SEASONAL AFFECTIVE DISORDER: EPISODE LINK
In this podcast episode, Dr. Norman E. Rosenthal discusses seasonal affective disorder (SAD) and its milder form, the winter blues. SAD is a more severe condition that occurs when the days get shorter and darker, leading to symptoms such as fatigue, difficulty waking up, increased sleep and appetite, weight gain, and loss of interest. The lack of environmental light is the main cause of SAD, and it affects three out of four women struggling with the disorder. Dr. Rosenthal emphasizes the importance of light therapy in treating SAD, recommending exposure to bright light in the morning. He also discusses the role of hormones and evolutionary factors in SAD. Additionally, he highlights the benefits of cognitive therapy and the combination of light therapy and antidepressants in managing the disorder. The episode concludes with suggestions for preparing and planning for the winter season to minimize the impact of SAD.
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TRANSCRIPT:
Welcome back to Hot Flashes and Cool Topics podcast everybody. Today we are talking to Dr. Norman E. Rosenthal and he writes a really great book or he has done research on sad seasonal effectiveness disorder and this seems very timely just coming with the recent.
time change here, where we had to fall back an hour, which I really personally dislike. And I felt that this book was very timely.
He has a book out called Defeating Sad, A Guide to Health and Happiness Through All Season. So, welcome to the show. Thank you. Well,
you know, I kind of wanted to talk about obviously with the time change. change in its dark route. Can you explain what SAD is, Seasonal Effective Disorder, and how it differs from the winter blues?
Well, both of these conditions, SAD and the winter blues, reflect our responses to the changing seasons. Because as the days get shorter and darker,
different people have different responses. Some people don’t have any responses. problem at all. They love the changing leaves, they love the cold weather, they love the darkness, but for those of us with either sad or the winter blues,
that is not the case. Sad is the more severe form. People with sad when the days get short and dark begin to experience symptoms that get worse and worse towards the time of year where we are.
now, around about November, December, and they get tired. It’s difficulty getting up in the morning. They need more sleep.
They eat more, especially sweets and starches. They gain weight and they lose interest in things. Their work suffers. Their personal relationships suffer.
and so it’s really quite bad in some people and it lasts until the spring and then they come out and it can be a full -fledged depression.
In other words, bad enough to be classed as a major depression, that’s sad. Now for every one of those there are other people who don’t have it quite as badly but nevertheless they just don’t work and live at their optimal level in the wintertime.
Maybe they just don’t have so much fun. If you were, say, you were a podcaster, like yourself, you might not really be looking forward to your interview.
You know, you’d go along because you’re a professional and you might do your job and sound okay, but you may be people who really follow you. you people who really knew you would feel There’s something missing.
She just hasn’t quite got that sparkle that she normally has and So that could continue and it can interfere with the quality of your life Although you keep going.
That’s the winter blues. It’s a milder version now somebody can have the winter blues one week one year and Sad the next year depending on a lot of factors factors and we can talk about those.
Right and you know some of the factors that you mentioned in your book it kind of you don’t make me think yeah I can understand this like your location in the world where you’re located.
Can you share a little bit about the location factors or even the day what the weather forecast for the day is? Definitely you know because the lack of environmental light is the precipitating cause of this seasonal affective disorder,
sad, how much light there is matters a lot. So if you’re up in Maine in the middle of the winter, you may have much more trouble than if you’re down in Sarasota,
Florida. I mean, I’m just giving you extremes. Or for that matter, if you’re up in the middle of the live in a basement apartment that has very little light coming in,
you may be much worse than if you’re in the penthouse with a 360 degree view. So I think that how much light you’re getting does affect how badly your symptoms are.
So in the penthouse, you could have full -fledged SAT, no, full -fledged, you can have full -fledged SAT. the winter blues, but in the basement, you can have SAT, I got it mixed up.
The less liked, the more symptoms, bottom line. – What was interesting, you start out the book by saying that you think of it as like a three -legged stool and it’s biology,
it’s light deprivation and it’s stress. So I thought that would be a great place to kind of start the conversation. First with biology, biology saying that three out of four people who struggle with sad are women and it lessens after 40 or 50 which is the time of men and pause.
So is there a connection with our hormones and sad? I’m pretty sure that there is there’s data suggesting it but I think it would be useful to think of it from an evolutionary point of view.
In the bad old days of the cave men and cave women, male -female equality was not the thing.
And in fact, it was a division of labor to sustain the species. And for a lot of the time,
women would be pregnant. And so it would be better for them to be pregnant during the winter, you know, when they weren’t out and about, when they were in the caves or in a sedentary place.
And the men could go out and hunt and gather and bring food for the, for their women and for the children, for the embryos,
fetuses. fetuses, call them what you like. And so there was a division. And so what happened through evolution, this is my speculation, is that the menstrual cycle got caught by the seasonal cycle,
so that women tended to develop more seasonal responsiveness than men. And I think that that’s kind of…
persisted and that that is why there are a lot more women than men with the problem. And what you find is that after the menopause, the seasonal problems tend to get less.
Yeah, that is so interesting because I’m just, you know, using my own personal response to this. And when I think I first heard about sad was probably in the 80s, probably when you were really starting out in this area,
and I started thinking that is what’s going on with me. And I felt like probably not sad, mine was more like winter blues, but I can remember even as a teenager,
just feeling those things, feeling I don’t like being cold. I don’t like it when it’s dark. I don’t like right now this time change it makes me angry.
(laughs) It really does, having to give up that extra hour of daylight at the end of the day. You know, I just know that that’s really something, and I have always responded if I do not like it to be really dark in a room.
