I'm Dr. Norman Rosenthal, Psychiatrist, Author & Scientist who first described Seasonal Affective Disorder. AMAA!

I mean no disrespect, but I read something last month that attempted to discredit SAD. Perhaps it was in relation to using light therapy as a means to mitigate its effects? I apologize for not having the link.

Having said that, I experience it every year, typically beginning with the time change.

What are your thoughts on current therapy?

No disrespect taken. Over the 30 years since I first described SAD, there have been many attempts to discredit it, yet millions of people suffer from the problem, myself included, so don't worry about detractors. Use your light therapy and reap the benefits.

I just want to thank you for your work, Dr. Rosenthal. I randomly came across a tiny article describing SAD, in my hometown newspaper, the Winnipeg Free Press, in the late eighties. It was extremely liberating to learn that I wasn't crazy, and to begin to try to take steps to deal with the symptoms.

Thank you. Feedback like yours makes my day!

Did you purposely make the acronym "SAD"?

Yes I did. At that time the mood disorders were call affective disorders, so I thought, "Why not seasonal affective disorder -- SAD" -- and the name stuck.

How can the brain suppress specific (traumatic) memories for decades, and then start to remember them? What is it that makes the brain "ready" to face those experiences?

Fantastic question. Researchers are finding specific brain chemicals that appear to be responsible for promoting such selective forgetting and remembering. On a psychological level, the brain is brilliantly organized to keep at bay memories that may disrupt growth and development and then release them later at a time when you have a better chance of dealing with them and hopefully resolving them.

What is your #1 advice for researchers? Specifically in the psychiatry field.

Psychiatry is a wonderful field for researchers -- the brain is such an unexplored frontier. I encourage all budding researchers to join the gold rush and find the key to what makes us human and the cures for many of the mental afflictions we suffer from

What's your number one advice for people who want to aid research, but don't actually want to be a lead researcher or anything like that? Like someone who just wants to help out in some way, make a real difference, writing reviews for a college, working at the psych library, anything at all. My aspirations aren't to be famous, earn grants or anything like that, I just want to contribute to humanity in some low risk way.

Here is where a good mentor would be really helpful. Look around and see who is doing research that you admire and whom you respect as a person, then approach that person and ask them if they have work that would be useful for you to do. A good mentor will then ask what sort of work you're interested in, and that will begin a conversation that will lead, hopefully, not only to a meaningful role in the research but to a professional relationship that might flourish for years to come.

Dr. Rosenthal, I want to thank you for your research. Ten years ago, through the use of a lightbox, timers and several bright lights going on at 6AM (my bedroom looked like a landing strip) I successfully treated my severe case of DSPS. Even though I only actively adhered to the light therapy for about 8 months (until I got engaged and my soon-to-be-husband moved in) I continue, to this day, to be appropriately drowsy around 9 or 10PM, vs. the 3-4AM-10AM sleep schedule I had prior to the therapy.

My question surrounds ADHD, which I also have. What are your thoughts on the correlation of ADHD with sleep and depression disorders? I know ADHD and depression are often so comorbid it's hard to see where one ends and the other begins. It seems like so many of these things are related, and revolve around the key activity of sleep and our hypothalamus. What key non-medical therapies do you think might help ADHD?

Thank you again for your work. When I did my light therapy I lived up in Northern Virginia, and I was definitely heavily impacted by SAD. I live back down south again in Charlotte, NC and the winters are much easier on me emotionally than before. Your research has changed my life.

Thanks for your comments and I'm so glad the light therapy worked. For those who don't know, DSPS is short for Delayed Sleep Phase Syndrome, a condition in which people go to bed and wake up late. We find that some people with SAD also have DSPS and ADHD. Light therapy in the morning helps the first two conditions, but ADHD usually requires separate treatment.

What do you think about the changes in the new DSM? I know that the way they categorized some things compared to in older editions was controversial to some in my University's psych department.

I don't have a very good feeling about the new DSM. In the first place, I don't why they needed a new one since I don't believe there has been sufficient advances in the area of diagnosis to justify a whole new system. I fear that thousands of hours of professional time and millions of dollars of money have been spent for an exercise that is not going to make much difference. Also, we will now have to spend millions of dollars on new manuals and waste hundreds of hours getting new code numbers in place -- all time that would be better spent taking care of patients.

just seeking some advice, i recently gave up my chance at my phD due to family issues, would you suggest that I return to my studies and gain the qualifications?

