Dear Doctor: Carly Snyder
The reproductive psychiatrist with a focus on educating and supporting women
Growing up, it was never a question for Dr. Carly Snyder whether she would end up in medicine, just what specialty she would focus on. Her path brought her to reproductive psychiatry, a subspecialty where she takes a psychiatric and integrative approach to provide mental health support to women before, during, and after pregnancy. Her passion for helping others and commitment to staying current in her field has also made her an excellent mentor and inspired her to share learnings with others through her HuffPost Blog and weekly radio show, both called MD For Moms. We spent an afternoon at her Upper East Side office discussing the importance of building relationships, how her field aims to destigmatize pre- and postpartum issues, and how being a mother herself helps her relate to patients.
“My father is a physician and loves what he does, so I’ve always had a positive association with medicine. The question for me was never whether I would practice medicine, but rather what type. I loved surgery — learning to suture, tying knots, the detail of it, so I thought I’d go into plastics. After I had my son at the end of medical school, I started thinking back to my childhood, where my family always had breakfast together growing up, and I realized that I wanted more control over my time than being a surgeon would likely allow. I switched gears and ended up doing a residency in psychiatry.”
Discovering Reproductive Psychiatry
The first few months in the hospital were hard. I was on the medicine float / code team. It was intense, and I loved it. I did a rotation in the pediatric unit and will never forget a baby who was admitted for EEG monitoring — he was two months old and had been seizing almost constantly since the day he was born. There was no treatment available, and this baby was dying. I stood in the room and felt, like everyone, unhelpful and incredibly sorry. I noticed that no one was checking in on the mom. I sat with her and let her cry. I really felt like this was the way I could help.
I ended up finding her a grief counselor, and a few months later I bumped into the pediatric neurologist who let me know they had instituted a program connecting moms whose babies were terminal with grief counselors in advance of the baby’s death because of how much it helped that first mom. It meant so much to me, and it’s really what kept me in psychiatry.
Subsequently, one of my senior residents connected me to a reproductive psychiatrist and, in my fourth year I did extra training in this subspecialty. It helped me bridge my interest in medicine and psychiatry, and as a mom, I could identify in a deeper way with my patients.
I later graduated and started my own practice, while simultaneously starting a Women’s Mental Health clinic embedded within OB-GYN at Beth Israel Medical Center. At the hospital, I had the opportunity to teach residents and help reduce the stigma for pregnant women around seeking help. After I had my third child, I began to pull back a bit from my work at Beth Israel; I continued to teach and lecture, but my focus turned more to my family. At the same time, I had the opportunity to join my dad’s psychiatry practice, Family Health Associates, and I jumped at the chance to expand my private practice and work with my hero. I continued to see many pregnant and postpartum women, and increasingly saw women following miscarriage and women going through the fertility treatment process.
I’ve joined the board of Postpartum Support International as their Research Chair to connect with professionals in my field; the exposure and the connections I’ve made have been awesome. I’m now on the President’s Advisory Council and appreciate the opportunity to help women who are struggling and their families around the world through this wonderful organization.
I love what I do. Everyone should have the opportunity to enjoy motherhood, and I’m honored to help with that process.
On Taking a Personal Approach
There is surely a stigma around Perinatal Mood And Anxiety Disorders (PMADs), or various mood symptoms and illnesses during pregnancy and postpartum. People have an image of what a woman should feel like in pregnancy and as a mom, and if it’s not like that, it leads to guilt or shame or fear. In reality, at least 20% of women struggle during and post-pregnancy with depression and/or anxiety.
First and foremost, I want to make sure women realize that having a perinatal mood disorder is never their fault and that treatment works.
My approach is to connect by building a relationship. In one way or another, a large part of my work involves educating people on risks and how to mitigate those, whether there is medication involved or not. I often see women taking initiative to come in before conception to talk about their past history and any potential concerns or questions about how pregnancy might impact their emotional state. I also see many women who are struggling to conceive, or are already pregnant or postpartum and feel overwhelmingly depressed or anxious and are not enjoying life. I work closely with each woman to ensure she can return to feeling like her former self without excessive mood symptoms.
The experience for my patients is very dependent on the person. It’s really important for me to get the full history. I always ask, “What is your past and present like and what do you want from your future?” I believe in autonomy. My role is to give information, not to make a decision for someone. We explore the risks and benefits of treatment versus potential risks of untreated illness, and I empower women to choose the option that feels most comfortable for them, knowing we can always adjust the plan over time.
On Learning and Teaching
There is lots of data that doesn’t get put in the press. Multiple studies have found no link between SSRIs in-utero and autism. This might not necessarily make it into the news, but I still need to know about it as a prescriber. So I always start my day my looking at what’s been published. I get every medical journal digitally and read them all online — everything I can find in my field. I’m also part of a listserv with others in my field, where we share new information.
I use Twitter and Facebook to share new information. I try to curate what I send out based on the high volume of news and updates that I read and to translate it into information that’s digestible for my followers.
I have a radio show that’s now had nearly 100 episodes. It started organically; the producers heard me on a show and approached me. It’s grown a lot, and has been a great platform to let women hear from other women. I primarily have physician moms on the show, especially those who have specialties that resonate with women and moms, like pediatrics, OB-GYN, and endocrinology. It’s a great way for me to learn too. The episodes are structured as one-to-two guests in conversation with me, and what’s really fun is that we get callers who phone in to ask questions. I focus on things that as a mom I would want to know. The episodes I love the most are those where you can tell my guest really loves what she does.
On Teaching
I’m only where I am because of my amazing mentors. In a field that can be complex, it’s important to have people you can rely on for tough cases and generally for support. I have a few people I know I can call from an intellectual standpoint and an emotional standpoint. Right now, I have two resident mentees. We’ve done research together, and I love watching them present their findings. I get emails and calls from residents from all over the country who are interested in learning more about reproductive psychiatry and I try to help however possible.
I love that I have patients who come pre-pregnancy, and now they’re on baby number three. I get pictures and get to be in the shadows supporting them through motherhood. I care and I want them to feel good and know I’m always there if they need me. Sometimes I’m even invited to a baby naming or a bris, and it’s so special that we’ve been able to develop this lovely, wonderful relationship. I am privileged to see my patients’ lives unfold, their children grow, families expand — there is nothing more rewarding than seeing a woman who had been sad, anxious, and unable to function well now enjoying motherhood and appreciating life.
Lightning Round
A small thing everyone can do for their health is…sleep. If a new mom can get seven hours a night, that’s incredible. I tell my patients to have their partner get involved. Even if you are the one who is nursing, your partner can get the baby and bring them to you.
I love what I do because…I take a holistic approach to treat situations that can be really personal and painful and help make someone feel better. I learn all the time, and it’s a small enough field that when I see new research, it’s likely I’ll know the person who published it.
I could talk for hours about…my kids! And skiing.
Favorites
Guilty pleasure: Watching Grey’s Anatomy and The Real Housewives.
NYC neighborhood: I love Central Park. I have trained for many marathons there. I am about to start training for several fall marathons this coming week and will be in Central Park a lot!
Relax ritual: Crocheting.
Summer activity: I love to garden. My son and I map out our garden each year and plant seeds to grow fruits and vegetables. All three kids love to harvest, prepare and eat our bounty — it’s awesome!
You can learn more about Dr. Synder here!
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