3 questions about seasonal affective disorder – SAD – for the psychiatrist who detects it

There’s a lot to enjoy about winter’s approach for those who live in a place with season-changing holidays! Cozy sweater! snow! For many, it is also a palpable fear. That’s often because reduced light and day length can negatively affect a person’s mood, leading to seasonal affective disorder (SAD) each year in about 5% of the U.S. population.

SAD, first discovered and named in the 1980s by South African psychiatrist Dr. Norman Rosenthal, can cause symptoms ranging from sadness to lethargy, which can lead to trouble in life. work and in relationships as well as deep depression, lasting an average of 40% per year. , until spring or summer returns.

For those struggling with full-blown SAD, a more clinical and severe form of depression than what some call the “winter blues,” there are many treatments besides waiting, from highly effective light therapy to medication and dietary changes.

Here, Rosenthal, a pioneer of light therapy and clinical professor of psychiatry at Georgetown University School of Medicine, who just published his 10th book, Beating SAD: A guide to health and happiness through every season, Share your insights.

1. How did you discover SAD?

“It was a several-year process,” which began when Rosenthal left Johannesburg for New York City for a psychiatry internship at Columbia University, he told Yahoo Life. “When I arrived, it was summer, the days were long and I loved it. I have a lot of energy. Then winter comes, the days get shorter and my strength declines.” Because his hometown of South Africa is about 27 degrees south of the equator and NYC is 40 degrees north, he points out, “I’ve never really had to deal with such a change in day length throughout my life.” But, he added, “when spring comes, I say, ‘Well, that wasn’t so bad,’ and then I’ll pick things up again. That will happen year after year, for three years.”

Finally, Rosenthal arrived at the National Institutes of Health and had to choose a research topic. “We came across a guy who had this type of season, but much worse than me. I thought, ‘Wow, there’s really something here,'” he said.

Rosenthal pieced together the elements of the syndrome based on thousands of questionnaires and observed common symptoms, which he describes as “increased need for sleep; difficulty waking up in the morning; increased cravings.” eating, especially sweets and starches; difficulty concentrating and concentrating.” and finish your work and retire.” He and his team then followed a group from summer to winter.

“They were having the most wonderful time of the summer, just like I had that first summer, and one of my colleagues said, ‘Well, what would you do if they weren’t depressed? Feeling on schedule? Do you look stupid??’ And I said, “I think they’ll be bored. And you know, being stupid isn’t the worst thing.” And sure enough,” he recalls, “as the days got shorter, all the people we studied became depressed one by one, right on schedule. And we put them into a clinical trial. And then one of the clinical trials.” The most thrilling experience of my research career, or even of my life, has been watching these people come out of depression. We were all very happy, surprised, impressed and realized that this was something real. We wrote it up, and that was our original article in 1984.”

His new book, he says, “was four decades in the making. It’s a distillation of everything I’ve learned that can be useful to everyone.”

2. How would you describe SAD?

In her book, Rosenthal defines the disorder as a “regular depressive condition that occurs in the fall and winter and is usually relieved in the spring and summer,” affecting women more often. men and there are many variations, including some that do not just have the disease. depressed in winter but “overexcited” in summer. However, the way he describes it concerns our relationship with both the animal world and our productivity-focused society.

“If you look around the world, in many cases animals have seasonal rhythms, especially animals that evolved a little further away from the equator, where there are seasonal rhythms of sunlight,” he said. and day length”. “And although seasonal rhythms in nature can often be very adaptive and helpful [as with] The seasonal rhythms of bear hibernation in humans can cause severe neck pain.”

When someone has SAD, “changes in behavior predictably occur starting as the days get shorter and continuing during the shorter days until spring, which can be varied and problematic,” causing the symptoms that Rosenthal first observed in his research.

Furthermore, he added, “One of my first patients said, ‘I should have been a bear. It’s a lot to hibernate’ and in that comment, she actually points out that these seasonal rhythms, while widespread, are not well tolerated in species that pride themselves on the ability to perform at high levels year-round. You have very little tolerance for curling up with junk food and waiting for winter to pass, you know? So that’s the problem with seasonal affective disorder.”

Rosenthal is often asked to explain the difference between depression and SAD. “Like you said, ‘How are cucumbers different from vegetables?’ Cucumber is a vegetable. And in the family of depression, SAD is a type,” he explained. “As bad as it can be, it’s a mistake to think that if it’s SAD it’s mild, just because it’s seasonal. But that’s not necessarily the case, and in fact, in my book I, I’m talking about two very suicidal people. But the pattern of its occurrence is consistent with the seasons. So that’s what differentiates it from non-seasonal depression.”

3. What do we know about light therapy and other forms of SAD treatment?

Because SAD is tied to seasonal changes in light, Rosenthal’s initial findings suggested that symptoms could be reversed by exposure to bright light. Since then, what is now known as bright light therapy or BLT, the use of SAD lamps, also known as light boxes, available in a variety of sizes and price points, has steadily been proven. Proven to be effective in the majority of over 60 studies.

“If you look at light therapy in clinical trials, most people respond, meaning they are better off using light therapy than not using light therapy,” he said. Thoi added that the majority of people appear to need additional treatments to achieve complete remission. “Light therapy can do the heavy lifting, but [there are] everything else to get the best results,” he says, noting that if he sees a patient still having SAD symptoms even while on a light therapy regimen, he will recommend lifestyle change recommendations.” I might say, ‘More exercise, and more outdoor exercise in the light. And what are you doing socially? Oh, you’re hanging out at home. Make some arrangements. And have you booked any holidays to sunny places in winter? Okay, hurry up before airfare prices increase.” So the collective combination is much better than light therapy alone.”

He added: “Light therapy is amazing. I don’t want to talk about it. It’s really a big contributor not just to SAD but to depression in general, which is largely unknown.” But it really works best when combined with other treatments. That’s the central theme of the book. And that’s why I have sections on habits. basics and medication, if you need it. And about CBT [cognitive behavioral therapy]It was an excellent treatment.”