23 Dec Anxiety, Depression & Nervous System Regulation for Midlife Women with Dr. Kristine Gravino
Anxiety, Depression & Nervous System Regulation for Midlife Women with Dr. Kristine Gravino
If you’re lying awake at night with racing thoughts, feeling that familiar manic energy coursing through your body, or finding yourself constantly overthinking everything—you’re not alone, and you’re definitely not crazy.
As someone who has navigated my own midlife health challenges, from digestive issues to stress-induced nervous system dysregulation, I’ve learned firsthand that what’s happening in our bodies during this phase of life is far more complex than most people realize. That nightly glass of wine you thought was helping you relax? It might actually be making things worse. The constant fatigue, the brain fog, the unexplained anxiety that seems to come out of nowhere—these aren’t character flaws or signs of weakness.
I brought Dr. Kristine Gravino, a PhD psychologist specializing in midlife women’s mental health, onto the podcast because these conversations matter. We need to stop whispering about anxiety and depression and start understanding what’s actually happening in our bodies. Whether you’re considering medication, already taking something, exploring natural approaches, or just trying to figure out if what you’re experiencing is normal, this conversation is for you. No judgment, just real information from someone who has spent 25 years helping women navigate exactly what you’re going through.
Understanding Anxiety: It’s a Spectrum, Not Just Panic Attacks
One of the biggest misconceptions about anxiety is that it has to look like a full-blown panic attack to be legitimate. Dr. Gravino explained that anxiety exists on a broad spectrum—from the person who simply overthinks everything and can’t stop their racing thoughts, all the way to someone experiencing chest tightness and feeling like they’re having a heart attack.
The research is startling: one out of two midlife women struggle with anxiety and depression. That’s not a small percentage—that’s half of us. And here’s the critical piece many doctors don’t explain clearly: this is directly related to decreasing estrogen levels. As estrogen drops during perimenopause and menopause, three crucial neurotransmitters—serotonin, dopamine, and GABA—all begin fluctuating wildly. These are the exact neurotransmitters responsible for regulating mood, anxiety, and depression.
This means your anxiety isn’t just “in your head” or something you should be able to willpower your way through. There’s actual biochemistry happening in your body that’s creating these symptoms.
When Anxiety Crosses the Line from Normal to Problematic
We all need some level of anxiety to function. A healthy amount of worry about your teenager who’s past curfew is normal. Concern about an upcoming work presentation is normal. But when does that normal anxiety become dysfunctional?
Dr. Gravino provided a clear framework: if your anxiety prevents you from sleeping through the night, if you can’t focus on basic tasks, if you’re unable to function in your relationships or at work—that’s when anxiety has crossed into problematic territory. The key indicator is whether your anxiety is impacting your ability to live your life.
One particularly helpful distinction she made was about recognizing physical symptoms. If you’re experiencing chest tightness and trouble breathing that lasts more than 30 minutes, it’s time to seek medical attention. But if you have a history of anxiety and recognize a panic attack coming on, learning to regulate your nervous system can help you move through it. True panic attacks, while terrifying, typically pass within five to ten minutes when you have the right tools.
The Anxiety-Depression Connection: Why They Often Come Together
For many midlife women, anxiety and depression aren’t separate issues—they’re interconnected. Dr. Gravino described this perfectly: when you carry a heavy load for years, feeling anxious for extended periods, you eventually become exhausted. That exhaustion can lead directly to depression.
This isn’t the severe, can’t-get-out-of-bed depression that requires hospitalization. For most midlife women, it manifests as a low-level sadness, an inability to fully enjoy life the way you used to, or a general sense of being tired of carrying everything.
The pattern is similar to what we see with cortisol dysregulation and adrenal fatigue—that spike of high cortisol followed by a crash into exhaustion and sadness. It’s all interconnected: our nervous system, our hormones, our stress response, and our mental health all influence each other constantly.
The Wine Conversation: Hard Truths About Alcohol and Anxiety
This is where Dr. Gravino didn’t sugarcoat things, and I appreciate her honesty. The research is now clear: zero amount of alcohol is actually good for us. That nightly glass of wine many of us have relied on to “take the edge off”? It’s actually increasing anxiety levels, decreasing digestion quality, and disrupting sleep—all of which removes the very tools we need to manage what’s happening inside our bodies.