What would you like to do?

the reason I am throwing the question back to you is not so as to sound like a psychiatrist but to point out that this is your life, so your desires, goals, and motivations will necessarily dictate what is best for you to do. That said, it may be very valuable to talk with many other people such as the counselors at the program you left and weigh everybody's input as to what makes sense for you.

well my main studies are in psychology but with my final years i branched out even into biological studies. so truely i dont quite know as of yet.

Sometimes it takes a while to sort out what works for you. Listen carefully to your emotional intelligence -- in other words what interests you the most and where your heart lies. That is often the best compass in our travels through life.

I recently read an article about the correlation between the microbial health in your digestive system and ones mental health.

Do you have any comments on this? Also, what kind of research do you think could further this field?

(Link to article) http://www.theverge.com/2013/8/21/4595712/gut-feelings-the-future-of-psychiatry-may-be-inside-your-stomach

This is still a fascinating and evolving field -- the notion that most of the DNA in our body is not ours but our microbes.' As of this time, scientists don't have a good understanding of how microbial DNA relates to our mental health.

I live in Alaska, and as you likely know, daylight in the summer can be incessant while the winters seem perpetually dark. Do you think there is a variant of SAD wherein excessive light exposure leads to manic-like symptoms? Im quite familiar with the winter blues form of SAD, and anecdotally, I see some evidence of a "summer mania." Do you have any data or theories on this? Thanks!

Summer mania is all too common -- and I routinely recommend that my bipolar patients use blackout shades in their windows to prevent too much sunlight getting in during the morning and triggering and sustaining manic symptoms. I remember personally being in Alaska during the very long days and having trouble. In vulnerable people, sleep deprivation can trigger mania. In hotel rooms, blackout shades are often standard there

I've been using the light for a few years now and it's a real godsend. I have noticed that I seem to have to start using it a little earlier in the year for the last couple years. Is this normal? Is it because I am getting older (60)? Thanks.

This is a very common situation. Usually it results from a growing awareness of even the more subtle symptoms of SAD, such that as soon as these symptoms appear, you recognize them and want to do whatever you can to reverse them. MAJOR TIP: Remember to replace the light bulbs every few years as they lose their intensity without this being easy to notice. They can therefore become less effective and you might not realize why.

Does going to a tanning saloon counts as light therapy?

Typical light therapy is administered to people with SAD, sleep disorders and other forms of depression by means of a light box, that contains ordinary fluorescent bulbs, shielded by a UV filter to prevent harmful UV rays from harming the eyes and the skin -- and they work great. Tanning salons use lights with high amounts of UV rays and, even though the eyes are shielded during sessions, the skin is exposed and the UV rays can damage the skin and even cause cancer, including the potentially fatal melanoma.

[deleted]

Great question. It always makes me feel good to stay there and I strongly recommend it if your budget permits. Incidentally, thanks for injecting a note of humor -- much needed on a Friday afternoon.

Your question reminds me of the first book I wrote about SAD, which was called "Seasons of the mind," a title based on a poem by John Keats. That book later became "Winter Blues," a much less poetic but more practical title. In the Keats' poem, the poet talks about "the four seasons in the mind of man." I wonder if that's where the hotel chain got its inspiration.

[deleted]

One thing you certainly ought to consider is Transcendental Meditation (TM) there is growing evidence that this simple twice-a-day technique (20 minutes each session) can help people with all sorts of PTSD. My colleagues and I published a pilot study of TM in veterans from Iraq and Afghanistan with PTSD, who did amazingly well. There is also another study from the Vietnam era (Brooks and Scarino), as well as a newly done study of refugees in Africa. Check out TM.org for more information as well as my website www.normanrosenthal.com, which will direct you to my book Transcendence, which is a good guide to TM and what it can do, for the general reader.

"It is presently not possible to say whether meditation has any effect on health, as the research to date has been of poor quality, including a high risk for bias due to the connection of researchers to the TM organization and the selection of subjects with a favorable opinion of TM. Independent systematic reviews have not found health benefits for TM exceeding those of relaxation and health education. A 2013 statement from the American Heart Association described the evidence supporting TM as a treatment for hypertension as Level IIB, meaning that TM 'may be considered' but that its effectiveness is 'unknown/unclear/uncertain or not well-established.'"

