Postpartum depression and anxiety aren’t unusual. After having a baby, about 15 percent of women experience postpartum depression (PPD), and between 10- and 17 percent develop postpartum anxiety (PPA). Some people experience just one. Others have both simultaneously. Postpartum anxiety and depression are real conditions that reduce the quality of life of mothers and their babies.

Know that postpartum depression and anxiety don’t have to interfere with your positive experiences with your new baby. Let’s take a closer look at these conditions and their symptoms, causes, effects, and treatments.  Armed with knowledge, you can beat PPD and PPA.

Postpartum Depression and Anxiety Symptoms

If you’re dealing with postpartum depression and/or anxiety, you’ll probably feel certain symptoms. The below lists highlight common symptoms, but you might not experience all of them, and there might be some things you experience that aren’t on the lists. That’s because PPD and PPA are very individual experiences.

General postpartum depression symptoms can involve feeling nothing or feeling intense emotions:

• Feeling empty, numb
• Feeling disconnected from your baby, unable to bond
• Uncontrollable crying
• Irritability
• Anger, rage
• Resentment (of your baby, of your partner, of others not experiencing this)

Common postpartum anxiety symptoms can include:

• Racing thoughts and overthinking
• Disturbing thoughts of the baby becoming ill, dying, being harmed—possibly by its own mother
• Fear of your baby being taken away
• A foreboding sense of dread or impending doom
• Non-stop worries, what-ifs, and worst-case scenarios
• Inability to relax
• Avoidance of people and places
• Being over-controlling toward loved ones
• Inability to leave the house
• Frequent crying

What causes these bothersome symptoms?  

Postpartum Depression and Anxiety Causes

While researchers are still studying what, exactly, causes postpartum depression and postpartum anxiety, they have discovered some likely culprits:  

• Hormonal changes
• Heredity
• Lack of sleep
• Life stressors
• Changes in relationships
• Lack of support
• A baby that is difficult to care for

These causes of PPD or PPA can lead to the expression of symptoms. Symptoms lead to unwanted effects.

Effects of Postpartum Depression and Anxiety

Postpartum depression and anxiety can be mild, moderate, or severe. They can become severe enough to disrupt the mother’s ability to care for her baby, her family, and herself. At their worse, PPD and PPA cause suicidal thoughts and behaviors as well as thoughts of harming the baby.

These experiences involve life-disrupting effects that can be prolonged. Just a few of the effects on mothers can involve:

• Difficulty sleeping
• Feeling and/or acting on excessive fear that something bad will happen to the baby
• Second-guessing everything to the point where it becomes paralyzing
• Increased stress in the family
• Increased risk of divorce
• Restricted bonding between mother and baby

Infants can feel the effects of PPD and PPA as well. According to a 2009 study conducted by Feldman et al., babies who were unable to bond with their mothers because of PPA and PPD were affected in the following ways. Compared to peers, these infants demonstrated:

• Low social engagement, interaction
• Reduced ability to self-soothe
• More negative emotionality
• Increased tendency to experience stress reactions, as indicated by cortisol levels

Clearly, PPD and PPA are detrimental to the physical and mental health of both mothers and babies. The good news is that these conditions are temporary and treatable.

Postpartum Depression and Anxiety Treatment

Different treatment options exist for postpartum depression and postpartum anxiety. The most common treatments are approaches such as:

• Therapy, especially interpersonal therapy (IPT) or cognitive behavior therapy (CBT)
• Medication
• Inpatient hospitalization
• Partial hospitalization (attending a program during the day and returning home in the evening)
• Peer support groups for PPD
• Some natural treatments for PPD

Medication for Postpartum Depression and Anxiety

Medication for postpartum depression and anxiety can also be an effective option. If PPD or PPA are very disruptive, medication might be in order.

Most doctors feel that the best medication for postpartum depression and anxiety is selective serotonin reuptake inhibitors (SSRIs). Some of the most widely used SSRI antidepressants include:

• Celexa (citalopram)
• Effexor (venlafaxine)
• Lexapro (escitalopram)
• Paxil, Pexeva (paroxetine)
• Prozac, Sarafem (fluoxetine)
• Wellbutrin, Zyban (bupropion)
• Zoloft (sertraline)

Occasionally, benzodiazepines are prescribed for postpartum anxiety because they calm nerve activity in the brain. Examples of benzodiazepines prescribed for PPA are

• Ativan (lorazepam)
• Klonopin (clonazepam)
• Valium, Diastat, Diastat Acudial (diazepam)

Benzodiazepines aren’t as commonly used as SSRIs. Benzodiazepines are sedatives. They are highly addictive and are dangerous to nursing infants.

