0:00

I'm Joe Graydon. And I'm Terry Graydon.

0:03

Welcome to this podcast of The People's

0:05

Pharmacy. You can find previous podcasts

0:08

and more information on a range

0:10

of health topics at peoplespharmacy.com.

0:14

When the days get short and

0:16

the nights get long, some people have

0:18

a hard time getting out of bed. Could they

0:20

be suffering from SAD? This

0:23

is The People's Pharmacy with Terry and

0:25

Joe Graydon.

0:34

Seasonal affective

0:35

disorder, or SAD, may affect

0:37

as many as 10 million Americans.

0:40

Is there a difference between SAD

0:42

and ordinary depression? People

0:45

who are susceptible to SAD often

0:47

feel irritable or pessimistic in

0:49

the winter. They may have trouble concentrating

0:52

and lose interest in usual activities.

0:55

Our guest today was an early pioneer

0:57

in developing treatments for SAD.

1:00

What should you know about light therapy?

1:01

Coming up on The People's Pharmacy,

1:04

learn about defeating seasonal

1:07

affective disorder.

1:14

In The People's Pharmacy health headlines,

1:17

masks can help prevent the spread of

1:19

viral infections during a pandemic.

1:22

That's the conclusion of a research review

1:24

in JAMA Network Open. The authors

1:27

wanted to know whether the use of face

1:29

masks could reduce transmission

1:31

of respiratory pathogens during the

1:33

next pandemic. They reviewed

1:35

the evidence that has been collected over the last

1:38

three years of COVID-19. Masks

1:41

alone are not adequate, but

1:43

consistent use of high-quality, well-fitting

1:46

masks can make a difference. The

1:48

investigators conclude, available

1:51

evidence strongly suggests that masking

1:53

in the community can reduce the spread

1:55

of SARS-CoV-2 and that masking

1:58

with the highest quality masks can help prevent the spread

5:59

hospitals. And that's

6:02

the health news from the People's Pharmacy

6:04

this week.

6:14

Welcome to the People's Pharmacy. I'm Terry

6:16

Creighton. And I'm Joe Creighton. In

6:19

the middle of the summer, we enjoy long

6:21

days with lots of sunshine. The

6:23

sun comes up early and goes down

6:26

late. But now the days are

6:28

getting shorter. In Madison, Wisconsin,

6:30

the sun sets before 5 p.m.

6:33

Does the lack of sunlight impact

6:35

our mental health? Today we're talking

6:38

about seasonal affective disorder,

6:40

also called SAD. What

6:43

is it? And what

6:44

can we do about it? Our guest today

6:47

is Dr. Norman Rosenthal. He

6:49

is a psychiatrist and scientist

6:51

who first described SAD in 1984 and

6:55

pioneered light therapy as a treatment.

6:58

Dr. Rosenthal is currently clinical professor

7:00

of psychiatry at Georgetown University

7:02

School of Medicine. He's the author of several

7:05

books, including his most recent, Defeating

7:08

SAD, Seasonal Affective

7:10

Disorder, a Guide to Health and

7:12

Happiness Through All Seasons.

7:16

Welcome to the People's Pharmacy, Dr.

7:18

Norman Rosenthal.

7:20

Thank you. Thank you. Dr.

7:23

Rosenthal, it's hard

7:25

to believe, but more than four

7:28

decades ago, you

7:30

coined the term SAD

7:33

for Seasonal Affective Disorder.

7:36

And I think that's one of the best acronyms

7:39

in medicine. So my first

7:41

question is, what got you

7:43

interested in SAD?

7:47

Well, the

7:48

first clue when I look

7:51

back was my own seasonality.

7:54

In South Africa, where I was born and raised,

7:57

the seasons are very mild. When I came

7:59

back, I was born and raised. up to New York City,

8:01

it was quite a shock. Originally

8:04

it was the summer, the days were long and

8:06

I was giddy with delight and I thought

8:08

well that's just because I'm in a new country

8:10

and in a new city but in retrospect

8:13

the long days were also driving my

8:16

exuberance. And then after

8:18

daylight savings time came, I

8:20

didn't know what hit me. And

8:23

I felt a rhythm of up

8:26

and down that went on for three

8:28

years through my residency.

8:31

And you know I managed, I hung

8:33

in through the winter, I played

8:36

and enjoyed myself in the summer. But

8:39

when I came to the National Institute of Mental

8:42

Health here in Bethesda, Maryland, my

8:44

colleagues and I encountered a scientist

8:47

who actually had much more severe

8:50

seasonal problems than I did. And

8:54

we had the idea to expose

8:56

him to very bright light in the winter

8:58

time and he came out

9:00

of his depression which was

9:03

a wondrous thing to observe. But

9:05

then I thought you know we're never going to get

9:07

a story unless we can collect

9:10

a group of people that we can do

9:12

controlled studies with and define

9:16

who are these people and how do

9:18

they respond to light etc. So

9:21

with that in mind I went to

9:23

a journalist here at

9:25

the Washington Post and I said would you be willing

9:28

to run an article? We just had one person

9:31

but I have a few more people who have given

9:33

us stories like this and

9:35

she was all on board. And then

9:38

we got thousands of responses

9:40

from all over the country. It

9:42

was before the internet so they all came

9:44

in letters from all the states

9:47

especially the northern ones

9:49

and I

9:50

sent them questionnaires which asked

9:53

them questions pertaining to the

9:55

things I had seen that changed

9:57

during the seasons and from that

10:00

I put together the syndrome which

10:04

we then explored and

10:06

that was the beginning of it.

