By Sarah Albert
Reviewed By Brunilda Nazario, MD
Does this sound like you or your significant other -- excessive sleepiness or insomnia, appetite changes, a libido that's kaput, and unwanted, nasty feelings of depression or anxiety that just won't quit? Or maybe it's a condition with names like OCD or ADHD that's left you or your mate emotionally and physically bankrupt. It's easy to find couples who are struggling with mental health problems despite the stigma and shame that may keep many people from talking about it. After all, the National Institute of Mental Health (NIMH) estimates that during any given year one in five adults suffers from a diagnosable mental disorder in the U.S. alone. Just as easy to find are couples who haven't made it through the struggle.
"One of the main reasons for marital problems and divorce is unrecognized depression," says Anne Sheffield, author of Depression Fallout, a book about how depression affects relationships. Having suffered from depression herself -- depression that also afflicted her mother and daughter -- she knows firsthand how devastating it can be for both partners. Mental health problems take their toll on relationships, and often people don't even realize what's happening.
"Sometimes depression is like a third entity in the marital system, and it can have great prominence in the relationship," says Eileen Sullivan-Leggett, PhD, MFT, a psychotherapist based in Kentfield, Calif. Sullivan-Leggett is also on the advisory board at the Hoffman Institute, where programs help couples break negative cycles and patterns of behavior and thinking.
"It's a family condition," says Julie Totten, the president and founder of Families for Depression Awareness. Partners of people with mental health problems are often left wondering where they fit in or how they can help the person they love. Left untreated, psychological conditions can take a toll on your relationship, but there is help available. Here's expert advice for couples about what to expect and how to cope.
Acknowledge What Lies Beneath
The first step to healing, recovering, or treating a psychological problem or mental disorder is to recognize its existence. Sheffield runs a web site that has a forum where people -- almost all in relationships -- have vented and discussed these issues for about five years. She's observed that a lot of couples go through an initial stage of bewilderment when one partner notices a significant and sudden change in their partners' personality, but it isn't necessarily linked to a psychological problem.
Any couple that is having inexplicable problems should consider the possibility that depression is at play, says Sheffield. One of the most extreme examples is when one partner has a total change of heart. "If they suddenly become very critical, distant, and unresponsive -- if they flinch when you try to put your arm around their shoulders -- you should consider the possibility that they are one of the 20 million people in the United States who suffer from depression," she says.
Broaching a Difficult Topic (or a Difficult Partner)
So what do you do if you know that there is a psychological problem going on with your partner, but they refuse to see it? There is a limit to what you can do, but the first step is recognizing what is happening instead of the more tempting yet destructive option of basking in denial. "I know from the message boards that there is a lot of stigma, and people feel this is something that has to be hidden," Sheffield says. You need to accept what is happening and discuss it with your partner, which can be touchy.
Sheffield recommends that you try focusing on the physical symptoms that often accompany problems like depression. People make the mistake of thinking a mental health condition is just a problem with thinking, when in fact the condition might also have long and short-term physical side effects. "Know the negative impact that depression has on health," she says. There is plenty of research that connects mental health disorders to physical problems. Sheffield says depression increases our risk of death after heart attack and contributes to heart disease and diabetes; studies also show a link between depression and cancer. "Depression is a very dangerous illness physically. When your [stress hormone] levels are elevated, as they are when you suffer from depression, it's as though your body is in total stress all the time and gets no relief. Untreated depression is very dangerous."
Other conditions might be accompanied by very different side effects including anxiety, excessive worry, obsessive thoughts, and an inability to concentrate. Telling your partner about the symptoms you are noticing -- instead of diagnosing them with a condition -- might get them to visit a doctor who is better equipped to point out the possibility of an underlying mental health condition.
Any Self-Medicating Happening?
Sex, alcohol, and food can all be very enjoyable parts of our lives, but they can also be used excessively to cope with depression, anxiety, or other psychological conditions. It's important to recognize when something is being used to mask a problem. If you sense that this is happening with you or your partner, don't ignore it. The consequences can be serious for the relationship and the individual. "Over time, a lot of the joy in a relationship -- the sort of juice that brought the couple together -- can dry up," Sullivan-Leggett tells WebMD. When this happens because of a psychological issue, self-medication is common, she says, and can come in the form of drugs, alcohol, television, and food. Sex too can become a form of self-medication, but often this occurs outside of the relationship, despite libido problems or a lack of sexual interest within the relationship. "Infidelity never happens in a vacuum."
