We have now had the SIP (shelter-in-place) order in effect for over 6 weeks. What has been glossed over in the media, is that there are other more insidious health dangers that exist at this time besides striving to prevent the spread of this novel virus. As our time in isolation increases, this can be a particularly difficult time for those individuals prone to anxiety and depression. This article is not only for those who are sheltering by themselves, but also for families who are just trying to keep some semblance of sanity, while homeschooling their kids and trying to stay on top of their job requirements from home. In my experience, it is far easier to provide support for anxiety and depression when the onset was relatively recent versus waiting until symptoms have been more entrenched.
Please note that these recommendations are educational and not considered a replacement for consulting with your doctor. In a majority of cases, it is suggested that you work with your doctor in order to create a personalized plan based on your specific needs. It is also important to know that some of these suggestions may be contraindicated if you are currently on prescription psychiatric medications.
At Home Strategies:
1. rRest®️ (Rapid Reprogramming of Emotional Stress Technique): This powerful technique performed between you and your practitioner can be used in order to effectively resolve and change the way that you normally react under acute and chronic stress. This technique works just as effectively over video conferencing as it does in-person. Consider rRest®️ if you are experiencing any of the following:
- You are easily triggered into reactions that are not serving you, or your family
- You have a general sense of agitation and your buttons are easily pushed by others
- You frequently find yourself focused on scarcity, fear, and helplessness, which may even wake you at night
What is rREST®️?
rREST®️ is an innovative, mind-body technology that is easily accessible through an online process from the comfort of your home.
rREST®️ is a fast and effective tool helping you break through emotional obstacles currently holding you back. This process can quickly and permanently eliminate subclinical stress response patterns that were generated early in your life and were reinforced by adversity throughout your lifetime.
2. Meditation: 30 minutes once to twice per day. There are many resources available that you can find online and there are also a number of free meditation apps that you can download to your device. No matter what meditation you choose, all of them will heavily rely on breath work. It is important to take deep, diaphragmatic breaths in order to promote the parasympathetic nervous system (responsible for relaxation and a sense of increased well-being).
Here are some great meditation apps:
https://www.headspace.com/
https://www.calm.com/
Another under appreciated technique is that of gratitude. It is incongruent for your mind to feel fear, anxiety, anger, or sadness when you truly feel grateful for something or somebody. This can be something small, like the spring flowers blooming or watching a hummingbird in flight, or a strongly positive memory where you felt unconditional love for someone. The trick is that you have to feel it in your body. This is not a mental exercise, it is an emotional exercise. You need to find the grateful thought with your mind, but then pull it down into a heart-centered feeling. Think about times like when you saw your child take his or her first steps and how you felt. Or, think about how you feel when you see a young puppy exploring the world.
There are also some good apps that can help you below:
https://gratefulness.me/
https://365gratitudejournal.com/
3. Exercise: Even with the SIP order in effect, in most counties it is allowable to travel up to 5 miles for exercise. I feel that it is very important to get outdoors, especially since the air quality has been better than I have ever seen it. Hiking and mountain biking are my favorite outdoor activities and really work as a reset from the monotony of sheltering in place.
There are also many different Tabata type workouts that can be found for free online. These exercises typically include using only your bodyweight for short, intense workouts that can definitely change your mental and emotional state in a hurry. Below is an excellent resource for efficient and effective workouts that can be done at home.
https://healthylivingrevolution.com/home-fitness-series/
https://7minuteworkout.jnj.com/
https://vimeo.com/402813484
https://vimeo.com/248443523
4. News: If you absolutely have to stay informed, I would suggest only looking at the news once per day, preferably in the morning to prevent sleep issues. It would also be a good idea to set a timer for 15 – 30 minutes so you don’t get sucked down the media rabbit hole.
5. Light Therapy: Full spectrum light boxes have become very affordable since they first were shown to be an effective therapy for SAD (seasonal affective disorder). Light Therapy has been shown to be 50-80% effective for those diagnosed with SAD. In order to support SAD, the light box needs to have a power rating of at least 10,000 lux. The therapy includes exposure to the light box for 30 minutes once per day, preferably in the morning in order to help burn off melatonin levels. You do not look directly at the light box, but instead have it off to the side of what you are doing, whether that is working on your computer, reading, or having a cup of tea. You can find light boxes with 10,000 lux by Verilux for under $100.
Even though we are in the beginning of Spring, do not underestimate what light therapy can do for depression. Since the SIP order went effective, I have found that many people are outside of their house far less than they ordinarily would be. On top of that, I have also found that people are spending more time on their phones, televisions, and/or computers. If you have an iPhone, check your daily average under settings if you do not believe me. This constant onslaught of blue light can cause problems with your circadian rhythm leading to excessive melatonin levels and persistent sleepiness, not to mention the adrenal issues it can cause.
