David Baxter PhD
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Hand in Hand: Marriages thrive best when depression becomes ?our problem?
by Sharon Anne Waldrop, Esperanza Magazine
August 2009
As a professional party entertainer, Phil S. of Sanbornton, New Hampshire can light up every face in the room with his comedy magic show and balloon twisting. But he can?t cheer up his wife, Cedar, when she?s experiencing a period of depression.
?It?s very hard for me when my wife is suffering and she can?t talk to me about it,? says Phil, 45.
Every marriage has its challenges, but the issues multiply when one spouse has depression. Communication problems arise, or deepen, when a spouse withdraws during a depressive episode. The other spouse may feel shut out?not to mention angry and resentful at having to shoulder more responsibility for household tasks and child-rearing.
Withdrawal can also affect the couple?s social life, leaving the well spouse prey to boredom and frustration?or determined to pursue a separate social life, which may deepen the emotional distance in the marriage.
A study of 774 married couples, published in the Journal of Consulting and Clinical Psychology in October 2004, found a strong correlation between depression (and to a lesser extent, anxiety) in one spouse and marital satisfaction for both spouses. The more severe the depression, the less satisfied both partners were with the marriage. In discussing the results, researcher Mark A. Whisman, PhD, of the University of Colorado at Boulder, drew a strong connection between seeking mental health services and survival of the marriage.
The fact is, depression in one partner affects both parties in the marriage. About half the adult population (ages 15 and older) in the U.S. and Canada is married, but no hard statistics turn up on how many of those marriages are affected by mental illness. Given that major depressive disorder affects 14.8 million American adults in a given year?or about 6.7 percent of the U.S. population ages 18 and older?the potential number of married Americans touched by depression could be as high as 28 million annually.
In Canada, meanwhile, government agencies calculate that about 11 percent of men and 16 percent of women will experience major depression in their lifetimes, with more than a million Canadians experiencing a major depressive episode annually.
The widely publicized statistic that half of all marriages end in divorce has come into dispute in recent years, with social scientists pegging the peak figure in the U.S. closer to 40 percent. It?s impossible to quantify the link between depression and divorce, but several studies done in the 1990s suggest that a history of depression increases the probability of separation and divorce, perhaps by as much as 70 percent.
While many factors go into deciding which marriages fail and which survive, one big influence seems to be how proactive both members of the couple are in dealing with the depression. Although each partner has a different role to play?the spouse with depression must take steps to manage the disorder, while the spouse who is well should seek education and provide support?it?s working together that helps the marriage thrive.
Communication gap
Cedar?s inability to talk to her husband when she?s depressed is a typical symptom of the illness. ?When one person is depressed, the communication lines break down,? says Michael E. Silverman, PhD, an assistant professor in the Department of Psychiatry at Mount Sinai School of Medicine in New York City. ?The depressed person will also withdraw, will not initiate conversation or activities, and will not take advantage of opportunities or take risks.?
In some cases where depression has not been diagnosed, that behavior can be misinterpreted by the other spouse, says Reef Karim, MD, an assistant clinical professor at the UCLA Semel Institute for Neuroscience.
?I?ve encountered a number of times when I?m doing couples therapy that one spouse thinks that the other has fallen out of love or is having an affair, or that they don?t make their partner happy any longer, but in reality, the other spouse has depression,? says Karim, who specializes in addiction and relationship therapy and is director of the Beverly Hills Center for Lifestyle Addictions. ?They don?t walk around with a big ?D? on their forehead, and a lot of times don?t know that they?re depressed.?
Researchers who study the relation-ship between depression and marital discord point out the back-and-forth nature of the problem?sometimes it?s hard to say which came first, or how one feeds into the other. But a number of studies have established that poor communication patterns in marriages where depression is present lead to greater marital conflict.
The converse, of course, is that developing greater empathy and emotional intimacy strengthens the bond between partners. However, getting a spouse who is experiencing depression to be more forthcoming isn?t always easy and sometimes isn?t possible.
It?s helpful if the other spouse looks at this in an objective way, says Gary Direnfeld, a social worker in private practice in Dundas, Ontario, who has counseled married couples dealing with the depression of one spouse.
?Separate the symptoms from the person,? says Direnfeld. ?It?s so often that when somebody is depressed you take that for the whole person instead of just dealing with the symptoms.
?It is important to separate the two so that you see the one you love, the one you married,? he adds. ?That way you don?t get caught up in the pain of seeing their symptoms, or your anger for their symptoms.?
