Depression and its effect on our relationships

By Christine Webber and David Delvin.

Depression adversely affects every aspect of our lives - including our relationships. Indeed, when one partner is depressed, the relationship may suffer so badly that it doesn't survive. But, in fact, a good relationship is very therapeutic for a depressed person; because when we're really low we need love, support and closeness more than ever - even if we can't show it ourselves.

Depressed people usually feel withdrawn. They don't feel they can raise the necessary energy to pursue their normal routine, or to do things with the family, or even to notice when their partner is being attentive. And that partner can quickly feel that he or she is in the way, or unwanted, or unloved. Sometimes a partner will misinterpret the other person's 'low' moods and become convinced that the depressed partner feels hostile towards them, or wants to end the relationship. Occasionally, things will seem so bad at home that a spouse will fear that the depressed person is having an affair. Partners can also feel that somehow they may even have caused the depressive illness.

This is all skewed thinking, but it's difficult to stay calm and confident when the person you thought you knew is acting strangely and appears to be so unhappy. However, any partner of a depressed patient should realise that it's normal to be upset by this situation. So even if you're at your wits' end because your loved one has lost the ability to concentrate on what you're saying, or to raise a smile, or to appreciate any of the good moments in life, try to accept that all these things are simply part of this awful illness. Try to remember too that it's unlikely your partner's depression has anything at all to do with you.

Sex and Performance

Unfortunately, we don't know nearly enough about the chemical changes that occur in the brain during depression. And practically no worthwhile research has been done on how these changes affect sex. However, from the clinical point of view, what is clear is that a depressive illness tends to affect ALL the bodily systems, dislocating them and often slowing them down. This effect is most marked with regard to SLEEP (which is almost invariably disrupted) and on any activity that requires verve, spontaneity and good co-ordination. That includes sex! So most people who are depressed tend to lose interest in sex. Admittedly, this isn't always the case, and some depressed people manage to maintain normal sex lives - sometimes even finding that sex is the only thing that gives them comfort and reassurance.

In men, the general damping down of brain activity causes feelings of tiredness and hopelessness, which may be associated with loss of libido and erection problems. And in women, this diminished brain activity tends to be associated with lack of interest in sex, and very often with difficulty in reaching orgasm. All these problems tend to diminish as the depressive illness gets better. Indeed, renewed interest in sex may be the first sign of recovery.

Sex and antidepressants

One vital point to bear in mind is that antidepressant medicines such as Prozac (which are now prescribed on a massive scale) can themselves often interfere with sexual function. One of the commonest side effects is interference with the process of orgasm, so that it is delayed, or doesn't occur at all. If this happens to you, ask your doctor for a change in medication.

How depressed people can help themselves and their relationship

Some days will seem better than others. On your better days, try to make an effort to show love and appreciation to your partner.

• Choose a code-word - the title of a favourite film, for example - and use it with your partner to indicate that you'd love a cuddle, but you don't feel like sex.
• Try to go for a walk every day - preferably with your partner. Walking not only gets you out in the fresh air, which will give you a bit of a lift, but also - like other forms of exercise - releases endorphins in the brain. These are 'happy' chemicals that rapidly elevate your mood.
• Even on your worst days, try to spot happy moments - a bird singing, a new flower blooming in your garden or a child's smile. Try to train yourself to notice three of these heart-warming moments per day.
• You may have an odd relationship with food while you're depressed - you could have little appetite, or find yourself constantly comfort eating - but try to eat five pieces of fruit per day. This is a caring thing to do for yourself and is good for your physical and mental health.
• You may feel you can't concentrate, but try to watch a TV comedy with your partner for just half an hour every day. Anything that will pierce your gloom and help to elevate your mood will give you some respite from your depression.
• Listen to music that matters to you.
• Have faith that the depression will pass, and that you will enjoy your life again.

How the partners of depressed people can help themselves and their relationship

• Don't keep saying that you understand what your partner is going through - you don't. Instead say: 'I can't know exactly how you're feeling, but I am trying very hard to understand and to help.'
• Don't despair. Some days you'll feel that your love for your partner doesn't seem to make any difference at all to them. But hang on in there. Your love and constant support does make a big difference and can help persuade your partner of their value.
• Do encourage your partner to get all the professional help available. Depression is not something to be stoically endured alone.
• Remember: it's exactly as if your partner was recovering from a serious physical illness or from surgery. Give plenty of tender loving care and encourage them to rest and recuperate. And don't expect improvement to be rapid.
• Do spend time every day doing nice things for yourself. Being around a depressed person is very draining, so it's important that you look after yourself. Have some time alone, or get out to a film or the hairdresser or see friends. Depressed people often want to stay home and do nothing, but if you do this too, you'll get terribly fed up.
• Remember that this period in your life will pass - and that your partner is the same person underneath the depression as he or she was before.

Written by Christine Webber, psychotherapist and David Delvin, GP and family planning specialist. (netdoctor.co.uk)

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