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Down & Up Show #35: Winter Blues: Everything You Need to Know to Beat Seasonal Affective Disorder

DR. REEF KARIM:
Welcome to the Down and Up Show on Depression is Real dot org, I'm Dr. Reef Karim, psychiatrist, addiction specialist and relationship (unint.). Today we're going to be speaking with Dr. Norman Rosenthal, author of "Winter Blues", a book about seasonal affective disorder.

As the winter months and holidays approach seasonal affective disorder is definitely more prevalent. Dr. Rosenthal is the medical director of Capital Clinic Research Associates, CCRA, a group that evaluates the effects of new medications on a variety of emotional issues.

Dr. Rosenthal, thank you for taking the time to speak with us today.

DR. NORMAN ROSENTHAL:
Oh it's a pleasure to be here.

DR. REEF KARIM:
Great, so what is seasonal affective disorder, what is winter blues?

DR. NORMAN ROSENTHAL:
Well firstly it's most common in the northern parts of the United States and in other parts of the world further away from the equator. What happens in a rather predictable is as the days get short and dark and so we're talking about October or November, people begin to have a very predictable set of symptoms.

They slow down, have a difficult time getting up in the morning, need more sleep, overeat, especially sweets and starches. They don't concentrate as well, they withdraw from friends and family and in the end they can feel rather blue and sad and disabled in some severe cases.

This persists for maybe four, five months until the days begin to get longer again and then they reverse everything and they come out of it and they sometimes feel just wonderful in the summertime. That is what we call seasonal affective disorder or SAD.

DR. REEF KARIM:
It's interesting it's called sad, isn't it, the the acronym. Well you know in general what I've seen is depression, hopelessness, anxiety, loss of energy, withdrawing socially, oversleeping, appetite changes, weight gains, difficulty concentrating which is really similar to clinical depression.

And some patients will think well, I'm clinically depressed, this is just the way it is and they don't realize that it has something to do with the season or light/dark or maybe the number of hours of light or dark in the day. In your experience, how do you differentiate between seasonal affective disorder and clinical depression?

DR. NORMAN ROSENTHAL:
Well in fact seasonal affective disorder is one kind of clinical depression. You know clinical depression comes in various shapes and sizes. Some people get it after child's birth, some people get it after the menopause, some people get it in various other situations.

But in these folks they get it when there's not enough lights around, when the days are short and dark. So in fact the whole syndrome maybe very similar to other kinds of depression and the only tip off that you're dealing with SAD is the fact that it comes on every year at the same time and goes away at the same time.

DR. REEF KARIM:
What in your experience, what do you think the cause is?

DR. NORMAN ROSENTHAL:
Well there are several causes and you can think about causes at different levels. But you know in a board sense the one cause is lack of light, so it's going to happen more with people who live nearer the poles, people who live in Alaska or in the northern part of the United States are going to get it more then people who live in LA.

So the lack of light, but it can also be, for example, if you move from a penthouse apartment to a basement apartment you may loose light. Or if you move from an office with lots of windows to one without any windows, that can do it. So a lack of light for any reason can bring out the symptoms.

The second thing is genetic vulnerability because you know people who are genetically predisposed, have it in their family, are more likely to get it. And finally stress, if you're stressed during the winter, the typical example might be the housewife who has to get three kids off to school early in the morning during the wintertime.

And she may suffer these symptoms every year until those kids go off to college and then all of a sudden she's able to sleep in late and life becomes easier and the SAD becomes less severe. So I would say it's a combination of stress, lack of light and genetic vulnerability.

DR. REEF KARIM:
Well let's say that let's use that example of housewife. Is she going to be genetically predisposed to having depression or is any housewife that suddenly is stressed out and maybe moves to a basement apartment vulnerable to seasonal affective disorder?

DR. NORMAN ROSENTHAL:
Well it's an interesting question. I think that there's a certain vulnerability in people with SAD that's a little bit different from other people with depression because the way it seems to me, life is a kind of a nutrient that that all of us need. But some of us need it more then others because some of us have a lack of sensitivity to perceiving life at the level of the brain.

In other words we can see just fine and we can read just fine but at the level of the brain excuse me a moment at the level of the brain, some people have a lack of sensitivity. We did a study, some colleagues and I at the NIH, where we showed that folks with seasonal affective disorder still show a seasonal change from summer to winter when it comes to measuring a basic biological parameter which is the secretion of the hormone melatonin.

Regular folks do not show any change from summer to winter, so in other words, in our world we use artificial lights and it's as though we've kind of flattened out the seasons, the seasons have been neutralized. That maybe so for most people, but for people with SAD, we have not neutralized the seasons because they're not as sensitive to artificial light.

