September 12, 2024 • 23 mins
In this episode, Eddie and Justin dive into the complexities of Seasonal Affective Disorder, a type of depression that typically hits during the fall and winter. They explore stats, science, and treatments. Whether you are affected by SAD or just curious to learn more, this episode has practical information to help navigate the winter blues.
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Episode Transcript
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Speaker 1 (00:00):
They're eating the dogs. They're eating the dogs. This is
Millennial Mental Health Channel. I'm doctor Justin Romano, a child
and adolescent psychiatry fellow.
Speaker 2 (00:11):
And I'm Ati Koreo, a licence clinical therapist. Our podcast
is here because we wanted to start a much need
to conversation about mental health.
Speaker 1 (00:18):
Our goal is to teach you as much as we
can by sharing our own experiences and interviewing experts in
the mental health field. We will discuss topics like mood disorders,
psychotic disorders, substance use, personality disorders, and many more.
Speaker 2 (00:30):
Millennial Mental Health Channel buy Millennials for everyone. We hope
you enjoyed today's episode.
Speaker 1 (00:37):
MMHD is a production of Speaker from iHeartMedia.
Speaker 2 (00:41):
I Heart mir I.
Speaker 1 (00:44):
Couldn't help myself.
Speaker 2 (00:46):
We're keeping that in hold. I did that for you.
Speaker 1 (00:50):
Because I knew that you'd get a kick out of
I hear you got some shout outs for today.
Speaker 2 (00:56):
I got one shout out to my lovely sister. That's it,
shout out to her. She was upset she didn't get
a shout out in the last episode, so she can
get her shout out at the very beginning.
Speaker 1 (01:07):
I got one shout out too. I know a couple
episodes back, we shouted out Uncle Calvin, my father in law,
but also his wife, Amy listens to a ton of
these episodes and it has been a huge supporter too,
so I wanted to spread the love to her. Thank
you so much for listening.
Speaker 2 (01:21):
Yeah, thanks for listening to Amy. What do we got today?
What are we talking about?
Speaker 1 (01:25):
I don't know, man, what are we What are you
gonna make an episode? Yeah, We're just going to ramble
and just make stuff up for thirty minutes.
Speaker 2 (01:33):
Oh God, ask people to turn it off if we
did that. Well, what we really are talking about. We've
done this episode in the past. We actually did this
long time ago, back before we are what we are today.
But I told Jessin it might be a good idea
to bring it back. It is that time of the year.
This impacts a portion of the country. I didn't look
(01:55):
up what regions specifically, but it is prevalent and it's
seasonal effect disorder. I live in Oregon. Justin's in Colorado,
except I think Justin Actually Colorado gets a lot of
sun technically like three hundred days a year. Yeah, but
Oregon does not. And I think we're hitting that patch
where we're mostly going to have clouds between now and
(02:16):
like March or April. I personally love this weather, but
not everybody does. And after having a very sunny and
warm summer, we start to experience changes. A lot of
people start to experience changes. It is a very real thing.
I do see a lot of teens working, you know,
in the different clasics I've worked at, are different. At
the hospital and now at the school that definitely have
(02:37):
SAD are impacted by the weather. Maybe it's not full
blown seasonal effective disorder, but they are impacted. Obviously. Another factor,
because it does coincide with the start of school, is
the start of school, So maybe how they're being impacted
does have to do more with school being a big
stressor But it is important to notice that this happens
like the changing of the weather. It gets dark really early.
(03:01):
Like that kind of stuff impacts you, It impacts people.
Just think of it this way here in Oregon, and
I know it's similar in other places. But for me,
you know, we get to daylight saving time and next thing,
I know, the clock hits four fifty pm and it's
pitch black. And you do that for you know, months
at a time, weeks at a time, it does start
to drain on you a little bit. So there's things
(03:21):
you can do, there's ways you can get help. But
we kind of wanted to do this as a public
service announcement. Seasonal effective disorder is a real thing. We'll
actually learn a little more about where it is in
the DSM. But actually, before I pass it to you,
justin I did want to say this is suicide Prevention month,
and I wanted to acknowledge that it is really important.
If you know somebody or are somebody who's struggling, the
(03:42):
National Suicide Lifeline nine eight eight is there for you.
But really wanted to highlight that it is I think
an important thing that we acknowledge. It is a tough
part of the job that you know, some of our kids,
our teens do deal with that. But yeah, just want
to acknowledge that September is suicide prevention month.
Speaker 1 (03:58):
You bring up a great point that there are a
lot of things going on at this time of the year.
School starting, weather's changing, sunlight's changing, and it's a lot
a lot more stressful. And I noticed that this time
of year, it tends to be my busiest time of
year because people are struggling more and mental health is
going downwards, especially after the high of the summer. I
(04:20):
know personally I tend to get a little bit down
this time of year too. It really happened for the
first time where I thought, like, the first time I
really ever thought to myself, like, am I depressed? Was
when I was in residency and it was fall and
everything was changing after I had a really good summer,
And so I feel it too, the loss of sunlight,
(04:42):
summer's ending. There's kind of a melancholy in the air,
a certain feel in the air that's just somewhat different,
and so we want to talk about it, help other
people understand that it's normal. It's a normal thing that
a lot of people go through, and to give you
some ideas of how to get help. If you feel
like this is happening to you too.
Speaker 2 (04:59):
You pretty much just say adjustin. But just like if
this impacts you, there's nothing wrong with you, Like there's
I think people almost feel like embarrassed of like, oh
the weather makes me sad, like it makes people sad,
like it is tough, So it's totally fine, there's nothing
wrong with it. But a definition will probably use SAD
and seasonal effective disorder interchangeably throughout the episode, but seasonal
(05:20):
effective disorder is a type of the depression that occurs
during specific seasons, usually during the fall and winter. It's
characterized by a seasonal pattern of depressive episodes that typically
start in that late fall or wintertime kind of when
like November December run into each each other January, and
then things to it tend to improve in the spring
(05:40):
or in the summer when we get more sunlight.
