTUM DEPRESSION, A

1404
00:50:58,080 --> 00:51:00,760
VERY HOT AREA OF STUDY. I ENJOY

1405
00:51:00,760 --> 00:51:02,680
TALKING WITH PETER SCHMIDT AND

1406
00:51:02,680 --> 00:51:03,760
TEAM ABOUT THE WORK THEY ARE

1407
00:51:03,760 --> 00:51:05,600
INTERESTED IN DOING HERE IN

1408
00:51:05,600 --> 00:51:06,920
THIS. THEN THE OTHER THING WE

1409
00:51:06,920 --> 00:51:10,520
ARE DOING IN COLLABORATING WITH

1410
00:51:10,520 --> 00:51:13,920
LESLIE MOREAU AT UNC IS WHY DOES

1411
00:51:13,920 --> 00:51:15,320
BREXANALONE WORK? WE KNOW IT IS

1412
00:51:15,320 --> 00:51:17,040
A NEURAL STEROID, IT IS A

1413
00:51:17,040 --> 00:51:18,800
POSITIVE ALLOSTERIC MODULATOR OF

1414
00:51:18,800 --> 00:51:21,240
THE GABA. APPARENTLY THAT ALSO

1415
00:51:21,240 --> 00:51:23,640
HELPFUL IN MAJOR DEPRESSION

1416
00:51:23,640 --> 00:51:25,200
OUTSIDE THE PERINATAL PERIOD

1417
00:51:25,200 --> 00:51:28,240
BASED ON ORAL DRUG STUDIES OF

1418
00:51:28,240 --> 00:51:33,320
ZURANALONE. SO WHY DOES IT WORK 

1419
00:51:33,320 --> 00:51:35,080
WE RESENTLY PUSHILIED A PAPER

1420
00:51:35,080 --> 00:51:36,640
LOOK AT -- PUBLISHED A PAPER

1421
00:51:36,640 --> 00:51:39,120
LOOKING AT BREX AND LOOKING AT

1422
00:51:39,120 --> 00:51:40,360
INHIBITION OF SYSTEMIC

1423
00:51:40,360 --> 00:51:41,760
INFLAMMATORY PATHWAYS.  LESLIE,

1424
00:51:41,760 --> 00:51:43,480
THIS IS HER SCIENCE AND BASIC

1425
00:51:43,480 --> 00:51:46,200
SCIENCE LAB, AS I MENTIONED DR.

1426
00:51:46,200 --> 00:51:48,520
PATTERSON IS THE INVESTIGATOR

1427
00:51:48,520 --> 00:51:50,600
AND SHE'S THE MEDICAL DIRECTOR

1428
00:51:50,600 --> 00:51:52,080
OF PATIENT PERINATAL UNIT SO

1429
00:51:52,080 --> 00:51:53,960
THIS IS AN EXAMPLE OF TEAM

1430
00:51:53,960 --> 00:51:55,840
SCIENCE. WELCOMING IN FOR

1431
00:51:55,840 --> 00:51:59,360
CLINICAL BREXANALONH PROGRAM, WE

1432
00:51:59,360 --> 00:52:02,160
COLLECT SAMPLES AND SEND IT OVER

1433
00:52:02,160 --> 00:52:04,040
TO DR. MOREAU'S LAB. SO THAT WE

1434
00:52:04,040 --> 00:52:07,200
WERE ABLE TO STUDY POTENTIAL

1435
00:52:07,200 --> 00:52:09,560
CONTRIBUTIONS OF INFLAMMATORY

1436
00:52:09,560 --> 00:52:12,360
PATHWAYS. WE WANTED TO TEST

1437
00:52:12,360 --> 00:52:14,800
HYPOTHESIS OF WHETHER

1438
00:52:14,800 --> 00:52:18,800
BREXANALONE INHIBITS

1439
00:52:18,800 --> 00:52:19,960
PRO-INFLAMMATORY MODULATORS AND

1440
00:52:19,960 --> 00:52:23,800
MACROPHAGE ACTIVATION.  WE SAW

1441
00:52:23,800 --> 00:52:26,600
ALTERED REDUCED LEVELS OF

1442
00:52:26,600 --> 00:52:27,880
INFLAMMATORY MEDIATORS AND

1443
00:52:27,880 --> 00:52:29,480
INHIBITED RESPONSE TO

1444
00:52:29,480 --> 00:52:31,600
INFLAMMATORY IMMUNE ACTIVATORS.