10:08

Well Dr. Rosenthal, we remember

10:10

those days when you could recruit

10:13

patients for a study through the newspaper.

10:16

That would be pretty hard nowadays because

10:19

nobody reads actual newspapers.

10:21

But you

10:23

say you put together

10:25

the elements of the syndrome. Would

10:27

you explain that please? What are the

10:29

elements of seasonal affective disorder?

10:32

Well I read through these interviews,

10:36

these filled up questionnaires

10:38

and had a growing

10:40

sense of excitement because in

10:43

psychiatry there is

10:45

such heterogeneity meaning

10:47

that people are so different

10:49

from one another even if they carry

10:51

the same diagnosis. But these

10:53

people had a sort of monotony

10:56

about their symptom patterns that

10:58

was thrilling to me because it

11:00

suggested that there might be some underlying

11:03

biological connection that

11:05

then would be more testable

11:08

than if you had just a general population

11:10

of depressed people. So here

11:13

was a typical story. When

11:15

October comes I feel slowed

11:18

down. I can't get my work

11:20

done. It's difficulty getting up in

11:22

the morning. It's hard

11:24

to keep to my diet. I get

11:27

cravings for sweets and starches.

11:30

I fail at my work. My relationship

11:33

seemed to deteriorate and so

11:35

I get depressed and at last through

11:38

the winter and in the spring

11:40

I begin to come to life again.

11:43

So that variance of that particular

11:45

story I read again and again

11:48

and as I read one after the other

11:50

I thought well we've got a syndrome here

11:52

because these people don't know each

11:54

other and yet they could be copying from

11:57

each other's playbook. So

12:00

that's when I put

12:02

pieces together and with the help of

12:05

my colleagues at the NIH, we ran

12:07

the first cohort from summer

12:10

into the winter, into the

12:12

autumn to see would they get depressed

12:14

on cue. And one of my colleagues

12:17

said to me, won't you look stupid if

12:19

they don't get depressed? And

12:22

I thought, well, you know, I've been depressed

12:25

and down in the winter. So I think

12:27

they will be and, you know, it's okay to look

12:29

a bit stupid. That's not such a bad thing.

12:32

Lots of us do it accidentally. So

12:35

in any event, they went

12:37

into depression as on cue.

12:40

And we put them through a controlled

12:43

study of life therapy and they

12:45

responded and that

12:47

was the beginning of this four decade,

12:50

very exciting adventure.

12:55

Now, you say a controlled study of life therapy.

12:57

How do you do a controlled study of life therapy?

13:00

That's such a great question, you know, because

13:03

we have struggled to find a good

13:05

control. The first one was

13:08

bright light versus dim light. And

13:11

the dim light actually was yellow

13:14

so that it had a sort of placebo

13:16

effect. You know, you could have the yellow

13:19

light, you could have the white light and

13:21

we tried to camouflage the fact that

13:23

the intensity was different.

13:26

And that proved to be that

13:30

the bright white light was more effective.

13:32

But then many people said, well, they

13:34

could have guessed that they could have known that.

13:37

And so went a long

13:41

effort on many researchers' parts

13:44

to find the best placebo.

13:48

And finally, a colleague of

13:50

mine, Dr. Charmaine Eastman, came

13:53

up with an ion generator.

13:55

You know, these ionizers have

13:57

been used as air cleansers.

14:00

and they give off negative ions

14:02

and she went a step further and deactivated

14:05

the ion generator

14:07

and

14:08

found that the bright light was

14:11

better than the ion generator even

14:13

though the expectations of the two treatments

14:16

was equivalent. And that became

14:18

a sort of standard control

14:20

treatment and basically every control

14:23

treatment has more or less worked. So

14:25

the cumulative effect

14:28

of all these positive studies

14:30

including ones which contained

14:32

placebos that were generally agreed

14:35

upon to be plausible

14:38

and you know that

14:40

they were truly blind to what our hypothesis

14:43

was and have all shown

14:46

collectively this very

14:48

powerful effect of bright light versus

14:51

whatever else we used. Now

14:53

Dr. Rosenthal, we'll talk a little

14:56

bit more about light therapy in

14:58

a moment but first I'm curious

15:00

how does sad

15:03

seasonal affective disorder differ from

15:06

other kinds of depression? Well

15:09

the first very typical way it differs

15:11

is by its temporal

15:14

association with the seasons. The

15:17

other thing is that the

15:20

picture of depression can vary between

15:23

what's called typical and what's called

15:25

atypical. In the typical

15:27

classical depression people

15:29

eat less, sleep less, lose

15:33

weight, that's one kind of

15:35

depression but that's not usually

15:37

what people with sad do.

15:40

They eat more, especially sweets

15:43

and starches, they gain weight,

15:45

they sleep more. It's more of

15:47

a kind of hibernation type depression

15:50

than a sort of over activated

15:54

agitated kind of depression.

15:56

So from the point of view

15:58

of symptom pattern, It's often

16:00

different, but also the key

16:03

difference is the timing. And

16:05

I was going to say the response to light,

16:08

however, more recently light

16:10

has been shown to be much more generally

16:14

effective, not exclusively

16:16

on seasonal affective disorder, but on other

16:19

kinds of depressions as well.

16:21

Do we have any idea how many

16:24

people suffer from seasonal affective

16:26

disorder?

16:27

We've done population studies

16:29

and our best estimate is that about 5%

16:32

of the general population adults suffer

16:36

from SAD and another 10% from

16:38

a less severe

16:41

variant which we call the winter blues.

