Your Mental Health at Midlife

Do find yourself snapping at the people you love over small things that didn't used to bother you? Breaking into tears for no reason? Feeling fabulous and in love with life one day and as if you're stuck in the bleakest tunnel the next? No, you're not going crazy. You're going through middle age.

This is a time of tremendous change, both physically and emotionally. You may be sending your children off to college, starting a new career or realizing that the one you've had for years has reached a dead end. This is the time of life when many women end long-term relationships, begin new ones or simply decide they want some time alone. It's also a time when you may be starting to deal with your parents' health issues or your own, coping with changes in your body, a sense of loss at the end of your fertility and the physical effects of the menopausal transition.

So it's no wonder your mood has more highs and lows than the stock market.

Don't let anyone chalk it all up to fluctuating hormones, however. Although levels of estrogen and progesterone do become more varied during this time of life, dropping significantly after menopause, they aren't directly related to mood or depression in middle-aged women. We know this because when researchers compared blood levels of reproductive hormones in women with perimenopausal depression to those of women who weren't depressed, they found no differences.

So if you can't blame it on hormones, what's going on?

Life! You have a lot going on right now in your life. Much of it is good, but some of it may be painful or difficult (aging parents, financial problems, relationship challenges). Plus, even good things can become overwhelmingly stressful. While the occasional down day or mood swing isn't anything to worry about, if these feelings become entrenched and begin interfering with your quality of life and daily activities, you may need to be evaluated for clinical depression.

Signs of depression include the following:

• Persistent sad, anxious or "empty" moods
• Feelings of hopelessness or pessimism
• Feelings of guilt, worthlessness or helplessness
• Loss of interest or pleasure in hobbies and activities that were once enjoyed, including sex
• Decreased energy, fatigue or being "slowed down"
• Difficulty concentrating, remembering or making decisions
• Insomnia, early-morning awakening or oversleeping
• Appetite and/or weight loss or overeating and weight gain
• Thoughts of death or suicide; suicide attempts
• Restlessness or irritability
• Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders and chronic pain

If you've experienced one or more of these signs for a week or longer, talk to your health care professional. While menopause, per se, doesn't increase your risk of depression, perimenopausal women are more vulnerable to depression during this time. That risk is higher in women who have previously been treated for depression, are having hot flashes, have had a long perimenopausal phase and have a lot of stress in their lives.

If you think you might be suffering from depression, it's important that you seek help. Today, there are excellent treatments for mental health disorders like depression and anxiety. You may benefit from therapy, medication or both.

Some things to remember about treatment:

• Every antidepressant works differently in different people. Just because one drug worked well for your best friend doesn't mean it will work for you. If the medication doesn't seem to be helping, talk to your health care professional about changing the dosage or type of medicine.
• Medication takes time to work. On average, it may take 10 days to two weeks before you see an improvement in your mood.
• There is some evidence that using some forms of estrogen therapy with antidepressants may help the medication work better (estrogen therapy alone cannot treat major depression).
• Therapy is an important part of any treatment for depression. The two most-studied forms in depression are interpersonal psychotherapy (IPT), a less intensive form of traditional psychotherapy, and cognitive behavioral therapy (CBT), in which you learn to alter your perception of the world. Some studies find therapy is as effective as medicine for some mild or moderate depression.

Whether your mood swings are related to depression or other issues in your life, certain lifestyle changes may also help. For instance, numerous studies find regular exercise can help reduce the risk of depression and improve mood. Social interaction is also important, with studies finding that supportive social relationships can improve the quality of life for those with depression and may even protect women against depression.

The bottom line: pay attention to how you're feeling emotionally as well as physically. If you notice the lows are more frequent than the highs, take action. This is a great time of life, and nothing should get in the way of your ability to enjoy it!