Episode 26: Diagnosing Seasonal Affective Disorder with Therese Sorrentino, Part One

00;00;09;00 – 00;01;14;22
Rick Hoaglund
It’s no secret that I get a little down in the winter. It’s a time of the year when the days are short. The temperatures are low, and it can be rather bleak. You see, I live near Seattle, Washington. We’re not known for our sunny, cloudless skies, but more for that variety of gray in our clouds! This time of the year, we’re a place where the forecasts are constantly reminding us that I live in a mostly cloudy with a chance of rain daily place. The sun is hiding from us with only eight and a half hours of daylight daily during January. A perfect setting where for topic today. It’s seasonal affective disorder or commonly called SAD. The big question on my mind, and quite possibly on yours, especially if you’re feeling the effects of winter, is do we have SAD or merely the winter blues? You’re listening to OnTopic by Empathia. I’m Rick Hoaglund. And today our guest is therapist Therese Sorrentino. She’s here to enlighten us on the topic. Welcome, Therese! Glad you’re here today!

00;01;14;25 – 00;01;17;17
Therese Sorrentino
Thanks for having me, Rick! Nice to meet you!

00;01;17;19 – 00;02;01;09
Rick Hoaglund
It’s estimated that 5% of Americans, that’s millions of people, experience seasonal affective disorder. While it’s not as common as in an adult, about 1 million children in the United States are also affected. It lasts for about four and a half months of the year. Statistically, the most difficult months for someone with SAD are January and February. In the United States, the further north you go, the more likely you are to suffer from the disorder. Alaska has the highest rate in the United States. Hello, Therese! Thanks for taking the time to speak to us. Our topic today is Seasonal Affective Disorder. Tell me a little bit about that. Like what – what is it?

00;02;01;11 – 00;02;59;25
Therese Sorrentino
Seasonal affective disorder is a form of depression that happens mostly in the winter months, and it’s due to when we have less sunlight and shorter days. It can create a chemical change in the brain. About 5% of Americans suffer from seasonal affective disorder, and it’s more common in northern countries and northern states. For instance, Alaska, Vermont and New Hampshire have the highest level of SAD. And conversely, the lowest levels are usually in Hawaii, Arizona and Florida. So, you know, it makes sense because, you know, there’s more sunshine there and less in the northern states and countries away from the equator.

00;02;59;27 – 00;03;04;03
Rick Hoaglund
So how do I know if I have SAD?

00;03;04;05 – 00;04;37;28
Therese Sorrentino
Well, I think most people, they know if they’re feeling some depression. And really it’s- it’s no different than having depression, except that it’s- it’s usually just for a period of time and maybe a period of time where you’re feeling that way all day, every day. But you notice that it starts to come on like maybe December, January, when things are grayer, there’s less sunlight and then you start to have symptoms. And some of those symptoms can be feeling sad most of the day, losing interest in activities, feeling kind of low energy or even sluggish, sleeping too much, difficulty concentrating, feeling hopeless, and then even some very physical things like appetite changes where some people will have a tendency to maybe start craving more carbs and eating more things, carbs and sugars, things they shouldn’t eat and gaining weight and maybe a decreased sex drive, feeling socially withdrawn, maybe having a tendency to isolate, not want to go out. And then some people may notice that they really increase their use of alcohol or drugs.

00;04;38;00 – 00;04;45;06
Rick Hoaglund
What’s the difference between SAD and the winter blues? You hear about people talking about having the winter blues. Is that the same thing?

00;04;45;09 – 00;05;25;01
Therese Sorrentino
Yeah, I think it’s pretty much the same thing. I mean, SAD is really it’s just another name, I think, for the Winter Blues. I mean, I think the only maybe distinction is they say winter blues. It’s like the difference between, I’m feeling sad or I’m feeling depressed. So I think, you know, maybe if there’s a difference, it’s that SAD or seasonal affective disorder symptoms are maybe there’s more symptoms and they tend to be a little bit, maybe more severe than if you’re just having the blues, just like with, you know, a diagnosis of depression. There’s different types of depression.

