COVID-19 and Seasonal Affective Disorder: How This Year Is Different

Coping With Seasonal Affective Disorder During COVID-19

COVID-19 and Seasonal Affective Disorder: How This Year Is Different

With the end of daylight saving time, daylight arrives earlier in the morning while darkness falls earlier in the day. For many people, this stretch of shortened days, extended nights and colder weather triggers a condition called seasonal affective disorder, or SAD.

Combined with all the uncertainty connected to the state of the economy and the COVID-19 pandemic, seasonal affective disorder season could be more difficult than usual this year.

As such, people with the disorder should take extra proactive steps in their self-care this year, since pandemic conditions may increase the severity of their symptoms.

What Is SAD?

SAD is a depressive disorder caused by the onset of certain seasons. Experts believe shortened days and less daylight set off a chemical change in the brain that leads to symptoms of depression in people with the disorder.

Common symptoms include:

  • Excessive sleep and daytime drowsiness
  • Feelings of sadness, guilt and hopelessness
  • Loss of interest and pleasure in activities normally enjoyed
  • Anxiety and grouchiness
  • Fatigue
  • Difficulty concentrating
  • Increased appetite, especially for sweets and carbs, and associated weight gain

Of the two main types of SAD – fall-onset and spring-onset – fall-onset SAD is much more common. Symptoms of fall-onset SAD, also called winter depression, start in the late fall or early winter months and usually go away during the summer months.

The American Psychiatric Association reports that approximately 5 percent of U.S. adults have SAD, and that the duration of the disorder is usually about 40 percent of the year. SAD affects four times as many women as men.

SAD and the Pandemic

With the ongoing pandemic, stresses and concerns related to continued social distancing/isolation, job loss, economic uncertainty, and our health and the health of our loved ones can affect anyone. As a result, no one is immune to experiencing symptoms of depression, heightened anxiety, and even feelings of hopelessness and despair at this distressing time.

In helping people with SAD, medical experts still stress the importance of using the tried-and-true conventional (and often very effective) treatments for the disorder, namely:

  • Increased exposure to sunlight, including spending time outside or near a window
  • Light therapy, in which a person sits or works near a light therapy box, a device that emits bright levels of light to mimic natural sunlight. This is best done in the mornings for only 20 to 40 minutes, so consult your provider for guidance.
  • Psychotherapy, including cognitive-behavioral and interpersonal therapeutic approaches
  • Antidepressants, at a doctor’s recommendation

In addition, the broader doctor-recommended advice for anyone suffering from symptoms of depression during the pandemic, whether seasonally triggered or otherwise, can help individuals diagnosed with SAD. These suggestions include:

Stay Connected to Other People

Don’t let social distancing stop you from nurturing relationships with friends and family. Phone calls, video chats, social media and even texting can help you feel socially connected and less lonely or isolated.

Focus on the Positive

Distract yourself from negative thoughts by shifting your mental focus, whenever possible, to things that bring meaning and pleasure to your life. For example, try reading that book you keep putting off, enrolling in an online class or taking up a new hobby.

Maintain a Daily Routine

Structuring your days can create a sense of satisfaction and predictability in these unpredictable times. Moreover, as we know that poor sleep quality is a significant contributing factor to depression, maintaining a daily routine can do much to improve poor sleep or maintain good sleep quality.

Get Regular Exercise

Regular exercise positively affects brains chemistry and mood.

If COVID-19 restrictions prevent you from visiting your favorite gym, you can still do weight/resistance training, body weight exercises and yoga at home, as well as walk or run in your neighborhood.

What’s more, outdoor exercise is doubly beneficial for people with SAD due to the sunlight exposure. Remember: We receive beneficial light from the sun even when the sky is overcast. Morning exercise may also help keep your circadian rhythms more balanced.

Eat Healthy

Steer away from “comfort foods” filled with sugar, unhealthy fats, and refined carbs, as those foods, along with excessive amounts of alcohol and caffeine, can adversely affect mood.

Instead, try to eat more fresh, wholesome foods and increase intake of mood-improving nutrients such as omega-3 fatty acids.

Also, consider taking a vitamin D supplement, as reduced exposure to sunlight depletes this vitamin, which plays a role in mood health.

A number of therapies, medications, and behavioral modifications can be used to effectively manage SAD symptoms during the COVID-19 pandemic. Also, keep in mind that the symptoms of other mental health conditions may be nearly identical to those of SAD. Always visit a health care provider for a proper diagnosis.

University Hospitals offer comprehensive evaluation, diagnosis and inpatient and outpatient treatment of psychiatric illness for adults, adolescents, children and older adults through programs that apply the most advanced diagnostic and therapeutic techniques available. Learn more about psychiatry and psychology services at University Hospitals.