A new antidepressant called Zulresso (brexanolone) is the first drug specifically designed for postpartum depression. Approved by the FDA in March 2019 and available for use in June 2019, this IV administered medication offers the promise of quick and efficient PPD relief.

Sometimes, women fear that seeking help is a sign of a bad mother. This couldn’t be further from the truth. Seeking treatment is a sign of maternal love and personal strength. Understanding your PPD and PPA and seeking help when necessary will give you back the joys of caring for your new baby, and it will allow the two of you to bond.

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Have you wondered about postpartum depression causes and risk factors? If you have postpartum depression (PPD), or are pregnant and worried about developing it, wanting to know the cause and risk factors is natural.

Postpartum depression is an illness with symptoms similar to other forms of major depression. The difference is that much of PPD is specific to childbirth and affects both you and your newborn. Symptoms can begin in pregnancy; more often they develop after childbirth.

Symptoms include lasting sadness that weighs you down, loss of interest in activities and people—including your baby—inability to feel pleasure and the joys of mothering an infant, feelings of guilt and worthlessness, and thoughts of suicide, self-harm, and sometimes harming the baby.

Before we explore the causes of and risk factors for postpartum depression, it’s important for you to know that you are most definitely not the cause of your PPD. The symptoms are thoughts, feelings, and behaviors you experience because of PPD.

Even experts in the field of mental illness agree. Professionals at the National Institute of Mental Health note that “Postpartum depression does not occur because of something a mother does or does not do.” (Postpartum Depression Facts, n.d.).

You’re not the cause, nor is your baby. Let’s examine the real causes and risk factors of this birth-specific depression.

Postpartum Depression Causes

The exact cause of postpartum depression is unknown. Researchers do know that there can be multiple causes or contributing factors, such as

• Genetics
• Hormonal fluctuations
• Sleep Deprivation

Postpartum depression might be genetic. Having a mother or a sister who went through this type of depression can sometimes be a cause of PPD. Not every woman who has an immediate family member who had PPD also develops this disorder, which means that genetics isn’t always a cause.

Hormonal changes play a significant role in the development of PPD. After giving birth, a woman’s body prepares to return to a non-pregnant state by suddenly decreasing estrogen and progesterone levels. The rapid and drastic hormonal changes can cause changes in the brain that lead to mood swings, anxiety, and depression. Further, birth control pills taken soon after childbirth can contribute to hormonal fluctuations that sometimes cause or aggravate PPD.

Sleep deprivation can also be a cause of PPD. A decrease in both the quality and amount of sleep after a baby is born is the rule rather than the exception. Lack of restorative sleep makes it hard for the brain and body to recover from pregnancy and childbirth. The exhaustion interferes in brain functioning, making lack of sleep a major postpartum depression cause.

Sleep deprivation and hormonal changes are common to every woman who gives birth. Genetics is behind PPD for some women. Yet not everyone gets postpartum depression. Approximately 15 percent of women develop it. Something else must contribute to PPD in addition to genetics, hormonal changes, and sleep deprivation. Other things, known as risk factors, can increase the chances that a woman will get PPD.

Postpartum Depression Risk Factors

The following situations, while they don’t cause PPD, increase a woman’s risk for developing it:

• Having had difficulties getting pregnant
• Delivering multiples
• Complications during pregnancy and/or childbirth
• Premature delivery
• Health problems that cause the baby to be hospitalized
• Stressful life events occurring during pregnancy or after childbirth
• Depression or anxiety during pregnancy
• PPD with previous deliveries
• Previous mood disorders
• Thyroid imbalance
• Lack of support
• Substance use

Demographics can be a postpartum depression risk factor as well. Studies have shown that women experiencing these conditions are more prone to having PPD:

• Financial hardship and/or below average income
• Unwanted pregnancy
• Single motherhood
• A young age

While researchers have identified things that can cause or increase the risk of developing postpartum depression, there isn’t one single factor that undoubtedly causes PPD. The exact reason for a woman’s postpartum depression isn’t always known. That’s okay, though, because even without knowing the cause, you can treat and manage your PPD and thrive. You can bond with your baby and enjoy their growth.