1445
00:52:31,600 --> 00:52:32,960
SO THIS IS REALLY INTERESTING

1446
00:52:32,960 --> 00:52:36,680
WORK. WE SAW ACTIONS THAT IT

1447
00:52:36,680 --> 00:52:38,320
CAUSED INLOBBYINGS OF

1448
00:52:38,320 --> 00:52:40,280
INFLAMMATORY MEDIATOR INHIBITION

1449
00:52:40,280 --> 00:52:43,960
TO TLR 4, TLR 7 ACTIVATORS

1450
00:52:43,960 --> 00:52:45,360
SUGGESTING INFLAMMATION MAY PLAY

1451
00:52:45,360 --> 00:52:46,800
A ROLE IN POSTPARTUM DEPRESSION

1452
00:52:46,800 --> 00:52:49,400
AND THAT THE INHIBITION OF

1453
00:52:49,400 --> 00:52:52,160
INFLAMMATORY PATHWAYS CRIBS TO

1454
00:52:52,160 --> 00:52:54,720
THERAPEUTIC EFFICACY. HERE IS

1455
00:52:54,720 --> 00:52:56,440
LESLIE MOREAU AND DR. PATTERSON.

1456
00:52:56,440 --> 00:52:58,160
I LOVE THIS BENCH TO BEDSIDE

1457
00:52:58,160 --> 00:53:01,440
MODEL. WHICH IS THIS IS LESLIE

1458
00:53:01,440 --> 00:53:02,240
MOREAU AND TEAM RUN BASIC

1459
00:53:02,240 --> 00:53:04,640
SCIENCE LAB PARTNERING WITH ONE

1460
00:53:04,640 --> 00:53:07,920
OF OUR CLINICIAN EDUCATORS TO

1461
00:53:07,920 --> 00:53:09,080
PARTNER IN THIS AND HERE IS THE

1462
00:53:09,080 --> 00:53:13,520
DATA YOU SEE LOOKING AT THE

1463
00:53:13,520 --> 00:53:15,320
DIFFERENCES PRE- AND POST BEFORE

1464
00:53:15,320 --> 00:53:18,400
TREATMENT IN TERMS OF IMMUNE

1465
00:53:18,400 --> 00:53:24,800
INHIBITION. SO TO CONCLUDE, THE

1466
00:53:24,800 --> 00:53:28,360
PANDEMIC HAS CERTAINLY HAD THIS

1467
00:53:28,360 --> 00:53:31,080
PROFOUND IMPACT ON THE ENTIRE

1468
00:53:31,080 --> 00:53:34,120
WORLD. I SEE IT AS A GLOBAL

1469
00:53:34,120 --> 00:53:37,120
TRAUMA. IT HAS MARKEDLY WORSENED

1470
00:53:37,120 --> 00:53:39,440
MENTAL HEALTH AND WE NOW HAVE A

1471
00:53:39,440 --> 00:53:42,680
ENORMOUS MENTAL HEALTH CRISIS

1472
00:53:42,680 --> 00:53:45,120
FACING THE COUNTRY. ALL OF US

1473
00:53:45,120 --> 00:53:47,640
ARE I THINK HAVE TO RISE TO THE

1474
00:53:47,640 --> 00:53:50,960
OCCASION AND AS A PSYCHIATRIST

1475
00:53:50,960 --> 00:53:52,760
AND A CHAIR OF A LARGE

1476
00:53:52,760 --> 00:53:54,400
DEPARTMENT I AM FACED EVERY DAY

1477
00:53:54,400 --> 00:53:56,000
WITH HOW WE MEET OUR CLINICAL

1478
00:53:56,000 --> 00:53:58,760
MISSION, HOW DO WE MEET OUR

1479
00:53:58,760 --> 00:54:00,400
RESEARCH MISSION OUR TRAINING

1480
00:54:00,400 --> 00:54:02,320
MISSION, TO ADDRESS THE PUBLIC

1481
00:54:02,320 --> 00:54:05,560
HEALTH CRISIS WE FACE?