16:44

And these are not hard and fast distinctions

16:46

because somebody could have the winter

16:49

blues one winter and then

16:51

the next winter maybe they have got deadline

16:53

pressures and they are stuck in the

16:55

office and they have to do their work

16:58

for the deadlines and they could have a real case

17:00

of SAD the next winter. And

17:03

then the following winter it's easier, they

17:05

may go back and just have the winter blues.

17:07

But if you look at it at any given time,

17:10

about 5% will

17:13

respond that they have really

17:15

significant troubles with the winter

17:18

of the kind that occur in SAD

17:20

and a 10% more

17:23

would say yes, they have

17:25

trouble but it's not disabling,

17:27

it's just interferes with their

17:30

best functioning. And of course

17:32

this varies with latitude, you know,

17:34

and with the pattern. So it's going to be

17:36

much worse, for example, in New Hampshire

17:39

than it is in Florida.

17:41

For listening to Dr. Norman Rosenthal,

17:43

clinical professor of psychiatry at

17:46

Georgetown University School of Medicine,

17:49

he was one of the first scientists to

17:51

identify SAD. His most

17:53

recent book is Defeating SAD,

17:56

Seasonal

17:56

Affective Disorder, a guide

17:58

to health and happiness through

17:59

all seasons after

18:02

the break will learn more about the links

18:04

between latitude and sad

18:06

is this condition especially

18:07

prevalent in northern places

18:09

like scandinavia what is the criteria

18:12

for selecting a light therapy

18:15

can

18:15

you get light therapy outside

18:17

as well as from a light box

18:20

how long should the exposure feet

18:22

for effectively alleviating

18:25

s a t you're

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20:16

Do you ever

20:18

get the winter blues?

20:20

When the days get short, do you find yourself

20:23

more irritable or on the edge of

20:25

tears? Are you likely to feel

20:27

stressed or anxious? Have you noticed

20:30

changes in appetite or sleep

20:32

patterns?

20:33

The farther north you go, the shorter

20:35

the days get. When we visited

20:37

Tromsø, Norway, in the summertime, it

20:39

was light nearly 24 hours

20:42

around the clock. That city is

20:44

north of the Arctic Circle, so they

20:46

experience midnight sun, but during

20:48

the winter they have hardly any

20:51

daylight. How does that affect

20:53

people's mood? Turning to the United

20:55

States, how does living in North

20:57

Dakota or Minnesota compare

21:00

to living in Texas

21:01

or Florida? Our guest

21:03

first described SAD,

21:06

or Seasonal Affective Disorder,

21:08

in 1984 after experiencing it

21:11

himself.

21:12

Dr. Norman Rosenthal is

21:14

a psychiatrist and scientist

21:16

who pioneered light therapy as a

21:19

treatment for seasonal affective disorder.

21:22

He's clinical professor of psychiatry

21:24

at Georgetown University School

21:27

of Medicine. Dr. Rosenthal

21:29

is the author of several books, his most

21:31

recent being Defeating SAD,

21:34

Seasonal Affective Disorder, a

21:36

guide to health and happiness through

21:39

all seasons.

21:41

Dr. Rosenthal, you just mentioned,

21:43

I'll call it latitude

21:46

and climate.

21:48

And so I'm wondering,

21:50

do people in

21:52

tropical climates

21:54

develop seasonal affective disorder?

21:57

I mean, what about in South Africa?

21:59

in the Caribbean? Are people just

22:02

always happy and having a great

22:04

time, never experienced seasonal

22:07

affective disorder? And do people

22:09

in, oh, let's say Finland and

22:11

Norway and Wisconsin, do

22:16

they always suffer from it? Well,

22:20

let's take your questions one

22:22

at a time. There is...

22:23

He

22:26

did pile up a few.

22:27

There is SAD

22:29

all over the world. In South Africa, you'll

22:32

have more of it in Cape Town, which is further

22:34

from the equator than, say, in Johannesburg.

22:37

But it's definitely been described there.

22:40

And it's also been described in

22:42

Australia. However, if you

22:44

look at the continental...

22:46

If you look at the distribution

22:49

of a continent on a map

22:52

or on the globe, you will see

22:54

that it's skewed north, that

22:56

there's a greater land mass in the north

22:59

than in the south, so that the

23:01

northern countries, by and large,

23:03

are more north than

23:06

the southern countries of south. Of course,

23:08

there are exceptions, like Patagonia

23:10

and other things that are very far south. But

23:13

for the most part, the north

23:16

is the more affected. That said,

23:19

remember, the real cause

23:23

of SAD is the lack of light. So

23:25

anything that causes light to

23:28

be lacking is going to be

23:30

a vulnerability factor for

23:33

SAD.

23:34

So, for example, there

23:36

are tropical areas that don't have

23:38

the dark

23:41

and light seasons connected with

23:43

the sun. They have it connected with

23:45

the monsoon winds. So if there

23:47

are monsoon winds that block out

23:49

the sky,

23:50

here,

23:51

for example, in the mid-Atlantic,

23:54

and I know in the northeast, we've had

23:56

this tropical storm that flouted

23:58

the sky. for like three

24:01

or four days and people

24:03

who are vulnerable are vulnerable to

24:05

SAD really, really felt it.

24:08

I felt it and it was gloomy

24:12

and overwhelming.

24:13

So in

24:14

places where there's heavy cloud cover,

24:18

you will get sad. Now for example,

24:21

Hawaii, which we all think of as

24:23

sunny, we think of it as sunny because

24:25

when we go there, we are in

24:28

holiday resorts for the most part

24:30

and they are on the sunny side of hillsides.

