Late fall and early winter are a busy time in my clinical practice. The combination of cold temperatures and shorter days often bring on feelings of social isolation and despair. My patients are not alone. According to the scientific data, over 66 million people suffer from some form of winter dysphoria and over 6 million experience depressive symptoms so severe they are unable to function in their daily lives. Many of these individuals are suffering from what the psychiatric literature refers to as Seasonal Affective Disorder (SAD).
This season, however, my practice has become busier than usual. With the onset of the pandemic, the increase in depression has become dramatic. It is like Seasonal Affective Disorder on steroids. The people I treat this year are suffering from a syndrome I have coined Pandemic Affective Disorder (PAD).
Symptoms of SAD typically start out mild in the fall and gradually become more severe as the winter approaches. This syndrome is often referred to as the “winter blues” because it is triggered by the lack of day light and the cold weather. Like other forms of depression, people who have SAD can be overwhelmed with feelings of guilt, anxiety and despair. They can feel like the energy in their body has been zapped resulting in sluggishness, poor concentration and little motivation to do activities that they once found to be pleasurable. Due to intrusive negative thoughts, they can easily become agitated. This high degree of irritability can make it hard to fall asleep and stay asleep, resulting in exhaustion and mood swings. One’s appetite is often affected and accompanied by either weight gain or loss. Many people who have SAD suffer from low self-esteem.
There are many explanations for this negative shift in mood. In the colder months, people tend to exercise less, stay in more, socially isolate, drink more alcohol excessively and eat more sugar and carbohydrates. Some of the factors that seem to play a role in the onset of SAD is a change in circadian rhythm. The research suggests the reduction in sunlight disrupts the body’s internal clock and throws off one’s sense of well-being. Not having enough sunlight can also cause of drop in serotonin, a neurotransmitter, that when lowered results in mood changes associated with depression and anxiety. The change in seasons can also disrupt the body’s level of melatonin. Melatonin plays an important role in sleep patterns, affect and energy level. Low or high sugar levels and diminished amounts of vitamin D can all lead to biologically induced mood instability.
As winter approaches, individuals with PAD are suffering from severe social isolation, anxiety associated with political unrest, financial insecurity including unemployment, and fear of getting ill. Some may not be able to go in to work or school. Others are not able to be with family members, an additional hardship around the holidays. Some may not be able to be with an ailing family member or had to experience the death of a loved one remotely.
My patients are not alone in their sense of dread and hopelessness. The American Psychological Association reports that over 80 percent of all Americans say they are experiencing some form of severe stress due to the coronavirus. The Center For Disease Control and Prevention (CDC) indicates that the level of depression amongst Americans since the outbreak of COVID-19 has gone up over 300 percent. During these trying times, being overwhelmed with depression and anxiety is no longer identified as a disorder, but rather, the current order of our everyday lives. Being overwhelmed with depression and anxiety can now be seen as a rational response during these horrific times of the coronavirus and the effects of political unrest.
There are many things people can do to help themselves during these dark and cold days of COVID-19. Try to be outside in the sun as much as possible. Exercise regularly, be it walks, yoga or exercise videos, or indoor exercise equipment. Develop bubbles of friends and family who you feel comfortable with, who have been socially distancing and have tested negative for the virus. Be creative with small outside gatherings, utilizing heat lamps, fire pits or warm blankets.
Use technology to meet with friends and family on a regular basis via video conferencing or phone calls. Avoid over watching negative news on the TV and try to have more family movie nights. Buy a sun lamp and sit under it for a few hours a day. During the day try to sit by a sunny window as much as possible.
Make an appointment with a psychologist and continue to see them on a weekly basis. Most psychologists are offering some form of video conferencing. Possibly talk with your psychiatrist or primary care doctor about taking medications to treat your situational depression and anxiety. Avoid alcohol. While alcohol can temporarily make you feel less anxious and numb, it may intensify feelings of depression and anger. Keep a daily activity journal so you can track of any mood swings, so you can remember the good times when you are feeling down. Perhaps even plan social events in the future so you have something to look forward to. Most importantly, keep things in perspective, for like the seasons, these dark times of the pandemic will pass.
Martin H. Klein, Ph.D. is a Clinical Psychologist in Westport.