I’ve been noticing the October “dip” into worse chronic health symptoms phenomenon for years (as reflected by countless posts alluding to it ever since I first started writing here) but, at last, I’m hearing a load of other people talking about it, or maybe my ears are just pricked-up looking for more answers, galling as it is to see a summer’s worth of steady health improvements set back once again with the changing seasons.

It now seems to be universally labelled “the October Slide” and, maybe it’s just the company I keep because I keep hearing that term bandied around at the moment. At least two of the forums I belong to have used shared articles on this topic as the pivot for discussion in the last week (with a ton of people saying they experience it themselves) and articles and Insta posts keep on appearing daily. I guess there’s some comfort in having company in an experience I’ve been battling with for decades as I used to feel so very alone in it and even wonder if it was real or “just me” getting gloomy because I didn’t favour the darkening days. Now, there’s emerging evidence that symptoms do often take a downturn in October in the northern hemisphere and it seems to be a fairly consistent experience across certain health conditions.

One article in particular has done the rounds in my feed twice now, via two different sources including The Zebra Club, entitled “The October Slide – Managing symptom Flare-Ups in the Fall” (see below), which links its prevalence to seven chronic conditions (on which list I can tick almost all), namely Fibromyalgia, Ehlers Danlos, Chronic Fatigue Syndrome/ME, POTS, Long Covid, rheumatoid conditions and autoimmunity. It seems all these things “get worse” in October, which is exactly my experience for decades with this year being no exception as it’s been especially tough since the end of summer and this month has been intense so far. In fact, I would say the fibromyalgia part gets particularly worse at this time of year, bringing back into focus the kind of gnawing generalised all-over pain that, at other other times in my case, takes more of a backseat compared to other things I have going on, such as POTS and MCAS. When it comes back on with a vengeance, along with much more active Ehlers Danlos issues in the autumn, it can feel like the straw that breaks the camel’s back.

That other thing that arrives with such a vengeance, in my case, is low mood or a sort of all pervading anhedonia that has a lot to do with the darkness as sunshine and general daylight is lost (the expectation that the sun might shine reasonably often is one of the main things to get me through at all other times of the year!) and also this feeling of, yes, inevitably sliding into darker, colder, shorter days for weeks and months ahead, none of which are my favourite things, and having absolutely no agency over that (loss of choice or personal sway over a situation being one of the biggest things to provoke me at any time).

Seasonal Affective Disorder (SAD) can be a hugely impactful thing, something those with ADHD are particularly prone to, and becomes another one-plus-one when you’re barely holding it together already due to having massively impactful symptoms you have to deal with literally every day. One thing I’ve found that helps me is that I take a lot of photos throughout the year and, glancing back at those yesterday, was reminded that the first flowers of the year were already pushing through the ground in the first weeks of January and the days did indeed start to feel lighter, even before the coldest month of February had happened (the combination of increasing cold and dark is what makes this time of year particularly challenging for me). In other words, this is the toughest bit but is also relatively brief in the grand scheme of things and I do what I can to prompt the daily realisation that I’m not now trapped in a perpetual hell of darkness because it will come and go relatively quickly.

Worth expanding on here is that, yes, ADHD symptoms can feel much worse when there is less sunlight for reasons that go far beyond being a mere lack of positivity around the darker days. Tesuced daylight actively disrupts the body’s circadian rhythm, leading to worsened inattention, mood, and sleep problems as well as potentially triggering SAD, as already mentioned, which is characterized by a drop in mood and energy during those months with less daylight. I know for myself that these provocations can lead to heightened inattention and bouts of what can seem like highly paradoxical hyperfixation on certain (not always helpful) things whilst yet being even more executively challenged and distractable away from attending to my own bodily needs than ever. I find myself feeling exhausted and cognitively defunct in the day trying to push through tasks that have to be faced down whilst still waking up at 3am with my brain hungry for dopamine snacks that keep it awake looking for more things to focus on. It can be a heady brew that leads to even more physical and cognitive burnout in the darker months.

