Transcription:

Scott Webb (Host): Many of us have had the winter blues from time to time. But when those feelings worsen, it might be an indication that we are suffering from a seasonal affective disorder. Also known as SAD and it might be a good time to reach out for assistance. And joining me today to help us understand seasonal affective disorders and the treatment options, is Ashley Turner. She's a Board Certified Psychiatric Mental Health Nurse Practitioner with Franciscan physician network, outpatient behavioral health.

This is the Franciscan Health Doc Pod. I'm Scott Webb. Ashley, thanks so much for joining me. You know, sometimes people do get the winter blues. And I think we all know what that's like. It gets a little gray, a little cold, and we start to feel the blues a little bit, but sometimes it's more than that for people. And that's what we're talking about today. We're talking about seasonal effective disorder. So, let's talk about that. What exactly is seasonal affective disorder?

Ashley Turner, PMHNP-BC (Guest): Yeah. So, seasonal affective disorder is a type of depression that usually comes and goes. The season typically starts in late fall and early winter. And then we see it go away in the spring and summer. It can occur in the summertime and then go away in winter. That's not near as typical, especially here in Indiana.

   Host:  So, what are the symptoms of seasonal affective disorder?

Ashley: So, the symptoms of seasonal affective disorder are really the same as the symptoms of depression. So, feeling sad, down, not having a lot of energy, feeling fatigued. And then we have some atypical symptoms, weight gain, sleeping too much, increased appetite. Sometimes people will find themselves withdrawing from social situations, isolating themselves.

Host: That prompts me to think about COVID and quarantining and lockdowns. And so this has probably not been a great time, winter, people getting seasonal affective disorder and trying to deal with COVID and social distancing and all of that. So how are you navigating all of that in your work with patients?

Ashley: It's been a very challenging time for our office and, you know, just everybody in general. It's a different world we're navigating through and we've seen a very increase in the amount of patients that are being referred to our office. And the patients that we are seeing are really struggling with changes in their day to day activities and the way that they're having to work, find childcare, all of that stuff is having effect on their mental health. And so not only are they dealing with their baseline mental health, but now they're having all of these external factors going on. And so we're really seeing some exacerbation of mental health symptoms and it's not been great.

We've really been encouraging people, especially in the winter time, not to withdraw socially and even though we can't get out and really get in big groups and go to social gatherings, still to maintain social contact, whether it be virtually, on the phone, things like that, so that we're not isolating.

Host: So, when we talk about seasonal affective disorder, who's at the greatest risk?

Ashley: Actually females. They are four more times likely than males to develop seasonal affective disorder. Definitely those that live in climates like we do. So, the further away you live from the equator, the more likely you are to develop seasonal affective disorder. I think the statistics show around like 1% of individuals in Florida have seasonal affective disorder. We're about 9% in the New England and Alaska area. And so of course we live in the Midwest where it's not sunny very much in the winter time. And so we see it a lot here.

Host: So, Ashley, when we talk about the treatment options for seasonal affective disorder, what are the different options available to people?

Ashley: There are lots of different options available. And I think, you know, the biggest thing would be to get outdoors. And I know people think, oh my gosh, it's cold. I don't want to get outside, but really getting outside, even if it's just for a short amount of time can be very beneficial. Even if it's overcast, we're still getting light and that's really important. So, getting outside, getting some physical activity, of course bundle up, you don't want to get frostbite is very important. Getting that fresh air. Vitamin D at this time is really important. So, having your provider checking vitamin D levels and making sure you're not deficient in that. One big thing I'm a fan of is light therapy and light therapy has been shown to be very effective for individuals suffering from seasonal affective disorder. So, I typically tell my patients to get a light that it doesn't matter what brand of light you get. It just has to be 10,000 LUX. That's the power of the light and using it in the morning for about 20 to 30 minutes.

