Due to the ongoing COVID-19 pandemic, many women are struggling with anxiety, stress and other mental health issues caused by seismic shifts in the workplace, parenting responsibilities, finances and more.
By Humaira A. Siddiqi, M.D.
Since the pandemic began in March 2020, I’ve heard from more female patients, especially those who are parents of school-aged children. This isn’t surprising. In my practice, I have seen more women than men. Women are twice as likely to be diagnosed with depression, and more women than men will seek help for a mental illness.
Depression in men often is expressed as aloofness, withdrawn anger and irritability. Women, though, are more likely to experience worthlessness and sadness. They frequently become depressed in response to a stressful event. And the stresses on women right now are unlike anything we have seen before.
The Brain Chemistry Behind Stress Reactions
We know that the amygdala, the part of the human brain that is the center for emotional memory, behavior and motivation, operates differently in women than in men. While the amygdala reacts the same way to new stimuli for women and men, the response to familiar stimuli is different.
When a woman’s amygdala repeatedly processes the same negative stimuli—think of the pronounced pandemic stressors—her brain becomes more sensitive and automatically generates an anxiety response. For women, negative effects persist longer in the amygdala; by contrast, a man’s amygdala will show greater response to positive stimuli.
This natural tendency to linger on negativity is adaptive in that women’s brains react better in emergency situations. Had the pandemic lasted a month or two, women would have weathered the stress better. But now, as we enter an even more difficult pandemic phase this winter, the negative stress stimuli in a woman’s brain will condition it to operate on emergency mode as a default setting.
The Effects of a Prolonged Pandemic and Depression
For many of my female patients, the early, shelter-in-place phase of the pandemic was filled with anxiety and uncertainty about their kids, job and their health and safety. In the 24/7 family togetherness, managing the pivot of a child’s remote learning while trying to work from home and handle increased housework and meal preparation, typically fell to the woman, unless she was in a true co-parenting relationship. These stressors have not abated. I tell my patients that if you are in a stressful situation long enough, that emotional taxation will morph into depression.
What’s being affected? Menstrual and sleep cycles are shifting. People can’t socialize the way they want to, leading to feelings of isolation. Economic hardships are creating tough choices. More and more of my patients are expressing what is called “learned helplessness.” They believe they can’t change anything and that things are not going to get better.
But while you can’t change the reality of the world right now, you can change how you react to it.
Coping Strategies During COVID-19
Often, when I initially see a female patient who is struggling with anxiety and depression, she says, “I just need an antidepressant or something to take the edge off the anxiety.” Medication is a very useful tool and helps many people with a mental illness, but my advice is always “skills before pills.” While medicine is like putting gas in the car, a good therapist teaches you how to operate the car, and this helps you reset how you approach stress and anxiety.
It’s not intuitive to take the driver’s seat and actively manipulate how your brain reacts to negative stimuli, but it can be done.
One of the most important things you can do is to take a health inventory. Identify the stressors in your life and note how you are reacting to them. How are you sleeping? Waking up at the same time every day, even on weekends, is critical to good mental health.
Watch your nutrition and alcohol intake. Being at home and stressed causes most of us to snack, but work at making better, healthier choices. I encourage my patients to stop having two cocktails/glasses of wine a day until they are feeling better. Consider everything you are putting in your body — even those biotin supplements to enrich hair, skin and nails. Thyroid levels can shift with an overload of biotin.
Pay attention to intimacy and sexual health as well. By being intimate, women can stay better in tune with their bodies. If you are in a relationship, “date night” with your partner may look different right now, but it’s critical that you make time to stay connected emotionally and physically.
Reimagine your physical space, too, if you can. Create separate sections in your home for work, quiet time and school, and respect those visual boundaries.
Staying physically active and doing it at the same time every day is important. I tell my patients that routines help lift people out of depression. When we do the same things at the same time each day, our hormones regulate around it. And routines, now more than ever, are important to creating a sense of normalcy.
If, despite your best efforts, you aren’t sure how to declutter worries in your mind, start by working with a psychotherapist. Perspective can be a powerful tool to align your priorities and settle worries. While supporting your mental stamina as you cope, your therapist can suggest a referral to a psychiatrist to explore medication options as well to help the therapy along. Talk to your primary care doctor for a referral.
For more tips on maintaining emotional and mental well-bring during the pandemic, read the CDC’s advice on women, caregiving and COVID-19.
Humaira A. Siddiqi is an interventional psychiatrist with the Mid-Atlantic Permanente Medical Group. She sees patients at the Kaiser Permanente Burke location and Tyson’s corner location and she offers patients care by video, phone and secure message.
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