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Carl Maronich (Host): Welcome to Expert insights from Carle Foundation Hospital. I'm Carl Maronich. And joining me today is Dr. Bienvenu Nzinga, a psychiatrist from Carle Foundation Hospital, And we're going to be talking about seasonal effects on mood and specifically seasonal affective disorder. Doctor, welcome to the podcast.

Bienvenu Nzinga, MD: Thank you so much.

Host: Yes. Glad to have you here. And maybe we can start by having you explain just what seasonal affective disorder is and how it affects people.

Bienvenu Nzinga, MD: Seasonal affective disorder can be defined as recurrent episodes of major depression or mania or hypomania with a season onset and remission. So, the essential feature is that onset, and the remission of the mood episodes occur at a specific time of the year. So, seasonal affective disorder, it's not a separate mood disorder, but a subtype of major depressive disorder or bipolar disorder. Major depressive disorder with seasonal pattern, especially the winter onset seasonal pattern is the most common one that we have.

Host: And what are the most common symptoms of seasonal affective disorder?

Bienvenu Nzinga, MD: So, the clinical feature of seasonal affective disorder depends on the specific mood disorder that is present. As I said, it can be major depressive disorder or bipolar disorder. I would like to focus on, which is most frequent or most common. As I said, major depressive disorder with a seasonal pattern is the most concerning, most especially the one that starts in winter. So, symptoms-wise, it's almost the same with non-seasonal depression. But we usually observe or notice typical features or symptoms, which include increased sleep, increased appetite, carbohydrate cravings, and weight gain. But besides these specific symptoms, we have this, in general, depressed mood. We can have anhedonia, which means loss of interest in the things that the patient likes to do. We also can have other symptoms that include disturbed sleep issues, difficulty sleeping, decreased appetite, difficulty concentrating, low energy, loss of motivation. And depending on the severity, we can have also, for some patients, suicidal ideation.

Host: Doctor, what are some of the treatments that are available for those suffering from seasonal affective disorder?

Bienvenu Nzinga, MD: Treatment is influenced by the severity of illness. Based on severity, it can be, one, what we call monotherapy, which means just one medication or combination therapy. In general, it's possible to use medication. So, we use antidepressants. So if it's not medication, it can be light therapy-- I can explain that. So, if it's not light therapy, we could also use psychotherapy. So, it's just talk therapy that a lot of people call counseling. But besides these three treatments, it's possible also to focus on a few things like sleep hygiene. Making sure the patient has good sleep, daily walks outside, exercising.

And in terms of medication, as I said, antidepressant can be SSRI or SNRI. But I would like to mention that for seasonal affective disorder, it's possible also to use a specific medication. It's called bupropion or Wellbutrin because studies demonstrated efficacy in preventing recurrences and avoid SSRI side effects such as weight gain or sexual dysfunction. But for Wellbutrin or bupropion, we need to make sure the patient doesn't have any history of seizure or some specific eating disorder like anorexia or bulimia because we can lower the seizure threshold and increase the risk of seizure.

Host: Doctor, maybe you could talk a little more about light therapy and talk a little bit about how that is prescribed and how long someone might sit in a light, or maybe you could just elaborate a little more on light therapy.

Bienvenu Nzinga, MD: So, light therapy, usually, we use the light box. We like to use the one with 10,000 lux. So, it's possible to get it. It's recommended to use it while the patient is seated and facing the box, typically 16 to 31 inches. And it's recommended to use it in early morning. It is suggested to do that 20 to 30 minutes in the morning. Usually, after using that for two to four weeks, for a lot of patient's, they can notice some benefit from using that. In general, by itself for some patients, it works. But for other patients, we need to combine light therapy with other types of treatment.

Host: Doctor, does the light box differ from just going outside and getting in the sunlight?

Bienvenu Nzinga, MD: Good question. We use it, as I said, for the most common, seasonal affective disorder. It's the one that starts in winter. So, we know that, in winter time, sunlight is very, very rare or infrequent. So, it's the reason also when we talk about causes, we notice that patient-- because of the change in daylight-- it's also possible that it increases the risk of seasonal affective disorder. So, if it's possible to be exposed to sign light, it'll be good. But we know that it's less frequent to have sunlight during the winter time.

Host: Doctor, what role does diet and exercise play in managing seasonal affective disorder?

Bienvenu Nzinga, MD: It's not just for seasonal affective disorder. We know, in general, for depression, exercising, diet, sleeping, all can affect positively or negatively our mood. So for someone who has difficulty sleeping, it's possible that it affects the mood. The same also for someone who's struggling or doesn't have a normal diet, not enough exercise. It's possible also that it affects negatively the mood. So again, it's not just for seasonal affective disorder, but it's mood in general. It's why besides medication, besids therapy, we also, usually in terms of treatment, make sure the patient has a good lifestyle, because we know that it can affect positively or negatively the patient's mood.

Host: Doctor, are there long-term implications of untreated seasonal affective disorder?

Bienvenu Nzinga, MD: So, long-term seasonal affective disorder, it's a type of mood disorder that can happen every time we have mood change. So, for some patients, it can happen every year. In general, depression, if it's not treated, it's possible that it becomes more severe with suicidal ideation. Some patients can go from a simple suicidal ideation to suicidal attempt or complete suicide. So, that will be a bad outcome.

Besides that, depression in general, we know that it can affect life for someone who works, for example. Depression, he's not going to be able to work. And not working or not being able to go to work means less income and more financial issues And for someone who struggles financially, it's possible also to have other issues in life. So, it's better, it's recommended to take any depression or depressive episode seriously to make sure the patient is able or is treated correctly in order to prevent suicidal attempt or any negative impact in his life in general.

Host: Doctor, as we wind up here, let me ask, what advice would you offer to someone who suspects they may be suffering from seasonal affective disorder and hasn't yet gotten professional help?

Bienvenu Nzinga, MD: My advice would be to seek help, not necessarily to see a psychiatrist. I'm sure that a lot of patients have a primary care doctor. So, it's my recommendation to start with the primary care doctor to make sure that the diagnosis is made and to also make sure that beside s seasonal affective disorder, if the patient doesn't have any other medical condition that also can cause or make depression worse. And to prevent any negative effect on his life, my recommendation is, at least, to see the primary care doctor. And a lot of times, a lot of primary care doctors are able to manage minor or moderate depression, and it could be enough. But in terms of when it's more severe, for a lot of primary care doctors, they prefer to refer the patient to a specialist.

Host: Yeah. Very good. So starting with your primary care doctor, always a good idea. Well, Dr. Bienvenu Nzinga, you've offered a lot of great information. We appreciate you being part of the podcast today.

Bienvenu Nzinga, MD: Thank you.

Host: For more information and to get connected to one of our providers, please visit carle.org. If you enjoyed this podcast, please share it on your social channels and check out the entire podcast library for topics of interest. And this is Expert Insights from Carle Foundation Hospital. Thanks for listening.