Speaker 1 (05:42):
Seasonal effective disorder is actually better diagnosed as major depressive
disorder with seasonal pattern in the DSM five, So that's
like the official diagnosis. It's a subtype of depression related
to mood changes that are linked to seasonal changes. The
diagnostics specify with seasonal pattern can describe a seasonal pattern
(06:03):
of symptoms in both major depressive disorder and bipolar disorder,
because there's two major types of depression, major depressive disorder
and bipolar depression, and so essentially this can go with
either one.
Speaker 2 (06:15):
Something I learned in researching SAD is not actually its
own diagnosis in the DSM five. This was new for me.
I pulled up my electronic version of the DSM five,
I did the control f to try to find seasonal
effective disorder and did not find it, and I was like,
what the fuck what are we doing? So then I
had to do a quick Google search and I learned
(06:35):
something new. You would think at this point I would
have a better idea of it, but we learned new
shit all the time, so I thought that was pretty
cool to share. I liked that little like nerding out
moment of like, oh, this is new in the DSM.
Oh I had no idea because I have that book
on my desk every single day. So it's fun to
learn new things.
Speaker 1 (06:53):
And when I think the last time we did this
episode was when we were still on the DSM five
before the textra vision the tr came out, So yeah,
that did that change it too much? That's how long
it's been. Yeah, because that's been a couple of years
since they out of the Tryah.
Speaker 2 (07:07):
I was explaining to a student the other day they
saw my big DSM in my bookshelf and then they're like, oh,
is that the DS sounds like it is. Here's my
pocket version. They're like, wow, that's so cool. I was like, yeah,
it's interesting because when I was in college, they moved
from the four to the five. So that's now. It
was in twenty thirteen, I think is when the change came.
(07:28):
So now we're eleven years later. Who knows when the
next one because I don't know how much time was
between the three and the four. Eleven years feels like
a chunk of time, but it feels like the text revised,
the tr version kind of buys them a little more
time before they have to consider making any big changes.
Speaker 1 (07:44):
And I at my job, there's a bookshelf just full
of old books, and there's actually an old copy of
the DSM three.
Speaker 2 (07:50):
Cool.
Speaker 1 (07:51):
I was pretty pumped. I'm going to go through it
one day when I have extra time, which is a
joke because I never had extra.
Speaker 2 (07:56):
Time, but I thought it was kind of cool. Yeah,
that is cool.
Speaker 1 (08:02):
So from the American Psychiatric Association, common symptoms of SAD
include fatigue even with too much sleep, so even though
you're sleeping all day, you're still tired, some weight gain
associated with overeating and carbohydrate cravings. SAD symptoms can vary
from mild to severe and can include many symptoms similar
(08:23):
to major depressive disorder, such as feeling sad or having
a depressed mood.
Speaker 2 (08:28):
Next is having a loss of interest or pleasure and
activities that you previously enjoyed.
Speaker 1 (08:33):
Change is an appetite, usually eating more and craving those carbohydrates.
Speaker 2 (08:37):
The change in sleep that justin mentioned, it's usually sleeping
too much. So you get kids that'll come into your
office that'll say, like, I slept twelve hours last night.
I don't know why, how can I still be tired?
Speaker 1 (08:48):
And on that note too, I just noticed that the
summer sleep schedule, going back to the school sleep schedule
is so rough on kids. Yes, go to sleep at
two to three am, waking up at noon and then
having to all of a sudden get up at six
am for school is a wild shift for young people
(09:08):
to have to make, and like, I would be miserable
if I had to do that, So I feel for
all you you people out there who have to make
those big changes in your sleep schedule.
Speaker 2 (09:18):
There's a school in our area that I think, or
a couple of schools the school district there's implementing some changes.
So I think their older kids are starting a little later,
and then their younger kids are starting a little earlier
because apparently for like certain age ranges that earlier is better,
and I guess we might have a little bit of
that in our school district. Our high school starts at
eight thirty nice, whereas our elementary school I think they
(09:40):
started at like seven fifty. So I don't know. It
definitely depends on the age. But for us working with teenagers, yeah, twelve,
going to leap at midnight, waking up at ten eleven
twelve in the afternoon and then having to shift that
by five hours even more rough.
Speaker 1 (09:59):
That's rough. It's hard brain. Plus, you're absolutely right, A
lot of studies have shown that a later start for
adolescence in school really helps our school performance. So loss
of energy back to symptoms of seasonal effective disorder, loss
of energy or increased fatigue despite increased sleep hours.
Speaker 2 (10:19):
Another one is increase in purposeless physical activity. This was
an interesting one, So basically inability to sit still, you're pacing,
hand ringing right like you're fidgeting with your hands, or
slowed movements or speech. These actions definitely can be severe,
or they must be severe enough to be observable by
others to count as the criteria.
Speaker 1 (10:38):
Sometimes seasonal effective disorder can have feelings of worthlessness or guiltiness.
Speaker 2 (10:44):
There's also difficulty thinking, concentrating, or making decisions, very common
that we see with teens that get diagnosed with major
depressive disorder without the seasonal pattern, and on.
Speaker 1 (10:55):
The more extreme end of things, sometimes people can even
have thoughts of death and suicide.
Speaker 2 (11:00):
Important to remember, just because someone is diagnosed as depression,
just because they have depressive symptoms, diagnosis of depression does
not equal thoughts of death and suicide. I think a
lot of people worry about that. I think a lot
of parents worry about that too. We've mentioned it before,
but there's like this assumption like, well, depression now means
they're suicidal, and now I'm really scared for my kid.
We can pump the brakes a little bit. It doesn't
(11:21):
automatically mean that it might be part of it. It
also might not be. You don't have to have every
criteria to be clinically diagnosed. So important reminder.
