Depression can be a huge challenge for a relationship. Loved ones of someone with depression often feel helpless. But there is actually a lot they can do ― and a lot they shouldn't.Six years ago, Stefan's relationship underwent a fundamental change. Back then, when the COVID-19 pandemic began, Stefan's wife, Jessica, had a breakdown and has been struggling with depression ever since. For privacy reasons, the couple has asked to be referred to by pseudonyms. Jessica was placed on sick leave and was unable to work for three years. She spent months in hospitals, underwent outpatient therapy and tried various medications. "After about three years, we came to the conclusion that things wouldn't be the same as before," said Stefan, a 44-year-old software developer. "That carefree, relaxed togetherness is no longer there." Early warning signs of depression: Feeling overwhelmed, withdrawal Stefan said it started with Jessica becoming increasingly afraid of people and developing social anxiety. She even withdrew from her circle of close friends. Grocery shopping became difficult; making calls to doctors or taking care of bureaucratic errands was impossible. Jessica also felt overwhelmed by Stefan. Mundane thoughts he used to share with her — for example, about things he had read or seen — were now too much to take in. Depression is hard for those who suffer from it. But loved ones suffer, too. In a romantic relationship, things shift. "There were times when I didn't have a wife, but one more child," said Stefan. The less Jessica could do on her own, the more he took over for her. Setting boundaries for your own mental health Birgit Esch helps family members of people with depression. For many years, she worked as a nurse with people suffering from mental illness. One thing she noticed: Only when family members are involved can those affected truly recover. Today, she is a systemic family therapist at a mental health clinic in Bonn, Germany, and a point of contact for people like Stefan. She offers courses in which family members spend three evenings learning about depression ― and about how their own feelings and experiences matter, too. "Most family members go through hell for about four weeks before the person affected is admitted to the hospital," Esch told DW. At this stage, family members have often tried everything, are running themselves ragged, and are tense, anxious and full of worry about their loved one. "'How are you actually doing?' This question is asked of [family members] far too rarely," said Esch. It is enormously important that family members learn to take good care of themselves and set boundaries, Esch emphasized, so that they themselves stay healthy. Only then can they be a real help to their sick loved one. 'No help without a request' When family members take on more and more daily tasks without being asked, it reinforces the passivity of the person with depression, which in turn feeds the depression, explained Esch. That self-sacrifice made by family members also intensifies feelings of guilt and shame for the person with depression. Stefan had to learn this the hard way. The more household chores he took over for his wife, and the more often he made calls for her, the more she felt like she was being a burden. "It would be better for you if I weren't here anymore," Jessica told him one day. Esch likes to say: "No help without a request." This preserves the depressed person's sense of self-efficacy, and, crucially, gives family members the chance to say "no" and prevent their own burnout. "Setting boundaries doesn't mean I’m rejecting the person, but that I'm only allowing the depression a certain amount of space," said Esch. Separating the person from the depression Setting boundaries becomes easier when family members manage to separate the depression from the person, according to Esch. Jessica is often frustrated because she can't meet her own expectations due to the illness, and quickly loses her patience. "Withdrawal, irritability and emotional distance don't come from the person, but from the depression," said Esch. "In a relationship, it's important to accept that the couple is living in a love triangle" with the disease. Communication becomes especially important — and at the same time, it's particularly difficult, especially when it comes to potential sources of conflict. "I always have to hold back and assess the situation first. That's very exhausting," said Stefan. At the same time, he's always afraid that the situation might escalate. Jessica and Stefan have therefore agreed that he will communicate certain concerns — for example, if he feels she has criticized him unfairly — via text message. Stefan can express himself, and Jessica can respond at her own pace. Coping with depression: Appreciating the small steps Jessica has been back at work for over a year now — four hours a day, four days a week. That's all she can manage right now. But Stefan is happy; after all, it's more than was possible for a long time. "Now she can even go grocery shopping after work," he said. Esch said it's important to appreciate the small steps, like shopping, washing her hair, taking out the trash. "Coping with the illness is hard work for the person affected," she added. As Jessica withdrew more and more, Stefan went into isolation with her. That's not uncommon, said Esch, but it doesn't help anyone. "We don't drag anyone off the couch by their hair," she said. But family members have the right to say, "I'm not going to sit here and be depressed with you." Help for family members through therapy, support groups In the fourth year of his wife's depression, Stefan developed nervous tics and an inexplicable itch that kept him awake. Psychosomatic disorders — presumably triggered by the strain his wife's illness placed on him as well. He sought out a therapist and also found his way to Esch. In addition to courses on various mental illnesses, she also offers individual counseling and support groups. All of this helped Stefan find his own place in the triangular relationship with his wife and her illness: to step back more and do more for himself. "That's also necessary to stay productive," said Stefan. The itching and tics have since disappeared. Stefan is out and about a lot, sometimes with Jessica, but also on his own. He wants to meet new people and try new things. He also wants to reduce his working hours, to have more time for sports. Separation advisable when depression at the center of everything Stefan and Jessica have found a way of interacting that works, but not all couples manage that. Esch has also supported people through breakups. A separation is advisable when depression serves as an excuse for everything, said Esch. An argument like "I'm sorry, I can't be nice to you — I'm depressed" does not contribute to a healthy relationship. This article was originally written in German. If you are suffering from serious emotional strain or suicidal thoughts, don't hesitate to seek professional help. You can find information on where to find such help, no matter where you live in the world, at this website: https://www.befrienders.org/