As COVID-19 continues to surge and the days grow colder and darker, many are concerned about seasonal depression colliding with a global pandemic. So how can we protect our mental health this winter? Psychologist Scott Bea, MD, discusses how the pandemic might affect seasonal depression this year and how, more than ever, we need to be proactive about protecting our mental health.

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Seasonal Depression During COVID-19: How This Year is Different with Dr. Scott Bea

Podcast Transcript

Cassandra:  Hi there, thanks for joining us. You are listening to the Health Essentials Podcast, brought to you by Cleveland Clinic. My name is Cassandra Holloway, and I'll be your host for this episode. Today, we're broadcasting virtually as we are practicing social distancing guidelines during the coronavirus pandemic. We're joined virtually by psychologists, Dr. Scott Bea. Dr. Bea, thank you for making time to speak with us and welcome to the podcast.

Dr. Scott Bea:  Oh, thanks for having me Cassandra, love being with you guys.

Cassandra:  So if 2020 has given us anything positive, it's the fact that we're starting to openly talk about the importance of taking care of our mental health. So today we'll be talking about what we can expect and what we should know about seasonal affective disorder also referred to as SAD and also called seasonal depression and how this condition is colliding with a global pandemic. We'll discuss why this year is different and what we can all do to protect our mental health. Before we dive into the podcast, we want to remind listeners that this is for informational purposes only, and is not intended to replace your own doctor's advice. Also, please note that this interview was prerecorded and does not reflect any changes to COVID-19 precautions that may have been made after the recording. So, Dr. Bea, I imagine you've been quite busy the past several months dealing with COVID-19 and helping people manage and cope, especially with mental health. So I want to first start off with asking you how you're doing with everything going on.

Dr. Scott Bea:  It's a great question. To start off Cassandra, I would say I'm busy, every behavioral health expert that I know is busy, but it's ordinary busy-ness, there's only one of us typically, and we're happy to help people out. We take them in sequence and we really appreciate the value that people are putting on their mental health and behavioral health services.

Cassandra:  Absolutely. So there's lots to unpack with this episode. So I want to start off with the basics. What is seasonal affective disorder?

Dr. Scott Bea:  Seasonal affective disorder, what we call seasonal depression is a very specific form of depression that begins characteristically at the onset of fall months and really reliably dissipates by the time spring months, roll around. It's a condition that has many characteristics in common with other forms of depression, but some additional ones, real tendency to feel very sleepy, sluggish, low energy, a tendency to crave carbohydrates, gain weight, maybe display some irritability as well.

Cassandra:  Is it more prevalent in a certain age group or demographic?

Dr. Scott Bea:  Indeed, it is. We find that it happens in younger adults more so than older adults. It happens more in females than males. About four times as many women will experience seasonal depression as males. We also know that it occurs much more commonly in individuals in Northern latitudes. That is the further you get away from the equator, the more likely you are to have it. Folks in Florida are a little bit more protected, those in New Hampshire and where we're at in Cleveland a little bit less so.

Cassandra:  Yeah. Unfortunately up here in Cleveland, Ohio, when the sun doesn't shine that much, we're really more prone to it.

Dr. Scott Bea:  Exactly.

Cassandra:  What about, you said some of the symptoms were, feeling tired, feeling sleepy, weight gain, craving those carbohydrates. What other symptoms might people experience?

Dr. Scott Bea:  Some of the common symptoms of depression, they may have a sense of worthlessness, helplessness. They may find it's hard to enjoy things they might more typically enjoy. There can be changes in sleep and appetite. We can find people having suicidal ideas as well. A more severe form of depression will often lead to those sorts of thoughts. So all the common characteristics of depression, a subjective sense of sadness can accompany this as well. And really a feeling like I don't want to do much of anything.

Cassandra:  I think it's really interesting you mentioned that it's really more prevalent in younger people, which as I was doing research for this, I thought it'd be more prevalent in older people. What about children? Obviously people are really struggling in general right now because of the pandemic. Is it typical to see seasonal depression in kids?

Dr. Scott Bea:  You would maybe see it more in older adolescents, a little bit less so in younger adolescents, and it'd be pretty negligible in small children. But nevertheless, in the era that we're in with the pandemic kids are suffering. We know that depression is exploding across the board, almost three times the rate as it might be ordinarily. And it's definitely affecting teenagers as well. Their lives are like the rest of us, very constricted. They're constrained from doing things that they most typically would be doing. And particularly they're missing their friends.