Stuck at home
People living with depression will not only withdraw from their spouse, they?ll avoid social situations, too. Since couples are typically expected to socialize as a couple, with other couples, the spouse without depression may end up without a social life as well.
Antisocial behaviors link to the body?s need to conserve energy during depression, says Scott Haltzman, MD, a psychiatrist, clinical assistant professor at Brown University in Providence, Rhode Island, and author of The Secrets of Happy Families: Eight Keys to Building a Lifetime of Connection and Contentment.
?The body begins to shut down, almost like a bear going into hibernation,? Haltzman says. ?It feels like any effort to do anything beyond what you need to survive, such as socializing and having any contact with the outside world, demands an extraordinary amount of energy and the body chooses to avoid it.?
Social withdrawal may be associated with low levels of serotonin in the brain, a condition also associated with depression. Haltzman points to studies done in the 1990s in which people without depression were given antidepressants. The medication increased their social ability, suggesting a link between serotonin levels and socialization.
In some cases, lack of energy isn?t the problem. For Will C. of Rancho Santa Margarita, California, it was the rage he experienced while depressed that had his wife, Nancy, avoiding or canceling social plans because she was afraid of unpleasant scenes.
Nancy, 52, describes herself as a very upbeat and social person. She would get frustrated at having to decline invitations or skip parties because Will, 54, was in no condition to attend.
?I was tired of making excuses and making things up,? says Nancy, who once had to phone in regrets to a wedding while they were on the way there. Over time, she began to withdraw from the marriage in her own way, building an active social life without Will.
Play together, stay together
Nancy was able to find a solution for her growing feelings of boredom and isolation. Although boredom may seem like the least of a couple?s problems when one spouse has depression, it can play into the mix of marital dissatisfaction. In a study published in Psychological Science in April, researchers at State University of New York?s Stony Brook center conclude that boredom reduces closeness in a marriage, resulting in reduced satisfaction in the relationship.
?One of the best ways to protect a marriage is to avoid boredom,? says Mount Sinai?s Silverman. ?People need to grow and to see their spouse grow. Without growth, it becomes very easy for the spouse who is not depressed to become impatient and frustrated.?
Heather M. of White Rock, British Columbia, who has depression and anxiety, says finding an activity to do together helped her and her husband, Gregor. It was Greg, 72, who suggested they join a square dancing group many years ago. Heather, 69, decided to give it a try, pushing herself to go even when she would rather have stayed home.
?I was quite resistant and wasn?t eager to go,? Heather recalls, ?but I am glad that I did. It kept us going even when I was in the depth of depression.?
With loving encouragement, it may be possible to gently draw a spouse from isolation, says Elizabeth Lombardo, PhD, a clinical psychologist in Wexford, Pennsylvania.
?There are times when you want to encourage your spouse to spend time with friends,? she says, adding that it?s unwise to push the idea too hard if the spouse isn?t receptive: ?They?re already feeling bad, don?t make them feel worse.?
But if the spouse does muster the energy to go out and be with others, be sure to recognize and praise the effort. ?Positive encouragement is more motivating than a wagging finger,? Lombardo says.
Taken to task
The energy crisis brought on by depression also affects whether or not chores get done. When one spouse can?t cope with household tasks and children because of depression, responsibilities fall more heavily on the other spouse. That often leads to guilt on the one side and resentment on the other, which can fester unless the couple recognizes and addresses the root cause.
?One of the symptoms of major depressive disorder, and other forms of depression, can be that people feel overwhelmed by what may seem to be the smallest project,? says Wayne Denton, MD, PhD, a psychiatrist in Dallas, Texas, and director of the Family Studies Center at University of Texas Southwestern Medical Center.
?No matter how much they know the project needs to be done or how much they push or berate themselves, it just feels too overwhelming.?
Cedar S. has been there. ?On the bad days, I could handle the mornings, but by around 4:00, I would start to fade,? she says.
This left Phil to clean up after dinner and complete the day?s unfinished chores while taking care of the couple?s four young children on his own for the rest of the evening.
Understanding what lay behind his wife?s apathy and exhaustion helped.
?I felt angry and resentful at the situation, but not at Cedar,? says Phil, who went into the marriage with full awareness of Cedar?s symptoms and a youthful suicide attempt.
Get smart
Getting educated about depression is one of the best things to do for oneself, one?s spouse and the marriage. Les Parrott, PhD, a professor of psychology at Seattle Pacific University and coauthor of Trading Places: The Best Move You?ll Ever Make in Your Marriage, says that well spouses often have no understanding of the pain of depression and don?t realize that their partner can?t just snap out of it. They don?t comprehend why their spouse feels sad when there doesn?t seem to be anything to be sad about.
