Joey Wahler (Host): It's often called SAD, S-A-D, or winter blues. So, we're Discussing Seasonal affective disorder. Our guest is Christine Emmel. She's a nurse practitioner with Mount Carmel Health System, This is Wellness In Reach, a Mount Carmel podcast. Thanks for joining us. I'm Joey Wahler. Hi there, Christine. Welcome.

Christine Emmel, APRN, CNP: Good morning. Thank you for having me.

Host: Great to have you. Appreciate the time. So first, in a nutshell, for those unfamiliar, what exactly is seasonal affective disorder and how would you say it differs from general depression that we hear so much about?

Christine Emmel, APRN, CNP: Seasonal affective disorder is a subtype of depression that occurs typically in the fall and winter months when our circadian rhythms and less daylight tend to affect our mood. So, it differs from regular depression, that it's only during those seasons and it will typically remit when we have more daylight and spring comes.

Host: I know personally, it's only recently that I discovered that this is actually a thing and it's a big thing for a lot of people, right?

Christine Emmel, APRN, CNP: It absolutely is. In fact, it wasn't until the early '80s that this was discussed as a possible condition that affected people that affected their daily lives and caused an interruption in their living.

Host: So, what is it about seasonal changes and any biological factors that go along with that that contribute to SAD?

Christine Emmel, APRN, CNP: Well, the lack of light is the biggest factor. As you know, we set our clocks back a couple of weeks ago, and most of us are still recovering, and finding that those evenings seem very long and very dark. That change has a profound effect on our moods. Light improves our moods. Sunlight helps us to feel good. It helps us to refresh. It provides us with vitamin D.

Host: And for those of us living in climates where it gets cold during the winter and, of course, starts to, to some degree, during the fall, there's also the idea that the spring and summer months are no more, and now it's time to bundle up and hunker down. And for a lot of people, that can be upsetting, right?

Christine Emmel, APRN, CNP: Absolutely. We enjoy our outdoor activities and the idea that the things that we may enjoy. I, for one, love to bike ride that's no longer an option. And trying to find a new activity when people have a summer activity or an activity that requires daylight that they enjoy, that's good for their mental health, that helps to keep them feeling sane. When that's no longer an option, we can struggle trying to replace that with a new activity that maybe we don't enjoy as much.

Host: Well, you mentioned the light factor, daylight. And we just covered the fact that the weather obviously gets colder, that's a factor here. So, what populations are more susceptible to experiencing this?

Christine Emmel, APRN, CNP: Really, there are no specific populations that are affected by this more than others. It can obviously exacerbate someone who was already being treated for depression, and that could become a bigger problem during the winter months and maybe the treatment plan would need to change.

For others, they may have no signs of depression, no issues with depression the rest of the year. And once the season hits, you're struggling with feeling motivation, wanting to get out and do things. You know, we go home at the end of the workday, it's dark and we don't want to leave. We're done. We're ready to hibernate. And that's common. That's common. When it's a problem is when it begins to affect your daily life. When you are not getting out of bed, when you're sleeping more, when you begin to eat more, especially, we all crave comfort food in the cold months. One of the facets of seasonal affective disorder is that you start to crave them more, so you might tend to gain weight. That would be a huge difference with other types of depression, which can have weight loss or weight gain. Typically, with seasonal affective disorder, it is weight gain.

Host: And so, it also seems, Christine, that a lot of these things you're discussing here that make people uncomfortable at that time of year, it really all kind of comes under the umbrella, doesn't it, of having less control over the situation. You can't go out when you want to. You can't, in your case, bike ride when you want to. It kind of makes you feel like a little bit more of a prisoner at times, right?

Christine Emmel, APRN, CNP: Exactly. And then, we isolate. So when our friends are asking us to go out to dinner or someone wants to go see a movie, we say no because we want to be home. And we don't want to leave our house. We're happy to hibernate. Those feelings of isolation compound the issue, because isolation thus creates worsening depression. It's a slippery slope.

Host: Absolutely. So, you mentioned that the line here, if you will, is when this type of thought process, this type of depression begins to control your daily life. So, how would someone go about getting this diagnosed to see if in fact that's happened?

Christine Emmel, APRN, CNP: Well, you would schedule an appointment with your primary care provider. Go in, talk to your PCP, let them know what's going on. It would be important to let them know has this happened before. Because repeated cycles of depression, you know, in the fall and winter months is indicative of seasonal affective disorder as opposed to just having the winter blues, which we all get.

Host: So since we've discussed the geographical impact here in terms of the weather changes, et cetera, is it safe to say that those that live in a climate where it's more the same year round weather-wise, they're less susceptible to this?

Christine Emmel, APRN, CNP: The further away from the equator that you live, the more that you'll be affected by it. You will have less daylight. So, I know how it is here in central Ohio. It can be think about people living in Canada closer to the Arctic Circle. It's worse.

Host: You mentioned the light factor. I want to ask you more about that. Because when daylight savings time comes into play in terms of changing the clocks, adjusting that one hour, it's interesting, isn't it, Christine? Because we're only talking about one hour. But if only psychologically, and we're talking psychologically here, it makes a huge difference to people, doesn't it?

