Nick Forrest always feels more sad and sluggish when it starts getting dark early.
For quite some time, the 35-year-old Philadelphia resident says, he has contemplated the possibility he might have seasonal affective disorder, a type of depression. People with SAD typically feel depressed each year when the clocks turn back, in late fall or early winter, and their symptoms dissolve in the spring.
Forrest has not been diagnosed with SAD, but he has been diagnosed with depression, which throughout his adult life has become exacerbated in the fall and winter. His father and his husband have SAD, and Forrest finds himself experiencing similar symptoms.
“In the springtime [my depression is] manageable, but in the winter it feels endless and unmanageable,” he said.
This year, Forrest’s seasonal depression feels worse, which he believes is a result of the isolating nature of the COVID-19 pandemic. Finding safe activities has become more difficult as the weather has gotten colder. And maintaining a regular social schedule, which typically calms his depression, has been challenging.
“Things are feeling overwhelming, and my normal coping mechanisms are unavailable to me, so I’m going back to, ‘Well, OK, I’m going to stay in bed or dissociate from the world or isolate myself,’” he said. “It feels more intense this year. This is the first time I’m considering talking to my therapist about seasonal affective disorder, because it’s hard for me to pick apart what’s the normal reaction to all the stress we’re facing and what’s a diagnosed condition I could get support for.”
He said he feels very fortunate to be able to work from home during the pandemic, but it’s also an isolating experience. Planning small things to look forward to with his husband, or going on walks, have helped. But he’s worried things are going to get worse since people won’t be gathering for the holiday and it feels like there’s not much to look forward to.
“I feel like we’ve lost these markers of time … and I’m a little concerned that if it’s feeling like this now, how will it feel in January or February?”
Isolated, distressed and stuck in the house
COVID-19 cases have been surging, which has prompted several states to issue new stay-at-home advisories and partially close businesses. In the summer, people could find safe outdoor activities to participate in, but as winter approaches, they’re finding themselves stuck inside the house.
For someone with seasonal affective disorder, the nature of the pandemic can make the symptoms much harder to manage.
“So many people are feeling more distressed, more worried, more disconnected, more isolated, so we’re coming into these winter months already feeling that level of distress,” said Janie Feldman, a psychologist in Warren, New Jersey. “There’s great hope to hold on to: Nothing lasts forever, and we can get through, and the vaccine is very promising and very much on its way. But if you experience depression or seasonal affective disorder, it’s even harder to see that there’s hope when you’re feeling hopeless, when you’re feeling stuck, and you’re feeling sluggish, and the things that make you happy aren’t really working for you anymore. That brings more of a state of despair.”
Those who have depression or bipolar disorder are at a higher risk of developing SAD, but other individuals can still be diagnosed with it. About 4 out of 5 people with SAD are women, and about 5% of the population are estimated to experience it.
A mental health specialist can conduct an interview to determine if someone has SAD. You must have worsening symptoms of major depression during the fall or winter for at least two years in a row to be diagnosed with it.
People experiencing SAD can have symptoms similar to major depression, such as depressed mood most days, not enjoying activities that once provided pleasure, changes in sleep and eating patterns, low energy, low self-esteem, and suicidal thoughts. Other symptoms associated with SAD include oversleeping, overeating, weight gain and withdrawing from others.
A less common disorder is summer-pattern SAD, experienced during the spring and summer. This type of SAD is associated with sleep deprivation, poor appetite, anxiety and aggressive episodes.
Many people feel low when the days get shorter because the lack of access to daylight affects neurotransmitters in the brain that regulate our moods. Mental health specialists call that the “winter blues,” but those are not diagnosable and don’t come with a depression as severe as the one that comes with SAD — although the cause is similar.
People with SAD also produce too much melatonin, which maintains a person’s normal sleep/wake cycle. Melatonin is produced when it’s darker, and that can increase sleepiness. There’s also a reduction of serotonin during darker seasons, which affects the mood of someone with SAD.
During the fall and winter, the body’s circadian rhythm changes because of the decreased sunlight. That affects some people’s internal body clocks, which can lead to feelings of depression.
“These changes in those chemicals disrupt the daily pattern so they’re not adjusting to the changes in the length of the day, and then that’s leading to problems with sleep and mood, and eventually behavior changes,” said Christina Zampitella, a psychologist with the Center for Grief and Trauma Therapy in Newark, Delaware.
There’s also been some research into how the reduction of vitamin D exposure from the sun can exacerbate SAD — and there are fewer cases of SAD in geographic locations that are closer to the equator.
It’s about the sun, but also about stress
Zampitella said the nature of the COVID-19 pandemic this winter could amplify SAD.
“If we’re home and not exposing ourselves to the sun, that’s an increase in the deficiency of vitamin D,” she said. “The coping skills many of us use in order to manage these winter blues, so to speak, we don’t have as much access to them. For example, I enjoy going to the gym and doing yoga. Well, I’m not going to the gym and doing yoga. And I know exercise is a significant coping mechanism, and a way to regulate the neurotransmitters we have in our brain.”
