487 - Diagnosis: Depression (The Best Thing That Ever Happened to Me)
Depression 101
Depression: A mental health disorder characterized by persistent feelings of sadness, hopelessness, and loss of interest in activities.
According to the WHO in 2021, an estimated 280 million people worldwide struggle with depression. Some of the symptoms of depression include:
Feelings of sadness, tearfulness, emptiness, or hopelessness.
Angry outbursts, irritability or frustration, even over small matters.
Loss of interest or pleasure in most or all normal activities, such as sex, hobbies, or sports.
Sleep disturbances, including insomnia or sleeping too much.
Tiredness and lack of energy, so even small tasks take extra effort.
Reduced appetite and weight loss or increased cravings for food and weight gain.
Anxiety, agitation, or restlessness.
Slowed thinking, speaking, or body movements.
Feelings of worthlessness or guilt, fixating on past failures or self-blame.
Trouble thinking, concentrating, making decisions, and remembering things.
Frequent or recurrent thoughts of death, suicidal thoughts, suicide attempts, or suicide.
Unexplained physical problems, such as back pain or headaches.
Depression does not always have a specific cause, but it can be caused by situational things, such as financial problems, extremely high levels of stress, the death of a loved one, loneliness, or major life changes.
In a relationship, depression can manifest in different ways, like:
Withdrawal and isolation from social interactions, including those with partners.
Irritability and negative outlook, leading to more frequent arguments and communication difficulties.
Decreased intimacy due to physical symptoms like fatigue and chronic pain.
Cognitive symptoms include difficulty concentrating, indecisiveness, and negative thought patterns.
These symptoms can lead to misunderstandings and hinder effective communication and conflict resolution.
Another term we discuss in today’s episode is high functioning depression. It has been popularized on social media recently, Some experts believe that the term comes from a lack of clarity surrounding persistent depressive disorder (PDD), or dysthymia, which is an ongoing form of depression. PDD is characterized by feeling depressed for at least two years with brief periods of up to two months of feeling good.
Challenges of depression
Untreated depression can negatively affect relationship satisfaction and stability as a result of isolation and withdrawal, low self-esteem, increased conflict, and/or physical symptoms. It can also create a cycle of negative outlook, constant need for reassurance, and partner frustration, which further deteriorates the relationship.
Being a supportive partner can be challenging as well. It can be difficult to set healthy boundaries in order to prevent conflicts and promote mutual respect. It’s hard not to try to fix your partner’s depression or take it personally. Self care for partners is vital in order to prevent burnout and maintain their own mental health.
The societal stigma surrounding depression can also hinder open communication and help-seeking in relationships. Stigma can make individuals reluctant to disclose their struggles or seek professional help, and partners may also feel ashamed or unsure of how to support their depressed loved one, often due to lack of understanding or social pressures.
Improving depression
We have a few tips for dealing with depression in relationships, promoting relationship health, and improving communication.
Communication strategies
Expressing empathy: Acknowledging and validating the partner's feelings, even if they are difficult to understand.
Using "I" statements: Expressing concerns and needs in a non-accusatory manner, focusing on personal feelings and experiences.
Find another outlet.
Check on the triforce: What type of support or help does your partner want?
Couples therapy and individual therapy
Couples therapy can promote enhanced communication, mutual support, and improved relationship satisfaction (ucl.ac.uk, ncbi.nlm.nih.gov):
Focuses on improving communication, understanding each other's needs, and resolving conflicts collaboratively.
Addresses negative interaction patterns and increases supportive behaviors.
Individual therapy has shown to improve communication skills, boundary setting, and self-discovery (easternshorecounseling.co, goodingsgrovepsych.com):
Provides a safe space to explore thoughts and emotions, develop coping strategies, and improve emotional regulation.
Helps individuals understand their triggers and behavioral patterns, enhancing interactions with partners.
Self-care and maintaining individual identities within the relationship
Encourage partners to engage in activities and hobbies that bring them joy and fulfillment.
Get enough sleep and give yourself permission to rest.
Highlight the value of maintaining friendships and support systems outside of the relationship.
Be patient, compassionate, and understanding towards yourself and your partner
Acknowledge that progress may be slow and setbacks are normal.
Emphasize the power of small, consistent efforts in improving the relationship and managing depression.
Find a way to care for your partner without taking on the entire burden of their mental health and don’t tolerate unacceptable behavior.
Transcript
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Jase: On this episode of the Multiamory Podcast, we're going to have a hopeful episode about depression and relationships. Depression is something that should be talked about often, and often is talked about, but sometimes the way we talk about it can add to the feeling of isolation or otherness or stigma, or that this is something that you would want to avoid for yourself. While there's certain parts of that, that are true, the point of this episode is to look at how depression can show up in relationships and how understanding it can actually be the best thing that's ever happened to you or at least it's been the best thing that's ever happened to me. We'll get into that personal story in just a little bit.
If you're enjoying this, and you would like to learn more about some of our fundamental communication tools that we reference on this show, you can check out our book, Multiamory: Essential Tools for Modern Relationships, which covers our most used communication tools for all types of relationships. You can find links to buy it at multiamory.com/book, or wherever fine books are sold. Also check out the first few episodes of this podcast, which cover some of our most fundamental episodes that we reference a lot on this show. Why are we talking about this, Dedeker and Emily?
