Seasonal Affective Disorder (SAD) with family medicine physician Beth Brinkman

[00:00:00] Pete Waggoner: Hello and welcome to Beyond the Checkup brought to you by Stellis Health.

[00:00:08] We’re neighbors. Care for neighbors. I’m Pete Wagner, ready to guide you to a healthier, happier life today. We’re here to inspire, explore, and to help you thrive in your health journey. So let’s dive right in with Dr. Beth Brinkman on today’s episode of beyond the checkup, Dr. Brinkman, thanks for joining us here today.

[00:00:26] And we’ve got quite the topic and I think it’s seasonal as we get into October here. Thanks for joining us here today. 

[00:00:32] Beth Brinkman: Yeah, thanks for having me. 

[00:00:34] Pete Waggoner: Of course, we’re going to talk about Seasonal Affective Disorder and, before we get into that, would you mind giving us a little bit more about your background, in your practice and what you do?

[00:00:43] Beth Brinkman: So I am a family practice doctor. I currently work out of the Buffalo clinic with Stellis health doing primary care. Seeing all different ages, adults, kids, everybody, , and pretty much any problem, family medicine, [00:01:00] we see it all. So a lot of variety, a lot of different things come in my way.

[00:01:05] Pete Waggoner: On our topic, of course, as I mentioned a moment ago is a seasonal affective disorder, and we hear a lot about it with our family and friends who, who may say, man, I feel a little bit different when we get into the shorter days and longer evenings, if you will. And we’ll get into that.

[00:01:22] Sometimes we call it the winter blues. But really how does it differ from the typical form of depression versus the winter blues? Is there a line? Is there a difference? What is that? 

[00:01:32] Beth Brinkman: Yeah. So I think it’s probably more of a spectrum than a line. There’s probably going to be a lot of overlap between them.

[00:01:41] Seasonal affective disorder, the definition is recurrent episodes of usually depression but could also be mania or hypomania like in bipolar disorder that regularly occurred during particular seasons and resolve and other seasons. Seasonal [00:02:00] affective disorder is actually a subtype of a different mood disorder, like major depressive disorder or bipolar disorder.

[00:02:09] And the only difference then between clinical depression, regular depression and seasonal affective disorder is the recurrent nature of it. Mostly we think of. winter depression. It’s the most common type of seasonal affective disorder. So it would be recurrent episodes of depression that typically begin in the fall or the winter.

[00:02:31] And assuming the person doesn’t do anything for it, there’s no treatment or anything. It would just resolve on its own in the spring or the summer.

[00:02:40] Pete Waggoner: Does that have to do with Light exclusively, or could it do with just the nature of the elements that you deal with? 

[00:02:51] Beth Brinkman: Both probably. One factor I think definitely is daylight because the natural length of daylight is shorter in the winter and longer in [00:03:00] the summer.

[00:03:01] And sometimes that’s because of the light itself. Sometimes it’s because of. Your circadian rhythm like your sleep wake cycle and when the sun doesn’t rise first thing in the morning, you don’t want to rise first thing in the morning either. And then sometimes I think it’s related to the fact that it’s cold and it’s dark and you’re not doing anything and you’re staying home and that’s bound to affect you to some extent as well.

[00:03:27] Pete Waggoner: You’re not able to move around. I don’t know about you, but I love to roll over at 7 30 in the morning when it’s still dark, but I had to go to work. You know how that goes. But it obviously does mostly occur in the fall and the winter, and we touched on it, but if you were to say to someone who was not really aware of what this is, and you were to put causes out specifically, what would you say?

[00:03:48] And are there some things within dietary purposes or anything that you’re involved with that can also contribute? 

[00:03:56] Beth Brinkman: You mean causes of seasonal affective disorder? 

[00:03:59] Pete Waggoner: Yeah we [00:04:00] talked about, some of the things that can, Be a part of it, but are there causes outside of the climate and the light cycles that we experience?

[00:04:10] Beth Brinkman: Yeah. I think daylight and the normal, like amount of day, amount of nights that you’re experiencing is a big part. There’s probably a genetic component. We don’t know for sure exactly what causes it. Some people definitely just seem to be predisposed to this type of thing. It does seem that People who have diagnosed seasonal affective disorder often have a family history of either seasonal affective disorder or other mood disorders, whether it’s depression or something else.

[00:04:48] But that doesn’t necessarily prove whether it’s in their genetics or if it’s based on the way they were raised or their environment or different things. We do know that. [00:05:00] Some things that can help with seasonal depression is making sure you’re getting good exercise, you’re outside, you’re moving, you’re getting a healthy, nutritious diet.

[00:05:11] So all of these things surely are playing a role in causing it, but It wouldn’t necessarily be the same for every person. 

