Image courtesy of Verywell Mind.
It’s no secret that the Covid-19 pandemic affects every aspect of our lives, from mask wearing outside of our homes, to how we shop, to the way healthcare operates. And it is wearing us thin in the middle. Even those of us who normally don’t contend with depression or anxiety as a diagnosis find themselves talking to a therapist and doctors and trying antidepressants or other medicines.
Forced to account for the spray of saliva and mucus that issues forth from our noses and mouths just by breathing-- let alone talking, singing, sneezing or coughing-- the medical and psychology communities have had to re-think their approach to treatments that were once considered harmless.
In this article, we’ll discuss:
- How the pandemic has affected depression and anxiety
- How the pandemic has altered treatments
- Why TMS is a safe and viable option to consider
As a patient, you must be a fully informed advocate for yourself, and this article will help you do that.
How the pandemic has worsened depression
There are a variety of causes that affect depression and anxiety during normal circumstances: stress at home or work, genetics, seasonal changes, traumas, major life changes, or the way in which we view life’s milestones (did we hit them or not?). During the pandemic, we can add three major components that have worsened depression and anxiety: economic loss, isolation, and pandemic fatigue.
As soon as it became apparent to the nation that the pandemic wasn’t going to be solved by a few weeks of mask wearing and extra hand washing, worries about the economy and its related financial threads began. Once lockdowns and restrictions became a reality, the economy took a huge hit, and jobs plummeted. Even big-name, heavy-hitting businesses such as Sephora and Delta Airlines had to lay off or terminate many of their employees. It’s no secret that large life changes can trigger depression and anxiety, but ones that bear the extra burden of financial loss are particularly nasty. There are plenty of sliding-scale clinics, to assist those with financial burdens that prevent them from being able to afford insurance or access mental health care, but are clients able to afford transportation? And with the pandemic, many mental health clinics were unable to take on new clients.
Depression feels isolating, and in some ways it actually can be isolating. Depression patients can feel overwhelmed by social events-- even small, one-on-one encounters may trigger them-- and depression can make it hard to keep plans, be on time for plans, or even just brush your teeth. And scientists know that socially isolating depression patients guarantees that the depression worsens. Unfortunately, necessary lockdowns and restrictions on social gatherings reinforced isolation from a feeling to a reality, worsening depression for many.
Pandemic fatigue is almost as prevalent as the dreaded virus itself-- maybe even more so. See, our brains are designed to stay on “red alert” only for so long, and the longer that switch is flipped all the way up, the brain starts accepting it as “normal.” But it wears on us. It exhausts us. Having to struggle to stay hyper-vigilant is not good for depression. It’s unavoidable, too.
It all adds up to a lose-lose situation: it’s dangerous to reopen and go about our lives willy-nilly as if the virus wasn’t there, but at the same time, it’s having consequences for those of us with shaky mental health.
How the pandemic has changed or cut off other treatment routes
The way in which Covid-19 spreads has drastically changed the way the entire world operates. To recap, it’s primarily spread through microscopic particles of the virus exhaled through the nose and mouth and either inhaled by someone in close physical proximity to the transmitter or spread by touching the eyes, face, etc. This is why the three main ways of fighting transmission-- wearing a fitted mask over both the nose and mouth, staying at least 6 feet away from others, and hand sanitizing/washing-- are in effect.
This also means that services that operate on a one-on-one level have either had to be suspended or moved online. This especially affects the mental health services, which were already out of reach for many without insurance, finances, transportation, childcare, etc. The pandemic worsened this for everyone, including those who already had mental health services just barely in reach, when for a time all services were shut down while virtual alternatives were set up. And when they were, without an internet connection or basic tech know-how, many patients were left scrambling or to fall off the grid.
Talk therapy, at least, is easily done over the phone if virtual visits aren’t possible, since it is accomplished through verbal communication. It’s a little different since therapists can’t read body language as well over the phone, but it’s at least an option. And virtual visits, if accessible to the patient, might have similar challenges as working from home, but they are at least better than nothing.
Doctor’s visits became fraught with the possibility of exposure to the virus, and many doctors either restricted their access to emergencies only or moved to virtual visits. Folks who lost their jobs or insurance were left scrambling to not only pay their bills and get set up with an overwhelmed and overly-complicated unemployment system, but also to find new doctors and mental health services that they perhaps could afford. Many sliding scale clinics became so overwhelmed with new clients that they had to freeze and stop taking them. Folks ran out of antidepressants, or their antidepressants stopped being enough to help them manage their symptoms and stressed-out pandemic lives, leaving many in a lurch.
Why TMS is a great option during the pandemic
Additionally, other treatments were put on hold in favor of making it safer for those who needed surgeries and other emergency services. This is why doctors are exploring TMS as a safer option during the pandemic.
One of the most effective alternative treatments for depression-- especially depression that’s not longer effectively managed with traditional pharmaceuticals-- is Electroconvulsive Therapy (ECT). The procedure involves placing the patient under anesthesia and delivering electronic pulses to the brain, causing it to rewire its neural pathways. While it does have some side effects, such as potential memory loss, it is one of the most effective and permanent ways to treat and possibly cure depression, even in pregnant women.
So why is ECT on hold due to the Covid-19 crisis? The patient must be put under anesthesia and often is on an oxygen delivery system, which can potentially spread the virus that causes Covid-19 to anyone who uses it. And the patient must be monitored in person, with multiple people in the room, all putting themselves at risk of contracting the virus and spreading it to other people-- including other patients.
But with Transcranial Magnetic Stimulation (TMS), there’s no oxygen mask, less people in the room, and the treatment can be delivered at more concentrated amounts to lessen the number of treatments and lessen the chances of exposure all around. TMS uses magnetic pulses delivered via a coil placed against the patient’s head to targeted areas of the brain. These magnetic pulses accomplish the same thing as ECT without the need for fussing with anesthesia, oxygen masks, ect.-- they help the brain rewire itself to be happier. The equipment is easier to sanitize, and there are no side effects to memory.
The pandemic forced scientists to rethink the treatments that they offer, and TMS is not only safer and less fussy than ECT in that sense, its intensity can also be increased to cut down on the number of treatments a patient must undergo to gain relief. Typical sessions are once a day for six weeks or longer. These newer, more intense sessions deliver around eight treatments a day over one or two weeks and may prove to be more effective at treating depression and anxiety than the slower approach. Additionally, by utilizing an MRI, scientists and doctors are able to more accurately target the areas of the brain causing the depression and deliver a more specific-- and therefore effective--treatment with better results.
So what are the side effects of these more intense sessions? So far, they are similar to the side effects for regular TMS sessions-- headaches for some, nothing for others. As this type of approach to TMS is newer, there’s not enough evidence to suggest anything else beyond the side effects that are already known.
The pandemic is still raging, and estimates for its end range from Fall 2021 to Summer 2022. There are vaccines available, and hope is on the horizon-- even if the horizon line keeps changing. In the meantime, we encourage you to keep taking the best care of yourself-- including taking your antidepressants and discussing your changing depression needs with your doctor and therapist. If you or a loved one is experiencing hardships that are obstacles to professional help, check with the sliding scale clinics in your area, 7cups.com or charities.