Thursday evening education —... | Georgia Telehealth Therapy

You know, um, when we talk about the weather, there's this very obvious, like undeniable difference between a light spring drizzle and a devastating category 5 hurricane. Oh, totally. I mean, they're completely different things, right? They both involve rain and wind. Sure. But you would never in a million years look at someone whose roof just blew off, shrug, and say, "Hey, it's just weather. Just grab an umbrella and push through it." Yeah. It would be completely absurd. It would be. But okay, let's unpack this because today we are taking a deep dive into a really pervasive medical misconception that does exactly that to millions of people and it does it every single month. Exactly. We are

exploring premenstrual dysphoric disorder which is commonly known as PMDD. And our mission today using some really fantastic foundational guidance from the coping and healing counseling practice or CHC is to completely and systematically dismantle the idea that PMDD is somehow just you know bad PMS. Right. What's fascinating here is how incredibly ingrained that specific misconception really is. I mean it is embedded deeply in our culture. Oh everywhere. Movies, TV, in media. Exactly. and unfortunately sometimes even in actual clinical settings which is just wild to me. It really is. So if you the listener or someone you care about is dealing with debilitating cyclical symptoms, we really need to establish right away that this is not an

overreaction, right? It is not a character flaw and it certainly isn't an inability to just like handle normal life. PMGD is a highly specific, recognized, and honestly severe medical reality. And that's exactly why we want to arm you with the exact terminology today. We're going through the strict diagnostic criteria and the evidence-based treatments because language is power in these situations. It really is. The goal is to give you the exact language you need to advocate for yourself or maybe a loved one in a medical setting so you just never get dismissed again. Yeah, we are essentially upgrading that cultural vocabulary from, you know, drizzle to hurricane. I love that upgrading the vocabulary. So, moving past

all those cultural myths, let's actually look at the strict diagnostic reality of this condition. Well, to truly understand PMDD, we have to look at the medical definition outlined in the DSM5. And for anyone who might be unfamiliar with that term, the DSM5 is essentially the core diagnostic playbook used by psychiatrists and mental health professionals. Right. Exactly. That's how they classify disorders. So PMDDD isn't just some casual descriptor you throw around. It is an official diagnosis in that manual. Wow. Okay. And the clinical data shows it actually affects roughly 3 to 8% of menrating people. You know, when you just zoom out and look at the global population, 3 to 8% is a massive number. It

really is. We are talking about millions upon millions of individuals living with this reality every single month. Yeah. The prevalence is surprisingly high. But the criteria to actually receive this official diagnosis are incredibly rigorous. Like they don't just hand it out. No, not at all. According to the DSM5, it requires the presence of five or more very specific symptoms. Five symptoms. Wow. Right. But it goes far beyond just like accumulating five symptoms at any random point in the month. The timeline is incredibly strict. Okay. Walk me through the timeline. So these symptoms must appear in the final week before Menses begins. Then they have to actively start to improve within a few days after the

onset, right? And finally, they must completely disappear in post-menstrual week. Wait, so the timing is just as crucial as the symptoms themselves. It absolutely is. The timing is actually the defining architecture of the entire disorder. I'm still trying to wrap my head around this. If the symptoms are really severe, like we're talking blinding rage or total hopelessness, why does the calendar matter so much to a doctor? Well, let's say a patient is experiencing extreme depressive episodes or maybe severe crippling anxiety, right? If those symptoms are present constantly, like day in and day out throughout the entire month, a clinician might actually be looking at major depressive disorder or generalized anxiety disorder. Oh, I see. So,

the baseline is different. Exactly. The fact that PMDD symptoms completely vanish in the postmenstrual week is the ultimate differentiator because it turns off like a switch. Yes. It proves definitively that this severe mood disturbance is tied inextricably to the physiological hormonal cycle. So, it's the fact that it operates like absolute clockwork that gives it away. That clears up the timeline aspect perfectly. Good. Yeah, the timeline is key. But we should probably also be specific about the symptoms themselves cuz I know they are intense, very intense. The criteria state you must have at least one core mood symptom, right? which includes marked mood swings, profound irritability or anger, deeply depressed mood, or like intense anxiety and