[Source]

Further reading.

Without going into a lengthy discussion that takes us too far afield, may I simply point out that the American Heart Association has recently specifically endorsed TM as a databased alternative approach to reducing blood pressure? To pass that level of professional peer review scrutiny requires powerful data that doesn't fit the description you offer. I should also point out that your main data source is wikipedia, which we all love, but which is not really a peer reviewed source. Many TM articles have in fact appeared in the peer review literature.

[deleted]

This is such a vast area and an important one. There are so many things one could suggest in terms of how to help these people. One question I have is whether there might be any benefit in group therapy, including specific exercises whereby people are encouraged to help one another -- as a means of helping themselves

the problem with helping people with brain injury is that they are resigned to the idea that whatever they are experiencing has to do with their damaged brain. another question, why are most brain injury survivors develop mental disorder? is this because of the "damaged" brain area or because they are psychologically predisposed?

I'm sure that as you work with many different people you find that the symptoms differ from person to person, depending on the nature, extent, and location of the brain injury. Different people are going to have different challenges and abilities. I have watched along with millions of others the courage and spirit of Gabby Gifford, who was so cruelly shot -- how she has supported efforts to prevent such things from happening, etc. It's very difficult to separate out organic from psychological, but basic principles suggest that it is important for people to acknowledge their deficits and accept them, and build on their strengths of people such as yourself.

Wow, thank you for being here!

I recently watched a TED Talk by Russell Foster about how important sleep is for a person's mental health and I found it fascinating. I guess I'm wondering what you, as a psychiatrist and scientist who has focused a lot on various forms of depression, think about the matter...:-).

Again, thank you for doing this AMA! This is really neat.

Although we are not sure exactly how sleep does it nobody will question its importance. Sleep is necessary not only for clear thinking, good decision-making and well-being but for life itself. Researcher Carol Everson sleep deprived rats for several days and they ended up developing sores and dying. All of this is to say be sure to get enough sleep in order to be healthy. And I haven't even gone in to the question of fatigue traffic accidents, etc.

What are your thoughts on the term "mental illness" and any stigmas you believe to be attached to it?

I believe that the brain like any other organ can become ill, and that mental illness should be viewed like any other illness. We should all work hard to destigmatize it, but I don't think anyone benefits from our denying its existence.

Does geography help?

When it comes to SAD, geography is king. Someone who suffers in New England may love their Summers in Florida. BUT some people have such bad SAD that they need treatment even in Florida or Southern California. Also, some people have Summer SAD -- they absolutely love the Winter but suffer terribly from depression in the hot bright Summer days. For them, a different type of geography may help.

I live in the US city that gets the least amount of sunshine. I have GAD and moderate depression. I am looking into getting a light box, how often is one supposed to use it and how well does it really work?

Thank you

Did you mean SAD (Seasonal Affective Disorder) or GAD (Generalized Anxiety Disorder)? If the former, the amount of light varies depending on the time of year and your personal needs and how much sunshine there is on any particular day but usual amounts range from 30 to 90 minutes per day. For GAD there is little evidence that light therapy works.

[deleted]

My answer will disappoint you, simply because we just don't know. There is animal data that suggests a role for Stathmin, a protein responsible for forming fear memories and gastrin releasing peptide (GRP), but these are all in their early stages

Hi Dr. Rosenthal, thank you for doing this AmA.

I apologize for my questions not being related to your research or works, but I promise I will look into them. My questions are:

1. What advice would you give to someone wanting to get into psychiatry?

2. What's it like being a psychiatrist?

3. Are the only differences between psychologists and psychiatrists really that psychiatrists can prescribe medication?

4. How do you like the NIMH? I think that if I don't enter a psychiatric practice, I'd love to go into research.

As an undergraduate, I still have a long way to go before I'm a psychiatrist. But I look forward to your insights :)

Here goes: 1. I have loved being a psychiatrist. I enjoy both working with people, especially those who are having some sort trouble related to their emotional well-being, so I will never regret that choice. I have also loved my work as a researcher and write about it in some detail in my books, which you may want to check out. 2. Being a psychiatrist, like any other job, has good and bad times. When you can really help people, it's exhilarating but that's not always possible, so there are difficult times too. But you can always try your best to offer understanding and kindness. 3. Besides the prescription issue, psychiatrists go through medical training where as psychologists learn more about personality testing and other things. 4. The NIMH was fantastic when I was first there. I describe that golden era in my book, "The Gift of Adversity," then it went through a bad patch, during which I was pushed out and, to be honest, I'm not sure how it is nowadays and whether it has come out of that bad patch. It's definitely something you would want to fully explore when the time comes to see what research funding is like and the organization at that time.