Christine Emmel, APRN, CNP: Well, it does. And that one hour is also in combination with us having less daylight, even if we weren't to change the clocks. So, just that one hour of setting everything back, suddenly we're leaving work at 5:00, 6:00 PM in the evening, and it's dark. It looks like it could be 9:00 or 10:00 PM. And psychologically, that makes you tired. It's not motivating.

Host: Absolutely. And so speaking of which, when we talk about light in this context, there's something called light therapy. What is that and how can that be helpful here?

Christine Emmel, APRN, CNP: Light therapy is a first line therapy that patients can use and you do not need to see your PCP. You don't need a prescription. You can go on to Amazon and order a light therapy box. There are certain specifications to get that will help you. Research has strongly suggested that using the light box every day-- consistency is key. But using it every day for 30 minutes, especially in the morning, will help to reset your circadian rhythm and help to dissipate those feelings of either the winter blues that some may be having or if it is true seasonal affective disorder.

Host: Circadian rhythm, meaning what exactly?

Christine Emmel, APRN, CNP: Our body's natural clock. Our body has an internal clock, and it gets reset when there's less daylight. It confuses our internal clock. Again, coupled with the switch in the daylight hours, it can make us think that, you know, it could be 6:30, we may feel like it's 10:00 PM. And then, suddenly, you're wanting to go to bed, because it looks to be midnight outside. So, the circadian rhythm, like I said, it changes. And the light box will help to reset those circadian rhythms or our natural clock that lives inside of us. That kind of lets us know when it's time to go to sleep, when it's time to wake up.

And then, coupled with the light box, having a normal sleep schedule, going to bed at the same time every night, getting up at the same time every morning. I know we don't want to hear that, you know, on the weekends or our days off, that we shouldn't be sleeping in, but it does affect our circadian rhythm as well.

Host: How about treatment options here? Which ones are most effective and are there any new advancements in this area?

Christine Emmel, APRN, CNP: Treatment options can include, in addition to the light box, which is a first line therapy, cognitive behavioral therapy is also a great option for patients to learn skills to deal with their depression that is occurring during the winter months, to learn skills, to learn strategies so that they can still lead a happy life so that they can still enjoy their life, even if they're not seeing as much of the sun.

Medication is always an option if these things didn't work or if someone were struggling to the point where they're not able to live their life. Wellbutrin is a first-line medication. It's an antidepressant that is often used. It is the one that is indicated for seasonal affective disorder, but others can be used as well. In addition, there is emerging research on other therapies such as vitamin D.

Host: A couple of other things for you, entering a seasonal change, you just talked about some treatment options, but how about on our own? Any specific preparation for the change upcoming or lifestyle changes we can make in general that can help mitigate these symptoms you've discussed?

Christine Emmel, APRN, CNP: So, I think being aware that it is pretty much a struggle for all of us when the daylight hours are changing and we're not seeing as much sunlight, which can rejuvenate us. So, coming up with a plan, listing some new activities. Maybe there's some outdoor activities, you know, on the weekend that you might enjoy doing in the colder months that aren't an option in the summer months. For example, tubing could be something fun to do. But as you start to get more snow, having weekly plans with our friends, maybe like a Tuesday night dinner date with a group of friends that you plan on going to, and that you all sort of hold each other accountable saying, you know, "We're going to go," no one wants to leave their house after 6:00 PM, we know that, but this is important. We don't want to isolate, because it's not going to make us feel better.

I would say taking your vitamin D supplements is also very helpful, because we are getting with less daylight, we get less vitamin D. And that can also-- not to get off topic-- affect our immune system and then we can be sad and sickly.

Host: Then, finally here, in summary, Christine, how would you say family, friends, loved ones can support someone that's dealing with seasonal affective disorder, especially if maybe they themselves don't suffer from it and maybe they can't relate firsthand.

Christine Emmel, APRN, CNP: If you have that friend who is constantly turning down plans, constantly just choosing to stay at home, and maybe this is someone who normally likes to go out, likes to have fun, likes to be social, and you noticed that they just don't have that desire anymore. You know, check on them, encourage them. Sometimes you can even be a little pushy, and that's okay. Just say, "I know that you're struggling. I know that you don't want to do this. But I promise you, you will enjoy being out amongst people, getting out of your house." Maybe go to their house, if it's someone that you feel you can just pop in on. Go over, you know, bring a pizza and just say, you know, "I just wanted to see you, and I want to make sure that you weren't alone."

Host: That sounds nice. I'm sure that those that suffer from this, just that little bit of attention, of thought, of caring can go a long way just to changing the mindset, right?

Christine Emmel, APRN, CNP: Absolutely, absolutely. We are not meant to live life alone.

Host: No question about that. Well, folks, we trust you are now more familiar with seasonal effective disorder, more common than you think. Christine, valuable information indeed, especially as the seasons change. Keep up all your great work and thanks so much again.

Christine Emmel, APRN, CNP: Thank you for having me.

Host: Absolutely. And for more information, please visit mchs.com. If you enjoyed this podcast, please share it on your social channels and check out the entire podcast library for topics of interest to you. Thanks so much again for being part of Wellness In Reach, a Mount Carmel podcast.