Maggie McKay (Host): Welcome to Cook County Health's Total Health Talks where we empower your journey to better health. I'm your host, Maggie McKay. As the days grow shorter and colder, many people notice changes in their mood and energy. Today, we're discussing seasonal effective disorder, often known as SAD, a form of depression that follows a seasonal pattern.

Joining us is Dr. Carlos Quezada-Gomez, Senior Behavioral Health Officer at Cook County Health. He is a psychologist with expertise in mood disorders and seasonal mental health. Thank you so much for being here, Dr. Gomez.

Carlos Quezada-Gomez, PsyD: Thank you for having me, Maggie.

Host: I am really interested in this topic, because I don't know that much about it, but I've heard of it through the years. So for those unfamiliar, what exactly is seasonal effective disorder-- referred to, as we said, as SAD? And how does it differ from just feeling a little down during the winter?

Carlos Quezada-Gomez, PsyD: First, I want to say thank you for inviting me to speak on this topic. It's personal, partly because I experience seasonal affective disorder myself. So, I'm going to be speaking not just from my personal experience, but also with a clinical background. So with seasonal affective disorder, you have symptoms similar to depression, clinical depression. So, you're going to have decreased energy, you can have lethargy, you might be sleeping too much, you might want to sleep a little bit more than normal, so a lot of those symptoms that we associate with depression.

The difference though is that whereas with depression, the symptoms are usually there throughout the whole year. With seasonal affective disorder, it follows the season. So typically, you're going to have it in the winter months when there's a lot less sun, though it can happen also in summer. So when we're looking at it, we're going to be looking at patterns. When do these symptoms kind show up? And if they show up at a particular time in the year and it's consistent over about two years, then we have a pretty good idea that it's going to be seasonal affective disorder.

Host: And what's happening in our brains or bodies when the seasons change that causes this shift in mood?

Carlos Quezada-Gomez, PsyD: It's really amazing. A lot of chemical changes are occurring in our brain. We're thinking, you know, the weather's changing. We understand that. We can see the leaves falling. It's getting colder. A lot of stuff is also happening at the same time. All these things that we see, like the leaves falling, sometimes the cold, those things are kind of like triggers for our mind. And it's saying all these changes are occurring.

So, we have chemicals in our brain called neurotransmitters, and what happens is these start changing, the levels of these neurotransmitters change. And sometimes those chemicals that give us a lot of energy, those go down a little bit and those chemicals that give us that sense of "I'm going to chill out." Those increase during this time because we have internal clocks and those get activated as the days get shorter, we have less sunlight. So, there's a lot going on in our bodies.

Host: Let's talk about where we live. Does that matter? Are there particular people or groups who seem more vulnerable to SAD?

Carlos Quezada-Gomez, PsyD: Absolutely, where you live definitely matters. In places where you have a shorter daytime, you know, less light during the day, like we do in the winter here in Chicago, places like Seattle, the northern part of the United States, you're going to have less sunlight, shorter days during the winter, and that's when you're more likely to experience it.

In addition to where you live, there are certain populations that experience seasonal affective disorder much more often. For example, women are diagnosed at a higher rate than men. Young adolescents, people that are transitioning from that middle school time to maybe going into junior high, they're also really susceptible to seasonal affective disorder. And a lot of that has to do with their schedules in school and just the hormonal changes that occur during that time.

Host: So, what are some early signs that someone might be developing sad as fall turns into winter?

Carlos Quezada-Gomez, PsyD: The first ones you're going to notice is that you don't have quite as much energy as you used to. It's a little harder to get up in the morning. Even though you slept the whole night, you wake up feeling tired. You wake up feeling a little worn out. And then, you're craving food often time. And it's usually the carbohydrates: cereal, cookies, things like that, that'll give us energy, that gives a little more pep for a little while. But also once you eat it, it gives you that sense of almost like relaxing and calm and just can sit back. You also might have some difficulty with concentration. You might feel some sadness, and just feel like you don't quite enjoy things like you used to anymore.

Host: Can these symptoms overlap with other forms of depression? And how do clinicians make that distinction? How do they know?