So can you share a little bit about why, or share a lot, how much you want about light therapy and the importance of light therapy? (upbeat music) Well, it’s very exciting for me to hear your story because there were hundreds of thousands of years before anybody knew about seasonal affective disorders.
So you didn’t have a name for it, you didn’t have a context to put it in, and people would blame themselves. Why aren’t you up for going to the Christmas party?
Why are you everybody else is having such a good time. Why are you sitting in a corner? Or why do you have to keep eating more and more of that Christmas pudding?
Don’t you have any willpower? You know, there were a lot of symptoms that were a function of sad or the winter blues that people blamed on themselves or maybe their spouse blamed them.
Why aren’t you up for it? a party? Everybody else is having fun in your wallflower. So, you know, I think that giving it a name, understanding that it has a context,
you know, has really, you know, made a big difference for all of us. And so it’s really good to hear that you now have a name to put to it and understand it better than it seemed at the time.
You know, my response to light, I know that is something that definitely… Like light to the second stool, the second light deprivation and what we can do.
Well, in some ways, it’s the most exciting leg of the stool because it’s the one that you can most easily do something about. So, you know,
finding that light light does more than just enable us to see. 50 years ago, the given wisdom was that light didn’t do anything to humans other than to enable us to see.
So in our lifetime, all of these benefits of light were not known, but now we know that it affects mood, it affects daily.
rhythms, it affects how you sleep. All of these things and along with mood comes energy, concentration, effectiveness. So yes,
so basically the treatment based on substantial research by multiple groups, the treatment is to expose people to much more light than they would get from an indoor space.
And in my book, I do explain how the amount of light, the strength of light that’s been developed to be the one that you want to get if you’re going to reverse the symptoms of sad is 10 ,000 lux.
LUX is an a measure of light. How much light will fall on a surface? And so over here under the light therapy section, I’ve said, well, how much light is 10 ,000 lux?
You know, give us some basis for comparison, because people aren’t necessarily going to know exactly what that is. And I’m trying to find right here that indoor lighting lighting,
regular indoors, 50 to 150 lux, hallways, 100, classrooms, 300, offices and showrooms, 500,
supermarkets, 750. In fact, in the early days before light therapy, some of my patients used to say, you know, we go and cruise the supermarkets at night to get more light.
And then an overcast day, outdoors is a thousand and a full daylight clear day outdoors is 10 ,000 lux. That’s not staring at the sun,
that’s just looking at the horizon. So we are trying to emulate what you would get on a summer day at sunrise as the measure of how much light you put out in the various light fixtures or light boxes that we have advocated for this condition and now luckily there are many different offerings and I list them in my book bigger ones that put out you know more light because they’re just bigger and those are the ones
you probably need if you really have sad and smaller ones ones that you can caught around with you travel with you that would be good for if you haven’t got a place to put a big light box.
So more light is the first leg of the stool is to recognize the light. You know, you are very thorough in the book listing different types of light boxes,
which is wonderful because people don’t really know which ones would be most effective, but if someone, so someone goes and they buy their light box, I think the question in my mind would be how often do I need to use it and how long will it work?
You know, like do I have to do this daily for 10 minutes and will it last all winter? Can you answer those questions? Yes, the first thing I would say is everybody’s different. So you need to be your own best laboratory.
assistant to figure out how much light you need to feel well. And remember, what makes it tricky is the amount you need in September or October may be very different,
much less than what you need in November or December. The amount you need when you’ve got a week of very cloudy weather may be very different from when there’s a snap of sunny weather.
So I mentioned in my book is that people need to develop their own internal light meter. When you know, okay, I’m feeling good.
I’m feeling happy. I’m feeling energetic. I’ve had enough light. It’s like, you know, when you have all of us have a certain amount of tea or coffee that we drink in the morning or through the day and we develop an ability to say okay I’ve got to cut myself off now because this is about it or I’ll be you’ll have to peel me off the roof So it’s it’s very much the same kind of internal Knowledge of oneself that
has to be developed Yes, you really are very thorough like Colleen said in the book about When there could be too much and maybe side effects and different things that you can do.
You also talk about hypomania, which, you know, as I read your book, I keep thinking, oh, is that like when I feel super excited on certain days, especially like on a summer day for me,
I might feel really thrilled off the charts, excited. And then when it’s cloudy or, you know, stormy day, I’m really low. Can you talk about some of the things that can happen with hypomania?
much and just trying to find where your internal limit is with that? Well when people get hypomanic, they get over jest up, over activated,
they may talk very fast or their thoughts may run very fast and they may be very jolly, they may have trouble sleeping and that’s a sense that you’re pushing your system.
too hard. And it can be relatively subtle, but it can progress to a more severe condition of mania.
And mania really is when people just are so revved up that they’re more or less out of control, you know. And that is something that is potentially dangerous.
that can escalate, people can have trouble sleeping and then it can get worse and worse. So the idea is to catch it early. I was with a client the other day in, you know,
we were doing a Zoom session and he was a very bright guy and he was talking to me and he was talking fast and I realized that I couldn’t really track what he was saying.
I couldn’t really, and I said to him, you know, you’re thinking a little fast here.” In other words, like too fast for your own good.
Either thoughts aren’t being carefully curated, thoughts aren’t being carefully articulated. We’re gonna need to slow you down a little bit. So that’s on the more subtle side of the thing.
You know, somebody else might have just said, “Oh, you know, he was talking fast, he was in a good mood, nothing wrong.” But in the end, end, there was he couldn’t make a coherent story out of it. So it’s,
it can be subtle, but it can also race on and become troublesome. So, but it’s not common. You know, but you have to really say,
okay, I’ve had enough. Like, I just give the analogy too much coffee. Do you ever have too much coffee? How do you feel when you have too much coffee?
