SAD: Seasonal Affective Disorder Symptoms And Treatments : Life Kit It's getting darker and colder, and there's still a pandemic. Oh, and then there's seasonal affective disorder. Here's how to spot it and what you can do.
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'Tis The Season: Coping With SAD, Or Seasonal Affective Disorder

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'Tis The Season: Coping With SAD, Or Seasonal Affective Disorder

'Tis The Season: Coping With SAD, Or Seasonal Affective Disorder

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KAVITHA CARDOZA, HOST:

This is NPR's LIFE KIT. I'm Kavitha Cardoza.

MXMTOON: (Singing) Seasonal depression's got me sleeping off the days. And we've wasted all our time feeling gray.

CARDOZA: Seasonal affective disorder may not be typical inspiration for a song, but Maia, then a teenager, was trying to understand her feelings. She's a singer-songwriter from California and doesn't use her last name to protect the privacy of her family. She goes by the name mxmtoon.

MXMTOON: And I was feeling sad, looking outside, seeing that the weather was really bad and that it was dark outside, like, just lying there for hours and hours not knowing how to get out of bed and move or do anything. And it just makes it really difficult to do basic, normal things like getting up and going to eat a meal or going to drink water or even using the bathroom.

CARDOZA: But being 16, instead of asking her parents or teachers or doctor, she tweeted about it.

MXMTOON: I went on Twitter, and I was like, am I crazy, because I feel really sad right now, and the weather is really horrible and I don't like it? And people were like, that sounds like you have seasonal affective disorder. It's, like, SAD, and you should look into it.

So I talked to my parents. They're like, yeah, that's also something that I experience and go through. And I talked to my friends, and they're like, yeah, it's also something that I go through. And I just realized that everybody feels - horrible weather outside also makes you feel horrible inside. And so that's how I kind of discovered it.

CARDOZA: Today, on this episode of LIFE KIT, we're talking about seasonal affective disorder, or SAD. It's a type of depression that's related to the change in seasons. Maybe you've never put a name to why, come winter, you just want to stay under the covers all day or didn't want to meet friends or just felt like you were in a fog all the time. We're going to talk about why you feel this way and simple ways to feel better, more like yourself.

(SOUNDBITE OF MUSIC)

CARDOZA: Dr. Norman Rosenthal is a clinical professor of psychiatry at Georgetown University School of Medicine. Years ago, he noticed feeling less energetic during the winter and began studying the problem in others who said they felt the same way.

NORMAN ROSENTHAL: Just like the autumn leaves, they became depressed on schedule, people getting less energetic and feeling worse as the days got shorter, and then in the spring, all of that being reversed. So it seemed like quite a distinct syndrome. And that was our first study of seasonal affective disorder, which is what it became known as.

CARDOZA: He found about 1 in 20 people in the U.S. has seasonal affective disorder or full-blown winter depression - feeling sluggish, depressed, oversleeping, overeating. You may gain weight and be disinterested in doing things you previously enjoyed. Many more have the winter blues, a milder version where you feel like basically a sadder, sleepier or slower version of yourself. One of Rosenthal's patients described themselves as feeling like a bear in the winter and wanting to hibernate.

ROSENTHAL: So if you feel any identification with a hibernating bear, I think you might well have SAD.

CARDOZA: But in spring, those symptoms go away and you start feeling like yourself again. Women are about three times more vulnerable than men, and the condition seems to be more common in the Northern Hemisphere. Rosenthal says mood disorders were called affective disorders.

ROSENTHAL: Affect is just another word for mood. And I thought, well, this is seasonal. And if we have seasonal affective disorder, it would be a snappy acronym, SAD, and that's what it's become known as ever since.

CARDOZA: So now we know what we're dealing with. Let's talk about a game plan.

(SOUNDBITE OF MUSIC)

CARDOZA: Takeaway one is recognize your symptoms and their seasonal pattern. A funny - well, not-so-funny story - a few years ago, I called a friend in January. I was in tears, and she said, I was expecting this. And I said, what do you mean? And she said, Kavitha, you always call me crying in January. It shouldn't have taken me years to connect my sadness with the seasons. Dr. Rosenthal says if every fall when it gets darker earlier, you feel like things are getting more difficult...

