Premenstrual dysphoric disorder is severe mood, irritability and anxiety symptoms in the week or two before menstruation that resolve after bleeding begins, affecting 3 to 8 percent of menstruating women. It is diagnosed by tracking symptoms across two cycles and treated with SSRIs taken continuously or only in the luteal phase, hormonal contraception containing drospirenone, and cognitive behavioral therapy. Stedfast Psychiatry treats premenstrual dysphoric disorder at 11641 Kew Gardens Ave in Palm Beach Gardens and by video across Florida; new patients call (561) 437-2199.
Premenstrual Dysphoric Disorder at our Palm Beach Gardens office
If you live near The Gardens Mall or in Mirasol, Frenchman's Creek, Frenchman's Reserve and Evergrene, this is your closest Stedfast Psychiatry office for premenstrual dysphoric disorder treatment. We also see residents of Juno Beach, Jupiter, Lake Park and Riviera Beach who prefer not to drive farther.
Free surface parking is available at the building, including accessible spaces near the main entrance. The lot is shared with other medical and professional offices, so arrive a few minutes early for your first visit. Patients coming for Deep TMS or Spravato sessions can park in the same lot. Hours are Monday to Friday, 8:00 AM to 5:00 PM, with weekend appointments by arrangement. New patients call (561) 437-2199; existing patients use (561) 402-3971.
Both Deep TMS and Spravato are delivered on site at this office, so a patient who does not respond to medication can move to an interventional option without changing clinics.
Who you will see in Palm Beach Gardens
The Palm Beach Gardens team includes psychiatrists Dr. Louis Velazquez and Dr. Tanya Peguero Estevez, psychiatric nurse practitioner Sophia Schulman and physician assistant Ellington Curtis. Visits in Spanish are available with Tanya Peguero Estevez. Children and teens are seen by Louis Velazquez, Sophia Schulman, Ellington Curtis and Stephanie Mills.
Dr. Louis Velazquez, MD
Psychiatrist · Ages 4 to 80
Sophia Schulman, PMHNP-BC
Psychiatric Nurse Practitioner · Children 7+, adolescents and adults
Ellington Curtis, PA-C
Physician Assistant · Adults and teens 14+
Dr. Tanya Peguero Estevez, MD
Psychiatrist · Adults 18+ · English, Spanish
Stephanie Mills
Clinician · Adults and teens 13+
Signs of premenstrual dysphoric disorder
- Marked irritability, anger or increased conflict in the week before your period
- Depressed mood, hopelessness or self-critical thoughts
- Anxiety, tension or feeling on edge
- Sudden mood swings, tearfulness or sensitivity to rejection
- Loss of interest in usual activities
- Difficulty concentrating
- Fatigue, changes in appetite or food cravings
- Sleeping too much or too little
How we diagnose it
PMDD is diagnosed by the pattern over time, not by a single visit or a blood test. We ask you to track symptoms daily for two menstrual cycles using the Daily Record of Severity of Problems (DRSP) or a tracking app, which confirms that symptoms are confined to the luteal phase and clear after menstruation begins. This distinguishes PMDD from premenstrual exacerbation of an underlying condition such as depression, anxiety, bipolar disorder or ADHD, where symptoms are present all month and worsen before the period; that pattern is treated differently. We screen with the PHQ-9 and GAD-7 at different points in the cycle, review your reproductive history, contraception and any prior treatment, and check thyroid function and a complete blood count when fatigue or other physical symptoms suggest a medical contributor. With your consent we coordinate with your gynecologist.
PMDD affects an estimated 3 to 8 percent of women of reproductive age, and up to 20 percent experience premenstrual symptoms severe enough to impair functioning.
Source: American College of Obstetricians and Gynecologists; American Psychiatric Association, DSM-5-TR
SSRIs reduce PMDD symptoms in about 60 to 75 percent of women, compared with roughly 30 percent for placebo, and are effective with luteal-phase-only dosing.
Source: Cochrane Review, Marjoribanks et al., 2013
PMDD was added to DSM-5 as a depressive disorder in 2013 and to the WHO's ICD-11 in 2019.
Source: American Psychiatric Association; World Health Organization
Women with PMDD have substantially elevated rates of suicidal ideation and attempts compared with women without the disorder.
