Courtney Collen (Host): Hello and welcome to “Her kind of Healthy,” a health podcast series brought to you by Sanford Women’s. I’m your host Courtney Collen with Sanford Health News. We want to start new conversations about age-old topics from fertility and postpartum depression to managing stress, healthy living, and so much more. “Her Kind of Healthy” is designed to bring you honest conversations about self-care, happiness, your overall well-being with our Sanford Health experts.
In this episode, we are focusing on seasonal affective disorder (SAD): what it is, how it affects us women, and what we need to know. I have the privilege of welcoming two guests for this conversation. I have Wendy Vetter, D.O., who is an internal medicine physician in Sioux Falls working to help patients understand how nutrition, mental and spiritual factors impact physical health. And I also have Karla Salem, a certified social worker who specializes in women’s mental health. Thank you both for joining me.
Karla Salem: Thank you.
Dr. Wendy Vetter: Thank you.
Host: Dr. Vetter, I’ll start with you. Can you define seasonal affective disorder and explain how common it really is?
Dr. Wendy Vetter: seasonal affective disorder is a variation on depression and it’s unique in that it seems to coincide with the fall and winter months and its onset and it also resolves typically with the coming of spring and summer.
Host: How common is seasonal affective disorder around here?
Dr. Wendy Vetter: So, because we are in the Midwest and we have shorter daytime hours in the winter we have a large amount of seasonal affective disorder, probably way underdiagnosed.
Karla Salem: And then the other part of it is there’s kind of a continuum for some people. They don’t have specifically seasonal affective disorder, but they’re very affected by the shorter days because of the brain chemistry issues that sunlight impacts serotonin levels and so when the days are shorter, serotonin levels decrease, which is kind of like serotonin is like the volume of your mood. So moods that would be just kind of stable and normal normally where are all of a sudden a little louder, like anger is a little more intense, sadness is a little bit more intense. So people can kind of feel that impact even without the official diagnosis of seasonal affective disorder.
Host: So what is physiologically happening in the brain, you talk about serotonin levels, when someone might be showing signs or symptoms potentially leading to a diagnosis of seasonal affective disorder?
Karla Salem: Well, serotonin is your, like I said, your control over your mood. It’s next to norepinephrine in your brain, which controls your thinking. So that’s your anxiety neurotransmitter. And the two really work very closely, hand in hand. So serotonin is, should be more buoyant and it becomes less buoyant when it’s not exposed to sunlight. But it is a genetically predisposed. So you’re born with your brain chemistry. So that’s kind of the underlying or the initial kind of indication that if you have a history of depression, then you might be more impacted by the winter the seasonal affective disorder, the extra symptoms that come with it. But our brains and our guts are also interconnected and then it’s interconnected with sleep. Because serotonin creates melatonin which makes our sustained. And then, so in the shorter days, sleep can either be more or less so you also have that sleep deprivation.
Dr. Wendy Vetter: Yeah. I was going mention the melatonin component as well in relation to circadian rhythms. Yeah. And I think that’s part of what we understand about seasonal affective disorder.
Host: We talk about what’s happening on the inside of our brain but let’s speak to the signs and symptoms. You talk about someone might be predisposed to seasonal affective disorder if they’re potentially struggling with mental health or have history of depression. What are the signs and symptoms that we should be looking for?
Karla Salem: People will have the typical signs of depression, which would be, you know, more lethargy, lack of energy maybe more hopeless thoughts. With seasonal affective disorder, there’s some additional, like you tend to want to hibernate, not get out of bed. There’s the carbohydrates or the diet issue. Have you seen that with your patients?
Dr. Wendy Vetter: Yeah. There’s a craving for carbohydrates.
Karla Salem: It’s maybe more intense symptoms or it’s just people just will report, “I just don’t feel like myself. I’m screaming at my kids and I don’t normally do that and I don’t want to exercise. I normally exercise, but I don’t feel like it.” So, it’s like you take some of the things that they use for normal coping and don’t have them anymore because they don’t have the energy to do it.
Dr. Wendy Vetter: And that seasonal affective disorder is a little bit more slanted in symptoms. They’re consistent with that fatigue, low energy, but sleeping more, weight gain and increased appetite. Whereas depression can sometimes go either way where there are problems with insomnia or sleeping too much. There can be problems with loss of appetite or increased appetite, but we see more of the hibernation, I think is a good word to describe the phenotype.
Karla Salem: So with every mood or anxiety, you always have three issues: you have the biological, you have the social, and then you have the psychological. So oftentimes people are coming off of Christmas, they might have seen family, not seen family, they’re still going through kind of sadness about maybe losses and, and they have no winter trip planned. So that also will impact people’s mood beyond just seasonal affective disorder.
Dr. Wendy Vetter: The key with making it a true diagnosis is that all of those impact symptoms impact your functioning like Karla was saying. So your social functioning, your biologic function and then of course memory and your work.