Cassandra:  So why does this actually happen? Why do darker days and colder weather lead to an increase in these depression symptoms?

Dr. Scott Bea:  Well, we have some good hypotheses about that. It's always being researched. We do believe that exposure to light, actually getting light into our eyes and on our retinas makes a difference. If we don't get much of that, if we're having dark days, cloudy days, daylight very short. We think that we may be producing certain chemicals in our brain, particularly melatonin. Some in the audience may know that melatonin is a sleep producer. If we're producing more of that chemical in our brain, we may show that characteristic, kind of hibernation quality of wanting to sleep, wanting to eat, to eat more carbohydrates, to gain weight because of sluggishness. There's also a serotonin hypothesis, that's another chemical in our brain that we think has a responsibility for helping us enjoy more favorable mood states. We think that there may be some suppression of the supply of serotonin in brains as well. Always being researched and I think we'll uncover some more answers across time.

Cassandra:  Especially this year as it collides with a global pandemic for sure.

Dr. Scott Bea:  My goodness. Yeah. What a tough confluence of difficult stressors.

Cassandra:  So let's get into that then. Why is this year different compared to other years? Should we be concerned about more people suffering from seasonal depression this year?

Dr. Scott Bea:  It's hard to know whether we'll see more people experiencing seasonal depression. I think what we will see is that individuals that experience seasonal depression might have an intensification or a worsening of their symptoms this year. There was actually some research going on at the start of the pandemic on seasonal depression in Vermont and individuals enrolled in that study actually showed some worsening of their condition at the start of the pandemic. So I think we could hypothesize that we're going to see a bit of this in individuals prone to that. And as I said before, we're seeing very high rates of depression. It might be that some individuals who are experiencing lower level of that diminished mood in the winter season, what we might call the winter blues, those people could cascade over into a more significant depression. It may be that we see more people experiencing some of those symptoms. So whether it is to the level of an absolute season of oppression, it's hard to tell. I know people are investigating that.

Cassandra:  Do you think that the pandemic will prolong that seasonal depression timeframe? I know you mentioned it starts early fall and goes to about early spring. Do you think maybe it'll go longer into the late spring I guess?

Dr. Scott Bea:  It's hard to absolutely know. I think it will be interesting to watch how people fare this year. It may be different. We may learn a few more things about seasonal depression as a result of that. I think culturally people are worn down. And we talk about COVID fatigue that people have an interest in resuming the life they remember, and this is acting on us all as a culture. So it's hard to know absolutely what the outcome is going to be for people who are experiencing depressions right now. I think once the season lifts many will start to feel a little bit better. I think once we have good answers for the pandemic, a lot of us are going to feel an awful lot better.

Cassandra:  Absolutely. For sure. And I feel like it's just another thing with COVID that we just don't know enough right now. And there's lots of research and healthcare providers are working really hard to help us figure this out, but we just don't know enough right now.

Dr. Scott Bea:  Yeah. There's a lot of mystery. We are uncovering and unfolding a little bit more on the medical side, certainly more on the behavioral health side as well. And I think there will be some positive outgrowths as a result of this era. I think we'll have a better understanding of humans, human beings and how to treat them not only physically, but also emotionally.

Cassandra:  So along this thinking, but on the flip side of this coin, instead of seeing an increase in people with seasonal depression, is there any reason to maybe suggest that the pandemic will actually help some people seasonal depression? With less traffic or less work meetings, or even less holiday parties, where are your thoughts on that?

Dr. Scott Bea:  It's interesting. I was talking to another news agency and the reporter had found two people who are actually feeling that their seasonal depression was better this year. And what they credited was habits that they developed before the season changed. That as part of their adjustment to the pandemic conditions, they started to exercise. They made friends with virtual technologies and meeting with other people and creating social connections in this way. And they credited that habit shift before the change of seasons for being protective. There may be people who also find some relief of tension in the holiday seasons. If I don't have to shop as much, if I'm not as in a forced match through various gatherings, some might find this is a little bit protective. There's maybe some who don't like the holiday season at all, and there'll be spared some of the tougher parts of that for themselves. So I think there'll be a few variations on seasonal depression in those instances. I think those will be exceptions rather than the rule hopper.

