Follow along with the transcript below for episode: Defeating SAD With Dr. Norman Rosenthal
[INTRODUCTION]
[00:00:02] PF: Thank you for joining us for episode 442 of Live Happy Now. We just turned our clocks back, which means shorter days and, for many, the onset of seasonal affective disorder. So this week, we’re going to talk to the man who identified SAD and also has tips for beating it.
I’m your host, Paula Felps. This week, it is my honor to talk with Dr. Norman Rosenthal, the world-renowned researcher and psychiatrist who spearheaded the discovery of SAD and also pioneered the use of light therapy as treatment. His new book, Defeating SAD: A Guide to Health and Happiness Through All Seasons, provides a road map for beating this disorder. Today, he’s here to tell us how his own experiences with seasonal affective disorder drove him to research it and what we can do to beat those winter blues. Let’s have a listen.
[INTERVIEW]
[00:00:56] PF: Dr. Norman, thank you for joining me today.
[00:00:58] NR: Oh, it’s great to be here.
[00:01:01] PF: Well, I’m really excited to talk to you because you are so instrumental in something that we all talk about right now, and that is that you defined seasonal affective disorder. So I’m curious because I’ve only grown up knowing that term. What were we calling SAD before it was SAD and what – can you kind of take us back to that time before we realized that this was really a thing?
[00:01:26] NR: That’s a terrific question because it brings me back to when I came here from South Africa. It was 1976, and I was thrown into the psychiatric residency which was very stimulating. It was Colombia, and there was no such a thing as SAD. They called it the Christmas crunch.
[00:01:51] PF: Oh, really?
[00:01:52] NR: People are having the Christmas crunch, and everybody in the office is down and out. So that’s about as much as it was at the time. Then I felt like these changes coming over me that in the winter I would get slowed down. The summer I would be so pumped up and doing all these amazing things. Then in the winter, I thought, “Were you crazy to be undertaking all those things?” Now, I’m just kind of – it’s all I can do to get out of bed and get my stuff done. It happened for three years until I came to the NIMH, the National Institute of Mental Health here in Bethesda, Maryland. That’s when all the pieces of the puzzle came together really.
[00:02:37] PF: How did you start researching that and diving into it? Because it was – as you said, we talked about it, but we didn’t really realize what it was.
[00:02:48] NR: I knew that we needed to find a group of people that it wasn’t just good enough to have one person who had observed these changes, experienced the effects of light, that I needed to have a group. So at that point, believe it or not, it was before the Internet.
[00:03:07] PF: So it was a lot harder to find people.
[00:03:08] NR: Yes. So we had an article in the Washington Post that was syndicated across the country. In the article, I said if you feel you’ve got this problem, let me know. I got thousands of responses from every corner of the country.
[00:03:27] PF: Wow. So how did you start deciding who would participate?
[00:03:30] NR: Well, I started reading through, and I found that there was a very stereotyped monotonous set of responses. In the autumn, when the days get short, maybe October, maybe November, I slow down. I have a need to sleep more. I have a craving for sweets and starches. I tend to gain weight. Then I get down and I’m having trouble at work and I lose my relationships in the winter that I made the previous summer. It was mostly women, three or four to one women to men. I thought we’ve got a syndrome here. That’s when I called it seasonal affective disorder or SAD for short. Now, everybody thinks it was always there.
[00:04:19] PF: I know. I know because when I got your book and then I was trying to think of the first time I had ever heard it because I can’t remember a time when that wasn’t a phrase. So I got to say, so that actually – this is kind of a little sidebar because you were actually the answer to a jeopardy question, weren’t you?
[00:04:39] NR: Yes, yes, yes, yes. That’s when my voicemail filled up, and I realized how many people listen to Jeopardy because I got calls from my trainer and from people all over the place. “Hey, Doc. You were on the Jeopardy, and you were a question and –” Yes.
[00:04:56] PF: What was the question?
[00:04:58] NR: The question was this condition was described by Dr. Norman Rosenthal and affects people in the winter. The answer was what is SAD.
[00:05:10] PF: That’s terrific. So as you discovered this, how do you go from saying we’ve got a disorder to educating people, to getting an entire world on board with the fact that this is a real condition, and this is what we need to do about it?
