Transcription:

Prakash Chandran: This Health Works Here COVID-19 podcast was recorded on November 30th, 2020.

Seasonal affective disorder affects millions of people each year. This winter season, it is expected to impact even more people as health protocols for the pandemic contribute to loneliness and feelings of isolation. We're going to talk about it today with Dr. Sid Pani, the Medical Director at Emerson Primary Care Associates at Sudbury at Emerson Hospital.

This is Health Works Here, the podcast from Emerson Hospital. I'm Prakash Chandran. So first of all, Dr. Pani, it is great to have you here today. What exactly is SAD or seasonal affective disorder?

Sid Pani: Years ago, there was this clinical professor of psychiatry at Georgetown University School of Medicine, Dr. Rosenthal. He observed every winter, just like autumn leaves, people became depressed on schedule. You know, they lost energy, they started feeling worse as the days grew shorter. And then in spring, all of a sudden things got reversed.

So it appeared like a distinct entity, which then he ended up giving a snappy acronym, S-A-D, SAD for seasonal affective disorder. So it's a subtype of major depression. The keywords here being seasonal and recurrent. Recognizing this disorder is important because SAD is so common and associated with a lot of psychosocial impairment. And there are treatments available for both acute illness as well as for maintenance to prevent future episodes.

Prakash Chandran: I see. And who exactly does SAD affect?

Sid Pani: A lot of studies done all over the wall and studies coming out Canada, the United States and the Europe say the lifetime prevalence of SAD in the general population is about 0.5 to 3%. And most of the community surveys and clinical surveys indicate that it's more common in women, adults usually between the age of 20 and 30 and in the higher latitudes. However, more recent rigorous studies are contradicting these findings. And they say the lifetime prevalence of SAD was almost equal or greater in men and, using standardized criteria to diagnose SAD, they found that not all the time latitude was associated with a higher prevalence of SAD.

Prakash Chandran: And when you say latitude, I am assuming that you mean places that experience more overcast. Is that correct?

Sid Pani: Yes, the recent studies do not say that, you know, it makes so much of a difference.

Prakash Chandran: And when you're experiencing SAD, what are some of the symptoms that one might be experiencing as they're going through it?

Sid Pani: Again, the key words are recurrence and seasonal. So during this time, an SAD person would be complaining of low energy insomnia or sleeping excessively, overeating, weight gain, craving carbs and social withdrawal. And just like any other non-seasonal major depression, one can have psychomotor agitation or retardation or feeling of guilt, feeling worthless. It can go up to such extremes like suicidal ideation or behavior.

And patients with SAD who have comorbid psychopathology, like who have associated alcoholism or ADHD or eating disorders or panic disorder, they tend to have SAD symptoms, which tend to be more severe than normal people.

So as a primary care doctor, more like me, you start suspecting this disorder when you have the following clues: seasonal depression worse in winter, depression which gets better with sunshine, abnormal sleeping patterns, carb craving, weight gain. We don't not have any instrument to screen SAD. So there is a questionnaire and we use this questionnaire to score points, but somewhere between 0 and 24. A score more than 11 is used to identify SAD.

Prakash Chandran: I see. Okay. And, you know, everything now, because we're in the midst of a pandemic, seems to be exacerbated when it comes to our emotions. You know, we are stuck inside. We can't do the same routines that we were once used to. Is that something that you are experiencing as well? And how does that relate to SAD?

Sid Pani: There was an article, a recent article with New York times. There's a professor of psychology at the University of Vermont, who mentioned that SAD normally disappears in summer. However, this summer, he did not see a full remission. And he feels that the anxiety and the stress provoked by the pandemic will only increase the severity and the risk of winter depression for everyone. There is a possibility of even the subclinical SAD, which normally, you know, it's there, but you don't see it, to become clinical because of the pandemic. And the stress will override the seasonal pattern. But it's a kind of a double whammy, first, the pandemic and then, SAD.

There are ways we can overcome this by developing healthy routines or waking up the same time every day or carving out time for relaxation or maintaining some kind of a support systems like Zoom gathering, et cetera.

