Almost as soon as coronavirus lockdowns went into effect in March, discussion turned to mental health. It’s well-documented that natural disasters, wars and other mass traumas can lead to significant increases in population-wide psychological distress. Weeks or months of anxiety, fear, sadness and social isolation can take their toll, leading many experts to fear the U.S. would face a mental health epidemic at the same time it fought a viral pandemic.
Now, a study published in JAMA Network Open offers one of the first nationally representative estimates of how severe that epidemic may be: Three times as many Americans met criteria for a depression diagnosis during the pandemic than before it, according to the paper.
A pre-pandemic survey of about 5,000 American adults found that 8.5% of them showed strong enough signs of depression (including feeling down or hopeless; loss of interest in things that normally bring joy; low energy; trouble concentrating; or thinking about self-harm) to warrant a probable diagnosis. When researchers surveyed almost 1,500 American adults about their mental health from March to April of this year, that number rose to almost 28%. Even more people—almost an additional 25%—showed milder signs of depression.
Logically, people were more likely to suffer symptoms of depression during the pandemic if they experienced “COVID-19 stressors,” including losing a job, the death of a loved one or financial distress. People who said they had less than $5,000 in savings were also about 50% more likely to suffer from depression than wealthier people, the researchers found. In keeping with usual demographic trends, women were more likely to experience depression than men, and single people were more likely to experience depression than married couples.
But trends only go so far. Anyone—regardless of race, gender, relationship status or income—can experience mental health issues during something as traumatic as a pandemic. Small lifestyle tweaks can help. Getting enough sleep and exercise go a long way, and studies have shown that meditation and yoga can have a positive effect on psychological well-being. Social support is also crucial, even if it happens virtually.
It’s also easier than ever to seek mental health care if you need it. Teletherapy is surging in popularity during the pandemic, making it easier to see a clinician from home. If you need more immediate help, there are also hotlines that can provide support. If you or someone you know may be contemplating suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255 or text HOME to 741741 to reach the Crisis Text Line. In emergencies, call 911, or seek care from a local hospital.
For the latest COVID-19 news and updates from Cleveland Clinic, please visit https://clevelandclinic.org/coronavirus From confusion and loneliness to worry and frustration, people are dealing with large and intense emotions while trying to navigate a new sense of normal. Psychologist Amy Sullivan, PsyD, ABPP, discusses how the coronavirus pandemic is starting to mentally wear on us and why it’s so important to protect our mental health.
In a new study, researchers have found a set of factors that could help prevent depression in adults. They named social connection as the strongest protective factor for depression and suggested that reducing sedentary activities such as TV watching and daytime napping could also help lower the risk of depression.
The research was conducted by a team from Massachusetts General Hospital (MGH). Depression is the leading cause of disability worldwide, but until now researchers have focused on only a handful of risk and protective factors, often in just one or two domains.
This study provides the most comprehensive picture to date of modifiable factors that could impact depression risk. To that end, researchers took a two-stage approach.
The first stage drew on a database of over 100,000 participants in the UK Biobank to systematically scan a wide range of modifiable factors that might be linked to the risk of depression, including social interaction, media use, sleep patterns, diet, physical activity, and environmental exposures.
The second stage took the strongest modifiable candidates to examine which factors may have a causal relationship to depression risk.
This two-stage approach allowed the researchers to narrow the field to a smaller set of promising and potentially causal targets for depression.
The team found an important protective effect of social connection and social cohesion.
These factors are more relevant now than ever at a time of social distancing and separation from friends and family.
The protective effects of social connection were present even for individuals who were at higher risk for depression as a result of genetic vulnerability or early life trauma.
On the other hand, factors linked to depression risk included time spent watching TV, though the authors note that additional research is needed to determine if that risk was due to media exposure per se or whether time in front of the TV was a proxy for being sedentary.
Perhaps more surprising, the tendency for daytime napping and regular use of multivitamins appeared to be linked to depression risk, though more research is needed to determine how these might contribute.
The study demonstrates an important new approach for evaluating a wide range of modifiable factors and using this evidence to prioritize targets for preventive interventions for depression.
One author of the study is Karmel Choi, Ph.D., an investigator in the Department of Psychiatry and the Harvard T.H. Chan School of Public Health.
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If you asked 100 people about psychedelics, you’d most likely get 100 opinions based on their firsthand experience, strong condemnation or stories from their adventures at Woodstock in the ’60s. No matter what people might know or think they know about psychedelics, the 40-year moratorium that closed down related research in the ’70s is now coming to an end. Psychiatrists are beginning to realize that strategic, supervised use of these psychopharmacological drugs is helping people with mental disorders including obsessive-compulsive disorder, post-traumatic stress disorder, alcoholism, depression and cluster headaches. Still, are there enough scientific studies to warrant the use of these drugs in mainstream society?
