Clinical overview
Reproductive-related mood disorders are real and still require diagnostic criteria. PMDD is a luteal-phase, prospectively tracked syndrome, not a bad week once. Postpartum depression is not 'baby blues' after two weeks. Perimenopausal mood change can be severe and still coexist with GAD or bipolar disorder. Dr. Dorothy Chatelier, DNP, FNP-BC, PMHNP-BC, can hold both the psychiatric diagnosis and selected hormone therapy. That is not the same as an OB/GYN high-risk clinic or a reproductive psychiatrist on a mother-baby unit.
How we evaluate
We date last menstrual period, pregnancy, breastfeeding, prior postpartum episodes, bipolar history, and current suicidal thinking. PMDD needs cycle tracking when possible. Postpartum psychosis (delusions, confusion, inability to sleep at all) is an emergency. Testosterone in women is not a first-line antidepressant. Estradiol and progesterone decisions follow contraindications (history of VTE, estrogen-sensitive cancer) rather than Instagram protocols.
Treatment stance
PMDD may respond to luteal or continuous SSRIs; hormone strategies are considered when SSRI is insufficient or declined. Perimenopausal depression may need an antidepressant, CBT, and, when indicated and without contraindication, menopausal hormone therapy. Postpartum depression treatment accounts for breastfeeding pharmacology. We do not treat postpartum psychosis as an HRT visit.
When to seek care
Seek care when luteal mood collapse, perimenopausal rage/tearfulness, or postpartum depression is impairing function. Go to an emergency department immediately for postpartum psychosis, thoughts of harming the infant, or inability to sleep for days.