Carlos Quezada-Gomez, PsyD: Absolutely. They definitely can overlap with other illnesses. So for example, if you're an adolescent, you're more likely to experience irritability. And your SAD can look like you're irritable, more like anxiety. And so, you need to make sure that you can rule that out. With adults, usually, it looks like your classic depression, where you have that sense of hopelessness, this idea of this lack of energy, this desire to eat more or either to sleep a lot less or to sleep a lot more. And what you need to do is really take a really good history, find out when the symptoms occur, when do they start? So, we see them aligning when fall begins to come around. Like now, when the seasons are changing and the trees are changing, those kinds of signs, and we see an increase in the symptoms. And we see that at least for about two years. Again, we're going to look at when do the symptoms occur. That's going to tell us if it's going to be seasonal affective disorder versus depression, or if it's more of that agitation, then it might be more of an anxiety disorder.

Host: Dr. Gomez, when should someone seek professional help and what does treatment usually involve?

Carlos Quezada-Gomez, PsyD: Probably the number one is that when your symptoms begin to interfere with your ability to be able to do what you normally do in life, to function, to be able to go to work, to do your work well, to concentrate. You don't want to be driving in the middle of a highway and, all of a sudden, you're not paying attention, you're not concentrating on traffic, and then you're prone to have an accident. So when the symptoms interfere with what you're doing day to day, that's when you definitely want to seek out help.

The other one is if you experience feelings and thoughts about wanting to hurt yourself, that's definitely where you want to make sure that you go out and seek some professional help.

Host: If someone has had SAD before, is there value in starting treatment or light therapy before symptoms begin?

Carlos Quezada-Gomez, PsyD: Absolutely. It's like almost anything else. If we know something is going to occur, the sooner you can start preparing for it, doing these treatments that we normally would do, so like spending more time outside in the sunlight, being more social, all these things that normally are going to counter the symptoms that we described earlier, you're going to want to do that. If you get on that runway, the longer the runway, the less serious those symptoms are going to be.

And then, of course, if you need to get treatment, then you're going to look at medications, potentially something called cognitive behavioral therapy that looks at the way we think. And then, light therapy, which is a special machine that's going to imitate the light that we normally have at daylight, and that's going to help reset our clocks, our internal clocks that we have, and to reduce some of these symptoms.

Host: Well, let's talk about what people can do right now as we move into late fall and winter. What are some practical steps to manage or prevent SAD? I know you mentioned exercise, which I always ramp it up during this time of year for this very reason. And I also think-- tell me if this is helpful or not-- to get up as early as you can so you have more sunlight.

Carlos Quezada-Gomez, PsyD: Absolutely. You're exactly right. It's those things, plus also maintaining a routine. Because what happens often is, you know, when seasons change, people start withdrawing a little more. And they're like, "Oh, it's too cold to go outside. I don't want to go outside and experience the cold, even if it's to visit with my friends and be social." We tend to withdraw a little bit more. So, keeping to your schedule, making sure you do get up a little earlier and you expose yourself to light first thing in the morning.

Also, even with eating, eating is a way that we also tell our body, "Hey, it's time to get activated, to get moving." So, the earlier you can also eat in the morning, it also starts telling your body, "Hey, get moving, get going." But again, ultimately, the most important thing is get that sunlight, be active, be social and keep to your schedule and watch what you eat. Try to avoid those carbs, eat healthy. Otherwise, it can exacerbate some of these symptoms.

Host: Don't hibernate like a bear, which is very tempting at this time of year.

Carlos Quezada-Gomez, PsyD: Exactly.

Host: You're all cozy in bed and you're like, "I got to get up to go work out. Okay." Well as we wrap up, what's the one message you'd like listeners to remember about seasonal affective disorder?

Carlos Quezada-Gomez, PsyD: Probably the most important thing is that, one, if you do suffer from seasonal affective disorder, there's things you can do. It's manageable. There's treatments for it. And a lot of the simple things that we do in life already just to stay healthy are the things that are going to help us manage this disease well and to live a full life. So, there's hope, and I think that's really important for all of us to keep in mind.

Host: This has been so encouraging and informative. Thank you so much for sharing your expertise.

Carlos Quezada-Gomez, PsyD: Thank you, Maggie, and have a great day.

Host: Thank you. You too. Again, that's Dr. Carlos Quezada-Gomez. To learn more, please visit cookcountyhealth.org/podcast. As we wrap up another insightful episode of Total Health Talks, make sure to visit cookcountyhealth.org/podcast and subscribe to our podcast, share and connect with us on social media. Stay tuned for more engaging discussions. This is Maggie McKay signing off from Total Health Talks. Stay well.