Some may call it the winter blues but Seasonal Affective Disorder or SAD can be a serious problem for some people. Kathryn A. Roecklein, Ph.D., Primary Investigator of the Seasonality Research Program at the University of Pittsburgh explains why it shouldn’t be taken lightly and discusses what you should know about treatments.

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– [Announcer] This podcast is for informational and educational purposes only. It is not medical care or advice. Clinicians should rely on their own medical judgments when advising their patients. Patients in need of medical care should consult their personal care provider.

– Some may call it the winter blues, but what exactly is seasonal affective disorder, or SAD? And is there anything you can do about it? Hi, I’m Tonia Caruso. Welcome to this UPMC HealthBeat podcast. And joining us right now is Dr. Kathryn Roecklein. She’s an associate professor of psychology and the primary investigator of the seasonality research program at the University of Pittsburgh. Thank you so much for joining us.

– Thanks for having me.

– So, SAD. In its most basic definition, what is it?

– Well, so, this is what’s really interesting. We all talk about it as seasonal affective disorder, but technically, it’s major depressive disorder, just with a seasonal pattern. So it’s diagnosed the same as the regular depression that can happen at any time of the year. It just typically occurs starting in fall or winter and remitting in spring or summer.

– And why is that? What do we know about that?

– The environmental variables that are most closely tied to the onset of SAD is day length. So the time of sunrise to sunset, the period of time there, we call “photo period” or “day length.” And that is the main trigger for the onset of depression in fall and winter.

– So how do you work or determine whether it’s something minor or something more significant, and you should start to get some help?

– One of the ways we determine if the symptoms a person is having is severe enough or warrants treatment is by looking at the number of symptoms and the severity or the frequency. So, for example, depressed mood that occurs once a week for half a day is probably not meeting that threshold. But if a person is experiencing down or depressed mood most of the day, nearly every day for as long as two weeks, then that’s something that we want to take a look at. Another, or that perhaps the second factor that we might use, is to gauge the impact of the symptoms on the person’s life. So, their ability to complete their daily activities, like going to school, or work, or caring for others, and also the quality of their interpersonal relationships. So, how are their relationships going with important people in their lives? If the symptoms are interfering with those parts of a person’s life, then we consider it clinically important to take a look at it.

– So, biologically, what’s going on with the brain? What happens? Are there people that are more predisposed to this?

– So that’s a new area of important investigation. And like most of depression, we’re not fully sure what biologically happens, and there may be different things happening in different people. So, for example, we know that serotonin is part of the answer, and we also know that the way the body processes information about light from our environment, biologically, is another part of the answer.

– So talk a little bit about serotonin and how that plays into this.

– Sure.

– What is it? Let’s start with that.

– Well, serotonin is an important molecule. We call it a neuro-transmitter. When it’s in the brain, it’s important for regulating mood, as well as some other things like sleep, which is another area in which a lot of people report a change in sleep in seasonal affective disorder: either less sleep than is normal for them, or much more sleep than is normal for them.

– Is there anything that you can do at home? We hear about vitamin D. We hear about those lights. Talk about how that plays into everything.

– Well, so, one thing to keep in mind is that the way light impacts the brain is by changing our narrow transmission and the chemicals that are involved, such as neurotransmitters. So just because light is not in pill form, or isn’t regulated by the FDA, that doesn’t mean it’s not a medical treatment or a biologic treatment. We call it a non-pharmacological biological treatment. This is something that I think is really important. Depression’s an important medical condition, and we wouldn’t necessarily go about treating anything else that was a medical condition on our own. So I think it’s important to remember that even though it’s “just depression” or it only happens during the winter, it’s important to see a professional. And one of the reasons why that is, is that if a person were to try home remedies and either do them in a way that wasn’t ideal for them personally, or not quite treat their depression enough, then they would suffer longer with the disorder. And the longer a person has the disorder going untreated, the worse the outcome is overall. So I think it’s really important to reach out to your psychologist, your primary care physician, find someone who can assess your symptoms, and diagnose and recommend treatments, and help you tailor the treatments to you and your life.

– And so what are some of the treatments if you go to see a professional?

– So one of the things that’s interesting about this is that there are three treatments that have been studied enough that we consider them empirically supported treatments. The first is really well-known antidepressant medication, and there are a number of options. The second is bright light therapy, which is the SAD lamp that you were mentioning a moment ago. And the third is a type of psychotherapy called cognitive behavioral therapy for SAD, or CBT-SAD.

– And what happens during that third therapy?

– So cognitive behavioral therapy generally focuses on the thoughts and the behaviors that are elicited in the winter when we are suffering from negative mood, and kind of often decreased energy, and less of an ability to kind of engage in the activity as we normally enjoy and less enjoyment from them. So it focuses on the thoughts and the behaviors behind those symptoms.

