Effect of COVID-19 on Loneliness and Depression

The Leaning Tower of Pisa (Dr. Noorali Bharwani)
The Leaning Tower of Pisa (Dr. Noorali Bharwani)

Stress, anxiety, and depression are not unusual for people of all ages.

Under the current environment (COVID-19), loneliness, stress, anxiety and depression are felt by most people. Certain individuals are affected more than others.

Whatever the level of anxiety and depression you have, you should know there is help.

Alberta Health Services has resources and services, such as Text4Hope, available to help you or someone you know. Remember, if you are struggling you are not alone. There are supports in place to help you.

Let us focus on two things: depression and loneliness.


Depression isn’t a weakness. Depression is a mood disorder that causes a persistent feeling of sadness and loss of interest.

It is also called major depressive disorder or clinical depression. It affects how you feel, think and behave. This can lead to a variety of emotional and physical problems. This can affect your daily activities.

Depression may require long-term treatment. Good news is most people with depression feel better with medication, psychotherapy or both.

Depressive symptoms vary a lot. Symptoms can be mild to severe. Symptoms can cause noticeable problems in day-to-day activities, such as work, school, social activities or relationships with others. Some people may feel generally miserable or unhappy without really knowing why.

It’s not known exactly what causes depression. As with many mental disorders, a variety of factors may be involved, such as: biological differences, brain chemistry, hormones and/or inherited traits.

Mental distress is common in public health emergencies like COVID-19. After a disaster, population rates of psychological distress tend to double or triple. Recovery time may vary from a year to several years. People who have a history of depression may take longer to recover.

Depression should be taken seriously. If you have a history of depression or if the current environment is affecting your mood and health then you should seek help.

Can we prevent depression?

There’s no sure way to prevent depression. However, some strategies may help. For example, take steps to boost your self-esteem, reach out to family and friends, especially in times of crisis, to help you weather rough spells. Get treatment at the earliest sign of a problem to help prevent depression from worsening. Consider getting long-term maintenance treatment to help prevent a relapse of symptoms.


Loneliness is the state of mind. You can be in a company or relationship and you may feel lonely. You may be alone and feel sorry for yourself. It’s a feeling of sadness or even anxiety that occurs when you want company.

Feeling of loneliness can occur in a crowded place where you are not interacting with others.

Loneliness has a wide range of negative effects on both physical and mental health, including stress, depression and cognitive decline. It can affect your heart. It can lead to stroke. It is associated with functional impairment and dementia.

Humans are social animals. Our connection to others enables us to survive and thrive.

There is no medical treatment for loneliness. As loneliness cannot be effectively treated with medications or acute care, health care practitioners may consider social prescribing to connect with sources of support in the community.

The bottom line is, people who engage in meaningful, productive activities with others tend to live longer, boost their mood, and have a sense of purpose.

Having a sense of purpose is important. Keep yourself mentally and physically active at home. Take care. Be safe. Be patient.

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Delirium After Surgery is Common in the Elderly

A senior couple at home. (iStockphoto/Thinkstock)
A senior couple at home. (iStockphoto/Thinkstock)

A dictionary defines delirium as a temporary state of mental confusion resulting from high fever, intoxication, shock or other causes, and characterized by anxiety, disorientation, memory impairment, hallucinations, trembling and incoherent speech.

Delirium after surgery under general anaesthetic is common in the elderly. Approximately half of all operations performed in North America are in patients greater than 65 years of age. This number is expected to increase as the population of elderly increases. Older adults represent a unique challenge to the surgeon, often presenting with multiple medical illnesses and higher risk for post-surgical complications, says an article in the Journal of the American College of Surgeons (JACS).

The incidence of delirium in various studies varies from nine per cent to 87 per cent. The development of delirium is associated with increased death rate, increased length of stay in the hospital and an increased rate of discharge to long term care facilities. Delirium is also associated with increased risk of major medical complications including heart attack, build up of fluid in the lungs, pneumonia, and respiratory failure.

Studies have also found that post-surgical delirium predicts future cognitive (mental processes of perception, memory, judgment and reasoning) decline and an increased risk of dementia. Delirium is not always easy to recognize and may be confused with other conditions common among the elderly such as dementia or depression.

