by Carla Hellekson, MD
Carla Hellekson MD was among the very first psychiatrists studying Seasonal Affective Disorder in the eighties, is a Charter member of the Society for Light Treatment and Biological Rhythms, and a Distinguished Lifetime Fellow of the American Psychiatric Association. Having lived for many years in Alaska, she gained a special understanding of extreme seasonal changes in daylight and its effects on humans.
I write this on August 1, 2020. August 1st is a date celebrated by the ancients, as Lammas, or the harvest holiday, when the first grains of the year were baked into bread. Over the 35 years of treating patients with Seasonal Affective disorder, numerous individuals would first notice the early signs of dread of the upcoming winter season during August, as the sun began its travels south in the sky. Over time, as my patients and I developed a pattern of treatment, involving a number of modalities, we would check in seasonally, and thus the “Quarterly Club” was so named.
We have learned to pay attention not just to the Quarter days of the year – Summer and Winter solstices, and spring and fall equinoxes. The Cross-Quarter days, marking the mid-points between the solstices and equinoxes are equally important. The names for these Cross-Quarter days vary among cultures, but the Celtic terms of Lammas (Aug 1), Samhain (Oct 31), Candlemas (Feb 2) and May Eve (May 1) are familiar to many.
One lesson learned is that after Lammas, in the early fall, is a good time to start taking action steps, to be ready for the late fall and early winter. This capitalizes on the energy of the warm and sunny fall days, before the lethargy of early winter sets in.
- Get out the light box to inspect how it is working, do new light bulbs need to be ordered, or parts replaced? Is it time to upgrade the light therapy unit? Might a spare light therapy unit for the home office, or one’s favorite reading chair, be a good splurge this year?
- If antidepressant medication has been a part of your treatment routine, this is a good time to make an appointment with your psychiatric prescriber to discuss whether restarting medication or making a seasonal adjustment in dose for the winter season is in order.
- Update other medical appointments to be sure you are all set to follow a well-rounded meal plan, balanced hormone replacement, especially thyroid replacement if needed, and a body ready to engage in a regular fitness routine throughout the winter season.
By mid-fall, or Samhain (meaning literally, in modern Irish, “summer’s end”), it’s time to put the plan developed in the early fall into action.
- Start using light therapy daily. A regular time, particularly in the morning, commonly results in better compliance. The length of time using light therapy may be adjusted to the amount of natural sunlight one is still able to enjoy during fall walking and gardening.
- Consider tying the light therapy into other daily routines including taking medications, supplements, and Vitamin D, as discussed with your prescriber.
- Keep on the best 24-hour circadian rhythm that has worked well in the past, with a regular time of arising, regular fitness routine, remembering to avoid blue light in the evening, and allowing enough time for sleep.
- Consider making plans for a midwinter sunny get away vacation.
By February 2nd, known as Candlemas, but better known these days, in the U.S., as Groundhog’s Day, if you have been able to keep to your routines, the longer days are coming, you feel relief. Or if you have slid under the covers, this is when folks come out and say, “I am never going to let this happen again.” By taking pro-active steps now, in the early fall, the best winter season possible is within your reach.
And as I write this during our pandemic stay-at-home time, it’s ever more important that we take active action steps about what we can control. Everything about effective treatment for winter depression is also good for what some are calling “COVID Fatigue.” Staying connected with loved ones, and joining new Zoom groups, help for social stimulation. This writer is bingeing on cooking classes and concert live streams. And remember that optimism is only partly genetic, and far more a matter of learned practice, of seeing the “sunny side of things.” A good reminder for us all, as we enjoy late summer, in anticipation of our fall and winter season.
With fond regards for my Quarterly Club patients whom I miss dearly in my retirement, but will never forget.