Every wonder why your energy is lower in the winter or on cloudy days? You may have SAD or Seasonal Affective Disorder. This TED style talk will help you know if you have it and what you and your doctor can do to manage it. The talk also covers Bipolar disorder with seasonal pattern which is similar to SAD. The talk is about an hour long and is written at the lay person level so it works well with public audiences. Please contact me via my website, www.scottcarrollmd.com if you are interesting having me present this or any other talk.

1. Or Why You Get the Winter Blues…
Scott Carroll, MD
UNM School of Medicine
www.scottcarrollmd.com

2. Objectives
• How Seasonal Affective Disorder (SAD) differs from other
mood disorders.
• What neurotransmitters and vitamins are associated with
SAD.
• 3 non-pharmacological treatments that may be effective
for SAD.

3. SAD – DSM 5 Criteria
• Mood d/o “with seasonal pattern”
• A – seasonal onset
• B – full remission/switch after season
• C – no non-seasonal episodes x 2yrs
• D – more lifetime seasonal episodes
• Not due to seasonal stressors

4. Winter Depression or Hibernation?
• Short, grey days
• Increased sleep
• Low energy
• Dep mood +/-
• Wt gain/crave carbs
• Isolate/low libido

5. Summer Depression or Hypomania?
• Long, sunny days
• Insomnia
• Anxiety
• Irritable mood
• Decreased appetite
• BPAD II is highly seasonal

6. SAD – Melatonin vs. Serotonin
• Melatonin – induces sleep
• Serotonin – alertness, mood
• Both made from tryptophan
• Alternate with each other
• Mel triggered by darkness
• NE suppresses melatonin

7. SAD - Epidemiology
• Alaska 9.9%
• Florida 1.4%
• AK subclin 24.9%
• Varies w/
latitude and
cloud cover

8. Geographic Variation
• Ireland ~ 20%
• Netherlands ~10%
• Iceland ~1%
• Japan ~2%
• Genetic?
• Fish based diet?

9. SAD – Risk Factors
• Female > male (MDD form, not BPAD)
• Young adults > elderly (low melatonin in elderly?)
• Family history
• Mood disorder > no mood disorder
• High latitude/cloud cover > equator/sunny
• Sedentary > regular exercisers
• Recent move to higher latitude or a cloudy area

10. SAD - Pharmacologic Therapy
• Norepinephren inhibits melatonin secretion
• Bupropiron (Wellbutrin/Zyban)
• Modafinil (Provigil) and (probably) armodafinil (Nuvigil)
• Atomoxetine (Strattera)
• Stimulants (methylphenidate and amphetamine)
• SNRI’s and SSRI’s
• Caffeine

11. Non-Pharmacologic Therapies
• Dawn/sunlight exposure (windows, going outside)
• Exercise (outdoors during daytime is best)
• Full spectrum light box at > 10K lux (blue or blue-green?)
• Cognitive-behavioral therapy (CBT)
• Negative air ionization therapy at high density
• Combination therapy

12. Alternative Treatments
• Melatonin
• Vitamin D
• Saint John’s Wort
• SAMe
• Fish oil/omega 3 fatty acid (or eating more fish)
• Travel to a sunny location

13. Fall/Winter BPAD Treatments
• Optimize mood stabilizers (esp. Lithium and Lamictal)
• Increase sunlight exposure especially at dawn
• Full spectrum light box (30-60 min every morning)
• Melatonin (3-6 mg every night)
• Fish oil (1K to 2K mg twice a day)
• Vitamin D (400 to 1K international units per day)
• Thyroid supplementation

14. Spring/Summer BPAD Treatment
• Blackout curtains and eye mask
• Melatonin
• Optimize sleep medications
• Optimize mood stabilizers (add antipsychotic?)
• Fish Oil
• Thyroid supplementation
• Vitamin D

15. Reversed BPAD Seasonal Pattern
• ~ 10 – 15% of BPAD w/seasonal pattern
• Confirm true reversed pattern
• Optimize mood stabilizers (Li and Lamictal)
• Melatonin
• Optimize sleep meds
• Fish oil and Vitamin D
• Thyroid supplementation

16. More Info At…
• www.mayoclinic.org
• Wikipedia
• www.webmd.com
• My slides are on
Slideshare.com, search for
Scott Carroll

17. Follow Dr. Scott on:
• www.scottcarrollmd.com
• Twitter @ScottCarrollMD
• Facebook - Scott Carroll MD