Disclaimer: This podcast is for informational purposes only and is not intended to be used as personalized medical advice.

Amanda Wilde (Host): Seasonal affective disorder or SAD is a type of depression that can affect anyone. Dr. Devon Kienzle is a family medicine provider who specializes in Obstetrics, and he's here to help us understand what SAD is and how to address the symptoms.

This is Be Well with Skagit Regional Health. I'm Amanda Wilde. Dr. Kienzle, thank you for joining me to unravel seasonal affective disorder or SAD.

Dr. Devon Kienzle: Yeah. Thank you so much for having me. I'm excited to talk about it. There's a lot of things to know about seasonal affective disorder and perceptions and misconceptions and how to handle it. So, it's a good conversation, especially for the season that we're in.

Host: Well, can you talk about what seasonal affective disorder really is?

Dr. Devon Kienzle: So, seasonal affective disorder is a type of mental health condition that has a seasonal pattern to it. Oftentimes, you'll hear people talk about winter depression or SAD, like you had mentioned, but it's a little bit of a misnomer, actually. Because there are people with major depressive disorder and people with bipolar disorder, that can have manic episodes or hypomanic episodes, so bipolar I and II. And actually, those people can also have seasonal components to their conditions. So, seasonal affective disorder is a seasonal component to either major depression or manic episodes. So, sometimes we miss it and our community misses it, we have providers that miss it, because they don't realize that there can be a summertime seasonal affective disorder as well.

Host: So, what causes these seasonal affective disorders? What about the seasons that causes SAD?

Dr. Devon Kienzle: Yeah. Perfect. I love how you worded that, seasonal affective disorders. That's perfect. And it's true, the majority of our population really does have the winter component of seasonal affective disorders, so it's much more common than the spring-summer component. The fall-winter is what we refer to it as. And fall-winter depression, seasonal affective disorder, is much more common.

And we don't know exactly what causes it. There's lots of potential theories and some that logically certainly make the most sense. For example, one of the most prevailing theories is just the component of disruption in the circadian rhythm, right? We tend to sleep differently as we move into a new season. I think we could probably take the rest of this podcast and talk about just the winter component, because that's what we're moving into. But as we move into the winter, certainly our sleep pattern changes, we have more darkness. And so, that change can lead to an onset of depressive symptoms that will persist throughout the winter and then start to resolve as we move into spring and summer.

But there's other theories, just the typical serotonin component of it is a major thought process of what causes it. There's also genetic components. There's a little bit of just actual light exposure as to the sleep dysregulation that can happen. But in the end, we don't really know what causes it, just that it happens and it seems to persist throughout the entire winter for those people.

Host: So, you defined what it is, but that there can be seasonal components to other kinds of depression. So, what are the most common signs or symptoms that someone might be dealing with seasonal affective disorder rather than one of those other conditions or just winter blues?

Dr. Devon Kienzle: Yeah, perfect. So, the real difference between winter blues and depression is the severity of your symptoms. That's it. So, what the seasonal affective disorder is a major depressive disorder that only persists throughout the winter season or the fall to winter. And it's characterized by some sort of sleep disturbance, whether that means you're not sleeping enough or you're sleeping too much, a change in level of interest in doing things, you stop enjoying the things that you would've otherwise enjoyed doing, a sense of guilt and worthlessness, lower energy, trouble concentrating, or trouble processing thoughts, change in appetite that can be increased or decreased, easier agitation or just, again, like a slow responsiveness. And then, of course, the big one, which I think would be the easiest way to say, "Hey, this is maybe more than winter blues," which is thoughts of hurting yourself.

The unique part specifically of seasonal affective disorder, all those things pertain to depression and seasonal affective disorder. The difference between seasonal affective disorder is that it's only during that, it sets in during the fall to winter and will resolve or start to resolve as we move into the spring. And another little detail there is that it tends to be that with seasonal affective, the sleep disturbance is that you're sleeping more, not less, and that your appetite is increased more than decreased, especially with carbs. And people notice a little bit of weight gain there. And those are kind of the more atypical components.

Host: Well, Washington State is known for its long gray winters. Are people here more prone to SAD compared to other parts of the country in those fall and winter months?