“Even physical touch, being able to go out and do things that are fun, going out to dinner and going to the movies, these things that provide us joy and release the tensions we experience,” she added. “Even people who have lost income because of COVID, lost their job, lost their health insurance, are becoming financially strapped; and their children at home who are being homeschooled, and that becomes a huge factor in all of this. I mean these stressors begin to outweigh the coping skills, and now we’re well on our way to exacerbation of any underlying mental health condition.”
The impact COVID-19 might have on mental health has come up in conversation several times with her clients, Zampitella said.
“More along the lines of, ‘Oh my gosh, here we go, we’re getting into winter and already winter is a hard time because I can’t go outside and do all the things I want to do, and now there’s COVID and there’s all these limitations, and I don’t know how to handle this,’” she said.
“And let’s not underestimate the changes in the way we’re celebrating our winter holidays. I was just talking to someone yesterday who was talking about how sad she was about the fact that for the first time in the lifespan of their family, they can’t celebrate Christmas together. We’re experiencing a lot of losses, and I don’t want to underestimate the impact of the grieving process in the many, many losses we are experiencing this time of the year,” she said. “I think it’s important to remember people are becoming increasingly more aware of what’s missing, what’s taken away from their lives, and if you’re already struggling with this kind of pattern, that certainly would become exacerbated.”
Zampitella and Feldman advise light therapy, which has been used as a treatment for SAD since the 1980s. Light boxes, which are about 20 times more bright than indoor light, mimic the sunlight that’s not available in the winter. People with SAD can sit in front of light boxes for 45 minutes a day to help improve their mood. The devices can be purchased online in a variety of sizes and costs.
People also can be tested for a vitamin D deficiency at their doctor’s office, Zampitella said, but vitamin D can’t be used as a sole treatment because studies on the matter are mixed.
Maintaining a routine is significantly important for maintaining physical, mental and emotional health, Feldman and Zampitella said.
“Making sure you get up, and eat in the morning, and try to get your sleep. Even if you’re sleepy at 7 o’clock at night, really try to keep your sleep regular, whatever it might be, like 10 to 6,” Zampitella said.
Adults need about eight hours of sleep a day, and should wake up at the same time every day with a 30-minute cushion. Teenagers should get nine hours of sleep per day.
“Sleep is essential for mood, concentration and ability to cope,” Feldman said.
The two therapists also recommend reducing exposure to electronics an hour before bedtime, and reducing caffeine. A healthy diet, staying hydrated, yoga and meditation, as well as physical activity are also part of their advice.
“You don’t have to be on the treadmill for 20 or 30 minutes, but if you can get up and do a couple jumping jacks or squats, take a walk around the house and take a walk around the block. Any movement you can have will be so much better than not,” Feldman said. “And yes, being outside is an essential thing to do right now. The fresh air, the sunlight, is really important.”
Being creative helps, when you can’t be in control
They also recommend that individuals discover creative ways to express their feelings — writing art, music, whatever.
“In terms of hobbies, a really great thing to do is create,” Feldman said. “You can take any kind of class online, but if you can create something, whether it’s cooking, or building, or artsy, or craftsy. It’s so much better than binge-watching your favorite Netflix program.”
Zampitella also suggested focusing on the aspects of life you can control, rather than fixating on things you can’t.
“If you’re going to get caught up in, ‘Oh my gosh, the days are so short, what am I going to do?’ you don’t have control over that. But what do you have control over? You have control over your sleep, you have control over what you do with your time, you have control over what you choose to do to help your symptoms,” she said.
All this advice is helpful for anyone, Zampitella said, whether a person has SAD or not.
If you continue to feel depressed after following the advice, seek out a mental health professional, they said. Most are offering therapy online during the pandemic. Zampitella and Feldman said a person should take the time to find the right therapist.
“The way you know is by interviewing them, get them on the phone. I give a free video consultation if someone wants to see me,” Feldman said. “‘Does this person hear me? How do they sound on the phone? Do they get what I’m talking about?’ You can get a sense from talking to somebody how it feels to be talking with them. Do you get a good feeling? Do you like the vibe you’re getting? Hopefully, you got that on your first try, but if you want to check out a couple people and talk to them, that’s fine too. It’s like trying on shoes — you want the fit that feels good for you, and you’re in the best position to know what works for you.”
“We do a lot of clinical trials for all kinds of mental health disorders, and SAD is included in that. I’m not saying people should be part of a clinical trial, but we are still working on trying to figure out what’s going on and try to prevent it,” she said. “There’s no convincing evidence at this point that starting light therapy or psychotherapy could prevent the onset of it, but preventative treatment may still prove to be exceptionally healthy.”
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