While hospitals fill up with COVID-19 patients, healthy families at home find themselves suffering from fear, anxiety, and never-ending stress. The mental health crisis this country faces is real. But we’re all victims of the pressures of this moment. We’re all lonely, stressed, and fearful to some degree right now. So when should you seek professional health — and at what point do you need to ask for medication?
From mid-February to mid-March, prescriptions for antidepressants and anti-anxiety medications rose by about 19 percent and 34 percent, respectively, according to a report from pharmaceutical company Express Scripts. People who managed depression and anxiety with therapy before COVID-19 may need a new tactic in the face of the pandemic. And those with no history of mental illness may benefit from treatment now.
“It’s very hard to figure out what is a normal reaction to what’s going on and what is a treatable mental health condition that needs medication,” says Jessica Gold, a psychiatry professor at Washington University School of Medicine in St. Louis. In normal times, clues that you have depression or anxiety could include changes in your sleeping and eating patterns, your interactions with others, and your ability to concentrate. But the pandemic can cause these symptoms in people without any sort of mental disorder.
One of the signs that you’re going through more than just a rough patch is duration, says Karen Cassiday, director and clinical psychologist at the Anxiety Treatment Center of Greater Chicago. A depression diagnosis requires at least two weeks of low mood, irritability, or inability to enjoy activities, according to the National Institute of Mental Health. For generalized anxiety disorder, you must have excessive worry most days for at least six months, according to the Anxiety and Depression Association of America. This isn’t very much help when you’re facing a pandemic that has eviscerated the economy and counts a death toll in the tens of thousands in little more than two months
In this moment, severity trumps duration. Having panic attacks several days in a row may warrant medication, and self-harm or suicidal thoughts require immediate treatment. But don’t wait until your mental health declines to that point, Cassiday says. Though sleep issues, elevated anxiety, and tiredness are normal, extreme versions of these symptoms are not. “If you’re finding that your mood is out of control, and you’re crying unexpectedly, or when you do cry you can’t stop, or you feel flat and don’t have any feelings… you really should be getting help,” Cassiday says.
But “getting help” is tough when the helpers are themselves so handicapped. A big part of that process is having psychologists consider how much your mental health messes with your life — which in the time of COVID-19 is very, very difficult to assess. This comparison can still be useful though. If you can’t get through the workday or have trouble bringing yourself to interact with your kid, that’s not normal, Gold says.
So if you’re meeting with a therapist for the first time, it’s going to be difficult to get a diagnosis, and it could be even harder to get medication. You may need to push for it. “Be scrappy and do something to help yourself,” Cassiday says. “Don’t wait, and don’t settle.” A significant amount of therapists are under the false impression that medication doesn’t work or should be a last resort, Cassiday adds, so you may need to advocate for yourself, or switch to a different psychologist who is more willing to refer you for medication.
For people living with anxiety and depression, a combination of therapy and medication often works best, Gold says. The two address different aspects of mental disorders. Medication alters your biology. For example, some antidepressants increase the amount of the chemical serotonin in your brain, which regulates mood. Medication may not help everyone with depression, but it is likely to help with symptoms such as fatigue, constant crying, and general disinterest in life. Because of potential side effects, such as a lower sex drive, insomnia, and nausea, antidepressants should be reserved for those who really need it, and people struggling with the normal amount under the pandemic shouldn’t take them.
Therapy is best for addressing social and psychological causes of depression and anxiety, such as by helping you develop coping skills to deal with loneliness or stress. For anxiety, cognitive behavioral therapy is a common short-term treatment to stop negative behaviors and thoughts connected to the disorder.
If your symptoms aren’t severe, you may choose to try therapy first to see if it resolves your issues. But if you can’t push through feelings of helplessness or a lack of energy, and you can’t make it through work or interactions with friends and family, you probably need medication to treat your depression, Cassiday says. Antidepressants take about 6 to 8 weeks to kick in, or 4 to 6 if you’re lucky, so you may want to push for a prescription when you begin therapy. If you do try an antidepressant, the first one you take may not help. Some people have to try several different drugs before they find one that alleviates their symptoms without major side effects.
For anxiety, the six months of symptoms needed for a diagnosis may delay you from getting medication. However, there are usually signs in a person’s past — for example, a history of perfectionism or risk avoidance, or a brief phobia during childhood — that can lead to faster diagnosis and treatment. However, anxiety medication should only be used to combat severe symptoms, such as constant worry, insomnia, nausea, and aches and pains. Antidepressants may help you handle your anxiety in the long-run, but just as with depression, these medications take several weeks to start their work.
To deal with panic attacks, psychiatrists prescribe a different class of drugs called benzodiazepines. These medications are fast-acting and are only to be taken when you feel a panic attack coming on, which can include difficulty breathing, rapid heart rate, and a sense of danger. The drugs can cause physical dependence, so you should only take them in the short-term as you start psychotherapy and before long-term medication kicks in.
Is prescription medicine a salve for the mental health crisis this country faces? Of course not. No expert would agree with that. But if it gives you essential mental coping in a time of heightened stress, it is doing what it’s meant to. Experts worry that extreme mental health issues, particularly suicide, may be the next big consequence of COVID-19. “Social deprivation and isolation and increased substance use is a tinderbox for suicide attempts,” Cassiday says. Medication not only helps people with mental illness cope, but it also keeps them alive. During the pandemic, that may be more necessary than ever.