Feeling stressed and blue this holiday season? Talk to your doctor

The holiday season can trigger depression for a number of reasons. Financial stress, family obligations and loss of a loved one can cause grief. Memories of loved ones who have passed away can be triggered at this time. The days are shorter and darker, which can result in seasonal affective disorder.

And this year, there’s the added stress of coping with the coronavirus pandemic. How do we celebrate the holidays while practicing social distancing? Well, there’s video chat, but that’s not nearly the same.

“Depression feeds on isolation,” says Karin Mirkin, MD, a board-certified family medicine physician at GBMC Health Partners Primary Care – Perry Hall. COVID-19 and social distancing have caused a significant spike in depression symptoms and anxiety found in patients coming into the primary care practice at Greater Baltimore Medical Center, she adds.

“People who weren’t depressed before, now are being diagnosed, so we help get those people into therapy,” says Dr. Mirkin.

The uptick is widespread. Earlier this year, the Centers for Disease Control and Prevention (CDC) conducted a survey assessing the impact of coronavirus on mental health. The findings estimated that the prevalence of depression in June 2020 was approximately four times more than reported in the second quarter of 2019 (24.3% versus 6.5%). This is a significant rise, and can partially be attributed to the impact of COVID-19.

A common illness with a stigma

Major or clinical depression is the most common mental health condition in the U.S., and it’s also the most common mental health condition among people who come into the primary care offices at GBMC, says Dr. Mirkin.

Primary care physicians (PCPs) can treat mild to moderate depression and anxiety. If there’s anything more severe, the PCP will refer patients to a psychiatrist and/or a therapist.

In 2017, 7.1% of all U.S. adults had at least one depressive episode — that's roughly 17.3 million adults, reports the National Institute of Mental Health.

Yet the stigma remains.

“We have to remember that the brain is part of the body,” Dr. Mirkin says. “It’s an organ, so the same way that your liver can dysfunction or your skin can have an outbreak, your brain can dysfunction when something’s out of balance, too.”

How to recognize depression symptoms in yourself and others

The two telltale signs to look out for are having depressed moods more days of the week than not and losing interest in doing things that previously were deemed enjoyable, says Dr. Mirkin.

Other signs and symptoms include changes in appetite and sleep, feelings of worthlessness, lack of energy and fatigue, difficulty concentrating, as well as withdrawing from friends and loved ones.“Irritability can be a presenting symptom of depression or anxiety,” she says.

Depression can cause suicidal thoughts — the brain’s way of asking for help and signaling it’s time to see a doctor.

How can you encourage someone to get help? Reassure the person (or yourself), letting them know they are cared for and they don’t have to live in melancholy and sadness. With the right treatment, people can feel better and live a happier life, but taking the first step to healing can be the hardest part.

How GBMC can help

Around June of this year, GBMC implemented the Collaborative Care Model for treating mental health more holistically with a coordinated team. The model is part of the primary care offices and uses a collaborative approach, meaning GBMC counselors and psychiatrists work together on patients’ treatment plans and overall progress. In some cases, the psychiatrist will advise on medication.

Depression can sometimes be caused by physiologic disorders, so those need to be ruled out before recommending a treatment solely based on behavioral health.

Typically, patients meet with a therapist weekly or every other week for therapy sessions. But under the Collaborative Care Model, patients receive counseling in shorter, more frequent sessions, depending on their level of need. Patients pay a monthly co-pay rather than paying per session, making therapy more affordable and accessible.

“It's like having a behavioral health coach who might give you homework to do. It's more goal-oriented, and the studies show that this type of approach is more effective to treat depression and help people get better faster,” Dr. Mirkin says.

Coping tips and techniques

If you feel sudden sadness or feelings of grief, experts recommend these coping strategies:

• Reach out to others.
• Do activities that you like to do, within the realm of COVID-19 safety precautions.
• Get moving. Exercise releases feel-good hormones, called endorphins, which can help stave off depression.
• Eat a healthy and well-balanced diet.
• Speak with your PCP about your symptoms so they can recommend a treatment plan.

For more information about family medicine, mental health or to schedule an appointment, visit www.gbmc.org/mydoctor.