Women’s mental health · Telehealth across Washington

Women’s mental health care in Washington

Medically reviewed by Dr. Iman Yunis, DNP, PMHNP-BC · Last reviewed October 31, 2026

Pregnancy, postpartum, PMDD, perimenopause, and ADHD in women. Evaluation and medication management by secure video, coordinated with your OB, midwife, or primary care provider.

New patients typically seen within 2–3 days

• ✓ Ages 13 and up
• ✓ Pregnancy and breastfeeding-aware care
• ✓ Seen within 2–3 days

The short answer

Peak Psychiatry and Wellness offers psychiatric care for women anywhere in Washington, by secure video, including pregnancy and postpartum mental health, PMDD, mood changes around perimenopause, and ADHD in women. Dr. Iman Yunis, DNP, PMHNP-BC, tailors treatment to your life stage and to plans for pregnancy or breastfeeding, and coordinates with your OB, midwife, or primary care provider.

Why it matters

Hormones and life stages change mental health

Mental health conditions are common during the reproductive years, and hormonal transitions such as pregnancy, birth, the menstrual cycle, and perimenopause can trigger or worsen symptoms. More than one in five people experience a mental health condition during pregnancy or the year after birth.^[1] These conditions are treatable, and care works best when it accounts for where you are in life, whether you are pregnant or breastfeeding, and what your other providers are doing.

This page is our complete guide. Each section is based on guidance from the American College of Obstetricians and Gynecologists (ACOG), federal health agencies, and peer-reviewed research, listed at the bottom.

Pregnancy

Mental health during pregnancy

About one in seven women experience perinatal depression, and anxiety is even more common among screened perinatal patients.^[1] ACOG recommends that everyone be screened for depression and anxiety at the first prenatal visit, later in pregnancy, and after birth using validated tools.^[1]

Untreated depression and anxiety are not harmless. ACOG notes that untreated illness has significant short-term and long-term effects, and that suicide and overdose are among the most common causes of pregnancy-associated death.^[1] That is why treatment decisions weigh the risks of medication against the real risks of untreated illness.

• Already on medication and pregnant or planning? Do not stop on your own. Stopping suddenly can cause relapse and withdrawal symptoms. Talk with Dr. Yunis and your OB first.
• New symptoms? Worry, low mood, intrusive thoughts, or trouble sleeping that goes beyond normal pregnancy changes deserve an evaluation.
• History of depression, anxiety, or bipolar disorder? A plan before birth lowers the risk of a postpartum episode.

After birth

Baby blues, postpartum depression, anxiety, and psychosis

• Baby bluesVery common. Tearfulness and mood swings start in the first few days after birth and usually fade within 2 weeks.^[4]
• Postpartum depressionAbout 1 in 8 women report symptoms after a recent birth.^[3] Symptoms last longer than 2 weeks or make it hard to function.
• Postpartum anxietyConstant worry, racing thoughts, or intrusive images. Roughly 15 to 18% report anxiety symptoms in the first months after birth.^[5]
• Postpartum psychosisRare, about 1 to 2 per 1,000 births, and a medical emergency. Call 911 or go to the nearest emergency room.^[2]

Treatment for postpartum depression may include therapy, an antidepressant, or both. In 2023, the FDA approved zuranolone, the first oral medication specifically for postpartum depression in adults.^[6] Learn more on our postpartum depression page, or print our postpartum mood guide.

Medication

Medication during pregnancy and breastfeeding

ACOG recommends SSRIs as first-line medication for perinatal depression and anxiety, and states that breastfeeding can continue with SSRIs or SNRIs.^[2] Decisions are individualized: Dr. Yunis reviews what has worked for you before, your current symptoms, and the evidence for each option, and coordinates with your OB, midwife, and pediatrician.

• Never start, stop, or change a medication on your own because of pregnancy or breastfeeding. Talk with your prescriber first.
• The lowest effective dose of a medication that has worked for you before is often a reasonable starting point.
• Read our medication guides: sertraline (Zoloft) and escitalopram (Lexapro).

PMDD

Premenstrual dysphoric disorder

PMDD is a severe form of premenstrual symptoms that causes depression, irritability, anxiety, or mood swings in the week or two before a period, easing during or shortly after it. Studies estimate that about 3 to 8% of women meet criteria.^[7]

ACOG guidance supports SSRIs taken every day or only in the second half of the cycle, cognitive behavioral therapy, and some combined oral contraceptives, with other hormonal options for severe cases.^[8] Tracking symptoms for two cycles helps confirm the pattern. We coordinate any hormonal treatment with your gynecologist.

Perimenopause

Mood changes around perimenopause

Perimenopause is a window of increased risk for depression, including for women with no prior history. Hot flashes, night sweats, and poor sleep can overlap with and worsen mood symptoms.^[9]

Guidelines from The Menopause Society and the National Network of Depression Centers recommend antidepressants and psychotherapy such as CBT as front-line treatments for perimenopausal depression.^[9] We work alongside your gynecologist or primary care provider, who manages hormone questions.

ADHD in women

Why ADHD is often missed in women

ADHD is diagnosed less often and later in girls and women, who often develop strategies that mask their symptoms. Hormonal transitions such as puberty, pregnancy, and perimenopause can make symptoms and mood harder to manage.^[10] Many women recognize their own ADHD in adulthood. Our ADHD evaluation looks at the whole picture, including anxiety, depression, and hormonal patterns.

