For more than two years now, all of us have had to deal with major disruptions in our lives. Coronavirus changed the way we live almost overnight. What’s more, every time we’ve thought it might be coming to a close, we discovered we were mistaken. Omicron may not be the last or the worst variant we will have to face. It is hardly surprising that a lot of people are fearful. Many also have to deal with depression and manage anxiety as their life circumstances change dramatically.
Social Distancing and Working from Home:
No matter how challenging your job, interacting with people at the workplace can be rewarding. That’s true even if it is just to talk about the latest sports event or movie. But now most sporting events are on hiatus. And very few people are going to the movies. People who can work from home are supposed to do so, although the uncertainty of back-to-work or back-to-school rules can be maddening.
Most people can probably handle social isolation for a short period of time. However, as it stretches on indefinitely, it can make many people feel quite anxious. Email, Facebook, Twitter and Instagram are no substitutes for real-time human contact. Relying on technology for connection can be dehumanizing.
GAD=Generalized Anxiety Disorder
A physician friend, who is one of the least anxious people we know, admits that COVID-19 plus politics have given him generalized anxiety. He is having a hard time focusing. Because this is so unusual for him, it is making him especially uncomfortable.
When asked if there was a way to measure anxiety, our friend referred to the GAD-7 scale. It was published in JAMA Internal Medicine (May 22, 2006) and is still relevant today.
GAD stands for “generalized anxiety disorder.” The “7” in the GAD-7 scale stands for a 7-item anxiety scale. The article asks people how often they have been bothered by the following problems during the last two weeks. Here are the issues:
1. Feeling nervous, anxious or on edge
2. Not being able to stop or control worrying
3. Worrying too much about different things
4. Trouble relaxing
5. Being so restless that it is hard to sit still
6. Becoming easily annoyed or irritable
7. Feeling afraid as if something awful might happen
Each issue has a rating from 0 (“not at all”) to 3 (“nearly every day”). We won’t make you more anxious than you already are by telling you what the “cut point” is for a diagnosis of generalized anxiety disorder. If you must know, though, here is a link to the study results.
The point is that almost everyone is feeling anxious these days. Between the news and the social isolation, it is hardly any wonder that people are having trouble relaxing. It’s not unreasonable to be “feeling afraid as if something awful might happen.” Sadly, plenty of awful things have already occurred.
How to Manage Anxiety and Deal with Depression:
What is our physician friend doing to manage anxiety? First, he is experiencing great empathy for his patients who suffer from this all the time! He now knows what they go through. Now we can all better empathize with those who have anxiety every day of their lives.
Next, this doctor is finding time to breathe deeply. He is also exercising regularly and finding time to practice mindful meditation. Should you be interested in some online assistance, here are some links:
“3 Easy Mindfulness Meditation Techniques“
“How to Meditate” By David Gelles for the New York Times “Well”
“Dr. Emmett Miller: Creating Your Island of Peace Meditation”
We have been recommending Dr. Emmett Miller’s relaxation audio and video recordings for decades. That’s because we think Dr. Miller has more experience than almost anyone else in this field. He also has a relaxing voice. His “Island of Peace Meditation” is only a few minutes and will introduce you to this practice quickly and easily. We all need an island of peace these days.
Exercise to Manage Anxiety:
Swedish researchers report that exercise can help alleviate symptoms of anxiety (Journal of Affective Disorders, Jan. 15, 2022). In the study, 286 patients with anxiety syndrome drew lots for assignment to group exercise or a control group that got advice on physical activity. There were two exercise groups–one with moderate intensity aerobic and strength training, and the other at high intensity. Group exercises were an hour at a time three times a week. The study lasted three months. According to the researchers, the more people exercised the better they felt. Exercisers also saw significant improvements in their symptoms of depression.
Drugs to Deal with Depression:
Workplace stress, worries about coronavirus or political rancor can also distress people. In addition, a diet full of processed foods may affect mood in a negative way.