So they still perceive the winter day as a short day even though they have artificial lights on inside.

DR. REEF KARIM:
Well that's a big segue into treatment. But what are the treatment options for people who suffer from seasonal affective disorder?

DR. NORMAN ROSENTHAL:
Well the first and easiest treatment is to get more light in your life. What that means is that you can either use special light fixtures or light boxes, there are several different varieties available and so that is the one thing to think about. You can even just bring more lamps into a room and make one room very bright.

Or you could go outdoors and take the walk in the morning sun on a winter day and that'll give you more light. In any event, the first thing is to bring more light into your room, either with a medical box that is available from a number of distributors or just regular light, lamps and things that make your room brighter.

Or you can get outdoors on a winter morning and get the natural light on a winter morning and all of these things can be very helpful. Decreased stress, stress as I said can cause or provoke SAD, so minimize stress. Don't for example, take on a project with a deadline in the spring because chances are you're not going to be able to meet that deadline if you're not feeling your best.

And if you're feeling really down and you can't pull yourself up easily, you may wish to check in with your doctor.

DR. REEF KARIM:
How many sufferers of seasonal affective disorder are there estimated in the US each year?

DR. NORMAN ROSENTHAL:
I would say about 14 million and then remember for every person with a severe case of seasonal affective disorder, there are probably two others who have a mild case. These are people with what we would call the winter blues so they would not necessarily go to a doctor because it's not bad enough, but they do experience a lack of creativity and a lack of productivity in the winter days.

DR. REEF KARIM:
Do you attribute the the holiday season where I'm sure both of us have seen quite a few quite a bit more upheaval in regards, these days, that a lot of people attribute it to well you know, it's Christmas time and it's New Year's Eve and my family's not the way I wanted them to be.

Do do you think quite a few of those people have either some aspect of the winter blues of seasonal affective disorder?

DR. NORMAN ROSENTHAL:
Well the tricky thing is that the holiday blues are an entity in themselves, there are people who feel down on the holidays.

It's it's a time when a lot of people feel melancholy. However that's a very short-lived thing, it's not really like the winter blues which is four or five months. It's a short-lived thing and somebody with the winter blues can only have a worse case of the holiday blues as well.

But it shouldn't be mistaken, I think the the context in which I've most often heard it is to sort of trivialize seasonal affective disorder, in other words, here is a condition that can last five months and I've many times heard it be passed off as well, this is just the holiday blues.

But it's really much more, remember with seasonal affective disorder, there's a disruption in sleeping, in eating, in energy level, in concentration, it's not just a phase of melancholy. They're two very different conditions that happen to occur at the same time of year.

DR. REEF KARIM:
Are there populations or groups of people, a demographic, that's more apt to experience seasonal affective disorder?

DR. NORMAN ROSENTHAL:
Yes, women more then men by three to one, we don't really know why but we think it's got something to do with the reproductive hormones because after puberty girls are much more likely to have it then before puberty whereas you do not see that same effect of puberty in boys.

After menopause it somehow seems to settle down a little, so it's those reproductive years when the reproductive hormones are having their cyclical fluxes that seem most vulnerable, something about those reproductive hormones seems to sensitize the brain to the effects of environmental light.

So women are more then men north people who live in the north more then people who live in the south and some races seem to be more resistant. For example, Icelanders seem less likely to get the problem and also people in Asia. We've done studies in Japan and China and those folks seem less vulnerable to the winter depression.

DR. REEF KARIM:
Wow, it's funny, women are about two to one more likely to show clinical depression but in seasonal affective disorder it's even higher, it's three to one.

DR. NORMAN ROSENTHAL:
Yes exactly, it's very, very common.

DR. REEF KARIM:
Alright, any final thoughts you wish to share with our listeners today?

DR. NORMAN ROSENTHAL:
No, just that I would say that you know seasonal affective disorder can sneak up on you, so it's easy to kind of pass away a lot of the symptoms as just the malaise of the time of year. But if you've got this collection of low energy and low zest for life and you're sleeping too much do consider that you may have a variation of seasonal affective disorder and that there are so very many things you can do about it.

And of course those things are all summarized in my book "Winter Blues".

DR. REEF KARIM:
Great so we shall look out for the book "Winter Blues". Thank you for speaking with us today Dr. Rosenthal

DR. REEF KARIM:
This is really important information given at a very important time of year. Join us next time for another segment of the Down and Up Show on Depression is Real.org.