In this episode, we interview the doctor who first identified seasonal affective disorder (back in 1984!) and went on to develop treatments. Even when days are short (but getting longer, little by little) and skies are gray, you don’t have to suffer with a bleak outlook. Find out what you can do to counteract this common but serious problem.

At The People’s Pharmacy, we strive to bring you up‑to‑date, rigorously researched insights and conversations about health, medicine, wellness and health policies and health systems. While these conversations intend to offer insight and perspective, the content is provided solely for informational and educational purposes. Please consult your healthcare provider before making any changes to your medical care or treatment.

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You could listen through your local public radio station or get the live stream at 7 am EST on Saturday, Feb. 7, 2026, through your computer or smart phone (wunc.org). Here is a link so you can find which stations carry our broadcast. If you can’t listen to the broadcast, you may wish to hear the podcast later. You can subscribe through your favorite podcast provider, download the mp3 using the link at the bottom of the page, or listen to the stream on this post starting on Feb. 9, 2026.

One of the most effective treatments for SAD and the similar but less severe winter blues is bright light therapy. Not all sufferers respond to light therapy alone, however. Dr. Rosenthal describes the additional approaches that improve people’s response. If you can’t listen to the broadcast, you may wish to hear the podcast later. You can subscribe through your favorite podcast provider, download the mp3 using the link at the bottom of the page, or listen to the stream on this post starting on November 13, 2023.

What Is Seasonal Affective Disorder?

By now, many people are aware that some individuals have a hard time with short days and long nights. Their appetites and sleep patterns may change, and they may retreat from social activities because they can’t get energized. They have trouble concentrating and may become irritable.

It’s as if they get depressed every year at the same time, on cue. Psychiatrists estimate that about 5 percent of the population experiences seasonal affective disorder, or SAD. That could be as many as 10 million Americans. At times, physicians may prescribe antidepressants, but usually the treatment that works best for SAD is light. Evidence suggests that the lack of sunlight, especially when someone feels stressed, is a prime trigger for seasonal affective disorder.

Is SAD Linked to Latitude?

The further from the equator you get, the more pronounced are seasonal differences in daylight. Think of a place above the Arctic Circle, for example, like Tromsø, Norway. In the summertime, they celebrate the midnight sun. In the winter, however, people in Tromsø see very little daylight. Unless they are uncommonly resilient, they could be susceptible to SAD.

Light for Seasonal Affective Disorder:

The principal treatment for SAD is light therapy, usually utilizing a light box. This must be a minimum of one foot square and supply at least 10,000 lux. That is the equivalent of being outside on a cloudy day. Generally, the prescription is for 20 to 30 minutes of exposure every morning. People who would rather not use a light box might be able to spend that time outdoors under the dome of the sky. A roof, awning or umbrella would undermine the treatment.

Approximately 30 to 40 percent of people with seasonal affective disorder do not respond completely to light therapy. They need additional help beyond light exposure alone. Exercise has been shown to benefit them, especially if it is conducted outside. Cognitive behavior therapy is also extremely helpful, as is meditation. Lastly, people with SAD may want to pull back from their usual social activities. If they can maintain their social connections, this is very therapeutic in the effort to defeat seasonal affective disorder.

The Autumn Checklist for Defeating Seasonal Affective Disorder:

Those who know that they often experience SAD should get ready before winter. Dr. Rosenthal recommends addressing the following questions:

1. Have I purchased a light box for the winter?
2. Do I have at least one bright, inviting room in my home?
3. Have I made plans for at least one winter vacation in the sun?
4. Should I check in with my doctor since I am entering my season of risk?
5. Have I notified close family members and friends that I may need extra support?
6. Do I have a physical fitness program in place? (It’s easier to keep exercising than to start.)
7. Could I reframe my attitude and look at winter as a challenge instead of an affront?
8. How can I find beauty in the colorful season of autumn, here and now?

Although Dr. Rosenthal doesn’t mention it, perhaps noticing signs of spring could instill hope. Our yard in North Carolina has both snowdrops and hellebores blooming in January, reminding us that spring blossoms will start up before too much longer.

