Possible Implications of the Novel Coronavirus for Mood Disorders

By Merry Noel Miller, M.D.

Feelings of anxiety, despair, and even suicidal thoughts may increase during the current pandemic.  These feelings are especially likely to develop among those who are more vulnerable due to a mood disorder. Some will feel new, intense sadness and difficulty functioning.  Others who already experienced depression, anxiety, or bipolar disorder find their conditions worsening at this time. 

We are all being told to “socially distance” ourselves, and some are being told to go into quarantine.  This leads to a level of social isolation that can be overwhelming for some.  The news is dire on every network.  Many people have lost their jobs and may be panicking about how to make ends meet.  Job loss may bring with it the loss of identity, routine, and social network.

We may be unable to access our usual sources of support.  The social distancing rules keep us from experiencing in person the daily conversations with friends and acquaintances that often give meaning to our lives.  Our normal lifestyles have been disrupted, including having children at home all day.  Frayed nerves can lead to increased conflict.  Families who are not used to being together all day may find themselves on edge and fighting more.  Others who live alone may experience intense loneliness. 

So, what can we do to maintain our emotional balance, especially if we already struggle with our emotions due to a mood disorder?

MAINTAIN HEALTHY BEHAVIORS

This is a time when it is essential to attend to the basics of self-care.  We are all under stress, and a mood disorder makes you more vulnerable.

Eat a healthy diet, avoiding excessive sugar or caffeine.  Nutritious food is an important ingredient for mental health.  Eat slowly, savoring your meals.  Strive for a balanced diet and stay hydrated.  Beware of emotional eating during the pandemic. 

Exercise has been shown to be effective in reducing depression and anxiety.  Although gyms and health clubs are now closed, there are still many ways to get exercise.  You may take a walk outside or follow an exercise regimen at home (you can find exercise videos online to follow if you like).  It is also healthy to seek time in the outdoors.  A dose of sunlight promotes wellbeing.  It may be difficult for those with mood disorders to get motivated to exercise, but remember that just taking a walk can boost your mood.

Beware of the temptation to escape your distress through alcohol or drugs.  Many people with depression turn to alcohol for some relief.  They may temporarily feel better and not realize that alcohol is actually making their depression worse.  You don’t have to be an “alcoholic” for alcohol to make you more depressed.  Whether alcohol use comes before or after depression, your mood is likely to improve if you stop drinking.  Some medications are not safe to combine with alcohol.  In addition, other treatments for depression are unlikely to be effective if you continue drinking.   

If you have been prescribed medication for your mood, be sure to take it as directed.  During times of stress such as these, it can be easy to let routines and usual schedules lapse.  Make an effort to give yourself reminders about taking your medication.

Sleep is especially important for those who have mood disorders, and can be easily disrupted at times of crisis (such as the pandemic) when there are many worrisome thoughts that may interfere with relaxation.  Restful sleep is important for emotional well-being, and poor sleep can contribute to depression as well as precipitate mania in those who have bipolar disorder.  For those who have difficulty sleeping, there are a number of ways to improve sleep:

• Avoid drinking alcoholic beverages near bedtime.
• Avoid excessive caffeine intake, especially in the evening.
• Exercise early in the day, not close to bedtime.
• Develop a sleep routine at bedtime that avoids stimulation, such as taking a warm bath or reading a book that will not affect you emotionally.  Consume foods high in the amino acid tryptophan as a bedtime snack, such as warm milk and bananas. Keep a regular schedule, getting up and going to bed at roughly the same time.
• Sleep in a cool, dark, quiet room.  If you wake at night, get up and leave the bedroom, read or do some quiet activity until you are sleepy again.
• Beware of watching television or working on a computer, tablet, or smartphone in the bedroom since the light from the screen has been shown to be stimulating.
• Avoid daytime napping, which may interfere with your body’s need for sleep at night.
• Go online and learn about Cognitive Behavioral Therapy for Insomnia (CBT-I).
• Consider sleep medication if other approaches are unsuccessful.  One readily available option is the over-the-counter hormone melatonin.

FIND WAYS TO REACH OUT TO OTHERS

It is especially important for those with mood disorders to have connection with others.  The presence of at least one confidante is protective against depression.  Everyone you know is going through this bizarre experience at the same time, so others may appreciate being contacted.  This could be a good time to call friends and family.   Put a priority on conversation.   Stay physically separated but emotionally connected with those you care about.

The availability of social media, the internet, and current methods of communication can help.  Social isolation can be lessened and connections maintained through phone calls, Facetime, texts, e-mails, Facebook, Twitter, Instagram, even letters and cards! 

Many religious services are now occurring virtually, which provides a way to remain in contact with an important source of support for many.  Book groups and other clubs may also choose to continue in this manner, providing both social and intellectual stimulation.   

For those with mood disorders, there has been a rapid shift in services provided by many doctors and therapists such that “telehealth” has become widely available.  This means that you may interact with a therapist, psychiatrist, and primary care doctor from your own home.  If you are already in treatment, be sure to follow your treatment plan or consider increasing the frequency of appointments. For those who find that they are developing suicidal thoughts, know that help is always available.  Seek professional help, and if needed call a Suicide Hotline.

LIMIT INTAKE OF NEWS MEDIA

News about the COVID-19 pandemic has developed so rapidly that some feel drawn to news broadcasts like never before.  The initial confusion about what was happening and what can be done about it has been followed by heart-wrenching images of patients dying alone in hospitals and stories about the unavailability of protective equipment.   

It is important to be informed and to understand our changing world, but excessive exposure to these disturbing stories can lead to emotional distress and agitation, especially for those with mood disorders.  As discussed above, you may find yourself having more difficulty sleeping, which is well-known to make mood disorders worse.  You may benefit from limiting your news exposure, for example to checking on the news briefly once per day.

DIRECT YOUR THOUGHTS

Depression is well-known to be associated with negative thinking.  Interestingly, even those who were previously optimistic may develop more errors in their thinking when they become depressed, and those negative thoughts then promote more depression.  Recognizing these damaging thoughts and consciously substituting more adaptive, positive ideas can have many benefits for your mood.

Journaling may help you to direct your thoughts toward gratitude and hope.  Begin your day with writing down positive ways to spend your day and making a list of all things, no matter how small, that you are grateful for can improve your outlook on life, regardless of circumstances.

Create plans for what you want to do with this time, and adhere to a schedule to gain more sense of control.  Give yourself the opportunity for both necessary tasks and those you would enjoy. Reduce your anxiety by calling to verify the availability of services that you may need (e.g. prescriptions, doctors’ appointments by telehealth).

Despite the social isolation and loneliness that you may now feel, you are not alone.  Be patient and kind to yourself.  We are all experiencing this pandemic, and it will not last forever.  Proactive behaviors can protect your mood during this challenging time.

Merry Noel Miller, MD, is a professor of psychiatry at Quillen College of Medicine, East Tennessee State University. She is the author of Finding Your Emotional Balance: A Guide for Women.