What Does the Future of the Mental Health Pandemic Hold?

Health experts across the country agree: we are in the midst of a mental health pandemic and have good reason to believe that this mental health crisis will lead to an increase in depression1 year-round.

This debilitating disease currently affects more than 17.3 million American adults, with research2 showing rates have tripled as a result of the COVID-19 pandemic. Unfortunately, many sufferers – an astonishing 6.2 million3 – find no relief from antidepressants. Depression treatments just aren't one size fits all. As we recover from the COVID-19 pandemic, it is more important than ever for clinicians to take a close look at our patients and their needs to make sure we explore all available options as early as possible to give them the best chance Relief – and potential remission – from this disease that afflicts too many.

The two health crises

With the physical toll of COVID-19 very visible, the mental health effects were often overlooked and not prioritized early as fears of contracting the virus permeated every element of life. As stores closed, schools went virtual, and quarantine orders were extended, the impact of the pandemic built a snowball effect. Young adults saw key milestones such as high school graduation or prom canceled, and 46 percent of parents4 said their teenagers showed signs of deteriorating mental health. Parents were forced to balance careers and childcare, which led to an increase in depression, stress and loneliness.5 Job loss also contributed to a 53.4 percent increase in the rate of depression or anxiety1.

Unfortunately, depression and anxiety aren't the only lingering effects. We have seen patients relapse and sit back on drug use to ease the feelings of hopelessness that the pandemic uncertainty created. In fact, recent statistics show that 13 percent of adults6 have used substances in the past year to help themselves cope.

What happens next?

Now that the vaccines are in place and people are slowly returning to a bit of normalcy, many will likely feel better, but for others, the battle against mental health will continue. This pandemic hit us all, but our frontline workers, especially those in the healthcare sector, were the ones who experienced unprecedented stress. As a result, I expect an increase in post-traumatic stress symptoms7 among frontline employees and long-term effects on their overall mental health.

Returning to a pre-pandemic lifestyle without the ability to properly process the events of the past 15 months and the grief and pain that came with it can be dangerous. As rates of depression rise, so too does the demand for treatments, ultimately leading to a shortage of mental health professionals who are qualified to support the sufferer. In my region, patient volumes have increased exponentially. We are fortunate to have relied on telemedicine technology that has become popular over the past year to help us stay connected and provide this critical care.

Aaron M. Hawkins, MD, The Hawkins Group

As housing arrangements began on the spot and people found themselves in their homes, many mental health professionals remained open to personal attention. Clinicians in underserved areas began making virtual appointments to reach patients who otherwise could not have received personal care – and the use of telemedicine soared8.

Thanks to its benefits and convenience, this newer technology has become a widely accepted method of treatment among my patients who understand the importance of seeking help but are not yet comfortable returning to personal treatment. With more practices safely treating patients personally, I expect the majority of patients will return to personal care in the coming months, and telemedicine is a great alternative in the meantime. I also believe that reliance on telemedicine for behavioral health care will outlast the pandemic, especially for those in less populated areas and with remote working likely to continue.

An increase in alternative treatment options

Although it seems that we are nearing the end of the COVID-19 pandemic, people are still struggling with mental illness and are looking for new treatment options. Since statistics show that drug therapy does not work in all depressed patients – in fact, research9 shows that the likelihood of remission decreases in depressed patients who do not benefit from multiple antidepressant drug attempts – one of my top recommendations for adult patients with depression who do not struggle. The benefit of antidepressants is TMS therapy. TMS therapy, or transcranial magnetic stimulation, is a non-drug, non-invasive treatment that uses magnetic pulses to stimulate areas of the brain that are underactive during depression. We have seen a response rate of 70 percent and a remission rate of more than 50 percent from my patients who have been treated with NeuroStar Advanced Therapy since my practice opened in early 2020. And thats just the beginning. It is important that both clinicians and patients are aware of this technology. Hope is not lost when drugs fail.

Although the first TMS device received FDA approval back in 2008, it still appears to be a relatively unknown treatment option to patients and sometimes even doctors. I've heard colleagues say they learned about electroconvulsive therapy in residency, but not about TMS therapy – which means there is an opportunity to improve our conversations about alternative treatments for depression. In my practice, we recognized this critical educational need and launched a campaign aimed at raising awareness of TMS therapy among other healthcare professionals, which is attracting the interest of local universities who want information about the education of their students.

Given the rising prevalence of depression in the US and the likelihood that cases will increase significantly, doctors should help mitigate the harm by alerting patients to non-drug treatment options such as TMS as early on their treatment journey as possible. TMS is safe, effective, and readily available. It is covered by most of the major insurers, is free from the side effects often associated with antidepressants, and patients can drive home themselves after treatment.

We all agree that the "end" of the COVID-19 pandemic does not mean a magical and seamless transition back to life before the pandemic. This transition will be slow as the effects of the past 15 months can be long lasting, especially for those who have felt incredible stress on their mental health. The good news is that there is hope with TMS therapy. Depression remission is possible when we look outside of antidepressants and think differently about how we approach mental wellbeing.

References

Panchal N, Kamal R, Cox C, Garfield R. The effects of COVID-19 on mental health and substance use. Kaiser Family Foundation. Published February 10, 2021. Accessed May 17, 2021. https://www.kff.org/coronavirus-covid-19/issue-brief/the-implications-of-covid-19-for-mental-health- and- substance use /
Ettman CK, Abdalla SM, Cohen GH, Sampson L, Vivier PM, Galeo S. Prevalence of depression symptoms in adults in the US before and during the COVID-19 pandemic. JAMA network open. Published September 2, 2020. doi: 10.1001 / jamanetworkopen.2020.19686
Major depression. National Institute of Mental Health. Updated February 2019. Retrieved May 17, 2021. https://www.nimh.nih.gov/health/statistics/major-depression
Mott Poll Report / How the Pandemic Affected Teenagers' Mental Health. C.S. Mott Children's Hospital. Published online March 15, 2021. Accessed May 17, 2021. https://mottpoll.org/reports/how-pandemic-has-impacted-teen-mental-health
The Bargeron E. survey shows that single parents with young children bear the brunt of the COVID-related stress. Georgetown University's Department of Health Policy, Center for Children and Families. Published online January 7, 2021. Accessed May 17, 2021. https://ccf.georgetown.edu/2021/01/07/survey-shows-single-parent-households-with-young-children-bear-the -brunt -from-covid-induced-stress /
Czeisler, M., Lane RI, Petrosky E, et al. Mental Health, Substance Use, and Thoughts of Suicide During the COVID-19 Pandemic – United States, Nov. 24-30 June 2020. Centers for Disease Control and Prevention. Published online August 14, 2021. Accessed May 17, 2021. https://www.cdc.gov/mmwr/volumes/69/wr/mm6932a1.htm
Benfante A, Di Tella M, Romeo A, Castelli L. Traumatic stress in healthcare workers during the COVID-19 pandemic: an overview of the immediate effects. Front Psychol. Published online October 23, 2020. doi: 10.3389 / fpsyg.2020.569935
Mochari-Greenberger H, Pande RL. Behavioral Health in America During the COVID-19 Pandemic: Meeting Increased Needs with Access to Quality Virtual Care. Am J health promotion. Published February 8, 2021. doi.org:10.1177/0890117120983982d
Haddad PM, Talbot PS, Anderson IM, McAllister-Williams RH. Dealing with inadequate antidepressant response in depressive illnesses. Br. Med. Bull. Published online August 26, 2015. doi: 10.1093 / bmb / ldv034

This article originally appeared on Psychiatry Advisor