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Secrets of a Formerly Miserable Wife
Author Diane England, Ph.D. has the credentials you expect, plus she has 
empathy and speaks from the heart because she has been there, too.

“Are You Discovering Depression Hurts?”
  (triggered by his narcissism, addictions & abuse)

We all know that life is inevitably filled with emotional ups and downs. But when the down times are long lasting or interfere with your ability to function, you may be suffering from a common yet serious mental disorder called depression. Clinical depression affects mood, mind, body, and behavior. And of course, depression hurts not only you, but your depression can hurt those around you, too. Now, I’m not worried about the impact on your narcissistic husband as much as I am about your depression’s effects on your children, for example.

When you live in an environment where you’re dealing with a narcissistic husband who might well have one or more addictions and who engages in emotional abuse and verbal abuse, for example, it’s not surprising that you might be depressed. Of course, you might not realize you are. But if you pay attention to your thoughts of hopelessness and helplessness, this might be a clue things aren’t right.

Depression hurts because it is a serious illness. And actually, it can even be life threatening.

Perhaps you’re aware that your current life circumstances are creating emotional pain, but you’re just looking for some means of temporary pain relief versus considering that you could be suffering from depression and other interventions might be necessary—like therapy and an antidepressant?

Maybe you realize you’re probably depressed, but you also assume you’ll snap out of it because you suffered a depressive episode once before and that’s what happened, right?

Well, you need to realize that depression hurts not only emotionally, but it can have negative ramifications on your body as well. It can do things like suppress the immune system so that you succumb to illnesses. These might even be life threatening.

You also need to realize something else. Just because you suffered one depressive episode in the past and got over it, this doesn’t guarantee that it won’t be worse and more debilitating in the future. After all, this can happen with depression.

Maybe you’ve been lucky thus far. You haven’t yet learned from personal experience that depression hurts. Well, I want you to realize something. How you’re living your life now is putting you at great risk of developing a depressive episode. And if you do find yourself incapacitated by depression, there’s a good chance that you’re spouse, assuming he’s pathologically narcissistic, isn’t going to be that concerned about what becomes of you.

You might want to think of a depressive episode as your body screaming at you that it’s time to change how you’re living. Your current lifestyle isn’t conducive to your physical or mental health.

Depression hurts. Depression also hurts in multiple ways. Let’s look more closely at some of the ways, just in case you’re experiencing depression now, but haven’t awoken to this fact.

People suffering from depression don’t all look alike. Not everyone displays the same symptoms, and the severity of symptoms can vary, too. Also, just because someone has depressive symptoms, this doesn’t mean she is clinically depressed. For example, it’s not unusual for someone who has lost a loved one to feel sad, helpless, and disinterested in regular activities for a period of time. But if these symptoms persist for an unusually long time, then there’s reason to suspect that grief has become depressive illness. Similarly, living with the stress of heavy workloads, financial problems, or family problems, for example, may cause irritability and "the blues." But when these feelings increase in duration and intensity, plus it’s impossible to function as usual, what seemed like a temporary mood may have become a clinical illness.

Now, your marital problems are probably ongoing (if you’ll be honest with yourself). Thus, it makes sense that you might feel helpless and hopeless. It  also makes sense that you might experience other symptoms of depression as well. After all, research has shown that the lack of an intimate confiding relationship, as well as overt marital disputes, are related to depression in women. In fact, rates of depression were found to be highest among unhappily married women.

But what are some of the symptoms you might experience that you should be concerned about because they might be indicative of depression?

If you experience at least three to five of the following symptoms for more than two weeks--or else the symptoms interfere with your work or family life--you should be evaluated for depression.

·         Persistent sad, anxious, or "empty" mood

·         Loss of interest or pleasure in activities, including sex

·         Restlessness, irritability, or excessive crying

·  Feelings of guilt, worthlessness, helplessness, hopelessness, or pessimism

·         Sleeping too much or too little,  or early-morning awakening

·         Appetite and/or weight loss or overeating and weight gain

·         Decreased energy, fatigue,  or feeling of being "slowed down"

·         Thoughts of death or suicide, or suicide attempts

·         Difficulty concentrating, remembering, or making decisions

·      Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain

Part of the evaluation for depression will involve an opportunity to discuss what is going on in your life. I would encourage you to be honest about your husband’s narcissism, addictions, and abuse. After all, you’ll probably need assistance determining how to deal with what you face now, and in a healthy manner.