This Week’s Guest:

Norman E. Rosenthal, MD is a psychiatrist and scientist who first described SAD in 1984 and pioneered light therapy as a treatment. Dr. Rosenthal is currently Clinical Professor of Psychiatry at Georgetown University School of Medicine. Dr. Rosenthal is the author of several books, his most recent being Defeating SAD (Seasonal Affective Disorder): A Guide to Health and Happiness Through All Seasons

His website is https://www.normanrosenthal.com/about/

Dr. Norman E. Rosenthal, author of Defeating SAD

Listen to the Podcast:

The podcast of this program will be available Monday, November 13, 2023, after broadcast on Nov. 11. You can stream the show from this site and download the podcast for free.

Download the mp3, or listen to the podcast on Apple Podcasts or Spotify.

Transcript of Show 1363:

A transcript of this show was created using automated speech-to-text software (AI-powered transcription), then carefully reviewed and edited for clarity. While we’ve done our best to ensure both readability and accuracy, please keep in mind that some mistakes may remain. If you have any questions regarding the content of this show, we encourage you to review the original audio recording. This transcript is copyrighted material, all rights reserved. No part of this transcript may be reproduced, distributed, or transmitted in any form without prior written permission.

Joe

00:00-00:01

I’m Joe Graedon.

Terry

00:01-00:05

And I’m Terry Graedon. Welcome to this podcast of The People’s Pharmacy.

Joe

00:06-00:26

You can find previous podcasts and more information on a range of health topics at peoplespharmacy.com. When the days get short and the nights get long, some people have a hard time getting out of bed. Could they be suffering from SAD? This is The People’s Pharmacy with Terry and Joe Graedon.

Terry

00:34-00:43

Seasonal Affective Disorder, or SAD, may affect as many as 10 million Americans. Is there a difference between SAD and ordinary depression?

Joe

00:44-00:55

People who are susceptible to SAD often feel irritable or pessimistic in the winter. They may have trouble concentrating and lose interest in usual activities.

Terry

00:55-01:01

Our guest today was an early pioneer in developing treatments for SAD. What should you know about light therapy?

Joe

01:02-01:08

Coming up on The People’s Pharmacy, learn about defeating seasonal affective disorder.

Terry

01:14-02:37

In The People’s Pharmacy Health Headlines: Your genes exert a powerful impact on your longevity. That’s the conclusion of a study published in the journal Science. The investigators studied over 2,000 siblings in Sweden and the United States to try and tease out the effects of nurture and nature. In other words, how much did genetics influence lifespan compared to other factors such as exercise, diet, and lifestyle choices?

The investigators tracked data from the Swedish Adoption Twin Study of Aging. Specifically, they analyzed data from twins raised apart for lifespan heritability. They also studied American siblings of U.S. centenarians.

Before this analysis, it was believed that mortality was only about 20 to 25 percent heritable. The new research suggests that genetics plays a role that’s more than double that, to about 55 percent. The authors were quick to point out that roughly half of our lifespan remains unexplained by genetics. They attribute the other half to lifestyle, access to health care, and socioeconomic factors.

They conclude their research by stating that identifying the genetic variants underlying this heritability would help us to understand the fundamental mechanisms of human aging.

Joe

02:38-03:24

A natural experiment involving an old shingles vaccine, Zostavax, adds additional data to the herpes virus theory of Alzheimer’s disease. There have been two prior studies, one involving people in Wales and the other examining data from Australia. In that research, scientists took advantage of natural experiments in which health care policies established arbitrary eligibility dates for people to receive the vaccine.

People only slightly older did not differ in other important respects, but they could not be vaccinated. As a result, the protective effects of the vaccine were clear. Those who had been vaccinated were 20% less likely to be diagnosed with dementia over the next several years.

Terry

03:25-04:21

The most recent study comes from Canada and involves people born between 1930 and 1960 in Canada. In Ontario, eligibility for the shingles vaccine was set for people born on or after January 1, 1946. Electronic health records from private practices in Ontario were analyzed from 1990 to 2022.

The absolute difference in dementia diagnoses for more than 200,000 patients was two percentage points between those eligible for the shingles shot and those who missed it by a few weeks or months.

