Depression and low mood: A guide for partners

If your partner is struggling with symptoms of depression or low mood, this guide is for you.

1.Who is this guide for?

This guide is for anyone whose partner is depressed. This includes people who are worried their partners may be depressed, or those whose partner has already been diagnosed with depression. It may be helpful to listen to this guide together, to check out whether it matches how things are for you and your partner.

Whether your partner’s symptoms are mild or more severe, this guide can help you:

• understand depression better
• work out what’s going on
• learn what you can do to

It will also help you understand why a good relationship is so important to mental health, and how you can start to make things better. We’ll talk about some self-help you can do together, how to find further help, and how to look after yourself.

If you’ve noticed the symptoms of depression in your partner, or are worried about them, it may feel like there’s nothing you can do to help. However, there are lots of simple steps you can take to support your partner, help yourself, and even improve your relationship.

There are many forms of depression, and it is important that your partner gets the right help. This guide gives some basic information about depression and practical tips on supporting your partner and looking after yourself.

This guide does not cover post-natal depression or bipolar disorder, and is not intended for anything other than mild depression. It is not intended to replace professional help for your partner – if in doubt, you should always seek professional help.

One of the most helpful first steps is for your partner to speak to their GP or other health professional, and work out what sort of depression you are dealing with. If the depression is mild, it may be that some of the simple advice in this guide alone may help. However, if the depression is more severe, this guide may still be helpful as something to use alongside other treatment.

2. What is depression and how is it different from low mood?

To begin with, we’re going to talk a little bit about what depression is. This will help you understand:

• how to know the difference between low mood and depression
• how to know the difference between a stressful period and depression
• the range of symptoms a depressed person can experience

We’ll talk about what can cause depression, what can keep it going, and why it can seem so hard to shift. Learning more about depression is helpful in learning to deal with it in the best way possible.

Depression is very common. One in five people will experience some form of depression in their lives. The symptoms can range from quite mild, like feeling in a low mood, to very severe. When depression is more severe, people may have thoughts of self- harm or suicide. Although very common, this should never be ignored. If your partner is having suicidal thoughts or feelings, it is very important to seek help immediately.

Many people feel flat or low in mood sometimes. Life can be challenging and tiring and most of us have felt low at some point. We’ve all had days when we don’t want to get out of bed, or can’t face the day. Often we don’t know what’s causing the low mood. We might be arguing with a friend, or worried about a sick relative, or short of money. Or we might just be really tired and need a good night’s sleep.

Fortunately, this feeling usually goes away once we have had a chance to talk things over, solve any practical problems, or just do something that cheers us up. But low mood that is there most of the day every day and won’t seem to go away for a long time, can start to get in the way of everyday life and become a much bigger problem.

If you’ve already taken steps to resolve practical problems together and things don’t improve after a few weeks, this may be a sign that low mood is actually a symptom of depression.

Depression can come on at any time. It can be triggered by a stressful event like a bereavement, or a series of difficult events, but it can also come on unexpectedly. You might not be able to identify any specific cause, and it may seem to have come out of nowhere.

However it starts, it’s important to understand that depression is more than just feeling sad or having a short bout of low mood. Symptoms of depression can range from mild to severe and may include:

• Low mood lasting two weeks or more
• Feeling guilty, worthless and hopeless
• Loss of interest or enjoyment in activities
• Feeling tired or lacking energy
• Doing less
• Not being able to concentrate on everyday things like reading or watching TV
• Changes in appetite – eating more/less than usual
• Not being able to sleep well, or sleeping more than usual
• Having thoughts of suicide or self harm

People can often feel guilty about having suicidal thoughts, and may avoid talking about them. Try to encourage your partner to talk about these feelings and to speak to their GP (General Practitioner or family doctor) as soon as they can. The GP will usually explain how common suicidal thoughts are for people who are depressed, but they can also do a risk assessment and, if necessary, refer your partner for further help.

Video clip – My partner suffers with low mood. How do I know if they’re depressed?
Watch this online at: bit.ly/2nmhlDs

3. How severe are the symptoms?

The symptoms of depression can range from mild to moderate, or more severe. People with mild depression may have many of the symptoms above and find life a bit more difficult than usual but still feel able to manage most of the time.

