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What are the mental health impacts of this pandemic?

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While there are many examples of love and connection all around us every day, the loss of lives and of economic stability for so many throughout the world related to the COVID-19 pandemic has been devastating.  Compounding what has already been an unsettling and challenging time of heightened stress and change for all of us, recent violent and tragic losses of our black and brown brothers and sisters and recognition of how far our country needs to come to begin to address the discrimination at the root of so much suffering has deepened feelings of anger, helplessness and despair. We have been hearing many of our patients apologize for bringing us their concerns about what they perceive as more minor mental health struggles in the face of such devastation around them.  But it is important to recognize that even in the homes where our own personal health and that of our loved ones has been preserved, the sadness, anger, fear, numbness and anxiety that so many of us have felt is very real for all who experience it, and is increasingly common.  For some of us, these feelings may be new.  For others, they may be all-too-familiar signs of a known history of clinical depression.  

Symptoms of depression are common after a traumatic event.  In medicine, to help differentiate between depression and periods of grieving, such as after the death of a loved one, we are more concerned about depressive symptoms if they last six weeks or longer.  This distinction is problematic during the pandemic, as the social isolation, economic stressors and infection risks have been long-lasting and, for many, appear likely to be present for a while. “Our nation is under stress. It may be that more people need [medical] treatment. It may be that we need to, as a population, do more to relieve the stress,“ says Jennifer Leiferman, a researcher at Colorado School of Public Health featured in a recent article on the topic in the Atlantic.  Leiferman is one of many in the medical community who have seen a tidal wave of depressive symptoms in the US since the pandemic began.   Before this year, approximately 5-7% of people met the criteria for a diagnosis of depression.  Given the somewhat subjective nature of the diagnosis, depending on how you define the condition, orders of magnitude more people are now meeting diagnostic criteria.  A recent Lancet study estimated about 50% of the US population is currently experiencing depressive symptoms.  Feelings of hopelessness, powerlessness, numbness, excessive fatigue and sleep problems are now so common many seem to consider them the new normal.  This creates a diagnostic conundrum for patients and their providers – how do we know when these symptoms are a normal part of grieving and adjustment vs when these symptoms have become something more that should be discussed with a medical professional?

For those who have had a clinical diagnosis of depression before, the risk of developing a clinical depression again is higher.  We recommend those of you in this category reach out early to your doctor or therapist if you are experiencing depressive symptoms.  For those on the other end of the spectrum, who are experiencing less frequent and more fleeting depressive symptoms, who are able to find enjoyment in activities you typically enjoy and who wake up most days feeling like you are ok, symptoms are more likely to return to their baseline eventually, as long as they are addressed.  Talking with loved ones about how you’re feeling, making sure to create daily time and space for social connection (via Facetime or socially-distanced in-person time) and healthy living such as adequate sleep and exercise, will be helpful.  And if things don’t improve or if you or a loved one is worried about your symptoms, call your doctor. For those who are experiencing more consistent depressive symptoms, give your doctor a call.  It may be that urgent, basic interventions that help create healthy routine and structure will be enough – this might involve creating more of a normal schedule around sleep and food, minimizing alcohol and other substances, exercising, avoiding the news and cutting back on aimless habits that might have emerged that were easier to moderate in normal times.  But it may be that additional medical care is needed.   

We are living in complicated times.  Know that no matter what category you fall into above, you are not alone.  And know that we are here for you.

(Jennifer Abrams, MD, June 8, 2020)