00;05;25;03 – 00;05;57;06
Rick Hoaglund
And I even look at here, I live in a place where it’s dark for a lot of year, just put it that way. And I would say like 90% of my friends and- and people I know have the winter blues. I don’t know how many actually have SAD, but I think everyone feels sluggish and kind of depressed in the winter just cause we have no sunlight here. How serious is it? Like if I really feel like I have SAD, Is this something I need to talk to a doctor or a therapist? Or where do I go for help with that?

00;05;57;09 – 00;06;32;27
Therese Sorrentino
Well, I think that it is good to talk to- maybe start with talking to a therapist and let the therapist assess how serious it is. And if the therapist thinks, hey, you know, you have some clinical symptoms and you’re feeling this way all the time, maybe would be a good time to see a psychiatrist or a doctor, depends, and have them evaluate whether they think you need some kind of intervention and or treatment.

00;06;33;00 – 00;06;48;02
Rick Hoaglund
So as a- as a therapist, do you have a way to diagnosed SAD like or is that just is it a general category that you just kind of say this person probably has SAD or is there a diagnosis that you actually have that is- as a finding?

00;06;48;05 – 00;08;05;05
Therese Sorrentino
Yeah, you know, there’s actually no diagnosis for SAD in the in the diagnostic manual that therapists use? So there there isn’t one. I think you can diagnose that it’s SAD if you’re talking to somebody and they just say, you know all of a sudden they just started feeling this way and they notice, you know, if I ask them, what did you notice this last year? Did you feel this way last year, in January? Because January they found is that the month where there is the highest rate of depression is in January. And so, you know, you can talk to them about that. Ask them what their symptoms are and then see how long, you know, it persists, especially after you suggest some treatment options and some ways to manage it. And if they can manage it and it’s manageable and they feel better, then great. And if they can’t and it’s just still interfering in the their ability to function day to day, then it’s definitely time to go see a doctor.

00;08;05;08 – 00;08;19;24
Rick Hoaglund
Are there individuals that are more susceptible to SAD? Is it a other genetics or is it a cultural thing? Is it a biochemistry thing that’s going on with them? Are there people that are more susceptible? I guess?

00;08;19;26 – 00;09;05;04
Therese Sorrentino
I think the people that are going to be more susceptible to SAD are people that maybe already have a mental health diagnosis or a mood disorder, like they have bipolar disorder, for instance. That’s- that’s one. And so if they’re already prone to having a mood disorder, then they’re going to be more prone to having seasonal affective disorder. So whatever they have is going to get worse. Probably, or can get worse during those months. There’s people who have a tendency to get a little depressed or down or sad. Those are the people they’re going to be probably going to be more susceptible to the seasonal change.

00;09;05;07 – 00;09;22;22
Rick Hoaglund
What does a person get commonly when you’re- when you’re talking to someone that has SAD, what are how are they describing how they feel? That might be a good way to to ask the question. What are they describing it being like? If you were to put on their shoes, what would you feel like?

00;09;22;25 – 00;09;51;27
Therese Sorrentino
You know, I think people are usually going to describe it as, gosh, I don’t know, boy, I’m really feeling down all of a sudden this month. And not sleeping too much. I’m- I’m eating stuff I shouldn’t be eating. And I’m feeling really tired and lethargic and I don’t know why. I don’t know what it is. I don’t know if it’s just let down from the holidays or- or what’s wrong. But I’m just not feeling myself right now.

00;09;51;29 – 00;10;06;19
Rick Hoaglund
And is there anything to do with your lifestyle? Does your lifestyle have anything to do with your ability or. Well, you’re- you’re susceptible ability to having this disease? Susceptibility! I guess that’s the word I should have used!