– Well, you know, you don’t really think of it in terms of like sad in the summer because it’s the opposite. So, but again, two extremes, it makes sense. The third leg of the equation is stress.
And you talk in the book about cognitive behavioral therapy as a, a can be helpful with the stress and its change in sleep.
Can you talk about the depressive aspect or the stressful aspect of sad. Yes, absolutely. You know, if you’re not functioning up to scratch,
that’s in itself depressing. If you don’t really feel like joining the party or getting together with other people, friends as you usually do in the summer, that can also be just depressing.
So cognitive behavior therapy seeks to change behavior and it seeks to change thinking. So let’s talk about each one.
For behavior, my colleague Kelly Rohan up in Vermont has done some wonderful research on cognitive behavior. behavior therapy. And for the behavior,
you might not feel like getting together with friends, but you would be encouraged to make lunch dates or to make appointments with friends. Things that normally you might just do spontaneously because you’re in such a good mood,
but now you’re not. But when you go along and you start talking about things and you start laughing. laughing and it gets to be fun, then you somehow you get into the spirit.
So the behavioral part is important. Or on the other side, when you wake up in the morning, you might feel like just pulling the covers over your head. That’s the worst thing to do because you’re going to block out the light.
You’re going to have too much sleep. It can make you feel worse. So if you know behaviorally, when you feel that way, throw the covers off, jump out of bed and go to your light box and get some light and be active.
And, you know, I’m right now, I often work out in the morning, sometimes with a trainer. And it’s fascinating to me how when I start the workout,
I will just feel lousy. I’ll feel like, what am I doing this for? I don’t feel like this is a good thing to do. I don’t feel like this is a good thing to do. And 10, 15 minutes into it, I think. You know, I’m getting into the swing here.
So I think cognitive therapy can be a behavior, but let’s shift to the cognitions for a moment. Let’s say you’re feeling depressed,
but you call up a friend, say, would you like to come out to dinner with me? And you’re like, I don’t know, I don’t feel like this is a good thing. And your friend says, “No, thanks.” Maybe it doesn’t clarify at all.
And you just, you put down the phone, you say, “Oh, oh, you know, maybe she or he, maybe they don’t like me anymore.” I guess, you know, lately people haven’t been responding to me.
And I guess I’m just losing it. And I’m not really, I’m a loser. And you start on a bad track and cognitive therapy. says, “Jewettek,
you’re making a lot of conclusions based on this one little exchange with a friend. What are the other possibilities? Why somebody might not be coming to dinner with you?” Well,
she may have another arrangement. She may not be feeling well. She may have something going on in her life that she feels a of,
and that’s why she didn’t want to tell you about it, etc, etc, etc. In other words, it’s not all about you. So that can be very,
very helpful. How do you test it? Maybe you call a couple other people. You call two more people, and guess what? The third person would love to go to dinner with you.
There you are, you know. you know, nobody needs to have everybody wanting to go to dinner with them. We haven’t got enough dinners to have everybody accommodated.
So in other words, you work on the behavior, you work on the thinking, you work on the light. The biggest point that I make in defeating sad is you have to add all of these things together so that you’re not just treating it,
you’re defeating it. Yes, you know, it’s stopping that spiral. So that was what was also very interesting in the book, it’s just talking about stopping the spiral of thinking and combining it with all these other therapies that can help to defeat the sad.
And I love the wake -up lights, because can you talk about what wake -up lights are? Yes, it was discovered that if you have a light coming on in your bedroom in the morning,
you know, it can help you wake up, but it can also make your mood better all day long. So they call them wake -up lights, they are available. And so they can be another excellent addition to help you get up in the morning and get your day going to a good start.
And I’ve got a couple of examples of them. I should mention that all of these devices usually come with money back guarantees that last four weeks,
you can return them all. So everybody can literally get a free trial of any of these devices. So keep the packaging,
keep the box, keep the packaging and you can send it back. And you can get through it. different ones and see which one you like best. So I just want to emphasize that side of the thing.
Mostly people don’t return the lights. That’s what I get from the light box dealers. They just feel so good and it’s so helpful that they usually feel like a good investment.
Right. And I love that the thought of the gradual light because you do mention in the book as well. as well, sometimes people have some side effects and they have to tweak it and move the level of where they’re looking at it.
And you have such great advice there about how you don’t want it right in your eyes, just 45 degrees and things like that. So that makes me really excited about the different types of lights that you can use.
But you also talk about that’s not really the only. thing that can help. Some people need antidepressants as well. Can you talk about the combining of those? – Yeah,
I’m so glad that you mentioned that because they are often very, very useful. And the one easy thing about antidepressants, you don’t have to work hard to take them.
They just swallow them. They do have side effects, but some are better than others. The one that has been… best studied in SAD is Wilbertron, or Bupropion is the brand name,
is the generic name. So I, you know, I mention them all, just because I think people need to have an understanding of all of their options.
That’s what I want to give people in the book is a sense of the abundance of choices. just like the abundance of life. And the goal,
of course, is to be able to access and enjoy that abundance. So here are all the different things you can do. And I would say that, you know, when I looked at the light therapy studies,
only about a third of patients or subjects got really pretty much completely better. The other two thirds did not. Those Those people have to add all these things in order to get feeling good all year round.