Cassandra:  So I think it's interesting talking more about the holidays. This year has been funny because I feel like people have been decorating really early and people are going all out on the decorations and being festive because what else are we supposed to do? Let's look forward to something positive. But I want to get your thoughts on how you think the holidays will play into seasonal depression. Are we setting ourselves up for more post-holiday blues or do you think that people will just be really excited and happy about it? And it's something to look forward to?

Dr. Scott Bea:  Well, I think if we can keep our expectations really modest, there's a much greater chance we'll be delighted. Expectations are the one thing we can adjust. And if we have really reasonable or low expectations, we might be delighted if our expectations are really high, there's a good chance we could be disappointed. I don't think there's any harm in doing things that we know help our brain feel better. So if it's decorating or going the extra mile on some aspects of a holiday meal that we plan, maybe in a really safe environment, there's nothing wrong with that. At the same time, I would not encourage people to expect this year to be like other years, I would be open to change, to seeing this as somehow different, not necessarily in a particularly bad way, just different. And if we can somehow be accepting of that, I think that will be protective of our emotions. And we all have a good interest in protecting ourselves physically and emotionally.

Cassandra:  I love that. Yeah. Making sure you just manage your own expectations. It's easy to be like, "Oh, I can't wait for the holidays, it's going to be so great, it's the best thing that's happened in months." But I think like you said, keeping everything even, and really being realistic about things is great advice.

Dr. Scott Bea:  Yeah. If we can be open to how it unfolds rather than predicting how it should go, I think we're going to be in much better shape.

Cassandra:  So let's talk a little bit about the courses of treatment for seasonal depression. What does that look like?

Dr. Scott Bea:  One of the simplest and pretty effective forms of treatment is light therapy. This is pretty simple, it's not real expensive. Usually a one-time expense to buy a therapy light. This is a very bright light needs to shine at 10,000 locks. They're easily available from online retailers. And it does require that an individual sit with that light shining on them and getting into their eyes for about 30 minutes every day. You have to be pretty faithful and committed to that dosing with it, very few side effects. And we know that it helps approximately 70% of individuals that are diagnosed with seasonal depression, experience, an increase or boost to their mood and diminished symptoms of the condition. Beyond that, many other options, psychotherapy is really effective for people. Common forms of therapy might be things such as cognitive behavioral therapy, where we're really trying to change attitudes and behavioral choices and get people involved in moving their bodies, scheduling activities in blocks of time, committing to those schedules as a way to stay engaged outside of your brain, where some of that misery is happening.

And also medications can be very useful for individuals suffering from seasonal depression, commonly anti-depressant medicines. Something called selective serotonin. We uptake inhibitors, particularly are known to be useful in protecting people. More than anything, behavioral health and mental health practitioners really want to help and we're really excited for people to make use of our services.

Cassandra:  I like how you said earlier, when we were talking about how some people with seasonal depression or who have been prone to seasonal depression might be feeling better this year because of some of the habits that they formed earlier when lockdown and the pandemic first started. You mentioned exercising and moving your body. What are some other healthy habits and those basic wellness tools that we can use in practice?

Dr. Scott Bea:  Social connectedness is certainly one of those things that keeps our mood up. Now, we have some challenges, we're not getting together in big groups or going to big gala events, all that we're restricted from. But I think it's important to make friends with the technology of the day, just like we're doing here. And instead of calling these get together virtual, I would say, this is the real thing. This is really how we connect and programming that into your day. Maybe having a list of people that you want to contact with some routine and maintain that. One of the symptoms of depression is the tendency for withdrawal from social context. So the jolting ourselves to maintain those contexts can be critical. And I mentioned this earlier, this doesn't have a lot of appeal on the surface, but it is a known biological treatment for depression. If we schedule a day's activities in blocks of timing, ideally if we do it a day in advance, we know what we're going to be doing in specific blocks of time, the following day, if we wake up, we can commit ourselves to those activities.

The gift of that is that the mind is not grinding on itself. Depression is a very inward condition where we're singing a pretty unhappy song, reminding ourselves of all the things that are wrong with ourselves, with the world, with the future. And rather than doing that, we can become engaged in the real moments of activity. And when we're doing that, or when we're speaking to another individual, that engagement is liberating. We do not feel that low mood, if you and I are just involved in this conversation, Cassandra, it doesn't feel like either of us are working, we're just conversing. We're a little outside of self-awareness and that's often where people go to feel good.