Information on the Causes of Depression

In your case, the stress of living with a man exhibiting narcissism, addictions, and abuse might well be a causative factor in your depression. After all, these can create a living environment that feels out of control that you sense you are powerless to change since you can’t control or change him. But some of the following might also play into your depression or its severity.

Genetic Factors

Did you know you’re at risk for depression when your family has a history of this illness? Yes, a biological vulnerability can be inherited. However, not everybody with a family history develops depressive illness. And certainly, major depression occurs in people whose families have never been impacted by depressive illness. Therefore, additional factors such as biochemistry, environmental stressors, and other psychosocial factors are apparently involved in the onset of depression.

Biochemical Factors

Brain biochemistry is a significant factor in depressive disorders. It’s known, for example, that individuals with major depressive illness typically have dysregulation of brain chemicals called neurotransmitters. We also know sleep patterns, something biochemically influenced, are typically different in people with depressive disorders. Hormones can have mood-altering properties. Also, we know that depression can also be induced by some drugs, while others alleviate it. But what we don’t yet know is whether the "biochemical disturbances" of depression are genetic in origin or secondary to stress, trauma, physical illness, or some other environmental condition.

Environmental and Other Stressors

From your own marriage, you might be well aware of some environmental and other factors that lead to depressive illness. In addition to a difficult relationship, a major change in life pattern or financial problems, for example, can contribute to depressive illness. Or, sometimes the onset of depression is associated with acute or chronic physical illness.

Approximately one third of people who end up experiencing a depressive disorder also have some form of a substance abuse disorder.

Other Psychological and Social Factors

You’re more apt to develop depression if you engage in pessimistic thinking, suffer from low self-esteem, believe you have little control over life events, or worry excessively. Why is this the case? Well, it’s assumed these attributes may heighten the effect of stressful events, as well as interfere with taking actions that increase ability to cope or get well.

What contributes to the development of these traits? It appears that both upbringing and sex role expectations come into play. It’s also interesting to not that negative thinking patterns typically develop in childhood or adolescence.

Some experts believe the traditional upbringing of girls might foster these traits and thus, contribute to the higher depression rates amongst women.

Now, more Reasons Why Women Might be at Greater Risk for Depression

Major depression and dysthymia, a milder form of depression that lasts for a period of greater than two years, both seem to affect twice as many women as men. This two-to-one ratio exists regardless of racial and ethnic background. Also, it isn’t affected by economic status. Furthermore, this same ratio has been reported in ten other countries.

There ate some factors unique to women's lives that are suspected to play a role in the development of depression. The National Institute of Mental Health (NIMH) report that factors being examined are: reproductive, hormonal, genetic or other biological factors; abuse and oppression; interpersonal factors; and certain psychological and personality characteristics.

Let’s look now at other areas of research relevant to higher depression rates in women.

The Issues of Adolescence

Prior to adolescence, there’s little difference in depression rates between boys and girls. Between the ages of 11 and 13, however, there’s a precipitous rise in depression rates for girls. Thus, by the age of 15, females are twice as likely as males to have experienced a major depressive episode. And in actuality, female high school students have significantly higher rates of depression, anxiety disorders, eating disorders, and adjustment disorders than male students. The boys are more apt to have higher rates of disruptive behavior disorders.

All adolescents face the stress of forming an identity, dealing with emerging sexuality, separating from parents, and making decisions for the first time, as well as dealing with physical, intellectual, and hormonal changes. However, these stresses are generally different for boys and girls, and it’s thought they may be associated more often with depression in females.

Adulthood: Relationships and Work Roles

Stress contributes to depression in persons biologically vulnerable to this illness. Some theorize higher incidence of depression in women is due to particular stresses that many women face, rather than due to increased vulnerability. Stresses cited include major responsibilities at home and work, single parenthood, and caring for children and aging parents simultaneously. Nevertheless, we don’t understand exactly how these factors affect women.

