Seasonal Affective Disorder During COVID-19
Winter is here to punctuate the ever-so-unexpected year 2020. Daylight savings time not only means a change in our clocks, but a change in our mental health as well. For those with Seasonal Affective Disorder (SAD), which affects five to ten percent of the U.S. population, wintertime isn’t as easy as merely dealing with colder weather. Instead, it’s a struggle that impacts the mental and emotional well being of individuals for months.
2020 is slightly different, though — the public health crisis, COVID-19, has amplified the overwhelming sense of listlessness familiar to all SAD sufferers. The pandemic has brought a myriad of uncertainty related to the economy, jobs, personal life, and the general state of the world. Furthermore, social distancing mandates have pulled people away from the benefits socializing brings during the holidays and winter months.
What is Seasonal Affective Disorder?
Seasonal Affective Disorder (SAD) is a depression type that typically begins and ends at the same time each year. Its symptoms emerge during the fall and winter months — going along with the typically ‘sunless’ months, and slowly fade away with the onset of spring. In the U.S., people feel the brunt of SAD during January and February. Women, especially between ages 20 to 40, tend to be affected more frequently than men.
Humanity has battled SAD for longer than the term has been coined. It is a global phenomenon. This is possibly why many cultures, with their major celebrations around this time of the year, involve lighting candles and illuminating their surroundings with various light-decorations.
However, SAD isn’t exclusively a winter phenomenon. It can be triggered during spring or early summer and then dissipate during the sunny days of summer. Regardless of the onset, the symptoms start mild and slowly intensify as the season continues its course.
The Science Behind Seasonal Affective Disorder
The specific mechanism behind SAD is still shrouded in mystery and the causes depend on numerous factors. Still, scientists have uncovered a few pieces of the puzzle, which mostly points to it being the result of a mismatch between our body’s circadian rhythm and the production of melatonin and serotonin, which is generally controlled by sunlight.
Melatonin, a hormone naturally produced by the body at night, releases in response to our body’s circadian rhythms. Circadian rhythms are 24-hour cycles that regulate specific physical, mental, and behavioral changes we go through every day. Melatonin level rises at night to induce sleep and falls in the morning so we can wake up, get out of bed, and go about our day without feeling drowsy.
When sunlight first hits specific receptors in our eyes, it signals to the body that it’s time to wake up and to inhibit the release of melatonin. This is a daily cycle, and its occurrence follows the body’s internal clock. Due to the change in our time structure with daylight savings time, and less sunlight in winter, many people wake up before dawn when it’s still dark out. They aren’t greeted by sunlight to reset the circadian rhythm. In other words, melatonin levels stay high into the morning hours. And the body still functions like it is nighttime.
Then there’s serotonin, a neurotransmitter responsible for elevating mood. Those with SAD are likely to have difficulty with serotonin regulation. Shorter days mean reduced sunlight, causing an increase in the release of a serotonin transporter (SERT). SERT is a protein that transports serotonin from the synaptic cleft to the presynaptic neuron. Too much SERT diminishes serotonin activity, which then leads to depression. In summer, sunshine keeps SERT low, but lack of sunlight in winter causes SERT to rise and serotonin fall.
The decreased serotonin and increased melatonin levels impair the body’s ability to synchronize our internal clock with seasonal changes effectively.
Symptoms of Seasonal Affective Disorder: What Does it Look Like?
SAD symptoms share similarities with the diagnosis of major depressive disorder, but they’re only present during fall and winter, not during the rest of the year.
To be diagnosed with SAD, one must exhibit depression symptoms for at least two years, and only during a specific time of the year (e.g., fall or winter) with a full remission occurring at a particular time of the year (e.g., spring). For the rest of the year, should be relatively symptom-free.
According to the National Institute of Mental Health common symptoms of SAD are as follows (all SAD sufferers may not experience all listed symptoms):
● Feeling depressed the majority of the day, almost every day
● Losing interest in activities that were once liked
● Experiencing changes in weight and appetite and weight
● Having sleep problems (this usually shows up as sleeping too much)
● Feeling sluggish or agitated
● An increased purposeless activity like inability to sit still, pacing back and forth, significantly slowed movements or speech
● Low energy despite sleeping a lot
● Feeling hopeless, worthless, or guilty
● Having a difficult time focusing on tasks or making decisions
● Frequent thoughts of suicide or death
Along with the above, additional signs specific to fall-onset SAD include:
● Hypersomnia (sleeping too much)
● Overeating (increased craving for carbohydrates)
● Weight gain
● Social withdrawal
Spring-onset SAD sufferers may find the following additional symptoms:
● Insomnia (trouble falling asleep)
● Poor appetite leading to weight loss
● Restlessness and agitation
● Anxiety
● Episodes of violent behavior
How to Cope with SAD Amidst Covid-19
Coping with SAD in the middle of a pandemic can seem overwhelming or even futile at times. With a little extra-self care and modification to the conventional treatments for the disorder, the heightened symptoms can be lessened.
● Light therapy: Light therapy, or photo-therapy, is the front-line treatment for SAD. It involves sitting in front of a specialized light box that emits broad-spectrum light. The device replaces the deficit caused by the reduced sunlight exposure and helps with resetting the body’s internal clock. Using it for just 20 to 30 minutes a day, first thing in the morning, diminishes the brain’s melatonin release, thereby alleviating feelings of melancholy, sleepiness, and lethargy that would otherwise lurk around your whole day like the grey clouds.