And so that’s the point that I wanted to make. Also in the book, you talk about preparation, being prepared. If you know you’re someone who gets winter blues or gets into a depressive mode like sad,
there are things you can do to prepare for it like if the bright light. light like diet and exercise and Meditation and you also talk about planning trips Yes,
I love that that is an excuse for me to go plan a trip because I can say to my husband I’m sorry, but I’m sad. I need to plan a trip Why is it that plan?
You know, are you talking about planning trips to the tropics so that there’s a lot of sunlight? What do you mean when you say plan a vacation? well Well, what I mean is that, you know,
here is the week after daylight savings time. If I had to now start planning a trip, it would be very difficult. I would have to juggle my pack practice.
I would have to get my wife on board. I would have to do all these kind of things. But knowing that I was going to have difficulty the week after the daylight savings time. I planned months in advance to go to sunny places one time in November and one time in January.
And it keeps you going, you know, you get, I mean, you don’t depend on it and rely on it, but those four days of rest and sun and swimming and whatever you like to do can really restore you.
And, and I think that it’s, you know, one of my early patients, referring to Esop’s fable of the ant and the grasshopper, said,
I was like the grasshopper that played all summer long, forgetting that the winter would ever come. And I’m saying to people, remember, you’re going to have some times when you’re going to feel really down,
plan ahead that you can do something good for yourself. And good really means light, sun, etc.
Do something good for yourself. And that is what I recommend. And there are other plans. I mean, some people like to go skiing. There’s a lot of sun that comes off the ski slopes,
whatever it is you enjoy, but usually it’s going to combine light, and exercise. Another thing I had never thought about or even heard of until I read your book was that seasonal affective disorder also affects people who don’t really enjoy the summertime as much.
Can you share how that might be different from the winter and what that is? Yes, yes the subtitle of the book is a guide to health and health. through all seasons,
because what you see is that there are people that have difficulty more or less at every time of the year, in the spring, in the summer, in the autumn, and what’s emerging is that summer -sad,
real depression in the summer is much more common than we thought because the emphasis has been on winter -sad. But there are people and they’re really… are depressed they often need antidepressants.
And we don’t fully understand are there environmental factors that could make them feel better if they had cold showers or cold baths, if they kept in air conditioned rooms with a curtain shut.
But what exactly is going to help them that hasn’t been studied to the same degree that the winter sad. But I think what we’re doing now, which I think is really important,
is simply saying, look, we acknowledge it, it’s out there, we don’t know all that much about it, but it has to be studied and treated because it’s a big issue and the world is getting hotter.
Yes, and I wonder how that’s, yeah, when you address that in the book as well, is that the changes in the climate. And I also wonder how many Perry menopausal women are feeling that because of the heat.
I really, you know, that’s when I, yeah, that’s when I really discovered that time in my life where maybe I didn’t enjoy the summer as much because of the excessive heat and the hot flashes and everything that came along with that.
– Well, it’s very apropos for your podcast title, hot flashes, cool topics. So yes, indeed. Good point. If someone struggles with SAD one year,
are they predisposed to have it every year, or can it just be, you know, one time thing? – Well, I think it depends what you do with the knowledge you get after that first attack of SAD.
If you say, “Ha ha, wait a sec.” I think I might have said that. What can I do to put in place the next year that’s going to make me less likely to have a repeat?” You’re in a much better position than if you don’t know what hit you,
because, you know, it’s like a swinging door. It hits you and then it hits you again, you know, because you’re not clear that it’s the door that’s going to swing back on you.
You know, those things are… in life where we make a mistake and then we do it again and we want to kick ourselves. Well, that’s a little bit like that. If you have a really bad winter and say,
wait a sec, what’s going on here? How am I gonna make next winter better? So I think whether or not you’re gonna get it again to a large extent depends upon how you’ve responded to the first one.
– And landing. – Yeah. Yeah, exactly. One other question that I had, I noticed in there that you said that when you do struggle with seasonal depression, that you crave sugars and carbohydrates.
And I immediately go to the holidays because everyone’s eating sugar and carbohydrates. Is there a link there? Well, if you think about it, in the holidays,
there’s a lot of light. whether you’re talking about a Christmas tree or a Hanukkah menorah. In other words, what I’m really saying is that people gravitate to things that they know are gonna make them feel better.
And it’s the same with puddings, Christmas puddings, and the other delightful delicatessen items for the Christmas tree.
holidays and so yes I think these are things that make people feel better and we actually did studies on giving people with sad cookies and they get more activated and alert when they have cookies and regular folks get more sedated so I think there’s something about the biochemistry and in fact we’ve got some speculations as to why the biochemistry works that way,
which may be more than what your listeners are interested in hearing or not. But we do know that there are biochemical mechanisms that make carbohydrates activating for people with sad.
– That’s so interesting. – That is interesting. It is, you know, I always felt like you get the lead up for the holiday season. And, you know, they accept that. and then you get the let down after the holidays the little bitty let down like and then you have that those months where we’re located uh where you have like January February even March into April where it’s colder and you’re almost like hibernating in that
time again so where are you located um well we’re actually in Nashville Tennessee which is a little warmer you know stays stays a little warmer longer. And you know,
since I’ve lived here, the fall, you know, lasts a little longer or should I say summer, because it seems to we have like three days of fall and then it goes straight to winter. But I did notice for a while I lived in Pittsburgh,
and lovely place. But I said, Oh, the winters are just too long here. Yeah, they’re much harsher when you get that far north. Definitely. Yes, yes.
Yeah, that I’ve really like a lot of that resonated with me when I was reading your book. Dr. Rosens, I’ll thank you so much for coming on today, talking about seasonal effective disorder,
what we can do to fight it. Again, the book lists so some great products for light therapy, for dawn awakening, and just answers a lot of our questions.
