How to Survive Seasonal Depression During a Pandemic
When the U.S. officially paused to enter the quarantine is one that no one will ever forget. Previously, it was business as usual for most people. Daily schedules in place, events planned, everyone looking forward to something on the horizon, whether it was a trip, night out, or gathering with friends. Then, there was a pause. Days turned into weeks, weeks turned into months, and now the year is coming to a quick end. The warm weather and sunshine of summer offered a quick reprieve and felt, for a bit, like the light at the end of the tunnel. But as the days get shorter and temperatures get cooler — and there's still no real end to COVID-19 in sight — a lot of people are feeling really nervous.
While 2020 is a beast of its own accord, for some people, the fall and winter months are already difficult to navigate due to seasonal affective disorder (SAD).
The Basics of Seasonal Affective Disorder
SAD is a type of depression (also known as seasonal depression or winter depression) that comes and goes with the seasons. It typically starts in the late fall and early winter and goes away during the summer, according to the National Institute of Mental Health. (While it's less common, there are also cases of summer SAD, aka reverse SAD.)
It's caused by three main factors: disruptions to your biological clock, serotonin levels, and melatonin levels. "It's directly tied to the seasons, due to the fact that the shorter days impact your circadian rhythm/biological clock," says JaNaè Taylor, Ph.D., of Taylor Counseling and Consulting Services. "The cues of sunlight are not available and this disrupts your biological clock and sleep. It also impacts serotonin, aka 'the happy hormone'; when it drops, it can trigger depression. SAD also impacts melatonin, a hormone that responds to darkness and plays a role in sleep patterns."
It's important to note that SAD is not considered a separate disorder from depression, according to The National Institute of Health. Rather, it is a type of depression displaying a recurring seasonal pattern. To be diagnosed, people must meet the criteria for depression coinciding with specific seasons (appearing in the winter or summer months) for at least two years. In fact, generally, symptoms of SAD "echo those of major depression," says Gina Moffa, L.C.S.W., a psychotherapist in Manhattan.
SAD is a lot more common than you might think, says Taylor. "At times, when people present with symptoms, it doesn't always meet a clinical diagnosis," she says. "People tend to feel tired and eat more comforting foods for example, many experience the change to some degree, but not as extreme as a diagnosis."
This presentation of symptoms might be considered low-grade SAD, a diagnosis that includes "reduced energy, low motivation, or you may find yourself more lethargic without a real understanding of the cause," adds Moffa. With these symptoms, it "doesn't mean that we should take it less seriously, but it can take longer to diagnose because some people will live with feelings of depression for some time before it is apparent to them," she says. (See: Michelle Obama Opened Up About Her Experience with Low-Grade Depression)
If you think you could have SAD, there are some noticeable factors that might indicate it's become more than just passing blues. Taylor recommends looking for signs such as sadness, isolation, and not taking care of yourself (such as changing clothes or showering). "We've gotten comfortable working from home, but check in with yourself: Are you at least changing into a new set of pajamas? If you're struggling four out of the seven days of the week you might want to think about getting help," says Taylor. "If you feel hopeless, isolated, don't want to be here, and these thoughts are persistent, it's time to get help." If you feel you need to get help Taylor suggests, doing whatever is easiest for you, whether that's asking your primary care doctor for a referral or seeking out a therapist on your own.
Another thing to consider is the timing of these depressive symptoms as they relate to events that have happened in your life. Moffa encourages reflecting on whether you may have any unresolved trauma or unresolved grief. "Depression can come as a result of something painful that people haven't had a chance to deal with," she says. "It's important to look back and think of situations that you haven't dealt with. People may have worked through a mental health struggle only to have it resurface again during the fall and winter months — or, now, because of the unpredictability of COVID-19."
Seasonal Depression During the Coronavirus Pandemic
Of course, one thing we're all trying to deal with is navigating life during a pandemic. Now, even with some states opening up in phases, there are still many restrictions. Depending on location and comfortability, many people still choose to stay inside while others are back to "business as usual" as if there's no pandemic.