[00:05:20] Pete Waggoner: What are some of the key symptoms if you have never really, maybe you’re listening to this podcast, say, Oh, that could be me. What are some of those key symptoms to look for in this?

[00:05:32] Beth Brinkman: Yeah. So like we said, the most common is winter depression. So usually people with winter depression are going to have increased sleep fatigue, tired all the time, often increased appetite, weight gain, and then usually feeling down, sad, not really wanting to do things that you used to enjoy doing, not really wanting to participate in.[00:06:00] 

[00:06:00] life activities. Sometimes depression can show up as the opposite. Like you can’t sleep at all. You can’t fall asleep. You can’t eat, you’re not hungry, you’re losing weight, that kind of thing. So both extremes absolutely could be the symptoms of seasonal affective disorder or a different depressive disorder as well.

[00:06:23] Pete Waggoner: What are your thoughts on light therapy and can that really help with SAD? And if so what are the uses? 

[00:06:31] Beth Brinkman: So maybe it might help. I think for some people it’s going to help more than others. And we may not know until we’ve tried it to know whether you’re one of those people that it could help, but.

[00:06:44] For the people who specifically are affected by the number of hours of natural daylight, or the people that are affected by the later sunrise, I think light therapy can absolutely be helpful. And there’s two different ways that you can do it. There’s [00:07:00] bright light therapy, where you basically just sit in front of a bright light for, Usually 30 minutes.

[00:07:06] And the other is dawn simulation. So basically simulating your own sunrise. And that goes on as you’re trying to wake up in the morning for, I think it’s like 45 to 90 minutes. So it gradually gets brighter and brighter for you instead of the sunrise. So that your brain thinks you’re getting daylight when you’re not.

[00:07:28] Pete Waggoner: Wow. That’s interesting. It’s a day to day thing or weekly. How do you view that? 

[00:07:34] Beth Brinkman: Yep. So if you are going to use it as a treatment, you would have to do it every single day. The bright light therapy is usually about 30 minutes. usually first thing in the morning. Some people will add another session in the evening around 8 PM.

[00:07:51] So sometimes it’s up to an hour a day of sitting in front of the light. You can do other things like some people will eat [00:08:00] breakfast while they’re doing that or read the newspaper or whatever, as long as you can be close enough to that light to get adequate exposure. 

[00:08:10] Pete Waggoner: How about other forms of therapies?

[00:08:12] Are there vitamin things you can do or anything diet related to help combat those symptoms? 

[00:08:20] Beth Brinkman: I think actually the data suggests that medications like antidepressant medications for truly clinical depression, so seasonal affective disorder, not necessarily milder cases or the winter blues, but medications can be very effective.

[00:08:38] There’s a lot of different options depending on specifically what symptoms you’re having and what other things you may have going on with your health. So that is definitely one option. Some people take them Only during the months that they tend to have symptoms. Some people take them all year round more preventatively rather than waiting to see if [00:09:00] symptoms start to come back.

[00:09:01] And then there’s therapy like psychotherapy can be really helpful for some people. It’s. Not necessarily enough by itself for truly clinical depression symptoms. They often need something else, but that combined with light therapy or combined with medications could be really helpful diet wise. is probably specific for every specific person.

[00:09:29] I think if you’re getting a good balanced diet with all the recommended nutrients, vitamins, vegetables, everything, that’s probably good. If you follow a really restrictive diet where perhaps you’re not getting enough protein or Eat any vegetables and fruits in the wintertime because they’re not growing that could cause problems and adding a multivitamin could be helpful.

[00:09:56] Pete Waggoner: Is there a time where, okay, so let’s say right now where the sun starts [00:10:00] setting at seven 30 and the things start to shorten down. Is there a period when you say, Hey, daylight savings comes and we start seeing more people asking about this or coming in about it or feeling a little bit more down and bluesy, or is it a gradual process where it’s Do you see that kind of like ramp up?

[00:10:20] Beth Brinkman: That’s a good question. I’m not actually sure if I’ve seen any specific pattern, but I don’t know that I’ve ever thought about it quite like that. So I’m not 100 percent sure. I would think it’s more gradual. Like some people are going to notice those changes a lot harder. Earlier on, some people are going to notice changes later, people who maybe are in school or teachers or who follow that kind of summer off schedule.

[00:10:51] They may notice symptoms starting when the school year starts, regardless of daylight hours and daylight savings time. So it’s probably a [00:11:00] gray zone, but I would say typically September, October, November would be typical to start having those types of symptoms. 

[00:11:09] Pete Waggoner: And if I start taking treatments of some sort, whether it be forms of the light therapy we spoke about or any medications, what typically is the turnaround time for someone to start seeing some improvements?