Individuals participating in light therapy are not required to stare directly into the light box, allowing them to continue doing their morning routine. The exact timing of using the device and how long to use it for will depend on the severity of symptoms and circadian rhythm. A mental health professional or doctor can help find the right dosage.
On average, results are noticed within two weeks, but continuous use is required throughout the winter to prevent relapse. In some cases, using light therapy before the onset of symptoms in the fall can prevent its occurrence.
● Get some natural sunlight: Although light therapy is great, natural sunlight is much more effective, even if it’s only for a short amount of time. While out in the sun, without sunglasses, the sunlight will find its way to your eyes naturally and have the same impact internally as previously mentioned in light therapy. Since the sun is naturally strong in general, there is no need to stare directly into the sun (which is never recommended). Of course, don’t forget your mask! Going for a walk at a nearby park, somewhere not crowded. Even a walk around a neighborhood or walk in the front or backyard. Being outside in the sun is the point but being safe and socially distanced about it is vital as well. The changes will be gradual but existent.
If going to a park isn’t a possibility, doing other morning activities near a window that provides morning sunlight or outside on a balcony can be helpful with receiving natural sunlight. For those of us working from home keeping the drapes open to let the natural light in is also helpful.
For some individuals, painting the walls in a lighter color or using bulbs that simulates daylight minimizes the intensity of symptoms and can improve their mental health.
● Exercise, preferably out in the sun: In some moderate SAD cases, consistent exercising can be as effective as medications. It’s even more beneficial being able to get a workout outside in the natural daylight.
Exercising boosts production of certain chemicals like serotonin, endorphins, and other hormones that naturally boosts moods. It can make someone feel energetic throughout the day and improve sleep quality at night.
When it comes to exercise types, pick something continuous and rhythmic requiring the use of multiple limbs, like swimming, weight training, yoga, Pilates, walking, dancing, etc.
Aim to exercise anywhere from 30 to 60 minutes. Being out, even if walking alone or with a dog, provides a “brain break” gives multiple external points to focus on, and interact with, thereby lessening the feeling of isolation.
● Stay connected virtually: For most SAD sufferers, the natural inclination may be to isolate. With the pandemic still thriving among us in full force, many aren’t very enthusiastic about meeting in person, so that kills the motivation to reach out to a friend for a cup of coffee. But the human connection is still a vital medicine to smooth and manage depression. Humans thrive while socializing to any level, but doing it in a safe way can be very helpful on the individual as well.
Utilizing social support networks using tools like FaceTime, Zoom, and Discord are great ways to stay in touch and avoid the negativity Social Media can often bring. Being part of conversations, joking around, laughing, listening to stories, playing games, watching movies together, and sharing daily life will keep the mind engaged and less isolated. Also, expanding social networks from just friends and families to online communities is a possibility while working from home more often. The benefits of support groups on Reddit and other social platforms really strive to bring people with similar passions together and can help.
But What About Lack of Motivation?
Most of the tips mentioned above require some willpower and motivation that many might naturally lack in the middle of a depressive episode. With lower motivation levels, it is difficult to feel like going out in the sun for a walk since home just feels too comfortable and safe. Or, talking to friends or family can feel like a chore when motivation or energy levels are lower.
Mental Health Therapists using a Dialectical Behavior Therapy (DBT) skill called “Opposite Action” can help an individual overcome these “don’t-feel-like-it” moments. The skill essentially requires you to deliberately act precisely the opposite of what your emotions tell you to do at the moment. As with any skill, it takes practice and it is best learned with the help of a licensed therapist.
This skill becomes invaluable in situations where a problem doesn’t warrant emotions or if certain feelings are impeding from acting effectively. This helps recognize that our thoughts aren’t facts and that we don’t have to work on all of our urges. So in the scope of Opposite Action, if going on a walk is not appealing, recognize that thought but choose to act the opposite. Using Opposite Action techniques consistently will help understand that humans aren’t chained to their thoughts and feelings. We acknowledge our ideas — however weak or negative — and choose to rise above it.
This isn’t something that might come easy at first. Which is natural and okay to experience. With continuous implementation and practice, being able to make Opposite Action a go-to coping skill when the mind sets up roadblocks from doing something that’s good and necessary to go forward.
It is always recommended, if noticing symptoms of SAD, it’s best to seek the help of mental health or medical professional. In severe cases, a doctor may prescribe medications. Sometimes getting a physical from a doctor to rule out biological causes or another medical condition like hypothyroidism, hypoglycemia, or other viral infections causing SAD-like symptoms.
A doctor or therapist will be able to provide the most effective plan of action to make SAD a manageable condition and to help fully enjoy the cozy pleasures that winter — just like every other season — brings.
Are you in need of finding some direction or understanding in your life? DigiTherapyOhio provides quality online mental health care for residents of Ohio. Find us at www.digitherapyohio.com
Resources
https://www.psychiatry.org/patients-families/depression/seasonal-affective-disorder
https://www.nimh.nih.gov/health/publications/seasonal-affective-disorder/index.shtml
https://en.m.wikipedia.org/wiki/Circadian_rhythm
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4673349/
https://www.helpguide.org/articles/depression/seasonal-affective-disorder-sad.htm