However, what’s going on here with the October slide is so much more than just a simple effect of the light!

What the above referenced article and others like it seem to be saying in unison (as indeed I have been saying for ages) is that these types of chronic condition often experience a flare-up of symptoms at this time of year, attributable to 1) low barometric pressure (and, I would add, the changeability or “choppiness” of air pressure back and forth as the weather systems work out what they are doing) 2) reduced vitamin D from reduced daylight 3) increased stress due to the return to work or school (I would also add PTSD if past trauma from school etc is still held in the body…definitely part of my neurodivergent backlash from schooldays) 4) increased risk of picking up seasonal illnesses like flu, covid, coughs and colds (and all the limitations that come from feeling like you have to avoid contact with people and crowded places that might spread them about…) 5) seasonal allergies that increase along with leaf mould and damp, leading to breathing issues, MCAS flares and, where there is MCAS, worsened dysautonomias such as POTS and 6) reduced physical activity as increased stiffness and pain start to inhibit even the most gentle of exercise routines such as daily walking.

My walks certainly become more intermittent and necessarily shorter from about mid September onwards as joints flare-up and injure more readily (I’m suddenly back into all those horrible elastic supports that l largely ditched in summer) with all the inherent loss of outdoors time and nature contact which can then profoundly affect quality of life and mood, with multiple knock-on effects.

On the topic of having to go back to using aids that I was able to do without in the warmer months, this phenomenon of feeling “set back”, in and of itself, can represent a large reason for losing morale in October as it becomes starkly apparent that progress believed to be a steady linear progression forwards was only ever destined to go forwards conditionally based on a better season and other more perfectly aligned circumstances, only to slip backwards once the barometer changes again. This highly frustrating experience of constantly swinging backwards and forwards can be a defining feature of chronic illnesses where improvement is generally about acquiring better symptom management rather than finding a definitive “cure”.

Not all but many of my symptoms do better in spring and summer than autumn and winter (POTS and MCAS are the exceptions) so it can feel like I am losing all the headway and traction of the rest of the year in October, plus MCAS and POTS don’t exactly go away as there are other things such as increased exposure to autumn mildew and mould, central heating and lack of movement provoking those things into flare-ups well into the winter months. I am working hard to adopt the outlook that I am always going to use various supports as and when I need to but without marking it as a failure when I have to resort to them again, even if I do feel like a mummy putting on all my various velcro accoutremants before I can go out the door or even stand up some days. Instead, I look forward to Spring when I know I can probably start to do without some of them again…and so it goes.

So a main sticking point can be lack of movement through lost opportunities and needing to find new ones that don’t then provoke worsened symptoms due to exercising in the cold and damp, plus modifying those exercise opportunities to fit joints that now have less sustainable capacity due to being more readily in flare mode, making shorter bursts of movement more appropriate to avoid injury or post exertional malaise. Going outside for walks, for me, becomes a fair weather activity in the autumn onwards and that helps me avoid worse or longer-lasting flares than when I used to continue to push myself outside everyday, come what may (as I used to do when I still had a dog and which triggered long painful winters with slow recoveries, though the loss of four-legged companionship to help me get through the long dark winter months is its own major topic and one for another day…). Which means that, currently, I’m lucky to get out for a walk two or three times a week but I try to appreciate them to the max by taking my camera with me and noticing all the beautiful seasonal things along my route. I also sit outside as much as I can tolerate, especially early in the day (for circadian cycle support and vitamin D) even when it takes togging up in many layers of warm clothing.

Whilst it’s not like-for-like in terms of joy quota, there are other things you can do for indoors exercise, for instance I am finally adding a bit of movement to music (I hesitate to call it dance…) back into my morning pilates routine, now I can tolerate being on my feet for longer than I could earlier in the year and all of last year, when POTS was so severe during the most severe part of long covid. Thanks to the daily Zebra Club movement routines, regular physio and taking LDN, I’ve made strides with my ability to be on my feet this year without the constant POTS episodes and, so far, October hasn’t set that backwards.