Major depression rates are highest among the separated and divorced, and lowest among the married (other than for those women who are unhappily married, that is). But among the separated and divorced, the depression rate is still higher for women than men.

Reproductive Events

Researchers have confirmed that hormones have an effect on the brain chemistry that controls emotions and mood. However, a specific biological mechanism explaining hormonal involvement is not known. Still, we do know that many women experience certain behavioral and physical changes associated with phases of their menstrual cycles. In some women, these changes are severe, occur regularly, and include depressed feelings, irritability, and other emotional and physical changes. We now call this premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD). The changes typically begin after ovulation and become gradually worse until menstruation starts. Scientists are exploring how the cyclical rise and fall of estrogen, as well as other hormones, may affect the brain chemistry associated with depressive illness.

A desired pregnancy seldom contributes to depression. And actually, abortions don’t seem to lead to a higher incidence of depression. However, women with infertility problems may be subject to extreme anxiety or sadness. Nevertheless, it’s unclear if this contributes to a higher rate of depressive illness.

Postpartum mood changes can range from transient "blues" immediately following childbirth, to an episode of major depression, to a severe and incapacitating psychotic depression. Studies suggest that women who experience major depression after childbirth typically have had prior depressive episodes, although these might never have been diagnosed and treated.

Motherhood may be a time of heightened risk for depression because of the stress and demands it imposes.

Menopause is generally not associated with an increased risk of depression. In fact, while once it was considered a unique disorder, research has shown that depressive illness at menopause is no different than at other ages. Women most vulnerable to change-of-life depression have a history of past depressive episodes.

Specific Cultural Considerations

The prevalence rate of depression in African American and Hispanic women remains about twice that of men. There’s some indication, however, that major depression and dysthymia may be diagnosed less frequently in African American women than in Caucasian women. Furthermore, it’s most frequently diagnosed in Hispanic women.

Differences in symptom presentation may affect the way depression is recognized and diagnosed among minorities. African Americans, for example, are more likely to report somatic symptoms such as appetite change and body aches and pains. This point up something that has been noted about people suffering from depression. Many are either aware of physiological symptoms associated with depression, or else with the depressive thoughts that plague them, but aren’t cognizant of physiological symptoms and depressive thoughts simultaneously, even though both are often present.

Prevalence information for other racial and ethnic groups is not definitive.

Victimization

Studies suggest that some childhood experiences increase the likelihood of experiencing clinical depression during the life cycle. For example, women molested as children or raped as adolescents seem to experience higher rates of depression. But experiences in adulthood can play a role in the development of depression, too. Thus, rape in adulthood can bring about depression. So can sexual harassment on the job. And of course, being abused within the marriage can bring about depression as well. It is believed that abuse might lead to depression by fostering low self-esteem, a sense of helplessness, self-blame, and social isolation.

There may be biological and environmental risk factors for depression that result from growing up in a dysfunctional family. At present, though, more research is needed to understand whether victimization is connected specifically to depression.

Poverty

Women and children represent seventy-five percent of the U.S. population that’s considered poor. In turn, low economic status can foster the stress of isolation, uncertainty, frequent negative events, and poor access to helpful resources. Also, sadness and low morale are more common among those with low incomes who also lack social supports.  Nevertheless, research hasn’t established whether depressive illnesses are more prevalent among people facing these environmental stressors.

Depression in Later Adulthood

At one time, it was commonly thought that women were particularly vulnerable to depression when their children left home and they were confronted with "empty nest syndrome.” After all, it was expected they’d experience a profound loss of both purpose and identity. However, studies don’t suggest there’s increased depressive illness amongst women at this stage of life.

While older people generally feel satisfied with their lives, more elderly women than men suffer from depressive illness. Similarly, as for all age groups, being unmarried (which includes widowhood) is a risk factor for depression.

Widows experience varying degrees of depressive symptoms. However, most do not need formal treatment. However, those who are moderately or severely sad appear to benefit from self-help groups or various psychosocial treatments. While actually a third of widows/widowers do meet criteria for major depressive episode in the first month after the death of their spouse, only half of these individuals remain clinically depressed one year later. But for those who are depressed, their depression is apt to respond to standard antidepressant treatments. However, research on when to start treatment or how medications should be combined with psychosocial treatments is still in early stages of study.