She spoke from personal experience as someone who once believed that nightly glass of wine was helping her relax, only to discover it was making everything worse. This is a hard truth to hear, especially for those of us who have used that evening ritual as a way to decompress. But if we’re serious about addressing the root causes of our anxiety rather than just masking symptoms, we need to look honestly at what’s actually helping versus what’s creating a temporary illusion of relief.
When Medication Makes Sense (And When It Doesn’t)
The conversation around anti-anxiety medications like Xanax has become complicated. Doctors are much more cautious about prescribing benzodiazepines now because of their highly addictive nature. But Dr. Gravino emphasized that there are situations where medication is absolutely indicated.
If someone is so anxious they can’t shut their brain off, can’t work, can’t function in relationships—that’s when medication can be beneficial. The key is using it appropriately: at a low dose, prescribed by a doctor who’s monitoring you, and ideally as a bridge to help you calm down enough to actually learn and implement other coping strategies.
She made an important point about why medication can sometimes be necessary: when someone is so heightened and anxious that they can’t even focus on learning breathing techniques or cognitive behavioral strategies, they need something to help calm their system down first so they can think straight.
For those looking for alternatives, medications like hydroxyzine (which I personally used during my severe cortisol spikes and hives) can be helpful without the same addiction risk as benzodiazepines. The critical message here is to work with your doctor and be honest about what you’ve tried and whether you’re also working with a mental health professional.
Depression vs. Sadness: Understanding the Difference
Dr. Gravino made a crucial distinction that I think many people miss: there’s a difference between appropriate sadness and clinical depression. If you experience a death in the family, of course you’re going to be sad. That’s grief, and it’s a normal, healthy response that you need to feel and process.
Depression is when that sadness continues and intensifies to the point where three months later, you’re still in bed, unable to shower, withdrawn from everyone. Appropriate grieving means you can still see your family, cry with them, feel the loss, but continue functioning in the world.
Similarly, if your child goes off to college and you feel sad about the empty nest, that’s a normal emotional response to a major life transition. Depression is when that sadness prevents you from working, seeing friends, or engaging with life at all.
The Estrogen Factor: Why HRT Isn’t a Magic Bullet
While hormone replacement therapy can be beneficial for many women (and I’m someone who uses it), Dr. Gravino cautioned against viewing it as a standalone solution. Perimenopause can last almost ten years, and during that time, hormone levels fluctuate constantly—sometimes day to day.
Even women on HRT can still experience anxiety and depression because those serotonin, dopamine, and GABA levels are still moving around. Blood tests only give us a snapshot of one moment in time, not the full picture of daily fluctuations.
This is why a comprehensive approach is essential. You need to look at nutrition, thyroid function, strength training, stress management, and nervous system regulation in addition to hormones. No single intervention works in isolation. And for women who can’t take HRT due to medical history (like Dr. Gravino herself due to a stroke at age 21), all these other tools become even more critical.
What “Regulating Your Nervous System” Actually Means
This phrase has become trendy, but what does it actually mean in practical terms? Dr. Gravino broke it down simply: it means being able to take a moment and become aware of how heightened you are.
Most women don’t even recognize when they’re feeling dysregulated. The first step is simply naming it—even if that means standing in your kitchen on Thanksgiving and saying out loud to the microwave, “I’m overwhelmed.” Just that act of acknowledgment and naming what you’re feeling can be powerful.
When someone is in a state of overwhelm and you tell them to “just calm down” or “take a deep breath,” it often triggers the opposite reaction. But if you change your own behavior—speaking slowly, breathing calmly, showing relaxation in your body—that person will naturally start to mirror you. This is a technique Dr. Gravino uses regularly in therapy, and it’s something we can all use when someone we love is anxious.
The Breathing Technique You’re Probably Doing Wrong
Here’s something that surprised me: it’s not the inhale that calms you down—it’s the exhale. For years, I thought taking that deep breath in was what created relaxation. But Dr. Gravino explained that when we hyperventilate, we’re breathing shallow and building up carbon dioxide in our system, which actually makes us more heightened.
When you take a nice breath in but then exhale for at least three seconds longer than your inhale, you’re releasing that built-up carbon dioxide. That release is what calms your body down.
