An Expert’s Guide to Fighting Coronavirus Fatigue and Seasonal Depression
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“I work in private practice and I know that I’ve had to extend my hours. I’ve heard that from other people as well. There are a lot of psychology clinics here that have wait times through to next year. They’ve said, ‘We can’t take any more new clients.’”
Dr. Damon Ashworth, Clinical Psychologist
As we approach the one year mark of living in a global pandemic, communities around the world are suffering from what experts are calling “pandemic fatigue”—the feeling of exhaustion of life in the new normal. The endurance and sense of unity that many of us felt months ago at the beginning of the crisis is beginning to dissipate, and in its place is a feeling of restlessness and impatience.
In the fall, Covid-19’s growth reached its “most explosive phase” yet—hitting nine million cases on October 30, then, ten days later, topping 10 million, and after another week, eclipsing 11 million. In response, restrictions have been newly imposed or extended in Utah, Oregon, Rhode Island, North Carolina, North Dakota, Idaho, Nebraska, Illinois, Georgia, and Delaware.
As of the end of 2020, over 300,000 Americans had died, with more than a “9/11 per day” predicted for the coming weeks. With cases spiking across the country, scientists had been predicting a rough winter—and those that struggle with seasonal affective disorder (SAD) face an especially trying season ahead.
SAD, which is recognized in the Diagnostic Manual of Mental Disorders as “Major Depressive Disorder with Seasonal Pattern,” is a type of depression that is related to changes in seasons. Most people with SAD begin to experience symptoms in the fall, which continue through the winter months.
“During the summer, when the weather’s good, they’re usually feeling pretty good and not suffering from too many symptoms, but then in the winter, once things start to get a bit darker, they notice that they feel like they need to sleep a lot more, that they’re feeling sad and maybe hopeless at times, that they’ve started to lose a bit more interest and enjoyment in activities that they normally enjoy. They feel quite tired, a bit fatigued, and find it hard to concentrate,” said Dr. Damon Ashworth, a clinical psychologist based in Melbourne.
He graciously offered his perspective on the collision of seasonal affective disorder and the winter pandemic fatigue.
Meet the Expert: Clinical Psychologist Dr. Damon Ashworth
Dr. Damon Ashworth is a clinical psychologist with over eight years of experience based in Melbourne, Australia. He completed a doctoral degree in Clinical Psychology at Monash University and a Bachelor of Behavioural Sciences and a Bachelor of Psychological Science with Honours at La Trobe University. His doctoral research was a randomized clinical trial that significantly reduced insomnia and depression severity in participants using Cognitive Behavioural Therapy (CBT) for insomnia.
Dr. Ashworth practices mostly from a Cognitive Behavioural Therapy or an Acceptance and Commitment Therapy framework, but also utilizes Existential, Psychodynamic, Interpersonal, Humanistic, and Positive Psychology principles where clients will benefit from such approaches.
Lessons From the Australian Winter & Covid-19 Fatigue
Living in the southern hemisphere, Australians have already experienced life in the pandemic during the winter. The past ten months have taken a toll on the nation’s mental health for a myriad of reasons, including the devastating bushfires and the spread of the coronavirus. The 0.3 percent of Australian adults who experience SAD each year were no doubt hit especially hard, as well.
“I work in private practice and I know that I’ve had to extend my hours. I’ve heard that from other people as well,” Dr. Ashworth said. “There are a lot of psychology clinics here that have wait times through to next year. They’ve said, ‘We can’t take any more new clients until then.’”
Between mid-March and August—the duration of the winter period in Australia—Australians accessed 5,774,696 mental health services funded by Medicare. About 1 million of those occurred in a four week period in August, which was 9.2 percent higher than the same period last year.
In response, Australia’s Government has doubled the number of Medicare-funded psychological services from 10 to 20 through the Better Access Initiative.
“So, they’ve noticed that there is that higher mental health need and they are trying to give support through that, which means more people can access it, but we still don’t have enough psychologists to be able to fill the need at the moment,” Dr. Ashworth said.
The U.S. has also allocated increased spending to mental health services in its congressional stimulus package, which included $425 million for mental-health and substance-use disorders as a result of the pandemic. Similarly, in the U.S., there has been an increase in demand for psychologists, which is likely to be aggravated even further now that we are upon the season in which SAD typically emerges.
With winter around the corner and pandemic fatigue setting in, we asked Dr. Ashworth his tips for staving off depression during our first winter in the new normal. He gave us his top six tips.
