If for one to two weeks every single... | Georgia Telehealth Therapy

You know the phrase, I mean, you've almost certainly heard it. Oh, yeah. Everybody has, right? And depending on who you are, you might have even had it directed at you like in a moment of total vulnerability. Usually when you're already exhausted. Exactly. You're expressing frustration or you're justifiably angry about something and someone just, you know, waves a hand and dismisses this entirely valid emotion by saying, "Oh, it's just PMS." It is honestly it's woven so deeply into our cultural fabric that we barely even register the damage it does anymore. We just use it as a punchline. Right. To invalidate a completely legitimate emotion. Exactly. But the danger there amplifies exponentially when that exact same cultural

minimization that dismissal bleeds over into the medical field, which happens sadly way more often than we'd like to admit. Way more often. And um that systemic dismissal is exactly what we're confronting on today's deep dive. We've actually gained access to this incredibly detailed set of clinical notes from coping and healing counseling. Right. Yes. Exactly. From coping and healing counseling or CHC, they've built this entire framework around treating premenstrual dysphoric disorder. PMDDD. PMDD. Yes. And we are looking directly at their protocols today to understand why, you know, brushing off PMDD as just bad PMS isn't just rude. It represents a profound medical failure. It really does. So, okay, let's unpack this because the sheer scale of

the biological mechanisms at play here and the evidence-based ways this is tracked and treated, I mean, this is an essential piece of medical advocacy you need in your back pocket. Absolutely. And to even like begin discussing those mechanisms, we really have to draw a rigid clinical boundary between normal premenstrual syndrome and PMDD, right? Cuz they are not the same thing at all. Not at all. The CHC clinical notes make this distinction their absolute foundation. Yeah. PMDD is categorized as a formal severe mood disorder. It's fully recognized in the DSM5, which is huge. I mean, just looking at the implications of that DSM5 inclusion, that places PMDD in the exact same diagnostic manual as major depressive

disorder, right? Yep. bipolar disorder, schizophrenia, it's all in there. It completely changes the conversation. You are no longer talking about some minor gynecological inconvenience. You are talking about a serious psychiatric reality that's driven by biology. And that classification is the crucial first step for clinical validation because PMDD is a distinct mood disorder that is strictly anchored to the menstrual cycle. Right? And the symptoms I mean they are not mild. The criteria involve marked mood liability, meaning like rapid emotional swings. Exactly. Rapid, entirely unpredictable swings, plus intense disproportionate irritability or anger, profound depressed mood, and severe anxiety or tension that can be practically paralyzing. And the sources are really careful to point out that these psychological

symptoms are paired with severe physical symptoms, too. Right. Yes. It's not just mood. It's joint pain, breast tenderness, extreme bloating, and a crushing fatigue. Yeah. totally debilitating fatigue. And looking at the numbers, the data shows this affects roughly 3 to 8% of menrating people, which is a massive demographic, right? Three to eight% of that global population is tens of millions of individuals. It makes me think of um the way we triage other medical issues. What do you mean? Like if someone says they have a cough, you might give them a lozenge, but if they have pneumonia, they need serious medical intervention. So, is calling PMDD bad PMS essentially the equivalent of calling pneumonia a bad

cough? I mean, that captures the disparity in severity perfectly. But what's fascinating here is that a more accurate way to look at the underlying mechanism is actually like an allergic reaction. Wait, really? An allergy? Sort of. Yeah. The hormones themselves during the menstrual cycle aren't bad or diseased. The brain is just highly atypically sensitive to their fluctuation. Oh, wow. Good. So when you lump PMDDD in with PMS, you are entirely stripping away that clinical urgency. Getting recognized in the DSM5 wasn't just some academic labeling exercise. It forces doctors to take it seriously. Exactly. Yeah. It forces the medical community to acknowledge that the brain's reaction to these normal hormonal shifts requires targeted specialized intervention, not

just, you know, a heating pad and some ibuprofen, right? because the suffering becomes undeniable when you look at the lived reality of these patients which is documented all over these clinical notes devastating to read it really is and the distinguishing factor the thing that separates PMDD from say generalized depression or anxiety is the strict timing right it is entirely anchored to the ludal phase yes the ludial phase that's the window of time right after oulation and before menes begins right what defines PMDD is that these severe symptoms the mood brutal ability, the joint pain, the despair we talked about, they emerge consistently during this specific lutial window and then they just go away. Crucially, yes,

