Intimacy and Depression: A Silent Epidemic

Intimacy and Depression: A Silent Epidemic

Depression doesn’t just happen to individuals. It happens to the people closest to them. Depression is tough on strong relationships, threatens the foundation of weaker ones, and can make forming new connections almost impossible.

It doesn’t matter whether depression begins as a slow burn or a five-alarm blaze, the result is the same.

Disconnection

Even the basics–like eating, sleeping, and paying attention–move from “automatic pilot” to problems. People locked in the grip of depression struggle to meet the most minimal demands on their resources. Getting through the day tends to “use up” all of a person’s energy, making it difficult to feel desire or joy. This is often worsened because a person may have trouble remembering that they actually once had those feelings or believing they might experience them in the future.

Intimacy–whether it’s laughing over a private joke in the living room or making love in the bedroom-is a quiet, but devastating casualty of depression. Depression sufferers don’t have much energy left over for intimate relationships. A depressed person’s partner has a ringside seat to observe the painful process of disconnection. Misery, in this case, does not love company, and often causes couples to withdraw from each other.

Depressed people sometimes transfer their inner pain to something or someone outside themselves. Partners may become the target of anger, blame, or dependency. They can feel abandoned, confused, frustrated, and fearful about the future. They may resent the extra burdens they have to bear as a result of their partner’s illness. Sometimes the stigma of depression can both isolate partners from others and deny them the social support they need.

How do people deal with the tremendous loneliness that depression introduces or intensifies in their lives? Finding and starting a new relationship demands many things the depressed person doesn’t have–energy, initiative, and the sturdy self esteem necessary to make new connections. Depression can make it impossible for them to put their best foot forward in meeting people and can take away the desire to meet new people at all. If people with depression do manage to summon the courage and energy for new encounters, how do they explain it to the new people in their lives?

Reconnecting

Antidepressant medicines, prescribed and monitored by a physician (usually a psychiatrist or primary care doctor), are usually effective in relieving symptoms of depression such as sleep and appetite changes and decreased energy. As an individual’s mood lifts, the depressive pessimism, helplessness, and self-criticism also begin to lessen. As recovery progresses, more and more of the “old self” returns. Investment in and energy for emotional and sexual intimacy increases.

When people talk to their healthcare professionals about the possibility of taking antidepressants, it is important for them to be as fully informed as possible about the medication. It is important to find out the following:

  • what the doctor expects the medication to do
  • the recommended dosage and timing of taking the medicine
  • how long before the drug can be expected to begin to relieve symptoms of depression
  • interactions with other prescription and nonprescription drugs the patient may be taking, including alcohol
  • how and when the patient and their healthcare professional will evaluate their progress on the medicine
  • common side effects, including effects on sexual function and desire

Patients should not make changes or discontinue the prescribed medicine without consulting their doctor. They should also consult their healthcare professional if they are experiencing any problems.

Psychotherapies developed specifically for the treatment of depression can be useful in treating depression and preventing future episodes. Individual psychotherapy can help people:

  • identify sources of stress
  • evaluate life choices
  • examine the ways they think about themselves, their relationships, and their future

Even with successful medical treatment, depression’s disconnecting influence on intimate relationships may still present problems. It’s important to remember that people usually don’t get depressed overnight, and they usually don’t recover in that time frame either. Getting a relationship back on track requires honesty, persistence, patience, and realistic expectations for both partners. Some find their way back to each other on their own. Others benefit from marital or couples psychotherapy, which can help both partners:

  • understand the impact of depression on their relationship
  • find new ways of relating that may relieve symptoms of depression
  • strengthen the partner’s supportiveness and the sense of intimacy in the relationship

People who have endured depression alone have different challenges to face. Thinking about everything it takes to start a new relationship can be a scary thing. Even as depression lifts, people’s self-confidence, particularly their social self-confidence, may feel shaky. It is easy to see old difficulties and loneliness as “proof” that no one could possibly find them interesting and attractive. The longer these thoughts stick around, the more trouble they’ll make in getting and keeping close relationships.

It’s important to focus on:

  • forming reasonable expectations about the process of finding new connections
  • taking small steps, for example, feeling good about a brief phone call they initiate or a casual invitation they accept
  • starting with less demanding interactions where social pressure doesn’t feel overwhelming, like sharing a movie rather than dinner at a restaurant
  • sharing concerns with others who’ve recovered from depression

Intimacy & Antidepressants

Sometimes, even when effective in alleviating depression, antidepressants may interfere with sexual drive, arousal, function, and satisfaction. It can be difficult to differentiate the sexual disinterest so common in depression from the sexual disinterest seen with some antidepressant medications.

Other changes in sexuality, such as difficulty becoming aroused, difficulty sustaining arousal, or difficulty reaching orgasm, are more clearly associated with medication.

People should not assume that sexual side effects are unavoidable. Their doctor may recommend altering the timing or dosage of their medicine, or switching to another medicine that may have fewer sexual side effects. There are antidepressants available that have few adverse effects on sexual function. It’s important for people to talk openly with their healthcare professional to determine the best treatment for them.

It can be difficult to initiate a conversation with a doctor about sex–especially when someone is having problems. People vary widely in their responses to medications, so it’s important that their doctor knows their unique reactions. One way to frame their concerns about sexuality is to compare what things were like before depression, during depression, and after treatment.

Including their partner in the process of identifying changes provides a good source of information and helps them feel like they are working together. Their partner may be helpful in providing an additional perspective. Having notes when they speak with their healthcare professional may increase their comfort level and help them focus directly on the problem and potential solutions.

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