PMDD Treatment Guidelines: A Clinical Overview
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Advanced, personalized care for depression that has not responded to previous treatment, for patients across New Jersey and New York.
Self-pay practice · Superbill provided for out-of-network reimbursement
If you have tried antidepressants without lasting relief, you are not out of options. Treatment-resistant depression, also called refractory depression, means depression that has not improved after adequate trials of at least two different medications. It calls for a more advanced, personalized approach rather than simply trying more of the same. After a thorough evaluation, you receive a plan built around your specific history, symptoms, and any co-occurring conditions.
Treatment-resistant depression is diagnosed when depressive symptoms persist after adequate trials of at least two different classes of antidepressant. Evaluation looks at your full treatment history, dosages, and how long each was tried, and rules out factors that can mimic resistance, such as poor absorption or drug interactions. I also assess for co-occurring conditions like anxiety, bipolar disorder, or substance use that can complicate recovery and change the plan.
Getting the diagnosis right is the foundation of effective care. I review your history of antidepressant trials, symptom timeline, and any conditions that may contribute, including chronic pain, trauma, or cognitive difficulties. Using current clinical guidelines and research from trusted sources such as the National Institute of Mental Health, I identify what has been missed and where a different approach is likely to help.
Sometimes the answer is a different class of antidepressant or a carefully chosen combination. Options include SSRIs, SNRIs, and, in select cases, older classes such as tricyclic antidepressants. Augmentation, adding a second medication such as an atypical antipsychotic or mood stabilizer to boost an antidepressant, can help when a single medication is not enough. Each change is monitored closely for response and side effects.
When medication alone has not worked, other evidence-based treatments may be considered. Intranasal esketamine, an FDA-approved nasal spray, can provide rapid relief for some people. Brain stimulation approaches such as repetitive transcranial magnetic stimulation and, in severe cases, electroconvulsive therapy have strong evidence for treatment-resistant depression. I discuss which options fit your situation and coordinate referrals where a treatment is delivered in a specialized setting.
⚠ This content is for informational purposes only. No medication should be started, stopped, or changed without guidance from a qualified psychiatric provider. All treatment decisions at Gimel Health are made following a comprehensive in-person or telehealth evaluation with Michael Feldman, PA-C.
Six focus areas. Click any to see the full approach.
Treatment for depression, bipolar, PMDD, and
complex mood patterns.
Specialized care for chronic worry, panic, PTSD,
and obsessive thoughts.
Treatment for depression, bipolar, PMDD, and
complex mood patterns.
Medical and medication support for anorexia,
bulimia, and binge eating.
Treatment for insomnia, rage, and impulse
control challenges.
Treatment-resistant cases, psychosis,
schizoaffective, autism spectrum.
Three steps. No surprises.
Tell me what's going on. I'll tell you if I'm
the right fit — or refer you to someone
who is.
Full clinical assessment.
We review full medical & psychiatric history, prior treatments, symptoms and
goals together.
Founder · Physician Assistant–Certified
Most psychiatric prescribing is trial-and-error. My background in
molecular biology — MSc from Hebrew University of Jerusalem, with
research at the Weizmann Institute and Mt Sinai — lets me think about
your case at the level of biological pathways, not just symptom
checklists. That means fewer wasted medication trials and a clearer
rationale for every decision.
Adults, adolescents, and children with anxiety, depression, ADHD,
bipolar disorder, OCD, eating disorders, and complex or treatment-
resistant cases. I work especially well with patients who've been let
down by rushed 15-minute medication checks elsewhere.
A 60-minute initial evaluation — in person at my Fort Lee office or via
telehealth anywhere in NJ or NY. We'll go through your full history,
current symptoms, prior treatments, and biological context. You leave
with a clear diagnosis and a specific medication plan, not a maybe.
FOUNDER VIDEO
Watch: Why I founded Gimel Health
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One of the most nicest, kindest and considerate doctors I met. He went over with me thoroughly on the documents and was generous enough to explain me everything that I asked. I think he is a real doctor of people and not just someone that's write prescriptions.
Michael is an amazing professional! He truly invests in his patients and provides care and feedback even during off hours. Although we have only been using his services for a short time, he already stands out as caring, knowledgeable, and confident in his approach. We plan to continue using his services and would absolutely recommend him to anyone!
Dr Michael Feldman is an amazing doctor. He prescribed the proper medication in the right dosage for me. He did this because he listens and asks very good questions. I highly recommend him
Michael Feldman is a wonderful and caring P.A. He always gives 100%. He listens attentively and provides many insights I would never thought of by myself. I find having him in my corner invaluable and I could not recommend him more highly. He's the best!