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The Mood Disorder Questionnaire (MDQ) was developed by a team of psychiatrists to help screen for possible symptoms of bipolar disorder. It was designed to help physicians screen for bipolar disorder  - it is not considered a diagnostic tool.

This questionnaire can be used during an office visit as part of a complete evaluation, or as a self-screening tool that patients complete prior to a visit.

Section 1

Has there ever been a period of time when:

Section 2

If you checked YES to more than one of the above, have several of these ever happened during the same period of time?

Yes  ~ No

Section 3

How much of a problem did any of these cause you -- like being unable to work, having family, money, or legal troubles; getting into arguments or fights?

No Problem ~ Minor Problem ~ Moderate Problem ~ Serious Problem

How to Score the Mood Disorders Questionnaire

The following scores are the most  indicative of having bipolar disorder, though be careful: a positive test does not mean you have bipolar disorder.  The authors of this test found these scores include the most individuals  who do have bipolar disorder, and "rule out" the most individuals who don't have it.

Section 1: 7 "yes" responses
Section 2: Yes
Section 3: Must have caused some problems in your life

Please be careful and understand: the test you took is not magic. Even using "7 yes's" as the cut-off, one person in 10 will be missed - with the test showing they "didn't have bipolar disorder". Similarly, getting 7 yes answers doesn't prove you have bipolar disorder, because there can be "false positives" too, with this or any such test.

But this is a good starting point to share with your doctor.

The impact of not getting a correct diagnosis of bipolar disorder (misdiagnosed as depression) and treatment for bipolar disorder.

Bipolar disorder commonly goes undiagnosed or is misdiagnosed as another condition, for an average of 8 years. It's also been shown that some people delay seeking medical care for up to 10 years after symptoms first appear. And at any given time, experts say, more than 60% of people with bipolar disorder are untreated, under-treated, or improperly treated.

What does this mean for people with undiagnosed or inadequately treated bipolar disorder?

Obviously, it can mean they suffer too long with bipolar symptoms that could be treated. But there are other important reasons to explore your current bipolar treatment needs.

People with bipolar disorder can lead healthy and productive lives when the illness is effectively treated. Without treatment, however, the natural course of bipolar disorder tends to worsen:

• Over time, a person may suffer more frequent and more severe manic and depressive episodes than those experienced when the illness first appeared.
• In addition, without effective treatment, the illness can lead to suicide in nearly 20 percent of cases.

Lack of proper treatment can also lead to substance abuse, failing at school or on the job, disrupted personal relationships, and an increased risk of violence, including suicide.

That's a pretty grim picture. But there are rays of hope, including bipolar mania treatments that can help prevent or reduce the risk that bipolar disorder will worsen.

Hope starts with a visit to the doctor to discuss your concerns.

Further distinctions between manic-depressive illness (bipolar disorder) and primary depressive disorder (unipolar depression)

G Winokur, W Coryell, J Endicott and H Akiskal
Department of Psychiatry, University of Iowa College of Medicine, Iowa City 52242

OBJECTIVE: Patients with bipolar disorder differ from patients with unipolar depression by having family histories of mania with an earlier onset and by having more episodes over a lifetime. This study was designed to determine whether additional aspects of course of illness, the presence of medical diseases, childhood traits, and other familial illnesses separate the two groups.

METHOD: In a large collaborative study, consecutively admitted bipolar and unipolar patients were systematically given clinical interviews. Data were collected on medical diseases and childhood behavioral traits. Systematic family history and family study data were also obtained. The patients were studied every 6 months for 5 years.

RESULTS: The group of bipolar patients had an earlier onset, a more acute onset, more total episodes, and more familial mania and were more likely to be male. These differences were relatively independent of each other. The bipolar patients were also more likely to have shown traits of hyperactivity as children. The unipolar patients had a significantly greater number of lifetime medical/surgical interventions than the bipolar patients, even when age was controlled. Alcoholism was more frequently found in the families of the bipolar patients, even when alcoholism in the probands was controlled; however, this difference was not significant.

CONCLUSIONS: This study supports the usefulness of distinguishing between bipolar and unipolar patients in treatment and research studies.

Am J Psychiatry 1993; 150:1176-1181
Copyright © 1993 by American Psychiatric Association

Read about the difference between bipolar disorder and depression and why many with bipolar are misdiagnosed with depression.