Karla Salem: So every part of you gets kind of impacted. It kind of feels like a mess sometimes, people report.
Host: So at what point is it time to seek help and, and at Sanford Health, where do you start?
Dr. Wendy Vetter: I would be biased to say you can start with your primary care doctor.
Karla Salem: I was going to say the same thing!
Host: Well, good thing we have both of you here.
Dr. Wendy Vetter: Yeah, absolutely. And then we’re very fortunate to have lots of options available to treat. I think sometimes just identifying it, naming it and getting it out in the open is a relief for people. So just simply having somebody to talk to about it and empathize. And then we have medications that can help with treatment and again, we have embedded our therapists and IHT (integrated health therapists) in our clinics to help with talking through what they can do for themselves.
Host: Let’s expand on the treatment and what that patient journey might look like and what, you know, as a therapist, as a social worker, Karla, and an expert in your field, what you bring to the table and how collaboration works to benefit the patient.
Karla Salem: Oftentimes people will want to go the route of medication. So, one of the things that can happen in therapy is kind of monitor how that’s going and kind of explain what it does for folks. The other, another really good behavioral technique is light therapy. It’s often used that it can restore what you’re losing because of the wintertime to your serotonin. And it’s real affordable. Used to be like light boxes you had to rent because they were so expensive. Now you can jump on Amazon and get one for $60. And so that used throughout the wintertime or when the days start getting shorter can also help in restoration. And then people just like, like Dr. Vetter said, normalizing the situation. Just making sure people understand because they’ll be thinking, thinking, thinking. And they’ll come in and say, ‘I think I’m crazy’ and no, this is a very normal way that, that people get during the wintertime and explanation and then ideas on how to get out of bed and go take a walk or go outside even though it’s really cold out to get some of those behavioral kinds of techniques to help.
Host: How might we support friends or loved ones who may be impacted by seasonal affective disorder?
Karla Salem: Well, one of the ways is just to understand and to listen. A lot of times people don’t want to talk about that with friends and loved one because they think that brings them down or, or they’re a burden. And so just to be open, if you notice something different, somebody’s kind of off. It doesn’t hurt to just ask, you know, ‘what’s going on? Is there something I can do to help?’ And just to be a listening ear oftentimes is very supportive.
Dr. Wendy Vetter: I would say if you are concerned about someone or if someone comes to you saying, ‘I’ve been feeling down or blue’ entering a conversation with curiosity, and I use that same phrasing with my staff in-clinic too. Just don’t make judgment. Just be open, patient curious and they’ll come to you with what they need in their time.
Karla Salem: You really encourage people to go to your medical doctor because those are usually people that patient trusts and so that’s something, you know, they tell them all sorts of things. And then can help guide them in a way. So that can also be a place where friends and family can guide a patient to go to talk to their doctor.
Host: Yeah, wonderful to have that support. Relative to that, we know winter can be a tough time of year, and if we don’t like the cold, we tend to spend a lot of time indoors. So what tips or advice do you have to combat any additional stress this time of year?
Dr. Wendy Vetter: There are lots of things I could say about that. I think like Karla was mentioning winter vacation or just even thinking about and planning forward to something in the future, whether or not it’s a trip. So setting a goal making sure we’re focusing on getting adequate sleep and in particular with seasonal affective disorder, having a very routine going to bedtime and getting out of bedtime can be helpful for maintaining, I guess, normal mood and energy and focusing on diet and, and physical activity or exercise definitely increases our endorphins and that improves our mood.
Karla Salem: And beyond, you want make sure, just like Dr. Vetter was saying, that your foundation is as solid as can be. The main eating and drinking water and sleeping and such and other ideas you can have is just to again, have some focus, have some directions, maybe some personal challenges during January: see how many books you can read or you can see how many steps you can walk like walking up your steps at your building or somewhere else. And just challenge yourself to those kinds of things. Those personal challenges. Also, you know, the planning, that’s such a great idea. I mean, even starting to plan your garden, starting to plant some seeds and have a little greenhouse ready to go. Any of those things that distract you from, from any kind of doldrums and charges you into the future just a little bit. Things that you can look forward to.
Host: Always good to plan ahead, especially thinking about those warmer months and those sunnier days. Is there anything else that I might not have asked you that you wanted to discuss on this topic of seasonal affective disorder and what women need to know about this?
Dr. Wendy Vetter: My high points would be it’s really common, don’t keep it to yourself and it will get better.
Karla Salem: Excellent notes to end on.
Host: Agree. Karla Salem, Dr. Wendy Vetter, thank you so much for your time and your expertise in all that you do here at Sanford Health. Thank you.
Dr. Wendy Vetter: Thanks.
Karla Salem: Thank you.
Host: I’m Courtney Collen. Have a great day.
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