"Quarantine and shelter-in-place is an obviously unique circumstance for our modern society," says Moffa. "Being in a situation where we have danger in the world and staying home is the way to stay safe imposes a deep fear, which can easily turn into heightened anxiety and depression."
In fact, a recent study from the Journal of the American Medica Association (JAMA) found that overall cases of depression among Americans have increased since the pandemic began. A pre-pandemic survey found that 8.5 percent of about 5,000 American adults showed signs of depression. This includes (but is not limited to) having low energy, feeling down, hopelessness, or thinking of self-harm. From March to April 2020, researchers surveyed about 1,500 American adults and found that that number rose from 8.5 to 28 percent (!!). Of course, we're still in the middle of a pandemic, so those numbers could certainly be higher now — and, on top of that, the season of SAD is approaching.
For that reason, experts do predict an increase of SAD cases overall. "Having cooler temperatures and shorter days will make this much more pronounced," says Moffa. Since the COVID pandemic began, she says she has also seen an "immense uptick in depression symptoms" in her own patients. "This is due to the increased isolation, anxiety over the uncertainty of the future, fear of contracting the illness or having someone they love get sick, lack of human contact/affection, and the grief, anxiety, and depression that comes with the loss of financial security and job loss," she says. Interestingly, Moffa has also seen SAD decrease in a few of her patients: "They report feeling less alone, because everyone is home doing the same thing all around the world and they don't feel left out, or they are missing something because everyone is going through it together." (See: Here's How COVID-19 Might Be Affecting Your Feelings of FOMO)
It's no question that the pandemic has created a lot of stress, depression, and anxiety. People are feeling isolated. "It's important to note that SAD during a pandemic can be more severe because one of the goals of treating SAD is to help people feel more connected," explains Moffa. "Yet, the grief of human interaction and in-person support right now can cause people to feel even more isolated, anxious, and overwhelmed."
"This year, SAD is compounded," says Moffa. "It's not just SAD, but, for so many people, it will be combined with trauma symptoms, PTSD, as well as elevated symptoms of grief, anxiety, addictive disorders, and depression." In her practice, she's "treating COVID-related depression more like trauma — which can mean focusing on helping patients regulate their emotions through cognitive-behavioral techniques as well as mindfulness-based exercises. I encourage balancing physical symptoms through movement, breathing exercises, and meditation. I also monitor, along with my patients, their sleeping and nutritional patterns, and social support system."
With SAD, in most cases, "there is an ending point and clear time when it stops," says Taylor. The difference now is that we're navigating a pandemic and everything else going on in the world, and we don't know the ending point. "Everyone is impacted in one way or another, and I don't know how it will affect people in the future," she says. "Many of us are just trying to make it through the day. I compare this to grief because with grief we don't have a determined end point." (See: Why It's So Important to Understand Grief During Coronavirus)
How to Cope with SAD + COVID-19
It's important to get support. "Sometimes it's not as formal as therapy and you may just need a reliable person to talk to," says Taylor. "If you feel you need additional help there is nothing wrong with seeking out a therapist."
Some of the treatments available for SAD include "talk therapy or light therapy using a specialized light therapy box which will emit bright light mimicking sunlight without the harmful UV rays," says Moffa. Most patients use light therapy on an as-needed basis, says Moffa. If you see an improvement with light therapy, you can lessen or stop until you need to resume.
Other patients might be prescribed an anti-depressant SSRI (serotonin-reuptake inhibitors). "Some people take it during a specific time and learn coping skills and can reduce the dosage or get off the medication all together," says Moffa. "This is to be determined by a professional don't take yourself off of medication unless directed to do so." (Related: The Stigma Around Psychiatric Medication Is Forcing People to Suffer In Silence)
Whether you have low-grade SAD or more severe symptoms, it's important to seek professional help. Here are some additional tips that will help you navigate SAD during a pandemic.
