The fall brings colder, darker evenings that can signal the start of "seasonal depression" on top of the challenges already presented by the COVID-19 pandemic, but there are ways to combat it, a National Park Medical Center psychiatrist says.
"The signs and symptoms of depression often develop gradually and may be difficult to notice at first," Dr. Peter Guresky said in an email to The Sentinel-Record. "In general, depression is characterized by sadness and a sense of hopelessness.
"Typically there is a loss of interest in work, family, or hobbies. A marked reduction in pleasure or satisfaction goes with the loss of interest. Disturbances in mood (anger, irritability, anxiety), or sleep are often present. Excessive fatigue or social withdrawal is common."
Seasonal depression, seasonal affective disorder or winter depression -- all synonymous -- are common and occur almost exclusively in the winter, with about 3 million U.S. cases annually, he said.
"The exact cause of SD is uncertain," Guresky said. "The general belief is that it is caused by a disturbance in circadian rhythms associated with reduced sunlight. Circadian rhythms are your biological clock.
"CRs tell your body when to get up and when to go to sleep. CRs are regulated by brain chemicals that are influenced by sunlight. Sunlight is diminished in winter. Those prone to SD are at higher risk in winter. Indeed, the incidence of SD increases as you move north and it is correlated with the reduced sunlight."
So, what is the solution for those prone to seasonal depression?
"Unfortunately, that is not practicable advice for most of us. Most patients just endure a mild dysthymia through winter, while others take an antidepressant medication. Most sufferers of SD benefit from artificial light exposure that "tricks" the brain into thinking the day is longer than it really is," he said.
"Light exposure is a relatively inexpensive and drug-free treatment, but it's important to be cautious. The light must have the proper wavelength to work. Ordinary light fixtures do not contain the right wavelength so you will have to purchase the proper bulb."
Although SD is a common illness many people experience every year as the weather and time changes, Guresky said he would expect more people to be susceptible to it this year with the pandemic thrown into the mix.
"Depression results from a combination of genetic susceptibility and environmental stressors," he said. "COVID-19 has fundamentally changed human intercourse and our normal social structure in 2020. Children cannot play together, friends cannot embrace, many businesses are digital, and millions have lost their jobs across the country.
"Changes like these can play a role for some people in causing depression-like symptoms. That's why it's important to always talk to your provider if you have questions or concerns."
For someone concerned they may be experiencing, or susceptible to experiencing, SD, Guresky said the two strongest bits of advice he can give are to "know thyself," and take "all things in moderation."
"If you know yourself, you should know when things are 'not right,'" he said. "The signs and symptoms of depression are mentioned above. Abraham Lincoln said, 'People are just about as happy as they choose to be.' Choose happy.
"As the stoic philosopher Epictetus advised, the first task in life is to divide everything into two categories: Things I can control, and things I cannot control.
"The second task is to focus ourselves exclusively on those things in our control and consciously dismiss things that are not. This is easier said than done, but if you do this daily it gets easier. And it's worth repeating anytime you have questions or concerns, it's important to talk with a medical provider that you know and trust."
Guresky said if the things previously mentioned do not work, keep doing them anyway because you will get better at them.
"Do not smoke," he said. "Do not take illicit drugs, do not drink to excess. Exercise. You do not have to run marathons, even a 30-minute walk three times a week will boost your mood. There is something protective about exercise. It works ... try it.
"Most depression improves with the above attitude changes and actions. If yours does not, see your doctor. An underactive thyroid, pancreatic cancer and other medical conditions often presents as depression," he said.
"If your doctor believes there is no underlying medical issue, then and only then should an antidepressant medication be prescribed. All too often medications are used as a first response.
"If a medication from your primary care doctor does not help, then consider seeing a psychiatrist. There are things the psychiatrist can do to treat treatment resistant depression," he said.