tension. Yeah. And those core mood symptoms are usually the most visible to the outside world. Yeah. But they are layered with a variety of other really intense physical and cognitive disruptions, too. Like what kind of disruptions? Well, the diagnostic criteria also include things like significant lethargy, severe concentration problems, noticeable changes in appetite or sleep patterns. Wow. So, it hits everything, right? and just a generalized overwhelming feeling of simply being out of control. And here is the element that really bridges the gap between, you know, an everyday inconvenience and a recognized medical disorder. The impact on daily life. Exactly. The DSM5 requires that these specific symptoms cause a meaningful impact on work, school, or relationships, which

is a huge distinction. Right. So, we aren't just talking about being a little snappy with a co-orker because you didn't sleep well on a Tuesday. No, not at all. We are talking about a level of impairment that fundamentally disrupts your ability to function as a human being. Yeah, it is a level of impairment that can actively threaten job security. It can derail someone's academic progress and cause deep lasting fractures in interpersonal relationships. The disruption is just profound. It really is. So, what does this all mean for the person actually experiencing it? I mean, if the diagnostic criteria are this incredibly specific and this heavily tied to the calendar, yeah, it's a lot to prove. Exactly.

How do doctors actually prove this timing to make an official diagnosis? Like, why is there a requirement for something called prospective tracking? Ah, prospective tracking. Yeah. Why can't a patient just sit down in a clinic and tell their doctor, "Hey, every single month before my period, I feel completely overwhelmed, angry, and hopeless." This raises an important question and it speaks directly to the complexities of human psychology and memory. How so? Well, think about what it actually feels like to be in the thick of a severe mood disturbance. It's awful, right? When an individual is experiencing profound hopelessness or intense blinding anger, it completely colors their perception of reality and their perception of time. Oh, I

see where you're going with this. It sounds like trying to write a calm, objective Yelp review of a restaurant while you are currently sitting inside it and the kitchen is completely on fire. That is a brilliant way to picture it. You just lose all perspective. Like when you feel terrible, it feels like you have always felt terrible and you always will feel terrible. The tunnel vision just takes over. Exactly. because of that exact tunnel vision phenomenon. Retrospective reporting like asking someone to look backward and accurately remember exactly which day the severe anxiety started and which day it lifted, right? Exactly which day it magically lifted it is notoriously inaccurate. Our brains just don't work that

way. No, the human brain simply isn't an objective calendar when it is operating under extreme emotional duress. That makes total sense. And that is exactly why the clinical standard requires two cycles of perspective tracking. Meaning you aren't looking backward at all. You are tracking the data in the present moment moving forward. Yes. You must log the data in real time day by day over the course of two consecutive menstrual cycles. Just writing it down as it happens. Exactly. You are documenting the presence and the severity of the symptoms as they occur. That real time data collection provides the hard, undeniable evidence needed to meet those strict DSM5 criteria. Wow. It's essentially asking the patient to

become a strict, methodical data scientist of their own body. It is a lot of work for the patient. Certainly, yeah, it's not easy. I can imagine. But when a patient walks into a clinic armed with two months of perspective tracking, it removes all the guesswork. It removes the subjective memory biases. It's hard data at that point. Exactly. It provides the exact irrefutable timeline required to confidently rule out those other overlapping conditions like generalized anxiety and officially confirm PMDD. Okay. So once a patient finally secures this hard one diagnosis with two months of track data, what actually happens next? Right. The treatment phase. Yeah. Because validating the problem is a huge relief obviously, but how do

we actually treat a severe neurochemical reaction? Well, there are several evidence-based treatments. Let's look at those actionable steps. According to the source material, the primary pillars are cognitive behavioral therapy or CBT, right? Combine hormonal contraceptives containing Drespon like Yas and SSRIs, which you know most people know as anti-depressants. Yes, those are the main three. And here's where it gets really interesting. those SSRIs. The protocol for PMDDD is entirely different than standard depression. It's very unique. You can take them continuously, sure, but you can also take them just during the ludal phase. Just that specific window of the cycle right before your period. Exactly. Taking an SSRI only during the ludal phase is like um putting