- Set a schedule. Set a time and create a series of activities to start and end your day. "When we lose anchors this is when days and months can bleed together," says Taylor. When people are depressed, "the ability to plan is a struggle which will increase fatigue. When there is a schedule and routine, you don't have to think about or make plans because the expectation is clear and that is one less thing you have to extend energy to do," she says.
- Take care of your body. Maintain regular eating and sleeping habits and exercise. "It is important to get the nutrients your body needs. Eat plenty of fruits and vegetables, this can help to minimize mood swings," explains Moffa. "Foods rich with vitamin C help with cortisol, a hormone that is released during times of stress. Folic acid and magnesium (green leafy vegetables) are known to help your mood. Peppermint and Chamomile teas are also calming," says Taylor. Another important factor is getting proper sleep. "Sleeping helps your mood, memory, and it improves our ability to sustain attention," she says. She also suggests getting proper rest when needed throughout the day and using a weighted blanket. "This is known to help reduce overwhelm and stress."
- Be gentle with yourself. These times are incredibly emotionally intense. "Allow yourself the space to feel your feelings. Add a nourishing ritual to your daily routine, whether a soothing cup of tea, journaling, or putting on a song that makes you want to move your body," says Moffa.
- Have fun. Reconnect with things that you enjoy. Art is where people find fun and creativity. Go jump rope, play games, and reconnect with things that make you smile," suggests Taylor. (Try some of these creative hobby ideas.)
- Create a specialized treatment plan with a professional. "Having a trusted PCP or therapist can help someone have more control over their symptoms. Also, maintaining therapy can help prevent the symptoms of SAD from returning or returning as aggressively," says Moffa. "There are many insurances waiving co-pays for therapy so we can be more accessible right now, and that is great," says Taylor. (See: How to Afford Therapy When You're Broke)
- Stay connected. "Having family time, digital gatherings, good conversations, and/or playing a game is helpful," says Taylor. "We tend to isolate when we are depressed, and that is counterproductive to feeling better. Having close and supportive relationships can be an invaluable lifeline when someone is struggling with depression and SAD symptoms. A virtual support group is also helpful and beneficial, as it cuts down the isolation."
- Practice mindfulness techniques. Moffa suggests Insight Timer, an app for meditations. Or try these other mindfulness exercises you can do anywhere and other meditation apps for beginners.
- Journal daily. "Writing out your feelings can help you gain control over them," says Moffa. "Oftentimes feelings can seem overwhelming and nebulous, but writing them down can help you not only get those feelings out but help you organize our thoughts, which can potentially lessen the sense of overwhelm when you can't decipher your thoughts and feelings, you just know they feel BIG." (See: The Mental Health Benefits of Using a Worry Journal)
- Practice radical self-care. "Treasure your time on earth and make yourself a priority," says Taylor. "It is okay to be selfish and choose you. If you need to rest, turn off the phone, limit screen time, it is okay." Take the time that you need to get to know and understand yourself so you can get proper support.
- Movement. Exercise boosts serotonin. Activities like "waking, yoga, or Tai Chi are great options. Dance as a therapeutic modality in addition to other types of therapy are helpful. To start, dance in your living room to your favorite song," says Moffa. It sounds simple, but it can have a surprisingly strong effect. (See: 12 Things to Do to Feel Good In Your Body Right Now)
- Monitor your mood. "In my practice, I monitor people's moods week to week and teach them to do the same. This can mean journaling daily, writing about feelings and experiences, but also recording sleep, appetite, social connections, and intrusive thoughts for the week. I also encourage people to listen to their bodies," says Moffa.
The information in this story is accurate as of press time. As updates about coronavirus COVID-19 continue to evolve, it’s possible that some information and recommendations in this story have changed since initial publication. We encourage you to check in regularly with resources such as the CDC, the WHO, and your local public health department for the most up-to-date data and recommendations.