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Depression and Marriage

Allan N. Schwartz, LCSW, Ph.D. Updated: Feb 6th 2009

Webmd recently ran a valuable article about the impact that a depressed spouse can have on their non depressed partner and the marriage. The article can be found by pressing this URL:

http://www.webmd.com/depression/features/divorcing-depression

It is an important article because there is a tendency to examine dozens of reasons for why marriages fail without examining the mental health of married partners who are in trouble. My years of experience in a private psychotherapy practice with individuals and couples convinced me of the fact that depression and personality disorders combine to play havoc on marital relations.

Fictional Case Study:

(The characters and events are completely fictional but do describe the types of dynamics that go on when depression enters a marriage. Any resemblance to yourself is completely random and accidental but does show how common the problem is).

The case:

"The couple had been married for ten years. They met in college and instantly fell deeply in love. They had two children and each had a successful career. Money was never a problem and the children were normal and healthy. However, soon after they were married Bob became extremely irritable. For no apparent reason, he would get angry, yell, complain and start a fight. Alice felt constantly criticized and on guard against Bob's next outburst. There seemed to be no rhyme or reason to these episodes of anger and hostility.

As the years went by Bob's behavior continued in the same pattern. Most of the time he seemed happy and well adjusted and then, for no reason, would come the anger. During the last year, Alice noticed that Bob was becoming increasingly withdrawn. He stopped playing soft ball with his friends, no longer wanted to go out to dinner, showed no interest in their children and even stopped being sexually involved with her. Alice wondered if Bob had found another woman.

Everything reached a crisis level one afternoon when Bob came home from work early and was drunk. He reported that he lost his job because of his frequent absence and lateness. She was shocked because he had never mentioned it was a problem. They ended up having the angriest argument between them in the two years of their marriage. She warned him that if they did not go for help, she would take the children and leave him. After he sobered up he relented and agreed to marriage counseling.

The marriage counselor, an experienced senior clinical social worker, diagnosed Bob with Major Depression, something that ran in his family. While marriage therapy continued, Bob was referred for both anti depressant medication and cognitive behavioral therapy with a clinical psychologist. The couple learned how to cope with one another. Alice learned how she was an unwitting catalyst for Bob's anger and Bob learned how to express his emotions in more realistic and grounded ways. Today, their marriage is a success."

Discussion:

1. One of the things I noticed about the Webmd article on marriage and depression was that they described the non depressed spouse as the one who becomes angry and resentful due to the withdrawal of the depressed partner. While this is often true, it is equally important to point out the important fact that depression often brings with it a lot of irritability and anger. Depressed people, far from being silent, are fully capable of exploding into rage, followed by withdrawal. This is one of the factors that drive the non depressed spouse into separation and divorce.

2. Withdrawal does occur with depression and one of the worst ways it expresses itself is in a lack of interest in sexual relations. It is human nature to think that if one's husband or wife is not interested in sex that there is something wrong, not with the disinterested spouse, but with the interested partner who starts to question their own attractiveness. The lack of sexual interest and activity commonly provokes lots of rage in a marriage.

3. It is quite frequently the case that neither spouse in this type of marriage is actually aware that depression is at work. It seems to be much easier for partners to become defensive, blame one another for no longer caring or loving the other or for being "lazy and useless."

4. The tendency towards blame can take place when and if the depressed spouse overeats and gains lots of weight. Overeating or not eating are symptoms of depression. Of course, over eating with massive weight gain and a tendency to sleep a lot of a way of escaping from the world, can have a devastating effect on the marriage in the ways described in the previous paragraph. "Oh, why don't you snap out of it," or "if you loved me you would lose weight," are the types of things frequently heard when there is depression that goes unacknowledged or unexplained.

5. A complicating factor can be the situation in which depression is discovered and acknowledged but misunderstood by the non depressed spouse. It is in this scenario that one can hear things like, "depression is nonsense, just snap out of it," or, "baloney, you always were lazy," or, you are not the man or woman I married and you are just making excuses." That type of marital situation does not bode well for the future of that marriage.

6. Due to the fact that depression can be so enervating that the resulting feelings of weakness and lack of motivation lead to job loss and financial problems. The economic impact of depression on a marriage is often disastrous.

