Maintaining your mental health during the COVID-19 crisis

Mental health in the time of COVID-19

Many people are feeling tense and anxious in this difficult time. But for people with Parkinson’s disease (PD), as well as for anyone with a chronic disease, this time can be more stressful than for those without health issues, for a number of reasons. I have previously discussed the relationship between stress, anxiety and PD in general, and these concepts are certainly very relevant in today’s situation. It is important to take care of yourself both physically and mentally, so we will discuss some potential causes of increased stress, as well as ways to manage your stress and feel more at ease.

Increased risk from the virus can cause stress

First and foremost, concerns about COVID-19 can be more acutely felt by older adults and those with chronic medical issues, because members of these populations have an increased risk of complications from COVID-19 infection. Knowing that you may be personally affected in a more profound way than others can be very anxiety-provoking. Being properly informed can help you. APDA has compiled a helpful overview of information and resources regarding COVID-19 and Parkinson’s. 

Anxiety and depression are common in the PD population at baseline

Many people with PD already experience anxiety and depression as a non-motor feature of their PD, so a stressful situation like the current pandemic can make it even more challenging. Many with PD are reporting that anxiety has increased during this tense time. For some, levels of depression can increase as well.

Should mental health issues start to become overwhelming, we are here to help. Call our toll free hotline at 1-800-223-2732 to get connected to resources that can help.

People with PD may need regular exercise and social interaction more than others

Many exercise, dance and movement classes have been postponed which can lead to people with PD asking questions like “will my condition deteriorate without my exercise class?”  And “how can I adapt so I still get some movement in my day?”  They also may feel a bit lonely or isolated without the social interaction they get by going to classes. It is important for people with PD to make a concerted effort to continue exercising. Also, some types of exercise like yoga and tai chi are particularly good for helping reduce stress and encouraging a sense of calm. Thankfully, there are lots of simple and safe ways to exercise at home

Kathy is a 73-year-old woman diagnosed with PD five years ago. Although COVID-19 is raising significant anxiety and concern for all her friends, she knows that her PD gives her unique concerns. “Because of my PD, I am extra anxious that I am not moving as much as before. Movement is so essential for me. I like to read, but I am afraid to sit for too long because I will get stiff.”

People with PD have additional health concerns that can be hard to manage during the COVID-19 crisis

People with PD may have addition anxiety about issues specific to their situation. I have heard from many of you about particular concerns including:

• Interacting with home health aides who leave and enter the home
• Being in a rehab or nursing facility where infection can spread easily
• The potential need of going to the Emergency Room or hospital for reasons unrelated to COVID-19 (for example, a urinary tract infection or an aspiration pneumonia)
• The possibility that a deep brain stimulation system will reach the end of its battery life when many surgeries are being delayed or postponed

These are all valid concerns and tricky scenarios to manage, and they can add to your stress levels and anxiety as you wonder “what’s the right thing to do?” Your first step should be to talk to your doctor about the issue you’re facing. Weighing risks and benefits with your physician will lead you to the best solution for your particular circumstance. But the bottom line is that having PD may necessitate being in a situation that you would rather avoid at this time (like going to the ER). These added concerns can contribute to the anxiety of an already stressful situation.

For all these reasons, and more, it is very important for people with PD to find ways to manage their anxiety and maintain their mental health.

Kathy, for example, is very aware that “when I wake up, my anxiety is at its peak. I do meditation in the morning which is helpful.” Another way to manage stress is to take help when it is offered. Kathy says “I had to learn how to accept help – such as when someone volunteers to go grocery shopping for me. I had to get over that hurdle of not wanting to take anyone up on their offer.”

Ways to manage stress

There are many things you can do to help minimize stress and normalize the current situation. Here are some ideas:

• Establish daily routines: Having some structure to your day can keep you focused, motivated and stimulated. Your normal schedule has likely been affected by COVID-19, but just because you might be stuck at home doesn’t mean you can’t have a plan for your day. Set a schedule for your meals, exercise, social connections, household chores, etc.
• Get fresh air everyday – take a walk or a bike ride (remembering to maintain 6-feet distance from others) or even simply spend some time in your yard or front porch.

David, a 74-year-old man who was diagnosed with PD three years ago, takes this advice to heart. “I take long walks with my wife every day and sometimes I take my bike out. ”

• Continue to exercise at home: There are many free resources to help you exercise safely at home. Your regular exercise class might be cancelled, but that doesn’t mean you can’t keep moving!

If you already belong to an exercise class, it may be moving online! Kathy shared with us “My boxing instructor now sends out a routine via email. Then the class organizes a Zoom session and we do the routine together. The class also allows us to connect socially and bond over our shared experience with this situation. We share tips about how to stay active”

• Stay connected with family and friends online or on the phone. Make a point to reach out to someone every day.
• Join Smart Patients, APDA’s online support network and discussion forum that connects you with others in the PD community so you can share ideas, concerns and advice.
• Take a break from the non-stop news coverage of the pandemic and enjoy a good book or fun TV show.
• Take up a new hobby or challenge – Is there something that you always wanted to learn how to do or a project that you have been wanting to tackle? A book you have always wanted to read? Now is the perfect time! Here are some ideas:
  • Search YouTube for instructional videos that can help you create something new – origami, scrapbooking, tie-dying etc. or to help you learn to play songs on any instrument you can think of.
  • Make a digital photobook (there are many websites for this, Snapfish and Shutterfly are just two examples).
  • Use an app or website to play an online version of bridge, chess, popular board games, etc. You can play against the computer or against friends in remote locations.
  • Check to see if your local library is offering free books online (many are).
  • Listen to audio books using an app like Audible.
  • Connect with friends, relatives and grandkids via video conference calls using a free service like Zoom or Skype.
  • Cook or bake something that you have never made before. There are tons of recipes online, or pull out an old cookbook.
• Stay in touch with your support group leader. Your regular support group may be making plans to transition to the phone or an online platform so you can still stay connected while you can’t meet in person.

Mental health via Telehealth

Many doctors around the country have transitioned to telehealth visits during this time. This means that the visit is conducted either online or via the telephone instead of in person. The services of psychiatrists and mental health professionals are uniquely amenable to being offered through telehealth. If your anxiety and depression are particularly acute now, ask your neurologist for a telehealth referral to a psychiatrist or mental health professional.

Because of the increased need, the rules that govern telehealth have changed due to the COVID-19 crisis to help more people access services. For example, in the past, a physician was required to hold a medical license in the state in which the patient being treated via telemedicine lived. Now this is no longer a requirement and a physician can treat someone via telemedicine over state lines. It’s important to get the care and support you need, so be sure to talk to your doctor.

Tips and Takeaways

• Mental health concerns can be significant for people with PD during the COVID-19 pandemic.
• There are several reasons why anxiety might increase and some may be specific to those with chronic illnesses like PD.
• There are many things you can do to help alleviate stress and stay healthy both physically and mentally. Create daily routines, get exercise, stay connected. APDA can help you find ways to manage stress.
• A telehealth visit with your neurologist or with a mental health professional can be very helpful if you’re feeling anxious or particularly stressed. Be sure to reach out to your doctor for help.