1482
00:54:05,560 --> 00:54:08,840
TELEHEALTH IS TURNING OUT TO BE

1483
00:54:08,840 --> 00:54:10,480
QUITE ADVANTAGEOUS FOR

1484
00:54:10,480 --> 00:54:11,680
PSYCHIATRY AND BEHAVIORAL

1485
00:54:11,680 --> 00:54:12,800
HEALTH, TRYING TO USE THAT

1486
00:54:12,800 --> 00:54:14,680
STRATEGICALLY. BEEN PARTNERING

1487
00:54:14,680 --> 00:54:17,720
WITH MY HEALTHCARE SYSTEM TO

1488
00:54:17,720 --> 00:54:19,640
BRING EXPERTISE TO CONSULT

1489
00:54:19,640 --> 00:54:21,960
ACROSS NORTH CAROLINA AND RURAL

1490
00:54:21,960 --> 00:54:23,360
AREAS WHERE THERE ARE NO MENTAL

1491
00:54:23,360 --> 00:54:25,360
HEALTH PROVIDERS AND THAT HAS

1492
00:54:25,360 --> 00:54:27,920
MADE US POPULAR. SO THAT HAS

1493
00:54:27,920 --> 00:54:30,040
BEEN AN OPPORTUNITY, THERE'S

1494
00:54:30,040 --> 00:54:32,560
BEEN HUGE NEED FOR PEOPLE TO

1495
00:54:32,560 --> 00:54:35,240
ENGAGE, WE ARE NOW SEEING RECORD

1496
00:54:35,240 --> 00:54:36,920
NUMBERS OF YOUNG PEOPLE APPLYING

1497
00:54:36,920 --> 00:54:40,440
IIN PSYCHIATRY FOR RESIDENCY. WE

1498
00:54:40,440 --> 00:54:44,280
ARE SEEING MARKED INCREASES IN

1499
00:54:44,280 --> 00:54:45,880
PHILANTHROPIC CONTRIBUTIONS, AND

1500
00:54:45,880 --> 00:54:46,880
NIH HAS A POWERFUL ROLE TO PLAY

1501
00:54:46,880 --> 00:54:48,840
IN THIS. AND THAT THERE IS A

1502
00:54:48,840 --> 00:54:50,520
GREAT NEED FOR NEW RAPIDLY

1503
00:54:50,520 --> 00:54:53,320
ACTING TREATMENTS THAT WILL

1504
00:54:53,320 --> 00:54:56,200
BREXA INHOLONE IS A GREAT

1505
00:54:56,200 --> 00:54:57,800
EXAMPLE OF STORY THAT USES THE

1506
00:54:57,800 --> 00:54:59,840
UNDERLYING PATHOPHYSIOLOGY TO

1507
00:54:59,840 --> 00:55:02,880
DEVELOP A NOVEL TREATMENT AND

1508
00:55:02,880 --> 00:55:04,520
STEP TOWARDS ASPIRATIONALLY HOW

1509
00:55:04,520 --> 00:55:05,600
WE THINK ABOUT PRECISION

1510
00:55:05,600 --> 00:55:07,200
PSYCHIATRY. SO LOVE ONE DAY TO

1511
00:55:07,200 --> 00:55:08,520
APPROACH IT IN THE WAY WHICH

1512
00:55:08,520 --> 00:55:10,520
APPROACH BREAST CANCER SO YOU

1513
00:55:10,520 --> 00:55:12,480
DON'T JUST THROW JELL-O AT THE

1514
00:55:12,480 --> 00:55:14,240
WALL AND SEE WHAT HITS. HOW CAN

1515
00:55:14,240 --> 00:55:15,640
WE DO BETTER TO CARE FOR MOTHERS

1516
00:55:15,640 --> 00:55:18,800
AND THEIR CHILDREN. SO LASTLY

1517
00:55:18,800 --> 00:55:20,400
MT. SPIRIT OF GREAT TEACHER TALK

1518
00:55:20,400 --> 00:55:22,240
I WANTED TO SHARE QUICKLY THINGS

1519
00:55:22,240 --> 00:55:26,040
I HAVE LEARNED ALONG THE WAY,

1520
00:55:26,040 --> 00:55:28,760
ONE IS PASSION FOR MAKES A

1521
00:55:28,760 --> 00:55:30,360
DIFFERENCE, YOU HAVE TO BE

1522
00:55:30,360 --> 00:55:32,280
PERSISTENT IN WHATEVER WE DO

1523
00:55:32,280 --> 00:55:35,600
THAT RELATIONSHIPS MATTER A LOT.