7. As alluded to in the fictional case study, drinking can accompany depression. This is true for a couple of reasons, such as the fact that alcohol increases serotonin levels in the brain leading to feeling of energy, optimism and even joy. However, these feelings are often short lived and as the alcohol wears off these joyful feelings can be replaced with increased depression and irritability. In other words, the tendency to self medicate with alcohol only adds to individual and marital problems.

Conclusion:

It has been my observation and experience that a marriage in which one spouse is depressed calls for marriage therapy as well as individual therapy and, perhaps, medication. It is rarely, in fact, never true, that one person causes all the problems in a marriage. Even when one spouse is depressed and causing a lot of anxiety and conflict, the "healthy spouse" contributes to the problems in ways that are often hidden and not apparent. The value of marriage therapy is to help both members of the dyad learn how they engage one another in unhealthy ways and learn more constructive patterns of interaction with one another.

Your experiences and comments are encouraged.

Allan N. Schwartz, PhD

Readers who live in the Boulder, Colorado metro area, or in Southwest Florida may contact Dr. Schwartz for face-to-face consultation. He is also available for psychotherapy through Skype video for those who are not in Florida or Colorado. He can be reached via email at dransphd@aol.com for details.

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Its like raising another kid - Exasperated partner - Oct 21st 2013

I agree with many of your points but do highlight that over the long haul, the depressed partner will make the non depressed partner very irritable - even if the non depressed partner and the depressed partner are aware of the illness and it is diagnosed.

I am that non depressed partner. I work full time, go out with colleagues, head off on my own to my boat every other week to get away, and provide most of the financial stability in the household.

I come home to a house that is a mess because my partner cant pick up after herself or do the laundry or look after or provide structure for our daughter. I usually come home to a sleeping partner, sleeping on the couch all day because she sat up all night alone. More often than is acceptable, I find out that the kid didnt go to school because of this backward sleeping arrangement, and since she didnt want to face the school staff arriving late she just called the kid in sick for the day. There is clutter everywhere because she cannot find either the energy to organize the valuable from the junk nor the fortitude to let go of even broken toddler toys from when the kid was 5 years younger.

I suggest forthright solutions to help when she complains of her mental state. Eating healthy food rather than junk, going for a walk or going swimming to get some exercise, perhaps getting a part time job to work on re-integrating into society. She smiles and agrees and nods and then things are exactly the same as the day before for ever day thereafter.

While we can be caring people and understand the illness, if it is prolonged we as the non depressed cant help but get extemely irritable. There's only so many times you can blow an entire weekend doing housekeeping chores to get the place back to a basic standard of reasonable cleanliness only to watch it all fall apart over the following week without so much as even an honest attempt to try to keep the place the way you left it Sunday evening without getting angry eventually.

How can you not become irritable and crave sexual attention from other people when your partner looks like they just rolled out of bed every hour of every day.

There is much written about how depression strains and even destroys relationships. Unfortunately most of the material written for the non-depressed spouse focuses on understanding the illness and helping the depressed to manage it. Nothing seems to focus on how to ensure that your depressed partner's seeming inability to even get up and face the day does not completely thrust you into a world of living with a practical zombie. I am a caring person, I have learned about depression, I have done all of the learning and helping with the appointments and the side effects of the medications. But I do however have my needs; needs that my depressed partner cannot come close to meeting. It might sound selfish, but deal with a depressed partner for 3 years and it makes perfect sense.

There has to be a curteous, professional way for the non depressed spouse to ensure that a basic standard of adult behavior is exhibited by the depressed spouse, to communicate this and to ensure it is followed. I am not speaking of controlling the depressed person or their depression, just rather a sort of relationship contract or agreement that no matter how crappy they feel that they will try to wake up in the morning or that they will not allow the house to descend into filth or that they will accept when a code word is spoken that they maybe are professing that the glass is half full too much.

Point no. 4 - sensitive woman - - Dec 29th 2010

Dear Dr. Schwartz,

I can totally relate to your point no. 4. I knew it was an "escapism from reality" related behavior but I had no idea it could be depression. I did not see any reason for my ex-husband to be depressed as he was a successful doctor (a specialist) from a secure family though he has a nagging/ constantly cribbing mom and a dad with Alzheimers. Could that be the reason for his depression?

