Depression, anxiety and cries for help grow amid the isolation of COVID-19

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Last month, Judy Sombar faced a Catch-22 due to COVID-19.

Her dilemma: Remain in her Mt. Lebanon, Pa., home, surrounded by her husband, four children and two dogs while risking her life because she has an immunocompromised condition and two of her four children could not self-isolate at the time. Or move temporarily into an Airbnb nearby but risk exacerbating her existing mental health conditions of depression and anxiety.

No one is immune from the stressors inherent in the new as well as the isolation of social distancing in an attempt to mitigate its spread. Particularly impacted are those already diagnosed with depression or like Sombar.

An estimated 11 million people in the United States had at least one major depressive episode with severe impairment in 2017, representing 7% of the adult population, according to the National Institute of Mental Health. Anxiety disorders are the most common mental illness in the country, affecting 40 million adults, 18% of the population, every year, according to the Anxiety and Depression Association of America. And countless others with no history of mental illness will suffer because of the uncertainty the deadly, highly contagious virus has wrought.

In the end, Sombar, 49, chose to protect her and moved into an Airbnb in Mt. Lebanon on March 20. Two of her sons, ages 19 and 12, moved with her to keep her company, but Sombar, 49, stil felt isolated and fearful. She sobbed uncontrollably. She felt hopeless. She thought of cutting herself, hoping would dull the mental anguish.

When she is anxious, writing allows her to detach from troubled thoughts. So she took to Facebook on March 22, the day after the first Allegheny County death from COVID-19 was reported. Her pain, helplessness and fear are palpable in her post.

"I am not OK," she wrote. "Tonight or tomorrow, it's possible that I will rally, as I did yesterday, and I will post here with a much different demeanor. This morning, however, I am feeling the profound loss of my normal life, of the peace that comes with familiarity of surroundings and loved ones and my albeit mundane dailiness, which I cannot access currently.....I AM NOT OK, TODAY."

Stress and anxiety are normal reactions to an extraordinary event and the COVID-19 pandemic certainly qualifies as one.

"This is a very stressful time," said Laurie Barnett Levine, executive director of Mental Health America of Southwestern PA. "Our lives have been changed forever by this in many known and unknown ways, and that produces anxiety."

It helps, she said, to get enough sleep, be physically active, eat a good diet and "focus on the present and things you do have control over, things that bring you joy."

But if stress and anxiety affect normal daily function—frequent crying and worrying, insomnia, inability to have pleasure, increase in alcohol or tobacco use or use of illegal drugs—it's time to seek help.

"It's really important that if you're experiencing anxiety that is not manageable that you talk to people in your support system or a professional," Levine said. "Talking about it can be very helpful. It's a way to release that anxiety. We say, 'It's OK to not be OK.'

"It's nothing to be ashamed of. It takes strength to ask for help."

Family members and friends who know someone who is struggling during the pandemic should reach out to them to show support, encouragement and understanding. "And to be kind. This is a time more than ever to be kind," Levine said.

People should also be acutely aware of the risk of suicide, she said. It's perfectly correct to ask someone, "'Are you OK? Are you thinking about hurting yourself?' It's a common myth that asking that puts the idea in their head. By asking them, you give them permission to talk about it. That's how you get them help."

Jack Rozel, medical director for Resolve Crisis Services for UPMC-Western Psychiatric Hospital, said there hasn't yet been a major increase in calls to Resolve's hotline, where Allegheny County residents with stress, anxiety or any other problem can speak for free with trained crisis clinicians.

"What we're seeing now is not high volumes, but the people we're seeing really have a lot of need," Dr. Rozel said. "We know that the need for mental health services in a crisis peaks much later than the event. We're seeing a slow build now, and we expect in coming months the demand for services will go up substantially. We expect to be able to handle that with internal staffing and other resources."

He noted that virtually all of the several hundreds of calls that Resolve's 24-hour hotline receives each day are from those without a diagnosed mental illness.

"We're social beings. Most people don't do well with social isolation. We say to call before a crisis becomes crisis," Dr. Rozel said.

"This is fairly novel and fairly unique," he said of the fallout from COVID-19. "The metaphor we use is: It's not a sprint, it's a marathon. As time goes on, we'll figure out a lot of new pathways, our new lifestyle, our new normal. It's going to get easier and we'll hit our stride.

"Help is out there. Hope is out there."

Bill Dorn, part of Isaly Counseling Associates, is among therapists who have adapted to social distancing restrictions by counseling clients, including families, via the telemedicine app doxy.me, which provides audio and video in a multilayered, encrypted and HIPAA-compliant platform. He texts or emails a link to his 90 clients. Upon their appointment, they click the link and enter a "waiting room" before starting their therapy session.

While he prefers face-to-face sessions because "70% of communication is nonverbal," he appreciates the fallback ability to meet with clients virtually. He says his clients are pleased as well. His only exception to using the app is for a new client, with whom he meets in either the group's Carnegie or Ross offices for a first session.

Since March 1, he has taken on 11 new clients, up slightly from his monthly average of about eight. The new clients told him that part of the reason they wanted to see him was due to issues surrounding the pandemic. It's affecting his existing clients as well.

"I see a lot of people—men, women and adolescents—for generalized anxiety disorder and COVID-19 is making it worse for them. The majority of my caseload is for mood disorders, depression or and relationship issues. All have been exacerbated by this incredible new normal," he said.

"The big picture for me is that it has removed from all of us a sense of having some power. When people lose choices in life, they can become mentally and emotionally troubled."

Sombar, still in the Airbnb, said she is maintaining her stability, remains on her medications and is using doxy.me to meet with her therapist.

"I'm functioning normally," she said. "Normal function for me is pretty great functioning. I'm productive, I have a lot of interpersonal skills and things I thrive on.

"The reason I posted on Facebook was because I felt I was in a such a bad state of mind at the time. I needed to think about ways I thrive in my normal life and to reach back and grab something I know works for me, which is writing. Why not tell the truth?

"I wanted to destigmatize mental health issues and make it normal for people to reach out for help just as they would if they had physical symptoms. Everyone is hearing news about the physical manifestation of the virus, but they're not hearing what this pandemic has done to our minds."


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