Elsewhere in Canada, where there was no shingles vaccination program, there’s no clear difference in risk of dementia by birth date. The investigators conclude, in conclusion, this study provides strong evidence of a protective effect of herpes zoster vaccination on incident dementia.

Joe

04:22-05:07

Metabolic syndrome is a cluster of three or more risk factors that increase the chance for cardiovascular complications such as heart attacks, strokes, peripheral artery disease, along with diabetes, kidney disease, and liver problems.

Risk factors for metabolic syndrome include high blood pressure, abdominal obesity, elevated blood sugar, and high triglycerides. A study has found that six months of lifestyle interventions to encourage new habits of healthier eating and greater physical activity led to long-term benefits.

The authors point out that the evolving science of sustained behavior change suggests that unique strategies are needed to achieve sustainability, one of which is new habit formation.

Terry

05:08-06:17

Exercise may be beneficial for people with knee osteoarthritis. According to the CDC, over 30 million Americans have some degree of pain, stiffness, and swelling in their joints. Nearly half have some discomfort in their knees.

A systematic review in the BMJ analyzed more than 200 studies and concluded that in patients with knee osteoarthritis, aerobic exercise is likely the most beneficial exercise modality for improving pain, function, gait performance, and quality of life, with moderate certainty.

The authors go on to specify that patients should engage regularly in structured aerobic activities such as walking, cycling, or swimming to optimize symptom management. And that’s the health news from the People’s Pharmacy this week.

Welcome to the People’s Pharmacy. I’m Terry Graedon.

Joe

06:17-06:32

And I’m Joe Graedon. In the middle of the summer, we enjoy long days with lots of sunshine. The sun comes up early and goes down late. But now the days are getting shorter. In Madison, Wisconsin, the sun sets before 5 p.m.

Terry

06:33-06:45

Does the lack of sunlight impact our mental health? Today we’re talking about seasonal affective disorder, also called SAD. What is it and what can we do about it?

Joe

06:46-07:14

Our guest today is Dr. Norman Rosenthal. He is a psychiatrist and scientist who first described SAD in 1984 and pioneered light therapy as a treatment. Dr. Rosenthal is currently clinical professor of psychiatry at Georgetown University School of Medicine.

He’s the author of several books, including his most recent, Defeating SAD (Seasonal Affective Disorder): A Guide to Health and Happiness Through All Seasons.

Terry

07:16-07:19

Welcome to The People’s Pharmacy, Dr. Norman Rosenthal.

Dr. Norman Rosenthal

07:20-07:21

Thank you. Thank you.

Joe

07:23-07:45

Dr. Rosenthal, it’s hard to believe, but more than four decades ago, you coined the term SAD for S And I think that’s one of the best acronyms in medicine. So my first question is, what got you interested in SAD?

Dr. Norman Rosenthal

07:47-10:08

Well, the first clue, when I look back, was my own seasonality. In South Africa, where I was born and raised, the seasons are very mild. When I came up to New York City, it was quite a shock. Originally, it was the summer, the days were long, and I was giddy with delight. And I thought, well, that’s just because I’m in a new country and in a new city. But in retrospect, the long days were also driving my exuberance.

And then after daylight savings time came, I didn’t know what hit me. And I felt a rhythm of up and down that went on for three years through my residency. And, you know, I managed. I hung in through the winter. I played and enjoyed myself in the summer, but when I came to the National Institute of Mental Health here in Bethesda, Maryland, my colleagues and I encountered a scientist who actually had much more severe seasonal problems than I did.

And we had the idea to expose him to very bright light in the wintertime, and he came out of his depression, which was a wondrous thing to observe. But then I thought, you know, we’re never going to get a story unless we can collect a group of people that we can do controlled studies with and define who are these people and how do they respond to light, etc.

So with that in mind, I went to a journalist here at the Washington Post and I said, would you be willing to run an article? We just had one person, but I have a few more people who’ve given us stories like this, and she was all on board. And then we got thousands of responses from all over the country.

It was before the internet, so they all came in letters from all the states, especially the northern ones. And I sent them questionnaires, which asked them questions pertaining to the things I had seen that changed during the seasons. And from that, I put together the syndrome, which we then explored. And that was the beginning of it.

