Andrew thought he was having a heart attack in the security queue at Heathrow. He was forty-four, fit, a non-smoker. The paramedics found nothing. Two weeks later it happened again in a client meeting. His GP said “anxiety”, and Andrew said, out loud: “I don’t get anxious.”
Anxiety in men over 40 often arrives as physical symptoms: chest tightness, a racing heart, broken sleep, stomach trouble, irritability and panic attacks. Midlife stacks pressures: ageing parents, teenagers, money, health scares and a career peak or plateau. See a GP first to check your heart and hormones. Then therapy helps you understand and settle the alarm.
01How it shows up
Most men over 40 do not describe worry. They describe symptoms.
- Chest tightness or palpitations.
- Waking at 3am with a racing mind.
- Stomach and bowel trouble.
- Snapping at the family over small things.
- A drink to get to sleep.
- Avoiding driving, flying or meetings after a first panic attack.
Men often go through months of tests before anyone mentions anxiety. The tests are right and necessary. They are not the end of the story.
02Why now
Hormones play a part too. Testosterone falls gradually with age, and poor sleep, alcohol and stress push it lower. Your GP checks this with a simple blood test.
The alarm is not broken. It has been on duty for twenty years.
Kita Tabachka, relational therapist
03What keeps it going
Anxiety grows on avoidance. After one panic attack on a plane, you avoid planes. Then airports. Then the conversation about the summer holiday.
Alcohol helps the evening and wrecks the night. Caffeine pushes the heart rate up. News at midnight feeds the sense of threat. None of this makes you weak. It makes you human and overloaded.
04What helps
Start with a GP check of your heart, blood pressure, thyroid and hormones. Then three practices.
Slow the out-breath. Breathe in for four, out for six, for two minutes. A longer exhale tells your nervous system the danger has passed.
Go back towards what you avoid, in small steps. A short drive before a long one. A short flight before a long-haul.
Talk about the load. Therapy for men over 40 often moves from the panic to the questions underneath it: what you carry, for whom, and for how long. Individual therapy online fits around a demanding job, and expat therapy covers the extra weight of caring for parents from abroad.
Andrew flew to Lisbon with his son in June. He said he still noticed his heart on take-off. He also noticed the view.
Chest pain, breathlessness or collapse need emergency care first. Call 999 in the UK or local emergency services abroad. Treat it as anxiety only after a doctor has ruled out a heart problem. If anxiety comes with thoughts of ending your life, call Samaritans free on 116 123.
Online sessions for men and couples, wherever you live
I work in English with men on their own and with couples, including partners living in two countries. See how sessions run in your city, or read about online couples therapy and therapy for men.
More from the journal
Weekly written counselling with Kita
When writing feels easier than speaking.
You can enquire about weekly written counselling for your own experience of relationships and life abroad. We agree whether this format is a useful fit before you pay.
Explore written counselling£50 per week. One personal written reply through Carepatron. Suitability, your weekly reply day and terms agreed before payment.
Kita Tabachka
I am a BACP-registered relational therapist. I work with individuals and couples, many of them living far from where they began, on relationship anxiety, attachment, intimacy and the strange business of building a self in a new country. The stories here are composites. The patterns are real. My writing is a door into the work, never a substitute for it.
More about my practiceQuestions people ask
This article is written by Kita Tabachka, MBACP, and is for general education and reflection. It describes patterns seen in clinical work, but it is not therapy, and it is not a substitute for individual advice from a qualified therapist, doctor or other professional who knows your situation.
Reading it cannot diagnose anything or replace your own judgement about what you need. If something here resonates and you would like support, you are welcome to learn more about my practice or book a free consultation. If you are in crisis or immediate danger, please contact local emergency services or an urgent mental health line in your country.
Join the conversation
If you have lived this, say so. Your words may be the thing a stranger at midnight needed to read.