Source: Pilver et al., Archives of Women's Mental Health, 2013
Treatment for premenstrual dysphoric disorder in Palm Beach Gardens
Medication management
SSRIs are first-line and work unusually fast in PMDD, often within one to three days rather than weeks. Fluoxetine, sertraline and paroxetine CR are FDA-approved for PMDD, and escitalopram and citalopram are also effective. They can be taken continuously, or only during the luteal phase (starting at ovulation, about 14 days before the period, and stopping when bleeding begins), or in a symptom-onset approach starting when symptoms appear; luteal-phase dosing reduces side effects and is preferred by many women. Hormonal options, coordinated with your gynecologist, include combined oral contraceptives containing drospirenone (Yaz is FDA-approved for PMDD) taken continuously to suppress cycling. For severe PMDD unresponsive to these, GnRH agonists with add-back hormone therapy produce a temporary medical menopause and are used under specialist care. Calcium 1,200 mg daily has modest evidence for premenstrual symptoms. We review response each cycle and adjust the dosing strategy to fit your pattern and side effects.
Psychotherapy
Cognitive behavioral therapy for PMDD helps you anticipate the luteal phase, plan around it, challenge the self-critical and catastrophic thoughts that intensify during it, manage interpersonal conflict, and reduce the shame that often follows a bad week. It is effective alone for milder cases and improves outcomes when combined with medication. Partners and family often benefit from understanding the cyclical pattern, and we involve them when you wish. Therapy also addresses the trauma, depression or anxiety that frequently accompany PMDD.
What to expect
Your first visit is a 45 to 60 minute evaluation, in person or by video, where we review your history and set up two cycles of symptom tracking. If your pattern is already clear and symptoms are severe, we may start treatment while tracking continues. Follow-ups are every four to six weeks, timed to cover at least one full cycle, and most can be done by telehealth from anywhere in Florida or South Carolina. We coordinate with your gynecologist on hormonal options and with your other providers as needed.
The complete guide, including causes, subtypes and research, is on our Premenstrual Dysphoric Disorder page.
Emergency and crisis resources near Palm Beach Gardens
In an emergency, call 911 or go to Palm Beach Gardens Medical Center Emergency Room (3360 Burns Rd, Palm Beach Gardens). The 988 Suicide and Crisis Lifeline is available by call or text 24 hours a day. Jupiter Medical Center Emergency Department and 988 Suicide and Crisis Lifeline are also listed on the Palm Beach Gardens office page.
Frequently asked questions
Who provides premenstrual dysphoric disorder treatment at the Palm Beach Gardens office?
The Palm Beach Gardens team includes psychiatrists Dr. Louis Velazquez and Dr. Tanya Peguero Estevez, psychiatric nurse practitioner Sophia Schulman and physician assistant Ellington Curtis. Visits in Spanish are available with Tanya Peguero Estevez. Every provider works under psychiatrist oversight and the same evaluation standard: about an hour for a first visit, validated screening scales, and a written plan.
Can I be seen by video instead of coming to Palm Beach Gardens?
Yes. Stedfast Psychiatry providers are licensed in Florida and offer video visits for evaluations and follow-ups. Some situations, including certain controlled-substance prescriptions and first visits for young children, require an in-person appointment at 11641 Kew Gardens Ave.
Does the Palm Beach Gardens office take my insurance?
We accept most major commercial plans and Medicare. Call (561) 437-2199 with your member ID and we will verify benefits before the visit. Self-pay new-patient evaluations are $185.
How soon can a new patient be seen in Palm Beach Gardens?
Most new patients are scheduled within one to two weeks. If you need to be seen sooner, ask about a video visit; those often open up within days. If you are in crisis, call or text 988 or go to the nearest emergency room rather than waiting.
Can I get Deep TMS or Spravato as a Palm Beach Gardens patient?
Yes. Deep TMS is delivered on site in Palm Beach Gardens. Spravato is available at Palm Beach Gardens, Palm Beach Gardens and Royal Palm Beach.
What is the difference between PMS and PMDD?
PMS involves mild to moderate physical and mood symptoms before a period that are annoying but manageable, and it affects most women at some point. PMDD is defined by severe mood symptoms, particularly irritability, depression, anxiety and mood swings, that significantly impair work, relationships or daily life and that resolve after bleeding starts. The distinction is severity and impairment, confirmed by tracking two cycles. If the premenstrual week regularly damages your life, it is not ordinary PMS.
Why would an antidepressant help if PMDD is hormonal?
Because the problem is how the brain's serotonin and GABA systems respond to normal hormone shifts, not the hormones themselves. SSRIs correct that response and, in PMDD, work within days rather than the weeks needed in depression, which is why they can be taken only during the luteal phase. Hormonal treatments work by stopping the cycle altogether. Both are valid and we choose based on your preferences, contraception needs and side-effect profile.
Nearby Stedfast offices
If you are in crisis, call or text 988 or go to the nearest emergency room. Educational content; individual results vary. Reviewed by Dr. David Husted, board-certified psychiatrist.