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Understanding Midlife Depression

April 05, 2017

The first episode of mood disorders like bipolar illness and major depressive disorder typically occurs in adolescence or early adulthood. However many adults in their 30s, 40s, 50s or older begin to struggle with depression in new ways as an older adult.

Medical problems and the losses we experience as we age can affect how we view ourselves and how we relate to the world around us. These changes can affect our mood and mental health.

Common Causes of Depression in Midlife

Depression can be caused by many life situations, some of the most common being medical problems, personal losses, changing relationships with children and parents. These can affect how we view ourselves and relate to the world around us. 

Common Causes of Depression in the Elderly

Signs & Symptoms of Midlife Depression

For adults with a mood disorder, symptoms of depression are more than just a “midlife crisis.” More than behavior that seems age-inappropriate or “feeling low,” a person with depression can feel sad, have low energy and motivation, lose interest in activities and social relationships, and have trouble sleeping. These symptoms may be disabling and affect a person’s ability to work or function day-to-day. Most concerning, sometimes those symptoms can result in thoughts about suicide.

How To Get Help For Depression

Some adults never received a diagnosis or treatment during earlier episodes of their illness. Their symptoms or behavior may have been attributed to something else, like a rocky transition to college, a stressful job, or a turbulent relationship.

For these adults, the comprehensive diagnostic process we implement at Skyland Trail is critical to an accurate diagnosis. We take a deep dive into each patient’s family and medical history to get a clear picture of his or her symptoms and mood episodes over time. If a person ever has had one manic episode, the diagnosis is likely bipolar illness, which necessitates a different treatment approach and medication strategy than unipolar depression. A thorough diagnostic interview can bring new information to light and improve treatment outcomes.

Psychiatric Assessment

If we discover that a patient does not have a history of depressive or manic episodes, the thorough medical diagnostic exam patients receive in our wellness clinic becomes very important. If a person has a first mood episode after age 40 (i.e. no prior depressive or manic episodes), it more likely is linked to a medical illness like hypothyroidism or pancreatic cancer. We conduct specialized lab tests and may recommend additional testing - like head imaging, a sleep study, or an electroencephalogram (EEG) - to rule out common medical illnesses and to help patients seek appropriate treatment when necessary. We find that 8 to 10 percent of Skyland Trail patients have some underlying medical problem that could cause or contribute to their depression.

underlying medical problems can cause or contribute to depression

Other patients have managed a diagnosis like bipolar illness or major depression for many years – perhaps successfully - but a major life change or loss may precipitate an increase in their symptoms.

While we hopefully gain experience and deeper relationships over our lifetimes, we also have to cope with aging and loss. We may lose physical qualities that challenge how we perceive our strengths or value. We may lose important relationships through death or divorce, or lose jobs that helped us define our worth to our community or family. Any of these significant events can lead to an increase in symptoms or affect someone’s ability to cope effectively with negative thoughts and low moods.

Fortunately treatment for depression can be very effective. Combined with appropriate medication, Cognitive Behavioral Therapy (CBT) is the best evidence-based treatment for depression. And, as compared to younger adults, older adults often find CBT concepts easier to grasp and use successfully.

With guidance from our CBT experts, our clients can learn new coping skills and re-evaluate how their thoughts, mood, and behaviors are connected. Over time, patients learn how, by changing one, they can affect the others. For example, consider the process for coping with losing your job. If you can accept the loss and refocus your thoughts on potential new opportunities, you may be able to improve your mood and find more motivation for taking steps toward that new goal.

CBT for Depression

How TMS Can Help with Treatment-Resistant Depression

Older adults also can benefit from other proven clinical treatments. While some older adults may have tried several medications without relief, there are some classes of medications often not used with younger adults that may be appropriate. Augmentation strategies – adding a supplement or a stimulant – may also improve success.

For treatment-resistant depression – meaning a person’s depression has not responded to three adequate trials of medications – electroconvulsive therapy (ECT) or transcranial magnetic stimulation (TMS) may be appropriate. In fact, more than 80 percent of patients with treatment-resistant depression who receive ECT reach remission. ECT often is under-utilized due to its historical negative stigma, but today’s ECT actually is a very effective procedure with minimal discomfort and side effects.

TMS at Skyland Trail

Residential Treatment Programs for Depression

While much of the current conversation about mental health treatment focuses on college students and young adults, accessing and engaging in an effective treatment program is important for adults of any age. In 2013, the highest suicide rate was among people 45 to 64 years old, and depression is the second leading cause of disability worldwide. These statistics do not have to apply to you or your loved one. Effective treatment is available and healing is possible.

The Skyland Trail South Residence offers our most intensive level of support for adults 25 and older. The campus includes 24 units, each with a private bedroom and bathroom. The South campus also includes a dining room; community living areas;  exercise room; and gardens.

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About Ray Kotwicki, MD, MPH

Chief Medical Officer

Dr. Ray Kotwicki is the chief medical officer of Skyland Trail. Located in Atlanta, Skyland Trail is a nationally recognized nonprofit mental health treatment organization serving adults ages 18 and older. For 26 years, Skyland Trail has been inspiring people with mental illnesses to thrive through a holistic program of evidence-based psychiatric treatment, integrated medical care, research and education.

Before joining Skyland Trail as full time chief medical officer, Dr. Kotwicki served as an associate professor the Department of Psychiatry and Behavioral Sciences at Emory University’s School of Medicine, and as an associate professor at Emory University’s Rollins School of Public Health. He remains on adjunctive faculty at the Emory University School of Medicine, as well as at the University of Miami Miller School of Medicine. Dr. Kotwicki is a Diplomate of the American Board of Psychiatry and Neurology, and has been elected an officer of the Georgia Psychiatric Physicians’ Association. Dr. Kotwicki received his undergraduate and medical degrees from the University of Wisconsin Medical School, and completed post-graduate training at Harvard Medical School, the Boston University School of Medicine, and Emory University, where he also earned a Master’s degree in public health.

This article was originally posted on March 14, 2016.