Transcription:
Seasonal Mood Disorder

Bill Klaproth (Host): What is seasonal affective disorder commonly known as SAD and how is it diagnosed and treated through medication management and from a behavior modification perspective? Here to talk with us about that is Kara Morse, a clinical social worker and psychiatrist Dr. Kevin DiCesare; both of Southern New Hampshire Health. Kara and Dr. DiCesare thank you for your time. Dr. DiCesare let’s start with you. What is seasonal affective disorder?

Kevin DiCesare, MD (Guest): Yes, and thanks for having us on your program. Seasonal affective disorder is a type of depression that occurs during specific times of the year; usually during certain seasons. Most of the people – most people think that seasonal affective disorder is primarily something that affects us during the winter months, although it can occur during other times of the year; but more typically, it is something that starts to affect people in the fall and into the winter months.

And the symptoms are very similar to symptoms of depression that people can have during anytime of the year. And those symptoms can include things like feeling sad or down most of the time, not having a lot of energy, possibly having changes in sleep or appetite. Usually in the winter months that would be often maybe a tendency to sleep more than usual or to eat more than usual; however, for folks that might have seasonal symptoms during other times of the year, it could be the opposite where they may have more energy or maybe not wanting to eat as much. But other symptoms of depression can include having trouble with concentration, feeling hopeless or helpless. Sometimes if depression symptoms are severe, it can even cause folks to have thoughts of maybe I’d be better off not being around or having thoughts of suicide or wanting to harm themselves. So, it can be a pretty significant condition to have and again having it during the winter months would be sort of the time of the year that folks with seasonal affective disorder typically would struggle with that.

Host: So, the symptoms can be varied, feeling sad, down, no energy, changes in sleep, loss of appetite, loss of concentration, feeling of hopelessness; certainly nothing to fool around with. Dr. DiCesare do we know what causes this?

Dr. DiCesare: Well it’s still a little bit of an unknown all the variables that go into why folks have depression in general, but specifically seasonal affective disorder. But some of the considerations of what may contribute to having seasonal affective disorder could be issues with having a drop in certain chemicals in the brain, certain neurotransmitters that play a role in mood; particularly serotonin. Another chemical that sometimes could contribute to having seasonal affective disorder might be changes in melatonin levels in the brain which can contribute sometimes to changes in mood or sleep patterns. Low levels of sunlight are what we typically think of in our part of the country where we are right now in the northeast. Sometimes that could definitely be a link to being at risk for having seasonal affective symptoms. So, lack of sunlight which also sometimes can affect their vitamin D levels. So, all of these potential factors can play a role of why some people might be susceptible of having seasonal affective disorder.

Host: And Dr. DiCesare how do you diagnose this and what are some of the medical treatment options?

Dr. DiCesare: Sure. Well the diagnosis is usually done by a professional and certainly Kara will be talking a little bit more about some of the therapeutic psychotherapy kind of treatment evaluations and options that are used. But a lot of times, the initial diagnosis may start with the primary care physician who may be able to do an overview evaluation of the symptoms and potentially either initiate treatment themselves or refer to a mental health provider to do more extensive evaluation and treatment.

As far as the medical treatments of seasonal affective disorder; the typical things we think of particularly for folks that have the more common winter type of seasonal affective disorder one is light therapy. Light therapy can be very, very effective in treating symptoms of seasonal depression and it’s something that can be obtained fairly easily. There is no need for necessarily a referral to get a light box which is what is used to provide the – sort of like the full spectrum light that kind of you would normally get from the sun. But usually that would be something that would be recommended by a professional, but it really involves being exposed 20 minutes to half an hour a day in front of a light box which emits this type of full spectrum light and over several days or a few weeks, it can make a major difference in the symptoms of the depression during the winter season.

Other treatments that can be helpful can include medications like antidepressants which would be standard treatment for a lot of patients that may have depression. So, some people might find that if they only get depressed during the winter months, they may want to talk to their physician about being on an antidepressant possibly even proactively if they tend to have seasonal depression on an annual basis. Vitamin D supplements can also be helpful especially if somebody has documented low vitamin D blood levels which a primary care physician certainly could evaluate for and supplementing with vitamin D definitely can also make a big difference.

Host: Alright, thank you Dr. DiCesare and Kara let’s bring you in. Can you talk about behavior modification?

Kara Morse, MSW, LICSW (Guest): So, if someone diagnosed with seasonal affective disorder were to begin therapy treatment some of the I think common techniques used by the therapists would be to help the patient maybe identify any negative thinking that they were having and learn how to reframe or challenge those negative thoughts that come along with depression symptoms. Also, strategies to improve their ability to just manage stress that might be occurring because not only are we dealing with the darker winter months, but the holidays also coincide with that. So, helping people get through sometimes those stressful holidays can be helpful. Maybe even mindfulness in the session helping the patient connect with their mind and body all in an effort to reduce these depressive symptoms that they are experiencing.

Host: And Kara what are some of the treatments while someone is in therapy?

Kara: So, for example maybe some lifestyle changes that the therapist would encourage the patient to engage in, getting out in the sunlight more often. So, as Dr. DiCesare was mentioning, there’s a correlation between the darker days and seasonal affective disorder. So, one way to combat that is to get outside, get sunlight, hopefully improve your vitamin D levels and then also while we are out in the sun, exercising is great. So, whether you are pairing that with being outdoors, hiking, snow shoeing, skiing or you maybe improve your gym frequency and get more exercise, more frequently.

Host: And Kara for someone listening where should they go for help?

Kara: I think a great place to start is with your primary care provider. Schedule an appointment, talk about your symptoms and I think that professional would be great at helping you if you needed a referral to behavioral health. Here at Southern New Hampshire, our behavioral health team works closely with our primary care providers. So, you will know that you will be treated holistically to address both your physical health and your mental health.

Host: And Kara if you could wrap it up for us, what else should we know about seasonal affective disorder?

Kara: I would say just with kind of the movement of reducing mental health stigma that seasonal affective disorder isn’t something that a person should be blamed for. Dr. DiCesare was reviewing all of the potential causes, so please both with seasonal affective disorder, any other mental health symptoms that someone is having, please know that you are not alone, reach out for help and there are services to assist you.

Host: Alright Kara thank you for that and thank you for your time. And Dr. DiCesare thank you for your time as well. For more information please visit www.snhhealth.org, that’s www.snhhealth.org. This is Simply Healthy a podcast by Southern New Hampshire Health. I’m Bill Klaproth. Thanks for listening.