A Glossary of Terms

Peri-Natal Psychiatry
Photo attribution: "Dictionary" by greeblie

In an effort to provide transparency and improve certainty, we have formed the glossary below. Please feel free to let us know at contact@carlysnydermd.com if you think there should be anything added or changed. We welcome your thoughts.

  • Alternative Therapies
    Any therapies or treatments that are often excluded by conventional medicine are included under the heading of ‘alternative’ medicine. When these are used alongside conventional medicine to bolster the effects of treatment, alternative treatments are known as‘Complementary Therapies.’

    • Such treatments often have a more holistic, or whole picture, point of view than conventional medicine.
    • Examples include, but are not limited to, relaxation techniques such as meditation, visualization, breathing exercises, physical therapies such as massage, yoga and acupuncture, and also herbal remedies and associated supplements and aromatherapy.
  • Cognitive Behavioral Therapy
    A type of time limited psychotherapy that is diagnosis and present-focused. Treatment is highly structured and organized, with a goal of helping a patient understand thoughts and feelings that influence and cause mood fluctuations and resultant behaviors.
  • Complementary Therapies
    Use of alternative therapy in conjunction with conventional medicine to bolster the effects of treatment. See alternative therapy

    • Examples include, but are not limited to meditation, visualization, breathing exercises, massage, yoga and acupuncture used in combination with more conventional medical treatments/therapies.
  • Diagnostic Testing
    Any medical test/tests performed to aid in the diagnosis or detection of a disease; diagnostic tests can also assist in ruling out potential diseases that may have similar symptoms.
  • Integrative Medicine
    Focuses on the mind, body and psyche/spirit. Integrative medicine incorporates alternative and complementary therapies and more conventional medicine treatments. Alternative medicine is used when appropriate, to minimize stress on the body and maximize wellness, with the goal of helping the body to function more effectively on its own. Conventional medical principles based on clear scientific rationale are also relied upon for optimal treatment. The doctor, patient, community relationships are highly valued and form a vital component of the integrative medicine philosophy and approach.
  • Interpersonal Therapy
    Diagnosis-focused, time-limited (12-16 sessions), present-focused form of psychotherapy that encourages patients to regain control of their mood; there are three phases of treatment, beginning, middle and end. Patients are encouraged to consider depression as an illness, not a personal fault or defect, to appreciate the connection between disturbing life situations and resultant mood changes, and that events can trigger or precipitate mood changes.
  • Intrauterine Insemination (IUI)
    Fertility treatment that uses a catheter to put washed sperm (ie semen separated from seminal fluid) directly into the uterus, in an attempt to improve the chance of fertilization by increasing the number of sperm that get directly to the fallopian tubes, as a head start. The sperm must still reach the egg and fertilize it for successful conception. Women may, but do not need to, be on medication to stimulate egg production to further improve the chance of conception. The average success rate is 10-20% per cycle, though is often improved for women under 35 years old, and less successful for women over 35 years old. IUI is an option for couples who have tried conceiving unassisted for 6 months to a year, and may have a number of conditions leading to impaired fertility.
  • In Vitro Insemination (IVF)
    The process of fertilization by combining the sperm and egg in a lab, monitoring growth of the early embryo and then if successful, transferring the embryo directly into the uterus. IVF is a form of Assisted Reproductive Technology (ART). IVF requires a woman be on medication(s) to control the timing of egg ripening, and to stimulate the ovaries to increase the number of eggs available for collection; this step is called ovarian induction. Next, the eggs are retrieved via a minor surgical procedure, called follicular aspiration. Sperm is also collected, often via ejaculation; this sperm is then combined in a lab with the retrieved eggs in incubators in a process termed insemination. The eggs are then monitored to ensure fertilization occurred successfully, as noted by cell division. The fertilized egg is now an embryo. The 2-4 celled embryo is transferred into the uterus one to six days (an average of 2-3 days) later in a process called embryo transfer. Anywhere from 1 to 4 or sometimes more embryos are transferred at once. After this point, a woman monitors for successful pregnancy symptoms and then has a blood test and possibly an early ultrasound to determine if successful implantation and pregnancy have occurred. On average, it takes up to 3 cycles to have a successful pregnancy, though it can happen on the first try or may require many more cycles. Success rates are measured by live births, and are highly dependent on the cause of fertility difficulty, as well as a woman’s age. Women under 35 years old have a 30-35% chance of success per cycle; women 35-37 years old have a 25% chance of success per cycle; women age 38-40 have a 15-20% success rate per cycle, and lastly women over age 40 have a success rate of 6-10% on average. IVF may be done with a woman’s egg and a man’s sperm, or may be done with donor eggs, sperm and/or embryos. IVF is a very demanding and time-consuming process, that is often financially and emotionally demanding, but can be invaluable for couples facing possible infertility.
