Some cities and towns cater to single people with ample entertainment, bars, restaurants, apartment buildings with multiple shared spaces, which lends to people staying out and about after work or on weekends. 

In crowded cities especially, someone single will likely keep costs down by having a smaller living space, and relying on access to more amenities available in public or shared spaces. Suddenly, losing valuable common areas, limits the single person to their smaller home, or studio apartment. 

Not only are the new restrictions limiting their access to shared areas, but there are less social interactions at work. Additionally the timeline has jumped from 2 weeks to 2 months or more of recommended social distancing, which was caught many off guard. 

It’s not surprising that the cumulative effect is increasing loneliness among those single or living alone. 

This new way of life does require new ways to socialize without increasing the risk of transmission of the virus. 

It’s a matter of finding resources to continue to socialize and to replace previous habits with new alternative activities.

Some recommendations include: 

Volunteering to tutor students, or offer other services online. This is a great way to meet new people but also have an added purpose to your time at home. 

Traditional phone calls may have been a “thing of the past” with the rampant use of social apps and texting, but hearing a familiar voice can help ease the lack of physical contact.

Scheduling facetime and group video chats with different groups in your life, like co-workers, friends, and family can be a great way to stay in touch and keep your social calendar full. Apps such as Houseparty, Facebook Messenger and Whatsapp are great ways to use a smart phone even if you do not have a laptop or computer at home.

Reading a book can be a great way to get to know someone else, even if it is a fictional or historical someone else. 

Trivia nights, and other usual group activities are being converted to online versions. Examples are, book clubs, happy hours, workout sessions, and group worship, etc.

Don’t forget that you can continue to see people in person but need to keep a 6 foot bubble between everyone, while avoiding touching things unnecessarily. Remember to wipe surfaces down afterwards as well.

It’s important to note, if loneliness is accompanied with issues of sleep, motivation, appetite or other depressive symptoms, then it’s time to reach out to a mental health professional like a therapist or psychiatrist for a video/online evaluation. Suicidal thoughts should always include calling a suicide prevention hotline, or calling 911.

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In regards to mental health services provided online, we often use the term telehealth. Telepsychiatry is another term, when the appointment or visit is with a Psychiatrist. Televisit may be another way the appointment with a therapist (someone that does not prescribe medications) may be described. Online visits incorporate the use of a video camera, a microphone, and speakers. Often computers have these already internally installed, or additional equipment can be purchased to plug into a laptop or computer. Smart phones also have these capabilities. 

Some companies may ask you to download a software to use while videoconferencing, but others are integrated into a website and there is no need for a software download. You simply click the link on a device that has the above requirements and you can use the website to access your appointment. 

Privacy regarding health information is very important. Many software companies are offering Hipaa compliant televideo conferencing services for your therapist or psychiatrist to use. In fact some of these services are free, such as https://www.doxy.me

At Inland Psychiatric Medical Group Inc in Southern California, we have been utilizing doxy.me as well as Kareo's integrated teleappointment software as well.

Online therapy or behavioral health services are often covered by health insurance plans, but may not always be, and so it is important to talk to your insurance company about what might be covered and if there is any difference in coverage between in-person visits and online visits. 

In light of COVID-19, many insurances are now newly covering online visits and so, even if in the recent past they had not been, its important to know if this has changed recently with your own medical insurance. Medicare is covering online appointments.

Sometimes if an insurance company is not covering the services, they will let you use your FSA funds towards the cost of the appointment. 

Online therapy or telehealth can be helpful in a health crisis such as the current COVID-19 crisis by helping with social distancing, limiting the spread of the infection, and reducing the risk of transmission of the infection. 

Having continued access to your therapist or psychiatrist is important and ofcourse during this heightened time of stress, it might be even more important for your mental health. Often medications prescribed by psychiatrists can be sent by an electronic prescription directly to the pharmacy and the pharmacy can offer home delivery, which further aids in lowering the risk of transmission of the virus. 

Some people may at first find televisits to be cumbersome, or intimidating due to the technology needed. For instance some people may not be familiar with using a computer, laptop, notepad, or smart phone. Its important to reach out to your friends and family that you know may not be technologically savvy and to help them set up their electronic devices so that they can continue to engage in care not only with their mental health professionals but with their other doctors as well.

RAINN is an organization that helps those suffering from sexual assault and sexual violence. They have a 24/7 hotline 1-800-565-HOPE (4673) 

RAINN stands for Rapte, Abuse, & Incest National Network.

Those suffering can talk to a trained staff member confidentially online as well.