Prakash Chandran: Yeah. So let's expand on that a little bit more. I'd love to learn how people can alleviate some of these symptoms. You know, you already mentioned establishing a routine, you know, just getting together with people virtually. What other things can people do to help alleviate SAD? And when also do you think that people need to start seeing their physician if they think SAD is getting the best of them?

Sid Pani: Once you start having the symptoms that we have talked about earlier. I think it's important to discuss them with your doctor. I mean there are a variety of treatment options starting from antidepressants, light therapy, psychotherapy, which your doctor might prescribe. In addition, there are adjunctive interventions like maintaining a sleep hygiene or taking a daily walk, even an aerobic exercise or improving your indoor lighting or now you have something called clocks with dawn simulation, where it's a technique that involves lights gradually get brighter in your clock as the time changes in the morning. So that your bedroom, you get the simulation that dawn is arriving.

And other things, essentially you can reduce your stress. You can decorate your room with bright colors, pictures that make you feel good. You do some meditation. You might make pleasurable plans, paint, dance, connect with your friends, so on and so forth.

But if these do not help, you know, the doctors prescribed something called an artificial light, which is something which generates intense indoor lighting to the tune of 10,000 lux, which is a much amount of light. And using this lamp 20 to 30 minutes a day will make a difference within two to three weeks.

If all these fails, there are medications, people use SSRIs, cognitive behavior therapy, et cetera.

Prakash Chandran: So it really sounds like when you establish a routine for yourself and do these activities, like you mentioned, exercise, meditation, virtual gatherings, those are all outlets that can help in addition to things like, for example, artificial lights, like all of those things in concert with one another help alleviate some of those SAD symptoms, wouldn't you say?

Sid Pani: Yes, that's true. We can take a step-wise approach. To start with, we can do some lifestyle modification and if that doesn't help, go over to the prescription method of treatment.

Prakash Chandran: And I'd love to just understand a little bit more about the mechanics of what causes SAD. You mentioned the artificial light, putting those 10,000 lux, is it really just the light we're exposed to and the lack thereof during the winter months? How does it actually work?

Sid Pani: I think what has been generally described as you lose the daily rhythm, which is in Latin what they call a circadian, which is essentially 24-hour rhythm. So within our body, every cell and system, you know, having a tiny little clock and each of these tiny clocks are approximately 24-hour cycles. So a master clock in your brain can coordinate and make sure they all work together. The circadian system essentially signals your body what time of the day it is and what time of the year it is. So what happens in SAD-- and light is a big stimulant to maintain the circadian rhythm. So as the amount of light reduces during winter, the entire cycle gets disturbed. And as a result of which, we produce a hormone called melatonin. And this hormone increases in amount and production of this increased amount of melatonin essentially causes depression.

Prakash Chandran: Yeah, that's fascinating to hear how it works. But just as we close here, there's going to be people that are listening to this that might either be experiencing some of these symptoms that we're talking about, or they want to avoid SAD as we go deeper into the winter months. What is one piece of advice that you'd like to share with our audience before we close?

Sid Pani: The first thing I would do is do everything about the light therapy in the sense that lighting my house and my workspace better. At the same time, I should continue with my adjunctive interventions like sleep hygiene, daily walks, aerobic exercises, and as I mentioned earlier about the Dawn simulation. When you to sleep as a part of sleep hygiene, make sure that you have minimal light exposure, especially to blue light from computer monitors and television. And all this may facilitate your sleep onset and have a healthy sleep pattern.

Prakash Chandran: Dr. Pani, I think that is a perfect place to end. I really appreciate your time today. It's been super informative. That's Dr. Sid Pani, the Medical Director at Emerson Primary Care Associates at Sudbury at Emerson Hospital. To make an appointment with Dr. Pani or other physicians in the practice, call (978) 579-6018 or visit EmersonHospital.org/sudburyPCP.

If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. This has been Emerson's Health Works Here podcast. Thanks for listening and we'll talk next time.