Type 3 Midlife Crisis: Depression

In "What Do You Mean There Are Four, or Five, or Six Types of Midlife Crisis?" we argued that since the 1970's, pop culture has muddled midlife psychological events by describing several different issues as "midlife crisis." One of those bits of the midlife crisis soup is more properly characterized as depression.

This table shows all the types of midlife crisis. THe third, depression, has a severe impact on the victim, but it is unrelated to middle age, one's own aging, or fears of one's mortality:

The executive who withdraws into a shell after losing their job or someone who feels worthless and adrift after a divorce could well be suffering from depression. But job loss and divorce are not unique to midlife -- they could also happen to someone suffering the same blows earlier or later in life (in fact, it may impact the younger person more severely, since some research indicates that middle aged and older people suffer less depression than the young).

There is significant overlap between depression and the what most people think of as "midlife crisis." Identifying the cause of the problem -- is it really that one is running out of time, or is it something else? -- helps zero in on treatment options.

Major Depression 101

Major depression affects mood and enjoyment to the point that life activities and relationships are negatively affected. Friends, family, and work may all be neglected. A depressed person exhibits some -- but not necessarily all -- of these symptoms:

• ongoing sadness, hopelessness, helplessness, pessimism
• loss of interest in once enjoyable activities
• lack of energy
• inability to focus or make decisions
• unusual sleep patterns
• unusual appetite / weight changes
• ... and more (see the (U.S.) National
  Institute of Mental Health website for a more complete list)

There is disagreement over whether depression is more common in women. Tradition has it that twice as many women as men suffer from the illness, but others argue that men don't report it, don't seek help for it, and when they do, it's under-diagnosed.

An article in Psychology Today says that many men mask depression with risk-taking behaviors that fit the midlife crisis stereotype, such as gambling, womanizing, or acts of daring.

The Role of Triggers

These symptoms rarely appear out of the blue. NIMH says that "... a serious loss, difficult relationship, financial problem, or any stressful (unwelcome or even desired) change in life patterns can trigger a depressive episode."

A crucial trigger, especially in men, is job loss. Surveys show that for many, work takes a central place during midlife. A career setback -- especially if one has been on the "fast track" -- can be a major life event. This is worsened by the loss of a significant part of one's social network and a negative change -- real or perceived -- in one's place in peer groups. This triple whammy can send someone into a tailspin.

According to a recent roundup of research on midlife issues, other events that might trigger depression include:

"... Marital separation or divorce elevated the risk of depression, although these effects were greater for men. The unemployed had higher depression than the employed and homemakers. ... There were gender differences in that for men, work and finances had the most important associations with depression, whereas for the women, health and family relationships along with work and finances all contributed to depression."(1)

Who Gets Depressed?

Most people suffer from major depression at least once in their lifetime. One study even found that in the prior year, 14.1% of subjects met the DSM-III-R standard for major depressive disorder (although -- perhaps using a different standard -- the CDC reported that in 2005, 4% of persons 45-54 had severe psychological distress of any type).

Despite what "everyone knows," depression is not more or less prevalent among the middle aged than younger or older people. One summary of the "state of the art" reported that "Nor does one find in rates of depression, suicide, career change, or divorce any evidence of increased personal upheaval during the supposed early 40s "midlife crisis" years." Focusing on men only, authors of another overview wrote "In an earlier study, it was discovered that divorce, job disenchantment and depression occurred with approximately equal frequency throughout a man's adult years." Other research even indicates that midlife is when depression is least likely to occur.

Depression is not evenhanded. At the individual level, some people are more prone to it than others. Not everyone gets depressed if their career plan falls apart, or their spouse leaves them, or if their business fails. One investigator found that "... a substantial part of of individual difference in risk of major depression is the result of different reactivity to stress."(2) People who, for whatever reason, are psychologically prepared to deal with trigger events will often get through them without suffering from depression.

More broadly, NIMH identifies "a combination of genetic, psychological, and environmental factors" as sparking the onset of depression.

Recent research also implicates medical illnesses, such as heart problems, as a cause of depressive disorders.

Treatment

The first stop for anyone who thinks they might be suffering from depression is a general practice physician, who can test for medical problems that have similar symptoms.

If you're reluctant to talk to a doctor about the possibility you're suffering from depression, take a (legitimate) online test such as this one from the National Mental Health Association. This objective measure may convince you to take the next step and contact your doctor.

If your physician diagnoses you with depression, there are a variety of medical and psychological treatments that have been proven effective at treating depression; it is up to the patient to work with their doctor to make an informed decision about what the mix should be. That's beyond our scope, but the NIMH website is an excellent jumping off point for further investigation.

Analyze Yourself

Our point is not to argue that "all midlife crises are really major depression," but to help anyone suffering through a midlife crisis get specific about identifying root causes. Sometimes the cause will really be tied to your time left on earth, or a mismatch between what you hoped to accomplish and have done; but often there is something else -- something very specific -- that's really the problem. If you can zero in on that, you've made a good first step through the tunnel to the other side.

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Offline Sources

(1) "Development in Midlife" by Dr. Margie Lachman, Annual Review of Psychology 2004, p305.

(2) "Age and Depression in the MIDUS Survey," Kessler, et al, in "How Healthy Are We?"