Sexual violence in a relationship is rarely an isolated incident. Warning signs of abuse include an abusive partner who attempts to cut their partner off from friends and family. This can be especially easy to do during the recommended social distancing during the pandemic Covid-19. Additionally if those that have experienced domestic violence loses their job or financial stability, the abuser may use this as an opportunity to gain even more control.

It is important to reach out if concerned for your safety or the safety of children in the household. Though the someone may still have strong feelings for the abuser, or afraid of what their family may think, they don't have to end the abusive relationship all alone, or on someone else's timeline. Making the first step by reaching out to a loved one, local organization or a law enforcement can lead to ending the relationship when ready to take that step. 

The National Domestic Violence Hotline is 800-799-SAFE (7233)

People in  an abusive relationship may develop symptoms of depression, post-traumatic stress disorder (PTSD), anxiety disorders, or develop a substance use disorder. It is important to seek mental health care from a therapist, counselor, or psychiatrist. Sometimes talk therapy by a Psychologist or Therapist is helpful enough, and other times the symptoms require medication to be prescribed by a Psychiatrist (MD or DO) or a Nurse Practitioner/Physician's Assistant that is working under a Psychiatrist. Your OBGYN or PCP can be of help to, and then help you find a Psychiatrist if needed. 

If you are Interested In outpatient mental health services and a resident of California, please take a look at www.inlandpsych.com for a location near you or call 909-335-3026 or email [email protected]. You can ask for me Neelima Kunam M.D. or for the next available Psychiatrist at a location closest to you. Additionally we are offering Video Visits and Telephone visits due to Covid 19. We take a variety of insurances, including Medical/Medicaid.

As always If you are having a medical emergency, or your life is in danger, please call 911 or go to the nearest emergency room safely.

Mixing benzodiazepines like Xanax, Ativan, or Klonopin  with alcohol is considered very unsafe. The effects of benzodiazepines are similar to the effects of alcohol, and the combination has many risks including death. Both bind to GABA receptors in the brain and nervous system. Effects include dizziness, confusion, disorientation, memory problems, falls, trouble breathing, stopping breathing completely. In addition to effects while intoxicated with the substances, there are dangers effects from suddenly stopping benzodiazepines and/or alcohol if taken daily for a period of time. The withdrawal of the substances can lead to shaking, anxiety, heart racing, seizures, hallucinations, delirium tremens and death. Just as with alcohol, many people, notice that small amounts or very infrequent use of benzodiazepines can be helpful but large amounts, or taken with other sedaitng substances, or taken too often for long periods of time can lead to a risk of addiction and/or emotional and/or physical dependency. Always talk to your doctor first before stopping, starting or changing medications. This is not medical advice and for informational purposes only. 

Carbamazepine is an anti-seizure medication. It is used to help control seizures for many people that suffer from seizures (also known as "fits" by some cultures.) Though it is an anti-epileptic, (treatment of epilepsy disorder) it is also used to treat Bipolar Disorder. As a Psychiatrist we often use this medication to help keep Bipolar symptoms under the radar. You may also recognized it by the brand names: Tegretol and Equetro in the U.S. 

It's important to see your doctor or Psychiatrist (whom is an MD or DO) after he/she prescribes you Carbamazepine. It's important because it has a very unique quality, called "autoinduction." This happens about 2-4 weeks after you start the medication. What does it mean? Well it's a fancy word to describe the medicine making itself change or get used up faster. This means though it may be effective in your blood for 24 hours the first 2 weeks you are taking the medication, it might quicken to being used up in just 8 hours. This means the medication isn't working they way it should after the 8th hour, like it had originally. This is a known phenomenon of Carbamazepine, and your doctor will likely try test the level or amount of Carbamazepine in your blood throughout the first month you are using it, to help adjust the dosing in response to "autoinduction." Once the dose is adjusted it can be expected to work as it was the first two weeks and there-after. Interestingly, this effect can influence other medications and your doctor will take this into consideration when deciding if Carbamazepine is the right choice for you. 

In a small and limited study published in Psychiatry Research in 2016, which became available online on April 13th, 2016 there is some indication that Transcranial Magnetic Stimulation (TMS) treatment can be helpful for Depersonalization Disorder. Depersonalization/derealization is described as a "disruption or discontinuity in the normal integration of consciousness, memory, identity, emotion, perception, body representation, motor [body] control, and behavior."1

Dissociative symptoms and Depersonalization symptoms often accompany Trauma, but may not always. Also trauma can be different for everyone. A similar experience for one person may not be traumatic, while quite traumatic for another.