How care works

Care that fits life with a newborn, or without one

1. 01Book onlineAnswer 4 quick questions. Note if you are pregnant or postpartum.
2. 02Evaluation by videoAbout 60 minutes. Feed or hold your baby during the visit if you need to.
3. 03A coordinated planWith your consent, we share the plan with your OB, midwife, or primary care provider.
4. 04Regular follow-upsWe adjust treatment as your body and life change.

Support

Help any time

• Emergency: call 911, or call or text 988 for the Suicide and Crisis Lifeline.
• National Maternal Mental Health Hotline: call or text 1-833-852-6262 (1-833-TLC-MAMA), free and 24/7, in English and Spanish.^[11]
• Postpartum Support International HelpLine: 1-800-944-4773. Leave a message and a trained volunteer calls back. Not a crisis line.^[12]
• Perinatal Support Washington: call or text the Warm Line at 1-888-404-7763 for peer support (se habla español).
• For providers: the UW Perinatal Psychiatry Consultation Line, 877-725-4666, offers free consultation to Washington clinicians caring for pregnant and postpartum patients.

Women’s mental health guide

Everything in this women’s mental health guide

• ConditionPostpartum depression treatment →Care during pregnancy and after birth, coordinated with your OB or midwife.
• PrintablePostpartum mood: when to get help →A printable guide to baby blues, postpartum depression, and warning signs.
• ScreenerFree depression test (PHQ-9) →A 2-minute screening you can take privately.
• ScreenerFree anxiety test (GAD-7) →A 2-minute screening for anxiety symptoms.
• Medication guideSertraline (Zoloft) →Uses, side effects, and use during pregnancy and breastfeeding.
• Medication guideEscitalopram (Lexapro) →Uses, side effects, and what to expect.
• Related guideDepression and anxiety guide →Our complete guide to evaluation and treatment.
• Related guideADHD in women →Why ADHD is often missed in women and how evaluation works.

Insurance and cost

Covered by most major Washington plans

We are in network with these plans and verify your benefits before your first visit. Tap your plan to learn more:

Self-pay: $300 initial evaluation · $150 follow-ups

See all insurance and payment options.

FAQ

Women’s mental health questions, answered

Sources

References

Written and medically reviewed by Dr. Iman Yunis, DNP, PMHNP-BC. For education only; not a substitute for personal medical advice.

1. American College of Obstetricians and Gynecologists. Clinical Practice Guideline No. 4: Screening and Diagnosis of Mental Health Conditions During Pregnancy and Postpartum. Obstet Gynecol. 2023;141(6):1232-1261. publications.smfm.org/publications/469-acog-clinical-practice-guideline-4-screening-and-diagnosis/
2. American College of Obstetricians and Gynecologists. Clinical Practice Guideline No. 5: Treatment and Management of Mental Health Conditions During Pregnancy and Postpartum. Obstet Gynecol. 2023;141(6):1262-1288. www.acog.org/clinical/guidance/clinical-practice-guideline/2023/06/treatment-and-management-of-mental-health-conditions-during-pregnancy-and-postpartum/
3. Centers for Disease Control and Prevention. Symptoms of Depression Among Women. www.cdc.gov/reproductive-health/depression/index.html
4. National Institute of Mental Health. Perinatal Depression. www.nimh.nih.gov/sites/default/files/documents/health/publications/perinatal-depression/perinatal-depression.pdf
5. Dennis CL, Falah-Hassani K, Shiri R. Prevalence of antenatal and postnatal anxiety: systematic review and meta-analysis. Br J Psychiatry. 2017;210(5). doi.org/10.1192/bjp.bp.116.187179
6. U.S. Food and Drug Administration. FDA Approves First Oral Treatment for Postpartum Depression. August 4, 2023. www.fda.gov/news-events/press-announcements/fda-approves-first-oral-treatment-postpartum-depression
7. Reilly TJ, et al. The prevalence of premenstrual dysphoric disorder: systematic review and meta-analysis. J Affect Disord. 2024;349. doi.org/10.1016/j.jad.2024.01.066
8. Premenstrual Disorders: Guidelines From the American College of Obstetricians and Gynecologists. Am Fam Physician. 2024;110(6):647-650. www.aafp.org/afp/2024/1200/practice-guidelines-premenstrual-disorders
9. Maki PM, Kornstein SG, Joffe H, et al. Guidelines for the evaluation and treatment of perimenopausal depression: summary and recommendations. Menopause. 2018;25(10):1069-1085. doi.org/10.1097/GME.0000000000001174
10. Kooij S, et al. Research advances and future directions in female ADHD: the lifelong interplay of hormonal fluctuations with mood, cognition, and disease. Front Glob Womens Health. 2025;6:1613628. doi.org/10.3389/fgwh.2025.1613628
11. Health Resources and Services Administration. National Maternal Mental Health Hotline. mchb.hrsa.gov/national-maternal-mental-health-hotline
12. Postpartum Support International. Get Help. www.postpartum.net/get-help

Care that fits your life stage

New patients typically seen within 2–3 days. Book online or call (425) 477-9272.