One may naturally ask a modern version of the elusive chicken-and-egg question — which comes first: depression or marital strife? There is no unique answer.

“Depression is a recurrent problem,” Beach said, “so it depends on whether you ask people if they have ever had a depressive episode or if you are focused on a current depressive episode.” Because individuals are getting married at older ages and diagnoses of depression are becoming prevalent at younger ages, more people than ever now have had a diagnosed depressive disorder prior to marriage, which a therapist also must take into account when deciding how to address a problematic union.

Beach has found that therapists and couples generally accomplish the most by looking at a specific depressive episode. Under such circumstances, some individuals will first notice marital stress and then slide into depression, whereas others will first notice the depression and then the marital stress. This crucial difference can help predict what type of treatment will be most appropriate.

“For people whose depression came first, cognitive therapy was generally effective, and as they got better they also rated their marital satisfaction higher. For patients whose marital discord came first, cognitive therapy did not improve marital satisfaction at all, although in some cases it still helped in relieving depressive symptoms,” he said.

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