Emily: Why indeed? I think that's your story to tell, hopeful
Dedeker: You're the one who wrote it, so.
Emily: Person. Hopeful boy.
Jase: Yes. Keeping with a long tradition of writing episodes about personal things going on in our lives, not all the time, just FYI, if you're out there trying to sleuth our personal lives through our episode topics, it's not always.
Emily: People can sleuth a little bit, but.
Jase: They can’t sleuth a lot.
Dedeker:There’s some that they can sleuth.
Emily: Oh, yes, I'm good.
Dedeker: It's not a non-zero amount that will be sleuthable.
Emily: Yes, for sure.
Jase: Yes, exactly. What inspired me, and I actually was really hesitant to do this episode and Emily was really encouraging me to actually do it. Basically what happened was, I was somewhat recently, a few months ago, diagnosed with depression. I think it's one of the best things that's ever happened to me. Aside from meeting the two of you and doing this show and all the other wonderful things in my life, but--
Dedeker: We're up there when you got diagnosed with depression.
Jase: Yes.
Dedeker: Cool.
Emily: That's very sweet. Thank you.
Jase: I think that can be a little bit counterintuitive for people because it's like, "Oh no, I'm now been sentenced to being this sad, depressed person, or I'm broken or something like that." I guess just to give the quick version of my story that I've went to therapy for the first time in college. We've talked about this all the time on the show, I have been to therapy at various points, seen counselors, acupuncturists, all sorts of stuff. I think it's all been really valuable, and it's been great.
Since I was in high school, it was the first time I remember having the thought, "Do I have depression? Am I depressed maybe?" Through the years, I've basically come up with reasons why that's not it. It's like, "Oh, I read about it, and it looks like it should be like this, and it's not quite like that, so I guess I don't have depression. I must just be stressed, or maybe I'm just overworked or not sleeping enough."
Dedeker: Can you talk about what that discrepancy was for you? Like what you would read that wouldn't match up with your experience?
Jase: There's a lot of emphasis put on being really antisocial, or not being able to engage in activities or not being able to focus or have the energy to do things, and I was always someone who was doing too much. I'm still someone who does too much, that even back in high school it's like I'm doing jazz band before school, and then I'm doing sports after school and then doing the musical in the evening and doing lots of stuff.
Usually, the traditional definition of depression is that sort of, "Oh, I just can't really get out of bed. I don't really want to do anything. I'm not motivated." That was usually the thing that myself, I would rule out depression as a possibility, or if I did talk to a therapist or a counselor or someone about it, it just wouldn't come up because I wouldn't be mentioning, I guess, the typical symptoms that they were looking for in order to go, "Aha depression, that's what it is."
I recently switched therapists, just because I wanted some new content, some new perspectives. Actually Dedeker and I had talked a little bit before that, where I'd said, "I think for this, I really want to just focus on some of these negative thoughts that I have and this negative self-talk that I can really fall into where immediately after a presentation or recording a podcast episode, I feel like I did all the wrong things, pople are going to hate me, thinking, "Oh, my co-worker only like me because it's convenient, and they're just really skilled at being social. They're nice to me, but they don't actually like me. They all find me really annoying," just this narrative going on.
I went in saying "It's gotten to a point where I want to talk about this and see what I can do about it." Right from the start, she was like, "Oh, it sounds like you have depression." I was like, "No, because I don't have these symptoms and I don't think that it's that." She's like, "No, you have depression. That's what it is. It's this thing called the high-functioning depression." We'll talk about that more a little bit later in the episode, what that actually means, and some controversy over the term. It was this, "Oh, oh."
Then she started to list some symptoms, describing it. She said, "I have this too, so this is why I relate to it." I felt like I could tell right away, which is very early for a therapist to give you a diagnosis like that. That's not normal to go there quickly, but she just sensed I was ready for it, I guess. She started listing off symptoms of it and I just immediately started crying because I was like, "Oh my gosh. I feel like someone's finally echoing back to me this way that I felt and telling me basically that you don't have to feel that way all the time and that this isn't just normal, you've got to suck it up or deal with it.
For me, that's why I say it's one of the best things that's happened, because the irony being, since getting that diagnosis and then actually doing more focused treatment for that, including medication, figuring out what's working for me with that, I feel better than I have in years, in so many areas of my life. It's like that's why I'm like, the irony is, since getting the diagnosis for depression, I feel less like I identify with a person who is depressed. Do you know what I mean? It's been this weird backwards thing that I never would have guessed.
Emily: Reporting as the person who lives with you, I will say that I think that getting that diagnosis really put you on the fast track of, "Oh, now I know what this is, and so I have more of a clear sense of direction of where I'm going in treating it and handling it. Where I feel like, again, before you spent so much time waffling off these really negative thoughts in my head, is this normal, is this not? Does everybody go through this? Do I just need to buck up and deal with it? I think that getting that clarity, my impression of you has been that it's been a night and day difference, honestly.
Dedeker: Can I ask any medication or any realization of the fact that this is a thing that you're going through? Has that also caused other emotions to not be as intense and volatile as well? I mean potentially everything, but also maybe like anger or something along those lines, or fear, or anxiety, or any of those things as well.
