Dr. Kerry Reller:
Alright. Hi everybody. Welcome back to the Get Healthy Tampa Bay Podcast. I'm your host, Dr. Kerry Reller, and today we have Dr. Nicole Shirvani. Welcome to the podcast.

Dr. Nicole Shirvani:
Hi. Great to be here.

Dr. Kerry Reller:
Why don't you start by telling us a little bit about who you are and what you do?

Dr. Nicole Shirvani:
Sure. I'm a psychiatrist. I specialize in women’s mental health and integrative psychiatry, and I'm here in the Tampa area.

Dr. Kerry Reller:
 And how long have you been in Florida?

Dr. Nicole Shirvani:
 About four and a half years now.

Dr. Kerry Reller:
 Nice. Tell me a little bit about your journey into psychiatry and how you ended up focusing on integrative psychiatry.

Dr. Nicole Shirvani:
 Sure. I actually always thought I was going to go into anesthesiology. When I was in medical school doing my rotations, that was my plan. Psychiatry happened to be my last rotation in medical school, and I just loved it. It really surprised me.

I'm what people sometimes call an “accidental psychiatrist.” I didn't originally plan to go into it, but once I experienced it, I knew it was the right fit. I changed directions and have been doing it ever since, and I'm so glad I did.

Dr. Kerry Reller:
 That's funny because those two specialties seem like complete opposites. With anesthesiology you almost don't talk to anyone, and psychiatry is basically all talking.

Dr. Nicole Shirvani:
 Exactly.

Dr. Kerry Reller:
 So what drew you specifically to women's mental health?

Dr. Nicole Shirvani:
 During residency I trained in a clinic where I was exposed to many different subspecialties within psychiatry. Around that time, I also had my daughter during residency. Through some of my own experiences navigating pregnancy and life changes, I realized I felt really passionate about women’s mental health and the challenges women go through at different stages of life.

That led me down this path. I still practice general psychiatry as well, but I have a particular passion for women’s mental health and how different life stages affect mental well-being.

Dr. Kerry Reller:
 Absolutely. And you also take more of an integrative approach in your practice. I know there are certifications in integrative medicine. Is that something you pursued?

Dr. Nicole Shirvani:
 I don't have the formal certification, but I incorporate integrative approaches into my practice. Of course, traditional treatments like medications and psychotherapy are important, but I also focus on other aspects of health.

That includes encouraging time outdoors, discussing nutrition and supplements when appropriate, exercise and strength training, and considering how hormones might be influencing how someone feels. I try to approach treatment holistically and use evidence-based strategies that can lead to meaningful improvements.

Dr. Kerry Reller:
 I think you might be giving away all your secrets.

So where should we begin? Maybe with women’s mental health and why it matters.

Dr. Nicole Shirvani:
 Women experience unique mental health challenges tied to the reproductive life cycle. That includes menstrual cycles, pregnancy, postpartum changes, and eventually perimenopause and menopause.

Even before menopause, women may experience premenstrual dysphoric disorder or mood and anxiety changes tied to their menstrual cycles. Later in life, hormonal transitions like perimenopause can also significantly impact mood and cognition.

Recognizing these connections is very important because these experiences are unique to women and may require different approaches to treatment.

Dr. Kerry Reller:
 Do you see adolescents in your practice?

Dr. Nicole Shirvani:
 I'm not specifically trained in adolescent psychiatry, but I do see many young adults and patients across different life stages.

Dr. Kerry Reller:
 How do hormonal transitions affect mental health?

Dr. Nicole Shirvani:
 Let's take the menopausal transition as an example. As women reach their late forties or early fifties, estrogen levels begin to decline. Estrogen plays a significant role in both mental and physical health.

Estrogen affects neurotransmitters such as serotonin and dopamine, which influence mood. It also impacts bone health, muscle strength, and many other physiological processes. When estrogen declines, it can create a ripple effect across many systems in the body.

Dr. Kerry Reller:
 Many women experience anxiety or depression during perimenopause. How do you approach patients who come in with those symptoms?

Dr. Nicole Shirvani:
 First, I take a thorough history and ask about menstrual cycles and other symptoms. Many women don't realize that their anxiety or mood changes might coincide with hormonal transitions.

Some women experience these symptoms for the first time during perimenopause. Others may have had anxiety or depression earlier in life that returns during this transition.

Treatment options may include antidepressants, but sometimes I also refer patients to their OB-GYN for hormonal evaluation and possible hormone therapy.