Like a bout of low mood, mild depression can often be treated with self-help, including dealing with any ongoing practical problems.

When the symptoms become worse, we might describe it as moderate depression. Although the word ‘moderate’ might lead you to think it’s not too serious, someone with this level of depression will already be starting to have difficulty coping with day-to-day activities, like going to work and being with friends.

In cases of severe depression, daily life can be a real struggle. People lose energy and interest, leading to a drop in activity, even for things they used to enjoy. The person’s mind can get very busy with gloomy thoughts about themselves, others, and the world in general.

4. When should we seek help?

Whether you feel your partner is mildly, moderately or severely depressed, you should always encourage them to seek help if you are concerned. This is especially important if the symptoms are severe or your partner has been depressed before. It’s also important to remember that depression is only one possible explanation for these symptoms. If you’re unsure about anything, it’s always best to get a professional opinion.

If you go to the GP yourself to speak about your concerns, they may not be able to discuss your partner without their permission, unless there is a severe risk of harm. It is usually better if you can go along together.

Even if your partner is receiving professional support, you may still find it helpful to use the self help tips and guidelines in this guide and other suggested resources.

Video clip – What if we both feel depressed?
Watch this online at: bit.ly/2mIHZcL

5. How do relationships affect well-being?

Good quality relationships are one of the most important factors influencing health and wellbeing.

Poor relationships can lead to poorer physical and emotional health, including depression. Unhappy relationships also increase the risk of further depressive episodes after recovery.

Happily, however, people in strong, good quality relationships often have better mental health. So, being a supportive partner can help to protect your partner from mental health issues like depression.

You can help by staying calm and being patient. Your partner may not always be able to accept your support, and may need to work through some things alone. Don’t take this personally. It may just be your partner’s way of coping.

Look for the positives. If your partner makes progress in one area but neglects another, do your best to focus on the positives and let the rest go. Even getting out of bed can be hard when someone is depressed, so don’t expect too much too soon.

Taking the time to understand a depressed person’s thought process can be an important part of their healing process, as it allows you to see things from their point of view, and make better choices about how to respond when you see them after what may have been a tough day.

6. Is it my fault? Am I making things worse?

You may wonder if you could be the cause of the depression, or that you might be making it worse. However, depression can sometimes come out of nowhere, so it’s very important to stay away from blame and instead focus on what you can do to help.

Relationships and mental health are linked, but that doesn’t mean you are at fault for your partner’s illness. Understanding the causes and the factors that can affect depression can put you in a stronger position to offer support.

Depression can come on at any time, sometimes following a series of setbacks or losses. The risk of depression is higher for people who don’t have strong links with friends and family, find it hard to talk about things, or don’t know how to ask for help. Poor sleeping patterns, unhealthy eating habits, and alcohol or drug use can also be linked with depression.

As the partner of someone with depression, you can help a lot by noticing the early signs, and offering your support and understanding. Simply doing this may help to ease the symptoms, and encourage your partner to seek further help from a professional before symptoms develop further.

If left unchecked, depression can become a vicious cycle, getting worse as it spirals. Depressed people don’t just avoid the difficult areas of their lives. Gloomy thoughts can lead them to withdraw from all kinds of social situations.

In the short term, this can seem like the best thing to do. It feels easier and helps your partner avoid the negative things they are worrying about. However, in the long term, it will only make things worse. Avoidance can cause people to miss out on opportunities to lift their mood and start seeing different ways of doing things.

Going into this cycle of depression nearly always reduces a person’s motivation.

Video clip – Have I caused my partner to be depressed?
Watch this online at: http://bit.ly/2nmlkjt

7. How can we break the cycle of depression?

This is where you, as the partner, may be able to help. When someone gets into a cycle of depression, they often start losing their will to do anything at all. It’s important to encourage your partner to get out and stay active.

Let’s say there’s a party you’ve been invited to. Your partner might desperately want to stay at home – they might try to convince you that they won’t be good company.

While that may be true for them in that moment, being out among other people could be a real help and may even lift their mood a little. People rarely feel worse when they do something that they would normally enjoy.