So thank you so much for your time, Dr. Rosens. coming on the show. We appreciate it. – Oh, it’s really a pleasure. I hope that your listeners got something from our podcast and that maybe they can,
if they want more information, they can look up my book and defeating sad and that it would be helpful to them. That would make me very happy.
– Absolutely. We’ll have the link in the show notes for anybody who’s interested. And I’m sure there will be. be many because I think it is a lot more common than we even realized. So thank you again for coming on. Thank you both., It’s been a real pleasure.
time change here, where we had to fall back an hour, which I really personally dislike. And I felt that this book was very timely.
He has a book out called Defeating Sad, A Guide to Health and Happiness Through All Season. So, welcome to the show. Thank you. Well,
you know, I kind of wanted to talk about obviously with the time change. change in its dark route. Can you explain what SAD is, Seasonal Effective Disorder, and how it differs from the winter blues?
Well, both of these conditions, SAD and the winter blues, reflect our responses to the changing seasons. Because as the days get shorter and darker,
different people have different responses. Some people don’t have any responses. problem at all. They love the changing leaves, they love the cold weather, they love the darkness, but for those of us with either sad or the winter blues,
that is not the case. Sad is the more severe form. People with sad when the days get short and dark begin to experience symptoms that get worse and worse towards the time of year where we are.
now, around about November, December, and they get tired. It’s difficulty getting up in the morning. They need more sleep.
They eat more, especially sweets and starches. They gain weight and they lose interest in things. Their work suffers. Their personal relationships suffer.
and so it’s really quite bad in some people and it lasts until the spring and then they come out and it can be a full -fledged depression.
In other words, bad enough to be classed as a major depression, that’s sad. Now for every one of those there are other people who don’t have it quite as badly but nevertheless they just don’t work and live at their optimal level in the wintertime.
Maybe they just don’t have so much fun. If you were, say, you were a podcaster, like yourself, you might not really be looking forward to your interview.
You know, you’d go along because you’re a professional and you might do your job and sound okay, but you may be people who really follow you. you people who really knew you would feel There’s something missing.
She just hasn’t quite got that sparkle that she normally has and So that could continue and it can interfere with the quality of your life Although you keep going.
That’s the winter blues. It’s a milder version now somebody can have the winter blues one week one year and Sad the next year depending on a lot of factors factors and we can talk about those.
Right and you know some of the factors that you mentioned in your book it kind of you don’t make me think yeah I can understand this like your location in the world where you’re located.
Can you share a little bit about the location factors or even the day what the weather forecast for the day is? Definitely you know because the lack of environmental light is the precipitating cause of this seasonal affective disorder,
sad, how much light there is matters a lot. So if you’re up in Maine in the middle of the winter, you may have much more trouble than if you’re down in Sarasota,
Florida. I mean, I’m just giving you extremes. Or for that matter, if you’re up in the middle of the live in a basement apartment that has very little light coming in,
you may be much worse than if you’re in the penthouse with a 360 degree view. So I think that how much light you’re getting does affect how badly your symptoms are.
So in the penthouse, you could have full -fledged SAT, no, full -fledged, you can have full -fledged SAT. the winter blues, but in the basement, you can have SAT, I got it mixed up.
The less liked, the more symptoms, bottom line. – What was interesting, you start out the book by saying that you think of it as like a three -legged stool and it’s biology,
it’s light deprivation and it’s stress. So I thought that would be a great place to kind of start the conversation. First with biology, biology saying that three out of four people who struggle with sad are women and it lessens after 40 or 50 which is the time of men and pause.
So is there a connection with our hormones and sad? I’m pretty sure that there is there’s data suggesting it but I think it would be useful to think of it from an evolutionary point of view.
In the bad old days of the cave men and cave women, male -female equality was not the thing.
And in fact, it was a division of labor to sustain the species. And for a lot of the time,
women would be pregnant. And so it would be better for them to be pregnant during the winter, you know, when they weren’t out and about, when they were in the caves or in a sedentary place.
And the men could go out and hunt and gather and bring food for the, for their women and for the children, for the embryos,
fetuses. fetuses, call them what you like. And so there was a division. And so what happened through evolution, this is my speculation, is that the menstrual cycle got caught by the seasonal cycle,
so that women tended to develop more seasonal responsiveness than men. And I think that that’s kind of…
persisted and that that is why there are a lot more women than men with the problem. And what you find is that after the menopause, the seasonal problems tend to get less.
Yeah, that is so interesting because I’m just, you know, using my own personal response to this. And when I think I first heard about sad was probably in the 80s, probably when you were really starting out in this area,
and I started thinking that is what’s going on with me. And I felt like probably not sad, mine was more like winter blues, but I can remember even as a teenager,
just feeling those things, feeling I don’t like being cold. I don’t like it when it’s dark. I don’t like right now this time change it makes me angry.
(laughs) It really does, having to give up that extra hour of daylight at the end of the day. You know, I just know that that’s really something, and I have always responded if I do not like it to be really dark in a room.
So can you share a little bit about why, or share a lot, how much you want about light therapy and the importance of light therapy? (upbeat music) Well, it’s very exciting for me to hear your story because there were hundreds of thousands of years before anybody knew about seasonal affective disorders.
So you didn’t have a name for it, you didn’t have a context to put it in, and people would blame themselves. Why aren’t you up for going to the Christmas party?
Why are you everybody else is having such a good time. Why are you sitting in a corner? Or why do you have to keep eating more and more of that Christmas pudding?
