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Depression is increasing in the United States, in no small part due to COVID-19. According to recent reports, depressive symptoms are at least three times higher than they were before the pandemic hit, suggesting that the emotional cost of living through this time is enormous.
For those who are vulnerable to depression already, this time is even more fraught.
Al (whose name has been changed for privacy) suffered bouts of depression on and off for years, but had made the decision to go off of his medications near the end of 2019. Then COVID hit, and it was hard to keep his mood from plummeting.
“I have more depressive symptoms than I did a year ago—more negative feelings about my relationship, about friends, in general,” he says. “If your imagination runs to the negative, this apocalyptic scenario just confirms your negative bias about how things are and how things turn out.”
Similarly, Michelle was already going through relationship struggles and worrying about her child’s mental health before COVID hit. All of the changes the pandemic wrought exacerbated these stressors, making her feel depressed.
“Whatever else felt stable in my life got knocked out from under me, and there was nothing left that I felt I could count on,” she says. “My social life disappeared or changed beyond recognition, and I didn’t know what the future of my job was, either. I felt completely rudderless.”
To some extent, all of us may be at risk for depression during the pandemic, says Nancy Liu, clinical professor at the University of California, Berkeley.
“You’re going to feel down. You’re going to feel a little hopeless or helpless,” she says. “You’re not going to be as eager to connect with people and are going to withdraw.” We should expect to feel anxious and depressed, as we would in any kind of disaster.
While we are all prone to feeling down these days, depression differs from normal sorrow or anxiety and is far more debilitating, says psychologist Shelby Harris, author of the book “The Women’s Guide to Overcoming Insomnia.” It persists, unrelenting, for weeks at a time and leads to an inability to function normally. Problems with sleep, significant weight loss or gain, not being able to get out of bed, lacking motivation or a sense self-worth, and finding no enjoyment from everyday activities—these are signs that you may be entering a depressive state.
“If you find you have trouble focusing, concentrating, or doing what you need to do in life because of these issues, consider having it assessed further,” she says.
Depression can also be life-threatening, when it becomes a precursor to suicide. Given the high price of depression, it’s important to understand what causes it, how to identify it, and the steps we can take to counter it. Here are some of the things we can do until the pandemic ends to look out for one another and stay healthier.
1. Get professional help
When Michelle started feeling deeply depressed, she knew she should be concerned, having experienced suicidal thoughts in the past. After her partner expressed concern, she called a therapist.
“That was step one,” she says. “I needed that outlet, to be able to talk to someone who I didn’t have to worry about burdening with my depressive thoughts.”
Liu encourages people to turn to therapy if depressed, because it can be very effective for overcoming mood disorders. But she bemoans the fact that many community clinics are overwhelmed right now, and some people lack the means to reach help.
“There’s just a huge need, but not everybody has access to secure Wi-Fi and Zoom to get remote treatment,” she says. “I worry that only a certain subset of the population is getting the services they need.”
If you don’t have ready access to a therapist, you may want to contact your health care provider, if you have one. See what they have to offer and if you’re eligible for services. Or you can simply ask friends or family if they can recommend any therapists. In many areas, there are sites that specialize in helping people find local therapists, or you can turn to the Psychologist Locator, a site operated by the American Psychological Association.
2. Add small, good things to your life
While professional treatment is ideal, what can people do when they see their mood sinking?
Harris says that it’s important to start adding small things to your life that you enjoy, to fight off feelings of helplessness that often come with depression.
“Plan small activities daily that allow for a moderate amount of pleasure and accomplishment (e.g., reading, cleaning out your office, painting a picture, styling your hair),” she says. “Activity scheduling is very effective at the outset with depression.”
Of course, it’s not always easy to do that now that many of our usual pleasurable activities have been curtailed during the pandemic. Still, it’s possible to adjust our expectations and try new things.
Michelle tried several ways to help snap her out of her funk. One of the most impactful for her was adopting a kitten, whom she came to love.
“That kitten saved my life, because when nothing else was interesting or could grab my attention, the kitten was the one thing in my life that made me happy,” she says.
Michelle also found it helpful to pursue creative self-expression by trying to do short writing exercises based on prompts she found in a book—such as, “What is a time in your life when you said no?” or “What do you think you’re destined to do in this life?”
“This was something I could do that gets me doing some kind of creativity, but isn’t a big commitment; and I didn’t have to think it up myself,” she says. Plus, it brought her a little joy, which helped alleviate her difficult moods.
3. Find ways to exercise your body
One of the best treatments for depression is getting physical exercise, while not getting exercise can induce depressive symptoms. Especially during this difficult time, it’s important to take care of your body.
