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Talkiatry
From the Armchair
TALKIATRY’S MONTHLY MENTAL HEALTH NEWSLETTER
Small steps for mental health
Take something you already do every day, like checking your phone or having your morning coffee, and do it outside tomorrow. Even a few minutes of fresh air and daylight can boost your mood and energy.
Three things a psychiatrist wants you to know about starting a new medication
With insights from:
Sophia Monsour, DO
Chief Psychiatrist
We recently asked what you’d like to read about, and a clear theme emerged across hundreds of responses: more information about medication and treatment. To start, we’re sharing tips for beginning a new medication, based on our clinicians’ experience.
Early progress can be easy to miss
Small shifts, like getting out of bed more easily or feeling a little less overwhelmed, can be meaningful signs that things are moving in the right direction.
Side effects are often temporary
Not everyone experiences side effects, but some people notice mild changes like nausea, headaches, or fatigue. These often improve as your body adjusts. If something feels uncomfortable or concerning, keep track of it and let your clinician know.
Give it time, but trust your experience
Most medications take time to work, so that patience can help the process. At the same time, you know your experience best. If something feels off or doesn’t seem sustainable, it’s worth bringing up. Finding the right medication is a collaborative process.
DEEP DIVE
PMDD vs. bipolar disorder:
What’s the Difference?
Reviewed by:
Caitlin Gardiner, MD
Staff Psychiatrist
Mood swings happen to all of us. But if you notice that your moods and emotions are interfering with your daily life, it could be a sign of an underlying condition such as PMDD (premenstrual dysphoric disorder) or bipolar disorder—two distinct psychiatric conditions known for causing abrupt changes in mood.
What is PMDD?
PMDD (premenstrual dysphoric disorder) is a more intense form of PMS (premenstrual syndrome) that affects up to 10% of women or people assigned female at birth (AFAB) of reproductive age. If you have PMDD, it generally happens in the week or two before your period (during what’s called the luteal phase).
While PMS and PMDD both have similar emotional and physical symptoms, like breast tenderness, bloating, cramping, fatigue, and changes in sleep and eating habits, PMDD is characterized by extreme mood shifts that can disrupt your daily life. The cause of PMDD isn’t clear, though it’s likely due to the hormonal changes that occur after ovulation and before menstruation.
Some people are more likely to experience PMDD than others. This includes if you have underlying anxiety or depression, PMS symptoms, a family history of PMS, PMDD, or mood disorders, and a family history of these conditions or trauma, abuse, or other highly stressful events in your past.
If you think you might have symptoms of PMDD, take Talkiatry’s free online assessment to find an experienced clinician who can help.
What is bipolar disorder?
Bipolar disorder is a mental health condition characterized by intense swings in a person’s mood, energy levels, behavior, and ability to function. These distinct swings, or episodes, typically last days or weeks at a time.
Bipolar episodes can range from extreme emotional “highs” (manic or less severe hypomanic episodes) involving euphoric, energized, or irritable behavior to “lows” (depressive episodes) involving intense hopelessness or indifference. While “highs” and “lows” are a normal part of most people’s lives, bipolar disorder causes symptoms that regularly interfere with your ability to live your life and get things done.
Similarities and differences between PMDD and bipolar disorder
Both bipolar disorder and PMDD involve mood disturbances and share a number of common symptoms, like experiencing a depressive episode. Additionally, some women and AFAB people with bipolar disorder report that their mood symptoms worsen during specific phases of the menstrual cycle, similar to the pattern seen in PMDD.
When it comes to treating bipolar disorder and PMDD, both conditions can be effectively managed with a combination of medication and talk therapy, like cognitive-behavioral therapy (CBT). Treatment options for PMDD include contraceptives and antidepressants, like SSRIs (selective serotonin reuptake inhibitors), while bipolar disorder medications include mood stabilizers and antipsychotics.
Despite these similarities, bipolar disorder and PMDD are two distinct conditions. While PMDD is primarily characterized by depressive symptoms during the week or two before menstruation, bipolar disorder involves distinct episodes of mania and depression, with periods of relatively stable mood in between independent of the menstrual phase.
Can I have both PMDD and bipolar disorder?
It is possible to have both PMDD and bipolar disorder, though it’s not known how common it is to have both among women and AFAB who ovulate. The connection between the two conditions is complex, though it is likely that they appear together in some people because they share some common biological mechanisms that result in more severe mood swings.
However, if you do have comorbid PMDD and bipolar disorder, your PMDD could impact your bipolar symptoms by worsening your depressive or manic/hypomanic symptoms. At the same time, bipolar disorder can make you more sensitive to hormonal fluctuations, causing increased mood changes during the menstrual cycle.
Because of the prevalence of overlapping symptoms, women and AFAB with PMDD are frequently misdiagnosed as having bipolar disorder. In order to receive an accurate diagnosis and proper treatment, you must seek out a professional diagnosis if you suspect you have PMDD, bipolar disorder, or both. Get started at Talkiatry by filling out a short online assessment.
Do I have PMDD or bipolar disorder?
Living with mood swings is challenging, and can be especially so if you haven’t yet found a correct diagnosis and proper treatment. The good news is that help is out there, and there are a number of ways to treat both bipolar and PMDD so that you can live without symptoms interfering with your daily life.
The only way to receive your diagnosis is to talk to a qualified clinician, like a psychiatrist. Before your appointment, try to track your own symptoms and moods in order to inform your provider and help them identify patterns. Try to pay attention to your premenstrual mood as well. When you see your doctor, they'll take all this information into account, and use their expertise, to give you a diagnosis and come up with the best treatment plan.
ON THE SHELF
Book recommendations from our clinicians
The Way Out: A Revolutionary, Scientifically Proven Approach to Healing Chronic Pain by Alan Gordon, LCSW
Learn more about the conditions we treat
ADHD
Anxiety
Depression
PTSD
OCD
Bipolar disorder
Insomnia
Mood disorders
Postpartum
Substance use disorder
Children’s mental health
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