This Doesn't Look Like Depression. But It Might Be | Perimenopause & Depression | Michaela Kozlik, LCPC | Chicago Illinois
- Michaela Kozlik
- Apr 19
- 10 min read
Updated: Apr 30
You don't think of yourself as depressed.
Depressed people stay in bed, they can't function. Depressed is visibly falling apart in ways other people notice and worry about.
You are doing none of that. You are showing up, getting things done. Managing your life, your work, your family, your obligations.... all of it, every single day.
You just don't feel anything while you're doing it.
And that's the part that's hard to explain. Not that you're falling apart — you're not. It's more like you're running a pretty convincing version of your own life without actually being inside it. Going through the motions, saying the right things at the right times. And underneath all of it, this persistent flatness that you can't shake and can't quite name and honestly aren't even sure how long it's been there.
You used to feel more than this. You're almost sure of it.
Things used to matter in a way they don't anymore. You used to feel excited about something. You felt alive in a way that right now, no matter how hard you try, you just can't seem to access.
And you don't know when it changed. There was no single moment. It just crept in — slowly enough that you almost didn't notice until one day you realized you've been running on empty for so long you've actually forgotten what full feels like.
That's perimenopause depression. And it is so much more common than most women know.
Why Perimenopause and Depression Are So Deeply Connected
First, the biology. Because you deserve to understand what is actually happening in your body, not just be told that you're struggling.
As I explain in You're Not Losing Your Mind. You're in Perimenopause. — estrogen plays a direct role in the regulation of serotonin and dopamine. These are the neurotransmitters most responsible for your mood, your motivation, your capacity for pleasure, and your general sense that life is worth showing up for.
When estrogen starts fluctuating and declining during perimenopause, serotonin and dopamine fluctuate right along with it. And the result, for a lot of women, is a mood that is lower, flatter, and harder to lift than it used to be.
Now layer on top of that: the sleep deprivation of perimenopause. The chronic stress of midlife, which I go into in What Chronic Stress Is Actually Doing to Your Body. The identity confusion, grief, the relationship strain and feeling of carrying everything for everyone with very little left over for yourself.
What you've got is a perfect storm of conditions that make depression not just possible, but honestly, kind of predictable.
What Perimenopause Depression Actually Looks Like
Perimenopause depression so rarely looks like what we think depression is supposed to look like, and that gap is exactly why so many women go so long without recognizing it or getting help for it.
It doesn't always look like crying. Sometimes it actually looks like not being able to cry at all. Like being weirdly numb, emotionally muted, unable to access the full range of feeling that used to come pretty naturally.
It doesn't always look like not functioning. Sometimes it looks like functioning completely fine on the outside while feeling totally hollowed out on the inside.
It doesn't always look like sadness. Sometimes it looks like flatness. Things that should feel good, don't.
It can look like a lot of things you might not immediately connect to depression:
Exhaustion that never lifts like heaviness in your body that doesn't respond to rest.
Feeling disconnected from the people you love. You're there but not quite there. Present but not really present.
More irritability and anger than usual. Depression in midlife very often shows up as irritability and rage before it ever shows up as sadness. If that's been happening for you, I wrote about it in Perimenopause Didn't Make You Angry. It Made You Honest; the anger and the depression are often more connected than they look.
Anxiety running alongside the flatness. This is another one that catches women off guard. Perimenopause depression and perimenopause anxiety very frequently coexist. The flatness and the panic are living in the same body, sometimes alternating, sometimes both present at the same time. Wired and empty at the same time.
A loss of your sense of self. Feeling like you don't quite know who you are or what you want anymore. This overlaps a lot with the identity stuff I wrote about in Who Am I Now?
Just... not feeling like yourself. This is the many of us experience most often. Not able to put our finger on exactly what's wrong, just a persistent sense that something is off.
Why It Goes Unrecognized for So Long
Here's what breaks my heart about perimenopause depression.
Most women who are experiencing it don't recognize it as depression. And most of the people around them, including, sometimes, their doctors, don't either.
