By Lori Gottlieb
How can you tell the difference between SAD (seasonal affective disorder) and depression?
SAD generally occurs during the winter months, when people don’t get enough sunlight exposure. We need sunlight because it provides vitamin D, and that absorption helps regulate our moods. Rates of SAD often depend on where people live. In California there might not be as many cases as there are in Seattle. There are those who experience SAD year-round.
Clinical depression is not affected by the seasons. SAD can trigger clinical depression, but people who suffer from clinical depression can have that any time of the year. In the winter a lot of people experience clinical depression, but there are many people with clinical depression who experience it year-round.
Many people end up with low vitamin D levels in the winter because they aren’t getting as much sunlight. Especially during the Covid-19 pandemic, people aren’t even getting that little bit of outdoor time they might have when traveling from home to work. It’s important to check in with your doctor. You might want to get your vitamin D levels checked and ask your doctor what vitamin D dosage will be best for you.
What are the signs that you should look for in yourself to know if you should seek help either for SAD or for clinical depression?
If you’re feeling tired more of the time, you have less energy, or if you’re not getting pleasure in the things that you normally love, whether it’s spending time with your family, or doing a hobby. Other signs of potential depression include trouble focusing or concentrating or feeling “foggy”. Disturbances in sleep – sleeping too much, or not enough, waking up in the middle of the night etc. are signs of depression. Changes in appetite – eating too much or no appetite and not being hungry at all are another sign of depression.
If you’re feeling any of these things, talk to your doctor. Often, people feel like they need to hit a certain threshold before they make that call. What I want people to know is that if something feels off to you, no matter how much or how little, now’s the time to make the call. You don’t have to wait until things feel really bad.
Because of the Covid-19 pandemic, we are being discouraged from doing thins that might help combat SAD, like walking to work, or spending time with friends. How would you suggest people cope with SAD when we now don’t have these tools at our disposal?
It’s really important for people to get creative when it comes to self-care. If you can take a few minutes and walk outside and get some fresh air during the day, that’s great, but even sitting by a window will help a lot. I know that sounds simple, but it is very effective.
Sit by an open window during the day whenever there’s daylight. With so many people working from home or staying indoors, it’s easy to forget when it’s light out or dark out or when it’s a weekday or the weekend. It’s really important to make those distinctions. Make sure that you structure a schedule for yourself. Try to go to bed around the same time every night so that you have good sleep hygiene. Try to wake up around the same time every day and open the shades when you wake up. Put new clothes on in the morning, even if it’s sweatpants. It’s important to get out of what you slept in. If you can work in a different room than you sleep in, that can be very helpful. And then at night, when you get in bed, there’s this neurological understanding that now it’s bedtime, and my body’s going to be tired, and I’m going to go to sleep.
In terms of the connection piece, make a virtual walking date with a friend. Go take a walk during the lightest time of the day and ask your friend to go take a walk wherever he or she is, and talk on the phone. You’re outdoors, you’ve changed your environment, and even it it’s cloudy or cold, you’re still getting outside. You’re moving your body, which is really good for endorphins, you’re getting a little bit of sunlight, ad you’re connecting with someone, so you’re checking off three things at once.
With so much uncertainty in the world right now, many of us wake up in the morning already feeling depressed or anxious. Do you have any tips on how to start out your day on the right foot?
Make your bed in the morning. I know it sounds kind of silly, because who cares right? But by making your bed, you’re making that distinction that you are up for the day. Having a nice physical environment can really lift your mood.
After waking up the first thing that many of us do is look at our phones. If you can take five minutes before you look at your phone and write down one thing that you are grateful for, that can make a world of difference in your day. It can be the smallest thing: “I’m grateful I can have orange juice for breakfast.” Or “I’m really grateful for my son’s smile.” Even if it’s something minor, if you think of your mood like a scale, it just sets you in the “plus zone” for the day.
Most people wake up immediately they go to negative five, because they look at the news, or see how many emails they have. Instead, try to start your day in positive territory, by letting yourself focus on gratitude. Then as things happen during the day, like work piles up, or family issues arise, your mood might go down a little bit, but hopefully you won’t go below zero.
You are far from alone in feeling alone. Here are some ideas to help.
adapted from an article By Julie Halpert·
Shelter-in-place orders have hit those who live alone particularly hard.