snow chains on your tires only when the blizzard hits rather than driving with them clanking around the dry pavement all year long. That's a great analogy. And if we connect this to the bigger picture, this highly unique prescribing method illuminates something profound about the underlying mechanics of PMDD. Oh, how so? Well, with traditional depression or chronic anxiety disorders, SSRIs generally take several weeks to build up in the patient's system, right? You always hear it takes like a month to work. Exactly. To effectively alter the brain chemistry. But with PMDDD, the clinical response to SSRIs administered only in the ludial phase is incredibly rapid. I have to admit that part confused me at first. Like, if

they normally take a month to build up, why do they work so fast for PMDD? Because in PMDD, we aren't necessarily treating a chronic baseline serotonin deficit like we might be in major depressive disorder. We are actually treating the brain's abnormal severe sensitivity to entirely normal hormonal fluctuations. Oh wow. So by deploying the SSRI just during that specific ludal window, it acts as a targeted strike. A targeted strike. I like that. Yeah. It essentially intercepts that severe neurochemical reaction precisely when it's triggered by the hormonal shift. It perfectly highlights the purely cyclical physiological nature of this disorder. That is absolutely wild to think about. It's not that the entire engine of the brain is broken.

No, not at all. It's that the engine temporarily and like violently misfires in response to a specific signal once a month precisely and the SSRI just acts as a targeted shield for that exact window. Right. And for some patients the most effective route is to just prevent those wild hormonal swings from happening in the first place which is where the birth control comes in. Exactly. That is where combined hormonal contraceptives come into play. Specifically contraceptives containing drospone such as Yas. Okay. And what makes that one special? Well, draw spirone is a unique formulation that can actually suppress ovulation and stabilize those cyclical hormonal fluctuations. So, it smooths it all out, right? It essentially flattens out

the roller coaster track that triggers the severe mood responses to begin with. Okay, so we have targeted medications to address the physiological side, but the source material also highlights cognitive behavioral therapy. Yes, CBT is a vital component. I think a lot of people might wonder how talking to a therapist actually helps a condition that is so deeply rooted in a biological hormonal shift. Like how does CBT specifically target PMDD? Well, PMDDD focused CBT isn't just generic talk therapy. It specifically targets the unique cognitive distortions caused by the condition. What do you mean by cognitive distortions? So during the ludal phase, the hormonal shift might trigger intensely intrusive thoughts. A patient might suddenly feel like their

partner doesn't love them anymore. Oh, wow. Or that they're a complete and total failure at work and it feels completely real to them in that moment. Exactly. CBT trains the patient to recognize these thoughts not as objective reality but as a symptom of the disorder. So it creates a sort of psychological firewall. That's exactly what it does. It helps the patient separate their baseline true identity from the intrusive thoughts triggered by the like ludial brain. And that separation is incredibly empowering. It provides the actual tools to manage the interpersonal fallout and the severe stress that the physiological symptoms create. Yeah, that makes total sense. Now, having a list of evidence-based treatments like targeted SSRI and

specialized CBT is fantastic. It is. But let's be incredibly real for a second. Knowing the treatments doesn't mean a thing if you can't actually access them. There's the unfortunate reality. Yeah. Access to specialized care is often the ultimate bottleneck in our healthare system. Absolutely. So, let's look at the specific resources provided by coping and healing counseling CHC to see how this care is actually being delivered and making a real difference in the real world. Analyzing their teleaalth model is crucial here. Yeah, because it's so different. It is because it demonstrates how to bridge the massive gap between receiving a severe diagnosis and finding practical sustainable treatment. Let's look at how they actually operate. CHC is

a 100% teleaalth IPA compliant practice and they serve all 159 counties in the state of Georgia. All 159 counties. All of them. And if you live in a rural area that's like hours away from a specialist, tellahalth isn't just a matter of convenience. It's an absolute lifeline. Oh, completely. Because finding a local specialist who simply understands the diagnostic criteria for PMDD, let alone actively treats it, can be near impossible. Tellah Health completely dismantles that geographic barrier. It truly democratizes access to specialized care. It really does. They've built a diverse ecosystem of mental health professionals who actually understand this condition. Yeah, their team is huge. We have a team of over 15 licensed therapists. We're talking