Don’t you have any willpower? You know, there were a lot of symptoms that were a function of sad or the winter blues that people blamed on themselves or maybe their spouse blamed them.
Why aren’t you up for it? a party? Everybody else is having fun in your wallflower. So, you know, I think that giving it a name, understanding that it has a context,
you know, has really, you know, made a big difference for all of us. And so it’s really good to hear that you now have a name to put to it and understand it better than it seemed at the time.
You know, my response to light, I know that is something that definitely… Like light to the second stool, the second light deprivation and what we can do.
Well, in some ways, it’s the most exciting leg of the stool because it’s the one that you can most easily do something about. So, you know,
finding that light light does more than just enable us to see. 50 years ago, the given wisdom was that light didn’t do anything to humans other than to enable us to see.
So in our lifetime, all of these benefits of light were not known, but now we know that it affects mood, it affects daily.
rhythms, it affects how you sleep. All of these things and along with mood comes energy, concentration, effectiveness. So yes,
so basically the treatment based on substantial research by multiple groups, the treatment is to expose people to much more light than they would get from an indoor space.
And in my book, I do explain how the amount of light, the strength of light that’s been developed to be the one that you want to get if you’re going to reverse the symptoms of sad is 10 ,000 lux.
LUX is an a measure of light. How much light will fall on a surface? And so over here under the light therapy section, I’ve said, well, how much light is 10 ,000 lux?
You know, give us some basis for comparison, because people aren’t necessarily going to know exactly what that is. And I’m trying to find right here that indoor lighting lighting,
regular indoors, 50 to 150 lux, hallways, 100, classrooms, 300, offices and showrooms, 500,
supermarkets, 750. In fact, in the early days before light therapy, some of my patients used to say, you know, we go and cruise the supermarkets at night to get more light.
And then an overcast day, outdoors is a thousand and a full daylight clear day outdoors is 10 ,000 lux. That’s not staring at the sun,
that’s just looking at the horizon. So we are trying to emulate what you would get on a summer day at sunrise as the measure of how much light you put out in the various light fixtures or light boxes that we have advocated for this condition and now luckily there are many different offerings and I list them in my book bigger ones that put out you know more light because they’re just bigger and those are the ones
you probably need if you really have sad and smaller ones ones that you can caught around with you travel with you that would be good for if you haven’t got a place to put a big light box.
So more light is the first leg of the stool is to recognize the light. You know, you are very thorough in the book listing different types of light boxes,
which is wonderful because people don’t really know which ones would be most effective, but if someone, so someone goes and they buy their light box, I think the question in my mind would be how often do I need to use it and how long will it work?
You know, like do I have to do this daily for 10 minutes and will it last all winter? Can you answer those questions? Yes, the first thing I would say is everybody’s different. So you need to be your own best laboratory.
assistant to figure out how much light you need to feel well. And remember, what makes it tricky is the amount you need in September or October may be very different,
much less than what you need in November or December. The amount you need when you’ve got a week of very cloudy weather may be very different from when there’s a snap of sunny weather.
So I mentioned in my book is that people need to develop their own internal light meter. When you know, okay, I’m feeling good.
I’m feeling happy. I’m feeling energetic. I’ve had enough light. It’s like, you know, when you have all of us have a certain amount of tea or coffee that we drink in the morning or through the day and we develop an ability to say okay I’ve got to cut myself off now because this is about it or I’ll be you’ll have to peel me off the roof So it’s it’s very much the same kind of internal Knowledge of oneself that
has to be developed Yes, you really are very thorough like Colleen said in the book about When there could be too much and maybe side effects and different things that you can do.
You also talk about hypomania, which, you know, as I read your book, I keep thinking, oh, is that like when I feel super excited on certain days, especially like on a summer day for me,
I might feel really thrilled off the charts, excited. And then when it’s cloudy or, you know, stormy day, I’m really low. Can you talk about some of the things that can happen with hypomania?
much and just trying to find where your internal limit is with that? Well when people get hypomanic, they get over jest up, over activated,
they may talk very fast or their thoughts may run very fast and they may be very jolly, they may have trouble sleeping and that’s a sense that you’re pushing your system.
too hard. And it can be relatively subtle, but it can progress to a more severe condition of mania.
And mania really is when people just are so revved up that they’re more or less out of control, you know. And that is something that is potentially dangerous.
that can escalate, people can have trouble sleeping and then it can get worse and worse. So the idea is to catch it early. I was with a client the other day in, you know,
we were doing a Zoom session and he was a very bright guy and he was talking to me and he was talking fast and I realized that I couldn’t really track what he was saying.
I couldn’t really, and I said to him, you know, you’re thinking a little fast here.” In other words, like too fast for your own good.
Either thoughts aren’t being carefully curated, thoughts aren’t being carefully articulated. We’re gonna need to slow you down a little bit. So that’s on the more subtle side of the thing.
You know, somebody else might have just said, “Oh, you know, he was talking fast, he was in a good mood, nothing wrong.” But in the end, end, there was he couldn’t make a coherent story out of it. So it’s,
it can be subtle, but it can also race on and become troublesome. So, but it’s not common. You know, but you have to really say,
okay, I’ve had enough. Like, I just give the analogy too much coffee. Do you ever have too much coffee? How do you feel when you have too much coffee?
– Well, you know, you don’t really think of it in terms of like sad in the summer because it’s the opposite. So, but again, two extremes, it makes sense. The third leg of the equation is stress.
And you talk in the book about cognitive behavioral therapy as a, a can be helpful with the stress and its change in sleep.
