Cecilia Ford Ph.DCecilia 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 counsels a 47-year-old woman with a good job who has “no joy in life.”



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Dear Dr. Ford:

I think I am depressed.  I wake up tired every morning and dread getting out of bed. I seem to have a cloud between my ears instead of a brain. I am 47 and still have regular periods. My life has not changed in any way.  I work 12-hour shifts as a RN in a nursing home where my job is secure and I am treated well. I like the patients and their families.  But lately, I don’t have any joy to share.

I am not married.  My parents are both retired and live across the country. Neither they nor I have the money to see each other more than every two years.

I am gaining weight, eating a lot at work, and when I am not working, I don’t want to do anything but watch television.  I saw my GP and he said that my blood tests were normal, except that my diabetes tests and cholesterol were both much higher than they were two years ago, when I saw him last. I don’t know how to get off the living room couch and get my old life back. By the way, my mother had depression that started when she was in her 40s, and she is still on medication that makes her a zombie.  Do you have any advice for me?



Dr. Ford Responds:

Dear Phyllis:

You are indeed suffering many of the symptoms of depression. There are several factors that may have predisposed you to this: your age, 47, usually coincides with perimenopause, which often precipitates mood changes. A second important factor is your family history. Since your mother’s depression began in her 40s, it may be that you are predisposed to this fate because of inheritable factors. It also may be that you have inherited a tendency for these two factors to interact.

This biological view of depression is in ascendance these days, as are pharmaceutical treatments, but psychological precipitants should not be downplayed. Though you don’t report any major changes or sad events in your life, there is “no joy.” Often what can be satisfying at one stage of life looks less so as we get older. Aging can cause us to reorder our priorities; unconsciously or consciously, it sets in motion a process of re-evaluation that the researcher Daniel Levinson detailed and was further described in Gail Sheey’s Passages.  Sometimes people will make career changes or other major life decisions as they move from one life stage to another. Perhaps you are, as a single woman, feeling concerned about aspects of your future as you anticipate some of the challenges of growing older and you watch your parents face the end of their lives.

It may not be clear what is brewing or why, so your first stop should be to consult with a psychotherapist to sort out what’s causing your unhappiness and how best to treat it. Many find that the simple act of beginning therapy and reaching out to someone energizes them enough to begin also making important lifestyle changes that are very difficult to make when you are weighted down with the heaviness of depression—or have a “cloud between your ears,” as you so aptly put it.

For example, it has been well established that exercise works as an antidote to depression, and in your case it would help with your general health as well. However, depression undermines not only the energy it takes to start a new exercise program but also the hope that it will make a difference. Similarly, it would help if you weren’t “isolating”—staying in and watching TV alone. When we’re in a depressed frame of mind, we often don’t feel that others want to be around us, and in any case, “the cloud” prevents social activities from being rewarding.

You and your therapist may decide that a short-term course of anti-depressants is warranted. Though you may be understandably wary of using drugs because of your mother’s experience, there have been many advances in this area recently. If you go to a well-respected psychiatrist with psychopharmacology training (NOT your GP), he or she can help you find a drug that targets your particular symptoms, with an idea of keeping on the drugs long enough for your mood to improve and for you to establish some new healthy pattern that will become lifelong habits. After those habits and positive changes are in place and your mood has lifted, many find they can taper off the drugs within six months to a year.

It is true that many people chose to stay on antidepressants for longer. There are those who realize that they have been chronically depressed and that they never really felt quite right until they started this kind of treatment. Others suffer from resistant or recurrent depression. Some people continue to take antidepressants longer than necessary, afraid that if they discontinue they will become depressed again. It is important that the administration of the drugs be handled by a specialist with mental health training, someone who understands the nuances of these issues. All too often, however, GPs and internists write these prescriptions, and patients are left to themselves to make these important decisions.

Studies have shown that the most powerful and effective approach to treating depression is a combination of psychotherapy and psychopharmacology. But left untreated, depression is dangerous: A study at Washington University reported that on autopsy, the brains of depressed subjects had atrophy in the hippocampus region. and the longer and more frequent the depression, the more damage was visible (Sheline, et. al). Also, the less treatment people get for their symptoms, the more likely that they will recur in the future. (See Peter D. Kramer’s book Against Depression, which also includes a comprehensive discussion of the research and of the importance of adequate and swift treatment for depressive disorders.)

So, Phyllis, you are facing a serious health issue that I recommend addressing right away. Equally important, though, is the question of quality of life: even though your life is tolerable, there is no “joy,” as you said. That is a state that you should not accept.  You have many years ahead of you, and perhaps this pain is a wake-up call warning you that things need to be reappraised and reshuffled for the future. If you can get through this—and you can—you may find there is a more satisfying way of living ahead.


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