So many women describe the same experience: everything looks fine on the outside, but on the inside, something feels deeply wrong. They can't cope the way they used to. Their anxiety is through the roof. Their mood is unpredictable. They don't feel like themselves – and they don't know why.
In this episode of the Her Health™ Podcast, Dr Jessica Stanbridge, clinical psychiatrist with a special interest in women's mental health, brought both clinical rigour and genuine compassion to a conversation that is long overdue. From ADHD in women and perimenopause to PMDD, the gut–brain axis, and the role of saffron in mood support, this conversation was built around one central idea: what you're experiencing is real, it's explainable, and there is something you can do about it.
Rapid Fire: What Affects Mental Health, Rated
We asked Jessica to rate common factors from zero (no effect on mental health) to 10 (major effect):
- Exercise – 9/10: One of the most evidence-backed mood regulators available.
- Stress – 10/10: Direct impact on neurotransmitters and brain circuitry.
- Sleep – 10/10: The most underrated tool in mental health management. More on this below.
- Vitamin D – 6/10: Supportive, particularly for mood and cognitive function.
- Omega-3 – 6/10: Important for neuronal health and anti-inflammatory support.
- Social support – 10/10: One of the most powerful protective factors available.
- ADHD – 10/10: Profoundly impacts functioning, mood, and emotional regulation in women – and is significantly underdiagnosed.
- Perimenopause – 10/10: One of the most significant hormonal drivers of mental health symptoms in women aged 35–50.
- PMS – 5/10: Real, but distinctly different from the more severe PMDD.
- Perfectionism – 4/10: A contributor, but less significant as a standalone factor than the lifestyle it creates.
- Self-compassion – 9/10: Underutilised and undervalued.
- Therapy – 10/10: Both preventative and curative. Not only for crisis.
- Diet – 8/10: The emerging field of nutritional psychiatry is building a strong evidence base here.
- Lifestyle – 8/10: The foundation everything else is built on.
Why So Many Women Feel Like They're Not Coping
Jessica opened the conversation with something important: she validated the experience before explaining it. Women aren't imagining that things feel harder. They aren't catastrophising. They aren't weak.
"Women feel like they're not coping because they aren't coping."
Jessica explained that society has been designed in a way that requires women to carry an enormous amount – and has long normalised that load as just the way things are. What has changed is the willingness to name it. Women are increasingly saying: this isn't supposed to feel this hard all the time. And that acknowledgement, she said, is the beginning of something important.
In her practice, the most common presentation she sees is mood and mental health symptoms in the context of hormonal transitions – perimenopause, pregnancy, postpartum, and the premenstrual phase. Women who have tried everything they could think of before finally making an appointment, and who arrive saying: no matter what I do, I don't feel like myself.
Perimenopause and Mental Health – Why They Can't Be Separated
Jessica was clear that life stress and hormonal shifts weren't two separate problems to be solved independently. They are deeply interconnected, and both have real, measurable effects on the brain.
Sustained stress elevates cortisol, which directly impacts neurotransmitters and brain circuitry – and can produce clinically significant mental health symptoms entirely independently of any hormonal factor. Add the hormonal fluctuations of perimenopause on top of that, and the effects compound.
In her practice, Jessica sees this regularly in women in their late 30s and into their 40s: the sense that everything they used to be able to hold is slipping. Cognitive capacity feels reduced. Sleep is disrupted. Anxiety appears in situations that never triggered it before. Mood drops without an obvious external cause.
"Everything's okay externally, but internally I'm not okay and I can't seem to figure out what's going on."
Lifestyle – The Foundation That Everything Else Depends On
Jessica described the lifestyle conversation as one of the most important and most emotionally charged parts of her work with women. For many of the patients she sees, the honest assessment is: what you're doing is completely unsustainable.
The pursuit of being the perfect mother, partner, professional, and friend – simultaneously and consistently – is a direct route to burnout. And burnout isn't just exhaustion. It's a neurobiological state with real consequences for mood, cognition, and anxiety. Read more on burnout and the stress response here.
Her framework was simple but not easy: reduce the expectations placed on self, prioritise the things known to support mental health – exercise, regular food, stress management, social connection – and acknowledge that looking after yourself is not selfish. It is the prerequisite for looking after everyone else.
She used the mother-child analogy deliberately: the mental health and wellbeing of children is substantially determined by the mental health and wellbeing of their mother. Putting her at the centre of that ecosystem isn't indulgence. It's strategy.
Nutritional Psychiatry – Why Diet Matters More Than We Thought
Jessica spoke about nutritional psychiatry – a relatively new and rapidly growing branch of research that examines the relationship between diet and mental health outcomes.
The central finding is consistent: a Mediterranean diet, with its strongly anti-inflammatory profile, shows the most protective effects on mental health. The mechanism makes sense – a significant body of research now supports the idea that many mental health conditions have a meaningful inflammatory component. Eating in an anti-inflammatory way can support both prevention and management of those conditions.
She also highlighted specific nutritional factors that directly support neuronal health: vitamin D, omega-3 fatty acids, B12, and iron. Deficiencies in any of these can produce or worsen mental health symptoms – which means that a poor diet isn't just bad for physical health. It is actively bad for the brain.
ADHD in Women – The Telescope Finally Pointed in the Right Direction
Jessica described the surge in ADHD diagnoses in women not as overdiagnosis, but as the delayed result of finally studying the right population.
"We have more data around ADHD and driving than we do around ADHD in women."
For decades, the diagnostic framework for ADHD was built on research conducted almost entirely in boys and men. The hyperactive, disruptive, externally obvious presentation that characterised ADHD in young boys simply didn't match how it presents in girls and women. As a result, generations of women went undiagnosed.
