How's Your Marriage, Doctor?

Does a lot of anger mean depression?This was a question posedto me by a patient's wife, Mrs.King, over the telephone recently. Shewas worried that her husband's depressionwas coming back.

Dr. King, an anesthesiologist, wasreferred to me about 18 months ago byhis urologist. He had just completedtreatment for prostate cancer. Urologically,he was doing well. However, hismood was down, his sleep was off, hewas preoccupied and absent-minded,and his energy was poor. Death was onhis mind, but he was not suicidal. He fitthe criteria for major depressive disorder,and he had had two untreated depressionsin the past—one during medicalschool and one during his residency. Heresponded nicely to an antidepressant,and that, coupled with psychotherapy,helped him a great deal.

Depression Effects

In his therapy sessions with me, hebegan to talk about his marriage. Thiswas the second marriage for both, andthere were no children. The two of themenjoyed skiing, sailing, tennis, and travel.However, Dr. King complained bitterlyabout his wife's "messiness" and "procrastination.""And she won't throw anythingout. We can't entertain becausethere's no place for people to sit. Plus it'sembarrassing to live in a home that lookslike it belongs to a crazy, dementedrecluse," he said with some emphasis. Idecided to do some marital therapy withthem. Both were willing.

Mrs. King's appearance certainlybelied the description of the home. Shewas attractive, immaculately groomed,and precise. She struck me as quite anxious,vulnerable, and very sensitive to criticism.In fact, she was so brittle that herthinking became almost paranoid attimes, especially when her husband triedto illustrate his concerns with anecdotes. Ihad to shut him down because I sensedthat she felt shamefully exposed and panicky.I was able to make suggestions thatI think were face-saving for each of them.I focused on what was healthy about theirmarriage and reworked Dr. King's laundrylist of "marital pathologies" (hisexpression). I urged him to put his complaints—which were numerous, obsessivelydetailed, and harsh—in the form ofrequests. Great strides were made in boththeir communication and in the "clutter"of the home over a 3-month period.

Medication Concerns

After being on his medication forover a year and symptom-free for agood 12 months, Dr. King wanted tocome off his meds, largely because ofside effects. I advised otherwise, givenhis mood history. However, he continuedto push, so I went along with a veryslow taper over several weeks of monitoring.He was at the lowest daily dosewhen his wife made the above telephonecall to me.

I scheduled a visit for the two ofthem together. Dr. King was very upsetthat his wife had called me. He said,"Don't get sucked in by her, Dr. Myers,she wants me to stay on these pills forever.She's just trying to get back at mefor telling you about her weird behaviorat home, that she's not the crazyone, I am." I decided to spend part ofthe visit with him alone, in which heconfided that he didn't feel as well atthe lower dose. He also told me that acouple of colleagues at work had askedhim if he was okay, that he seemed kindof cranky. He was willing to return to atherapeutic dose of the drug.

Mood disorders and marriage arestrange bedfellows. Each needs examinationand care.

Michael F. Myers, MD, a clinical

professor in the Department of

Psychiatry at the University of

British Columbia in Vancouver,

Canada, is the author of Doctors'

Marriages: A Look at the Problems

and Their Solutions (Plenum Pub Corp;

1994) and How's Your Marriage?: A Book for

Men and Women (American Psychiatric Press;

1998). He is the past president of the Canadian

Psychiatric Association and welcomes questions

or comments at myers@telus.net.