– And when it comes to the lamps, I know it would depend upon the individual and the severity, but, you know, how much time, is it a daily thing? What does that look like?

– Yeah. So, the lamp, if you think about it, the lamp to some degree may replace bright light in the mornings, which is really important for our circadian clocks. So the way that we typically begin a patient on light therapy is to recommend about 45 minutes of exposure to the standard 10,000 lux light box first thing upon awakening at the same time of day, seven days a week. And therein lies the challenge, because that means Saturday and Sunday as well, for those who work five days a week.

– If you don’t have a therapist or a psychologist, what are those first steps in connecting with someone like that? Should you go through a PCP? What does that look like?

– Most patients do talk to their PCP first, but one of the things about UPMC is there are multiple experts in psychiatry and psychology who treat mood and sleep disorders and are very familiar with seasonal affective disorder.

– And so, vitamin D. We also hear that. Does that play into anything here?

– Our research on vitamin D suggests that most people with seasonal affective disorder don’t have a deficit in vitamin D, but the first thing that most PCPs will do when a patient has depression is order blood work. But it’s probably not the answer for most people with seasonal depression.

– Let’s talk about the work that goes on in your research program. How long has this been in play? And tell us about the work that you do there and sort of the mission.

– Sure. Well, back in about 2001, we discovered a cell in the retina that no one knew was there before. These cells are similar to rods and cones that you might’ve learned about in the retina, which respond to photons of light by generating a neural signal to the brain. And this new type of cell called melanopsin cells send neural signals to the part of the brain that is the circadian clock, the body’s internal clock. And this part of the brain keeps us waking up in the mornings and going to sleep at night rather than the other way around, which is really important. It’s been critical through human development to be awake during daylight hours for hunting and gathering, and critical to be restive or sleeping at night and avoiding predators. So the studies that we’re conducting with a number of undergrads and graduate fellows is we are looking at these melanopsin cells in the retina. All Pittsburghers experience the shorter days and the darker skies; not all individuals experience seasonal affective disorder. So the hypothesis is that these melanopsin cells are less reactive to light in the individuals who are vulnerable to seasonal affective disorder. So we are measuring retinol responses to light using pupillometry, which is infrared photography or video of the pupil size in response to light stimuli.

– And how far along are you in this research? And when do you hope to be able to share results?

– Well, we just published this year a replication of the very first study that we found lower retinol responses to light in seasonal affective disorder. And in this most recent publication, we showed that this occurs in winter and not in summer. So we know that there’s something going on in winter in people with SAD, such that their retinas just aren’t responding to light the way others without depression, without SAD, are responding. So the next step in our research is to determine if those with lower retinal responsivity are the ones who show some improvement and experience some benefit from bright light therapy.

– And so do you think ultimately that’s the goal? So you identify it, we know what causes it, and then there’s that treatment. Are you envisioning some other sort of treatment that could come out of this?

– So the treatment’s pretty effective. It’s actually about 50/50, and that compares rather favorably to the other two treatments, CBT-SAD and antidepressant medication. But the big challenge with treating depression is that most patients undergo an unfortunately long period of trial and error until they find the treatment that works best. So precision medicine approaches would allow us to determine, through testing some biomarkers such as retinol responsivity, and determine which treatment a given patient is most likely to benefit from. So they can start that treatment first and not spend time engaging in treatments that are unlikely to work.

– What do you want to say to people about taking this seriously? What do you say to that?

– Well, I guess I would say to focus on the symptoms and the way in which those symptoms impact your life. Regardless of cause, it’s important for your long-term health, as well as your current functioning. There’s a lot of what we call a disease burden to depression. And the way we understand that is that depression, especially recurrent depression, which means it happens year after year most of the time, is associated with a lot of negative physical health outcomes.

– Well, this is all so fascinating. We thank you so much for coming in and spending some time with us today. We certainly do appreciate it.

– You’re welcome. Thanks for highlighting this important mental health condition.

– You’re welcome. I’m Tonia Caruso. Thank you for joining us. This is UPMC HealthBeat.

About UPMC Western Behavioral Health

UPMC Western Psychiatric Hospital is the hub of UPMC Behavioral Health, a network of community-based programs providing specialized mental health and addiction care for children, adolescents, adults, and seniors. Our mission is to provide comprehensive, compassionate care to people of all ages with mental health conditions. UPMC Western Psychiatric Hospital is a nationally recognized leader in mental health clinical care, research, and education. It is one of the nation’s foremost university-based psychiatric care facilities through its integration with the Department of Psychiatry of the University of Pittsburgh School of Medicine. We are here to help at every stage of your care and recovery.