Depression can place significant strain on a partnership. Those close to someone experiencing depression frequently feel powerless. However, there is much they can do — and much they should avoid.
Six years ago, Stefan’s relationship experienced a major shift. At that time, as the COVID-19 pandemic began, Stefan’s wife, Jessica, suffered a collapse and has been dealing with depression ever since. For reasons of privacy, the couple has requested to be referred to by pseudonyms.
Jessica was placed on medical leave and was unable to work for three years. She spent months in hospital, underwent outpatient therapy, and tried various medications.
"After about three years, we realized that things would never be the same as before," said Stefan, a 44-year-old software developer. "That carefree, relaxed connection is no longer there."
Early indicators of depression: Feeling overwhelmed, social withdrawal
Stefan noted that it began with Jessica becoming increasingly fearful of others and developing social anxiety. She even distanced herself from her close group of friends. Tasks like grocery shopping became challenging; making phone calls to doctors or handling administrative chores became impossible.
Jessica also felt overwhelmed by Stefan. Simple thoughts he used to share with her — such as things he had read or seen — became too much for her to process.
Depression is difficult for those experiencing it. But loved ones suffer as well. In a romantic relationship, dynamics change.
"There were moments when I didn't have a wife, but an additional child," said Stefan.
The less Jessica could manage independently, the more he took over for her.
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Establishing boundaries for your own mental well-being
Birgit Esch assists family members of individuals with depression. She worked for many years as a nurse with people affected by mental illness. One observation she made: Recovery is truly possible only when family members are included.
Today, she works as a systemic family therapist at a mental health clinic in Bonn, Germany, and serves as a resource for people like Stefan. She provides courses where family members spend three evenings learning about depression — and about how their own emotions and experiences are equally important.
"Most family members endure a nightmare for about four weeks before the affected person is admitted to hospital," Esch told DW.
At that stage, family members have often exhausted all options, are overextending themselves, and feel tense, anxious, and deeply concerned about their loved one.
"'How are you actually doing?' That question is asked of [family members] far too infrequently," said Esch.
It is critically important that family members learn to care for themselves and establish boundaries, Esch stressed, so they can remain healthy themselves. Only then can they genuinely support their ill loved one.
'No assistance without a request'
When family members take over more daily tasks without being asked, it reinforces the passivity of the person with depression, which in turn fuels the depression, Esch explained.
That self-sacrifice by family members also heightens feelings of guilt and shame in the person with depression. Stefan had to learn this the hard way. The more household chores he took on for his wife, and the more often he made calls on her behalf, the more she felt like a burden.
"It would be better for you if I weren't here anymore," Jessica told him one day.
Esch often says: "No assistance without a request."
This preserves the depressed person’s sense of self-efficacy and, crucially, gives family members the opportunity to say "no" and avoid their own burnout.
"Setting boundaries doesn't mean I’m rejecting the person, but that I’m only giving the depression a certain amount of space," said Esch.
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Separating the person from the depression
Setting boundaries becomes easier when family members manage to separate the depression from the individual, according to Esch. Jessica often feels frustrated because she cannot meet her own expectations due to the illness, and she quickly loses patience.
"Withdrawal, irritability, and emotional distance come not from the person, but from the depression," said Esch. "In a relationship, it’s important to accept that the couple is living in a love triangle" with the disease.
Communication becomes especially vital — and simultaneously, it’s particularly challenging, especially regarding potential sources of conflict.
"I always have to hold back and assess the situation first. That’s very draining," said Stefan.
At the same time, he constantly fears the situation might escalate. Jessica and Stefan have therefore agreed that he will communicate certain concerns — for example, if he feels she has unfairly criticized him — via text message. Stefan can express himself, and Jessica can respond at her own pace.
Managing depression: Valuing small achievements
Jessica has been back at work for over a year now — four hours a day, four days a week. That’s all she can handle at the moment. But Stefan is pleased; after all, it’s more than was possible for a long time.
"Now she can even go grocery shopping after work," he said.
Esch emphasized the importance of appreciating small steps, such as shopping, washing her hair, or taking out the trash. "Coping with the illness is hard work for the affected person," she added.
As Jessica withdrew more and more, Stefan went into isolation alongside her. That’s not unusual, said Esch, but it doesn’t help anyone.
"We don’t drag anyone off the couch by their hair," she said. But family members have the right to say, "I’m not going to sit here and be depressed with you."
Support for family members through therapy, support groups
In the fourth year of his wife’s depression, Stefan developed nervous tics and an unexplained itch that kept him awake. Psychosomatic disorders — likely triggered by the strain his wife’s illness placed on him as well.
He sought out a therapist and also found his way to Esch. In addition to courses on various mental illnesses, she offers individual counseling and support groups.
All of this helped Stefan find his own place in the triangular relationship with his wife and her illness: to step back more and focus more on himself.
"That’s also necessary to stay productive," said Stefan.
The itching and tics have since disappeared. Stefan is out and about frequently, sometimes with Jessica, but also on his own. He wants to meet new people and try new experiences. He also plans to reduce his working hours to have more time for sports.
Separation advisable when depression dominates everything
Stefan and Jessica have found a way of interacting that works, but not all couples manage that. Esch has also supported people through breakups. A separation is advisable when depression serves as an excuse for everything, said Esch.
An argument like "I’m sorry, I can’t be nice to you — I’m depressed" does not contribute to a healthy relationship.
This article was originally written in German.
If you are suffering from serious emotional strain or suicidal thoughts, don't hesitate to seek professional help. You can find information on where to find such help, no matter where you live in the world, at this website: https://www.befrienders.org/