Emotional Health · Marriage & Life Partners

When a Spouse Is Depressed

Dear Millie,

Your situation is very difficult, though not unusual. At least 1 in 10 Americans are clinically depressed and that represents just those who are brought to our attention. Within a given year, 6.6 percent of the adult population will experience major depression, but there are many instances in which it is not recognized and more where it is not treated. There are people who might be called reclusive or shy or who like to keep to themselves who may actually be suffering from undiagnosed depression. More than 80 percent of people with symptoms of clinical depression are not receiving any specific treatment. A study done at Harvard, revealed the number of patients in whom depression is diagnosed  increases by approximately 20 percent per year.

The sad thing is that when left untreated it can take hold and get worse. That may be what happened to your husband. His original low mood was sparked by a real event — the setback at work — but it grew into something more. It is hard to say whether or not this is because of “psychological issues” or the changes in brain chemistry that can take place if a depression remains untreated, or both.

An example of a psychologically induced depression might look something like this: your husband always felt like a fraud — that his success was based on fooling people — and the work problem confirmed these fears, unleashing long-buried wounds. Another scenario encountered  frequently in middle-aged men is depression due to signs of aging, which can set off fears of mortality. While some men try to deny or overcome this fear by engaging in “counterphobic” activities, like extra-marital affairs or buying a sports car, others feel it more directly and can succumb to depression.

It is hard to know what is really going on with your husband, but I do know that depression can be treated. There are many different kinds of drugs on the market now, and too often people give up if the first one doesn’t do the trick. That is a mistake. It often takes a good deal of tinkering, as well as patience to get the right drug and the right dosage. This can be especially frustrating for the patient who is struggling from depression and his or her family, but it can be worth it.

I recall a patient who was quite seriously depressed — unable to sleep, constantly tearful, and so anxious that she could not even read the newspaper or watch TV. Luckily, she was working with a very well-trained psychiatrist with a good background in psychopharmacology. But after the initial six-week trial period did not yield results (some drugs can take that long to show effects), I was upset and complained about to her about my patient’s suffering. The psychiatrist asked me to try to hang on, saying that this was an especially good treatment but some patients took eight weeks rather than six to respond.

Sure enough, about two weeks later the patient began to emerge from the depths of her despair. Though we still had much to do, she was clearly on the upswing.

This story also illustrates how important it is for a patient who is undergoing treatment for depression to have regular psychotherapy as well as drug treatment. The course of recovery can be difficult and even dangerous, and he or she must be monitored and supported throughout. Too many people are getting prescriptions from their internists for antidepressants without the other crucial part of the treatment, the therapy.

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