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E143
June 23, 2026
Train Your Brain To Thrive Through Menopause
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In this episode of unPAUSED, Dr. Mary Claire Haver sits down with Dr. Sue Varma, a board certified psychiatrist, distinguished fellow of the American Psychiatric Association, and author of Practical Optimism. They open by taking on a question that sits at the intersection of psychiatry and menopause medicine: why do some women thrive through the most difficult biological transition of their lives, and what can the rest of us learn from them?

Early in the conversation, Dr. Varma shares a finding that reframes everything: only 25% of people are born optimistic, and there is actually a gene for it. The other 75% have to learn it. Dr. Varma explains why optimism is not toxic positivity, what practical optimism actually means, and why both extreme optimists and extreme pessimists end up paralyzed into inaction in different ways. She also addresses what happens when depression, anxiety, and brain fog layer on top of the hormonal changes of menopause and perimenopause, and why so many women are being undertreated as a result.

Dr. Varma walks through the practical applications of her framework, explaining why waiting for motivation to strike is a losing strategy, how chronic stress and cortisol keep women stuck in survival mode, how to move healthy behaviors out of the prefrontal cortex and into the basal ganglia where they become automatic, and why lowering the entry barrier rather than overcommitting is the key to building habits that stick. She also covers the U-shaped happiness curve, why 47 to 48 is statistically the lowest point of midlife happiness and coincides with peak perimenopause, and why that nadir is actually an opportunity for rebuilding.

Dr. Varma and Dr. Haver also dig into shame and the failure cycle many women experience in midlife, the default mode network and how rumination takes hold, the four steps of emotional processing, and what the four Ms of mental health, movement, mastery, meaningful engagement, and mindfulness, look like in daily practice. They also cover loneliness in midlife, the sandwich generation, sleep disruption and the 3:00 AM wake-up cycle, and why a worry journal works better than most people expect.

Guest links:

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Other Resources:

Chapters

00:00:00 – Practical Optimism vs. Toxic Positivity
00:03:35 – Lessons from 9/11 Survivors
00:09:53 – The Science of Optimism
00:14:12 – Why Healthy Habits Feel So Hard
00:19:11 – Building Motivation Through Action
00:28:49 – When Women Feel Dismissed by Medicine
00:32:21 – Breaking Shame & Negative Thought Loops
00:36:48 – The Midlife Happiness Curve
00:39:07 – Loss, Purpose & Reinvention
00:43:16 – A 4-Step Framework for Managing Stress
00:47:38 – Boundaries, Burnout & Reclaiming Time
00:49:16 – The Wisdom of Menopause
00:52:04 – Aging, Longevity & Healthspan
00:55:57 – Hormones, Depression & Mental Health
01:01:21 – Turning Worry Into Action
01:09:30 – The Four Pillars of Mental Wellbeing
01:17:00 – Building Resilience in Midlife
01:21:00 – Final Thoughts on Thriving Through Change

About the guest

Dr. Sue Varma

Dr. Sue Varma, MD, PC, DFAPA, is a distinguished psychiatrist and cognitive behavioral therapist based in New York City. With over two decades of private practice experience, Dr. Varma has made significant contributions to the field of mental health. Notably, she served as the pioneering medical director and psychiatrist for the esteemed 9/11 mental health program at NYU. Alongside her clinical work, Dr. Varma holds the position of Clinical Assistant Professor of Psychiatry at New York University (NYU) Langone Health. Her accomplishments have been recognized by the American Psychiatric Association (APA), where she was honored as a Distinguished Fellow, the highest honor bestowed upon its members.

Dr. Varma has garnered national acclaim as a sought-after medical commentator, appearing on major news programs and networks. Her expertise has been instrumental in guiding the public through various mental health challenges, from trauma and resilience to stress management and relationship issues. Dr. Varma can frequently be seen discussing breaking news on the morning shows including the Today Show, CBS Mornings and GMA, as well as prime time specials and news documentaries. In addition to her media contributions, Dr. Varma is a captivating speaker, engaging diverse audiences with her messages of inspiration, compassion, and hope. From C-suite executives to healthcare professionals, educators, and the general public, she imparts valuable knowledge on topics such as self-compassion, psychological safety, work-life balance, and women’s mental health.

Throughout her career, Dr. Varma has received numerous prestigious awards for her groundbreaking work in mental health education and advocacy: two Sharecare Emmy awards (including an inaugural Sharecare Emmy), the Ivan Goldberg Award for Outstanding Service and a Mayoral Proclamation. Notably, she was recognized as one of the world’s top five leading health experts by Global Citizen for her contributions during the pandemic. 

Dr. Varma’s integrative approach to mental health, encompassing the 4 Ms of mental health, empowers individuals to boost their mood, mastery, and sense of meaning in life. Dr. Varma’s forthcoming book, “Practical Optimism: The Art, Science and Practice of Exceptional Wellbeing” (Penguin Random House, 2/2024), anticipated worldwide with multiple translations, offers valuable insights into promoting optimal mental health and wellness. She believes that physicians have a duty to not only take their patients from a state of dysfunction to function, but also from functional to optimal. Dr. Varma is an avid traveler and has visited fifty countries over five continents and counting!