Transcript - Outsmarting Seasonal Depression With Dr. Hannah Nearney

Follow along with the transcript below for episode: Outsmarting Seasonal Depression With Dr. Hannah Nearney

[INTRODUCTION]

[0:00:04] PF: Thank you for joining us for episode 543 of Live Happy Now. As the seasons change and the days get shorter, some people are filled with excitement, while others have a sense of dread. But today’s guest says it doesn’t have to be that way. I’m your host, Paula Felps, and this week I’m joined by Dr. Hannah Nearney, a clinical psychiatrist and medical director at Flow Neuroscience in the UK. Hannah is here to talk about what happens in our brains during seasonal changes that can cause depression, what factors can influence the severity of it, and then she shares some of the ways we can prepare for it and protect our mental health as the days get shorter. Let’s have a listen.

[INTERVIEW]

[0:00:42] PF: Dr. Hannah, thank you for joining me on Live Happy Now.

[0:00:46] HN: Oh, thank you so much. It’s a pleasure to be here.

[0:00:48] PF: This is a great topic to talk about. We’re getting ready to set our clocks back as daylight saving time ends, and then we know the days are getting shorter. It is a great time to talk about how we can prepare and protect our mental health. I wanted to start by getting a picture of how big a problem this is. How common is it for people to be affected by the earlier sunsets and shorter days?

[0:01:12] HN: Well, it’s a really good question, and it depends on where you live in the world. If we think about the change in daylight hours, it really varies a lot depending on how far you are from the equator. People who are in the Northern Hemisphere countries, they’re like Northern America, Canada, much of Europe, etc., have a big variation from with the seasonal change. Like you were just saying, they have to change their clocks. There’s a big change over that fall into winter compared to the summer in terms of the daylight length.

Actually, what we find is that people who have seasonal episodes of depression is much more common the further from the equator you are in the Northern Hemisphere. It can vary anything from 1% to 10%, depending on what studies you look at and whereabouts in the world you’re looking at the population.

[0:02:04] PF: What are some of the ways that it affects us? We hear a lot about it, but what exactly does it do to us?

[0:02:12] HN: We don’t fully understand exactly what’s going on when people have an episode of depression that’s linked to the seasonal change. But what we do know is that it’s very much triggered in some way by the change in the daylight exposure and probably to some extent by other things that go on in the seasons when they change. If you think about it, there’s stuff that is probably harder to measure, but we naturally do differently if we live in an area of the world where our days are much shorter for half the year or so.

For example, if you live somewhere where it’s very sunny and bright till late in the day, you’re going to be much more likely to sit outside and enjoy socializing and doing things when it’s warm. You’re not going to sit out in your garden when it’s dark around 6 pm and freezing cold, are you? There’s an element of what comes with that as well. But certainly, the theory is that there are biological changes that happen related to a disruption in our circadian rhythm in our brains from the change in the daylight, and that has a knock-on effect on things like melatonin and neurotransmitters, like serotonin, so that they are not regulated in the same way, and this disruption seems to, for some people, who are perhaps a bit predisposed to it, maybe through genetic factors, or whatever, it seems to trigger off these episodes of mood that are very related to the seasons.

[0:03:48] PF: I was going to ask if it’s a genetic thing, or if it’s situational, or do you know what it is that makes one person susceptible and somebody else is not?

[0:03:59] HN: I think the answer is going to be inevitably that it’s a mix. Everything’s complicated. We know in all mental health conditions that there’s an element of the biological, psychological, social interplay. We definitely know any way from mood disorders; there’s a genetic component to those, and we know that people who have episodes of depression confined to the seasonal variation, they do also have family history of either bipolar often or depressive episodes in family members. There does seem to be some specific genes that have been linked to an increased risk of people having these seasonal episodes as well.

There’s definitely a genetic component to this, but that doesn’t mean that people are destined to have these episodes, or destined to have them forever, just because they’ve had them several times. But there is definitely some kind of genetic predisposition.

[0:04:57] PF: Yeah, because I know some people who suffer from it badly. It really affects their mood, it affects their sleep, it affects their energy levels. Even as it’s coming toward us, it’s like this monster that’s like, no, they’re already posting about it, they’re dreading having this time of year come to us. What is going on in our brains as we know this is about to be a seasonal change, and then what happens to our brains once that change gets here?

[0:05:27] HN: Yeah. I mean, I think it’s really natural for people to approach that season with quite a lot of anticipatory fear, actually. Because if you have an episode of depression that lasts for a whole winter and you’ve had that a couple of times or even more, that’s a lot of your life that is significantly impacted. I mean, this is a very serious condition. It’s very distressing for people, disruptive to their lives, their work, their income, often, family, relationship. It has such an impact.

