Dr. Cecilia Ford, who has been a psychologist in private practice in New York City since 1987, has addressed emotional issues for us in many articles over the years. This week, she takes up a perplexing issue: Why is this woman depressed, when she acknowledges that she has “no clear reason to be depressed”?

 

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Dear Dr. Ford:

I think I am depressed, and I don’t have a clear reason to be depressed. My mother had depression with menopause and used medications with terrible side effects (she gained a lot of weight and seemed absent emotionally a lot of the time).  I always feared that this would happen to me.  I did have a bout of postpartum depression but it didn’t last long and I never saw anyone for treatment. I am 48 and have two children just out of college.  I haven’t worked “outside the home,” as doctors describe it,  since I had my first child.  I was a teacher then.

My marriage is fine. We are lucky, I know, to be middle class and have no debt and no real worries.

My mood began to change after my menstrual cycles began to change. I still have a period every six to eight weeks.  I became more volatile, needed more sleep, and, for no reason, would sink into an emotional pit: feeling hopeless, having trouble concentrating, and not knowing how to climb out of the pit.  I have friends and I go to church, but it is harder and harder for me to be around people. It just takes too much effort. 

My GP offered to give me Zoloft.  I read about the side effects and was too frightened to start it. I live about 30 minutes from a city with access to therapists.  I know I need to do something.  I just don’t know what to do.

Jenny

 

Dr. Ford Replies:

Dear Jenny:

It’s not uncommon for depression to set in without a clear reason, though your letter does give us some clues. For one thing, you mention that your mood darkened around the same time that your menstrual cycles changed. Also, you say that you suffered briefly from postpartum depression.

Finally, you write that your mother suffered from similar symptoms around this same time in her life.

It’s possible that you inherited from your mother a predisposition to be particularly sensitive to changes in hormonal levels. All women react with mood swings to major hormonal changes, and a smaller group of those women go on to develop clinical depression as a result.

It is very important that you pay attention to your symptoms and get help. Evidence has shown that the longer depression goes untreated, the harder it can be to reverse. Furthermore, untreated depression, even if it remits spontaneously, increases your likelihood of recurrence.

First, make an appointment to see a therapist in your nearby city.  He or she will need to evaluate with you whether or not therapy and/or medication are indicated. I know you are wary of medication because of your mother’s experience and what you have read online. Since your mother was your age, however, there has been a revolution in psychopharmacology, and the drugs available to treat depression are more varied, targeted, and free of serious side effects. Also, while there are mild side effects to some antidepressants, there are many different choices, and not everyone reacts the same way to these drugs.

Finally, it is never a good idea to put much trust in what you read online about medical issues. The opinion of a trained professional who has evaluated you personally is what you should pay attention to.

Once you have found a therapist, check to see whether he or she works with an M.D. if medication does turn out to be indicated.  Meanwhile, sometimes just taking the action of making an appointment is enough of a start to cause a small lift. If possible, do anything else you can do to make contact with other people and get outside the house (preferably outdoors). Until you start feeling better, try to force yourself to go through the motions anyway. Research has shown that “acting as if” you feel a certain way (e.g., happier, more sociable) can actually result in making you feel that way. If you are able to sleep through the night, go to bed early enough so that you can get up at the same time every morning and take a walk. If your husband or a friend can walk with you, even better.

Jenny, like your mother before you, the physical demands of being a woman and mother have taken a bigger toll on you than on the average person. The journey from menarche to menopause is fraught with pitfalls, but for women with your predisposition it can be especially treacherous. Nevertheless, you can definitely overcome your depression if you take the necessary steps. Also, it sounds as if you have led a successful, rewarding life nurturing and raising children as a mother (and a teacher before that). Perhaps more than most of us you know the secret paradox expressed by the early 20th century dancer (and free spirit) Isadora Duncan: “With what price we pay for the glory of motherhood!”