Major Depressive Disorder: How I Manage


By Deborah Serani, PsyD, as told to Hallie Levine


When it comes to talking about how depression affects relationships, I’m the expert. And it’s not just because I’m a psychologist. I’ve lived with major depressive disorder since I was 19. I not only work on this issue with my patients, but I encounter it in my own life every single day.

There’s no doubt that strong relationships can help provide a buffer against depression and lessen the severity of depressive episodes. One study, for example, followed American adults aged 25-75 for 10 years and found that people who reported poor relationships with their spouse or other family members were at higher risk of depression.

But it can be hard to maintain relationships when you’re hurting so much yourself. Here’s what I tell my patients and what I want everyone who experiences depression, and those who care about them, to know.

Depression can be hard to understand because it’s an “invisible” illness. This is especially true if you struggle with it yourself. Most of us “get” that a broken leg is an injury, for example, and that we need a cast and crutches so we can move around. But if you have symptoms of depression such as moodiness, difficulty concentrating, trouble sleeping, and just generally feeling sad and uninterested in anything, it can be hard to resist the temptation to just tell yourself to snap out of it.

But if you don’t accept the fact that your depression is real, and just as much of a chronic illness as high blood sugar or arthritis, you’ll be setting yourself up for relationship trouble. Why? You’re setting unrealistic expectations for yourself.

Your loved ones want to help you and make your life easier. They need you to tell them what you’re up for, and when you need help, or a break. Spouses and other family members tend to over-worry. You can make their lives and yours easier if you’re simply upfront about how you feel.

Make clear that depression isn’t your everything. It’s easy for loved ones to mistake real, authentic sadness or irritability for depression. You might be upset about the situation in Ukraine, or worried about COVID-19, and a loved one will mistake these genuine emotions as just a relapse of symptoms.

Again, they’re just looking out for you and your health. I recommend that you be upfront with them and say, ‘No, it’s not that I skipped my medicine, or that my depression is worsening. I have a real legitimate reason to be upset, and it’s X, Y or Z.’ Then talk to them about it. You’ll feel better for sharing your thoughts and they’ll feel better knowing that you’ve got a handle on your symptoms.

This is especially true when it comes to children. My daughter, who is now in her 30s, is used to having a mom with depression. When she was little, I could tell that she worried about me when I seemed quiet or moody. I’d at times have to reassure her that mom was fine.

Kids who have parents with depression tend to feel like they need to walk on eggshells, that they don’t want to upset that parent. They want to be caretakers, and they forgo their own needs because they want to make sure that they don’t set up a row of collapsing dominos for their mom or dad with a chronic illness.

It’s important that both you and your partner reassure them that they don’t need to feel that way. Let them know that yes, you’re OK, but you might need some time in the sun or to go for a walk outdoors to regroup and begin to feel like yourself again. Just as it’s important for you to check in on your own mental health, check in on theirs.

Be selective about who you share your depression diagnosis with. It might seem that you “should” be open about your depression and let your boss and co-workers know. But think carefully before doing so. Yes, we’ve come a long way in understanding mental illness, but it’s still stigmatized. Employers view depression differently than other chronic conditions like heart disease.

I’ve found this to be true in my own professional life. Yes, I’ve found that it helps patients to know that I also have days when I struggle to get out of bed, or that I’m well acquainted with the side effects of certain antidepressant medications. The stigma I’ve faced has been, surprisingly, from other therapists, who feel that I’m oversharing.

As a result, I’ve learned to be very careful about whom I share personal struggles with. You can have depression and be a wonderful parent and have a stellar career. But there’s still this misconception that if you have this condition, you’re flawed as a person. It’s very sad, but unfortunately, it’s a reality.

Check in with yourself frequently. It won’t just help you; it will help your relationships. I ask patients to ask themselves these three questions at least once every few weeks:

  • Has your partner commented that you seem more moody, sad, or irritable lately?
  • Have you found yourself struggling every day for at least 2 weeks in more than one situation? (For example, feeling overwhelmed with both your work and your kids.)
  • Are you finding it hard to do things with family and friends that you usually enjoy, like seeing a movie or going out to eat?

If at least one of your answers is yes, then check in with your therapist. And if you don’t have a therapist right now, consider getting one. You may also be due for a medication check, whether it’s to change drugs or up your dose.

Make it a priority to have some self-care time, too. It may seem like a luxury you can’t afford, either financially or time-wise. But if you take just a few minutes a week, whether it’s going to the gym or taking a relaxing bath, you’ll feel better about yourself and be more willing to give in your relationships. Trust me. Your partner, kids, friends, and other family members will thank you.

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