Sexual Intimacy and Depression

Several factors influenced my resistance to sex over so many years of our marriage. My sexual and emotional baggage and my responses to relational hurt were at the top of the list.

One more factor played a major role: depression.

I’ve hesitated to write this post, although I’ve thought about it many times.   I have no problem being transparent about other aspects of my marriage, but I’ve been reluctant to open up this part.

So why am I writing about it now? I suspect it has something to do with the fact that over the past month, I’ve had many conversations about depression and how it can affect our marriages. I know far too many women who suffer from untreated depression; their marriages suffer as well.

God has been telling me it’s time to write this.

What is depression?

Many of us have an image of depression as sadness, yet sadness is only one of many symptoms that can present.

Mayo Clinic provides a good overview of depression:

Depression is a mood disorder that causes a persistent feeling of sadness and loss of interest. Also called major depressive disorder or clinical depression, it affects how you feel, think and behave and can lead to a variety of emotional and physical problems. You may have trouble doing normal day-to-day activities, and sometimes you may feel as if life isn’t worth living. (Mayo Clinic)

My depression feels like a heavy fog that makes me constantly weary. I find it difficult to experience any joy at all. Sometimes I find that I don’t experience negative emotions, either. Not only is my mood lower than when I’m not depressed, it is even, with no ups or downs at all. Life feels flat.

We don’t completely understand what causes depression, although research points to several possibilities, including improper mood regulation (relating to anatomical difference or an imbalance of the brain chemistry), genetics, stressful or traumatic experiences, and hormonal shifts (depression can be a symptom of both menopause in women and low testosterone in men). (Harvard Medical School)

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Symptoms of depression include changes in emotional, behavioral, physical, and mental well-being:

• Feelings of sadness, tearfulness, emptiness or hopelessness
• Angry outbursts, irritability or frustration, even over small matters
• Loss of interest or pleasure in most or all normal activities, such as sex, hobbies or sports
• Sleep disturbances, including insomnia or sleeping too much
• Tiredness and lack of energy, so even small tasks take extra effort
• Changes in appetite — often reduced appetite and weight loss, but increased cravings for food and weight gain in some people
• Anxiety, agitation or restlessness
• Slowed thinking, speaking or body movements
• Feelings of worthlessness or guilt, fixating on past failures or blaming yourself for things that aren’t your responsibility
• Trouble thinking, concentrating, making decisions and remembering things
• Frequent or recurrent thoughts of death, suicidal thoughts, suicide attempts or suicide
• Unexplained physical problems, such as back pain or headaches (Mayo Clinic)

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When my depression is untreated, I experience the majority of the symptoms on this list. It is mentally, emotionally, and physically exhausting. The illness invades my entire life. Even something as simple as taking a shower or deciding what to have for dinner can be a struggle for me. I am more an observer of my own life than I am a participant.

My depression symptoms make it difficult to seek help. I don’t think clearly, so it is hard for me to even recognize that what I am experiencing is depression. Because it is hard for me to make decisions, even if I know I need treatment I can’t seem to make the decision to do so. The feelings of worthlessness tell me that there is no point in even bothering to get help because surely I am not worth the effort. On top of all that, when I am experiencing depression, I feel bad about myself for having the illness in the first place.

Depression, like other mental health conditions, is stigmatized in our society. We often view depression as a weakness or a character flaw. We think that if we could just try harder, we would get over it. Comments from others that dismiss depression  or treatment options make it difficult for people with depression to seek the treatment they need—and believe me when I say that people with untreated depression find it hard enough to pursue treatment.

For Christians, depression can carry additional burdens. We’re supposed to have hope and joy in Jesus—yet we don’t experience hope or joy when we are depressed. We wonder if our lack of joy is the result of moral failure. We know that God can heal anything—so we tell ourselves we just need to pray harder or pray more or pray better. We frame our symptoms as a spiritual problem and are discouraged (sometimes by our churches) from seeking professional help because all we need to do is take it to the cross. So we do that, only much of the time it doesn’t seem to work. So we question whether God even sees our suffering. We question whether or not he cares. Our spiritual life suffers right alongside everything else.

God can heal depression, but just like the many other illnesses we experience, he doesn’t always do so.

Depression is not a moral failure, nor is it a character flaw. It is an illness.

Depression takes its toll on marriage

My untreated depression contributed in a major way to my struggles with sexual intimacy in our marriage. Although it didn’t cause the problems, it significantly exacerbated existing problems and interfered with my motivation and ability to try to make changes.

• Physically I was something of a wreck. I got little sleep, and I dragged the symptoms of sleep deprivation around with me every day. My body had inexplicable aches and pains, and sex was downright uncomfortable for me. I had absolutely no libido, even when my hormones normally would be taking over.
• Everything overwhelmed me. Household chores, bills, work, and parenting were exhausting. After getting dinner started, I would have to sit and rest. Dealing with a small squabble between my children left me in need of recovery. I simply didn’t have the energy to deal with my husband on top of the rest of life. I was overwhelmed by sex and by his sex drive. I had nothing left for thinking about our sexual struggles or figuring out how to work on sex.
• On those occasions when I did consider trying to work on sex, my feelings of worthlessness got in the way. I just knew I would fail. I believed it was just a matter of time before my husband left me. I was unworthy of a happy marriage or a good sex life.
• The loss of pleasure in even small things took its toll on my sexual responsiveness. Even when my heart and mind were in the right place and my husband was doing all the right things, I felt . . . nothing.

As these symptoms continued over a period of years, our marriage spiraled downward.

Occasionally I could see through my mental fog enough to think that maybe I should try doing something about sex. But there in front of me was a barrier. I didn’t see a high mountain that would be hard to climb.