I’ll admit that talk of psychedelic therapy to treat depression makes me nervous. In researching my book, Unstoppable, I looked at other key triggers that can mimic psychological disorders like depression and anxiety, such as inflammation, nutritional deficiencies, hormonal changes, side effects from medications, gut imbalances and food sensitivities. The reality is, depression is complex. What works for one may not work for another. Any successful treatment must first identify the root cause of one’s depression successfully, which can be a complex process if not done under the right medical care. A psychedelic treatment isn’t suddenly going to fix a nutritional deficiency, for example, but it may help target other symptoms and behaviors that correspond with depression. This is why it was critical to set my own biases aside and speak to an expert.
I was fortunate enough to interview Dr. Domenick J. Sportelli, who is board-certified by the American Board of Neurology and Psychiatry for General Psychiatry and fellowship-trained and Board Certified in Child and Adolescent Psychiatry. He also specializes in human behavior and psychopharmacology. I wanted to get the most current information on the use of psychedelics in treatment for depression, anxiety and PTSD, so I first asked him first to clarify what psychedelics were.
“The term ‘psychedelic substance’ refers to an exogenous substance [derived outside the body] that, when taken into the body in various ways, physiologically, neurologically and psychologically manifest an internal personal experience of altered states of consciousness,” he explains. “This includes perceptual distortions, hallucinations, synesthesia [a mixing of the senses], altered sense of time and space, as well as potentially inducing what researchers call a ‘mystical experience’ — a sense of oneness, of noetic experience and an undefinable but profoundly spiritual quality.”
Is there enough evidence to support psychedelic therapy?
Sportelli wants to make clear that the most researched psychedelics — LSD, psilocybin (mushrooms), peyote, MDMA, DMT and ketamine — have different mechanisms of action and even induce subtle, subjective experiential differences. Although each is grouped under the term “psychedelics,” they are quite disparate.
Dr. Sportelli is cautiously optimistic about the multitudes of large-scale, university-based testing and prior research compiled decades ago, but worries about the abiliity to circumvent bureaucracy and conduct safe, credible and substantial testing today. He does add that recent testing of psilocybin, LSD, ketamine and MDMA in particular has generated cause for optimism, and that they will likely have a place not only in continued, diverse research design and protocol, but eventually in therapeutic use.
What types of depression can psychedelics treat?
If we were to look at the onset of most mental illnesses, the majority start to become evident between the ages of 11 and 24, according to the National Institute of Health. With only 42 percent of people getting treatment, most typically do not seek out assistance until a secondary mental illness occurs several years later.
When asked how broadly psychedelics might be able to help treat people with depression, Sportelli concedes that, “Unfortunately, research hasn’t determined the level of scientific data to specify the type of depression or mood disorder that psychedelic therapy will benefit.” But he does add that research and data are beginning to show statistically significant improvements in mood, reduced anxiety, change in positive personality traits over time, the possibility of reducing addictive behaviors, reduction in suicidal tendencies and increased personal insight.
Do psychedelics treat the symptoms or the cause?
According to Dr. Sportelli, depression stems from a mix of genetic, biological, neurological, psychological and sociological factors. Recent research has demonstrated how the chemical breakdown of psilocybins closely resembles that of serotonin, and indicated the promising interplay of select hormone transmission. Dr. Sportelli stresses the critical role that these drugs might offer in mood disorders is at the forefront of the pharmaceutical quest for treatment.
“We have never seen substances like these that can potentially change the way that we look at our life and change perspective with lasting results,” he says, noting that they might be able to help “supercharge psychotherapy.”
Is this ultimately a recommend treatment, and where does one turn for it?
“At this time, in the U.S., I would only recommend this treatment be a part of, and under the close supervision of, a university-based IRB [Institutional Review Board]-monitored clinical trial,” Sportelli emphasizes. Before any psychiatric treatment, Dr. Sportelli also recommends a full medical and neurological evaluation to rule out any of the multitudes of medical circumstances that can manifest as a primary mood disorder, and reiterates that significant and often profoundly adverse outcomes associated with such powerful, mind-altering chemicals need to be weighed further as well. That’s why, as part of any regulated trial, all the necessary medical workups would be completed before participation.
Is the stigma around psychedelic therapy warranted?
Sportelli acknowledges that there is a safety concern associated with psychedelics, and does not condone their recreational or illict use. But he does believe that regulated clinical trials, judicious and ethical research methodology and the progression for therapeutic intervention should not be overlook based on previous stigma and possible misclassification.
I’ve never been one to throw the baby out with the bathwater. After interviewing Dr. Sportelli, I hold hope for the future, but also a concern for those who may seek out this kind of treatment without an accurate medical diagnosis. My number-one hesitation remains — that is we simply do not have the studies to show which types of depression psychedelic therapy successfully treats, which may result in people attempting to use a hammer when in fact they need a nail.
Either way, if you are to venture into this arena, find someone who specializes in it. The risk of going it alone could come at too a high price.
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