How to Recognize Depression in your Partner

How many people get depression?

The National Institute of Mental Health (NIMH) estimates that 16.2 million US adults had at least one major depressive episode in 2016. That’s 6.7% of the US adult population.

In 18 to 25-year-olds this figure is 10.9% – about one in nine people. Remember that this is only one year – each year, there will be another different 6.7% who suffer.

Women are roughly twice as likely to be prescribed antidepressant tablets as men.

1. It’s the predominant mental health problem worldwide.
2. It’s the second leading cause of years lived with a disability, after low back pain.

Types of depression

• Single bout or recurrent bouts
• Persistent Depression
• Bipolar Disorder with alternating depression and mania
• Seasonal Affective Disorder (SAD). It usually starts in the autumn and eases in the spring
• Postpartum Depression after giving birth
• Psychotic Depression often with paranoia or other more profound loss of contact with reality

People at higher risk of depression

• Black, Asian, and minority ethnic groups
• Those with Physical Health problems
• Victims of Domestic or Sexual Abuse
• Refugees and Asylum Seekers
• LGBT community
• Those with Learning Disability
• Bereaved
• Carers
• Alcohol and Drug abusers
• Those with a close Family History of Depression
• People going through major life events – getting married, moving house, changing employment, relationship breakups, and so on.

How to spot depression

Some people with depression will tell their partner that they feel depressed, however, there are many who don’t even know it themselves. There are others who have an idea of what’s going on but won’t admit it to themselves or their partners.

Some people still attach a stigma to mental health problems and don’t want to admit the diagnosis.

In most cases, depression has a gradual onset and the changes that occur can be quite subtle. Even when a person presents to their doctor they often present with one of the following vague symptoms.

It isn’t always easy to make a diagnosis straight away.

Here are some symptoms which can be linked with depression:

Anxiety

Anxiety frequently goes hand in hand with depression. The person worries unduly about small things. They may obsess about their own health and keep mentioning a variety of symptoms that don’t appear to have a physical cause. Some will repeatedly attend the doctor and undergo numerous examinations and tests which are all normal.

Withdrawal

Some become less social, they may withdraw from sports and social activity. They may not want to talk so much and want more time to themselves.

Appetite change

This can go either way. Some people binge eat with depression, usually with unhealthy food like chocolate and snacks. With depression, the person is less motivated to maintain a healthy lifestyle.

In severe depression, the appetite is classically poor and associated with weight loss.

Low self-esteem

Typically the person thinks less of themselves. They may think they look terrible when the opposite is true. They may feel unable to do tasks that they can easily manage. There may be a sense of worthlessness.

Related: Why is Self-Esteem Important?

Poor concentration

They may drift off and not follow a conversation. With poor concentration, simple tasks become difficult. Things get forgotten. Food gets burned. Children’s pick-up times get missed.

Work performance can suffer, leading to problems there.

Poor sleep

Sleeping patterns are disturbed. Typically there is early morning waking, but some struggle to get sleep, and others wake in the night worrying and fretting.

Fatigue

This may be a consequence of poor sleep. Energy levels are low, contributing to the sense of inertia.

Irritability

If your partner is always grumpy and irritable, your first thought may be that you’re making them grumpy or perhaps that there’s something fundamentally wrong with the relationship.

Someone who is depressed may be irritable due to a combination of the factors we’re discussing here. With the right treatment, that may change.

Libido

Reduced sex drive is a common symptom of depression. It doesn’t necessarily mean he or she doesn’t love you. It doesn’t mean he or she is being unfaithful.

Agitation

By this, I mean a more severe illogical restlessness. It might occur for very little or no reason and can manifest as an endless screaming rant with plates getting thrown around the kitchen.

It’s very difficult to manage as a partner, especially when you’re on the receiving end. There may be other problems with anger management.

Paranoia

This is when someone believes that another person is getting at them when there is no basis for the thought. A sufferer may feel that a neighbor closing his car door is intending to intentionally disturb him or her.

A normal conversation starter like “How was your day at work?” might become an argument by the reply, “Stop asking me that. You’re always checking up on me.”

In more severe cases, the sufferer may make bizarre claims, which are clearly not true, and have no insight into the incredibility of the claim.

Guilt

Irrational guilt may be present.

Memory loss

This may be an issue. People with Alzheimer’s or Parkinson’s disease might be expected to have a poor memory, but if depression is present as well, this will make the severity worse.

Untreated Hypothyroidism is also associated with poor memory and mental health disorders.

Seasonality

With Seasonal Affective Disorder (SAD) depressive symptoms set in as the days get shorter and generally ease in the spring. This can get missed amid the fog of life. It can take a few months to twig to the diagnosis, by which time things are beginning to improve.

Postnatal depression

Nearly every new mother has spells of “The blues.” It’s a difficult time as the body recovers from pregnancy and hormone levels are fluctuating. Feeding can be hard to establish, and sleep patterns are constantly disturbed and changing.

The mother realizes she has a 24 hour a day responsibility for the baby. Some develop a more persistent depression requiring help.

Self harm or suicidal thoughts

Obviously, anyone who is self-harming, considering suicide, or describing suicidal intent should seek professional help.

If a person is suggesting that the world would be a better place without them, it suggests a serious problem.

What you should do if you suspect your partner is depressed?

Depression comes in a whole spectrum of severity from very mild right through to major depression. Someone who is actually harming or threatening to harm themselves or others should be encouraged to see a doctor urgently.

If it isn’t absolutely clear that a depressive disorder is the problem, you may have to do some detective work.