Get Involved With Treatment
Hopefully once you or your partner accepts and acknowledges that there is a psychological problem worth exploring, you will seek treatment and address some of the related issues with a physician and a therapist. This doesn't have to be something that is only done individually. Totten recommends that partners stay active in each other's mental health care. "Become a partner in treatment by seeing or calling the clinician," she says. "If your husband or wife agrees to it, you can go to meetings with the clinician," she says, making it easier for you to help monitor treatments.
Totten started Families for Depression Awareness after her brother committed suicide when he was 26 years old. "He wasn't diagnosed with depression, and I was unaware of what mental illness really was at that point," she says. "I did intuitively try to help him, but it didn't work."
After helping her father get diagnosed and treated for his depression, Totten realized there was a real gap in information and support for family members to help those battling mental illness. "I really felt a need for depressive disorders to be approached as a family condition," she says. This includes understanding what they are and how they can be managed and treated.
You should immediately contact a clinician if there are any dangerous symptoms you observe, especially suicidal thoughts. The clinician won't be able to discuss your partner with you if you are calling without their consent, but you can still call with concerns about symptoms, says Totten. "The most important thing is to be a partner in treatment." But this doesn't mean you should hold yourself accountable for their diagnosis and treatment.
It's Not Your Fault
It's important that you don't take responsibility for your partner's mental health problems, even if they hold you responsible, says Sullivan-Leggett. "Don't take it on," she says. Couples coping with depression often have co-dependant relationships and systems that need to be broken. While the depressed or anxious partner might blame their partner unnecessarily for their condition, the other partner might hold themselves unnecessarily accountable. Realizing that you are not to blame will also help when it comes to treatment, because you won't mistakenly believe that you have the power to fix things.
Take Treatment Seriously
Take your mental health seriously, and seek treatment -- possibly medication and/or therapy -- as soon as possible if you think you might be suffering from depression, anxiety or another mental health condition. Would you dillydally if you suddenly became physically ill? "Take treatment seriously. Even low-grade chronic depression is serious," says Sullivan-Leggett. "It's not given much press, but life is too short and too precious to live with even a low level of chronic depression." Don't simplify the treatment either; overcoming or managing a mental health issue isn't just about popping a pill or going to a couple of therapy sessions. It's often much more time consuming and ongoing than that, but worth the rewards.
Take Care of Yourself
It's crucial that you take care of yourself if you are living with someone who has a chronic mental health condition. It's also not uncommon to develop your own psychological problems in the process, problems that should also be taken seriously and at times treated.
"A spouse should realize that this affects them," says Totten. Sheffield says often partners of people with depression feel demoralized, which mimics depression. Either way you aren't any help to anyone, or to your relationship, if you too are suffering. "Take care of yourself emotionally, spiritually, and physically," says Sullivan-Leggett. "Make time for yourself." Talking to your friends and staying connected is really important. You might even want to join a support group or seek individual counseling.
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When Treatment Is Resisted
There is no doubt that relationships end and deteriorate because of mental health problems, and in some cases splitting up is the best option for both partners. Individual treatment and couples counseling can be very beneficial, but sometimes a partner won't even consider those options.
If you've tried everything and your partner still refuses treatment, something Sheffield says is common, you may need to leave the relationship. Going for a quick fix without any serious commitment to treatment can often spell trouble for you and your partner.
Remember: It's a Cycle Worth Breaking
We have to remember that mental illness, including depression and anxiety, often runs in the family. Sullivan-Leggett says it's a process that extends from generation to generation. "It moves through the family, not just genetically, but also in the soul," she says. When there is depression in the family system, there is a loyalty to carry on that family pain, and it's very difficult to break that cycle -- to break that loyalty to the pain and live without the depression, she says. This is something you should be especially aware of if you have children. "But depression is very treatable, and with treatment you can break the cycle."
Published Nov. 15, 2004.
SOURCES: Julie Totten, president and founder, Families for Depressive Awareness. Eileen Sullivan-Leggett, PhD, MFT, psychotherapist, Kentfield, Calif.; board of directors, The Hoffman Institute, San Anselmo, Calif. Anne Sheffield, author, Depression Fallout. National Institute of Mental Health.
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