His mom would constantly pick fights with me for no reason; ranging from my dressing sense to my looks to my complexion to the colour of my lipstick. We would constantly argue when I was at home and not at work. She would also pick fights with all the maids.

He said this disturbed him but he never once attempted to live separately from his parents, not even when I said I would find a place close to their home so we could visit them often but not live with this situation day in and day out. He said I had to adjust to his parents since I was married to him and I had to accept his parents the way they are. I put up with all this but when he started getting into substance abuse and started getting physically abusive, I left him. During the time of our legal separation I was much calmer and did very well in my career as well since I could concentrate on it without any emotional stresses. But now after the divorce, I am in a state of shock I guess. I feel numbed with pain. I feel nothing. I cant concentrate. I left my job. I keep staring into space for hours or reading novels. I cant believe this has happened with me. I have always been very adjusting, never demanded anything from my ex. I just keep thinking why he behaved like this? What was it that drove him to substance abuse? He would disappear in the nights and come back drunk. He refused to seek counselling and kept blaming me and calling me crazy. He would force me to drink everyday to which I refused. When things started going out of hand, I left him. But all this is difficult for me to deal with. I'm wondering why I'm so affected now after the divorce. Why cant I concentrate or move on in life?

I'm terrified of a job again or people asking about my personal life. I'm a very attractive woman and people are usually very curious to know. What do I do doctor? I'm terrified! My husband was a doctor too, a specialist... yet he resorted to substance abuse and ruined our future together. Why did all this happen? Where did I falter in my duties as a wife?

it takes two? - - Aug 26th 2010

how about the situation where both spouses are cycling in and out of their own depressions brought on by heredity, upbringing, and general grief over how their lives have turned out? they bounce around off of each other never knowing if the other is making them depressed, or if they are just 'taking things too personally'. they each secretly fear that they ARE the problem in the relationship, so both intermittently withdraw, frustrating the other who at that point wants to try anew to repair things after experiencing a break in their own fog.

this kind of relationship can apparently last for very many unhappy & unhealthy years out of pure lethargy and despair that there is any alternative.

my vote is, as always, to make mental-health care more affordable. especially in these downward economic times.

when to leave - alia - May 29th 2010

In short, you leave once the abuse or episodes begins to effect your health; that of your child; or your ability to provide a healthy environment for the child long term. Period.

I finally left a 9 year relationship with a 12 month old after the mental/verbal/emotional/financial abuse stepped up to physical and extreme financial (including bankruptcy) during my pregnancy; and after a failed suicide attempt after I made the move to leave. Best thing, for all 3 of us, I ever did. And yes, it took blowing up my low self esteem and mustering all I could, and I wish I could say that did, but it was the suicide attempt that finally pushed me over the edge to end things and seek help.

I am not looking back, and 6 months later still feeling IMMENSE RELIEF. Abuse experts are right, it only gets worse... btw, I also suspect my spouse's chronic depression is complicated by a personality disorder.

Married for 21 years to depressed spouse - Kleigh - May 2nd 2010

So what do you do when you've been married for 21 years with 2 teenage boys and you know your husband is depressed, both his father and grandmother were suicidal depressed, but he REFUSES to go on any "psycho BS drugs" or go to the counselor. We see a therapist for our 14 yr old and he goes to that but won't see him for our marriage. It is ripping me apart. I will do just about anything to make it work but he right now is being distant; won't answer my texts, won't talk to me when he's home, goes in our bedroom to watch tv, he is constantly getting in our 17 yr olds face. Our kid is never in trouble is an honors student, boy scout, football captain, chorus member, etc., and is only a little lippy from time to time. My husband pushed too hard and the 17 yr old finally blew up and said he felt he couldn't talk to his dad about things because if he does, his dad mocks him. And what did his dad do? he mocked him. It is ruining our family. He says its his job that's making him miserable. So I suggested he do something about it. but he won't. So if he refuses to get help, isn't it time for me to go?