When the coronavirus hit it brought feelings of isolation into sharp focus, especially for those of us who live alone.
The moments that are most difficult are when I think about not knowing when I’ll be able to touch another human being again. I had a new granddaughter born at the end of March, and even though she is only 20 minutes away, it feels like she is on the other side of the world. As someone with no partner, I sometimes feel profoundly lonely. I wonder if I fell, how long would it take for someone to find me?
Julianne Holt-Lunstad, a professor of psychology and neuroscience at Brigham Young University who has studied loneliness extensively, says social connection is something we biologically crave. “We’re social beings and our bodies respond when we lack the proximity to others,” she said. So, the new normal prompted by Covid-19 “is a difficult kind of situation where we need to try to still remain socially connected while being physically distant,” she said.
Dr. Holt-Lunstad has found that loneliness can lead to serious consequences. One of her studies found that lacking any social connection may be comparable to smoking up to 15 cigarettes per day as a risk factor for mortality. Another study found that loneliness increases the risk of an earlier death by 26 percent. She also found that social isolation, loneliness and living alone exceed the risks of death associated with obesity, physical activity and air pollution.
Susan Pinker, a psychologist and author of “The Village Effect,” said that loneliness is a subjective feeling of being alone against your will. She said that you can be alone and not be lonely or you can be lonely even if you’re surrounded by people. It’s “a feeling of being excluded and of existential angst,” she said.
The situation is particularly serious, given that many Americans had been lonely even before the coronavirus pandemic hit.
According to a January 2020 survey of 10,000 Americans ages 18 and over conducted by Cigna, 61 percent of adults — three in five — reported they are lonely. That number is up seven percentage points from 2018. With Americans more physically isolated now because of coronavirus stay-at-home orders, the sense of loneliness is even greater, said Dr. Doug Nemecek, Cigna’s chief medical officer for behavioral health. Cigna’s study indicated that major factors corresponding with loneliness were a lack of social support and too few meaningful social interactions; it also found those who telecommute are more lonely than those who work in an office.
“Because of Covid-19, this is impacting many more of us. We are socially distanced. We can’t interact with friends or neighbors. We can’t visit elderly parents who are in nursing homes,” he said. “All of this has the potential of impacting how we feel from social connection and loneliness.”
The Cigna study indicated that 79 percent of those aged 18 to 22 considered themselves lonely. Among this group, heavy social media users were more likely to say they’re feeling lonely, Dr. Nemecek said, “so leveraging social media in the right way to make and maintain meaningful connections with someone else is very important.” For example, he said it’s likely to be more beneficial to have a video chat instead of just reading the news on social media or scrolling through Twitter posts.
There can be a greater risk of depression among those who have no social contact or social support, said Lisa Cox, a licensed clinical social worker and professor of social work and gerontology at Stockton University. But she says if those individuals exercise self-care, they can fare well. This includes participating in online support groups, yoga and stretching, keeping a gratitude journal, practicing mindfulness and immersing yourself in creative endeavors like drawing and listening to music.
Dr. Cox acknowledged that it can be difficult to exert the energy to try new things when you’re lonely, but said it’s worth giving it a try. Dr. Pinker said video chats are the next best thing to being there — anything that mimics the reciprocity of real interactions, or where you’re all “paying attention to the same thing at the same time.”
It’s an ideal time to pick up the phone and check in with friends and family with whom you’ve lost contact, she said. And just getting out and taking a walk around the block can help replicate the routine of your day as you once headed to work or a coffee shop, creating the opportunity to “see people in a casual way,” Dr. Pinker said. Both she and Dr. Cox say apps like Houseparty, which allows you to participate virtually in activities like games with friends or Netflix Party, where you can watch movies with friends who aren’t with you, can provide a means of social connection.
This time can be particularly challenging for older adults. A 2020 report by the National Academies of Sciences, Engineering and Medicine found that nearly half of adults ages 60 and older report feeling lonely. Lisa Marsh Ryerson, president of the AARP Foundation, cites AARP findings that over 42 million Americans — a third of the population age 45 and older — were lonely before coronavirus hit and says those numbers are on the rise in the current situation. She suggests that older adults prepare a “Friendventory,” a list that begins with an inner circle of friends and neighbors and expands to include former work colleagues and classmates. “It’s hard for people to take the first step, but it’s important to reach out,” she said.
