ST. LOUIS _ Danielle Armey, 22, of St. Louis, was diagnosed with depression and general anxiety disorder two years ago. She and her roommate are both restaurant servers and have had to file for unemployment. Her graduation from Maryville University has been canceled.
Her anxiety makes her assume the worst; her depression is triggered by isolation.
"What is happening now is an anxiety-ridden person's worst nightmare," Armey said. "Things are spiraling out of control ... the feeling of worry and terror hasn't stopped."
People are fearful that they and their loved ones may get sick. Many are suffering financially from sudden job loss. They're inundated with nonstop news, and figuring out a new way of life at home.
"All of the stressful things happening in life are happening all at once," said Shelby Zurick Beasley, a therapist with Provident Behavioral Health.
Things that bring people joy and relief _ sports, concerts, church services, going to the gym, even just relaxing at a coffee shop _ are no longer accessible.
"It's been hard because coping skills that people use on a daily basis might not be available anymore," Beasley said.
Families are challenged to find a new normal with working and schooling from home, while dealing with the disappointments of college cut short, and prom, graduations, tournaments and birthday parties canceled.
The avalanche has many feeling overwhelmed by stress and loneliness for the first time, while exacerbating the symptoms of those already living with depression and anxiety disorders.
Hotlines to mental health providers have been flooded with calls since the spreading coronavirus has shuttered people in their homes and shut down businesses.
The national Disaster Distress Helpline routed to Provident Behavioral Health in St. Louis has received more than 2,000 calls since the beginning of March, a threefold increase over January and February. And the number is still rising, with big jumps each week.
Hotlines handled by the region's Behavioral Health Response Network also have seen a huge increase in volume from callers experiencing anxiety, stress and depression.
"That has been exacerbated and blown out of the water," said Holly Nemec, BHR community relations manager. "We are in uncharted waters."
To prevent spreading the coronavirus and overwhelming hospitals' ability to care for patients, a historic advisory has been issued to all St. Louisans, urging them to stay in their homes and only to go out for essentials such as food and exercise _ being sure to keep at least 6 feet from others.
Monthlong orders to stay home went into effect last week in the St. Louis area, but many people already were well into efforts to distance themselves from the public.
Counselors on the end of crisis lines say they can help. They can connect people to services and offer tailored advice on how to build resilience and stay positive.
Give yourself a break, Beasley says.
"Life is not going to be normal right now, and we are all figuring out how to deal with it," she said. "Try not to be so hard on yourself or your family or your friends. Everyone is taking this day by day, and minute by minute and trying to make it work."
Bridget Keller Rodriguez, 36, of St. Louis, is used to working from home as a real estate agent. But now her husband, a property manager, is taking over her home office while trying to avoid their twin 8-year-old boys as they do schoolwork remotely.
It's been hard to create boundaries between work, parenting and self care, Rodriguez said. They lose track of what day and time it is.
"You feel like you are in a casino," she said. "There is no sense of time when you have nowhere to be."
They are trying to find a new rhythm, she said. They make sure to have dinner around 6 p.m. and go for a walk afterward.
Beasley said it's OK to hide in your room for a couple of hours. She suggests communicating concerns with family members to prevent feelings exploding into anger and arguments.
"What are things in the past you've enjoyed doing and or always talked about wanting to do, and can you do those things now?" Beasley said.
Plan dates with your spouse, such as a movie, workout or cooking a new recipe together, she added. "Make sure not everything in your marriage is about stress right now."
Rodriguez also said she and her husband are unsure how to talk about their plans for the day with their children listening.
"We don't want to panic them. We want to talk to them in way that doesn't scare them," Rodriguez said. "They need to understand why they can't go to see their grandparents and can't go see a friend at the park."
Nemec says it's important for families to have conversations about what they are doing differently and why. Not knowing is scarier, and so is turning to questionable information on social media.
Amy Whisler, 41, of Webster Groves, said she was feeling bogged down, worrying about her parents and her 4- and 8-year-old children.
So Whisler and her neighbors began sewing masks for grocery store clerks and health care workers.
"That has really channeled all that anxiety," Whisler said. "I don't have time to skim social media looking for information, and it reduces the feeling of being helpless."
Productivity makes people feel good about themselves, Beasley pointed out. Even if it's just organizing a closet or cleaning the stove.
With uncertainty about the country's health and economy, it's important for people to focus on what they can control, Beasley said.
"Am I following the CDC recommendations? How much social media do I consume? What do I do in my free time that might make my life better?" she said. "Those are the only things we have control over."
Isolation can be particularly dangerous for the elderly.
"This is a really unprecedented crisis for older adults," said Dr. Eric Lenze, a geriatric psychiatrist at the Washington University School of Medicine. "It's basically what I call a double whammy."
The elderly are at the highest risk of complications from the virus, making it vital for them to separate from others. But older adults are also the most vulnerable to loneliness, which has been linked to early death and cognitive decline.
Lenze advises getting rid of the term "social distancing."
"We need physical distancing," he said, "but we need to be more socially connected."
Many seniors are tech savvy and able to connect with others through video chats, but others are not, Lenze said. He suggests getting outside and talking to others while staying six feet away.
Mindfulness _ a practice of focusing on the present _ can also be beneficial, Lenze said. He is recruiting seniors age 65 and over for a remote mindfulness study, in which participants with depression can get free classes through their iPhone.
Lisa Buhr, 63, of St. Louis, said the hardest thing is not being able to see her six grandchildren, ages 2 to 9. Her husband, 65, is recovering from surgery and radiation for prostate cancer, and they want to be cautious. Her daughter is also pregnant.
Edmund Acosta, 73, lives alone in University City. He misses sessions on the rowing machine at the gym that had finally ended his chronic back pain. He had stayed socially active with STL Village, a membership community that plans group activities for seniors.
The group's happy hours and morning coffees no longer take place in bars and cafes, but on the Zoom video conferencing app that has suddenly infiltrated everyone's lives.
"We should be calling ourselves the Boomer Zoomers," Acosta joked.
He's discovered online exercise classes, informational TED Talks and comedy shows.
"I looked up comedians like Buddy Hackett and Phyllis Diller," Acosta said. "Laughter, being a way to defeat anxiety, is available to me from some of these people I haven't seen in 25 to 30 years."
Beverly Foster, 73, of St. Louis, misses going to church but has found joy in listening to sermons on YouTube. Her computer, however, is old and failing.
"If something happens to my computer," Foster said, "it will be traumatic."
Clinicians said people should reach out for help if they struggle to get through the day.
"We encourage people to call when they've given it their best shot to cope with the situation, and they are still feeling distressed," Beasley said.
When people call the distress helpline, which is for problems other than an urgent crisis, counselors help people identify their emotions and physical symptoms such as headaches, crying or upset stomach.
"What we try to help people understand is that this is how you are hard-wired to respond to stress. It's how we are wired for survival," Nemec said. "So rather than trying to eliminate them, how do we manage those symptoms?"
Counselors offer techniques such as mindfulness, imagery and breathing. Suggestions include exercising, eating healthy and focusing on what you can do rather than what you can't.
Beasley said she likes to encourage gratitude.
"If we focus on something we are grateful for and focus on it for 30 seconds, we can rewire our brain to be happier," she said.
Neighbors are helping each other cope by displaying art on front steps, placing encouraging signs in yards and playing music in the streets.
On recent evenings, Whisler's neighbor, Lia Fairbanks, 12, played Leonard Cohen's "Hallelujah" on the violin outside. Whisler's family and other neighbors gathered on their porches and in their yards to listen.
