Seasonal Affective Disorder in the Spring

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1:01When your therapist won't take your calls anymore, there's always the last show with David Cooper. In November every year, around the time change, when we lose an hour of light in the evening, we talk about seasonal, effective disorder, about the winter blues. But what I don't hear people talk about often is what happens around March when we get more sunlight. And things look on the up, the spring sunshine. How does that affect us and how does it affect us with some psychiatric disorders? That's what we're going to discuss with psychiatry professor at the University of California, San Diego, Jared Young. Jared, welcome back to the show. It's great to have you. Thanks very much for having me back, David. It's great to be here. So, people joke about the winter blues. I have the sad or seasonal, effective disorder. Side note, what a hilariously named disorder, that acronym. I mean, it's accurate. Before we get to how things look now for people who suffer from this, how do things look around the winter months when we lose less daylight in the evening because of the time

2:01change? So, I mean, this is one of the, that's one of the fundamental things we all understand. And like we're aware of, and when I say all, it depends on where you are in the longitude and latitude. If, like I live in San Diego now, it's remarkable how light it is during the winter months. But I remember going to school in Scotland where it's like 60 degree, like on the 60 degree line, very high, very north. We have about three hours of daylight in the winter shows this. So, so I would walk to school in the morning, in the dark, and then I'd walk home from school in the afternoon, and it would be dark. So like my only time of seeing the sun was the one moment of recess that I would get to run outside. And so like that's how I grew up, that was normal to me. And like I say, it's different in San Diego, you get a lot more light. But living in that, living in that latitude, like experiencing that very short moment of like, oh, I'm out in the sun, I like led me to my interest in how that can actually impact

3:07mood. And I have a family history of seasonal affective disorder. And you can begin to see people around you really hating getting into those winter months. And frankly, it's understandable in terms of never seeing the sunlight having to be indoors, et cetera, et cetera. By understanding the mechanism behind it, that's more interesting. And then you brought up obviously the entering into the winter, the summer months, and we all get happier, that's also incredibly interesting for me. I kind of hate that I have this seasonal cycle, like that I know that I'm going to be kind of down in the winter. And then I know that things are going to be like amazing in the spring. And it's like, where's this uplifting mood that I want in December, in February? But then boom, it comes like clockwork. How big of a mood dip. And then a mood spike, do we see for like the average person? And then people who suffer from things like bipolar disorder? Yep, that's a, that's really what's key. So you mentioned them in department. It's like, I dream, I'm here to try and help understand the neural mechanisms underlying

4:11disorders, we can develop treatments. And as I said, my growing up in that, in that kind of like, who are like in the middle of summer, that means quite the opposite in the middle of summer. When we were younger, we're like, come back when it gets dark, like two or three hours of darkness in the middle of summer. So we had a great time. And it is very different. And so, and people experience that even if they don't have a psychiatric condition, people with bipolar disorder, however, are vastly affected by it. And you actually see hospitalization spikes happening in March and April, as we enter into summer. So in it's a reliable pattern for a lot of people. As you enter into summer and spring, you will see spikes in a hospitalization for manic episodes. That's for people with bipolar disorders, which between depressed and manic, where there's a lot of energy for mania, there's a lot in it, like wanting to sleep lots and depression during the winter. So, to summer, lots of, lots of manic hospitalizations, winter, lots of depressed hospitalizations.

5:16And it's like clockwork. I find people use like technical, medical, psychiatric language to describe stuff in their life that may not quite match. I've heard people say, oh, I'm having a manic episode just because they're feeling good that day. I think it's fine, whatever. We don't need to get into, you know, how people talk on TikTok or something. But my question for you, what does a manic episode look like? That might require hospitalization. What might that be like? So, that's a great question. And you're right. People use it. People use such language to try and express feelings. But manic episodes are actually can be incredibly destructive for the people undergoing it. So we think about people with mania, they have incredible energy. And that sounds like a great thing, and it certainly can be. But that energy then leads to a decision making, the racing thoughts, pressure, speech, music, technical terms here, but people just can't get things out.

