I’m Dr. Norman Rosenthal, the psychiatrist who first described seasonal affective disorder (SAD) and researched light therapy to treat it. My latest project is using poetry to treat patients! I am back for another AMA for Mental Health Awareness M...

Hello, thanks for the AMA!

What is your opinion on projects, such as MAPS, investigating scheduled drugs such as MDMA, psilocybin, DMT to treat conditions such as depression, PTSD and addiction?

I think it is an excellent idea, and am impressed by the latest phase 3 study of MDMA for PTSD in veterans. As long as the research is done carefully and well, with all the necessary safeguards, this is how knowledge is advanced and new treatments are developed.

What do you think of the adverse and often detrimental effects of Vogon poetry on the mental health of people?

I gather that Vogon poetry is very bureaucratic so it would not be my first choice as a therapeutic option.

I moved to a less sunny climate and felt SAD-type symptoms for a few years (love my special lamp) until this year, when I spent a lot more time in the sunlight because of work-from-home.

Are windowless offices really an exacerbating factor?

How can people in these environments do more to avoid SAD? How can our employers help?

Yes, windowless environments are bad for people with SAD. I recommend walking outside as much as possible and employers should certainly reimburse for therapy lamps. Also, it may be possible for employees to motivate for offices with windows on the basis of their medical need.

i love this question.

what light therapy lamp do you use?

If you are in the U.S., the light therapy box that I personally use at my desk is the Daylight by Carex, which also has a smaller version with a handier footprint called the Theralite. In my bedroom and exercise room, I use the Sunsquare, the largest box commercially available, which stands on a tall stand so that it projects the light into the room. If you are in the UK, I recommend you check out the products by Lumie, which has outstanding light boxes as well as an excellent dawn simulator called the Body Clock which I personally use. You might also look into the SAD Box Company, which has some excellent boxes as well.

I experienced complex grief 3 years ago, and the only thing to help was a short, simple poem by Ursula Le Guin. I ended up memorizing it and found it to be healing in an inexplicable way. Is this a similar effect?

Thank you so much for sharing this. I would love to know the poem. Could you share that with the group? It is a perfect example of what I have tried to communicate in Poetry Rx, where I have selected 50 poems that in my experience have the capacity to heal in many different circumstances -- including grieving -- it sounds like you have discovered yet one more brilliant example of this general principle.

hello Dr. Rosenthal -
I am a bipolar doctor, just graduated from Stony Brook - I began writing poetry as a form of self-therapy during medical school, after a suicide attempt; other than medications and sleep, poetry has been my most effective form of therapy. I was hoping to train in psychiatry, but unfortunately I did not match into any residency program. I doubt I will be able to match into residency next year either, and so I am currently prioritizing law school applications. I am still passionate about becoming a psychiatrist or otherwise helping that patient population - do you have any recommendations for alternative paths to explore?

I also have one specific question - I have explored the possibility of using light therapy to treat my SAD, but my psychiatrists have cautioned me that it has been associated with conversion to mania. Is there any way to tell whether light therapy is worth the risk for depressed bipolar patients?

thank you very much for your work, and for your availability in this forum.

Thanks for your comments and questions. You sound like a gifted person with significant challenges. It is difficult for me to judge what steps you would need to take in order to become a psychiatrist and I hesitate to be superficial on this particular forum. As for the use of light for SAD, there is a chance of triggering mania, but if done properly, this can be avoided. In fact there is a recent article out by Dorothy Sit, which showed that light therapy can help bipolar depression. Best of luck

Thank you for your research. I live in a place with less sunshine and I believe its because of your research that I became aware of my vitamin D deficiency and was able to treat it.

Question: Besides taking vitamin D are there other practical ways to combat SAD? Like fake uv light?

Just to be clear the light therapy used for SAD does not involve UV which can be harmful to the eyes and skin. It is only visible light, but enough of it coming from the light therapy unit to make a difference.

Other effective ways for treating SAD include:

1. Stress management
2. Exercise
3. Going outdoors on a winter day
4. Staying social and not depriving yourself of positive stimuli
5. Meditation
6. Keeping yourself well informed. You may find my book Winter Blues helpful in this regard.

