How to manage stress

Explains what stress is, what might cause it and how it can affect you. Includes information about ways you can help yourself and how to get support.

What is stress?

We all know what it’s like to feel stressed, but it’s not easy to pin down exactly what stress means. When we say things like “this is stressful” or “I’m stressed”, we might be talking about:

  • Situations or events that put pressure on us – for example, times where we have lots to do and think about, or don’t have much control over what happens.
  • Our reaction to being placed under pressure – the feelings we get when we have demands placed on us that we find difficult to cope with.

“It’s overwhelming. Sometimes you can’t see beyond the thick fog of stress.”

There’s no medical definition of stress, and health care professionals often disagree over whether stress is the cause of problems or the result of them. This can make it difficult for you to work out what causes your feelings of stress, or how to deal with them. But whatever your personal definition of stress is, it’s likely that you can learn to manage your stress better by:

  • managing external pressures, so stressful situations don’t seem to happen to you quite so often
  • developing your emotional resilience, so you’re better at coping with tough situations when they do happen and don’t feel quite so stressed

Is stress a mental health problem?

Being under pressure is a normal part of life. It can help you take action, feel more energised and get results. But if you often become overwhelmed by stress, these feelings could start to be a problem for you.

Stress isn’t a psychiatric diagnosis, but it’s closely linked to your mental health in two important ways:

  • Stress can cause mental health problems, and make existing problems worse. For example, if you often struggle to manage feelings of stress, you might develop a mental health problem like anxiety or depression.
  • Mental health problems can cause stress. You might find coping with the day-to-day symptoms of your mental health problem, as well as potentially needing to manage medication, heath care appointments or treatments, can become extra sources of stress.

This can start to feel like a vicious circle, and it might be hard to see where stress ends and your mental health problem begins.

“[When I’m stressed] I feel like I’m on the verge of a breakdown.”

Why does stress affect me physically?

You might find that your first clues about being stressed are physical signs, such as tiredness, headaches or an upset stomach.

There could be many reasons for this, as when we feel stressed we often find it hard to sleep or eat well, and poor diet and lack of sleep can both affect our physical health. This in turn can make us feel more stressed emotionally.

Also, when we feel anxious, our bodies release hormones called cortisol and adrenaline. (This is the body’s automatic way of preparing to respond to a threat, sometimes called the ‘fight, flight or freeze’ response). If you’re often stressed then you’re probably producing high levels of these hormones, which can make you feel physically unwell and could affect your health in the longer term.

Seasonal affective disorder (SAD)

What is seasonal affective disorder (SAD)?

Seasonal affective disorder (SAD) is a type of depression that you experience during particular seasons or times of year. Depression is a low mood that lasts for a long time, and affects your everyday life.

If you have SAD, you’ll experience depression during some seasons in particular, or because of certain types of weather.

“It’s like having your own portable black cloud.”

It’s common to be affected by changing seasons and weather, or to have times of year when you feel more or less comfortable. For example, you might find that your mood or energy levels drop when it gets colder or warmer, or notice changes in your sleeping or eating patterns.

But if your feelings are interfering with your day to day life, it could be a sign that you have depression – and if they keep coming back at the same time of year, doctors might call this seasonal affective disorder or ‘seasonal depression’.

“In the weeks before the clocks go back I start to feel sluggish and down, it’s harder to keep to my morning routine of going out for a walk before breakfast because it’s wet, cold and dark.”

What are the symptoms of SAD?

If you have SAD, you might experience some of the signs and symptoms below. But it’s different for different people, and can vary season to season, so you might also have other kinds of feelings which aren’t listed here:

  • lack of energy
  • finding it hard to concentrate
  • not wanting to see people
  • sleep problems, such as sleeping more or less than usual, difficulty
  • waking up, or difficulty falling or staying asleep
  • feeling sad, low, tearful, guilty or hopeless
  • changes in your appetite, for example feeling more hungry or wanting
  • more snacks
  • being more prone to physical health problems, such as colds, infections or other illnesses
  • losing interest in sex or physical contact
  • suicidal feelings
  • other symptoms of depression.

