Apologies for the late post. I had this typed up and ready to go yesterday, and then the internet gremlins ate it. Took me until this morning to be able to rewrite it.
This post and others discussing specific mental disorders will reference the Diagnostic and Statistical Manuel of Psychiatry and Psychology, Edition Five (DSM-V). Apologies to my international readers, I’m just not familiar enough with the ICD to use it as a reference.
Please note: everyone’s experience of depression is different. This is general information meant to give you an idea of what to expect. Nothing in this blog is intended to diagnose or treat. Please see a psych professional if you or someone you love is suffering from depression.
The Depressive Disorders
The DSM-V recognize four main depressive disorders:
- Disruptive Mood Dysregulation Disorder (DMDD)
- Major Depressive Disorder (MDD)
- Single and Recurrent Episodes Persistent Depressive Disorder (Dysthymia)
- Premenstrual Dysphoric Disorder (PMDD)
Other depressive disorders are depression caused by medication or substance abuse, depression caused by another medical condition and two varieties of “other” depressive disorders (specified and unspecified).
Of the four main disorders, three are recognizably “depression”: major depressive disorder (MDD), Single and Recurrent Episodes Persistent Depressive Disorder (Dysthymia), and Premenstrual Dysphoric Disorder (PMDD). While there are some symptom differences, the main distinction between these three disorders is the depth and duration of the depressive episodes.
These are the three disorders this post will focus on.
Disruptive Mood Dysregulation Disorder (DMDD) is only diagnosed among children and adolescents, and on the surface looks more like an anger/attitude problem than depression. However DMDD is usually a precursor to MDD or dysthymia, so it is included as a depressive disorder.
Symptoms of Depression
Given responses I’ve gotten, my post last week seems to be a very good description of many people’s experiences of a major depressive episode. (Diagnostically a major depressive episode (layman’s term) might fall under either MDD or dysthymia depending on how long it lasts). If you haven’t read it yet, take the time to check it out now.
The main symptoms of depression are depressed mood (sad or empty) and loss of interest in activities. One of these two symptoms need to be present for a doctor to diagnose depression. Other common symptoms are:
- changes in sleep or eating patterns
- restlessness and/or moving very slowly (sometimes both will be present at the same time)
- exhaustion or fatigue
- feelings of worthlessness or guilt
- loss of focus, inability to concentrate, or indecisiveness
- suicidal ideation (thinking about dying without making actual plans or attempts)
Dysthymia is often (though not always) a subtle disorder with symptoms seeming to just be part of a person’s personality. Low energy, lack of interest in activities and low self-esteem are easy to see as “part of who you are” when they don’t reach the point of interfering in life’s basic necessities. PMDD is, as the name implies, a form of depression that strikes during pre-menstrual periods. It can range from mild to extreme, and some researchers believe it is triggered by hormonal changes. MDD is a major depressive episode that lasts at least two weeks. If the episode lasts for or recurs regularly for two or more years, it is an extreme case of dysthymia.
Treatments for Depression
The most common treatments for depressive disorders are medication and therapy.
Medication is said to have around a 50% success rate in treating depression, though it often takes several tries to find the right medication. SSRI (selective serotonin re-uptake inhibitors) are the first line medication for depression. The idea is that depression is often accompanied by low levels of serotonin, so increasing the levels of serotonin in the brain should make the depression better. Personally I think it’s a bit of a chicken-and-the-egg problem–which came first the low serotonin or the depression? Regardless, many people do benefit significantly from medications–once they find the right one.
The most effective form of therapy is cognitive behavioral therapy (CBT). Cognitive behavioral therapy focuses on identifying the recurring thoughts and mental patterns that form an individual’s experience of depression and re-training the mind to stop those thoughts and patterns, and develop healthy thoughts and patterns instead. It sounds strange, but many people I’ve spoken with have commented on how helpful CBT was–and my own experience agrees.
Other forms of “talk” therapy are more familiar: “let’s talk about what’s bothering” or “how is your relationship with your mother” type stuff. Family system’s therapy is very difficult to find, but focuses on the family as an interacting unit, and can be very helpful when depression is part of a long-standing unhealthy life pattern within a family.
Talk therapy (CBT or other forms) combined with medication are usually more effective than either alone, but this will vary from person to person.