If you’re depressed for five months or so of a year, that is a massive, massive thing for people to deal with. There’s no wonder that people would actually really have those thoughts and feel quite anxious about it in advance. We know that actually, the more we think something, the more it can be true. Actually, those thought patterns might be counterproductive and actually contributing to people becoming stressed and entering that season in a state of mind where they’re not perhaps at their best and not as robust as they could be. That certainly is one aspect that is important to address for people, so they actually can feel empowered and they can get help, rather than just feeling like, “Oh, my goodness. This is happening and it’s coming and it’s inevitable for me.”

I think that’s one area that people can definitely do something about, and they can also get help with. There’s types of CBT that, for example, that are particularly aimed at people who have this type of seasonal pattern, where they would particularly look at that preemptive thinking that people might have, and to try and help address that as well. Yes, that is a big factor.

I think as well, the other thing is that when people are depressed in the winter, they might have a slightly different presentation to that depression. We know that some, what we call atypical symptoms of depression. That’s the way that people might have changes in things like sleep, or appetite, or their energy levels are a bit different sometimes in a winter depression. People are more likely to sleep more, rather than having poor sleep, like a typical depression to get insomnia. They might actually have hyposomnia. They’re sleeping a lot and really can’t not feeling refreshed, that they’re sluggish, or they might be hungrier and crave carbs and overeat, rather than feel they don’t have an appetite and lose weight, and they might feel particularly lacking in their energy. It’s really pronounced. It’s almost like, if you imagine someone hibernating in that depressed state, that’s what it’s like for people. It can be a really, really difficult type of depression to have.

[0:08:16] PF: The holidays don’t really help that for a couple of reasons. One is there’s so much holiday pressure. Everyone has some little baggage that comes with their holiday family gatherings. Then the food. There’s a lot of carbs and a lot of food that can just invite you to continue eating. How do the holidays add to that pressure?

[0:08:36] HN: I think, like holidays, so celebrations, family visits, all those things, they absolutely are quite an additional pressure and stress for a lot of people. They’re not really the core trigger for a seasonal episode of depression, but they certainly don’t help. Often, it’s like an added pressure at that time of year for people. Certainly, when people are thinking ahead about how they might get themselves in a really good position to manage that season in the best way they can, I would say, thinking ahead about those things that are big stresses, or even big decisions that people might need to make about what they’re doing over the holidays. Those are things that you can, perhaps, think a bit more about in advance of the season to try and almost do yourself a favor in advance, that you’re going to try and reduce that stress ahead of time.

[0:09:32] PF: That is the good thing about it, because unlike a lot of forms of depression, we know it’s coming, so that gives us a chance to prepare. What’s the difference between having those normal winter blues, which people oftentimes get, or if it’s a form of seasonal depression that actually needs treatment?

[0:09:51] HN: Yeah. I mean, that sub threshold, not quite depression, but certainly mild intermittent, but still problematic depressive symptoms. Again, there’s lots of people who will have that. They don’t meet full criteria for a depressive episode, but they certainly do struggle on and off through winter. Some of the things that you can do in advance to really promote your mental health over the winter period are still going to be really relevant for that group of people. For the people who actually have a real major depressive episode over that period, what you would see is this persistent presentation. Going on for a couple of weeks, if not longer, and persistently before we would say you’re in the criteria as such, of your mood is really low. It’s not picking up even if things around you are going well. You just have much less interest and enjoyment in the things you would normally have.

You would feel energy is lower. You’re easily fatigued. Concentrations not so good, and those sleep and appetite changes that we were just talking about. Then a lot of self-critical, or negative type thinking, hopelessness. Sometimes people obviously can start feeling they might be a risk to themselves, even when they’re very severely depressed. All of this together, and it’s persistent for at least two weeks, that’s what we call a depressive episode. It’s a bit different to blues. Blues are still important to think about, because we want to help people have good mental well-being, but it’s this really persistent presentation that we’re concerned about.

[0:11:36] PF: We’ll be right back with more of Live Happy Now.

[BREAK]

[0:11:44] PF: Now, let’s hear more from Dr. Hannah Nearney.

[INTERVIEW CONTINUED]

[0:11:48] PF: We’ve talked about what can happen to us and how bad we can feel, but there is hope. I know one of the things that’s been very common in the past is light therapy. I know a gentleman who has the light that he said he has to use daily once the seasons change. That’s really commonly prescribed. Can you talk about how effective that is for people?

[0:12:09] HN: Yeah. There is reasonable evidence for light therapy. The thing is, light therapy is also very well tolerated and not associated with a huge amount of side effects for the most people. Having said that, obviously, people should always talk to their doctor, and everyone’s an individual and all of that. But say, for a few people in the minority who might have some eye condition, or really struggles to tolerate, or migraines or something, who struggles to tolerate the light. Most people, it doesn’t cause too many side effects, and it’s something that is relatively easy to do.