Whether or not more people are depressed, prescriptions for antidepressants have been on the rise. By our calculations, more than 37 million Americans are on medications like sertraline, escitalopram, bupropion, trazodone or fluoxetine. Many health professionals seem to believe that the easiest way to deal with depression is to write a prescription.
Some people do very well with antidepressant drugs. Others may need to try several before they find one that works for them.
One large well-designed study, the STAR*D trial, found that about one quarter of patients responded to the antidepressants bupropion, sertraline or venlafaxine after they did not get better on citalopram (New England Journal of Medicine, March 23, 2006).
This study (Sequenced Treatment Alternatives to Relieve Depression) showed that most of the antidepressants they tested worked about as well as the others. Unfortunately, only about half the patients in the trial ultimately got better.
Antidepressant Side Effects:
We conclude that some people are exposed to possible drug side effects without getting the benefits they expected. The most popular category of antidepressants, the selective serotonin re-uptake inhibitors (SSRIs), can cause insomnia, restlessness and agitation. Drugs like fluoxetine, paroxetine and sertraline can also cause digestive distress, fatigue, dizziness, headache and sexual dysfunction. (Medical Letter on Drugs and Therapeutics, Feb. 24, 2020).
Other antidepressants can also cause adverse reactions. SNRI medicines like desvenlafaxine, duloxetine and venlafaxine have similar side effect profiles to the SSRIs, but they may also cause sweating, constipation, rapid heart rate, elevated blood pressure and difficulty urinating.
“Discontinuation Syndrome” aka Withdrawal:
One reason so many people may be on antidepressants is that they are hard to get off! Stopping such medications suddenly can lead to unpleasant symptoms that go away if the person starts taking the medicine again. Nervousness, anxiety, sensations like electric shocks, dizziness, confusion, insomnia and bouts of unprovoked crying can be hard to handle.
Doctors might prescribe other antidepressants such as bupropion or mirtazapine. Older medicines such as amitriptyline can be effective in some cases, but they can also be hard to tolerate. They may cause anticholinergic effects such as dry mouth, urinary retention, constipation and blurred vision. There is growing concern that anticholinergic drugs may affect the brain and increase the risk for dementia. Here is a link to a comprehensive list of anticholinergic drugs.
Other Non-Drug Ways to Deal with Depression:
Cognitive Behavioral Therapy:
Are there any helpful non-drug alternatives for people suffering with depression? Cognitive behavioral therapy has been shown to be useful (Trends in Psychiatry and Psychotherapy, March 2, 2020). Another approach that can help is exercise (Journal of Affective Disorders, Sep. 15, 2016). Not surprisingly, it works nearly as well to deal with depression as with anxiety.
Light Therapy:
Bright light therapy, frequently used for seasonal affective disorder that occurs in the winter months, can also help relieve depression at other times (Chronobiology International, April 2014). Finally, a Mediterranean-style diet rich in vegetables, fruit, fish and lean meat can help reduce symptoms of depression (PLOS One, Oct. 9, 2019). Any of these nondrug approaches could be combined with the others or with an antidepressant.
We received this testimonial from an individual who found both these non-drug approaches useful.
Combining Non-Drug Approaches:
Q. Beginning in my 30s, I tried a variety of prescribed antidepressants. The results were uniformly disastrous. When I was 50, I found a psychiatrist who diagnosed me with seasonal affective disorder (SAD) and prescribed a light box. It’s been life changing.
I would encourage people who have problems with depression, especially if it’s more serious in the winter months, to investigate light boxes. Mine has been a huge help for over 20 years. I also found a counselor who used CBT (cognitive behavioral therapy), but for me it was an adjunct to the light box.
A. Bright light therapy (BLT) has been used to treat SAD for at least three decades. A review of 19 randomized controlled trials found such treatment to be effective (Psychotherapy and Psychosomatics, Jan. 2020). Thank you for reminding us that some people find light therapy to be quite helpful when they must deal with depression.
Learn More:
You may find our eGuide to Dealing with Depression of additional help. You can find this online resource in the Health eGuide section of this website. In addition, you may find Show 1271: New Approaches to Managing Depression worth a listen.