  • Lifestyle Modifications
    Walk instead of taking a cab, go for a run, drink less coffee, choose to purchase and eat organic over non organic produce, read a book over watching tv, use your brain; engage with kids rather than going to the movies, go out with friends and socialize instead of being alone – be an active participant in life instead of waiting for life to happen to you. Have a hobby – make it happen – join a running club, don’t just assume something will happen to you, but actually make changes in your life to make life happen such that things improve.
  • Mood State
    A temporary way of being or feeling. It does not define who you are, just how you feel internally in the moment. If a mood persists over time, then it may be due to a mood disorder, such a depression, anxiety or bipolar disorders.
    Compared to emotions, moods are often less specific and less intense, and are not typically triggered by events or memories.
  • Nutrition plans
    Dietary choices can have a significant affect on mood stability, including depressive or anxiety symptoms. I proscribe to the notion that the healthiest diet is one that is inclusive and contains real, unprocessed foods. An ideal diet, assuming you do not have any gluten or casein intolerances/allergies, is a Mediterranean diet over a Western diet. Try to minimize ingestion of processed sugars, drink no more than 200mg/day of caffeine (a cup of coffee is roughly 80-100mg). One’s focus should ideally be on eating healthy food, not less food. Choosing organic, locally sourced foods often minimizes toxin exposure and protects the nutritional value of produce. Similarly, eating NON-feedlot meat and wild rather than farm-raised fish minimizes hormone and toxin exposure, and provides additional sources of omega-3′s, plus vital nutrients, vitamins and minerals. In the case of fish, eating wild rather than farm raised fish minimizes exposure to mercury. The caveat is that women of childbearing age who are pregnant of planning a pregnancy, should limit intake of large, predatory fish that contain high levels of mercury. Examples include but are not limited to tuna, swordfish, tile fish and mahi mahi. For a complete list, see Mayo Clinic and NRDC.Additional food-related lifestyle modifications that can be beneficial for health and well-being include using glass rather than plastic for food storage and heating, and minimizing use of the microwave in order to maximize healthy cooking. Choose fresh produce over packaged or canned versions whenever possible.Furthermore, it is essential for a healthy body and mind to go outdoors at least daily, exercise regularly and make informed, sound sleep hygiene choices. Complementary therapies such as yoga, acupuncture, meditation, breathing exercises, mindfulness, and of course, psychotherapy are additional tools. All of these things are of vital utility for total body health and wellness.
  • Pharmacotherapy
    Carly Snyder’s M.D. approach to Pharmacotherapy is first try to improve overall body health and wellness, decrease external causes for any mood symptoms, and change factors that are modifiable that may be negatively affecting mood, but if you require psychotropic medications to stabilize mood due to a neurochemical imbalance that is not improved with lifestyle modifications, dietary changes, exercise, sleep improvements etc, and use of supplements, than explore options of appropriate medications given symptoms; lowest effective dose used with focus on minimizing side effects, maximizing efficacy and minimizing use of polypharmacy.Use specific supplements carefully and methodically to improve mood, enhance effect of antidepressant or antianxiety medication if possible to ideally minimize doses required for psychotropics. Enhance health and wellness with supplements, minimize symptoms when possible with appropriate supplements, and use psychotropics to stabilize mood to improve overall life so that one can move forward and enjoy every day without physical and emotional discomfort/pain.
  • Physiologic
    Consistent with the normal functioning of an organism.
  • Premenstrual Dysphoric Disorder (PMDD)
    A severe form of PMS that affects up to 8% of women with premenstrual syndrome (PMS). PMDD may impair a woman’s ability to go to work and may disrupt relationships due to extreme mood swings along with physical effects. Symptoms often begin 7-10 days prior to onset of menses, and may continue for a day or two into a woman’s period. This occurs every month. Women suffering from PMDD may have severe depressive symptoms of hopelessness or sadness, possibly extreme irritability or anger, notable moodiness and/or anxiety or tension before menstruation; they may have physical symptoms like bloating or breast tenderness, and may have difficulty sleeping and/or a change in appetite and/or weight, among other possible symptoms.
    There are several options for treatment including lifestyle and dietary changes, birth control pills and/or SSRI’s (selective serotonin reuptake inhibitors) used in various dosing patterns to minimize symptoms and decrease life disruptions from symptoms.
  • Psychodynamic Psychotherapy