[00:11:23] Beth Brinkman: That’s a good question. I would say most of them probably take at least several weeks to see a real benefit. Especially with most of the medications, it does take a while for them to build up in your system and to actually see the benefit from it. I don’t know for certain about lights, about light therapy, but I think probably similar, it would take more than one or two days to really turn things around for you.

[00:11:53] Pete Waggoner: And then, in terms of, we hear go to a sunnier climate or, yeah, sure. It’s, it could be [00:12:00] sunnier day by day, but it’s really about sunrise, sunset, isn’t it? Kind of type of thing. So is there really a place you could escape to sunny Florida? For instance, does that make a difference or no?

[00:12:12] Beth Brinkman: Probably not. I think maybe for some people it would spending more time outdoors would be helpful. So if you’re someone who refuses to go outside when it’s cold out, then maybe it would be better to be in a warmer climate. But I think many Minnesotans don’t really care if it’s cold out, they go outside and they’re cross country skiing or snowshoeing or playing hockey or those people, it probably won’t make a big difference to go somewhere.

[00:12:40] Just spending time outside is helpful. 

[00:12:43] Pete Waggoner: I know we spoke a little bit about some of the things and the signs of what you should be watching out for. What advice would you give to I’m going to give you two groups of people here with this question. First, the person that may be dealing with it and suspecting they have something wrong.

[00:12:59] [00:13:00] And a loved one or someone close to them that’s observing this, what type of advice would you give them about seeking help? And when is it time to do that? 

[00:13:10] Beth Brinkman: Yeah, that’s a good question. So I think it’s probably the same whether you’re experiencing those symptoms or your loved one is experiencing those symptoms.

[00:13:20] I think the main thing to look out for is how severe is it and is it affecting your life in some way? Back to what’s the difference between the winter blues and seasonal affective disorder. I think the winter blues is just a layman’s term not technically a medical term, and it’s probably a mild version of seasonal depressive disorder where Maybe you’re a little sad or you’re a little more tired, but it’s not really that big of a deal.

[00:13:49] But if you’re having severe symptoms, like you can hardly get out of bed, you’re not eating as usual, you’re gaining weight or losing weight [00:14:00] specifically, or you just feel miserable, you’re sad all the time, anything like that. I think if it feels like a problem to you, it’s probably a problem and it would be a good idea to come in and talk to somebody.

[00:14:15] And I think there’s a few different routes to go. You could absolutely go talk to your primary care provider. If you have one, if you don’t have one, this might be a good excuse to get one. If you have a therapist or if you know a therapist, you could start with therapy. I think if you’re in school, the school counselor may be a good option to bounce the ideas off of and see am I just normal or is this a problem?

[00:14:41] And we can navigate it with you if we, if you don’t want a medication, that’s fine. If you just want to know if you meet criteria, we can walk you through that too. 

[00:14:53] Pete Waggoner: So how is it best or easiest for those if they’re looking for a physician such as yourself, how do they get ahold of [00:15:00] you? 

[00:15:00] Beth Brinkman: For Stellis Health, we have a website and our phone line.

[00:15:05] They could schedule an appointment either way. If they already have a doctor, they just call us up and say, I want to see Dr. Brinkman and you can tell the scheduler why that makes it a little easier for me to prepare for the appointment, but you could also just write. personal or say it’s personal and then we’ll figure it out when you get here.

[00:15:26] If you don’t have a primary doctor you maybe want to check with your health insurance to see if you have to go to a certain clinic or something, but pretty much you should be able to go to a primary care clinic and establish care with a provider and talk to them about your concerns. 

[00:15:44] Pete Waggoner: That is great stuff.

[00:15:45] We appreciate everything that you do and providing this great information on this topic. And when I saw this one come up, it was so seasonal because I can guarantee you that discussion is had between me and some friends. I can think back to when I was maybe in And 7th, [00:16:00] 8th grade. And it’s always Oh yeah, it’s that time of the year.

[00:16:03] So I think it’s important to listen to ourselves and hear what our bodies and our minds are saying to us. And that’s what you’re here for to assist with that. So you provided some valuable insight and information. We appreciate it. Thanks. You bet. Thank you, Dr. Brinkman. And that’s going to wrap up today’s episode of Beyond the Checkup, brought to you by Stellis Health, where we believe in neighbors caring for neighbors.

[00:16:27] I’m Pete Waggoner. Thank you for joining us on this journey to better health. And thank you, Dr. Brinkman. Remember, your journey to wellness doesn’t stop here at this podcast. We’re always here to support. Guide and inspire you. Be sure to reach out to your Stellis Health provider for personalized care. And don’t forget to subscribe to the beyond the checkup for more health insights and stories.

[00:16:47] Share this episode with friends and family. Let’s spread the word on living healthier, happier lives together. Until next time, stay healthy, stay connected and continue to thrive. Thanks for listening so long, everybody.