Most people think that the most effective response to depression is taking anti-depressive medication. But 40-50% of people, especially those with mild to moderate depression, don't respond at all to this treatment (Kocsis, 2003). When all the research is examined, these drugs don't have any impact on mild to moderate depression (Kirshch et al., 2008).
Cognitive Behavioral Therapy has been demonstrated to be more effective than medication for mild to moderate depression. However, for more severe forms of depression, it is best to use both drugs and psychotherapy.
Couples therapy has also been demonstrated to be effective when given in two “doses” over a two-year period. It both lowers the frequency of depressive episodes and the intensity of each episode.
Symptoms of depression
Depression is tough to live with especially dealing with depression in family members. Depression sufferers especially hyper-focus on negative thoughts, feelings, and experiences.
Depression can negatively affect even the happiest marriage. Symptoms can include feeling hopeless, worthless, excessive guilt, difficulty concentrating, difficulty sleeping or oversleeping, appetite changes, and loss of energy. Partners feel that they are "picking up the slack" given their partner's mental illness.
The non-depressed spouse often begins to feel more hopeless and helpless. Depression is "contagious" in that it is depressing to live with someone who is depressed. Those with depressed spouses report feeling like they are in a "no-win" situation.
Partners may try to comfort and console their depressed spouse only to be told to leave them alone. Once they do, their partner may complain that no one is paying any attention to them.
Researchers agree that depression is episodic. The goal is to shorten the length of the episodes and have larger periods of normality. We also want to decrease the intensity of each episode.
Is it my marriage or depression?
Mental health professionals have learned that the two are woven together. A bad marriage is a risk factor for living with depression. Depression increases your likelihood of having a troubled family life.
A study by Whisman (1999) showed a strong correlation between distressed relationships and depression. People in troubled relationships are over three times more likely to be diagnosed with Major Depression. They are over five times more likely to have Dysthymia. This research suggests that interpersonal relationships are key to mental health.
In addition, marriage counseling can address depressive symptoms. Many research studies indicate that symptoms of depression lessen as relationships improve.
Research is clear that couples therapy can treat individuals who suffer from depression. Whether or not the therapist is trying to treat the mood disorder or improve the marriage, good couples therapy does both.
Therapy can provide an objective, safe space for couples. They gain insight into how their relationship dynamics impact their emotional well-being.
Depression and divorce
Depressive problems have been found to predict divorce , but it's difficult to say what causes what. Chronic problems within the marriage lead to feelings of mental distress and subsequent divorce.
On the other hand, depression can also be a direct cause of marital dissolution. The more depressed you are, the worse your marriage looks. The worse your marriage is, the more easily you can become depressed.
Marriage counseling can help a couple sort out the influence of both to decide if divorce is the best option. Then couples make this decision in a more informed way.
What is the connection between loneliness and depression?
Loneliness is a major contributing factor to depression. When you feel disconnected from your partner, it can generate a deep feeling of sadness that can lead to depression. In addition, when a person is struggling with depression, they may withdraw from social situations, creating a sense of loneliness.
This can create a vicious cycle. Loneliness can worsen depression, while depression can make a person feel more isolated and alone.
Marital treatment for depression
Research on couples therapy for treating depression is clear. Couples working together in therapy learn of the positive qualities of their relationship. Therapies that benefit the relationship reduce depression at the same time. When you improve one, you improve the other.
It is very hopeful that briefer couples therapy can prove effective, even with more severely depressed individuals. Surprisingly, in one study, the more severe the depression, the more beneficial the couples therapy was.
Relationship health is as important as physical or mental health. These factors are as important to well-being as diet, exercise, physical health, or good dental care.
In marriage counseling, couples learn to enhance intimacy and allow vulnerable feelings to be expressed. It can normalize common relationship concerns.
This work can reduce destructive patterns while introducing positive ones. Of course, both learn about the symptoms of depression and how to manage them.
Couples learn to become more flexible with one another, gain greater acceptance, and institute concrete actions that improve depressive mood. They learn how to talk in a vulnerable way with one another. They are given homework assignments to practice and keep up with this intimacy.
Research findings demonstrate that even brief couples therapy can improve depressive symptoms, particularly for women. Furthermore, it can reduce the fluctuations in mood so commonly seen.
Given that John Gottman's research has indicated that 69% of couples' problems are perpetual, this alone can be uplifting. Couples can learn to become more compassionate and accepting of these differences. The more accepting of differences in personality, preferences, and habits, the less it will impact mood.
Effective science-based couples therapy creates a bridge between partners that allows them each to feel deeply understood and accepted. A couple experiences the ability to safely communicate their fears, resentments, disappointments, and anger. As they talk about their worries and concerns, depressive symptoms lower, according to research.
As couples learn to support each other, feelings of loneliness can be reduced, and depression can be effectively managed.
Couples therapy can provide a safe and supportive environment to recognize the signs of depression. Even in the midst of a depression, couples can learn how to communicate better, build trust, and resolve conflicts.
Building a secure, trusting relationship is good for everyone, even those suffering from mild to severe depression. Couples therapy can help a couple to recognize and understand the impact of their own behaviors that contribute to depression. The depressed person can learn new coping strategies that the spouse can support.
Couples can learn about depression and its impact on marriage. They can also identify triggers of depression, create coping strategies, and create a plan for improving their relationship. Depressed spouses learn to shift the focus of attention to more positive qualities of experience resulting in improved mood outcomes.
They can also identify triggers of depression, create coping strategies, and manage depressive symptoms together. Couples therapy can also help couples reconnect and learn how to support each other during these difficult times.
Gray, T D., Hawrilenko, Cordova M., J. V. Randomized Controlled Trial of the Marriage Checkup: Depression Outcomes. Journal of Marital and Family Therapy 46(3): 507–522 doi: 10.1111/jmft.12411
Kirsch, I., Deacon, B.J., Huedo-Medina, T.B., Scoboria, A., Moore, T.J., & Johnson, B.T. (2008). Initial severity and antidepressant benefits: A meta-analysis of data submitted to the Food and Drug Administration. PLoS Med, 5 (2), 45. https://doi.org/10.1371/journal.pmed.0050045.
Kocsis, J.H. (2003). Pharmacotherapy and chronic depression. Journal of Clinical Psychology, 59, 885–892. https://d oi.org/10.1002/jclp.10180.
Whisman, M.A. (1999). Marital dissatisfaction and psychiatric disorders: Results from the National Comorbidity Survey. Journal of Abnormal Psychology, 108, 701–708. https://doi.org/10.1037/0021-843X.108.4.701.