How to Deal with a Depressed Spouse

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If you think your partner may be depressed, your first step is to pay attention to the clues to get the right diagnosis and treatment. Here’s what to look for and how to take action.

When one spouse is depressed, a marriage is depressed. This illness erodes emotional and sexual intimacy and suffuses a relationship with pessimism and resentment, anger and isolation. Even the sunniest, most capable partner can be pulled into depression’s strong undertow: You may be overwhelmed by extra household chores that your partner is too lethargic to finish, resentful because your spouse won’t just snap out of it, or feel that you’re somehow to blame for the illness itself. You may feel alone yet unwilling to tell anyone there’s depression in your household, or you may simply wonder when the sparkle and joy, the humor and fun seeped out of your relationship.

If there’s depression in your marriage, it’s time to act—for your partner and yourself. Waiting increases the chances that your relationship won’t last; depressed couples are nine times more likely to divorce. And trying to fight or make peace with this often misunderstood illness on your own raises risks for both of you. The longer a nondepressed spouse lives with a depressed partner, the higher his or her own risks for depression. The deeper a depressed spouse sinks, the tougher it may be to finally treat the depression—and the greater the risk for alcoholism, drug abuse, violence, and even suicide. The stakes are high, but the odds are that things will improve.

Remember, you’re not alone. An estimated 19 million Americans are currently going through depression. In the Reader’s Digest Marriage in America Survey, 42 percent of respondents named depression as a major challenge in their relationships. It’s not surprising that most said this insidious illness had a negative effect on them. But there was an unexpected ray of hope: One in four said depression had a positive outcome for their marriages. “Getting diagnosed and treated makes all the difference,” says Emily Scott-Lowe, Ph.D., an assistant visiting professor of social work at Pepperdine University, who leads workshops across the country about depression and marriage with her husband, Dennis Lowe, Ph.D., a psychologist and director of Pepperdine’s Center for the Family. “Just 33 percent of people with depression seek and get help. But when you do, your chances for significant improvement are 80 to 90 percent. Almost everyone gets some relief.”

Depression isn’t a choice or a little case of the blues. It’s a physical illness as serious and life-altering as diabetes, heart disease, or arthritis. A depressed spouse can’t just “snap out of it” or “get on with life.” The reason: Depression is marked by dramatic shifts in brain chemistry that alter mood, thoughts, sleep, appetite, and energy levels. Genetics usually make many of us susceptible to depression; any number of factors can trigger the slide, including prolonged or severe stress, financial problems, a big loss or change in your life, the birth of a child, parenthood, and even some health conditions and prescription drugs. Marriage itself even raises your risk: Up to 1 in 10 brides experience “postnuptial depression” in the months after the wedding. And up to half of all women and men in unhappy marriages may be depressed, perhaps due to marriage problems (though some experts suspect that undiagnosed depression is behind the problems).

If you think your partner may be depressed, your first step is to pay attention to the clues—and help him or her get a diagnosis and treatment. These steps can help.

Be alert to small changes. Depression can come on slowly, almost imperceptibly. “You look for all types of other explanations—we just had a new baby, it’s a tough time at work, it’s a phase,” Emily Scott-Lowe notes. “It can take a while to see the pattern or to be ready to accept that depression might be the cause.”

Often it’s up to the nondepressed spouse to take the lead: The illness itself often prevents depressed people from recognizing that something’s wrong or seeking help. They may feel too lethargic or withdrawn or may think they can fix it alone.

If you notice that your spouse isn’t acting, feeling, or thinking as he or she normally does, ask yourself if it could be depression, but don’t stop there. Depression may be the reason your spouse is working extremely long hours, drinking too much, using recreational drugs, or looking for thrills in risky activities. It can also look different in men and women.

Don’t wait for your spouse to hit bottom. Letting a depressed person sink low before offering help is an old-school approach borrowed from the early days of alcohol- and drug-addiction treatment. But the reasoning behind it is flawed and dangerous. Long-term depression is harder on your marriage, tougher to treat, and more likely to recur, and it leaves its victim in despair. The most chilling risk: It leaves open the very real possibility of suicide. About 60 percent of people who attempt suicide have major or minor depression or another mood disorder—and depressed men are four times more likely than depressed women to take their own lives.