Speaker 1 (11:29):
Some stats and facts about seasonal affective disorder, So the prevalence,
how many people actually get it. Approximately five percent of
adults in the United States experience seasonal effective disorder, and
this is according to the American Psychiatric Association.
Speaker 2 (11:44):
Ten to twenty percent of people may experience milder forms
of seasonal mood changes, and women are more likely to
be diagnosed, with sixty to ninety percent of cases occurring
in women.
Speaker 1 (11:54):
The typical age of onset is between age eighteen and thirty,
but it can also have at any time, at any
point in someone's.
Speaker 2 (12:02):
Life, maybe specifically with teenagers like we work with, like
twelve to sixteen, seventeen eighteen. Your location may have an
impact on it, So I talked about it earlier of
like what parts of the country may experience it more.
But research has shown that the farther from the equator,
the higher the prevalence. So an example that they give
is one percent of people in Florida diagnosed or it's
(12:24):
prevalent in Florida see no effective disorder, while in Alaska
it's up to like nine percent of people will get
impacted by it. Big difference.
Speaker 1 (12:33):
That's fascinating to me how big that difference is between
Florida and Alaska. And I know that I've mentioned it
on the show in the past that I did a
rotation up in Alaska when I was in medical school
and it was in the spring, so it was April
May time period, and getting used to the sun going
down at midnight was wild for me. It was so
(12:56):
much different than anything I'd ever experienced. And I thought,
I am so glad i am on this side, on
the spring side, and not on the fall side and
winter side when there's times in Alaska where the sun
never rises. Oh it's just completely totally dark.
Speaker 2 (13:11):
No, thank you, that would probably get me. Yeah.
Speaker 1 (13:14):
And then typical duration of symptoms for seasonal affective disorder
is about four to five months out of the year,
So that's a long time, a long time for people
to be struggling and suffering.
Speaker 2 (13:24):
Yeah, almost half the year. Some biological and environmental factors.
One could be light exposure, so or do Sunlight can
disrupt your circadian rhythm and your serotonin level. So, like
Justin was saying, he was in Alaska during the springtime,
but if you're there in the full time and you're
getting minimal sunlight like the least like in the whole country,
that can have any huge impact on you.
Speaker 1 (13:44):
And I was even trying to look into the mechanism
of this, and they think that sunlight actually induces your
monoamine oxidase, which is an enzyme that breaks down your serotonin.
And your different catcola means, of course, so it actually
can enhance this enzyme to break down your serotonin and
(14:07):
drop your serotonin levels in your brain. We're not one
hundred percent sure of the mechanism of why seasonal affective
disorder happens, but I think it's fascinating that the light
that comes in through our eyes actually changes the hormone
balance in our brains. That's just crazy to me.
Speaker 2 (14:25):
It sounded like I knew what you were talking about
right with my.
Speaker 1 (14:27):
Mes, Yeah, you passed it off. Also, people who with
seasonal effective disorder produce too much melatonin, And I know
we talked about people who are oversleeping, sleeping too much
but still feel depressed, and that likely is because they're
overproducing melatonin in those situations, it makes sense.
Speaker 2 (14:47):
And then the last environmental factor in biological factor that
we'll mention is vitamin D deficiency. If you know people
who live in Oregon or the Pacific northwestern places where
we get a lot of clouds and rain, they tend
to talk about the fact that they might be on
a vitamin D supplement, So lower levels of some light
can contribute to a vitamin D deficiency. I actually had
a student and they family tell me recently that they
(15:09):
had recently started taking vitamin D supplement and that they
were hopeful about these next coming months and the impact
on their mental health.
Speaker 1 (15:18):
I actually had a professor in my first year at
medical school who was very aware of the fact that
in Laramie, Wyoming, where I did my first year, that
there isn't a lot of sun in the winter, and
he would actually go out in the cold in his
underwear and I'm not really sure why he would do,
but he would hold his ears. I don't remember why
(15:38):
he did that, but he would hold his ears and
like do squats out in his yard almost naked to
try and get more vitamin D production. That was his
way of trying to combat the seasonal affect of disorder.
Speaker 2 (15:52):
Was this related to seasonal factor disorder? Are you getting
in confused with something else?
Speaker 1 (15:56):
He was trying to get more vitamin D by exposing his.
Speaker 2 (15:59):
Oh, so he wanted to sell in his skin to
be exposed. Yeah.
Speaker 1 (16:03):
He also really was very detailed about telling me how
often he measured his urine output. Is kind of strange, dude.
We were like, do you want to know what my
maximum urine output has? Spin like I really don't care.
Speaker 2 (16:18):
Like year and a half, like fluid ounce, yeah, yeah,
it was measure.
Speaker 1 (16:23):
I think it was around a lider and a half.
Speaker 2 (16:25):
What is that announces I needed?
Speaker 1 (16:26):
Like, oh, let's check here. Fifty ounce.
Speaker 2 (16:34):
That was his max.
Speaker 1 (16:35):
That was probably after you know, a big night.
Speaker 2 (16:37):
So and an unrelated note treatment for sad how do
we feel better without needing to go outside in our underwear,
pulling down our ears and trying to get as much
sunlight as possible. I guess kind of related light therapy.
Once that he said it could be effective in sixty
to eighty percent of cases. It might be a little
(16:58):
more of a placebo effect, but that's totally fine. Placebo
effects in my book count If you feel better, that's
all I care about.
Speaker 1 (17:05):
I'm really fascinated by base travel. Are we doing this
with astronauts? Are we trying to replicate conditions on the
Earth because our bodies are so in tune with the
Earth and the different cycles of the Earth, And if
we completely change that, how is that going to work
in space? So I'm always curious about how those things
(17:26):
are going to impact space travel. Plus sixty to eighty
percent effectiveness, or I would say, that's even more effective
than most antidepressant medications too. So if you're an all
natural person and you have seasonal components of your depression
and you want to try light therapy, there are hardly
(17:47):
any side effects possible and it's a very effective thing.