Dr. Devon Kienzle: Yeah, that's a great component. And something else I think is worth talking about, because I think sometimes people who live in the lower states and the lower latitudes think that, "Oh, I live where it's sunny all the time. I shouldn't be having seasonal affective disorder," or some people might even consider moving to resolve their seasonal affective disorder. And the literature is not entirely clear. It depends on the studies we look at. Some of those studies say yes, higher prevalence in Washington State and Alaska, and places where it's darker more frequently. But a lot of those studies use less stringent criteria for the diagnosis.

There are plenty of studies also that say that really it can affect anyone regardless of where you live. And it's more of that, again, just a change in sleep patterns or change in serotonin as the season changes. So, I would say it's fair to assume, fair to think that, yeah, we live in Washington, so you're higher risk. But if you don't live in Washington, I would caution people not to just clearly rule out that that's what it is.

Host: At what point should someone consider seeing a doctor for SAD?

Dr. Devon Kienzle: That's probably the toughest question for me to answer, but I would say if you feel like there's something wrong, if you feel or if your partner feels like there's something wrong, someone close to you, a friend says, "Hey, I noticed that you are having trouble as we move into the winter," or "What's different about you?" And then, you notice, "Well, it is winter," that might be a great time to talk to a provider.

The probably biggest thing though, is that if it's affecting your day-to-day activities. If some of those symptoms that we listed a minute ago are affecting your ability to accomplish the things that you want to do or you notice that you used to enjoy something and now you don't, that's a good time to talk to a doctor about it and leave it to them to decide is this more of a seasonal affective disorder and should that change how we manage it, because it can.

Host: So, you really have to observe your own self and make decisions based from there. But if you do decide to go to the doctor, what can we expect in terms of diagnosis and then treatment options?

Dr. Devon Kienzle: In terms of diagnosis, the first step is going to be asking questions about those symptoms I just brought up. But there should be more to that. There should always be a doctor or providers who should always question if there is a seasonal component to things. When did it start? When did it get better? Has this happened before? A common story is that like, "Well, yeah, every winter for years, I've had a hard time. But it gets better in the summer, so I don't worry about it." And that might be fine. The question is, "Well, is every winter, your family's suffering? Is every winter, your job's suffering? Is every winter, your relationship's having trouble? Do you go through a breakup every single fall, winter season?" or something like that, that really we could help you manage that so it doesn't happen. So, we'll talk about that. We'll ask about symptoms; we'll ask about the seasonal patterns. And then, we find out, "Okay, what else is contributing to these things?" You know, a good follow-up question is, well, what can we do about it? Well, some of those things are a matter of making sure that we have good sleep hygiene, making sure that other conditions aren't contributing, right? Do we have ADD that's undermanaged? Do we have other generalized anxiety or situational anxiety that's undermanaged? There's lots of different things that can be contributing. We want to ask about all those things to make sure that we're really taking care of people as a whole person and from different sides of life and lifestyle management as opposed to just throwing in those kind of classic treatment remedies, which maybe we should talk about too.

Host: Yeah. Well, tell us what some of the most effective treatments are that you have seen.

Dr. Devon Kienzle: A lot of times when we're approaching seasonal affective disorder or depression, there's a lot of overlap. We kind of think of things as what's the first-line or the first things we should do, and what should follow after that if those things don't work. And again, whether it's seasonal affective disorder, depression, any mental health condition, I tend to talk about a few things, and this is where sometimes I get a little bit discouraged. I think that sometimes people think that the doctor's just going to push a medication or something like that. And the reality is that, no, our first step should always be those other things I mentioned a minute ago, lifestyle changes. What sort of lifestyle changes can we make? Is therapy an option? Can we look into therapy? Is that feasible for you?

And then, other modifiable risk factors we say. So in seasonal affective disorder, a big one there is light therapy. So, we do offer everyone, that's when we know it's seasonal affective. We talk about bright light therapy, and we can talk about what that is in detail. But we also often will couple that with an antidepressant, if that's according to the patient's goals. We talk about that and say, "Hey. What does this look like and how long is that going to look? Are we going to use an antidepressant just for the winter season or are we going to use it all year round?" And a lot of times that's just a patient-centered decision on how they want to approach that and what they think would be best. And if meds and light therapy and those modifiable risk factors don't work, then we might talk more seriously about what counseling and what therapy needs to look at.