If you don't mind me jumping in here: I don't have SAD but I have major depressive disorder. My doctor ran some tests and found out that I had a severe vitamin d deficiency.

I was "prescribed" a light box to improve my production of vitamin d. After decades of depression, I'm doing so much better. Daily use of the box, coupled with meds and therapy, has changed my whole quality of life.

Vitamin D deficiency I recommend Vitamin D3 supplementation. Whereas light therapy can be very helpful for SAD, it is not helpful for Vitamin D deficiency because it uses visible light not UV light.

yo, why'd you name it SAD? I basically have to say the "seasonal affective disorder" all out, because otherwise if I tell somebody I have "sad," they won't take me seriously.

Most people just love acronyms. They help an idea stick in the mind. But hey! It's your condition so feel free to call it whatever you like.

Hi Dr. Rosenthal! How did you discover poetry to help heal? Was it a happy coincidence or something you had observed previously that you wanted more information on?

When I left South Africa with my young family, I left my parents behind. They were generous and kind to let me go without making me feel guilty. But I didn't realize that I felt guilty anyway. In retrospect, that was the reason why I kept reading a poem called Letter to my mother, which is now one of the poems in my collection Poetry Rx. In that poem, the poet Salvadore Quasimodo writes to his mother who is now an old woman, expressing his gratitude at her for sending him to the north of Italy to find his fortune. It is a very beautiful poem, which I recommend, as I do the other lovely poems in Poetry Rx.

Do you think, like poetry, fiction (prose, longer and in narrative format) can also be used in a structured way for therapy?

I think that all literature offers consolation and ideas that can improve one's life. I remember for example one of my patients whose home life had been very depriving and traumatic. He used novels as a way of seeing how other people lived to inspire to live a better life. For example, he couldn't believe that in some families people wake up and have breakfast together and talk about things of mutual interest and wish one another a good day. It was a revelation to him and he determined that when he grew up, his family would be like that.

Why I have settled on poetry is because the therapeutic elements can be condensed into a short space, which makes it ideal for our busy lives.

Have you done any research into how this affects people born and raised in northern areas? In Iceland we have been aware of this and coined the term "short day depression".

The frequency of SAD does not seem so much a result of where you were born and raised, but is apparently genetic to some degree. In fact, even though Iceland is so far north, the prevalence of SAD there is relatively low. And I also have heard of your short days depression, which my Icelandic psychiatrist friend, Andres Magnusson tells me is called skamdegistunglindi (excuse spelling)

Dr. Rosenthal, I believe you are doing some pioneering work on TBI and ultra rapid cycling bipolar. Is there a correlation between lunar tidal periods and mood disorders? Are there any resources like a calendar that would give a heads up as to high/low periods?

I am looking into a study of Transcendental Meditation for TBI (traumatic brain injury) but not rapid cycling at this time. I would recommend you look for articles by Thomas Wehr on the influence of lunar cycles and mood and menstrual cycles. To my knowledge no resources are available at this time for using this information. However if you feel it is relevant to you daily ratings, even very simple ones, over time might give you a basis for developing customized interventions with the help of experts such as Dr. Wehr or Dr. David Avery in Seattle.

The days should be getting longer in the spring so what causes April/May/June to be so awful?

There are so many things that can cause people to feel bad as the days are getting longer. Let me count the ways:

1. Some people find long days agitating and disrupting of sleep.
2. Some people get depressed in summer, perhaps because of the heat or too much light.
3. Summer can bring other problems, such as allergies, bug bites, sunburn etc.
4. You may be surprised to learn that suicides peak in the summer months and so does violence.

How would you recommend someone who can't turn their brain off/stop thinking to start meditating?

I have clinical depression and generalized anxiety disorder, I think meditating would help me, but I cannot stop thinking. I cannot turn off my brain, I'm constantly running through thoughts and scenarios in my head. This is a major part of my anxiety.

I think if I can learn to turn my brain off and meditate, it would help me a lot. So do you have any suggestions?

