You probably don’t need me to tell you that the pandemic has not been great for our collective mental health. Everyone is feeling it in some way. Maybe you’ve been feeling incredibly sad, angry, or anxious. Maybe you spend a lot of time spiraling about the future or worrying about your safety. Maybe you’re eating and sleeping way more or way less than you normally do. Or maybe you’re having a ton of trouble getting your work done or finding enjoyment in things you used to love.
If you know something about mental health, you might know that a psychiatrist like me would typically consider these changes potential warning signs for mood and anxiety disorders like major depression and generalized anxiety disorder (GAD). Especially if they’d been hanging around for a certain amount of time and were different than your normal behavior.
Notice I said “typically.” Because now, these symptoms also double as…totally normal reactions to living through a pandemic. Yes, we aren’t sleeping, but have you seen the news? Yes, we aren’t concentrating, but we’re working from home (maybe with kids! or roommates! or no privacy or space to work!). And yes, we can’t stop worrying, but with COVID-19 increasing in cases all over the country, without a readily available vaccine (yet!), what else are we supposed to be doing?
In other words, for many of us, our baseline mental health in 2020 now includes some degree of anxiety and depression. So how do you tell the difference between an expected mental health reaction to the pandemic and a mental health condition? And therefore, how do you know when you should seek some help?
Let’s talk about it.
First, here’s the usual difference between feeling depressed or anxious and having a disorder.
Before the pandemic, it was easier to delineate between typical feelings of depression and anxiety and mental health diagnoses related to depression and anxiety, thanks to diagnostic criteria established by the DSM-5, the manual mental health experts like me use to diagnose mental illnesses. Each mental health condition has a list of symptoms and other requirements that you have to meet to be diagnosed, sort of like a checklist. (Of course, it’s worth noting that even in pre-pandemic times, diagnoses overlap and nothing is perfect or clear-cut, but at the very least, diagnostic criteria help us move forward with an initial treatment plan.)
For example, some signs you might be dealing with major depression include persistent sad, anxious, or empty mood, feelings of hopelessness, irritability, fatigue, difficulty concentrating, losing interest in hobbies, and eating and sleeping more or less than usual, according to the National Institute on Mental Health (NIMH). Generalized anxiety disorder, on the other hand, includes symptoms like excessive worry, restlessness, fatigue, muscle tension, and troubles with sleep and concentration, the NIMH says.
Intensity and duration matter, too. For instance, a diagnosis of GAD requires at least six months of excessive worry and a major depressive episode means having symptoms most of the day, nearly every day, for at least two weeks. In normal times, these would be pretty easy to spot. But six months of feeling constantly anxious and sad seems par for the course when we’re almost nine months into this pandemic.
So what does it mean if you find yourself meeting these diagnostic criteria? Is it that the DSM-5 isn’t suited for these unprecedented times and this is just how we should expect to feel now, or is it possible that the pandemic is causing actual clinical mental health conditions? Well, it’s (you guessed it) complicated. Life events like a major illness, death of a loved one, divorce, or job loss can certainly trigger an episode of major depression, panic attacks, or unmanageable levels of anxiety. And this pandemic is nothing if not full of big life stressors like these.
But it’s not a simple case of cause and effect. Even when people develop mental health conditions after a severe stressful life event, there’s a good chance that they had other things going on that put them at a higher risk in the first place, like genetic factors, personal psychiatric histories, adverse childhood experiences, or even certain personality characteristics. So it could be that the pandemic is creating the circumstances needed for certain people to develop a disorder they were already at risk for, not necessarily causing mental health conditions.
No matter what, there are still specific warning signs you should look out for.
Even if it’s more difficult to draw a line between a mental health disorder and symptoms brought on by the pandemic, going through any difficult time is reason enough to seek out help. I tell my patients to look out for these three signs that, pandemic or not, you’re struggling with your mental health and could use some support.
Dealing with symptoms for days at a time is a pretty common experience, especially during a pandemic that has thrown off all of our normal routines and habits. But weeks without any real breaks? That is much more concerning—and harder to deal with. It can be tough to judge given the state of the world (who doesn’t feel like they haven’t been in an anxious haze for months?), so look out for specific symptoms, especially more severe ones. The ones I often tell patients to pay attention to are issues with sleeping and eating (too much or too little or both) and fatigue, because those can be especially disruptive or even dangerous if you deal with them for too long. But any symptom that goes on long enough is bound to impact your quality of life. Speaking of…
Okay, what counts as your day-to-day life is pretty subjective right now, but we often think about it in terms of three main buckets: relationships, work/school, and fun/activities. Obviously, the pandemic has impacted these areas in countless ways, so you’ll have to adjust how you evaluate them in the “new normal” the best you can.
For example, it’s one thing to take longer to finish your work because you’re having a hard time concentrating, but it’s another to not be able to finish it at all. Or if you’re feeling super irritable lately, there’s a difference between finding your partner’s habits more annoying than usual and picking regular fights. And while it might be frustrating that your once-favorite hobby is now too exhausting to bother with, it’s less worrying if you’ve been able to replace it with another activity than if you’ve been unable to enjoy anything at all. All of these scenarios are great reasons to seek help if you can and want to, but the potential impact might make some signs a bit more urgent.
For symptoms to be severe, of course, they might interfere in your day-to-day life—but that can be hard to judge amid the pandemic or if your symptoms make it so you don’t really care about the impact they’re having on your life. So sometimes, it’s easier to evaluate based on symptoms alone. For example, if you can’t practice basic self-care (like getting out of bed or brushing your teeth), then you likely need help. Or if you’re having suicidal thoughts for the first time or your usual suicidal ideation is worsening. Or if you used to have panic attacks every week and now you have them every day. These changes would highlight a clear need, even when that need is buried in an already rotten baseline.
My advice? Try not to worry about labeling what you’re going through right now.
Don’t get me wrong: There are a ton of valid reasons why you might wonder about the difference between an expected mental health reaction to the pandemic and a mental health condition. Maybe you want to know what the best course of treatment might be, if any. Would medication help how depressed you’re feeling about the pandemic? Is this something you can go to therapy for? Will it pass in time? Should you wait it out? These are questions I field all the time.
Other reasons for this curiosity are less practical but no less valid. You might want to know how your experience compares to how other people are reacting or you might want to know if you should be worried. Plus, it’s totally human to want to know exactly what you’re experiencing and how you can define it. Sometimes a diagnosis can validate feelings or help you make sense of your behaviors.
But while it’s normal and understandable to wonder, it might be beside the point. When we’re busy trying to figure out whether our experiences fit a certain diagnostic box, we can lose sight of something arguably more important: giving ourselves space to acknowledge what we’re feeling, process our experiences, and explore ways to cope. The desire for knowing what “counts” as a diagnosis is often another way of wondering what “counts” as a good reason to ask for help. But it’s important to remember that just because a reaction is “normal” doesn’t mean you have to suck it up and deal.
Because here’s the important part: It doesn’t matter what you call your reactions to the world, or even what symptoms you are experiencing. If you want to get help, there is absolutely no wrong time to ask for it, whether from a mental health professional or your family physician if you’re unsure where to start. As a psychiatrist, I’m less interested in how to label your experience than I am in how to help with it.
In the end, diagnosing anxiety and depression during a pandemic is not clear-cut or obvious. Sometimes it might not even be necessary. Whatever you are feeling, have felt, or are worried you might feel in the future, you are not alone and deserve help whenever you are ready.