Depression and the Midlife Woman

I’ve been having trouble writing the last couple of weeks.   A friend shot themselves and it shook my world.

It was sudden.   We missed the signs.  I want to say that it was because they were selfishly hiding the signs but they were probably trying to act their way out of a depression.

Depression is not the blues.  It’s not a bad day or even a series of bad days.  It’s a serious illness  of despair and hopelessness that can ravage our hearts, minds, lives, and the lives or our loved ones.  Two major studies show that midlife women have the highest rate of depression among everyone else.  A British 2009 study by NHS reports that 1 in 4 women between 40 and 59 are either clinically depressed or suffering from severe anxiety, while the Center for Disease Control’s 2014 study reports that 1 in 8 suffer just from clinical depression.  Those are very high numbers. Either our friends or ourselves are suffering.   And it is a daily suffering.

The DSM-V (the authoritative guide for mental health professionals) list the following symptoms for depression:

• Depressed mood or a loss of interest or pleasure in daily activities for more than two weeks.

• Mood represents a change from the person’s baseline.

• Impaired function: social, occupational, educational.

• Specific symptoms, at least 5 of these 9, present nearly every day:

1.  Depressed mood or irritable most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful).
2.  Decreased interest or pleasure in most activities, most of each day
3.  Change in sleep: Insomnia or hypersomnia
4. Change in activity: Psychomotor agitation or retardation
5.  Fatigue or loss of energy
6.  Guilt/worthlessness: Feelings of worthlessness or excessive or inappropriate guilt
7.  Concentration: diminished ability to think or concentrate, or more indecisiveness
8.  Suicidality: Thoughts of death or suicide, or has suicide plan
9. Significant change in  weight (5%)

DSM – V proposed (not yet adopted) anxiety symptoms that may indicate depression: irrational worry, preoccupation with unpleasant worries, trouble relaxing, feeling tense, fear that something awful might happen.

According to Loraine Dennerstein and Claudio Soares in the World Psychiatry Journal, there is a unique challenge in treating a woman’s midlife depression.  Studies show that the depression might or might not have a causal relationship to menopause.  Then there is the “empty nest syndrome” and the generational sandwiching of care, the burden of which usually falls on women.  What Dennerstein and Soares didn’t mention is a loss of youthful looks in a youth oriented world or retirement fears for a work life that earns a fraction of what men earn.   We women not only juggle a lot in life but also in our generalised reasons for depression.

Midlife is a time when the chickens come home to roost for women in many ways and the treatment of depression needs address all these areas.

A problem is that some of the defining characteristics of midlife depression are withdrawal, isolation and rumination.  We aren’t talking about it, but we are thinking about it. Less than 1/3 of us seek help. We aren’t seeking help— because after all who has time?

We need to make the time.  We need to force ourselves out of isolation.  We need to give ourselves the care that we give our families. Depression is a very serious disease, but it is treatable.  We don’t have to muscle through the darkness alone.

The battle against depression requires a full frontal assault;  mindfulness, meditation, nutrition, exercise, talk therapy, fun, and maybe medication.  It may seem daunting at first, but what we know doesn’t work is muscling through pretending all is right with the world.  We are so good at juggling, why not juggle what we need to do for our mental health.

As always,

Beth

National Suicide Hotline:   1-800-273-8255