24:33

But on the other side where the shadows

24:36

fall from these mountains,

24:39

live people who are not

24:42

in these

24:43

upscale hotels, they are

24:45

down in the valley, in

24:47

the shadow and they are often

24:50

experiencing SAD. That's

24:53

not a very well-known fact. The

24:55

reason I really raise it is to really

24:58

emphasize that it's not just a seasonal

25:00

problem, it's a light deprivation

25:03

problem. So that means

25:05

that if you are in a basement apartment

25:09

or in any situation where the light is

25:11

not easily accessed,

25:14

in like Manhattan where you can be, right

25:16

up against another building, all

25:19

of these settings are such

25:21

that there's not much life and you're going to be

25:23

vulnerable if you have that biological

25:26

tendency. Has anyone

25:28

done a study of a place

25:31

like Tromso in

25:33

Norway, which is north of the

25:35

Arctic Circle and in the summer

25:38

it's like it's sunlight all day long

25:40

and most of the night. So you

25:42

have to have dark shades on your windows if

25:44

you want to go to sleep, but in the winter

25:47

it's dark, really

25:49

dark for like 23 hours of the day. You

25:53

maybe get an hour or two of sunlight. Has

25:55

anybody studied to see if people

25:58

in places like Tromso are more determined?

25:59

depressed?

26:01

You know it's a wonderful question and Tromsø

26:03

is a wonderful town and I did

26:06

go in to visit there personally in the

26:08

midst of the winter. Some pharmaceutical

26:11

company was running their symposium

26:14

at that time as a PR stunt. It

26:16

was the middle of the winter and people

26:19

were hunkered down into their homes.

26:21

The northern lights were

26:24

on display and

26:26

it was a quiet peaceful time

26:28

but then when I went back in the summertime

26:31

people were fishing from the bridges

26:33

like it one and two o'clock in the morning

26:36

and the behavior was completely

26:38

different.

26:40

The

26:41

question of whether there

26:44

is much SAD

26:46

in Tromsø is a debatable

26:49

one.

26:50

There is a

26:52

New Yorker article that was written

26:55

maybe 40 or so years ago by a man named

27:01

Westbrook

27:02

and he

27:05

documented going up to Tromsø

27:07

and how much people were

27:10

complaining about the winter but

27:12

apparently it just wasn't the thing to

27:14

complain about the winter so they would say

27:16

something like, oh I'm feeling terrible

27:19

right now you know in these

27:22

dark days but really it's not so bad.

27:24

Everybody, you know what I'm saying,

27:27

it was obviously a cultural bias

27:29

not to complain and

27:31

but a lot of complaining occurred nonetheless.

27:34

The other thing is

27:36

realistically you don't end

27:38

up in such a northern town

27:41

north of the Arctic Circle unless

27:44

you have a certain amount of

27:46

resilience with regard to your

27:48

seasonality. Lots of people

27:51

incidentally there when they fly south

27:53

for a vacation in the middle of the winter

27:55

they fly south to Oslo for

27:57

a vacation and if you to

28:00

Oslo to get the sun. You know

28:03

you're in trouble. Repeat

28:05

desperate. Yes, and we too

28:07

have had the opportunity to visit

28:09

Thromso in the summer. In

28:12

the summer when it was sunny all

28:14

day long and into the night and it was a

28:16

delightful experience.

28:18

Dr. Rosenthal, we have

28:21

had some comments on our website

28:24

that are related to SAD

28:26

and I would like to read you one of them

28:29

for your comment. Lindsay

28:31

wrote, I live way up north and have suffered

28:34

badly with SAD for years and years.

28:37

Light boxes don't help. I

28:39

refuse to take antidepressants.

28:42

Sami helps a little but I'm just

28:44

miserable for eight months of the year. I'd

28:47

move south if I could. Sometimes

28:50

more thyroid medication through the dark

28:52

months help and I could actually

28:54

add my data point

28:56

to Lindsay's which is I too

28:58

find that I need a

29:01

higher dose of levothyroxine in the

29:03

wintertime.

29:05

Your response to Lindsay's comment?

29:08

Well

29:09

my response first and foremost

29:12

is absolute fascination because

29:14

I would really

29:17

want to sort of drill down and

29:19

find out what is going on

29:21

here with the light. You know why

29:23

isn't the light doing any good?

29:26

And I would

29:27

look at kind of lights

29:29

being used, make sure there was

29:31

enough light. You know some people are

29:33

going to use more light. I would want

29:36

to be sure that her eyes were functioning

29:38

well, that she wasn't developing cataracts

29:40

for example that could block the

29:43

light. And I would like to

29:45

see what kind of light box is she using.

29:47

Is she using a teeny weeny one which

29:49

is supposed to give out the so called ten

29:52

thousand lux which is a measurement but

29:55

isn't big enough? Should

29:57

she be using more than one light box? So

29:59

I would go into it like Sherlock

30:01

Holmes and try and figure

30:04

out what is going on with the lights. But

30:06

then I would shift gears

30:09

and say there are many other

30:11

things you can do even besides

30:13

antidepressants. And this is,

30:16

and I know it's kind

30:18

of not cool to say in

30:20

my book, so I'm sort of absolutely

30:23

minimizing that

30:25

comment. But that is the point that

30:28

I have made in my new

30:30

pitch here.

30:31

Even when you look at light

30:34

therapy studies done in

30:36

research

30:37

settings,

30:39

you see

30:40

that the number of people,

30:42

the percentage of people who don't just respond

30:45

but actually remit, which means that

30:47

they virtually have no measurable

30:50

symptoms because they're doing so well with their

30:52

treatments, the number or the percentage

30:55

of people that really respond

30:58

to that degree is rather

31:00

small. It's like 30 or 40 percent.