What are your thoughts on the medical use of marijuana?

It certainly seems as though there are medical benefits to marijuana, for example, reducing nausea in cancer patients, but I suspect that many people who claim medical need are using the herb for other purposes.

Hi, Dr. Rosenthal. I work with adults with developmental disabilities, and every day is a different day. Nonetheless, I wouldn't trade my job for the world. I understand first hand how important research like yours truly is, and I thank you for that.

My question is, out of all the research you've conducted, what has been your most profound discovery? Also, what are your thoughts on the stigma surrounding mental disorders? What would you suggest to those who are afraid to confront their disorders and seek help? Thank you for your time!

Thanks Mike for the wonderful work you are doing and your thoughtful questions. Of all the work I have done, I think my description of SAD and development of light therapy has helped most people. More recently, my work on Transcendental Meditation and writings that bring attention to its potential benefits for so many people -- including those with disabilities -- I believe to be important. I have also done research with Dr. Eric Finzi on the role of Botox for depression, which I'm proud of. Finally, I have also written a book called "The Gift of Adversity" which distills my experience of a lifetime with people suffering all forms of adversity -- and it sounds as though you are something of an expert in that area -- with an emphasis on how to overcome adversity as well as how to harvest the unexpected benefits that adversity sometimes bring.

Hi there, Doc.

I was wondering if you or any of your peers have considered what would basically be the exact opposite of how you describe SAD, in that a person notices severe psychological effects during the Spring and Summer months, while functioning best during the colder half of the year.

I'm asking because I'm one of those people. The Summer months (especially here in Florida and other super-heated areas of the world I'm sure) always leave me feeling extremely temperamental, and I'm edge all of the time so long as it's hot outside and the sun is always in my eyes. It also affects my productivity, as I'm a musician who finds most inspiration in a more melancholy, cool atmosphere. The months between April and September very rarely see me write anything new, and almost everything else in my normal day-to-day activities takes a noticeable dip as well.

I have mild bipolar disorder, so that's likely a contributing factor. My friends always joke about how the Summer causes many things to meltdown, but mostly me.

I'll admit, I haven't done the research because I haven't put as much thought into it as I could have, so this might already be a well-known and documented disorder.

Anyhow, I just wanted to see if you wouldn't mind sharing your findings on the subject with me, as the end of Summer draws near and I'm constantly struggling with this problem.

Thank you!

Edit

Wow, I really should have read through the rest of this thread before I asked you about this! Still though, it's always nice to have a professional reassure you that you're not insane or inventing disorders for yourself.

Thank you. If you want more info on this, I have written a blog specifically about Summer SAD

Here is the link

Alright, I've just finished reading the blog post you linked, and I had to let you know that everything you've written in your list of symptoms is exactly what happens to me in the Summer months.

I really had no idea that there was such a strong link between bipolar disorder and Summer SAD. It helps to understand this, but it also kind of sucks in a way because shutting myself out of the light is what helps me, and my friends and family are always bothered when I can't bring myself to join them for picnics or trips to the beach.

I guess I can explain all of this to them, now that I know about it, but it's getting progressively more difficult to keep explaining the disorders I have without feeling like I sound self-pitying.

As you can tell from my research, I always favor natural and non-drug methods wherever possible, but remember there are wonderful medicines out there that can make life much easier because sometimes these alternative treatments can be very labor intensive and not always effective. Often the best outcomes emerge from a combination of medications plus alternative treatments.

Do you think SAD could be triggered by summer and not winter?

Yes. Check several other links, including those by people affected by Summer SAD.

[deleted]

These are great topics to research, but why confine your explorations to qualitative research? It's great but often benefits by quantitative approaches as well. This is an ideal set of interests for someone who wants to go into psychology with a research track in mind. And, indeed, I have become fascinated by adversity, including how it often delivers unexpected benefits.