If you also have other mental health problems, you might find that things get worse at times when you’re affected by SAD.

“I just can’t stay awake and the thought of having to go out, stay awake, make conversation. I just can’t do it.”

When might I have SAD?

SAD can affect you during any season or time of year. Some people experience it in summer, although less research has been conducted on this so you might find people are more aware of winter SAD.

You don’t need to wait to see a pattern before seeking support – it’s ok to ask for help at any time.

“I close the curtains in the evening and wish it was dark so I could go to bed early but it’s broad daylight. I need to sleep and withdraw again from the world.”

Experiences of facing stigma

Lots of people have heard of SAD and depression in general, but this doesn’t mean that they understand what it’s like or how you’re affected. It doesn’t mean you ‘just feel a bit sad’, and there are many factors that can cause depression – for some people it develops without there being a specific reason.

It can be frustrating and upsetting if people don’t understand this, but it’s important to remember that you are not alone.

The misconceptions surrounding SAD

“During this time I feel down, upset and ready to cry at even the tiniest thing.

Tomorrow we will continue the seasonal affective disorder theme with Vicky’s Story

LAXATIVE ABUSE

Laxative Abuse

Laxatives are available in several forms, functioning in a manner depending on the needs of each user. For example, bulk-forming laxatives work like fiber, and increase “the bulk of the stool.” Osmotic laxatives increase water that go out of the bowels to soften the stool; stimulant laxatives increase the speed of movement in the bowels. Some of these are available in powder form and can be mixed into liquids.

Lastly, stool softeners reduce the texture of stools by decreasing the surface tension. Some forms of laxatives can take a day or 2 to work; therefore, if someone is seeking instant relief, they may have to try another form, or some may double their dosage. Though laxative abuse is relatively small in past years, it can become a problem, with short and long-term side effects.

Laxative Side Effects

Despite its intended use, people have used laxatives to achieve their ideal body weight. Since laxatives encourage regular bowel movements, they can decrease bloating and assist in weight loss. Side effects are mild, but uncomfortable, including:

  • Flatulence
  • Bloating
  • Dehydration
  • Feeling sick
  • Dark urine

Taking laxatives according to the recommended doses is usually harmless. However, when taken over time, laxatives have potential for abuse as well as harmful side effects.

Laxative Myths

Laxative abuse occurs when someone wants to use laxatives to lose weight. Studies revealed laxatives do not assist in weight loss. Laxatives do help with shedding water weight, hence their popularity in weight detox regimens.

No studies have confirmed the connection between laxative use and weight loss. However, other studies confirm weight loss that does occur is temporary. Water weight, or bloating differs from losing fat in the body. Because of how laxatives work by “keeping water in the gut around the stool,” the loss of water weight causes a temporary reduction of the appearance of belly fat or bloating.

A study noted “56.3% of people with eating disorders used laxatives.”

Laxative Abuse And Eating Disorders

Laxative misuse is often associated with people who suffer from the eating disorders anorexia nervosa or bulimia nervosa. Additionally, it is most commonly associated with teenagers and some obese populations. Sadly, statistics concerning laxative use were revealing of the myths surrounding their use.

A study noted “56.3% of people with eating disorders used laxatives.” Additionally, “71.6% of people suffering with purging anorexia abused laxatives.” Furthermore, these findings reveal laxative use is not just for vanity, but can be addictive to support feelings of shame, depression, body dysmorphia, the need to fix in, or anxiety.

These statistics noted women between 14 to 19 endured eating disorders. Often times, there is a connection between traumas like Post-Traumatic Stress Disorder and eating disorders like bulimia; hence the laxative dependence. While the laxative itself may not be as addictive as other substances, the desire to feel empty via abusing a chemical can be a motivating factor.

Effects of Laxative Abuse

When someone uses laxatives on a continued basis, he or she reduces vital minerals in the body like magnesium, sodium, potassium, and phosphates, which allow muscles to work correctly. As a result, our most important organs may not function in the best form for our bodies. Long-term laxative use can wreak havoc on the bowels, the digestion, and cause dehydration.

