Dr. Decipher: Do You Have the Middle-Age Blues?

By Dr. John Janousek, M.D. Monday, January 02, 2012

Are you middle aged? Do you sometimes feel that life has passed you by? Have you not achieved all your aspirations? If so, then you have plenty of company. A study from Dartmouth College in New Hampshire in 2008 showed that there is a consistent pattern of depression and happiness that is related to age.

Depression rates follow a horseshoe curve with lowest levels at the beginning and end of lives, highest levels at mid-life. The peak of depression occurs around age 50 in men and age 40 in women. Why is this?

At mid-life people are set in their careers and roles that may not be what they had imagined for themselves. Alternatively, people may have achieved their goals in terms of profession or earnings, but they may not feel satisfied; “is this all there is?” There is worry about retirement savings and the future economic outlook (ugh).

In middle age, health problems begin to occur, and physical endurance is not what it used to be. It is the time of menopause. Social stress may worsen, as about half of marriages end in divorce. Children are teen-aged or young adults; they no longer require much physical care and social support, but are financially needy and invariably get into trouble, some more than others.

Parents are aging or may have already died, and old friends may be far away or having health problems themselves.

Youth is glorified in the media. Look at fashion models, movie stars, advertisements, music. Have you seen a “cool” middle-age person depicted, or is it more like a middle-age fool?  Do 40- and 50-year-olds wear Vans, knee high fashion boots or short skirts? Do they skateboard down sidewalks or hip hop dance?

I have treated many middle-age patients who are taking anti-depressants, usually SSRIs (selective serotonin re-uptake inhibitors) such as Prozac, Celexa, Paxil, and Zoloft or SNRIs (serotonin-Norepinephrine reuptake inhibitors) including Cymbalta and Effexor. The prolonged presence of the neurotransmitters serotonin and norepinephrine in the brain's electrical connections (synapses) decreases depression.

What are some other ways to become happier in middle age? Exercise is beneficial to mental as well as physical health. Some folks take it a step further to participate in organized races; there has always been a large contingent of middle agers in the 5K races I have run. One of my wife’s friends learned to ride a bicycle at age 40 and now has completed her first triathlon. Social support can be found in a club such as a charity, golf group, or church organization. Spirituality is important.

I have already started a bucket list. Done: trip to Alaska, backpacking in Philmont New Mexico, glacier climbing. To do: trip to Europe, scuba diving, dog sledding, medical mission trip, and skiing the Rockies.

There is the old story of middle-age crazy, where one compensates by doing something outrageous such as buying a Harley, getting a much younger boy or girlfriend, or going overseas for an extended period of time. Come to think of it, I did get a BMW convertible last year (but it was a used 2001 model).

Do you have any anecdotes or suggestions for overcoming middle age depression/craziness?