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Midlife Crisis or Midlife Depression: Knowing When to Seek Help
Laurence Lippsett
You've hit middle age and feel like you're in a rut. Maybe some setbacks have piled up and chronic aches are slowing you down. The hope, excitement, and drive of your youth have faded, and you're in a consistent state of disappointment. This may sound like a midlife crisis—just another stage of life, like adolescence or old age. But it could be more than that. You may be experiencing depression, which is a medical condition that needs to be treated.
Is It a Midlife Crisis or Depression?
Descriptions of the existential challenges of mid life have existed for centuries, but the phenomenon of the mid life crisis was academically introduced as recently as 1957. Then popular books such as Gail Sheehy's Passages: Predictable Crises of Adult Life made it a household phrase in the 1970s. The midlife crisis has become part of our cultural consciousness because "middle age" is often a period in people's lives when they are likely to face stressful changes in their relationships and other major life events. Their children, the focus of their love and attention for so many years, have grown up and left. Their parents have aged, and they may need to take care of them. Their work demands have hovered near the red zone for years. Their stamina isn't what it used to be, and once-easy tasks have become more burdensome.
Any of these circumstances can make it harder to feel happy, but they could also trigger depression. While a mid life crisis can be a normal state of development, depression is not. It's important to remember that depression is not simply a catch-all term for feeling sad. Depression is associated with changes in chemicals in the brain that regulate signaling and moods—and it's a medically recognized condition that requires treatment.
Understanding Midlife Depression
As the term "midlife crisis" gained notoriety, scientists began to investigate whether depression might be caused by middle-age physiological changes in the body that show up in different ways in women and men. Ever hear the term "male menopause"? But research has not shown that these biological changes are a cause of depression (though some of them can contribute to depression). More likely, a variety or combination of factors in midlife, both emotional and physiological, may cause depression. Still, it's necessary to acknowledge that midlife depression is not a universal experience, and it should not be considered normal or expected. Therefore, it's important to recognize the symptoms of midlife depression—especially because different symptoms can appear in different people. Here's a list to keep an eye on:
- You often feel overwhelmed with feelings of helplessness, hopelessness, worthlessness, or guilt.
- You experience big mood shifts, becoming much more angry, irritable, anxious, sad, or hopeless.
- You've lost interest in activities, hobbies, and people you once enjoyed, and you've withdrawn from family, friends, and colleagues.
- You've lost interest in your work, or just the opposite—lost yourself in work and become a workaholic.
- Your eating and sleeping habits have also been affected—whether eating too much or too little, or having trouble sleeping or trouble getting out of bed.
These unhealthy changes, along with stress, can cause a wide range of physical ailments, including backaches, headaches, fatigue, stomach problems, and sexual dysfunction. Mentally, those with depression can have difficulty focusing, remembering things, and making decisions. Some of those clichéd midlife crisis behaviors—buying a flashy sports car or having an affair—may be the result of feeling worthless or withdrawn from relationships, among other symptoms of depression.
Moving forward and Seeking Treatment
If you are between your late 30s and early 50s and experiencing any of the symptoms above, don't shrug it off as "just a midlife crisis." Depression is not an inevitable part of middle age; many in their 40s, 50s, and beyond acclimate to life changes and continue to enjoy good physical and mental health. Depression is a condition, like any condition at any age, that can detract from quality of life for you and your loved ones. According to current research, two-thirds of people with depression don't seek or get treatment. Many people have effectively treated depression with therapy and medications. If those haven't worked for you, though, there are other options to try, such as Transcranial Magnetic Stimulation (TMS). TMS is an FDA-cleared non-invasive and drug-free treatment. In a private treatment room, you sit in a comfortable chair, awake and alert, while a device near your scalp delivers gentle magnetic pulses, similar to those in an MRI scan. These pulses stimulate changes in brain chemical signaling that can alleviate symptoms of Major Depressive Disorder. You can drive yourself home or back to work afterward. Whatever path you choose, make sure to consult your doctor and get the help you deserve. Your life isn't half over when you reach middle age. You have plenty ahead of you, and with treatment for depression, you can find relief from your symptoms and make your best memories yet.