[00:05:25] NR: Well, the first thing we had to do was the work. We had to do the research because we suspected that light was involved. Year after year, we did studies of light. Some people thought it was very, very funny because the idea that light – I remember one colleague of mine calling me at a meeting saying, “Come here, Norm. Come under the light because I’m feeling a little depressed.” It was a joke.
But bit by bit, the work was done. We did a lot of the work. It was replicated all over the United States and Europe. It was found that this is a replicable thing. You can find the people with the problem, you can describe it, you can treat it with light, and you can help the problem. You can defeat the problem. That’s the name of my new book is Defeating SAD. It’s not good enough to treat it. You’ve got to defeat it.
[00:06:23] PF: I love that. It’s just conquer that thing and make it go away. I love that. So as you developed treatments, what did you see as the most important things? You just mentioned light, and it goes beyond that. Can you kind of talk about how you found the things that would treat it and how you approached that and maybe how our approach has changed from your early research to now?
[00:06:48] NR: Excellent questions. Well, at the beginning, we used light. We used light of a certain brightness. Then subsequent studies found that if you multiply that brightness by four, you got a more potent effect. That’s now the standard treatment with the bright light. So-called lux is a measure of life, and 10,000 lux is what you would get on a – if you went outdoors on a sunny day. They found that 10,000 lux was a good amount, and that’s what the standardized light boxes give out. We use it for a variable amount of time in the morning.
Every step of the way, they had to discover things that morning was usually better than evening. That white light was better than red light, that this was better than that. Slowly, slowly, slowly, we evolved light therapy. So that was the one big discovery there. Then other people came in and found things that light did and ways that light might work and things that were wrong with people when they had SAD, what that might be due to. The eye might not be working.
I had a fascinating man. He was in his mid-50s. He came in, couldn’t think of any reason why he got SAD. I would ask all the routine things like, “Did you have a change of job so that you’re now indoors, and you used to be outdoors?” No. “Did you move from the penthouse to the basement and being dark?” No. This, this, and this all negative. Then so I said, “Well, let’s try you on light therapy.”
As I suggested that, his wife who was in the consultation and said, “Well, what about his cataract?” I said, “Well, what cataract?” She said, “Well, you know, just before he developed SAD, he had an injury, an accident, and he injured an eye, and a cataract grew over the eye.” So half the light was not coming in between the two eyes, and that caused the SAD. So there could be multiple reasons, and we began to piece it together bit by bit. But at the same time, other people began to look for other things that could help.
One of my colleagues up in Vermont, Dr. Kelly Rohan, she looked at cognitive behavior therapy for SAD and found that it could be in itself very useful. So I guess that as the treatments evolved, what the new book has distilled is all the things that you need to do to really corral the beast. It means light therapy. It means foundational habits like good eating, and good sleeping, and exercise, and on and on and on. You put these things together. That’s when you get a real cure and not just an improvement.
[00:09:49] PF: Let me ask you because when someone’s affected by a depression, I know it can be very difficult for them to get off the couch and do the things that they need to do to deal with that. Is it the same way with SAD that it’s challenging for them to be able to start making those steps that will cure them, that will help them defeat it? Doing the light therapy, doing the eating right and exercising?
[00:10:16] NR: Absolutely. It is. It is a challenge, and I encourage friends and family to be recruited into the process. Let’s say it’s a wife because it often is woman who suffers. Maybe her husband can bring or I should say her wife. I don’t want to be stereotyped here. Whoever it is can bring coffee and a light box towards where she’s sitting and put it on and say, “Come on.” Then within a half an hour, the person is kind of up and ready and happy and grateful. So I think it’s a wonderful opportunity to get people working together.
[00:11:00] PF: Yes. That’s a wonderful point to make because oftentimes, when we’re listening to a podcast or reading a book, we’re thinking about ourselves and how I can apply this. But we all know people who are affected by this. So what can we just as casual friends or as a neighbor do if we know that somebody is suffering, if we see all the symptoms kicking in? We’ve just changed times, and we’re now going to have shorter days, and it’s going to get dark earlier. So I think this is when it really starts affecting people. What do we do if we see someone we know that seems to be slipping into that?