There are many different ways to meditate. The one that I know most about is Transcendental Meditation (TM). One thing I really like about TM is that you are not expected to turn your thinking off. It is taught by professionals who are highly skilled in the practice and in getting people to learn it. One element in the practice that you are not expected to turn off your thoughts. Instead you are taught to think a mantra or word sound in a way and your thoughts somehow take care of themselves. You can learn a lot more about this technique on my website

What do you suggest if someone is definitely aware they suffer from depression (diagnosed even); but part of the problem is they feel they deserve it? Or like, they don't feel they have earned happiness, sort of thing...?

A feeling of being undeserving is a symptom of depression. Nobody deserves to suffer from depression. I recommend that you override that feeling and get help. It is such a painful condition and so treatable that I see it as a human right to get help. So I recommend that you override the feeling of being undeserving and get the help you need.

Since sunlight exposure has such a big impact on mood yet many people spend most of their time indoors what recommendations do you have for increasing total sunshine exposure over the course of a week? Do you think focusing on being out at solar noon once a day for 20m is enough? Thanks!

Get outdoors whenever you can. I go walking everyday rain, snow or shine with few exceptions. Look up at the sky. Even if it is cloudy, a great deal of light will come your way.

Hi Norman,

Why is that sad songs and poems make some people happy, while others get sad from sad subject matters?

Personally, I’ve always had an affinity for sad music because it was full of authentic feelings and I’ve felt a deep connection with the artist. Has your project into poetry and healing had any similar results?

Dear Meow Mox

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It is strange how sometimes sad songs are just what we need. It can feel comfy to know that others are sad but were still about to live, love and be creative. Often jolly jingles are very irritating to sad people, but as you say, it varies. So the best bet is for each person to gravitate to poems that they feel resonate at that moment. That is one reason I included a lot of different poems in Poetry Rx to cater to many different tastes.

Have you seen evidence that weather affects depression? I know that SAD is affected by short days and limited light exposure, but what about people who live in areas that tend to be more overcast or get a lot of rain, in comparison to those who live in sunnier areas?

Weather certainly affects mood. As you point out, it's not just short days but bad weather that contributes to bad mood.

I experience SAD, but have also struggled a lot with MDD and anxiety. Is SAD something that people either have or don't have in response to a lack of sun, or is it more like a symptom that comes and goes from other psychiatric conditions?

For example, if my overall mood and resilience improved, would I be able to handle living in Portland more than I would now (which is to say I'd never even try to live there because I think the gloom would kill me)?

Thank you!

Firstly, I'm sorry to hear that you have so many challenging things to contend with. SAD can occur side by side with other problems, such as you describe. Each problem needs to be dealt with on its own merits though sometimes the treatment for one can help the other. For example, light therapy for SAD can help your MDD and vice versa. Best of luck

I have a degree in creative writing and love myself a great poem. I too believe that the power of reading an impactful poem can be transformative as therapeutic.

I’m curious, did you study how different forms of poems affect people?

Is it possible that the differing forms could impact different people with different diagnoses?

Did you look into clients writing their own poetry? I could see there being a benefit to the intentionality involved in writing poetry to help distill and concentrate experiences and emotions (which is why we write poetry to begin with).

Also, was there a difference in how clients communicated their thoughts before reading the poem vs after?

Do you think the poems influenced the clients in a way where it may have been a sort of “lead”? (Think like a journalist asking a leading question....)

Thank you for you time! I’m super curious in this work!!

Thank you for your terrific questions. Here are some answers:

1. There are no formal studies of poetry as of now. It is all at an anecdotal level, but all treatments begin as anecdotes, as was the case with light therapy for SAD.
2. Different people will respond to different poems. Someone who has just broken up in a relationship will respond to one poem for example, whereas someone deeply in love will respond to another. I included 50 poems in Poetry Rx to cover many different life circumstances.
3. Although it may be therapeutic to writer their own poems, that is not the approach I've taken. Rather, I have focused on the receptive aspects of reading, hearing and reciting carefully chosen poems that have stood the test of time.
4. Any treatment intervention will have placebo effects. If someone reads a poem I recommend and feels better as a result, I'll celebrate it whether or not it is a placebo.