Jase: That has been interesting because I think I've told this story on the show before. When I was in college, I was prescribed Paxil was the one for anxiety, specifically. I don't remember the specifics of what the dosage was that I was given or anything like that, but I remember I had a really bad experience with it, where it's like, yes anxiety went away, but I was just dead inside.
Dedeker: I remember you talking about that.
Jase: I've learned that the term for this is emotional blunting, I absolutely had that. Then when I went off of it, had really bad side effects from quitting it. It was just like it gave me a really negative impression of SSRIs and that type of medication, and so I was hesitant trying something like that this time. In bringing that up with my therapist and then also with the doctor who was prescribing the medication for me, in bringing that up, definitely got a lot of reassurances of, if that's how you felt that was wrong.
That either meant the drug was bad for you or the dosage was wrong or something really, but that's not how it should feel. I've definitely found that to be true. It's like I still have a full range of emotions. I still down sometimes and happy other times, but it's like the center of the black hole pulling me to that particular place is not there. It's like the neutral point is moved more toward neutral, but there's still this range. I have not felt like I'll still get really angry and frustrated if something frustrating happens or still get moved by something or be sad about something or feel happy or feel tired or discouraged. There's still that whole range there, but it's just, I guess like the center of it has shifted or it just feels more, I don't know, like I have a little more control in it. It's really hard to define. It's been a very interesting experience.
Let's get into the episode here. I do want to clarify this episode is more focusing on the personal side of depression and relationships with people with depression, or if you have depression. Depression for me has been this long-term thing in my life. It can also be something that comes into your life for a little while and can go away.
This is something that many people will encounter at some point in their life in some kind of relationship even if it's not for themself. For example, the WHO predicts that around 280 million people worldwide are affected by depression themselves personally. Then if you expand that out to all of their relationships, where if you assume each of us has, what is it, like the roughly seven close relationships in our lives, you do the math, you multiply all that out, somewhere in your life you will be affected by this at some point. We do want to cover a little bit of the basics of just what it is, what we're even talking about, but then we'll get into more focusing on relationships and how this can show up there.
Emily: I think we're all pretty familiar with maybe the most common symptoms of depression. We tend to associate with feelings of sadness, or emptiness, or hopelessness, but it can also present as irritability or frustration even over very small things, maybe as occasional angry outbursts. Others, the loss of interest in activities that maybe were once enjoyable or pleasurable, having sleep disturbances, like either sleeping too much or staying in bed too much or having insomnia, or sometimes both being in the cycle of having insomnia and then oversleeping to compensate and then not being able to sleep at night, which also feeds into a sense of tiredness or a lack of energy.
For some people there's reduced appetite, which brings with it weight loss or the opposite, increased cravings for food and weight gain. There can be these feelings of worthlessness or guilt, affixation on past failures or self-blame, trouble thinking, trouble concentrating, difficulty making decisions, frequent or recurrent thoughts of death or suicidal ideation, and also unexplained physical problems such as back pain or headaches. That was a long, long, long list of symptoms. Of course, don't be getting your medical advice from us because we are not doctors, but these are just the many, many ways that it can show up.
Dedeker: Depression can happen, like Jase said, over a long period of time. It can be something that you live with for a long period of time, or it can happen in very short bursts. It doesn't always have to have a specific cause, but it can happen because of things like financial problems or extremely high levels of stress, the death of a loved one, or just loneliness that happens maybe at a period of time in your life, or even major life changes. I know I felt like I've had a little bit of depression since moving to New York.
I think that that's just because my life has changed so much over the last few months. I feel like I'm starting to get out of it, but for maybe the first couple months that I was here, I was doing my thing and going along, but realizing I'm not as happy as I thought that I would be, but I realized part of that is because I've got to give myself probably a little bit of grace in terms of the changes that I just went through. I think that that can happen for anyone.
Jase: Definitely.
Emily: I know for myself, I think the only long-lasting and deepest depressive episode that I had was definitely on the heels of untreated PTSD basically. I guess ironically, I could take a page out of Jase's book to say that the day that I finally acknowledged that I am depressed. To be honest, I think I've shared this story on the show before, the kicker was when our editor, Mauricio, reached out to me, to be like, "I can tell something's up with you. I can tell you're going through something. I don't know what it is and you don't have to share it with me, but I hope that you're doing okay, basically." That was just from Mauricio editing our show.
Jase: Listening to us talk about
Emily: Yes. Exactly, and he could tell. That was when I was like, "This is now becoming not only obvious to me but obvious enough to people around me and people tangentially related to me that I need to do something about this." Weirdly, I think I would feel that same sentiment is when I was at the deepest level of my depression, that was, I don't know, like a rock bottom moment I guess, of realizing, "I need to do something," and it got me into therapy for the first time in my life.
Jase: That was hugely helpful, as a person who was in a relationship with you during that time, then living with you during some of that time. It's like I really saw how bad it got, then that turning point as things started to get better. It took a while but it was a pretty dramatic recovery, I would say.