LCSWs, LPCs, LMFTs, providing culturally competent care across individual, couples, family, and teen therapy for ages 13 and up, plus life coaching. That's a huge spectrum of care. And they specialize in exactly the kinds of overwhelming symptoms PMDD produces like anxiety, depression, trauma, PTSD, grief, and severe relationship stress. But, you know, geography isn't the only wall people hit. The financial barrier is usually the tallest one. Oh, without a doubt. And this is huge. CHC accepts Medicaid with a Z co-pay. Zero. That is incredible. For other major commercial insuranceances like Etna, Sigma, BCBS, UHC, Humanana, the cost ranges from 0 to $40 per session. Wow. A $0 co-pay for specialized teleaalth completely changes the landscape for people

who previously thought expert therapy was an impossible luxury. It is a massive step for healthcare equity. And from a treatment efficacy standpoint, what makes their approach particularly impressive is how they deploy that PMDD focused cognitive behavioral therapy. They do not operate in a silo. CHC clinicians provide what is called coordinated care. Okay. Why is coordinated care so essential for something like PMDDD because usually a therapist and an OB/GYN never even speak to each other, right? But coordinated care means that your therapist at CHC isn't just working with you in isolation. They are actively communicating and collaborating directly with your prescribers and your OB/GYN. Oh, that's brilliant. Think back to our evidence-based treatments. The SSRIs and

the hormonal contraceptives represent the physiological support, right? And the cognitive behavioral therapy represents the psychological support. When a condition involves such an intense, intricate interplay between physical hormones and mental health, the treatment strategy must be unified. So, the therapist and the doctor are basically forming a unified team around the patient. Exactly. Your OB/GYN understands the psychological nuances of your symptom tracking and your therapist is fully aware of how your medication schedule like that specific loot phase SSRI dosing is impacting your cognitive state. They're all on the same page. It ensures that the psychological and physiological treatments are working perfectly in tandem rather than accidentally working at cross purposes. That is exactly how complex healthc care

should function. It's a holistic approach to a really multiaceted disorder. It really is the gold standard. And for anyone listening who is located in Georgia and and this resonates with you or it sounds like exactly what you've been looking for, you can reach out to them directly. Their contact information is straightforward. You can call them at 4048320102. Visit chiedge theapy.com or email support theapy.com. It is a vital accessible resource for anyone navigating the exhausting complexities of this condition. Definitely. Now, as we bring this deep dive to a close, we really want to reiterate the foundational message we started with. Severe PMDD can be utterly debilitating. Yes. If the rigorous criteria, the extreme mood shifts, and

that highly specific premenstrual timeline sound intimately familiar to you, you are not overreacting. No, you are not. We encourage you to use this information, start your perspective tracking, and get a real evidence-based evaluation. The medical community recognizes this reality. The strict criteria exist to protect and accurately diagnose you. And specialized coordinated care is available to help you reclaim your time, your relationships, and your health. So true. You know, we began today by comparing PMDD to a hurricane, contrasting it with the drizzle of a normal bad mood. Right. And as we leave you today, I want you to consider a broader somewhat provocative question that really builds on everything we've uncovered. Okay. What is it? If

3 to 8% of all menrating people suffer from this distinct, highly disruptive medical disorder, how much massive human potential has been silently lost simply because our culture historically normalized extreme pain and severe mood disruption as just a normal part of the menstrual cycle. Wow. Like how many promotions were missed? How many relationships frayed? What breakthroughs might society have achieved if we had stopped dismissing these severe physiological cycles as just a bad mood decades ago and instead started treating them with the immediate targeted medical rigor they actually require? It is a staggering thought. I mean, how much brilliance and energy has been suppressed by a hurricane that society decided to simply ignore. Yeah, exactly. Well, thank

you so much for taking this deep dive with us today. Keep questioning the things you've been told are just normal. Keep advocating for yourselves and keep seeking out the facts.