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From confusion and loneliness to worry and frustration, people are dealing with large and intense emotions while trying to navigate a new sense of normal. Psychologist Amy Sullivan, PsyD, ABPP, discusses how the coronavirus pandemic is starting to mentally wear on us and why it’s so important to protect our mental health. Whether you’re isolating alone or just feel alone, Dr. Sullivan gives practical advice on working through our thoughts and feelings.

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How to Protect Your Mental Health During COVID-19 with Dr. Amy Sullivan

Podcast Transcript

Nada:  Hi, thank you for joining us. I'm your host, Nada Youssef, and we're listening to Health Essentials Podcast brought to you by Cleveland Clinic. Stay at home orders have turned parents into teachers and homes into offices. Families are finding themselves apart during birthdays, births, holidays and even deaths. Mentally, this is taking a toll on many of us and to some it's leading to depression. So today, we're joined virtually with Dr. Amy Sullivan to talk about dealing with depression during these difficult times. Thank you so much doctor for being here today.

Dr. Amy Sullivan:  Yeah, thanks for having me.

Nada:  Dr. Sullivan is the Director of Behavioral Medicine Research and Training at the Mellen Center for MS. She's also the chair of the Neurological Institute Physician and Caregiver Engagement Team and she's here with us today to address depression. And please remember, this is for informational purposes only and it's not intended to replace your own physician's advice. So as weeks of distancing turn into months, many people are experiencing a greater sense of isolation and even depression. Living through this pandemic is taking a toll on many of our mental health. So can you talk about the mental effects of these changes today?

Dr. Amy Sullivan:  Yeah. I can. So I wanted to first talk about the fact that I think it's very normal for people to have a mixed array of emotion. So what I'm seeing are that people are having waves of emotion. So at some point people can be very grateful that they're alive and well and having the ability to spend time with their family. And then an hour later, they're having a difficult time with the isolation or the restrictions that have been put on them. And so to me, it's just really important to normalize that those range of emotions is occurring and it's important for people too to be able to really talk about those and have a safe place to do that.

Nada:  So with all the emotional changes that you've just mentioned, how do we know if someone is just feeling down from everything that's happening versus clinically depressed?

Dr. Amy Sullivan:  That's a great question. So down is, again, it's a normal part of this process. Feeling down is sometimes described as just a blue feeling or feeling unmotivated, just not feeling great, which is very different from depression. Depression is more of a cluster of symptoms and it's notably different. It's a different duration of symptoms. So it's feeling like somebody is down, depressed. We hear a lot of irritability for long periods of time. Typically, this can last for up to two weeks at a time or even longer, as well as having little interest in pleasure and things that people once enjoy. So those are two key essential symptoms of depression versus being just down. And I guess I would add one thing... I'm sorry. We know that depression starts to impact people's everyday function. So activities of daily living or their will to do things and when it really starts to impact things that are important to you, that's a definite signification that it's more of a depression versus just the down mood.

Nada:  Now, can we talk a little bit about what it looks like? For example, eating. What does that look like when someone's on depression? Signs that we can tell if someone's depressed?

Dr. Amy Sullivan:  That's a great question. So in our field, we use an acronym called SIG E CAPS. And so what that stands for is, S, is that there's a subjective mood change. So a change like an irritability, a mood, depression, sadness. The I stands for interests. So things that people once enjoyed, they're now not doing. The G is for guilt. So we find that people feel guilty about having these symptoms or they feel worthless. The E is for energy. So changes in energy patterns. Typically they feel more fatigued or they're not moving as quickly. The C is for concentration or cognitive changes that we see. And then A, getting to your point, is for appetite. So this can be changes in appetite, either up or down. And the P is for psychomotor agitation, the S is for sleep, and then the S is for suicidal ideation.

Nada:  Now when it comes to sleep, is it irritability where you cannot sleep or are you sleeping more?

Dr. Amy Sullivan:  Right. It could be both or either. And so sometimes people come in saying they're unable to fall asleep. Sometimes people are having difficulty staying asleep. It really depends on the individual person and each person is likely going to have different symptoms.

Nada:  That's a good point. Now, can prolonged loneliness contribute to depression?

Dr. Amy Sullivan:  So we're seeing a lot of this right now. So loneliness is a very interesting topic because I'm seeing people that are feeling lonely despite the fact that they're at home with people that they love. So we have to remember that loneliness is subjective. So many times you have people that their whole world is wrapped up in their homes and that's great. So they're probably doing very well with these stay-at-home orders. But you also have people who their world is at home and with friends or family members that they're not with. And so there's a great sense of loneliness right now with individuals who want to be with extended family or family that's really important to them that doesn't live in their house. And so I think we have to make sure that we're taking care of each other and checking in on each other, given that there's different situations for every person. So yes, for sure. Loneliness can be a contributing factor.