Even when spouses tune in to what depression is doing to their partners, this awareness is not always reciprocated. ?A depressed person has a difficult time looking beyond their own pain,? says Parrott. ?It?s like a toothache and they can?t think about anything else.?
It also can be difficult for spouses to accept that they cannot lift their partner out of depression. Nancy C. recalls feeling frustrated when Will would stay in bed for three or four days and cry. There was nothing she could say or do to get him over it and that made her feel guilty. More than that, his ongoing unwillingness to seek treatment for depression ate away at her sympathy for him.
Listening to a third party validate the symptoms of depression can be helpful to both partners in the relationship. A growing body of research indicates that couples therapy reduces marital distress when one partner has depression more than individual treatment for depression does. A review of the literature on ?Marital distress, co-occurring depression, and marital therapy,? published in the July 2002 issue of the Journal of Marital and Family Therapy, concludes that since depression is a chronic illness, ?therapy aimed at helping couples learn to adapt to the depressed individual?s symptoms holds the promise of improving their quality of life.?
Phil and Cedar S. agree they have found joint counseling useful in helping each of them understand what the other is going through.
?Inviting the spouse to join a therapy session serves a double purpose,? explains Oren Amitay, PhD, a clinical psychologist in private practice and an instructor at Ryerson University and the University of Toronto. ?One is to help my client convey to the spouse what?s reasonable to expect from them. I also let the client know that this is the chance for the spouse to vent or show their frustrations.?
Plan together
Learning how depression affects a partner?s behavior is one step on a couple?s road to managing the disorder together. Another step is talking together about how the depression may affect major life decisions, such as having children and supporting the family.
Lombardo, the clinical psychologist, lists some of the things to consider when planning for children: how well the spouse with depression will be able to care for a child, how the added stress of raising a child will affect the course of depression, how to handle the additional costs of raising a child and the likelihood that the child also will have depression.
If the couple decides to have a child, they should consider whether and how the child will be told about the depression, how to minimize adverse effects on the child and how to care for the child when the spouse with depression can?t.
In terms of finances, the person with depression may need to find a less stressful but lower-paying job, or the family may need to move closer to the workplace to minimize the hassle of commuting. The couple should discuss under what conditions the spouse with depression should stop working and how the couple would live on one income. They should also look into options for medical leave and filing for temporary disability.
Although it?s a difficult topic to approach, the couple should also discuss what to do if the spouse with depression becomes suicidal. ?It?s very important to openly discuss a plan if this were to happen,? says Lombardo. ?Developing this plan will not plant a seed in the person?s mind and increase the likelihood of suicidal ideations.?
Matters may never reach that extreme, but the recurring difficulties that depression adds to a marriage need to be addressed if the marriage is to thrive. Since depression affects both partners in a relationship, it?s vital for partners to talk about its cycles and how to get through it as a couple.
Anna Stookey, a marriage and family therapist in Beverly Hills, California, has found that the more a couple can talk about depression as a phenomenon that affects both of them and can be understood and managed as a couple, the better.
?It empowers both partners to feel that they are on the same team in managing and working through the process of depression,? she says. ?One partner isn?t carrying it alone and being a ?nuisance? to an otherwise perfect relationship.?
William & Nancy, Rancho Santa Margarita, California
Will and Nancy have been married for 18 years, but both had doubts that the marriage would make it this far.
Will has had major depressive disorder for 30 years. His fits of rage during depressive episodes were the biggest problem in the marriage.
?After a rage, I felt guilt-ridden and ashamed and that I was sabotaging my marriage because I didn?t measure up to the type of man that Nancy deserved,? he says.
?He would throw things across the room and get angry in public when things didn?t go his way,? says Nancy. ?Watching him tear people apart was horrifying and humiliating to me.
?I felt that this ugly thing about him was okay because he doesn?t gamble, cheat, drink, or use drugs,? she adds. ?He?s a romantic and attentive husband on the good days, so I was able to look beyond the bad ones.?
But as the years progressed, Will?s rages ruined Nancy?s social life. She became bored and began to develop friendships with single people who shared her interests in things like music and cooking. She began to take long walks on her own and joined the Sierra Club to hike with others.
About three years ago, Nancy got to the point where she?d had it with Will?s behavior. She would not consider divorce, but secretly hoped that something would happen to release her from the marriage.
