Outsmarting Seasonal Depression With Dr. Hannah Nearney

0:03Thank 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.

0:40Let's have a listen Dr. Hannah, thank you for joining me on live happy now Oh, thank you so much. It's a pleasure to be here This is a great topic to talk about We're getting ready to set our clocks back as daylight saving times ends and then we know the days are getting shorter. So it is a great time to talk about how we can prepare and kind of protect our mental health. So I wanted to start by getting kind of 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? Well, it's a really good question and it kind of depends on where you live in the world.

1:16So if we think about the change in daylight hours, it really varies a lot depending on how far you are from the equator and so people who are in the northern hemisphere countries say like northern america canada much of europe etc have a big variation from like with the seasonal change like like you were just saying they have to change the clocks and there's a big change over that fall into winter compared to the summer in terms of the daylight length so 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.

1:54So it can vary anything from like one to 10 percent depending on what studies you look at and whereabouts in the world you're looking at the population. So what are some of the ways that it affects us? We hear a lot about it, but what exactly does it do to us? We don't fully understand exactly what's going on when people have an episode of like 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 so 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 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 at 6 p.m and freezing cold are you so so there's there's there's an element of the you know what comes with that as well but certainly the i the theory is that there are kind of biological changes that happen related to a disruption in our like 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 kind of not regulated in the same way and this disruption seems to for some people who are perhaps a bit predisposed to it, maybe through like genetic factors or whatever, it seems to trigger off these episodes of mood that are very related to the seasons.

3:47And 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? I think the answer is going to be inevitably that it's a mix. Like everything's complicated. We know in all mental health conditions that there's an element of the biological, psychological, social kind of interplay. We definitely know any way for mood disorders, there's a genetic component to those. And we know that people who have episodes of depression confined to kind of seasonal variation, they do also have family history of either bipolar often or depressive episodes in family members.

4:33and there does seem to be some specific genes that have been linked to like an increased risk of people having these seasonal episodes as well so 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's there is definitely some kind of genetic predisposition yeah because i know some people who suffer from it badly like it really affects their mood, it affects their sleep, it affects their energy levels. And even as it's coming toward us, they kind of, it's like this monster.

5:10It's like, no, they're already posting about it. They're dreading having this time of year come to us. So 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. 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.

5:50It's very distressing for people disruptive to their lives their work their income often family relationships like it has such an impact and if you if you're depressed for five months or so of a year that is a massive massive thing for people to deal with so there's no wonder that people would actually really have those thoughts and feel quite anxious about about it in advance and we know that actually the more we think something the more it can be true and actually those kind of thought patterns might be counterproductive and actually contributing to people becoming stressed and and kind of entering that season in a state of mind where they're not perhaps at their best and not as robust as they could be so 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 and I think that's one area that people can definitely do something about and they can also get help with you know there's types of CBT that for example that are particularly aimed at people who have this type of seasonal pattern who where they would like particularly look at that kind of kind of preemptive kind of thinking that people might have and to try and help address that as well.

7:09So 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. So we know that some, what we call like atypical symptoms of depression. So that's like the way that people might have changes in things like sleep or appetite or their kind of energy levels are a bit different sometimes in like a winter depression. So people are more likely to sleep more like rather than having poor sleep like a typical depression they get insomnia they might actually have hypersomnia so they're sleeping a lot and really can't not feeling refreshed so they're kind of sluggish or they might be hungrier and like crave carbs and overeat rather than feel like they don't have an appetite and lose weight and they might feel particularly lacking in the energy so it's like really pronounced and they're kind of it's almost like if you imagine someone hibernating in that depressed state.

8:08That's kind of like what it's like for people. So it can be a really, really difficult type of depression to have. And the holidays don't really help that for a couple of reasons. One is there's so much holiday pressure. Everyone has some sort of little baggage that comes with their holiday family gatherings. And then the food, there's a lot of carbs and a lot of food that can just invite you to continue eating. So how do the holidays add to that pressure? So I think like holidays, so celebrations, family visits, all those kinds of things, they absolutely are quite an additional pressure and stress for a lot of people.