Emily: Speaking of relationships, of course, I think that's what's always top of my mind is that often when there's mental health issues, especially something like depression, it's really hard to just keep that all inside and not have it spill over into your life and into your relationships. Like when you're feeling really depressed, that can manifest as things really wanting to withdraw, wanting to isolate yourself, not wanting to engage in social interactions including those with a partner, or if you're feeling that irritability or that negative outlook, that can lead to more frequent arguments or communication issues with a partner.
Of course, if you are physically not feeling well, if you're feeling fatigue or you're feeling chronic pain, chances are you probably don't want to either engage in physical activities with your partner or sexual activities sometimes. Also having difficulty concentrating, or being indecisive, or having a negative thought pattern or having a sense of fuzziness or difficulty remembering things can also create conflict in relationships.
I think even when everyone's aware of what's going on, that this person has depression or my partner has depression or maybe we both have depression, even when there's awareness, it doesn't necessarily make it any easier, because then of course the other person wants to help but doesn't know how to help, maybe feels like they're making things worse, but doesn't know like, should I try to rescue with my partner, or should I really not? Do they need to save themselves?
This is such a common issue that so many people have to deal with. I will pause right here to say that there is hope, there are really positive and wonderful ways to deal with this in relationship. Also this is so common and plagues so many people. Just know that if this is your situation, you're definitely not alone.
Jase: Definitely. I want to loop back to this concept of high functioning depression that I mentioned before, and my therapist said, "I think this is what's going on because you've clearly done a lot and accomplished a lot, and in those cases, people will often not diagnose depression for exactly the same reasons that I had described before." That high functioning depression is not in the DSM, that's not an official diagnosis. There's also not a lot of research on it because it's not an official thing, but in looking into this, basically it's a concept that was popularized on social media.
A lot of therapists were part of that. They would see this trend and go, "There's this other thing, we need another word for that." I think that high functioning depression grew out of this desire to help more people recognize, "Hey, this might be going on and there could be help for you," getting more people to realize depression can look a lot of different ways. However, there're a few problems with it. One, it's like how we don't say high functioning autism anymore, that in it is this inherent judgment against people with normal depression in that like, oh, they're not high functioning. There's a little bit of a judgment built in. Also that there is an existing term called persistent depressive disorder, or PDD as opposed to MDD, which is major depressive disorder, which is normally what we mean when we say depression, that some experts say, "Actually, you're just talking about this, so why don't we be precise and say that instead of trying to come up with this new term and come up with this other thing?"
PDD, basically to give you the short difference as I understand it, again, not as a doctor, is that it's characterized by feeling depressed with generally lower symptoms than a major depressive disorder, but for at least two years, pretty continuously. It's this much, much longer-term thing. There could be brief periods of not feeling depressed, of feeling better for up to two months at a time. That overall, it's this longer-term two-plus years of feeling this way.
For teens apparently, and children, one year is the threshold for it, to say it might be this versus a major depressive disorder where, like I said, you'd come in and out of it, but the outs of it could last longer than two months. That's one of the key differentiators also of the big list of depressive symptoms.
For the persistent one, as far as I understand it, the diagnosis is you just have two of these, but you have at least two of the symptoms but you've had them for a very long time, versus major depressive disorder usually requires you to have five of the major symptoms of it, and it tends to be much more acute but can come and go. Of course, as all the great things, you can have both, also you could have persistent depressive disorder and then have a major depressive episode for a while as well.
As we mentioned, could be related to trauma or not, it could be related to some experience or stress, or it could just be part of you. That it doesn't always have to be tied to something. However, your life events can cause ups and downs within it, because none of it's static. It's not like, "Oh, you always feel exactly the same." There's still some amounts of ups and downs and ebbs and flows through your life based on your health, and your stress, and your work, and your sleep, and relationships, and all the other things that we all know about already.
The reason why I wanted to throw that in here is because I know for me, that's what made it take a long time to realize that there was potentially a diagnosis and that there were things that could help. I just wanted to throw that out here because with persistent depressive disorder, I think in addition to the symptoms being a little bit less and that they appear not as depressed outwardly, it's like, "Oh, they still have a job, they have relationships, they're still going to work, they're still getting out of bed," all these things can mask it.
The thing I experienced is that because this has been basically as long as I can remember, it's like, "This must be normal then," everyone must feel like this to a certain extent, or maybe this is just some intrinsic trait of me rather than something that could change, or that could be medicated or helped or that therapy could actually change more than just learning how to get by, I guess.
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Emily: There are a lot of challenges that come with depression in general. Of course, just all of the feelings and all of the things that we discussed earlier can be really challenging to deal with, especially if depression is left untreated. It also can negatively affect our relationships in many ways. Untreated depression can affect relationship satisfaction and stability.
Also, things like isolation and withdrawal that can happen from our partners, we can choose to not want to be around them in various ways or simply just withdraw emotionally from them. It also may contribute to things like low self-esteem, increased conflict, and physical symptoms as well. Then it can also create a vicious cycle of negative outlook or a need for reassurance from our partners. That may cause our partners to get super frustrated and that might further deteriorate the relationship as well. Now, we want to get into, what if not you but your partner is the one with depression. Like Dedeker, for instance, was in this and is, I guess, still currently in this boat.
Dedeker: I guess--
Emily: What do you do with that?