Since laxative use is intended to reduce bloating and lose weight, many of the effects of laxative abuse will be physical, although they will vary. Some of the signs of laxative abuse include but are not limited to:

  • Vomiting
  • Blurred vision
  • Fainting
  • Dehydration
  • Skin rashes
  • Depression
  • Gas
  • Bloating
  • Heart attack
  • Muscle spasms
  • Urinary Tract Infections (UTI)
  • Diarrhea
  • Intestinal paralysis
  • Increased risk of colon cancer

Not only do these symptoms cause physical injury and physical dysfunction, the added pressure to be thin, and concerned family members can complicate matters even more. Lastly, if someone is not feeling physically well, he or she won’t be their healthiest self, and may withdraw from feelings of depression. Once depression occurs, he or she may self-medicate in unhealthy ways.

Long-Term Effects of Laxative Abuse

In addition to health problems, depression, a lack of self-confidence and digestion problems, there are more long-term health risks associated with laxative abuse. Many of these are irreversible and severely damaging. Some of these include:

  • Kidney failure
  • Gastrointestinal damage
  • Liver damage
  • Bowel nerve damage

Bowel nerve damage can cause the intestinal tract to function poorly, hence someone continually using laxatives to assist in bowel movements.

Get Help Today

Stopping a laxative use disorder can be difficult to do at home or alone. If you are struggling to stop abusing laxatives, and have experienced a traumatic experience, you may need a hands-on approach to treatment. Contact a treatment provider and discover how having support and one-on-one counseling can target deep-seated trauma. Lastly, nutritional plans are available to help restore a healthy weight for patients. Don’t delay; you owe it to yourself to find the best treatment available.

Bipolar type one

Bipolar Type 1 is considered the most severe form of this illness.

According to the DSM 5, Bipolar I Disorder is characterized by one or more manic episode or mixed episodes (mixed episodes involve mania and depression) accompanied by episodes of depression alone (without mania or hypomania).

This is the most distinguishing, defining element of Bipolar I, (i.e. at least one truly manic episode).

A person may display psychotic symptoms such as delusions of grandeur or hallucinations.

In these cases, the condition is described as Bipolar Disorder I with psychotic features.

Bipolar I episodes of mania are so severe and debilitating that some experts use the term “raging Bipolar”.

A key point is “the symptoms are severe enough to disrupt the patient’s ability to work and socialize.”

Someone suffering from Bipolar I can have great difficulty functioning. You could have trouble holding down a job or maintaining a healthy relationship and typical, every day interactions with family and friends.1

Some symptoms you might experience during a manic episode include:

1. Decreased need for sleep.

2. Racing thoughts.

3. Pressured speech.

4. Excess energy or excessive hyperactivity.

5. Increased involvement in reckless or risky behavior.

6. Grandiosity or inflated self-esteem.

7. Becoming easily distracted or unable to finish one task or activity.

It is the tendency to become involved in risky or reckless behaviors that makes a manic episode the most dangerous to a patient. Driving carelessly, spending excessively and engaging in unsafe and reckless sex can have serious consequences that just do not matter to you at the time.

In a severe manic episode a person can lose all touch with reality. Left untreated a manic episode can last anywhere from a few days to several years of recurring episodes. Most of the time these symptoms will last for a few weeks or a few months.

The key difference between Bipolar I and Bipolar II is the presence of mania versus hypomania. It is important to understand this distinction in detail.

Bipolar I mania is often followed by a depressive episode. It can come within days or not pop up for several weeks or months.

During a depressive episode you may feel drained, in deep despair, guilty for no reason, worthless and irritable.

BP_Type_1

Activities you normally enjoy will hold no interest. You may experience sudden weight loss or weight gain and uncontrollable crying spells. At your lowest moment you may even have thoughts of suicide.

Again, possible consequences mean nothing to the afflicted person. These depressive episodes can last for years, which is why Bipolar I is often mistaken for chronic depression.

Many people with Bipolar I Disorder can enjoy periods where they don’t experience any symptoms in between episodes. These individuals are often able to go about their life, work, participate in family life, and socialize like anyone else. A minority of patients have rapid-cycling symptoms between mania and depression. In extreme cases symptoms of mania and depression can even alternate in the same day.2

Causes of Bipolar Disorder.