Tip #1: Remain Involved in Purposeful Activities
Finding a creative outlet isn’t just a good way to kill time—it’s an anecdote for depression. Research about art and healing has shown that music engagement, visual arts therapy, movement-based creative expression, and expressive writing are all highly beneficial to mental health.
“I do think it’s a great time for creative outlets,” Dr. Ashworth said. “So, some clients have decided to learn a language, others have learned a musical instrument, others have taken up jigsaw puzzling or sewing.”
“Anything that can really help to occupy the time and help you feel like you’re being productive and tick a few things off the to-do list, but also to get that sense of achievement.”
Tip #2: Eat a Healthy, Balanced Diet
Diet plays such a critical role in our mental health that it has a dedicated field of medicine called nutritional psychiatry. Research has shown the link between diet and mental well-being over and over again.
According to Science Direct, “A dietary pattern characterized by a high intake of fruit, vegetables, whole grain, fish, olive oil, low-fat dairy and antioxidants and low intakes of animal foods was apparently associated with a decreased risk of depression. A dietary pattern characterized by a high consumption of red and/or processed meat, refined grains, sweets, high-fat dairy products, butter, potatoes and high-fat gravy, and low intakes of fruits and vegetables is associated with an increased risk of depression.”
So, be sure to stock your fridge with fruits and vegetables and avoid unhealthy delivery options as much as you can.
Tip #3: Engage in Exercise or Physical Activity
We all know that exercise boosts your mood by releasing feel-good endorphins, but how does it affect people with depression, specifically?
“In people who are depressed, neuroscientists have noticed that the hippocampus in the brain—the region that helps regulate mood—is smaller. Exercise supports nerve cell growth in the hippocampus, improving nerve cell connections, which helps relieve depression,” Dr. Michael Craig Miller, assistant professor of psychiatry at Harvard Medical School said in an article from Harvard Health Publishing.
“I have tried to make sure that I’m doing 10,000 steps a day, which means getting out and going for long walks,” Dr. Ashworth said.
If 10,000 steps sound overwhelming, start smaller. Finding the motivation to get moving can be difficult when you are living with depression. Even a ten-minute walk is enough to jumpstart your mood.
Tip #4: Maintain a Sleep Schedule
Depression and sleep are so closely connected that almost all people with depression experience sleep issues. Because depression can be, in part, caused by getting poor sleep, tackling sleep issues is essential.
“Make sure you get enough sleep at night and choose a bedtime and a rise time that doesn’t vary too much from day to day,” Dr. Ashworth said.
Research has shown that having a regular bedtime is equally as important as the length of time a person sleeps; our brains respond positively to routines, which help combat feelings of lethargy during the day.
Establishing a sleep schedule is easier said than done when living with depression, “but the benefits of heading to bed and waking at the same time every day—weekends included—is enormous,” the National Alliance on Mental Illness says.
Tip #5: Use Light Therapy
We know that a lack of sunlight contributes to SAD, which is why getting more light can reverse it. “Bright light works by stimulating cells in the retina that connect to the hypothalamus, a part of the brain that helps control circadian rhythms,” Harvard Health Publishing writes. “Activating the hypothalamus at a certain time every day can restore a normal circadian rhythm and thus banish seasonal symptoms.”
“It is really important if you can to try to increase that exposure to light. So if you can’t get outside, spend time near a window,” Dr. Ashworth said. “Morning light exposure shortly after you awaken helps to bring forward the timing of your melatonin onset the following night. It will help you to feel sleepy earlier, as long as you do not get too much light exposure in the evening and before bed.”
“There are also light therapy boxes that people can buy and these emit bright levels of light so that people can use them indoors. That way, they’re still getting a bit of light exposure, which can offset some of the symptoms.”
These boxes provide 10,000 lux, a measure of light intensity, which is about 100 times brighter than typical indoor lighting. (A sunny day provides 50,000 lux or more.) Sitting close to a light box for 30 minutes a day, usually soon after waking up while you read a book or catch up on your emails, is enough to start seeing positive effects.
You can find light therapy boxes on Amazon for $30 to $40.
Tip #6: Contact a Doctor
“The other bit of advice is if you are really struggling it is really important that you talk to a doctor. We know for depression, a combination of therapy where you talk to a psychologist or a licensed professional or getting antidepressant medication—that combination tends to work best for major depressive disorder.”
Psychology Today provides a free database of mental health professionals to help get your search started.
Dr. Ashworth wrote an in-depth blog post about how to stay mentally healthy during stay-at-home orders and lockdowns. For more ideas on how to stay busy as the winter season approaches, you can check it out here.