Healthy Coping in an Uncertain World

From Linda M. Rio, MA, Marriage & Family Therapist – “The relevance for all of this for those diagnosed, or in the process of obtaining a diagnosis of pituitary disorder is that depression, anxiety, and other mental health conditions frequently do co-occur with disorders of the endocrine system.”

How Are We Affected?

According to US Census Bureau data one-third of Americans are currently showing signs of diagnosable or clinical anxiety or depression, much of this attributed to the coronavirus pandemic (Fowers & Wan, 2020). Of those questioned this poll 24 percent reacted with responses indicative of major depressive disorder (MDD), 34 percent with responses showing generalized anxiety disorder. This is a huge leap from previous surveys, in fact, double the findings of the 2014 results. And, these latest results show the largest increases among women, young adults, and the poor.  The U.S. Centers for Disease Control provide resources and information specific to the COVID-10 pandemic (CDC 2020) and also more general information about depression and stress associated with illnesses.  According to this site stress during an infectious disease outbreak can sometimes cause the following: fear and worry about your own health and the health of your loved ones, your financial situation or job, or loss of support services you rely on, changes in sleep or eating patterns, difficulty sleeping or concentrating, worsening of chronic health problems and worsening of mental health conditions. They caution that such issues can then lead to the increased use of alcohol, tobacco, and other products. Of course, we also know that many also turn to food (eating disorders), illegal substances, gambling, compulsive/illicit/illegal sexual behaviors, excessive and/or compulsive shopping, and other behaviors. All of these behaviors have aspects that range along a continuum from healthy and positive to destructive, even lethal.

Of course, in spite of dire predictions about Americans’/the World’s mental health in under the pall of COVID-19 not everyone will become depressed, anxious, or even any of the myriad of other DSM V diagnoses that exist.  For some, many, a more accurate and descriptive term that might be more appropriate during our current times is grief.  And there still are those who for many reasons just seem immune to the effect of stress and/or trauma and seem to breeze through life untroubled. Those unfamiliar with the professional use of the term “grief” may think of this as only applying to those who have lost a loved one to death. But grief has been looked at in recent years much more broadly as applying to many more situations than an actual loss of life.  Grief responses can be seen in those who’ve gone through a divorce, a loss of a job, and, yes, even the inability to live a life unencumbered by having to wear a mask and stay socially distant from other human beings. Maurizio Fava, MD, psychiatrist-in-chief, Department of Psychiatry at Massachusetts General Hospital states, “It’s quite understandable the COVID-19 pandemic is likely to cause significant stress and psychological distress for a large proportion of the population…and we know the rates are progressively increasing” (Mass General, 2020). A study published in JAMA Psychiatry distinguishes between grief and depression. And in this article, there is further delineation seeing “grief”, “complicated grief”, and depression as all distinctly unique (Shear, Wang &, Skritskaya, 2014). Dr. Katherine Shear, program director for Columbia University’s Center for Complicated Grief explains the differences. In grief, the pain may be accompanied by positive emotions, such as humor, relief, and warmth from others. When depression is also present, pervasive misery leaves no room for positive emotions. Thoughts and memories predominate in grief. In grief complicated by depression, the thoughts also are focused on “oneself being bad, undeserving, or unworthy. Self-esteem is usually preserved in grief. In depression, the grief is accompanied by “thoughts of worthlessness and self-loathing.” Grieving individuals are capable of feeling the support of friends and family. When depression intervenes, the grieving individual is less consolable or approachable (Shear, Wang, & Skritskaya, 2014).  Although children are thought not to be as at-risk of COVID-19 their lives have been changed and they too can feel the effects and even depression (Miller, C., 2020).

Effects on the Pituitary?

Compounding factors must also be considered. Not only is the world trying to address a pandemic, but much of the world also has been affected, some would use the term “woke” in regards to racial injustice now leading to intense social unrest. In the United States, 2020 is also a highly charged political year.  And, for many employment/jobs have at the very least had a major adjustment due to safety concerns of the pandemic, thousands have lost their jobs. Work and schooling have changed almost overnight, some for the positive and extremely challenging also. Medicine has had to adapt; telehealth is suddenly not a novel thing but probably here to stay. The list of changes we have all faced is extensive.  Now there is not singular grief but much. Actual depression can grow out of the global grief that is everywhere.