Ask your partner how they have been over the last month.

• Are they feeling down, depressed or hopeless?
• Do they have little interest or pleasure in doing things?

If the answer is yes to any of these questions, it’s advisable to seek a doctor’s opinion.

There are depression assessment questionnaires available online. The PHQ questionnaire gives a score out of 27- the higher the score, the more depressed the person.

As a General Practitioner, I used a slightly simplistic rule of thumb that if a person scored over 15, there was a good chance they would need antidepressant tablets, and if they scored over 20 a psychiatric referral was in order.

How can you help when you notice signs of depression?

Depression is sometimes cyclical. The low mood may improve spontaneously as time passes.

Make some allowance for your partner’s depressive illness. If they seem to be picking a fight, try to defuse the situation rather than get into a full-blown argument.

Exercise has been shown to help depression. Any exercise that works up a sweat for 30 mins three times a week can help. Personally, I believe it’s better to get outdoors in the fresh air because this also gives a chance for social interaction. This lifestyle change helps the mood.

Encourage a healthy lifestyle. Alcohol excess definitely doesn’t help. Alcohol is a depressant, and although it might give a short-term lift, it won’t help over the long term. The same applies to drug abuse.

Organize a treat each week – try to break up a monotonous routine.

Try to encourage social activity, get them to join a class or a club, and get involved in hobbies or interests.

There are often problems that have triggered depression. Try to itemize the problems. Put them into two categories, the ones you can do something about and the ones you can’t. If you can’t influence a problem, you have to come to terms with it so try not to spend emotional currency worrying about it.

Target the problems you can influence. For each issue, write down the pros and cons of the different possible courses of action. For instance, if you’re buying a house, your options are to buy it or not. Next, it’s to apply for mortgage A or mortgage B, etc.

Most people can handle one big worry better than they can handle multiple smaller worries. The brain skips from one issue to another without resolving anything. It’s best to fight one battle at a time.

Suggest they get involved with helping others in some capacity. The more you put into life, the more you get back.

SAD can be helped by vitamin D and the use of a lightbox. It’s best to get into daylight as much as possible.

Maintain physical contact. Even if things are quiet in the bedroom, continue to cuddle, show affection, and touch.

How does a depressed partner affect your family?

Many people with more severe depression will be off sick from work or unable to work at all. This has obvious financial implications for the family.

Be aware that because of all the symptoms of depression, things may be said between you. To every action, there can be a reaction. Relationships can spiral downhill very quickly if this happens.

Anxiety in your partner can cause you and others in the family to be anxious. When it is clearly unnecessary worry, this can be annoying. If your partner is withdrawn, you may feel shunned or neglected or even be concerned that your other half has found someone else.

Appetite changes can cause mealtimes to be a bone of contention. Why is your spouse not eating the food you have cooked? If they’re overeating that can cause weight gain.

If a person doesn’t value themselves, they wonder what a partner sees in them. They may become overanxious about any other friendships you have.

Because of poor concentration, you may feel your partner is being rude or ignoring you.

If your other half is sleeping poorly, there’s a fair chance that your night’s sleep is being disturbed.

Agitation and paranoia can be extremely difficult to deal with. It’s usually you that bears the brunt of the agitation. At times paranoid ideation may be targeting you. The sufferer might think you are trying to poison him or her. They might think you are moving things that have been mislaid accidentally.

Memory loss can lead to disputes over simple household mishaps. Who’s left the window open? Who’s left the milk out?

Postnatal depression can be severe, leading to difficulties arranging baby care. You may have to take more time off work to help out.

With a depressed partner, your workload is likely to go up in all sorts of ways.

Your mood may suffer as a consequence: this leaves you more susceptible to depression as well.

What therapy will the doctor arrange?

If the simple remedies above aren’t helping, encourage your partner to see a doctor.

The family doctor can refer on for counseling therapy – cognitive behavior therapy is often used. This form of therapy tries to give the patient the emotional tools to better manage their problems.

Antidepressant tablets are an option. I would tend to use these if the depression is persistent or in the moderate/severe categories. They generally take a week or two to give benefit, and they need to be taken regularly to work.

It’s no use stopping after a week saying they haven’t helped, and they won’t work if you take them intermittently.

I would generally advise a course of several months. If a person finds they are working well after a month and the tablets are stopped, the mood can drop again, and you’re back to square one.

If the sufferer has several months of treatment, I would hope this will normalize the mood and allow working and social relationships to mend. Relationships have invariably been stretched if someone has moderate to severe depression.

Tablets do usually help, but it sometimes takes some trial and error to get a tablet that suits. In severe or unresponsive cases, the help of a psychiatrist is needed.

What do you do if your partner is unwilling to seek help?

This happens quite a lot, and it puts you in a very difficult position. You can try to get other family and friends to talk to your partner. Sometimes this helps.

If the depression isn’t too bad, there is a chance it will improve without any medical intervention.

If things are deteriorating, you need to speak to your partner’s doctor. This is particularly important if there is any suggestion of self-harm or harm to others. You can provide the doctor with information, but the doctor is unlikely to discuss a patient’s details with you without consent.

In an extreme case, your doctor should be able to arrange an urgent psychiatric assessment.

If your partner is seen by a doctor, it would be a good idea for you to attend the appointment as well. This way, the doctor will get more information, and you will hear what has been advised.

References:

• Vos et al. The Lancet 386(9995), 743-800
• Ferrani et al. 2013 PLOS Medicine 10(11)