The technique is simple: breathe deeply into your diaphragm (pushing your stomach out, not just raising your chest), then make sure your exhale is longer than your inhale. Do this consistently, and it builds in your system like medication would—studies have proven this. It literally acts as medicine for your nervous system.
The Bare Minimum Strategy: What to Do When You’re Paralyzed
When you’re feeling completely overwhelmed and paralyzed—and I’ve been there, sitting on the couch unable to figure out what to do next—Dr. Gravino recommends the bare minimum strategy. Don’t try to tackle everything. Just pick one thing:
Mindset: Take two minutes for a mindset check. What’s your self-talk like? What have you said to yourself? Create a simple mantra like “I’ve got this” or “inhale peace, exhale pressure.” Just change one word in your internal dialogue.
Macros: Eat protein-forward. If you can’t think of anything healthy to eat, just make sure you’re getting adequate protein, carbohydrates, and healthy fats. Your brain needs all three to function optimally, especially when dealing with anxiety and depression.
Movement: This doesn’t mean an intense workout. Put cold water on your face. Walk outside. Get two minutes of sunlight. Even just feeling warmth on your skin can brighten your mood, beyond all the vitamin D benefits.
The key is not trying to do everything—just pick one thing when you’re feeling stuck.
The Sunlight and Nature Factor
Both Dr. Gravino and I are big believers in the power of nature and natural light. She’s a hiker who loves being in the forest, and I’ve experienced firsthand how much sunlight affects my mood and nervous system regulation.
I shared a story about a gym I used to belong to that had all the windows closed, creating a cave-like environment with only neon lights. I would go in motivated and leave feeling drained and overwhelmed. When I finally quit and rejoined later after they opened the windows and let in natural sunlight, the difference was remarkable.
The impact of artificial light, blue light, and EMFs on our nervous system is significant. It’s ironic how many wellness centers and gyms have bright, flickering lights that are actually affecting our nervous systems in dangerous ways, while people try to counter those effects with more interventions that further stress the system.
The Histamine Connection (My Personal Discovery)
While this isn’t Dr. Gravino’s area of specialty, I shared my growing conviction that there’s a huge connection between histamine, nervous system dysregulation, and cortisol. Through my own health journey with severe hives and cortisol spikes, I discovered that completely cutting high-histamine foods from my diet made an incredible difference in my nervous system regulation.
High-histamine foods include things many people don’t realize: leftovers (reheated food is high in histamine), bone broth, fermented foods, and long-stewed soups. During my worst outbreaks, I was making bone broth chicken soup thinking it would help, and it was actually one of the highest histamine things I could have been eating.
I’m not saying everyone needs to cut histamine permanently, but the difference it made for me was so dramatic that I’m seriously considering sharing this information more broadly. There’s been so much talk about adding fermented foods for gut health, and I think for some people, it’s actually contributing to the problem rather than solving it.
Macros: Why Your Brain Needs Carbohydrates
One of the most important nutritional points Dr. Gravino made was about macronutrients. After 30 years of being told to fear carbohydrates (she specifically mentioned being afraid of bananas), she discovered through her integrative mental health training that our bodies actually need the right balance of proteins, carbohydrates, and healthy fats to function optimally.
This is especially true for midlife women and especially true for mental health. Our brains need all three macronutrients—not just protein, not just fats, but carbohydrates too. When someone says they feel amazing on carnivore or another restrictive approach, Dr. Gravino expressed concern about the long-term impact, particularly on mental health.
From a mental health professional’s perspective, restricting entire macronutrient groups puts you on a slippery slope. Your brain simply cannot function at its most optimal state without all three. And she’s particularly concerned about fiber, which she considers as important as protein for overall health.
What You Don’t Need: The Gadget-Free Approach
When I asked Dr. Gravino if you need a bunch of gadgets for nervous system regulation, her answer was clear: no. You don’t need a weighted vest, a trampoline, a red light sauna (though she admitted it’s on her Christmas wish list), or any expensive equipment.
You can do air squats and pushups without a gym membership. You can practice deep breathing anywhere. You can walk outside for free. You can put cold water on your face using your bathroom sink.
