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Hello, I'm Dr. Tracey
Marks, a psychiatrist
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and I make mental health education videos.
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Today's video is based on a
viewer question from Tanqueray
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who asks, "Dr. Marks, I hate the holidays
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"and get really depressed
every single year.
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"Is this the same as
seasonal affective disorder?
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"And if so, should I take
medication this time of year?"
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Thanks, Tanqueray, for your question.
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So first off, T, many people get sad
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or feel depressed during
the holidays from the stress
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of expectations, loneliness,
missing loved ones
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who are no longer celebrating
the holidays with you.
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For some people, the dread
starts around early November
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and then drops off shortly
after the hustle and bustle ends
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and the new year begins.
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Even though this may
happen every single year,
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it's not the same as
seasonal affective disorder.
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It's sadness that's tied
to a specific situation,
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and once that situation has passed,
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you return to your usual state.
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We usually refer to this
as the holiday blues
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to describe the situational mood changes,
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but it's not a clinical disorder.
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Seasonal affective disorder, or SAD,
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is a subtype of major depression.
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The official term
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is major depressive
disorder seasonal pattern.
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Symptoms include feeling
hopeless, having low energy,
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social withdrawal, and
changes in sleep and appetite.
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For it to be considered SAD,
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the depressive episodes must
follow a seasonal pattern
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for two consecutive years.
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Also, the symptoms tend
to last several months.
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There are two types of SAD
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and they look a little
different from each other.
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There's a fall onset SAD,
also called winter depression,
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that begins in the late
fall or early winter.
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Common symptoms with
this are oversleeping,
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increased appetite, especially
craving carbohydrates,
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which is unfortunate timing
for the holiday parties,
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and then weight gain.
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You can also feel really tired,
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like you could just stay in bed all day
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or even if you are up and about,
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you can have low energy
or hardly any stamina.
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It's like you get worn down really easily.
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People often feel the need to hibernate
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or withdraw socially.
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The winter onset is the
most common form of SAD.
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The second form of SAD is a spring onset,
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also called summer depression.
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This starts in the late
spring or early summer,
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and these symptoms look a little different
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from the winter form, as the sleep problem
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tends to be trouble sleeping
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or poor appetite leading to weight loss,
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restlessness, agitation and anxiety.
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And it's like an agitated,
amped up form of depression.
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It's not the same as hypomania
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because your mood state
is still low and negative,
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but it can look similar to
hypomania as the anxiety
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or worry can be mistaken
for racing thoughts.
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How can you tell the difference?
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One key difference between the
racing thoughts of hypomania
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and anxiety is anxiety
is usually fear-based
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or causes worry and fretting.
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The racing thoughts with
hypomania could be about anything.
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You're not necessarily worrying,
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but your thoughts are moving fast
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from one thing to the next.
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Another difference between
this agitated summer depression
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and the hypomania is how
the energy is expressed.
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With depression, the increased
activation is agitation
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and restlessness.
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You may be pacing and feeling
like you can't sit still
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or don't feel comfortable in your skin,
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and you just want to
scream or swing at someone.
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With hypomania, you have increased energy
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that's more focused.
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You may be organizing closets,
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developing new business ideas,
gambling or having affairs.
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It's like increased productivity
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that's a little too excessive
to be completely beneficial.
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The exact cause of SAD
is not fully understood,
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but some thoughts are that
the decreased sunlight
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in the fall and winter
disrupt your circadian rhythm.
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Your body clock is on a 24-hour schedule
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that controls your sleep,
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but also it controls other body processes.
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Disrupting this schedule
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disrupts your body's overall homeostasis,
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and this includes your mood.
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Another possible cause
is that less sunlight
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causes decreased serotonin activity
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and low levels of
serotonin increase the risk
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of developing depression.
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Here's how sunlight affects serotonin.
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Serotonin is made from
tryptophan inside the nerves
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that start in your midbrain.
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These nerves are called
presynaptic neurons,
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and they project to
other parts of the brain.
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At their destination,
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they pair up with a postsynaptic neuron.
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This is how nerves
communicate with each other.
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We'll call this setup, for
now, nerve one and nerve two.
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Nerve one releases serotonin
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into the space called the synapse.
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The serotonin floats around
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and binds to receptors on nerve two.
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Have you ever played
that musical chair game
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where the music plays and
you walk around the chairs
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and there's not enough chairs
for everyone to sit down?
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When the music stops,
everyone scrambles to sit down
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and anyone left standing
has to leave the game.
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This is a similar situation.
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Serotonin is released from nerve one
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and there are only so many receptors
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or chairs for the serotonin to bind to.
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The serotonin that binds to
the mood regulating receptors
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on nerve two are granted
entry into the cell,
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and then it gets a
chance to work its magic
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in regulating mood.
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The free roaming serotonin gets scooped up
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by a serotonin transport
protein called SERT.
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SERT is like the police picking
up people off the street
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and it takes the unbound serotonin
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and sends it back to nerve one.
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Inside nerve one, the
serotonin either gets recycled
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for parts or stored for later use.
