As winter continues its slow trudge to spring, many struggle with the “winter blues” – or in clinical terms, Seasonal Affective Disorder (SAD). Categorized as Major Depressive Disorder with a seasonal onset, SAD is a term some are familiar with, but don’t truly understand. It affects about 5% of the population, primarily women, and lasts for 40% of the year in areas that see seasonal changes. 

In this month’s “IHP Interview,” Jessica Spissinger, Psychiatric Physician Assistant and Instructor at the MGH-IHP Physician Assistant Studies Program,  breaks down the disorder, shedding light on misconceptions and sharing tips on getting through it.

The conversation below has been edited for brevity and clarity.

Why don't you give a brief overview of seasonal affective disorder for us? 

JS: Seasonal affective disorder is kind of a term that people are familiar with, and we use it colloquially. However, it's not actually clinically defined in the Diagnostic and Statistical Manual of Mental Illnesses. It’s similar to postpartum depression, which is not actually a specifically defined disorder, but rather both are sub-specifiers of major depressive disorder. 

A lot of people are familiar with the fact that in the winter, people can feel depressed and lose motivation. They can lose interest in things they have otherwise been interested in before, they can start overeating and feeling bad about themselves. And so there can be kind of a general malaise. And I think it's important to recognize that if it's more of that seasonal component, it's not just coming out of nowhere, and it will get better. 

Does the holiday season play into seasonal affective disorder with winter onset? 

JS: I have a lot of patients who go through seasonal affective disorder in the winter, and I see it play out in two different ways. 

On the one hand, some people enjoy the holidays, the holiday spirit, and see it as this buoyant period if they have good memories of the season or if that's something they’ve traditionally enjoyed in the past. But these individuals often then have a lot of dread for what comes after the holiday season. For those people, as soon as the holidays are over, that's when they really start to fall flat because the days are so cold. The days are still very dark, and there's not a whole lot that they're excited about except trying to get to that period where we have the more daylight.  

For others, the holiday season can bring up bad memories or stress in terms of finances or family situations, and therefore can exacerbate or even cause seasonal affective disorder.

We tend to think of seasonal affective disorder as happening only in the winter, but that’s not the case, is it? 

JS: Seasonal affective disorder happens in the summer too, when it can be triggered by intense heat and humidity. In this season, it turns into a feeling of overstimulation and irritability, versus depression. Fatigue can be a big part of it as well as a lack of motivation, especially when it's so hot. As soon as you start to move, your body starts to slow down, which can then lead to you having more time indoors with air conditioning. 

What are some warning signs of seasonal affective disorder? 

JS: A lot of that comes with history. A person with seasonal affective disorder may notice a pattern, that this is something he or she goes through every year. It's just recognizing every year at this time of year ‘I feel really terrible.’ But once they get to spring, they feel a lot better. The problem kind of solves itself, but sometimes they do need some extra tools and resources to get through that period. 

Speaking of resources, what are some treatments then that might be useful for these individuals?

JS: With any kind of mental health treatment, we're always thinking about therapeutic support, such as counseling and psychotropics, but specifically for seasonal affective disorder in the winter, we like to use therapeutic lamps which generate 10,000 lux for 15 minutes twice a day. It’s really amazing how powerful bright light can be, and it’s one of those things you almost have try it out to see for yourself. 

For those with summer seasonal affective disorder, more research needs to go into this area but bright light therapy isn’t a treatment here. In this instance, we recommend individuals find a “dark cave” – essentially, somewhere they can hide out from the heat and bright sun. For these individuals, the goal is to reduce stimulation and light exposure.

You created the IHP’s postgraduate certificate in psychiatry. What are your goals for the program and why is it important for PAs to work in psychiatry? 

JS: We need mental health providers, more than ever. Many PAs are interested in either specializing in psychiatry or improving their knowledge base in mental health while practicing in a generalized setting, such as family medicine. Some PAs may choose to pursue a post-graduate fellowship, however there are limited placements available, and this generally requires a move, so this may not always be an accessible option. 

My goal with this program is to provide advanced training in psychiatry that can be utilized from any geographic location. Whether a new graduate PA or a seasoned clinician looking to build upon their skills in psychiatry, this program will help to build upon their foundational knowledge acquired in PA school and find tune their psychiatric skills. As it provides 50 CME (continuing medical education hours) in psychiatry and follows the blueprint of the NCCPA Certificate of Additional Qualification (CAQ), any PAs looking to pursue their CAQ will be well set up to do so.  This CME is unique in that it is created by PAs specifically for PAs. 

As awareness of mental health conditions continue to rise, so does the demand for services. PAs are essential clinicians who are ready and able to meet the needs of the mental health needs of their patients. 

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