The exact cause of Bipolar Disorders is not precisely understood. It seems to be a combination of 3 things:

1. Genetics.

2. Chemical imbalances in the brain.

3. Stress and triggering events that somehow “activate” an inherited or genetic predisposition to the disorder.

Are Bipolar I and Bipolar II treated differently?

When you go for an assessment, just like with any other illness, you will be asked about family history. A close relative such as a parent with suspected or diagnosed bipolar disorder greatly increases the likelihood other family members also having the illness.

If you are concerned, take a Bipolar test.

So far, there does not seem to be any way to prevent the illness, but you can prevent some episodes of mania or depression once a doctor establishes that you do in fact have Bipolar I Disorder.

Bipolar I almost always requires the person to take medication for effective management. Don’t worry – stability and sanity is SO worth it!3

The key factor is stabilization. Regular therapy, a healthy diet, exercise and – MOST OF ALL – mood stabilizing medications such as
lithium can greatly reduce the frequency and severity of Bipolar I episodes.

Book Review: The Depression Toolkit — Mental Health @ Home

The Depression Toolkit by William Knaus, Alex Korb, Patricia J. Robinson, Lisa M. Schab, and Kirk D. Strosahl offers a combination of evidence-based tools to help readers with depression feel better. It contains 46 activities divided into 5 sections: find refuge from negative thoughts, get unstuck when you’re down, beat hopelessness and low motivation, make […]

Book Review: The Depression Toolkit — Mental Health @ Home

Depression, Anxiety & Me

Around the year 2000 I started suffering Depression, Anxiety and what I remember most about it was I had no get up and go about me. (I just couldn’t be bothered). As far as the anxiety was concerned I would get up tight about things to a point where I realised I was holding my breath. ( Not a clever idea is it?)

There are two things that stick in my mind even all these years later about my depression and anxiety,

Around this time our daughter was 8/9yrs old and we decided to hire a static caravan in Northumberland here in the UK along with my parents. As my wife wasn’t sure of the way there my father said he knew how to get where we were going.

It was on the road home an anxiety issue arose because despite being told to follow my father, my wife overtook my father and I and up ahead their was a fork in the road. She should have taken the fork to the right when she took the fork to left. This meant my father and I waiting at that junction anxiously till they reappeared.

Having Depression and anxiety quite often meant I couldn’t go further than my front door. I am a uniformed Salvationist of the Salvation Army and I can even remember every Sunday for weeks on end putting my uniform on (except jacket) until it came time to go and I would come to put jacket on and I couldn’t. Nerves and anxiety got the better of me and I used to ask my wife to call the Church to say I wouldn’t be there.

The main factor that played a part in my recovery was every week my father came to see me and we didn’t just talk about my depression we had general conversations as well. I also used to get regular visits from my then pastor who used to suffer from Clinical Depression, again the discussion I had with him again were general.

There’s a saying on one of the UK’s tv channel’s says “It’s good to talk”.

Dogs for Bipolar Disorder

Service dogs have a long history of providing assistance to people with physical challenges and are increasingly used to aid those with psychiatric challenges. Psychiatric service dogs are extensively trained to perform specific tasks to meet the individualized needs of their handler and are permitted access to public places in accordance with the Americans with Disabilities Act (ADA).1

Psychiatric service dogs can be trained to assist people living with bipolar disorder as well as other mental health challenges, including autism, schizophreniapost-traumatic stress disorderdepression, and panic disorder. The tasks a service dog is trained to perform to aid someone living with bipolar disorder ​depend on the individual’s circumstances and personal challenges and needs.