You’re Aware Depression is a Treatable Illness, Aren’t you?

Did you know that even severe depression can be highly responsive to treatment? But sadly, believing one's condition is "incurable" is often part of the hopelessness that accompanies serious depression. If this is your attitude (or that of someone you know) please realize that the earlier treatment begins, the more effective and the greater the likelihood of preventing serious recurrences. Of course, treatment will not eliminate life's inevitable stresses and ups and downs. But it can greatly enhance the ability to manage such challenges, as well as lead to greater enjoyment of life.

The first step in treatment for depression should be a thorough examination to rule out any physical illnesses that may cause depressive symptoms. Since certain medications can cause the same symptoms as depression, the examining physician should be alerted to any medications being used. If there is no apparent physical cause for the depression, then the physician (or a mental health professional) should conduct a psychological evaluation.

Types of Treatment for Depression

The most commonly used treatments for depression are antidepressant medication, psychotherapy, or a combination of the two. In mild or moderate depression, one or both of these treatments may be useful. However, in severe or incapacitating depression, medication is generally recommended as a first step in the treatment. After all, medication can relieve physical symptoms quickly. Nevertheless, psychotherapy provides an opportunity to learn more effective ways of handling problems.

Medications

There are several types of antidepressant medications used to treat depressive disorders. These include newer medications—chiefly the selective serotonin reuptake inhibitors (SSRIs)—and the tricyclics and monoamine oxidase inhibitors (MAOIs). The SSRIs—and other newer medications that affect neurotransmitters such as dopamine or norepinephrine—generally have fewer side effects than tricyclics.  (Please also read my article, Why Living with a Narcissistic Man who Engages in Emotional Abuse and Verbal Abuse Harms Your Brain for information on how SSRIs might promote a process called neurogenesis and how neurogenesis impacts depression).

Each medication acts on different chemical pathways of the human brain that are related to moods. Although some individuals notice improvement in the first couple of weeks, usually antidepressant medications must be taken regularly for at least four weeks and, in some cases, as many as eight weeks, before the full therapeutic effect occurs. To be effective and to prevent a relapse of the depression, medications must be taken for about six to twelve months. During this time, it’s important to follow the doctor's instructions. Medications also must be monitored to ensure the most effective dosage as well as to minimize side effects.

The prescribing doctor will provide information about possible side effects and, in the case of MAOIs, dietary and medication restrictions. In addition, other prescribed and over-the-counter medications or dietary supplements being used should be reviewed because some can interact negatively with antidepressant medication. There may also be restrictions during pregnancy.

For those who have had several bouts of depression, long-term treatment with medication is the most effective means of preventing recurring episodes.

Herbal Therapy

In the past few years, many people have become interested in the use of herbs in the treatment of both depression and anxiety. St. John's wort (Hypericum perforatum), an herb used extensively in the treatment of mild to moderate depression in Europe, has also aroused interest in the United States.

St. John's wort is an attractive bushy, low-growing plant covered with yellow flowers in summer. It has been used for centuries in many folk and herbal remedies. Today in Germany, however, Hypericum is used in the treatment of depression more than any other antidepressant. It’s important to note that scientific studies conducted on its use have been short-term and they’ve used several different doses.

The Food and Drug Administration issued a Public Health Advisory on February 10, 2000. It stated that St. John's wort appears to affect an important metabolic pathway that is used by many drugs prescribed to treat conditions such as heart disease, depression, seizures, certain cancers, and rejection of transplants. Therefore, health care providers should alert their patients about these potential drug interactions. Any herbal supplement should be taken only after consultation with the doctor or other health care provider.

Psychotherapy

In mild to moderate cases of depression, psychotherapy is also a treatment option. Some short-term (10 to 20 week) therapies have been very effective in several types of depression. Research has shown that two short-term psychotherapies, interpersonal and cognitive-behavioral, are helpful for some forms of depression. Interpersonal therapy works to change interpersonal relationships that cause or exacerbate depression. Cognitive-behavioral therapy helps change negative styles of thinking and behaving that may contribute to the depression.