This movement to music activity brings lightheartedness, fun, variety and novelty (crucial for ADHD) back into a daily routine that could otherwise feel quite flat on days when damp or cold weather keeps me indoors because I already do daily pilates throughout spring and summer (so it can feel about as eventful as brushing my teeth) but then, at those times, I still have my walk and getting outdoors to look forwards to. I need to keep my interest and enthusiasm “up” at this time of the year when whatever I do indoors is often as good as it gets so music brings increased endorphins and dopamine into the picture, especially when I put cheerful playlists together. The dopamine factor is HUGE in my case due to my ADHD so if I don’t keep exercise interesting and make it into an event that I look forward to, I’m already half way to the doldrums and that impacts so many other things once my brain chemistry starts to flounder, including pain levels.

On that topic, it’s so important to throw myself back into my interests with a vengeance at this time of year so I made sure to stock up on materials and to get both painting and embroidering projects well underway before the worst of the October dip hit me since initiating new projects only gets harder once I’m deep into the doldrums but keeping them going is easier to do (and I’ve also, finally, invested in a good daylight quality lamp that’s portable to wherever I’m doing my activities so that the darker afternoons don’t curtail me).

So I now have an afternoon painting project and other crafty challenges to get stuck into as the impulse takes me, which helps to give me positive focus. Having a variety of different things you can pick up and put down, requiring different sitting or standing postures, varying types of skill or work space and so on can really help with pacing and dopamine because having different rooms you get to spend time in, different demands and type of activity etc. can really help boost endorphins and dopamine some more by keeping life interesting whilst not overdoing any one particular task to the point of overdoing things. In my case, it’s also a way of hacking my ADHD brain (which also flounders mightily at this more limited, less novelty providing, time of year to the point of stalling because it doesn’t know how to initiate tasks on such low levels of brain fuel) by providing a dopa-menu I can pick from everyday without too much task initiation panic every time I crave a particular type of activity because I already have options set up and ready to go.

I know many of these interests are still pretty sedentary in my case because I still can’t stand for prolonged periods (though at least when I paint, I “sit” on a kneeling chair which gives my back and hips a rest from the usual posture) but it may also be possible to increase your actual steps indoors if you have the room to move around from room to room, something we didn’t have, two years ago, when renting such a tiny place that we could hardly stretch our arms out without hitting a wall or ceiling, so I do know firsthand just how impactful lack of space can be during this time of the year. I swear I am still paying the price for that winter’s lack of movement as it was the most sedentary I’ve been ever and I lost just so much muscle tone, which then translated into the worst POTS of my life in the months afterwards. In hindsight, I should have made more effort to do some sort of static exercise but I kept thinking of it as temporary and the body keeps the score of these things so the effects can be cumulative. Keeping reasonable muscle tone in my calves, thighs and glutes is a primary objective now and dancing or being on my feet in the house doing little tasks in short bursts really helps with those things.

So, these days, I find myself making excuses to go upstairs or get something from another room just to keep my body moving every few minutes and it’s amazing what kind of a step count I can get from days like these. I swear it also cheers me up compared to becoming part of the sofa and I think there is an element of feeling like I’m still in control, still have some agency and some purpose in life as long as I keep on moving. So I would suggest perhaps incorporating more movement through doing small, well-paced house chores if that’s within scope (for instance I try to clean a bathroom or dust one room each day and turn it into a kind of pilates routine by staying conscious of how I use different parts of my body without provoking laxity or hanging off my joints). If I need to put on a back brace or SI belt before I can do these things then I don’t let it stop me. We recently tried out having a cleaner but it didn’t work out, for various reasons, including my strong dislike of having a procession of different strangers show up in my home moving my stuff around (hello autism) but I now feel relieved because I have a steady flow of small manageable tasks I can do myself indoors over the autumn and winter months (I delegate the rest to my now retired husband).

