In this era of advanced medical detection and intervention, the medical care of patients and the reduction of mortality for life threatening illness has never been greater.  Against this backdrop of success, however, what is often overlooked by professionals, family, even patients, is the experience of medical illness as psychological trauma.

• While some efforts like the emerging field of Psycho-oncology are starting to address the totality of the patient and the American Psychiatric Association now officially considers “ being diagnosed with a life –threatening illness” a potentially traumatic event, it is perhaps most important that patients and families understand why and how medical illness often brings with it- anxiety, anger, depression, panic and post-traumatic stress symptoms.
• Understanding, normalizing and validating common stress reactions can demystify and lower anxiety at a time when so much feels beyond understanding or out of control.
• Given that the experience of trauma is a function of many variables including age, nature of trauma, duration and personal meaning, people will differ in their psychological response to medical illness.
• Some may experience a few symptoms which abate within months, others will deal with a delay in the experience of depression or anxiety until well after the medical crisis, and for others the persistence of emotional distress may warrant professional help.

Given that there are now 81 million baby boomers in this country ranging from ages 46 to 66, there are many people navigating the transitions of midlife. When you add to that the fact that 80% of the male boomers and 77% of the females are married the journey gets more complicated.

Amazon lists over 2,000 books dealing with midlife with titles as different as Awakening at Midlife, Midlife Meltdown, Thinking about Tomorrow: Re-inventing Yourself at Midlife, How to Survive Your Husband’s Midlife Crisis, Midlife Crisis For Men: Male Menopause, My Favorite Midlife Crisis etc. The message is that against the backdrop of mortality and a story half told, men and women navigate their midlife passage in different ways with different challenges and different needs. When married, the impact they have on each other is inevitable.

Suicide ranks as the eleventh leading cause of death in the United States. We have lost loved ones across the generations.

• Older Americans are disproportionately likely to die by suicide. Although they comprise only 12 percent of the U.S. population, people age 65 and older accounted for 16 percent of suicide deaths in 2004.
• Suicide is the second leading cause of death in college students and the third leading cause of death in adolescents.  Every day 14 teens take their own lives.
•  According to the Centers for Disease Control and Prevention, for the second year in a row, middle -aged adults have the highest suicide rate in the country, surpassing even older Americans.

While there are many factors that contribute to suicide, an important new study identifies two factors that have been associated with increased risk for suicidal thought and behavior across the lifespan – hopelessness and lack of connectedness to others.

Numerous studies have identified exercise as a key factor in reducing depression symptoms. A recent study heightens the argument by finding that as compared to age, race, gender, body mass index cholesterol, blood pressure and diabetes, it was the sedentary lifestyle of a depressed person that alone accounted for about 25% of the risk of heart-related deaths. The message is that we need to move because our lives depend on it!

The problem is that when you are depressed often the last thing you want to do is exercise.

Given the despair, lethargy, self-doubt, exhaustion, disinterest in activities and shame experienced with depression, the suggestion to exercise feels like adding insult to injury. “I’m not exercising because I’m depressed.”

Knowing exercise could help, but feeling unable to do so often adds to the self-recriminations and low self-esteem of depression.  In one case, the more the young woman watched other family members exercise – the less possible it felt.

Depression’s Landscape.

Given the recent discussion of the pros and cons of medications and treatments for depression, it seems clear that people need to have information and treatment options. It also seems important to stack the deck toward feeling better with anything that might work for you. If you have wanted to exercise but find it impossible – here are some suggestions.

Last week the media reported the sad and unanticipated deaths of two men. Derek Boogaard of the Rangers died from an accidental overdose of the drug oxycodone mixed with alcohol and retired lieutenant, John A. Garcia, a 23-year veteran of FDNY who not only responded to 9/11 but responded and lost two of his men in the Deutsche Bank Fire. died by suicide.

One can’t help but wonder if the tragic deaths reflect the danger of hidden depression in men.  Increasingly we have become aware that although women are twice as likely to be diagnosed with depression, many men, beyond the 10-17% diagnosed, may also be suffering with depression.

Depression May Be More Deadly for Men

What makes depression in men so dangerous? It too often goes unrecognized and untreated because it is masked by physical complaints, substance abuse, anger and other stealth symptoms.