En español | For some people, feelings of anxiety, uncertainty and sadness have grown persistent during the COVID-19 pandemic, as the outbreak has kept many of us confined to our homes and separated from friends and family — and the world as we know it has been upended.
But how do you know whether what you're experiencing is a normal reaction to a bad situation or clinical depression that should be treated?
"The blues come and go. They don't last for two weeks,” says Vaile Wright, a clinical psychologist and senior director of health care innovation at the American Psychological Association. “That's your hallmark.”
Depression may be inherited, and for some people it's a lifelong presence whose severity ebbs and flows. Sudden stressful experiences can trigger bouts of serious depression, says New York-based psychologist Deborah Serani, author of Depression in Later Life. She notes that situations such as a job loss, death of a loved one, illness, home strife and, yes, the current quarantine can “raise the stress levels of cortisol, acetylcholine and norepinephrine, and deplete feel-good hormones like serotonin and dopamine. As a result, you can get irritable and depressed."
According to the National Institute of Mental Health, if you or a loved one experience the following signs and symptoms for most of the day nearly every day for at least two weeks, you may be depressed:
- Persistent sad, anxious, or “empty” mood
- Feelings of hopelessness, or pessimism
- Feelings of guilt, worthlessness or helplessness
- Loss of interest or pleasure in hobbies and activities
- Decreased energy or fatigue
- Moving or talking more slowly
- Feeling restless or having trouble sitting still
- Difficulty concentrating, remembering or making decisions
- Difficulty sleeping, early-morning awakening or oversleeping
- Appetite and/or weight changes
- Thoughts of death or suicide, or suicide attempts
- Aches or pains, headaches, cramps, or digestive problems without a clear physical cause and/or that do not ease even with treatment
Because common symptoms of depression include fatigue and irritability, the illness can sometimes be misdiagnosed as dementia or attributed to a grumpy personality in older adults, says Wright. Sometimes “depression can look like crankiness,” she adds. “But depression is not just a part of aging, it's a disease."
And Pavan Madan, M.D., a psychiatrist with Community Psychiatry based in Davis, California, says, “Anytime someone 60 or older comes with any complaint of memory loss, my first thought is that they may be depressed.” He notes that depression can appear as “pseudo dementia,” in some patients, “and when we treat their depression, their memory improves a lot."
Less well-known symptoms may include a dulling of the senses, excessive quietness or stillness and feelings of physical or emotional numbness.
Clinical or situational?
Situational depression differs from clinical depression in that once the situation changes, so do the depressive symptoms. To determine if your depression is clinical, ask yourself these questions:
- How did I feel prior to this situation? (In the case of the coronavirus outbreak, if you were doing well before the pandemic, chances are your depression is situational.)
- Do I often find myself feeling depressed during stressful times? (If the depression lifts when the stress subsides, it's probably situational.)
- During difficult times, does hopeful news lift my spirits? (Clinical depression is not often eased by hopeful news.)
- Madan says the big question is, are you able to cope? “If you're not functioning well, if you're not doing your job, if you're not able to pay attention to things, if you're up all night crying a lot, if you're breaking down, if you're getting into fights with your friends, then that's when I really feel like people should seek out help, because their functioning is impaired."
Regardless of the source or type of depression, don't be reluctant to consult a mental health professional if you're struggling. Depending on the severity of the depression, treatment options that a professional may suggest include lifestyle changes, psychotherapy or cognitive behavior therapy, which involves working with a therapist to change patterns of distorted, negative thinking, as well as medication. Madan says that if symptoms are mild, you could start with lifestyle changes. “One of the best treatments we know in terms of lifestyle changes is exercise,” he adds.
When depression is mild to moderate, says Madan, “I start introducing the idea of doing cognitive behavior therapy and possibly adding medications if things are not improving.” If depression is more severe, he will consider suggesting a combination of treatments.
In addition to counseling sessions and any other indicated medical treatment, it's important to focus on key contributors to well-being during difficult times: exercising, eating right, maintaining a regular sleep routine and getting fresh air every day, even if that just means opening the windows and letting in some sunlight. If you can take a walk outdoors safely, do so: “Nature is soothing and helps lift our mood,” says Parulekar. If your mobility is limited, look for simple stretching exercises online that require no more equipment than a chair.
But if you — or a loved one — haven't slept for a week, have hardly eaten, are feeling aggressive or are having thoughts of suicide or self-harm, experts say, call your doctor or 911 immediately.
"Emergency rooms are open for all of us in emergencies, not just COVID-19 patients,” says Manisha Parulekar, M.D., division chief for geriatrics at Hackensack University Medical Center in New Jersey. “Please call and let us make that decision.”
You can also call the National Suicide Prevention Lifeline 24/7 at 800-273-8255.
How to help others
"Right now it's important for all of us to be vigilant about monitoring ourselves or loved ones for depression,” says Parulekar. Those predisposed to depression are often advised to spend time outside and to socialize more — things that are limited during the pandemic, she says.
If you're worried about loved ones who seem seriously depressed, check in on them every day, either by phone or video call, especially if they're living alone. If they are in an assisted living facility or nursing home, sometimes staff can assist with technology.
"If it seems as if they're not interested in the conversation, or their behavior seems off, the family should be concerned and ask more questions,” says Parulekar.
And don't be afraid to ask someone you're concerned about whether they are having thoughts of suicide. “Asking about suicide is not going to put the idea in their head,” says Wright. “If they're thinking about it, they were already thinking about it. Asking can save a life."