‘No escape.’ With COVID-19 in the shadows, why seasonal depression could be worse than ever this year

Natalie Montgomerie already knows what it's like to live through seasonal depression during a global pandemic.

Her symptoms, which usually begin as days get shorter in November and last until March, lingered this year all the way into the summer months. It's unusual for her seasonal depression to last that long, but the pandemic-mandated lockdown upended her routine and offered her little in the way of relief.

COVID-19 made it a lot worse," Montgomerie said.

Now that winter is approaching, Montgomerie is bracing for the return of her seasonal depression symptoms. But this time, she knows getting through the next few months will be an even harder battle.

The changing seasons won't only mean shorter days and pitch-black skies before dinner for those who already suffer from seasonal depression. Winter also means fewer chances of enjoying fresh air and socializing outside with friends and family from a safe distance - a freedom cherished by many as socializing indoors can sometimes mean a higher chance of catching COVID-19.

The issue even made it to the Ontario legislature, with a private member's bill tabled by Progressive Conservative MPP Jeremy Roberts (Ottawa West-Nepean) on Oct. 1, asking house members to consider moving permanently to daylight saving time, as research shows moving the clock back an hour in the fall - slated to happen Nov. 1 - is exacerbating depression in people. But the move hinges on Quebec and New York state doing the same and won't take effect during the pandemic.

Ontario and Quebec are now in the midst of a second wave of COVID-19. Restrictions on gatherings were brought down to 10 people indoors and 25 outdoors, with warnings against socializing with people who don't live under the same roof. Indoor dining is prohibited in Toronto, Ottawa and Peel Region as of Oct. 9, and gyms and casinos are now closed. And as of Oct. 19, York Region will also adopt similar restrictions. All these changes make socializing a bigger challenge after the summer brought respite with small, social-distanced, outdoor freedoms.

With already higher rates of depression and anxiety reported as a result of the pandemic in the general population, experts are cautious about the compounded mental health struggles seasonal changes will bring. And for now, people are going to have to figure out how to cope.

The impact of Montgomerie's seasonal depression earlier in the pandemic was worsened when her daughter's school shut down, piling on the responsibilities for the single mother from Brampton. Going to the mall or the store was not an option, and grocery shopping heightened her anxiety. Parks were closed, meaning she couldn't offer her daughter any relief either. Then she lost her customer service job due to her workplace not accommodating her mental health needs.

There was no escape," Montgomerie said. I was stuck inside these four walls constantly."

Psychiatrist Dr. Robert Levitan, an expert on seasonal disorders and the Cameron Wilson Chair in Depression Research at the Centre for Addiction and Mental Health (CAMH), said mood changes fuelled by the season are felt by a large number of Canadians.

Thirty-three per cent feel what is classified as seasonal blues," Levitan said. Another 10 or 15 per cent get what we would call subsyndromal Seasonal Affective Disorder, which is the same symptoms but just milder and not enough to cause disability."

An additional 3 to 5 per cent of Canadians suffer from diagnosed Seasonal Affective Disorder, also known as SAD - a type of depression related to limited light exposure in the winter months. Symptoms often start in the fall and continue throughout the later part of the year before they wane in the spring. SAD can be debilitating, significantly draining energy and cause moodiness.

When you add it all up, it's a significant proportion of individuals getting some seasonal changes," Levitan said.

The effects of SAD are a yearly occurrence, especially for people living through Canadian winters where days are much shorter and nights stretch on in the frigid cold. But with so many affected by it in big or small ways, Levitan said he worries about SAD worsening with growing rates of depression and anxiety among Canadians due to the pandemic.

Prior to COVID-19, research by the Mental Health Council of Canada showed that 6 per cent of Canadians reported a high level of depression. That has doubled to 13 per cent since the pandemic began. The number of Canadians feeling a medium level of depression also increased, from 20 per cent before COVID-19 to 25 per cent.

Levitan said he believes the winter months will likely lead to an increase in depression overall, though the increase will not be because of any change to the amount of sunlight people will be getting, but rather due to the already unprecedented increase in depression due to the pandemic.

He added that Christmastime and early January will be a critical period in knowing whether people who already suffer from seasonal depression will be feeling worse as a result of the pandemic. He hypothesized it may also take longer for people to feel better overall if lockdown restrictions are mandated through the spring.

In the meantime, doctors have been pondering solutions that may help people who notice an increase in symptoms of depression in the winter.

One solution, Levitan said, is lighting therapy units that CAMH lends out to SAD patients if needed, though he added social distancing measures will make accessing this type of treatment in person more difficult. People can still purchase similar units online, Levitan added, provided they have the capability of blocking ultraviolet light.

A change in time mandated by the province could also be another solution to alleviate depression rates in the winter for years to come.

MPP Roberts' private members bill, which is awaiting its third and final reading in committee hearings, would change Ontario's time to daylight saving time if neighbouring Quebec and New York state pass similar legislation, meaning clocks would go back one hour permanently and not move forward in the spring. Roberts tabled the motion partly because of strong research that time change has led to higher rates of depression over the years.

Roberts referenced a 2017 Danish study that found an 8 per cent increase in depression rates due to time changes.

That sort of got me thinking, why is it that we keep following this outdated practice?" Roberts said.

Legislation proposing the permanent shift to daylight saving time - introduced in Ontario in 1918 to save energy and provide more light in the evening - has gained some traction across Canada in recent years. A similar bill was passed in British Columbia in October 2019, though the change still hinges on neighbouring American states doing the same, which requires approval by the U.S. government.

Time change does indeed impact people's mental health, Levitan said, and he is in favour of ending it permanently. It's like having the entire population of the country go through jetlag, and when you do that, of course there's a subgroup of people that can't handle that," he said. It seems like a small thing, but it's actually not."

But experts, including Levitan, have long argued that a permanent time change has to be done correctly - keeping the clock permanently on standard time instead of on daylight saving time because it ensures people wake up to sunlight in the morning.

It's sunlight in the morning that is most helpful to us," Levitan said. Keeping the time at daylight standard, he added, would mean people would still wake up to a pitch black sky.

That would probably lead to much higher rates of depression and suicide as well, and just overall lethargy," he said.

A permanent time change backwards, Levitan added, is worrisome when thinking about the pandemic and how social distancing measures have impacted people's routines in general, causing a compounded effect on depression that will likely be felt for years to come.

That's two things now that you're dealing with that are moving in the wrong direction, and that's terrible," Levitan said.

When Montgomerie's seasonal depression escalated earlier in the year, she received help from a mental health worker through the Canadian Mental Health Association, who has been offering her support for over a year.

She has also leaned on cognitive behavioural therapy group sessions - a psychotherapy practice where people are encouraged to challenge their negative thoughts and how they impact their behaviour - to help her through her depression, but these sessions will likely be virtual this time around.

Again, is it really helping?" Montgomerie reflected. We're still stuck in our house."

She said she worries resources in Peel or Toronto will not be enough to help people suffering with depression, especially with social distancing measures shifting the bulk of available care online. But she added she hopes speaking out about her own experience will let others know they are not alone.

With seasonal depression, you have to really, really push yourself," Montgomerie said.

I'm ahead, I understand it now. But it's taken me years to understand it."

Nadine Yousif is a Toronto-based reporter for the Star covering mental health. Her reporting is funded by the Canadian government through its Local Journalism Initiative. Follow her on Twitter: @nadineyousif_