Terry

10:08-10:31

Well, Dr. Rosenthal, we remember those days when you could recruit patients for a study through the newspaper. That would be pretty hard nowadays because nobody reads actual newspapers. But you say you put together the elements of the syndrome. Would you explain that, please? What are the elements of seasonal affective disorder?

Dr. Norman Rosenthal

10:32-12:52

Well, I read through these interviews, these filled-up questionnaires, and had a growing sense of excitement because in psychiatry, there is such heterogeneity, meaning that people are so different from one another, even if they carry the same diagnosis. But these people had a sort of monotony about their symptom patterns that was thrilling to me, because it suggested that there might be some underlying biological connection that then would be more testable than if you had just a general population of depressed people.

So here was a typical story: When October comes, I feel slowed down. I can’t get my work done. It’s difficulty getting up in the morning. It’s hard to keep to my diet. I get cravings for sweets and starches. I fail at my work. My relationships seem to deteriorate and so I get depressed and it lasts through the winter, and in the spring I begin to come to life again.

So that, variants of that particular story I read again and again. And as I read one after the other, I thought, well, we’ve got a syndrome here because these people don’t know each other and yet they could be copying from each other’s playbook. And so that’s when I put pieces together.

And with the help of my colleagues at the NIH, we ran the first cohort from the summer into the winter, into the autumn to see: would they get depressed on cue? And one of my colleagues said to me, “Won’t you look stupid if they don’t get depressed?” And I thought, well, you know, I’ve been depressed and down in the winter, so I think they will be. And, you know, it’s okay to look a bit stupid. That’s not such a bad thing. Lots of us do it accidentally.

So in any event, they went into depression as on cue. And we put them through a controlled study of light therapy, and they responded. And that was the beginning of this four-decade, very exciting adventure.

Terry

12:55-12:59

Now, you say a controlled study of light therapy. How do you do a controlled study of light therapy?

Dr. Norman Rosenthal

13:00-14:52

That’s such a great question, you know, because we have struggled to find a good control. The first one was bright light versus dim light. And the dim light actually was yellow so that it had a sort of placebo effect. You know, you could have the yellow light or you could have the white light and we tried to camouflage the fact that the intensity was different and that proved to be that the bright white light was more effective. But then many people said, well, they could have guessed that, they could have known that.

And so went a long effort on many researchers’ parts to find the best placebo. And finally, a colleague of mine, Dr. Charmaine Eastman, came up with an ion generator. You know, these ionizers have been used as air cleansers, and they give off negative ions. And she went a step further and deactivated the ion generator and found that the bright light was better than the ion generator, even though the expectations of the two treatments was equivalent. And that became a sort of standard control treatment.

And basically, every control treatment has more or less worked. So the cumulative effect of all these positive studies, including ones which contained placebos that were generally agreed upon to be plausible and that they were truly blind to what our hypothesis was, have all shown collectively this very powerful effect of bright light versus whatever else we used.

Joe

14:53-15:07

Now, Dr. Rosenthal, we’ll talk a little bit more about light therapy in a moment, but first, I’m curious, how does SAD, seasonal affective disorder, differ from other kinds of depression?

Dr. Norman Rosenthal

15:08-16:21

Well, the first very typical way it differs is by its temporal association with the seasons. The other thing is that the picture of depression can vary between what’s called typical and what’s called atypical.

In the typical classical depression, people eat less, sleep less, lose weight. That’s one kind of depression, but that’s not usually what people with SAD do. They eat more, especially sweets and starches. They gain weight. They sleep more. It’s more of a kind of hibernation-type depression than a sort of over-activated, agitated kind of depression.

So from the point of view of symptom pattern, it often differs. But also the key difference is the timing. And I was going to say the response to light. However, more recently, light has been shown to be much more generally effective, not exclusively on seasonal affective disorder, but on other kinds of depressions as well.

Terry

16:21-16:26

Do we have any idea how many people suffer from seasonal affective disorder?

