Hormonal mood psychiatry for perimenopausal women — telehealth across Virginia.

Hormonal Mood Psychiatry · DepthWorks Psychiatry™

Your brain changed
before anyone told you
it was coming.

Psychiatric care for women at the intersection of hormonal transition and mental health — where conventional psychiatry has always fallen short, and where the women who needed it most were left without a map.

Telehealth across Virginia · Now accepting new patients · Care begins at $295

What brought you here

You have been on the same medication for years.

It worked. Until it didn't.

You are not in crisis. You still show up.

You are somewhere between 40 and 52 and have never felt this far from yourself.

Your doctor says the labs are fine.

Your brain changed —

and no one told you that was coming.

This is not a new illness.

This is a hormonal transition quietly rewriting the neurochemistry

your medication was written for.

Traditional psychiatry sees a treatment failure.
This practice sees a woman whose body moved into a new chapter before anyone gave her the map.

The data you were never given

The women who need this most
are the least likely to receive it.

8.5

Months earlier Black women reach menopause compared to white women — while experiencing more severe depression, sleep disturbance, and vasomotor symptoms throughout the transition.

University of Michigan School of Public Health, 2022

26%

Less likely Black women are to be prescribed hormone therapy for menopause symptoms — despite experiencing more frequent and more severe symptoms than the populations for whom the research was designed.

Journal of Women's Health, 2023

32%

Less likely Hispanic women are to receive hormone therapy — a disparity that compounds across decades of undertreated symptoms, undertreated mental health, and the cultural silence that keeps both invisible.

Journal of Women's Health, 2023

The "Strong Black Woman Schema" — the cultural expectation to portray strength and suppress emotion — is directly linked to worsened mental health outcomes during the menopausal transition. The woman holding everything together rarely receives the care she needs. This practice was built for her.

What this practice offers

Not a menopause clinic.
A different kind of care entirely.

What I offer

Psychiatric evaluation through a hormonal lens
Assessment of why medications stopped working
Adjustment of psychiatric care for the body you have right now
Understanding of how hormonal shifts affect neurotransmitters
Integrative treatment: medication, botanicals, and narrative work
Coordination with your OB/GYN or primary care
Cultural attunement for Caribbean-rooted and bicultural women
Unhurried 90-minute evaluations. The full picture, not a symptom list.

Where I refer out

Primary hormone therapy prescribing (HRT)
Gynecologic procedures and examinations
Bone density and cardiovascular management
Vaginal health and genitourinary procedures

"I don't replace your gynecologist. I manage what happens to your mind, your mood, and your medications when your hormones shift — because that's a psychiatric problem, and it has always deserved a psychiatric answer."

The DepthWorks approach

How care works here

Care at DepthWorks is built around your whole system — not a symptom list and a prescription pad. The hormonal picture and the human picture are always seen together.

01

The 90-Minute Depth Evaluation

Your first appointment is 90 minutes. Not 20. We assess your psychiatric history, your hormonal picture, your medication timeline, your sleep, your story, and the cultural architecture you carry. Nothing is rushed. Nothing is skipped.

02

The Five-Lens Formulation

Every client at DepthWorks is understood through five lenses simultaneously: biological, nervous system, narrative, cultural, and meaning. For hormonal mood presentations, each lens has a specific addition — because the woman who was never given the map needs the whole terrain named, not just the diagnosis.

03

Integrative Medication Management

Where medication is indicated, it is prescribed with precision — and adjusted for the hormonal context, not in isolation from it. Botanical and nutraceutical support is woven into treatment from the beginning: targeted, evidence-informed, and never an afterthought.

04

Narrative and Identity Work

Perimenopause is not only a biological event. For the woman who has spent decades being the strong one, this transition often arrives at the intersection of hormonal disruption and identity disruption simultaneously. The narrative work is a clinical intervention — not an add-on.

