Ronald M. Podell, M.D., is a board-certified psychiatrist with degrees from Amherst College and Columbia University. He is the founder and director of the Center for Bio-Behavioral Science in Los Angeles. He completed his post-graduate psychiatric training at UCLA, where he was appointed to the clinical faculty in 1979 and served more than 20 years as assistant clinical professor of psychiatry. He authored the book Contagious Emotions: Staying Well When Your Loved One is Depressed. This interview centered on the COVID-19 pandemic and how that plays out in mental health.
Ronald M. Podell, M.D.
What problems do you believe are the most traumatic for Americans right now?
People are recoiling from multiple aspects of the reality that’s impacting their lives on social, emotional and financial levels. It may be a long time until we know who is protected by antibodies, who remains uninfected or poses an active risk to others. For example, some people may be in the incubation period or maybe shedding the virus and appear perfectly healthy.
Also, we currently don’t have enough fast-turnaround diagnostic tests available to diagnose and trace contacts of those who are infected. In addition to becoming seriously ill with the virus, people can also develop an “affective syndrome,” a kind of mixed depressive and anxiety disorder.
When we first began talking about the wide array of mood and anxiety disorders, you mentioned that people are grieving many losses right now. Can you expand further on that?
The first thing is a loss of freedom. I joke that I thought “house arrest” was barely a penalty. Now, I can tell you that even with a view of the Pacific and green mountains, I hate the confinement. I cannot see my grandchildren, eat at my favorite restaurants or go to a movie. I also must wear gloves and a mask to go to the pharmacy or a food store. There is a restlessness and sadness due to the isolation.
Thankfully, we are not yet in a financial crisis. However, most people feel they can only go a short time without regular work. They worry about permanent job loss and a Depression rivaling 1929. Nothing seems safe, including health and shelter — two key needs for every person. People experience physical symptoms and worry they are getting sick. It’s a time of significant uncertainty, which breeds anxiety and grief.
Could you add more to what you just shared about grieving to help people try to figure out whether they may be depressed or grieving right now?
Grieving is a natural reaction to loss and is often unpleasant. Family and friends may be intolerant of the bad feelings coming from a distressed person. I try to help people work through grief or anxiety and despair without drugs whenever possible. However, if I believe the grieving process is becoming pathological and it isn’t healing, I’ll prescribe medications that address the abnormal brain chemistry that occurs in mood and anxiety disorders.
I must then carefully observe the patient and employ psychological methods that help treat the mood or anxiety disorder. A professional is needed to discern between normal grief, sadness, stress reactions and a major depressive episode. There are specialists within psychiatry who are adept at using medications and are called psychopharmacologists.
When we spoke earlier, you reviewed some of the common signs of a major depressive episode. I will list some of them below before asking you to comment on them.
- Having less energy and often feeling fatigued.
- Feeling sad or hopeless about current life and the future.
- Losing your sex drive — or any desire for physical intimacy.
- Being unable to feel good about yourself — or feeling worthless or guilty.
- Struggling with sleep disturbances — sleeping much less or much more
- Problems with eating. You may feel less hungry or suddenly crave carbs.
- You find yourself thinking about dying or even self-harm and suicide.
- Having problems focusing so that concentration and recent memory become harder.
- Losing interest in most of the activities you once enjoyed or having no joy.
- Feeling very restless or being unable to sit still.
Would you comment more about this list?
Yes, but remember that I’m wanting to address the behaviors related to depression as a disorder requiring treatment. A patient who is experiencing a major depressive disorder will be struggling with at least four or five of the behaviors listed above — and experiencing a depressed mood — for 14 days straight. Also, the key thing with clinically depressed people is to talk with them honestly. Ask them if they want to die, have thoughts of killing themselves, or even have a plan for ending their lives.
Patients who are struggling with the biological symptoms referenced above may often require medication or the help of medical devices. The highest treatment response rate comes from a combination of medication therapy and psychotherapy.
Regarding problems with anxiety, what general recommendations can you provide that might help those who may need therapy or medication but haven’t reached out for it yet?
Exercise is always very important, but it should be approved by a person’s doctor. Also, meditation can be useful. I also recommend obtaining professional help with cognitive and behavioral therapy methods. These can correct distortions in thinking and behavior that make depression worse and lessen a person’s tendency to ruminate or isolate from others. Prior to the COVID-19 pandemic, as many as 20 million Americans suffered from generalized anxiety disorder, a condition where people feel anxious, even though there may be no reason for it.
You mentioned shortly before this interview began that your center, CBBS, treats patients of all ages for mood, anxiety and memory disorders. And you also said that you’re doing more work with seniors since Medicare is now more willing to provide teletherapy and other psychological services for them — including neuropsychological testing for memory disorders.
We can now deliver psychotherapy and even medication therapy by audio and audio-visual contacts with patients. This has helped a great deal since people are sheltered in their homes. Until now, Medicare did not pay for this service. I believe they will continue it once we are all vaccinated and can return to the freedoms we dearly miss. Testing can help determine if memory problems are age-related or more severe.
Hopefully, as public health officials begin gradually moving the country toward reopening, many of our most dire concerns will be alleviated. However, all of America’s recent, devastating losses will require each one of us to keep a close eye on our own mental and emotional health — as we adjust to each “new normal” that presents itself.
If you or someone you love is experiencing suicidal thoughts, please reach out for help. One resource is the National Suicide Prevention Lifeline.