Intro: With a relentless focus on excellence in healthcare, Pullman Regional presents The Health Podcast.

Deborah Howell (Host): Ever wondered why you feel a little blue in the winter months? Well, today, we'll break down what seasonal affective disorder is, what symptoms are associated with it, and why it affects some people more than others. Our guest is Christine Land, a board-certified psychiatric mental health nurse practitioner

Host: at Palouse Psychiatry and Behavioral Health.

Deborah Howell (Host): Hello, Christine, and welcome.

Christine Land: Hi, thank you for having me.

Host: It's our pleasure. Okay. Let's dive right in. What is seasonal affective disorder, and is it the same thing as seasonal depression?

Christine Land: You know, those terms are used interchangeably, but they essentially are the same thing. So, seasonal affective disorder, which you'll often hear people call or refer to as SAD, it is a form of depression, so it doesn't have its own diagnostic criteria. But depressive symptoms when you have seasonal affective disorder, follow a very seasonal pattern, typically in the winter, very rarely in the summer, but that does exist, and they usually last four to five months.

Host: Wow, that's a long time. Do we know what causes seasonal affective disorder and why it does affect some people more than others?

Christine Land: There's three main theories for it because there's no clear psychopathology for what creates this. But the primary theories are, one, your circadian rhythm. And the circadian rhythm is just a fancy term for our biological clock that tells us when to wake and sleep. But we do know that exposure to sunlight impacts that cycle. And so naturally, in the winter months, when you have less sunlight available, that rhythm gets dysregulated and typically leads to those symptoms of SAD.

The other theory is with the serotonin, which is a neurotransmitter or a brain chemical, and that there is typically reduced activity during these periods as well. Sunlight has an impact on how the molecules maintain serotonin levels. So once again, with less sunlight, then your serotonin typically goes down and that reduced activity occurs.

And then, the third thought is that melatonin also plays a part in that. And melatonin is just a hormone that our body produces itself, but it also regulates our sleep cycles. You know, again, it tells us when to sleep each night. So in the seasons, with the changes and stuff, the melatonin levels are produced differently.

So, those are the three main things that attribute to causes of seasonal affective disorder. Some people are just affected more by it. And there's a couple of different reasons for it. There's some risk factors that are common. So, if you have already been diagnosed with major depression or bipolar depression, then you run a higher risk of having a seasonal pattern to your depression. That could mean that you have a low level of depression all the time, but it just worsens during those seasons.

Host: I see.

Christine Land: Yeah. And so, they do think that also there's a family or genetic component to it. That can happen, because they do find it more common in people who have relatives that have other mental health issues such as depression or even schizophrenia.

Host: Okay. All right. Good to know. So, I'm curious, are there certain age groups, locations or maybe other demographics that are more likely to be affected than others?

Christine Land: As far as ages and stuff, it can happen within the age. But the most typical onset of this is between 18 and 30 years of age. And then, it can obviously continue through life for some people. Location wise, the thought is that the occurrence is more common in those of us who live in the northern latitudes, which when you think about it, yeah, we have more winters, less sun, so it certainly is going to lead to some of that. And then, demographic wise, it tends to happen more often in women than it does in men. Some say it could be as many as 5% of adults in the United States have this. It's often underdiagnosed because it can be difficult to know, you know, "Is this just lack of activities to do so I feel a little down?" But there can be some medical issues that can kind of mimic it as well.

Host: So, what can people do to help alleviate seasonal affective disorder symptoms and feelings?

Christine Land: There's a couple of things that can be done. So, one of the things that we can do on our own first is just take care of your general health and your wellness. And that's things like, regular exercise or movement, eating healthy, making sure you get sleep, because as we mentioned, sleep has a big part of this. And then, just staying active and connected, which can be things like volunteering, going out with friends and family, just finding things to do. But other than that, we can look for somebody who has the diagnosis of seasonal affective disorder.

Light therapy can be very helpful. It's really kind of interesting. We know it actually has been around since the 1980s, just used in different ways and becoming more and more well known now. But that exposure to that light every single day helps make up for the natural sunlight that we're missing during certain times of the year. You do have to be cautious about where you get this light. They call them the sad lights. I call it the happy light because that's what we want it to be. but just make sure you do your research as far as what the intensity of the light bulbs are and that they are the regular light bulbs because you're not going to use just our everyday normal light bulbs and stuff. But that is known to be really helpful for people who can use that for 30 to 60 minutes every single day and just get that exposure during those times.

The other thing we can do is antidepressants can be very helpful for people. And typically, the SSRIs, which are selective serotonin reuptake inhibitors, again, referring back to that disruption in our serotonin, those usually respond very well for people, and that can be something that somebody takes leading up to the season that they're affected so, for instance, starting in the fall and then discontinuing it in early spring or something. They did find that there is another type of antidepressant called bupropion, which is very helpful and can be used for long term if somebody needs that.

Psychotherapy is another component that can be very helpful for people. And typically, that's using cognitive behavioral therapy, which is a specific form that teaches people the skills to cope with difficult situations. So, in this situation, it could be replacing the negative thoughts about dreading that winter's coming. "I'm not going to be able to be outside as much." So, how do we replace those negative thoughts for something more positive and bring about change that way?

Host: Does lack of vitamin D play a role in seasonal affective disorder?

Christine Land: There is a role to it. It's not responsible for it, but we do know that a lot of people that have seasonal affective disorder also have a vitamin D deficiency. So, vitamin D is important for promoting serotonin activity so, again, going back to that key brain chemical there. And our bodies produce vitamin D. We can get it through some food sources, but a lot of it comes from exposure of sunlight on our skin. So again, less sunlight out there, yeah, there goes your vitamin D. So, sometimes, vitamin D supplementation can be really helpful in relieving some of the symptoms and stuff. It's something that you probably should check with your mental health or medical professional just to see what your levels are, and if supplementation is helpful for it.

Host: Okay. I have one last question for you, Christine. When is it time to seek out care from a mental health professional?

Christine Land: Good question, because we do know with depression, if it goes untreated, it can become progressively worse. And we certainly don't want that to happen. When seasonal affective disorder starts impairing your daily functional activities, you know, having an impact on being able to go to work, to care for yourself, care for your children. Those are clear signs that help could be very helpful for you. So, we encourage people to, if they don't already have a mental health professional, contact your primary care provider to try to get a referral, but just reach out to somebody. If it got to the point where somebody started having thoughts of harming themselves, again, seek help immediately. And if you can't get into your provider, there are national hotline numbers, 988, which you can call or text, get some help that way, and find resources.

The other thing that's really important about reaching out to a medical provider, if you are having this, is that we want to rule out that there aren't some physical or medical conditions causing this, again, vitamin D deficiency, thyroid, things like that. So, those can be causes for the symptoms or they can just contribute and make it worse. So, it's a good thing to reach out for that.

Host: This is so enlightening. Christine, we so appreciate your time and everything you do to help our wonderful patients. Thank you so much for being with us today.

Christine Land: Well, thank you for having me.

Host: That was Christine Land, a board-certified psychiatric mental health nurse practitioner at Palouse Psychiatry and Behavioral Health. And you can learn more about this subject, providers and services at Pullman Regional Hospital online at pullmanregional.org/mentalhealth. This has been the health podcast from Pullman Regional. I'm your host, Debra Deborah. Thanks for listening and have yourself a terrific day.