Approaches to Stave Off Depression
At last estimate, depression among older adults in the United States was high—roughly one in 10—and perhaps double that, if you include those just shy of meeting clinical criteria.
And that was on a relatively good, pre-COVID-19 day.
At this writing in May 2020, amid efforts to stop the spread of the virus, risk factors are closing in on this vulnerable population: Loneliness. Sleeplessness. Seeing the very real threat to health and safety in the headlines every day. Maybe a growing roster of friends to grieve—and no one on hand to grieve with in the era of social distancing.
Pitt’s Charles (Chip) Reynolds III notes that social distancing is vitally important (though he prefers the term physical distancing) and may continue for some time. However, it’s helpful to keep in mind that the connections between loneliness, depression and grief are profound as well as bidirectional, cautions Reynolds, Distinguished Professor of Psychiatry Emeritus.
Further, grief in the time of COVID-19 is emerging differently—not just for older adults, but for all of us.
"The fact that family members are not able to be with loved ones at the time of death because they’re physically separated [and] the fact that funerals are not possible or have to be conducted in other ways will definitely be occasions for, in many instances, derailing grief."
Once off the rails, grief can devolve into what’s termed prolonged grief; that’s when a painful, acute condition becomes chronic, and symptoms like intense longing and searching for the deceased linger for upwards of a year. (Prolonged grief is a longstanding interest for Reynolds and his Pitt colleagues.)
Reynolds serves on the Lancet Commission for Depression and recently finished a stint on the American Psychological Association’s depression treatment guideline panel. In partnership with the Depression and Bipolar Support Alliance, he’s now working to create support groups to help older adults navigate this difficult time.
He’s also part of a five-site collaborative network, dubbed OPTIMUM, that aims to improve treatment for older adults with difficult-to-treat depression. Recently, the OPTIMUM team began interviewing a number of the participants during the COVID-19 crisis, examining how people are feeling and coping. Heading the qualitative research project is Jordan Karp, Pitt professor of psychiatry, anesthesiology and also clinical and translational science. Megan Hamm, assistant professor of medicine, leads the team that is analyzing the interviews. The study is supported in part by the Pitt's Department of Psychiatry and the Commonwealth of Pennsylvania Department of Health.
"For the older adults we interviewed," says Hamm, "one of the most difficult aspects of social distancing is not being able to interact in-person with their grandchildren."
"We’re early in this project," says Reynolds, "but we think it will be important to understand how the current pandemic and its progeny of anxiety, depression and grief are affecting older adults who are already living with difficult-to-treat depression."
The team is concerned about the health and well-being of older adults generally. In light of the challenges related to the pandemic, Reynolds suggests a few practical coping strategies:
Care for the caregiver. Some older adults are caring for loved ones with dementia, a round-the-clock job without reprieve. Daily check-in calls are important for such caregivers, Reynolds says. And the Alzheimer’s Association sponsors another tool that can be helpful as well: online support groups for commiseration and mutual problem solving.
Take it porch-side. Friends, family and neighbors can stop by and talk—outside, while maintaining appropriate physical distancing guidelines—to lessen the sting of solitude. Offer reassurance that they’re safe and cared for, Reynolds suggests, as well as help with a household task or two.
Break out the albums. Flipping through old photos, or putting together new albums—tools in what’s called reminiscence therapy—“can be a potent boost to morale,” Reynolds says. The reason: It encourages storytelling and meaning-making. “Rediscovering meaning and purpose can have strong value in promoting a sense of well-being and also in promoting other positive feelings like gratitude, which are key to mental health,” he says.
Turn off the tube. Cringe-bingeing newscasts is all too easy now. To avoid overarousal, Reynolds suggests people tune in just once or twice a day.
Set a new schedule. Maintain regular wake times and bedtimes. Stave off boredom by filling the hours in between with things that are pleasant and distracting.
Do what you love. Books, audiobooks, movies, music. Crafts, show-and-tell, charades, storytelling. Virtual concerts or museum tours.
Connect. Social media channels like Facebook can be a rewarding way to catch up with friends, family and communities of faith, Reynolds says. Same with get togethers through online platforms. (Sometimes it’s helpful to get someone with experience with a platform on the phone to guide the novice.)
Get moving. Short walks outside (wearing masks and observing physical distancing), seated exercise or gentle stretching can lift spirits.
Eat well, live well. Proper nutrition is important too, Reynolds reminds. Essentially, anything that helps maintain and nourish a body can also maintain and nourish well-being.