31:03

So this is like a secret that 30

31:07

or 40 percent don't feel 100 percent

31:10

better with the light therapy. So

31:12

you need to add things. And

31:14

that's why I say you've got to add exercise.

31:17

You've got to add socialization.

31:19

You've got to add cognitive

31:21

behavior therapy, which is a wonderful,

31:24

tested kind of treatment for SARE.

31:28

And exercise outside

31:30

with natural light, you can't compete

31:33

with a dome of the sky in

31:35

terms of a light box.

31:37

One of the patients

31:40

I mentioned did not like the

31:42

light therapy. She instead

31:45

did meditation. She did meditation,

31:48

which was very helpful. And in fact, I've

31:51

written about meditation for

31:54

SAD. So you've got to be

31:56

very skillful, as I point

31:59

out.

33:57

excellent

34:00

one. The Sun Square or

34:03

the Sunray by Sunbox is

34:05

an excellent one. These are two very

34:08

good brands. There's North

34:10

Star. I've listed various ones.

34:12

They're big enough. They've been around

34:15

long enough, and they

34:17

put out a decent amount of life. And

34:20

I'm assuming that you have listed

34:22

them in your book? Yes,

34:25

absolutely. I really have

34:27

no financial agreements

34:29

with any of these companies. I've never wanted

34:32

to do that because I knew it would

34:34

detract from my credibility. But

34:37

I've just

34:40

thought, finally, I really need to come

34:42

out and be very specific.

34:44

That's very helpful.

34:45

That is very helpful. And how much light,

34:48

that is to say, lux or whatever

34:50

measurement we should use, should we be looking

34:52

for? The classic

34:55

amount now is 10,000 lux

34:58

of light, about three feet away

35:00

from the light source. And 10,000

35:04

lux, how much is that? It's how

35:06

much light you'd get if you were outdoors

35:08

on a cloudy day, and you look to

35:10

the sky. That's about 10,000 lux. And

35:13

for how long, either inside

35:16

or outside? Well,

35:18

how long is variable from person

35:21

to person? It's like saying, how much Tylenol

35:24

should you take for your headache? Well,

35:27

one person may need only one, and another person

35:29

may need three. It's variable

35:32

in dosage.

35:34

But I think the thing that I want to emphasize, because

35:38

if you ask me, what do I do

35:40

myself for my own seasonal

35:43

affective disorder? I

35:44

have got

35:46

a number of light boxes around

35:48

the house, because I don't want to have to

35:50

cart my light box around with me

35:53

wherever I go. I have them in the bedroom,

35:55

I have them in my study, I have them by

35:57

the kitchen table, I have them in my gym.

35:59

room.

36:00

Now you know that's a lot of life boxes

36:03

and it's a lot of money and not

36:05

everybody may be able to afford

36:07

that. But if you

36:09

compare it

36:12

to what is a seven-day

36:14

holiday, a seven-day vacation in Hawaii

36:17

costs, it's probably much

36:20

cheaper than that and it lasts you

36:22

all winter long, every single winter.

36:25

So

36:26

yes, one week

36:28

in Hawaii is maybe much more fun than

36:30

having light boxes all over the house.

36:33

But it's a matter of how do you choose

36:35

to spend your money and it doesn't

36:38

have to be so much. Do you just

36:40

leave the light boxes on and just walk

36:42

from room to room or what if somebody said,

36:45

well I just want to buy one light box, I'll

36:47

put it in my study, how long should

36:49

I sit in front of that darn box?

36:52

I would say you know at least 20 to 30

36:55

minutes in the morning and I

36:57

want to also mention that there are smaller

36:59

lights like they're the size maybe

37:01

of a tablet, an iPad

37:04

or you know they're

37:07

quite good and you could take a couple of them

37:09

and they're much easier to walk around the house

37:11

with and you can position them like

37:13

in stereo coming from both

37:16

directions to be sure that a greater

37:19

amount of your retina gets saved

37:21

in life.

37:22

You are listening to Dr. Norman

37:25

Rosenthal. He's a psychiatrist

37:27

and scientist who first described

37:29

seasonal affective disorder in 1984

37:31

and pioneered light

37:34

therapy as a treatment. Dr.

37:36

Rosenthal is clinical professor of psychiatry

37:39

at Georgetown University School

37:42

of Medicine. He has written a number

37:44

of books including The Gift

37:46

of Adversity, The Unexpected

37:49

Benefits of Life's Difficulties,

37:51

Setbacks and Imperfections and

37:54

his most recent Defeating

37:56

Sad Seasonal Affective Disorder,

37:59

a guide to health and health.

37:59

happiness through all seasons. After

38:02

the break, we'll find out how people can

38:04

use outdoor light to overcome

38:06

SAD. Does cognitive behavioral

38:09

therapy help? How would someone recognize

38:12

that they have seasonal affective

38:14

disorder?

38:15

We'll hear about the research that distinguishes

38:17

SAD

38:18

from other forms of depression.

38:21

Can people do anything in the autumn

38:23

to prevent the onset of SAD?

38:39

You're listening to The People's Pharmacy with

38:41

Joe and Terry Graydon.

38:44

This podcast is made possible

38:46

in part by Gaia Herbs.

38:49

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39:22

Welcome back to The People's

39:24

Pharmacy. I'm Terry Graydon. And

39:26

I'm Joe Graydon. The People's Pharmacy is

39:28

made possible in part by Coco Via

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at Coco Via dot

39:44

com. Are

39:45

you less productive during the winter?