Feel low in mood. Have gloomy thoughts. Physically do less. Feel unwell. Circle diagram.

On the other hand, spending time alone dwelling on upsetting thoughts and problems can allow negative thinking and low mood to get worse.

Try to agree that you’ll keep up with social events and other activity as much as you can. Remind your partner that it’s worth seeing friends. This will help in the long run. You can plan to increase social outings gradually but just agree on small goals to begin with, even if it means only staying for a short time.

Diagram. Make a plan. Go see a friend. Join in activities. Get some exercise. Do something fun.

8. How might depression affect us as a couple?

Depression is very powerful. Its effect on an individual can naturally spill over into the couple relationship. It’s helpful to know how depression can affect your relationship so you can protect against it, or at least be aware that it’s the depression, and not you, that’s causing it.

Some things that may affect couples:

• Low mood. Your partner’s personality may seem to have changed completely, their happy nature, sparkle and sense of humour having been replaced with gloomy This can feel quite rejecting and isolating for you.

• Loss of energy, motivation and interest. Depressed people often lose interest in most things, including themselves and other They may not want to go out, and seem uninterested in things you used to enjoy doing together, often including sex.

• Concentration. When concentration is poor, everyday activities we normally take for granted can become difficult – even something as simple as holding a conversation.

• Sleep. Disrupted sleep is very common and can affect both of Tiredness can lead to irritability, and other symptoms can get worse. Even sleeping too much can lead to low energy and memory problems.

• Appetite. Depression often affects eating, and your partner may lose or gain weight. If you usually enjoy cooking together and sharing meals, this can be a big change.

• Guilt. Depressed people often feel very guilty about the effect they have on others. This can lead to further withdrawal, and feelings of being unworthy of love and affection.

• Low self-worth. Feelings of self-worth often reach rock bottom and depressed people often feel awful about themselves. People with very low self-confidence and self-esteem can become critical of the people close to them as well as themselves.

• Suicidal thoughts. It is very common for a depressed person to have thoughts of This can be very difficult to cope with when you love someone.

Couples where one partner is depressed can have trouble communicating with each other. They may have more instances of blame, withdrawal, and verbal aggression and fewer instances of positive communication.

Some couples may also avoid talking about depression and its impact on the relationship. This is often an attempt to fend off conflict, or it may just feel like the relationship has already become so distant that it isn’t possible to discuss the topic.

But it’s not just the depressed partner who leads the negative communication. Partners of depressed people can sometimes become more critical and confrontational towards their depressed partner as an attempt to motivate the depressed partner to solve problems or change their behaviour.

Try to avoid becoming overly critical. Depression could be one of the most stressful things your partner has to deal with so it’s really important to remain gentle and non-judgmental.

You should also avoid going too far in the other direction. Overprotection like avoiding social contact and taking over responsibilities can risk isolating your partner, or cause them to become too dependent on you.

Video clip – My partner feels like a different person… can depression affect someone’s personality?
Watch this online at: bit.ly/2mOKISo

9. How can I get help for my partner?

Getting your partner into treatment may not be as simple as just suggesting it to them. When someone is depressed and in a negative pattern of thinking, logical arguments won’t always get through. Your partner may not even think it’s worth getting help. Your best starting point is being sensitive and supportive.

Pathways to help
The first step is to learn about depression and self-help. You are already taking this step by listening to this guide.

If you are at all concerned, you should always seek external help. Your GP is a good place to start, and you can go with your partner to the appointment if it makes things easier.

From there, your GP can point you towards a treatment plan, which will depend on the nature and severity of the depression. Your GP might give you and your partner some further work to do at home before coming back to see them again.

Talking therapy
Your partner may be referred to a talking therapy such as

cognitive behavioural therapy (CBT) which may include an element of mindfulness. The therapy may be face to face, over the phone, or sometimes online. This may be referred to as computerised CBT (CCBT).

As the partner, you may be asked to go along to therapy sessions. The NICE (National Institute for Health and Care Excellence) guidelines recommend behavioural couples therapy for treating depression, as partner support has been shown to be particularly helpful.

In some cases, doctors will prescribe medication as well.

Self-help
Self-help is important. Wherever possible, take advice from experts on the best ways to look after yourself and your partner. You can find advice online (such as in this guide), from your GP, or from the people who are treating your partner.