?If he had cancer or had been crippled or disfigured, I never would have thought about leaving, but Will wasn?t being proactive about his illness and nothing would help because he wouldn?t help himself,? she says.
She didn?t tell Will how she was feeling, instead clinging to the hope that somehow, someday, the situation would change for the better. And it did: Will finally reached a point where he didn?t want to go on as before. He was ready to take steps to help himself, and that has helped his marriage.
A former pastor, he found more of a lifeline in his faith and belief in redemption than in the medications he tried. To further his therapy, he coauthored a book about his journey, Hope, Lessons from a Hummingbird: A Redemptive Adventure of How a Regular Guy Got Free From Depression and Rage.
?There was some healing value in the writing process,? says Will.
Greg & Heather, White Rock, British Columbia
Heather and Greg have been married for 45 years. It wasn?t until 16 years into the marriage, at the age of 40, that Heather was diagnosed with depression and anxiety, although she believes she?d been living with the disorders all her life. That made for tough times when she was a young wife and mother.
?Many days all I did was cry and sleep and was unable to function,? says Heather, now 69. While she says her two daughters weren?t neglected, sometimes it was all she could do in a day to make sure they were fed. She felt guilty for not doing more, compounding the emotional distress of her depression.
She credits Greg, now 72, with stepping in to tell the girls that their mother just needed some time alone. That gave Heather the down time she needed to get through the day. Greg didn?t step in to help with the housework, she says, in part because of his severe diabetes and perhaps because he came from a more traditional generation.
When the girls got older, Heather found herself with an even more overwhelming challenge: raising teenagers with mental illnesses on top of the usual adolescent disruptions. Around the time Heather sought help and was finally diagnosed, her daughters were also diagnosed with mood disorders?one with depression and anxiety, the other with bipolar disorder.
Even after she received a diagnosis, Heather says, Greg still didn?t fully understand her depression. He has been quietly accepting, but has not read up on mood disorders or joined her in counseling.
?He?s very stoic about it,? adds Heather, who has found her greatest support through the Mood Disorders Association (MDA) of British Columbia. She is now a facilitator of the MDA group in White Rock.
Through medication and regular visits to a psychiatrist, Heather has seen a great improvement in her condition over the years. She also credits Greg for suggesting the couple take up square dancing.
?Greg felt that it was something we could do together that would help,? says Heather. And it did, she says?strengthening their marriage, giving them a common bond and an active social life for 25 years.
Phil & Cedar, Sanbornton, New Hampshire
It took a suicide attempt nearly two years ago to finally get Cedar a diagnosis of clinical depression, and the therapy and medication that is helping her manage the disorder. Looking back, though, she traces her depression back to age 12.
?It didn?t get severe until after we got married,? she says.
A study published in Social Psychiatry and Psychiatric Epidemiology in May 2007 concludes that the demands of working and raising children under the age of 15 results in an increased risk of mental illness. Cedar and Phil had four children in six years (now ages 4 through 10), and Cedar also manages the family?s party entertainment business from home.
Phil & Cedar went through a long period of thinking that Cedar?s despair was postpartum depression. By the time the youngest child was 2, it became apparent that was not the full answer.
Cedar says she couldn?t have asked for a more understanding and compassionate husband than Phil. He had the right tools for coping with her depression, such as an understanding of Cedar?s limitations and abilities and the knowledge that his anger and resentment were normal. This doesn?t mean that the 12 years of their marriage has been easy.
?When Cedar would get depressed, it made everyone in the family grumpy,? says Phil. ?Her depression affected how she dealt with me and the kids. She was unable to take care of the family and everything she started would get just half done. Even the easiest things were an uphill battle.?
Phil and Cedar both admit to starting fights to deal with their anger and frustration. It was usually Phil who would see where the argument was going and put a stop to it.
Phil says that when Cedar is depressed, all she wants to do is sleep. She would fight it, but Phil insisted that Cedar go to sleep when she needed to, even if it meant more household work for him.
?I could see it coming,? he says, ?Her speech would start stammering and I knew that it was time to put her to bed.?
?I?m an enabler and want to take care of everyone else, just not myself,? says Cedar. ?Giving in and going to sleep meant that I was not in control and I had a hard time dealing with that.?
Now that Cedar goes to therapy?sometimes with Phil?and takes medication, her despair is not as deep when it hits. She also has fewer difficult days, which is a win-win situation for the whole family.
Sharon Anne Waldrop writes from her horse farm in rural Georgia. Her work has appeared in Good Housekeeping, Woman's Day, Health, Heart Healthy Living, and many national consumer magazines across the U.S.