I saw an impenetrable and unclimbable vertical wall.

Treatment

Fortunately, I experienced pain related to another undiagnosed condition, so I went to see my doctor. Somehow, she could see that something was going on besides my new diagnosis of GERD. I will always be grateful for the doctor who listened between the lines of my words, who heard what I didn’t want to say.

Treatment for depression can involve medication (anti-depressants), therapy to help patients cope with their symptoms, and caring for your body (exercise, good nutrition, and sleep). Many people use supplements. And yes, prayer helps, too.

What worked for me was medication. My brain chemistry needs help regulating itself, and the right dose of the right anti-depressant corrects the chemicals so I can cope with life in a normal fashion. The first anti-depressant I tried had side effects I didn’t like (including sexual side effects, which I was surprised to actually care about). After several years of using that medication and then trying to manage life without the medication, I started on a new one that works very well for me.

When my seasonal depression kicks in every fall, I am intentional about spending time outside for natural light therapy. Although that isn’t sufficient for my depression during the rest of the year, it keeps my depression symptoms at bay during the autumnal dark.

Anti-depressants* are not the right solution for everyone with depression, but they do the best job in helping me have a normal life again.

When the fog lifted

About a month after I finally got on the right dosage of my medication, I felt like I’d emerged from a years-long fog. I was feeling again. I was able to recognize that our marriage was in trouble—and I actually cared about that. God had been working on me during my fog years, and my heart and mind were finally ready to tackle the hard work of making change in our marriage.

I found myself reading an article about Christian marriage and sex. That moment changed everything—and it did so only because treatment had removed that insurmountable wall from my view. Instead, I saw a climbable mountain that would help me pursue healthy sexual intimacy in my marriage.

Treatment for depression is not a guarantee of willingness to work on the marriage, but it can remove one huge barrier to growth. And here’s something else to consider: I have heard from many women that their own efforts to finally work on sexual intimacy began shortly after they started on their anti-depressants or began other treatment for their depression. I don’t think that is a coincidence.

If you struggle with sexual intimacy in your marriage and experience any of the symptoms on the list above, consider whether depression may be a factor in your struggles. If you have untreated depression, treatment won’t make the growth easy–but it likely will make your growth possible.

Although prayer did not lead to a release from my depression, it has been a great comfort to me on those days when I struggle. I am reminded of God’s ever-present comfort. He is the great healer, and God led me to the right doctor and treatment so I can live the life he has planned for me.

If you struggle with the symptoms of depression, seek treatment. With the right treatment, you can live a normal life again and pursue healing in your marriage.

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Resources for Christians with depression

• 5 Things Christians Should Know About Depression and Anxiety, Relevant Magazine
• Understanding Depression, Christianity Today
• Depression in the Christian Family, Focus on the Family
• Christians: Take Depression Seriously, Beliefnet
• “My Friend Prozac”: Mary Beth Chapman on Battling Clinical Depression, Crosswalk

Resources about how depression affects marriage

• 5 Things You Need to Know about Your Spouse Who Struggles with Depression, Crosswalk
• Is Depression Destroying Your Relationship? Eleven Commonly Overlooked Symptoms, The Huffington Post
• Is Depression Impacting Your Sexual Intimacy? Hot, Holy & Humorous
• Depression and Divorce, WebMD
• The Warning Signs That Depression is Affecting Your Relationship, Scientific American
• How Does Depression Affect A Marriage?, PsyWeb

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*Standing on my soapbox about anti-depressants.

Pardon me while I go on a rant.

I’ve heard it all:

Depression isn’t real. We are an over-medicated society. People on anti-depressants are just trying to avoid dealing with life. My neighbor/friend/relative dealt with her depression by exercising, so that’s all that’s needed. They’re just the latest trend and everyone thinks pills are the answer to everything.

I fully acknowledge that anti-depressants are sometimes prescribed without trying other approaches first, but too many people dismiss their value altogether.

1. Anti-depressants correct a chemical imbalance in the brain. This is a physical problem, not a moral one. Sometimes (especially with mild depression) other approaches can work. Exercise, light therapy, and counseling are always worth trying first. However, this simply may not be enough. If the depression is moderate or severe, the proper medication can help the person get to a point of being open to these other approaches.

2. The seeming prevalence of anti-depressants might not be a reflection of some assumed character flaw on the part of individuals or society. Consider that it might be a result of medical advances that finally allow us to treat something that used to cause years-long daily suffering. It might also be the result of the fact that people are making a genuine effort to be transparent about their treatment in an effort to destigmatize mental illness.

3. Most people on anti-depressants are not trying to avoid dealing with life; they are trying to be able to deal with life. Anti-depressants are hardly a happy pill or magic pill. They provide what the brain needs in order to function appropriately. Using medication allowed me to face my problems and start working through them. I did have a week or two of being super happy and upbeat; it was a response to finally being able to experience any joy at all. After feeling so off for years, I was elated at being able to feel normally again.

4. Some people can use anti-depressants on a short-term basis. Some can address depression using other means. Others need to stay on the medication long term. I would love to be able to function normally without the medication–but when I have tried to go without (under a doctor’s supervision), I have felt myself sinking into a mud pit of sorrow and dysfunction. I am aware of it as it happens, and as much as I know what to do and try to do it, it just isn’t enough to pull me back up. What works for one person does not necessarily work for another. Don’t assume that just because one approach worked for your relative or neighbor, it will work for everyone.

It is true that other approaches can work for some people, that we as a society use a lot of medication, and that anti-depressants sometimes come with side effects that interfere with other aspects of life. However, it is also true that for many of us, anti-depressants have saved our lives. Depression that is untreated can deepen and interfere with life far more than any medication side effects do.

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