Michael Feldman is an excellent doctor! Very knowledgeable, attentive to patient's needs, caring, great bedside manners! Highly recommend!
I met Michael Feldman after years of search and trial and error. If you look for a professional who is invested in his patient's progress, research-oriented, with a deep understanding of the body-mind connection and a wholistic approach to treatment, look no further.
I had an exceptional experience with Dr. Feldman and truly feel fortunate to have found such a compassionate and knowledgeable psychiatrist for my teenager son. From the very first appointment, they took the time to listen without judgment and made me feel genuinely understood. Their explanations were clear, thoughtful, and grounded in evidence, which helped me feel confident in my treatment plan. The office staff is also friendly and efficient, making scheduling and follow‑ups easy. I highly recommend Dr. Feldman to anyone seeking a psychiatrist, especially for children.
My dad was recommended to see Dr. Feldman through his psychologist. He got him on track with medication and I finally feel like he’s himself again. Speaks Hebrew fluently as well which was a plus. Would recommend to anyone looking for an attentive and kind professional. Thank you!!
I was looking for support in working through my trauma. From the very first moment, I felt a comfortable atmosphere, even though the meetings were held via Zoom. It was clear that Mikhail was truly listening and delving into the problem. After each session, I felt empowered and calm. I definitely recommend Mikhail Feldman as an excellent specialist.
Great medication management! I was worried about the correct path to take to improve my mental health, and Michael really helped to properly explain my options and recommending the right medication. Highly recommend!
Dr. Feldman is very professional, intelligent, and highly knowledgeable. Appointments always run on time. After we switched to him, he immediately recognized that the previous diagnosis was incorrect. We’re very confident in his care and look forward to continuing with him.
I don't bill insurance directly, and that's intentional. Insurance-driven psychiatry means short appointments, rigid formularies, and a provider who barely knows your case. This practice is self-pay so I can give you full evaluations and make medication decisions based on what's right for your biology, not what's on the insurer's approved list. Most patients with out-of-network benefits recover 50–80% of fees by submitting the detailed superbill I provide at every visit.
Things patients usually want to know before reaching out.
Treatment-resistant depression, also called refractory depression, is major depressive disorder that has not improved after adequate trials of at least two different antidepressant medications at the right dose and duration. It often involves persistent low mood, loss of function, and sometimes suicidal thoughts despite consistent treatment. Co-occurring conditions such as anxiety, bipolar disorder, or substance use can contribute, which is why a careful evaluation matters.
Options go beyond standard antidepressants. They include switching to a different antidepressant or class, combining medications, or augmentation with an atypical antipsychotic or mood stabilizer. For some people, intranasal esketamine offers rapid relief, and brain stimulation approaches such as rTMS or, in severe cases, ECT have strong evidence. Therapy, sleep, and lifestyle support are part of the plan too. The right combination depends on your history and response.
It is generally identified when a person has not responded to at least two adequate trials of different antidepressants. I review your treatment history, dosages, and how long each medication was tried, and rule out factors like poor absorption or drug interactions. I also consider co-occurring conditions and symptom severity, since these affect both the diagnosis and the next steps.
Brain stimulation approaches such as rTMS and ECT are generally safe when delivered in a clinical setting under medical supervision, and they are often effective for people who have not responded to medication. Side effects are usually short-term and manageable. Peer-reviewed research, including in journals like JAMA Psychiatry, has reported meaningful remission rates from these procedures.
Switching medications or moving to a different class can involve withdrawal symptoms or, less commonly, interactions such as serotonin syndrome, along with side effects like weight changes. In practice, though, a carefully managed switch can meaningfully improve the odds of finding an effective treatment. Each change is guided by your history and monitored closely to keep it as safe and smooth as possible.
Yes. Cognitive behavioral therapy and other talk therapies remain an important part of care, even when medication alone has not worked. Combining therapy with medication can reduce symptoms, improve emotional regulation, and address underlying patterns, trauma, or family dynamics that medication cannot reach on its own. For many people, the combination works better than either approach alone.
The difference is response to treatment. Many people improve on the first or second antidepressant they try. Treatment-resistant depression describes cases where standard medications have not brought relief despite adequate trials. It is not a sign that recovery is impossible; it means a more advanced, individualized approach is needed, which is exactly what this kind of care is designed to provide.
I personally read every inquiry and respond within one business day.
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440 West Str, Ste 307 Fort Lee, Bergen County, NJ 07024
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Comprehensive services are designed for each individual. Treatment of Anxiety, Depression, ADHD, Eating Disorders,
Psychosis, schizophrenia, and other psychiatric conditions.
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