Delirium is a complex phenomenon, often involving multiple factors to trigger the problem and likely affecting multiple spheres of the central nervous system. Some of the common factors responsible for post-surgical dementia are lack of oxygen, low blood sugar level, electrolyte imbalances, body fluid depletion, infection and drug interactions.

A surgeon has to remember that pain is a common post-surgical complaint and delirious patients may not be able to effectively communicate with providers about pain. Both under treatment of pain and overuse of narcotics can make delirium worse and makes postoperative pain management a challenge.

Which elderly patient is at high risk of developing post-surgical delirium?

One study identified seven predictors that could be used preoperatively to assess an individual patient’s risk of delirium. These factors include age greater than 70 years, self-reported alcohol abuse, poor cognitive status, poor functional status, abnormalities of serum sodium, potassium or glucose, non-cardiac thoracic surgery or abdominal aneurysm surgery, says the JACS article.

The strongest predictors of postoperative delirium are the presence of preexisting cognitive dysfunction, advanced age and multiple medical comorbidities. To reduce the incidence of postoperative delirium, hospitals should identify patients at risk, have good geriatrics pre-operative consultation services and assign patients to multidisciplinary teams of providers with experience caring for elderly patients.

JACS article says that despite the best preventive efforts, a certain percentage of patients will become delirious in the postoperative period. It is important to identify and treat underlying causes, along with emphasizing non-pharmacologic interventions to decrease severity and duration of delirium.

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How Do You Know If You Are Depressed?

The other day I was talking to a lady who said that she was on the verge of depression. She said, “I am not there but I am close.”

“Depression is a major public health problem, which is predicted to be second only to cardiovascular disease as the leading cause of disease-related disability worldwide by 2020,” says an article in the Canadian Medical Association Journal (CMAJ).

The article laments that depression goes unrecognized and poorly treated because physicians are too busy dealing with physical ailments and have no time for mental health care. There is stigma attached to diagnoses of mental illness so patients are in denial for a long time. Lastly, there is uncertainty about treatment efficacy and patients sometimes feel poorly treated.

Amongst teenagers, depression is a very common problem and affects as many as one in eight teenagers. Just like in adults, depression amongst teenagers affects more girls than boys.

Why does one feel helpless and depressed?

There isn’t one single factor that makes a person feel anxious and depressed. Some of the factors which influence how you feel depend on genetics, environment, other medical conditions and events which have occurred in your life and how you react to them.

In western countries, our lifestyle plays a significant role in causing depression. Some of the lifestyle factors are: our constant desire to get rich and acquire materialistic things, our desire to achieve success as defined by our peers rather than our desire to achieve happiness and the ever changing world economics make our job and financial well being insecure.

How can one know that he or she is on the verge of depression?

Life is not fair. There is stress and there is sadness. If the feeling of sadness lingers on and interferes with your ability to participate in normal activities then you know it is a warning sign, either you are depressed or you are on the verge of depression. You need to seek help immediately.

How does one feel if he or she was depressed?

There are various symptoms of depression. For example a person feels sad most of the time (sometimes for no obvious reasons), there is lack of energy, there is inability to enjoy things that used to bring pleasure, you tend to withdraw from friends and family, there is easy irritability, anger, or anxiety, you are unable to concentrate, there may be significant weight gain or loss, there is significant change in sleep patterns, there is feelings of guilt or worthlessness, there is pessimism and indifference, and there are thoughts of death or suicide

If you think you were on the verge of depression then what can you do to get back to “normal”?

Immediately get help from your family doctor. It is as simple as that. It is important to find happiness in life. Happy people live longer, give more, have more energy, are more likely to get married and people generally like to be around happy people rather than people who constantly complain of life’s little or big discomforts.

There are many books written about happiness. That means there is no easy solution to finding happiness. But some of the things you can do to be happy are: practice act of kindness, express gratitude, cultivate optimism, avoid over thinking, learn to forgive, develop social skills, do not depend on others and thank heavens for glass half full rather than half empty.

Do I see you smiling? Well, half the battle is already won!

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!