First, thank you so much for all your amazing work! I'm very interested in your new book and would love to know if there are certain types of poetry or specific poets who help certain types of patients? As a young girl I discovered Dorothy Parker and her poetry helped me through depressive times, feeling like I was understood and connecting to her (mostly also depressing) words. Thank you for your time!

Thanks for your comments.

My book Poetry Rx is divided into 5 sections that correspond to different areas in which poetry can be helpful:

1. Loving and losing
2. Responses to nature
3. The search for meaning and a design for living
4. Various aspects of the human condition
5. The last phase of life

You can find out more about the poems on my website. Here is the relevant link:

https://www.normanrosenthal.com/poetry-rx/

2 questions:

1. Is vitamin D supplementation sufficient to combat SAD?

2. Did you ever live in New England? I only ask because my mother bought a home in one New England state and she had a story about a former owner coining seasonal affectiveness disorder - there was a room in that house above the garage with tons of natural light supposedly to help his daughters case of SAD.

Even though some people swear by Vitamin D supplementation as a way of treating their SAD, there are no actual studies to support that.

And no, I have never lived in New England.

Hi Doctor Rosenthal, penultimate year medical student in the UK, with a strong inclination to do psychiatry. What psychiatry specialty would you recommend for somebody who has strong interest in the arts as a therapeutic tool (specifically music and literature)?

I would find a training program that would be broad minded and sympathetic to the arts. I remember when I was a resident initiating a seminar/discussion group in which my group of residents considered the influence of loss on poetry. In retrospect I think I was dealing with my own loss of my home country and family and using poetry as one means of doing that. To the great credit of my program, both faculty and residents were very receptive of my suggestion, which was quite innovative at the time. It's that sort of openness that I would be looking for in a program you choose -- in addition to all the other necessary components for being a good psychiatrist. Best of luck

What’s your thoughts on a full moon making patients more agitated on psychiatric units?

I'm not sure whether the full moon makes people more agitated though it could do so if it interrupts people's sleep. However, my colleague Dr. Thomas Wehr has written some brilliant articles showing a previously unknown connection between lunar cycles and moods.

Does SAD specifically occur more at higher latitudes or in places that get less sun such as the UK or some areas in the US like the Pacific Northwest? Also are there perhaps other confounds involved that are not directly tied to light?

The answer is simply yes. In the U.S. when you go up as far north as New Hampshire the frequency of SAD has been estimated at 9% as compared with may 1.5% in Florida.

Hi Dr. Rosenthal,

Would you recommend poetry to treat trauma in addition to depression?

Yes, yes, yes.

I think poetry is a wonderful way to process trauma. One poem in my collection Poetry Rx that addresses that question is The Sentence by the brilliant Russian poet Anna Akhmatova. Check it out. Trauma is such a profound and central shaping force in our psychological development that it is an area ripe for poetic exploration. Thank you for this question.

What are your thoughts on "reverse" SAD that's worse in the summer? I'm particularly curious about whether summer anxiety versus summer depression versus regular SAD are all aspects of the same underlying conditions, or unique conditions.

Thanks for doing this AMA!

I see summer SAD and winter SAD as two separate conditions except that all depressions may have elements in common. Currently even after all our research we still don't know what unites or separates different kinds of depressions. The link between light and SAD seems one of the most tantalizing clues as to what special physiology underlies the winter SAD depression.

What is it about poetry that makes it useful for treatment?

Poetry deals with life in all its pain and glory, heartache and ecstasy. It looks at nature and human beings and everything else with a charmed eye and warm heart. That's what makes it special.

Dr Rosenthal,

I have been reading, learning and reciting poetry since I'm a child (mostly Goethe) and I totally get the comforting part. Sometimes I automatically start reciting poems to myself and I often get asked if I'm praying. I'm certainly not, as I am an agnostic but it came to my mind, that maybe it has the same effect as praying for some people. What do you think about that theory?

Also, poetry is really inspiring, I'm always amazed how beautiful poets can express themselves, like you could really feel their longing, passion, griev ect just by reading words.

