A child’s falling grades, a young adult’s sleepless nights and a middle-aged parent’s exhaustion can be understandable responses to life’s pressures. They can also signal that ordinary stress has become a mental health problem.
“The difference often lies in how long symptoms last and whether they interfere with daily life,” explains Dr. Rachna Raisinghani, chief of psychiatry at Greater Baltimore Medical Center and medical director of consultation services at Sheppard Pratt Health System.
A warning sign may be a “persistently sad mood beyond the regular ups and downs of life,” she says, or anxiety that leaves someone unable to function or enjoy familiar activities.
Dr. Marilou Tablang-Jimenez, chair of psychiatry at MedStar Montgomery Medical Center, also points to changes in sleep, appetite, energy and concentration. Someone accustomed to seven to nine hours of sleep may suddenly get only four to six because troubling thoughts keep the person awake. Another may spend 12 hours in bed.
Mental health pressures change from childhood through older age. Families should notice symptoms too easily dismissed as growing pains, everyday stress or a normal part of aging. Supportive relationships, consistent routines and timely help can keep problems from worsening.
When “just a phase” is more
Children and teenagers often struggle to recognize or explain emotional changes.
“Young people are often not adept at recognizing any changes in emotions,” Raisinghani cautions. Even when they recognize them, they may have difficulty communicating what they are experiencing.
What adults brush off as school stress or developmental change may be “something more concerning brewing underneath,” she says.
Tablang-Jimenez adds, “Families should watch for sudden changes in their behavior,” including declining school performance, social withdrawal, persistent sadness or irritability, and changes in sleep or appetite.
Young people may face academic pressure, learning difficulties, bullying, family conflict or trauma. “Social media creates opportunities for connection but has also amplified comparison, cyberbullying and unrealistic expectations,” Tablang-Jimenez says.
She recommends stable relationships, consistent routines and communication without immediate judgment or punishment.
“There’s no perfect parent,” she says. “Children thrive when they feel heard, valued and safe.”
Technology limits and physical activity can also pull children away from screens and help them connect.
The unsettled years of young adulthood
Leaving home can bring excitement and uncertainty.
Raisinghani says most young adults need time to adjust. But continued struggles may signal a problem that requires support.
Young adults may face academic demands, tuition bills, an uncertain job market, high rent and questions about relationships and identity. Anxiety, depression, psychosis and substance misuse may also emerge during late adolescence and early adulthood, Tablang-Jimenez says.
She encourages young adults to build healthy coping skills, protect their sleep, seek therapy when needed and choose supportive friends.
“We put this pressure on our adults that they should have life figured out by age 25,” she says. “In reality, uncertainty is the norm.”
Work, family and the sandwich years
In midlife, responsibilities can arrive from every direction.
Adults may be raising children, helping aging parents, managing a marriage, paying a mortgage and saving for retirement while facing health problems.
Raisinghani describes it as a “double squeeze.” Adults are caring for younger and older generations while also serving as breadwinners.
“It just creates an enormous amount of pressure,” she says. “There is very little room to fail for most adults at that stage.”
Tablang-Jimenez says caregivers should resist carrying the entire burden. Siblings can divide responsibilities according to time, money and ability.
“You need to be talking to each other and making sure that you understand what each one of you can contribute,” she says.
Adults also need to preserve friendships, make time for partners and treat sleep as essential.
“If the kitchen is not clean after the kids have gone to sleep, don’t worry about it,” Tablang-Jimenez says. “It’s still going to be there.”
Hormonal changes during perimenopause may cause sleep disruption, mood changes, anxiety and trouble concentrating. They can also worsen existing mood or anxiety disorders, Raisinghani says.
She compared the experience to “trying to step on the gas, but your car won’t go beyond second or third gear.”
“There’s certainly help available,” Raisinghani says, “including medication or hormone treatment when appropriate.”
Mental health in later life
Older adults experience losses including retirement, declining health and the deaths of friends or a spouse.
Depression, however, is not a normal part of aging.
Raisinghani says an older adult who still enjoys others’ company, feels purpose and attends to personal needs may be grieving without being clinically depressed.
Troubling signs include isolation, poor self-care, losing the wish to live or saying one feels “like a burden on others.”
Sadness after a loss is expected, Tablang-Jimenez says, but depression reaches beyond sadness. It can affect energy, concentration, sleep, appetite, motivation and physical health.
“That’s the biggest myth,” she says. “Depression is a normal part of aging. It is not.”
“There are very energetic 70-year-old people playing pickleball, 75-year-olds who are traveling all over the world,” she says. “Depression is not a normal part of aging.”
Retirement can bring strain and satisfaction. Someone leaving a fulfilling career may look back with “a sense of satisfaction and gratitude,” Raisinghani explains, while still needing “something new that defines them.”
At every age, connection is one of the strongest protections.
“A sense of belonging and purpose supports mental health,” Raisinghani says. “Positive relationships create a sense of community and buffer against life’s challenges.”
When someone appears to be struggling, she recommends being “nonjudgmental and supportive,” describing the changes observed and offering to listen.
Thoughts of suicide are always a red flag. When safety is in question, Raisinghani says, “it is always better to seek help.”
Mental health challenges are part of the human experience, Tablang-Jimenez adds, not a sign of weakness.
“None of us are immune to stress, loss, anxiety or sadness,” she explaines. “There’s no vaccination for that.”
“Healing begins when we reach out, stay connected and allow others to help carry the burden.”