Cassandra:  Sure. I love that idea of scheduling your days out. So I want to talk more about examples of that. So would you give this advice to patients that you say, you're going to get up at the same time every day, and then maybe you work out from 6:00 to 7:00 and then you work from 8:00 to 2:00 then you take a 20 minute reading break. Is that what you're saying of scheduling hobbies or things out?

Dr. Scott Bea:  Yeah, like I say, it doesn't sound real appealing at the outset, but yes, brains and bodies love rituals, and we're more apt to do things when we can commit to them. So the schedule can help us with commitments. There's something called the rule of opposite action that is often offered as a treatment in depression, which is do the opposite of what you're feeling. So if you feel like staying in bed, get out of bed. Now, if that's on the schedule, you would also schedule things like hygiene and get in the shower and nutrition, then go eat breakfast. And then maybe engage in a work effort for 45 minutes, maybe followed by a 15 minute break to talk to a loved one. And it can be a compassionate schedule, it doesn't have to be a work grind, it can include moving our bodies, good nutrition, socialization, maybe involvement with hobbies, reading, listening to music, all those things.

But when we're in that activity, if we're having intrusive thoughts, if all I'm doing is watching a favorite television show and I have an intrusive thought, "Oh my gosh, what about the dishes?" The dishes aren't on the schedule yet, I'm free to just stay with the thing that's right in front of me. So it liberates me from my own thoughts and the intrusive thoughts that often are part of depression.

Cassandra:  I love that. And it really makes you be in the present moment and be mindful about what's happening right now, or this hour.

Dr. Scott Bea:

That is really the goal, the goal is to keep you engaged in what's really happening. Since again, depression is often coming from our thoughts about things, not the thing itself.

Cassandra:  So you mentioned the therapy lamp and getting those levels of light into our eyes. What about the actual sun? What about taking a walk and just that regulating your wake, sleep cycle. And also, what about vitamin D? I know those two things go hand in hand.

Dr. Scott Bea:  Getting out in the sunlight is great. Anytime you can spend out in the daylight is super, in Cleveland folks that live around here know it's pretty gray, so it's not easy to get light on yourself and particularly on your extremities, but any opportunity to be outside is good, any light getting into our eyes is good. Vitamin D, I mean, in the area we're living in, it's very common that we're a bit depleted in vitamin D. I really think it's smart to get a look at vitamin D levels with your physician. If you're depleted, it's good to supplement that I believe, but we can't look to vitamin D necessarily as a good treatment or cure for seasonal depression necessarily. I think we have to look at some of the other options there.

Cassandra:  I want to switch gears for a minute and talk about OCD and the pandemic. So we know the pandemic has taken a big toll on people's mental health in general, but what about those suffering from OCD? Particularly if they were a little bit of a germaphobe before the pandemic, or maybe they're just really up in their heads, disinfecting, everything like crazy and they can't really be in the present anymore. What advice would you have for people suffering from this contamination OCD?

Dr. Scott Bea:  It's really a difficult time for individuals with that specific condition. It's a large part in my practice. And I'd say even those of us that intervene with individuals with this form of OCD are trying to modify the way we approach it. Not only are they avoiding, they're often not going anywhere and if, and when they do, or when loved ones are going out, they're frightened. They're offering advisements to their loved ones on social distancing and mask wearing and sanitization. And I think this is a time where we're not going to necessarily make a lot of headway at suppressing hand-washing as a behavior, but we might try to limit it. We might try to limit it just to the advice, 20 seconds of hand washing is advisable. And we're really trying to help people to live in those kind of parameters of safety, but not so much so that it's creating tremendous interference or it's preventing ordinary interactions.

It's really a tough time. We can't enact all the things that we would like. It's funny, I've done a podcast on OCD. And when I looked at that and the suggestions we make about exposure and ritual prevention, let's expose you to things that shake up your brain and create anxiety and prevent you from ritualistically getting rid of that, that podcast sounds a little barbaric in the pandemic era right now. So we're modifying those practices a little bit. My heart really goes out to these individuals. There is professional help, you want to modify the symptoms as much as you can to reduce the interference. And once again, living presently, noticing thoughts as just thoughts, being in the real moments that we're living is also a very valuable component of treating folks with OCD at this time.

Cassandra:  Absolutely. And I imagine there's some sort of spectrum when we talk about contamination OCD, people who it's in their life, it's affecting them, all the way up to people not leaving the house. So it's where do you fall? And then the things that we talked about, in preventing it and treating it, what can you control? What can we schedule? What can we take care of?

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