Managing Anxiety During Eee Season: Expert Advice

  • Jasmine Abdy Bachelor of Science - BSc, Medical Microbiology with a Year in Industry, University of Bristol
  • Celina-Ruth Centeno Carter Master of Science - MS, Clinical Psychology, Swansea University, UK

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Introduction

Medical research shows a link between allergy severity and anxiety symptoms, especially if the individual experiences mood disorders that occur during times of the year when allergens are high. Similarly, studies have found that people with seasonal allergies tend to feel more depressed during pollen season, likely because of the accompanying inflammation and poor sleep. 

Research indicated that seasonal allergies are connected to various mental health issues like depression, anxiety, and post-traumatic stress disorder (PTSD), even when other mental health problems are taken into account.1 Also, feeling generally anxious is more common in people with seasonal allergies. This suggests that when doctors treat allergies, they should also think about the person’s mental health and offer support. 

While there aren't clear instructions on how to specifically treat anxiety related to allergy season, it's important for healthcare providers to understand the connection and offer a well-rounded approach to care. 

Understanding anxiety

Anxiety is a complex response that involves worrying, fears about social situations or performance, sudden panic attacks, and avoiding things that trigger anxiety. In the US, around 34% of people experience anxiety at some point in their lives. It can greatly affect how well someone lives their life and functions on a day-to-day basis. Anxiety disorders vary from person to person in terms of symptoms, causes, and how they affect people's lives. They're often present alongside other mental or neurological conditions.2

Medical literature discusses how anxiety can be affected by the changing seasons. This means that some people may feel more anxious during certain times of the year. However, there isn't any evidence in the medical literature that directly connects anxiety to the season when eastern equine encephalitis (EEE) is more common. While studies discuss how anxiety can be influenced by seasonal changes and allergies, there's no specific mention of anxiety being tied to the period when EEE is more prevalent. This means that while seasonal factors and certain seasonal conditions might impact anxiety levels, there isn't established research linking anxiety directly to the timing of EEE outbreaks.3

Triggers and causes

Several factors associated with seasonal changes can trigger or worsen anxiety symptoms. These include variations in daylight exposure, weather conditions, and social/environmental changes.4

Impact of daylight on mood

During fall and winter when daylight hours are shorter, some people may experience seasonal affective disorder (SAD), which involves symptoms of depression and anxiety. The lack of sunlight can disrupt the body's internal clock and serotonin levels, leading to mood changes.

Immune responses 

Changes in weather-related immune responses, particularly the balance between different immune systems, can also affect anxiety levels. For instance, hyperactivation of certain immune responses during autumn and winter may contribute to anxiety by impacting brain regions responsible for mood regulation.

Environmental factors 

Exposure to environmental pollutants like fine particulate matter and changes to food security during different seasons can also predict changes in anxiety symptoms. These factors act as stressors that can trigger or worsen anxiety in susceptible individuals.

Circadian rhythm and anxiety

The body's internal clock, known as the circadian rhythm, plays a crucial role in regulating sleep patterns and mood. Changes in daylight hours during different seasons can disrupt this rhythm, leading to sleep disturbances and mood disorders, including anxiety.4

Impact of shorter daylight hours

During fall and winter, shorter daylight hours can delay the timing of sleep leading to disruptions in the circadian rhythm. This misalignment can contribute to sleep problems and mood disorders like anxiety.2,3

Serotonin and mood regulation

Reduced sunlight during these months can also affect serotonin levels in the brain, which are linked to mood disorders. This further contributes to the development or worsening of anxiety symptoms.

Challenges of longer daylight hours

Conversely, during spring and summer with longer daylight hours, some individuals may struggle to adjust to increased light exposure, disrupting their circadian rhythms and contributing to anxiety symptoms.

Managing anxiety during season changes

To effectively manage anxiety during seasonal transitions, a combination involving both medication and lifestyle adjustments is recommended.3,4

Non-pharmacological interventions (NPI):

  • Cognitive behavioural therapy (CBT) - CBT tailored for SAD has proven effective in treating winter depression by challenging seasonal beliefs
  • Light therapy - This involves exposure to bright artificial light, particularly helpful for patients with SAD

Pharmacological interventions:

  • Selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) - Medications like sertraline can be prescribed to manage anxiety disorders, with dosage adjusted based on individual needs and responses.
  • Buspirone: Another medication used for anxiety management, with dosages tailored to the patient's condition.

Individualised approach

Management strategies should be personalised, taking into account factors such as symptom severity, functional impairment, and treatment response. A stepped care model helps tailor interventions based on individual variables.

Lifestyle modifications

  • Exercise - Incorporating regular physical activity into one's routine can improve mental health outcomes and help alleviate symptoms of anxiety and depression.
  • Anti-inflammatory foods - Following a lower-inflammatory dietary pattern, like the Mediterranean diet, can benefit mental health and reduce anxiety. Including foods such as fish, fresh fruits, and whole grains can help manage symptoms.
  • Maintaining adequate hydration - Hydration is essential for cognitive function and mood regulation, which can influence anxiety levels. Advising patients to stay hydrated, particularly during exercise or in extreme temperatures, can help prevent worsening symptoms.

Summary

Research suggests a strong connection between allergy severity and anxiety symptoms, especially during peak allergy seasons, indicating the need for integrated care approaches. Seasonal changes, including variations in daylight exposure and immune responses, can impact anxiety levels, with factors like shorter daylight hours potentially exacerbating symptoms. Lifestyle modifications such as regular exercise, dietary changes, and maintaining hydration can also play a crucial role in managing anxiety during seasonal changes. Effective management for anxiety during seasonal transitions involves a combination of NPIs like CBT and light therapy, along with pharmacologic options tailored to individual needs.

References 

  1. Sigmon ST, Pells JJ, Schartel JG, Hermann BA, Edenfield TM, LaMattina SM, et al. Stress reactivity and coping in seasonal and nonseasonal depression. Behav Res Ther. 2007; 45(5):965–75.
  2. Rohan KJ, Burt KB, Norton RJ, Perez J, Iyiewuare P, Terman JM. Change in Seasonal Beliefs Mediates the Durability Advantage of Cognitive-Behavioral Therapy Over Light Therapy for Winter Depression. Behav Ther. 2023; 54(4):682–95.
  3. Dollish HK, Tsyglakova M, McClung CA. Circadian rhythms and mood disorders: Time to see the light. Neuron. 2024; 112(1):25–40.
  4. Masento NA, Golightly M, Field DT, Butler LT, Reekum CM van. Effects of hydration status on cognitive performance and mood. Br J Nutr. 2014; 111(10):1841–52.

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