Managing Expectations When Your Partner Is Severely Depressed

When your spouse or romantic partner has severe depression, their behavior is likely to change in ways you may find confusing or upsetting. They may pull away or act indifferently toward you. This withdrawal and non-responsiveness could cause you to feel hurt or rejected – unless you learn to reframe your expectations to reflect the reality of depression's effects. 

Once you learn more about how depression changes people, you can reframe your expectations of your partner's behavior and not feel personally rejected, plus adopt more realistic and effective coping strategies. Having reasonable expectations can protect both you and your partner and help keep your relationship intact.

If you break your arm, your doctor gives you a time frame for how long it will take to heal. Not so for depression.

"There's no average – no 'one size fits all,' " says Nicolle Osequeda, a marriage and family therapist in Chicago. "It takes time."

The road can also be bumpy, with good days mixed with bad, rather than a single, upward path. 

This lack of a clear light on the horizon can be frustrating for you as a caregiver, since you don't know how many more difficult days, weeks, or months are ahead. To get through this, Osequeda advises "taking it day by day. Don't think so far ahead that you overwhelm yourself."

You may think if you just say or do the right things, you can bring your loved one out of their depression. But it doesn't work this way.

Medical intervention typically is needed to treat this complex condition. "The first step is always getting the depressed partner connected with a therapist, if they're not already," says Mandolin Moody, a therapist in New York.

Instead of being a fixer, Osequeda says, your role "is being a consistent, steady source of support." She recognizes how hard this can be, since you want your partner to feel better and you're trying to do everything to help. But "depression is an internal process, which your best efforts aren't likely to shift," she says. Instead, "what helps is just being there."

Paul Greene, a psychologist in Manhattan, regularly advises caregivers who don't realize that their depressed partners can't control their illness. They assume their partner is choosing to be depressed. 

"They feel like their partners should just be able to figure it out and get over it – and that may not be very realistic for that person," he says.

Don't underestimate how much support your partner needs, Greene advises, "and how difficult the challenges are that they're facing."

Moody agrees, pointing out that your partner "doesn't want to be feeling like this either." 

To help, you'll need to practice "a lot of patience and empathy," she says, "and really educate yourself about depression as a clinical disorder."

In the movies, a take-charge friend bursts into a depressed person's darkened bedroom, pushes open the curtains and makes them get out of bed. Voila: they're cured!

Not so in real life.

"When you push, then people often withdraw more," Osequeda says. 

Encouragement is more likely to work. "Saying, 'I'm going to go to the grocery store, why don't you come with me?' might be more effective than saying, 'Why don't you go to the store and get out of the house,' " Greene says.

Or, you may suggest your partner do something with language such as: "I think it would be really good for you to go see your friends today," Greene advises. But, if they say no, don't keep pushing.

Depression can literally slow your brain down. Scans show lack of brain activity in people with severe depression, especially in the part of the brain responsible for executive function. It's no wonder, then, that your partner can take longer to reach decisions or take actions, so keep this in mind as you are supporting and encouraging them.

If you expect your partner to hurry up and see the doctor already or get out and meet friends, or whatever, you're more likely to become resentful or stressed when it doesn't happen on your timetable. It's better to keep gently encouraging while practicing patience, which can reduce your stress – and theirs, since they're likely to pick up on your irritation.

Depression most often brings common symptoms like withdrawal, lack of energy, looking sad, and maybe crying. But some people have so-called smiling depression, where from the outside, they appear and act happy. It's only inside that depressive symptoms like feelings of hopelessness, sadness, anger, and worthlessness have taken hold. 

If your partner has "smiling depression," they may hide how they're really feeling from you, to try not to burden you with their pain. If your Spidey-sense is telling you that something isn't quite right with your partner, watch for more subtle depression symptoms, such as fatigue, irritation, and withdrawing from their social life. Encourage them to talk to you about how they really feel – and to get the medical help they need.

When your partner is depressed, you may need to try different ways to talk to them. Open-ended questions ("How are you feeling?") may work better than yes-or-no questions ("Are you feeling OK?"). Sometimes, though, it's better to be more specific. Instead of asking, "How can I help?" – which may require your partner to think too much – offer to do one helpful thing for them. 

Also avoid being judgmental. "Be supportive; make sure your partner knows you are on their side," Greene advises. "Try to be encouraging without being critical." If something's hard for your partner to do, use supportive language like, "I think you can do this," vs. "You should do this. Why don't you want to do this?"

Your partner turns to you and says, "I'm so depressed today I can't even go to work." Negative statements like this are normal for someone with depression. But they can still be hard for you as a caregiver to deal with, day after day, especially if you're expecting a more positive attitude.

Greene advises answering in a way that validates your partner's feelings. "It's better to respond with, 'I'm so sorry you're feeling this way. That sounds terrible. Let me think how I might be able to help' – rather than saying, 'Get your butt out of bed; you'll feel better.' "

Also keep on encouraging your partner to get medical help, Greene says, "because there are treatments for depression that are effective."

You may not be able to do the activities you're used to doing right now, but that doesn't mean you and your partner can't find new things to do that can bring joy.  Moody says to keep in mind that depression can be physically and emotionally exhausting, so choose things to do – preferably together – that are quick and easy. One example: going on a 10-minute walk.

"It's relatively low energy, with a low time commitment, so it feels a little bit more agreeable – and you can build up from there," Moody says.

Also look at combining some daily routines, she says. This can be bonding for you as a couple, and it can gradually help your partner become more active and engaged.

Depression can cause your partner to withdraw from you, which can feel like rejection. But you can still share time and find other ways to maintain your bond. Instead of focusing on what you are missing from your partner right now, cherish little, everyday moments together. Notice the things your partner still may do for you – sending you a thoughtful text, leaving a note, helping with a household chore they don't normally do.

Find and cherish even the smallest of things that show your couple bond is still there – a smile, a touch, a special look. If you don't see this today, keep reminding yourself that your partner will get better, one day at a time.

Your partner's doctor may prescribe antidepressants or other medications. But, Moody says, you need to manage your expectations about how quickly they may work. Most take four to eight weeks. And sometimes, dosages need to be adjusted or another medication tried before the right one (or combination of drugs) is found – a fine-tuning process that can take months. 

Also, medications can come with side effects, says Moody – including sexual side effects, such as lowered sex drive and difficulty reaching orgasm.  It's important for you and your partner to be aware this is a possibility and to talk about it with each other, she says, as well as discuss side effects with the doctor who prescribed them.

Caring for someone with a serious illness like depression can put you at risk of physical or mental illness yourself, especially if you don't set aside time for yourself – and learn to say no.

"Boundaries are really important," Osequeda says. "It's about protecting your capacity for what you can do and how much you can do while not over-functioning – doing more and more as you try to help. This can lead to burnout."

Instead, figure out how much time you need for yourself and what you can and can't do. "Boundaries are not about not caring for your partner anymore," Osequeda says. "It's making that space for yourself … and finding your own support so you can be there for your partner."

"Keeping up your daily routine can be very helpful, and I would definitely recommend it," Greene says. This may mean working or taking part in social activities, hobbies, exercise, journaling – even sleeping.

If you're the only caregiver, and especially if you have young children in the house, this can be tricky to achieve without help. So, get some – tap into friends and family, if available, for respite care. Also consider therapy for yourself, as well as community support groups for caregivers. (The National Alliance on Mental Illness, or NAMI, has lists. Or you can ask your doctor for referrals.)