Shining the Light on S.A.D.

​Dr. Terako Amison, Assistant Professor of Clinical Psychiatry and Behavioral Sciences and Psychiatry Clerkship Director at Vanderbilt, discusses Seasonal Affective Disorder (S.A.D.), its causes, and treatment options.

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Rosemary Cope:  Welcome to this edition of the Vanderbilt Health and Wellness Wellcast.  I am Rosemary Cope with Work/Life Connections, Employee Assistance Program.  I am here today with my colleague, Dr. Terako Amison, who received her undergraduate degree from Samford University and graduated from the University of Alabama School of Medicine.  She is an Assistant Professor of Clinical Psychiatry and Behavioral Sciences, and is also the Psychiatry Clerkship Director at Vanderbilt.  As we are all aware, things slow down in the winter months.  The days are darker and shorter, and many of us want to stay indoors and wrap up with a soft blanket, but how do you know when a seasonal change is a more serious problem?  Seasonal affective disorder, commonly called SAD, is a type of depression that appears during particular seasons of the year.  Dr. Amison, can you tell our listeners what they might notice if they are experiencing symptoms of seasonal affective disorder?

Dr. Terako Amison:  Seasonal affective disorder is typically associated with depressive episodes that start in one season and get better in another.  We generally think of the winter blues as depression that starts or gets worse in the fall or winter, and improves in the spring or summer.  Some of the symptoms that can be associated with depression are changes in sleep or appetite.  In particular, people with a fall or winter onset of seasonal affective disorder may notice that they may want to sleep or eat more.  When people are depressed, they may also notice that they don't concentrate as well, and that they have less motivation or energy to get things done.  In severe cases, people who become depressed can have thoughts of suicide or self-harm.  It is important to note that not all of these symptoms are present in every case, though.  We typically see people who report seasonal affective disorder that occurs in the fall and winter; however, there are some rare cases in which people notice the opposite, in that their moods get worse in the spring and summer, but improve in the fall and winter.  For the purpose of today's conversation, we will be focusing primarily on the type of seasonal affective disorder that is associated with a fall or winter onset.

Rosemary Cope:  What causes SAD?

Dr. Terako Amison:  So, there are a few things that are thought to cause seasonal affective disorder.  The biggest issue is less sunlight, which affects the sleep/wake cycle.  Also, cold weather and less sunlight can cause people to feel confined to being indoors, which can lead to feeling depressed.  Finally, alterations and chemicals in the brain that affect mood and sleep, such as serotonin and melatonin, are thought to also play a role.

Rosemary Cope:  How would I know if I need to consult a physician, and what kind of treatments are offered to help me?

Dr. Terako Amison:  I would say that, when in doubt, it is always best to have any decline in mood evaluated.  It is especially concerning when a person has depression that is associated with a decline in functioning.  So, for example, a depressive episode would be really concerning if a person felt that they weren't able to go to work or to care for their children.  Turning to alcohol or elicit drugs to cope is also a warning sign.  Finally, having thoughts of suicide or self-harm are also signs that suggest that depression needs to be addressed.  Consulting with one's primary care provider is always a good place to start, and based on that consultation, the primary care provider can inform the person if seeing a mental health professional is warranted.  In regards to treatment options, the first line of treatment is an antidepressant in conjunction with light therapy.  Getting out and being exposed to natural sunlight is best, but of course, that isn't always feasible in the winter.  An alternative is using a light therapy box, which basically consists of sitting in front of a box that emits a bright light.  There are a few issues that are worth mentioning about a light box.  First, in order for light therapy to be effective, the box needs to emit light at about 10,000 lux.  So, this is going to be different than your standard light bulb.  Light boxes can be purchased online, and I encourage my patients to make sure that they buy the type that emits the appropriate number of lux.  Also, in order for light boxes to be effective, a person needs to be able to sit in front of it for at least 30 minutes once a day, typically in the morning.  The frequency of using the light box might need to be increased based on the response that the person gets.  The instructions that come with the light box will tell you how close you need to sit to the light box for it be effective, and a person shouldn't stare directly at the light box in order to avoid injury to the eyes.  People typically stop using the light box when spring and summer arrive.  In regards to the medication, some people will only use an antidepressant during the fall and winter, while others may decide to stick with the medication all year long.

Rosemary Cope:  Are there any websites that you would suggest to our listeners for more information?

Dr. Terako Amison:  I would suggest looking at UpToDate's website, which provides information on seasonal affective disorder in a format that is easy to understand.

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