Are You More Likely to Be SAD This Winter?
Tips on coping with seasonal depression during the pandemic
If you suffer from seasonal depression and worry about your risk factors should you get the coronavirus, this winter could be tougher than usual.
Shorter and cooler days are already limiting opportunities for the boost that comes from socializing and exercising outdoors, where rates of transmission of COVID-19 are lower than indoors. The specter of diminished holidays, a 6.9% unemployment rate, a third wave of the virus and more than 238,000 coronavirus deaths add to the mental health risks this winter. But there are things you can do.
"People have really embraced the outside as the safest place and relied on their ability to be outside to bolster their mental health," says Vaile Wright, senior director of health care innovation for the American Psychological Association.
"I have way more anxiety this year. I have COVID fatigue, and I'm anxious about the coming winter."
"The more you can prepare, the better you'll be," Wright says. "Think proactively about 'What can I do to utilize the outside more?'" For example, she says, maybe invest in an outdoor heater, already a hot commodity.
Seasonal depression, also called winter depression, seasonal affective disorder or SAD, is linked to a biochemical imbalance in the brain prompted by shorter daylight hours and less sunlight in winter. The American Psychiatric Association estimates that about 5% of adults in the U.S. experience SAD. Symptoms include depression and fatigue, carbohydrate cravings, increased appetite and weight gain, and withdrawal from other people.
"The further north you go, the more the rates of seasonal impairment go up," says Dr. Paul Desan, director of the Winter Depression Research Clinic at Yale University.
"Plenty of people don't meet the criteria for major depression but feel lousy in the winter," he adds. "Fifteen percent have a symptom that causes depression that they would like treatment for. And ninety percent of people will say they feel different in some way."
He says that more time indoors with dim light and less time driving to work in bright light in the morning has exacerbated the problem.
"I'm worried about this year," Desan says. "The rates of seasonal changes will be worse."
Depression and Anxiety On the Rise
Though never diagnosed with SAD, Robin Farmer, a 59-year-old writer who lives in Mechanicsville, Va., had all the symptoms when she worked in Connecticut at The Hartford Courant newspaper. "It was a sense of feeling blue, low energy, anxiety. I would stuff my face with carbs to feel better. I remember going back to the apartment and turning on every light," she says. "I have way more anxiety this year. I have COVID fatigue, and I'm anxious about the coming winter."
She is not alone. A survey by Mental Health America, conducted from January to September 2020, found that the number of people with moderate to severe depression and anxiety increased through 2020 and was higher than in the same period before COVID-19. "The number of people looking for help with anxiety and depression has skyrocketed," according to the report.
Dr. XinQi Dong, director of the Institute for Health, Health Care Policy and Aging Research at Rutgers University, notes that hurricanes in the South and fires on the West Coast are also pushing people inside.
People with SAD can have double the trouble: their usual symptoms and what the pandemic has wrought at a time of year when they are especially vulnerable.
"Issues relating to loneliness, despair, suicide, all of them accumulate when COVID limits social connectedness," says Dong. He hopes that when connecting virtually, people can appreciate "that it's not about physical presence, it's about emotional connectedness."
Fabiana Araujo, assistant professor of psychiatry and behavioral neuroscience at University of Chicago Medicine, says "replacement strategies" can mitigate stress.
"What you want to do is signal to your brain and body that this is a light and bright place."
"Of course going outside is wonderful, but there are a number of activities that can be done indoors," says Araujo. "I would highlight the small pleasures that we take for granted, making a cup of tea, preparing an indoor garden, practicing yoga, learning a new handcraft…paying attention to small rituals on a daily basis."
Worrying and uncertainty "are a perfect combination for a storm," she says. "But we have the ability to shift our attention to experiences in our life that are not anxiety-provoking … This could be saying, 'I am home, I am safe, I wore a mask.' It's not that we should lower our guards. Let's maintain that and at the same time not let it take over our experience."
The Best Light Therapy
Desan says that for treatment of SAD, a half hour of bright light therapy in the morning, with the proper device at 10,000 lux, under the supervision of a clinician, is safe and effective. SAD lights can be found at many retailers costing from $30 to more than $300. Many are shaped like iPads and boxes, but there are also lamps and even eyeglasses.
Desan cautions that many devices are too dim and too small, though; he and colleagues who tested 24 light therapy boxes found that only seven met their clinical criteria.
He says an early morning walk with exposure to bright light can also alleviate symptoms. Those who have a significant mental health problem should see a mental health clinician, he says.
Getting enough sleep, exercise, and healthy eating are also important; indeed, Farmer felt better when she switched to a diet that minimized carbs and sugar and included healthy fats. And paradoxically, a house fire in 2015 offered the chance to rebuild with overhead lighting that brightened her mood.
Luckily, you don't need a house fire to make choices that can support good health.
Natural Light and Houseplants
Jamie Gold, a consultant in wellness design and author of a book on the topic called "Wellness By Design," says, "You can look at your window coverings to see if they're letting light in during the day while providing privacy. You can also look at adding natural light with solar tubes, similar to skylights but smaller, orientating furniture placements near windows and patio doors, making the most of our outdoor living space and considering lighter paint colors that reflect light rather than absorb it."
She is also a believer in having houseplants, whose health benefits, such as reducing physiological and psychological stress, are documented in a 2015 study.
The 59-year-old had winter depression when she lived in New York but left it behind with the cold weather when she moved to San Diego. In her townhouse, artwork and decorative details incorporate "comfort and joy."
"What you want to do is signal to your brain and body that this is a light and bright place," Gold says.
Wright encourages people to write letters or pick up the phone, which people seem to be doing, as telecommunications companies report an uptick in phone calls.
"We know that social isolation has a negative effect on well-being. We really still need to be mindful of reaching out to those we love," she says.
"If you know your family won't be together (on Thanksgiving), maybe you Zoom and say what you're grateful for."