When Depression is in your bed

Sex as Nervous System Co-Regulation: Depression in the Bedroom

• Trish Sanders, LCSW • Season 1 • Episode 26

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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.

Speaker 1:

Hello and welcome to the when Depression is in your Bed podcast. Would you like to explore the connection between depression, sex and your nervous system? Are you interested in learning how they can work together and also sometimes work against each other, especially when we're talking about long-term intimate partners? If you're curious, please join me today as I explore this complex and deep topic. I'm your host, trish Sanders, and I am delighted that you are here. Let's get started.

Speaker 1:

Today is an exciting episode, not just because of the topic, which is, in fact, exciting in my opinion, but also because it's my 26th episode. So that means that I have been recording weekly podcasts for six months, and when I began this project, or when I started to think about beginning this project, thinking about podcasting for six months seemed just about impossible, but not completely impossible, because I took on the challenge. And here I am today and I'm really excited to be here and the experience so far has been so amazing and I can't wait to see how my journey unfolds in this whole podcasting world. I will say that part of me noticing that I was coming upon this milestone really made me wonder about what I wanted today's episode to be about, and as I started thinking. I started realizing that I have a podcast called when Depression Is In your Bed, and somehow I have gone six months hardly mentioning sex at all. And so when you think about relationships and beds, sex is something that often comes up and I think it's really important to talk about, and I certainly haven't been avoiding the topic and it also wasn't my intention for that to be the primary focus of this podcast, but it's a really important topic for relationships and I thought that now was the time to talk about it. I do want to just say a little note that when I thought about what to name the podcast, the name when Depression Is In your Bed was the very first name that really came to me and it just fit, and not just because of how depression affects a relationship's sex life, which it often does, but also because there's so many pieces about when depression is in your bed, in your life as an individual and in your relationship.

Speaker 1:

It affects how you sleep. It affects how you literally dream at night, but also how you dream and hope when you're awake. It affects if you go to bed at night or if it's hard for you to go to bed at night, right Like if you suffer from insomnia and you can't get to sleep or you actually can't even get out of bed because you're so immobilized, and it affects how you feel when you wake up in the morning and, of course, when you're in relationship. Depression affects many aspects when it's in your bed in this literal way, when your nervous system and body is experiencing depression and it is physically in your bed, how that affects your ability to connect again with yourself, of course, but also with your partner, and that includes every yourself, of course, but also with your partner, and that includes every possible type of connection, whether it's emotional or spiritual, or psychological or, of course, physical. You know how you cuddle up at night, if you kiss each other goodnight, or kiss each other or cuddle in the morning. All of that is affected when depression is in your bed, and so that's how I came to the topic, and those were all the things that I was thinking about.

Speaker 1:

But, like I said, sex is definitely a part of that, and today I'm going to just begin this conversation, because it is so vast and there are so many different experiences that people may have with sex or physical intimacy and depression. Today I will just be starting to create this frame of understanding so we can start to see how sex and physical intimacy can be used in intimate partner relationship. It doesn't have to be an intimate partner relationship, but I am going to be talking about long-term committed partners and how we can use it to regulate our nervous system and how that could be a really positive experience, and also just a little tiny bit, for today at least, about how that can really become problematic in relationship. I'm going to talk about some overarching ideas about co-regulation and how sex is used, specifically as it pertains to depression. But you don't have to be diagnosed with depression to use sex in this way, because even if you're not clinically depressed, all of us have a nervous system that only has three states that it can access, and it's a ventral state of safety. It is a mobilized response to threat, which is our sympathetic fight or flight response Something's happening to me, I have to do something about it. And then there's dorsal, which is the immobilized response to threat. Things are so overwhelming I need to collapse or withdraw or hide, or I don't have the resources to fight, so I have to replenish and renew, and that's the dorsal state, which is associated with depression. And so, even if you're not stuck in depression or clinically depressed, your nervous system also goes to the dorsal state, and this could definitely apply in any and every relationship, even when a diagnosis is not present.

Speaker 1:

So, to begin, what is co-regulation? It is in nervous system terms, and I work from a polyvagal, informed perspective, so this is in line with polyvagal theory, which is all about how our nervous system is at the heart of everything we do and how we experience ourselves and others and the world, and so co-regulation is the idea that two nervous systems or two people in any kind of relationship Again, I'm talking about long term intimate partner relationships but any two people in any kind of relationship it could be your coworker, it could be a friend, it could be the person standing next to you online at the grocery store, but our nervous systems are always interacting with the other nervous systems around us, and you can imagine that when you're in an intimate partner relationship, it's called intimate. I'm referring to it as an intimate relationship. Right, there's an intimacy, there's a closeness, and depression certainly affects that experience of closeness. When we're in our dorsal state, that's a state of disconnection, and so we often feel disconnected, even from the people that we love the most.