1524
00:55:35,600 --> 00:55:37,240
I STILL AM IN TOUCH WITH MENTORS

1525
00:55:37,240 --> 00:55:39,720
AND COLLABORATORS I HAVE HAD FOR

1526
00:55:39,720 --> 00:55:41,800
DECADES THAT KINDNESS AND

1527
00:55:41,800 --> 00:55:43,320
GENEROSITY OF SPIRIT GOES A LONG

1528
00:55:43,320 --> 00:55:45,360
WAY ASSUMING GOOD INTENTIONS,

1529
00:55:45,360 --> 00:55:47,600
NOT TAKING YOURSELF TOO

1530
00:55:47,600 --> 00:55:49,520
SERIOUSLY WHICH I THINK IS

1531
00:55:49,520 --> 00:55:50,880
REALLY IMPORTANT. AND MAKING

1532
00:55:50,880 --> 00:55:52,480
SURE YOU HAVE A LIFE OUTSIDE OF

1533
00:55:52,480 --> 00:55:53,720
WORK WHICH I THINK CONTRIBUTES

1534
00:55:53,720 --> 00:55:55,880
TO PEOPLE'S HAPPINESS AND

1535
00:55:55,880 --> 00:55:58,600
EFFECTIVENESS. SO JUST WANTED TO

1536
00:55:58,600 --> 00:56:00,200
THANK ALL COLLEAGUES

1537
00:56:00,200 --> 00:56:02,040
COLLABORATORS AND PATIENTS WHO

1538
00:56:02,040 --> 00:56:04,000
TRUST US WITH THEIR CARE. IT IS

1539
00:56:04,000 --> 00:56:05,720
A REAL PRIVILEGE AND HONOR TO BE

1540
00:56:05,720 --> 00:56:07,560
PART OF PEOPLE'S LIVES IN THIS

1541
00:56:07,560 --> 00:56:09,920
WAY. AND TO MYRY IF I CAN

1542
00:56:09,920 --> 00:56:12,160
COLLEAGUE AT OUR UNC CENTER FOR

1543
00:56:12,160 --> 00:56:13,080
WOMEN'S MOOD DISORDERS. THANK

1544
00:56:13,080 --> 00:56:13,640
YOU. 

1545
00:56:13,640 --> 00:56:19,720
[APPLAUSE]

1546
00:56:19,720 --> 00:56:21,840
>>NOW YOU CAN SEE WHY DR.
BRODY

1547
00:56:21,840 --> 00:56:25,080
IS A GREAT TEACHER. REALLY

1548
00:56:25,080 --> 00:56:26,560
COMPREHENSIVE AND WONDERFUL. I

1549
00:56:26,560 --> 00:56:28,680
DO HAVE ONE QUESTION FOR YOU

1550
00:56:28,680 --> 00:56:29,720
FROM THE VIDEOCAST.

1551
00:56:29,720 --> 00:56:33,040
>>OKAY.

1552
00:56:33,040 --> 00:56:34,480
>>IF PEOPLE WANT THE ASK

1553
00:56:34,480 --> 00:56:35,120
QUESTIONS THEY CAN COME UP TO

1554
00:56:35,120 --> 00:56:37,400
THE MICROPHONE, I THINK WE HAVE

1555
00:56:37,400 --> 00:56:43,520
GOT ONE OR TWO QUESTIONS. SO YOU

1556
00:56:43,520 --> 00:56:45,440
MAY OR MAY NOT HAVE TOUCHED ON

1557
00:56:45,440 --> 00:56:46,920
THIS, AS SOMEONE WHO HAVE PEOPLE

1558
00:56:46,920 --> 00:56:48,920
WITH PMMD IN MY LIFE I WAS

1559
00:56:48,920 --> 00:56:50,880
WONDERING ARE PEOPLE WITH PMMD

1560
00:56:50,880 --> 00:56:54,840
AT HIGHER RISK OF PERINATAL

1561
00:56:54,840 --> 00:56:55,800
DEPRESSION?