You are really speaking to me here -- not only as a fellow poetry lover, but one who really gets the healing power of poetry. Could you share some of your favorite poems with us, ones that you have found particularly healing or soothing? I don't know much about Goethe's poetry, but would love to know more. Where do you suggest I begin?

How do you feel about the use of psychedelics in the treatment of depression?

At this point psychedelics are still under investigation for the treatment of depression. I recommend that in general they be given only as part of research programs and certainly not in a DIY fashion. Two exceptions that have been approved by the FDA are ketamine and esketamine, which should be used only by authorized providers, who have undertaken special training in their usage.

Psychedelics, by all accounts are great at helping people through things like depression, PTSD, anxiety etc. Anyone saying otherwise is ignoring the results achieved by these methods because of some underlying moral objection. Which you might say is a bad approach to medicine.

I agree with you that moral objections should have no place in giving people safe and effective treatment. Although I am all for novel and experimental approaches, we need to balance care and safety against novelty. So, once all the safeguards are in place, we can proceed with novel drugs e.g. psychedelics. In the meanwhile, I celebrate the existence of novel approaches that are safe, such as meditation and poetry.

Hey Doc! No better person to ask you a question than someone who lives in 19.5hrs of darkness a few months of the year. I live in Alaska. I've never had SAD and the dark has never bothered me up until I had kids. We still do outdoor activities in the winter of course, but from your research and discovery, why would someone not have SAD and then develope SAD after having kids? Thanks for what you do and taking the time to read and answer my question!

This is a very difficult question because I have never exactly encountered it before. When kids are very young, their waking and sleeping can disrupt our sleep and circadian rhythms, could that explain it? Or the stress of being a parent as well as everything else you have to juggle? Were there things you were able to do before to help your stress that our now difficult? Or did something else happen at the same time you had kids that explains it? I know, lots of questions and no answers. Try to be your own detective.

Hi Dr. Rosenthal! Your work is great and I’m so excited to see you participating in Mental Health Awareness Week. I am curious to hear your thoughts on how melanin levels interact with SAD. I have close friends who live in Northeast US states. Some have lighter skin and don’t seem to suffer with SAD. Others have darker skin and tend to suffer more. Is it possible that the level of melanin in one’s skin predisposes them to SAD? Would light therapy be different for people with varying levels of melanin in their skin?

Note: I’m well aware that anti-black racism is likely a confounding variable. It may be difficult to isolate epigenetic/socio-political factors when conducting research.

Thank you for your comment.

Since the antidepressant effects of light therapy appear to come through the eye and not the skin, I think it is unlikely that melanin plays a significant role in its development. Certainly there are psychological challenges that go along with belonging to different racial groups that very likely override any biological influences that may exist. (though I want to emphasize that no such biological differences with regard to mood disorders have to my knowledge been uncovered)

Good afternoon, Dr. Rosenthal! I hope you're doing well. I have a some questions for you if you don't mind. Feel free to pick and choose what to answer if it seems like a lot!

1) Do you think mental disorders like SAD would have affected our ancient ancestors? I'm thinking less along the line of Ancient peoples and more like the species of the Homo Erectus. And also, if it did affect other hominids that weren't our ancestors, like the Australopithecus and maybe what that would look like.

2) If SAD is less common among people who live near the equator, do you think they'd view mental disorders like SAD differently? I know it varies with different cultures but would the social stigma (or lack thereof) be different?

3) What do you think about astrology? More specifically, the idea that the planets can somehow affect people's moods worldwide. I know the mercury being in retrograde is a big thing for some people and I admit to considering the idea more than once.

And finally, I just wanted to let you know that I really appreciate everything you've done. It's very validating and quite a big relief finding out about things like SAD. Especially when I would've usually chalked it up to me being a terrible and lazy human being. Of course, it doesn't excuse everything but giving things a name make them feel way less powerful. Less like something inevitable and more like something I could overcome. I hope your research with poetry as a treatment goes well! Best wishes!

All I have time to respond here is to say thank you, for your creativity, curiosity and kindness.

Dr. Rosenthal, do you think doctors are prescribe drugs too frequently or with ease? I have heard people (some medical professional mostly not) criticize the medical system for jumping to drugs instead of other threapy/treatment plans.

