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Doctors & Advice, Family Health

Will COVID-19 Make Seasonal Affective Disorder Worse?

BY CARRIE MACMILLAN November 23, 2020

A Yale Medicine expert explains seasonal affective disorder and how COVID-19 may impact it.

As the number of daylight hours drops around this time of year, so, too, do many people’s moods and energy levels. It’s a condition called seasonal affective disorder (SAD), and one that medical experts say could be an even larger problem than usual this year.  

“I’m 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,” says Paul Desan, MD, PhD, director of the Psychiatric Consultation Service at Yale New Haven Hospital.

Sometimes called the winter blues, SAD is a form of recurrent depression that typically starts in late fall or early winter and resolves in the spring or summer. Symptoms include poor mood, low energy, excessive sleepiness during the day, craving carbohydrates, over-eating and gaining weight, and social withdrawal. 

If you get the sensation that you feel different in the winter, it’s not your imagination. We live indoors, where there is less light, and that magnifies the winter signal. Paul Desan, MD, PhD, director of the Psychiatric Consultation Service at Yale New Haven Hospital

SAD is more common in women and in people who live far from the equator. For example, it affects an estimated 1% of people in Florida and 9% of those in Alaska. In the Northeast, most studies suggest that SAD, in its most marked form, affects 3 to 5% of the population, Dr. Desan says, adding that roughly 15% of people are believed to experience a milder form of seasonal changes in mood, energy, sleep, or appetite.

Doctors aren’t sure what causes SAD, but Dr. Desan says that human beings are “seasonal organisms.” Like hibernating bears, he says patients often tell him they tend to eat and sleep more in the winter.

“Appetites can increase and energy gets low. And then patients may have a hard time losing that weight in the summer,” he says. “So, if you get the sensation that you feel different in the winter, it’s not your imagination. And we live indoors, where there is less light, and that magnifies the winter signal.”

Treatment for SAD is available

Light therapy is the frontline treatment for SAD. Light therapy is the use of medical-grade light devices or “boxes” that aim to replace the reduced light of shorter days with bright, artificial light. Appropriate light boxes filter out harmful ultraviolet rays and deliver 10,000 lux (a measure of brightness), which is more than 20 times greater than ordinary indoor lighting.

“Indoor illumination is relatively dim, around 50 to 200 lux. Offices are typically 200 to 400 lux, while outdoor light is thousands of lux,” Dr. Desan explains. “For the many people working from home now, this can be a change. They are in a dimmer space, maybe getting up later, and not getting outside to drive to work.”

Light therapy users should sit in front of their device for 30 minutes every day before 8 a.m., Dr. Desan says. “You don’t need to stare at the light, you can be doing other things like eating your breakfast or reading a book,” he explains.  

For some people, it is enough to go outside and take a walk or work in the yard during the very early morning hours. For those who do not benefit from light therapy, antidepressant medication may be an option.

COVID-19 brings uptick in mental health needs

SAD isn’t the only mental health problem that has Dr. Desan concerned right now.

“We are seeing an obvious increase in the number of people seeking help for anxiety, and that’s not unreasonable. People are anxious about catching COVID-19, among other related issues,” Dr. Desan says. “This is a major mental health event.”

Indeed, in early October, the World Health Organization (WHO) published the results of a survey about the impact of the pandemic on mental, neurological, and substance use services in 130 countries. Most countries, according to the survey, are experiencing at least some disruption to mental health services, particularly community- and prevention-based programs. Roughly 89% of countries report that mental health and psychological support was part of their COVID-19 response strategy, but only 17% have given additional funding to it.

These statistics, experts say, follow increasing evidence that the pandemic is affecting the well-being of people around the world and that it is unclear how that crisis will be handled.

Fortunately, telehealth appointments have helped many patients stay connected to therapists and allowed others to start care, Dr. Desan points out. There are many resources available to people who are struggling. 

In addition to calling your primary care physician or psychologist, if you have one, resources include the Substance Abuse and Mental Health Services Administration Disaster Distress hotline, 1-800-985-5990, or text TalkWithUs; the National Domestic Violence Hotline, 1-800-799-7233 (TTY: 1-800-787-3224); and the National Suicide Prevention Lifeline, 1-800-273-8255, or call 911.

The first step to dealing with a mental health problem is simply identifying it, Dr. Desan says. “This really is a scary year. You are going to feel this generalized dread,” he says. “We need more ways of dealing with stress like this, and not activities like drinking more or people isolating themselves. Many people are finding it helpful to explore healthy ways to help sustain themselves, including exercise, yoga, and spiritual pursuits. And it always helps to stay connected to friends and family, too.”