39:48

Is it harder to get energized or

39:50

organized? We're talking about

39:53

how seasonal affective disorder

39:55

affects people's emotions and

39:57

behavior and what they can do

39:59

to... defeat SAD.

40:01

Our guest is Dr.

40:03

Norman Rosenthal. He is

40:05

a psychiatrist and scientist who first

40:07

described SAD in 1984 and pioneered

40:10

light therapy as a treatment.

40:14

Dr. Rosenthal is currently clinical professor

40:16

of psychiatry at Georgetown University

40:19

School of Medicine. Dr. Rosenthal

40:21

is the author of several books, his most

40:23

recent being Defeating Sad, Seasonal

40:26

Affective Disorder, a guide to

40:28

health and happiness through all seasons.

40:32

Dr. Rosenthal, we

40:34

have just discussed

40:37

light therapy for indoor

40:39

situations. How can people

40:41

use the outdoors, assuming there

40:44

is some light outdoors and they're not

40:46

above the Arctic Circle, how

40:49

do they use outdoor light

40:52

to help their seasonal affective disorder?

40:55

Well I'm absolutely thrilled that

40:57

you're asking this question because

40:59

people often get so fixated

41:01

around light boxes and indoor lights that

41:04

they forget that they've got

41:06

God's light box overhead

41:09

as they walk outside and

41:12

the huge dome of the sky

41:15

is going to give off more light even

41:17

on the cloudy day then you're going

41:20

to get from a light box. Now of

41:22

course one of the problems is when it's a cloudy

41:24

day with maybe a little bit of drizzle, what

41:27

have you got? You've got a cat

41:29

on, you've got a hat on, you've got a scarf,

41:31

you've got a muffler, you're not seeing

41:34

any of that wonderful light. So

41:36

be sure to look up at that sky

41:38

even if it's cloudy of course you're never going to stare

41:40

straight at the Sun but

41:42

look up at the cloudy sky and

41:44

a

41:45

magic combination

41:47

is light plus exercise. You're

41:50

going up and down hills, you're getting your high

41:53

intermittent high intensity exercise,

41:55

going up and down hills, you're looking up at

41:57

the sky and

41:58

all of a sudden

41:59

And don't be surprised if your SAD

42:03

just falls away and you feel

42:05

so happy because it's a powerful

42:08

combination. And I

42:11

love the word combination because

42:13

in SAD, the fox

42:16

with its many tricks combines

42:18

all these different tricks. So we've got

42:21

exercise, we've got bright light,

42:23

we've got light boxes inside,

42:25

we've got

42:26

social

42:28

plans that we don't allow to drop

42:30

off our agenda. We've got help

42:32

with the training with

42:35

both aerobic and resistance

42:38

training. We do a little bit of yoga, we

42:40

meditate, we really embrace

42:42

the winter in all its different aspects.

42:46

And collectively, that's what's

42:48

going to hold us through the winter

42:50

with light therapy as the jewel in the

42:52

crown.

42:53

Let's talk a little bit about some of those

42:56

individual aspects that add

42:58

to the benefits of

43:01

light therapy. I'm wondering if you

43:03

would start with cognitive behavioral therapy.

43:06

Well, cognitive behavior therapy has

43:09

been thoroughly explored by my

43:11

colleague, Dr. Kelly Rohan up

43:13

in Vermont. She's done wonderful

43:15

work and what she's found is

43:18

that cognitive therapy

43:20

was as good as light therapy in

43:22

the first winter where they studied it. And

43:25

then in the subsequent winter, cognitive

43:28

behavior therapy actually prevented

43:31

the recurrence of SAD

43:33

better than the previous light

43:36

therapy group. And it

43:38

wasn't actually a surprise to me because

43:41

when we ask our patients

43:43

in our seasonal affective disorder studies

43:46

at the NIH, what

43:48

was the most useful thing you learned

43:50

from your participation in the program?

43:53

I thought they would say light therapy, but

43:55

instead they said

43:57

understanding

43:58

the nature of our illness. because

44:01

you know people are smart

44:03

and

44:06

they can think of all these inventive

44:09

ways to overcome that cause

44:11

and effect relationship.

44:13

So

44:15

Dr. Rohan shared a lot of her

44:17

information on her studies with me

44:20

which I was able then to incorporate

44:23

into my book and she emphasizes

44:26

the importance of behavior

44:28

because SAD

44:30

is an illness

44:32

where your behavior

44:34

contributes to the symptoms and you

44:37

can modify it. So the worst

44:39

thing you can do with SAD is to when

44:41

you wake up in the morning pull the covers over

44:44

your head because that's preventing

44:46

you from seeing the light. Instead

44:48

if you got out of bed, looked out

44:51

of the window, opened the curtains, put

44:53

on your light box, you're doing behavior

44:56

relief, all the kinds of little

44:58

things that are going to make a huge difference.

45:01

So

45:02

the magical word about treating

45:05

seasonal affective disorder SAD

45:08

is combination. So if

45:10

you combine with

45:12

your light therapy, exercise,

45:15

cognitive behavior therapy,

45:17

a few winter vacations,

45:20

maintain your social connections

45:23

and know

45:24

and understand what

45:27

are the factors that make you feel down

45:29

and how can you reverse them, you

45:32

will do a great job in managing

45:34

your winter depression. Thank

45:37

you for that Dr. Rosenthal. I guess it's

45:40

important for us to go back and

45:43

review what

45:46

is SAD, seasonal

45:48

affective disorder. What are the

45:50

symptoms? How would somebody know

45:54

that they are vulnerable to maybe

45:57

bad winter blues or in fact

45:59

seasonal If

46:03

you wonder, have I got Seasonal Affective

46:05

Disorder? Look

46:07

back. How do I feel normally

46:10

at Christmas time, at Thanksgiving?

