Practical tips and online support can help people with depression, anxiety and other conditions cope.
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Living with depression, anxiety, bipolar disorder, PTSD and other mental health conditions can pose a challenge even in "normal" times.
Then COVID-19 came along. For nearly a month, it's added new twists to life with a mental illness. The inability to see a trusted therapist in person. Added stress about jobs, whether losing one, having to work in public despite the risk of getting sick, or having to adapt to working from home. Worries about getting medication refills on time, or being able to pay for them. Uncertainty about the future.
Challenges that are traumatic enough for Americans without mental health conditions can be doubly so for those who have such conditions – whether they're diagnosed or not, says Michelle Riba, M.D., a professor and psychiatrist at Michigan Medicine.
She and her colleagues have put together a free online toolkit to help people with a broad range of mental health conditions understand how the COVID-19 situation may affect them, and offering guidance on how to adapt and cope.
Even if someone hasn't received a formal diagnosis of anxiety or depression, the stress and social distancing requirements of the coronavirus pandemic may make their mild symptoms worse, or tip the balance into more full blown episodes, Riba notes.
"This pandemic has set up a perfect storm of people having stress and anxiety, and not having the usual ways to talk and connect with people about it," she says. "We can't go for coffee or chat at the office water cooler about what we're feeling, and that can make people feel worse than they were already."
The U-M Depression Center, of which Riba is associate director, offers a free online Depression Toolkit that can help anyone recognize, manage and support others with signs of depression.
Special advice for people with a mental health diagnosis
She encourages people with mental health conditions, and the friends and family members who love them, to use the new toolkit.
One of the most crucial things, she says, is for people to take advantage of the fact that because of COVID-19, health insurance will now pay for mental health care, and many kinds of physical health care, to be provided over the telephone, internet and special smartphone apps.
"If you have a regular provider for your mental health condition, whether it be a psychiatrist, psychologist, primary care doctor or nurse practitioner, or addiction counselor, don't assume that they're off limits to you because their office is closed for in-person visits," she says. "If anything, you need more than ever to connect with someone who knows how to treat your condition."
The change from winter to spring is a common time for small changes to medications for mental health conditions, so people taking medications should be sure to connect with their provider about those – and about making arrangements for delivery of medications to save them a trip to the pharmacy.
For people who left their usual homes to stay with relatives in other states before the stay-home orders took effect, it's especially important to check that they can still have virtual visits with their providers, or get their medications, especially if there are special rules about patients and providers being in the same state, or shipping certain medicines across state lines.
And for people who think their never-diagnosed condition has gotten worse because of the stress of the pandemic and its effects, now's the time to seek help, before more time goes by.
Good advice for everyone
Riba also offers some tips to help everyone's mental state, whether or not they have a diagnosable condition:
Maintain a daily schedule: Keep sleep hours and eating times consistent to maintain your circadian rhythms. Get up, shower and get dressed to signal to your brain that your day has begun. If you're not working, you can still set a schedule for specific activities during the day, and time limits on activities like browsing social media and the news that you know will suck your time if you let them.
If you're working from home, set your 'office hours' don't forget to get up and walk around the house or apartment once in a while, and reclaim your former commute time as 'you' time. If you're leaving home to work at an essential job, make sure you schedule down time for yourself. If you have children in the home, try to ensure they have a schedule, too.
Don't use alcohol, tobacco, vapes, marijuana or other substances more than usual: The stay-home restrictions designed to slow the pandemic seem to be giving some people the idea that they have a license to drink, smoke and use drugs more. People with mental health conditions are more likely to use these substances in problematic ways, and stress can alter the brain's response to substances. Even if someone didn't have a problem with them before, additional use could feed a tendency toward addiction, Riba says.
Connect with those you care about virtually: Telephone calls, video chats, texting, chats with neighbors from across the street, and even old fashioned letter writing can all help people feel supported and cared for. This can ease stress and the sense of isolation.
Don't be ashamed to use resources to help you cope financially and emotionally: New programs to get food to children, older adults, healthcare workers and people who have lost income are popping up. So are state programs for unemployed people, people who have lost their health insurance, people who want to find new ways to spend time volunteering, and people who just need someone to talk to.
Don't be afraid to seek in-person help for mental and physical illness if you need it: Hospitals and clinics still have the ability to see non-COVID-19 patients who need immediate attention, though they may do it in different places than usual. If you or someone you know is having urgent symptoms such as a panic attack, suicidal thoughts, manic episodes or a major physical injury or symptom, seek immediate help.
Take a break from the news and social media: The flow of information, most of it distressing, can be overwhelming and stressful. Riba advises taking it in measured "doses" just like a medicine. That means setting aside a specific amount of time to keep up to date, focusing on trustworthy media sources with experienced journalists, government health agencies, major hospitals and universities and large health-related nonprofit organizations.
Distract yourself: Whether it's books and magazines, music and dance, movies and sitcoms, crafting, drawing or painting, cooking, spring cleaning, carpentry, organizing, playing board games, doing a puzzle, do-it-yourself home and car repairs, yard work, rearranging furniture and decorations, meditating, watching a faith-based broadcast, or going through old photos, pick at least one thing a day to occupy your time without a screen.
Just move: Exercise at home, with any of the free stretching, yoga and workout videos available. Going out for a walk, run, bike ride, hike, or dog walking is good for your body and mind because it involves both movement and exposure to nature. And, it's allowed under stay-home orders as long as it's done away from other people and wearing a homemade mask or cloth if many others are around.
Above all, keep the goal of stay-home orders in mind: The importance of slowing the spread of the virus so that fewer people are seriously ill at one time, hospitals don't get overwhelmed, scientists can find better treatments and develop vaccines, more test kits can be made to detect cases early, and health care providers can be there for everyone who needs them.
"Right now, we don't have control over things in our lives that we once had control over, and this is something new for all of us," says Riba. "We need to show compassion to others, and to ourselves. We should offer help to others when we can give it, and seek help when we need it."
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