Hey Doc, I found this in the Journal of Neuroscience, about using invitro blasts of light that produced decreased depression and antisocial behavior in labrats. Are you (or NIMH) exploring this Men-In-Black like technology and research? http://www.jneurosci.org/content/30/48/16082.long

Edit: Referring to the fictional Neuralyzer used to erase memory.

Hi there. Not sure what you're referring to, but light can be very powerful and effect biological processes both in live animals and in the test tube. I don't know how you would evaluate depression in test tubes however. Tough call. As for the Men In Black effects of light, we'll leave that for the movies.

Hi Dr. Rosenthal, I'm a canadian medical student very interested in Psychiatry and I just wanted to say thanks for coming out to do this and for answering questions so diligently! Your body of research and work is very impressive.

My apologies for the broad question- In a few sentences, what would be your advice to new psychiatrists looking to get involved with affective and addiction disorders? Are there any emerging treatments or therapies that you think will explode in the next couple decades? I'm really attracted to older, more intensive psychotherapies (as opposed to the standard 12 sessions CBT that's so popular these days) but it seems the practice is losing favour in the current medical model.

Cheers!

Many years ago when I was a junior psychiatrist, I went to say goodbye to the chairman of the New York State Psychiatric Institute, Dr. Edward Sachar. I asked him, "Where does the future of psychiatry lie?" He replied, "I don't know where it lies, but wherever that is, I'm sure you'll be there." It was such a kind and generous comment on his part and it stayed with me and I went on to explore many new frontiers, which would not have been imaginable even to a chairman of his brilliance -- because you don't really know where the big breakthroughs are going to be. So the best thing is to dream and hold on to your dreams, to pursue what you love even when other people disparage it and to be curious and fascinated by the journey and not just the prize. By the way, I am also a great believer in long-term therapy, which I practice myself but which is becoming harder to find or afford in our modern world of rationed healthcare. Good luck and let me know how it goes.

Hello! This is the first time I have heard of your work, but it seems your helping lots of people! I am an aspiring psychiatrist and I want to go to college for a doctorate when I get out of high school. Do you have any advice on psychiatry and how to get started? Thanks ahead of time!

Well, thanks for joining us. It's a good beginning. When I was in high school, I was fascinated by the workings of the mind and decided at age 16 to become a psychiatric researcher. So, that's about your age right now. I would recommend first that you hold on to your dream and second that you be a sponge soaking as much information as you can from articles, books, and the net. Your interests will direct your readings and lead you to the gold at the end of the rainbow.

So, I developed a sensitivity to wheat while pregnant with my son. I only discovered this recently (my son is 2). After cutting wheat out of my diet, I stopped feeling moody and depressed, and I began to experience a broader range of emotions than I had been able to. I also felt less foggy in my thinking. This is in addition to a bunch of GI symptoms including bloating and also fatigue.
I feel lucky to be back to normal, but I think a lot about the process of figuring out what the hell was wrong with me. I was considering seeing a psychiatrist for the depression, and wonder a lot about the process of diagnosing someone and how that relates to the things we don't know about the body. There are no doctors I've met that recommended cutting wheat out of my diet. But every doctor I've told since has said, "Yep, i buy it, it's a real thing." When do things become accepted medical and psychiatric ideas and practices?

Fantastic question -- and congratulations for finding the answer out yourself. It takes a long time for new information to seep into medical consciousness. I saw that with light therapy. Also, it is very hard to figure out connections -- in your case, it was happily a clear association. But I also find people who avoid all sorts of things in case they hit upon the culprit. In any event, thanks so much for your comment. I will certainly be more conscious of this as a factor going forward.

Any thoughts on MDMA as treatment for PTSD? Will it ever be approved?

I don't have any experience with MDMA, so can't comment on it with any degree of authority.

I have bipolar which is affected by the seasons, have you heard of this...?

Definitely -- many people with bipolar disorder are seasonal -- and knowing about their seasonality can help manage symptoms in all sorts of ways -- preventing both the depressed and manic phases of the condition.

Also meds wouldn't work because the way they worked changed throughout the year, making finding my level fairly impossible.

Also, although controversial, DMT has actually had longer term beneficial effects for my bipolar.