Dr. Kerry Reller:
 Sometimes it’s not necessarily jumping straight to an SSRI. It could be something like an estrogen patch.

Dr. Nicole Shirvani:
 Exactly. For some women, hormone therapy alone can significantly improve symptoms. For others, a combination of hormone therapy and antidepressants works best.

Dr. Kerry Reller:
 Can you explain the role of neurotransmitters like serotonin and dopamine?

Dr. Nicole Shirvani:
 Serotonin and dopamine are neurotransmitters that play important roles in mood regulation. Dopamine is often associated with the brain’s reward pathway and feelings of motivation and pleasure. Serotonin helps regulate mood, anxiety, and overall emotional balance.

Changes in estrogen levels can affect how these neurotransmitters function.

Dr. Kerry Reller:
 And that’s where medications like SSRIs come in.

Dr. Nicole Shirvani:
 Right. SSRIs are selective serotonin reuptake inhibitors. They help increase the availability of serotonin in the brain by preventing its reabsorption between neurons. This allows serotonin to stay active longer and improve mood and anxiety symptoms.

Dr. Kerry Reller:
 So there can be synergy between SSRIs and hormone therapy.

Dr. Nicole Shirvani:
 Exactly.

Dr. Kerry Reller:
 You also have a passion for strength training. Why is resistance training important for mental health?

Dr. Nicole Shirvani:
 Strength training has many benefits. It improves bone density and muscle mass, which become increasingly important as estrogen declines with age.

Exercise also releases endorphins and increases dopamine and serotonin levels, which improves mood. It also encourages people to prioritize time for themselves, which is an important part of self-care.

Dr. Kerry Reller:
 Many people struggle to start exercising, but once they begin, they feel better afterward.

Dr. Nicole Shirvani:
 Exactly. Even small amounts can make a difference.

Studies have shown that even 10 minutes of strength training three times per week can have benefits. It doesn't have to be a major lifestyle overhaul. Small, consistent habits can add up over time.

Dr. Kerry Reller:
 Strength training can also improve insulin sensitivity.

Dr. Nicole Shirvani:
 Yes. Building muscle helps reduce insulin resistance and stabilize blood sugar levels, which can also influence mood and energy.

Dr. Kerry Reller:
 Inflammation also plays a role in depression.

Dr. Nicole Shirvani:
 Correct. Chronic low-grade inflammation has been associated with depression. Reducing inflammation through exercise, nutrition, and lifestyle changes can help improve both physical and mental health.

Dr. Kerry Reller:
 Sleep is another important factor.

Dr. Nicole Shirvani:
 Sleep is a restorative process. During sleep, the brain repairs itself and restores neurotransmitters. When sleep is disrupted, mood, focus, and cognitive function can suffer.

Dr. Kerry Reller:
 Let’s talk about integrative approaches.

Dr. Nicole Shirvani:
 For example, when someone struggles with sleep, we might discuss sleep hygiene first. That includes reducing screen time before bed, maintaining a consistent bedtime, and making the bedroom a relaxing environment.

We may also discuss cognitive behavioral therapy for insomnia, supplements like magnesium or melatonin, or other strategies before jumping straight to prescription medications.

Dr. Kerry Reller:
 You also recommend spending time outdoors.

Dr. Nicole Shirvani:
 Yes. Nature has measurable benefits for mental health. Being outdoors can reduce cortisol levels and improve mood. Some countries even prescribe time in nature as part of treatment plans.

Dr. Kerry Reller:
 You also mentioned the importance of doing nothing sometimes.

Dr. Nicole Shirvani:
 Yes. Many people feel guilty taking time for themselves. But even 10 minutes of quiet time can make a big difference.

Every morning I sit with my coffee and my dogs for about 10 minutes before my day starts. That quiet time helps set the tone for the rest of the day.

Dr. Kerry Reller:
 If a woman could do just one thing this week for her mental health, what would you recommend?

Dr. Nicole Shirvani:
 Take 10 minutes for yourself and begin building a simple strength training routine.

Dr. Kerry Reller:
 Where can people find you?

Dr. Nicole Shirvani:
 They can visit my website at healinghermd.com or find me on Instagram at HealingHerMD.

Dr. Kerry Reller:
 Thank you so much for joining us today. This was a great conversation.

Dr. Nicole Shirvani:
 Thank you for having me.

Dr. Kerry Reller:
 Thanks everyone for listening. We'll see you next week.