Seasonal Affective Disorder

COVID-19 and Seasonal Affective Disorder: How This Year Is Different

SAD is a condition where a person experiences mood changes or depression when the season changes.

For example, some people may feel “down” as the days become shorter in autumn and begin to feel better at the start of spring when daylight hours are longer.

In some cases, these seasonal mood changes can become more serious and negatively impact how a person feels, thinks and handles daily activities.

Erik Nelson, MD, UC Health psychiatrist at the University of Cincinnati Gardner Neuroscience Institute’s Mood Disorders Center and associate professor of psychiatry at the UC College of Medicine, is an expertin SAD, and provides answers to the most common questions focused on SAD and how COVID-19 fatigue might also affect those who have this type of depression. 

What is seasonal affective disorder (SAD)?

Less sunlight and shorter days are thought to be linked to a chemical change in the brain and may be part of the cause of SAD. Melatonin, a sleep-related hormone, also has been linked to SAD. The body naturally makes more melatonin when it's dark. When the days are shorter and darker, more melatonin is made.

Seasonal affective disorder is typically defined as experiencing a seasonal pattern to the onset of major depression.

The most common variant includes depression with a fall to winter onset, though it is possible for sufferers from SAD to experience recurrent depression in the spring and summer months instead.

 ​Many patients who have depressive episodes that don't strictly follow a seasonal pattern report worsening of their symptoms in the fall and/or winter months.

What are the signs and symptoms of SAD?

SAD includes the same signs and symptoms that we associate with major depression in general—the defining characteristic that separates SAD from other forms of major depression is the seasonal pattern of recurrence.

Therefore, people who have SAD will typically experience a combination of low mood, lack of ability to take joy from their usual activities, low energy, sleep and appetite changes, a decrease in sexual drive, low self-esteem and even thoughts of death.

Increased fatigue, sleep and appetite/weight gain are especially common symptoms in patients with winter depression.

How does SAD impact a person’s outlook and well-being?

During the fall and winter months, or more rarely spring and summer, patients with SAD will often have a “dark” outlook and experience a general loss of their sense of well-being.

Even if they are not experiencing a full major depressive episode, patients may struggle with “winter blues.

” Decreased interest and a diminished sense of pleasure from things a person usually enjoys are very common symptoms of depression due to SAD as well. 

Who is at risk for SAD?

SAD usually starts during adulthood. The risk of SAD increases with age. It is rare in people under age 20. Women are affected more often than men.

How long does SAD typically last?

SAD is not considered a separate disorder but is a type of depression characterized by its recurrent seasonal pattern, with symptoms often lasting up to four to five months per year.

How would you describe the symptoms of someone experiencing COVID-19 fatigue?

COVID-19 can present in a variety of ways, and symptoms can include profound fatigue. However, even outside of those actually infected by COVID, many people are describing a significant emotional impact from anxiety around COVID, for themselves or loved ones—as well as from the many restrictions necessitated by the pandemic.

How can those who have SAD be further impacted by fatigue from dealing with the COVID-19 pandemic?

Episodes of depression are often precipitated by external stressors, which disturb our emotional equilibrium. The consequences of COVID-19 and anxiety around the pandemic can serve as a major stressor for vulnerable individuals.

Deeper into the winter, individuals who already have a propensity to mood disorders this time of year are at even greater risk of experiencing fatigue and other symptoms of depression.

 ​Given that fatigue is common in depression, and especially winter depression, people with SAD may be more severely affected by COVID-19-related fatigue.

Treating the preexisting SAD using evidence-based strategies such as bright light therapy, psychotherapy, nutritional interventions and certain antidepressant medications may help reduce the «double whammy» of COVID-19 fatigue combined with symptoms of SAD.

What treatment is available for SAD?

SAD is treated other forms of depression, but may be especially responsive to light therapy. This treatment uses a special type of light source called a lightbox, which is much brighter than a typical lamp or light fixture found within the home, and which is the type of light that has been determined to most ly improve SAD.

Light therapy is easy and safe with few side effects. Those who have eye problems or who take medications that cause sensitivity to light should not use light therapy without first consulting a doctor. Individuals with bipolar depression should also speak with their provider before using a lightbox.

Light therapy is usually started in the fall and continued through spring. It is usually prescribed for 30 minutes to two hours per day, depending on the intensity of the light used and individual response. Individuals who are just starting light therapy should begin using their lightbox for no more than 15 minutes and gradually increase their exposure.

The most common side effects of light therapy include headache, eye strain and nausea.

You may feel tired during the first week of therapy due to changes in sleep-wake patterns, however, this typically goes away in a week or so.