Can you talk about the depressive aspect or the stressful aspect of sad. Yes, absolutely. You know, if you’re not functioning up to scratch,
that’s in itself depressing. If you don’t really feel like joining the party or getting together with other people, friends as you usually do in the summer, that can also be just depressing.
So cognitive behavior therapy seeks to change behavior and it seeks to change thinking. So let’s talk about each one.
For behavior, my colleague Kelly Rohan up in Vermont has done some wonderful research on cognitive behavior. behavior therapy. And for the behavior,
you might not feel like getting together with friends, but you would be encouraged to make lunch dates or to make appointments with friends. Things that normally you might just do spontaneously because you’re in such a good mood,
but now you’re not. But when you go along and you start talking about things and you start laughing. laughing and it gets to be fun, then you somehow you get into the spirit.
So the behavioral part is important. Or on the other side, when you wake up in the morning, you might feel like just pulling the covers over your head. That’s the worst thing to do because you’re going to block out the light.
You’re going to have too much sleep. It can make you feel worse. So if you know behaviorally, when you feel that way, throw the covers off, jump out of bed and go to your light box and get some light and be active.
And, you know, I’m right now, I often work out in the morning, sometimes with a trainer. And it’s fascinating to me how when I start the workout,
I will just feel lousy. I’ll feel like, what am I doing this for? I don’t feel like this is a good thing to do. I don’t feel like this is a good thing to do. And 10, 15 minutes into it, I think. You know, I’m getting into the swing here.
So I think cognitive therapy can be a behavior, but let’s shift to the cognitions for a moment. Let’s say you’re feeling depressed,
but you call up a friend, say, would you like to come out to dinner with me? And you’re like, I don’t know, I don’t feel like this is a good thing. And your friend says, “No, thanks.” Maybe it doesn’t clarify at all.
And you just, you put down the phone, you say, “Oh, oh, you know, maybe she or he, maybe they don’t like me anymore.” I guess, you know, lately people haven’t been responding to me.
And I guess I’m just losing it. And I’m not really, I’m a loser. And you start on a bad track and cognitive therapy. says, “Jewettek,
you’re making a lot of conclusions based on this one little exchange with a friend. What are the other possibilities? Why somebody might not be coming to dinner with you?” Well,
she may have another arrangement. She may not be feeling well. She may have something going on in her life that she feels a of,
and that’s why she didn’t want to tell you about it, etc, etc, etc. In other words, it’s not all about you. So that can be very,
very helpful. How do you test it? Maybe you call a couple other people. You call two more people, and guess what? The third person would love to go to dinner with you.
There you are, you know. you know, nobody needs to have everybody wanting to go to dinner with them. We haven’t got enough dinners to have everybody accommodated.
So in other words, you work on the behavior, you work on the thinking, you work on the light. The biggest point that I make in defeating sad is you have to add all of these things together so that you’re not just treating it,
you’re defeating it. Yes, you know, it’s stopping that spiral. So that was what was also very interesting in the book, it’s just talking about stopping the spiral of thinking and combining it with all these other therapies that can help to defeat the sad.
And I love the wake -up lights, because can you talk about what wake -up lights are? Yes, it was discovered that if you have a light coming on in your bedroom in the morning,
you know, it can help you wake up, but it can also make your mood better all day long. So they call them wake -up lights, they are available. And so they can be another excellent addition to help you get up in the morning and get your day going to a good start.
And I’ve got a couple of examples of them. I should mention that all of these devices usually come with money back guarantees that last four weeks,
you can return them all. So everybody can literally get a free trial of any of these devices. So keep the packaging,
keep the box, keep the packaging and you can send it back. And you can get through it. different ones and see which one you like best. So I just want to emphasize that side of the thing.
Mostly people don’t return the lights. That’s what I get from the light box dealers. They just feel so good and it’s so helpful that they usually feel like a good investment.
Right. And I love that the thought of the gradual light because you do mention in the book as well. as well, sometimes people have some side effects and they have to tweak it and move the level of where they’re looking at it.
And you have such great advice there about how you don’t want it right in your eyes, just 45 degrees and things like that. So that makes me really excited about the different types of lights that you can use.
But you also talk about that’s not really the only. thing that can help. Some people need antidepressants as well. Can you talk about the combining of those? – Yeah,
I’m so glad that you mentioned that because they are often very, very useful. And the one easy thing about antidepressants, you don’t have to work hard to take them.
They just swallow them. They do have side effects, but some are better than others. The one that has been… best studied in SAD is Wilbertron, or Bupropion is the brand name,
is the generic name. So I, you know, I mention them all, just because I think people need to have an understanding of all of their options.
That’s what I want to give people in the book is a sense of the abundance of choices. just like the abundance of life. And the goal,
of course, is to be able to access and enjoy that abundance. So here are all the different things you can do. And I would say that, you know, when I looked at the light therapy studies,
only about a third of patients or subjects got really pretty much completely better. The other two thirds did not. Those Those people have to add all these things in order to get feeling good all year round.
And so that’s the point that I wanted to make. Also in the book, you talk about preparation, being prepared. If you know you’re someone who gets winter blues or gets into a depressive mode like sad,
there are things you can do to prepare for it like if the bright light. light like diet and exercise and Meditation and you also talk about planning trips Yes,
I love that that is an excuse for me to go plan a trip because I can say to my husband I’m sorry, but I’m sad. I need to plan a trip Why is it that plan?
You know, are you talking about planning trips to the tropics so that there’s a lot of sunlight? What do you mean when you say plan a vacation? well Well, what I mean is that, you know,
here is the week after daylight savings time. If I had to now start planning a trip, it would be very difficult. I would have to juggle my pack practice.