[00:11:38] NR: Well, I think it’s kind to say something, and it’s even kinder if you say it nicely instead of, “You’re such a drag today.”
[00:11:50] PF: It’s like, “You’re not fun. We’re not going to play again till summer.”
[00:11:53] NR: I’ve kind of noticed that when it gets dark, when the weather gets down, you just lose a little bit of that sparkle that we all know you for. I wonder if maybe this is something worth looking into.
[00:12:09] PF: That’s a great way to do it. Like you said, instead of being a spouse that’s bringing the light box and coffee, maybe you go visit a neighbor and say, “Come for a walk with me,” or something like that.
[00:12:21] NR: Definitely. Walking, exercising outside. Even from a cloudy sky, you get a lot of light, so outdoor exercise is wonderful. To go exercise with a friend, how nice would that be?
[00:12:37] PF: Yes. It kind of doubles the reward of it.
[00:12:39] NR: Exactly.
[00:12:40] PF: So now, you did mention when people responded to your article, your call for people with conditions, that it was primarily women. So do you still see that? Is it primarily women who are affected by it? If so, why is that?
[00:12:56] NR: It’s three or four to one women to men, and it’s also women in their reproductive years. So we’ve looked at children and we see that in girls. Before and after the menarche, when they start menstruating and when they have the change of puberty, that’s when SAD jumps up. Then on the other side of the menstrual spectrum, when women are going into menopause, then they tend to be less seasonal. So somewhere along the line, the reproductive cycle and the seasonal cycle have gotten caught on top of each other, surely by way of hormones and chemicals.
But that’s the reason I think why women have got it more, and there’s probably an evolutionary element there, where it might have been adaptive for a species for the women to be nursing in the dark or nursing at home while the men were out and about in the fields, gathering stuff, and couldn’t afford to be laid out and sitting on the proverbial couch. The Stone Age couch was probably quite uncomfortable.
[00:14:16] PF: And there was no television to watch.
[00:14:18] NR: No television to watch. Not even – yes. What’s that –
[00:14:23] PF: The Flintstones?
[00:14:25] NR: The Flintstones. Not even The Flintstones. Yes, that’s right.
[00:14:30] PF: So does it affect men and women differently? If men do have it, do you see different patterns with them than how a woman responds? Or is it pretty universal?
[00:14:40] NR: That’s a great question. I would say just in terms of my experience that the eating the carbohydrate craving, the social withdrawal. Men tend to get angry, lose their temper because they’re frustrated, and they’re finding themselves less able to do things. Men often get – you’re angry when that happens. Women withdraw and get down when that happens. Men drink more maybe. I mean, these are just impressions. I don’t have solid data. But you asked a good question.
[00:15:14] PF: So is there a difference in how you approach them? Say as a spouse, is there a difference? I know not all men are going to be open to the idea of a light box, and they might not even think that they have seasonal affective disorder. They might shrug off the fact that that could be affecting them.
[00:15:33] NR: Well, I tell you, men respond very well to having performance discussed. You want to be at your peak performance, and I see that you don’t quite have your edge. You’re always brilliant, but you’re even more brilliant in the summer than in the winter. We want to be very careful with our delicate egos. So in any event, I think that the reason I’m sort of thinking of that is that one of my clients who is a Wall Street financier, he says, “You would be amazed at how many light boxes there are on the trading floor.”
[00:16:17] PF: Really?
[00:16:18] NR: Yes. That is because they find anything to give you that extra little edge over the next person. So I think men respond to performance, and women respond more to feelings.
[00:16:33] PF: That makes perfect sense, absolute perfect sense. In dealing with it, is it different than other mood disorders? Like what are some of the similarities it might have to other mood disorders, and how is it different?
[00:16:46] NR: Well, if we leave aside the seasonality because that, obviously, is the whole
market, it affects you more in the winter than in the summer. That said, if you’ve got a spell of cloudy weather for two weeks, that can really bring people down. But beyond the timing of the mood difficulties is the symptom pattern because what’s called typical depression, people lose their appetite. They don’t sleep as well. They lose weight, more likely to be suicidal, whereas with SAD, they gain weight. They eat more. They sleep more, less suicidal on the whole.