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by Sharon Anne Waldrop, Esperanza Magazine
August 2009
As a professional party entertainer, Phil S. of Sanbornton, New Hampshire can light up every face in the room with his comedy magic show and balloon twisting. But he can?t cheer up his wife, Cedar, when she?s experiencing a period of depression.
?It?s very hard for me when my wife is suffering and she can?t talk to me about it,? says Phil, 45.
Every marriage has its challenges, but the issues multiply when one spouse has depression. Communication problems arise, or deepen, when a spouse withdraws during a depressive episode. The other spouse may feel shut out?not to mention angry and resentful at having to shoulder more responsibility for household tasks and child-rearing.
Withdrawal can also affect the couple?s social life, leaving the well spouse prey to boredom and frustration?or determined to pursue a separate social life, which may deepen the emotional distance in the marriage.
A study of 774 married couples, published in the Journal of Consulting and Clinical Psychology in October 2004, found a strong correlation between depression (and to a lesser extent, anxiety) in one spouse and marital satisfaction for both spouses. The more severe the depression, the less satisfied both partners were with the marriage. In discussing the results, researcher Mark A. Whisman, PhD, of the University of Colorado at Boulder, drew a strong connection between seeking mental health services and survival of the marriage.
The fact is, depression in one partner affects both parties in the marriage. About half the adult population (ages 15 and older) in the U.S. and Canada is married, but no hard statistics turn up on how many of those marriages are affected by mental illness. Given that major depressive disorder affects 14.8 million American adults in a given year?or about 6.7 percent of the U.S. population ages 18 and older?the potential number of married Americans touched by depression could be as high as 28 million annually.
In Canada, meanwhile, government agencies calculate that about 11 percent of men and 16 percent of women will experience major depression in their lifetimes, with more than a million Canadians experiencing a major depressive episode annually.
The widely publicized statistic that half of all marriages end in divorce has come into dispute in recent years, with social scientists pegging the peak figure in the U.S. closer to 40 percent. It?s impossible to quantify the link between depression and divorce, but several studies done in the 1990s suggest that a history of depression increases the probability of separation and divorce, perhaps by as much as 70 percent.
While many factors go into deciding which marriages fail and which survive, one big influence seems to be how proactive both members of the couple are in dealing with the depression. Although each partner has a different role to play?the spouse with depression must take steps to manage the disorder, while the spouse who is well should seek education and provide support?it?s working together that helps the marriage thrive.
Communication gap
Cedar?s inability to talk to her husband when she?s depressed is a typical symptom of the illness. ?When one person is depressed, the communication lines break down,? says Michael E. Silverman, PhD, an assistant professor in the Department of Psychiatry at Mount Sinai School of Medicine in New York City. ?The depressed person will also withdraw, will not initiate conversation or activities, and will not take advantage of opportunities or take risks.?
In some cases where depression has not been diagnosed, that behavior can be misinterpreted by the other spouse, says Reef Karim, MD, an assistant clinical professor at the UCLA Semel Institute for Neuroscience.
?I?ve encountered a number of times when I?m doing couples therapy that one spouse thinks that the other has fallen out of love or is having an affair, or that they don?t make their partner happy any longer, but in reality, the other spouse has depression,? says Karim, who specializes in addiction and relationship therapy and is director of the Beverly Hills Center for Lifestyle Addictions. ?They don?t walk around with a big ?D? on their forehead, and a lot of times don?t know that they?re depressed.?
Researchers who study the relation-ship between depression and marital discord point out the back-and-forth nature of the problem?sometimes it?s hard to say which came first, or how one feeds into the other. But a number of studies have established that poor communication patterns in marriages where depression is present lead to greater marital conflict.
The converse, of course, is that developing greater empathy and emotional intimacy strengthens the bond between partners. However, getting a spouse who is experiencing depression to be more forthcoming isn?t always easy and sometimes isn?t possible.
It?s helpful if the other spouse looks at this in an objective way, says Gary Direnfeld, a social worker in private practice in Dundas, Ontario, who has counseled married couples dealing with the depression of one spouse.
?Separate the symptoms from the person,? says Direnfeld. ?It?s so often that when somebody is depressed you take that for the whole person instead of just dealing with the symptoms.
?It is important to separate the two so that you see the one you love, the one you married,? he adds. ?That way you don?t get caught up in the pain of seeing their symptoms, or your anger for their symptoms.?