Speaker 1:

And so the idea of co-regulation is how two nervous systems can really work together and communicate together, as a matter of fact, in their own nervous system language, not in words. And of course, this is where sex and physical intimacy can be really powerful, because you don't need words, right, it's a very physical, body, sensory experience. And so when two nervous systems for my purposes I'm going to talk about intimate partners when two partners can feel safe together and they are attuned to their own needs and each other's needs and they can have a meaningful social engagement with each other, that feels really positive and can feel really delightful and wonderful. And if you think about a really great sexual experience or intimate physical experience you've had, if you think about one of the best when you felt so connected, so loved, so safe, so seen, so powerful even then that's really what we're talking about when our nervous system is in our safe ventral state. And so that's one experience of regulation and one way to co-regulate, when two partners are both in that ventral safe state and they can come together and enjoy a really satisfying, meaningful, fun, sexy, physically intimate experience, right? So that's one way to use sex. Is you're feeling good already and you're just feeling even more good with your partner.

Speaker 1:

There's self-regulation, which is how we make ourselves either stay in a ventral state or how we help our nervous systems move from a protected state, that sympathetic or dorsal, and move into ventral. And then there's co-regulation, which is how we do that with a partner right, and so that's what we're talking about today. The first way we can co-regulate with sex is sort of like hey, I'm already feeling good, you're feeling good, let's enjoy this experience together, and so that's wonderful. That is generally not the experience you're going to be having when depression is in your bed, certainly if there's active depression. So, moving on to another function of sex, when it comes to the nervous system and depression, there is that aspect of co-regulation versus self-regulation that I just mentioned.

Speaker 1:

And when you're in dorsal, when you're stuck again, this is an immobilized state, this is not. Oh, I don't feel like doing something. This is I am physically unable to take action. Now that's a deep, deep depression. There's a lot of flavors or degrees. I call them the steps of depression. A lot of the time that you know if you're in a deep, deep depression you're not getting out of bed, but you can be on one of the higher steps as I envision it, where you are kind of going through the motions, you're feeling numb but you're still like going through the day to day and there's a little bit more energy.

Speaker 1:

But self-regulation can be hard to grasp when you're in that dorsal state. So reaching out to your partner can be a really lovely experience of like, hey, can you offer me a hand Right? And there's a lot of different ways that this could be done. Today we're talking about sex, so I'm going to stick to talking about that. But it can be at times and I will explore this in much greater detail in later episodes so I know that there's a lot that's not being said here or not being said in a comprehensive way, but that can actually be a very positive and healthy experience if both partners are aligned and attuned to one another and they both feel safe that the depressed partner or the partner whose nervous system is stuck in dorsal can reach out to their other partner whose nervous system is not stuck in dorsal and say, hey, can I use some of your energy to kind of help lift me out of here? Or physical intimacy doesn't have to be sexual intercourse sex I'm using is a very broad word for touch, for caressing, for cuddling, for eye gazing, for massage, so a very wide array of what that can mean. And so that's one way that a depressed person can reach out and benefit from the energy of their partner's nervous system that can help them to move into a more regulated state.

Speaker 1:

Also, sex is something that if you're able to engage in when you're feeling depressed, it can really help you feel alive, because when you're in dorsal I mean most people, certainly my experience it's very empty, it's dark, it's dreary, it's definitely alone, it's a very dead feeling space, and so the experience of sex can be amazing and alive, and it might just last for the duration of the sexual experience, or it might help lift somebody out of that dorsal experience and they might be able to be a little bit more regulated in a little bit more of a lasting way. Nothing is an immediate and forever lasting fix, and what I mean by that is that our nervous systems are constantly in flux, we're constantly going through different states throughout the day, and we need to be able to do that. That's vitally important for our survival and for our thriving, but it is about not getting stuck in a state and being able to regulate and manage. So, again, I can talk a lot more about that, and I I have in previous episodes and I will again. But moving back into how sex can be used as a co-regulation tool is also in that idea that being able to engage again with that eye contact, with that soft and gentle touch, with even the rocking, the motion, could be words, but without even using words. If you think about the sounds of sex, that can be sort of rhythmic or it can be massaging. If you think about the sounds of sex, that can be sort of rhythmic or it can be massaging. If you think about moaning, or if you think about humming and sighing, there's a lot of similarities that could be the sounds that are helpful for our nervous system and they can really help us reach for ventral. So there's all of these really positive ways that sex can be used to help a depressed partner be able to regulate.

