Dr. Phil talks to competitive twins and triplets who say their relationships are suffering. Are they willing to change their behavior? And, Noel says that her years-long struggle with depression is ruining her marriage to her husband, Don. Dr. Freda Lewis-Hall, Chief Medical Officer of Pfizer (gethealthystayhealthy.com), gives important information on the signs of depression — and how it can be treated. Can Noel finally get the help that she needs?

Twin Trouble

Megan, 24, says that her identical twin sister, Mandi's, extreme competitiveness is threatening to destroy their relationship. Megan recalls that when they were children, she and Mandi were the best of friends and "did everything the same" — they played the same sports, took the same classes and even dressed alike. But she says that their relationship started to change for the worse during junior high school. "Nowadays, it seems like our connection is all about competition," she says.

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Mandi admits that she likes feeling superior to her sister — and boasts that she is the "better twin" in every way. "My life is perfect compared to hers," Mandi claims. "I have better clothes ... I own my home and she rents hers ... My husband is cuter ... My husband has the better job," she brags. Mandi adds that she has a newer car than her sister, a cuter dog, and is even better at keeping her house clean than Megan. "I’m a stay-at-home mom, and I’m a homemaker. I get to make my house look beautiful. She still has to work," Mandi says. "I definitely win the sister competition," she concludes.

"So you’re just mighty proud of the way you turned out," Dr. Phil says to Mandi.

"I'm very proud of it," she replies. "It's true ... My house is better. I have a cuter dog. I have a cuter husband. I have a better car," she says. "Everything is better."

"I don't think so. I think she's a little greedy for thinking that," Megan counters. She says that it makes her sad to know that her sister takes pleasure in putting her down, but explains that she tries not to take Mandi's remarks personally. "There's something wrong with her insecurities," Megan insists. "What she says to me, I can kind of put behind me, in a way," she says.

"She says you're insecure, and I say that you are being petty and toxic." How does Mandi respond?

"What do you dislike about yourself so badly that you need someone else to do worse?"

"My sister will look for any opportunity at all to make herself look better than me," Megan says. She explains that when she got pregnant in high school, Mandi took it upon herself to tell their family — before she had the chance to. "She is always trying to paint me as the sinner, and she is always Mrs. Perfect," Megan says.

Mandi insists that she lived her life "the right way" by waiting to have kids until after she was married. She admits that she takes every opportunity to point out Megan's flaws and mistakes to their family, in order to make herself look better. "I don’t really think about what it does to her," she says. "I've never tried to stop. It's just always been a need — that I have to do it."

"You be a gracious winner. You be a gracious loser. These are the things that make up the fiber of character."

"The only mistake I think you’re making is giving her any voice, any moment, any presence in how you feel about yourself," Dr. Phil tells Megan. "I think in terms of emotional evolution and development, you are worlds past where your sister is," he says.

"I'm hoping that sometime you'll pop in a tape of this show and you'll look at this," Dr. Phil continues, turning to Mandi. "It might seem like I'm being mean to you, but I just kind of adjust the level of my rhetoric and the directness of my comments to what it takes to get through the wall of the person I'm talking to," he explains. "For you, I feel like I need to get back and take a big old run at you, because you just don't get it." Dr. Phil adds that he hopes that a day will come when Mandi will support her sister and offer her help if she needs it, rather than kicking her while she's down. "That that would be something I would admire, because I certainly don't admire what you're doing now," he says.

Triplets at Odds

Identical triplets Ashley, Brianne and Christina say that they’ve always done everything together, but now, at 19, they couldn't be more different. The girls admit that they fight and call each other names — and Ashley insists that she doesn't even want to be a triplet anymore. Their mother, Paula, says that she fears the sisters will be forever divided if something doesn't change.

Dr. Phil lists some of the things the sisters say they compete over, including who gets the best grades and who is the best athlete. "What I think is if you girls ever encounter a real problem, God only knows what you would do," he tells the triplets. "I have never heard such trivial, petty, back-and-forth between sisters in my entire life."

"One of you needs to break this triad of pettiness." And, what advice does Dr. Phil have for Paula?

Marriage Misery

Noel confides that she has struggled with depression since her grandparents passed away exactly a year apart from one another, in 2006 and 2007. She says that her condition is taking an emotional toll on her marriage to her husband, Don, and she desperately wants to find relief. She explains that she's seen several therapists, tried 17 different medications and has even had electroshock therapy, but so far, nothing has seemed to help. "My depression got so bad that I couldn’t even get off the couch," Noel recalls. "All I did was sleep. I barely ate. I never went outside." She says that she's doing better now, but still feels like a burden on Don.

"Noel’s depression has been extremely frustrating for me," Don admits. "I don’t know what to do. I don’t know how to handle it," he says. "There are so many doctors' appointments. She doesn't know how to handle certain situations ... I can't solve her problems and still keep my mind focused at work," he explains. Don adds that Noel is very insecure about their relationship and constantly wants to be reassured about his feelings for her. He admits that he has threatened to file for divorce — even though that's not the outcome he wants. "I want the Noel I married back — the one who I dated," he says.

Dr. Phil introduces Dr. Freda Lewis-Hall, Chief Medical Officer of Pfizer, who explains that depression is a serious and common illness, which affects women more often than men. It is believed to be caused by a combination of genetic, environmental and other factors, in addition to a trigger, such as the death of a loved one. "To really look for treatment is the important key," she tells Noel and Don, "because unless you do that, depression can worsen or lead to other physical and mental health problems."

How can you distinguish sadness from depression? And, what are some treatment options? Dr. Freda Lewis-Hall explains.

Dr. Phil offers to provide Noel with resources to complement the professional treatment she is already receiving, and she accepts.

If you are depressed and suicidal, call the 24-hour National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255).

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