they remit. They fade away almost entirely shortly after men's actually begins. The subjective experiences detailed in the sources are just heartbreaking. Patients describe going through these twoe stretches every single month feeling like a completely different person. Yes, that exact phrase comes up so often. like they experience blinding rage over a misplaced set of keys or a deep hollow despair that has absolutely no external trigger. Right? There's no logical reason for it in their environment. And this isn't just a tough weekend. The diagnostic criteria require that there is meaningful functional impairment occurring in most cycles over the past year. And we have to really pause and consider what functional impairment means in a practical sense. You

know, right? It means an inability to maintain your baseline performance at work. It means withdrawing from your partner or snapping at your children or canceling every single social obligation. Exactly. I mean, imagine trying to build a career trajectory or sustain a marriage when the ground falls out from under your personality for up to 14 days every single month. Wait, so this is almost like a Jacqueline Hyde scenario governed by a calendar. That's a really good way to put it. How can a person possibly maintain their career or relationships if their personality is hijacked for up to two weeks every single month? The compounding trauma of that must be immense. It's a constant cycle of destruction

and repair. Yeah. You spend two weeks dismantling your life and then the next two weeks frantically apologizing and trying to rebuild it only for the cycle to just start all over again. But that rapid relief you mentioned earlier, the fact that the despair lifts right after menes begins, that is incredibly significant, right? Because the sudden drop off in symptoms isn't a quirk. It is the definitive biological signature. It tells a practitioner that the mood disorder is intrinsically linked to the hormonal drop that triggers menration. Which brings us to the actual mechanics of getting a diagnosis. If that strip cycllical pattern is the defining feature, identifying it requires rigorous proof. Oh, highly rigorous. And according to

the clinical notes from CHC, diagnosing PMDDD is notoriously difficult in a standard primary care setting. Because it requires a level of data collection that goes way beyond a typical 15-minute doctor's visit. A patient simply sitting on an exam table and saying, "I feel terrible before my period is not enough." Right. The clinical guidelines are explicit about that. Yes. Retrospective self-report alone is completely insufficient for a PMDD diagnosis. Here's where it gets really interesting to me. We fundamentally misunderstand how human memory works when it comes to our own emotional states. How so? Well, relying on memory for our moods is notoriously flawed. It's like trying to remember exactly how much it rained last month instead of

putting out a rain gauge every single day. That is a great analogy. Why is human memory not enough for a doctor to just take a patient's word for it? Like we suffer from state dependent memory, right? Exactly. State dependent memory is huge here. When you are feeling great in your follicular phase, it's biologically difficult to accurately recall the absolute depths of your ludial despair and vice versa, I imagine. Right. And a clinician cannot simply take the patients retrospective word for it. Not because they doubt the suffering, but because PMDDD perfectly mimics other severe disorders. Oh, like generalized anxiety. Yes. Or major depressive disorder, which can also fluctuate naturally. So to justify the highly specific treatments

for PMDD, a clinician has to mathematically prove that the distress is locked exclusively to the ludal phase. So they have to prove it's not just a generalized disorder getting a little worse during a period. Precisely. That's why diagnosis legally and medically requires prospective symptom tracking across at least two full menstrual cycles. Two full cycles. Wow. Yep. The CHC protocols specifically highlight the use of validated tools like the DRSP. The daily record of severity of problems. That's the one. Which acts as that daily ring gauge we were talking about. Exactly. It requires the patient to document their physical and emotional states every single day in real time. Then the clinician maps that objective symptom data against

the patient's biological cycle. And you need that mathematical correlation over 60 days to officially confirm it. That is the only way. That is heavy detective work. I mean, you and your doctor are building a rigorous data set to solve the mystery of your own neurobiology. It's a lot of work, but it's necessary. But let's say you do the work. You fill out the DRSP. You track the data for two cycles. The map aligns perfectly and boom, you have PMDD. What is the action plan? Yeah. Because if we are dealing with a severe DSM5 validated disorder, the treatment arsenal has to be far more robust than the generic drink some tea and take a bath advice