It helps to feel like I make some directly positive impact on our living circumstances again and have that sense of agency back, rather than sitting here helplessly waiting for someone else to show up and do things for me. One thing that has really helped make this feasible is getting an affordable robo vac that does all the vacuuming, even mopping, and leaves me with the manageable tasks and I now feel a lot happier in myself, compared to when I felt completely incapacitated (as I was when POTS was so bad for well over a year). It gives me a lot of satisfaction to look at a job well done…by me…but I also make sure to do it all in small bursts, like wiping down the surfaces of a bathroom right after brushing my teeth in the morning, so it’s relatively painless and doesn’t take me over my exertion limit.

So the key for me is to move some way or other every day, even if I can’t always get outdoors, and to keep an eye on those steps to maintain a regular target. Just doing these simple things helps buffer me from the most demoralising aspects of The Slide and makes the days go quicker but also because, as proven in studies, regular movement prevents that loss of muscle tone and increased stiffness and pain that I experienced a couple of years ago.

That pacing factor I just mentioned is absolutely key…at any time…but perhaps especially at this time of year so I factor in intervals throughout the day when I just stop what I’m doing to elevate my legs and maybe listen to a podcast or send a message to a friend (in other words, this doesn’t have to be “dead” time) or even have a nap and try to alternate types of tasks so that I am never leaning too hard into anything concertedly creative or cognitive or physical for very sustained lengths of time because that can also be fatiguing. Variety is the key to good pacing as I written about before, though I appreciate the temptation to get stuck in monotropic activities and the extremely hyperfocused preoccupations such as hobbies and interests can be high when there is less appealing distraction outside (which is fine, but I try to go at something for no more than two hours at a time these days). Having good self-awareness is therefore another key survival skill so that you can keep an eye on your own fixations and habits and work hard to keep on mixing things up to avoid overdoing it and crashing or provoking symptoms through excesses. It’s exactly the sort of mindfulness in action that is my takeaway from years of struggling with the meditation variety but which makes sure I’m (fairly consistently) the objective observer of my own habits, from which perspective I’m best able to notice where they help or hinder, plus all the ways I can nudge them into the most helpful format to ensure I don’t keep on tripping myself up through factors such as overdoing it with monotropism or getting my wheels stuck in a particular fixation for eons only to realise much later that I forgot all about self-care!

I’ve also started using the Tiimo app, which is a more visually engaging daily planner designed for ADHD and executive function challenges, so I can gain satisfaction from checking things off and sticking to the rough outline of my “plan for the day” (made the night before or over breakfast) before I get completely lost in excessive hyperfocus!

Healthy diet is also crucial, with avoidance of inflammatory and histamine-high ingredients being top of the autumn list, although that can be so hard to do at a time of year when comfort foods are literally crying out to you as a means of fending off low mood and lack of dopamine or serotonin. I know for a fact that I am currently paying the price for succumbing to quite a few sweet treats and cheesy nibbles over the last few weeks, exacerbated by a pretty tough and emotionally draining few days away to visit an elderly family member where the temptations came thick and fast because we were having to eat out every single day (losing all control over ingredients and drifting far from those that I stick to when at home) and now I am dealing with flare-ups of mastcell and inflammatory issues as payback, so I am hardly in a position to preach. It’s a case of doing your best without making yourself miserable and, I would also say, allow a few treats in moderation because serotonin is important (not just for mood but for pain limitation) and a row of dark chocolate or some other treat you look forwards to can be a useful thing if there are no obvious consequences (remembering that chocolate = caffeine so eat earlier on in the day to avoid sleep disruption). There are other ways of increasing serotonin such as taking saffron supplements (which can also help with ADHD) or experimenting with 5HTP and triptophan, which you can learn about more from Trudy Scott’s useful website Every Woman Over 29.