46:13

Am I the life and soul of the party

46:15

or am I the one sitting in the corner because

46:18

I'm feeling down? In fact, I don't even

46:20

want to go to the parties. I

46:22

don't want to celebrate. I don't want to make

46:24

all these things that a lot of people say is

46:26

necessary for the holidays

46:29

because I'm just not feeling myself.

46:32

If you have that pattern,

46:34

then you can say, do I need

46:36

more sleep? Do I eat

46:39

more? Do I gain weight? Do I

46:41

withdraw from friends and family?

46:44

Is it hard for me to get my work done?

46:46

And this happens each year in the

46:48

wintertime and it gets better in the spring

46:50

and summer. Chances are you

46:53

have Seasonal Affective Disorder. I'd

46:56

like to share a message that we got

46:58

from Teresa and

47:00

it's a little different and I wonder

47:02

if she's doing the right thing. So help

47:04

us come up with an answer for

47:06

Teresa. She says, I really enjoy your program

47:09

on KERA here in Texas.

47:12

I profoundly suffer every winter

47:14

from SAD and it seems

47:17

like everyone around me is unaffected.

47:21

Things always seem more hopeful by February

47:23

because I reside in the South. I'm

47:26

always hopeful around March for the return

47:28

of the light. My whole life

47:31

revolves around the natural, the

47:33

only thing that makes me happy. I

47:35

prefer to work in the winter and be off

47:38

in the summer, which is rarely possible

47:40

though. When it's a sunny day, I can't

47:42

stand to have to leave the house.

47:45

I just want to sit and look out at the sun

47:47

like I'm starred for those UV rays.

47:50

On gloomy days, I prefer to go out for

47:52

mundane activities. I reside

47:55

in the South but sunny days still seem

47:57

like rare gold to me. I

48:00

love to stay home just staring out the

48:02

window. The light means more than food,

48:05

water, anything. If I had money,

48:07

I'd book flights to the hemispheres

48:09

according to the season. By that I

48:11

mean I would fly down to New Zealand

48:13

in December while it's summer

48:15

there. So what advice

48:18

do you have

48:19

for Teresa?

48:21

The first thing I would say is that

48:23

description is so beautiful

48:27

because

48:28

in one point in my writing

48:31

I quote, the lion drink

48:33

to me only with thine eyes

48:36

and I will pledge with mine. The

48:38

idea of drinking with the eyes

48:40

is so profound

48:43

to me because if you are

48:45

one of those people who long for the light,

48:48

you are like a thirsty man in

48:51

the desert and when you come up

48:53

with a little bit of water on your tongue, it

48:56

feels so wonderful the receptors

48:58

of your tongue are responding to the water

49:00

and feeling so joyful and that's

49:03

how it is when you long for the light. So

49:05

I really

49:07

think Teresa has done a fantastic

49:09

job of explaining it.

49:11

Now

49:12

what's happening with Teresa is

49:14

that

49:15

she is

49:17

very very sensitive

49:19

to the light and even far into

49:22

the south,

49:23

she

49:24

misses it terribly in the winter

49:26

and craves it in the summer. So

49:29

I've had some of those people who have

49:31

actually moved down to the south and

49:34

even in the south when there's a lot

49:36

of light for most people, they have still needed

49:38

to use light therapy

49:40

to supplement

49:41

their natural light even though

49:43

it's a sunny climate. So she

49:46

just has the problem to a greater

49:48

extent and she needs to exercise

49:51

these options that we've been describing

49:54

to a greater degree than most people.

49:56

Dr. Rosenthal, I'm

49:58

going to raise the microphone. is an issue

50:01

that is somewhat controversial now. You

50:04

introduced the concept of seasonal affective

50:06

disorder decades ago, and

50:09

most people accept it, but

50:11

apparently some of your colleagues

50:14

are now questioning whether it

50:17

is a real thing. Can

50:20

you tell us about the research

50:22

and your reaction to it?

50:26

Yes,

50:28

I know the research. What

50:31

the researchers did was they looked

50:33

at depression ratings

50:36

in a large dataset

50:39

that was collected for

50:41

various reasons, whether it was an

50:43

insurance company or someone

50:46

had these large datasets where they looked

50:49

at parameters

50:51

of various behaviors over the year

50:53

and they looked at depression as one of them,

50:56

and

50:56

when they looked at that,

50:58

they did not find a winter

51:01

peak. It was all kind of flat.

51:04

But the problem was nobody

51:06

really knew who these people were. I

51:08

mean, were they people

51:10

with summer depression? You know, they're people

51:13

who get depressed every summer, they're people

51:15

who get depressed every spring, they're

51:17

people who get depressed at all kinds

51:19

of different times of the year.

51:22

So you've got a very mixed

51:25

database, and those people

51:27

who get depressed in the autumn,

51:30

you see, remember, winter

51:33

depression, it's not just winter. People

51:35

are getting depressed already in September,

51:37

some even as early as August, because the

51:39

light is already waning in

51:42

some parts of the country at that time. So

51:45

August, September, October, November,

51:47

December, January, February,

51:50

March, people with SAD could

51:52

be affected in all of those

51:54

months. So that's half of their data, and

51:57

the other half of the data, there's maybe

51:59

some return depression and maybe all kinds

52:01

of things, it's a mixed data set

52:04

where the signal has been camouflaged.