6:16And their behavior around people becomes disordered as a result of that. And so you're around someone that is, you know, people say, oh, I'm having a bit of a manic episode and they're like, oh, I just have a bit more energy. Imagine being around someone that is up to 11 on that. And so they can then start to have delusions, and the delusions become incredibly problematic. Many think that they either converse with God or are actually God because of the lack of sleep, the high energy, the reduced level of sleep. They can push them into a state where they're no longer linked to reality. And that's when they become dangerous, both to themselves and to others, and especially for family and friends nearby. And it can be really problematic. Hence the need for hospitalization, put them in a stable environment, and effectively start bringing them back to normalcy. I've heard of things like an entry level employee at a huge Fortune 500 company like walking into the CEO's office saying they have a great idea and then explaining a nonsensical

7:20idea. Like, it really can affect people's lives. Yeah, for example, or that thing that you've always been wanting to tell someone and all of your inhibitions are gone and you just walk in and you do it and you suddenly decide that no, I had a friend who was sitting for a law degree and suddenly during the summer was like, you know what, I have a great idea for a company quit his law degree, went off the rail, started trying to set something up and I had absolutely nothing to do with any of his skills or it was massively problematic as you can imagine. So I've talked a lot about how to help folks with experts like you during the dark months, you've got the lamps, you've got going to talk to a therapist, you've got a lot of techniques to deal with the depression side of seasonal affective disorder. But the manic side, you know, making sure we have a good handle on our elevated mood into the summer months in case we don't, what are some of the strategies to deal with perhaps

8:20feeling too good during the other side of the coin year? And it sounds horrible to try and put that into you start to feel good and there's a stage before mania called hypomania and it's when you're at that elevated stage, but that's when that tumble continues and that self perpetuating kind of cycle happens that leads to mania. You're having a really good time in hypomania, but that's when you know you really got to cut it off and it sounds terrible to be like, no, you're having a great time, you're being super productive and then having all of your goals, but you're no, you're not sleeping, the cycle has started. So, so the techniques are somewhat similar to what you would see during depression, during the winter months, but as it flipped, one of the key elements that I suggest for people is social rhythm therapy and like on the the winter side where you're talking about you okay, bring out lights and bring out the such like in the summer, have blackout cartons, set a bedtime for yourself, know that that's when you need to go to sleep, know you get up at

9:24the same time every day to earn those lights on. You should be planning on having a light cycle, that is consistent. In the animal world, because I do research in animals as well as in humans and in the animal world we call it a 12-12, 12 hours of light, 12 hours of dark and it's that's a consistent environment, consistent environment, we keep our animals and all the time. And so, but in humans, we're experiencing this fluctuation where everyone in their equator is 12-12 or in the you know, the spring equinox is a 12-12, but in the summer there's a lot of light in the winter, there's hardly any light and we oscillate through that. So, what you try and do is try and keep that steady for yourself, try and keep things consistent for yourself. Exema is unpredictable, but you can blur a less with eggless, a once-monthly treatment for moderate to superior eczema. After an initial four-month or longer dosing phase, about four and ten people taking eggless, achieved itch relief and glare are almost glare skin at 16 weeks,

10:25and most of those people maintain skin that's still more glare at one year with monthly dosing. Eggless, Libri Kizumap, LBKZ, a 250mg per 2mL injection is a prescription medicine used to treat adults and children 12 years of age and older who weigh at least 88lbs or 40kg with moderate to severe eczema. Also called a topic dermatitis that is not well controlled with prescription therapies used on the skin or topicals or who cannot use topical therapies. Ebgless can be used with or without topical corticosteroids. Don't use if you're allergic to Ebgless, allergic reactions can occur that can be severe. Eye problems can occur. Tell your doctor if you have new or worsening eye problems. You should not receive a live vaccine when treated with Ebgless. Before starting Ebgless, tell your doctor if you have a parasitic infection. Ask your doctor about Ebgless and visit ebgless.lily.com or call 1-800-LilyRX or 1-800-545-5979. Seasonal effective disorder. Sad. It gets a lot of air play during the dark months, times when people get a little more depressed. But into the summer months, when things get a little better, we want to make sure they don't get too good and we don't get into manic states. We're here with Jared Young, a psychiatry professor at the University of California, San Diego, to continue our