Countless number of patients and their family members have asked me about manic-depression and major depression. "Is there any difference?" "Are they one and the same?" "Is the treatment the same?" And so on. Each time I encounter a chorus of questions like these, I am enthused to provide answers.

You know why? Because the difference between these two disorders is enormous. The difference does not lie on clinical presentation alone. The treatment of these two disorders is significantly distinct.

Let me begin by describing major depression (officially called major depressive disorder). Major depression is a primary psychiatric disorder characterized by the presence of either a depressed mood or lack of interest to do usual activities occurring on a daily basis for at least two weeks. Just like other disorders, this illness has associated features such as impairment in energy, appetite, sleep, concentration, and desire to have sex.

In addition, patients afflicted with this disorder also suffer from feelings of hopelessness and worthlessness. Tearfulness or crying episodes and irritability are not uncommon. If left untreated, patients get worse. They become socially withdrawn and can't go to work. Moreover, about 15% of depressed patients become suicidal and occasionally, homicidal. Other patients develop psychosis -hearing voices (hallucinations) or having false beliefs (delusions) that people are out to get them.

What about manic-depression or bipolar disorder?

Manic-depression is a type of primary psychiatric disorder characterized by the presence of major depression (as described above) and episodes of mania that last for at least a week. When mania is present, patients show signs opposite of clinical depression. During the episode, patients show significant euphoria or extreme irritability. In addition, patients become talkative and loud.

Moreover, this type of patient doesn't need a lot of sleep. At night, they are very busy making phone calls, cleaning the house, and starting new projects. Despite apparent lack of sleep, they are still very energetic in the morning - ready to establish new business endeavors. Because they believe that they have special powers, they get involved in unreasonable business deals and unrealistic personal projects.

They also become hypersexual - wanting to have sex several times a day. One-night stands can happen resulting in marital conflict. Like depressed patients, manic patients develop delusions (false beliefs). I know a manic patient who thinks that he is the "Chosen One." Another patient claims that the President of the United States and the Prime Minister of Canada ask for her advice.

So the big difference between bipolar disorder and major depression is the presence of mania. This manic episode has treatment implications. In fact, the treatment of these disorders is completely different. While major depression needs antidepressants, manic-depression requires a mood stabilizer such as lithium and valproate (Depakene). Recently, newer antipsychotics, for example, quetiapine (Seroquel), aripiprazole (Abilify), risperidone (Risperdal), and olanzapine (Zyprexa) have been shown to be effective for acute mania.

In general, giving an antidepressant to bipolar, or manic-depressed, patients can make their condition worse because this medication can precipitate a switch to a manic episode. Although there are some exceptions to the rule (extreme depression, lack of response to mood stabilizers, among others), it is preferable to avoid antidepressants among bipolar patients.

When considering the use of an antidepressant in a depressed bipolar patient, clinicians should combine the medication with a mood stabilizer and should use an antidepressant (e.g. Bupropion - Wellbutrin) that has a low tendency to cause a switch to mania.

Copyright © 2004. All rights reserved. Dr. Michael G. Rayel  - author (First Aid to Mental Illness  - Finalist, Reader's Preference Choice Award 2002), speaker, workshop leader, and psychiatrist. Dr. Rayel pioneered the CARE Approach as first aid for mental health.

For detailed bipolar information, from symptoms to treatments.

Being misdiagnosed with depression when you have bipolar disorder is not unusual. Read this man's story of bipolar misdiagnosis.

When Curt Bohn's latest antidepressant failed to end his 10-year battle with depression, he stole a bottle of cyanide from his office where he worked as a medical engineer. He then went into his garage and made a final videotape, bidding farewell to his wife of 24 years and their two children.

Just in time, Bohn's wife convinced him to see a local psychiatrist in Salt Lake City. The doctor immediately diagnosed a recently identified mood disorder. He yanked Bohn off the antidepressants and put him on mood stabilizers. Bohn responded right away and has been a happy, functioning man ever since.

"I got very lucky," Bohn said. "Life is so much better."

Bohn is one of a few happy stories in a sad history of misdiagnosis of the disorder, bipolar II. Only officially recognized by the psychiatric profession as an illness in 1995, few psychiatrists and even fewer family physicians know how to differentiate it from classic depression. A wrong diagnosis can be deadly, experts say. Prescribing antidepressants like Prozac instead of mood stabilizers like Lithium can actually intensify the depression, and can lead to suicide.

