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No End in Sight: Living With COVID Malaise

photo of family social distancing

Nov. 10, 2020 -- If 9 months of pandemic living has left you struggling to find the bright side of things, you’re not alone. Welcome to COVID malaise.

“We’re in Dante’s Inferno. It feels like we’re going in circles,” says Lynda Spiegel of Forest Hills, NY. She belongs to a high-risk group. And after a recent spike in cases, her neighborhood was deemed a “red zone” by New York City Mayor Bill de Blasio. All nonessential businesses and schools shut down for a second time, and nonessential gatherings were prohibited.

“For me, it’s this incredible sense of isolation,” she says. “The thing that’s always kept me from feeling isolated was to take a break, bike over to another neighborhood, and eat somewhere interesting. That can’t be done now -- I’m still riding, but there’s no destination.”

Amber Ying is a grad student studying neuroscience at Harvard Extension School in Cambridge, MA. “I knew intellectually that in times of high stress, you’ll have a higher rate of depression and anxiety in the population, but I didn’t think I’d be one of those people,” she says. “But the pandemic is getting to me. I sleep more, and I’m more fatigued. I’ve developed irrational fears -- I’m afraid of elevators now, stairs, bridges.”

Ying and her therapist think it’s about the loss of control she’s gone through in the pandemic.

Emotional responses to the pandemic are widespread. In a survey by the Kaiser Family Foundation over the summer, 53% of American adults said COVID-related worry and stress had negatively affected their mental health. A study published in JAMA Network Open found that depression symptoms had tripled among American adults since the pandemic began. And a survey of 1,000 American adults by Recovery Village found that more than half were consuming more alcohol than they had been, and more than one-third were using more illicit drugs.

What Causes COVID Malaise?

The open-ended nature of any pandemic can leave people feeling unsettled, but in this country, the course of COVID-19 has created some especially trying circumstances.

“With a blizzard, everything shuts down, but you know it’ll be a day, 2, maybe 3. It has some degree of a time frame,” says Philip R. Muskin, MD, a professor of psychiatry at Columbia University Medical Center. “This has no time frame. You can’t assess anything because we don’t have reliable information. The information we have is always tempered with politics. Who do you believe?”

Staying home indefinitely leads to behavior that can worsen your malaise. How many Zoom calls have you sat through without getting fully dressed? “For many of us, every day feels like every other day, even if we’re working,” says Muskin. “We joke about being in our underwear, but that’s different from how most of us work. No tie, no suit, no dress -- the homogeneity of days contributes to the sense that this will never end.”

That was the case for Marvin Doctor of Corona, NY. “In the beginning, I really wasn’t coping well,” he says. “Working from home, I could get away with not doing certain things, and that led me into a depressive episode.”

He found himself sleeping more and letting projects that weren’t urgent go unfinished. When he developed symptoms that might be COVID, his mood sank even further. “The paranoia of being sick contributed somewhat. I got tested and was negative, but the feeling of being a pariah was horrible,” Doctor says. Once the art gallery where he works began to reopen, his outlook improved.

Isolation, too, can dull your mood. “We’re missing something called the amplification effect, the idea that when we're around other humans, our emotions intensify, both positively and negatively,” says Marisa G. Franco, PhD, a psychologist and friendship expert. “When we're not around people in the same way, we're not getting that amplification of our emotions. We’re in a state of constantly feeling blah.”

For others, the financial effects of the shutdown have been overwhelming. Sofia Moncayo of Sunnyside, NY, owns a martial arts studio with her husband. They were forced to close for 6 months.

“The first few weeks, I was a little numb, trying to adjust, waiting for it to be over,” she says. “It was scary and stressful, and you just wanted everybody to be safe. And then it became, ‘Oh my gosh, what are we going to do? How are we going to get by? How will we make ends meet?’ That was a really difficult time.”

Your Brain and the Pandemic

Living with long-term stress -- like, say, being stuck at home, or losing your job, or worrying about getting sick during a seemingly endless pandemic -- can actually change the structure of your brain. Those changes have been linked to emotional and behavioral issues.

“Our hippocampus has the job of comparing every new memory to everything we’ve ever known, predicting good and bad, safe and not safe,” says Muskin. “When our brains are subjected to this chronic stress, all this stuff around us -- the news, numbers going up in some places, all the uncertainty -- it weighs on us, and you can’t change it. You can only change how you deal with it.”