Al is aware of how his physical health affects his mood; so, he’s made sure to maintain routines of self-care, like getting enough sleep, eating well, and getting outside when possible—all of which have been tied to preventing depression. Though adjustments to his exercise routines were needed because of the pandemic, some of those changes were positive, he found.
“It may be less fun, but it’s more flexible at the same time,” he says. “You don’t have to coordinate with other people or take other people’s schedules into account.”
When the pandemic ended Michelle’s in-person yoga class, she tried the Zoom version of the class, but found it wanting. So, she made it a point to find other exercise outlets—like taking walks and bicycling—which made her feel better.
“I don’t do big bicycle trips yet. But even if I just pedal across the street and around the neighborhood, I’ve at least gotten out there,” she says. “It definitely helps.”
4. Foster a sense of agency
For Al, it was important to make progress on personal goals, like improving his piano playing or his golf game. While it was sometimes difficult to find the motivation and energy when depressed, he found ways to trick himself into getting started, which not only helped him get closer to his goals, but improved his mood.
“Just taking small steps, consciously having low expectations, and telling myself, “Don’t make a big deal out of it,” helped me to go through the motions—to get to the range or to the piano,” he says. “Sometimes it’s less about the actual thing you’re doing than the fact that you are trying something—that you are taking control and taking action of some kind—that helps.”
Having a sense of agency—the sense that you have some control over what happens to you—is important for staving off depression, says Liu. But that can be hard now, when so many people are working from home and finding blurred boundaries between their job hours, home life, and time for self-care. She suggests it’s a good idea to create structure in your day, to make sure you schedule things that are important for your wellbeing.
“You should be making time to read that book, cook, ride your bike, or go for a walk—all the little things that make you happy,” she says.
5. Try meditation and self-compassion
Sometimes, though, negative thoughts get in the way. Maybe you feel you don’t deserve to do nice things for yourself or you aren’t good enough to reach your goals. For that, Liu suggests practicing self-compassion. After all, she says, we are going through a global pandemic and are not going to be the best, most productive versions of ourselves…and that’s OK.
“Getting a little bit of extra help or doing some things to be kind to yourself and take care of yourself is important right now,” she says.
It can also be extremely useful for people to consider doing a daily meditation practice, to ward off negative thoughts, says Harris.
“Start small, even a minute or two, and do it during times when you’re not necessarily highly stressed or anxious,” she says. “The more you practice, the more you’ll be able to notice your thoughts and be able to let them go, getting more distance from them.”
Meditation can also soothe difficult emotions, helping us focus less on ourselves and be more available for others—another depression reliever, says Liu.
“Giving to others is an antidote to the sense of helplessness that we’re all experiencing right now, and it gives us a larger sense of connectedness,” she says. “It’s definitely something that helps us even as it helps others.”
6. Reach out to other people
Both Harris and Liu emphasize the importance of connecting with others for preventing depression. Liu encourages people who are depressed to make an effort to call old friends or family members, take company on your walks (if you can take walks), or engage in other ways with people you care about.
“Social support goes such a long way, even in the face of natural disasters, because experiencing something together creates connection and understanding,” she says.
Michelle definitely feels interacting with other people helps her. But she worries about asking people who are already overwhelmed to spend time with her—and then finding herself turned down or ignored.
“It’s a little disheartening to feel like I reach out a lot and don’t always hear back from people,” she says.
Al also questions socializing as a good strategy for himself.
“I have trouble reaching out,” he says. “I often think, accurately or inaccurately, that it’s asking for trouble.”
This is where Liu thinks friends, families, and communities could step up more to help. Checking in with those who may be isolated or depressed can be hard, especially if they are a bit crankier than normal or even actively block your efforts. Still, it’s good to let people know you are thinking of them and to be willing to listen with empathy if they open up, she says. And, she adds, you don’t have to be pushy.
“Making the space to be a listening, gentle presence and validating someone’s experience—that can go a long way,” she says. “Even leaving unimposing messages of support and understanding makes people feel less alone and that someone cares about them, which is a protective factor.”
While there is no guarantee that we can stop someone from sinking into depression, or that they can stop themselves, it’s important to try. After all, when someone is depressed, it affects everyone.
“Depression doesn’t just impact the person with depression. It frequently has a domino effect that then touches family, friends, employers, etc., in varying ways,” says Harris. “By recognizing it in others, we can be better equipped to help them at a time when they might be suffering in silence and just going through the motions.”
That’s why it’s good to be alert to signs of depression in ourselves and in others. Not only are there things that depressed people can do to help themselves, we all can make a difference if we show up for each other and express care.
“On the rare occasions that I ask someone, “Hey, can we have a chat? Can we have tea? Can we go for a walk?,” it would be nice to have people commit to that and make it happen,” says Michelle. “If I were to ask anything of my family or community, I would ask for that.”
Jill Suttie, University of California – Berkeley