    Or insight-oriented therapy, is a form of psychotherapy rooted in and informed by psychoanalytic theory. Psychodynamic therapy requires less frequent visits as compared to psychoanalysis, and often is shorter in duration. The focus in psychodynamic psychotherapy is often on gaining an understanding of unconscious thoughts and feelings that inform and may direct current behavior. By recognizing how the past influences current behavior, and gaining self-awareness, one can modify maladaptive behaviors and make informed, conscious behavioral decisions rather than repeating harmful patterns. Interpersonal relationships are explored, including prior and current dysfunctional relationships and how these may continue to color one’s behavior towards others and in new or different relationships today. The dynamic between therapist and patient is explored and used as a tool for further understanding of behavior and eventual increased self-awareness and growth.
  • Psychotherapy (talk therapy, therapy, or counseling)
    A process that can help improve understanding, awareness and adjust responses during times of stress due to any life event or change. Psychotherapy is highly beneficial in most circumstances to gain improved understanding of the cause for one’s emotional response and improve mood as a result. With greater appreciation for the underlying cause of one’s reactions and an improved sense of purpose and understanding, one may tackle life stressors with greater ease. Psychotherapy may be used alone as a treatment for various psychiatric disorders, though more moderate to severe illness often benefits most from a combination of psychotherapy plus medication management. Whether psychotherapy can be used as the only treatment depends on the severity of illness and specific symptoms being treated.
  • Psychotropics
    Medication used for psychiatric illness.
  • Supportive Psychotherapy
    A psychotherapeutic approach that combines interpersonal, cognitive behavioral and psychodynamic approaches to reinforce positive, healthy adaptive behaviors and patterns, in order to minimize any maladaptive or detrimental patterns and reduce internal conflicts that produce negative mood symptoms. The therapist works closely and actively with the patient in a trusting, secure and encouraging relationship. The therapist helps a patient to understand and mitigate issues and to consider alternative options; the work bolsters a patients self esteem, sense of hope and purpose, and confidence in tackling various life stressors.
  • Thyroid Hormone
    May masquerade as a psychiatric illness. Underactive thyroid, called hypothyroid, may present symptoms similar to depression; sad mood, low energy, joint and muscle pain, and fatigue. Hypothyroidism often has additional symptoms not seen in depression, such as weight gain despite no change in food intake (due to slowed metabolism), dry skin, constipation, cold intolerance, and excessive menstrual bleeding. It is most often caused by an autoimmune disease called Hashimoto’s disease, but has several other causes also. Treatment is often via replacement of thyroid hormone. Over active thyroid is called Hyperthyroidism, and may present with anxiety or in severe cases, manic like behavior. Additional symptoms can include irritability, sense of panic due to episodic increases in pulse, and difficulty sleeping. Other symptoms unrelated to mood disorders that can present in hyperthyroidism include but are not limited to heat intolerance, weight loss despite (often eating more than usual), hand tremors, muscle weakness, sweating more, and lighter menstrual flow. There are multiple causes for hyperthyroidism, most commonly the autoimmune disease ‘Grave’s disease.’Thyroiditis is inflammation or swelling of the thyroid, and can be seen in postpartum thyroiditis, which affects up to 10% of women in the months after giving birth. Like the thyroid diseases above, an autoimmune process likely causes postpartum thyroiditis where the body attacks the thyroid. However, unlike Hashimoto’s and graves diseases, postpartum thyroiditis is often transient and self-limited. In the first 1-4 months after delivery, the thyroid damaged by the body’s altered immune system that attacks itself, leaks thyroid hormone. In the ensuing period, often 4-8 months after delivery, the thyroid has leaked out all its hormones and is now nearly empty, so symptoms of hypothyroidism may be present at this stage. The thyroid reconstitutes and heals often by 12 -18 months postpartum. However, once postpartum thyroiditis is identified, it is often truncated via medication.Not all women experience both phases of postpartum thyroiditis. Women at increased risk for postpartum thyroiditis include those who have had it following previous deliveries, women with pre-existing thyroid disease, either for themselves or in closely related family members, and those with other autoimmune diseases.It is imperative and can be highly informative either during or after a pregnancy to have a full thyroid panel drawn. This includes TSH (thyroid stimulating hormone), free T4 and T3 (thyroid hormones), and thyroid antibodies. TSH tells the thyroid to make thyroid hormone, and elevations or reductions in TSH as compared to thyroid hormone levels can be informative about any possible thyroid abnormality present.Normal TSH, free T4 and T3 but elevated autoantibodies may indicate a heightened risk for a postpartum thyroiditis and postpartum depression, and warrants further evaluation by a specialist.
    Undiagnosed and/or untreated hyper- or hypo-thyroid may make it more difficult to conceive, and untreated, both may negatively impact a pregnancy in terms of both maternal and fetal health. Untreated thyroid illness can cause mood disturbances during and after pregnancy as well as at any time in a woman’s life, as reviewed above. As such, it is always important to evaluate the health of the thyroid and treat any present abnormality in order to ensure overall physical health and mood stability.

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