you see online. Oh, completely. The clinical notes detail a highly targeted multi-tered approach. Now, they do mention lifestyle interventions like sleep regularity and exercise, right? Sleep, routine exercise, stress management techniques, and reducing alcohol intake. M but there is a massive clinical caveat attached to those lifestyle changes. Yeah. The sources explicitly state they are useful adjuncts but they are typically not sufficient on their own. Exactly. They build a healthier physiological foundation but they cannot cure the underlying neurobiological reaction to the hormonal shift. So what does this all mean? It sounds like if a doctor just tells a patient to do yoga and reduce stress, they're actually shortch changing them of evidence-based medical care, right? Yes, they

are failing to provide the standard of care for a recognized psychiatric disorder. So, let's look at the actual treatment plan, the psychological side first. The sources highlight cognitive behavioral therapy or CBT, but it's not just standard talk therapy, is it? No. The CBT must be specifically adapted for cycle locked mood disorders. Because standard CBT focuses on challenging irrational thoughts, right? But with PMDD, the therapist and patient have to acknowledge the biological reality of the ludial phase. You can't just think your way out of a hormonal cascade. That makes total sense. You can't outthink a hormone. Exactly. So, adapted CBT involves anticipatory coping, preparing strategies for when the biological shift happens and practicing radical acceptance of

that physiological state. Wow. Okay. But what about the medical side? Because we are dealing with a profound biological trigger here. The pharmarmacology is where this condition really proves how unique it is. SSRIs are a primary evidence-based treatment. But for PMDD, they can be prescribed in a highly unusual way. Right. I was reading this. While they can be taken continuously every day, they can also be prescribed with a ludial phaseonly dosing schedule. Yes. Now, anyone who follows psychiatric medicine knows that standard depression requires taking an SSRI daily for weeks to build up a steady therapeutic state in the brain, right? It takes time to remodel those neural pathways. So, how is it clinically possible that an

intermittent SSRI works here? You just start taking it the week before your period and stop when you bleed. If we connect this to the bigger picture, the mechanism of action here is a total revelation. Because PMDD is so uniquely tied to the rapid hormonal shift, the SSRI doesn't need weeks to remodel the brain. Oh, interesting. It acts almost immediately to stabilize the brain's acute reactivity to that lydial shift. That is incredible. The fact that ludalphase only dosing is highly effective for many patients proves undeniably that this condition is biologically distinct from standard clinical depression. The treatment itself validates the uniqueness of the diagnosis. Furthermore, the notes from coping and healing counseling detail specific hormonal interventions

like they utilize combined oral contraceptives that specifically contain drospyronone and drospanone is a very specific synthetic progesterone, right? Like it functions differently than older birth control pills. It does. It has unique properties that really help mitigate the extreme fluid retention and physiological bloating that drive the physical symptoms of PMDD while also stabilizing the hormonal baseline. And in more severe cases, the notes even mention G&RH analoges which essentially induce a temporary chemical menopause. Right. Like they pause the menstrual cycle entirely to stop the hormonal fluctuations at their source. Exactly. But deploying tools like Drosparinone or G&RH analoges requires meticulous management. You are fundamentally altering the endocrine system. So it has to be carefully coordinated with a

gynecologist or endocrinologist. Exactly. Which honestly exposes a massive systemic gap in how we deliver healthcare. And it brings us to why the coping and healing counseling model is so vital to study. Because knowing the correct CBT protocol or the ludialphase dosing schedule is completely useless if you can't find a provider who understands how to orchestrate all of it together. Exactly. If primary care is routinely missing this, where do patients go? This is why specialized interdisciplinary practices are really the only sustainable solution. The CHCE framework we're reviewing isn't just a list of treatments. It's an entire delivery model. And they provide this PMDD informed teleaalth across all 159 counties in Georgia. Right. Yes. All 159 counties.

