The nights are long, many of the days are gray, and the Christmas lights have been packed up and put away. In the Lowcountry and elsewhere, January’s bleakness is where the cold, slow march toward spring begins. The cheer of the holidays is over, the energy of the college football season is behind us, and those moments made for getting outdoors and basking in the Palmetto State sunshine are fewer and further between.
It’s tough on everyone in a part of the world where beaches, boating and golf are fundamental parts of the social fabric. But for others, the depths of winter can bring on an intractable or disabling depression. They’re not just sad the season has changed—they’re suffering from a clinically diagnosable mental disorder that goes by the acronym SAD.
For those impacted by it, seasonal affective disorder comes on every year—usually beginning when days shorten in December, hitting its nadir in January and February, and lifting as the days lengthen again toward spring. It tends to be more prevalent the farther you get from the equator; the rate of SAD at the Lowcountry’s latitude is approximately 3 percent, according to an Ohio State study, compared to 8 percent in upper New York State and 10 in Montana.
But there’s a milder form of the disorder, known as the “winter blues,” that is much more prevalent. And the presence of the Covid-19 pandemic could worsen seasonal affective disorder even in the Lowcountry, given the levels of social separation, isolation and anxiety that many people have been experiencing already.
“If you look at trends and you look at risk factors, I do think all that is going to play into this year. We have basically been having cabin fever since March. And you’re seeing those increased Covid numbers from people who have just gotten fatigued from being isolated at the beginning of the holiday season,” said Ashley Gardner, a licensed professional counselor for the S.C. Department of Mental Health.
“We’re already seeing that that cabin fever is having some really big effects on kids and adults. And any sort of mood disorder or disruption like that will put people at more risk of having some sort of mental illness, anxiety, or something like that. So I do think it’s going to play into how prevalent seasonal affective disorder is this year.”
A confusion of brain chemicals
Much of the academic research into seasonal affective disorder has focused on polar regions, which don’t just see a decrease in sunlight over the winter - some places see none at all. One study from the early 2000s examined Inuit people living in the Canadian Arctic, and found their seasonal mood changes to be more elevated than those from other groups. A later study found winter insomnia to be more prevalent among residents of Tromso, Norway, located 200 miles above the Arctic Circle.
But SAD can be found almost anywhere, even in Florida, where it impacts roughly 1 percent of the population. There’s even a less-prevalent type of seasonal affective disorder that strikes in the spring and summer, when days are longer and sunshine is plentiful. SAD can bring on a depression of its own or stem from an underlying mood disorder, and some of the reasons behind the condition remain undefined.
“We’re not 100 percent sure what causes it, but the leading theories are that the circadian rhythm is off because we have shorter days, and we’re not getting outside as much as we were because it’s cold outside,” said Gardner. He works out of the Charleston-Dorchester Mental Health Center and is a mental health therapist at two West Ashley elementary schools. “So those things to really throw off a number of chemicals in your brain, your hormones, your serotonin levels, and it can cause you to have some depression.”
SAD can feel exactly like typical depression, except that it comes on once a year. “And for most people, it happens year after year,” Gardner said. Symptoms include increased difficulty with sleep, trouble with focus and motivation, isolation, irritability, guilt and anxiety, overwhelming fatigue, and food cravings. Once spring arrives, the condition typically improves.
Those who suffer from some moderate symptoms but do not meet the diagnostic criteria for depression may have a milder form of the disorder known as the “winter blues.” According to Dr. Norman Rosenthal of Georgetown University Medical School, around 14 percent of the U.S. adult population suffers from winter blues. At the Lowcountry’s latitude, that rate is about 10 percent, compared to 17 for upper New York State and 20 percent for Montana.
The winter blues are more treatable than SAD, with symptoms that often go away on their own. For a parallel, Gardner suggests the “baby blues” compared to diagnosable and more serious postpartum depression. And even though the winter blues tend to be mild, Gardner said they shouldn’t be dismissed.
“Anything that’s affecting the mood of a family member is going to have impacts on other family members,” she said. “So even if it doesn’t have a clinical diagnosis like seasonal affective disorder does, that doesn’t mean the winter blues isn’t affecting how someone might be interacting with their kids, or the kids with their siblings and their parents. So it’s still impactful.”
Covid and concern about kids
The age group most likely to be affected by seasonal affective disorder is 18-30, making it a condition that impacts adults primarily. But the presence of the Covid-19 pandemic has made kids more isolated and anxious than ever before—making Gardner concerned that even the students she works with may be more susceptive to the disorder.
“What I see, especially with my daughter, is that she doesn’t remember any season changes being as difficult as the one that you have right now. Kids these days, they have less socialization than they’ve ever had,” Gardner said.
“They’re literally separated from their friends—when they’re in school, they have masks on and they have these little barriers in the classrooms. They’re not socializing at school, or they are in virtual school and they have very little socialization. And so they rely on that hour to two hours after school for the time that they play. And now, all of a sudden, that time is cut short (due to less daylight). I think with those increased stressors that kids are facing right now, it’s going to put that population at a higher risk for, if not seasonal affective disorder, then at least having some sort of impact.”
Gardner isn’t alone in those concerns. Mental health professionals are prepared for SAD to be an even larger problem this winter, given that so many people are already isolated and anxious due to the pandemic. “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,” Dr. Paul Desan, director of psychiatric consultation at Yale New Haven Hospital, told the institution’s website.
Many children’s hospitals in the Northeast and Midwest have issued news bulletins about SAD, listing symptoms for parents to watch out for, such as a lack of self-esteem and low interest in usual activities. But even in the Charleston area, Gardner says many kids feel they’ve been denied certain events or traditions, creating an undercurrent of angst that could be exacerbated by less sunlight and less time to play outside.
“A lot of the kids in my school are telling me they feel robbed right now,” Gardner said. “They feel robbed because they didn’t get to do trick-or-treating the way they used to. They feel robbed because they’re not playing with their friends at recess. They feel robbed because they are not doing the traditions they are used to doing. And when you take that and then you combine it with less time to play outside, less sunlight, I think you’ve kind of got a recipe that we have to be looking at in terms of risk for the winter blues.”
To ward that off, she advises considering changes such as adjusting the times kids usually do homework or chores—make it a little later, so they can take full advantage of what sunlight they have after school. For kids studying virtually, perhaps ensure their desk is in front of a window. On particularly nice days, maybe even consider doing some schoolwork or homework outside.
For others who suffer from seasonal affective disorder, light therapy—the use of lights that mimic outdoor sunshine—often proves effective, in sometimes as little as a few weeks. For more stubborn cases, certain medications and talk therapy may prove helpful, though those alternatives take longer to work. And anyone concerned about suicide can contact the S.C. Department of Mental Health Community Crisis Response and Intervention Team at (833) 364-2274, or the National Suicide Hotline at (800) 273-8255.
Preventatively, Gardner advises good nutrition, exercise, socialization, stress management and play—for adults as well as children.
“Play just means doing something fun for the sake of doing something fun. There’s no extra gain to it,” Gardner said. “It’s really important for kids, because it will help to manage their stress and decrease their risk for the winter blues. And adults don’t do it enough, either. It’s really important for adults to play and for adults to play with their kids. There’s a benefit there.”