How to Deal with a Depressed Spouse

When one spouse is depressed, a marriage is depressed, says Fran Walfish, relationship psychotherapist in Beverly Hills, CA, author, and co-host of Sex Box TV. This illness erodes emotional and sexual intimacy and suffuses a relationship with pessimism and resentment, anger and isolation, she explains. Even the sunniest, most capable partner can be pulled into depression’s strong undertow. For example, 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, and the humor and fun seeped out of your relationship. A challenging marriage can worsen depression, but it doesn’t in and of itself cause it. (Not sure if your spouse is depressed? Watch for these 8 hidden signs of depression.)

What to do if a spouse is depressed

If there’s depression in your marriage, it’s time to act—for your partner and yourself, Walfish says. Waiting increases the chances that your relationship won’t last; couples where one or both partners are depressed are significantly more likely to divorce than couples who aren’t depressed, according to a study published in BMC Public Health. And trying to fight or make peace with this often misunderstood illness on your own raises risks for both of you. The longer a non-depressed spouse lives with a depressed partner, the higher his or her own risks for depression, the researchers found. 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, according to the Department of Health and Human Services (HHS). 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, PhD, an assistant visiting professor of social work at Pepperdine University in Malibu, CA, who leads workshops across the country about depression and marriage with her husband, Dennis Lowe, PhD, a psychologist and director of Pepperdine’s Center for the Family in Los Angeles, CA. “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.”

What causes depression

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, Scott-Lowe explains. (These are 17 other facts psychologists wish people knew about depression.)

Genetic predisposition, or a family history of mental illness, can make some people more susceptible than others 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, Walfish says. Although marriage itself is seen as protective against depression and suicide, it is a big life change and up to 1 in 10 brides experience “postnuptial depression” in the months after the wedding, according to a study published in Personal Relationships. Marriage in and of itself doesn’t cause depression, although a challenging marriage can exacerbate things. Up to half of all women and men in unhappy marriages may be depressed, perhaps due to marriage problems, the researchers added. (Though it may be a case of chicken-and-egg, as undiagnosed depression can cause relationship problems too, Walfish adds.) 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.

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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,” 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 non-depressed spouse to take the lead, Walfish says. 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, she adds.

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—plus, it leaves its victim in despair, Walfish says. 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, according to the National Institutes of Mental Health. Don’t miss these 14 signs of suicide.

Break the ice gently yet firmly

If you suspect your partner is depressed, don’t blurt out a layperson’s: “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, Walfish says. 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?”

Check for underlying conditions

Dozens of health conditions—including heart disease, diabetes, lupus, viral infections, and chronic pain—can trigger the same symptoms as depression, Walfish notes. 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.

Get a diagnosis—together

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,” 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

Up to 80 percent of people report seeing an improvement within four to six weeks of starting treatment, according to statistics from the Depression and Bipolar Support Alliance. Usually, the road back is relatively simple: antidepressants, counseling, or a combination of the two, they report. That said, recovery may take time and patience, Walfish says. 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. (Thinking about starting therapy? Here are 22 things your therapist won’t tell you.) The results are worth it.

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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,” 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 85 percent of people who suffer a bout of major depression will have a relapse within a decade—and half will have a recurrence within a year, according to a study published in International Journal of Neuropharmacology. The researchers recommended a maintenance dose of antidepressants and/or therapy to prevent a relapse. Both spouses should also stay alert for signs that the illness is returning, Walfish adds.

Caring for a depressed spouse can be lonely, overwhelming, and emotionally draining, she says. You may blame yourself, feel helpless, grow pessimistic, lose your sense of humor, and even consider leaving. (Here’s what you should know about divorce.) It’s easy for the non-depressed spouse to become angry and frustrated with an irritable, lethargic mate who’s pessimistic and critical, who can’t unload the dishwasher, or who can’t 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,” 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 non-depressed 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, Walfish advises.

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,” 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.'” (These are the best ways to help someone with depression.)

This shift in thinking can clear the air. “It was a relief for me,” 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.”

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Find support

Admitting there’s depression in your marriage can be tough. So can accepting help. Choose a trusted friend to confide in—preferably someone who’s experienced depression in their own life or within their family, Scott-Lowe says. And if you’re overwhelmed by extra household duties because your spouse can’t do his or her share, say yes when others offer assistance. “At one point, I was crying at church, when my friend shook me and said, ‘Emily, people here at church are lined up waiting to help you.’ I kept saying we didn’t need help until she shook me into reality. We had people bringing us dinner several nights a week. One neighbor took our sons to spend the night, and it was so nice to know they were having fun. Depression can suck the energy right out of a household.”

Monitor your own moods and thinking

Enduring barrages of negative comments, holding the household and family together, and losing the sweetest, most supportive aspects of your marriage isn’t easy. Over months and years, the non-depressed spouse may give in to confusion, self-blame, demoralization, and resentment, notes Anne Sheffield, author of Depression Fallout: The Impact of Depression on Couples and What You Can Do to Preserve the Bond. You may conclude that you must leave to save yourself. If this sounds familiar, get help for yourself—and insist that your mate do the same. “Depression separates couples with surgical skill and is a major home-breaker,” Sheffield wrote in her book.

Conquer depression before you try to work on your marriage

Depression can wreak major havoc in your marriage. You may be tempted to fix what seem like smaller issues before tackling the illness head-on (it may be easier to ask your partner to communicate more effectively than it is to say “It’s time to get help,” for example). It’s reasonable to ask your spouse to help all he or she can around the house, to be responsible and treat you well, Walfish says. But looking for major changes while your spouse is under the influence of depression may simply create more frustration. Focus on lifting depression first.

Respect your own needs

If your spouse has depression, you still deserve everyday niceties—a neat house, regular meals, a calm family environment—as well as friendships, a social life, and time to pursue meaningful interests, Walfish says. (Use these tips to find a hobby you love.) As much as possible, pursue these things. It’s easy to spend your time dealing with your spouse’s needs and issues. But don’t sacrifice your own joys and goals needlessly. As we noted, you are susceptible to depression too. Pursuing your personal pleasures will not only help prevent that but also better prepare you for aiding your spouse.