00;10;06;22 – 00;13;43;02
Therese Sorrentino
Yeah. No, I don’t. I don’t think so! Because it’s- melatonin is this- is a sleep related hormone that’s linked to SAD, okay? And the body naturally makes more melatonin when it’s dark which is what we need to sleep. And you know, humans human life for thousands of years revolves around the cycle of light. Our biological clocks regulate our circadian rhythms and tell our bodies to sleep as they day shortens each day. But that may get to you, but that may be disrupted. Your body’s internal clock gets disrupted from maybe what it hit it had been prior to this. So then what happens is the melatonin levels are regulated by the pineal gland, which secretes the melatonin in the absence of light. So light exposure suppresses melatonin. So you want light because you want to suppress the melatonin. What happens is that cues get sent. You know, sunlight goes through into the retina to the back of the eye, and that creates a signal which passes through the optic nerve to the midbrain and setting in motion a number of chemical changes. So when that happens, that- that’s going to disrupt people’s sleep, especially and I said that earlier, I think sleep is a big issue because you’re, it’s- you’re you’re not suppressing the melatonin. And then we need serotonin, which is another chemical, brain chemical to feel good. That’s a feel good chemical. And it’s often referred to people hear it referred to as a neurotransmitter. We have typically three, you know, neurotransmitters in our brain, and that affects the brain chemistry. So serotonin, when there’s a, you know, reduced sunlight, there’s a drop in serotonin, and that creates a trigger for depression. So in- so what you want is you want to increase their serotonin to lift the mood, which is why then oftentimes, you know, a doctor may prescribe an antidepressant that that has serotonin, which is often referred to as an SSRI because you want to increase the serotonin. So melatonin is released at night because it’s needed at sleep at night to sleep, and then serotonin is increased during the day, which helps us feel more energized and happier. So- so the challenge is in order to keep the brain chemistry balanced and keep it, is how do you how do you keep that balance with the melatonin and the serotonin and how do you get those chemicals working the way they should be, in the way they do normally? And, you know, how do you counter the of- the the effect of the lack of light?

00;13;43;04 – 00;13;56;05
Rick Hoaglund
Is this a condition that you can outgrow? Like if someone goes untreated, will they eventually just say, I’ll outgrow this or it’s only going to last for a short while? Or is this something that’s lifelong?

00;13;56;08 – 00;14;33;19
Therese Sorrentino
You know, I really don’t know the answer to that. I haven’t read anything about that. I think that’s probably a really hard thing to predict. You know, I’m- I’m guessing that, you know, if somebody is prone to that, they’re going to continue to be prone to it. I don’t know that age or outgrowing it, but so it’s hard to say. But I think the more people learn, understand it and learn how to manage it, then probably, you know, less likely that it will continue to maybe affect them as much as they go down down the road.

00;14;33;22 – 00;14;50;00
Rick Hoaglund
So let’s talk about light. And I know we’ve talked a little bit about this already and we’re going to really get into the therapy piece in our next section. But is it- can I turn on my overhead lights? Does that help?

00;14;50;03 – 00;16;45;26
Therese Sorrentino
Yeah, I think it does help! I think sitting by your windows during the day and plus or the window where you get get some light, that’s helpful. I will tell you I’ve had problem with this myself and I’ve had sleep issues. So I finally went and saw a doctor who was a specialist in sleep and she gave me some really good suggestions for that because I think, you know, is she she called what I had a delayed sleep syndrome, but in part, essentially what that was, is my circadian clock was was screwed up. So she recommended that I go out in the morning first thing in the morning, sit outside for 20 minutes or 30 minutes and try to get some light in my eyes, some sun. So if it’s not raining or snowing and you can go sit outside, I always tell my patients, you know, grab your coffee or your tea and take it out, sit outside on your patio. That’s what I do every morning and sit somewhere where you’re whatever sun is out there, like you’re going to get the light. So that’s a natural way to do it and in a good way to do it. When you can’t do that, to substitute for that is you can buy a light box and they’re very inexpensive and you can- you can get them online very easily and you can put a light box, say, on your desk if you’re working to the side or on your nightstand, wherever you want to put it, and you turn it on and sit near the light box for 20, 30 minutes a day. And that’s that’s a good substitute if you can’t be outside and get just natural sun.

00;16;45;28 – 00;16;55;02
Rick Hoaglund
You brought up an interesting point, and that was SAD and sleep there connected. And can you expand a little bit on that?

