Treatment for the individual suffering major depression tends to be a combination of cognitive behavioral therapy and medication. While both have been shown to cause improvements, the combination of both demonstrates the best outcomes. Often untreated over the course of an individual’s depression are the persons with whom the sufferer cohabits. Typically this means spouses and children. As the individual with depression deals with and hopefully addresses their depression, the other family members may be suffering themselves, bearing upset and burden, themselves coping with their depressed family member. When the depressed person is a spouse and parent, at times when their depression is florid, their availability to meet the needs of others, notably children or to fulfill their role may be compromised. To the uninformed spouse, this can lead to conflict, feeling their partner is not carrying their weight. To children, their needs, be they instrumental or emotional may not be adequately met in a timely fashion. Both the spouse and children may also be concerned for the well-being of the depressed family member yet feel unable to comment upon or speak out about their concern for fear of further upsetting the depressed person. Hence there is the collateral impact on family members of those living with a depressed individual.

In the absence of treatment for the entire family, there is an increased risk of marital decline and breakdown with its impact on children. There is also a risk that children may seek inappropriate strategies to cope themselves with their unacknowledged worries and concerns. Hence children may act out their feelings such as with aggressive behaviour and oppositional behaviour or alternately, they may internalize their feelings, appear despondent and withdrawn themselves and may even take to drug or alcohol use to cope. They are at risk of falling grades and academic difficulties. In view of this negative cascade, family problems are intensified, thus contributing further to the person affected with depression.

In view of the above, while it is necessary for the person affected with depression to obtain treatment for themselves, it is also necessary for the entire family to obtain counselling. Such counselling needs to be educative with respect to matters of depression and supportive in that it is also aimed to facilitate adjustment and problem solving to cope and adjust to life with an affected family member.

While guilt by the affected family member may be a potent force keeping people out of family treatment so as to avoid feeling bad for one’s impact on the family, it is important to not have the family run by the issues of the affected individual. Hence the decision for family treatment may need to be taken by well members and presented in a manner