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Starting any medical treatment for the first time can leave you with questions, especially if you’re looking forward to the benefits it may bring. It’s no different when you’re preparing for your nasal esketamine treatment. Your previous mental health treatments may have consisted solely of taking antidepressants at home or visiting a therapist’s office for cognitive behavioral therapy (CBT), so nasal esketamine is probably a new treatment experience for you. If you're wondering what it's like to start nasal esketamine and get ready for your first session, keep reading. Getting Started with the Nasal Esketamine Treatment As with any new treatment, you’ll first talk to your primary care provider or psychiatrist about whether nasal esketamine is a good fit for you. Alternatively, you can schedule your esketamine nasal spray consultation with a treatment center (such as Greenbrook) that has certification by the FDA’s Risk Evaluation and Mitigation Strategy (REMS). At Greenbrook's REMS-certified nasal esketamine treatment centers, our Greenbrook-affiliated psychiatrists and psychiatric nurse practitioners will review your medical history and also conduct our own assessment to help determine whether nasal esketamine treatment is right for you. Certain conditions, including blood vessel disease and a history of psychosis, may make treatment a risk for you. Make sure you discuss all previous and present conditions with your doctor or nasal esketamine provider before beginning treatment. If the medication is deemed a good fit, you’ll receive your prescription from the Greenbrook-affiliated provider. Your Greenbrook Care Team will put together a personalized care plan for the weeks and months to follow. Keep in mind that you will need to take a standard (oral) antidepressant along with your nasal esketamine treatment. There are two important regulations to note when it comes to preparing for treatment: Each treatment is followed by a mandatory two-hour observation period. This means you will need to plan to stay at the center for at least two hours following your self-administration of the esketamine nasal spray. You cannot drive during the rest of the day after treatment and must arrange for transportation. These regulations are mandatory. It may be helpful to sit down and plan out several weeks’ worth of transportation once you know your treatment schedule. In addition, if you’re wondering what to bring for the treatment, we recommend entertainment such as an audiobook or playlist of favorite songs and a pair of headphones. You may want them during the two-hour observation period. What to Expect During Nasal Esketamine Treatment On the day of treatment, you’ll need to stop eating any food two hours before your appointment and stop drinking all fluids 30 minutes before you come in. Your Greenbrook Care Team will confirm that you are prepared for the two-hour observation period and that you have a ride home. You’ll get the opportunity to practice using a “trainer sprayer” that mimics the real nasal esketamine sprayer but does not release any medication. The Care Team will encourage you to use the restroom and set up your preferred environment in your private treatment bay or room. Some patients like reduced lighting, for example, while others don’t request light adjustments. You’ll complete a depression scale before each treatment session. Your Greenbrook provider will confirm that the dose kit is yours, show you how to administer it, and then hand it to you. Each sprayer contained 28mg of Spravato esketamine nasal spray. Patients usually start with two sprayers (56mg) and soon increase to 84mg (three sprayers) per treatment. But, your dosage maybe vary. Should you be left with a metallic taste by the spray, the Care Team will offer suckers to help make the flavor dissipate. After your dose, you’ll be encouraged to lie back in your comfortable recliner. While most patients enjoy a quiet setting, Greenbrook is prepared to accommodate patients with a more animated reaction to the medication. You may feel sleepy, dizzy, mildly dissociated, and/or nauseated during treatment. Greenbrook's Care Team is readily available if you need assistance. How to Prepare for after your Nasal Esketamine Treatment Most side effects begin to wane in the second hour of observation, but if you’re wondering, “Is it safe to drive immediately after nasal esketamine treatment?” the answer is a resounding no. In addition to the mandatory ride home, you will need to block off time to rest and let side effects fully dissipate. This extended rest period is especially important in the first weeks of treatment when you’ll have treatment twice a week. Do not drive or operate machinery of any kind until the day after treatment. Just take it easy, relax, and take care of yourself. If you’re unsure what activities you can do or should avoid during this time, talk to your Care Team for more information. While side effects tend to dissipate completely after a good night’s sleep, many nasal esketamine patients begin feeling relief from depression symptoms within hours of their treatment. Other Tips in Preparing for Your Nasal Esketamine Treatment At Greenbrook, we make every effort to schedule your treatment in the afternoons or whenever it is most convenient for you. We encourage you to see each treatment session as an opportunity to relax and take care of your mental health. If you have any questions or concerns, talk to your doctor or the Greenbrook Care Team. At Greenbrook, we’ll help you feel at ease when preparing for each treatment session. Schedule A Free Consultation To get started with nasal esketamine, schedule your free consultation today.
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