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Combatting Depression During the Pandemic

Combatting Depression During the Pandemic

There has been so much going on lately surrounding the pandemic and more that is affecting our mental state because it is affecting us. There will not be a sudden shift returning to things as they were but instead a more gradual move to what will be. What changes there will be are yet to be determined, but there will be an other side to what we are currently experiencing.

Some have asked how our current situation is affecting my patients. Having a general psychiatric practice allows me to hear what my patients are thinking. Themes emerge that have caused distress for all of us and frequently exacerbated symptoms for those already struggling with emotional strain.

One recurring theme among my patients and professional colleagues, is how do we combat depression during the pandemic?

Many people have been taken out of their typical structure and yet continue with even more responsibilities than ever. People have been forced to juggle work, unemployment, home life, family and friends all without their familiar support and stress relievers. One way to ponder the “other side” is to think in terms of how to remain or return to functioning at our previous level.

Depression is a serious illness that continues to be a significant health concern. Unfortunately, people with depression frequently struggle more with multifaceted stress, which can be initiated in this context or made worse.

We know that with increased unemployment, there is an increase in suicide, and previously existing depression worsens this situation. This is a complicated position. We are looking for options to make symptoms better and improve functioning in personal life and employment. We, as individuals and as businesses, want a return to the best functioning possible.

When depression is present, it is essential to get the help that is needed. It can start with taking care of oneself with exercise, nutrition, socialization and mindfulness, but may require professional help. Options to combat depression include psychotherapy and/or medications as an initial approach. However, many times these approaches are not successful, and treatment-resistant depression is present.

When people struggle with this depression, it interferes with the ability to function. It is critical to seek treatment so functioning can improve, and someone can be a parent, partner, employee or friend to the best of their ability.

There are alternatives for depression treatment beyond psychotherapy or antidepressants that prove ineffective, ranging from minimally invasive to non-invasive options.

TMS Therapy: Non-invasive, Medication-free Transcranial Magnetic Stimulation (TMS) Therapy is a non-invasive neuromodulation option that is medication-free. TMS Therapy was cleared by the FDA in 2008 to treat depression when a person has not responded to an antidepressant. TMS technology involves using an MRI-like magnetic pulse to simulate the left dorsolateral prefrontal cortex, a part of the brain that is not functioning optimally in depression. TMS Therapy is an outpatient procedure that is effective, safe and durable in numerous studies. It is well tolerated and has no systemic side effects.

Esketamine: Minimally Invasive, Medication-prescribed Esketamine has been cleared as a pharmacologic treatment for depression when a person has not responded to medications. The therapy involves nasal administration of esketamine and the addition of a new antidepressant regiment.

ECT: Invasive, Sedation required Electroconvulsive Therapy (ECT) or more commonly known as “shock therapy,” is an invasive neuromodulation technique. ECT involves anesthesia and sedation, then applying a generalized seizure.

Vagal Nerve Stimulation: Invasive, Surgery and Sedation required VNS is a surgical procedure that involves placing a device in the chest that stimulates the Vagus nerve through electrical impulses, stimulating the brain.

With all the treatment options available, advances in medicine and technology, relief from depression is possible, even during this period of great uncertainty. There is so much happening that’s out of our control, one thing that we can control is if and when to seek help if you or a loved one is suffering from depression.

With the complications associated with depression affecting our personal and professional lives, it is imperative to find ways to improve mood. We and our workplaces would be well served to advocate aggressive depression treatment so that we are all as healthy as possible, can cope well and be productive, once we reach the “other side.”


Depression Has Skyrocketed During the COVID-19 Pandemic, Study Says

A lmost as soon as coronavirus lockdowns went into effect in March, discussion turned to mental health. It&rsquos well-documented that natural disasters, wars and other mass traumas can lead to significant increases in population-wide psychological distress. Weeks or months of anxiety, fear, sadness and social isolation can take their toll, leading many experts to fear the U.S. would face a mental health epidemic at the same time it fought a viral pandemic.

Now, a study published in JAMA Network Open offers one of the first nationally representative estimates of how severe that epidemic may be: Three times as many Americans met criteria for a depression diagnosis during the pandemic than before it, according to the paper.