Keeping up fluids is especially important and, if you have POTS, keep adding electrolytes to those water bottles as they aren’t just meant for summer, in fact I’ve had one of the worst POTS flares of the year this October so I had to really up the ante on coping tactics such as salt and compression when we were away from home. Dysautonomias can often respond negatively to changeable conditions and mine can have a proper flare-up in this autumn season, including hot flushes in the night (which can seem so counter intuitive as nights get cooler but there it is, dysautonomia in a nutshell, there is no rhyme or reason to it). Vagal stimulation can also helps with that, for which I continue to use my neck fan, even at times I’m wrapped up well to the rest of my body, because it’s the cold burst of air (or a cold wet flannel can do the trick) on the face that helps me reset my nervous system to deter a dysautonomic spike, which can then avoid a more severe crash developing. Going back to fluids, I also make good use of herbals like nettle tea for histamine control and chamomile for sleep and stay well away from sugary drinks and caffeine because a choppy month like October doesn’t need any extra provocation from sugar or adrenaline spikes (so its a big no to pumpkin lattes and other such seasonal beverages).

For me, clothes have to be completely comfortable, non-aggravating and not too tight yet warm (but worn in layers that can be quickly removed when dysautonomia is active because my temperature can still swing around wildly) in this cooler season. It can help if fabrics are pleasantly tactile at this time of year…for instance (for me, your preferences might be completely different) I like soft cashmere wool around the face and feet and cotton velvets on upholstery and dressing gowns as even touching these soft fabrics can help regulate me when I am feeling like pain is all there is.

But what about another factor that comes into the October doldrums for some of us and that is all those sensory sensitivities to do with being autistic or having ADHD? I know that I, for one, often feel like I am living in a vastly more hypersensitive body at this time of year than at any other time, with raw nerve endings that find fault with almost every environmental trigger factor going. Every source of noise or bright light (including the white glare on those excessively cloudy days) or overstimulation from anything extraneous going on like drilling sounds from outside or people being rowdy etc. can be acutely painful and disruptive for me during this transitional slide such that it can feel like I am trapped inside some kind of autistic hell for weeks on end, praying that this isn’t my new sensory normal…though it usually settles down a bit as the cooler seasons get better established.

It’s the transitional nature of this tricky autumn phase that seems to heighten all these sensitivities to the max for me. In fact, transitions, full stop, are such a major trigger point to so many autistic folk that I wonder if that is one of the main reasons why October can be such a tough one.

In my case, the whole change of light availability and light source (to shorter days and more reliance on electric lights); the increased amount of clothing required with more potential, therefore, for things to irritate; the major change in routines; the addition of more artificial sources of irritation (not just light but central or electric heating etc.) can all be major trip factors and take a lot of getting used to. In fact this year, of all years (following diagnosis), I’ve finally stopped underestimating the impact of what seem like individually subtle and “perfectly ordinary” domestic sensory triggers when they mount up, especially when those everyday contacts and exposures have had to abruptly change to meet the new seasonal demands. One minute it’s still warm enough to sit outside listening to the birds over breakfast and the next I’m holed up with the heating on and that can be a lot for my autistic system to adjust to in a hurry. I’m learning to make allowance for that and go softly on the internal panics that want to arise because everything suddenly feels so utterly abhorrent in my body!

So if I need to shut down and be on my own in a reduce sensory zone for a while, to reset myself whilst I adjust, then I claim the right to do that without apology these days and I think its been quite an eye-opener for my husband, who never normally sees my unmasked behaviours at this time of year (since he would normally be at work but now he’s retired) to see me struggling so openly like this and, yes, part of it is that I’m dropping the masked behaviours more than ever these days. Looking back into the not so distant past, I now see how I generally benefitted from the whole family disappearing back to office or school at this time of the year, leaving me to handle the autumn transition on my own so they really had no idea how much effort…and sensory withdrawal…that took in those first choppy few weeks every year. When they came home in the evenings, they would only get to see the more masked and put-together version of me at the end of a day in which I might have spent much of it shut down or self-soothing whatever way I needed to in order to l cope and with nobody to judge me or worry about me for doing so (though I remember weekends would be so hard at this time of year with everyone at home). Now, its a case of full exposure of my struggles to anyone who happens to be nearby and I just can’t hide or compensate for it any longer, I just have to do what I do and there’s an end to it.

