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Anxiety and Depression in an Environment of Uncertainty

July 17, 2020

With summer of 2020 upon us, COVID-19 remains a dominant issue both in the news and in people’s minds. New Jersey still benefits from drastically lower new daily cases than we saw in April – from a total of more than 4,000 to now between 300 and 500. The virus isn’t gone, however, and our national news is often headlined with stories of other states experiencing dramatic upsurges.

With that backdrop, Peter Bolo, MD, chairman of psychiatry at Overlook Medical Center and Atlantic Health System’s resiliency advocate, understands how people would be concerned about New Jersey’s planned, phased re-opening. After months of worrying about keeping ourselves and our loved ones safe, about our jobs and bills and the broader economy, and about how and when life might get back to normal, it’s reasonable to now feel anxious that New Jersey is opening too much, too soon.

One piece of advice Dr. Bolo has for dealing with that anxiety, however, is to focus on the local government’s recommendations “and to heed them. If our governor is saying that this is what you’re allowed to do at this point and this is how you can do it – wear a mask, be socially distanced, wait in line before you go into the grocery store – then I believe that it’s safe to go ahead and do those things and that you should do those things.”

Uncertainty: The breeding ground of anxiety

One side effect of COVID-19 has been the challenge patients have had in receiving their usual treatment. For anyone experiencing acute symptoms of anxiety or depression, or who has been unable to continue with ongoing treatment, Dr. Bolo suggests they contact Atlantic Health System’s access number – 1-888-247-1400.

“Anxiety,” explains Dr. Bolo, is “largely the emotional response to uncertainty or some kind of threat.” And the coronavirus has brought many threats. First, of course, is the virus itself. “But simultaneously we have an emotional pandemic of anxiety …. everywhere you look there’s something else that’s uncertain: the condition itself; who it’s going to affect; what’s going to happen economically for us; how long will it last; how do I manage through this?”

That kind of uncertainty, says Dr. Bolo, is the breeding ground of anxiety. But, he states, “Everyone’s anxious, so we can take some comfort and solace in the fact that we’re all in that together as well.”

Depression, however, “is the reaction to a loss or the threat of a loss. It could be the loss of work, a loved one, or self-esteem. Any type of loss can trigger a sense of grief that can go on to a depression.” Medically, depression “is a qualitatively different mood that lasts for at least two weeks, every day.” People may feel sad, emotionless, or tense – which can make it difficult to discern from anxiety. Symptoms include loss of appetite, bouts of insomnia, loss of self-esteem, and difficulty concentrating.

While depression and anxiety are not the same thing, there is some overlap in their symptoms, and they can coexist. Which can make an accurate diagnosis difficult. 

“Depression tends to lift over time with treatment,” Dr. Bolo says, “and we’ve got great treatment for depression. For outpatient behavioral health services at Atlantic, we have one number that people can call to get service throughout our region.”

Risk factors of anxiety and depression 

According to Dr. Bolo, the greatest risk factor in having an episode of anxiety or depression is having had a prior episode. The second greatest risk factor is family history. If depression, bipolar disorder, panic disorder, OCD, or another anxiety disorder is in your family’s history, you will be more likely than the next person to develop an episode.

However, in today’s environment, possibly the most salient contributing factor for both depression and anxiety is stress. “I can’t imagine many things more stressful than a pandemic,” says Dr. Bolo. Anxiety and depressive disorders can be triggered by stress. Their symptoms can be exacerbated by stress. And stress can cause episodes to recur.

Because of the exacerbating nature of stress, and the increased probability for people who’ve had prior episodes, Dr. Bolo recommends that this at-risk population “get in touch with a psychiatrist or therapist, or that they get adequate ongoing treatment to help prevent them from having an episode.”While there are contributing factors that increase the chances of having anxiety or depression, Dr. Bolo stresses that they aren’t limited to an ethnic group or a gender. Their universality, rather, provides, “an opportunity for us all to be together on this issue.”

Constructive coping mechanisms

While anxiety and depression are universal, some personality types seem better able to deal with uncertainty and loss than others. And there are some coping mechanisms that everyone can include in their lives.“Number one,” says Dr. Bolo, “is to take care of yourself … get adequate sleep, nutrition, and hydration. Get some exercise. And I recommend exercising outdoors, and even sometimes with someone else. It’s possible to walk and stay six feet apart and be physically distant, but also connect with other people.”

This is particularly important, says Dr. Bolo, as connecting with people is another critical part of managing anxiety. In stressful times, we are more open to deep communication. At the same time, particularly for people who are nervous about the state re-opening and how they can include themselves in that safely, seeking out calm people with trusted opinions is another great coping mechanism.

Both anxiety and calm, says Dr. Bolo, “are very catching. You want to be around calm people. Listen to their experiences of going out and then, if you’re still nervous, take baby steps yourself.”

Also, for people still nervous about returning to work or normal life while still under the threat of COVID, follow the guidelines. Don’t go to places the guidelines say you shouldn’t yet like indoor dining at restaurants. But do go to those places the guidelines say you can. Just be sure to follow any mitigating measures such as wearing masks or staying six feet apart.

“It’s really important for people to take care of themselves and a lot of people have been avoiding or ignoring that. People have actually ended up becoming sick by not taking care of their ongoing health problems,” Dr. Bolo advises. If you are hesitating to get the ongoing care you need, he suggests you “call your physician and call the place where you need to go in and ask them how they’re keeping you safe. I think you’ll be surprised at the number of steps we’ve taken.”

The intake of media, which can be overly dramatized, should be monitored and limited. You want to stay informed, but too much is overwhelming.

Finally, don’t get so fed up with the guidelines that you ignore them completely. Instead, Dr. Bolo encourages people to find ways to take a break from the pandemic and its restrictions. Look for ways to follow the guidelines without feeling that your life is constrained. Invite a friend over for an outdoor picnic, or a walk in the park or through the neighborhood.

Resiliency in the COVID era

At Atlantic Health System, says Dr. Bolo, the working definition of resiliency is the ability to bounce back from, and even grow through, challenges. And one factor that drives resiliency is the ability to nurture connections with other people – especially those people in your life you can turn to for support.“I think it’s really been an opportunity to bring us together” he says. “Through a shared sort of traumatic experience of living through a pandemic that continues, to find the common ground amongst us and to support each other.”

Another driving factor in resiliency, says Dr. Bolo, is purpose. Ask yourself why you do what you do, and recommit to that purpose. Reflect on why you get up every day, what your purpose is in life, and how you want other people to think about you.

During the pandemic, for people who have been furloughed, lost time at work, or in other ways had their purpose derailed, it’s helpful to create a pandemic-version of themselves. Finding a new purpose and a new mission – helping other people, or giving in to a creative urge – will fill that need for purpose and increase resiliency.Finally, continuing or finding an exercise program that helps clear your head and takes care of your body can aid resiliency. 

The Atlantic Behavioral Health access number 

If you suffer from anxiety or depression and have had trouble accessing care in these turbulent months – or if you’ve suffered in the past and feel the weight of these stressful times – reach out to Atlantic Behavioral Health at 1-888-247-1400.