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Having a baby tends to change your marriage. How could it not? You’re adding another (beautiful) human being to your household. A human being who requires you to fulfill their every need, usually every few minutes, and who rarely lets you sleep. And most of us aren’t exactly at our best when we’re sleep deprived, stressed and spent.

When you add postpartum depression (PPD) to the mix, your marriage might feel especially fragile. Even after you’ve recovered from PPD, your foundation may be shaky. You might feel disconnected from each other. You’re physically in the same house, in the same room, and yet your hearts are many miles apart.

So much may remain unsaid between you. So many (mistaken) assumptions may be made.He resents me for having struggled with depression. He thinks I’m a terrible mother. She thinks I didn’t support her enough. She thinks I’m a horrible husband. She wants to be alone. He doesn’t want anything to do with me.

In their thoughtful, insightful and practical book Tokens of Affection: Reclaiming Your Marriage After Postpartum DepressionKaren Kleiman, MSW, LCSW, and Amy Wenzel, Ph.D, ABPP, share eight “tokens” or principles to help partners reconnect and solidify their bond. Kleiman is the founder of The Postpartum Stress Center, a treatment and training center for prenatal and postpartum depression and anxiety. Wenzel is a clinical psychologist who specializes in depression, anxiety and relationship problems.

The tokens are: esteem; collaboration; compromise; selflessness; sanctuary; expression; tolerance; and loyalty. Below are five tips from their book based on some of these tokens to help you reconnect. 

Speak the same language.

Even if you’ve been married for years, you still might make incorrect assumptions about what your partner needs and prefers. And they can do the same. It might seem obvious to you that you want your spouse to ask how you’re doing. But they assume you want to be left alone (maybe because that’s what they prefer when they’re stressed out).

To help you speak the same language, Kleiman and Wenzel suggest completing the below sentences. Ask your partner to complete them, too. Then discuss your responses.

• “I love it when you _________________.”
• “When you ______________, I have a hard time understanding what you want.”
• “I know you have really heard me when you _____________.”
• “It might seem silly, but when you _____________ it makes me feel totally loved by you.”
• “I feel like we communicate best when we _______________.”
• “When you are upset, perhaps it would be best for me to _______________.”
• “However, when I am upset, I would prefer you to ______________.” 

Give first.

“Always, always, be aware of how your partner is feeling,” write Kleiman and Wenzel. In fact, they believe that “what is most fundamental to the well-being of your marriage is how much you care about what your partner is feeling.”

Before telling your spouse what you need, name their emotional state: “I know you are ____________ (tired, busy, frustrated), but I need ____________ (you to, go and, take a). Or mention how your partner might see your request: “I know you hate to hear this, but I would love it if you could ___________.”

Be kind and curious.  

This isn’t easy to do when you have a baby, but when you have the opportunity, engage in novel activities together. Try a new hobby. Take dance lessons. Play a sport.

Talk to your spouse about something you’ve never talked about before. Share a part of yourself that you’ve yet to share. Say nice things to each other. Don’t underestimate the power of a compliment or of showing your admiration for each other.

Check in.

Even when you don’t feel like it, check in with your spouse. This shows them you care unconditionally. As the authors write, “One of the things my clients hear me say, over and over again, is that you don’t have to want to do something, to do it…”

Ask questions, and listen fully to the answers (without interrupting or judging what they say). Kleiman and Wenzel share these examples: “Are you feeling better today? What was the best part of your day? What happened at your meeting? How does your back feel today?”

Remember your love.

“As marriages move beyond recovery and readjust to the transition into parenthood, couples can easily begin to take each other for granted,” write Kleiman and Wenzel. You might forget why you fell in love with your partner in the first place. You might forget the qualities you’ve always admired. Instead you both might be focused on the annoyances, on any resentment that’s built up.

To remind yourselves of your love, each make a list of the qualities you love about the other and the initial reasons you fell in love. Talk about your lists. Talk about why you married your partner. Or tell your partner what you miss. Or talk about “why you are dedicated to doing this work and finding your way back home.”