And depression, grief, anxiety and more can become overwhelming for some, not to be diminished or minimized just because millions may be also experiencing some version of the same thing. It is important for each person to be watchful and cautious of their own mental health during such times of uncertainty and unpredictability.  

The relevance for all of this for those diagnosed, or in the process of obtaining a diagnosis of pituitary disorder is that depression, anxiety, and other mental health conditions frequently do co-occur with disorders of the endocrine system. Pituitary World News has addressed patient concerns about potential susceptibility for those with pituitary disorders (Yeun, K., & Blevins, L., 2020; Rio, L., 2020).  A person diagnosed with a pituitary disorder is known to potentially incur losses such as those listed above as well as the negative impact on sex drive/intimacy and the inability to fulfill other normal social roles (Golden, 2013). As a result, the disease alone may add additional risk for mental health impairments of depression, anxiety, and more.

Humans do crave and seek out stability and predictability. We often tend to find solace in knowing what to expect. Even if in reality nothing is truly guaranteed the illusion keeps many from a complete state of panic. Today there is far less that is certain.  But there is an illumination behind this dark cloud that may appear like despair. Learning about recent as well as past history provides comfort in that humans have faced many fearsome threats yet persevere. Plagues and pestilence have devastated, wars, natural disasters have threatened survival but human beings have found ways through. The effects of these are severe but life has a way of pushing through. COVID-19 and all else in our current world are a challenge to this generation but many have found and are continuing to discover creative ways to cope. New businesses are being developed, new ways of connecting with family, friends, workmates are becoming “normal”. We do need to be more watchful for ourselves and one another.

What Can You Do?

No one individual can solve the pandemic +++ issues we currently face but each person does have a lot of power to contribute to a more positive, healthy world. When faced with any huge problem the first thing to do it to find a small, even tiny part of that problem that you alone can do something about. Can you develop the vaccine the whole world awaits? Probably not, but you can make a commitment and small effort today to help yourself be more healthy. Almost everyone can make better choices in terms of food and exercise. Taking extra efforts toward reaching-out to those you know might be immunocompromised and unable to go out. If you are in the high-risk group then reaching-out to someone for help, a friend, relative, an organization can give them a greater sense of purpose while helping you too. Try some of those Zoom meetings, some might actually be fun.  Get outside into nature, notice a sunset, marvel at the behavior of birds nesting; start a garden, craft, or activity. If you are older use wisdom and life experience. Yes, even having a pituitary tumor can be a valuable experience that can be shared with a young person that might even inspire them in some wonderful way!  Read, there is so much about the world to know! Allow quiet to potentially open-up new thoughts, calm the body. Volunteer for a cause you support and if you cannot get out, offer to do what you can from home. Reach-out to other pituitary patients …maybe make a friend!

Grief, loss, depression, fear, worry…are all part of our current world. But the phoenix did rise out of ashes and so can we too rise from 2020 to a future where we can hopefully look back on what we learned.  Let’s strive to actually see that we found creative ways to help ourselves, and the world to be a better place. We must have hope!

 

National Hotlines for Mental Health Assistance

National Domestic Violence Hotline: https://www.thehotline.org/ 1-800-799-7233 or text LOVEIS to 22522

Childhelp National Child Abuse Hotline: https://www.childhelp.org/hotline/  1-800-4AChild (1-800-422-4453) or text 1-800-422-4453

National Suicide Prevention Hotline: https://suicidepreventionlifeline.org/ 1-800-273-TALK (8255) for English, 1-888-628-9454 for Spanish, or Lifeline Crisis Chatexternal icon

Help Guide: https://www.helpguide.org/articles/depression/dealing-with-depression-during-coronavirus.htm

 

 

References:

Centers for Disease Control.(2020). Coronavirus 2019 (COVID-19). Retrieved, July 28, 2020 from https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/managing-stress-anxiety.html

Fowers, A, Wan, W. (2020). A third of Americans now show signs of clinical anxiety or depression, Census Bureau finds amid coronavirus pandemic. Retrieved, July 29, 2020 from:https://www.washingtonpost.com/health/2020/05/26/americans-with-depression-anxiety-pandemic/?arc404=true

Golden, V. (2013). Mental health aspects of pituitary disorders. In E. R. Laws, S. Ezzat, S.L. Asa, L.M. Rio, L. Michel, & R. Knutzen (Eds.) Pituitary Disorders Diagnosis and Management (pp. 17-18). Oxford, U.K.: Wiley-Blackwell.