In combination, we always recommend therapy, and cognitive behavioral therapy
has been a type of therapy that has been shown
and improven treatment for season one effective disorder too.
Speaker 2 (18:01):
Yeah, can you tell me more about medications or are
we just are we using similar ones for major depression
and the seasonal effective disorder.
Speaker 1 (18:09):
Yeah, Typically, like SSRIs, the medicines that increase that serotonin
in your brain can be effective for seasonal effective disorder.
And I also learned in residency that there's an old
depression medicine called well butrin. It tends to be a
little bit more of an activating gives you a little
bit more energy. Actually doesn't impact your serotonin system as much,
(18:29):
but more your dopamine and norepinephrine systems in your brain.
That's actually a very effective medicine for seasonal effective disorder too.
So there are a couple of good options if that
is what you want to try.
Speaker 2 (18:40):
And then last thing we've talked about it and you
might be familiar already, but vitamin D supplements they might
help mitigate the effects of SAD. It seems to be
pretty common for people who maybe don't have a chance
to see a therapist just kind of know that about
themselves that each year around the winter time, they start
to get a little more low, so they have that
on hand already. Seems to be effective. I can't say
(19:01):
one way or the other their experience, but seems to
be effective.
Speaker 1 (19:04):
All natural way of getting that vitamin D is exposing
your skin to direct sunlight. If you do have seasonal
effective disorder, it's important to be mindful of it and say, Okay,
I'm starting to get a little bit less light exposure.
Maybe I should spend a little more time outside. Maybe
I should get a little bit more light on my skin.
That could be something that helps. Now bear in mind,
(19:24):
my mother was actually a nurse for a dermatologist, so
she would always say, like, don't get too much sun
contact because it increase your risk for skin cancer. True,
but it can also help give you that vitamin D
because your your skin makes vitamin D with direct sunlight
exposure or sunscreen too, but then you don't make as
much vitamin D it blocks those blocks those.
Speaker 2 (19:44):
Right if you do, damn if you don't. Other things
to consider if you have seasonal depression. Right, you've talked
about the light box, We've talked about talking to your doctor.
We've talked about going to therapy. It doesn't have to
be all three can only just can be just one
of them. But definitely, if you start to notice this
is a pattern, we get to October November, I am
feeling impacted. It's okay to try to ask for help
(20:06):
and know that it's not weird, it's not random, it's
not a fake thing. It's a very real thing that
impacts a lot of people.
Speaker 1 (20:12):
So one of our favorite things on this show is
talking about different celebrities that have come out and talked
about their experiences. And the first celebrity we want to
talk about is Kristin Bell. And although she's more widely
known for her advocacy around mental health and anxiety, Kristin
Bell has spoken about experiencing seasonal mood changes that resemble
(20:33):
seasonal effective disorder, often referring to her need for more
light and how the winter months affect her her mental
health negatively.
Speaker 2 (20:41):
Another one is Adele. She's mentioned a few times how
much sunny Los Angeles has positively impacted her mental health,
so that might be her roundabout way of saying that
she gets impacted by the seasonal I will say, in researching,
there's a number of celebrities who have made comments saying
that the colder, darker months impact them, but they haven't
really explicitly mentioned seasonal effective disorders, so you can infer.
(21:04):
But just wanted to mention that usually when when Justin
or I do research and we see, you know, celebrities
related to certain disorders, they'll explicitly say it. This was
one where it just was kind of like you could
take a guess and probably be right.
Speaker 1 (21:19):
It's so funny looking up different celebrities and their mental
health disorders and which topics just have lists and listen
lists of people who have come out and said like
especially like bipolar disorder, regular depression, anxiety. You can take
your pick of celebrities you want to talk about who
have had those things.
Speaker 2 (21:35):
But once you.
Speaker 1 (21:36):
Start getting into a little bit more of the niche diagnoses,
it's harder to find and it sounds like seasonal effective
disorder is not something that's on a lot of people's radars,
which is one of the reasons why we wanted to
do this episode. Bring a little bit more attention to
it and tell people that it's okay, it's a normal
thing that happens.
Speaker 2 (21:53):
Absolutely, that's our first take on point. It's fairly common
and it's definitely treatable. Don't be afraid to ask for
help when it comes to seasonal effective disorder.
Speaker 1 (22:02):
If you notice that you have mental health changes around
certain times of the year, consider seeking help and getting
help for this, because you shouldn't have to suffer alone.
Speaker 2 (22:11):
And while seasonal effective disorder is not its own diagnosis,
that doesn't mean it's any less important and that you
shouldn't get help. You should definitely get help. I tell
students all the time, so many students when I talk
with them, so many teens over the years, will say like, ah,
this is really dumb. I don't want to say it,
and I have to remind them if it's impacting you,
if you're having a hard time, it is not dumb.
(22:32):
It is important. I want to know about it so
we can talk about it and it gets you some help.
So same thing with seasonal effective disorder. It's not its
own diagnosis, but it's still very important. You still deserve
to get help, and it's okay to be struggling with
that because it's a very real thing.
Speaker 1 (22:46):
Perception is reality. If you're feeling like things are bad
during a certain time of year, then go with it.
Speaker 2 (22:53):
Well, thank you all. We hope this impacts somebody out
there listening and understands that this could be a real
thing that's on its way and how to treat it.
We appreciate you all for listening. On Apple Podcasts, Spotify,
whatever app you use, you know the you know the
drill we're on there. Feel free to leave us a
five star review. You can hit follow, you can hit subscribe,
whatever it is you do on your app. On social media, Twitter, Instagram, TikTok,
(23:16):
YouTube at Millennial MHC and MILLENNIALIMHC dot com. One last time,
thank y'all for listening. Again, this is suicide Prevention Month.