Here are some links to some good choices:
Verilux HappyLight VT22 Lucent 10,000 Lux LED Therapy Light
Miroco LED Bright White Therapy Light 10,000 Lux
6. Drugs: Every person copes with stress in an entirely different way, but alcohol, caffeine, and marijuana seem to be the most common. It is especially important now to evaluate whether your use of these substances has increased since the SIP order. Abuse of any of these substances can create anxiety and depression. Even during the SIP, please note that most therapists and psychiatrists are still working and offering telehealth visits in order to support their clients from home.
7. Create Routine / Create Purpose: It is interesting, before now I would only have to discuss this strategy with patients who were retired. Now, I see it as an important strategy for everyone. If the SIP has made anything blatantly obvious, it is that most people had very clear routines before this began. Setting a routine creates a sense of duty and accountability and with that duty comes purpose. Do you ever notice that the most effective people that you know are the ones with the most on their plate?
8. Eat for blood sugar balance. Did you know that low blood sugar can look like anxiety? Yes it can. This is one factor we do have control over. We recommend small frequent meals and not going long periods of time in between meals to help maintain a balanced blood sugar.
Nutritional Supplementation:
1. L-Tryptophan and/or 5-HTP: Both of these substances support an increase in serotonin and melatonin synthesis, leading to decreased feelings of sadness, easier sleep initiation, and an increased sense of wellbeing. Both of these substances need to be used with extreme caution, and oversight by your doctor is strongly suggested to prevent serotonin syndrome if being used in conjunction with SSRI’s or SNRI’s.
When an individual is under higher stress levels (whether emotional, mental, or physical) there will be a rise in stress hormones such as cortisol and epinephrine. These substances are basically fire alarms telling your body to jump into action to address an imminent danger. This is what is called the sympathetic nervous system response. When your body is in this mode, it is incongruent for you to feel relaxed with a general feeling of wellbeing. Your body will then prevent the formation of serotonin and actually speed up the breakdown to ensure that your nervous system will be hypervigilant, on edge, and ready to act on any perceived danger. If the real or perceived stressor continues over time, you can become serotonin deficiency leading to depression and anxiety.
Typical dosage for L-Tryptophan ranges from 500mg – 3000mg at bedtime, while the typical dosage for 5-HTP is from 50mg – 300mg at bedtime. Please note that both of these compounds work on the same pathway, so it is unnecessary to use both of them in your plan at the same time. It is always suggested that an individual start at the lowest dosage for both of these supplements.
2. L-Theanine: This compound is derived from the tea plant (Camellia sinensis) and is one of the safest remedies for anxiety and anxiety-related depression. This is one of my favorite supplements to prescribe because of its overall effectiveness and because it is one of the few therapies for anxiety that will not cause drowsiness. I have found that this stand-alone supplement works particularly well for kids to promote calmness. Typical dosage ranges from 100mg – 600mg twice to three times per day.
3. Magnesium Threonate: This compound is the only oral magnesium that can cross the blood brain barrier. By doing so, it creates a relaxation response on the central nervous system. This supplement works well for insomnia, nervous exhaustion, anxiety, or depression caused by prolonged anxiety. It will also aid in restoring stress-induced memory loss and increase general energy levels. The typical dosage is 1000mg – 2000mg two to three times per day.
4. Ashwagandha (Withania somnifera): This medicinal herb has been used by humans for centuries in Ayurvedic medicine. It works extraordinarily well for individuals who suffer from prolonged anxiety or neurasthenia (fatigue and other physical complaints caused by a prolonged emotional disturbance) and is extremely safe. One of my favorite aspects of this supplement is that it has been shown to bind to GABA receptors, which reduce anxiety and promote relaxation. This herb will also work as an adaptogen, aiding in moderating adrenal function for those under pronounced stress for long periods of time. Typical dosage is 500mg – 1000mg once to twice per day.
5. Valerian Root (Valeriana officinalis): This root is one the strongest anti-anxiety medicines in natural medicine. This supplement is particularly suited for individuals with very high anxiety that also causes insomnia. Dosage is typically 300-600mg at once per day at bedtime, but for severe anxiety it can be given two to three times per day. Drowsiness and sleepiness are common side effects of this supplement, so use caution if you are going to use it during the daytime. Also, due to the action of this supplement, it could be contraindicated if the individual is currently taking prescription medications for anxiety, such as benzodiazepines.
