Before you think Im really stretching for something to write about, please consider the special risk factors that affect people with bipolar disorder during the coronavirus pandemic.

The one that affects everyone is the loss of routine and the increase in stress that results from the shutdown and the insecure reopening. Social isolation, new work requirements and decreased in-person contact with family and friends greatly impact mood and can lead to disruptions in sleep and increased episodes of depression and/or mania.

People with bipolar disorder have a tendency toward substance abuse, and its been demonstrated that increased stress and feelings of isolation make a person turn more quickly to alcohol or drugs to help ameliorate suffering and uncertainty. An epidemic in deaths of despair is expected to closely follow the covid-19 pandemic.

Calls to crisis hotlines have skyrocketed and the suicide rate has spiked, with increases in cases as the restrictions to protect us from covid-19 drag on.

Exacerbating these factors is the cut back in visits to doctors as nonemergency medical care has been delayed. As medical centers reopen a backlog of elective cases leads to difficulty in obtaining treatment, and even simple prescription refills have been interrupted.

Now research is beginning to reveal that people with bipolar disorder who contract covid-19 face unique risks. From a report from the Jawaharlal Institute of Postgraduate Medical Education in India, there is evidence of an association between seropositivity for coronaviruses and the risk of mood disorders and suicide. Though the significance of this association is unclear, it may be related to the neurotropic potential of respiratory coronaviruses, or to their ability to provoke a systemic inflammatory reaction, both of which may be associated with mood dysregulation.

All is not glum. A person with bipolar disorder can successfully face the stresses of the pandemic by solidifying community connections, even through app-based technology like Zoom, Skype and Facetime, with peer groups, faith-based institutions, on-line classes and other supports. These connections, if the technology is accessible, may even be easier to forge now than before the shutdown.

We should never underestimate the positive impact relationships and community can have on our mental health.

Common stress management techniques like exercise, healthy eating, proper sleep, hobbies and meditation can also help. By staying productive it is easier to stay well.

While the risk factors to people with bipolar disorder that result from our experience with the threat of covid-19 are real and significant, they dont have to lead to disruptive mood changes or dangerous behavior.

Just as we have to develop sensible practices to protect us from the virus, and to protect others if we may have been infected, we can positively act to minimize the threat of the pandemic to our mental health.

If you are thinking of suicide please call the National Suicide Prevention hotline at 800-273-8255 in the US or find a local number at in the UK.

My new book Resilience: Handling Anxiety in a Time of Crisis is available wherever books are sold.