And it has to be two feet away from your face because it's pretty bright. And what that light does is it helps shut down natural melatonin production to restore that circadian rhythm. And when the circadian rhythm is restored, that kind of helps with sleep, helps you feel more energetic during the day and helps with those symptoms of the seasonal affective disorder, because they think one of the theories is that because it gets dark early, is that it creates a disruption in our circadian rhythm that kind of leads to these depressive symptoms. And that's kind of the theory behind light therapy. I use it a lot for my patients and a lot of them have found it pretty helpful. Another thing is exercise and I can't stress that enough. I think that's such an important component just with health in general. But especially with people who suffer from depression is getting that exercise, getting your heart moving and getting it probably about three to five times a week, 20 minutes a day. It boosts all the good chemicals in your brain, serotonin, dopamine, all of that. Also something called BDNF is released. And so BDNF is brain derived neurotrophic factor and that's essentially like miracle grow for your brain. And so, that spurs on neurogenesis and neurogenesis helps change and grow and make the brain heal and make smoother connections in the brain. So that your brain is not as static. It helps release natural endogenous endorphins that help with pain control, mood, sense of safety and security and can kind of help with those symptoms of seasonal affective disorder and other mental health issues that people are facing. And so if anything, exercise. And exercising outdoors, even though it's cold.

Host: Are meds kind of a last resort?

Ashley: You know, really they are. Anytime we can do anything that's non-medication I think we should try that first because medications are chemicals, right. We're putting a foreign substance into our body. So, anything that we can do that is not medication to improve our health. I would say trying that first. And so doing the exercise, getting the vitamin D checked, utilizing the light therapy, as long as somebody's not to the point where they're feeling suicidal or they're not taking care of themselves, I think doing those natural things first, is a great way to start improving their mental health before relying on medications. When it comes to medications, medications such as SSRIs and Wellbutrin are good options for treating seasonal affective disorder.

Host: So, Ashley, if you don't have a diagnosis of SAD, but suffer from depression or bipolar, what can you do to help prevent symptoms from worsening during these winter blues, these winter months, or when seasonal effective disorder usually kicks in for people?

Ashley: I think one thing that's really important is especially if you know that you're prone to seasonal affective disorder, or if you already have a diagnosis of depression or bipolar, that it worsens during the winter months, is to get ahead of the game. So, yeah, before fall hits is to do a self-assessment or get with your mental health provider and say, okay, where am I mentally? It's becoming that time, closer to winter where I know I get worse typically. So, do I need to make sure that my meds are right? I need to get out my therapy lamp? I need to make sure that I'm eating healthy and that I'm on a good exercise program and kind of planning for that potential decompensation in their mental health. And I think that's really important, because I think if we can get ahead of the game, then we're less likely to see a decompensation in symptoms.

Host: And Ashley, as we get close to wrapping up here obviously there's a lot of stigma when it comes to mental health for people and so reaching out and getting people, encouraging people to reach out when they need the help that they need, whether it's because of seasonal affective disorder or any other mental health reasons. So, what's your best advice? How can we get people to do that? How can we make them feel like it's okay to reach out if they need help because of SAD or really anything else?

Ashley: I think that it's very important that we obviously promote mental health and help break that stigma, because I think a lot of people think that just because they're experiencing mental health symptoms, that for some reason they're weak or there's something wrong with them. And it's really no different than if they had diabetes or some other physical ailment. And so, I think it's important to let people know that if they are feeling bad, to reach out to their primary care provider who can help with a referral or to reach out to a close friend. A lot of times employers have employee assistance programs that they can reach out to. And a lot of these programs are confidential. I know our offices definitely have to follow HIPAA guidelines where it's confidential. So, if people are worried about that, don't be afraid to ask for help and even just to be assessed and it may be something that you don't need medication. We can offer other suggestions. We have therapy in our office. Maybe it's just that you need to talk to somebody. And so really don't wait before it gets too out of control. You know, if you're feeling bad, seek out help.

Host: Yeah, that's great advice. And sure, a lot of people get the winter blues, if you will. But sometimes it's more than that. Sometimes it is seasonal affective disorder and there are so many options available, as you said, that don't include meds, therapy, light therapy, vitamin D. We just want people to reach out. So, whether they're reaching out to their primary and then escalating and speaking with someone like yourself, the main thing is it's a real thing. It's highly treatable. We can do it at home and we can, you know, advocate and look out for and take care of ourselves. And we really hope that people do that. So, Ashley, thanks so much for your time today and you stay well.

Ashley: Thank you. You too.

Scott Webb (Host): Call 844-FPN-APPT to find a primary care provider or visit Franciscandocs.org. And we hope you found this podcast to be helpful and informative. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.