And, again, instead of making assumptions, talk to your spouse. Be honest about your feelings and needs, without lashing out or criticizing. Listen to each other.

Reconnecting with your partner after PPD may be a circuitous, bumpy process. The above tips can absolutely help. They speak to the things we forget to do when we’re stressed out, there’s a lot on our plates and we’ve been together for a long time. They speak to the small steps we can take in loving, respecting and caring for each other.

But the best course of action is to work with a therapist who specializes in couples. A professional can help you successfully navigate your specific issues.

And please don’t blame yourself. Postpartum depression is an illness. It’s not something you can control or will away. It’s not something that characterizes you as a person or your ability as a mom. Even though you’ve recovered or are recovering, you still might feel fragile and emotionally raw. Do whatever you need to do to keep getting better. Again, this usually includes continuing to see a therapist.

Take good care of yourself, and take good care of your marriage.

Ever since I started an online community for treatment-resistant depression — depression and anxiety that don’t respond to psychotropic medications — I’ve been inundated with mail from desperate people who have tried as many as 30 to 40 different kinds of antidepressants, and feel no relief.

I repeatedly hear from family members of folks who have tried everything, and are not getting better. I sense the utter frustration and despair in their words, and it pains me. I, too, felt hopeless after trying countless medication combinations and sitting through years of psychotherapy sessions, only to continue my death obsessions.

I wish I could respond to everyone individually — spend an hour on the phone with them, begging them not to give up because they won’t always feel this way. Unfortunately, I can’t (step six). So the next best thing is to outline these nine basic steps for people who are treatment-resistant, because these actions, more than any medication I have tried in the last seven years, have helped me emerge from the other side of depression.

I’m not anti-medication by any means. Drugs serve an important purpose. But with so many people not responding, or only partially responding (myself included), I felt compelled to list the other parts of my recovery that have been critical to my wellness — things that most doctors don’t discuss. These steps didn’t fix me for good: I still have a lot of work ahead of me, and I have plenty of bad days.

I believe everyone has a chance at recovery, even those who have been depressed and anxious most of their lives.

I wish you good health with all my heart.

1. Identify Any Underlying Conditions

I would venture to say that most people with treatment-resistant depression are also suffering from undiagnosed conditions. My list was long: Crohn’s disease, small intestine bacteria overgrowth (SIBO), hypothyroidism, low stomach acid (hypochlorhydria), adrenal fatigue, Raynaud’s phenomenon and connective tissue problems, pituitary tumor, aortic valve regurgitation, and certain nutrient deficiencies (iron, vitamin D, and vitamin B-12).

It’s really best to work with an integrative or functional doctor. Many are listed on the website for the Institute of Functional Medicine, but you need to proceed with caution, because some of them are very expensive and will run unnecessary tests if you’re not careful. At the very least, I would ask your primary care physician or psychiatrist to run these four blood tests: a complete blood count (CBC); comprehensive metabolic profile (CMP); a thyroid full panel, including TSH, free T4, free T3, and thyroid antibodies (read Dana Trentini’s important blog on this); and the 25-OH vitamin D test, as well as B-12 levels. It may also be worth finding out if you have a Methylenetetrahydrofolate reductase (MTHFR) gene mutation (present in 15 to 40 percent of the general population), because we need the MTHFR enzyme to convert folate to its active form, methylfolate — and folate deficiencies make it difficult for antidepressants to work. In fact, many studies link low folate levels to depression.

I have actually learned more about my various conditions from the people on my depression forums, and in books and articles, than I have from sitting in doctors’ offices. The folks on Project Beyond Blue and Group Beyond Blue are working with nutritionists, integrative doctors, gastrointestinal specialists, and other experts, and are experimenting with new things all the time and willing to share their experience with you for free. I’ve learned from them about certain supplements, protocols, and resources that have really helped mitigate some of my symptoms.