[00:17:28] PF: Oh, that’s interesting. You have brought up the idea of the light box. Can we dive into that a little bit and kind of explain more about what that is and how that works?
[00:17:39] NR: Well, there was a challenge as to how we could get a lot of lights coming at you in intense ways at a certain time of day. The practical solution has been a light box, a device that emits a lot of light from a relatively small area, which I would say would be at least one foot square, and has got a screen that filters out the ultraviolet light.
To do all that, you have to have a manufacturer who takes these things seriously, certain amount of light, certain position in relation to the eyes. Usually, maybe two feet away, often coming from a little bit above because that’s how our eyes get used to light hitting us from the sky. So the sun box or light box mimics that. It’s a couple feet away, coming a little from above. Ultraviolet light is screened out. It’s typical white light. It’s got a couple of different settings and a manufacturer that will stand by the product.
I do mention in defeating SAD several light boxes that I found particularly helpful, some of them bigger, some of them smaller, although I would discourage you from getting the teeny-weeny ones. Even though they’re going to be very cheap and very seductive for that reason, they don’t put out enough light. They’re too bright. I don’t trust them. The good reputable manufacturer will stand by the product. On all the online ordering, you can almost always that I’ve encountered return it within a certain reasonable amount of time, which is really plenty of time for you to get a decent trial of the light. So imagine that. Here is this non-medicinal –
[00:19:32] PF: That’s what I love so much about it. Yes.
[00:19:34] NR: That you can have for two or three weeks. If you don’t like it, you can send it back, money back, and simple instructions that I outlined along with all the other things you can do besides the light. I mean, it’s like too good to pass over.
[00:19:52] PF: So how long do you need to spend with the light on you when you’re going to embark on this form of therapy?
[00:19:59] NR: That’s variable, just like the dose of a medication is variable. Some people might need one Tylenol. Some people might need two or whatever the medicine is. So I would say between 20 minutes and an hour would be sufficient for most people.
[00:20:17] PF: You’re saying it’s more effective at the beginning of the day.
[00:20:20] NR: Yes. The morning is a better time in general. But if you find yourself wilting later in the day, it’s fine to go get a little extra light.
[00:20:29] PF: So when do most of your patients use like – how do they work that into their morning routine? Because I can just – you can hear people going, “Oh, I don’t have 20 minutes to an hour every morning to do this.” So how do people work that into their routine?
[00:20:44] NR: Well, what I say is you’re probably going to be sitting down doing something for 20 minutes to an hour. Doing what, you’ll say. Well, how about reading the paper, being on a podcast, being on a Zoom meeting with your colleagues, putting on your makeup, eating your breakfast, playing Wordle? You’re going to do something for that half an hour, and you may as well have the light on. So it can seamlessly be incorporated into everybody’s day.
[00:21:20] PF: Well, that’s good because I was thinking of it as something where you’re just going to sit there. It’s just you and the light box, and nothing else can go on.
[00:21:27] NR: No. You’ll find people competing for it. Come on. Let me – can I sit a little closer? I’ve had that situation when the issue first came up with the use of light boxes in the office. We were all worried that people would feel stigmatized because you’ve got this illness, because you need a light box, blah, blah, blah. When I asked people, they said, “No, no. Everybody comes crowding into my office so that they can get a bit of the light.” It was very well accepted in almost every circumstance, even early on, before it was a well-known thing.
[00:22:01] PF: That is interesting because most things aren’t like that. If we consider ourselves a little different, we don’t want anybody to know. But this really is something that seems universally embraced and –
[00:22:12] NR: That is a really good observation, and I think what has happened with seasonal affective disorder from the beginning is we kind of realized that it connects us to the animal world, that bears hibernate. You were telling me about a dog that wasn’t as chipper when it was in the dark. We feel a connection and a kinship with nature that the whole world is changing, and it’s okay if we’re changing as well. Here’s something we can do about it.
[00:22:44] PF: I love that. So if someone has had this problem in the past, they know it’s coming up as we enter this new season, but maybe a light box seems kind of out of reach, what would be the other things like in order that you would say, “Okay. Try this, this, and this, for sure. If you’re not going to be able to do light therapy, try these things.”?