Dedeker: That's a whole other conversation and a whole other episode we could probably do. I think Jase and I we were just talking about the other day, but now that you're medicated, do you identify as somebody with depression-
Emily: Interesting.
Dedeker: -or as having depression? We really have to split hairs here, I suppose.
Jase: That's the weird thing, where it's like the irony of I guess having that identity but don't feel as much like I had it as I did when I didn't think that I had it. It's that weird Catch-22. Just to bring this back around to what Emily was getting at here with the negative parts of it come from leaving it untreated and not addressed, is that I was telling my mom about this.
We were having a conversation and she expressed this like, "Oh, I don't know. I wouldn't want to be diagnosed with depression." I said, "Why? If it could be helped, why would you not?" She's like, "I don't know, I guess I just really have something I'm hanging on to that makes me feel like, oh, if someone said I had it, that it would, I don't know, unlock it-
Emil: Make it real?
Jase: -so it could get worse. It would make it real, it would make me have to deal with it." I was expressing to her how, for me it's been the opposite. It's like I finally feel more in control rather than being something that gets unlocked by diagnosis and now is this problem. I do think there can be that fear or stigma about it, depending on how you were raised and what culture you are brought up in, and what your peers think about it and how they talk about it could really affect the way you approach it.
Dedeker: I think I've inherited some of that too. Also being the child of boomers who often tend to have their own received values around mental health and things like depression, because I think I'll always be the last person to label myself as feeling depressed. I think, like for instance, was it last year? I think I was maybe going through a little bit of an episode, but of course, I'd be the last person in the world to say that, and it was Jase, you were the one who came to me, and he was like, "Hey, I feel like maybe you might be exhibiting some signs of depression right now."
I was like, "Oh, no, that's depressing to hear." It actually really helped because I was like, "That's what it is. I know what I need to do. I know I need to take care of myself in these particular ways." I feel like basically as soon as we had that conversation, I was on a much better trajectory of getting out of that particular episode, because that's how it tends to manifest for me. Is I tend to have just tiny little episodes occasionally. For me, it's nothing that's ever been really chronic outside of when I was recovering from PTSD.
Jase: By tiny, we're still talking about several weeks to a couple of months.
Dedeker: Oh, was it?
Jase: Not tiny like, "Oh, this afternoon, I felt bad."
Dedeker: It feels tiny to me. It feels like maybe a couple of days or maybe a couple of weeks.
Jase: No, no. Definitely longer than that.
Dedeker: What is time though? What is--
Jase: I think that's the difference between, "Oh, I'm just feeling down or stressed right now," versus having a depressive episode. It's that it stretches longer than that, than just the normal up-down. That's what I recognized in you at that time. I was like, "Hey, I'm noticing a bigger trend here." Not just, "Oh, today you're being a grump."
Dedeker: Right. Yes. Which happens.
Jase: That happens.
Dedeker: That happens a lot more often.
Jase: Yes.
Emily: I think it is something that I really relate to that both of you said, is just putting a name to the thing or saying it out loud and admitting it is extremely helpful. Being able to say like, "Hey, I've been feeling a little depressed." I said that to my partner regarding how I was feeling recently, and I feel like even just right after doing that, I started to have a little bit of a sense of like, "I've said it out loud, I've admitted it to myself and to him, and so therefore I'm able to figure out what are things that I can do to get myself out of it, or figure out ways to feel better." That is really powerful. It's like this denial makes it worse ultimately, but the really powerful thing and being courageous enough to say, "Yes, this is what's going on," is actually the most helpful thing to do.
Dedeker: I know in my experience, also on the other side of being with a partner who is depressed, most of my lived experience has been with partners who are definitely depressed but in denial about it, or aren't taking care of their mental health or not seeking any support in particular. I think that's been the hardest situations that I've been in because also, you never want to have that conversation where you slap the depression label on somebody because they're not going to appreciate that. You can't have the conversation necessarily where you're trying to force someone into therapy, because that's probably just going to create a backlash, or at least them being really, really resistant.
It's really difficult. I know for myself, my brain will go to these places that I think is really common for people's brains to go maybe telling yourself this story like, "Oh, my partner's depression is my fault. I am not stepping up enough to help them have a better life, or there are things that I can do. I can step up and I can fix my partner's depression. Maybe I just need to give them an inspiring enough speech or just need to care for them just well enough or offer them the right resources or give them the referral to my therapist, or whatever, and that's going to be the thing that's going to going to fix them." Or the opposite, like going into a place of resentment of saying, "Maybe this is just an excuse for poor behavior, this is just an excuse for laziness."
I sometimes have moments where I'm stressed or I'm down, but I manage it, why can't they manage it? I think that the interesting thing when it comes to any kind of mental health issues, everyone has a story, whether it's your own mental health issue, and then of course there's going to be the stories that you tell yourself around that. Then same thing if it's a partner's, you're going to have a story about your partner's mental health. Your story may be correct, it may be incorrect, but I think it's important to acknowledge, I guess, the story creation that we do around these things.
Jase: If you are the one who's trying to be a supportive partner, I think there's also this challenge in how do you take care of yourself at the same time. I think this can show up, whether it's depression, or PTSD, or anxiety, or any number of other things that your partner is going through, is that how do I be helpful and do what I can to help care for them and help them in their personal growth, but setting up some healthy boundaries to hopefully avoid conflict, have some mutual respect for each other, but not take on the job of, now I personally need to fix you because that doesn't serve either of you.