00;16;55;04 – 00;18;25;16
Therese Sorrentino
Probably the biggest factor is going to be sleep disruption in some form. Either people are having difficulty, maybe they’re having difficulty falling asleep, maybe they’re sleeping like way too much, like they have a hard time getting up in the morning. They really don’t want to get up or they or when they do fall asleep in their they wake up during the night, maybe several times and they fall back asleep and they, you know, hard to get up in the morning. So it definitely because it affects your circadian clock, your circadian rhythm and you know can interrupt your sleep. As a matter of fact, when I had seen a sleep doctor because I was having some issues with that and one of the things she told me to do that I thought was really interesting was she told me to turn my alarm clock around and not to be able to see it. And I thought, that’s interesting. But it made sense to me. Later I realized that- that say you wake up in the middle of the night through 3 a.m. and you look and you go, my God, it’s 3 a.m.. Go back to sleep. You might wake up again the next night at 3 a.m. and the next night somehow. And I don’t know how how it works, but somehow our body gets the message out, gets 3 a.m., we’re supposed to wake up and then you start this repeated cycle of waking up at that time. So she said, Whatever you do, turn the clock around. Don’t look at it. So you don’t know what time it is.

00;18;25;18 – 00;18;57;02
Rick Hoaglund
So we’re trying to reset our circadian rhythm as part of the treatment for SAD, I’m guessing, right? That’s a big goal of this. There could be other things as well, but we’re really trying to make sure that we’re getting adequate sleep. That’s not too much sleep as part of our treatment plan. And tell me a little bit about more what I mean, if I can diagnosed, I have SAD, what are my treatment options? Like what? What are what as as a therapist, what are you looking at? What are you looking at?

00;18;57;05 – 00;21;34;26
Therese Sorrentino
So what I would tell a patient to do is first and foremost, the number one thing is trying to get more exposure to sunlight. So if you can sit outside in the morning and get some exposure first thing in the morning, 20, 30 minutes, have your coffee. That’s great. If you- if you can’t because of the weather or maybe time constraintsk, sit by windows. And the the other option and a great alternative is to buy a light box. And they I mean, you can get a light box on line between I mean, really it’s just $40 to $60. You don’t need anything fancy, just a small lightbox. You could on your nightstand, put it next to your computer. And that because what that does then is you want to decrease the melatonin, which happens when it’s dark and which what you need to sleep, but you’re sleeping maybe too much. You can’t get up and get going in the morning and you want to increase your serotonin. So so the light therapy is going to help you do those two things to balance out the melatonin and the serotonin and your brain chemistry, because it’s affecting your brain chemistry, which then is- is affecting your circadian clock and in your biological rhythms. So- so light therapy is like number one, other things that you can do are you can take vitamin D and that’s a really important thing to take, really is important to take it all the time that you especially want to be taking it Vitamin D, A lot of times you get it through your skin and so you’re not- you’re, you’re not doing that in these months. It’s cold. You’re not being- your skin isn’t being exposed to the sun. So you aren’t- you aren’t getting enough vitamin D and that that can have an effect. So taking vitamin D, decreasing alcohol and especially or drugs, because those can be a depressant. So that can increase your depression and also cause you to wake up at night too, because alcohol may make you feel like relaxed and tired before you go to bed. And Oh, I’m nice and relaxed, I’m gonna go to bed now. But then as it wears off, it can cause you to wake up. The other thing is going to therapy and working with a therapist, doing some cognitive behavioral therapy. That’s- really can make a difference.

00;21;34;28 – 00;22;19;03
Rick Hoaglund
Does seasonal affective disorder occur only in the winter? The answer is no. While it’s not as common, SAD can occur in the summer. If you feel you may have seasonal affective disorder, there are online diagnostic tools that may help in determining if you need to seek emotional or medical assistance. Just type in Seasonal Affective Disorder screening tool into your favorite search engine. To hear other episodes of OnTopic with Empathia, visit our website, www.Empathia.com. Follow us on social media @Empathia, and subscribe to OnTopic with Empathia to hear new episodes as soon as they go live. I’m Rick Hoaglund – thanks for listening to OnTopic with Empathia!