A pre-pandemic survey of about 5,000 American adults found that 8.5% of them showed strong enough signs of depression (including feeling down or hopeless loss of interest in things that normally bring joy low energy trouble concentrating or thinking about self-harm) to warrant a probable diagnosis. When researchers surveyed almost 1,500 American adults about their mental health from March to April of this year, that number rose to almost 28%. Even more people&mdashalmost an additional 25%&mdashshowed milder signs of depression.

Logically, people were more likely to suffer symptoms of depression during the pandemic if they experienced &ldquoCOVID-19 stressors,&rdquo including losing a job, the death of a loved one or financial distress. People who said they had less than $5,000 in savings were also about 50% more likely to suffer from depression than wealthier people, the researchers found. In keeping with usual demographic trends, women were more likely to experience depression than men, and single people were more likely to experience depression than married couples.

But trends only go so far. Anyone&mdashregardless of race, gender, relationship status or income&mdashcan experience mental health issues during something as traumatic as a pandemic. Small lifestyle tweaks can help. Getting enough sleep and exercise go a long way, and studies have shown that meditation and yoga can have a positive effect on psychological well-being. Social support is also crucial, even if it happens virtually.

It&rsquos also easier than ever to seek mental health care if you need it. Teletherapy is surging in popularity during the pandemic, making it easier to see a clinician from home. If you need more immediate help, there are also hotlines that can provide support. If you or someone you know may be contemplating suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255 or text HOME to 741741 to reach the Crisis Text Line. In emergencies, call 911, or seek care from a local hospital.


Psychological Resilience and Depression during the Covid-19 Pandemic in Turkey

Background: Turkey is one of the countries affected during the period of COVID-19 outbreak. The purpose of the current study is to investigate psychological resilience and depression in individuals during the period of COVID-19 outbreak in Turkey in relation to different variables. The study also aims to explore the relationship between psychological resilience and depression.

Subjects and methods: The current study was conducted on a total of 518 people over the social media through the Google e-forms. In the study, the "Short Psychological Resilience Scale" and the "Beck Depression Scale" were used to collect data. In the analysis of the collected data, t-test, One Way Anova, Mann-Whitney U Test, Kruskal Wallis-H Test, Pearson Correlation Coefficient were used.

Results: In the current study, psychological resilience and depression were investigated in relation to different variables. Psychological resilience was found to be higher male participants, educators,university graduates and groups with not mental health problems. Depression was found to be higher females, university students, high school and lower graduates,with mental health problems. When the relationship between psychological resilience and depression was investigated, it was found that there is a medium and negative correlation between them. Moreover, the cut-off point for the depression score was set to be 17 and the rate of the people having 17 points or higher scores was found to be 16.6%.

Conclusion: In light of the findings of the current study, it can be suggested to offer more mental health care services to those having higher levels of depression. Studies can be conducted to improve online psychological support services. A medium and negative correlation was found between psychological resilience and depression in the current study, which shows that more importance should be attached to activities to improve psychological resilience.


Factors associated with depression, anxiety, and PTSD symptomatology during the COVID-19 pandemic: Clinical implications for U.S. young adult mental health

This study sought to identify factors associated with depression, anxiety, and PTSD symptomatology in U.S. young adults (18-30 years) during the COVID-19 pandemic. This cross-sectional online study assessed 898 participants from April 13, 2020 to May 19, 2020, approximately one month after the U.S. declared a state of emergency due to COVID-19 and prior to the initial lifting of restrictions across 50 U.S. states. Respondents reported high levels of depression (43.3%, PHQ-8 scores ≥ 10), high anxiety scores (45.4%, GAD-7 scores ≥ 10), and high levels of PTSD symptoms (31.8%, PCL-C scores ≥ 45). High levels of loneliness, high levels of COVID-19-specific worry, and low distress tolerance were significantly associated with clinical levels of depression, anxiety, and PTSD symptoms. Resilience was associated with low levels of depression and anxiety symptoms but not PTSD. Most respondents had high levels of social support social support from family, but not from partner or peers, was associated with low levels of depression and PTSD. Compared to Whites, Asian Americans were less likely to report high levels across mental health symptoms, and Hispanic/Latinos were less likely to report high levels of anxiety. These factors provide initial guidance regarding the clinical management for COVID-19-related mental health problems.

