Letters to the Editor • Opinion
The coronavirus might not be the worst of it
The Washington PostDemocracy Dies in Darkness

Pandemic depression is about to collide with seasonal depression. Make a plan, experts say.


Lindsey Hornickel, a 25-year-old in Louisville, felt fine at the beginning of the pandemic. Although she has long experienced depression, Hornickel says, her mental state didn’t worsen immediately. In fact, she began overcompensating, taking on more work and pushing worries out of her mind.

“I kept saying, ‘It’s fine, it’s fine,’ ” she says. Until, suddenly, it wasn’t. Over the summer, Hornickel’s mental health nosedived.

“I went through a depressive swing. It was unbearable,” she says. Eventually, Hornickel told her roommate she wanted to die.

Since then, Hornickel has been in a partial hospitalization program to treat suicidal ideation, depression and bipolar disorder, and she recognizes that her initial reaction to quarantine was a manic episode. Although she’s doing a lot better, there’s a nagging worry: wintertime.

“For me, personally, the nighttime is really hard,” Hornickel says. “And when there’s not sunlight and sunshine and things to do — at that time in the winter — it definitely compounds those feelings.”

[The pandemic proves we all should know ‘psychological first aid.’ Here are the basics.]

Hornickel is describing seasonal depression, known as seasonal affective disorder, or SAD. It’s a type of depression that occurs when it gets colder, there’s less light and it’s more difficult to get outside. Mental health experts worry that, because the pandemic has already triggered depressive symptoms in many Americans, more people will experience seasonal depressive symptoms this winter. 

Reporter Nicole Ellis speaks with a mental health expert about ways to cope with anxiety, stress and adjusting to how covid-19 is changing our lives. (Video: The Washington Post)

A survey study published in the the JAMA Network Open in September found that U.S. adults were reporting levels of depressive symptoms more than three times higher during the pandemic than before it. A survey conducted by the Centers for Disease Control and Prevention in June yielded similar results, with more U.S. adults reporting adverse mental health symptoms, particularly in young adults, racial and ethnic minorities and essential workers. (On the flip side, a survey done of U.S. teens from May to July found that teens actually fared well when it came to depression and loneliness.)

The American Psychological Association has seen a sharp increase in suicidal ideation, particularly among young adults, during the pandemic, according to Vaile Wright, senior director of health-care innovation. “I think that’s, in large part, due to the level of uncertainty around covid,” she says. While most disasters have a beginning, middle and end, she adds, the pandemic has continued — with no end in sight. 

Summer offered a bit of a respite. As evidence mounted that socializing outdoors is safer, “I think people really relied on their ability to take advantage of the nice weather,” Wright says. But the coming winter months will probably complicate how people are experiencing depression, whether they also suffer from SAD or not, experts say.

The National Suicide Prevention Hotline is 800-273-8255

Although only a small percentage of people typically report seasonal depression (most estimates put it at 6 percent of the U.S. population for severe symptoms and 14 percent for mild symptoms), Wright says she wouldn’t be surprised if there’s another increase in depressive symptoms among the population in general as the cold weather compounds social isolation.

Lisa Carlson, president of the American Public Health Association, agrees. According to Carlson, seasonal depression is more common in people who have a history of depression. “It may be the people who are at risk of seasonal affective disorder may be the same people for whom covid has already triggered depression,” she says. “So, we may have a lot of overlap in those people.” Carlson also says seasonal depression and clinical depression exhibit similar symptoms, including social withdrawal and weight gain, which may make it hard for sufferers to distinguish between the two.

[Sign up for What Day Is It?, a 7-day newsletter about recovering time and mental health during the pandemic]

Regardless, providers agree: Now is the time for people who fear that they may experience symptoms of depression or that their depression may worsen during winter months to make a plan. And it’s an especially crucial time, because research has found that the transition from daylight saving time to standard time, or shifting the clocks backward, which happens Nov. 1, has been associated with a rise in depressive episodes.

Here are some tips from both providers and people who have experienced depression and seasonal depression.

Line up things that help: Joshua
Gordon, director of the National Institute of Mental Health, advises: “If you know today is okay, but winter may be harder, lay the groundwork.” Gordon says this can include ensuring you have a steady supply of medication in case it becomes harder to get out, having a therapist lined up and scheduling weekly calls with loved ones. If exercise helps, make a plan to work out safely indoors during wintertime; Mark Riechers, a 34-year-old radio producer with an affinity for cycling, says that can provide structure and normalcy. 

Know your triggers: Be aware of what might trigger a depressive episode. Hornickel says recognizing her triggers helps her know when it’s time to seek more help; for her, that’s when she takes less care of her personal hygiene, including not brushing her teeth.

She recommends writing down in advance the warning signs of when depression may be deepening — for example, when you stop taking care of yourself or your home.

Get a light box or SAD lamp: These are lamps specifically created to mimic outdoor light. Ken Duckworth, chief medical officer of the National Alliance on Mental Illness, says people with SAD should use one for a couple of hours in the morning during the winter. Wright agrees, but says if you can’t get your hands on a lamp, plan your day around maximizing sunlight: running errands during daylight hours or spending 10 minutes drinking coffee by the window. Emily Pfenning, a 26-year-old in Portland, Ore., who has experienced both clinical and seasonal depression, uses one frequently, both because she lives in an area with less sunlight and because she is fearful of going outside because of a lack of mask-wearing in her area.

Figure out ways to stay connected: Wright says the instinct of some people with depressive symptoms may be to isolate, but she advises fighting against the urge, especially now, when isolating is easier to do. “Even during the darkest months, we know that human connection is really critical to managing our anxiety and depression,” she says. So, it may be time to get back to using Zoom or other remote ways to connect with people — popular at the start of the pandemic, but abandoned by some when fatigue set in

Taking care of yourself during the pandemic, from head to toe

And try to broaden your support network beyond your loved ones. “Reach out to the people around you, find your online communities, just to know that you’re not alone,” Pfenning says.

Gordon says talking to someone else about your feelings can also help you gauge whether you’re just feeling off or whether there’s something more serious going on. “For people who are thinking of harming themselves, talking to someone really helps,” he says. 

Take advantage of online therapy: Barb Foy, a 58-year-old retired social worker and mental health activist in Northern California, sees a therapist twice a month to treat her clinical depression, but to do so safely, they speak over FaceTime. It’s one of the tools she’s using to prepare for the winter months and to stay out of what she describes as a black hole.

Telehealth, or virtual health care, is revolutionizing mental health care and making it more accessible, Carlson says. It can also make therapy a little less daunting for new patients, because it can be accessed directly from home.

Preparing coping mechanisms such as this will do more than help mitigate depression; it will make people more prepared to handle new crises, Gordon says. “While the pandemic is a challenge to all of us,” he says, “it’s also an opportunity to build resilience.”  

Chelsea Cirruzzo is a health policy and local news reporter based in the District.