Speaker 1:

However, there's a lot of caution in this because it's not always a good experience and it can't always be the go-to each and every time. And I will talk a little bit about the evolution of my husband and our experience of sex and regulation in our relationship over 21 years, which I will talk about in a moment. I just want to say that there are a lot of ways you can have dysregulated sex. You're still very shut down or it could be very disconnecting. Either you yourself are disconnected because you're depressed or your partner maybe is not depressed, but they become disconnected because they're really not feeling safe themselves in that experience. So they're not having a connected experience of sex or physical intimacy with you, which can be very problematic. Again, I'm not really going to go deep into that today, but I will absolutely talk a lot more about that in the future. So just know that I'm not sending a message of sex is the way to help your depressed partner get out of their depression. Please know that that's not what I'm saying, but that it is one of the options that can be on the menu, so to speak, of what partners can do together to help one partner or both partners to reconnect with that ventral safe nervous system state.

Speaker 1:

So just to kind of give you an idea of my own personal experience and how this has looked in my own life, I'm going to tell you again kind of like the sex, depression and nervous system story of Trish and Ben over our 21 year relationship and it's going to sound very linear the way I'll tell it. Over time, as I dive more into this, I will definitely tell you more details and you'll see that it is not in any way a linear journey, but it definitely has evolved over time. And so, going back to our very early days, this is before we had kids, before we were married, before we were well-established in our careers, and at that time we were both dorsal dwellers, which is a Deb Dana term, and Deb Dana I've referenced before, she is the clinical application person of all things, polyvagal and she's amazing. And so being a dorsal dweller means that your nervous system has a tendency to get stuck in that dorsal experience. I and my husband both found safety and protection in that shut down, withdrawn, collapsed place while we were growing up and we took that safety, that way of finding safety, into our adult lives.

Speaker 1:

And in our early relationship we were totally functional. I mean I was in graduate school when we met and he was going through a career change and we then had jobs that we held with no issue. We were able to get up in the morning and do what we had to do and get everything done and we were pretty good employees, I would say. But at night, on the weekends, we were very shut down. We would sleep all weekend long and we drank a lot of wine at night, for sure, back then, and we were very functional dorsal dwellers, I would say, and at that time we often use sex as co-regulation and we would be able to connect with that physical intimacy. My husband, if you know the love languages, one of his love languages is definitely physical affection and just being very close.

Speaker 1:

If you know the term kangaroo care, when a baby is born they recommend skin to skin contact. And when our son was born, we learned about kangaroo care. We were like, wow, we do kangaroo care too as adults. Right, and that's true, we used to do kangaroo care, we used to just do skin to skin contact. And how safe and connected we could feel, even when one or both of us were feeling depressed. It's maybe even a little bit hard to describe, but I can experience that feeling. I can experience it in my nervous system right now as I think about it, because I just felt like I didn't feel alone anymore. I felt like this was my person. Here we are, us against the world. We can both be safe here in this really beautiful space and it was incredible and that was really our very early beginning and there was a lot of co-regulation that was beautiful and mutually beneficial and certainly safe for both of us and then eventually fast forward lots of time that I won't go into all the details now, although you've heard me talk about some and again, you'll absolutely hear me talk about them again in the future.

Speaker 1:

But eventually things became a little lopsided because I started feeling like my husband's go to. As I mentioned before, if sex is your go to, I feel depressed. Let me have sex with my partner. Eventually. While I totally understand why that makes sense and why that works, eventually it doesn't always feel so good because it's not, as I started off talking about in this episode, that eventual experience that both partners are feeling good and then it just becomes like this way to just enjoy feeling good together. It's lopsided that I was not necessarily feeling depressed and he was, and he was again reaching up a hand saying, hey, can you pull me up? But it kind of was like hey, my back's hurting, I'm leaning over pulling you up a lot, you know and it stopped being so fun and enjoyable for me, whether that was eye gazing or kangaroo care or sexual intercourse, sexual activity and all the things under that umbrella. I started feeling resentful about that experience and I didn't want to have that experience anymore. And so then I could disconnect and go into my own dorsal shutdown, and it caused a lot of problems over many, many, many years, and again I'll dive in deeper into the specifics in later episodes.