8:46They're not really the core kind of trigger for like a seasonal episode of depression, but they certainly don't help. And often it's like an added kind of pressure at that time of year for people. And 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 kind of things that are big stresses or even big decisions that people might need to make about what they're doing over the holidays. or those are things that you can perhaps think a bit more about in advance of the season to try and kind of almost do yourself a favor in advance that you're going to like try and reduce that stress ahead of time.

9:31And that is the good thing about it because unlike a lot of forms of depression, we know it's coming. So that is kind of like 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? Yeah. So I think, I mean, there's sub like that sub threshold, like not quite depression, but certainly kind of mild intermittent, but still problematic depressive symptoms. You know, 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.

10:13And so some of the things that you can do in advance to kind of really promote your mental health over the winter period are still going to be really relevant for that group of people but for the people who actually have like a real major depressive episode over that period like what you would see is this persistent presentation so you know for going on for a couple of weeks if not longer and persistently before we would kind of say you're in the criteria as such of you know 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 like energy is lower you're easily fatigued concentration is not so good and like those sleep and appetite changes that we were just talking about and then like a lot of self-critical or negative type thinking hopelessness sometimes people obviously can start feeling like they might be a risk to themselves even when they're very severely depressed so all of this together and it's persistent for at least two weeks, that's what we call a depressive episode.

11:20So it's a bit different to blues. Blues are still important to think about because we want to help people, you know, have good mental well-being. But it's this kind of really persistent presentation that we're concerned about. We'll be right back with more of Live Happy Now. If you're looking for your new favorite summer t-shirt, we've got you covered. Check out our brand new Live Happy t-shirts in the Live Happy Store, so you can share your happiness wherever you go. Whether you're heading to the beach, walking the dog, or just grabbing your morning coffee, these tees are your new go-to for spreading joy everywhere you go.

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12:34and now let's hear more from dr hannah newney so we've talked about what can happen to us and how bad we can feel but there is hope and so 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 once the seasons change that's really commonly prescribed can you talk about how effective that is for people? Yeah, so there is reasonable evidence for light therapy. And the thing is, light therapy is also very kind of well tolerated and not associated with a huge amount of side effects for most people. Having said that, you know, obviously people should always talk to their doctor and everyone's an individual and all of that.

13:22But save for a few people in the minority who might have some kind of eye condition or really struggle 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. So 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. So you do have to do it consistently. You have to do it in the morning and you have to be really near it. And it has to be the right kind of light.

14:01So it has to be like a medically kind of approved with the right amount of lux, which is like the units of light in order for it to be, you know, as effective as it should be for you. So you're saying I can't just shine a flashlight in my face. No, you can't do that, unfortunately and and also you know practically although although it's it's a good treatment for a lot of people practically there are some people who you know like maybe parents of young children or whatever who for whatever reason they're so busy they they can't sit down and stay in one place for 30 minutes in the morning so again some people it's it's easy to fit in if you work at a desk and you're kind of there in the morning like it's an ideal time to use your light some people that's not so easy and so adherence can be a little bit of an issue for some people depending on their schedule but yeah there is there is good evidence for it however I would say that even though we've got evidence from like meta-analysis which is like a gold standard where they've looked at lots of different studies and used a systematic way to kind of 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 so 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 a seasonal depression I think again it might 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 it does seem to be pretty helpful for a lot of people and And the thing is that a lot of people with these seasonal mood episodes will benefit from combining one or more strategies or treatments together.

15:48And you can safely combine like treatment if it's OK for you with other things like lifestyle interventions, possibly vitamin D, medication if you need it or other treatments like, you know, CBT or whatever. So it's definitely something that I think is specific for those winter depression episodes that can be really worth people thinking about. That's great. Yeah, you bring up some points. I just I really hadn't even thought about with using it and especially the idea of having to use it early in the day. And if you're going to work, if 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.