"We're trying to get doctors to ask more detailed questions before they prescribe drugs like Prozac," said Dr. James Phelps, an Oregon-based psychiatrist. Phelps treats patients whose antidepressants have seemingly worked for a short period of time, then abruptly stalled, and others whose antidepressants made them irritable, sleep deprived, or hyper. This adverse reaction is the very subtle second pole of bipolar II disorder, called hypomania.

For those who aren't experts like Phelps, bipolar II's symptoms can be hard to recognize. Unlike bipolar I, formerly known as manic depression, the hyper-energetic happy swings are not so pronounced. In fact, Phelps believes doctors are looking for the wrong symptoms because the word hypomania is a misnomer.

"Hypomania can consist entirely of very unpleasant agitation, irritability or anxiety." Phelps said. Without proper understanding of hypomania, doctors may mistakenly look for periods of excessive happiness in a patient's history, or episodes of "mini-mania." Bipolar II patients very often exhibit no actual mania and therefore go without adequate treatment, including the mood stabilizers that could save their lives.

In a recent study by Harvard Medical School, doctors found that 37 percent of bipolar disorder patients who previously experienced a manic or hypomanic episode had diagnoses of classic depression. The study further concluded that it may take an average of 12 years for bipolar II patients to get the proper diagnosis and treatment, if the patient survives the lag time. According to the DSM-IV, the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders, as many as one in five people with bipolar II will commit suicide.

"Since the DSM-IV came out, more bipolar II cases have been recognized," said Dr. Michael First, a DSM expert for the American Psychiatric Association. First says so many bipolar II patients appeared in the '80s and '90s, the illness was formerly added the DSM in 1994. "Bipolar II now has a precise definition to be used uniformly by clinicians who are encouraged to recognize it," said First. But patients who go unrecognized struggle to stay alive.

"General practitioners are to blame for many wrong diagnoses," said Dr. Larry Seivers, a mood disorder expert at Mount Sinai Hospital in New York. Seivers says bipolar patients can even become psychotic while taking antidepressants. "It happens often, and it's really dangerous," said Seivers. "These people can really go off."

Educating doctors before they put antidepressants in the hands of bipolar II patients who might "go off" is what Phelps hopes to accomplish with his educational Web site and a project he's launched with several primary care doctors in Ohio.

The doctors participating in Phelps' study are learning fast. They give a mood disorder questionnaire to every patient before an antidepressant is prescribed. If a patient scores seven or higher on Phelps' test, the patient is suspected of having hypomania and is sent immediately to a psychiatrist for further evaluation. Phelps estimates he and his colleagues diagnose one bipolar II patient a week.

Other doctors are not convinced antidepressants pose any risk. "No antidepressant ever made anyone suicidal," (see editor's note at bottom) said Dr. Jack Hirshowitz, also a Mount Sinai Hospital psychiatrist. Hirshowitz attributes the occurrence of suicide in patients who recently started taking antidepressants to the efficacy of the drugs, and not their potentially negative side effects.

"People feel more energized when the antidepressant starts working, but they are still very depressed," Hirshowitz explains. "They commit suicide because they have the energy to do it."

Energy is something Bohn is on guard for. While taking various antidepressants in the past, Bohn had surges of agitation so invigorating that he impulsively purchased a piano, a special edition Chrysler sports car and he chartered a yacht for his family in the Caribbean.

Today, Bohn is on the mood stabilizer known as Depakote, which appears to be calming the emotional roller coaster. When his wife accidentally sideswiped his Chevy Tahoe into their garage, he didn't feel the uncontrollable fit that used to mark his episodic behavior. "I'm finally on the right meds and I feel normal," Bohn said. "My life is truly normal.

Source: Columbia News Service

Editor's Note: In 2004, the FDA required a "black box warning" on all antidepressants saying: Antidepressants increased the risk of suicidal thinking and behavior (suicidality) in children, adolescents and adults with Major Depressive Disorder (MDD) and other psychiatric disorders.

Depression in relationships is incredibly common, but that doesn’t mean it’s easy. Depression is an illness that affects 19 million people in the United States, and there’s no cure-all solution. However, many relationships survive a diagnosis of depression and claim the experience brought them closer together. There are others, however, that buckle under the strain of depression, and sometimes for good reason. Find out when to say goodbye in our depression and relationships article.

Could Depression Break Up My Relationship?

