Anxiety and Mood in Midlife: When You No Longer Feel Like Yourself

'I feel anxious about things that never used to bother me.' 'I snap at the people I love, and I don't even recognize myself in the moment.'

So many Women say some version of these words to me.

A low hum of dread with no clear cause. Wide awake at 3 in the morning with what I call moon-pie eyes, the mind already racing through tomorrow.

A short fuse, rage that comes out of nowhere, and guilt right after. You may snap at someone you love, cry at a commercial, and wonder who that was.

I know the edge from the inside. A voice in me said, 'Everyone in the world is tired. Buck up. Don't be a baby.' That voice kept me pushing through 7 years of symptoms, dressed up as discipline.

I also know how fast the edge can arrive. During the prep for my first SIBO breath test, a single day without anything sugary left me shocked at how irritable and mean I felt. That was chemistry, and it taught me to look underneath the feeling.

I teach anxiety as an alert, and I prefer the phrase 'the sensations of anxiousness', because it describes what the body actually experiences. The sensations of anxiousness are asking you to pause, get curious, and investigate. This chapter is your map for that investigation.

If you are having thoughts of harming yourself or ending your life, please reach out today. In the US and Canada, call or text 988, 24 hours a day. Elsewhere, findahelpline.com lists the line for your country. If you are in immediate danger, call your local emergency number. Both lines are listed in the Resource Directory, and nothing in this book is a reason to wait.

What Can Be Behind It

In Midlife, several of these usually pull on each other at once. When they do, I call it a chemical storm, and a Woman inside that storm can feel like she is losing her mind. Each piece is testable, and each piece becomes workable once someone looks.

Instead of asking how do I calm down, we ask, what is in the way of my calm right now. Is it biology, neurology, or lifestyle?

Low progesterone, the hormone of calm. Your brain turns some of your progesterone into allopregnanolone, which acts on GABA receptors, the same calming receptors many sleep and anti-anxiety medications target. Progesterone is often the first hormone to fall, sometimes in your late 30's, as more cycles pass without ovulation.

When anxiety arrives in your 40's with no reason you can name, your hormones deserve a look before your personality does. 'What Is Actually Happening in Your Midlife Body' goes deeper.

Anxiety that tracks your cycle. Anxiety or rage that builds in the week or 2 before your period and lifts when you bleed points toward low progesterone, PMS, or PMDD, which often worsen in Perimenopause. The Progesterone section of 'What Is Actually Happening in Your Midlife Body' and 'Anxiety, Irritability, and Rage' in 'The Mimics' go deeper.

Estrogen swings. Estrogen supports serotonin and dopamine, the brain chemicals behind mood and reward. In Perimenopause, estrogen can surge and dip on top of an overall decline, so your mood can change from week to week. 'What Is Actually Happening in Your Midlife Body' and 'Hormone Therapy 101' go deeper.

Blood sugar and adrenaline. A blood sugar crash, a third coffee, or the rebound the morning after wine each release adrenaline, which brings a racing heart, shaky hands, and a dread that can feel exactly like panic. If the anxiety eases after a few bites of food, blood sugar is the likely sender of that message. 'Sugar, and the Addiction Nobody Names' goes deeper, and 'Sleep' covers the 3 AM version.

Your thyroid. An overactive thyroid, a dose set too high, or the swings of Hashimoto's, when a thyroid under attack spills stored hormone for days or weeks, can bring anxiety, palpitations, and rage that seem to come from nowhere. A 2018 review in JAMA Psychiatry found people with Autoimmune thyroiditis about 3.5 times as likely to have depression and about 2.3 times as likely to have an anxiety disorder. 'Your Thyroid, In Depth' goes deeper.

Iron and ferritin. Low ferritin looks and acts like depression, and your brain needs iron to make dopamine. Heavy bleeding from low progesterone drains iron month after month, so low progesterone and low ferritin often travel together, and both feel like exhaustion and anxiety. The section on low ferritin in 'Supplements: Test, Don't Guess' goes deeper.

Sleep. Night sweats and the 3 AM wake-up can fragment sleep for years, and a brain running on less sleep has less buffer between a thought and a reaction. 'Sleep: Why It Breaks in Midlife' goes deeper.

Cortisol and your adrenals. A cortisol curve running high can leave you wired, anxious, and unable to wind down, and a curve that has gone flat leaves you tired and wired at the same time. 'Cortisol and Midlife Burnout' and 'Burnout and Fatigue' go deeper.

Stress, and nutrients. Years of carrying a workplace, a household, teenagers, and aging parents in the same week keep your Nervous System braced, and low magnesium, B12, and vitamin D add to the load. 'Stress: The Load Women Stop Noticing' and 'Supplements: Test, Don't Guess' go deeper.

