A depressed spouse deserves both empathy and our high expectations

I've been married almost 20 years, and am honestly stumped. My husband suffers from depression that doesn't seem to respond much to medications (he's been on several over the past 10 years, and is currently on the one that works the best). He's not ever been suicidal, but he does get sick all the time and will just stay in bed for days on end. Sometimes I try to get him up and out in the sunshine. Sometimes I just close the door and hope the sleep helps. Sometimes I am ready to walk out on the marriage entirely. I have been in therapy myself a couple of times. He's not willing to go to therapy himself, and just thinks he "happens" to get sick a lot. He does not believe the days in bed are depression related. He's the love of my life & I miss him. The real him. Any suggestions for something a spouse can do to help? J., Las Vegas

Sick all the time? I'd want to know more about the actual symptoms and actual frequency of what you're calling "sick." What medication and what dosage is he currently on? For how long? How is it better than other things he has tried? What is his resistance to therapy? And, if you say you "miss him," then you must have memories of a man who did not suffer from depression. When did you last see this man you miss? How long ago?

Depression is real. It's scientifically measurable. For most people, it's episodic. A response to a given set of experiences. For others, it is cyclical. Something that comes and goes, ebbs and flows. More the rhythms of temperament than a response to experience. For still others, it is the consequence of diagnosable conditions, such as bipolar disorder or major depressive illness.

There remains debate about whether depression is congenital, or a response to trauma/loss, or lifestyle. I'm convinced the answer to that debate is "yes." Meaning, some people are born not producing sufficient dopamine and serotonin, while, for others, significant trauma/loss impedes sufficient production and delivery of these vital, stabilizing, 'feel good' chemicals to the human brain stem.

Depression is also correlated to poor nutrition and lack of exercise. It might sound cavalier, but I often tell myself we could end or largely ameliorate the suffering of half the depressed population if they would exercise, eat really good food, and volunteer their time and energy for a cause larger than self. We'd put pharmaceutical companies out of business, and collapse the U.S. economy.

I'm going to say two things at once. It will sound as if I'm contradicting myself. But both are true.
1. Depression deserves our understanding, empathy, and skillful medical and psychological intervention.
2. Depressed people have a responsibility to manage their condition/illness.

J., what would you do if your beloved had high blood pressure and suddenly stopped taking his medication and started eating cubes of butter and Twinkies for breakfast with a Hawaiian Punch chaser? Answer: You'd get in his face and kick his keister from here to Kingdom Come. You'd tell him it's more than merely his responsibility to himself, but remind him also of his responsibility to you and others who love and need him. If necessary, you'd use volume and colorful metaphors.

Mental health is no different.

I know a woman who fell in love with a man suffering major depressive illness. For years in the marriage his disease conscripted the household. Countermanded, in one way or another, every breath and every action of every family member. The marriage, the sex life, child-rearing, work, play - all subordinated to accommodate the depressive illness. Every journey, every hope, every plan, every desire was a script written around the man's chronic and unpredictable darkness within.

Until one day ...

The wife took the husband to Denny's restaurant. She drew a line in the sand. Said he had to get a grip. Go to a doctor. Get your butt to therapy. Do not pass go. Do not collect $200. Faithfully monitor your condition. Stay on your meds. Exercise. Show up in your marriage. Show up as a father. Laugh. Smile. Animate.

The essential message was "I'm sorry depression is your health burden, and I have true compassion for how difficult it is to bear. But bear it! Responsibly and creatively. Starting now. Or I can't stay.

How can you help, J? By raising your expectations.