Depression is immensely difficult to handle, in yourself and in the people around you. Watching a loved one, especially a spouse, struggle with depression is one of the hardest challenges you can face in a relationship.

It's also easy to get it wrong. You can hurt your relationship, you can hurt your spouse, and you can even make things worse if you do the wrong things.

Treatment-resistant depression is especially challenging, but there are things you can do and ways you can help. You can make it through this journey together.

We've compiled this list of tips to help you out, so you can be a pillar of strength and stability in a turbulent emotional landscape.

Before we begin, always remember to call emergency services ASAP in the event of a crisis. 988 will reach the Michigan Crisis and Access Line, a 24/7 helpline that can connect you to appropriate emergency services and help you in a crisis.

DISCLAIMER: This article is for informational and educational purposes only and should not be considered medical or psychological advice. The information presented here is not intended to diagnose, treat, cure, or prevent any mental health condition or replace professional therapeutic care. Every individual's experience with trauma and mental health is unique. Please consult with a qualified mental health professional, therapist, or healthcare provider to determine the most appropriate treatment approach for your specific situation. If you are experiencing a mental health crisis or emergency, please contact your local emergency services or crisis hotline immediately.

Understand the Basics of Treatment-Resistant Depression

The first thing it's worth doing is learning what it means to have treatment-resistant depression. What is TRD, and how does it differ from regular depression?

Treatment-resistant depression is a major depressive disorder, and it's characterized by resisting treatment. That doesn't mean "trying therapy and it didn't work", it means trying at least two different antidepressant medications and failing to improve.

A common source of conflict with a spouse with TRD is the flawed assumptions surrounding treatment resistance. It's not that they "aren't trying hard enough" or "don't want to fix this" or anything of the sort. These kinds of assumptions can be harmful and can both harm your relationship and set back any treatment that is working.

It can also be worth recognizing that treatment-resistant depression often has existing root causes or secondary influences that contribute to resistance. Ongoing grief, high levels of stress, lack of sleep, substance abuse, and certain medications can all contribute. Treatment-resistant depression can also be made worse seasonally as seasonal affective disorder can compound.

In some cases, TRD is also a misdiagnosis, and your spouse could have undiagnosed (and thus untreated) issues such as bipolar disorder, ADHD, or even a thyroid disorder. In some cases, it can be worth seeking a second opinion to look for these possibilities.

Offering Help and Support at Home

You can't get inside your spouse's head, so the best thing to do is offer them support when you can at home. Fortunately, there are a lot of ways you can do this, and you can incorporate many of them into your daily routine. This can help you foster an environment more conducive to healing.

Practice Active Listening

One of the most difficult aspects of treatment-resistant depression is the feeling of isolation that can bear down on you. In particular, it can feel like no matter how you try to express yourself, other people just don't get it.

As a spouse of a partner with treatment-resistant depression, active listening can help bridge this gap. Your goal is to foster a supportive environment. Initiate conversations and truly listen to replies.

Begin by asking open-ended questions. Simple starters like "How are you feeling today?" are always a good place to start. You can also ask if there's anything you can do to help.

Keep the conversation going by empathizing. "Sounds like a rough week" or "I get you" can often be enough. You want to validate their experiences and their feelings, not disregard or diminish them.

The red flag here is to avoid giving advice. You're here to listen, not to try to solve the problem. If you find yourself thinking about solutions or considering a "have you tried" question, don't.

Celebrate Efforts, Even the Little Ones

When you're struggling with depression, even getting out of bed can feel impossible. Living a normal (or mostly normal) day is worthy of celebration.

We're not saying you need to buy a cake and throw a party every day your partner gets out of bed. But praise, positive feedback, and low-key congratulations are all worth working into your daily routine. It's all about the " little wins".

• "I'm proud of you today."
• "It means a lot that we've had this talk."
• "You're doing your best, and that's enough."

Even if it seems mundane or minimal to you, it can be a surprisingly large accomplishment for someone struggling with depression. Offering positive feedback and reinforcement helps bolster those positive feelings. It can build confidence, grow hope, and encourage further motivation.

Bear the Burden of Daily Life

Day-to-day life is a struggle for many of us, even when there aren't mental health disorders getting in the way. The never-ending list of chores and responsibilities is always growing. When you're used to sharing responsibilities, losing a big chunk of that effort can make things that much harder for you both.

Your goal is to be supportive and take on that burden. That might mean meal prepping, handling the grocery shopping, doing the dishes and laundry, cleaning around the house, scheduling appointments, running errands, handling children, or anything else that needs doing.

Whatever you do, do it "with a smile". Not literally, perhaps, but you want to avoid expressing frustration, resentment, or ill will over the increased workload. It sucks, definitely, but if your partner can tell you feel that way, they'll feel bad about making you go through it, and that further reinforces their depression.

Maintain Your Connection

This is part of why you want to practice active listening through routine conversations: to keep up with your connection. Depression is very isolating, and if you try to "wait it out" and "let them work on themselves," it can feel like you're abandoning them. Positive intentions or not, it tends not to work out that way.