So my husband has already gained a real insight into some of my major October struggles on a day to day basis but also into my autistic coping mechanisms…the stims, the shutdowns, the long phases of becoming non-vocal or losing myself completely in monotropic activities whilst I adjust. Inside of me, there’s been a constant internal battle not to feel guilty for subjecting him to all this, combined with the resolve to be more authentic whilst also letting him know that none of my withdrawals are personal, they are just how I cope when I’m struggling with sensory overwhelm, which happens in spadeloads in this particular season.

It can help to hang around (at least virtually) with other people who truly relate to how impactful sensory triggers can be, even to the point of burnout. In fact, in the podcast Divergent Conversations (my absolute favourite these days and which I get just so much out of) they recently recorded a series of episodes entitled Burnout City (from episode 113 “Perpetual Sensory Hell”) in which they describe, with more than a touch of black humour, all the most heinous sensory effects that would be found in some sort of autistic hell “city” that would likely trigger an autistic burnout. It’s worth a listen if you are a sensory hypersensitive person because there wasn’t a single item on that list that I didn’t relate to and it can feel so good and validating to hear other people describe the same issues that afflict you on a daily basis.

I know that some of these factors, like the aroma from laundry detergents on other people’s clothing or wafting from neighbours’ houses on laundry day, plug-in air fresheners (yugh, hate and can’t be anywhere near them!), screaming babies, sirens, crowds of people all talking at once in an enclosed space, flickering light sources especially fluorescent strips, friction-inducing clothing that rubs against skin and clothing tags or irritating seams, nylon in any form, certain food smells and textures (we each have our pet peeves there) and so on can drive us into states of sensory agony at any time but I’m pretty convinced that I’m doubly afflicted in this season, so why is that? Is it, again, lack of vitamin D and low serotonin making my nervous system more sensitive due to lack of sunlight? Is it the one-plus-one of all the other symptoms suddenly switching back on at the same time, taking me over my way over my usual pain tolerance threshold? Is it chronic disruption of sleep (mine has been heinously bad for the past 8 weeks, as so often happens with big seasonal transitions)? Whatever it is, I feel sure its a factor in the October slide and can make the effects of this month feel utterly all consuming and hellish…to which my only real antidote has only ever been the belief that this too shall pass, eventually, with the inevitable turning of the pages of the calendar.

If this is you, do be extra kind to yourself in this season and keep in mind that there are going to be some things that can help you to navigate it better, which takes some experimentation and self-compassion plus the oversight to realise this is probably your symptom year at its absolute worse, not some new version of normal that will be here forever. Hoping some of these ideas and my overview help to get you through it and over to the other side!

Here’s some more articles and resources on this topic:

The October Slide: Managing Symptom Flare-Ups in the Fall EDS Clinic

Preparing for the October Slide with Chronic Illness throughfibrofog.com.

The October Slide: Chronic Illness Flares in the Fall, NormaLyte.

Blame it on the weather? The association between pain in fibromyalgia, relative humidity, temperature, and barometric pressure. PLoS ONE. 2019​.

Influence of Weather on Daily Symptoms of Pain and Fatigue in Female Patients With Fibromyalgia. Arthritis Care Res. 2013​.

Life event, stress and illness. Malaysian Journal of Medical Sciences. 2008​.

Local weather is associated with rates of online searches for musculoskeletal pain symptoms. PLoS ONE

Disclaimer: This blog, it’s content and any material linked to it are presented for autobiographical, general interest and anecdotal purposes only. They are not intended to serve as medical advice, diagnosis, treatment or prescribing. Opinions are my own based on personal experience. Please seek medical advice from a professional if you are experiencing any mental or physical symptoms that concern you.