The winter blues are a normal part of the season—but what happens when you add pandemic stress and depression on top of that?

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Winter is coming, and this year it promises to be more grim than usual, with the ongoing specter of COVID-19 still hanging over nearly everything we do. The winter blues are normal as the days get shorter and time spent outside of the house is limited by cold weather. But doctors are warning that a double whammy of depression is about to hit hard—as COVID-19 stress combines with the mental health effects of seasonal affective disorder (SAD). If you struggle with SAD or are close to others who do, here's what you need to know.

What is seasonal affective disorder?

SAD is a type of depression, Hanne Hoffmann, PhD, assistant professor at Michigan State University, tells Health. People with SAD tend to experience common depression symptoms: feeling depressed most days, losing interest in activities they once enjoyed, experiencing changes in appetite or weight, having problems with sleep, having low energy, and feeling hopeless or worthless.

But SAD only affects people for four or five months of the year—typically, the winter months, when the days become shorter. "Light promotes the secretion of hormones and neurotransmitters in the brain, specifically serotonin, which stabilizes your mood, feelings of well-being, and happiness," says Hoffman. "Because there's less daylight and the light isn't as intense in the winter, we don't produce as much serotonin—and that can lead to depression." (It is possible to experience SAD in the spring and summer months, but that's much less common.)

Up to 3% of people in the US are affected by SAD each year—and women are four times more likely to experience it than men. Where you live can also affect your likelihood of getting SAD. "It's unlikely that those in the southern US, where the days are longer, will experience SAD," explains Hoffman. "But in the north, we can see as many as 20 to 40 percent of the population experiencing some degree of it."

Will COVID-19 make SAD worse this year?

In short, probably. Here's why: The amount of people experiencing symptoms of depression in the US has already increased by more than three times—from 8.5% to 27.8% of the population—since mid-April, according to recent research published in the journal JAMA Network Open. This rise in depression symptoms coincides with the arrival of the coronavirus pandemic that put most of the US in lockdown and upended our typical lives and routines.

"People are more susceptible to depression in general this year," psychologist Sherry Benton, PhD, founder of TAO Connect, tells Health. "Social connection, meaningful work, exercise—those are all things that create in us a sense of well-being. When you drop too many of those things, we pay a price."

The pandemic led to months of social distancing and isolation and increased stress related to employment and the economy—"both of which are risk factors for depression and SAD," says Hoffman. Continued (and in some cases stricter) stay-at-home measures will further limit the little light people do absorb when they go outside in the colder months. That will make it even harder for stressed-out brains to produce the necessary amount of serotonin to avoid falling into a depression.

How to avoid SAD and COVID depression this winter

Even though experts expect the effects of SAD to be heavy as winter begins, it is possible to protect yourself from developing SAD with a little proactive preparation. For starters, SAD is a slow-onset issue—it can start creeping in as soon as the days start getting shorter, but you may not actually notice the effects until the frigid, dark days of January. Which means taking action now can help you fend off depression further into the season.

The most important thing: If you can still get outside, do it! But move your schedule around so you get outside before noon, whether that's for a run or walk or even just going grocery shopping. "That's the time of the day that the light-sensitive cells of your eyes project on to the brain to help boost those neurotransmitters," explains Hoffman. Aim for 30 to 60 minutes of bright, direct sunlight. The later you go out, the more light exposure you'll need to get the same benefits.

That's why so many people invest in light therapy. Bright light has been shown to be effective in preventing and treating SAD, according to research in the Einstein Journal of Biology and Medicine. If you are going to buy a lamp, make sure it uses white light at 10,000 lux, says Hoffman. "The good ones run around $100," she says. It's worth spending a little more because they are not FDA-regulated, and skimping on price likely means you're not getting the benefits you want, either.

From a lifestyle standpoint, think about the things that help you feel a sense of happiness or joy—and what's dropped out because of the pandemic or season. "Now, think about what you might put in the place of those things to give you that same sense of well-being," says Benton. "I don't think it's an accident that things like knitting and baking sourdough bread have become such a huge deal during the pandemic. They're coping strategies people use as alternatives to what they may normally do."

Changing the way you think can help, too. "When we get depressed, our brains get stuck on this hamster wheel of negativity, ruminating on things that are not helpful or productive," says Benton. "Write those thoughts down and ask yourself questions like: Is this realistic or an exaggeration? Are these thoughts useful or not? What would you tell a friend who's thinking like this? Then try to modify your thinking." Mindfulness meditation can be a way to do that, she adds—"it's a way to turn your brain off by focusing on the here and now."

Finally, find accountability buddies. "Talk therapy is very effective at helping to reduce depression," says Hoffman. This winter may be dark, but you're not the only one experiencing that. "Set up a weekly check-in call, whether it's Zoom or whatever, with friends or family so you can just check in with each other. It really helps to share what you're going through."

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