Because it doesn't look dramatic, it gets dismissed as normal aging, the inevitable result of having too much on your plate.... something to push through rather than something to actually treat.
We tell ourselves: I don't have a reason to be depressed. My life is fine. Other people have it so much worse. I should be grateful. I just need to try harder.
And so we push harder, give more, and ask for less. And the depression deepens...
You don't need a dramatic reason to be depressed. You don't need to have experienced trauma or loss or some terrible catastrophe. Perimenopause alone is enough. Actually, it's more than enough. And you deserve support that recognizes that.
What's Underneath It... Because There's Almost Always Something
Here's the other thing worth saying. Because the biology tells part of the story but not all of it.
Perimenopause depression is almost always happening on top of something. Unprocessed grief I wrote about in Grief and Perimenopause — Why So Much Is Rising to the Surface Right Now, years of chronic stress that has depleted the nervous system below its baseline. Trauma that resurfaces when the hormones start to shift — something I go into in When the Past Comes Back: Trauma Resurfacing During Perimenopause. Identity in crisis, relationships that are strained and needs that are unmet.
The depression is real and it is also, very often, pointing at something. Life that has been lived too much on other people's terms.
Treating the depression without addressing what's underneath it, with medication alone, or with surface-level coping strategies, often produces incomplete results. You feel a little better but not really better. The flatness lifts a little but doesn't fully go away. Because what needed attention was never just the biology, but the whole picture.
What Actually Helps
First, please talk to your doctor. A thorough hormonal evaluation is important. For some women, hormone therapy makes a significant difference to mood. For some, antidepressants are a helpful part of the picture. These are real options and they are worth exploring.
And alongside the medical piece consider therapy. Real therapy that goes underneath the symptoms and addresses what's actually driving them.
In therapy we work on:
Understanding what your depression is carrying. The grief, the loss, the years of too much giving and not enough receiving. The things that never got to be said or felt or acknowledged. Getting underneath the flatness and finding out what is actually there.
Nervous system work. Depression lives in the body, not just in thoughts and patterns. Learning to work with your nervous system and bring it back toward aliveness rather than forcing or shaming it into feeling better. That' some of the most important work we do together.
The identity piece. So much of midlife depression is connected to our outgrowing of the version of ourselves we've been living as and haven't yet found our way to the next one. That transition needs real space and time and support to move through.
The relationship piece. Depression happens inside your closest relationships and those relationships are both affected by and often contributing to how you feel.
Therapy Intensives for Perimenopause Depression
For women who have been managing and functioning and holding it together while running on empty, sometimes what's needed is something more concentrated and focused
A therapy intensive gives you the time to actually go somewhere and get underneath the the symptoms, to do the kind of deep work that moves things rather than just manages them. Many women describe leaving an intensive feeling more alive than they have in years.
I work with women virtually throughout Chicago and the Chicagoland area — Evanston, Oak Park, Naperville, Wilmette, Hinsdale, Downers Grove, Schaumburg, Glenview, Libertyville, the North Shore and across all Illinois.
Let's Talk
📞 773-343-5005 🌐 inpsychotherapy.com 📧 Michaela@inpsychotherapy.com
📍 Virtual therapy across all of Illinois | therapy intensives serving Chicago & Chicagoland suburbs including Evanston, Oak Park, Naperville, Wilmette, Hinsdale, Downers Grove, Schaumburg, Glenview & Libertyville
FAQ: Perimenopause, Depression & Therapy | Chicago & Chicagoland Illinois
Is depression actually a part of perimenopause or am I just struggling?
Both, and they're not mutually exclusive. Estrogen directly affects serotonin and dopamine — the chemicals most responsible for your mood, your motivation, and your ability to feel like life is worth showing up for. When estrogen starts fluctuating during perimenopause, all of that fluctuates with it. Add the sleep deprivation, the chronic stress, the identity confusion, and the relationship strain of midlife....and depression makes complete psychological and biological sense.
How do I know if it's depression or just perimenopause being hard?