1562
00:56:55,800 --> 00:56:57,080
>>IT IS A GREAT QUESTION.
YOU

1563
00:56:57,080 --> 00:56:59,680
HAVE ONE OF THE WORLD'S EXPERTS

1564
00:56:59,680 --> 00:57:02,480
ON PMDD SITTING HERE. SO I THINK

1565
00:57:02,480 --> 00:57:06,640
THAT THE LITERATURE IS

1566
00:57:06,640 --> 00:57:08,040
CONFLICTED IN TERMS OF SOME

1567
00:57:08,040 --> 00:57:10,520
WOMEN APPEAR TO HAVE

1568
00:57:10,520 --> 00:57:11,880
DIFFERENTIAL SENSITIVITY TO ANY

1569
00:57:11,880 --> 00:57:13,840
TIME OF HORMONAL FLUX SO YOU SEE

1570
00:57:13,840 --> 00:57:16,560
PEOPLE THAT SAY I HAVE PMDD I

1571
00:57:16,560 --> 00:57:18,120
HAD PERINATAL DEPRESSION AND

1572
00:57:18,120 --> 00:57:19,920
FOLLOWED ME THROUGH THE

1573
00:57:19,920 --> 00:57:21,120
PERIMENOPAUSE TRANSITION. OTHERS

1574
00:57:21,120 --> 00:57:22,400
DO NOT.  THEY MAY HAVE ONE AND

1575
00:57:22,400 --> 00:57:24,520
NOT THE OTHE OTHER. SO THERE ARE

1576
00:57:24,520 --> 00:57:29,680
WOMEN WITH PMDD WHO DON'T HAVE

1577
00:57:29,680 --> 00:57:31,000
PERINATAL DEPRESSION AND WOMEN

1578
00:57:31,000 --> 00:57:32,280
WITH PERINATAL DEPRESSION

1579
00:57:32,280 --> 00:57:34,800
WITHOUT PMDDD. DIFFERENT

1580
00:57:34,800 --> 00:57:37,720
MECHANISMS LIKELY THERE'S BOTH

1581
00:57:37,720 --> 00:57:39,600
PEOPLE THAT MAY HAVE

1582
00:57:39,600 --> 00:57:41,320
DIFFERENTIAL SENSITIVITY BECAUSE

1583
00:57:41,320 --> 00:57:42,840
THE UNDERLYING PATHOPHYSIOLOGY

1584
00:57:42,840 --> 00:57:44,440
IS SPECIFIC TO THAT VERSUS A

1585
00:57:44,440 --> 00:57:45,920
DIFFERENT UNDERLYING

1586
00:57:45,920 --> 00:57:46,960
PATHOPHYSIOLOGY FOR WHAT IS

1587
00:57:46,960 --> 00:57:47,680
TRIGGERING POSTPARTUM

1588
00:57:47,680 --> 00:57:50,720
DEPRESSION. SO THE JURY IS OUT.

1589
00:57:50,720 --> 00:57:52,320
BUT BEING STUDIED.  BUT IT IS

1590
00:57:52,320 --> 00:57:57,240
NOT AS SIMPLE ANSWER OF YES NO R

1591
00:57:57,240 --> 00:57:57,440
NO.