It's not going to help them feel any better. It can actually set them back if you're taking some of that agency away from them, even though it's coming from the best place. There is a certain amount of needing to find this negotiation of what's the amount of distance versus what's the amount of getting all up in there, getting involved with that process.
Then the importance of self-care for yourself as well to avoid feeling burned out and maintaining your own mental health. I definitely know there have been times where, not even looking at this through the lens of capital D depression like a depressive disorder, but just the lowercase D depression of just feeling down, feeling depressed, that you can fall into this cycle.
I know Dedeker and I have had some times in the past, years ago when we've done this of one person is feeling down, the other person works hard to cheer them up, they start to feel better, and then that person who used all their energy to cheer them up, now they feel down. You do this seesaw back and forth of pulling each other up but pulling yourself down at the same time.
Dedeker: I know we talked about this a lot years ago, the giving someone's emotional labor back to them.
Jase: Sure. Requesting it back in return.
Dedeker: Doing, I don't know, it's like this weird sense of maybe you're there supporting a partner as they're going through something hard and then you turn around to be like, "I need support from you because it's been so hard for me to support you, and so now I need--
Jase: It's hard.
Dedeker: In an ideal world that would work, but that's not how it works in reality.
Emily: That's really interesting. I found it fascinating what you were describing with that conversation you had with your mom, Jase, just because there is so much social stigma surrounding depression. It really can hinder like open communication or realizing within yourself, "Hey, that's something that maybe I need to figure out and that is something that is actually going on," and just questioning or asking for help in relationships, it really can make individuals reluctant to disclose their struggles or seek professional help.
I know for myself, I've absolutely been a person who over the years has been like, you know what? I got it. I can figure it out as opposed to going to a therapist. I have been to therapy, but I still struggle with that. I haven't been to therapy recently throughout this whole ordeal that I've been through recently too and I should, and I definitely, maybe I'll do that after we complete this episode. Or go right away.
Dedeker: Just jump right in.
Jase: I love that. Be proactive.
Emily: Exactly. Partners might also feel ashamed or unsure of how to support their loved ones because they don't really understand what's going on, or as society tells you, just figure it out and cheer them up somehow, but it may not be really what your partner needs in that moment. Also, they may just think that whatever that person's going through is normal, that it's just the ebb and flow of how we feel on any given day or just that that's how that person is normally and they just need to deal with whatever is going on like everybody else. It sounds like, Jase, that's something that you internally thought about yourself.
Jase: Something I wanted to share on that point was that, I remember that Dedeker and I would fall into this weird pattern as I started to open up and vocalize more about some of this internal talk and how I was feeling about myself that I had been there for a long time but I guess I at some point started opening up more about it or talking to her about it. I would have this weird thing where to my mind I'm like, "Oh, I'm just sharing a Triforce number one style just to let you know a little bit about my inner world and just these normal thoughts about how everybody hates me." Hates is a little strong word.
Emily: That is the word that you used though.
Dedeker: I was going to say that is the word that you would use.
Jase: That is the word I would use.
Dedeker: You realize now that it's a strong word to use.
Jase: It's a strong word.
Emily: Yes, it is.
Jase: What I'm getting at is that I was expressing just a very normal in the way that someone would share, "Oh, I'm feeling tired today," or, "I'm feeling stressed today," sharing a feeling about that of like, "Oh, I just worry that my coworkers hate me and my manager hates me," and all this or whatever sorts of negative thoughts like that about, "Oh, I think I said all the wrong things today on that call, or in that episode. I was terrible, can you edit out all the parts with me in it?" Those sorts of things.
That to me is just a normal, that's a normal, everyone feels that way all the time, what's the big deal? Then your reaction would be this, you'd get very upset, you'd get worried and concerned and then I would get frustrated feeling like, "No, stop it. I'm not asking for your help. This is just fine. I'm just letting you know that that's what's going on in my head," but it's fine, I've dealt with it for a long time, it's no big deal.
It led to this weird conflict over to you that seemed alarming and to me it felt normal. It was this weird, and ultimately that's through you getting upset about it so much is what led me to go, "Maybe I'll bring this up more with my therapist and try to focus on this for a bit," which led to this. Ultimately I do think that was helpful, but I think added some tension in our relationship for a while there first. I'm curious about your impression of that from your side.
Dedeker: I wouldn't characterize it like that was the tension in our relationship constantly, all day, every day. Yes, it would be upsetting for sure, especially someone that I love so much, I think is great and who also, PS by the way, everyone on the freaking planet thinks is great, I don't care-
Emily: 100%.
Dedeker: -you can fight me on this, but everyone meets you and falls in love with you and is just totally charmed by you and think you're great. That dissonance of the way that you would talk to yourself, it was sad.
Emily: And surprising too.
Dedeker: Yes.
Emily: Just because there was no reason for it.
Jase: Gosh.
Dedeker: I'm going to cry now too.
Jase: Oh geez. I said this was going to be a hopeful-
Dedeker: I know, you said it would be fun.