However, you do have to time it correctly. You have to use it in the morning. If you use it later in the day, it’s going to probably disrupt your body clock in the wrong direction. You do have to do it consistently. You have to do it in the morning. You have to be really near it, and it has to be the right kind of light. It has to be medically approved with the right amount of lux, which is the units of light, in order for it to be as effective as it should be for you.

[0:13:21] PF: You’re saying, I can’t just shine a flashlight in my face.

[0:13:23] HN: No. You can’t do that, unfortunately. Also, practically, although it’s a good treatment for lots of people, practically, there are some people who, maybe parents of young children, whatever, who, for whatever reason they’re so busy, they can’t sit down and stay in one place for 30 minutes in the morning. Again, some people, it’s easy to fit in. If you work at a desk and you’re there in the morning, it’s an ideal time to use your light. Some people, it’s not so easy. Adherence can be a little bit of an issue for some people, depending on their schedule.

Yeah, there is good evidence for it. However, I would say that even though we’ve got evidence from meta-analysis, which is a gold standard, where they’ve looked at lots of different studies and use the systematic way to really pull that information out, even that has said, there is some problems with the quality of the evidence and there is more to come really. We know that that it is helpful for people. It seems like it probably starts to work within around a couple of weeks of using it consistently for people, which is good to know. We don’t really know how good it is at preventing someone from becoming, getting the seasonal depression.

I think again, it’s not that it won’t, it’s just that I don’t know if the evidence is clear enough on that yet. But it does seem to be pretty helpful for lots of people. The thing is that a lot of people with these seasonal mood episodes will benefit from combining one or more strategies, or treatments together, and you can safely combine treatment if it’s okay for you with other things like lifestyle interventions, possibly vitamin D, medication if you need it, or other treatments like CBT or whatever. It’s definitely something that I think is specific for those winter depression episodes that can be really worth people thinking about.

[0:15:21] PF: That’s great. Yeah, you bring up some points. I really hadn’t even thought about with using it, and especially the idea of having to use it early in the day. If you’re going to work, you’re right, if you’re a busy mom, trying to get the kids to school, now you’ve got to get to work yourself, it’s going to be very difficult to find 30 minutes to do that. You’ve been working on something that is really, really interesting with at home brain stimulation. This is something I’d never heard of. Can you tell us what it is and what it does?

[0:15:49] HN: Basically, I am UK medical director for Flow Neuroscience. Flow is type of brain simulations and at home brain stimulation headset that people wear, and it uses a treatment called transcranial direct current stimulation, or TDCs for short. Basically, it’s a very, very gentle electrical current. You wear the headset up high on your forehead, and you’ve got two electrodes that are in place and delivering this very, very gentle current to the left side of the front part of your brain. It’s called the dorsolateral prefrontal cortex. That’s the front part of the brain that is really involved in our executive functioning. It helps with mood regulation, motivation. We know that that area is less active when people are depressed.

What the flow headset does is basically, very gently encourage activity to be restored and, like, in better balance in that area of the brain. That helps to relieve symptoms of depression for people. Again, a bit like we were talking with the light, because it’s non-medication-based treatment and because of how it works, it’s very, very well tolerated by people. It does have very few side effects compared to some treatments that people might need to use for depression. It can be combined. It can be combined with other treatments as well, so it can be used on its own or as an adjunct. Yeah, we have really fantastic results with it.

[0:17:19] PF: Is that available only in the UK now? Or is it available in the US as well? Or what’s the situation on that?

[0:17:25] HN: Um, so well. So, hopefully soon in the US. But yeah, we’ll have to watch that space, because obviously, every country where Flow is moving into, there’s different regulatory requirements and all of that. Hopefully, we’ll have some news on that to share soon.

[0:17:43] PF: You’ve put together a toolkit, if you will, that suggests how people can incorporate some other practices to overcome the effects of the seasonal depression. Can you talk about some of those things? I know you mentioned a couple of them, but can you talk about some of the things that they can do to offset this?

[0:18:02] HN: Yeah. I would say that what we really want to think about is this proactive, like think about what you can do in advance that’s going to be helpful. Because, like we alluded to earlier, people can get really fearful and also can just feel there’s nothing they can do, so it’s almost it’s inevitable. I think, having this message, because actually we do know that yes, although this is recurrent for a lot of people, if you do follow people with seasonal episodes over time, most of them do actually stop having them eventually. It’s not inevitable, and there are things that you can do.