It's usually both. But here's what to look for. Flatness or emptiness that doesn't gp away. Losing interest in things that used to matter to you. Exhaustion that sleep doesn't help. Going through the motions of your life without actually feeling present in it. Increased irritability or emotional numbness. Persistent sense that something is off even when you can't point to a specific reason. If any of that has been hanging around for more than a few weeks, please don't dismiss it. That's worth talking to someone about.
I'm still functioning. I'm still getting everything done. Can I really be depressed?
Yes. And this is so important. Perimenopause depression very often looks like high functioning on the outside and completely hollow or exhausted on the inside. You can be showing up for everyone, getting it all done, maintaining every appearance of a life that is working....and still be depressed. Just because you're not falling apart doesn't mean you're actually okay. If the inside of your experience doesn't match the outside of your life, that gap matters and it's worth paying attention to.
Is perimenopause depression different from regular depression?
In some really important ways, yes. It almost always shows up alongside other perimenopause symptoms like sleep disruption, brain fog, anxiety, and physical changes that make it harder to identify as depression specifically. And it's happening in the context of a major identity transition and real life changes, which means treating just the neurochemistry without addressing everything else often produces incomplete results. The whole picture needs attention.
Can I be depressed and anxious at the same time? Because that's what it feels like.
Yes, and this combination is so common during perimenopause and so exhausting to live with. The numbness and the panic, not caring and the worrying about everything, or the emptiness and the racing thoughts. It feels contradictory and it is also makes complete sense because your nervous system is dysregulated in multiple directions at once. This is something that nervous system-focused, trauma-informed therapy is really well equipped to work with. You don't have to choose which one to address first.
I don't have a reason to feel this way. My life is actually pretty good. What's wrong with me?
Nothing is wrong with you. And this right here is the thing that keeps so many women from getting support for so long. You don't need a dramatic reason to be depressed. Perimenopause alone is more than enough. The absence of an obvious external reason doesn't make what you're feeling less real. It actually makes it more important to understand what's driving it internally.
Could this be connected to old trauma or grief I haven't dealt with?
Almost certainly, at least in part. Perimenopause depression rarely happens in a vacuum. Underneath it, there is almost always something like unprocessed grief, accumulated chronic stress, trauma that resurfaces after many years, needs that have gone unmet for a very long time. I wrote about the grief piece in Grief and Perimenopause and the trauma piece in When the Past Comes Back, both worth reading alongside this one. Treating the depression without addressing what's underneath it often leaves women feeling a little better but not really better.
Should I try medication or therapy, or both?
Really individual question, and worth exploring with both your doctor and a therapist. For some women hormone therapy makes a real difference in their mood. For some antidepressants are helpful part of the picture. For many women therapy, especially therapy that goes underneath the symptoms to address the nervous system, the grief, the trauma, and the identity shifts, is what creates lasting change. A lot of women do best with a combination. I'm always happy to work collaboratively with your doctor.
I've been feeling this way for years. Is it too late?
Never. Please hear that. The women who do the most meaningful work in therapy are not always the ones who caught it early. Sometimes they're the women who carried it for years and finally, in perimenopause, decided they were done just managing it. However long you have been feeling this way is exactly how long this support has been waiting for you. It is not too late. It's actually exactly the right time.
Would a therapy intensive help with depression specifically?
Yes and for women who have been living with it for a long time, it can be especially powerful. A therapy intensive gives us the time to actually get underneath the depression and do the kind of deep work that moves things rather than just manages them. A lot of women describe leaving an intensive feeling more alive than they have in years.
How do I get started?
Just reach out. We'll have a free consultation call and talk about what's been going on and what might actually help. You don't need to have it figured out before you call. That's literally what the consultation is for.
📞 773-343-5005 🌐 inpsychotherapy.com 📧 Michaela@inpsychotherapy.com
Michaela Kozlik, LCPC — Licensed therapist in Illinois specializing in trauma, , anxiety, depression, grief, and nervous system regulation for women in perimenopause and midlife transitions. Offering individual therapy and therapy intensives virtually throughout Illinois.
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