We hope that if you need help or you know
someone that needs help, that they reach out and call
the lifeline or get community or county resources and remember,
take care of all mentals.
They're eating the dogs. They're eating the dogs. This is
Millennial Mental Health Channel. I'm doctor Justin Romano, a child
and adolescent psychiatry fellow.
Speaker 2 (00:11):
And I'm Ati Koreo, a licence clinical therapist. Our podcast
is here because we wanted to start a much need
to conversation about mental health.
Speaker 1 (00:18):
Our goal is to teach you as much as we
can by sharing our own experiences and interviewing experts in
the mental health field. We will discuss topics like mood disorders,
psychotic disorders, substance use, personality disorders, and many more.
Speaker 2 (00:30):
Millennial Mental Health Channel buy Millennials for everyone. We hope
you enjoyed today's episode.
Speaker 1 (00:37):
MMHD is a production of Speaker from iHeartMedia.
Speaker 2 (00:41):
I Heart mir I.
Speaker 1 (00:44):
Couldn't help myself.
Speaker 2 (00:46):
We're keeping that in hold. I did that for you.
Speaker 1 (00:50):
Because I knew that you'd get a kick out of
I hear you got some shout outs for today.
Speaker 2 (00:56):
I got one shout out to my lovely sister. That's it,
shout out to her. She was upset she didn't get
a shout out in the last episode, so she can
get her shout out at the very beginning.
Speaker 1 (01:07):
I got one shout out too. I know a couple
episodes back, we shouted out Uncle Calvin, my father in law,
but also his wife, Amy listens to a ton of
these episodes and it has been a huge supporter too,
so I wanted to spread the love to her. Thank
you so much for listening.
Speaker 2 (01:21):
Yeah, thanks for listening to Amy. What do we got today?
What are we talking about?
Speaker 1 (01:25):
I don't know, man, what are we What are you
gonna make an episode? Yeah, We're just going to ramble
and just make stuff up for thirty minutes.
Speaker 2 (01:33):
Oh God, ask people to turn it off if we
did that. Well, what we really are talking about. We've
done this episode in the past. We actually did this
long time ago, back before we are what we are today.
But I told Jessin it might be a good idea
to bring it back. It is that time of the year.
This impacts a portion of the country. I didn't look
(01:55):
up what regions specifically, but it is prevalent and it's
seasonal effect disorder. I live in Oregon. Justin's in Colorado,
except I think Justin Actually Colorado gets a lot of
sun technically like three hundred days a year. Yeah, but
Oregon does not. And I think we're hitting that patch
where we're mostly going to have clouds between now and
(02:16):
like March or April. I personally love this weather, but
not everybody does. And after having a very sunny and
warm summer, we start to experience changes. A lot of
people start to experience changes. It is a very real thing.
I do see a lot of teens working, you know,
in the different clasics I've worked at, are different. At
the hospital and now at the school that definitely have
(02:37):
SAD are impacted by the weather. Maybe it's not full
blown seasonal effective disorder, but they are impacted. Obviously. Another factor,
because it does coincide with the start of school, is
the start of school, So maybe how they're being impacted
does have to do more with school being a big
stressor But it is important to notice that this happens
like the changing of the weather. It gets dark really early.
(03:01):
Like that kind of stuff impacts you, It impacts people.
Just think of it this way here in Oregon, and
I know it's similar in other places. But for me,
you know, we get to daylight saving time and next thing,
I know, the clock hits four fifty pm and it's
pitch black. And you do that for you know, months
at a time, weeks at a time, it does start
to drain on you a little bit. So there's things
(03:21):
you can do, there's ways you can get help. But
we kind of wanted to do this as a public
service announcement. Seasonal effective disorder is a real thing. We'll
actually learn a little more about where it is in
the DSM. But actually, before I pass it to you,
justin I did want to say this is suicide Prevention month,
and I wanted to acknowledge that it is really important.
If you know somebody or are somebody who's struggling, the
(03:42):
National Suicide Lifeline nine eight eight is there for you.
But really wanted to highlight that it is I think
an important thing that we acknowledge. It is a tough
part of the job that you know, some of our kids,
our teens do deal with that. But yeah, just want
to acknowledge that September is suicide prevention month.
Speaker 1 (03:58):
You bring up a great point that there are a
lot of things going on at this time of the year.
School starting, weather's changing, sunlight's changing, and it's a lot
a lot more stressful. And I noticed that this time
of year, it tends to be my busiest time of
year because people are struggling more and mental health is
going downwards, especially after the high of the summer. I
(04:20):
know personally I tend to get a little bit down
this time of year too. It really happened for the
first time where I thought, like, the first time I
really ever thought to myself, like, am I depressed? Was
when I was in residency and it was fall and
everything was changing after I had a really good summer,
And so I feel it too, the loss of sunlight,
(04:42):
summer's ending. There's kind of a melancholy in the air,
a certain feel in the air that's just somewhat different,
and so we want to talk about it, help other
people understand that it's normal. It's a normal thing that
a lot of people go through, and to give you
some ideas of how to get help. If you feel
like this is happening to you too.
Speaker 2 (04:59):
You pretty much just say adjustin. But just like if
this impacts you, there's nothing wrong with you, Like there's
I think people almost feel like embarrassed of like, oh
the weather makes me sad, like it makes people sad,
like it is tough, So it's totally fine, there's nothing
wrong with it. But a definition will probably use SAD
and seasonal effective disorder interchangeably throughout the episode, but seasonal
(05:20):
effective disorder is a type of the depression that occurs
during specific seasons, usually during the fall and winter. It's
characterized by a seasonal pattern of depressive episodes that typically
start in that late fall or wintertime kind of when
like November December run into each each other January, and
then things to it tend to improve in the spring
(05:40):
or in the summer when we get more sunlight.