Keywords: Anxiety COVID-19 Depression Ethnicity PTSD Psychological stress, Loneliness Social support University health services.


This pandemic has become a health crisis in more ways than one. COVID-19 is a clear threat to our physical health, but the feelings of fear, uncertainty, and isolation it's led to have also created a very real mental health crisis, especially coupled with other traumatic events over the past few months: graphic displays of police brutality against Black people, devastating natural disasters, and heightening political unrest. Recent studies are already showing the effects on our mental health. By mid-April, according to a Boston University study, rates of depression symptoms had already tripled compared to pre-pandemic levels. Another study revealed that younger adults, racial minorities, essential workers, and unpaid adult caregivers reported worse mental health outcomes, increased substance abuse, and elevated suicidal ideation due to the pandemic.

"This is a very, very difficult time," Chevonna Gaylor, LMFT, a Los Angeles-based therapist, told POPSUGAR. "For people who have already struggled with depression, it's going to be worse. With people who have never experienced depression, they may now be struggling. We're going to see a heightened experiencing of depression, anxiety, and PTSD, at the very least."


Anxiety and depression in the Republic of Ireland during the COVID-19 pandemic

Background: The COVID-19 pandemic in Ireland resulted in a nationwide quarantine on March 27, 2020. This study represents the first assessment of rates of anxiety and depression in the general population of Ireland during the pandemic.

Aims: Our first aim was to estimate the probable prevalence rates of generalized anxiety disorder (GAD) and depression and to identify sociodemographic risk factors associated with screening positive for GAD or depression. Our second aim was to determine if COVID-19 related anxiety was highest amongst those in society at greatest risk of morality from COVID-19.

Method: Self-report data were collected from a nationally representative Irish sample (N = 1041) online between March 31 and April 5 the first week of the nationwide quarantine measures. Recognized cut-off scores on the GAD-7 and PHQ-9 were used to estimate rates of GAD and depression. Correlates of screening positive for GAD or depression were assessed using logistic regression analysis.

Results: GAD (20.0%), depression (22.8%) and GAD or depression (27.7%) was common. Screening positive for GAD or depression was associated with younger age, female sex, loss of income due to COVID-19, COVID-19 infection and higher perceived risk of COVID-19 infection. Citizens aged 65 and older had significantly higher levels of COVID-19 related anxiety than adults aged 18-34.

Conclusions: Initial results from this multi-wave study monitoring changes in population anxiety and depression throughout the pandemic indicate that GAD and depression were common experiences in the population during the initial phase of the COVID-19 pandemic.

Keywords: COVID-19 anxiety coronavirus depression mental health.


Conclusions

Finally, this review also acknowledges the implications for guideline and policies on different populations and therefore, (1) efforts to improve engagement of policy makers may be beneficial to address mental health outcomes during public health emergency and (2) civil society and human rights champions (including lived experience representatives), health care providers, and policy makers should work together to identify the policy, services, and interventions that enforce human rights which have a lasting impact on mental health of key populations during emergencies. We will be better served to understand the tradeoffs and the reciprocating relationships among physical health, mental health, human rights, and individual rights, that there could be better statements in global reports of values-driven, shared objectives in light of these tradeoffs and relationships, and a more thorough consideration of many relevant areas of science (including but not limited to, infectious disease) to establish a policy that strikes the most acceptable balance.


‘Coronaphobia’: Covid anxiety has a name. Here’s how to cope.

We’re living in a time when every little cough, sniffle, olfactory or circulatory problem can elicit a knee-jerk bout of worry: Is this the beginning of covid-19? For some people, however, it’s more than a fleeting concern: Experts say and research shows that the pandemic has triggered a surge in health anxiety. In fact, health anxiety related to the coronavirus has been given its own name: coronaphobia.

“People are very concerned and anxious about getting covid,” says Lynn Bufka, a senior director at the American Psychological Association and a practicing licensed clinical psychologist in Maryland. “We should all have some kind of heightened vigilance about protecting ourselves, but for some people, [the anxiety] is out of proportion to the actual risk and generally disrupts life.”