I’ll admit, I love my hydrogen breathing device and my infrared sauna, but they’re wants, not needs. They’re luxuries I enjoy, not necessities for nervous system health. The things that have made me feel my absolute best are the free ones: walking outside, being in real sunlight, watching sunrise and sunset, turning off notifications, and literally just lying by the pool reading a book with my phone put away.
The One “Have-To” Per Day Rule
This might be the most important practical takeaway from our conversation: I’ve literally changed my life by deciding I will only have one “have-to” thing per day. Just one. That doesn’t mean I don’t work the rest of the day—it just means there’s only one thing that absolutely must happen.
I even canceled my biggest launch (which represents most of my annual income) because I knew that’s what my nervous system needed. Do I know how I’ll figure out the financial piece? No. But I know that creating space isn’t just nice—it’s literally a prescription for my survival and sanity right now.
It’s wild how when you actually prioritize what your body and mind need, other opportunities start to appear. Things you thought had to happen immediately can wait. And your health—mental and physical—can’t.
Boundaries: Filters, Not Walls
Though we only touched on this briefly, Dr. Gravino mentioned that boundaries are crucial for nervous system regulation. And I love how she framed it: boundaries aren’t walls that shut people out—they’re filters that protect your peace.
So many midlife women have spent their entire lives prioritizing everyone else—work, family, friends—and putting themselves at the bottom of the list. The goal isn’t to put yourself above everyone else; it’s simply to put yourself on the same level. Stop putting yourself below everyone and everything else.
Just say: “This is what I have to do for my health, for my happiness, for my nervous system.” Trust me, months ago I would have said there was no way I could do this. But after going through my health crisis, I realized it’s not optional anymore.
Should Everyone Be in Therapy?
As a psychologist with 25 years of experience, Dr. Gravino had an interesting answer to this question: no, not everyone needs to be in therapy, but yes, it would be useful for everyone.
The key is understanding how to utilize it. Therapists are trained to give you skills and help you manage things—whether that’s past trauma, current stress, grief and loss, or anxiety and depression. But therapy is work. You’re coming to do work, and that work is not easy. It usually gets harder before it gets easier.
If you find yourself not making any progress in therapy, something is missing. Maybe you’re not doing the work that needs to be done. Maybe you’re not with the right therapist. You have to shop around to find a good fit—not every therapist is right for every person, and that’s okay.
Understanding the Difference: Psychologist vs. Psychiatrist vs. Coach
This is a basic but important distinction:
Psychologist: Has a PhD in clinical or counseling psychology. Their degree is very theoretical and science-based, involving lots of research and empirical knowledge. They can have their own practice and charge insurance, but they cannot prescribe medication.
Psychiatrist: Has gone to medical school and earned an MD degree, then specialized in psychiatric care with residency on inpatient units. They can prescribe medication and have their own practice. Some do therapy, but many focus primarily on medication management.
Life Coach: This is where credentials vary widely. While there may be legitimate certifications, the field is less regulated, so it’s important to understand what training and background your coach actually has.
Moving from Reaction to Prevention
One of the most important points Dr. Gravino made at the end of our conversation was about prevention versus reaction. She wishes more people could understand that these tools and strategies are possible to implement now—before a medical diagnosis, before a crisis, before something major happens.
Typically, people don’t start taking their nervous system health seriously until after they’ve received a scary diagnosis or experienced some kind of health crisis. She wants this society to move toward prevention rather than waiting for reaction.
As someone who recently went through my own health crisis with severe histamine reactions and nervous system dysregulation, I can’t emphasize this enough. Don’t wait until your body forces you to pay attention. Start implementing these strategies now—the breathing, the boundaries, the one have-to per day, the mindfulness about what you’re putting in your body, the time in nature and sunlight.
Your midlife health journey doesn’t have to be about decline and resignation. It can be about optimization, understanding, and reclaiming your energy and peace. But it requires choosing prevention over procrastination, awareness over avoidance, and self-care over self-sacrifice.
The contents of the Midlife Conversations podcast is for educational and informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always consult with a qualified healthcare provider. Some episodes of Midlife Conversations may be sponsored by products or services discussed during the show. The host may receive compensation for such advertisements or if you purchase products through affiliate links mentioned on this podcast.