Electroconvulsive Therapy

For individuals whose depression is severe or life threatening, or for those who cannot take antidepressant medication, electroconvulsive therapy (ECT) is useful. This is particularly true for those with extreme suicide risk, severe agitation, psychotic thinking, severe weight loss, or physical debilitation as a result of physical illness.

Over the years, ECT has been much improved. A muscle relaxant is given before treatment, which is done under brief anesthesia. Electrodes are placed at precise locations on the head to deliver electrical impulses. The stimulation causes a brief (about 30 seconds) seizure within the brain. The person receiving ECT does not consciously experience the electrical stimulus. At least several sessions of ECT, usually given at the rate of three per week, are required for full therapeutic benefit.

Treating Recurrent Depression

Even when treatment is successful, depression may recur. Studies indicate that certain treatment strategies are very useful in this instance. Often, by continuing antidepressant medication at the same dose that successfully treated the acute episode, recurrence can be prevented. Also, monthly interpersonal psychotherapy can lengthen the time between episodes in patients not taking medication.

Introducing the Path to Healing

In order to reap the benefits of treatment one must of course first recognize the signs of depression. The next step is to be evaluated by a qualified professional. Often a primary care physician will refer the patient to a psychiatrist, psychologist, clinical social worker, or another mental health professional.

Treatment is a partnership between the patient and the health care provider. It's important to be an informed consumer who knows her treatment options and discusses her concerns with the provider as they arise.

If there are no positive results after two to three months of treatment, or if symptoms worsen, it is important to discuss another treatment approach with the provider. Also, a second opinion from another health or mental health professional may also be in order.

If you experience a recurrence, remember what you know about coping with depression. In other words, don't shy away from seeking help again. The sooner a recurrence is treated, the shorter its duration will be.

Depressive illnesses make you feel exhausted, worthless, helpless, and hopeless. Such feelings make some people want to give up. It is important to realize that these negative feelings are part of the depression. As a result, they will fade as treatment begins to take effect.

Along with professional treatment, there are other things you can do to help yourself get better. Some people find participating in support groups very helpful. It may also help to spend some time with other people and to participate in activities that make you feel better, such as mild exercise or yoga. Just don't expect too much from yourself right away. Feeling better takes time.

Where to Get Help

If you are unsure where to go for help, ask your family doctor, OB/GYN physician, or health clinic for assistance. You can also check the Yellow Pages under "mental health," "health," "social services," "suicide prevention," "crisis intervention services," "hotlines," "hospitals," or "physicians" for phone numbers and addresses. In times of crisis, the emergency room doctor at a hospital may be able to provide temporary help for an emotional problem, as well as tell you where and how to get further help.

Disclaimer: This how-to and self-help relationship advice and information for women about narcissism, addictions and abuse should be considered educational or inspirational—a guide or directory to things to consider and inform questions to ask a professional you contact for sound advice. It is not a substitute for marriage counseling, individual therapy, or legal advice. Women coping with domestic violence such as emotional abuse, verbal abuse, and/or sexual abuse—even where no physical abuse is present—are encouraged to seek professional help for treatment of depression, anxiety, self esteem, and other likely associated issues.

All material at www.NarcissismAddictionsAbuse is copyrighted. Feel free to duplicate and distribute this article for noncommercial and educational purposes, though we require it remain completely intact as laid out, from the header to the bottom of this copyright notice. No article may be placed on a website without permission. If you have a website that attracts women who could benefit from the information at this site, please link to it.

Key Search Terms for this Page: Depression, Depression Treatment, Symptom of Depression, Depression Self Help, Depression Help, Sign of Depression,  Cause of Depression, Treating Depression, Mental Depression, Major Depression, Woman and Depression, Overcoming Depression, Information on Depression, Dealing with Depression, Anxiety Depression  Symptom, Codependency, Co-dependency, Codependent, Codependent No More, Self help,  Verbal Abuse, Emotional Abuse, Sexual Abuse, the Verbally Abusive Relationship, the Emotionally Abusive Relationship

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