For example, you might ask for suggestions about how much to encourage your partner to do, and what you can do for them. It’s important to find a balance, so you can help your partner recover without setting them back by doing too much. You should also ask your partner what level of support they need from you.

Another helpful step is to seek advice on understanding how the illness and recovery are likely to progress. For example, it can be useful to know how to recognise when things are getting better.

Your role in your partner’s support will change over time, and you may need guidance on this:

• Look up self- help groups, support groups, and other local resources.
• Find out about local family or carer support groups and voluntary organisations that can help you with support and information

You can also support your partner by helping them to:

• establish regular sleeping and waking times
• avoid excess eating, smoking, or drinking alcohol before sleep
• create a proper environment for sleep
• take regular physical exercise

Research suggests that regular exercise can be as helpful in treating depression as some antidepressant medications.  Drinking alcohol is shown to make depression worse. It is important that your partner does not drink lots of alcohol even if it makes them feel relaxed in the short term.

Medication
Depression is often treated with antidepressant medication, which is usually prescribed alongside talking therapies. In cases of moderate depression, antidepressant medication is usually not as effective on its own as it is in combination with other therapies.

A major initiative has been set up in most areas of the UK to treat mild to moderate depression in Improving Access to Psychological Therapy (IAPT) services, sometimes called

Wellbeing Services. There are specially trained mental health workers who are employed to deliver talking therapies.

 Video clip – Is there anything I can do to help them?
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Video clip – What other practical things can I do to help?
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10. Will my partner get better?

Even in severe cases, depression can be treated and most people do get better. But it’s important to remember that any improvement is going to be gradual. Don’t expect your partner to just ‘snap out of it’.

You might see their sleep and appetite improving before their mood starts to lift. Noticing and commenting on these little improvements is one of the helpful things you can do to support your partner’s recovery. As they start to improve, your partner may start to find it easier to recognise their own symptoms and feelings, and begin to feel better.

Recognising improvements
Look out for the things that are making a difference. For example, if your partner feels better when they go for a short walk in the morning, encourage them to keep this habit up. It is important

for your partner to keep doing the activities that make them feel good.

You might find it helpful to keep a mood diary with your partner, noting down their activities, and how they feel. This can be a reminder to your partner that they are making some

improvement. It can also help you see which activities have been most helpful.

Video clip – Is depression a life-long thing?
Watch this online at: bit.ly/2mqLHFG

11. What about me? What should I do to help myself?

Research suggests that having a depressed partner can increase your own psychological distress. Particularly if you live with your partner, you may be very busy looking after them, alongside emotional distress from seeing what they are going through.

People whose partners have experienced depression may be more susceptible to depression themselves. Prolonged feelings of being overwhelmed, worried, tired, frustrated, afraid, guilty, and helpless can start to take their toll.

You may also feel a sense of loss at the seeming disappearance of your once supportive partner, and start to worry that your relationship may never be the same again. As a carer, you may start to suffer from depression yourself.

So, it’s essential to get support for yourself and stay aware of your own health. Lean on the support of your friends and family, try to stay active, and keep doing the things you enjoy.

Self-help for you and your partner
Whether your partner is in treatment or not, you can still take advantage of self-help techniques to make things easier and support their recovery. There are many things you can do to help you overcome depression as a couple. These can include the following areas:

• Improving communication
• Planning to take action
• Managing stress
• Making little changes
• Solving practical problems

Improving communication
Tune into what your partner is saying or trying to say. You can improve your listening by trying to do the following:

• Practise ‘active listening’.  Clarify what is being said in a way that supports and validates your partner without making an argument.
• Summarise  and reflect back  what you have heard.  This can help you avoid getting the wrong idea.
• Avoid making assumptions about what your partner is saying.  Wait for them to finish before thinking of your response.

