Depression and Anxiety: Effects on Marriage and Family

Definitions and Descriptions of Depression and Anxiety

This paper considers the nature and etiology of depression and anxiety, presents research on the effects of these disorders on marriage and family, and concludes with a discussion of therapy involving the spouse and family of the depressed or anxious individual.

According to the Surgeon General (1998), the primary symptoms of major depressive disorder (referred to as "depression" throughout this paper) are depressed mood and loss of interest or pleasure in activities. Other symptoms vary considerably. For example, insomnia and weight loss are thought to be key signs, even though many depressed patients show the opposite — weight gain and excessive sleep. The DSM-IV (American Psychiatric Association, 1994) addresses such variability by using diagnostic criteria that allow for differing presentations and prevalence. As one example, the Surgeon General's report notes that "a severe depressive syndrome characterized by a constellation of classical signs and symptoms, called melancholia, is more common among older than among younger people, as are depressions characterized by psychotic features (i.e., delusions and hallucinations)." In addition, the so-called reversed symptoms — oversleeping, overeating, and weight gain — may be more prevalent in women than in men. Anxiety symptoms such as panic attacks, phobias, and obsessions also occur.

An untreated depressive episode lasts, on average, about nine months. Eighty to ninety percent of untreated individuals will not have a recurrence within two years of the first episode. Thereafter, more than 50% of depressions will recur, and after three or more episodes the odds of recurrence within three years increases to 70–80%. Moreover, each new episode increases the risks of severe disability and suicide (Surgeon General, 1998).

In her memoir, writer and magazine editor Brampton (2008) described what it felt like to be depressed:

I was tired all the time and not normal fatigue but bone-weary exhaustion. I slept as if I had been knocked unconscious and struggled to wake in the morning, dragging my leaden limbs through the day… My arms and legs ached constantly, so painfully that, at times, I took painkillers every four hours. And my weight, which had been the same all my life, kept going up despite eating very little. (p. 56)

Devastating psychic wreckage can also occur with Generalized Anxiety Disorder (referred to as "GAD" throughout this paper), which is characterized by chronic and exaggerated worry and tension, often accompanied by fatigue, headaches, muscle tension and aches, irritability, sweating, and trembling. The DSM-IV specifies that symptoms must occur more days than not over a span of at least six months for a diagnosis of GAD. As the "generalized" part of the name implies, the excessive worries often pertain to many areas, including work, relationships, finances, the well-being of one's family, potential misfortunes, and impending deadlines. Somatic anxiety symptoms are common, as are sporadic panic attacks (Surgeon General, 1998).

The following excerpt describes in verse a college student's anxiety episode (Schutz, 2006):

I don't understand what's happening. / I am sitting in Writing Seminar / and it feels like my hands are shaking, like I've got a tremor. / I try hard to focus, stare at my hands, but I can't tell whether or not they're shaking. (p. 31)

Researchers, for the most part, agree that heredity influences susceptibility to depression (Fendukian and Wilson, 2008; Surgeon General, 1998). However, they also give causal credit to other factors, such as childhood environment, life experiences, and environmental stressors. Some research (see, for example, Holden, 2003) has aimed at identifying the predisposing gene or genes, but most writers suggest that several different genes on different chromosomes — varying across family and ethnic groups — promote susceptibility to depression (Fendukian and Wilson, 2008).

Causes of Depression and Anxiety

GAD, on the other hand, appears to have only a modest genetic component (NIMH, 2009). In this disorder, childhood experiences and early environmental stress appear to be the more relevant causal factors. Approximately 50% of cases begin in childhood or adolescence.

Both depression and anxiety are more common among women than men. For both disorders, the average female-to-male ratio is approximately 2:1 (Kung, 2000; NIMH, 2009).

Anxiety and depression are frequently comorbid — that is, the two conditions can be present in the same individual at the same time. Moreover, many of the medications used to treat either one are often used to treat the other. The question of why anxiety and depression are so interrelated has not been satisfactorily answered.

Clues to answering this question are expected to come from similarities in precursors, correlates, and consequences of each condition. Similarities in brain chemistry and brain anatomy have been found. Relatively recent research finds that the long-term consequences of depression and some kinds of anxiety appear at the same anatomical site — the hippocampus. Human imaging studies revealed smaller hippocampal volume in patients with a form of anxiety and in patients with recurrent depression. However, the complete sequence of events preceding and following hippocampal damage remains unknown (Surgeon General, 1998). The "chicken or egg" question — whether psychological distress causes damage to the hippocampus, or whether the damaged hippocampus causes psychological distress — has not been resolved. Indeed, neither may be the cause of the other; each may simply be a correlate arising from some other underlying cause.

Conclusion

It appears that psychotherapy involving a depressed individual has become more and more attuned to social context. This review revealed a trend, over the last thirty years, from individual to spousal to family therapy — the latter becoming especially relevant when there are children in the household. The research consistently points to the importance of treating depression and anxiety not merely as individual disorders but as conditions embedded within relational systems, where the suffering of one member affects all others and where healing, too, can be a shared endeavor.