Dr. Norman Rosenthal

16:27-17:40

We’ve done population studies, and our best estimate is that about 5% of the general population adults suffer from SAD and another 10% from a less severe variant, which we call the winter blues. And these are not hard and fast distinctions because somebody could have the winter blues one winter and then the next winter maybe they have got deadline pressures and they are stuck in the office and they have to do their work for the deadlines and they could have a real case of SAD the next winter.

And then the following winter, it’s easier. They may go back and just have the winter blues. But if you look at it at any given time, about 5% will respond that they have really significant troubles with the winter of the kind that occur in SAD. And a 10% more would say, yes, they have trouble, but it’s not disabling. It just interferes with their best functioning.

And of course, this varies with latitude, you know, and with weather patterns. So it’s going to be much worse, for example, in New Hampshire than it is in Florida.

Terry

17:41-18:01

You’re listening to Dr. Norman Rosenthal, clinical professor of psychiatry at Georgetown University School of Medicine. He was one of the first scientists to identify SAD.

His most recent book is Defeating SAD (Seasonal Affective Disorder): A Guide to Health and Happiness Through All Seasons.

Joe

18:01-18:05

After the break, we’ll learn more about the links between latitude and SAD.

Terry

18:06-18:10

Is this condition especially prevalent in northern places like Scandinavia?

Joe

18:11-18:25

What are the criteria for selecting light therapy? Can you get light therapy outside as well as from a light box? How long should the exposure be for effectively alleviating SAD?

Terry

18:39-19:00

You’re listening to The People’s Pharmacy with Joe and Terry Graedon.

Joe

20:42-20:46

Welcome back to The People’s Pharmacy. I’m Joe Graedon.

Terry

20:46-21:11

And I’m Terry Graedon. Do you ever get the winter blues?

Joe

21:12-21:24

When the days get short, you find yourself more irritable or on the edge of tears. Are you likely to feel stressed or anxious? Have you noticed changes in appetite or sleep patterns?

Terry

21:25-21:53

The farther north you go, the shorter the days get. When we visited Tromsø, Norway, in the summertime, it was light nearly 24 hours around the clock. That city is north of the Arctic Circle, so they experience midnight sun.

But during the winter, they have hardly any daylight. How does that affect people’s mood? Turning to the United States, how does living in North Dakota or Minnesota compare to living in Texas or Florida?

Joe

21:54-22:03

Our guest first described S-A-D, SAD, or Seasonal Affective Disorder, in 1984 after experiencing it himself.

Terry

22:04-22:31

Dr. Norman Rosenthal is a psychiatrist and scientist who pioneered light therapy as a treatment for seasonal affective disorder. He’s clinical professor of psychiatry at Georgetown University School of Medicine.

Dr. Rosenthal is the author of several books, his most recent being Defeating SAD (Seasonal Affective Disorder): A Guide to Health and Happiness Through All Seasons.

Joe

22:33-23:09

Dr. Rosenthal, you just mentioned, I’ll call it latitude and climate. And so I’m wondering, do people in tropical climates develop seasonal affective disorder? I mean, what about in South Africa or in the Caribbean?

Are people just always happy and having a great time, never experienced seasonal affective disorder? And do people in, oh, let’s say Finland and Norway and Wisconsin, do they always suffer from it?

Dr. Norman Rosenthal

23:11-23:15

Well, let’s take your questions one at a time. There is…

Terry

23:17-23:19

He did pile up a few.

Dr. Norman Rosenthal

23:19-26:19

There is SAD all over the world. In South Africa, you’ll have more of it in Cape Town, which is further from the equator than, say, in Johannesburg, but it’s definitely been described there, and it’s also been described in Australia.

However, if you look at the distribution of the continents on a map or on the globe, you will see that it’s skewed north, that there’s a greater land mass in the north than in the south, so that the northern countries, by and large, are more north than the southern countries are south. Of course, there are exceptions like Patagonia and other things that are very far south. But for the most part, the north is the more affected.

That said, remember, the real cause of SAD is the lack of light. So anything that causes light to be lacking is going to be a vulnerability factor for SAD. So, for example, there are tropical areas that don’t have the dark and light seasons connected with the sun. They may have it connected with the monsoon winds. So if there are monsoon winds that block out the sky, here, for example, in the mid-Atlantic and I know in the Northeast, we’ve had this tropical storm that clouded the sky for like three or four days. And people who are vulnerable to SAD really, really felt it. I felt it was quite gloomy and overwhelming. So in places where there’s heavy cloud cover, you will get SAD.