[00:23:01] NR: I would say take one room in your home and make it very bright. Clear everything away from the sides of the windows, those heavy window treatments or hedges or creepers. Give it a good cleaning so that the grime from the summer is removed. Then paint the walls light. Have colored throws and cushions all around. Bring some more regular lights in. It doesn’t have to be the official light box to give you more light. So those are all good things and very cheap. Put a bedside lamp on a timer to go on half an hour before you’re due to wake up in the morning.
That would be a kind of treatment that’s actually being studied called dawn simulation because at the early hours, before we wake up, the eyes are super sensitive to light. So if the light is coming on at that time, so a bright room, simulated dawn. Outdoors, as we said. I find that going up and down hills while looking at the sky is a fantastic way. Preferably listening to some wonderful music or podcast or whatever is a fabulous way to spend a half an hour, and it doesn’t cost anything really. The up and down hills gives you this high-intensity intermittent exercise that’s so good for you.
Be creative. People with SAD are very creative people. They’ve learned they have to be. So I encourage creativity. But don’t be creative with taking lights that aren’t validated and sit in front of very bright lights that aren’t official light boxes because you can hurt your eyes with too much bright light. Even looking – you never want to look at the sun, for example. So I think just be sensible about it.
[00:25:04] PF: So don’t just shine a flashlight in your spouse’s face and –
[00:25:07] NR: Well, it depends on what your goals are.
[00:25:14] PF: Of course –
[00:25:14] NR: Getting rid of your spouse maybe.
[00:25:16] PF: Maybe that’s why you’re SAD, right. So one thing that they can do, too, because your book is amazing and covers so much territory, and that’s a great thing, too, is like they can pick that up. You really walk them through how to manage this, and you really are there with them step by step. So when you were writing that, what was the main intention? Was it to do that to make them feel like they’ve got a partner on this journey?
[00:25:44] NR: Yes, yes. You nailed it. More than a partner, a friend, someone who’s been there myself, knows the journey. Also, it is a much shorter book than books that I have written in the past. I know I like books to be short but to the point but also beautiful. So I’ll read to you the very first page of the book because it really summarizes my goal. It’s a quote by Albert Camus, that wonderful author. He says, “In the midst of winter, I found there was within me an invincible summer, and that makes me happy for it says that no matter how hard the world pushes against me, within me there’s something stronger, something better pushing right back.”
That was the goal of the book, to show how you can push back and defeat it. Then I love the cover because it’s full of bright vivid colors. But, also, if you look at the spine, it’s very thin. I thought the least I can do for my fellow SAD sufferers is not give them any extraneous information they don’t need. So I’ve tried to make it short and enticing, and I hope I’ve succeeded.
[00:27:14] PF: You definitely have, and I believe we’re giving them a free chapter. I believe our listeners can go to the website, get a free chapter.
[00:27:21] NR: Absolutely, yes. Good. That’s a great suggestion.
[00:27:26] PF: Yes. So they’re going to be able to learn more about it, and we’re going to tell them on our landing page. They’re going to go. They can find out more about you, more about the other work that you’ve done, more about the book, and they can follow you on social media.
So, Dr. Norman, thank you again. Thank you for sitting down with me and really talking through this. I know many of our listeners are struggling with it and in the months to come might be struggling with it more. So thanks for sharing this with us.
[00:27:51] NR: Well, it’s such a pleasure. The time just whizzed by. You’re such a great interviewer. It didn’t feel like an official thing. It felt like a tea with a friend, so.
[00:28:03] PF: It was. I really enjoyed talking with you.
[END OF INTERVIEW]
[00:28:10] PF: That was Dr. Norman Rosenthal, talking about how we can overcome seasonal affective disorder. If you’d like to learn more about Dr. Norm, check out his new book, Defeating Sad: A Guide to Health and Happiness Through All Seasons, follow him on social media, or download a free chapter of his book, just visit us at livehappy.com and click on the podcast tab.
That is all we have time for today. We’ll meet you back here again next week for an all-new episode. Until then, this is Paula Felps, reminding you to make every day happy one.