11:30conversation about this. Jared, welcome back to the show. Thanks for having me back, David. Happy to talk about it. So it's so interesting to me that the way we want to deal with the good months to make sure they don't get too good and we end up having manic episodes is focusing on light the same way we would in the winter, but just the other way. So like blackout curtains, are there any other strategies we can take to make sure that the good times, if we have seasonal effective disorder, aren't too good? Yeah, so we mentioned blackout curtains and we've mentioned about trying to maintain things like in a 12-12 light period. And that is blackout curtains, but it's also, you know, making sure you do go to bed at the time where you normally should go to bed. And there are techniques to try and help you get to sleep better. As you enter into summer months, that light is there. Like we all get excited. We all want to spend all of our time out to know that we can do that, but being dedicated, keeping ensuring that you actually

12:31try and go to sleep at the same time, you're trying to get up at the same time. It takes dedication, but that is absolutely something you need to have to do. And trying to maintain the same kind of social life that you have during the winter months that you would have during the summer, I can say, social rhythm therapy, maintaining consistency is amongst the best. Despite the fact that you want to do otherwise. So we evolved, I don't know, our ancestors, apes or whatever, with seasons and light changes for many, many thousands of years. Why does modern life make these mood swings worse? Is it worse now? Or did we always struggle with this? Do chip-and-z struggle with this, too? We talk, we, some of us talk about this a lot and I'm so glad you brought up a big fan of trying to understand things through an evolutionary perspective. And if you imagine, the back in the day, we didn't have lights. So if you take human beings out into the middle of the desert and have them just no lights, no nothing, eventually people start to entrain themselves,

13:34they wake up when the sun comes up, they go to bed when the sun goes down. And eventually, the light cycle changes that. So we still have that mechanism. We are modern, but we are still apes. So what's remarkable, if we think about hunter-gatherer societies back in the day, like the most in the summer, the most you can go and hunt and gather and collect food, etc. for the coming winter months, the best people are the ones that can do it the most. They can sleep the least, they can run the longest, they can collect food, they can think faster, they are stronger. And then imagine in the winter, they are the ones that can slow down and conserve energy. And this sounds familiar, right? Yeah, there's, it sounds like there's some sort of biological evolutionary utility to feeling great in the summer and being kind of down in the winter. Exactly. And one of the things that happens with nature as with everything, we know this from offshoots of past,

14:35offshore apathachine, etc., past humanoids that never actually made it, nature tends to try in an experiment. Imagine the two best, the best women, the best man, being able to do all of this, they're children. Some of them might be like also great with them, but some of them might go a little bit extreme and they might be a little bit off and they might go way too far and have difficulty regulating things back. Personally, I think that's how bipolar, the genes that the dry bipolar disorder, I think that's how they first came around. Those alleleic variants, I think that's how they got created was this hunter gatherer motif that still impacts this today. Interesting. How linked are bipolar disorder and seasonal effective disorder? Are they always linked? Is there just a strong connection? There's a strong connection. And I think part of that is, I think there is a strong connection, but it's likely genetically, but also the environmental impact affects all the same way. People with seasonal effective disorder do exhibit some behaviors

