Across the globe, the term “lockdown” will continue to linger in the minds of many people for a long time. The coronavirus disease 2019 (COVID-19) pandemic and associated lockdown coupled with stay at home restrictions have ushered the world into an era in which social distancing has forced many to avoid congregating.

The resulting effect is the loss of jobs (temporary and permanent), fewer working hours, changes in work schedules and environment, parents becoming home teachers, and cancelled events such as weddings, parties, and funerals. These are trying and difficult moments, as the most exciting aspects of the busy and stressful lifestyles people tend to lead have been taken away by COVID-19.

Day in and day out, the news on the internet, television, and radio has been alarming. The death toll continues to rise, as state and federal officials (despite their efforts to keep calm) have made it clear that COVID-19 is an uncharted challenge. The uncertainty surrounding the pandemic breeds stress and anxiety, which may lead to depression in many people.

For many who would generally be considered to as healthy, the level of anxiety may not be as high as people living with chronic diseases or those on medications that affect their immune systems. People living with chronic diseases generally have a higher tendency to express depression-like symptoms.1 For these people, being locked down could compound their plight, as social isolation and loneliness can also lead to depression.

In order manage these increased pressures, improving and maintaining brain health is a necessity that cannot be taken for granted. People should conduct self-mental health checks from time to time. Signs of depression include some of these symptoms lasting most days for more than 2 weeks:
 
  • feelings of sadness, tearfulness, emptiness, or hopelessness
  • anger, irritability, or frustration
  • loss of interest or pleasure in most or all normal activities
  • fatigue, tiredness, and lack of energy
  • sleeping too little or too much
  • changes in appetite, including eating too little or too much
  • anxiety, agitation or restlessness2

Some useful ways to manage the pandemic stress are taking deep breaths, stretching, exercising, meditation, eating healthy, getting plenty of sleep, and avoiding drugs and alcohol. In addition to the allopathic or prescription medications given by doctors to manage depression or any associated mental disorder stemming from this pandemic, there are integrative medicines, as well as health and wellness modalities, that can be used to improve mental health.

Some health and wellness modalities like acupuncture, art therapy, yoga, light therapy, music therapy, relaxation therapy and Tai Chi can be helpful in reducing stress and maintaining improving brain health in the wake of the lock down. Foods and supplements rich in essential fatty acids like fish oil (omega-3 fatty acids), DHA (docosahexaenoic acid), EPA (eicosatetraenoic acid), folic acid, vitamins C and E, Ginkgo (Ginkgo biloba), saffron (crocus sativus) and turmeric (curcuma longa) can help in maintaining mental health.3

Among the many natural medicines that may be used in managing depression, St. John’s wort is the best-known natural antidepressant. It works similarly to conventional antidepressants by inhibiting the reuptake of serotonin, norepinephrine, and dopamine.

It also appears to affect other neurochemicals such as glutamate and gamma-aminobutyric acid (GABA).4 Despite its proven efficacy St. John’s wort induces cytochrome P450 3A4 enzymes responsible for breaking down of medicines in the body. More than 50% of drugs on the market are affected by the CYP34 enzyme. This does not make St. John’s wort the best candidate for treating or managing depression as it has the tendency to interact with a long list of conventional drugs.5

Anyone who is taking or has the intention to take a product containing St John’s wort must first have a discussion with a pharmacist. COVID-19 may have exerted its negative impact on the lives of many but it is important for all to ensure that our brains stay healthy in a healthy body.

About the Authors
Nana Mainoo will graduate from the Nova Southeastern College of Pharmacy in spring of 2021.
Jonathan Ogurchak, PharmD, CSP, is the founder and CEO of STACK, a pharmacy compliance management software, and serves as preceptor for a virtual Advanced Pharmacy Practice Experiential Rotation for specialty pharmacy, during which this article was composed.

References
  1. Pryce CR, Fontana A. Depression in Autoimmune Diseases. Curr Top Behav Neurosci. 2017; 31:139‐154. doi:10.1007/7854_2016_7
  2. https://creakyjoints.org/living-with-arthritis/coronavirus-isolation-loneliness-chronic-illness-patients/?gclid=Cj0KCQjwlN32BRCCARIsADZ-J4tgtyroDiNUXlYJFcnrrHrn8Px_s7gWb8JvushrzaE1OkIKNRzC3Z4aAjkDEALw_wcB
  3. http://naturaldatabase.therapeuticresearch.com.ezproxylocal.library.nova.edu/ce/CECourse.aspx?cs=naturalstandard&s=ND&pm=5&pc=19-105
  4. Singer A, Wonnemann M, Muller WE. Hyperforin, a major antidepressant constituent of St. John's wort, inhibits serotonin uptake by elevating free intracellular Na+1. J Pharmacol Exp Ther 1999; 290:1363-8.
  5. Morales AJ, Haubrich RH, Hwang JY, et al. The effect of six months treatment with a 100 mg daily dose of dehydroepiandrosterone (DHEA) on circulating sex steroids, body composition and muscle strength in age-advanced men and women. Clin Endocrinol (Oxf)1998; 49:421-32.