Don't Let Clinical Depression Ruin Your Relationship

Bob and Melissa have been married for three years. Melissa stopped going out with her friends after work and constantly complained of being tired each evening. Their sex life was almost non-existent. Melissa always seemed to be down all the time, she didn't smile much and slept most of the weekend. They stopped going out to dinner because Melissa didn't have much of an appetite, she wasn't comfortable having friends or relatives for dinner and she cried for little or no reason. Bob was concerned about Melissa and didn't know what had come over her; he noticed his wife seemed distant, dark and didn't find pleasure in anything. Bob's feelings varied from frustration to anger to sadness about Melissa. She was slipping away from him.

Bob convinced Melissa to schedule an appointment with a psychiatrist. She was diagnosed with Major Depression Disorder and given a prescription for antidepressants. She was assigned to a psychotherapist for talk therapy to accompany her medication. Bob was thankful that Melissa found a therapist she was comfortable with, and after a few weeks, she joined a fitness class and within a few months, she was back to her normal self.

What is Clinical Depression?
Major depressive disorder, also known as clinical depression, is a mental health mood disorder in which feelings of sadness, loss, anger or frustration interfere with everyday life. These intense feelings may last for two weeks or longer. Clinical depression is a disabling condition that adversely affects a person's family, work or school life, sleeping and eating habits and general health. Clinical depression is usually diagnosed when a person reports a depressed mood most of the day, particularly in the morning, and a loss of interest in normal activities and relationships. According to the Diagnostic Statistical Manual version 5 (DSM-5), a manual used by the American Psychiatric Association to diagnose mental health conditions, a person will have five or more of the symptoms of depression almost every day for a minimum of two weeks.

Clinical depression is based on the patient's self-reported experiences, behavior reported by relatives or friends and a mental status examination. According to the National Institute of Mental Health, major depression affects about 7% of the United States population over age 18. Between 20 and 25% of adults may suffer an episode of major depression at some point during their life-time. Symptoms may include the following:

• Feelings of sadness or irritability
• Fatigue or loss of energy almost every day
• Feelings of worthlessness or guilt almost every day
• Impaired concentration, indecisiveness
• Insomnia (little to no sleeping) or hypersomnia (excessive sleeping) almost every day
• Markedly diminished interest or pleasure in almost all activities nearly everyday (called anhedonia, this symptom can be indicated by reports from significant others)
• Restless or feeling slowed down
• Recurring thoughts of death or suicide
• Significant weight loss or gain (a change of more than 5% of body weight in a month)

How Can Clinical Depression by Treated?
Telling a person who is depressed to "snap out of it" or to "cheer up," will not make them feel better. Clinical Depression is an illness, not a personal weakness or character flaw and can be effectively treated so that the depression fades. People who are clinically depressed need proper treatment to get rid of depression. This usually includes medication, psychotherapy or a combination of these two elements. It may take a few weeks of treatment before you feel better, so it's important to maintain consistency in treatment.

Some patients have uncomfortable side effects caused by their prescribed medication. Yet, they still have significant clinical depression symptoms. These patients may require additional treatment methods that may include not only a combination of psychotherapy (talk therapy) and medication, but deep brain stimulation (DBS) in which electrodes are placed at specific points in a patient's brain, and acts as a pacemaker for the brain, regulating the hyperactive sadness circuits. Another electrical treatment is Electroconvulsive Therapy (ECT) in which seizures are electrically induced to provide relief from psychiatric illnesses. An electrical current is passed across the entire brain and is effective, but may cause some memory loss. ECT is typically given to improve the moods of people with severe depression or suicidal thoughts.

The newest technology for treatment of depression is Transcranial Magnetic Stimulation (TMS). TMS is a groundbreaking non-drug therapy that is noninvasive and uses energy waves from magnets directed to the prefrontal cortex to improve symptoms of depression to reset the neurons in the brain.

Dr. Oz investigated TMS and expressed surprise that more people, including practitioners, did not already know about this method of treatment. Dr. Oz commented, "TMS is controversial, un-orthodox and revolutionary," but "I believe this can be an effective treatment for depression." Introduced in 2008 and approved by the FDA in 2013, TMS can be effective for patients who don't tolerate medications due to the side effects or who don't consider ECT an option. This method has been introduced as a method to completely eliminate depression in a patient over a series of treatment sessions.

Natural Alternatives
Regular physical exercise could be considered the equivalent of an anti-depressant pill for some people. Aerobic activity boosts norepinephrine, which is a neurotransmitter that plays a role in mood changes. It is important to get enough sleep, reduce workload and make common lifestyle adjustments, such as eliminating sugar from the diet, drinking more water and getting more sunshine. Many find help through spiritual or social communities. Of course, because of the severity of the illness, natural treatments will not work for everyone.

How Does Clinical Depression Affect Relationships?
When two people are in a romantic relationship and one of them has clinical depression, they both suffer. One feels hopeless, worthless and totally fatigued all the time. The other one feels frustrated and maybe even resentful or angry toward their partner. There will probably be a loss of sex drive, disinterest in pleasant activities and a general melancholy mood.

If someone you know and love is depressed, help them by being understanding. Be kind and empathic to people dealing with depression. Realize if they could "snap out of it" or "get over it," they would. Be aware that clinical depression is a medical condition and needs to be treated by a professional. Assist your loved one in seeking help.

Learn more about depression so that you can recognize the warning symptoms. Attend family or couples therapy as appropriate. Take care of yourself while you care for your partner. Remain a helper, not an enabler, in the relationship.