Health anxiety is defined as worries and anxiety that relate to a perceived threat to your health. It exists on a continuum and can be a facet of several psychiatric illnesses, including hypochondriasis (now called illness anxiety disorder).

“Health anxiety relates to the belief that bodily sensations or changes are due to some disease process,” says Gordon Asmundson, a professor of psychology at the University of Regina in Canada and co-author with Steven Taylor of “It’s Not All in Your Head: How Worrying about Your Health Could Be Making You Sick — and What You Can Do About It.” During such viral outbreaks as the coronavirus, for example, people with high health anxiety may misinterpret post-exercise muscle aches or a bout of coughing as telltale signs that they’re infected, which in turn increases anxiety and can bring on stress-related symptoms.

Although having some anxiety about your health is beneficial, because it can motivate you to take smart steps to protect it — such as wearing a mask, maintaining social distance and frequently washing your hands — too much can tilt the balance into troublesome territory. “People with excessive levels of health anxiety engage in lots of checking behaviors, such as taking their pulse or temperature, or they engage in reassurance-seeking and often go from doctor to doctor seeking reassurance,” explains Taylor, a professor and clinical psychologist at the University of British Columbia. “Reassurance can be like a drug of addiction. It can perpetuate the problem.”

Health anxiety also can lead people to frequently search the Internet to see if their symptoms match whatever illness they’re afraid they might have. “That’s a real problem, because Dr. Google will pop up with scary diagnoses or things that could be wrong,” Taylor says. “It’s going down a rabbit hole: You check one thing, and that can lead you to another, and you can end up scaring yourself even more.” Research has found that people have a tendency to engage in disease-related “query escalation” during Internet searches, which can cause health anxiety to build.

In addition, health anxiety can interfere with sleep, especially if an endless loop of what-if scenarios plays in your mind. It can trigger physical symptoms, such as a rapid heart rate, shallow breathing, headaches and stomach distress. And it can interfere with your daytime quality of life, impairing your mood, concentration and ability to enjoy normally pleasant activities. “It becomes a concern when the worry and preoccupation are out of proportion to the actual risk, or if it interferes with your ability to do other things — such as work, school or being a parent — in life,” Bufka says. At this point, you should definitely take steps to quell your health anxiety.

People who are susceptible to health anxiety may have grown up with general feelings of anxiety or vulnerability, relatives with the condition, or exposure to certain behaviors, Asmundson says. If your parents constantly fretted about their digestion or excessively fussed over you when you had a cold, for example, you may be more likely to perceive yourself as fragile or to closely monitor your body for changes and develop health anxiety.

Research has found that adults who have a greater intolerance for uncertainty tend to have higher health anxiety during a pandemic (such as the 2009 H1N1 pandemic). And a December study found that people prone to feeling pre-pandemic disgust and those who have high perceived stress levels are especially susceptible to coronavirus anxiety.

Although you might think that the availability of coronavirus vaccines would ease health anxiety, that’s not necessarily true. People with health anxiety may worry about the vaccines’ safety, Taylor says, or about the possibility of having an adverse reaction to being vaccinated. Those eager to get a vaccine may experience anxiety as they wait until they become eligible or can secure an appointment for it. Adding to these worries, Bufka says, is the fact that questions about the vaccines remain unanswered, such as “how soon people will need to be vaccinated again, and how much the vaccines will lead to immunity in the community.”

The good news is that you can get a grip on health anxiety on your own or with professional help. Here’s how:

Stick with a healthy lifestyle

Consume a healthy diet, get enough sleep, stay connected to others (even if it’s from afar) and exercise regularly. Although people with severe levels of health anxiety may avoid exercise because it makes them physically uncomfortable, Taylor says, that only compounds the problem. “Physical deconditioning kicks in very quickly,” he says, which can bring on other worrisome symptoms, such as an elevated heart rate or shortness of breath after climbing stairs. By contrast, research shows that aerobic exercise, especially high-intensity exercise, such as jogging, can have a significant and rapid effect in lowering anxiety.