Defeating the Malaise

The good news in all this: There are plenty of things you can do to lift yourself out of your pandemic malaise.

“The most important thing is structure. When there’s no structure, the malaise can settle in,” says Muskin. Treat your workday the same as you would if you were going to a workplace: Wake up, shower, get dressed. Create a schedule for yourself right down to coffee and lunch breaks. “Even if you’ve lost your job, you can spend time enhancing your skills or learning new ones,” he says.

That structure should also include some kind of exercise. It doesn’t have to be much -- just go for a walk (wearing your mask and practicing social distancing, of course). “Research has shown that it has similar effects to antidepressants,” says Franco. “One of the real powers of exercise is that it activates your sympathetic nervous system, the part that’s activated when you’re energetic, engaged, awake, alert.”

This has proved true for Spiegel. “I bought myself a spin bike for my apartment since I can’t go to the gym,” she says. “Exercise always helps.” For Doctor, riding his bike to work has made a huge difference.

Find ways to connect with other people, especially if you live alone, Franco advises. “If you don’t have a preexisting network of friends, I suggest reconnecting with people from your past. We know from the research that reconnecting can supercharge a relationship, because you have more trust, sooner,” she says. “So if there’s a friend from your past you’re missing, it’s a great time to reach out and say, ‘I was thinking about you.’”

Ying has found that strong relationships are key to maintaining her optimism. “Once a week, my best friend and I get online and play a game called Stardew Valley. We enjoy our time together, talk, and catch up.”

Meditative work -- deep breathing, yoga, anything that requires your full attention -- can also help, says Muskin. “Spend time every day doing nothing but that task, something that frees you from all this,” he says. For him, meditative work comes in several forms: He uses a deep-breathing app called Breathe2Relax, he’s learned origami, and he makes desserts called halva and marzipan. “When I make marzipan, there’s a moment where the almond flour and sugar becomes a ball. I watch it go around, watching just to experience it happen,” he says.

Another great way to lift your spirits: volunteering. Studies have shown that it lessens symptoms of depression, among other benefits. After the small food pantry at her church saw a surge in visitors due to the lockdown, Moncayo leapt into action. She now oversees it, coordinating donations, recruiting volunteers, and providing food for around 1,500 people each week. “Without the food pantry, I think I’d probably be in some state of depression,” she says. “It makes me nervous to think about, what if I didn’t have this outlet?”

When to Seek Help

For some people, malaise deepens into depression. It’s important to know how to recognize the symptoms.

“If you’re drinking at noon, you’re using alcohol as a drug. If you’re drunk every day or using a lot of edibles, that’s a sign of trouble,” says Muskin. “If you think ‘I hope I don’t wake up tomorrow,’ if your heart’s pounding in your chest and you’re panicking, if you’re being abused or abusing someone: Think, ‘This is a maladapted way to live, and I need help.’”

Franco, too, has hallmarks to watch for. “If your mood starts to affect your ability to get through daily tasks, you can’t focus, you can’t keep up with hygiene, you’re not exercising, you can’t get out of bed -- it’s time to get professional help.”

For Ying, who was in therapy before the pandemic, having someone to talk to has helped. “This pandemic has affected our mental health, and it’s OK to recognize how our mental health has changed,” she says. “Think about how big events like this can really affect us.”

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Sources

Lynda Spiegel, Forest Hills, NY.

Kaiser Family Foundation: “KFF Health Tracking Poll - July 2020.”

JAMA Network Open: “Prevalence of Depression Symptoms in US Adults Before and During the COVID-19 Pandemic.”

The Recovery Village: “Drug and Alcohol Use Increase During COVID-19.”

Philip R. Muskin, MD, professor of psychiatry, Columbia University Medical Center.

Marvin Doctor, Corona, NY.

Marisa G. Franco, PhD, psychologist and friendship expert.

Sofia Moncayo, Sunnyside, NY.

Future Science OA: “The effects of chronic stress on health: new insights into the molecular mechanisms of brain-body communication.”

Amber Ying, Cambridge, MA.

BMC Public Health: “Is volunteering a public health intervention? A systematic review and meta-analysis of the health and survival of volunteers.”

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