Bianca Bagnarelli

Editor's Note: Every Monday, Lori Gottlieb answers questions from readers about their problems, big and small. Have a question? Email her at dear.therapist@theatlantic.com.

Dear Therapist,

My boyfriend and I are in our early 20s, and we recently moved in together after being in a long-distance relationship for four years. I've always known that he battles depression and has mild Asperger’s. Recently, his depression has gotten much worse, and because this is the first time he has gotten very depressed since we’ve been physically together, I have no idea what I’m doing. It is like I’m walking on eggshells every time we speak, and if I say the wrong thing, he just shuts down. I can’t push him for information or try to get him to help me with something around the house. I can barely get a normal conversation. I feel so alone.

I love him very much, and I plan to spend the rest of my life with him, but I don’t know how to live feeling like the floor could come out from under me at any time. He is trying to get help, but he refuses to go on any medications or stick with a plan to get better for very long. I am so scared that this is going to always be his life—a constant roller-coaster ride controlled by depression. I want so much more for him, and for us.

When he is not in the throes of depression, my boyfriend is hilarious, loving, and really fun. I feel like I may have taken that away from him by moving him away from his home. I’m scared that one day he will come to the same conclusion and leave me to go back home. For four years, we lived only an hour or two apart; then I got a job out of state, and he was so supportive of the idea that he told me I had to go, and even decided to come with me—leaving his family, friends, and comfort zone behind. Every time I ask him whether he wishes he had never left, he tells me, “I came here to be with you, and I won’t go back home until you’re ready.” This puts a huge amount of pressure on me. I love my job, and it’s a wonderful opportunity for me, but I love him so much more than this job. I am torn between wanting to go home to make him happy and being worried that I might resent him for making me leave these opportunities behind.

I understand that there’s nothing I can do to fix his depression. I just want to be there for him, but I can’t sacrifice myself to his depression either. I need my boyfriend back. Help me, please.

Maggie
Destin, Fla.


Dear Maggie,

I understand what you mean when you say that you want your boyfriend back, but I think it will help to remember that your boyfriend hasn’t gone anywhere. He’s still the same guy you’ve always known—“hilarious, loving, and really fun,” but who also suffers from depression and has mild Asperger’s. (People with Asperger’s syndrome are more likely to suffer from depression, because they’re also more likely to feel socially isolated, a risk factor for depression.)

The good news is, now that you’re living together, you’re going to learn much more about each other than you were able to while dating long-distance. You’ll get a much better view of the other person’s day-to-day life, and sitting together in the same room will help you engage in the kinds of conversations you’ll want to begin having about what’s going on not just with him, but between you two.

A person can do several things to help a partner who’s struggling with depression, but before I get to those, I want to point out that you’re both still young. It sounds like there’s a lot of love between you two, but sometimes even with that love, you might decide not to spend your lives together. He might not, for instance, be willing to live in Florida indefinitely. You might not, in turn, be willing to tolerate what you call “a constant roller-coaster ride” of depression and what that means when it cycles into your lives. Knowing that depression is something that might recur will be important to keep in mind as you see what can be done to help your boyfriend now. In other words, consider this current episode of depression a trial run, and as it’s a trial run, you now have a chance to learn a lot about who he is, who you are, and how you’ll handle various challenges together in the future.

Depression, like many other medical conditions, can certainly be managed, but it will nevertheless be something that your boyfriend lives with—which means his depression will be something that you will at times live with too. Living with it, though, doesn’t have to mean sacrificing yourself to it. But you should be aware that it will be a part of your life together, and you might want to think more about whether this is something you’re really on board with for the long haul. That way, if you do commit to a future together, you’ve made a clear-eyed decision.

First, if your boyfriend isn’t willing to get help, that’s some useful information. It’s one thing to be mired in depression; it’s another to refuse treatment. Medications for depression can be quite effective, but they also often involve some trial and error and require time to take effect, and the side effects can be unpleasant. Many people simply give up, thinking that nothing will work.

I’d encourage you to understand more about why your boyfriend doesn’t want to take medication or stick with a different plan so that you can find one that he’s on board with. If he won’t say much (one sign of depression is the shutting down you mention; another might be anger), you could tell him that you love him and don’t want him to suffer so much, and to that end, you’d like him to see a clinician who can help him formulate a plan he’s comfortable with. It could be seeing a psychiatrist for a medication consultation, or a psychotherapist for support (though talk therapy may be hard for him, depending on how his Asperger’s manifests), or a cognitive behavioral therapist (because depression involves cognitive distortions, such as “Nothing I do matters” or “I’m not lovable” or “I’ll never feel good again”).

Another option is to see a couples therapist to get help figuring out how to work together as a team not just when your boyfriend gets depressed, but also when dealing with whatever other issues are going on in your relationship—such as the transition to living together and the move to a city where your boyfriend is away from his support system. A therapist can help you both talk about how these changes are affecting you individually and as a couple. Whichever route you go, a clinician should be involved to monitor his depression and assess for suicidal thoughts as well.

Meanwhile, you’ll want to be sure not to neglect self-care—for both of you. You can guide your boyfriend toward what might help in the day-to-day (exercise, sunlight, eating well, getting out of the house, staying in touch with family or friends), but you can’t be his therapist. What you can do is make sure that you exercise, get together with friends or go to social events (with or without him), and don’t take his mood personally. You can also divvy up the household tasks so that while you’ll temporarily take on more, he can do the chores he’ll more easily manage. For instance, if he lacks energy, he’ll probably struggle with mopping the floor or scrubbing the counters, but he can probably handle grocery shopping or picking up the dry cleaning (which also gets him out of the house, helping with the depression). Finally, remember that you don’t have to manage this alone. You can loop in his family and friends back home and enlist their help and support. They too care about your boyfriend and may even have more experience helping him through a depressive episode.

It can be hard to find the sweet spot between being loving but unhelpful (“It’s okay, you don’t have to get help if you don’t want to”) and pushing to the point of being controlling, which generally leads to further anger and withdrawal. Now is a good time to figure out that balance. If your boyfriend is willing to get help, and you’re willing to put in the effort to work with him and also take care of yourself, you’ll get some invaluable practice for managing this challenge together going forward.


Dear Therapist is for informational purposes only, does not constitute medical advice, and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician, mental-health professional, or other qualified health provider with any questions you may have regarding a medical condition. By submitting a letter, you are agreeing to let The Atlantic use it—in part or in full—and we may edit it for length and/or clarity.

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