Michelle Obama: Thanks for Reminding Us We’re Not Alone

You probably read last week that Michelle Obama acknowledged she’d been experiencing what she described as low-grade depression. You may have wondered aloud, as I did, how anyone who sees what’s going on in the world could avoid it.

Many of us are feeling hopeless or anxious, ruminating about where this is all going, eating or sleeping poorly, and maybe drinking too much.

Among other things, Mrs Obama said her depression was triggered by “the pandemic, race relations in the US and the political strife surrounding it all.” To that she added frustration with people who refuse to wear masks.

The emotionally-taxing litany of what we’ve been experiencing includes the isolation of quarantine, the unimaginable pain of people who lost any of the 162,000 friends or family (Trump commented, perhaps channeling Tony Soprano, “It is what it is”), the racial strife in the US, a skyrocketing suicide rate among young Black men, and the utter failure of the federal government to provide real support to the American people, whether medical, financial, or simply emotional.

If monetary support is not forthcoming, in the next several weeks many Americans will be both homeless and hungry, in this the richest nation on the globe.

Sub-clinical or situational depression
Psychiatrists sometimes call Mrs Obama’s self-described low-grade depression “sub-clinical depression” or “situational depression,” but labels aren’t really relevant here. The point is that you find yourself having emotions that you don’t recognize as your usual self.

You need to experience just two or three from the following list to acknowledge that you might be joining Mrs Obama at this moment in time.

Symptoms of low-grade depression can include:
–Hopelessness.
–Sadness.
–Not enjoying normal activities.
–Crying regularly.
–Constantly worrying or feeling anxious or stressed out.
–Difficulty sleeping.
–Lack of interest in food.
–Trouble focusing.
–Difficulty carrying out daily activities.
–Feeling overwhelmed.
–Avoiding social interactions/situations.
–Not taking care of important matters like paying your bills or going to work.

If you’re going through the more serious Major Depressive Disorder (MDD), you’ve got amplified versions of many of the listed points, but often have difficulty articulating just why you’re so depressed.

With MDD, if you talk to a therapist you might say something like, “My life is basically good but I can’t sleep and I’m crying all the time.”

Usually MDD responds to a combination of counseling and medication to raise brain levels of the neurotransmitter serotonin, which improves your resilience to stress. Since 15% of the US population over age ten is taking an antidepressant, you’ve probably heard of these medicines, including the SSRI group: Prozac, Zoloft, Lexapro, etc.

Because women have only a quarter the amount of serotonin in their brains that men do, they’re more vulnerable to stress. Women are 2.5 times more likely to be taking an antidepressant than men and in fact 25% of women over 40 are taking an SSRI.

One quick piece of good news: some early research shows that SSRIs might be able to protect us from Covid-19 infection.

What I’ve been seeing in my own practice is that patients who for years have had relatively mild symptoms of mood disorders (including mild depression, anxiety, obsessive compulsive disorder, social anxiety, and a tendency to self-medicate with food or alcohol) are now experiencing a worsening of symptoms, or even some new ones that don’t want to let go.

It comes as no surprise that since the pandemic began, prescriptions for antidepressants, anti-anxiety meds (like alprazolam and clonazepam), and sleep meds (Ambien, Lunesta) have skyrocketed. There’s currently a national shortage of Zoloft (sertraline) and probably more shortages will follow.

Coping steps
Whether she knows it or not, the coping steps Mrs Obama is taking to deal with her depression are well-known strategies to raise serotonin levels in the brain. You can do these as well:

—Regular physical exercise is vital. No shortage of clinical studies have proven that daily exercise (brisk walking is fine) can be as effective as an antidepressant or anti-anxiety med for mild to moderate symptoms.

—Go outside, wearing your face mask, of course. Sunlight raises serotonin. Conversely, dark overcast days lower it, hence the challenges of seasonal affective disorder (SAD) in autumn here in the Northern Hemisphere.

—Eat a healthful diet with high quality proteins, fruits, and veggies. Include foods high in tryptophan, which your brain will put to work making more serotonin.

—Use technology to maintain and expand your social network. Again, it’s well established that social isolation both triggers and worsens depression. Quarantining and physical distancing are needed to prevent spread of the virus, yes, but we also need to keep in touch with each other, via phone, email, or video chat.

—Be wary of your PMS days. Your serotonin will drop during the week before your period. If you’ve been emotionally toughing out Covid-19 on your own and then suddenly find yourself reaching for a machete to use against someone not wearing a mask, it’s probably your hormones talking.

—Check your thyroid status. Most women feel better emotionally when their thyroid hormone levels are just a smidgen under hyperactive. Experienced psychiatrists often supercharge their antidepressant prescriptions with small doses of thyroid hormone.

—Nutritional supplements will improve your mood by raising serotonin. Good choices are St. John’s Wort (450 mg twice daily), 5-HTP (100 mg at bedtime), and B complex (one daily).

Mrs Obama updated her tens of millions of followers on her Instagram account (click here), assuring them they didn’t have to be concerned about her.

My editor insists on changing every “Michelle” reference in this Health Tip to “Mrs Obama,” but I don’t think the former First Lady would mind my using her first name, given the degree of respect and affection we have for her.

Michelle: Thank you for sharing your emotions publicly like you did. It’s reassuring to know you understand what we’re all going through.

Be well,
David Edelberg, MD