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Inside Out: Midlife depression: Not unusual or incurable

Marge was 48 years old when she came to my office last year complaining of depression. She said her marriage was "comfortable, but without passion." Her teenage children were doing well, but she was worried about paying tuition when the time cam

Marge was 48 years old when she came to my office last year complaining of depression. She said her marriage was "comfortable, but without passion." Her teenage children were doing well, but she was worried about paying tuition when the time came. Her work life had been stable for 15 years. And then she woke up one day and realized that, at her age, many of her professional dreams would never come true. And she would probably be spending the rest of her life in her merely "comfortable" marriage.

I've treated many people like Marge over the years: men and women in middle age who realize they are unhappy with their lives yet fear it is too late to change. This is also a time when many marriages end because one spouse leaves to find the kind of love felt to be missing.

Research published this month in the journal Social Science & Medicine found that the probability of depression rises around middle age, peaking around age 44. After studying data from 500,000 Americans and Western Europeans, the researchers discovered that psychological well-being is at its lowest during the middle of the life cycle regardless of gender or location.

It has been like this for many years but now things seem to have gotten worse. The U.S. Centers for Disease Control and Prevention just reported that the suicide rate among 45- to 54-year-olds increased nearly 20 percent from 1999 to 2004.

Midlife has always been difficult. Often it's the first time we feel the effects of aging and mortality. Our children need us less, forcing a shift in focus back to ourselves - and often we are unhappy with what we find.

And pressures on middle-age people have increased consistently over the last several years. Many in that generation are now caring for children and parents at the same time. Insecurities seem to have grown, pushing us to work harder, worry more, and sleep less and socialize less. As a matter of fact, other studies have shown that Americans have significantly fewer close friends and support systems than they did a generation ago. All of this increases one's risk for depression.

So what can be done?

Plenty. A history of depression in your family places you at increased risk in midlife. If you are feeling depressed, and see changes in your sleep, appetite or social activities, get treatment quickly. Often a loved one will notice these changes before you will. A combination of psychotherapy and medication works well with depression, and the prognosis is better if it's caught early.

Sometimes, however, sadness or irritability in middle age is a signal that you are living an unfulfilled life, and a thoughtful review might be helpful. The great pain of midlife isn't feeling mortality for the first time - it's feeling death without having experienced a fulfilling life.

So a review may include mourning the loss of your dreams (some of them, anyway) and your youth. It can also be an exploration of what it is that you hold most precious, and what changes you can make to create a life that brings you more meaning, joy and love.

Marge did well with depression medication and psychotherapy. As part of her treatment, she reached out to people she felt close to, and they spent more time together. She and her husband not only got into counseling, they also made a commitment to go out on a date at least once a week. And she volunteered at her local Boys and Girls Club, which gave her great pleasure.

Most pieces of her life didn't change. She still had the same job, still worried about tuition and, the last time I saw her, was still in a marriage that was "comfortable, but without passion." But she was happier.

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