The Role of Service Dogs for Bipolar Disorder

The ultimate function of a psychiatric service dog is to alleviate or diminish the negative effects of bipolar disorder on the handler’s life. Examples of tasks a dog might be trained to perform for its human partner include:

  • Bring medication or remind their partner to take prescribed medicine at a specific time(s)
  • Awaken their partner at a specific time each day
  • Remind their partner to go to bed at a specific time to keep sleep cycles regular
  • Bring a portable phone to their partner or call 9-1-1 if the handler exhibits behaviors that might indicate a manic episode or severe depression
  • Interrupt potentially dangerous behaviors in their partner by nudging, nagging, or distracting with play
  • Alert the handler to the telephone, doorbell, or smoke alarm if their partner is asleep or possibly sedated due to medication
  • Calm or interrupt hypomanic or manic behaviors by leaning into their partner, or placing their head in the handler’s lap
  • Provide a link to reality if their partner experiences delusions during a manic episode2

While not considered a service dog function per se, the emotional support provided by a canine helper is often as valuable as the tasks the animal performs.

The presence of the dog can also help ground an individual with bipolar disorder and introduce a sense of stability and routine.

Laws Relating to Service Dogs

It is important to note that to qualify for the protections and allowances of the ADA, both the individual and the canine must meet specific criteria. In short, an individual must have a disability and a service dog must be specifically trained to meet the needs imposed by that disability.

  • An individual with a disability is defined by the ADA as a person who has a physical or mental impairment that substantially limits one or more major life activities, a person who has a history or record of such an impairment, or a person who is perceived by others as having such an impairment.
  • The ADA defines a service animal like a dog individually trained to do work or perform specific tasks to provide assistance to an individual with a disability. If a dog meets this definition, it is considered a service animal under the ADA, regardless of whether it has been licensed or certified by a state or local government.3

Importantly, a psychiatric service dog differs from an emotional support dog, also called a comfort dog. While emotional support dogs certainly provide love, companionship, and comfort to their human partners, they are not trained to perform specific tasks that aid the handler in daily functioning. As such, emotional support dogs are not covered under the ADA.3

Other Considerations

If you’re living with bipolar disorder and considering getting a psychiatric service dog or an emotional support dog, talk with your doctor to determine what type of canine companion is best for you. A psychiatric service dog involves a considerable financial commitment because of the extensive training required, which may take up to two years to complete. Depending on your specific needs, however, you may consider this an invaluable investment.

How to Care for the Disabled

Caring for the disabled can be a monumental task, especially if you are handling a loved one or close friend. Not only are you watching over the person to avoid further complications, but you also have feelings yourself. You might feel overburdened and angry at times, even though you are doing everything you can to help. It takes tremendous energy and strength on your part. But people being cared for go through similar difficulties, knowing that your struggles are necessary for their needs.

Develop a strong support system. To relieve yourself of the many duties that have to be done, have friends and family available to share in the caring. Keep in close contact with health care aides who may also be involved.

Arrange all medical care needed. This includes setting up or monitoring scheduled visits to the doctor or medical clinic. Help the person with any medications that need to be taken on a regular basis. Avoid the possibility of overdoses or missing doses of medicine. Pillboxes are a good way to properly sort medications according to the days of the week. Stay informed about the medication the person is taking through communication with the person’s physician.

Keep your loved one’s mind and body active to help prevent the depression and hopelessness that can strike any disabled person. Good nutrition and exercise play a key role in improving one’s strength and moods. Nutritious foods should always be available at the home, kept fresh and up to date so it does not become unhealthy. Any physical activity, of course, will have to be done based on the person’s abilities.

Protect your loved one from any dangers in the home. Make sure the house is safe. This may include removing rugs that can cause slips, installing handrails in the bathroom or on walls throughout the home, making sure the rooms are free from debris or anything else that pertains to the person’s disability.

Take charge of yourself. As a person caring for a disabled loved one, you must remember your abilities and limits. Take regular breaks with the help of a relative or someone close to avoid becoming frustrated or feeling helpless.

Try to make the disabled person feel as independent as possible. Allow your loved one to handle as many tasks as he or she can without your assistance.

Zonisamide

What is zonisamide?

Zonisamide is used together with other medicines to treat partial seizures in adults and teenagers at least 16 years old.

Zonisamide may also be used for purposes not listed in this medication guide.

Important Information

Taking zonisamide can cause permanent vision loss. Tell your doctor right away if you have any eye pain or redness or any changes in your vision.

Some people have thoughts about suicide while taking zonisamide. Stay alert to changes in your mood or symptoms. Report any new or worsening symptoms to your doctor.

