Time for a check-up? COVID-19 and your mental healthQ&A with a top expert on psychiatry

The opening up of Florida amid a still-active pandemic presents a conundrum for deciding what’s safe and what’s not. This latest tension adds to a growing pattern of emotional turmoil that has followed COVID-19 from the beginning. 

Government phone surveys reveal a nearly four-fold (400%) uptick in symptoms of anxiety and depression between December 2019 (11%) and December 2020 (42%) among U.S. adults over 18. And a recent medical report from The Lancet Psychiatry (April 2021) adds that among those with COVID-19, 1 in 3 suffers from a neurologic or mental health problem within 6 months of becoming infected.
 
To better understand the range and extent of mental health problems in the era of COVID-19, 83 Degrees asked Dr. Bruce Shephard to interview Dr. Glenn Currier, Chairman of the Department of Psychiatry at the University of South Florida Morsani College of Medicine.

Read on for the complete conversation.

Dr. Shephard: How significantly has COVID-19 affected mental health in the general population?

Dr. Currier: It’s been over a year from the start of this pandemic and we’ve known Dr. Glenn Currierfrom the get-go that the mental health burden has increased dramatically. Among the most interesting series of data that I’ve been following are the phone surveys coming from the Kaiser Family Foundation. Immediately the burden of anxiety and mood disorders was noted to be clearly much higher but we weren’t entirely sure why. People were losing their jobs, are stuck in their house all the time and rates of “illnesses of despair” were climbing -- with alcohol abuse, domestic violence, depression, suicide all up. It’s a chicken or an egg thing in terms of determining if it is the virus or the circumstances it causes that’s responsible for the mental health symptoms.

Dr. Shephard: And what do we know about mental health issues among those who actually have had COVID-19?

Dr. Currier: Just recently there’s been a pretty useful analysis published in The Lancet Psychiatry journal (May 2021) looking at people who were infected with COVID-19 that compares them with people who had other kinds of illness like the flu or respiratory illnesses. Over 200,000 people from insurance claims were reviewed, showing the virus does seem to confer an extra risk and that’s how things are playing out in our own practice here at USF.
 
Dr. Shephard: Is a history of anxiety or depression a risk factor for having COVID-related mental health issues?

Dr. Currier:  Yes, but we’re seeing people who have had no mental health history and who are high functioning in society -- successful lawyers, judges, doctors -- who had been laid low by the virus including some suicides. It’s been a difficult road.

Dr. Shephard: How is the severity of COVID-19 related to the likelihood of developing subsequent mental health issues?

Dr. Currier: One large group of patients who we see and were severely ill from the virus, have gone through the whole “cytokine storm” thing and then come out on the other side with longstanding deficits almost like a kind of protracted delirium. Another group has had only mild symptoms and still others have had chronic, protracted respiratory symptoms, the so-called “long haulers.” What’s interesting is that there can be a delay in the onset of these mental sequelae (results or consequences), even several months after the initial medical event.
 
Dr. Shephard: Are the medical treatments for anxiety and depression the same for patients regardless of their history of having COVID-19?

Dr. Currier:  In my experience, many of these COVID-19 patients are not amenable to the standard medical treatments like SSRIs (mood stabilizers). These drugs do help people who become situationally depressed -- if their lives are falling apart, they lost their job or something similar. They continue to respond at the same rates as we’ve always known. But for some COVID-19 patients, the SSRIs don’t work really well, especially those who had severe symptoms with cytokine storm or for some “long-haulers” who continue with chronic symptoms. So, we’re trying very hard to collect data on that here at USF as are other universities. The only thing that seems to work in some of these severely depressed patients is electroconvulsive therapy. It’s important to understand, this is a story still being told and there are a thousand ways to look at it and questions to ask but we don’t have all the answers yet.

Dr. Shephard: Have you seen an uptick in the number of patients at USF since the pandemic?

Dr. Currier: Absolutely. We cannot keep up with demand and have a six-month waiting list now.

Dr. Shephard: Reports from the National Center for Health Statistics cite slightly higher rates of anxiety and depression among women. Has that been reflected in patients seeking psychiatric services at USF?
 
Dr. Currier: We haven’t really done that analysis. We know, generally speaking, women reach out more often even though men are at higher risk for suicide. So, we encourage men to seek help although the stigma associating seeking help with failure still persists.

Dr. Shephard: What is your general approach to patients with mild symptoms of anxiety or depression?

Dr. Currier: Our approach is to avoid medicines if at all possible, even though they are helpful to many people. Often talking about the problem in a therapeutic setting can be sufficient because people are confused by what they’re going through, are unsure of how to put it into the context of their life and that’s where therapy can help deal with strategies to help them cope. For some people, medications can be very useful. Generally, SSRIs are the first line of defense for either anxiety or depression although they do often take a matter of weeks to work. Sometimes, something more rapidly acting, and used on a time-limited basis, like a benzodiazepine is used but we really try to avoid that if we can.

Dr. Shephard:  What is your advice as to when to seek professional help?

Dr. Currier: I use a rule of thumb that if symptoms persist more than a few weeks and they affect whatever it is you do in your life, you should talk to somebody.

Dr. Shephard: That seems like a tried-and-true approach.

Dr. Currier: Yes, but people don’t do it. They lumber along for weeks and months at 50% capacity, not knowing that there’s help to be had. But I am encouraged by the number of people at our doorstep. This feeling that seeking help is somehow a failure or moral weakness is very much a 19th-century notion.

Dr. Shephard: What research in the mental health field is now being conducted at USF?

Dr. Currier: We are conducting several novel clinical trials including ketamine, which appears promising in biologically driven depressions. If people are interested in participating, they should reach out to the Department of Psychiatry. (813-974-2831 for information on depression clinical studies).

Dr. Shephard: Much has been made of the various strategies to strengthen mental health. They include participating in regular exercise, healthy eating, establishing a routine, practicing gratefulness, maintaining spiritual connections, and nurturing relationships to name a few. Do you have any suggestions for those who may feel particular stress during these times?

Dr. Currier: I think basically just realizing that the virus and all the things surrounding the virus can all promote emotional turmoil. So, either getting the virus can do something to the brain or living in a society that’s in turmoil because of the virus -- both of those things can cause problems. First of all, let yourself off the hook a little bit. If you’re feeling a little bit not yourself right now, everybody’s feeling like this right now. Give yourself permission to take a deep breath. But if it persists, if it gets in the way, there’s no reason not to get help because help can be had.

“Who wouldn’t be anxious at a time like this,” he added.
 

Read more articles by Dr. Bruce Shephard.

Dr. Bruce D. Shephard, a retired Obstetrician-Gynecologist and Affiliate Associate Professor, Department of Obstetrics and Gynecology, USF Morsani College of Medicine, is best known locally for delivering more than 7,350 babies. He now occasionally teaches and always practices good health, dabbles in writing, and raises monarch butterflies. He and his wife, Coleen, live in Tampa.
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