Your gut. When your gut lining is inflamed, the upward signals carry inflammatory information to your brain, and inflammation shows up in the brain as brain fog, anxiousness, low mood, and racing, worried thoughts. 'The Gut, In Depth' and 'Inflammation: The Fire Under Everything' go deeper.

Testosterone and flatness. Low testosterone looks like the 'I just don't care anymore' feeling, and it can quietly turn down the wanting itself. 'What Is Actually Happening in Your Midlife Body' goes deeper, and 'Loss of Zest' in 'The Mimics' gives the pattern clues.

Caffeine and alcohol. Caffeine's average half-life is about 5 hours, and anxiety that peaks the morning after drinking points toward alcohol rebound. 'Sugar, and the Addiction Nobody Names' covers both.

The Emotional Layer. Midlife arrives for many Women as an identity quake, often alongside grief that rarely gets called grief. When emotion has nowhere to go, the body holds it for you, and for many Women that held energy is part of what they feel as anxiety. Jump ahead to 'The Emotional Layer: When Midlife Feels Like an Identity Quake'.

The Mental Layer. Anxious thoughts fall into familiar families: worry, concern, upset, complaint, and criticism. Each time you believe the same stressful thought, your body runs the whole cascade again. Jump ahead to 'The Mental Layer: Your Memory and Your Clear Thinking'.

Depression and anxiety in their own right. In SWAN, Women were 2 to 4 times more likely to have an episode of major depression during Perimenopause and early post-Menopause than in the years before it. Flatness with hopelessness, guilt, changes in sleep and appetite, and loss of pleasure in nearly everything for 2 weeks or more points toward clinical depression, which deserves prompt care. 'The Mimics' walks through each look-alike.

Medication, and the order of operations. 1 in 5 Women aged 40 to 59 took an antidepressant in the last 30 days, often before anyone checked her hormones, thyroid, or ferritin. For some Women, anti-anxiety medication and antidepressants are life-saving and life-giving, and in my view the Physical layer deserves a full look at the same time. Every decision to start, change, or stop a medication stays with your prescriber, and 'The 5 Midlife Crises No One's Talking About' goes deeper.

What Helps

Be a scientist with your own anxiety, and look at every layer before you decide it lives only in your head.

• Track 2 or 3 cycles. When the anxiety or rage arrives, note the time, your cycle day, your last meal, and your caffeine and alcohol in the previous 24 hours.
• Have the progesterone conversation. Taken by mouth at night, micronized progesterone breaks down in part into allopregnanolone, and many Women sleep and settle better on it. Every dose decision stays with your prescriber. 'Hormone Therapy 101' goes deeper.
• Steady your blood sugar. Protein and fat at breakfast, vegetables first at meals, and coffee only with or after food. If you wake in the night with anxiety that eases after you eat, a small bedtime snack with protein and fat, such as turkey with avocado, can carry you through. 'Sugar, and the Addiction Nobody Names' goes deeper.
• Optimize your thyroid and restore your ferritin, after testing. 'Your Thyroid, In Depth' and 'Supplements: Test, Don't Guess' show you how.
• Protect your sleep. 'Sleep' has the wind-down routine and CBT-I, the first treatment sleep medicine recommends for insomnia.
• Inhale deep, exhale long. Diaphragmatic belly breathing, with the exhale longer than the inhale, regulates your Nervous System. Try 5 breaths before a hard conversation, in a waiting room, or awake at 2 in the morning.
• Name the feeling, in 1 word. In brain imaging research at UCLA, putting a feeling into words calmed activity in the amygdala, the brain's alarm center.
• Let it move. Shake your whole body for 2 minutes, stomp-walk down a hallway, or dance to 1 song, and then sit. 'The Emotional Layer' teaches both practices.
• Question 1 thought a day. Byron Katie's first 2 questions: Is it true? Can I absolutely know that it's true? 'The Mental Layer' goes deeper, including the kind Wisdom Voice underneath the critic.
• Supplements, after testing. Magnesium glycinate, L-theanine, saffron, and an EPA-weighted omega-3 each have trial evidence for some Women. 'Stress', 'The Mental Layer', and 'The Emotional Layer' give the evidence, the brands, and the cautions.
• Do not do this alone. A therapist who understands how Perimenopause affects mood, and 1 person you tell the truth to this week. We are not designed to heal in isolation.

If the low mood includes thoughts of harming yourself or ending your life, please reach out today: call or text 988 in the US and Canada, or find your country's line at findahelpline.com.