Massachusetts General Hospital (2020). Depression on the rise during COVID-19: resources for patients and their families. Retrieved, August 3, 2020, from https://www.massgeneral.org/news/coronavirus/depression-on-rise-during-covid-19

Miller, C. (2020). Signs of depression during the coronavirus. Child Mind Institute. Retrieved, August 3, 2020, from https://childmind.org/article/signs-of-depression-during-coronavirus-crisis/

Rio, L. (2020, March 5). Coronavirus and global fears: a commentary on family, relationships, and pituitary patients. Pituitary World News. Retrieved from https://www.pituitaryworldnews.org/coronavirus-and-global-fears-a-commentary-on-family-relationships-and-pituitary-patients/

Yuen, K, & Blevins, L. (2020, April 18). Critical COVID-19 information for pituitary patients [Podcast]. Retrieved from https://www.pituitaryworldnews.org/podcast-critical-information-for-pituitary-patients-about-covid-19/

Shear, K. M., Wang, Y., Skritskaya, N.; et al (2014). JAMA Psychiatry. 2014;71(11):1287-1295. doi:10.1001/jamapsychiatry.2014.1242 Retrieved, August 1, 2020, from https://jamanetwork.com/journals/jamapsychiatry/fullarticle/1910337

 

For additional postings about positive ways to respond to coronavirus and other mental health topics on Facebook:  Linda M. Rio, MA, MFT

Linda M. Rio, M.A., LMFT  (805) 619-0950 www.Lindamrio.comavailable through Amazon.com and other major booksellers

© 2020, Pituitary World News. All rights reserved.

 

Image by Christo Anestev from Pixabay

© 2020, Pituitary World News. All rights reserved.

1 COMMENT

  1. Totally ass about way of seeing this for hypopituitarism patients. As a patient, we get first hand experience at how much endocrine deficiencies affect our psychological balance, and the constant push by the majority of endocrinologists to under treat the endocrine system focussing on the physiological aspects of endocrinology rather than also focussing on the physiological as well. In my case, and confirmed with many others, with low cortisol, a trip to the supermarket is stressful! A normal person with a healthy reactive adrenal system doesn’t have that problem. If you are low cortisol, and increase your levels with Hydrocortisone (HC) then the trip to the supermarket is fine! Many endocrinologists will throw psych meds at a patient while under dosing them with cortisol, leading to more psych problems while trying to mask the neurological symptoms of low cortisol. This doesn’t even scratch the surface of what the effect of a low metabolic rate has on neurons. Low metabolism in a muscle cell we can easily surmise that tiredness and lethargy can result from a lower metabolic rate, but what about a neuron? The impact on higher functions like cognition, memory both inscription and recall, general outlook on life? Yet again the typical endocrinologist reaches for psych meds rather than addressing the problem of low metabolic rate. Having started on thyroid replacement, there has been an improvement in my outlook and general functioning, not anywhere near restoration of what I used to be like, but changing my T3 replacement doses has a noticeable effect on my physiological status, it would be great to see how much additional improvement there would be If other hormones like prolactin (-> Dopamine), oxytocin, ADH (tightly interrelated to oxytocin), testosterone and growth hormone, would improve my brain function and outlook on life, again, endocrinologists tend to stop at the blood brain barrier… I see this article as a form of “victim blaming” ask the patient how they feel, adjust hormone meds, rinse and repeat, only after ensuring that the patient is on the correct levels of replacement (highly individual and cant be assessed by numbers on test results) look to other causes of psychological issues. The fear endocrinologists have of bad long term effects, of having hypocorticoid patients up in the optimal range must stop! Treating low T4, and ignoring low T3 and not monitoring reverseT3, must also stop! Work with the patient to find the subtle first symptoms of too high and too low, inbetween those two points are that patients normal levels, this changes daily in everyone, in normal people, it is an automatic function, in hypopituitarism, it’s a daily self monitoring thing, we have to be constantly aware of the subtle early signs of our body’s needs especially for T3 and Cortisol, and make subtle adjustments, some of those subtle signs are emotional not physiological, not surprising as the pituitary is attached to the hypothalamus.

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