Stuck at home
People living with depression will not only withdraw from their spouse, they?ll avoid social situations, too. Since couples are typically expected to socialize as a couple, with other couples, the spouse without depression may end up without a social life as well.
Antisocial behaviors link to the body?s need to conserve energy during depression, says Scott Haltzman, MD, a psychiatrist, clinical assistant professor at Brown University in Providence, Rhode Island, and author of The Secrets of Happy Families: Eight Keys to Building a Lifetime of Connection and Contentment.
?The body begins to shut down, almost like a bear going into hibernation,? Haltzman says. ?It feels like any effort to do anything beyond what you need to survive, such as socializing and having any contact with the outside world, demands an extraordinary amount of energy and the body chooses to avoid it.?
Social withdrawal may be associated with low levels of serotonin in the brain, a condition also associated with depression. Haltzman points to studies done in the 1990s in which people without depression were given antidepressants. The medication increased their social ability, suggesting a link between serotonin levels and socialization.
In some cases, lack of energy isn?t the problem. For Will C. of Rancho Santa Margarita, California, it was the rage he experienced while depressed that had his wife, Nancy, avoiding or canceling social plans because she was afraid of unpleasant scenes.
Nancy, 52, describes herself as a very upbeat and social person. She would get frustrated at having to decline invitations or skip parties because Will, 54, was in no condition to attend.
?I was tired of making excuses and making things up,? says Nancy, who once had to phone in regrets to a wedding while they were on the way there. Over time, she began to withdraw from the marriage in her own way, building an active social life without Will.
Play together, stay together
Nancy was able to find a solution for her growing feelings of boredom and isolation. Although boredom may seem like the least of a couple?s problems when one spouse has depression, it can play into the mix of marital dissatisfaction. In a study published in Psychological Science in April, researchers at State University of New York?s Stony Brook center conclude that boredom reduces closeness in a marriage, resulting in reduced satisfaction in the relationship.
?One of the best ways to protect a marriage is to avoid boredom,? says Mount Sinai?s Silverman. ?People need to grow and to see their spouse grow. Without growth, it becomes very easy for the spouse who is not depressed to become impatient and frustrated.?
Heather M. of White Rock, British Columbia, who has depression and anxiety, says finding an activity to do together helped her and her husband, Gregor. It was Greg, 72, who suggested they join a square dancing group many years ago. Heather, 69, decided to give it a try, pushing herself to go even when she would rather have stayed home.
?I was quite resistant and wasn?t eager to go,? Heather recalls, ?but I am glad that I did. It kept us going even when I was in the depth of depression.?
With loving encouragement, it may be possible to gently draw a spouse from isolation, says Elizabeth Lombardo, PhD, a clinical psychologist in Wexford, Pennsylvania.
?There are times when you want to encourage your spouse to spend time with friends,? she says, adding that it?s unwise to push the idea too hard if the spouse isn?t receptive: ?They?re already feeling bad, don?t make them feel worse.?
But if the spouse does muster the energy to go out and be with others, be sure to recognize and praise the effort. ?Positive encouragement is more motivating than a wagging finger,? Lombardo says.
Taken to task
The energy crisis brought on by depression also affects whether or not chores get done. When one spouse can?t cope with household tasks and children because of depression, responsibilities fall more heavily on the other spouse. That often leads to guilt on the one side and resentment on the other, which can fester unless the couple recognizes and addresses the root cause.
?One of the symptoms of major depressive disorder, and other forms of depression, can be that people feel overwhelmed by what may seem to be the smallest project,? says Wayne Denton, MD, PhD, a psychiatrist in Dallas, Texas, and director of the Family Studies Center at University of Texas Southwestern Medical Center.
?No matter how much they know the project needs to be done or how much they push or berate themselves, it just feels too overwhelming.?
Cedar S. has been there. ?On the bad days, I could handle the mornings, but by around 4:00, I would start to fade,? she says.
This left Phil to clean up after dinner and complete the day?s unfinished chores while taking care of the couple?s four young children on his own for the rest of the evening.
Understanding what lay behind his wife?s apathy and exhaustion helped.
?I felt angry and resentful at the situation, but not at Cedar,? says Phil, who went into the marriage with full awareness of Cedar?s symptoms and a youthful suicide attempt.
Get smart
Getting educated about depression is one of the best things to do for oneself, one?s spouse and the marriage. Les Parrott, PhD, a professor of psychology at Seattle Pacific University and coauthor of Trading Places: The Best Move You?ll Ever Make in Your Marriage, says that well spouses often have no understanding of the pain of depression and don?t realize that their partner can?t just snap out of it. They don?t comprehend why their spouse feels sad when there doesn?t seem to be anything to be sad about.