2. Eliminate Triggers of Inflammation

Certain foods and substances create inflammation in our bodies, including in our brains, which leads to depression. The usual suspects are sugar, gluten, dairy, caffeine, and alcohol. Some people, like my daughter, may have more dramatic reactions to dairy, whereas others, like my son, are more affected by gluten. Me? I can’t go near sugar if I don’t want the death thoughts to return. You won’t really know until you do an elimination diet and get rid of everything for a few weeks, and then gradually add them back in (that is, if you tolerate them fine). I will warn you, though: You can’t cheat for those few weeks, because your system has to be totally clean for you to identify the problem. A spike in cytokines, proteins that are pumped into our bloodstream when our immune system is fighting off a foreign agent, happens when people are depressed. The process looks the same as when a person is fighting an infection of any kind. Unfortunately, a lot of fun, processed foods that taste really good, like Twinkies and Doritos, can cause inflammation — but clearly some people are more sensitive to others. Here’s an easy rule to follow: If a food comes in a nicely marketed package (even with the words “gluten free,” “dairy free” and ESPECIALLY “sugar free”), and its ingredients contain a bunch of words that you don’t know how to pronounce, it’s not going to make you any saner.

And not to be a total killjoy, but it’s worth examining what other kinds of toxins you are immersed in daily. Those could be causing inflammation, too. Not until three months ago did I realize that swimming in chlorine a few times a week was probably contributing to my gut problems and thyroid issues, both of which are critical in establishing a stable mood. So I switched to hot yoga (step five), and I began to feel better.

3. Go Green

Dark, leafy greens like spinach, Swiss chard, and kale fuel every system in your body more completely than any other kind of food. They are nutrition powerhouses, packed with vitamins A, C, E, K, and folate; minerals like iron and calcium; carotenoids; fiber; antioxidants; omega-3s; and phytochemicals. They are also a major source of chlorophyll, which, according to Green for Life author Victoria Boutenko, “heals and cleanses all our organs, and even destroys many of our internal enemies, like pathogenic bacteria, fungi, cancer cells, and many others.”

I started to feel a little better when I swapped my sandwich at lunch for a salad full of greens, and made a conscious effort to eat mood-lifting foods during the day. But I began to really heal when I started drinking green smoothies. I realize I sound like an infomercial at this point, but the only way my body was able to easily absorb and process all the nutrients in the greens was when they were blended into very small pieces. Like most people who have been on medications for decades, my stomach acid was very low, so eating lots of raw vegetables and greens was producing bloating and gas. I was not happy when my husband spent $500 on a refurbished Vitamix, but it has proven to be one of the smartest investments we’ve ever made. Now I try to drink two smoothies each day, and I really believe it has made a substantial impact on my health.

4. Heal Your Gut

Embedded into the walls of our intestines is an intricate enteric nervous system, consisting of some 100 million neurons, that is often referred to as our second brain. In fact, the nerve cells in our gut manufacture 80 to 90 percent of our body’s serotonin. There’s also a complex collection of bacteria living in our guts that a substantial volume of research says impacts our mood. It’s fascinating stuff for people like me who have always suffered from gastrointestinal problems and never before connected the dots.

In my article 10 Ways to Cultivate Good Gut Bacteria and Reduce Depression, I outline some of the steps I have taken to clean up my gut. Among them, I believe it’s important to consume prebiotic foods, like garlic, onions, artichokes, leeks, and dandelion greens, and probiotic foods, like active-culture yogurt, kefir, pickles, and fermented foods. It’s also good to avoid the use of antibiotics as much as possible.

5. Do Yoga

Any kind of workout or movement lifts your mood — boosting our brain’s dopamine levels and providing endorphins — but some kinds of exercises are much more healing than others, especially for people who have been depressed for decades or have stress-related conditions like adrenal fatigue. Unlike other aerobic workouts, like running or CrossFit, that raise cortisol levels and essentially wear out your body, yoga lowers levels of this stress hormone that is critical to the maintenance of homeostasis and regulating immune responses, blood sugar, and central nervous system functions. Several studiesillustrate how yoga tames the stress response by priming the parasympathetic nervous system, and is therefore an effective therapy for depression and anxiety.