Depersonalization/Derealization Disorder is described as persistent or recurrent symptoms or episodes of feeling detached, feeling not a part of reality. It often starts in the teen years. If often is mistaken for Panic Attacks, or Panic Disorder. It can also be mistaken for Psychosis. 1

Treatment can include SSRI antidepressants, mood stabilizers, typical and atypical antipsychotics, anticonvulsants. Talk therapy such as psychotherapy including psychodynamic, cognitive, cognitive-behavioral, hypnotherapuetic and supportive can be used as well for treatment. 2

TMS is a newer modality of treatment, and there are reports that the reduction of symptoms can be over 25%.3  Further studies are needed, including stronger studies with placebo controls. This is not medical advice. You should not change your treatment plan before talking to your personal doctor. This is for educational purposes only.

Reference & Citation: 
1. Dissociative Disorders. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. May 2013
2. Dissociative Disorder. Synopsis of Psychiatry. Tenth Edition. 2007.
3. Jay, E. et al; Ventrolateral prefontal cortex repetitive transcranial magnetic stimulation in the treatmentof depersonalization disorder: A consecutive case series. Psychiatry Research 240 April  2016: 118-122 http://dx.doi.org/10.1016/j.psychres.2016.04.027

What is social anxiety also known as social phobia? Often it's misrepresented as someone that is not interested in being social or engaging with groups of people. The fact is, the true definition, is actually that they "avoid" socializing though they actually enjoy and desire to do so. How does this make sense, you ask? Imagine wanting to try something new, and exciting, but also being nervous and overwhelmed by the idea, and thus delaying your activity. Imagine this happens every day, multiple times a day, and eventually you never actually do this new and exciting thing you actually really want to do because you can never overcome the worrying, apprehension or restlessness preceding the activity. 

The worry, or apprehension mainly comes down to the fear of humiliating one self. Most have felt the sensation of feeling self-conscious or embarrassed. Social Anxiety or Social Phobia, is this emotion, but it being constant, daily, and quite debilitating. 

Though self-talk, positive self-talk, can be helpful to some extent, quite often the need for an SSRI or a TCA is required in addition to cognitive behavioral talk therapy. Woah, you say. Dr. Kunam, you are throwing alot of acronyms and fancy words around, you say. 

Here's the breakdown:
Serotonin is a big brain chemical (neurotransmitter) that helps use regulate our emotions, fears, feelings, etc. The theory behind the use of Prozac, Paxil, Lexapro, Celexa, etc is that they help our brain have more Serotonin to work with to help us regulate our emotions better. How does this help with social anxiety/social phobia? The serotonin that sticks around longer in the brain, for the brain to use, helps reduce anxiety, reduce restlessness, reduce worry, reduce sadness, reduce irritability, etc. This in turn, helps the person worrying, calm down, and actually listen to their own thoughts of "this is going to be fine, I know these people, why do I even feel nervous about meeting up with my cousins?" This is where Cognitive Behavioral Therapy (CBT) comes in. Though many of us know what it means to be positive, think positively, be around positive people, if we don't have enough serotonin to help us listen to those people, or positive thoughts, we are still going feel anxious, worried, with our heart beating fast, and our palms getting sweaty. 

That being said, how does one manage the "physical" symptoms of anxiety that can be present in social phobia? Often SSRI's are a great way to reduce daily worry/avoidance, but when symptoms come on strong and quick or as we say "acutely"... we can turn to medications or skills that lower the heart rate, lower the blood pressure, lower trembling, and other physical symptoms. Often your doctor may prescribe an "as needed" or "only once in a while" medication like a blood pressure medication to help reduce the physical symptoms of anxiety. These can be used right before a public event, public speaking, or group activity. Sometimes an alternative to blood pressure medications can be offered, such as benzodiazepines, which are considered sedatives. Though these medications are highly effective in reducing severe anxiety quickly, the body does become tolerant to the chemical, and requires higher and higher doses, if taken regularly and often. Unfortunately there is no way to avoid the tolerance to the medication unless you just make sure to use it infrequently. 

Wait, did we go over the coping skills yet? Let's not skip over the power of thoughts and talk. This is where psychotherapy fits in. The skills taught by a therapist/psychologist or other health care professional can be as "simple" as deep breathing, or splashing water on your face, but with some professional guidance, becomes truly effective "belly breathing" and "diving reflex based water immersion." Taking advantage of the body's natural phenomena in reducing blood pressure, heart rate, stress hormones, is a great way to tackle anxiety either alone, or with the combination of medications.

Look into seeing a Licensed Healthcare Professional, like a Licensed Therapist, Psychologist, PHD, or MD/DO to discuss the risks and benefits of all these options and combinations. Remember this blog post is not a substitute for medical advice, and you should never change, stop or start a treatment based on a blog post even if written by a healthcare professional. This information is for educaitonal purposes, and you should follow the advice of your own personal health care professional after an evaluation of your current symptoms.