Doctor shares tips about how to manage seasonal affective disorder

INDIANAPOLIS (WISH) — Daylight saving time has ended and the days of sunshine are getting shorter, leaving people vulnerable to seasonal affective disorder. 

News 8 interviewed Dr. Heather Fretwell, psychiatrist at Eskenazi Health, who spoke about the mental condition, signs and symptoms, as well as ways to manage it. 

Gillis: Seasonal affective disorder. Can you explain what this is and who does it affect? And why does this happen?

Fretwell: Seasonal affective disorder has been with us for as old as time, but was only really described in the 1980s. And now 40 years later it is a very well established medical condition. It affects approximately 5% of Americans, but it differentiates by latitude. So, it will be about 1% in Florida and 9% in Alaska. In Indiana, we’re about at that 5% mark. It’s more than it sounds like. That’s one in about twenty people.

Gillis: And what are the factors that contribute to this?

Fretwell: We think that it’s caused mostly by changing in the exposure to natural light. We’re very responsive to light and sunlight duration. We’ve found that when we have less light duration in our lives and a less light intensity in our life, as happens in the fall and when winter in Indiana hits, that our brains produce melatonin and at different times than it usually does, which can lead to a very sluggish, slow feeling.

Also in terms of people who are most susceptible to seasonal affective disorder also process serotonin differently during this time as well. In fact, they tend to express more levels of a protein that decreases the amount of serotonin that’s available to signal from one brain cell to the next. And this starts leading into a clinical depression. 

Gillis: Circling back to sluggishness…tell us about signs and symptoms we might experience if we’re suffering from this. 

Fretwell: Absolutely. So, starting out with fatigue to poor concentration to that feeling of depression or sadness or just not being able to enjoy your usual activities. A lot of people find themselves being a little more irritable and short with their friends and family members.

In fact, that’s one of the things that’s reflective in those people that have that self-awareness to say that something is going on that’s not in my usual mode. It can progress to being very serious indeed. And some people with seasonal affective disorder also have important life-threatening symptoms including thoughts about death, dying or how to carry out a suicide plan. 

Gillis: So, some people have bad days, but this is sort of a prolonged condition that tends to get worse. Family members might start to notice these dark thoughts we have. When should a person seek help?

Fretwell: There’s no bad time. Honestly, as soon as you start worrying about yourself. As soon as you have a conversation with a friend or a loved one and say something like “Do I seem to you that I’m not quite myself these days?” because often an external perspective can sense changes earlier than the person themselves can. There’s no “wrong” time. There’s no “too early” time to seek professional help. 

GIllis: And ways to cope? Natural versus medication?

Fretwell: In terms of treatments for seasonal affective disorder actually one of the best studied is light therapy. So, that’s not necessarily medication as is required to treat this condition. Although medication often does find benefits in this condition as well. Also, talk therapy. Cognitive behavioral therapy specifically has been studied for seasonal affective disorder and this has proven to be beneficial. 

Gillis: Going back to medication and talk therapy. Is there a time frame that we should do this? Or should this be lasting?

Fretwell: For a lot of folks with seasonal affective disorder it’s a treatment basically during the winter and into the early spring and then this naturalistically tends to resolve itself by late spring. One can often come off medicine if this is the only component of the major depression or mood disorder.

Unfortunately, some folks have a recurrent major depression that is not seasonally linked, but may also have a seasonal affective component on top of another episode and in those cases I would recommend discussing with your doctor about being on medication year-round. But for folks specifically with seasonal affective disorder? Oftentimes the time can be limited to during the episodes of the disorder. 

GIllis: And you mentioned early spring that this starts to lift a little bit. Do we have a time-frame in which this happens or occurs? Or is it different for everyone?

Fretwell: It’s a little bit different for everyone, but if you think about our seasonal patterns just past the middle of March is our spring equinox and that really does mark when we’re starting to have more daylight in our lives again, which would reverse some of those physiological changes that I was describing earlier. Our melatonin production would normalize and that production of that protein that artificially gives us access to that serotonin also normalizes with this light exposure. 

Gillis: Well, it’s incredible what environmental change can do. And anything else you’d like to tell the people of Indiana who might be suffering or maybe has a loved one that they suspect is suffering. 

Fretwell: Please know this is a very treatable condition. We have a lot of science and evidence of things that can be helpful. And also please know that this is not a weakness. It’s just like asthma or insulin resistant diabetes or any other kind of medical condition. This is not something somebody has because they are weak or defective. It’s the way we are built and one thing that all we humans are potentially vulnerable to. So, please understand that and get whatever help you need to get through this trying time because this 2020 season especially has its own special challenges compared to any other prior year.  

News 8’s medical reporter, Dr. Mary Elizabeth Gillis, D.Ed., is a classically trained medical physiologist and biobehavioral research scientist. She has been a health, medical and science reporter for over 5 years. Her work has been featured in national media outlets. You can follow her on Instagram @reportergillis and Facebook @DrMaryGillis.