I would hate to generalize. Like all other professionals, there are good and bad doctors. One thing that may incline doctors to jump to medications too quickly is that they are often under terrible time pressures and it takes a long time to listen to people, ask questions carefully and customize your treatment approach whereas it takes just a few minutes to write a prescription. One reason why I have spent time researching and using alternative treatments like light therapy and poetry is to provide an alternative to medications. That said, when medications are indicated, I will not hesitate to prescribe them. They can be life changing if properly used.

I do find words inspiring and uplifting, but am not a huge reader of poetry. Do you have a poem that would serve as a nice gateway into the world of “poetry for healing?”

A wonderful poem by the Persian poet Rumi is The Guest House which argues for the value of not only accepting your feelings, but actually welcoming them even if they are "a crowd of sorrows"

What's your favorite depressing poem?

What's your favorite inspirational poem?

My favorite depressing poems are "Stop all the clocks" by W.H. Auden and "One Art" by Elizabeth Bishop and my favorite inspirational poem is "Hope is the thing with feathers" by Emily Dickinson. Of course, I have included all three of these poems along with take away lessons that the poems teach us, and short bios of the brilliant poets who wrote such inspiring verses in Poetry Rx.

Does SAD only occur due to winter/less light or can there be a 'summer SAD'?

There definitely can be summer SAD. In fact I have a whole chapter on that subject in my book Winter Blues.

Hey, so you know about the luminette glasses? I am thinking about getting a pair but they have way under 10,000 lux. What so you think about the efficiency of a 1,500 lux device?

I know of no data that speak to the effectiveness of this device. Maybe that's just my ignorance or maybe data still need to be developed.

I want to thank you for your work. I was in my 30s before being diagnosed, about 30 years ago. Treating this helped avoid major depressive episodes. It did however become much more acute after menopause. Is there any research on the role hormones play in it?

Hormonal fluctuations have been found to trigger depression in some cases. You may want to consult your doctor to see whether hormonal adjustments might be helpful.

I see some questions about bipolar. My cousin has bipolar disorder and I worry for her. Do you have any advice? Are there any promising treatments?

Luckily there are many many treatments for bipolar disorder. I hope that your cousin gets in the hands of a competent psychiatrist. If she has not so far, that may be the best way for you to help her.

I think I might suffer from SAD. What resources would you recommend for more information and treatments?

You might want to check out my website normanrosenthal.com , which has many blogs and tips on treating SAD and also my book Winter Blues, now in its 4th edition.

I continuously tell my self everyday that I am not depressed, am I depressed ?

When you tell yourself you are not depressed, do you succeed in persuading yourself or is there a little voice that says very quietly, "Well, actually I am." You are the best person to answer this question. But usually we don't keep asking ourselves something if there isn't a hint that it is there.

Is it possible that a lot more people than we think are currently on a sort of spectrum for SAD? I’ve noticed improvements in my mood as I’ve sat outside in the sun for a while in the nice weather. I’ve seen others feeling happier too.

Definitely. We estimate that there are two to three SAD spectrum people for everyone with full blown SAD. It sounds like you may be one of them who has found a solution.

I'm actually looking for more books of poetry on Audible. I found this book but there was no sample - only the option to preorder? Checked Goodreads and there is only 1 review and that reviewer rambled on. I have had great comfort with T.E. Eliot's " Old Possums Book of Practical Cats " which I got on Audible so I could fall asleep to the poems. Also Bukowski's book " On Cats " is another book of poetry I got in audible form and listen to that sometimes when I'm going to sleep.

I'd love to find out more about the poems in your book? as I can't handle too many sad poems but your book sounds great. I have precious few and I'd like to add to my collection. Thank you for your time and contribution. Best Regards.

Incidentally, I know how many people love cats and certainly T.S. Eliot's book is a charming example about how different cats have different personalities and enchant in different ways. I think a creative way to use poetry to find whatever it is that gives you comfort and delight is to look up poems that play to your special interest. In Poetry Rx for example, there is a whole section on responses to nature for those who love the natural world. There are two poems about flying (4 if you count Icarus). And so it is that whatever you love and whatever cheers you up, you will find poems about that.