1592
00:57:57,440 --> 00:58:04,440
(OFF MIC)

1593
00:58:04,440 --> 00:58:06,480
SOME SOCIAL MEDIA FEED ON IN

1594
00:58:06,480 --> 00:58:07,840
NATURE ABOUT THESE THINGS THAT

1595
00:58:07,840 --> 00:58:09,600
WE ARE TALKING ABOUT TOO MUCH

1596
00:58:09,600 --> 00:58:11,720
NOW ABOUT CHAT GTP AND LARGE

1597
00:58:11,720 --> 00:58:13,040
LANGUAGE MODELS.  WHEN I SAW

1598
00:58:13,040 --> 00:58:14,320
YOUR SUMMIT SLIDES I WAS

1599
00:58:14,320 --> 00:58:16,160
WONDERING I KNOW WE ARE GOING TO

1600
00:58:16,160 --> 00:58:17,880
STUDY THESE MODELS IN VARIOUS

1601
00:58:17,880 --> 00:58:19,440
CONTEXT BUT WHAT ARE YOUR

1602
00:58:19,440 --> 00:58:20,480
THOUGHTS ABOUT THAT IN THIS

1603
00:58:20,480 --> 00:58:22,560
PARTICULAR AREA YOU ARE TALKING

1604
00:58:22,560 --> 00:58:27,200
ABOUT SUM A -- SUCH AS SUMMIT

1605
00:58:27,200 --> 00:58:28,600
TRIAL IS? IS THAT GOOD BAD UGLY?

1606
00:58:28,600 --> 00:58:29,960
>>I THINK IT IS HERE TO
STAY

1607
00:58:29,960 --> 00:58:31,560
AND WE HAVE TO LEVERAGE IT FOR

1608
00:58:31,560 --> 00:58:35,600
GOOD. SO I THINK THAT HOW WE

1609
00:58:35,600 --> 00:58:37,200
REACH PATIENTS TO HELP PEOPLE

1610
00:58:37,200 --> 00:58:40,080
HAVE EDUCATION, TO HAVE

1611
00:58:40,080 --> 00:58:41,520
SCREENING, TO THEN GET

1612
00:58:41,520 --> 00:58:45,400
INFORMATION ABOUT WHERE TO SEEK

1613
00:58:45,400 --> 00:58:47,920
CARE, TO GET THINGS OUT OF THE

1614
00:58:47,920 --> 00:58:49,960
DARK WHICH IS MOTHERS WILL FEEL

1615
00:58:49,960 --> 00:58:51,200
THEY ARE FAILING BECAUSE THEY

1616
00:58:51,200 --> 00:58:52,160
DON'T UNDERSTAND WHAT THEY HAVE

1617
00:58:52,160 --> 00:58:53,480
AND NO ONE TOLD THEM AND THEY

1618
00:58:53,480 --> 00:58:55,560
FEEL LIKE THEY ARE HORRIBLE.

1619
00:58:55,560 --> 00:58:58,440
THAT USING SOCIAL MEDIA AND AI

1620
00:58:58,440 --> 00:59:02,320
AND OTHER THINGS THAT CAN DETECT

1621
00:59:02,320 --> 00:59:03,840
AND YOU CAN DETECT WHO IS AT

1622
00:59:03,840 --> 00:59:05,080
RISK FOR THINGS BASED ON ANY

1623
00:59:05,080 --> 00:59:06,600
NUMBER OF THINGS, I THINK THOSE

1624
00:59:06,600 --> 00:59:09,240
ARE ALL POTENTIAL GOOD. THEN

1625
00:59:09,240 --> 00:59:11,160
WILL IS DOWN SIDE. SO IT IS A

1626
00:59:11,160 --> 00:59:12,480
REAL -- EVERYTHING IN THAT REALM

1627
00:59:12,480 --> 00:59:14,080
IS A DOUBLE EDGE SWORD AND HOW

1628
00:59:14,080 --> 00:59:15,800
WE NAVIGATE THAT IS GOING TO BE

1629
00:59:15,800 --> 00:59:16,920
I THINK ONE OF THE GREAT

1630
00:59:16,920 --> 00:59:20,840
CHALLENGES OF OUR TIME.

1631
00:59:20,840 --> 00:59:26,040
>>THANKS SO MUCH. SO FOR
PEOPLE

1632
00:59:26,040 --> 00:59:27,720
THAT ONSET THIRD TRIMESTER WHAT

1633
00:59:27,720 --> 00:59:29,840
YOUR THOUGHTS STARTING TREATMENT

1634
00:59:29,840 --> 00:59:30,240
DURING PREGNANCY?