She also suggests that everyone else call at least one older adult each day who may be at risk for loneliness to ask how they’re doing and listen to their response. Perhaps you can also help by offering to talk them through setting up virtual chats with their friends and family.
I came across a post by Sara Rodrigues that I could have authored myself. Depression is real. I hope this piece helps shed some light on what it is like to live with and through depression.
A few years ago I had a big international trip planned. I made arrangements for my travel and was excited about the prospects of traveling for a few weeks.Fast forward a month before takeoff and I called to cancel my flight because I could no longer go on this trip. Sure, on paper everything was fine. I was fine. So why couldn’t I go anymore?
Plain and simple: depression. It’s hovered and lingered above and within me off-and-on since my early adolescence, and if I’ve learned anything about this nasty thing it’s that it works in cycles and waves, so it never disappears completely. Plus, depression has this ugly little friend named anxiety, and anxiety said, “ you can’t go on this trip.”
(The internal dialogue was obviously more involved, but I’ll spare you the intensity.)
I tried to explain to the agent on the phone that, as per the literature regarding the travel insurance I’d purchased, I should get at least some sort of refund given the nature of my cancellation. It was medical. I had been treated for it in the past, though I had not visited a doctor with my most recent episode, so I had no current proof of the situation…but it was in fact real.
“It’s because of issues involving depression and anxiety,” I told her. I dare you to guess how she responded.
She laughed. Laughed.
In her defense, I’m sure those words—those foggy, unsure words that no one talks about unless plastered with motivational quotes and stories of glamorous success—made her severely uncomfortable. It’s not her fault; we’ve created a society and countless industries that not only perpetuate such issues of mental health, but shudder at their mentioning. Those words are meant only to be whispered, if spoken at all.
I also understand that if we could all cry “depression” without current proof of such conditions (like medication, which not everyone opts to take in the first place) and get refunds for it at our leisure, we would.
But I do not understand why she had to laugh.
I knew all too well that getting on that plane would have been the absolute worst decision. I was in no state to experience new things and my body and brain were persistent in relaying that urgent message.
No one else knew my internal state. I kept it to myself and on the surface, I remained “normal.” Healthy. Just fine.
That’s what makes mental health such a daunting entity: no one can see it.
But that experience, this agent’s likely innocent laugh, taught me an important lesson—that maybe it’s time we (those who have experienced it) let it be seen in a light that has nothing to do with overcoming or conquering the illness, but has everything to do with the experience of it—the day-to-day reality of inexplicable pain and shattering emptiness.
So, while the experience of depression is relatively unique to each individual who suffers from it, there are certain characteristics that ring true for all of us who’ve been there—namely (and perhaps most importantly in many cases) what depression is not:
Everyone reacts differently to feelings of discomfort, especially in situations they do not entirely understand. Some remain silent as they try to process information. Some blurt out their initial reactions. Some blush. Some let out a confused giggle. To be perfectly blunt about this, it is never okay to laugh at depression.
If someone told you they’d been diagnosed with cancer or any other illness deemed a serious condition, you would not laugh or giggle no matter how uncomfortable you felt; you’d be more concerned with their wellbeing, their treatment plan, what you could do to help in such a difficult time.
Mental illness is just as serious. It’s not an exaggeration. It’s not a melodramatic statement. It’s just the truth.
Depression is not funny. It’s never funny. Don’t invalidate people’s feelings and experiences by laughing at it.
As I said before, we as a society are pretty familiar with the success stories of moving beyond and overcoming depressive states to “live a more brilliant life” and whatnot (that is, we love “self-help”). Let me be clear: this is wonderful. It’s a beautiful thing to hear the stories of those who’ve been low but managed to rise above those circumstances.
By the same token, this is also something that’s often glamorized to make depression seem like a cool and sexy thing to experience. It’s not.
Yes, it’s amazing to witness the transformations that take place to bring those who’ve struggled into the light of a hopeful future. It’s inspiring and empowering and their voices are deeply impactful for so many. However, when those voices place a rose-colored lens over their darkness so that it might sell better, it not only appears less authentic, but almost insulting.
No, depression is not a beautiful road to self-discovery. It’s not a blissful adventure taken separately from everyday life in order to inspire a rebirth-turned-bestselling memoir.