Speaker 1:

Eventually though I don't know how many years 15 years, 18 years in some ways we're still going through it after 21 years, although we've come an awful long way, I have to say. But eventually I was like, hey, like this is not the kind of sex that I want to be having. And my husband was like, yeah, me, neither, I don't enjoy it when you're shut down. I'm like, oh, yeah, well, I don't enjoy it when you're depressed and you're reaching up to me as your only lifeline, right? And those were the conversations, and there were many, many conversations we had. And eventually we're like we have to do this different, right, it doesn't feel good for either of us, so we have to figure out a new way.

Speaker 1:

So that and it has been quite the journey it's been very bumpy at times, but also really beautiful and really connecting at times because with the nervous system language we are understanding and I can have absolute compassion for why Ben reaches out for me in that way and he can understand. While I welcome supporting him, I don't want sex to only be. It's really not only only is such an absolute term, but it's not the only way that he uses sex or that we have sex together. It's not that at all, but that's how it feels for my nervous system. That's the nervous system story. The only time we have sex is when you're reaching out to feel better, when you're depressed or when you've had a bad day at work, and then that doesn't make me feel special, I don't feel important, I don't feel seen, I don't feel like he's able to attune to me and, quite honestly, he probably isn't when he's really dysregulated, which makes total sense, right. And so now we've really gotten to this place where we have this beautiful language, where I can say to him you know what I want to have, this really enjoyable co-regulation experience of sex where we're both feeling good and we're both bringing our whole selves, our whole body, our whole spirit into our sexual experience. And that can be fireworks and really exciting. I can feel chills and goosebumps as I talk about it, right. That's like the delicious, juicy, wonderful active sexual desire and fun and sexy. Right, that's the sexy, wonderful stuff that people maybe dream about, or certainly I dream about and absolutely experience when my nervous system is regulated and when Ben's nervous system is regulated. So we've been really figuring this out, and adding the layer of the nervous system has been profoundly enlightening for me because it helps me understand, without any judgment and with real full compassion, my own experience and Ben's experience. And so that's where I'm gonna end for today, because there's so much here and I can't wait to talk to you about it. So stay tuned for future episodes.

Speaker 1:

For the next several episodes, I'm gonna do something a little bit different. I think it's gonna be fun, because we're in to summer right now. I'm going to be doing what I imagine will be mini episodes where I'll talk about my lived experience, like something that happened that week, something that went really well or something that didn't go so well, and how I handled it or didn't handle it, or how I figured it out after the fact, if I kind of really was dysregulated and made a lot of missteps. And I'm just going to share some of those experiences and I'll take a little break from sharing these frameworks. I felt like it was important for me to share how I look at my world and my relationship, and certainly the relationships that I work with as a therapist and as a coach, and I wanted you to have that information to refer to to help deepen your understanding, if that's what you're interested in. And now I'm going to just talk about my experience for a little while and see how that goes, and I hope you're enjoying summer or whatever season it is for you right now, and I'm going to go continue enjoying some more of my summer and play with these little mini episodes for a few weeks and I'll be back to full length episodes in the fall. But I didn't want to stop the flow because I'm really enjoying this podcast experience and I'm really enjoying connecting with you and I look forward to connecting with you more. So be sure to follow me on social media and definitely connect with me there and check out my Getting the Love you Want workshops and retreats that I have coming up. And that's all for today.

Speaker 1:

As our time comes to a close, I ask you to keep listening for just a few more moments because I wanna thank you for showing up today and I want to leave you with an invitation as you hit, stop and move back out into the world on your own unique wellness journey In order to move from where you are today to the place where you want to be.

Speaker 1:

The path may seem long or unclear or unknown, and I want you to know that if that seems scary or daunting or downright terrifying or anything else, that is totally okay. Know that you do not have to create the whole way all at once. We don't travel a whole journey in one stride, and that is why my invitation to you today is to take a step, just one, any type, any size, in any direction. It can be an external step that can be observed or measured, or it could be a step you visualize taking in your mind. It can be a step towards action, or towards rest or connection or self-care, or whatever step makes sense to you.

Speaker 1:

I invite you to take a step today because getting to a place that feels better, more joyful, more connected than the place where you are today is possible for everyone, including you, and even when depression is in your bed. If today's episode resonated with you, please subscribe so you can be notified when each weekly episode gets released. I encourage you to leave a review and reach out to me on social media at trishsanderslcsw. Review and reach out to me on social media at trishsanderslcsw. Your feedback will help guide future episodes and I love hearing from you. Also, please share this podcast with anyone who you think may be interested or who may get something from what I have shared. Until the next time we connect, take care of yourself and take a step.