52:08

And in fact, until

52:11

we looked at people

52:13

longitudinally, the

52:15

signal didn't emerge. People

52:17

found that they looked at hospitalizations

52:20

for depression and most occurred in

52:22

spring and fall. Well, most

52:25

people with SAD don't get hospitalized.

52:27

It's not that kind of depression.

52:30

So when you've gone ahead for a genius

52:32

data set and you're sampling people

52:35

in this particular way, you

52:37

are bound to miss a signal, whatever

52:40

that signal happens to be. I've got colleagues

52:42

who are working in similar

52:44

areas where signals get camouflaged

52:48

because of, like let's say you

52:50

look for PMS and

52:52

you looked all over and you looked

52:55

at it not by when people's menstrual

52:58

periods were, but when the seasons were.

53:00

You wouldn't necessarily find any link

53:03

at all. So it's the methodology

53:06

that led to a negative finding.

53:09

And then the negative finding was

53:11

very boldly interpreted

53:14

as a complete revolution

53:18

in scientific discovery debunking 40

53:22

years of work, which I think

53:24

was extremely a very

53:27

kind self-interpretation

53:30

of the data by the researchers. So

53:32

I think that, yes, it's

53:35

a kind of man bites dog

53:37

story as far as I'm concerned.

53:40

And I don't think it's really

53:43

been replicated. I don't think much

53:45

has happened with it. But it does stand out there

53:48

as an interesting controversial

53:50

item that I think really

53:52

doesn't have any bearing on debunking

53:55

what really is hundreds of papers. Well,

53:57

Dr. Rosenthal, before you went to the hospital, I was going to say, I was

53:59

going

53:59

Before we conclude our conversation

54:02

today, I wonder if you can

54:05

tell us, are there things that people who suspect

54:07

they might have sad can

54:10

do in the autumn to prevent

54:13

the onset of symptoms?

54:16

That is an absolutely wonderful

54:19

question and I think we really

54:21

need to have an autumn

54:24

checklist.

54:25

And

54:26

so may I read an

54:28

autumn checklist over here? Yes, please do. Because

54:31

I have one right here in my book and

54:33

it's so important. Here is the

54:35

checklist.

54:38

Ask yourself. Have

54:41

I purchased the light box or boxes

54:43

for the winter?

54:45

Do I have at least one room in my home

54:47

that is bright and inviting?

54:51

Have I made plans for a winter vacation

54:54

or two in the sun? Is

54:57

this a good time to check in with my doctor

54:59

and put her or him on notice

55:01

that I'm entering my season of risk? Have

55:05

I notified those close to me that

55:07

I may need a bit more support from

55:09

them in the coming months? Have

55:12

I put a physical fitness program

55:14

in place? If you start an exercise

55:17

program before winter hits in full

55:19

force, it will be easier to continue

55:22

when your energy and motivation flag. Have

55:26

I evaluated my outlook to see

55:28

whether it could be improved? For example,

55:31

can I view winter at least in part

55:34

as a challenge and an adventure

55:36

rather than an unmitigated

55:38

pain in the neck,

55:39

as it so often feels? And

55:42

finally, how can I find beauty

55:45

in this colorful season of autumn,

55:48

resplendent with the fruits of

55:50

summer?

55:59

Thank you so much for having me as a guest.

56:02

You've been listening to Dr. Norman Rosenthal.

56:06

He's a psychiatrist and scientist who

56:08

first described seasonal affective

56:10

disorder in 1984 and

56:12

pioneered light therapy as a treatment.

56:15

Dr. Rosenthal is clinical professor

56:18

of psychiatry at Georgetown University

56:21

School of Medicine. He's the author

56:23

of several books, including Winter

56:26

Blues, Everything You Need to Know

56:28

to Beat Seasonal Affective Disorder

56:31

and Transcendence, Healing

56:33

and Transformation through Transcendental

56:35

Meditation. His most recent

56:38

book is Defeating S.A.D.

56:41

Seasonal Affective Disorder, a

56:43

Guide to Health and Happiness Through All

56:45

Seasons.

56:46

Lynn Siegel produced today's

56:48

show, Al Wodarsky Engineered. Dave

56:50

Graydon edits or interviews. B.J.

56:53

Liederman composed our theme music.

56:55

This show is a co-production of North

56:57

Carolina Public Radio WUNC

57:00

with The People's Pharmacy.

57:02

The People's Pharmacy is made possible

57:04

in part by Cocovia Dietary Supplements.

57:07

Cocovia memory and focus is

57:09

a unique formula made with a special

57:11

blend of ingredients that work together to

57:13

promote attention and support long-term

57:16

memory. It supports five areas

57:18

of brain performance in one capsule.

57:20

More information at cocovia.com.

57:24

Today's show is number 1,363. You

57:28

can find it online at peoplespharmacy.com.

57:32

That's where you can share your comments about today's

57:34

interview. Tell us about your experience

57:37

with S.A.D. Have you ever tried

57:39

a lightbox? How well did it work for

57:41

you? We'd like to hear about it. You

57:44

can also reach us through email, radio,

57:46

at peoplespharmacy.com.

57:46

Our

57:50

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57:54

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57:57

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57:57

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58:14

topics we'll

58:15

be covering. In Durham, North

58:17

Carolina, I'm Joe Graden. And

58:19

I'm Terry Graden. Thank you for listening.

58:22

Please join us again next

58:24

week.

58:45

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58:47

Podcast. It's an honor and

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