15:41that excitement in the summer, but we all do. They just don't take it as far, but you can think of seasonal effective disorder somewhat as bipolar like, but light. They don't quite go into bad a depression as well. And it's the light change and the duration of the light that really is making the difference here. We've shown in the past that it's nothing to do with a heat, nothing to do with wet and cold or with warmer temperatures. It's all about light. We've done animal studies replicating some of that work as well. If someone listening suspects they have seasonal effective disorder, but they're not sure if that's just normal seasonal grumpiness or normal seasonal elevated mood, what point should they consider talking to a medical professional? How do you know that you have this thing? I know we should always caution against self-diagnosing here, but how would you know whether to talk to someone about it? Absolutely, avoid self-diagnosis despite Google being a wonderful source. But as you have had these experiences, especially seasonal effective disorder, or likewise with bipolar disorder, if you're having these experiences

16:45and you tend to have them repeated last season, I felt the same. You know, when it seems to come around every single time, the point where you talk to a therapist is when you're starting to get into impacting your life. And that's true for any condition you might think to imagine. You should speak to someone if the situation you find yourself and is negatively impacting your ability to function, you should seek help. And that's true for everything. But if you see a seasonal pattern to it, then you might have some inkling of what's going on. Now, is it just light or there are other mechanisms that play here? Like how strong does light affect the cells in our body, the cells in our brain? Light is remarkable. It's the strongest zeitgeist. And we see it across every species, whether it's mammalian, everything, and it drives so much in a way of changes. One of the most amazing swipes got into this research in part coming from Scotland, walking to school in the morning, I mentioned, and it being dark, walking back, and it being dark

17:46in the middle of winter. So I got into this research, seeing the spike in mania and bipolar disorder in the summer and the spike of depression in the winter. And I'm like, well, that could be the mechanism. And I saw a talk by Nick Spitzer here at UCSD. And he was, he wasn't talking about bipolar disorder. He was interested in what we refer to as neurotransmitter switching. So he's looking at a brain region where that brain region exposed to a different environment and they produce a completely different neurotransmitter depending on the environment. And so this area of the brain, it's called the power of intricular nuclei. Just part of the brain that is, there's a second stop for the, for the eyes to the super-guysmatic nucleus. It controls our circadian rhythm basically. What I'm saying is, this part of the brain, if you put, when Nick put animals into a long photo period of light, just light, not changing temperature or anything, they produce dopamine. But if they put them into a long period of dark, they produce CRF, a stress response.

18:47But it didn't happen over one day, didn't happen over two days. I had to happen over seven days. And remember how it took, I mentioned it takes people seven days to train to light. So after seven days, this part of the brain has simply changed switched neurotransmitters and hormones depending on what source of light that they're in. And what was very cool, he went back to, he actually went to Scotland, took the brains of people who had died all of a sudden in the height of summer or in the height of winter and basically showed the exact same thing was happening in humans if they died in the height of summer and the height of winter. Lots of dopamine in the summer, lots of stress responses in the winter, rumourful. For someone listening and they believe everything you're saying and they want to fix any kind of seasonality to their moods, but they're just not willing to give up that iPhone at night or just not willing to give up a chaotic sleep schedule and party and not really take care of themselves at when it comes to light. What would you recommend? Actually, caring about yourself or it comes

19:48to recommending like one of the things that we know now is it's not just simply light. It's really about blue light. Yeah. And there are lots of screens you can get TVs, my laptops and your phone where they have red light filters that go on top. I have them all the time and I do it on everything. I actually use also dim light at night. All my entire house is on dimmer switches. So like at night, I put it down to a dimmer light when before I'm going to bed. Stage is while I'm getting ready for bed, dim the lights and I thoroughly recommend that. I do the same. I put the wildest orange filter on my TV in my bedroom. I'm not willing to give up the TV, which I know would be the best thing, but the second best thing is yeah, filter all that blue light. Use that red light. It's a great it's a great first step. Jared, I've enjoyed this chat. Thanks so much for being on the show. My pleasure. Thanks for having me. Jared Young is the psychiatry professor at the University of California at San Diego.

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