When it comes to depression and relationships, it’s important to remember that there is no universal response to the above question. While depression can put considerable strain on a relationship, it is not depression itself that causes a relationship to end. The longevity of a relationship is dependent on both people's ability to communicate and care for one another, even when life is difficult. No two relationships will respond the same way to this kind of event.

When one or both partners are depressed, that crucial need to communicate is compromised. The depressed partner may feel like no one will understand how they're feeling or they may not have the energy to talk. Depression often tells people they’re better off alone, and that voice can be very persuasive. The non-depressed partner may then feel frustrated and angry that their partner won’t communicate. They may also blame themselves or feel ashamed that they can’t make things better and don't know how to deal with the depressed spouse or partner.

Part of being in a romantic relationship is realizing that there will be challenges along the road. You or your partner experiencing depression doesn't necessarily spell the end of the relationship, but it does require you to grow and adapt as a couple. You will need to find new ways to communicate and try to avoid offending or insulting one another, however fraught things get. You will need to be patient, understanding and compassionate as you try to navigate depression and your relationship together.

Depression and Relationships: When to Say Goodbye

Of course, whether or not you stay in a relationship with someone who's depressed depends on many factors. It's important to be there for our loved ones when they get sick, but you cannot do that at the expense of your own happiness and wellbeing. Here are some reasons why it's totally okay to say goodbye to your relationship:

Your relationship is making you depressed: Relationships don’t necessarily cause depression, but they can be a contributing factor. If you are unhappy in your relationship, it is important to pay attention to that feeling and talk to your partner. If there are issues you cannot resolve, you may decide to end the relationship.  

Your partner puts you down: Whether your partner is mentally ill or not, it’s never alright for them to belittle and degrade you. If insults, put-downs and controlling behavior occur regularly in your relationship, that’s emotional abuse, and it’s a very good reason to walk away. Sometimes it's difficult to decide if you're unhappy in your relationship or depressed, but if your partner abuses you it's a sure sign your relationship isn't healthy.

You have become isolated: It’s normal for people who are depressed to want to isolate themselves, but this shouldn’t always include you. If you have become isolated from your family and friends, this is a sign that your relationship isn’t healthy. Talk to your partner. They may not realize how you feel.

Your needs are ignored: When your partner is sick, they may need more from you than usual. However, your own needs for space, time alone, socializing with friends or intimacy should not be ignored – even if your partner can’t always provide exactly what you need, they should be able to communicate with you about this.

Depression and relationship breakups are tough, so make sure you have a support system to fall back on during this time. If you don’t have somewhere to turn, you can visit the Depression and Bipolar Support Alliance for peer support, information on groups in your area, online services and crisis resources.

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Depression and love relationships can get complicated. While many of us say that words "In sickness and in health," or at least agree with the sentiment, caring for someone with a mental illness isn't easy. What's more, being the one who's depressed can isolate you from those you love, causing a chasm that’s hard to bridge. We know that people face many challenges when dealing with depression, but are their relationships doomed to fail? Find out everything you need to know about depression and love or romantic relationships.

Depression and Love Relationships: What Challenges Do Partners Face?

When it comes to depression and love relationships, whether you experience depression or you love someone who does, dealing with any illness in a relationship can be difficult. However, because of the stigma surrounding mental illness and people's unwillingness to talk about how it affects them, people with depression take on a whole other set of challenges.

If you are a depressed spouse, you might feel guilty that your partner is having to care for you or take on the work of running a house or raising a family. You may feel like an emotional burden or that your partner is tired of your negativity. Low self-esteem and negative self-talk are common symptoms of depression. These thoughts may cause you to become overly dependent or even push your loved one away.

If you are the partner of someone who is depressed, you may feel helpless and frustrated. You know it's not your job to fix them, but you can't help but think that they wouldn't be depressed if only you could make them happy or somehow help your spouse or partner with depression. Looking after someone who’s depressed is also exhausting, and you may feel resentful, hurt or angry at times. All of this is normal and expected, but it can take its toll on a relationship.

Warning Signs That Depression Is Hurting Your Relationship

Protecting your love relationship from the effects of depression isn’t easy. According to Shannon Kolakowski, author of When Depression Hurts Your Relationship: How To Regain Intimacy and Reconnect with Your Partner When You’re Depressed, identifying the warning signs is half the battle. However, they can be difficult to spot. Here are some signs that depression is affecting your love or romantic relationship:

• You’ve lost empathy for your partner
• Your sex life has diminished or ceased completely
• You can’t see a future for the relationship
• You and your partner are hiding your true feelings from one another
• You feel anxious when it’s time to spend time with your partner
• You can’t communicate without arguing
• You feel resentful toward your partner
• You imagine your life would be better without them

If any or all of these warning signs are present in your love relationship, that doesn’t mean it is doomed to fail. It just means that both partners must be prepared to do some work, and you must be patient. While the road to recovery from depression isn't always smooth, many people feel better once they start treatment – whether that's talking therapy, medication, lifestyle changes or a combination of all three.