In women, the hyperactivity is internal. It is a brain that can't switch off – relentlessly busy, constantly generating. Emotional dysregulation is a hallmark feature, frequently misdiagnosed as depression or anxiety. Women develop sophisticated compensatory strategies – perfectionism, rigid structure, over-preparation – that mask the underlying condition effectively enough that it goes unnoticed until those strategies collapse.
The collapse most commonly happens in two contexts: motherhood and perimenopause. Both involve significant hormonal changes that affect the neurotransmitter systems central to ADHD. Both also dramatically increase cognitive and emotional demand. The compensatory mechanisms that held for decades suddenly stop working – and what remains is a woman who feels like she is falling apart, with no idea why.
Jessica noted on the episode that a common path to diagnosis was a parent accompanying their child to an ADHD assessment and recognising themselves in the description.
PMDD – More Than Just Bad PMS
Jessica drew a clear distinction between PMS and PMDD. PMS is real and uncomfortable. PMDD – premenstrual dysphoric disorder – is a severe clinical condition that significantly impairs functioning. Mood symptoms, anxiety, and physical symptoms in the luteal phase of the cycle are severe enough to disrupt daily life. It isn't just feeling low before a period. It is debilitating.
She explained that PMDD is more commonly diagnosed in the 35–45 age bracket, because the hormonal changes of perimenopause make symptoms that had previously been manageable suddenly much harder to contain.
The overlap with ADHD is significant and frequently missed: untreated ADHD makes PMDD symptoms far harder to control. Treating the ADHD is often a necessary prerequisite for getting PMDD under control.
In terms of treatment, Jessica outlined that SSRIs are first-line, combined oral contraceptives are an option in some cases – though external hormones can worsen mood symptoms in certain women – and antihistamines are showing anecdotal promise. The proposed mechanism is that PMDD may involve a histamine–hormone interaction, and reducing histamine levels appears to reduce sensitivity to hormonal fluctuations.
The Gut–Brain Axis – Serotonin Starts in the Gut
Jessica confirmed what was becoming one of the most important concepts in modern psychiatry: the gut and the brain are in constant two-way communication via the vagus nerve, and what happens in one directly affects the other.
The most striking piece of the mechanism she shared on the episode was around serotonin – the neurotransmitter most associated with mood regulation. The majority of the body's serotonin isn't produced in the brain. It is produced in the gut. A healthy gut is therefore not just a digestive matter. It is a neurological one. Read more on the gut-brain-axis here.
Dopamine, ADHD, and the Motivation Problem
Jessica explained the dopamine dysregulation that underpins ADHD in a way that makes the condition immediately recognisable to anyone who has experienced it.
In an ADHD brain, tasks that provide a natural dopamine reward – interesting, novel, urgent – are accessible. Tasks that don't – administrative, repetitive, low-stimulation – feel like trying to push through a cement wall. This isn't laziness. It is a dopaminergic disorder: the brain simply can't generate the motivation signal that neurotypical brains produce automatically.
ADHD medication works by supporting that dopamine system – not to produce artificial productivity, but to remove the barrier between the person and the task. Jessica emphasised on the episode that in women, this also means emotional regulation. Managing motherhood, relationships, and daily life with an undertreated ADHD brain is far harder than it needs to be – and medication changes that.
Saffron – Where Natural Support Has a Role
When asked directly about saffron on the episode, Jessica explained that for mild symptoms, natural supplements like saffron can be genuinely helpful in their own right. In the context of more significant symptoms, they work best as adjunct therapy alongside psychiatric treatment – supporting the overall system rather than replacing clinical intervention.
She described saffron as particularly useful for mood, anxiety, and cognitive functioning in women – something that can be used both preventatively and alongside treatment, and sustained long-term.
Community Questions Answered
Can ADHD be triggered by stress later in life?
Stress doesn't create ADHD. What it does is make existing, undiagnosed ADHD impossible to manage. The disorder was always there. The environmental change – stress, motherhood, perimenopause – removes the compensatory mechanisms that had kept it hidden.
How is PMDD treated?
First-line treatment is SSRIs. Combined oral contraceptives are a second option but require careful monitoring given the potential for mood worsening in some women. Antihistamines are showing anecdotal promise, with a proposed histamine–hormone mechanism. Screening for comorbid ADHD is essential – undertreated ADHD consistently undermines PMDD outcomes, and more scientific data now shows a link between ADHD and postpartum mood and anxiety disorder risk.
Do you have to stay on psychiatric medication forever?
For depression and anxiety, the goal is to regulate a dysregulated system long enough for healthy neural wiring to establish itself – typically one to five years depending on severity and history. For ADHD, the condition is managed rather than cured, and medication support may be needed for as long as the brain needs to function in daily life.
One Tip Everyone Can Start Today
On the most underrated thing a woman can do for her mental health: Sleep.
"There is such an important interplay between getting enough sleep and mood improvement, ADHD symptom improvement, anxiety improvement, and just a general sense of being able to cope better in your day."
And the one daily habit she recommended above all others: gratitude. Not as a feel-good exercise, but as a neurological intervention. Human brains are wired to scan for threat and fixate on the negative. Actively and deliberately focusing on something positive each day rewires that default toward a more balanced experience of the world.
Women's mental health is not a niche topic or a soft one. As Dr Jessica Stanbridge reminded us on this episode, it is the foundation on which everything else rests – and understanding what is actually happening in the brain, rather than pushing through and hoping for the best, is where real change begins.
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This content is for informational purposes only and does not constitute medical advice. Always consult with your healthcare provider or a qualified mental health professional before making any changes to your mental health treatment or supplement routine. This unregistered medicine has not been evaluated by SAHPRA for its quality, safety or intended use. If symptoms persist, consult your healthcare provider.