Speaker 1 (05:42):
Seasonal effective disorder is actually better diagnosed as major depressive
disorder with seasonal pattern in the DSM five, So that's
like the official diagnosis. It's a subtype of depression related
to mood changes that are linked to seasonal changes. The
diagnostics specify with seasonal pattern can describe a seasonal pattern
(06:03):
of symptoms in both major depressive disorder and bipolar disorder,
because there's two major types of depression, major depressive disorder
and bipolar depression, and so essentially this can go with
either one.
Speaker 2 (06:15):
Something I learned in researching SAD is not actually its
own diagnosis in the DSM five. This was new for me.
I pulled up my electronic version of the DSM five,
I did the control f to try to find seasonal
effective disorder and did not find it, and I was like,
what the fuck what are we doing? So then I
had to do a quick Google search and I learned
(06:35):
something new. You would think at this point I would
have a better idea of it, but we learned new
shit all the time, so I thought that was pretty
cool to share. I liked that little like nerding out
moment of like, oh, this is new in the DSM.
Oh I had no idea because I have that book
on my desk every single day. So it's fun to
learn new things.
Speaker 1 (06:53):
And when I think the last time we did this
episode was when we were still on the DSM five
before the textra vision the tr came out, So yeah,
that did that change it too much? That's how long
it's been. Yeah, because that's been a couple of years
since they out of the Tryah.
Speaker 2 (07:07):
I was explaining to a student the other day they
saw my big DSM in my bookshelf and then they're like, oh,
is that the DS sounds like it is. Here's my
pocket version. They're like, wow, that's so cool. I was like, yeah,
it's interesting because when I was in college, they moved
from the four to the five. So that's now. It
was in twenty thirteen, I think is when the change came.
(07:28):
So now we're eleven years later. Who knows when the
next one because I don't know how much time was
between the three and the four. Eleven years feels like
a chunk of time, but it feels like the text revised,
the tr version kind of buys them a little more
time before they have to consider making any big changes.
Speaker 1 (07:44):
And I at my job, there's a bookshelf just full
of old books, and there's actually an old copy of
the DSM three.
Speaker 2 (07:50):
Cool.
Speaker 1 (07:51):
I was pretty pumped. I'm going to go through it
one day when I have extra time, which is a
joke because I never had extra.
Speaker 2 (07:56):
Time, but I thought it was kind of cool. Yeah,
that is cool.
Speaker 1 (08:02):
So from the American Psychiatric Association, common symptoms of SAD
include fatigue even with too much sleep, so even though
you're sleeping all day, you're still tired, some weight gain
associated with overeating and carbohydrate cravings. SAD symptoms can vary
from mild to severe and can include many symptoms similar
(08:23):
to major depressive disorder, such as feeling sad or having
a depressed mood.
Speaker 2 (08:28):
Next is having a loss of interest or pleasure and
activities that you previously enjoyed.
Speaker 1 (08:33):
Change is an appetite, usually eating more and craving those carbohydrates.
Speaker 2 (08:37):
The change in sleep that justin mentioned, it's usually sleeping
too much. So you get kids that'll come into your
office that'll say, like, I slept twelve hours last night.
I don't know why, how can I still be tired?
Speaker 1 (08:48):
And on that note too, I just noticed that the
summer sleep schedule, going back to the school sleep schedule
is so rough on kids. Yes, go to sleep at
two to three am, waking up at noon and then
having to all of a sudden get up at six
am for school is a wild shift for young people
(09:08):
to have to make, and like, I would be miserable
if I had to do that, So I feel for
all you you people out there who have to make
those big changes in your sleep schedule.
Speaker 2 (09:18):
There's a school in our area that I think, or
a couple of schools the school district there's implementing some changes.
So I think their older kids are starting a little later,
and then their younger kids are starting a little earlier
because apparently for like certain age ranges that earlier is better,
and I guess we might have a little bit of
that in our school district. Our high school starts at
eight thirty nice, whereas our elementary school I think they
(09:40):
started at like seven fifty. So I don't know. It
definitely depends on the age. But for us working with teenagers, yeah, twelve,
going to leap at midnight, waking up at ten eleven
twelve in the afternoon and then having to shift that
by five hours even more rough.
Speaker 1 (09:59):
That's rough. It's hard brain. Plus, you're absolutely right, A
lot of studies have shown that a later start for
adolescence in school really helps our school performance. So loss
of energy back to symptoms of seasonal effective disorder, loss
of energy or increased fatigue despite increased sleep hours.
Speaker 2 (10:19):
Another one is increase in purposeless physical activity. This was
an interesting one, So basically inability to sit still, you're pacing,
hand ringing right like you're fidgeting with your hands, or
slowed movements or speech. These actions definitely can be severe,
or they must be severe enough to be observable by
others to count as the criteria.
Speaker 1 (10:38):
Sometimes seasonal effective disorder can have feelings of worthlessness or guiltiness.
Speaker 2 (10:44):
There's also difficulty thinking, concentrating, or making decisions, very common
that we see with teens that get diagnosed with major
depressive disorder without the seasonal pattern, and on.
Speaker 1 (10:55):
The more extreme end of things, sometimes people can even
have thoughts of death and suicide.
Speaker 2 (11:00):
Important to remember, just because someone is diagnosed as depression,
just because they have depressive symptoms, diagnosis of depression does
not equal thoughts of death and suicide. I think a
lot of people worry about that. I think a lot
of parents worry about that too. We've mentioned it before,
but there's like this assumption like, well, depression now means
they're suicidal, and now I'm really scared for my kid.
We can pump the brakes a little bit. It doesn't
(11:21):
automatically mean that it might be part of it. It
also might not be. You don't have to have every
criteria to be clinically diagnosed. So important reminder.
Speaker 1 (11:29):
Some stats and facts about seasonal affective disorder, So the prevalence,
how many people actually get it. Approximately five percent of
adults in the United States experience seasonal effective disorder, and
this is according to the American Psychiatric Association.