I have tried different types of yoga, but the one in which I feel the most benefit is Bikram, a sequence of 26 Hatha yoga positions, and two breathing exercises, designed to engage and heal all of the systems of your body. It’s not for everyone, as you’re stuck for 90 minutes in a room heated to 105 degrees (sweating helps flush out the toxins). But when I can get there on a regular basis (at least four times a week), I feel a profound, calming effect — and I’ve heard the same from several other people who struggle with chronic anxiety and depression.

Sure, the thought counts. So think twice.

I have clinical depression. It’s been a part of my life since I hit puberty. I have had highs and lows and will continue to have them throughout my life.

I’m an adult, I’m in treatment, and years of it has taught me incredible coping skills.

But that doesn’t always make it easy.

This Comic Sums Up EXACTLY What It’s Like Living With Depression

One of the toughest things about having depression is something people don’t always talk about: interacting with others.

In the US, depression is less stigmatized than it is in other parts of the world for sure. We’re more open about mental illness here, though we still have miles to go.

An unfortunate side effect of that openness can be dealing with people who don’t understand how to deal with people who have depression.

Below you’ll find nine things people with depression (myself included) are tired of having to confront on a daily basis.

I don’t want to sound snide or unappreciative of the people who think they are showing us support, and I hope conversations like this one will make an ongoing dialogue about mental illness easier for everyone involved.

1. “You don’t seem depressed.”

All depression is not created equal and the people who suffer from it are also all totally different from one another. I can get a blow-out, put on lipstick, laugh at a joke in public, and still have depression. That doesn’t make me magically better.

2. “You should try meditation.”

It’s great, great, great that your friend/uncle/co-worker cured their depression with a regularly scheduled meditation session. I’m so happy that they found the peace and coping mechanism that they needed. I’ve tried it, and meditation is great, but for me personally it is not as great as weekly therapy and a low dose of antidepressant.

3. “I exercise, so I never get depressed.”

It’s true that exercise releases serotonin, one of the chemicals produced by the brain that makes you feel happy. A natural side effect of exercise is that lovely rush of serotonin. I’m a depressed person and exercise definitely gives me a little boost. But it’s not a cure. People with depression have brains that actually produce LESS serotonin than everyone else on a regular basis. So while the uptick in the stuff feels great, it doesn’t solve the overall problem.

4. “Can’t you just take medication?”

I’ve been fortunate enough in my life to be friends with people who understand that managing depression is a lifelong struggle, and a real one. But I can’t tell you how many people I know whose mental illness has been dismissed as no big deal now that antidepressants exist. While we’ve made great strides with drugs to treat depression, that’s no reason to dismiss someone else’s experience.

5. “It’s just a party.”

What feels like the easiest thing in the world to you can be a challenge of the highest order for a person going through a depressive episode. I have had days where the concept of blinking was more than I could handle. Sure, parties are great. But when you’re struggling to do simple things, please understand how a big social event might be overwhelming for us.

6. “You shouldn’t sleep so much.”

A person with depression isn’t sleeping because they are lazy. A person with depression is sleeping because they have real, physical symptoms that have totally exhausted them. Sleeping when you’re depressed can, in fact, be a good thing. Sleep is when the body does most of its healing.

7. “Oh my god I know, I get so depressed when it’s cold outside!”

The word depression itself has become deeply overused. There is a difference because clinical depression and you getting a little annoyed that you have to wear pants instead of the cute skirt you just bought to work. We all get bummed out, depression is different.

I Refuse To Let My Wife’s Depression Ruin My Marriage

8. “Have you ever tried to kill yourself?”

Legitimately I have been asked this twice when talking about my depression. If a depressed person chooses to share their story with you, that’s their prerogative. I, for one, don’t relish talking about the darkest periods of my life while also splitting cheese dip.

9. “Don’t watch this part of the movie, you won’t be able to handle it.”

It’s really kind when people try to protect their friend with depression from things they think they won’t be able to handle. But here’s the thing, while we may have depression, we’re also adults. We know our own minds. We can turn away from something if we feel like it will be triggering. If we need your help, we won’t be afraid to ask for it.