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Why do you need to know all this?
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Because most therapies
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to improve depression
are all about the SERT.
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Antidepressants increase
serotonin availability
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by blocking SERT.
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That's how they block reuptake.
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Keeping SERT away gives
the loose serotonin
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a chance to wait around
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until there's more available
receptors to bind to,
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and here's where sunlight comes in.
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Sunlight also blocks SERT,
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or, at least, keeps the numbers down,
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so there's less police around
to scoop up the serotonin.
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When you have less sunlight in the fall
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and winter, SERT replicates unchecked,
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and there's more of it to remove serotonin
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before the serotonin has a chance to bind.
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Two more possible causes
or, at least, associations.
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People with SAD are thought
to have high melatonin levels
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and these high levels
contribute to feeling tired
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and sluggish, especially
with the winter subtype.
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There's also some evidence to suggest
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that vitamin D may play a role in SAD.
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Since vitamin D is produced in
your skin from sun exposure,
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reduced sunlight in the winter months
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can lead to vitamin D deficiency.
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Vitamin D deficiency is
linked to depression,
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but it's not a proven cause of depression.
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But because of this link,
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it's recommended to restore
your vitamin D to normal levels,
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and so that's one intervention for SAD,
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vitamin D supplementation.
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It's always best to get your
vitamin D levels checked
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and labs can vary in what they consider
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to be the normal range,
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but in general, less than
20 nanograms per milliliter
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is considered deficient.
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If you're that low,
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your doctor will likely
prescribe a high dose tablet
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or capsule of 50,000
international units per week.
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How long you take it depends
on how your body absorbs it.
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A typical course, though,
may be six to 12 weeks.
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You do not want to do this
on your own by taking a bunch
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of vitamin D that you
purchase over the counter.
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Vitamin D is a fat-soluble vitamin,
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which means that it
gets stored in your body
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and you can get toxic if
you take too much of it.
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So you'll need to restore
a vitamin D deficiency
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under a doctor's supervision.
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Many people, though, have
low levels and don't know it.
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An adequate level of vitamin D is 40
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to 60 nanograms per milliliter.
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If you spend a lot of time
indoors, wear sunscreen
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or have darker skin,
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you could be on the low end of the range.
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If you fall into any of these categories
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and you feel sluggish
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or just not at your best, you
should get your level checked.
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However, that said,
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even if you don't get your level checked,
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daily supplementation of 1,000
to 2,000 international units
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can help you stay in the
adequate or optimal range.
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While we're talking about vitamin D,
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what's the difference
between vitamin D3 and D2?
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Vitamin D2 comes from plant sources,
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like fungi or certain types of yeast.
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It can also be produced synthetically.
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Vitamin D3 is the form of vitamin D
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that is synthesized in your skin
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when it's exposed to sunlight.
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It also comes from
animal-based dietary sources,
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such as fatty fish or cod liver oil,
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or it can also be produced synthetically.
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Both D3 and D2 are converted in your body
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to the active form that is
called 25 hydroxy vitamin D,
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and it's this 25 hydroxy form
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that's measured in blood tests.
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In general, though,
vitamin D3 is considered
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to be more efficient at raising your level
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because it's better
absorbed by your intestines.
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A second thing you can do, if
you have the winter version,
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is to use a light therapy box
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that has an intensity of 10,000 lux.
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This 10,000 lux is the equivalent
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of being exposed to a mix of
direct and indirect sunlight.
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I talk in detail about
how to use a light box
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in a video on getting morning sunlight.
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I'll have it linked to this video.
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Using light therapy is not recommended
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for the summer depression,
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and it can make it worse
given the abundance of light
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during these seasons.
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In this case, you may want
to try antidepressants,
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if you're not already on them,
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or have your doctor tweak
your medication regimen
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for the six months around
spring and summer seasons.
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So going back to T's original question,
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the answer is if your sadness
is situationally focused
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on the holidays and
resolves after it's over,
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antidepressants aren't really warranted
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and may not do much for you.
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You'll want to find other things to do
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to distract yourself from
what's going on around you.
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Seasonal affective disorder
is a form of major depression
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that usually lasts for several
months, usually six or more.
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Antidepressants work better
for SAD, as does light therapy,
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if you have the winter form though.
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You should always consult a doctor
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for an evaluation if
you have any questions
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about how to handle your
specific circumstance.
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Thanks to the Mental Wellness Space Store
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for supporting this video.
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I am the creator of this online store
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that offers products, like
canvas prints, wall posters,
00:10:59
tumblers, shirts, digital workbooks,
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and other tools designed
to promote mental wellness.
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It's wellness woven into everyday life,
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reflecting my mission
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to integrate mental
wellbeing into daily living.
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It's about celebrating and
elevating mental health.
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And just as the shirt says,
00:11:21
mental health commands
a seat at the table.
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Join me in pulling up a chair
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and bringing mental health
into everyday conversation.
00:11:30
Watch this video for more
on using light therapy.
00:11:33
Thank you for watching
today, see you next time.