Many poems in my book are uplifting from Shakespeare's sonnets to Jack Gilbert's Failing and Flying to Wordsworth's Daffodils and Tintern Abbey and Emily Dickinson's Hope is the thing with feathers. From Kipling's If to Langston Hughes' Dreams. I could go on and on. The strange thing is that many people gravitate not so much to cheerful poems but one's with which they can empathize, which offer ways of finding hope and renewal even when things seem rough and gloomy.

Hi Dr. Rosenthal!

Thanks for all of your great work. Have you studied SAD here in Finland?

Thank you. No I have not studied SAD in Finland but I know that your far northern location makes it a big problem. In fact, I have heard that you even have light therapy units on the buses in the winter. Enjoy the long summer days while they last.

Hi Doc, thanks for doing this AMA!

I’m in the Southern Hemisphere and have always found myself to be lethargic and even somewhat depressed in the autumn months. How does the shortening of days factor into SAD?

Short days are short days, regardless of which hemisphere you are in, and lethargy is very common as the days get shorter. Use all the same advice that applies to those in the northern hemisphere, just at the opposite time of the year. Best of luck

Did you choose the acronym or name for the disorder first?

I chose seasonal affective disorder and SAD more or less at the same time. I realized that the full name would make for a snappy acronym. It was of those aha moments!

Hotdog.

Is it a sandwich?

It could be a dachshund on a mid-summer day unless it is a sausage on a roll with mustard.

Hi Dr. Rosenthal, thanks for doing this AMA. I have had struggles through the winter since college and at certain latitudes. I grew up in So Cal 34° N and now live in the SF Bay 37° where my mood is much worse from Oct. through about March. For the first time because of the pandemic I was supplementing with Vitamin D, but I noticed my mood was much better while on Vitamin D. Thinking about this and about findings of lithium levels in municipal water supply, how much can we attribute light and levels of nutrients and minerals to mood? Are these different sides of a similar problem (light treatment maybe does a similar thing physiologically as vitamin D supplement may be doing)?

As I said before, there is no evidence of Vitamin D helping SAD based on scientific studies, though many people swear by it. Certainly if levels of Vitamin D are low they should be supplemented with capsules. As far as lithium is concerned, there is not enough in the public water to make a difference in mood. If used, lithium should only be given under strict supervision because too much is toxic.

Hey Doc, thanks for the AMA. I always get in the winter funk for three or so months, what can I do to be proactive in the Fall to mitigate the symptoms this year? Thanks!

What you call the winter funk others might call subsyndromal SAD, which should respond to all the treatments that work for real SAD. Scroll up to see what they are, but I should add getting one or two vacations in the sun if you can do so. Also, start early with light therapy or a dawn simulator in the fall to prevent its development. At the risk of being accused of advertising, check out my book Winter Blues, which is a complete survival manual for anybody who has a funk in the winter.

What’s your advice on what to look for in a light therapy lamp? Can I get something like a light bulb that’ll do light therapy?

I’ve been having trouble with flicker from LEDs, is that related at all to your work or can you recommend experts?

Be careful about do it yourself approaches. For example, staring at a lightbulb can be harmful to the eyes. I am grateful that we now have excellent light therapy companies, whose products meet safety standards and the test of time. See above for specific examples and avoid DIY approaches.

I'm up to 20 mcg of melatonin a night. I've tried cutting it out of my routine with no luck. Any ideas?

20 mcg is actually a very small dose. Perhaps you mean 20mg, which is a large dose. It's not clear to me what happens when you decrease that dose, but certainly it is out of line with what people usually use. Perhaps it is time to check in with your doctor about it.

Ya got anything for my tinnitus, doc?

Tinnitus or ringing in the ears is a very vexing and sometimes disabling symptom. I presume you have had it checked out by a competent ENT person because sometimes infections or allergies can contribute. Avoid loud noises, which can exacerbate it. Sometimes even if the tinnitus itself can't be eliminated, it is possible to adjust one's attitude towards it from it being a terrible nuisance to something you can learn to live with -- like the noise of secadas buzzing on a summer night. Good luck