Treatment

Women’s mental health

Mood, anxiety, and sleep are shaped by hormones across a woman’s life: the menstrual cycle, pregnancy and the year after birth, and the transition to menopause. These conditions are common, often missed, and very treatable when they are recognized for what they are.

Conditions treated

Premenstrual dysphoric disorder (PMDD): Severe irritability, depression, anxiety, or rage in the week or two before a period that lifts within days of bleeding, month after month. PMDD is not ordinary PMS; it is a recognized psychiatric diagnosis that affects roughly one in twenty menstruating women and is frequently misdiagnosed as bipolar disorder or a personality disorder. Diagnosis rests on prospective daily symptom tracking across two cycles, which we set up at the first visit using the IAPMD symptom tracker. Treatment options include SSRIs taken continuously or only in the luteal phase, hormonal approaches in coordination with your gynecologist, and CBT. Premenstrual exacerbation (PME), in which an existing condition such as depression or ADHD worsens before each period, is assessed the same way. The International Association for Premenstrual Disorders is the best patient resource.
Depression and anxiety in pregnancy: About one in seven women experiences depression during pregnancy, and anxiety is at least as common. Untreated illness carries its own risks for mother and baby, so the question is never simply whether to treat but how. Dr. Giddens works with you and your obstetrician to weigh psychotherapy, medication, and both, using the current safety data for each option. The MGH Center for Women’s Mental Health maintains the most thorough public summary of that evidence.
Postpartum depression, anxiety, and OCD: The year after birth is the highest-risk period in a woman’s life for a first episode of depression or anxiety. Postpartum OCD, with intrusive, unwanted thoughts about harm coming to the baby, is common and deeply frightening, and is not the same as wanting to cause harm. All of these respond well to treatment, including medications compatible with breastfeeding. Postpartum Support International offers a helpline and peer groups. Postpartum psychosis is rare and is an emergency: call 911 or go to the nearest emergency department.
Perimenopause and menopause: The years around menopause bring a well-documented rise in new-onset depression, anxiety, insomnia, and difficulty concentrating, often in women who have never had these problems before. Because sleep is Dr. Giddens’s research area, particular attention goes to insomnia and night waking, which drive much of the daytime mood and cognitive change. Treatment may include CBT-I, antidepressants, and coordination with your gynecologist about hormone therapy. The Menopause Society has clear patient information.
Medication decisions before, during, and after pregnancy: Planning a pregnancy while taking psychiatric medication, or discovering one while on it, raises questions that deserve a careful, unhurried answer. A consultation reviews your specific medications and history against current evidence so that you and your obstetrician can decide together. Stopping medication abruptly is rarely the safest choice.
ADHD in women: ADHD is diagnosed later in girls and women, often in adulthood, and symptoms typically worsen premenstrually and in perimenopause as estrogen falls. Evaluation takes this into account, and treatment is adjusted across the cycle when needed.
Loss, infertility, and trauma: Miscarriage, stillbirth, infertility treatment, and traumatic births carry grief and anxiety that are often minimized by others. Care here is offered without a timetable for “moving on,” and includes trauma-focused therapy when a birth or loss has left lasting fear or intrusive memories.

How care is organized

Symptom tracking across the menstrual cycle when the pattern matters, using a simple daily rating so that diagnosis rests on data.
Coordination with your obstetrician, gynecologist, midwife, or reproductive endocrinologist, with your permission, so that psychiatric and reproductive care are planned together.
Both therapy and medication are available; many women prefer to start with therapy in pregnancy, and that is fully supported. Interpersonal psychotherapy (IPT) and CBT have the strongest evidence for perinatal depression.
Attention to sleep at every stage, since it is often the earliest thing to change and the fastest to improve.
Care in New York, Washington, DC, and by video for established patients.

Helpful resources

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