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It is important to keep our rational thinking alive and not be driven by irrational thoughts in order to keep our mental health in check in the time of Covid-19, says psychiatrist Dr. Gaurav Kulkarni. He says people may not be able to control the biological or social causes of depression, but they can try to control how they perceive things and protect themselves from falling into a depressive state during the pandemic.
However, people shouldn’t ignore any signs and symptoms of depression or try to treat it on their own. “Seek a consultation, let a professional decide whether it’s just a passing phase or does it require intervention. It can become chronic and harder to treat if people wait longer,” he says. Dr. Kulkarni spoke to us about dealing with depression during the pandemic. Edited excerpts:
- The pandemic may be a breeding ground for mental health issues like depression. What should we do if we start feeling low or start noticing some kind of a depressive state? Is there a way to prevent it?
- What should someone do if people are unable to think positively, and they notice symptoms of depression? What are the steps should they take?
- What about people who are already experiencing some kind of mental illness and it’s been exacerbated by the pandemic. What should they do?
- How can people cope with a panic attack?
The pandemic may be a breeding ground for mental health issues like depression. What should we do if we start feeling low or start noticing some kind of a depressive state? Is there a way to prevent it?
The chances of developing conditions like depression during this time are very high. There are many factors that are in play right now. Even though depression is a biological condition, there are also neurochemicals at fault.
Mental health issues like depression have biological, psychological and a social elements associated with it. Our social lives are completely disrupted because of the pandemic, but we can try to keep in touch with our friends, family, or therapist virtually. Having these resources can help with the symptoms of depression and anxiety.
The biological factors are not in our control. So, if our serotonin and dopamine levels, which control our mood and emotion are affected, they are affected. We can’t control it.
We can, however, control the psychological aspect to an extent — how we perceive things, how we respond, how much we internalise our experiences, and how much of it we actually carry along with us. The psychological aspect is what we should focus on during this time.
So, how can we do that? We need to understand that this is not a time of progress and prosperity; we just need to sustain. We, as mental health professionals, tell people it’s okay if they’re not progressing during this time, or their business is not booming, it’s fine if their startup is not picking up, if academics are not happening. If we have our own perception under control, we may be able to overcome our depressive feelings. But if we let it get to us and look at it as the end of life, we are cognitively, psychologically adding to our depressive state. We tell people to make a change in their perception, tell themselves that this year they are not going to make a profit or have the best of health, or have a vacation. Instead, they need to focus on the other side of things. For example, if we can’t go on a holiday, we get to spend more time with our family which we wouldn’t otherwise.
If we are able to keep our rational thinking alive, not get driven by irrational thoughts, or leave them unchecked, depressive episodes can be taken care of to an extent. When we know we can’t do much about a particular situation, we can just hold ourselves up, and try to not be affected by the situation too much. We need to make sure that our rational thinking is strong and guard ourselves against irrational thoughts.
Apart from that, people have been finding it hard to maintain their exercising routine or other self care activities that are beneficial to our mental health. It is helpful to find ways to continue any self care activities and mindful exercises during this time. We need to make some time for a walk, or yoga, or stretching, whatever helps.
Sleeping on time and maintaining a proper routine has been hard for people as well. Sleeping and waking up at a particular time, and having a schedule help us have better control over our day, and it helps our mental health.
What should someone do if people are unable to think positively, and they notice symptoms of depression? What are the steps should they take?
They should definitely not ignore any symptoms. Our advice to people is not to try to treat depression on their own or wait for it to pass. At least seek a consultation, let a professional decide whether it’s just a passing phase or does it require intervention. It can become chronic and harder to treat if people wait longer.
Some of the important symptoms of depression are: low mood or sadness that lasts for at least about two weeks. Having a lot of negative or pessimistic thoughts about yourself, others, and the world. Experiencing feelings of helplessness, hopelessness, worthlessness, a sense of failure. Biological functions can be significantly affected by depression, people may feel a loss in physical energy, significant exhaustion, mental exhaustion, fatigue, and physical exertion. Behaviourally, people may feel agitation, irritability, restlessness, and socially isolate themselves. People also experience cognitive symptoms like lack of concentration, or thoughts of harming oneself.
Mental health professionals are worried about a wave of mental illness post Covid. Unfortunately, the number of mental health professionals is very low. Our suggestion is that people shouldn’t ignore the signs and symptoms. If they feel that they are doing everything that they can but still experiencing depressive symptoms, then they should immediately look for a mental health consultant.
What about people who are already experiencing some kind of mental illness and it’s been exacerbated by the pandemic. What should they do?
This is the first time for a pandemic for us as well. We were not really sure how it would impact people mentally and emotionally. And now that we are more than a year into it, we think this should be an alarm for all of us, for all those who have had some form of mental illness in the past that they need to be prepared. Those who were off their treatment because they started feeling better, they need to know that they are in a state of high vulnerability and high unpredictability and they stand a slightly higher chance of being affected. They need to ensure that they all are particular about medication, if they are on it, be vigilant about symptoms, and never ignore them. They can try to identify all their stressors, and consult their doctor if they haven’t in a while.
Think of it like planning a vacation to a cold place. We don’t know how cold we will feel but we will carry a jacket. In the same way, we don’t know if the pandemic will impact your mental state but you need to make sure that you are be prepared. Talk to your family, friends, therapist or counselor and plan what should be done if you don’t feel okay. Improving the level of preparedness is important. If things start to get bad and symptoms start to resurface, it is important to have your doctor’s number handy and call them.
How can people cope with a panic attack?
If someone is experiencing panic attacks frequently, their anxiety levels are higher than normal. This is an indicator that they might need treatment. Our body and brain have a natural mechanism to bring down our anxiety, but the fact that it isn’t able to do so is an indicator that it may be something serious. Definitely, people undergoing frequent panic attacks require assessment.
Our advice to patients prone to panic is to identify their stressors. For example, a common stressor that is often ignored is substance abuse, which has increased during the pandemic. People have more time on their hands, many don’t have to travel to work, there is anxiety regarding various things, so some people have gone back to smoking, alcohol use, or other forms of substance abuse. Stressors like substance use can cause panic. Our advice to such patients is to correct their substance use, reduce it, or get help for it .
A simple technique that people can use to manage a panic attack if they are on their own and have no help is the paper bag technique. All you need to do is find a plastic or paper bag, cover your mouth and nose with it and take 6-12 breaths. You just have to breathe in and breathe out and remove the bag. Repeat if needed.
When we inhale the same air from the bag, the slightly higher concentration of carbon dioxide in that air is known to abort a panic attack. This can be done anywhere, while travelling, in a flight, in a car, or at home if you have no other help. People can also try to distract their mind by thinking of something peaceful and tranquil and divert their attention to more pleasant and positive thoughts.
If someone is prone to panic attacks, they can start journaling, or have a thought log, this can help them identify their stressor. This helps people think what were the negative thoughts that hit them badly and spiraled into an anxiety attack. This helps generate more rational, more logical explanation to what they experienced. This is basically self help cognitive behavioural therapy (CBT). However, if panic attacks persist, the person should seek professional help. There may be time during the pandemic that someone’s therapist is not available, so these small steps can help.
Dr. Gaurav Kulkarni
MBBS, M.D. (Psychiatry)
Psychiatrist, Sexologist, Addiction Psychiatrist
Ph: +91 99875 45314
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