I would have to get my wife on board. I would have to do all these kind of things. But knowing that I was going to have difficulty the week after the daylight savings time. I planned months in advance to go to sunny places one time in November and one time in January.
And it keeps you going, you know, you get, I mean, you don’t depend on it and rely on it, but those four days of rest and sun and swimming and whatever you like to do can really restore you.
And, and I think that it’s, you know, one of my early patients, referring to Esop’s fable of the ant and the grasshopper, said,
I was like the grasshopper that played all summer long, forgetting that the winter would ever come. And I’m saying to people, remember, you’re going to have some times when you’re going to feel really down,
plan ahead that you can do something good for yourself. And good really means light, sun, etc.
Do something good for yourself. And that is what I recommend. And there are other plans. I mean, some people like to go skiing. There’s a lot of sun that comes off the ski slopes,
whatever it is you enjoy, but usually it’s going to combine light, and exercise. Another thing I had never thought about or even heard of until I read your book was that seasonal affective disorder also affects people who don’t really enjoy the summertime as much.
Can you share how that might be different from the winter and what that is? Yes, yes the subtitle of the book is a guide to health and health. through all seasons,
because what you see is that there are people that have difficulty more or less at every time of the year, in the spring, in the summer, in the autumn, and what’s emerging is that summer -sad,
real depression in the summer is much more common than we thought because the emphasis has been on winter -sad. But there are people and they’re really… are depressed they often need antidepressants.
And we don’t fully understand are there environmental factors that could make them feel better if they had cold showers or cold baths, if they kept in air conditioned rooms with a curtain shut.
But what exactly is going to help them that hasn’t been studied to the same degree that the winter sad. But I think what we’re doing now, which I think is really important,
is simply saying, look, we acknowledge it, it’s out there, we don’t know all that much about it, but it has to be studied and treated because it’s a big issue and the world is getting hotter.
Yes, and I wonder how that’s, yeah, when you address that in the book as well, is that the changes in the climate. And I also wonder how many Perry menopausal women are feeling that because of the heat.
I really, you know, that’s when I, yeah, that’s when I really discovered that time in my life where maybe I didn’t enjoy the summer as much because of the excessive heat and the hot flashes and everything that came along with that.
– Well, it’s very apropos for your podcast title, hot flashes, cool topics. So yes, indeed. Good point. If someone struggles with SAD one year,
are they predisposed to have it every year, or can it just be, you know, one time thing? – Well, I think it depends what you do with the knowledge you get after that first attack of SAD.
If you say, “Ha ha, wait a sec.” I think I might have said that. What can I do to put in place the next year that’s going to make me less likely to have a repeat?” You’re in a much better position than if you don’t know what hit you,
because, you know, it’s like a swinging door. It hits you and then it hits you again, you know, because you’re not clear that it’s the door that’s going to swing back on you.
You know, those things are… in life where we make a mistake and then we do it again and we want to kick ourselves. Well, that’s a little bit like that. If you have a really bad winter and say,
wait a sec, what’s going on here? How am I gonna make next winter better? So I think whether or not you’re gonna get it again to a large extent depends upon how you’ve responded to the first one.
– And landing. – Yeah. Yeah, exactly. One other question that I had, I noticed in there that you said that when you do struggle with seasonal depression, that you crave sugars and carbohydrates.
And I immediately go to the holidays because everyone’s eating sugar and carbohydrates. Is there a link there? Well, if you think about it, in the holidays,
there’s a lot of light. whether you’re talking about a Christmas tree or a Hanukkah menorah. In other words, what I’m really saying is that people gravitate to things that they know are gonna make them feel better.
And it’s the same with puddings, Christmas puddings, and the other delightful delicatessen items for the Christmas tree.
holidays and so yes I think these are things that make people feel better and we actually did studies on giving people with sad cookies and they get more activated and alert when they have cookies and regular folks get more sedated so I think there’s something about the biochemistry and in fact we’ve got some speculations as to why the biochemistry works that way,
which may be more than what your listeners are interested in hearing or not. But we do know that there are biochemical mechanisms that make carbohydrates activating for people with sad.
– That’s so interesting. – That is interesting. It is, you know, I always felt like you get the lead up for the holiday season. And, you know, they accept that. and then you get the let down after the holidays the little bitty let down like and then you have that those months where we’re located uh where you have like January February even March into April where it’s colder and you’re almost like hibernating in that
time again so where are you located um well we’re actually in Nashville Tennessee which is a little warmer you know stays stays a little warmer longer. And you know,
since I’ve lived here, the fall, you know, lasts a little longer or should I say summer, because it seems to we have like three days of fall and then it goes straight to winter. But I did notice for a while I lived in Pittsburgh,
and lovely place. But I said, Oh, the winters are just too long here. Yeah, they’re much harsher when you get that far north. Definitely. Yes, yes.
Yeah, that I’ve really like a lot of that resonated with me when I was reading your book. Dr. Rosens, I’ll thank you so much for coming on today, talking about seasonal effective disorder,
what we can do to fight it. Again, the book lists so some great products for light therapy, for dawn awakening, and just answers a lot of our questions.
So thank you so much for your time, Dr. Rosens. coming on the show. We appreciate it. – Oh, it’s really a pleasure. I hope that your listeners got something from our podcast and that maybe they can,
if they want more information, they can look up my book and defeating sad and that it would be helpful to them. That would make me very happy.
– Absolutely. We’ll have the link in the show notes for anybody who’s interested. And I’m sure there will be. be many because I think it is a lot more common than we even realized. So thank you again for coming on. Thank you both., It’s been a real pleasure.
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