05

Collaborative Care Coordination

When HRT or gynecologic consultation is indicated, I facilitate that conversation — and I send your full clinical picture to the receiving provider, not a diagnosis alone. You should not have to explain yourself in two separate rooms.

For the woman who carried it alone

The silence
that was taught.

In many Caribbean, African, and South Asian households, menopause was not spoken about. It was pushed through. It was the "change of life" — something a strong woman managed quietly, without complaint, without help.

The women who came before you carried this in silence. It cost them something.

The strength was real. The silence was not required.

Care here understands where you come from. It does not ask you to explain your culture away in order to receive good medicine.

"Your anxiety did not return because you stopped trying. Your antidepressant did not stop working because something is wrong with you. Your brain changed — and you were never given the map for this particular chapter."

I am Patria Alexander, PMHNP-BC. I am Caribbean-rooted. I grew up watching plant medicine work long before I had the clinical language to explain why. I know the world you came from. I come from it too. I built this practice because too many high-functioning women — women who look like us — are navigating one of the most significant transitions of their lives without a clinician who understands the full picture of what they're carrying.

What you can expect

Care built for the body
you actually have right now.

Not the body that responded to that medication seven years ago. Not the body conventional psychiatry has been writing protocols for. This one. Now.

◈

Unhurried evaluation

90 minutes for your initial appointment. The full hormonal and psychiatric picture — not a 20-minute intake and a refill.

◈

Hormonal-psychiatric integration

Your medication is reviewed in the context of your hormonal stage — not independently. What works at 35 may need adjustment at 47.

◈

Botanical and integrative layer

Evidence-based botanical and nutraceutical support for the nervous system — woven in from the beginning, never offered as an afterthought.

◈

Cultural attunement

You do not have to explain the world you came from. It is already part of how care is held here.

◈

Narrative and identity work

The story of this transition — what it means, what it's taking, and what it might be making room for — is treated as clinical material.

◈

Telehealth across Virginia

Accessible, private, unhurried care from wherever you are. Superbills provided for out-of-network reimbursement.

Questions you may be holding

Frequently asked

Is this for me if I haven't been formally diagnosed with perimenopause?+

Yes. Many women arrive without a formal diagnosis — only a sense that something has shifted and that standard care hasn't been able to name it. If your mood, anxiety, sleep, or medication response has changed noticeably in your 40s or early 50s, a hormonal contribution is worth assessing. You do not need a diagnosis to begin.

Do you prescribe hormone therapy (HRT)?+

DepthWorks is a psychiatric practice. My clinical work focuses on the psychiatric presentation — mood, anxiety, sleep, medication management, and the narrative dimension of this transition. When HRT is clinically indicated, I facilitate a referral to OB/GYN and communicate your full clinical picture to that provider. You should not have to start over in two separate rooms.

My antidepressant worked for years. Why would it stop now?+

Estradiol modulates serotonin synthesis and receptor sensitivity. As estradiol declines in perimenopause, the neurochemical environment your medication was written for changes significantly. A medication that was precisely calibrated to your biology at 38 may be genuinely insufficient for your biology at 47 — not because of anything you did. This is one of the most common and most undertreated presentations in midlife women's psychiatric care.

Do you accept insurance?+

DepthWorks is a private pay practice. Superbills are provided at the end of each month for submission to your insurance for potential out-of-network reimbursement. Care begins at $295. Many clients receive partial reimbursement through their out-of-network benefits.

I have never sought psychiatric care before. Is this still for me?+

Yes. Many women arrive at this practice for the first time in their 40s or 50s — having carried things quietly for decades, having managed, having been the strong one. This transition often becomes the moment when the management strategies that worked stop being sufficient. You do not have to have a psychiatric history to deserve steady, precise, culturally attuned care.

The next step

If something here named
what you have been privately
carrying —

that recognition is the beginning. The next step is simply a conversation. Not a commitment. Not a diagnosis. Just a conversation with a clinician who already understands something of where you come from.

Schedule Your Consultation

Care begins at $295 · Telehealth across Virginia · Superbills provided