At the time of this writing, we are in the middle of the “Time of COVID,” as my wife Pat refers to the pandemic. We are both working from home, me upstairs practicing telemedicine and remote management of my addiction medicine patients, and Pat downstairs coordinating her university medical librarian projects.

When thinking about the circumstance, I often say to myself, “We’ve been in a pandemic for this long?” or “It’s only been this long?” We try and keep somewhat normal work schedules, mirroring what we had been doing before COVID. My telemedicine setup allows me to both see and hear my patients, but patients only have the ability to hear me, which I think is odd. Most of my patients are very understanding about this setup. “No problem,” they say as I acknowledge the strangeness of communicating this way. (It took me almost a month to understand that they did not have the ability see me, and I was embarrassed when I learned that, especially since I had been putting on a nice shirt and making myself presentable for the camera.)

This has also been a trying time emotionally for me and probably also for many other clinicians working at home. But I know that the burden of this new way of life is miniscule when compared to the bravery and remarkable courage of physician assistants (PAs) and nurse practitioners (NPs) dealing face to face with patients and SARS-CoV-2.

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I started to struggle with my emotions after the first few weeks of the pandemic lockdown, feeling mentally off and out of sorts. I am the type of person who values management of mental health and believes strongly in counseling and self-care. But when I started to feel what I now think were clear signs of depression, I completely misread my emotions. I was feeling tired all the time, emotional, and tearing up about things that would normally not cause such a response. I was depressed.

The genesis of depression is often multifactorial. For me, my depression originated from the adjustment to the bizarre and often lonely new COVID world. My wife and I have enhanced our relationship since COVID, and I am so lucky to have that. But there’s also no denying the inevitable sense of loss in no longer being able to navigate all there is to do and see outside our house.

As medically-oriented professionals, we’re more attuned than others to the darkest aspects of COVID. For example, it is probably not much of a mood-enhancing exercise to see the new death data from COVID on the news. “Oops, looks like we’ve reached over 163,000 deaths now in the United States.”  

Once I finally realized my depression, it opened an array of possibilities for me. Some of the needed actions were so obvious, and I was disappointed that I’d been so dense as to not even notice. I’m a licensed medical provider. I work closely with patients with profound psychiatric maladies. How could I have missed this?

This is a question that patients who suffer from the depression often share. I see it frequently. I call it the “last to know” syndrome. Patients with depression often describe their frustration with not noticing the signs of their depression. Of course, this gets at the importance of teaching patients with depressive disorders the skills and tools to notice these signs early, allowing them to martial their mood-regulation skills in a way that can reduce both the severity and the duration of depressive episodes.

For me, there was a major obstacle that stunted my ability to have recognized my own depressive symptoms: the “First World Problem” scenario. A friend of mine shared that phrase with me, and it describes the relative insignificance of some of the annoyances and problems that get in the way of those of us lucky enough to have good jobs, homes, cars, relationships, the ability to travel, etc.

When I hear myself or others complain, I’ll be struck, in retrospect, by the smallness of the issue, particularly when compared to people who have no homes, no food, no clothing, no medical care, etc. So how can I, with the luxury of working at home during a pandemic, spend time worrying about feeling down while my colleagues are battling it out daily, fighting for their lives and the lives of others in front line battle against COVID? How can I say, “I think I’d feel better if could exercise, but now I can’t because I can’t go to the gym,” when my colleagues can’t even get the PPE they need? I don’t know what the best answer to this dilemma is. One simple insight gained when I spoke with my incredibly sensitive and insightful PA is to remember that depression creates havoc across all populations. It’s particularly important for people like myself and other PAs/NPs who are charged with the care of all populations, including those much less fortunate than us, to insightfully address our own mental health status in order to best be able to effectively help others, especially during this time of need.