Outside of talk therapy there are “fringe” treatments such as art therapy, music therapy, animal therapy, and group therapy. These treatments are fringe only in not having been studied enough to assess their treatment value for depression, they are largely recognized and supported by the APA for some, though not all, mental illnesses.
Some studies suggest 2 ounces of dark chocolate a day is as effective in treating depression as SSRIs. As dark chocolate has been shown to increase the serotonin levels of the brain (explaining why it is so many people’s go-to for when they are stressed) this fits fairly well with the current theories of depression.
Getting sun, exercise, interacting with people in a healthy environment, meditation, and spending time with animals have all been shown to increase serotonin levels and be effective in fighting depression.
People with severe and lasting depression may qualify to receive a trained service animal (yes, there are service animals for mental illness. I’m most familiar with them in treating PTSD, but they can be “prescribed” for depression.)
When Depression and Polyamory Collide
Put a few of the common symptoms together–depressed mood, lack of interest in activities, low energy, low self-esteem–and it’s easy to understand how and why depression affects a poly relationship.
Dates and activities will be cancelled frequently as the depressed partner is unable to generate the interest or energy in going. Low libido will become a problem as low-self esteem, lack of interest and low energy combine to kill your sex life. Weepiness and other signs of a depressed mood can be off-putting to poly partners who don’t want to be “brought down” by hanging around someone who is never happy.
Perhaps most damagingly, for people who don’t know their partner is suffering from depression, or don’t understand depression, the limited sex life and frequently cancelled/turned down date nights and activities can seem like the depressed partner is no longer interested in them. In fact, depression does not affect how we feel about the people in our lives. It does curtail, severely, the ways we are able to express our feelings. And in a culture where “actions speak louder than words” it is very easy for a depressed person’s actions (or inability to act) to seem like a reality and their words of love an (at best) self-delusion.
Ways to Manage Depression in a Poly Relationship
Dates and activities are more likely to actually happen if they are low energy and low key. Needing to pick out a coordinated outfit, review possible restaurants, and take three busses to get to your meeting point are all major hurdles for someone with depression. Think of it this way: Getting done up for a night on the town is the depressed person’s equivalent of walking 500 miles to prove their love. It’s not something that can be done every night, or even every week.
Good dates or activities:
- At home movie night curled up on the couch with popcorn
- Sitting on the porch blowing bubbles or other sit-down outdoor activity
- Eating out at a casual restaurant
- Going for a walk
The closer you can bring a date to “throw clothes on, you are good to go” the less likely it is that your depressed partner will need to cancel due to their depression.
Don’t cancel a group date because a depressed poly partner doesn’t feel up to going. This can be one of the hardest situations for everyone. But canceling the entire date because your depressed partner can’t go will often just leave your depressed partner feeling worse due to guilt at ruining the fun for everyone. On the other hand, if everyone is going anyway, the group energy of people getting ready to go may help your depressed partner get motivated enough to come anyway–and in my experience we usually end up having fun after all. If they still can’t come, that’s okay. “We’d love for you to come, but we understand if you can’t” is often the best approach all around. No guilt, no pressure, and always welcome. If your depressed partner is always being left behind on group activities, work on coming up with group activities that are low-key enough they can join in, whether it’s a family picnic in the park or a night binge watching the latest Netflix release.
That said, the above does not apply if your depressed partner says “I need you to stay with me.” “I need you to stay” is very different from “I just don’t feel up to going out.” However much your partner needs you, only you can decide if the right thing to do is stay–there were times I asked my partners not to go to work because I needed them. I did, really and truly need them, but the bills needed to get paid too. Was I damaged when they went to work anyway? Yes. Was going to work the best decision they could make? Probably. The judgement call has to be yours.
Depression has a way of making you feel completely cut off from the world. Anything which bridges that gap–a hug, cuddling on the couch, reading to each other, playing a video game, holding hands, cooking a favorite meal–can make a big difference to a person battling depression. Incorporating small but regular interactions into your relationship can strengthen your relationship against the influence of depression, and help your depressed partner in their journey back to health.
How has depression influenced your poly relationships? What ways have you found to take care of your relationships in the face of depression?
This post is part of the Polyamory and Mental Illness blog series.