ROSENTHAL: Ask yourself, does it get better in the bright days of spring and summer? And if the answer is yes, it's almost a diagnosis one can make on one's own.

CARDOZA: You probably have SAD. But a reminder if you have any concerns, always consult a professional. Rosenthal says the change in seasons affect people along a spectrum, meaning some people don't feel different at all, and some people are quite disabled by it.

ROSENTHAL: We've defined SAD as being people who would go to a doctor because the problem was bad enough.

CARDOZA: There's been a lot of skepticism over the years about whether SAD is a real disorder. Rosenthal says that's because it creeps up on you.

ROSENTHAL: For example, it, you know, might be a little bit serious in September and a little worse in October and a little worse in November. It's a little bit like the story of the frog in the bowl that keeps getting warmed up, and he doesn't really realize that he's going to die of overheating because it happens so incrementally. That's how it is with SAD and the winter blues.

CARDOZA: But he says recognizing your symptoms and taking them seriously is critical because SAD can be debilitating or worse.

Takeaway two is let there be light, because light and not getting enough of it is at the heart of this disorder. Light is the main cue for when to wake up and when to sleep. It kind of acts as a universal synchronizer between all life. We'll talk more about that in a second.

ROSENTHAL: It turns out that a fundamental part of the physiology of this condition is that some people just need more light. They don't seem as sensitive to light as other people.

CARDOZA: One often-recommended fix for this is a SAD lamp. Rosenthal says these lamps generate light that's far more intense than indoor lighting - about 10,000 lux, a measurement of light.

ROSENTHAL: I like fixtures that are a little larger, for example, maybe 1 foot by 1 1/2 feet - 1 foot up and down, 1 1/2 foot across.

CARDOZA: He says this light is absorbed through the eyes, not the skin.

ROSENTHAL: I never stare at the light. It's always coming down a little bit from an upper angle. I like the boxes that transmit the light downwards because that's how we evolved to see light, with the heavens above and the sun shining down so that it comes and hits the bottom part of our retina. The morning is often the best time, and the earlier the better.

CARDOZA: He says if you use a lamp for about 20 to 30 minutes a day, you should feel a difference within two weeks. If you don't, return it. Recent studies suggest that the value of preventative light therapy is inconclusive. It's really a patient's preference whether to use it or not. But Rosenthal says it's still a common treatment for those with SAD because for some, SAD lamps can make a big difference, like Isabella (ph) Harris, who's known as Iz in the vlogging world and lives in Virginia. She experiences SAD as...

IZ HARRIS: General, like, fogginess and sleepiness.

CARDOZA: Most people go about their day normally with indoor lighting. But for people with SAD, that indoor lighting is the equivalent of darkness. Iz bought a SAD lamp, as they're known. And the result was night and day.

HARRIS: It's like what someone feels like when they jump into cold water, and it brings you to, like, a sharper alertness. If I come in, like, feeling a bit foggy-headed, I'll turn it on. And it functions a lot like taking a walk outside. It's like allowing my brain to wake up a little bit. And that's probably not the clinical term, but it feels like it's, like, waking up.

CARDOZA: She's used this special SAD lamp for eight years.

HARRIS: And on the days that I don't, I notice a significant difference in, you know, irritability and kind of just general hopelessness and definitely in energy levels.

CARDOZA: And even if you do use a SAD lamp, make sure you're still trying to get as much natural light as possible. Go outside even if you don't feel like it. Even when it seems overcast, you're still getting light from the sun. Remember; small things can make a difference, so trim any overgrowth around your windows and clean the panes.

(SOUNDBITE OF MUSIC)

CARDOZA: Takeaway three is being thoughtful and consistent about what you eat. Dr. Rosenthal says people with SAD have a tremendous craving for carbohydrates.

ROSENTHAL: They crave sweets and starches. And needless to say, that puts on weight, and they can't always take it off in the summer. So every year, they're ratcheting up a little more, a little more, and it's a real problem.

CARDOZA: Emily Manoogian is a Ph.D. and clinical researcher at the Salk Institute for Biological Studies. She says it's not just what you eat and how much, but when. To understand this, we need to talk about circadian rhythms.

