Depression?

Q:  Can you please tell me why I feel so lonely and unfilled most of the time? I have been married for almost 26 years. I know my husband loves me, but I feel like I have been married all my life (I married at 19). I am now 45; my husband is 47. My three children are in college, and we have one adopted son who is 11.

My husband practiced dentistry for 21 years. He returned to school and is now a minister, pastoring a very small church. He used to work long hours and was not home much, but now he is home too much and there is just too much togetherness. I do painting for pleasure, I have friends and I do some of my own activities but it is a different lifestyle than we had. I do not want for anything, but I keep looking for something that I do not have. I am dreadfully bored, and I have migraine headaches.

I am approaching menopause and I am wondering if I am depressed. What are the symptoms? I do not feel as if I am depressed. I feel just unfilled. I act like I am happy, but this is because I know as a minister's wife, I am supposed to act like that. I think I do not love him anymore. I find myself sometimes wishing he would find someone who wants to be a good minister's wife. I do not. There are times that I get so tired of pretending, and I am tired of being married to my husband, but my church does not believe in divorce.

My husband does not sense that anything is wrong with our marriage. I am laughing on the outside, and crying on the inside. Lovemaking, who needs it? Again, I pretend. Please, any suggestions? There are likely more women out there like me who just do not want to admit it. One last thing, if he thinks something is amiss, he tries hard to please me and this just disgusts me more.

A:  You express yourself well, so well that anyone reading your letter can feel the pain and frustration you're experiencing. You sound trapped in your own life, in what some people might call a "mid-life crisis."

Jokes about men going through this stage are common (e.g. buying the Porsche and having an affair with the young secretary), but I agree with you that there are many women as well who find themselves confused and emotionally empty. Women just tend to be more private about their inner turmoil and restrained in their outward actions.

Your question is not strictly medical, so there is no easy answer. We're not talking about a remedy for cold sores, but the complex interaction of your own mind, body and soul and your relationship to your husband. In your case particularly, you can't simply go to your pastor for counseling!

Often people in a similar situation will start with their primary care physician who can help determine if there is an underlying medical reason for feeling tired (e.g., underactive thyroid), having mood swings and decreased sex drive, or new headaches (a brain tumor is unlikely but possible).

Although you say you don't feel depressed, depression is a possibility which is very treatable. Here are some of the warning signs:

• Less enjoyment from usual activities
• Disappointment with self
• Hopelessness
• Irritability
• Difficulty sleeping
• Dissatisfaction

About 90% of people suffering from depression will answer yes to these symptoms. In a recent study, women reported self-disappointment with the greatest frequency, while men most often reported dissatisfaction and difficulty sleeping.

I suggest that you start with a good medical exam and also request referral to a good psychotherapist as soon as possible. You can do something to get your life back. Please write back and let me know what happens.

"Dear Doctor" is a compilation of patient questions answered by doctors from the Medical College of Wisconsin.