file4801310649783“What is the opposite of two? A lonely me. A lonely you.” -Richard Wilbur

“It is not a lack of love, but a lack of friendship that makes unhappy marriages.” -Friedrich Nietzsche

The TV ads would have all of us believe that the best cure for depression is the latest and greatest medication. First it was Prozac and now it’s Pristiq and Abilify. Although medication is a life saver for many, for others the side effects are too debilitating, and the meds don’t seem to help enough anyway.

Study after study has shown that the best treatment for depression includes some form of psychotherapy. Once again, there is always the cure du jour–right now it is cognitive behavioral (CBT or DBT). Nothing wrong with that. It’s just that something is missing from the information.

Your doctor or family may have told you (if you are the depressed one) to get help. What you haven’t been told is to make sure you do some counseling with your spouse, your children, and/or your family as well. Here’s why this missing information is so important…

file1871264468042It is More Than Just Social Support

Psychotherapists have long known that social support is crucial–not only when the patient suffers from depression but with any physical or emotional illness or disability. When you visit your doctor for your annual check-up, how often are you asked about the quality of your relationships? We now know that this is even more important than we thought.

A new study by Alan Teo and his team in the Psychiatry Department of the University of Michigan conducted a ten-year follow-up of almost 5000 adults aged 25-75 to determine just how big a part relationship factors played in the risk of developing depression years later. Their conclusion: the magnitude of the impact of social relationship quality on risk for depression is as strong as the effect of biological risk factors (like obesity, smoking, high blood pressure) for cardiovascular disease.

file7281249918714Quality is More Important than Quantity

Perhaps surprising to many, social isolation was not predictive of future bouts of depression. Social isolation is measured by things such as whether or not you have regular contact with family, friends, and neighbors and whether you live alone or with someone. Apparently, some people are less social than others–and happily so.

It turns out that what is relevant is how each of us subjectively feel about the quality of our relationships. The study revealed that of the people who rate their relationships as positive and supportive, only 1 in 15 will develop a diagnosable depression in ten years time. In marked contrast, 1 in 7 who describe poor social relationships will get depressed. Now that’s a big difference.

file0001203965What Clinicians Should Be Asking

Most of the research to date has focused primarily on the positive aspects of social support. Teo and his researchers found that equally important–or perhaps even more crucial–is to look at the negative aspects in order to assess for social strain. This means asking questions like:

  • How do you feel about your marriage or about the person you are dating?
  • Do you feel that your partner cares about you and understands what you are going through?
  • Do you feel that your partner is critical of you too much of the time?
  • Do you know that you are loved by your spouse? your children? your friends? your family?
  • Can you share with your closest friends or family members when you are stressed or having problems?

Including questions about the client’s subjective assessment of both positive and negative aspects of their ¬†relationships “should be considered evidence-based, much like inquiring about past depressive episodes” warns Teo.

It’s A Family Affair

file361245785428The research also indicated that not all relationships are created equal. Perhaps it should be obvious that the number one relationship that affects us is the relationship with our spouse or significant other. Second to that is our relationship to other family members. Friends are important but their presence or absence does not play a significant role in the later development of depression. Our loved ones do.

So the next time you notice relationship strains, think about which of you may be the most vulnerable to developing depression down the line. You? Your partner? One of your children? (Check out my blog on the warning signs of a troubled marriage). It might take years but the odds tell us that negativity in our relationships breeds resentment which can lead to more conflict or to isolation and loneliness. Doesn’t that sound depressing? Turns out, it is.