Depressed and lonely - bee - Mar 14th 2010

I am a depressed person. the glass is half full and the blame game not far away. I have just walked away from a marriage of 29 years. I sought counselling for 24 of those years, but my spouse would never attend but allow me to go. I took antidepressants and continue to do so, to function normally, without them I am an angry person. It was no help to be labelled by spouse as having a mental health problem or had I taken my crazy pills yet. Once labelled, all marriage concerns became a result of my depression and no validity was made to concerns. My spouse, had to deal with a lot from me, due to sexual abuse when young, living in an institution and a difficulty to be a good wife and mother. I acknowledge that I caused a lot of pain and heartache. But know this also, growth never stops, some people mature later than others. Your loved ones need to take responsibility for their own happiness, you need to take responsibility for yours. Set the boundaries, and be supportive. Tough love, dont be a doormat.

I am very lonely now that I have left this abusive relationship, however I am also growing and finally at peace. Though still depressed.

Depression and Diabetes - Allan N. Schwartz, PhD - Jan 25th 2010

Hi Jackie,

Your complaint comes across loud and clear and no one can blame you for your frustration.

Of course, I do not know what your husband was like before his Diabetes but Diabetes and Depression go together. The incidence of Diabetics becoming depressed is very high. Perhaps some of them were depressed before they got diabetes. However, it is not know whether depression causes diabetes. It may be that some people who are depressed fail to care for themselves including how they eat and become diabetic. But, that is not true in all cases.

Most certainly, once someone has developed diabetes, depression is soon to follow.

Your husband needs anti depressant medication but, he most definitely needs psychotherapy. You are correct, an anti depressant pill will not do it all by itself.

Dr. Schwartz

depression and diabetes - jackie - Jan 25th 2010

i am writing to let you know that i know my spouse is living with diabetes and depression life has become unbearable now he is in hospital at moment i have been ringing and no one gives me any answers i have to told the hospital that i am not willing to have him home due to the fact that he tried to kill himself he is getting me into debt please can someone help we have been together seen we were 16 he is 50 i am 51 it would a shame to loos it. why do the familys of deprssed people nerver get to give the full story of what life is like at the begining of any tretments give a pill is not always the answer

The Partner and Additional Information - Allan N. Schwartz, PhD - Dec 29th 2009

Hi "Partner,"

The points you make have a lot of merit and bring to mind the fact that depression can be complicated by a Personality Disorder. A Personality Disorder is defined, broadly speaking, as repeated and habitual patterns of behavior that are learned early and are difficult to change. In some respects, the symptoms you identify are those of a person who is depressed and who also has a personality disorder of some type. There are myriad types.

I recommend psychotherapy, most certainly for your spouse and for you: so that you can learn to cope better with a difficult situation.

You have my empathy and full support.

Dr. Schwartz

some missing info - the partner - Dec 29th 2009

Dr. Schwartz - while the general outline you've presented is broadly accurate, as the partner in a 12 year marriage to someone who has chronic, interspersed with episodic, depression, I think it's important to add a few things:

- male depression can look significantly different from what people expect depression to be; it may involve extreme anger, jealousy, and hypersexuality

- depressed individuals often follow what seems like a script: they expect the spouse to fix everything while simultaneously resisting every effort the spouse attempts, and also making harsh and critical accusations (you don't do anything for me, you don't care about me, etc). They frequently threaten to leave the relationship - and much of their communication is verbally & emotionally abusive

- the partner of a depressed individual can do everything "right" and can follow textbook recommendations for positive communication, but communication models are predicated upon rationale adult actors. That assumption flies out the window when one member of the marriage is depressed, and leads to feelings of extreme frustration and self-doubt ("crazymaking")

- the partner of a depressed spouse has some choice and power in the relationship (for instance, to walk away when the depressed spouse becomes critical, rather than to argue and fall into what will inevitably become a very destructive demand-withdraw pattern), but ultimately the depressed person is setting the paradigm. Not getting out of bed, not seeking help - however passive these acts are, they exercise power over the nondepressed spouse and the relationship. While the non depressed partner cannot fix the depression in her/his spouse, s/he must be able to set limits on how power is exercised in the marriage.

I wish I knew the outcome - happy or not - in my marriage, but it's still a work in progress. One thing I am certain of, after keeping the pain and difficulty of dealing with a depressed spouse bottled up inside of me for years, is that seeking support from friends, family, a therapist, etc. just for me has been critical. I hope that anyone else in a similar situation has a strong support structure and the courage to use it.

depression and employment problems - - Dec 22nd 2009

Depression is real and depression is (at least partially) treatable. But --

At the risk of oversimplifying the situation, depression and employment problems present a kind of chicken-and-egg issue, at least for males. A troubled job history is very neatly explained by depression, and the reverse seems also to be true. In fact, depression works so well as an explanation for difficulties at work that it seems to then be pressed into service to explain and/or justify just about everything. The kinder or more "supportive" a wife, the worse the situation seems to become . . .