Now, for example, Hawaii, which we all think of as sunny, we think of it as sunny because when we go there, we are in holiday resorts for the most part, and they are on the sunny side of hillsides. But on the other side, where the shadows fall from these mountains, live people who are not in these upscale hotels. They are down in the valley, in the shadow, and they are often experiencing SAD. That’s not a very well-known fact.

And the reason I really raise it is to really emphasize that it’s not just a seasonal problem. It’s a light deprivation problem. So that means that if you are in a basement apartment or in any situation where the light is not easily accessed, in like Manhattan, where you can be right up against another building. All of these settings are such that there’s not much light, and you’re going to be vulnerable if you have that biological tendency.

Joe

26:19-26:52

Has anyone done a study of a place like Tromsø in Norway, which is north of the Arctic Circle? And in the summer, it’s like it’s sunlight all day long and most of the night. So you have to have dark shades on your windows if you want to go to sleep. But in the winter, it’s dark, really dark for like 23 hours of the day. You maybe get an hour or two of sunlight. Has anybody studied to see if people in places like Tromsø are more depressed?

Dr. Norman Rosenthal

26:52-28:55

You know, it’s a wonderful question. And Tromsø is a wonderful town, and I did go and visit there personally in the midst of the winter. Some pharmaceutical company was running their symposium at that time as a PR stunt. It was the middle of the winter, and people were hunkered down into their homes. The northern lights were on display, and it was a quiet, peaceful time. But then when I went back in the summertime, people were fishing from the bridges like at one and two o’clock in the morning, and the behavior was completely different.

The question of whether there is much SAD in Tromsø is a debatable one. There is a New Yorker article that was written maybe 40 or so years ago by a man named Westbrook. And he documented going up to Tromsø and how much people were complaining about the winter. But apparently it just wasn’t the thing to complain about the winter. So they would say some things like, oh, I’m feeling terrible right now in these dark days. But really, it’s not so bad. Everybody, you know what I’m saying? It was obviously a cultural bias not to complain. But a lot of complaining occurred nonetheless.

The other thing is, realistically, you don’t end up in such a northern town north of the Arctic Circle unless you have a certain amount of resilience with regard to your seasonality. Lots of people, incidentally, when they fly south for a vacation in the middle of the winter, they fly south to Oslo for a vacation. And if you have to fly south to Oslo to get the sun, you know you’re in trouble.

Terry

28:56-28:57

Pretty desperate.

Joe

28:58-29:02

Yes, and we too have had the opportunity to visit Tromsø.

Terry

29:02-29:03

In the summertime.

Joe

29:03-29:09

In the summer, when it was sunny all day long and into the night, and it was a delightful experience.

Terry

29:10-29:58

Dr. Rosenthal, we have had some comments on our website that are related to SAD, and I would like to read you one of them for your comment. Lindsay wrote, “I live way up north and have suffered badly with SAD for years and years. Light boxes don’t help. I refuse to take antidepressants. SAMe helps a little, but I’m just miserable for eight months of the year. I’d move south if I could. Sometimes more thyroid medication through the dark months helps.”

And I could actually add my data point to Lindsay’s, which is I too find that I need a higher dose of levothyroxine in the wintertime. Your response to Lindsay’s comment?

Dr. Norman Rosenthal

29:59-33:20

Well, my response, first and foremost, is absolute fascination, because I would really want to sort of drill down and find out what is going on here with the light. You know, why isn’t the light doing any good? And I would look at the kind of lights being used, make sure there was enough light.

You know, some people are going to use more light. I would want to be sure that her eyes were functioning well, that she wasn’t developing cataracts, for example, that could block the light. And I would like to see what kind of light box is she using? Is she using a teeny weeny one, which is supposed to give out the so-called 10,000 lux, which is a measurement, but isn’t big enough? Should she be using more than one light box?