The opposite end of the spectrum is being overbearing and overwhelming. Finding the right balance is challenging, but not impossible.

Try the occasional check-in, stopping by and asking if your partner wants anything, be it a glass of water or a snack, a cuddle moment with the dog, or a comforting blanket.

If you know they're spending time on their phone or are receptive to you bringing yours to them, you can share low-pressure messages. Send them a funny video of a cat, a meme you think they'd get a kick out of, or a supportive message from a friend.

One thing to do, generally daily, is make sure to reiterate that you're there and available if they want to talk or do something together.

It's also good to invite your spouse to activities, whether it's dinner, watching TV together, doing a puzzle, or going shopping together. Even if you expect a refusal, the invitation is the important part. Let them know they aren't excluded, and they aren't abandoned.

Don't Forget to Take Care of Yourself

During this time, you're going to be taking on a lot of extra burden. You have your normal work, your normal load of chores and daily tasks, but also much of what your spouse would do as well. It's challenging and stressful, and if you have a breakdown, it can compound with everything else.

Sometimes, it's okay to let the dishes build up and use paper plates for a while. Sometimes, the laundry doesn't need to be folded right away. Sometimes you can cancel an appointment or a hang-out activity. Healing takes priority.

One difficulty that you're likely to encounter is confronting a lack of progress, or a feeling of a lack of progress. You're doing so much, so why aren't they getting better? This stress can lead to burnout, and burnout makes everything so much harder.

Recognize that you aren't responsible for your spouse's recovery. You can make the environment more beneficial for them, you can handle and alleviate some of their stressors, but at the end of the day, it's their mental health and their efforts that need to come through.

We also highly recommend seeing a therapist of your own, even if you don't feel like you need it, and you haven't been diagnosed with any mental health disorder. You're under a lot of stress. Plus, working with a therapist can help better prepare you for passing on what you learn to your spouse. They can go into much greater detail on all of the things we've said and more, plus they can offer specific advice relevant to your situation and your relationship.

Build Up Healthy Habits, Together

Building and working on a healthy lifestyle can also help. Going for a walk isn't going to cure depression, certainly, but being more active, getting fresh air and sunlight, changing the scenery, and doing other activities can be a positive influence. Diet, as well, is worth focusing on. It's a very "eat your vegetables" piece of advice, literally, but it really can help.

Some people find solace in supplements. Some show improvement with iron supplements, and others see benefits from vitamin D. These, again, aren't going to cure depression, but they won't hurt either.

Something like a simple walk around a block or through a park can also be a good time to have a discussion and practice that active listening we've mentioned.

If your spouse is receptive to bigger activities, you can plan things like a moderate hike, a day at the beach, a gym session, group tai chi, or whatever else suits your fancy. The specific activity matters less than the fact that you're doing it together.

What Not to Do

We've covered some of the red flag behaviors you should avoid already, but it's worth reiterating them here.

Your goal is to provide a supportive environment that fosters recovery. Anything that jeopardizes that is something to avoid.

• Try not to react with anger, resentment, shortness, flippancy, or other negative reactions. Even if you feel that way, control your outward behavior as much as you can.
• Avoid laying blame. Depression isn't a personal failing or a willful behavior. Your spouse isn't acting the way they are out of spite or to get back at you for something.

Most of all, don't give up hope. Depression is temporary, and it can be treated, even treatment-resistant depression. It can take time, yes, but you have that time. And statistically, most couples make it through and survive with their relationships intact.

Seeking Professional Help

Treatment-resistant depression can be a very complex mental illness, and it can take trained specialists a lot of time and effort to untangle. Still, it's a good idea to see professional therapy when you can. A therapist can:

• Work on depression directly.
• Work on related mental health issues, like anxiety, PTSD, grief, or ADHD.
• Diagnose and recommend treatment for substance use disorder.
• Evaluate medications and look for potential interactions or side effects that contribute.
• Explore alternative treatment options, from different medications or therapies to different modalities.

Here in the Detroit area, we're proud to be able to offer these services. In fact, we recommend three avenues you can explore with us.

The first is working with us to get your spouse into therapy to help them with their depression. Even if they're resistant to the idea, together we can keep working at it until something sticks.

The second is your own individual therapy. Living with and handling a spouse with treatment-resistant depression is far from easy, and you have your own struggles to cope with. Therapy for you helps you, but it can also help you help your spouse.

Third is couples therapy. Working together with a therapist in a neutral setting can help you express your feelings to one another, bridge the communication gap, and foster the mutual understanding necessary to further benefit your home life together.

All of this, alongside medication management and other therapy options, is available in our office in Troy. At BMC-Troy, we're waiting to hear from you, and we're happy to get the ball rolling on the treatment you and your partner both deserve.

So, don't hesitate; fill out our new patient intake form right here on the web, or call us at 248.528.9000, and we'll help you take the next step, together.