Depression can ruin a marriage - Laura - Nov 4th 2009

It is important to realize that non-depressed spouses need support as well. Life happens, and though depressed spouses are there for the ups, they often cannot provide support for the downs. I was committed to supporting my clinically depressed husband because I loved him fiercely and because I have always been emotionally able to invest that sort of energy into keeping him afloat. His detachment became more problematic after the birth of our child, when I essentially became a single parent. When my mother died, my husband became even more detached when I needed him most. I resented the unreciprocated emotional investment I placed in him - I asked for a divorce. His response was characteristically apathetic, alternating with episodes of insults and lashing out. Now the divorce process is taking its toll, and he has cut off our child completely - our therapist suggests that guilt has a large role in his detachment. The constant analysis and explanation of detached behavior is draining. I've learned that the lack of communication and unilateral demands characteristic of depressed individuals seem counterintuitive to the basic requirements of marriage.

Depression and emotional abuse - Marie - Oct 23rd 2009

I left my partner 5 months ago, leaving a relationship described as emotionally abusive. He has since been diagnosied as clinically depressed (the separation hasn't helped) and made the comment that he had been depressed for a long time.

The good times were great; then there were outbursts of anger - no interest in sex, withdrawl from his family.... everything described above sounds familiar. The night I left him, he got a kitchen gas torch and threatened to burn the home down (in front of my 5yr old).

I read the above with interest - are many women in controlling / abusive relationships really just dealing with depressed partners? Does the fact that they are depressed mean that we should stick by them and support them or are we dealing with different illnesses?

Helplessness - Susan - Oct 6th 2009

As the non-depressed spouse, I experience an immense sense of helplessness when my husband is going through an "episode". Just last night he bacame angry with me over the most trivial thing. Now he will not talk to me (currently we are 1800 miles apart). I feel so lost to try and help him. I tell myself that if he would just call me we could talk and work this out. But he has withdrawn from me. This has happened before. I totally understand the dynamics of depression but it doesn't make it any easier to handle. I worry that these episodes will break us apart. I should tell you, he is 67 and has had major depression for over 30 years. He recently started a new drug, Cymbalta and he has been feeling much better and coping with life so much better. We have been married for only 3.5 years. I love him so much and I want to help but I just don't know what to do. Yes, I have suggest marriage counseling but he refuses. He has no faith in in personal couseling/therapy either having had many years of it and with little or no improvement.

Thank you for listening.

Dysfunctional spouse - - Sep 28th 2009

I am confused about what constitutes "responsibility" in a relationship. If one spouse clearly has problems coping and refuses help, surely they are creating the majority of problems in the relationship? Isn't that just common sense? If one has major depression with suicidal thoughts, the other has to respond in the best way possible, but continued exposure to this negativity will bring them down. They will get angry, frustrated. Are they "contributing" to the problem or simply responding to being with someone who is letting a health problem go unmedicated?

I think this 50-50 business is created by therapists to pacify the partner who is causing most of the problems. If I have high blood pressure and I don't take my medication, does my partner have to take responsibility for that too?? Why is it different for mental health?

Optimist! :-) - malign - Feb 9th 2009

The first thing I noticed about the fictional scenario is that it has a happy ending. :-)

In other words, although it described some of the interactions that might occur between a depressed spouse and a non-depressed one, the assumption is, in fact, that only one of them has a major problem, at least at the beginning of the scenario. What happens when the non-depressed spouse starts off with problems of their own? For instance, with low self-esteem? Such a person might not be able to confront their depressed spouse in a constructive enough way to get both of them to counseling, or might be so sure that the problem is theirs that the depressed spouse's problem never gets addressed.

Anyway, that's how I could tell the scenario didn't describe my own marriage: it wasn't complicated enough. ;-)

I do agree with the basic premise, though, that the emotional problems that the spouses bring to the marriage are often as much a factor in breakups as the dynamics between them.

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