Nada:  And how can we help others or loved ones that we may be living with that's going through depression at this time?

Dr. Amy Sullivan:  Yeah. So I think first and foremost, we need to remember that each person is going to deal with this differently. So while this may be enjoyable for some, I have a daughter that I think this is going to be very... She fits very well with this world right now. It's going to be actually very hard for her to get back to it. So we have to remember that there's some that I think are really enjoying this and then there's others who are having a very difficult time. So I think that we can be creative at this point and we can find ways that we're coping and we're helping others cope. But some of the basic things I think are important. One is having an overall sense of wellness and wellbeing. So what that means is making sure that we're eating properly. So that means eating a healthy, balanced diet, making sure that we're moving or exercising or getting your heart rate up, something that you're doing good for your body.

Dr. Amy Sullivan:  We talked about sleep earlier, making sure that our sleep is still scheduled, making sure that we're falling asleep and waking up on a regular routine time and then taking care of our mental health. So that's from a wellness perspective. Now, I think that there are other things that we need to do for others as well. So we talked about checking in. So making sure that we're still staying connected to people despite the fact that these stay-at-home orders are in place right now. So we can do things like Skype or FaceTime or Zoom meetings. I think I've seen my kids become very creative in terms of playing games with their cousins or friends, having marathon TV shows with each other.

Dr. Amy Sullivan:  Another thing that I think is important is to express gratitude. So there are so many people who are out there really risking their lives and their families' health and they're out there every day. So everybody from, of course, our frontline healthcare workers, but grocery store workers, our mailmen, our first response police officers. These are people who maybe we go outside of ourselves and we express our gratitude to them and in turn, it makes us feel a lot better.

Nada:  So if this is really serious for someone and someone's going through depression or severe depression, is there someone they can talk to today?

Dr. Amy Sullivan:  So the Cleveland Clinic has a lot of resources on our website and it's important too to look at those under the COVID website webpage and it has a bunch of resources listed there. So that's one place to start where you can get a lot of information. Knowing that all behavioral medicine at this point, or most of us in behavioral medicine have converted to virtual appointments. So we're all available to help. Also, there's the 1-800-273 talk phone number, so that's a 24/7 crisis hotline that I like to give to my patients on a continual basis. And then if you look online for NAMI, which is the National Alliance of Mental Health, they have resources as well.

Nada:  Very good. Thank you. So many people are working from home or not even able to go to work at all right now and might feel a loss in a sense of purpose or productivity. How do we stay productive, engaged or interested when we're feeling down or depressed?

Dr. Amy Sullivan:  Yeah, that's a great question too. I think first we need to look at how do we take care of ourselves on, again, a holistic basis. So making sure that we're taking care of ourselves from a wellbeing perspective. But next, make sure that you're doing something to better yourself on a daily basis. So what does that look like? So does that look like learning something new? Does that look like doing something physical, learning a new skill? There are ways that we can still stay productive and still feel worthwhile during this process. But I also think it's important to talk about this.

Dr. Amy Sullivan:  So as mental health practitioners, one of the things that we know that works the best is to have people to process your emotions with. And that can be somebody that you really trust, that can also be somebody that's, in the mental health field, that's there to help people. So I think there are many ways for people to still feel productive. And again, when a person is feeling rather depressed or feeling like they're just not themselves, you know that they need to seek help and seek the help of a mental health provider.

Nada:  So you've mentioned reaching out to loved ones that may be suffering from depression right now or feeling down. Now, as a friend of a loved one, what can I do or how can I be a better listener or what should I say to someone that is feeling down?

Dr. Amy Sullivan:  Yeah. So one of the things I would suggest is to not try to fix your friend or your loved one. Instead, just be there to listen. And so I find that people sometimes just need the opportunity to process. So you might ask them questions like, "How can I help you with this? " Or, "Can you tell me more about this?" "I'm sensing that you're feeling X, Y, or Z. It's really important to me to be able to hear you. So tell me more." And I think that if you use these open ended questions and the person knows that you're really there for them, it will create a really great opportunity to have a conversation with them.

Dr. Amy Sullivan:  So I think it starts with conversation, trust and just consistently being there for somebody. What I find too are that people want to do the right thing and good things for people and sometimes they just don't know how to do it. And so what I encourage my patients to do is to regularly and consistently reach out and that could be reaching out for themselves and that could also be allowing other people to know that they need some help right now.

