Seasonal Affective Disorder (SAD): How has COVID-19 made SAD worse?

Illustrated by Jennifer Broza

The sky turns pitch black as snow falls on the cold, hard ground. You crave the warm blanket of sleep and cannot bring yourself to leave your bed to interact with others around you. Like a hibernating animal, all you wish to do is eat, sleep and repeat. For some, this is a feeling that spans long months every winter called Seasonal Affective Disorder. 

Seasonal Affective Disorder, also known as SAD, is a type of depression characterized by symptoms similar to other depressive disorders. These symptoms often begin in the late fall and disappear in the spring. This type of SAD is called winter-pattern SAD and symptoms can last around four to five months each year [6]. The symptoms of general depression include: losing interest in activities you once enjoyed, experiencing changes in appetite or weight, having trouble sleeping, feeling fatigued, hopeless or worthless, having low energy and having thoughts of death or suicide [6]. For winter-pattern SAD in particular, more specific symptoms include oversleeping, overeating—especially with a craving for carbohydrates—weight gain and social withdrawal [6]. Diagnosis for SAD involves having symptoms of major depression or winter-pattern SAD during the specific seasons for at least two years in a row, and these depressive episodes must occur more often than other general depressive episodes that a person has had during other times of the year [6].

As expected, SAD is more common in places farther north, where days are shorter and nights are longer during winter seasons. SAD is more common in women than it is in men and is more often diagnosed in those with major depressive disorder or bipolar disorder [6]. Further, people who have SAD also tend to experience symptoms of other mental disorders like ADHD, eating disorders, anxiety disorders and panic disorders [6].

The causes of SAD are still not fully known, but research has shown that those with SAD potentially have inhibited serotonin activity, which is a neurotransmitter that is involved in regulating mood [6]. Also, research has found that sunlight may have a role in maintaining molecules that control serotonin levels, the regulation of which does not work properly in those with SAD [6]. Other research suggests that SAD-affected individuals over-produce melatonin, which is instrumental in regulating the sleep-wake cycle [6]. Since people with SAD have disrupted serotonin and melatonin levels, their normal daily rhythms are also disrupted and dysregulated. Therefore, those with SAD are not able to adjust their daily rhythms to adapt to seasonal changes, which leads to changes in sleep, mood and behavior [6].

Additionally, a lack of vitamin D, which is normally produced when skin is exposed to sunlight, can further exacerbate these issues because vitamin D is known to promote serotonin activity [6]. In the winter, as days become shorter, the amount of time people can be exposed to sunlight decreases, which plays a role in the manifestation of winter-pattern SAD. 

As one might expect, in the era of COVID-19, an abundance of uncertainty and anxiety combined with the winter season compound into a manifestation of winter-pattern SAD that is more severe than ever before witnessed. The main causes of SAD—disrupted serotonin and melatonin levels, as well as the lack of vitamin D—are all worsened with the effects of a pandemic. As restrictions are put into place forcing people into their homes and away from the sunlight and other social interaction, the effects of SAD are likely to become magnified. 

In an article titled “Will COVID-19 Make Seasonal Affective Disorder Worse?”, Paul Desan, MD, PhD, director of the Psychiatric Consultation Service at Yale New Haven Hospital, explains how he is “… quite worried about how this winter will be for people who experience SAD. Most are already nervous about COVID-19. They will be indoors, and they won’t be exposed to the same amount of bright light” [3]. According to Dr. Desan, the COVID-19 pandemic, in general, is a “major mental health event,” and many are attempting to find help to cope with anxiety and stress [3].

In the article, “COVID-19 and Seasonal Affective Disorder: How This Year Is Different,” by Sara Lindberg, methods to treat and manage SAD during the pandemic include engaging in social activities virtually or in a socially distant manner, self care through healthy eating and getting regular exercise, partaking in teletherapy and psychotherapy and maximizing light intake through light therapy [2]. Light therapy, or phototherapy, is essentially exposing skin to artificial sunlight. Leela R. Magavi, MD, an adolescent and child psychiatrist and regional medical director for Community Psychiatry, suggests sitting by a 10,000 lux light box for at least 30 minutes to help alleviate the negative symptoms of SAD [2]. 

A study titled “Effects of bright light on sleepiness, melatonin, and 25-hydroxyvitamin D(3) in winter seasonal affective disorder” by Partonen, Vakkuri, Lamberg-Allardt and Lonnqvist in 1996 showed that one hour of light therapy reduced depressive symptoms significantly for the 16 out of a group of 29 patients who had SAD [5]. Another study looked at the effect vitamin D supplements had on patients with SAD. Researchers Gloth, Alam and Hollis found that depression was significantly decreased in subjects who had received vitamin D compared to those who underwent phototherapy treatment [1].

The pandemic has undoubtedly increased the amount of stress and anxiety that everyone is experiencing right now, and for those with SAD, this has only snowballed along with the shorter days and longer nights to make for an even more stressful and depressing winter. Desan says, “This really is a scary year. You are going to feel this generalized dread,” which is a feeling that many of us can relate to [3]. To deal with this stress, it is important to turn to healthy coping mechanisms, like exercise, eating well, mindfulness and maintaining relationships with friends and family. While life isn’t going back to the way it was before COVID-19 any time soon, there is light at the end of the tunnel—vaccinations have begun rolling out across the country and days are slowly but surely growing longer, as the cold, dark winter comes to a close. 

*If you have thoughts of death or suicide, you’re not alone. Help is available 24/7. Call the National Suicide Prevention Hotline at 800.273.8255 to speak to a professional. If you’re experiencing an emergency, call 911 [4].

Edited by: Nick Rogers
Illustrated by: Jennifer Broza

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