Depression is often described as a lonely experience. The withdrawal, the flatness, the lack of energy and enjoyment. What is less talked about is what depression does to the people closest to the person experiencing it, and what it does to the relationship itself.
Depression creeps into the relationship for many couples in Maryland. One partner starts to pull back. Conversations get shorter. You get less physical affection. The other partner tries harder, then backs away too. Before either of them is even sure what has happened, a distance has opened up that neither one knows how to close.
This article is for individuals and couples in Maryland who are navigating the intersection of depression, relationship health, and intimacy. For the partner who is trying to understand or both of you, the relational effects of depression are something that responds to focused support if you are the one who is depressed.
For Marylanders outside Baltimore, telehealth has created access to this type of specialized support across the state in a way that just wasn’t there a few years ago.
Table of Contents
How Depression Affects Relationships
There are a few different ways depression affects relationships. When you understand those ways individually it is easier to deal with them.
Withdrawal and emotional distancing
Depression diminishes the ability to connect emotionally. The depressed partner may be there physically, but not emotionally, unable to access the warmth, responsiveness and attunement that a relationship needs to feel alive. To the other partner, this comes off as indifference or rejection, even though it is not. The pain and confusion that follow are often left unspoken, widening the gap.
Irritability and conflict
Irritability is often a symptom of depression, especially in men, but not just men. The partner who is having internal difficulties may project that tension as impatience, criticism or explosive responses to normal friction. This pattern of couples often cycles through conflict without it ever being recognized that depression is the driver, resulting in a pattern of never addressing the source of the arguments.
Decline in sexual desire and intimacy
Depression kills desire on a neurological level. Sexual interest and responsiveness are affected by the same depletion of motivation, pleasure and energy that affects other areas of life. It is one of the most consistent, and least talked about, relational effects of depression. For the non-depressed partner, the loss of physical intimacy can be a deeply personal experience, exacerbating their own insecurities about their attractiveness and the viability of the relationship.
It should be borne in mind that some antidepressant drugs have effects on sexual function, adding a pharmacological dimension to the already complex picture. This is a discussion to have with a prescribing provider and a therapist.
Caretaking dynamics Role distortion
When one partner is depressed over a long period, the other tends to take on an ever-expanding caretaking role. Doing more of the household work, doing more of the emotional work, keeping an eye on the well-being of the depressed partner. This can create resentment in the caretaking partner and shame in the depressed one, and it fundamentally alters the relationship dynamics in ways that outlast the depression itself if not addressed.
The Partner’s Experience
Living with a depressed partner is an experience in itself and deserves to be acknowledged. It’s not the same as depression, but it’s really hard in ways that are often dismissed.
Partners of depressed people often talk about how lonely they feel in the relationship, guilty for feeling resentful, uncertain how hard to push versus how much space to give, and exhausted by the sustained effort of holding things together without acknowledgment. Many feel they can’t talk openly about their own needs without coming across as selfish given what their partner is going through.
These experiences are authentic and they matter. The partner’s wellbeing is not a secondary to the person’s experience of depression. Therapy that only addresses one side of that equation is incomplete .
Depression and Sex: What You Should Know
Depression has a particular impact on sexual intimacy that needs more specific attention than it generally receives, as it is one of the areas where couples are most likely to suffer silently.
A low desire caused by depression is not the same as a low desire caused by relationship problems or sexual dysfunction, even though it may look the same from the outside. The difference is significant for treatment . If sexual desire is primarily a symptom of depression, then treating it as a relationship or communication issue will have limited success. The depression has to be treated first, or at least at the same time as the relational work.
Mark Goldberg’s AASECT-certified sex therapy at CICC is uniquely suited to tease out these presentations, as well as to address the sexual aspect of how depression operates within the larger relational context. This is clinical work that is outside of the usual, either individual or couples therapy, and requires training in both.
For couples in Maryland who have been affected by depression in their sexual relationship, having a therapist who is certified in both EFT and AASECT sex therapy means this work doesn’t have to be split between multiple providers.
Therapeutic Approaches to Relational Impact of Depression
The Center for Intimacy, Connection and Change, Pikesville, Maryland, uses the following evidence-based approaches to address the impact of depression on the relational and intimacy.