Jase: -lighthearted episode without depression. It would be fun. I did promise all of that. That's why we're going to go into the third part of this episode, where we're going to talk about some strategies for actually coping with this, as well as some research about different types of therapy and stuff like that, that you might consider for yourself, if this seems relevant to you or interesting to you. It's all honestly just fascinating stuff to learn about.
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Dedeker: Let's dive in by talking about some strategies that you might employ if you are in a relationship and you're dealing with depression or you're dealing with a partner's depression. Of course, the first place to go to is express empathy. Now it can be really helpful, like I was saying earlier, if you're aware of the stories you already tell yourselves about mental health in general. If you're aware of that story, and if you don't like that story or if it's not a very helpful or supportive story, you can choose to communicate in a different way.
You can choose empathy, so acknowledging your partner's feelings, validating them, even if they're difficult for you to understand. Even if you're somebody who's never experienced depression or never experienced chronic depression, for instance, still making an effort to acknowledge and validate. It's really good I think to air on the side of not teetering in this situation. Now, if you don't know what I just said, go check out our episode about The Triforce of Communication. What I'm saying in layman's terms is don't jump into fix-it mode right away or giving advice unless your partner has specifically asked, "Hey, can you give me some advice about dealing with depression?" Or, "Can you tell me about your experience with dealing with depression?" Or, "Can you give me a referral to a therapist," or whatever?
Just err on the side of not doing that unless it's been asked for. It's good if you have concerns about a partner to express those concerns and needs in a non-accusatory manner, not making it about them failing, taking care of their mental health. Focus on your personal feelings and experiences. Also, I think this is so crucial that if whether you are the one who's experiencing depression, or you're supporting a partner through depression, it's so important to have an expanded support network outside of just the two of you.
Either that means having a trusted professional, for instance, like a therapist, a counselor, having friends that you trust and feel like it's okay to go to on either side, because again, like Jase and I used to get into those loops of, I need to share with you how hard it has been for to support you and then you share with me how hard it has been to support me and no one ends up feeling really well supported at the end.
It's because you need to add more people to the team. You need a more robust support network outside of just the two of you. Even if it's just one person, you don't need to go out and try to make 20 friends all of a sudden to be able to share the load of this. Even if you go from zero to one other person, that's going to give you a lot of bang for your buck to put it in really inappropriate terms.
Jase: Sure. Yes. Then this next one I think is worth just acknowledging and talking about a little bit, which is seeking professional help with it. That can look a lot of different ways, but one of the recurring things in research about depression and anxiety, which are very closely related. Essentially, the studies show that medication and therapy both work about equally well, but that the two together can often be the most effective. That is something that I found for myself as someone who has done a fair amount of therapy off and on through the years.
Then doing this show where we're talking about relationships and mental health and communication a lot, that I had a lot of good coping tools for getting myself by and having a relatively good life and not feeling like, "Oh, I'm this total failure," even if there is that voice kind of saying those sorts of things to me. For me, the missing piece was a diagnosis and then having even just a small amount of medication to help that was like, oh, I had all those tools in place. I've heard for other people it's, they might have a doctor who right away is like, "Oh, you have a problem, here's medication." It only helps because maybe they haven't learned some of the tools and the patterns and stuff that have been shown to be effective in therapy.
I would definitely advocate for doing both. Maybe if you're listening to this and going, "I've done one or the other and it's only helped so much," it might be worth looking into that combination because I know, at least for me, I think that some of how quickly I've experienced a difference is because I'd been doing the one half of it for a while, that that helped be like, "Oh, this was this extra nudge, this piece that I needed."
Like I said, I'm still only a few months into this journey, so who knows where that will go from now but I do think that's worth acknowledging. Something though, when I was researching this episode that had not even occurred to me was the concept of doing couples therapy if one person has depression, doing couples therapy as a way for that one person to work on their depression.
I actually found this 2018 meta-analysis, so a review of a bunch of different studies and this was by Barbato, D'Avanzo and Parabiaghi. They found evidence that both couples therapy and individual therapy can be found to be equally likely to help relationships when one partner is struggling with depression.
Emily: Oh, really? Oh, that's helpful.
Jase: Yes. Cool. That both are effective, which I did not expect. I thought for sure it was going to be individual therapy is helpful and couples therapy not as much, but they found both to be equally effective. Again, looking across a bunch of different studies, one potential advantage they found to couples therapy is there's a little bit of evidence to suggest that dropout rates might be lower if you're doing it a couple instead of just by yourself. They did say that the evidence for that one wasn't very strong and it was mostly from one not super strong study. Take that with a grain of salt but that could be helpful.
They reiterated that therapy and medication both found to be equally helpful and that, no surprises, both therapy on its own and medication on its own were found to be better than just leaving it untreated and not dealt with, no surprises there. If this is something you're considering, a few things to consider on the couple's therapy side is that you get that mutual support. It can lead to improved relationship satisfaction and enhanced communication about it because you have that third person there to help give some understanding and some context to what you're talking about.
It can also help to address more quickly some of the negative interaction patterns that you may have fallen into as you're then dealing with the depression itself as well. On the other hand, in individual therapy, you're able to focus more on your own self discovery of what might be behind this. For some people, it might just be easier to do that on your own than trying to find times in both of our schedules and finding someone who wants to work with both of us. It provides you with a little more of a safe space to just process your own emotions and coping strategies and develop emotional regulation tools, understanding your own triggers, things like that.