Before taking this medicine

You should not use zonisamide if you are allergic to it.

You may not be able to take zonisamide if you have ever had a severe allergic to a sulfa drug.

Tell your doctor if you have ever had:

  • liver disease;
  • kidney disease;
  • high levels of ammonia;
  • stomach flu or illness causing diarrhea;
  • a growth disorder;
  • a bone disorder that causes soft or weak bones or low bone mineral density;
  • depression, or suicidal thoughts or actions;
  • if you have ever had metabolic acidosis (too much acid in your blood); or
  • if you have been on a ketogenic diet (high-fat, high-protein, low-carb).

Some people have thoughts about suicide while taking zonisamide. Your doctor will need to check your progress at regular visits. Your family or other caregivers should also be alert to changes in your mood or symptoms.

Zonisamide may harm an unborn baby. Use effective birth control to prevent pregnancy, and tell your doctor if you become pregnant.

If you are pregnant, your name may be listed on a pregnancy registry to track the effects of zonisamide on the baby.

You should not breastfeed while using zonisamide.

Zonisamide is not approved for use by anyone younger than 16 years old.

How should I take zonisamide?

Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose. Use the medicine exactly as directed.

Zonisamide can be taken with or without food.

Swallow the capsule whole and do not crush, chew, break, or open it.

While using zonisamide, you may need frequent blood tests.

Do not stop using zonisamide suddenly, even if you feel fine. Stopping suddenly may cause increased seizures. Follow your doctor’s instructions about tapering your dose.

Do not share zonisamide with another person, even if they have the same symptoms you have.

Store at room temperature away from moisture, heat, and light.

What happens if I miss a dose?

Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not take two doses at one time.

What happens if I overdose?

Seek emergency medical attention

Overdose symptoms may include slow heart rate, feeling light-headed, fainting, and slow or shallow breathing.

What should I avoid while taking zonisamide?

Avoid driving or hazardous activity until you know how zonisamide will affect you. Your reactions could be impaired.

Drinking alcohol with this medicine can cause side effects.

Zonisamide side effects

Get emergency medical help if you have signs of an allergic reaction: any form of skin rashhives; fever, swollen glands, feeling weak or tired, severe muscle pain, unusual bruising or bleeding; yellowing of your skin or eyes; difficult breathing; swelling of your face, lips, tongue, or throat.

Report any new or worsening symptoms to your doctor, such as: sudden mood or behavior changes, anxietypanic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), depressed, or have thoughts about suicide or hurting yourself.

Call your doctor at once if you have:

  • eye pain or redness or any changes in your vision;
  • decreased sweating, feeling very hot;
  • signs of metabolic acidosis–confusion, vomiting, lack of energy, irregular heartbeats;
  • symptoms of a blood cell disorder–fever, chills, body aches, flu symptoms, sores in your mouth and throat;
  • symptoms of a kidney stone–severe pain in your stomach or lower back, blood in your urine;
  • increased or worsening seizures;
  • the first sign of any skin rash, no matter how mild; or
  • severe skin reaction–fever, sore throat, swelling in your face or tongue, burning in your eyes, skin pain followed by a red or purple skin rash that spreads (especially in the face or upper body) and causes blistering and peeling.

Common side effects may include:

  • drowsiness, dizziness;
  • problems with memory or concentration;
  • feeling agitated or irritable;
  • loss of coordination, trouble walking; or
  • loss of appetite.

Zonisamide dosing information

Usual Adult Dose for Seizures:

16 years of age and older:
-Initial dose: 100 mg orally once a day
-Titration: After 2 weeks at 100 mg/day, the dose may be increased to 200 mg/day as either a single or divided dose (100 mg orally 2 times a day) for at least 2 weeks; it can then be increased to 300 mg/day, then 400 mg/day either as a single daily dose or divided into 2 daily doses, with the dose stable for at least 2 weeks to achieve steady state at each level
-Maintenance dose: 400 mg/day
-Maximum dose: 600 mg/day

Comments:
-This drug may be taken with or without food.
-Capsules should be swallowed whole.
-Because of the long half-life of this drug, up to 2 weeks may be required to achieve steady state levels upon reaching a stable dose or following dosage adjustment.
-The prescriber may wish to prolong the duration of treatment at the lower doses in order to fully assess the effects of this drug at steady state (noting that many of the side effects are more frequent at doses of 300 mg per day and above). Although there is some evidence of greater response at doses above 100 to 200 mg/day, the increase appears small and formal dose response studies have not been conducted.

