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| How to Tell if It’s More Than Just a Bad Mood | How to Tell if It’s More Than Just a Bad Mood |
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| 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. | 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? | 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. | 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. | 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. | 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. | 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.” | “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.” | 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. | 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.” | “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. | 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.” | “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. | 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.” | “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. | 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.” | “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. | 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. |
| Updated June 5, 2020 | Updated June 5, 2020 |
| So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement. | |
| A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study. | |
| The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April. | The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April. |
| Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission. | Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission. |
| Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home. | Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home. |
| States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people. | States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people. |
| Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks. | Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks. |
| Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days. | Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days. |
| If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.) | If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.) |
| Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications. | Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications. |
| The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing. | The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing. |
| If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others. | If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others. |
| If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested. | If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested. |
| “Look for evidence-based psychotherapy,” Dr. Marques advised. “Interview your therapist. Don’t work with someone you feel doesn’t have the skills.” | “Look for evidence-based psychotherapy,” Dr. Marques advised. “Interview your therapist. Don’t work with someone you feel doesn’t have the skills.” |
| Your primary care doctor can connect you to specialists; the Anxiety and Depression Association of America has a therapist locator. Most psychiatrists, psychologists and social workers have migrated to telemedicine. Many states are allowing Medicaid and Medicare reimbursement for mental health services during the pandemic; resources are available for those in financial distress. You can call the Substance Abuse and Mental Health Services Administration, the suicide prevention line, or use the Crisis Text Line. | Your primary care doctor can connect you to specialists; the Anxiety and Depression Association of America has a therapist locator. Most psychiatrists, psychologists and social workers have migrated to telemedicine. Many states are allowing Medicaid and Medicare reimbursement for mental health services during the pandemic; resources are available for those in financial distress. You can call the Substance Abuse and Mental Health Services Administration, the suicide prevention line, or use the Crisis Text Line. |
| Think you should be able to bootstrap it alone? In such stressful conditions, go easy on yourself. | 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.” | “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. | 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. | 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.” | “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.” |