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A Case of Depression

Jenny is a 40-year-old attorney and a divorced and remarried mother. She was referred to me by her therapist of two years for psychiatric evaluation and consideration of medication to treat her worsening depression.
At our initial interview, Jenny’s husband, Frank, an accountant, was present in order to provide some history. He was quite cooperative yet strangely detached but answered all questions. I prescribed medication and Jenny responded nicely to it while continuing with her therapy. Over the course of one year she relapsed four times, with new medication being prescribed, all with limited success and a variety of side effects.

It gradually became clear that the source of Jenny’s depression was her husband’s lack of accountability and responsibility regarding their marriage. While Frank said all the right things, he would frequently and unpredictably be late for couple’s sessions and not follow through on promises. Jenny was helpless and then changed one evening when I was paged at 11:30 p.m. on a Saturday night. Jenny was in a hotel 2,000 miles from home, threatening suicide.

It turned out Jenny’s husband had discontinued couple’s therapy several weeks earlier and was clearly not engaged in her attempt to improve the marriage. Jenny felt trapped between failure in a second marriage and helplessness about improving the relationship. That Saturday night she saw suicide as the only way out.

Now, Jenny wanted me to tell her whether she should stay out of the house or go back to her husband. I advised Jenny that a change in her context was medically indicated and that her husband was creating a depressogenic [depression-inducing] context that attitude change and/or medication could not counterbalance. I advised her to stay out of the home and if she and her husband chose to, they could continue in couple’s psychotherapy. Jenny followed my advice, and a two-year follow-up revealed that she did not relapse into depression