Cognitive Behavioral Therapy (CBT)
As taught in Beck Institute training, CBT focuses on the cognitive patterns that cause and maintain depression: the negative self-appraisals, the hopelessness, and the withdrawal behaviors that reduce access to positive experience. In a relationship context, CBT also addresses the interpretative patterns that each partner brings to the other’s behavior, reducing the misreads that depression-driven withdrawal usually produces.
Acceptance and Commitment Therapy (ACT)
ACT is especially helpful for the values clarification and behavioral activation that depression interferes with. When depression has drained away a person’s sense of what matters and what is worth pursuing, the focus of ACT on identified values and committed action provides a framework for re-engaging with life and with the relationship. ACT helps partners be flexible and compassionate with themselves as they care for a struggling loved one.
Mindfulness Therapy
Mindfulness-based approaches target the rumination and self-critical thoughts that are central features of depression. They also foster the present-moment attentiveness and emotional attunement that depression erodes in relationships. Mindfulness practices can be a place for couples to reconnect during a time when other forms of connection feel out of reach.
Emotionally Focused Therapy (EFT)
EFT works on the attachment cycles that depression disrupts and distorts. Much of EFT is about the pursuer–withdrawer pattern that often develops when one partner is depressed, whereby one partner reaches out for connection and the other withdraws. It is the rebuilding of secure attachment between partners that often makes the recovery from depression’s relational impact sustainable.
Availability of Therapy in Maryland: Telehealth
In Maryland, geographic access to specialized couples and sex therapy has traditionally been more limited for those living outside of the Baltimore metro area. Baltimore, Bethesda and Annapolis were magnets for specialty practices, leaving many communities across the state with few local options for the kind of differentiated clinical work that depression’s relational impact often requires.
That’s been turned on its head by telehealth. CICC offers therapy statewide in Maryland through telehealth, meaning couples and individuals in Frederick, Hagerstown, Salisbury, Cumberland, and communities across the state can get EFT-certified couples therapy and AASECT-certified sex therapy without a two-hour round trip.
Removing the logistical hurdle of traveling to a specialty practice is not a minor convenience for couples in which the depression of one partner has already depleted the energy remaining for the relationship. Often, it’s what makes beginning therapy even possible.
Frequently Asked Questions
Does the depressed partner need individual therapy prior to couple therapy?
No. Not always. And not necessarily. The answer depends on the severity of the depression and the nature of the relational concerns presented. Often, couples therapy can be an effective treatment for mild to moderate depression when the relational dynamic is a significant contributing factor. Severe depression usually needs individual treatment first, and then couples work after some stability has been achieved. CICC offers a free consultation that can help you figure out what sequence makes sense for you.
My partner doesn’t think their depression has any bearing on our relationship. How do I handle this?
That’s a very common situation. Starting with individual therapy for the non-depressed partner is a good place to start, both for your own support and to learn better ways to communicate your experience without it coming across as criticism. Sometimes your own individual work opens something up for your partner that they couldn’t get into before.
Can sex therapy treat low desire related to depression?
Yes. CICC’s AASECT-certified sex therapy specializes in low desire and the complete picture, including depression. This means differentiating between loss of desire caused by depression, relationship dynamics, medication side effects, or other reasons, and addressing each contributor separately. This is clinical work that benefits greatly from a therapist trained in both relationship therapy and sex therapy.
Does CICC have telehealth available in all of Maryland?
Yes. CICC provides telehealth therapy for individuals and couples statewide in Maryland. Our office is located in Pikesville, MD and serves the greater Baltimore area. This means clients throughout Maryland, including those in more rural or underserved areas, can receive the same specialized therapy through a secure telehealth platform.
Partnering with CICC in Maryland
The Center for Intimacy, Connection and Change is a specialty therapy practice in Pikesville, MD. Mark Goldberg, LCMFT is AASECT Certified in sex therapy and EFT Certified in couples therapy and works with individuals and couples across Maryland on the relational and intimacy effects of depression.
If you feel your relationship, your intimacy, or both, are being affected by depression, we provide a free 15 minute consultation to help you see if CICC is a good match for what you are dealing with.
