Feel Well Again Blog

Coronavirus (COVID-19) has caused havoc on people’s mental well-being.  As a psychiatrist in Chicago, I discuss its effect on our patients and practice.

How have patients been affected from the Coronavirus (COVID-19) restrictions?

As seen below, the restrictions’ effect are dependent on the type/severity of illness you have, and quality of your existing relationships.

For patients who suffer from chronic apathy, social isolation, and hadn’t worked or attended school prior to the coronavirus epidemic:

Daily life is mostly unchanged. These are a fraction of my milder “treatment-resistant” cases, where I have patients feeling well without depressed mood or anxious thoughts when they’re in the safety of their home.  However, their functioning outside the home is limited, typically due to lack of social support.

Why would life be mostly unchanged?

The techniques we use to help you functioning at your highest level outside of home, involve more discomfort than treatments that may solely help improve mood and anxiety symptoms when you are relaxing at home.  For example, a good medication regimen plus visits for supportive psychotherapy can help resolve symptoms of depression and anxiety when you are in a controlled home environment, but may not be enough to help you get out the door and functioning at a high level at work or school.  The treatments that get you to that next step, include behavioral activation and exposure therapy.  These two treatments involve daily exercises that can be terrifying or unappealing to a person in need of of them.

Slow down.  What is exposure therapy, and when would you consider recommending it?

If a patient won’t leave the house due to anxiety about driving, then we would consider doing “exposure therapy” as one of many treatment options.  This involves gradually exposing the patient to the act of driving.  They may start by sitting in a car alone 10 minutes a day for one month, then progress to being a passenger for a five-minute daily drive the next month.  Eventually, they progress to driving around town with a family member, before we ultimately get them driving without supervision.

Okay.  What is behavioral activation?

If anxiety is not the issue, and instead it’s pure lack of motivation to move around, then we will consider a treatment called “behavioral activation”.  We may start by recommended five-minute daily activities, such as walking to the mailbox and back daily.  This could progress to walking around the block daily, then to 30 minutes of exercise a day, and so on.

So, how do these things relate to social support, and life being mostly unchanged?

The idea of doing exposure therapy or behavioral activation can either be terrifying or unappealing to individuals suffering from these illnesses.  Motivating them to expose themselves to something uncomfortable on a daily basis without help from family can be a nearly impossible task.

For those with strong family support, I work with the family and patient as a team.  The family can help nudge and support the patient as they expose themselves to uncomfortable daily exercises.  Similar to intense physical exercise, the process of doing these treatments is uncomfortable, but accomplishing them daily will provide long term benefits.

For a small percentage of patients, who unfortunately have little to no support at home, we end up stuck at a plateau.  Why? Because the only person they have cheering them on to move forward, or to hold them accountable, is me.  I can’t be present in their lives daily.  As a result, these patients may feel well at home, and only leave for brief periods of time to do groceries and small errands.  From my perspective as a psychiatrist in Chicago, with exception of those who have lost family members or experienced other tragedies, the coronavirus restrictions has caused minimal changes to their daily life.

For patients who suffer from social anxiety, anxiety related to school or the workplace, or parental/child separation anxiety:

The restrictions have made life a little bit better. One of the core symptoms of anxiety is avoidance of anxiety-inducing triggers. If you have social anxiety, you may avoid meeting new people or speaking in front of groups.

If a child has anxiety related to school or separation anxiety from his/her parent, getting the child to school may be a struggle. The child’s anxiety may either cause or give heightened perception of physical symptoms (i.e., stomach aches) to help convince the parents to keep them home.  The child may seek “homebound” school instruction, where they can participate in school from home.

In rare cases, if a parent also has separation anxiety from his/her child, they may give in to what the child is experiencing and allow them time off.  They may also seek for the child to achieve “homebound” school instruction. For those with anxiety due to problems at the workplace, they may be more apt to seek medical leave.

Why is life typically a bit better for these patients right now, all things considered?

Because their triggers have been eliminated, through no fault of their own. Unfortunately, the longer you avoid anxiety-inducing triggers, the worse your anxiety will become over time. Avoidance will provide short-term relief but heighten your susceptibility to anxiety in the long term.  Gradually and continually exposing yourself to increasingly frequent and severe anxiety-inducing triggers will cause daily short-term discomfort, in exchange for long-term relief. As a result, while these patients may enjoy a short-term relief, in the long-term they will be worse off.

For children who have ADHD, or children who previously dealt with psychiatric problems that are now in remission:

The results are mixed.  Kids tell me they are bored because they can’t play or socialize with their friends.  They also don’t have their usual after-school sports to let off steam. However, they have the unusual setup of being at home with one or more parents daily.  This leads to more bonding time with parents over projects that were previously tossed aside (arts and crafts, building a treehouse).

For individuals who suffer from generalized anxiety disorder (worries about “everything”) or depression:

Life is worse. Reasons include social isolation, reduced exercise opportunities, heightened concern about health of themselves or family members, and limited ability or reason to leave the home. More time spent alone at home leads to more time spent trapped with negative or anxious thoughts.  Left unaddressed, these thoughts can cascade and compound upon each other.  This can then lead to panic attacks, suicidal thoughts/desires, and emergency room visits.

For all patients, regardless of their psychiatric history, gender, social class, or age:

Sleep quality and structure have been affected. If you don’t have to wake up for school or work and can get away with hitting the snooze button for as long as you’d like, then this can lead to sleeping in late. Sleeping in leads to feeling energized later into the following night, causing you to fall asleep later than preferred.  Therefore, you may sleep in late again the following morning.  If no firm sleep/wake schedule is adhered to, then this problem can cascade into insomnia at night and sleeping too much during the day.

For those with a history of substance abuse:

There has been a higher incidence of drug/alcohol relapse since the coronavirus restrictions.  Job loss, social isolation, ill family members, sudden deaths in family, chronic physical separation from a loved one who works in healthcare, relationship stress from too many family members home simultaneously, reduced exercise, cancellation of substance abuse group meetings, and financial stress are just a fraction of the factors that I have seen contributing to drug and alcohol relapse.

As a psychiatrist in Chicago, how has your practice been affected from the Coronavirus (COVID-19) epidemic?

Prior to March 2020, our practice was largely telehealth based. All of our patients were typically seen in person for their first or second visit, but, by the third visit onward, many of our follow-up visits were done via telehealth. After mid-March 2020, all of our visits, including initial evaluations, became telehealth based. Since we had experience with practicing psychiatry online for years, we were well positioned to handle this transition.

Since March 2020, we have noticed a reduction in new patient inquiries.  This is likely related to a combination of factors, e.g., job/insurance losses, lack of awareness of telehealth options, and drastic life changes leading to a temporary shift in priorities. Why would anyone look to find a psychiatrist in Chicago, when they may have greater concerns about the immediate health of themselves/their family, the stability of their job, or the welfare of their children who now cannot go to school or daycare? Despite this, we have remained busy with maintaining the health and well-being of our existing patients.

I have problems with depression and anxiety due to the Coronavirus epidemic. I need a psychiatrist near me. What should I do?

If your concerns are not life threatening, and you would like to have a psychiatric evaluation or second opinion by an online psychiatrist in Chicago, contact us.  If you need to see a psychiatrist online and are outside of Illinois, you can contact your insurance company or state mental health authority for further guidance on finding the best psychiatrist near you.