I will say that a big thing that's been helpful for me talking to a therapist right now is just that I get to, during the week, write down all my questions or my concerns or my worries about like, "Well, but will this medication make me like this?" Or, "Is this normal to feel?" Or, "Now I'm feeling this way. What's going on with that?" Just to have someone with more experience than just their own to go, "Oh, yes, that's pretty normal," or, "Oh no, it's not going to feel that way," at least it shouldn't, like I mentioned with the emotional blunting thing when I had taken medication in college, they're like, "No, that's not normal. That's not what you want."
Also being able to tell me, if you experience these side effects, these are the ones you should be alarmed about and should talk to your doctor right away, versus these other ones, that's fine, and that'll probably get better over the next few weeks, just having someone to give some perspective. I could imagine to go back to some of the conversations we had, Dedeker, if we were doing that in couples therapy, they could probably add a little more context for, "Now Jase is saying that he thinks everyone hates him." They're giving a little context and a container around that rather than it being like, "I don't know how to help you." This seems really dire.
Dedeker: Am I correct that you said that almost immediately that it was within the first week of taking medication you started to feel different and better?
Jase: Yes. I'd say within two days.
Dedeker: That's amazing.
Jase: Again, another thing, because everything I'd read said it can take up to-
Dedeker: A month or something or longer?
Jase: -four to six weeks to start really feeling the benefits of it. Again, being able to talk to my therapist and say, "Hey, I heard it should be this but my experience was this. What's the deal? Is there something wrong? What could cause that?"
Dedeker: Is it magic?
Jase: Right. Again, having someone with just more perspective than me to say, "I've seen that." She said that for herself in the past she also tends to respond very quickly to it. She's like, "It just means that whatever you're taking that definitely seems to be affecting whatever's going on in your brain that's causing this and it's like you really needed it, and so that's affecting it right away." She's also helped give some perspective on things like saying if I felt weird about taking medication, because I do still have my own, whatever, internalized ableism-
Emily: Stories.
Jase: -or my own stories about that like we're talking about, I still struggle with that, of her making the analogy of saying, if you had diabetes you would take insulin because that's something that you would need for your body to function and for you to be healthy. This isn't really any different than that. We just don't treat mental stuff the same that we do physical things from an emotional standpoint. Even though they're all chemicals. It's all chemicals in our body doing things and the body is a bit of a mystery and the brain is a bit of a mystery, still the medical science today, but we at least have things that we've seen now with SSRIs many decades worth of research and seeing what's been effective for people and what kinds of side effects and how it's helped people.
Dedeker: That's a really great point. When you are dealing with a partner that is going through depression, it's really important to also be able to have your own sense of self-care and maintaining individual identities within the relationship. Engage in activities and hobbies that bring both you and bring them joy and fulfillment. It's really important to get enough sleep and to give yourself permission to rest, and then also, maintaining friendships and support systems outside of the relationship, like we said before, that's huge.
I think regardless of what your relationship status is, if your partner is depressed or not, that's something that we really, really advocate for on this show. It's important to have a sense of autonomy and be able to see people with different perspectives, to have a good time outside of just the main relationship that you're in or the multiple relationships that you're in, especially if something like this is going on.
Also, finally, be patient, compassionate, and understanding towards yourself and your partner. Acknowledge that progress on this is slow. There are going to be setbacks, that is normal, and small consistent efforts in improving the relationship, that's super important, and managing depression, because again, it's not just like, "We're going to the moon, and it's always an upward trajectory, and that's it, and we're going to be fine now." Things happen. Life happens, and so because of that, people may have setbacks and that's totally okay.
Lastly, find a way to take care of your partner without taking on the entire burden of their mental health. Don't tolerate unacceptable behavior if that happens. Yes, depression can cause people to be angry at times, or people to withdraw from the relationship, but if unacceptable behavior is happening, look into that, and maybe, like Jase said, go to couples counseling.
Jase: It's okay to have those boundaries and to take care of yourself, because ultimately it's everyone's journey to figure this out themselves. Hopefully, they can have some good support networks around them, but you're not required to do that if it's resulting in you being treated in an unacceptable way. I do think that's worth just mentioning there.
I hope that as a whole, you dear listener, are able to come away from this episode with just a little bit of sense of, I guess, just some of the real human stories that are involved in all of this, and how we're all just humans. It can be easy to fall into these tropes of just throwing out facts or statistics or talking about, oh yes, this is really important, or no, this isn't, or medication's good, or medication's bad, or whatever, and just finding these quippy things, but just to realize there's a whole spectrum of that, and there's different things that are important for different people, and we've all got these different experiences.
I hope that some of you feel a little bit seen by this episode, in a way that I felt so seen by my therapist when she finally unlocked this for me, and that for some of you, that is the beginning or maybe a continuation, of a journey to feeling better, and ironically, by accepting it, actually feeling it less, by being able to move past that and not dwell so much in the way that you're feeling and feeling stuck in it, which is definitely how I felt for a long time. I hope that this is helpful for all of you.