One in five women and one in six men will experience depression at some point in their lives. Given the prevalence of depression, it is important to know the signs of midlife depression, its causes and, most importantly, what you can do about it.
Signs of Depression
While everyone experiences sadness on occasion, it is important to know the signs of depression to recognize when the sadness is escalating into something more. Joshua L. Straus, M.D., attending psychiatrist, NorthShore University HealthSystem, explains that the DSM-V definition of major depression includes both having little interest in pleasure and activities once enjoyed as well as a depressed mood with a core feeling of sadness and hopelessness for the majority of the day over the course of two weeks.
In addition to depressed mood, other signs of depression include:
- low energy and feeling tired all the time
- difficulty concentrating
- sleep problems, including difficulty sleeping or sleeping too much
- lack of interest in eating accompanied by weight loss, or weight gain that is more than five percent of body weight in a month
- a sense of personal worthlessness
- trouble concentrating during ordinary activities
If sadness is “interfering with your life by keeping you from going to work or if it means you are not hanging out with friends, not taking care of yourself, not enjoying favorite movies or music, that’s significant,” says Serena Wadhwa, Psy.D., LCPC, CADC.
Of course, people who are having suicidal thoughts or thinking of harming themselves should seek immediate professional attention.
What Causes Depression?
“There are a variety of factors that contribute to depression, including hormonal, biological and genetic factors. Stress is also a factor,” Wadhwa says.
Researchers used to think that menopause was a key variable in depression. John F. Greden, M.D., executive director of the University of Michigan Comprehensive Depression Center, says that thinking has changed.
“While hormones do play a role, that role is often overstated,” Greden says. “If treated adequately, depression does not worsen in menopause, and many people can ride right through it.”
Midlife can be a time of great stress due to significant life changes, including children leaving home, job changes, caring for aging parents and financial pressures. Wadhwa says people coping with a number of those mid-life pressures often have less time to take care of themselves, which can increase the risk of depression.
“Those changes and the uncertainty that may come with them can spiral into depression because the changes are overwhelming,” she says. “People don’t know what to do, and may cope in destructive ways.”
Changes in midlife can certainly play a role in depression, but Greden explains that the onset of depression peaks between ages 15 to 24. He says that while depression often manifests in midlife, for most people it started in a milder form decades earlier. Depressive episodes recur and often worsen when untreated, which is why he says seeking treatment for midlife depression is very important.
In addition, addiction and depression are often linked. Mary Pittman, M.S., RN., co-founder of Elmhurst Professionals Program, says her program sees a lot of people that have diagnoses of addiction and depression. She says that the addiction must be treated first before it can be determined if there is an underlying depression issue.
“Someone could have trouble with depression and one of the ways they may choose to manage the uncomfortable feelings, anger, irritability that come with it is drugs or alcohol,” says Glenn Siegel, M.D., psychiatrist and co-founder of Elmhurst Professionals Program. “Alternatively, there are people that may begin with straight addiction and eventually develop depression in that process.”
Many medical conditions can also contribute to depression, says Straus, and those can include overactive or underactive thyroid, issues that come with gastric bypass surgery and sleep apnea.
Ways to Treat Depression
Anyone struggling with depression should seek help. Straus says many people suffer with depression unnecessarily for years, but that the condition is highly treatable.
“The treatments for depression surpass anything we have available in cardiology, oncology, etcetera, in terms of the high percentage of people who can be helped,” Straus says.
It is important to seek help from a professional. Siegel says relying only on yourself or your spouse is not adequate. “It has not been successful or you wouldn’t have gotten to this point,” he says “If a person is depressed, they need to seek out a professional.”
One option is seeing a therapist, and it is important to find the right one for you. “Finding an effective therapist is like looking for a good pair of jeans. Sometimes you have to shop around until you find the right one,” Wadhwa says. “Therapy is not an easy path. It’s work, and there are lots of different styles. It’s important to find someone with whom you can collaborate.”
Another option is talking with a primary care physician. Straus says that 70 percent of medications for depression are prescribed by primary physicians. Primary care physicians and other physicians like OB-GYNs can also help patients find a mental health professional and direct them to other resources.
“Most of the time, they are very good at noticing the symptoms,” he says.
In addition to seeking professional help, there are ways people can reduce their risk of depression. Living a healthy lifestyle, including eating a balanced diet, getting enough sleep and consuming alcohol in moderation, can be very helpful.
“It’s common sense, and really just everything our grandma told us to do,” Greden says. “What really counts is that people do it.”
Experts also stress the importance of exercise, which has been shown to change brain metabolism and brain structure and releases neurotrophins, proteins that are essential for healthy brains. Greden explains that even walking 30 minutes a day can have a big impact on wellness. Even better, he says, is walking with a friend.
Finding the time to take care of yourself is vitally important. A therapist may be able to help you figure out how to fit self-care into your busy schedule.
“When I see clients who are stressed out and talk about how they don’t have time, we look together at how they can make time for themselves, even if it is just ten minutes a day,” Wadhwa says.
Failing to take the time for self-care can have dire consequences. “If someone cannot find the time to prioritize themselves, then they will pay a huge price, their family members will pay a huge price and that price will get higher and higher as time goes on,” Greden says.
He also explains that just getting a bit better is insufficient. “Just improving is not enough. Wellness is the goal and you want to get as well as you can, not just better.”
Once wellness is achieved, it is important that individuals keeping doing what got them to wellness. Greden cautions that many people get better, stop treatment and then experience a recurrence.
“If you get well, keep doing what you’re doing,” he says. “Stay with what’s working.”
That’s especially important given that depression is rarely a one-time event.
“If untreated, depressive episodes tend to come back and become more frequent, closer together, harder to treat and often chronic,” Greden says. “If someone is experiencing depression in midlife, it is really important to get on top of it, achieve real wellness if possible, and then stay that way.”