I have lots of bipolar people whose med needs change with the seasons, and you just have to keep close track of both moods and meds. Usually you can do a good job -- but need to see your doctor regularly. I have no knowledge of DMT for mood disorders.

[deleted]

You have my sympathies. I suffer from SAD too. Here are a few key tips: 1. Get more light, indoor and outdoor. 2. Anticipate sources of stress and try to minimize them ahead of time. 3. Put family and friends on the alert that this is a difficult time for you and you need extra help and support. 4. Plan a vacation in the south well ahead of time during your worst month. There are many resources to help you including the blog on my website and my book , Winter Blues, which I recently revised for its fourth edition which includes a whole chapter on how meditation can help with SAD by reducing stress at this most stressful time of year. Best of luck.

[deleted]

Just being there is a huge start in terms of helping, but I do hope that your friend is getting professional help, because it is a treatable condition. Friendship, however, is one of the best medicines we have

Hello! Being a psychiatrist i imagine you see plenty of schizophrenics or at least have. My question is have you ever considered treating a patients schizophrenia as a real thing? Basically what I'm getting at here is that shamans for thousands of years used hallucinogenic drugs in order to question our normal reality and these drugs helped them realize sooooo much of what our "reality" is, is created by our own minds. One of the main things shamans believe is if you experience something its real. So do you think there is any treatments that come close to this? Like instead of telling them they're seeing things lets treat it like they're not and find out exactly whats happening.

There are cultures where psychiatrists acknowledge the reality of the experiences of patients with schizophrenia, but recommend medicines to help them feel less upset about their experiences. In our culture, of course, we are more candid that we believe this to be an illness that needs treatment. It is probably not a good comparison to equate people with schizophrenia with people with healthy brains who are temporarily under the influence of hallucinogens.

Do you have any theories as to the cause or treatment for depersonalization disorder? Thank you so much! :)

We commonly think of what we call dissociative conditions as defenses against overwhelming trauma. These conditions include depersonalization, when one feels almost apart from one's own body or derealization, where the world feels unreal. At a psychological level, such distancing may be protective against the pain associated with trauma.

What kind of machine/instrument would you recommend for light therapy? Are there certain things I should look for or specifications I should stay within?

Look at the question above in which I detail some of the elements that I like to find in a good light box.

Hi! I just wanted to say that you are an awesome human being. Thanx, and good luck with your future endevours!

Thanks. I think we're all trying to make the world a better place together.

1. What is your opinion on the DSM-V? Is there a currently "legitimized" brain disorder that you think is a load of bollocks?

2. If you had the power/resources/knowledge/etc to create an organic being akin to Frankenstein's Monster, would you?

3. Do you think working on AI/computerized sentience could benefit psychology?

4. What are your thoughts on this article on the development of human brains from stem cells? Would you have any advice for someone interested in being able to work on such projects?

1. I stated my opinion on DSM - V above. I think all disorders that have gone through the careful process of review by experts have some legitimacy.
2. I would not spend my time and energy following the hallowed footsteps of Mary Shelley's Dr. Frankenstein. I would rather spend my time and effort helping to heal people who already been created.
3. Yes. I am sure the field of AI will become enormously important in psychology and many other fields.
4. I have not read the article but I will. Stem cell research, however, will certainly be a huge field in the future.

I think this guy might be my friends dad???

WCHS 05'

Nope; you are mixing me up with someone else

Most likely

Anyways - What brand lightbox do you suggest? I saw some at Brookstone and Bed Bath and Beyond that looked promising.

Let me first respond generically. You need light that fits into your bedroom or workspace, uses flluorescent white light (not blue LEDs), and is of a decent size -- say about 1 foot square. There are several good companies that put these out. Two of my personal favorites are Verilux and SunBox, though there are other good companies too

I'm a lurker and found this AMA through /r/psychology... Why is it mostly inactive/dormant accounts are asking questions in this thread? Seems a bit shilly to me. Whatever.

All are welcome, lurkers included. Since I am an expert answering questions in my field, I have no idea why various people are asking what they're asking. All I want to do is to provide information that can be useful to Reddit viewers. Do you have any question in which I can be of help to you?

do you feel bad conning sick people for money?

I don't think anybody should con anybody for money -- sick or healthy. Whether or not we are licensed professionals, we should all hold ourselves to high standards of morality.