It takes a strong person to endure these things and you even being able to sympathize with his condition to the point of powering through the hard times - I seriously bow down to you. Caregivers don't always get affirmations, but should.

From someone who suffers from it, and exhibited/exhibits very similar behavior as your husband, here is how I feel and hopefully if anything it can give you insight.

I feel so guilty about not pulling my weight. It is like my thoughts overcome me, and then I feel the physical effects from that activity. It feels like I've run a marathon in my mind. Sometimes all I can muster during a depressive episode is getting out of bed and eating something substantial. Taking a shower and brushing my teeth feels like moving a mountain. What makes me feel "valid" sometimes is knowing that I would never choose to be this way. I don't want to be this way. I want to WANT to shower, do something I enjoy and earn money, be able to help others less fortunate. Nobody wants to feel like they are worthless. But my brain tells me I am. When I'm not depressed, I don't feel worthless. I may not have the best self-esteem in the world, but I don't feel useless or worthless.

I imagine he lives with massive guilt every day, as do I, that he isn't "pulling his weight" and feels like a total failure. The symptoms of depression contribute to further depression. Vicious cycle. And if one has to be hospitalized, or even when one comes to the realization that they do have depression and need help, it's depressing and for some reason, adds to feelings of helplessness and feeling powerless. And to answer your question, absolutely one can be in denial about depression. Pride and denial go hand in hand.

I don't have any idea how I would expect my husband to handle everything alone if I refused to seek help. It took me ending up in a hospital (and you said you had already been down that road) for me to realize what my depression was doing to both of us.

At this point, he has to see a therapist, at minimum and if that isn't enough, a psychiatrist. I agree that if you are in therapy together since you can ask him questions and get his answers in front of someone you're paying to be unbiased and help you both, is ideal. Also, he may be able to learn to trust his therapist once he finds one that he clicks with, which is so important in recovery. A therapist may also be able to discuss psychiatry if it comes to medication being part of his treatment plan. It also helped to hear someone say that medication may not always be necessary, and I don't necessarily have to take it forever. It just depends on what's ahead and how I deal with it.

I hope this helped, and hope you have a good rest of the day. <3