Clinical overview
Mood disorders are not a single chemistry problem. DSM-5-TR still requires a longitudinal history: episode polarity, duration, mixed features, postpartum onset, seasonal pattern, psychosis, and suicide risk. A PMHNP-BC evaluation at Peace & Heart Wellness starts there, then decides whether a thyroid panel, ferritin, B12, or selected hormones could change the plan. We do not diagnose bipolar disorder from a one-item irritability screen, and we do not call every low mood 'chemical imbalance.'
How we evaluate
The intake maps first-episode versus recurrent depression, antidepressant-induced activation, family history of bipolar illness, sleep-wake reversal, and substance use. PHQ-9 and MDQ are instruments, not diagnoses. If hypomania is in the history, an antidepressant-only plan is not the default. Medical mimics (hypothyroidism, anemia, sleep apnea, steroids) are named when the story fits, not as a shotgun panel.
Treatment stance
Treatment may include an SSRI/SNRI, bupropion, an atypical antipsychotic when indicated, a mood stabilizer when bipolar spectrum criteria are met, sleep stabilization, and psychotherapy referral. Hormone-informed care is additive when perimenopause, postpartum, or hypogonadism is documented — it is not a substitute for a mood-disorder diagnosis. Acute mania, psychotic depression, or active suicidal intent is an emergency-department or higher-acuity path, not a telehealth titration visit.
When to seek care
Seek evaluation when low mood, anhedonia, or energy collapse lasts most days for two weeks or more, or when elevated mood, reduced need for sleep, and impaired judgment appear. Call 988 or go to an emergency department for suicidal intent, inability to care for yourself, or suspected mania with psychosis.