How to Tell if It’s More Than Just a Bad Mood

The New York Times

By Nancy Wartik

May 21, 2020

It is understandable if the coronavirus pandemic has put you in a funk, but depression should be evaluated and treated.

For quite a while after it hit, life wasn’t bad. I had a job, at least, and was buoyed by family togetherness, by connecting and reconnecting virtually with friends. By the sensation of living through history. By walks in the park, observing fellow New Yorkers trying to fortify themselves, like I was.

The last few weeks have been much harder. We’re holed up in Manhattan, the future a fog without end. The days bleed together. Why get up? Easier to work from bed, especially as I’m tired and sleep deprived. Why reaffirm connection when I can scroll internet memes? And family members, can’t they take care of themselves?

I know these aren’t ideal coping patterns. I’ve struggled with them before. They’re harbingers of depression, described by William Styron, author of Sophie’s Choice, as a storm of murk. In ordinary times, clinical depression, often believed to have biological underpinnings, is not uncommon. In 2017, the last year for which statistics are available, 17.3 million, or about 7 percent of American adults (twice as many women as men) experienced it.

But these aren’t ordinary days; rather the state of affairs is a veritable petri dish for brewing depressive symptoms (sadness, insomnia, irritability, exhaustion, under- or overeating, trouble concentrating). We’re locked in, some of us alone or in very stressful conditions. Tens of millions have lost livelihoods, and many are grieving friends or family. Normal outlets for rejuvenation — gym workouts, vacations, church, office banter, drinks with friends — are often unavailable. We can’t necessarily make routine health care appointments either.

There’s already evidence that growing numbers of people are depressed. From Feb. 16 to March 15 the number of antidepressant prescriptions filled in the United States rose by 18.6 percent. A University of Michigan survey of some 460 people, conducted in mid-April, found 33.6 percent of respondents reported symptoms of major depression, including fatigue, insomnia and feelings of hopelessness.

Even so, mental health specialists are reluctant to label what people are experiencing as depression, in the usual sense.

“I don’t know anyone right now that’s not having depression-like symptoms,” said Luana Marques, a psychologist at Harvard Medical School and the president of the Anxiety and Depression Association of America. “It’s hard to keep going when our brains are constantly on fight or flight. It makes people really tired. If you’re having trouble concentrating or getting out of bed, it’s not abnormal. It’s an evolutionary response to a threat.”

Craig Sawchuk, a psychologist at the Mayo Clinic in Rochester, Minn., agreed. “One concept that fits is depressive realism,” he said. “It’s not necessarily that we’re overexaggerating. An unusual set of circumstances calls for an unusual way of responding and interpreting. We have to accept this is a really difficult, in some cases, a tragic situation.”

But that doesn’t mean we should give in and suffer. Depression, no matter its provenance, hurts, stoking feelings of worthlessness and siphoning pleasure. It can lead to complications like substance abuse, relationship conflicts, or at the extreme, suicide. Some 60 percent of those who take their lives are depressed. The earlier we intervene on our own — or someone else’s — behalf, the better.

“We don’t know how long this pandemic will go on,” said Dr. Neil Greenberg, a psychiatrist at King’s College London, who studies how disasters affect mental health. “What you shouldn’t do is just cross your fingers and hope. The nip-it-in-the-bud approach is absolutely what we should all be doing. Otherwise your mental health could spiral down.”

Familiarize yourself with depression’s physical and mental markers. Or take a self-diagnostic test. When depression isn’t severe, a self-care routine may be enough, said Dr. Joshua Gordon, director of the National Institute of Mental Health.

“If you’re just feeling a little down, maybe having some trouble sleeping but functioning well, there are things you can do such as exercise, social contact, getting regular sleep cycles and eating healthy,” Dr. Gordon said. “Put those together and you’ve got a generally good program to stave off mild depressive symptoms.”

Find workouts to do at home, if need be. Ask others to hold you to routines. Or seek virtual support: online forums and apps exist for anything you’re struggling with, whether it’s poor eating habits or lack of sleep. At first it may seem you’re going through the motions. But you’re creating a feedback loop, in which taking action improves mood, allowing you to follow up with things to improve mood even more.

“I think about my car battery,” Dr. Marques said. “I have to drive it to recharge it, there’s no other way. Our bodies are similar. You have to spend energy to feel better.”

For some people, though, self care alone won’t work. Perhaps you’re already prone to depression. Maybe you’ve been hit by major loss or financial hardship. Front line workers are at higher risk for depression; a study showed more than 20 percent of health care workers at a Chinese hospital still had significant depressive symptoms three years after the SARS outbreak. Last month, two New York City emergency responders died by suicide, days apart.

“If you really can’t sleep, your appetite is changing, you can’t function, can’t work, can’t take care of your kids or can’t grocery shop, that’s a sign you need professional help,” Dr. Gordon said. “If you’re wondering, ‘Why should I get out of bed or reach out for help?’ those very questions are symptoms of your disorder.”

Medication and psychotherapy combined are typically considered today’s treatment gold standard, though each can work alone. No single antidepressant is a panacea and not all therapists are equally effective.

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“Look for evidence-based psychotherapy,” Dr. Marques advised. “Interview your therapist. Don’t work with someone you feel doesn’t have the skills.”

Think you should be able to bootstrap it alone? In such stressful conditions, go easy on yourself.

“You’re human and this takes a toll,” said Dr. Sawchuk. “Look at your mental and emotional health just like part of your health, like diabetes. There are things you can do to feel better when you’re diabetic. This is important, too.”

Depression can be a wily beast. In my case, it makes me lethargic, self-isolating and grouchy. Banish it one day — it’s back the next. I’ve long taken antidepressants, so no change there. But if I push myself to take a walk, FaceTime a friend or tidy the house, almost without fail I feel better, able to envision a day when we will emerge from the fog. I’m more hopeful, the opposite of depressed. Add one small triumph to the daily tally sheet.

Most experts expect to see rates of depression and other psychological disorders increase in the coming months, as the pandemic continues. And yet, a majority of those who seek treatment for depression will improve if they persist.

“When we look back at natural disasters or wartime, when really bad things happened on a grand scale, the majority of people didn’t get stuck,” Dr. Sawchuk told me. “They didn’t end up with clinical anxiety or depression. Resiliency is our natural trajectory. It doesn’t mean we’re unscathed or that we bounce back to exactly where we were, prestressor. But we can get to a better place than we’re at right at the moment.”