Speaker 2 (11:44):
Ten to twenty percent of people may experience milder forms
of seasonal mood changes, and women are more likely to
be diagnosed, with sixty to ninety percent of cases occurring
in women.
Speaker 1 (11:54):
The typical age of onset is between age eighteen and thirty,
but it can also have at any time, at any
point in someone's.
Speaker 2 (12:02):
Life, maybe specifically with teenagers like we work with, like
twelve to sixteen, seventeen eighteen. Your location may have an
impact on it, So I talked about it earlier of
like what parts of the country may experience it more.
But research has shown that the farther from the equator,
the higher the prevalence. So an example that they give
is one percent of people in Florida diagnosed or it's
(12:24):
prevalent in Florida see no effective disorder, while in Alaska
it's up to like nine percent of people will get
impacted by it. Big difference.
Speaker 1 (12:33):
That's fascinating to me how big that difference is between
Florida and Alaska. And I know that I've mentioned it
on the show in the past that I did a
rotation up in Alaska when I was in medical school
and it was in the spring, so it was April
May time period, and getting used to the sun going
down at midnight was wild for me. It was so
(12:56):
much different than anything I'd ever experienced. And I thought,
I am so glad i am on this side, on
the spring side, and not on the fall side and
winter side when there's times in Alaska where the sun
never rises. Oh it's just completely totally dark.
Speaker 2 (13:11):
No, thank you, that would probably get me. Yeah.
Speaker 1 (13:14):
And then typical duration of symptoms for seasonal affective disorder
is about four to five months out of the year,
So that's a long time, a long time for people
to be struggling and suffering.
Speaker 2 (13:24):
Yeah, almost half the year. Some biological and environmental factors.
One could be light exposure, so or do Sunlight can
disrupt your circadian rhythm and your serotonin level. So, like
Justin was saying, he was in Alaska during the springtime,
but if you're there in the full time and you're
getting minimal sunlight like the least like in the whole country,
that can have any huge impact on you.
Speaker 1 (13:44):
And I was even trying to look into the mechanism
of this, and they think that sunlight actually induces your
monoamine oxidase, which is an enzyme that breaks down your serotonin.
And your different catcola means, of course, so it actually
can enhance this enzyme to break down your serotonin and
(14:07):
drop your serotonin levels in your brain. We're not one
hundred percent sure of the mechanism of why seasonal affective
disorder happens, but I think it's fascinating that the light
that comes in through our eyes actually changes the hormone
balance in our brains. That's just crazy to me.
Speaker 2 (14:25):
It sounded like I knew what you were talking about
right with my.
Speaker 1 (14:27):
Mes, Yeah, you passed it off. Also, people who with
seasonal effective disorder produce too much melatonin, And I know
we talked about people who are oversleeping, sleeping too much
but still feel depressed, and that likely is because they're
overproducing melatonin in those situations, it makes sense.
Speaker 2 (14:47):
And then the last environmental factor in biological factor that
we'll mention is vitamin D deficiency. If you know people
who live in Oregon or the Pacific northwestern places where
we get a lot of clouds and rain, they tend
to talk about the fact that they might be on
a vitamin D supplement, So lower levels of some light
can contribute to a vitamin D deficiency. I actually had
a student and they family tell me recently that they
(15:09):
had recently started taking vitamin D supplement and that they
were hopeful about these next coming months and the impact
on their mental health.
Speaker 1 (15:18):
I actually had a professor in my first year at
medical school who was very aware of the fact that
in Laramie, Wyoming, where I did my first year, that
there isn't a lot of sun in the winter, and
he would actually go out in the cold in his
underwear and I'm not really sure why he would do,
but he would hold his ears. I don't remember why
(15:38):
he did that, but he would hold his ears and
like do squats out in his yard almost naked to
try and get more vitamin D production. That was his
way of trying to combat the seasonal affect of disorder.
Speaker 2 (15:52):
Was this related to seasonal factor disorder? Are you getting
in confused with something else?
Speaker 1 (15:56):
He was trying to get more vitamin D by exposing his.
Speaker 2 (15:59):
Oh, so he wanted to sell in his skin to
be exposed. Yeah.
Speaker 1 (16:03):
He also really was very detailed about telling me how
often he measured his urine output. Is kind of strange, dude.
We were like, do you want to know what my
maximum urine output has? Spin like I really don't care.
Speaker 2 (16:18):
Like year and a half, like fluid ounce, yeah, yeah,
it was measure.
Speaker 1 (16:23):
I think it was around a lider and a half.
Speaker 2 (16:25):
What is that announces I needed?
Speaker 1 (16:26):
Like, oh, let's check here. Fifty ounce.
Speaker 2 (16:34):
That was his max.
Speaker 1 (16:35):
That was probably after you know, a big night.
Speaker 2 (16:37):
So and an unrelated note treatment for sad how do
we feel better without needing to go outside in our underwear,
pulling down our ears and trying to get as much
sunlight as possible. I guess kind of related light therapy.
Once that he said it could be effective in sixty
to eighty percent of cases. It might be a little
(16:58):
more of a placebo effect, but that's totally fine. Placebo
effects in my book count If you feel better, that's
all I care about.
Speaker 1 (17:05):
I'm really fascinated by base travel. Are we doing this
with astronauts? Are we trying to replicate conditions on the
Earth because our bodies are so in tune with the
Earth and the different cycles of the Earth, And if
we completely change that, how is that going to work
in space? So I'm always curious about how those things
(17:26):
are going to impact space travel. Plus sixty to eighty
percent effectiveness, or I would say, that's even more effective
than most antidepressant medications too. So if you're an all
natural person and you have seasonal components of your depression
and you want to try light therapy, there are hardly
(17:47):
any side effects possible and it's a very effective thing.