Nada:  Okay. So can we expect people that are feeling down or depressed right now to be back to normal after return to work and school? Why or why not?

Dr. Amy Sullivan:  Yeah. That's a great question and I've actually put a lot of thought into this. I don't think that we can. I think that like we had talked about a few moments ago, there are going to be some people who have really enjoyed being at home. These are more of your introverted individuals, they're really enjoying being at home. And so those getting back to whatever we see as normal in the future is going to be very, very difficult. And then on the flip side, there are going to be people who are very excited to get back to whatever normal is in the future. But it's also going to be a challenge for them to rejoin society as it was because society is not going to be what we once knew it as. And so I think that we just have to take it slowly. I think it's going to be a process, as we've heard the governor say and Dr. Acton say, it's a step by step approach and that's going to be no different from the way that we handle our own emotions and getting back into the regular whatever normal looks like.

Nada:  So myself personally, should I not expect my mental health to be exactly as where it was at before the quarantine and to gradually that it will get better? Is that what you mean?

Dr. Amy Sullivan:  That's what I mean, yeah. So I think we need to give ourselves grace. And what that means is we don't know what normal's going to look like. We don't know how we're going to respond to normal. And I think we need to be okay with not necessarily knowing what normal looks like and how we jump back into society. I think a lot of people are finding the gifts in the moment right now. So the gifts being that life is not as busy right now and that is quite a gift to many of us to be able to say, "We're going to have dinner with our families on a nightly basis," and just go back to the basics. And that may change and that's going to be hard for people too to get back the everyday swing of things and the chaos that we all knew prior to this. So I think learning how to take with us some of these wonderful lessons I would call them that we've all learned in this moment is going to be important and applying those as we go through whatever our new normal is.

Nada:  Great. That's very useful information. Thank you. Okay, one more question for you.

Dr. Amy Sullivan:  Sure.

Nada:  So if someone who has depression is listening or watching this right now, are there any encouraging words to help them through this that you would like to tell them?

Dr. Amy Sullivan:  Oh yeah. I would just like to let them know that we look at depression much differently than we did, I don't know, even 20 years ago. So now we're really on a kick of normalizing and not stigmatizing depression. And one of our greatest Cleveland people that we have is Kevin Love and look what he did for the stigmatization of mental health. He's really come out and talked about the fact that people have experiences and emotions that need to be discussed. And to him, I am so grateful because he's opened up a huge opportunity for specifically our men to be able to talk about their emotions and to feel like it's okay to talk about our emotions. He has really normalized it. And so for anyone who's experiencing depression, I would just say it's rather normal to have these feelings, these ebbs and these flows and emotions and when it does impact your daily functioning or activities of daily living or you just don't feel like yourself, seek help.

Dr. Amy Sullivan:  There are people out there who are trained in this and who can help you through this. And so I would just really encourage people to not look at it as a stigma anymore. Look at it more as this is just part of our overall wellbeing. And one other thing I would say to that is that we look at depression or anxiety as a chronic disease. And just like we would look at blood pressure or we would look at sugar, diabetes, we look at all of these as chronic diseases. So in an instance of somebody who has high blood pressure or who has diabetes and they eat too much sugar or they have too much fat or something, they're going to really set off their numbers and it's no different from what our individuals that are faced with depression are doing.

Dr. Amy Sullivan:  So this is really going to set some people off. And so by that I mean it's really important for them to understand that this is a chronic disease and that right now we're in a very difficult situation. And so this may trigger depression for somebody who was rather managed in the past. And so just like diabetes or blood pressure, we just have to get it under control again. And we do that by way of therapy and/or medication. And so again, making sure you're taking care of yourself just like you would any other physical condition.

Nada:  I love that. That's vital information because you do see a lot of information on the news, a lot of physical changes happening to us, but understanding the mental changes are happening is just as important as a physical changes. Thank you so much, Dr. Sullivan, for being here today.

Dr. Amy Sullivan:  You're welcome. Thanks so much for having me.

Nada:  Sure thing. And for more resources on mental health or to make an appointment with a behavioral health specialist, please visit clevelandclinic.org/behavioralhealth and for the latest coronavirus news and updates from Cleveland Clinic, please visit clevelandclinic.org/coronavirus. And thanks to our listeners and viewers for tuning in. If you found this information helpful and would like to listen to more of our Cleveland Clinic health experts, please go to clevelandclinic.org/hepodcasts. Thank you again for tuning in.

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