Host: So, no magic pill, but a combination of approaches.

Dr. Devon Kienzle: Yes. I think that really is. And I hope that for people that are listening to this, they realize that, if they feel like they're just part of an algorithm, then they're probably not getting the best care. It really is, yes, we have guidelines and standards that we follow, because those things tend to work the best for everyone. But there has to be some individualization. There has to be a custom package for you because not everyone sleeps the same. Not everyone has the same housing circumstances. Not everyone has the same family dynamics. And a lot of time with depression and seasonal affective disorder, there's some component of a group effort.

Host: Well, how can family or friends support someone who might be struggling with seasonal affective disorder?

Dr. Devon Kienzle: The big thing I think is just being aware of it, especially for actually the person that is suffering, being willing to listen to someone when they say that, "Hey, I think that there's something not quite right." And then, being supportive. And also, I guess this is what I see the most often in my practice. I'll see someone that's coming in because they're struggling with depression, whether it's seasonal or not.

And one of the things we'll talk about is sleep hygiene. And they'll say, "Oh, well, my partner says, 'I'm watching TV.' So, it's really hard for me not to, because the TV's in the bedroom or something like that. So, that's where if you feel like your partner is struggling, then it might mean that you need to step up on some of those things too, like making sure that there's good sleep hygiene, which is a whole different podcast. Hopefully, we've got one out there for that. But whether it's sleep hygiene or eating healthy or exercise, all of those things are shown to have benefit and management of this stuff.

Host: Do you have any tips as we prepare mentally and physically for fall and winter, especially for those who've experienced SAD before?

Dr. Devon Kienzle: I would say the biggest one is looking into the past and saying, "Hey, are winters harder for me? And are there things that have helped me get through the winter better?" If you look back and you can't find anything and you say, "Yeah, winters are hard for me and I don't know what to change," that's a good reason to talk to a doctor and ask them to help you find things to change-- or a therapist. Sometimes it's just thinking out of the box a little bit or family or whatever.

Another thing is one of the first-line therapies that doesn't need to be a prescription is light therapy. And so, they can look into getting bright light therapy or a light box, and those are widely available. There's lots of different qualities out there. But what it really is, it's an artificial bright white light. It's fluorescent. It shouldn't be incandescent because incandescent can harm the eyes and the retina. You can look for things that have light dispersion and UV light filtration. There's details about how far away you should set those things from your eyes. And we could talk more about when to use those, but you want 10,000 lux for those devices. And that's a thing that you can start using earlier on, that's really a pretty simple thing. That is one of the first-line therapies for seasonal affective disorder and has really no harm, but only potential benefit.

Host: No bad side effects.

Dr. Devon Kienzle: Yeah, exactly. Unless you're really staring at it, don't do that.

Host: Yeah. Don't stare directly at it. Before we end Dr. Kienzle, are there any misconceptions about SAD that you'd like to address?

Dr. Devon Kienzle: Just a couple. One which I think we've alluded to, which is that there's only so many things you can do about it. I think a lot of patients don't want to just, "Well, I don't want to be on an antidepressant all of winter," or they're worried about what that will look like. And I think they should just come in and talk to us about it. But also, that there's other options and sometimes it's just that just talking to someone and having some accountability during the winter about what sort of things you're trying to work on can make a big difference for people.

The other component, which I do see, and it's why I bring it up, like we talked about in the beginning, it's much less common, but people do have spring-summer symptoms too. So, we always talk about it during the winter, but I personally always worry about how many people there are that feel like they should be doing better in the spring or summer, or have a partner that becomes manic or hypomanic in the summer. And they just don't notice, and they could be getting help too. So even as we go through this next fall, winter, remember your family members that might be in the spring to summer that are also having trouble.

Host: Well, hopefully, what you just said will raise awareness about this disorder. And thank you, Dr. Kienzle, for walking us through the symptoms and management of seasonal affective disorder.

Dr. Devon Kienzle: Yeah. You're so welcome. Thank you very much for having me.

Host: Dr. Devon Kienzle is a family medicine provider who specializes in Obstetrics at Skagit Regional Health. Visit skagitregionalhealth.org to learn more. If you found this podcast helpful, we encourage you to share it on your social media and explore our entire podcast library for more topics of interest. Thanks for listening to Be Well with Skagit Regional Health.