In terms of depression and your love relationship, seeing a couple’s counselor can help you communicate more effectively and could help you get your emotional and physical intimacy back on track.

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What do you do when depression hurts your relationship? Due to the complexity of depression and the many different forms it takes, this is not an easy problem to solve. All relationships require a certain level of commitment, openness and understanding, but this is especially true when one or more partners are depressed. If you have depression, it may feel like the odds are stacked against you ever maintaining a healthy and happy relationship. However, if you are both prepared to work through these challenges of depression affecting your relationship, there’s no reason to fear. Here's what to do when depression hurts your relationship.

What to Do When Depression Hurts Your Relationship

Depression doesn’t always spell doom for a relationship. Sure, it can be challenging for one or both partners to experience depression, but this isn’t always the case. Some couples claim that experiencing a mental illness actually brought them closer together.

Psychologists and researchers state that maintaining a healthy and loving relationship can help fortify both you and your partner against the effects of depression. However, before you can act to save your relationship, you need to know what you're fighting. Therefore, the key to maintaining a relationship despite depression is to understand the illness.

“Depression is often referred to as the ‘Black Dog.’ Just like a real dog, it needs to be embraced and understood, taught new tricks, and ultimately brought to heel.” – World Health Organization.

How Depression Can Hurt Your Relationship

Depression can make it difficult to maintain healthy and fulfilling relationships. There are all kinds of reasons why romantic relationships suffer in light of depression, but the main issue tends to boil down to a lack of communication from one partner and an absence of understanding from the other.

If you love someone who has depression, you shouldn’t feel guilty or ashamed for not understanding exactly what they’re going through. People who are depressed often find it hard to explain how they are feeling. They may feel locked in their own heads and like there is “no point” trying to make others understand. They might also feel so overwhelmed by their physical and emotional symptoms that they don’t have the energy to communicate properly, even if it will make them feel better to talk.

How to Protect Your Relationship from Depression

If you have a partner who is depressed, there is plenty you can do to support them and protect your relationship:

Don’t try to fix it: It is not your job to diagnose your partner or tell them how to treat their depression, however much you might want to fix them. Your role is to provide support and encouragement, not to provide an answer.

• Don’t make them feel weak: Depression has a way of sinking its teeth in and robbing people of positive thoughts, especially about themselves. Tell your partner how strong they are and congratulate them on their small achievements.
• Don’t give unsolicited advice: By telling your partner to work out more or change their diet, you may think you are being helpful, but it can often come across like you think they are doing something wrong. Depression is an illness, so leave the advice to the professionals.
• Be thoughtful and kind: When someone has depression, you can never be too thoughtful or kind. Compassion is limitless, and someone with depression needs as much as you can give.
• Know when not to talk: Often, your partner may not have the energy to speak. Sometimes they might just want you to curl up with them and watch a movie. Other times, they may need you to listen while they try to communicate their feelings. You don't always need to know what to say.
• Help them simplify their life: Stress, lack of sleep and emotional conflict can all make depression worse. If you want to do something practical to help your partner, try to make life as simple as possible for them by taking on the lion’s share of the housework, getting their clothes ready for them each morning, cooking them healthy meals or helping them to create (and stick to) a daily routine.
• Encourage them to seek professional advice: Ultimately, there is only so much you can do to help someone who’s depressed. While your words and actions can make a huge difference, you cannot treat their depression. Encourage your partner to see a counselor (either as a couple or on a one-to-one basis) and to visit their doctor for advice about treatment.

For relationships to survive (and perhaps even thrive) in the wake of depression, couples need to present a united front. However, as the partner of someone who is depressed, you must also realize that you alone do not have the power to rescue your loved one or make them better. There will be times when your partner’s illness feels like too much to handle, so be sure to prioritize your own needs as well as theirs.

See Also:

• Depression and Relationships: When to Say Goodbye
• My Depression is Ruining My Relationship: Withdrawal & Sexless

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