Depression is a dark, lonely, empty cave through which one must travel while trying to maintain some semblance of normalcy. It’s unforgiving and unwilling to back down. It’s difficult to survive (it seems being dead wouldn’t feel much different sometimes), and more often than not, it makes everyday functions and tasks impossible.
3. A decision.
That brings us to another thing depression is not: a decision, a choice, a conscious submission to such wrenching and largely inexplicable pain. It’s not a tool one would willingly employ to acquire some sort of attention or concern.
I would never wish this struggle on myself or anyone for that matter.
This was not a choice. It was never a choice. Of all the factors that go into a person’s predisposition for depression, conscious reasoning is not one of them, of this I am sure. But I am also sure that many of those who suffer from it are made to feel so ashamed and frowned upon that they come to believe that they have in fact brought it on themselves—and the inauthentic voices promoting “motivational” ideas like “you are in control of your happiness” and “it’s up to you to change your attitude and so your life” only exacerbate this sense of guilt.
I’m all about inspiring and motivating others, but make no mistake: when suffering from depression, happiness is not something one can control. Depression is not a decision; if it were merely a matter of “changing our attitudes,” then believe me, we would.
Any conversation I have about depression (which there are few, to be clear) ends with some variation of this question: “… but you’re fine now, right?”
That question always hurts, mostly because I have no choice but to answer with “yes, sure, everything’s fine.”
I never bother explaining the fact that depression is not a finite entity, that it’s not a one-time storm that blows over and never returns; that it’s more so a lingering disposition that ebbs and flows with life as it happens.
Depression is cyclical. Even when one receives treatment for it, it comes and goes in various forms and degrees of intensity. It’s not guaranteed to go away forever, nor is it guaranteed to return once it subsides for a while, and for those who care about its victims, that’s a seemingly difficult concept to grasp. All they want to hear is “yes, everything’s fine now” and be done with it.
While perfectly understandable, that’s unfortunately not how it works. Depression is not something to be “done with.” Sure, one day might be great and productive—maybe even weeks or months!—but the next might be a laborious struggle just to get out of bed or a painful relapse into related habits of self-harm. Either way, offering any kind of care or support to someone who has experienced/is experiencing depression involves understanding the cyclical and ever-changing nature of the beast.
5. A reason for shame.
I can’t tell you how many times I’ve felt guilty and ashamed for being depressed, believing that my darkened state made me the absolute worst wife, mother, daughter, sister, friend. I was a toxic presence in my own mind, a harmful being that poisoned whatever environment she inhabited—a notion I’m still trying to shake along with all the habits I’ve adopted in its wake.
As I mentioned before, all our beloved self-help gurus plastering quotes meant to awaken and inspire the beauty in each of us doesn’t necessarily help this feeling of shame. When someone says “just be more grateful, it will make you feel better” or “think positively and you’ll change your life,” I have to believe the intentions are good; however, in my experience, these concepts only worsen the guilt that surrounds depression.
Don’t tell me to be more grateful. Don’t tell me to think happier thoughts. Again, if I could, I would, but depression is an illness involving the chemicals in the brain essentially making it so that I can’t just be more grateful or think happier thoughts. It’s not a matter of flipping a switch. It’s not a matter of manifesting the happiness I seek.
Don’t tell me it’s as simple as that. It’s not. When you say it is, you reinforce the shame that surrounds this hush-hush disease, and so further into that dark place we go.
“The first step toward change is awareness. The second step is acceptance.” ~ Nathaniel Branden
Depression is a difficult cloud to contemplate; it hangs over so many of us, yet most are so uncomfortable by its presence that it’s hard to openly discuss it, especially from an in-the-thick-of-it point of view. No one sees it until the storm becomes violent—that is, until the signs of the illness become visible. (For example, to one extreme, a suicide attempt or physical self-harm.)
But that doesn’t always happen, and perhaps it’s the unseen parts that make for the darkest moments as we struggle to survive.
It’s not funny. It’s not glamorous. It’s not a decision. It’s not finite. And it’s definitely not a reason to be ashamed.
Until the masses become more aware of and sensitive to the needs of those suffering, we must be the ones to reiterate the importance of acceptance, of recognizing that this is a real and serious illness that demands a real and serious response—not a laugh, not a shrug, not a motivational quote demanding “gratitude to fix your attitude.”
We must take care to show what is not easily or comfortably seen. And here and now is always a good place to start.