In combination, we always recommend therapy, and cognitive behavioral therapy
has been a type of therapy that has been shown
and improven treatment for season one effective disorder too.
Speaker 2 (18:01):
Yeah, can you tell me more about medications or are
we just are we using similar ones for major depression
and the seasonal effective disorder.
Speaker 1 (18:09):
Yeah, Typically, like SSRIs, the medicines that increase that serotonin
in your brain can be effective for seasonal effective disorder.
And I also learned in residency that there's an old
depression medicine called well butrin. It tends to be a
little bit more of an activating gives you a little
bit more energy. Actually doesn't impact your serotonin system as much,
(18:29):
but more your dopamine and norepinephrine systems in your brain.
That's actually a very effective medicine for seasonal effective disorder too.
So there are a couple of good options if that
is what you want to try.
Speaker 2 (18:40):
And then last thing we've talked about it and you
might be familiar already, but vitamin D supplements they might
help mitigate the effects of SAD. It seems to be
pretty common for people who maybe don't have a chance
to see a therapist just kind of know that about
themselves that each year around the winter time, they start
to get a little more low, so they have that
on hand already. Seems to be effective. I can't say
(19:01):
one way or the other their experience, but seems to
be effective.
Speaker 1 (19:04):
All natural way of getting that vitamin D is exposing
your skin to direct sunlight. If you do have seasonal
effective disorder, it's important to be mindful of it and say, Okay,
I'm starting to get a little bit less light exposure.
Maybe I should spend a little more time outside. Maybe
I should get a little bit more light on my skin.
That could be something that helps. Now bear in mind,
(19:24):
my mother was actually a nurse for a dermatologist, so
she would always say, like, don't get too much sun
contact because it increase your risk for skin cancer. True,
but it can also help give you that vitamin D
because your your skin makes vitamin D with direct sunlight
exposure or sunscreen too, but then you don't make as
much vitamin D it blocks those blocks those.
Speaker 2 (19:44):
Right if you do, damn if you don't. Other things
to consider if you have seasonal depression. Right, you've talked
about the light box, We've talked about talking to your doctor.
We've talked about going to therapy. It doesn't have to
be all three can only just can be just one
of them. But definitely, if you start to notice this
is a pattern, we get to October November, I am
feeling impacted. It's okay to try to ask for help
(20:06):
and know that it's not weird, it's not random, it's
not a fake thing. It's a very real thing that
impacts a lot of people.
Speaker 1 (20:12):
So one of our favorite things on this show is
talking about different celebrities that have come out and talked
about their experiences. And the first celebrity we want to
talk about is Kristin Bell. And although she's more widely
known for her advocacy around mental health and anxiety, Kristin
Bell has spoken about experiencing seasonal mood changes that resemble
(20:33):
seasonal effective disorder, often referring to her need for more
light and how the winter months affect her her mental
health negatively.
Speaker 2 (20:41):
Another one is Adele. She's mentioned a few times how
much sunny Los Angeles has positively impacted her mental health,
so that might be her roundabout way of saying that
she gets impacted by the seasonal I will say, in researching,
there's a number of celebrities who have made comments saying
that the colder, darker months impact them, but they haven't
really explicitly mentioned seasonal effective disorders, so you can infer.
(21:04):
But just wanted to mention that usually when when Justin
or I do research and we see, you know, celebrities
related to certain disorders, they'll explicitly say it. This was
one where it just was kind of like you could
take a guess and probably be right.
Speaker 1 (21:19):
It's so funny looking up different celebrities and their mental
health disorders and which topics just have lists and listen
lists of people who have come out and said like
especially like bipolar disorder, regular depression, anxiety. You can take
your pick of celebrities you want to talk about who
have had those things.
Speaker 2 (21:35):
But once you.
Speaker 1 (21:36):
Start getting into a little bit more of the niche diagnoses,
it's harder to find and it sounds like seasonal effective
disorder is not something that's on a lot of people's radars,
which is one of the reasons why we wanted to
do this episode. Bring a little bit more attention to
it and tell people that it's okay, it's a normal
thing that happens.
Speaker 2 (21:53):
Absolutely, that's our first take on point. It's fairly common
and it's definitely treatable. Don't be afraid to ask for
help when it comes to seasonal effective disorder.
Speaker 1 (22:02):
If you notice that you have mental health changes around
certain times of the year, consider seeking help and getting
help for this, because you shouldn't have to suffer alone.
Speaker 2 (22:11):
And while seasonal effective disorder is not its own diagnosis,
that doesn't mean it's any less important and that you
shouldn't get help. You should definitely get help. I tell
students all the time, so many students when I talk
with them, so many teens over the years, will say like, ah,
this is really dumb. I don't want to say it,
and I have to remind them if it's impacting you,
if you're having a hard time, it is not dumb.
(22:32):
It is important. I want to know about it so
we can talk about it and it gets you some help.
So same thing with seasonal effective disorder. It's not its
own diagnosis, but it's still very important. You still deserve
to get help, and it's okay to be struggling with
that because it's a very real thing.
Speaker 1 (22:46):
Perception is reality. If you're feeling like things are bad
during a certain time of year, then go with it.
Speaker 2 (22:53):
Well, thank you all. We hope this impacts somebody out
there listening and understands that this could be a real
thing that's on its way and how to treat it.
We appreciate you all for listening. On Apple Podcasts, Spotify,
whatever app you use, you know the you know the
drill we're on there. Feel free to leave us a
five star review. You can hit follow, you can hit subscribe,
whatever it is you do on your app. On social media, Twitter, Instagram, TikTok,
(23:16):
YouTube at Millennial MHC and MILLENNIALIMHC dot com. One last time,
thank y'all for listening. Again, this is suicide Prevention Month.
We hope that if you need help or you know
someone that needs help, that they reach out and call
the lifeline or get community or county resources and remember,
take care of all mentals.
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