ICYMI, our friends Margaret Duncan and Preston Roche launched their psychiatry podcast How to Be Patient earlier this year – and we're executive producers!
With fall finally here and winter on the horizon, a lot of us (and our patients) are beginning to feel – or dread – the effects of waning daylight hours and cold weather. So for this month's deep dive, we tapped Margaret to share some psychiatrist-approved tips for keeping your mental health at the forefront this season.
We hope you enjoy – and make sure to check out How to Be Patient anywhere you get your podcasts!
Enjoy!
The Glaucomfleckens
Pumpkin Spiced Mental Health Tips
with Margaret Duncan, MD
Fall magic is at its peak this month, and whether you celebrate Halloween with your kids and trick-or-treating, at a themed bar crawl, or in the hospital on the shift no one wanted, you can’t help but get swept up in it.
As a bookish psychiatrist born in October, the magic of this month and season has always come quite naturally. But once I started my training in psychiatry 5 years ago, it became clear that many others have very different associations with my favorite month.
Waning daylight, long nights, cold temperatures, and isolation were the sensory experiences my patients and later my readers would talk about. Dread, not delight, was the predominant feeling as the leaves changed and winter loomed.
From a clinical perspective, the change of the seasons can negatively impact healthcare workers, our families, and our patients in a multitude of ways. As we always do on our show, we can break this down in a biopsychosocial model of symptoms and illness.
Neurobiologically, the decrease of daylight hours and our decreased interaction with sunlight can impact our circadian rhythms, especially given that most of us do not change our working schedules based on the time of the year we are in. This change can lead to both sleep and energy level changes. It’s important to consider that this is not necessarily a binary impact, but rather can be partial.
Say you have a patient with chronic pain who already struggles with energy levels and fatigue at baseline–in the winter, a fractional decrease in energy or sleep can make self-care, routine, and management more difficult to complete.
If you have a patient with ADHD who already struggles at baseline with conservation of effort and energy throughout the day, and now there are no external cues for sleep timing and waking, ADHD symptom presentation can impair function more.
Another component of winter time mental health is increased barriers to protective and preventative habits that may reduce the burden of illness. These can be incredibly personalized to each individual, but two of the biggest ones are access to exercise and socializing.
Consider here the person who walks home for their commute during the summer, but as it gets cold they have to switch to driving, thus reducing their exercise from 1 hour a day of walking to none. We know that regular exercise can be as powerful for moderate depressive or anxiety symptoms–for many people, the change in seasons can make exercise harder to access. Isolation–due to bad roads, decreased length of day, unpleasant temperatures, and earlier sleep times can contribute to the sense of “cabin fever” that many experience each winter.
Some people experience the opposite of winter blues–they thrive in the cold, and experience worsening symptoms during the summer. In fact, it seems that some cultures may even have a different experience of winter based on cultural framing of the season and wintertime activities.
For more on this topic, you can check out our season 1 episodes of How to Be Patient, “Making It Through Winter: Seasonal Affective Disorder and Winter Mental Health Tips.”
With all this being said, here are the five things I try to discuss with my patients with Seasonal Affective Disorder to help them manage its effects:
#1: Think about your pillars of wellbeing.
The world is busy–life in healthcare and training is even busier. We recently did an episode with Drew Ramsey, MD, a nutritional psychiatrist, on his book Healing the Modern Brain. The book describes basic tenets and research behind nine lifestyle approaches to wellbeing.
The change of schedules, timing, weather, and busyness in winter can impact many of these pillars. Before the season starts, see if a few minutes can be spent predicting or looking at past winters to see which pillar may most benefit actively strategizing for it in the future.
#2: Consider ways to get away midwinter.
I know, I know–I bet you laughed even reading that, and of COURSE a psychiatrist would say that (I’ll give you that).
However, one of the things legitimately discussed in the literature on SAD is planning a vacation somewhere warm and sunny, specifically during dark, cold months. If you are a trainee, you can continue to guffaw at this one, but for the rest of us (myself included), a consideration is owed here.
Even if you cannot go somewhere in a different season, consider a day trip or weekend trip somewhere for novelty during a season when grayness and boredom can be challenging. If you laughed too hard at this one, here is our episode on the History of Burn Out.
#3: Consider how to bring the light in.
Of course, this is the part where I mention “happy lights”, or 10,000 lux lights that you use for 20-30 minutes when you wake up in the morning (with minimal UV).
Broadening this beyond clinical indications, consider simple changes for making the sensory experience of winter better. This may sound simple, but I’ve found that even convincing some people that maybe they want to buy two more (regular) lamps for their home can help them take a more active role in trying to make winter less intolerable.
Similar ways to help prepare to make winter less sensorially unpleasant:
- Warm enough coats for walking outside.
- Specific routines for beginning or ending the day when these times are no longer marked by the sun rising or setting.
- Planning for dates or events at places where you’ve been wanting to go in your town but didn’t have time to during the summer – on the calendar, and difficult to back out of when you’re feeling low energy.
#4: Move your body.
We cannot overemphasize how important movement is for the brain at this point. We’ve even done two episodes on it, and here’s the first one.
In a season when movement diminishes due to avoiding weather and lower socializing, prioritize exercise or daily walks to continue to move for your overall brain and body wellbeing.
#5: Be proactive in connecting with a clinician.
This one is especially important if you’ve struggled for multiple years with significant changes to your mood during winters, and tried the above or other lifestyle tips.
Depending on presentation and other factors (ie consideration of metabolic or lab differences contributing to energy, sleep, fatigue), medication can help, particularly SSRIs. Even if patients are already on SSRIs, sometimes increasing the dose before and through the winter months can be a huge help.
As always, apply these care tips to yourselves as much as you do for everyone you care for.
I always tell my patients winter can be a season for creativity, and that we need that creativity to figure out how to best get through it. I already know this readership already loves when creativity and healthcare go together.
-Margaret Duncan, MD, AKA ½ of How to Be Patient
In Last Month's Issue
Last month, we released the 250th episode of our podcast, Knock Knock, Hi! 🎉
To celebrate, we took a look back through some of our favorite moments and greatest hits. And if you haven't listened to the show yet – there's no time like the present!
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