So I would go into it like Sherlock Holmes and try and figure out what is going on with the light. But then I would shift gears and say, there are many other things you can do, even besides antidepressants. And this is, and I know it’s kind of not cool to say in my book, so I’m sort of absolutely minimizing that comment. But that is the point that I have made in my new pitch here. Even when you look at light therapy studies done in research settings, you see that the number of people or the percentage of people who don’t just respond but actually remit, which means that they virtually have no measurable symptoms because they’re doing so well with their treatments. The number or the percentage of people that really respond to that degree is rather small. It’s like 30 or 40%.

So this is like a secret that 30 or 40% don’t feel 100% better with the light therapy. So you need to add things. And that’s why I say you’ve got to add exercise. You’ve got to add socialization. You’ve got to add cognitive behavior therapy, which is a wonderful tested kind of treatment for SAD. And, you know, exercise outside with natural lights. You can’t compete with a dome of the sky in terms of a light box.

One of the patients I mentioned did not like the light therapy. She instead did meditation. She did a sort of meditation, which was very helpful. And in fact, I’ve written about meditation for SAD. So you’ve got to be very skillful.

As I point out, you know, the Greek poet Archelaika said, the fox has many tricks, but the porcupine has one big trick. And I say, that’s how we should be when we deal with our SAD. We need to be like a porcupine with our big trick, which is our light therapy, but we also need to be like the fox with many little tricks, which collectively will help us get back to feeling almost as good as we do in the summer.

Joe

33:22-34:01

Dr. Rosenthal, let’s drill down on light therapy. You’ve already described that it’s not perfect, but it’s pretty darn good. What are the different devices? What should people be looking for when they start shopping around for a light box?

I suspect if they go online, they’ll find many options. How do they pick the right one for them? And then how does the light box compare to natural sunlight, even in the winter? Because even if you’re in Wisconsin, you can still get some light if you go outside.

Dr. Norman Rosenthal

34:02-34:33

Wonderful questions. Yeah, I think firstly, when you choose a light box, it needs to be big enough. And all the research studies that have shown effects of light have used light boxes with a surface area of at least one foot square. They should be produced by a reputable company that’s been in business for a while. So you know that it has sort of stood the test of time, that it has met various standards, and that it stands by its products.

Joe

34:34-34:35

Such as?

Dr. Norman Rosenthal

34:36-35:10

You mean the names of the lightboxes? I’m happy to give them to you. I’ve got them. For the first time in defeating SAD, I’ve actually given the names of lightboxes. I would say the Day-Light by Carex is an excellent one. The Sun Square or the Sunray by Sunbox is an excellent one. These are two very good brands. There’s North Star.

I’ve listed various ones. They’re big enough. They’ve been around long enough. And they put out a decent amount of light.

Joe

35:11-35:15

And I’m assuming that you have listed them in your book?

Dr. Norman Rosenthal

35:16-35:35

Yes, absolutely. I really, you know, I have no financial agreements with any of these companies. I’ve never wanted to do that because I knew it would detract from my credibility. And, but I’ve just I thought, finally, I really need to come out and be very specific.

Joe

35:36-35:44

That’s very helpful. That is very helpful. And how much light, that is to say, lux or whatever measurement we should use, should we be looking for?

Dr. Norman Rosenthal

35:45-36:04

The classic amount now is 10,000 lux of light, about three feet away from the light source. And 10,000 lux, how much is that? It’s how much light you’d get if you were outdoors on a cloudy day and you look to the sky. That’s about 10,000 lux.

Joe

36:05-36:08

And for how long, either inside or outside?

Dr. Norman Rosenthal

36:09-37:30

Well, how long is variable from person to person? It’s like saying how much Tylenol should you take for your headache? Well, one person may need only one and another person may need three. It’s variable in dosage.

But I think the thing that I want to emphasize, because if you ask me what do I do myself for my own seasonal affective disorder, I have got a number of light boxes around the house because I don’t want to have to cart my light box around with me wherever I go. I have them in the bedroom. I have them in my study. I have them by the kitchen table. I have them in my gym room.