Use: As adjunctive therapy in the treatment of partial seizures

Usual Pediatric Dose for Seizures:

Less than 16 years of age: Not recommended
16 years of age and older: See adult dosing

What other drugs will affect zonisamide?

Taking zonisamide with other drugs that make you sleepy can worsen this effect. Ask your doctor before taking zonisamide with a sleeping pill, narcotic pain medicine, muscle relaxer, or medicine for anxiety or depression.

Other drugs may interact with zonisamide, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell each of your health care providers about all medicines you use now and any medicine you start or stop using.

Further information

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Mental Health in a Time of Pandemic

Photo by CDC on Pexels.com

The ongoing Covid-19 outbreak is in many ways unprecedented, in both the scale of this challenge, the scale of public health response, and the historical context in which all this is unfolding. Covid-19 is the first global pandemic of the social media age, the first of the “alternative facts” era, and is occurring at a moment when politics and society seem to be in a state of accelerated flux.

Yet for all that is new about Covid-19, the disease still behaves like any number of prior epidemics. It is, for example, similar to the 2003 severe acute respiratory syndrome (SARS) outbreak, an event which created a number of lessons for our present moment. SARS was, in many ways, the best-case scenario for responding to a global infectious threat. The spread of SARS was contained fairly quickly by public health efforts, chiefly through the widespread use of quarantine. But even this relative success still had consequences for health. In 2004, I worked with colleagues on a study of SARS control and the psychological effects of quarantine in Toronto, Canada. We found among quarantined persons a high prevalence of psychological distress, including symptoms of depression and posttraumatic stress disorder (PTSD). A key takeaway: Even if we can halt the physical spread of a disease through the expeditious use of quarantine and social distancing, we will still have to contend with its mental health effects in the long-term.

This is a message that is frequently forgotten. The mental health effects of Covid-19 can shape health for many years, long past the events that precipitated them. We have been focusing, correctly, on saving lives and mitigating the short-term consequences of Covid-19, but the long-term consequences may be equally, if not more, important. While it can be difficult to take the long view when the events of the moment are so compelling, it is necessary, if we are to ensure the steps we take now are in the best interest of public health once this pandemic passes and our task moves from one of response to one of recovery.

To envision how this long-term future may unfold, it helps to look to the past, and not just to past epidemics. Protests, riots, mass uprisings, and natural disasters can also teach us much about how large-scale, disruptive events can shape mental health. What do we know about the consequences of such events?

In a study published earlier this year, I worked with colleagues to investigate the mental health effects of protests, riots, and revolutions. Our work looked at the immediate effects of these events, as well as their long-term consequences. We found that the prevalence of depression and PTSD among populations after collective actions like protests and riots is comparable to levels experienced after natural disasters and terrorist attacks. This was the case for populations directly and indirectly affected by such events, suggesting a “spillover effect,” as anxiety over a disruptive event ripples through communities. We see similar effects after natural disasters, where mental health consequences can include depression, PTSD, and substance use disorders.

Then there are the economic effects of such events. In the case of Covid-19, we have already seen traces of these effects in the falling stock market, but the fortunes of Wall Street do not reflect what may be the true cost of this pandemic. With so many eyes focused on the stock market, it is possible to miss that the economic brunt of Covid-19 will likely be borne by low-wage, hourly workers, who can ill-afford the time away from work that containing the disease may necessitate. This will have consequences for health. Income is closely linked to health—physical and mental. There is, for example, a 10 to 15 year difference in life expectancy between Americans at the very bottom of the economic ladder and those at the very top, and income inequality has been linked with depression risk. Covid-19 could deepen this inequality over the long-term, even as, in the short-term, it undermines the peace of mind necessary for robust mental health, and compounds the challenges of people already prone to mental health struggles.