by Alexa Peters
Winter blues, low spirits, whatever you want to call it — many Americans become depressed when the winter sets in. This type of mood imbalance, tied intimately to seasonal changes and shorter days, is known in the latest edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as a major depressive disorder with a seasonal pattern, or more commonly as Seasonal Affective Disorder (SAD).
An estimated six percent of the US population struggle with SAD and those affected tend to be concentrated in northern climates, where sunlight is most limited in winter. So, as one of the gloomiest northern-most climates in the United States, it’s not surprising that Seattle is home to many with SAD, whether formally or self-diagnosed.
“In Seattle, we have a lot of people who experience SAD,” says Mackenzi Kingdon, a Seattle-area therapist with her own practice, Restoration Counseling, where she commonly treats patients with depressive disorders like SAD. “It can be really tough for people to live here, especially transplants. They get here, and they’re like, ‘This is way harder than I expected.’”
Unfortunately, this winter could be even harder for those with SAD who deal with symptoms like low mood, low energy, insomnia, and overeating that interfere with their daily lives. These symptoms don’t usually set in until wintertime, but many SAD sufferers are already feeling them this year, thanks to the COVID-19 quarantine and all the other events of 2020 that have forced them to stay inside, withdraw socially, and stew in anxiety about the world.
Dave Pascal, a long-time Seattle resident, says he’s been grappling with SAD symptoms for about a decade, though like many who suffer with seasonal depression he is self-diagnosed. Since the pandemic began, he’s noticed his key SAD symptoms — malaise and low spirits. Then, when the late-summer wildfire smoke made spending time outside untenable, the feelings continued.
“COVID hit right around the time that SAD usually tapers off,” said Pascal. “I guess maybe the depression associated with dark weather may have just kind of segued into the depression associated with social isolation. [And] I have been thinking that the situation with the smoke has led to ‘early onset SAD.’”
Sure enough, Pascal’s assessment of this early onset SAD aligns with what Kingdon is seeing at her practice and with what other formally diagnosed sufferers of SAD in Seattle are saying. Seattle’s Anna Stienle, for instance, has general anxiety disorder with a seasonal pattern, meaning her symptoms — extreme anxiety, lack of appetite, nausea, insomnia, shortness of breath, dizziness, and pounding heartbeat — are markedly worse in the winter months. This year, she noticed her symptoms as early as July.
“I did notice these symptoms during the summer of 2020 more than I ever remember having symptoms in any summer prior,” said Steinle. “[It’s] because so much is unknown in the world right now; the feeling that ‘something is going to go wrong’ has become much more present and…people are acting much differently than normal.”
Likewise, Seattle’s Tiffany Costello, who was recently diagnosed with major depressive disorder in a seasonal pattern as well as general anxiety disorder, says her symptoms are worse due to the quarantine, and they remain worse because she can’t counteract them with “social outlets or live creative performances to watch or partake in.”
And it’s not just Seattleites feeling the winter doldrums early. Minneapolis’ Kari Keller was formally diagnosed with SAD in 1995. This year, she’s feeling ickier earlier and more anxious about the winter than normal, because like Costello, she won’t be able to engage in most of the activities that usually help her SAD.
“Add COVID in and I feel 100 times worse. My symptoms kicked in last month,” she says. “I basically hibernate for the winter. I have a light box. The last few winters I started going to listen to live music five to six nights a week. This winter that will not happen. I’m very scared how I will survive this winter.”
The things Keller usually does to help herself feel better are, in fact, what doctors would prescribe. Many psychiatrists believe that while SAD has a cognitive component, it is also affected by behavior. In fact, in a normal year Brian Noonan, psychiatric nurse practitioner and owner of Ballard Psychiatry, would treat SAD using something called “Behavioral Activation,” a cornerstone of Cognitive Behavioral Therapy (CBT) that involves engaging in activities and behaviors that could result in a positive outcome, like seeing friends or going out to see live music. But with quarantine and other snags in 2020, that treatment method isn’t so accessible.
“The restriction of daylight and of course in Seattle the rain, and now with quarantine lockdowns — essentially [these factors] induce depressive behaviors in us to the extent that we are not engaged with reinforcing activities in the outside world. We’re not socializing, we’re not doing hobbies, we’re not going to the movies, we’re not going to restaurants, or even going to work, and that has some sort of payoff,” says Noonan. “We’re all behaving as a depressed person would behave, in terms of the [social] withdrawal and how small our world has become.”
For that reason, Noonan says being proactive about your depression — and open-minded about different treatments — is more important than ever.
“I say medication first because Seattle is a unique place where many people are really hesitant [about medication]. But more often than not the regret people have is that they didn’t try medication sooner,” says Noonan. “Wellbutrin and Prozac are the two most common medications prescribed for SAD, and of course they’re effective for depression in general.”
Kingdon also recommends that those with SAD and anyone else experiencing mood changes seek out therapy in tandem with medication. Some with SAD also have luck with supplemental vitamin D and light therapy, which involves sitting near a light therapy box that mimics natural daylight and is said to affect brain chemicals.
Lastly, Kingdon says she frequently starts treating those with SAD by reminding clients to be gentle on themselves during this unconventional time and to take advantage of resources like the National Suicide Prevention Hotline if necessary. She also takes care to validate her clients’ concerns about the coming winter.
“Even I’m worried about the winter,” says Kingdon. “Potentially [COVID’s] going to get worse, and we’re heading into it. And I think for most people February especially is really brutal. The holidays are over, it’s freezing, it’s wet. Recognize your limitations, and don’t push yourself. Just get through the day as best you can and prioritize self-care and prioritize your health.”
Alexa Peters is a Seattle-based writer.
Illustration by Vlad Verano