Six months into the "When Depression Is In Your Bed" podcast, I realized I'd barely touched on one of the most significant aspects of depression in relationships—the impact on sexual intimacy and physical connection. The bed isn't just where we sleep; it's where we dream, where we struggle with insomnia or can't find the energy to rise, and where we reach for connection with our partners.

Physical intimacy becomes particularly fascinating when viewed through the lens of nervous system regulation. Our nervous system can be in one of three states: ventral (safe and connected), sympathetic (fight or flight), or dorsal (shutdown and depression). When depression takes hold, that dorsal state dominates, leaving us feeling disconnected and alone, even beside someone we love. Sex and touch can serve as powerful tools for co-regulation—the way two nervous systems help each other feel safe and connected.

Drawing from my 21-year relationship journey, I share how physical intimacy functions differently throughout a partnership affected by depression. In our early years, my husband and I were both "dorsal dwellers," finding safety in withdrawal but using physical connection to temporarily emerge. Sex was mutually beneficial co-regulation, creating bridges of connection between our often shutdown states. As time passed, patterns shifted—my husband began frequently reaching for intimacy when depressed as a means of feeling better, creating an imbalance where I felt more like a regulating tool than a partner. Resentment grew, leading to my own disconnection during intimate moments, creating a destructive cycle we've spent years untangling.

After years of working through this together, we made significant progress once we began to understand the language of our nervous systems. Without judgment, I could see his reaching for connection was his system seeking safety, rather than believing negative misinterpretations about his behavior. He could understand my withdrawal wasn't rejection but self-protection. This compassionate framework has transformed how we approach intimacy, allowing us to distinguish between different needs and experiences—sometimes one partner needs support, other times both are regulated enough to enjoy fully mutual connection.

This summer, I'll be sharing mini-episodes about my lived experiences navigating depression in relationships. Follow me @trish.sanders.lcsw on social media and check out my upcoming Getting the Love You Want workshops and retreats.

- If you and your partner are ready to co-create the roadmap to the relationship of your dreams, join us for the next in-person "Getting the Love You Want" Weekend Couples Retreat!

For support in how to have deeper connections and better communication in the relationships that matter most in your life, follow the host, Trish Sanders on Instagram , Bluesky or LinkedIn.