As the coronavirus advances across the country, more Americans are staying in their homes. That sort of "social distancing" is considered essential to slowing the spread of the virus and easing the burden on the beleaguered health infrastructure.
But for those suffering from depression, especially those who struggle with suicidal thoughts, it is definitely not what the doctor ordered.
Any "isolation is so devastating to our own mood because we're left stuck with our own thoughts," said Emily Roberts, a Manhattan-based psychotherapist. "If you're struggling with a mental health disease, if you are relying on therapy which requires you getting out of your house, it's going to be very hard to motivate yourself to get the help you need.
"The fact that there's so much of an urgency to disconnect creates a lot of fear with people."
The potential side effect of the crisis is something mental health professionals are scrambling to address amid the uncertainty of COVID-19, especially as health resources are diverted to the most immediate concerns. The scale of those concerns in turn is precisely what makes this time an unprecedented stressor for even the most well adjusted among us.
"It's unclear from one day to the next what any local community is going to do in response to the coronavirus, if people are going to have to stay at home, which then has implications on how we work on caring for them," said Lynn Bufka, associate executive director for research and policy for the American Psychological Association.
"What's going to be the implication for disruption? Not everyone is going to be able to continue to get the help they need. Clinicians are very much thinking right now about how to do that."
Especially when a person battling depression has to simultaneously contend with being infected with the coronavirus in self-isolation.
"It's important for those who are infected or who feel physically ill and have depression to be in touch with their support systems," Roberts said. "For clinicians and counselors who have clients with depression, for family members and friends of someone in isolation, especially with a history of depression, it is imperative that you check in and remain in contact with them.
"Motivation is hard to muster when one is ill. When you couple that with depression, it's even harder to find the energy to get out of bed and take care of yourself."
Part of what takes such a big mental health toll during a pandemic is that it goes against the primal human social instinct to seek comfort in a larger group — whether it be family, friends, neighbors or co-workers.
In post-9/11 New York City, for example, many residents leaned on a shared sense of experience and community to process an unprecedented attack. This time around, it's easy to slip into the unease of viewing a fellow New Yorker as a potential coronavirus carrier or a rival for that last bottle of hand sanitizer on a store shelf.
"Humans are wired to be social creatures, and that's how we cope when a big disaster happens," said Judith Moskowitz, a professor of medical social science at Northwestern University's Feinberg School of Medicine. "Now, we're being told to cope with this by staying away from each other."
She pointed to a 2004 study of 129 Toronto residents who were under quarantine during the SARS epidemic of the previous year, which found that post-traumatic stress disorder and depression were observed in 28.9 percent and 31.2 percent of respondents, respectively.
Moskowitz said that as the need for social distancing or self-isolation continues, the key is to maintain human contact as best as people can.
If more than one person is hunkering down in the same place, shared activities, such as playing with children or having conversations that focus on pleasant topics, can be positive distractions. If a person is alone, connecting with loved ones — even if it's virtually through FaceTime, Zoom or Skype — is essential.
Similarly, therapy can be available remotely, as well. But there is a question, Bufka said, as to whether enough insurance companies have moved quickly enough to adapt, with some still requiring face-to-face therapy sessions for financial reimbursement.
Roberts, who has been recording video advice to navigate anxiety amid the pandemic on her TheGuidanceGirl.com website, said self-care is important, as is staying on a routine of sleeping, waking, taking medications and eating at regular times. Netflix and chilling is fine without going overboard; screen time and intensely focusing on news updates should be compartmentalized.
Physical activity is more imperative for those afflicted with mood disorders for a dose of serotonin — the neurotransmitter that helps regulate emotions. That can include stepping into a backyard, and going for a walk around the block when it's not crowded is also a boost. "If you're not sick, going outside safely to get some vitamin D from sunlight and fresh air can be very helpful," Roberts said.
Every little bit can help lower the potentially toxic effects of boredom, loneliness and anxiety.
"If you can, picture carrying around a bucket that gets filled up by various pressures, and the more filled it gets, the harder it is to walk," Bufka said. "For some of us, some space is taken up by the challenges of child care or a stressful job. Depression is something that takes up a lot of space in a bucket. It makes carrying it around more unwieldy.
"If you add in the stressor of coronavirus, it can get filled up past the top."