It is incredible that they cover 159 counties virtually. That logistical footprint is staggering and it solves a massive equity issue. It really does. For listeners in rural areas, you know, rural healthcare deserts. This means they aren't locked out of specialized care. A completely IPA compliant teleaalth model means your zip code no longer dictates your psychiatric care. And they bring a robust infrastructure to that virtual setting, too. CHC utilizes a highly diverse, culturally competent team of over 15 licensed therapists. Wow. So, we're talking clinical social workers, professional counselors, marriage and family therapists, right? LCSSWS, LPC's, LMFTs. They don't just treat the individual in a vacuum either. They offer individual therapy, sure, but also couples and family

therapy, teen therapy for ages 13 and up, and life coaching. Because as we discussed, the functional impairment of PMDD damages the entire family unit. It doesn't just happen to one person. Exactly. But the detail in their clinical model that really stands out to me, especially after discussing SSRIs and G&R analoges, is their commitment to active care coordination. How crucial is CHC's step of actively coordinating with the patients medical providers? Oh, it's absolutely essential that interdisciplinary communication is the gold standard for complex conditions because PMDDD sits precisely the intersection of mental health like therapy and CBT and physical health like gynecology and phicotherapy. Right? You can't treat it in isolation. No, care cannot happen in silos.

You have psychological trauma that requires specialized CBT, but a biological root cause that requires a medical doctor. If those providers operate in isolated silers, the patient ends up having to manage their own complex care which is overwhelming on a good day. CHC's model of bridging that gap ensures the therapeutic and medical strategies are pulling in the exact same direction. They are essentially building a cohesive wraparound care team for the patient and they are doing it in a way that actually acknowledges the financial barriers of the healthare system which is so rare. It is specialized interdisciplinary care usually comes with an astronomical out-ofpocket price tag, but CHC is actually in network with major insurance providers. We're

talking Etna, Sigma, Blue Cross Blue Shield, United Healthcare, Humanana, and their co-pays generally sit between like 10 and $40. And critically for patients on Medicaid, the co-pay is 0. Z a Z co-pay for a multi-tiered PMDD informed therapeutic approach that completely dismantles a barrier to entry. I mean, evidence-based treatment for a severe mood disorder cannot be treated as a luxury good. It validates the patients right to accessible targeted care regardless of their economic status. Exactly. So, let's pull all these threads together as we wrap up because the sheer density of this clinical framework is exactly what patients need to advocate for themselves, right? To summarize, PMDDD is emphatically not just PMS. No, it is a

serious DSM5 recognized psychiatric mood disorder driven by an atypical neurological sensitivity to the normal hormonal fluctuations of the ludial phase. And because of that biological reality, we cannot rely on memory to diagnose it. It requires the rigor of prospective daily tracking using tools like the DRSP to mathematically prove the correlation over at least two cycles. Right? And once that data proves the cycle, the treatment requires an aggressive specialized approach, adapted CBT, ludialphase, SSRI dosing, targeted hormonal suppression, and securing that care requires providers who don't operate in silos, which is exactly why providers like coping and healing counseling are making it accessible and fundamentally changing the landscape of treatment in states like Georgia. It is a

profound shift from systemic dismissal to precise, validated medical intervention. It truly is. But um before we sign off on this deep dive, there is one philosophical thread running through these clinical notes that I really cannot shake. Oh, what's that? It goes back to that concept we discussed earlier, state dependent memory. You know, the idea that our retrospective memory of our own emotions is utterly unreliable once our biological state shifts. It really challenges our perception of cognitive control, doesn't it? It does. And I want to leave you, the listener, with this thought to mull over long after you finish listening. If our memories of our own emotional depths are erased or distorted simply because our hormones

shifted. Mhm. If a cyclic biological tide can quite literally make us feel like an entirely different person for 2 weeks every month, altering how we love, how we work, and how we view the entire world, then where does our true baseline identity actually reside? Wow. How much of the personality we claim as who we are is really just a temporary reflection of the neurobiological phase we happen to be surviving today. That is a haunting, deeply scientific question. I mean, we like to think of our minds as completely separate from our bodies, but we are undeniably tethered to our biology. We really, really are. Well, if you or someone you love in Georgia is trapped in

this cycle and needs interdisciplinary support, you have options. You can explore CHC's teleaalth resources at cheekapy.com or give them a call at 4048320102. Definitely reach out. Don't accept casual dismissals of your health. Keep tracking your data. Keep advocating for your baseline and keep learning. Thank you so much for joining us on this deep dive.