I came from one of these small Northwest logging towns where there's not a whole lot known about mental health. I actually went to medical school to become an emergency room physician because I like variability. On my psychiatric rotation, I was actually on the adolescent unit, and was amazed at the resilience of some of these kids, some with really significant family histories of schizophrenia. They were braver than I think I ever would have been in similar situations. The only reason that I was in medical school on the rotation and they weren't, was because I had a different genetic card. I happen to have been born without a significant family history of mental illness.

Over the course of a practice, we see people who have difficult-to-treat symptoms more and more, because the people who get better you don't see again. We set up a transcranial magnetic stimulation (TMS) a bit over a year ago - the first one in the area - because we want to do everything possible to help someone feel better. I knew transcranial magnetic stimulation had wonderful benefits.

TMS Therapy - transcranial magnetic stimulation - is a quickly growing treatment for depression and anxiety using an electromagnetic coil that stimulates neurons in the brain where mood is regulated. TMS is FDA-approved and noninvasive.

We live in unprecedented times, obviously. And all of us, every person, I believe will get depressed under the right circumstances. It has to do with your genetic risk factors and your predispositions. Sometimes people are able to go through rough patches without depression even during a major national disaster. If you have a high level of genetic loading for depression, or bipolar, it takes relatively little stressors - if any at all - we're all along that spectrum somewhere.

With COVID-19, job insecurity, what do you do with your children, your social isolation, your sense of unpredictability, health concerns, decreased exercise because gyms aren't open, and the inability to engage in the things that recharge your batteries like hobbies, travel, things that aren't super remote outdoors - we are seeing a lot of depression. It's understandable because people are isolated and aren't able to enjoy the things that recharge them. They're feeling unsettled because no one knows what's going to happen.

What advice is there to keep a healthy mental state in this great year 2020.

Some clients I've given prescriptions to for various ailments or clients who are socially isolated during these stressful times, particularly with health concerns, I have prescribed a daily Zoom meeting with their family members. We are social beings, so maintaining social connections can help. If you can't get out, I prescribe one Zoom meeting with one family member every single day as a help.

Structure is vital, too. I advise that people to set an alarm for 9 a.m., 7 a.m. or whatever. Even if you can get out of the house for a five-minute walk, there is success in doing that. Most of the time the walk turns out longer. The feeling of accomplishment of getting off the couch by itself can be enough.

When is a good time for someone to actually seek out a mental health professional?

If you're having thoughts like you'd be better off dead, maybe you don't want to be alive or rather life is worth living - those are fairly obvious things that need to clue you in that it's time to do something. If people around you have been commenting about negative changes they see in you, that can be an indicator too.

Also, if you find yourself gravitating towards substances, alcohol, marijuana, whatever it is, most people feel intense shame around that. But they're often treating something underneath that needs to be addressed, or should be addressed, because no one wants to engage in excessive substance use. If you're in pain and maybe you can't even admit it to yourself that you're in pain, this is a way of feeling better in the short term that can clue you in.

When I look for depression symptoms, the things I really gravitate towards are things that you can't really will yourself out of. Now is actually a good time to be seeking treatment, which is kind of an unusual thing to say given the current climate. Because of the expansion of telehealth and telemedicine, a lot of good therapist have openings.

For depression, a primary care doctor is a good place to start. Primary care doctors aren't psychologists or psychiatrists, but a large component of a primary care family doctor practice is first-line treatment of depression. You're not the only person, it might be 10% of what a primary care doctor deals with, so whatever feelings you're having, your doctor sees it a lot.

Finally, it's not your fault. During these unprecedented times, if you haven't experienced feelings of depression before, but are now, it's completely understandable, and it's not your fault. We all have some genetic programming and genetic risk factors.

David Penner MD is a Harvard trained psychiatrist who is double boarded in both Psychiatry and the Sub-specialty of Child and Adolescent Psychiatry. He can be reached at www.olympiatms.com or (360) 539-1736.

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