EMILY MANOOGIAN: Circadian is just Latin for about a day. And so when we talk about circadian rhythms, it's referring to these 24-hour rhythms that we have within our body and kind of throughout biology.

CARDOZA: Think of every cell and system in your body as having a tiny clock, and each of these tiny clocks are on approximately 24-hour cycles, so a master clock in your brain has to coordinate and make sure they all work together. This circadian system essentially signals your body what time of day it is, what time of year it is, and helps match your behavior with the environment. Manoogian says people with SAD usually have a sort of delay in their circadian rhythm, meaning something's a little off.

MANOOGIAN: It might really be getting at that they're having a harder time coordinating their internal rhythms with the environment. And so as you start to not be able to re-sync every day, that can lead to kind of this misalignment of, my body doesn't think it's time, and now I'm forcing it to wake up.

CARDOZA: Manoogian says, just like light, food is a strong environmental signal.

MANOOGIAN: If you're eating, your body thinks it should be awake. Eating is the biggest cue to your digestive system, to the rest of your body.

CARDOZA: So what does this have to do with SAD? She says when days get shorter, eating or not eating is a good way to signal all those tiny clocks.

MANOOGIAN: Being able to coordinate your internal clocks with your environment can kind of help ease any burden that changes in seasons might have.

CARDOZA: Make sure to stop eating three hours before you go to bed so your body knows it's time to rest.

MANOOGIAN: By just controlling the time that you eat and, say, keep it to a consistent 10 to 12 hours every day, you're now giving your body a really strong cue to tell it the time of day that it is regardless of anything else that's going on.

CARDOZA: Takeaway four is get some exercise. Emily Manoogian says, like light or food, it's another environmental cue that helps signal all those internal clocks what time it is.

MANOOGIAN: There's a lot more data coming out now on how physical activity actually affects your clocks and how that feedback feeds back on the master clock in the brain to be able to kind of coordinate your system.

CARDOZA: She says physical activity is a cue that says, wake up.

MANOOGIAN: And so by doing things like exercising, you know, during the active time of your day can actually help your body, again, know kind of what time of day it is, coordinate, you know, using all that energy and, you know, stimulating the brain to be awake to the right time of day and then allowing your body to really rest in the evening. Really controlling those external cues allows your body to really respond to the environment much better.

CARDOZA: If you work out indoors, Rosenthal says make sure you put on that SAD lamp for a twofer.

ROSENTHAL: I never work out indoors during the winter without having my lightbox on. And I would encourage other people, especially those with this problem, to do the same.

CARDOZA: He says when it's cold and dark and you don't feel energetic and aren't active, it's a vicious cycle.

ROSENTHAL: You don't feel like getting up in the morning, so you pull the covers over your head so you get less light, so you feel more depressed, so you feel even less like getting up. Whereas if you force yourself to get up, then push yourself to do all these things, then you can feel much, much better.

CARDOZA: And feeling much, much better is the goal.

(SOUNDBITE OF MUSIC)

CARDOZA: Takeaway five is to reduce stress. You may want to decorate a room with bright colors and photographs that make you smile. You may want to see a therapist and talk through how you feel. You may want to try meditation. Rosenthal says the effects of practicing meditation and SAD haven't been fully studied yet, but he believes it can help.

ROSENTHAL: What meditation does is it de-stresses you.

CARDOZA: He says seasonal affective disorder has three main causes. There's a genetic component, a lack of light component, and there's stress.

ROSENTHAL: Stress is going to bring up the symptoms because if you didn't have anything you had to get up and do and you could lie around, it wouldn't emerge in such a symptomatic way. But it's when you've got things to do and you're feeling down and not thinking straight and not feeling effective - that's when you can really feel most depressed. So anything that reduces stress, which meditation can do, can make a better adjustment to the winter.

CARDOZA: Another thing you can do is make pleasurable plans - it may need a little more creativity because of the coronavirus, maybe painting or dancing or meeting a friend - because sometimes when you plan to do something enjoyable and you make yourself go through with it, in spite of everything, you find yourself having a wonderful time.