 Patients with bipolar disorder who are considering using light therapy for winter depression may experience a breakthrough of manic symptoms and should therefore consult with their physician before beginning treatment.

Can SAD treatments also help with overcoming COVID-19 fatigue?

COVID-19-related factors can precipitate and exacerbate depression, while depression may make navigating the current COVID-19 environment even more difficult. Aggressively treating symptoms of depression through a range of approaches can help to mitigate the effects of COVID-19 and to maintain our general sense of well-being.

Discover More

UC Health Psychiatry, in conjunction with the UC College of Medicine Department of Psychiatry, is conducting a clinical trial for people who are not responding adequately to an antidepressant treatment. Those who have an interest in participating in this trial should call 513-558-4997 or click here for information. 


What causes SAD?

Less sunlight and shorter days are thought to be linked to a chemical change in the brain and may be part of the cause of SAD.

Melatonin, a sleep-related hormone, also has been linked to SAD. The body naturally makes more melatonin when it's dark. So, when the days are shorter and darker, more melatonin is made.

There are two types of SAD:

  1. Fall-onset.This is also called «winter depression.» Symptoms of depression begin in the late fall to early winter months and ease during the summer months.

  2. Spring-onset.This is also called «summer depression.» Symptoms of depression begin in late spring to early summer. This type is much less common.

The following are the most common symptoms of SAD:

  • Increased sleep and daytime drowsiness

  • Loss of interest and pleasure in activities formerly enjoyed

  • Social withdrawal and increased sensitivity to rejection

  • Irritability and anxiety

  • Feelings of guilt and hopelessness

  • Fatigue, or low energy level

  • Decreased sex drive

  • Decreased ability to focus or concentrate

  • Trouble thinking clearly

  • Increased appetite, especially for sweets and carbohydrates

  • Weight gain

  • Physical problems, such as headaches

Symptoms tend to come back and then improve at about the same times every year.

The symptoms of SAD may look other mental health conditions. Always see a healthcare provider for a diagnosis.

How is SAD diagnosed?

Depression often happens with other conditions, such as heart disease or cancer. It may also happen with other mood disorders, such as substance abuse or anxiety. For these reasons, early diagnosis and treatment is key to recovery.

A diagnosis of SAD may be made after a careful mental health exam and medical history done by a psychiatrist or other mental health professional.

How is SAD treated?

The treatments for «winter depression» and «summer depression» often differ, and may include any, or a combination, of the following:

  • Exposure to sunlight. Spending time outside or near a window can help relieve symptoms.

  • Light therapy. If increasing sunlight is not possible, exposure to a special light for a specific amount of time each day may help.

  • Psychotherapy. Cognitive-behavioral or interpersonal therapy helps change the distorted views you may have of yourself and the environment around you. It can help you improve interpersonal relationship skills, and identifying things that cause you stress as well as how to manage them.

  • Antidepressants. These prescription medicines can help correct the chemical imbalance that may lead to SAD.

There are also things you can do for yourself to help relieve symptoms:

  • Get help. If you think you may be depressed, see a healthcare provider as soon as possible.

  • Set realistic goals in light of the depression. Don't take on too much. Break large tasks into small ones, set priorities, and do what you can as you can.

  • Try to be with other people and confide in someone. It is usually better than being alone and secretive.

  • Do things that make you feel better. Going to a movie, gardening, or taking part in religious, social, or other activities may help. Doing something nice for someone else can also help you feel better.

  • Get regular exercise.

  • Expect your mood to get better slowly, not right away. Feeling better takes time.

  • Eat healthy, well-balanced meals.

  • Stay away from alcohol and drugs. These can make depression worse.

  • Delay big decisions until the depression has lifted. Before deciding to make a significant transition—change jobs, get married or divorced—discuss it with others who know you well and have a more objective view of your situation.

  • Remember: People rarely «snap » a depression. But they can feel a little better day-by-day.

  • Try to be patient and focus on the positives. This may help replace the negative thinking that is part of the depression. The negative thoughts will disappear as your depression responds to treatment.

  • Let your family and friends help you.

Key points about SAD

  • SAD is a type of depression that happens during a certain season of the year—most often fall and winter.

  • There is no clear cause of SAD. Less sunlight and shorter days are thought to be linked to a chemical change in the brain and may be part of the cause of seasonal affective disorder (SAD). Melatonin, a sleep-related hormone, also may be linked to SAD.

  • In general, nearly everyone with depression has ongoing feelings of sadness, and may feel helpless, hopeless, and irritable.

  • SAD may be diagnosed after a careful mental health exam and medical history done by a psychiatrist or other mental health professional.

  • Depression is most often treated with light therapy, therapy, and in some cases antidepressants.


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