You can also work on trying to express yourself as clearly as possible. You may both need to work on this. The following may help:

• Use direct statements and try to be clear on what it is you want to
• Try to use ‘I’ statements rather than ‘we’ or ‘you’ statements For example, rather than saying ‘You are not helping yourself by staying in bed all day’, it’s far less confrontational to say something like ‘I feel upset when I come in and you haven’t got out of bed yet’.
• Introduce your concerns gently by expressing appreciation for your partner first.
• Avoid ending a positive point with a point with a criticism.
• Share your feelings as well as your thoughts and experiences.
• Support the expression of depressed feelings, so that your partner knows it’s safe to discuss.  You should also feel safe expressing your response to those feelings.

All the way through, let your partner know that you will be there as a support wherever you can.

Planning to take action
It is important that both you and your partner try to deal with the depression as best you can, and try not to take things personally. It’s helpful to have a plan of action and do whatever you can to stay informed:

• Learn about depression and the symptoms of depression (which you are already doing by using this guide).
• Accept that depression is an illness and nobody’s fault.  There is no need for guilt or blame – in the same we wouldn’t feel guilty or blaming about a broken leg.
• Try to notice the things that set off negative feeling or make them worse.
• Recognise the topics that can lead to arguments and agree to call ‘time out’ when they come up.
• Help your partner to prioritise tasks and get involved with social and other activities.

Managing stress
Dealing with depression and the changes it brings can be very stressful. You can help to deal with stress by doing the following:

• Encourage your partner to think about what they might find helpful in managing stress.
• Start with topics that are outside of your home and relationship before going on to talk about things that are closer to home.
• Show gratitude for the support you’ve been given in your relationship and remind your partner of how much this helped you.
• Keep reminding your partner of how much you care about them.

Making little changes

Just a few small behaviour changes can start to make a really positive difference in the way you see the situation, and how well you both cope:

• Help your partner come up with a list of specific, positive things you could do to help each other. Try and increase the positive things you do
• Encourage your partner to talk about specific changes they want to make in themselves and in the relationship. These can include big things like improving communication, or increasing the time you spend together; or more specific things like how to raise concerns in
• Work together to make these changes, and accept that they may have to happen gradually.
• Talk together about how these changes might improve your relationship and reduce.
• Try small positive steps like going for a walk or cooking a healthy meal.

Solving practical problems
We’ve talked about how solving practical problems can help take away some of the triggers for depressive episodes. To do this, it’s important to try and step back from the problem and think about it before you react to it. That way, you can both plan your solution to the problem.

Sometimes we feel overwhelmed by the very complicated and difficult things we have to do. One thing that helps with this sort of problem is to write down each of the steps you have to take to complete the job – then tackle them one step at a time.

Problem solving can seem more difficult when you feel depressed. If your partner has a particularly difficult problem, look back to times when you may have solved similar problems as a couple and use the same approach. Be clear. Write down all your possible options. Use ‘brainstorming’, where you let yourself write down even silly ideas to be considered. Once you’ve got a list of things that might work, get together and choose the best approach.

It is also important to avoid complaints and criticism as much as possible when sharing problems:

• Use specific examples, rather than raising general concerns.
• Explain why it’s important to you.
• Be clear about how it makes you feel
• Deal with one problem at a time
• Try not to get sidetracked by other issues
• If there isn’t time to address an issue fully, save it for when there will be.
• Remember to list the positives

Video clip – Looking after my partner is hard-going. What should I do?
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Video clip – Things don’t seem to be getting better. I’m not sure how much longer I can do this!
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12. Where can we find further help and support?

We hope you will find some of the information and exercises suggested in this guide useful. They should help you begin to understand depression and its effect on your partner and your relationship.

If you feel that things aren’t changing, you should always look to external help to aid your partner in overcoming the problem. Your GP is usually the best person to go to.

If your partner feels so depressed that they have thoughts of harming themselves or taking their own life, then ask them to visit their doctor as soon as possible.

A list of useful contacts, books and references are available in the written version of this guide.

There is further help available from the following organisations and publications. This list is by no means exhaustive:

Written by: Jimi Odell and Consultant Clinical Psychologists Dr Lesley Maunder and Lorna Cameron.

Co-created by OnePlusOne and Northumberland, Tyne and Wear NHS Foundation Trust.

Introduction by Dr Steve Barton and video clips by Prof. Janet Reibstein.

Many thanks to Sunderland Carers Centre, service users and healthcare staff who have contributed to the review of this guide.