Even when spouses tune in to what depression is doing to their partners, this awareness is not always reciprocated. ?A depressed person has a difficult time looking beyond their own pain,? says Parrott. ?It?s like a toothache and they can?t think about anything else.?
It also can be difficult for spouses to accept that they cannot lift their partner out of depression. Nancy C. recalls feeling frustrated when Will would stay in bed for three or four days and cry. There was nothing she could say or do to get him over it and that made her feel guilty. More than that, his ongoing unwillingness to seek treatment for depression ate away at her sympathy for him.
Listening to a third party validate the symptoms of depression can be helpful to both partners in the relationship. A growing body of research indicates that couples therapy reduces marital distress when one partner has depression more than individual treatment for depression does. A review of the literature on ?Marital distress, co-occurring depression, and marital therapy,? published in the July 2002 issue of the Journal of Marital and Family Therapy, concludes that since depression is a chronic illness, ?therapy aimed at helping couples learn to adapt to the depressed individual?s symptoms holds the promise of improving their quality of life.?
Phil and Cedar S. agree they have found joint counseling useful in helping each of them understand what the other is going through.
?Inviting the spouse to join a therapy session serves a double purpose,? explains Oren Amitay, PhD, a clinical psychologist in private practice and an instructor at Ryerson University and the University of Toronto. ?One is to help my client convey to the spouse what?s reasonable to expect from them. I also let the client know that this is the chance for the spouse to vent or show their frustrations.?
Plan together
Learning how depression affects a partner?s behavior is one step on a couple?s road to managing the disorder together. Another step is talking together about how the depression may affect major life decisions, such as having children and supporting the family.
Lombardo, the clinical psychologist, lists some of the things to consider when planning for children: how well the spouse with depression will be able to care for a child, how the added stress of raising a child will affect the course of depression, how to handle the additional costs of raising a child and the likelihood that the child also will have depression.
If the couple decides to have a child, they should consider whether and how the child will be told about the depression, how to minimize adverse effects on the child and how to care for the child when the spouse with depression can?t.
In terms of finances, the person with depression may need to find a less stressful but lower-paying job, or the family may need to move closer to the workplace to minimize the hassle of commuting. The couple should discuss under what conditions the spouse with depression should stop working and how the couple would live on one income. They should also look into options for medical leave and filing for temporary disability.
Although it?s a difficult topic to approach, the couple should also discuss what to do if the spouse with depression becomes suicidal. ?It?s very important to openly discuss a plan if this were to happen,? says Lombardo. ?Developing this plan will not plant a seed in the person?s mind and increase the likelihood of suicidal ideations.?
Matters may never reach that extreme, but the recurring difficulties that depression adds to a marriage need to be addressed if the marriage is to thrive. Since depression affects both partners in a relationship, it?s vital for partners to talk about its cycles and how to get through it as a couple.
Anna Stookey, a marriage and family therapist in Beverly Hills, California, has found that the more a couple can talk about depression as a phenomenon that affects both of them and can be understood and managed as a couple, the better.
?It empowers both partners to feel that they are on the same team in managing and working through the process of depression,? she says. ?One partner isn?t carrying it alone and being a ?nuisance? to an otherwise perfect relationship.?
William & Nancy, Rancho Santa Margarita, California
Will and Nancy have been married for 18 years, but both had doubts that the marriage would make it this far.
Will has had major depressive disorder for 30 years. His fits of rage during depressive episodes were the biggest problem in the marriage.
?After a rage, I felt guilt-ridden and ashamed and that I was sabotaging my marriage because I didn?t measure up to the type of man that Nancy deserved,? he says.
?He would throw things across the room and get angry in public when things didn?t go his way,? says Nancy. ?Watching him tear people apart was horrifying and humiliating to me.
?I felt that this ugly thing about him was okay because he doesn?t gamble, cheat, drink, or use drugs,? she adds. ?He?s a romantic and attentive husband on the good days, so I was able to look beyond the bad ones.?
But as the years progressed, Will?s rages ruined Nancy?s social life. She became bored and began to develop friendships with single people who shared her interests in things like music and cooking. She began to take long walks on her own and joined the Sierra Club to hike with others.
About three years ago, Nancy got to the point where she?d had it with Will?s behavior. She would not consider divorce, but secretly hoped that something would happen to release her from the marriage.