Practice mindful acceptance

When you feel worry flaring up, “sit with your health anxiety, accept that it’s there and put it in a mental box, so you can proceed with your life,” Bufka says. Or, try writing your health worries in a notebook, then closing the notebook and consciously switching your attention to something else. With practice, you can train yourself to set aside your concerns.

Calm your nervous system

“If you learn how to control your autonomic nervous system activation — the flight-or-flight response — it puts you in more of a business-as-usual mode, rather than a danger mode, which can help with health anxiety,” Asmundson says. You can do this with paced diaphragmatic breathing (slowly inhaling through your nose for two counts, pausing for one or two counts, then exhaling for two counts your belly should rise and fall with each breath), progressive muscle relaxation (systematically tensing then relaxing specific muscle groups) or meditation.

Refrain from excessive checking behaviors

Repeatedly monitoring your temperature or sense of smell for covid-19, or searching your skin for signs of cancer, isn’t going to do you any favors. If you become so vigilant about checking a raised mole or a swollen lymph node, for instance, you could irritate it with all your poking and prodding — and become more convinced that it’s a sign of a serious illness, warns Jonathan Abramowitz, a professor of psychology and director of the Anxiety and Stress Disorders Clinic at the University of North Carolina at Chapel Hill. If you have truly worrisome symptoms, such as dizziness, fainting or a persistent lump in your breast or groin, by all means, see a trusted doctor and follow their advice. But don’t hop from one doctor to another seeking reassurance, and don’t spend hours searching health information online. To avoid these checking behaviors, stay off the Internet when you’re not working and/or keep your hands and mind busy with activities such as coloring, knitting or reading in your free time.

Change your mind-set

The way you think about bodily sensations and your overall health can provoke anxiety or dial it down, experts say. For example, focusing on negative symptoms or jumping to catastrophic conclusions can increase health anxiety. You can break these patterns with cognitive reframing: questioning your anxious thoughts and trying to create a more realistic assessment of your health, Bufka says. To do this, take a particular thought (I’ve been exhausted this week, so I must be getting sick) and consider other ways of looking at the situation (I’ve been working hard and skimping on sleep, so that’s why I’m wiped out).

Seek professional help

If you can’t reframe anxious thoughts on your own, cognitive behavioral therapy (CBT) can help, Abramowitz says. And don’t fret about having to physically meet with a practitioner: A September study that compared online with face-to-face CBT treatment for health anxiety found that the Internet version was as effective as in-person sessions, and cost less. (To find a reputable CBT professional, Abramowitz suggests turning to the Association for Behavioral and Cognitive Therapies or the Anxiety and Depression Association of America.) If a therapist can’t help, consult a psychiatrist experts say that some people with intense health anxiety can benefit from taking an SSRI antidepressant.

If you think you might have coronaphobia, and one of your worries is that this problem is destined to be with you for life, keep this in mind: “Health anxiety can be transient,” Taylor says. “Just because you’re experiencing health anxiety during the pandemic doesn’t mean it’s going to become a long-term problem.” The key is to take steps now to manage it and prevent it from becoming entrenched.

Illustrations by Asia Pietrzyk. Edited by Elizabeth Chang. Copy edited by Rachael Bolek. Designed by Victoria Adams Fogg.


Find Sources of Comfort

Finding ways to give yourself comfort even when you are feeling lonely can help to improve your mental health. Below are some ideas of "comfort measures" that you can take even if you are alone.

  • Give yourself a foot massage or use a foot spa.
  • Take a bath.
  • Focus on your pet.
  • Cook healthy comfort food.
  • Watch favorite TV shows or read favorite books.
  • Have a cup of herbal tea (chamomile will help you to relax).
  • Light scented candles (lavender will help to reduce stress).
  • Practice sleep hygiene to make sure you are getting enough rest.

Winter triggers

Winter, especially during the pandemic, brings additional challenges that can tax our mental health.

These may include:

    Cold weather. Being outside is something we rely on to help maintain our emotional wellbeing. “People may not feel they can access that respite,” Wright said.

“We’re carrying the stress, anxiety and anticipation of multiple things that are all coming to a head at once,” Weingarden said.