1635
00:59:30,240 --> 00:59:35,720
>>WELL, WE DO. WE DON'T
USE

1636
00:59:35,720 --> 00:59:39,000
ALLO PREGNANOLONE BECAUSE YOU

1637
00:59:39,000 --> 00:59:40,640
ALREADY HAVE HIGH LEVELS OF

1638
00:59:40,640 --> 00:59:42,160
HORMONES AND THAT WOULD BE

1639
00:59:42,160 --> 00:59:43,040
CHALLENGING, IT IS NOT APPROVED

1640
00:59:43,040 --> 00:59:45,360
IN PREGNANCY. BUT WE CERTAINLY

1641
00:59:45,360 --> 00:59:48,080
TREAT WITH SSRIs, FIRST LINE

1642
00:59:48,080 --> 00:59:50,800
TREATMENT IS PSYCHOTHERAPY. WE

1643
00:59:50,800 --> 00:59:52,440
DO THAT REGULARLY BUT WE ALSO

1644
00:59:52,440 --> 00:59:55,080
TREAT WITH OTHER ANTIDEPRESSANTS

1645
00:59:55,080 --> 00:59:56,120
SSRIs, FOR PEOPLE THAT START

1646
00:59:56,120 --> 00:59:58,200
GETTING DEPRESSED OR WHO HAVE A

1647
00:59:58,200 --> 01:00:00,320
PREVIOUS HISTORY TO TRY AND

1648
01:00:00,320 --> 01:00:02,600
MITIGATE AND WARD IT OFF.

1649
01:00:02,600 --> 01:00:04,040
DEPENDING ON THE LEVEL OF

1650
01:00:04,040 --> 01:00:05,720
SEVERITY, WE GET MORE OR LESS

1651
01:00:05,720 --> 01:00:07,000
AGGRESSIVE IF SOMEONE HAS

1652
01:00:07,000 --> 01:00:08,200
HISTORY DEPENDING ON WHAT

1653
01:00:08,200 --> 01:00:10,480
HAPPENED.  BUT YES I THINK

1654
01:00:10,480 --> 01:00:12,680
INTERVENING DURING PREGNANCY IS

1655
01:00:12,680 --> 01:00:14,640
HUGE. INTERVENING WHEN PEOPLE

1656
01:00:14,640 --> 01:00:17,600
HAVE MILD SYMPTOMS TO TRY TO

1657
01:00:17,600 --> 01:00:18,880
PREVENT FROM WORSENING IS REALLY

1658
01:00:18,880 --> 01:00:19,480
IMPORTANT.

1659
01:00:19,480 --> 01:00:22,000
>>THANK YOU VERY MUCH. WE
ARE

1660
01:00:22,000 --> 01:00:23,360
GOING TO GIVE YOU YOUR AWARD. 

1661
01:00:23,360 --> 01:00:28,640
[APPLAUSE]

1662
01:00:28,640 --> 01:00:30,840
>>I'M THE CHAIR OF THE

1663
01:00:30,840 --> 01:00:31,920
MEDICAL EXECUTIVE COMMITTEE AND

1664
01:00:31,920 --> 01:00:33,640
ON BEHALF OF THE MEDICAL

1665
01:00:33,640 --> 01:00:35,560
EXECUTIVE COMMITTEE WE ARE

1666
01:00:35,560 --> 01:00:37,440
DELIGHTED TO PRESENT TO THIS

1667
01:00:37,440 --> 01:00:41,080
VERY BEAUTIFUL PLAQUE TO DR.

1668
01:00:41,080 --> 01:00:43,360
SAMANTHA MELTZER BRODY FOR

1669
01:00:43,360 --> 01:00:44,800
DELIVERING CONTEMPORARY

1670
01:00:44,800 --> 01:00:46,280
MEDICINES GREAT TEACHER LECTURE.

1671
01:00:46,280 --> 01:00:48,080
THIS WILL BE MAILED TO HER SO

1672
01:00:48,080 --> 01:00:49,560
SHE DOESN'T HAVE TO TAKE IT BACK

1673
01:00:49,560 --> 01:00:50,880
ON THE PLANE.

1674
01:00:50,880 --> 01:00:51,440
>>THANK YOU. I APPRECIATE
IT.

1675
01:00:51,440 --> 01:01:02,920
IT IS BEAUTIFUL.  THANK YOU.