These are uncertain times: a pandemic, an economic depression, civil unrest.

So much to worry about! There’s the constant anxiety about health: Those of us who work in healthcare face a much higher risk of contracting COVID-19. I worry about getting sick; I worry about transmitting sickness to my friends and family. I worry about friends and family who’ve lost jobs. How will they pay for housing as these crises stretch on, month after month? What about healthcare? How will those who’ve lost their jobs get adequate care?

It’s overwhelming. Even worse, there’s not much we can do about the global, interconnected, historical forces roiling our lives. How to take action? It’s largely limited to what we choose to do each day, and how we choose to react to bad news.

This is a time to do things that give you comfort. I’d love to have a glass of wine, a cup of coffee, or some chocolate—but all those things interfere with my sleep. So I started by treating myself to more baked goods, cheddar biscuits, almond meal brownies. Alas, I’ve gained weight. But that homemade sourdough does make me feel a little better.

Since these uncertain times show no sign of becoming more certain, I’m becoming more intentional about doing things to ease the stress and anxiety. Here’s what works for me:

Make Time For Exercise

If you are over 40 years old and haven’t had an exercise routine, check in with your doctor first. Don’t just start running three miles a day. You might be fine, but better to have a physician advise you about what’s right given the state of your joints and your cardiovascular system.

I’ve developed foot arthritis, so running is out for me. Now, I make time each day to walk or to cycle, usually for about an hour. When I exercise, I sleep better, and I focus better. I feel strong.

Start slow. Even 30 minutes of brisk walking can make a huge difference to both your mood and your health. If you have not been physically active much, speak with your doctor before you start running 3 miles a day. It may be fine, but for your heart and joints, it is better to start slowly with 30 minutes of brisk activity on most days, that you like, and build from there.

Focus On What You Can Change

As a doctor in training, I did a rotation on the Alcohol Detox ward. It was unbelievably stressful. Some days, it felt like it was all too much. That’s when I learned “The Serenity Prayer.” This prayer is central to 12-step programs like Alcoholics Anonymous. It has roots in the Christian tradition, but it can be helpful whatever your religious practice, or lack thereof. Here’s how it goes:

God grant me the serenity to accept the things I cannot change.
The courage to change the things I can.
And the wisdom to know the difference.

I find myself repeating this prayer on most days. I cannot help all people, but I do what I can. I will check on my elderly neighbor today and bring them some of those cheddar biscuits. If things get too stressful, I’ll let the housekeeping wait and spend some more time walking. I feel stressed. I walk a bit more that day and let the housekeeping wait.

Limit The Use Of Caffeine, Nicotine, Sugar, And Alcohol

I don’t mean to be a bummer, but all these things will decrease your sleep quality. A cup of coffee or a pint of ice cream or a couple of gin and tonics might make you feel better for a while. But when the effects of these things fade, you’ll feel worse. And too much of any of these things can make you gain weight and lead to health problems.

There’s another reason to avoid anything you smoke: marijuana, cigarettes, e-cigs: They significantly increase your risk of getting COVID-19. Just think about it: all that touching of packs and matches and then touching your mouth.

Avoid “Anxiety Pills”

They’re addictive. They may help for a few weeks, but if you take these medications for longer than a week or two, they can lead to confusion. Long-term use can make your anxiety worse. For elders with cognitive decline, these drugs can also cause agitation, falls, and aggression. This is especially true of Xanax, which I call the “Crack of the Suburbs.” See www.ElderConsult.com/medication for a complete explanation of why this is so.

If You Feel Depressed Or Anxious, Discuss Antidepressants With Your Doctor

Anxiety may be helped with antidepressants. Long-term, it’s a better idea than tranquilizers like Ativan, Klonopin, and Xanax or sleeping pills like Ambien. Beware some medications such as Prozac, or Effexor may cause less sleep and more anxiety. Paxil may lead to more confusion, particularly for elders. Make sure to discuss this with your physician. You can find general guidelines at www.ElderConsult.com/medication.

Reach Out

Call family and friends. Set up a video call or a virtual wine and cheese gathering. Isolation is very stressful.

Of course, virtual socializing is not the same as seeing people in person, but it’s helpful and much, much better than having no contact with others.

If you do choose to meet someone in person, it’s best to do so outside. Keep 6 feet away. Wear a mask, and do not share items. Avoid public bathrooms that many people use. It’s better to meet for 30 minutes and go home to use the facilities.

If You Feel Very, Very Down, Get Help

If you feel that life is not worth living, call your doctor or a suicide hotline now.

Reach out. Say, “Hi.” Take care of yourself. Accept that you can’t solve everything. You’re not alone. Others are challenged, too. Together, we can get through this.

Resources for Anxiety, Depression, and Suicide

Anxiety and Depression Society of America

Anxiety Network

Depression and Bipolar Support Alliance

American Foundation for Suicide Prevention

National Suicide Prevention Hotline 800-273-8255

Mental Health America

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