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With the help of medication, Linda Eun was able to keep her anxiety and depression under control when California, where she lives, issued stay-at-home orders on March 19.

For the 57-year old Los Angeles-based lawyer, the anxiety — which has been relentless — suddenly spiked a couple weeks ago. Eun has hypertension and a chronic low white blood cell count, which puts her in a high-risk category for covid-19.

“Probably seeing the reopening, anti-lockdown protests etc. the last two weeks is causing the surge in anxiety,” Eun wrote in a message. “Since then, [I’ve] had to increase dosage to stay semi-sane. Never had panic attacks before but have experienced a few mild ones since.”

She’s not alone.

In March, the federal government’s disaster distress hotline saw a 338 percent jump in call volume over February, agency spokesman Christopher Garrett said. Text messages to the hotline have also skyrocketed — from 1,790 in April 2019 to 9,985 in April 2020, Garrett said.

With America now several weeks or months (is there even a difference?) into this new normal, our mental health needs have changed. Many people are reporting their anxiety is manifesting differently from even one or two months ago. That’s especially been the case for women.

“Remember — before we go into the situation that we’re currently in — women have twice the incidence of anxiety and depressive disorders as men,” said Maureen Sayres Van Niel, president of the American Psychiatric Association Women’s Caucus and a psychiatrist in Cambridge, Mass. “People who already have an existing mental health disorder like depression or anxiety — they’ve been more symptomatic from the onset of this quarantine.”

Neha Chaudhary, a psychiatrist at Massachusetts General Hospital and Harvard Medical School and co-founder of Brainstorm, Stanford’s Lab for Mental Health Innovation, has noted a prevalence of trauma-related symptoms “like heightened jumpiness or nightmares, as well as symptoms of grief over all of the devastating loss.”

Her patients have also suffered from a range of symptoms, including having “seen anxiety worsen for people who are having difficulty managing their new day-to-day, balancing work with kids at home and a lack of usual resources. For some people depression has crept in, especially those who have felt increasingly isolated, disconnected or lonely,” she said.

An aspect of treatment that has surprised her is early manifestations of guilt.

“I thought it would come into play later in the form of survivor's guilt, but turns out pretty quickly people expressed feeling guilty that they had it better than others and feeling like they had no way to help,” Chaudhary said.

Some experts and therapists have also noted a change in behavior in just the last couple of weeks.

“Now at this point, I would say for the last two weeks — I’m seeing people who don’t have preexisting mental health diagnoses start to develop symptoms that are fairly significant — and that’s what the change has been,” Van Niel said.

“Everybody was just getting up their courage and dealing with the situation for a number of weeks and we’re starting to get to the point where people are not able to keep the same kind of approach to life as they were able to do, say, a month ago, thinking this would be a temporary thing,” she said.

“Everyone who has had post-traumatic stress disorder, in some way, they have been reminded of their own trauma,” Van Niel said. “It’s not just an incidental medical finding. This is a major trauma to the country right now.”

It’s hard to quantify the mental health of the country during a pandemic that is still in full swing. Right as shelter-in-place orders began, more than one-third of Americans (36 percent) said coronavirus was having a serious impact on their mental health, according to a poll by the American Psychiatric Association.

The same survey, which drew from a nationally representative sample of 1,004 adults on March 18 and 19, found that 19 percent reported having trouble sleeping, 8 percent were consuming more alcohol or other drugs or substances, and 12 percent reported increased fighting with loved ones.

Now, some like Eun, who felt their symptoms were under control for the first several weeks of sheltering-in-place, are having intense anxiety reactions as states start to reopen on different timetables to different degrees.

But others say having preexisting mental health diagnoses have left them better equipped to manage with our collective new reality.

Lisa Gray, a therapist in Livermore in Northern California noted this phenomenon.

“My clients who have already struggled with depression and anxiety are actually doing better than people that I have just begun to see who have no history of depression and anxiety. I think that is because they went into this pandemic already having a lot of tools for coping,” Gray said.

Van Niel cautioned people who believed they have depression or anxiety to seek a medical diagnosis, and not diagnose themselves.

Gray agreed: “I think most people know this, but almost every therapist that I know is doing video sessions right now, so people should not think that they have to wait until after this is over to seek therapy. I am even doing a lot of couples therapy over video and it works perfectly fine.”

For Los Angeles-based behavioral analyst Jon Roos, the difference between his clients is mostly demarcated between those have a strong internal mediated structure and those who respond mostly to external structure.

Those who fundamentally require an external structure such as school, work or playdates to modulate their behavior are having “meltdowns” and struggling with sleep and socializing, which can further feelings of chaos.

He has also observed an increase in obsessive-compulsive behaviors — repeated behaviors and literal wandering around the house for those struggling.

He suggests writing down a schedule, even if it includes “screentime” or “watching Netflix and eating snacks” and planning on it rather than relying entirely on emotions to dictate activities.

Roos also recommends mindfulness exercises, meditation and even listening to soothing music to keep anxiety levels low so that self-destructive behaviors aren’t as tempting.

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