16:25It's going to be very difficult to find 30 minutes to do that. But you've been working on something that is really, really interesting with at-home brain stimulation. This is something I'd never heard of. And can you tell us what it is and what it does? Basically, I am UK Medical Director for Flow Neuroscience. So Flow is a type of brain stimulation. So it's an at-home brain stimulation headset that people wear. and it uses a treatment called transcranial direct current stimulation or TDCS for short. So basically it's a very, very gentle electrical current. So 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.

17:16It's called the dorsolateral prefrontal cortex. And that's the front part of the brain that is really involved in our executive functioning. It helps with mood regulation, motivation. And we know that that area is less active when people are depressed. So 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. And that helps to relieve symptoms of depression for people. And 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.

17:53So 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. And yeah, we have really fantastic results with it. Is that available only in the UK now or is it available in the US as well? Or what's the situation on that? So, well, 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. So hopefully we'll have some news on that to share soon.

18:33But you've also, you've put together a toolkit, if you will, that kind of suggests how people can incorporate some other practices to overcome the effects of the seasonal depression. And 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? Yeah. Yeah. So 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 and also can just feel like there's nothing they can do so it's almost like it's inevitable so 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 so it it's not it's not inevitable and there are things that you can do and I would say obviously understanding as much as you can about the condition is good.

19:39And also talking to someone in the family or someone who knows you well, I think is also really key. But I would say the thing that I would say to do as a kind of a toolkit, as it were, would be to kind of really sit down and make your own individual like 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. And I would break it down into things like what your actual 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, I would definitely include.

20:29And also, like we said earlier, things like stressful events and kind of key kind of life kind of celebrations things like that and I would like map that out what it's like in the summer and then the winter and then the next thing I would encourage people to do is to really think about what steps they could take to kind of address those differences and what they could do to optimize in those areas because I think people get bombarded feeling like there's so much they have to do and when people are depressed or struggling they they don't want big things because it's too overwhelming so it's like I do encourage people to think really small so things like could I move my desk to be near a window for example like you know even just something like that so you've got more natural light exposure throughout that day or could I you know, sit and have my morning cup of coffee out in my garden with my coat on, for example, you know, those kinds of things that are fairly small and doable.

21:36I 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 that are doable and consistent for them. Absolutely. So what about our screen exposure? Because during the wintertime, again, we're staying inside, we're kind of hibernating. So we're probably on our screens even more. And that's something that's going to also affect our sleep. So how do we create new habits around that? Because I think that's something a lot of people struggle with. Yeah, I think, and me included, I think we all affected by this. And it is difficult.

22:14We live in a world where we're always like on our phones and laptops or whatever. So definitely, like, 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. So you really do need to be a bit diligent about it. And 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.

22:55And again, it depends what works for different people. I mean, I would say for me, when I realize I'm using too much screen time, I probably take certain apps just off my phone temporarily. And so it's kind of have a reset. So like, I'm not just mindlessly scrolling when I'm a bit bored for five minutes, because we're, you know, we're all guilty of that. So I think trying to get into some kind of habits, thinking a bit about what would be a good 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.

23:35But 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. 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. So 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? I mean, I think that the real takeaway is that it's not inevitable that you will get depressed. And there are lots of things within your gift. Make sure you think you're proactive.

24:10I would say always talk to your healthcare professional in advance, you know, be proactive, make sure you've got a bit of a plan. And if things do deteriorate with your mood, don't be afraid to do that. And there are lots and lots of things out there that you can try and you can combine things. So, you know, try not to feel like it's inevitable. And yeah, just, you know, 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. So, you know, 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?

24:52What do you think? You know, we like to hear from people and, yeah, be able to step in and do something at an early stage. So that's really the best approach for people to have. 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. And again, I just thank you for sitting down with me. It's great to meet you. Thank you so much.

25:21That was Dr. Hannah Nierny 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. And until then, this is Paula Phelps reminding you to make every day a happy one.