If your mood shifts hard in the days before your period, or pregnancy and new parenthood have brought sadness or anxiety you did not expect, you are not “just hormonal” and you are not alone. These are real, common, and very treatable conditions. You are welcome here.

What PMDD and perinatal mood conditions are

Premenstrual dysphoric disorder (PMDD) is a severe form of premenstrual symptoms — strong mood changes in the week or two before your period that ease once it begins. Perinatal mood and anxiety conditions are depression or anxiety that occur during pregnancy or in the year after birth; perinatal depression affects as many as 1 in 7 people and is one of the most common complications of pregnancy and the postpartum period (U.S. Preventive Services Task Force, 2019).

Signs and symptoms

With PMDD, people often notice, in the days before a period:

• Marked irritability, anger, or conflict with others.
• Sadness, hopelessness, or tearfulness.
• Anxiety, tension, or feeling on edge.
• Symptoms that lift within a few days of the period starting.

With perinatal conditions, people may notice persistent sadness or anxiety, guilt, trouble sleeping even when the baby sleeps, difficulty bonding, or frightening intrusive thoughts. Intrusive thoughts are common and do not mean you would act on them — but they are worth talking about.

Some situations are emergencies. Thoughts of harming yourself or your baby, or losing touch with reality after birth (postpartum psychosis), need help right away — call 988 or 911, or go to the nearest emergency room.

How it is understood and evaluated

For PMDD, the key is the timing — tracking symptoms across a cycle or two shows the clear premenstrual pattern that distinguishes it from other mood conditions. For perinatal mood, a brief, caring evaluation and a short questionnaire help us understand what you are experiencing. You can share at your own pace.

Brief screening (96127)

We use brief, validated questionnaires — scored and documented on the CNS Vital Signs platform and billed under code 96127 (brief emotional/behavioral assessment) — including the PHQ-9 for depression, and for pregnancy and postpartum we use the Edinburgh Postnatal Depression Scale (EPDS), the standard perinatal screen (Cox et al., 1987; CNS Vital Signs, n.d.). Each takes only a few minutes.

How it is treated — and how we approach it at OhanaPsych

For PMDD, SSRIs are first-line and work differently than for depression: they often help within a few days, at lower doses, and can be taken either every day or only during the two weeks before your period (Marjoribanks et al., 2013). Lifestyle steps and, for some, hormonal options coordinated with your OB/GYN can also help.

For perinatal depression and anxiety, talk therapy works well — national guidelines recommend counseling such as cognitive behavioral therapy or interpersonal therapy to prevent and treat perinatal depression (U.S. Preventive Services Task Force, 2019). When medication is helpful, we choose it carefully with pregnancy and breastfeeding in mind, and newer FDA-approved options for postpartum depression are available. We coordinate closely with your OB/GYN and primary-care team.

We hold this work with aloha and without judgment, with the goal of restoring lōkahi (balance and harmony) so you can feel like yourself and care for the people you love.

Getting care by telehealth

Most of our care is delivered by secure video, so you can begin from a private, comfortable place of your own — especially helpful with a new baby at home. Some parts of care — such as certain controlled medications — still follow the federal Ryan Haight Act and DEA rules and may call for an in-person step; we will tell you clearly if that applies to you.

Lasting access by telehealth

As we complete the final stages of becoming a Rural Health Clinic (RHC), telehealth for mental-health care is here to stay with us. Under Medicare’s rural-health rules, RHCs are permanently authorized to provide behavioral and mental-health care by telehealth — including into your home, anywhere in Hawaiʻi — not under the temporary flexibilities that expire and must be renewed. For our patients, that means dependable, lasting telehealth access to the care you need.

Wherever you live, OhanaPsych is your statewide practice. We provide care across the entire state of Hawaiʻi by telehealth, reaching every island — Hawaiʻi Island, Maui, Oʻahu, Kauaʻi, Molokaʻi, Lānaʻi, and Niʻihau. If you would rather be seen in person, you have that option at our offices in Hilo and Honolulu.

When to reach out

You do not need to be in crisis to reach out — new patients are welcome. Call (808) 777-9460 or start your request online.

If you or someone you love is thinking about suicide or self-harm, or having thoughts of harming the baby, get help right away. Call or text the 988 Suicide & Crisis Lifeline (call or text 988, or chat at 988lifeline.org). In Hawaiʻi, Hawaiʻi CARES is available by calling or texting 988, or at 808-832-3100 / 800-753-6879. In a life-threatening emergency, call 911.

Medically reviewed by George Mackel, MSN, APRN, NP-C, PMHNP-BC, CARN-AP — President & Owner, OhanaPsych / Ohana Care Clinic.
Last reviewed: June 28, 2026. Citations verified: June 28, 2026.

This page is general health education from OhanaPsych. It is not a substitute for a personal evaluation by a qualified clinician who knows your situation, and reading it does not create a provider–patient relationship. If you think you may have a mental health condition, reach out to us or another licensed provider. In an emergency, call 911.

References

CNS Vital Signs. (n.d.). CNS Vital Signs computerized rating instruments. https://www.cnsvs.com/WhitePapers/CNSVS-RatingInstruments.pdf

Cox, J. L., Holden, J. M., & Sagovsky, R. (1987). Detection of postnatal depression: Development of the 10-item Edinburgh Postnatal Depression Scale. The British Journal of Psychiatry, 150(6), 782–786. https://doi.org/10.1192/bjp.150.6.782

Marjoribanks, J., Brown, J., O’Brien, P. M. S., & Wyatt, K. (2013). Selective serotonin reuptake inhibitors for premenstrual syndrome. Cochrane Database of Systematic Reviews, (6), CD001396. https://doi.org/10.1002/14651858.CD001396.pub3

U.S. Preventive Services Task Force. (2019). Interventions to prevent perinatal depression: US Preventive Services Task Force recommendation statement. JAMA, 321(6), 580–587. https://doi.org/10.1001/jama.2019.0007