Loneliness is defined as being sad because one has no friends or company or without companions; solitary. When we hear that definition, we generally think of someone who is by themselves literally--physically. But what if you are alone emotionally? How is that a factor in your depression?

I worked with a client (*Patsy) the other day who has been battling depression and anxiety for most of her life. While Patsy has some past family issues that are clearly at the foundation of her depression - she always wondered why it was an ongoing problem. She felt she had gotten past her old family baggage and was wondering why she couldn't beat what she felt was a huge monkey on her back.

It was clear to me that Patsy couldn't understand the source of her depression because she had so many things going on in her life that were typically great. She had a job that she loved. She was married with two children who were healthy and doing well in school. She also had friends and family who she stayed in touch with.

So I started asking Patsy questions about her "wonderful life" in an effort to get to the source of what may be going on. And we discovered quite simply that even with all of those great things and people in her life - Patsy was lonely. And had been for a very long time.

Patsy's husband was a hard worker who had always worked two jobs to help ends meet. When he got home from work, his typical routine included a shower, a meal, and bed. He always hugged and kissed Patsy good night - but rarely asked her about her day or the kids' day. They rarely were intimate based on the fact that he was so tired and never initiated it. Patsy didn't initiate sex either because she was too afraid of rejection - based on the fact that he was so tired. Working hard for the family. Even married, to a great guy - Patsy was alone.

Patsy's children were great kids who were hard workers in school and had lots of friends - but because Patsy never really had an open dialogue with them when they were little, they found it difficult to talk casually with their mom about school and friends at their ages now (13 & 15). They never did it and certainly weren't about to start now. So while she had no complaints about her kids, Patsy was missing a certain communication with them that left her feeling a bit disconnected. And lonely.

Neither of these situations were new. They were ongoing divisions in her home that were growing a bit bigger with each passing day, month, year. Patsy felt alone in her home, and it was a major "feeder" of her depression.

The next step? To create a plan of change for Patsy and her family. Opening up communication with her children. Finding pockets of time for her and her husband. Initiating conversation and sex with her husband. Carving out family time.

Is this a tall order for someone who is suffering from depression like Patsy? Yes. But it is not impossible. And if she can even accomplish half of what we designed for her - she will soon be on the road to recovery.

*name changed

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Lisa Angelettie MSW, "GirlShrink" is a psychotherapist, author, and relationship advice authority. Her site GirlShrink.com is the #1 "Advice & Counseling" site on the web. Please visit us for more discussion on this topic in the depression forum to talk about it further. Don't forget to subscribe to our newsletter for topics in the news, new articles, website & book reviews, and other useful depression resources. Subscribe below.