?If he had cancer or had been crippled or disfigured, I never would have thought about leaving, but Will wasn?t being proactive about his illness and nothing would help because he wouldn?t help himself,? she says.
She didn?t tell Will how she was feeling, instead clinging to the hope that somehow, someday, the situation would change for the better. And it did: Will finally reached a point where he didn?t want to go on as before. He was ready to take steps to help himself, and that has helped his marriage.
A former pastor, he found more of a lifeline in his faith and belief in redemption than in the medications he tried. To further his therapy, he coauthored a book about his journey, Hope, Lessons from a Hummingbird: A Redemptive Adventure of How a Regular Guy Got Free From Depression and Rage.
?There was some healing value in the writing process,? says Will.
Greg & Heather, White Rock, British Columbia
Heather and Greg have been married for 45 years. It wasn?t until 16 years into the marriage, at the age of 40, that Heather was diagnosed with depression and anxiety, although she believes she?d been living with the disorders all her life. That made for tough times when she was a young wife and mother.
?Many days all I did was cry and sleep and was unable to function,? says Heather, now 69. While she says her two daughters weren?t neglected, sometimes it was all she could do in a day to make sure they were fed. She felt guilty for not doing more, compounding the emotional distress of her depression.
She credits Greg, now 72, with stepping in to tell the girls that their mother just needed some time alone. That gave Heather the down time she needed to get through the day. Greg didn?t step in to help with the housework, she says, in part because of his severe diabetes and perhaps because he came from a more traditional generation.
When the girls got older, Heather found herself with an even more overwhelming challenge: raising teenagers with mental illnesses on top of the usual adolescent disruptions. Around the time Heather sought help and was finally diagnosed, her daughters were also diagnosed with mood disorders?one with depression and anxiety, the other with bipolar disorder.
Even after she received a diagnosis, Heather says, Greg still didn?t fully understand her depression. He has been quietly accepting, but has not read up on mood disorders or joined her in counseling.
?He?s very stoic about it,? adds Heather, who has found her greatest support through the Mood Disorders Association (MDA) of British Columbia. She is now a facilitator of the MDA group in White Rock.
Through medication and regular visits to a psychiatrist, Heather has seen a great improvement in her condition over the years. She also credits Greg for suggesting the couple take up square dancing.
?Greg felt that it was something we could do together that would help,? says Heather. And it did, she says?strengthening their marriage, giving them a common bond and an active social life for 25 years.
Phil & Cedar, Sanbornton, New Hampshire
It took a suicide attempt nearly two years ago to finally get Cedar a diagnosis of clinical depression, and the therapy and medication that is helping her manage the disorder. Looking back, though, she traces her depression back to age 12.
?It didn?t get severe until after we got married,? she says.
A study published in Social Psychiatry and Psychiatric Epidemiology in May 2007 concludes that the demands of working and raising children under the age of 15 results in an increased risk of mental illness. Cedar and Phil had four children in six years (now ages 4 through 10), and Cedar also manages the family?s party entertainment business from home.
Phil & Cedar went through a long period of thinking that Cedar?s despair was postpartum depression. By the time the youngest child was 2, it became apparent that was not the full answer.
Cedar says she couldn?t have asked for a more understanding and compassionate husband than Phil. He had the right tools for coping with her depression, such as an understanding of Cedar?s limitations and abilities and the knowledge that his anger and resentment were normal. This doesn?t mean that the 12 years of their marriage has been easy.
?When Cedar would get depressed, it made everyone in the family grumpy,? says Phil. ?Her depression affected how she dealt with me and the kids. She was unable to take care of the family and everything she started would get just half done. Even the easiest things were an uphill battle.?
Phil and Cedar both admit to starting fights to deal with their anger and frustration. It was usually Phil who would see where the argument was going and put a stop to it.
Phil says that when Cedar is depressed, all she wants to do is sleep. She would fight it, but Phil insisted that Cedar go to sleep when she needed to, even if it meant more household work for him.
?I could see it coming,? he says, ?Her speech would start stammering and I knew that it was time to put her to bed.?
?I?m an enabler and want to take care of everyone else, just not myself,? says Cedar. ?Giving in and going to sleep meant that I was not in control and I had a hard time dealing with that.?
Now that Cedar goes to therapy?sometimes with Phil?and takes medication, her despair is not as deep when it hits. She also has fewer difficult days, which is a win-win situation for the whole family.
Sharon Anne Waldrop writes from her horse farm in rural Georgia. Her work has appeared in Good Housekeeping, Woman's Day, Health, Heart Healthy Living, and many national consumer magazines across the U.S.
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