I would say, obviously, understanding as much as you can about the condition is good, and also talking to someone in the family, or someone who knows you well, I think, is also really key. I would say, the thing that I would say to do as a toolkit, as it were, would be to really sit down and make your own individual inventory of your lifestyle, what it’s like in the summer and the winter? Because I’m sure for most people, me included, that is quite different. I would break it down into things, like what your activity levels are like, your light exposure, your exercise, or your movement time, your diet, your sleep habits and quality, your types of social interaction, your alcohol use, so it definitely include. Also, like we said earlier, things like stressful events and key life celebrations, things like that. I would map that out, what it’s like in the summer, and then the winter.

Then the next thing I would encourage people to do is to really think about what steps they could take to address those differences and what they could do to optimize in those areas. Because I think people get bombarded, feeling they’re so much they have to do. When people are depressed or struggling, they don’t want big things, because it’s too overwhelming. I do encourage people to think really small. Things like, could I move my desk to be near a window, for example? Even just something like that. So, you’ve got more natural light exposure throughout that day. Or, could I sit and have my morning cup of coffee out in my garden with my coat on, for example? Those kinds of things that are fairly small and doable. I think that’s the important thing. Because what we really want is to help people really think about those areas and just make small changes, but they’re doable and consistent for them.

[0:20:58] PF: Absolutely. What about our screen exposure? Because during the winter time, again, we’re staying inside, we’re hibernating. We’re probably on our screens even more. That’s something that’s going to also affect our sleep. How do we create new habits around that? Because I think that’s something a lot of people struggle with.

[0:21:17] HN: Yeah, I think, and me included, I think we’re all affected by this. It is difficult. We live in a world where we’re always on our phones and laptops, or whatever. Definitely, if we’re prone to this anyway, our blue light exposure in the evening from screens is really undoing any good work you’re trying to do by correcting it, like I was just explaining. You really do need to be a bit diligent about it. Again, there’s different things that work for different people, but this is something you can factor in. It might be that you have filters on your phone, where you can change what the light setting is, that you have times where your phone locks itself out. I mean, there’s different apps you can get that help with some of this. Again, it depends what works with different people.

I mean, I would say for me, when I realized I’m using too much screen time, I probably take certain apps just off my phone temporarily, so just to have a reset. So, I’m not just mindlessly scrolling when I’m a bit bored for five minutes, because we’re all guilty of that. I think, trying to get into some habits, thinking a bit about what would be a good schedule to be in, what works for you, and not being afraid to try different things to address the screen issue, because different things do work for different people. The fact that you’re trying to find something and almost be a bit experimental with it, I would say, try a few different strategies and see what the difference really is for you.

[0:22:53] PF: I like it. Well, Dr. Hannah, you’ve given us a lot to think about. You’ve given us some great prescriptions for moving forward through this season. As we let you go, what is the one thing that you want people to keep in mind as we enter this change of seasons?

[0:23:07] HN: I mean, I think that the real takeaway is that it’s not inevitable that you will get depressed. There are lots of things within your gift. Make sure you’re proactive. I would say, always talk to your healthcare professional in advance. Be proactive. Make sure you’ve got a bit of a plan if things do deteriorate with your mood. Don’t be afraid to do that. There are lots and lots of things out there that you can try, and you can combine things. Try not to feel like it’s inevitable. Yeah, just reach out for help at an early stage, because we always know that it’s easier to treat depression if people come early and they get better quicker.

As a psychiatrist, I’m always delighted. But if a patient gets in touch with me proactively and says, “Look, can I check in early? Or I’m a bit concerned about this. What do you think?” We like to hear from people, and yeah, be able to step in and do something at an early stage. That’s really the best approach for people to have.

[0:24:11] PF: Well, thank you for all your advice, all your insight, and all your input today. It’s been a pleasure talking with you. We’re going to tell our listeners how they can find you, find out more about the work that you’re doing, find out about Flow Neuroscience. Again, I just thank you for sitting down with me.

[0:24:26] HN: Oh, it’s great to meet you. Thank you so much.

[END OF INTERVIEW]

[0:24:31] PF: That was Dr. Hannah Nearney, talking with me about seasonal depression and some of the ways we can combat it. If you’d like to learn more about Dr. Hannah and the research she’s doing, or discover more about Flow Neuroscience, just visit us at livehappy.com and click on this podcast episode.

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 a happy one.

[END]

In this episode, you’ll learn:

How seasonal changes affect brain chemistry and mood regulation.
The difference between winter blues and clinical seasonal depression.
Practical tools and practices to protect your mental health as the days get shorter.

Visit Dr. Hannah’s website here.

Follow along with the transcript.

Follow Dr. Hannah on Social Media:

Instagram: @psychiatristhannah

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