PMHNP-led hormone therapy for perimenopausal depression, PMDD, postpartum mood, and low-T depression. Because the right treatment isn't always another SSRI.
"Hormonal mood disorders are frequently dismissed or over-medicated with antidepressants that don't address the root cause. We look upstream — at estrogen, progesterone, testosterone, and cortisol — before reaching for another SSRI."
— Kristin McKnight, MSN, APRN, PMHNP-BC
These are psychiatric presentations with a hormonal driver — not cosmetic concerns. Each diagnosis is evaluated as part of a complete psychiatric picture.
Irritability, depression, anxiety, and emotional dysregulation during the menopausal transition — often beginning years before the last period. Fluctuating estrogen is a primary driver, not simply "stress."
Severe mood changes, irritability, depression, or anxiety in the week before menstruation that resolve with the onset of flow. A hormonal trigger with psychiatric severity — often responds to hormonal intervention alongside or instead of SSRIs.
Postpartum depression and anxiety with a clear hormonal precipitant — the dramatic drop in estrogen and progesterone after delivery. Hormonal stabilization can be a critical piece of the treatment plan alongside antidepressants.
Abrupt estrogen loss following oophorectomy produces immediate, often severe mood symptoms that differ from natural menopause. Requires prompt hormonal evaluation — not just antidepressant escalation.
Cognitive slowing, memory complaints, and flat affect during menopause — a cluster that responds to estrogen restoration in ways antidepressants alone do not address.
Hot flashes and night sweats that chronically disrupt sleep — which then drives depression, anxiety, and cognitive impairment. Treating the vasomotor root directly often does more for mood than adding a sedative-hypnotic.
Fatigue, low libido, irritability, anhedonia, and flat affect in men (and women) with documented low testosterone — a clinical picture that mimics MDD but responds poorly to antidepressants without addressing the hormonal substrate.
Chronic opioid use suppresses the HPG axis, causing testosterone deficiency in both men and women. A commonly missed contributor to depression, fatigue, and anhedonia in patients on opioid therapy — including those in MAT programs.
Our hormonal psychiatry program has specific clinical boundaries. If you fall into any of these categories, we'll help identify the right referral path.
Standard blood work shows your hormone levels. The DUTCH test (Dried Urine Test for Comprehensive Hormones) shows something deeper — how your body actually produces and metabolizes them. Collected at home on simple dried-urine strips (no blood draw), it maps your sex hormones and their metabolites, plus your daily cortisol rhythm — details a single blood draw can miss.
As a certified DUTCH provider, Kristin McKnight, PMHNP-BC uses these results to personalize your HRT/TRT — matching the right hormone, dose, and approach to your physiology, and catching imbalances (estrogen metabolism, cortisol dysregulation) that standard panels overlook. DUTCH complements standard labs to guide an individualized plan built around your goals.
DUTCH testing complements standard lab work and is used as part of your individualized evaluation.