Depression and anxiety in midlife and later life

Is it depression, or just this stage of life?

Depression and anxiety in midlife and later life are real conditions, not an inevitable part of getting older. The National Institute of Mental Health (NIMH) notes that many people adjust to the changes that come with age, such as illness or the loss of someone close, but that when feelings of grief, isolation or loneliness persist, they can lead to depression and anxiety. NIMH is equally clear that effective treatment options exist for older adults.

The difficulty is that the symptoms overlap with things people expect at this age. Poor sleep, low energy, aches, forgetfulness and losing interest in things can each be put down to stress, hormones or getting older. Sometimes that is right. But when the change is steady, lasts for weeks and is narrowing your life, it is worth asking whether depression or anxiety is part of the picture.

How depression can look in your 40s, 50s and 60s

NIMH describes some ways depression tends to differ by age. Middle-aged adults may have more depressive episodes, reduced sex drive, middle-of-the-night insomnia or waking early in the morning, and they often report stomach problems. Those are easy to treat as separate complaints rather than as one picture.

Midlife also stacks pressures on top of one another. You may be caring for aging parents and for children or young adults at the same time, carrying the most responsibility at work, or watching the house go quiet as children leave. Our pages on the midlife transition and the empty nest look at those shifts in their own right.

How depression and anxiety can look in later life

In older adults, NIMH notes, depression may show up as sadness or grief, but also as less obvious symptoms, including a lack of emotion rather than a low mood. Older adults are also more likely to have medical conditions or pain that cause or contribute to depression, and in severe cases memory and thinking problems can be prominent. That last point matters: trouble concentrating or remembering is not always the start of dementia, and it deserves a proper medical look rather than a shrug.

NIMH's list of signs to watch for in older adults includes changes in mood, energy or appetite; feeling flat; sleeping too little or too much; restlessness or increased worry; irritability; ongoing aches or digestive problems; misusing alcohol or drugs; hopelessness; and thoughts of death or suicide. Anxiety in later life often attaches itself to health, money, family and the future. Our Tryon page on anxiety in retirement goes into those worries in more detail.

• Losing a spouse, siblings or close friends, sometimes several in a short space of time.
• Retirement and the loss of structure, purpose and daily company that work provided.
• Chronic illness, pain or reduced mobility, and the medications that come with them.
• Caring for a spouse with a serious illness such as dementia.
• Loneliness and isolation, especially after a move or the loss of a driver's license.

Why it so often goes unnoticed

The World Health Organization (WHO) says mental health conditions among older people are often underrecognized and undertreated, and that stigma can make people reluctant to seek help. WHO estimates that in 2023 about 14.75% of adults aged 70 and over were living with a mental disorder, most commonly anxiety or depression.

WHO names several risk factors in later life: bereavement, reduced income or sense of purpose at retirement, declining physical ability, ageism, and caring for a spouse with a chronic condition. It singles out social isolation and loneliness, which it says affect about a quarter of older people, as key risk factors, and reports that meaningful social activity can improve mental health and reduce depressive symptoms.

Many people in their sixties and older also grew up at a time when talking about mental health was not done. Some worry that saying they feel low will be taken as weakness, or that a doctor will simply add another pill. Saying it anyway is often the turning point.

What helps

NIMH suggests a primary care provider as a good place to start: they can check whether a medical condition or a medication is contributing, and refer you to a mental health professional. Bring a list of everything you take, including supplements, since some medications can contribute to depression symptoms.

Talk therapy helps people of every age. The research-supported approaches described in therapy for depression and anxiety are not limited to younger adults, and interpersonal therapy in particular was built around the kinds of changes that dominate these years: role transitions, grief and shifts in relationships. If medication is part of the conversation, see therapy, medication or both.

Connection is part of treatment, not an extra. Reconnecting with friends, joining a group, volunteering or taking a class can rebuild some of the daily contact that work, children at home or a late spouse once provided. For loss specifically, the grief and loss section and its page on losing a spouse or partner may help.

Counseling with Laura Bass

Laura Bass is a psychotherapist in Charlotte, North Carolina, who works with adults, and depression, anxiety, grief and life transitions are among the concerns she sees. She works with the whole person, mind, body and spirit, and many people at this stage of life find that questions of meaning and purpose are part of what they want to talk about. She does not prescribe medication; that stays with your physician. You can read about individual counseling or contact Laura to ask how she works.

If you or someone you love has thoughts of suicide, call or text 988 at any hour. In an emergency, call 911.

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