Break the ice gently yet firmly. If you suspect your partner is depressed, don’t blurt out a layperson’s diagnosis: “You’re depressed!” or announce: “You better get help!” In order to begin the process of healing, approach your spouse with concern and with an action plan. You might say, “I’m concerned about how feeling tired and losing your appetite are affecting you. You deserve to feel better. Our doctor may be able to help you, and I’d like to arrange a time when we can meet with him. Next week, I can go on Wednesday or Friday. What’s good for you?”

Get a diagnosis—together. Dozens of health conditions—including heart disease, diabetes, lupus, viral infections, and chronic pain—can trigger the same symptoms as depression. So can scores of prescription medications, including some birth-control pills and drugs that treat acne, herpes, high blood pressure, high cholesterol, and cancer. Your family doctor can rule out underlying causes and decide whether or not it’s really depression.

Ask your spouse if it’s okay for you to attend this evaluation. “When you’re down that low, you may not be able to express what’s going on or even realize what all your symptoms are,” Emily Scott-Lowe notes. “And you may not be able to concentrate on the treatment recommendations your doctor is making. You need an ally in the room.”

Know that the odds are in your favor. As we noted, the success rate of depression treatment is as high as 90 percent. Usually the road back is relatively simple: antidepressants, counseling, or a combination of the two. That said, recovery may take time and patience. There may be an initial trial-and-error period while you try various antidepressants or see whether various therapy techniques, such as cognitive behavioral therapy and interpersonal counseling, are helpful. The results are worth it.

Find a mental-health counselor for the two of you. Depression affects both of you—and your whole family. The Lowes suggest finding a therapist or counselor who has worked with depression in couples. “You may have issues to deal with individually as the depressed person, and the two of you may have issues to deal with that stem from coping with depression,” Dennis Lowe says. “We found it very helpful to have a counselor we could see together at times and separately at other times.”

Keep on learning about depression. Read books, check out websites, ask your doctor about advances in treatment and understanding of this illness. The more you know, the better you can cope and fight.

Be alert for relapses. About half of all people who suffer a bout of major depression will have a relapse; 75 percent of those will have another relapse; and 90 percent of those will have yet another. Once a first episode passes, many doctors prescribe a maintenance dose of antidepressants to prevent a relapse. Both spouses should also stay alert for signs that the illness is returning.

Caring for a depressed spouse can be lonely, overwhelming, and emotionally draining. You may blame yourself, feel helpless, grow pessimistic, lose your sense of humor, and even consider leaving. It’s easy for the nondepressed spouse to become angry and frustrated with an irritable, lethargic mate who’s pessimistic and critical, who can’t unload the dishwasher or get the kids ready for bed anymore—let alone make love, ask how you’re doing, or acknowledge that you’ve been holding things together for weeks, months, or years.

“This starts a cycle that burns you out and doesn’t help your partner at all,” Emily Scott-Lowe notes. “I did this with Dennis—I would become extremely angry with him. Then I would feel really guilty and try to make up for it by taking on more and more around the house. Then I would get angry all over again. This wasn’t helping Dennis, of course, and it was wearing me out emotionally and physically.”

These steps can help the nondepressed spouse stay well—and protect your marriage and your family while helping a depressed partner.

Admit that you cannot cure your partner’s depression. Your spouse needs your love, support, and concern. But these important qualities can’t reverse depression any more than they can control blood sugar, ease arthritis pain, or clear out clogged arteries. Just as you wouldn’t rely on love alone to cure a medical condition—or withdraw love because it didn’t—don’t expect that your feelings or attention will be able to alter your spouse’s off-kilter brain chemistry. Use your love to get help and to remind your partner of his or her intrinsic worth during this challenging time.

See depression as an intruder in your marriage. Like any other illness, depression is an outside force—an unwelcome visitor wreaking havoc with your spouse’s health, your marriage, and your home life. Seeing it this way can allow both of you to talk about its effects without blame or shame. “Once we started talking about it as a third party—as ‘the depression’—we could express our frustrations constructively,” Emily Scott-Lowe says. “If Dennis was really doubting his worth, I could say, ‘That’s just the depression talking. It’s not you. When you’re not depressed, you don’t think this way. It’s feeding you lies.’”

This shift in thinking can clear the air. “It was a relief for me,” Dennis Lowe says. “I felt Emily was walking on eggshells sometimes, not wanting to tell me how she was feeling. Depression was the elephant in the room that no one wanted to talk about, and I felt even guiltier. Seeing it as the intruder was an accurate perspective. It helped me see why I felt the way I did and let me accept reassurance because it acknowledges what’s going on instead of denying it.”