Maia says she doesn't wait for occasions like a birthday or holidays to do something special.

MXMTOON: I think as people - I know for myself, at least, I spend so much time waiting for other people to give me permission to be excited about things. And I think that the moment where we can kind of choose to make our own calendars and schedule something that genuinely will bring us joy is a really big changing point.

CARDOZA: She celebrates the little things.

MXMTOON: And so I try and make myself have things to look forward to, whether it's, like, baking a pie on the weekend or drinking a cup of tea every single day. And that fuels me a little bit more and feeds me as a person when I'm not able to go outside and feel fed by the world.

CARDOZA: For Maia, an important form of self-care is songwriting. And a few years ago, she released "Seasonal Depression" as mxmtoon.

(SOUNDBITE OF SONG, "SEASONAL DEPRESSION")

MXMTOON: (Singing) I just don't see a whole lot of sun. And lately, I just can't seem to have any fun.

CARDOZA: She also accepts that for her, winter will never feel like summer.

MXMTOON: I think that's been something that I've also reminded myself is that it's just an indication that the year is passing by, and that's OK, and reminding yourself that everything is cyclical and, you know, it's bad right now, but it will be good in the future.

(SOUNDBITE OF SONG, "SEASONAL DEPRESSION")

MXMTOON: (Singing) Seasonal depression's got me sleeping off the days. And I've wasted all my time feeling gray.

CARDOZA: We haven't talked about medications mostly because, well, we're not doctors. But Dr. Rosenthal, who is, says a lot of people do really well following these simple measures. But if you don't find yourself feeling better or SAD is interfering with your personal relationships or work, he says medication can be very effective.

Keep in mind none of this will make the disorder go away. But as Rosenthal puts it...

ROSENTHAL: It's not a cure, but it's like if you do all the things I've said, then sometimes the SAD dies of neglect.

(SOUNDBITE OF SONG, "SEASONAL DEPRESSION")

MXMTOON: (Singing) Seasonal depression's got me sleeping off the days. And I've wasted all my time feeling gray.

CARDOZA: All right, so let's recap tips for managing your SAD symptoms and not being a bear this winter. Takeaway one - recognize your symptoms.

HARRIS: I think that, for me, it always started with a decrease in energy and a general hopelessness.

CARDOZA: Takeaway two - get some light. A SAD lamp can be very effective.

ROSENTHAL: Some people just need more light. They don't seem as sensitive to light as other people.

CARDOZA: Takeaway three - be thoughtful and consistent around what and when you eat. Stop eating three hours before bedtime is a good rule of thumb.

OK, takeaway four - exercise even if you don't feel like it.

MANOOGIAN: Really controlling those external cues allows your body to really respond to the environment much better.

CARDOZA: And finally, takeaway five - reduce stress. Make plans you can look forward to. And, remember; they don't have to be grand plans.

MXMTOON: So I try and make myself have things to look forward to, whether it's, like, baking a pie on the weekend or drinking a cup of tea every single day.

(SOUNDBITE OF MUSIC)

CARDOZA: For more LIFE KIT, check out our other episodes. We've got an episode on how to start therapy, another one on how to give advice and lots more. You can find those at npr.org/lifekit. And if you love LIFE KIT and want more, subscribe to our newsletter at npr.org/lifekitnewsletter.

And as always, here's a completely random tip, this time from listener Gee Mason (ph).

GEE MASON: Hi, LIFE KIT. I've got a quick tip for you guys. If you expect to have, let's say, a rough day or a stressful day, it might be a good idea to set up reminders for yourself to kind of check in later on about things you're grateful for. So for example, if you know it's going to be a bit of a tough day, have an automatic timer that kind of tells you, hey, you're grateful to your family and friends, or whatever that message might be. Thanks a lot.

CARDOZA: Do you have a random tip? Leave us a voicemail at 202-216-9823 or email us a voice memo at lifekit@npr.org.

This episode was produced by Andee Tagle. Meghan Keane is the managing producer. Beth Donovan is our senior editor. Our digital editor is Clare Lombardo. And our editorial assistant is Clare Marie Schneider. I'm Kavitha Cardoza. Thanks for listening.

(SOUNDBITE OF MUSIC)

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