Now, you know, that’s a lot of light boxes and it’s a lot of money. And not everybody may be able to afford that. But if you compare it to what a seven-day vacation in Hawaii costs, it’s probably much cheaper than that. And it lasts you all winter long, every single winter.

So, yes, one week in Hawaii is maybe much more fun than having light boxes all over the house. But it’s a matter of how do you choose to spend your money, and it doesn’t have to be so much.

Joe

37:31-37:43

Do you just leave the light boxes on and just walk from room to room? Or what if somebody said, well, I just want to buy one light box, I’ll put it in my study. How long should I sit in front of that darn box?

Dr. Norman Rosenthal

37:43-38:13

I would say, you know, at least 20 to 30 minutes in the morning. And I want to also mention that there are smaller lights like they’re the size maybe of a tablet, an iPad or, you know, and they’re quite good. And you could take a couple of them, and they’re much easier to walk around the house with. And you can position them like in stereo, coming from both directions to be sure that a greater amount of your retina gets bathed in light.

Terry

38:14-38:53

You are listening to Dr. Norman Rosenthal. He’s a psychiatrist and scientist who first described seasonal affective disorder in 1984 and pioneered light therapy as a treatment.

Dr. Rosenthal is clinical professor of psychiatry at Georgetown University School of Medicine. He has written a number of books, including The Gift of Adversity, The Unexpected Benefits of Life’s Difficulties, Setbacks, and Imperfections, and his most recent, Defeating SAD (Seasonal Affective Disorder): A Guide to Health and Happiness Through All Seasons.

Joe

38:53-39:06

After the break, we’ll find out how people can use outdoor light to overcome SAD. Does cognitive behavioral therapy help? How would someone recognize that they have seasonal affective disorder?

Terry

39:06-39:11

We’ll hear about the research that distinguishes SAD from other forms of depression.

Joe

39:12-39:17

Can people do anything in the autumn to prevent the onset of SAD?

Terry

39:31-39:46

You’re listening to The People’s Pharmacy with Joe and Terry Graedon. Welcome back to The People’s Pharmacy. I’m Terry Graedon.

Joe

39:46-40:05

And I’m Joe Graedon.

Terry

40:06-40:21

Are you less productive during the winter? Is it harder to get energized or organized? We’re talking about how seasonal affective disorder affects people’s emotions and behavior and what they can do to defeat SAD.

Joe

40:22-40:51

Our guest is Dr. Norman Rosenthal. He is a psychiatrist and scientist who first described SAD in 1984 and pioneered light therapy as a treatment.

Dr. Rosenthal is currently clinical professor of psychiatry at Georgetown University School of Medicine. Dr. Rosenthal is the author of several books, his most recent being Defeating SAD (Seasonal Affective Disorder): A Guide to Health and Happiness Through All Seasons.

Terry

40:52-41:14

Dr. Rosenthal, we have just discussed light therapy for indoor situations. How can people use the outdoors, assuming there is some light outdoors and they’re not above the Arctic Circle? How do they use outdoor light to help their seasonal affective disorder?

Dr. Norman Rosenthal

41:15-43:14

Well, I’m absolutely thrilled that you’re asking this question because people often get so fixated around light boxes and indoor life that they forget that they’ve got God’s light box overhead as they walk outside. And the huge dome of the sky is going to give off more light, even on a cloudy day, than you’re going to get from a light box.

Now, of course, one of the problems is when it’s a cloudy day with maybe a little bit of drizzle, what have you got? You’ve got a cap on, you’ve got a hat on, you’ve got a scarf, you’ve got a muffler. You’re not seeing any of that wonderful light. So be sure to look up at that sky, even if it’s cloudy.

Of course, you’re never going to stare straight at the sun. But look up at a cloudy sky and a magic combination is light plus exercise. You’re going up and down hills. You’re getting your high intermittent high intensity exercise going up and down hills. You’re looking up at the sky.

And all of a sudden, don’t be surprised if your SAD just falls away and you feel so happy because it’s a powerful combination. And I love the word combination because in SAD, the fox with its many tricks combines all these different tricks. So we’ve got exercise, we’ve got bright light, we’ve got light boxes inside, we’ve got social plans that we don’t allow to drop off our agenda. We’ve got help with the training with both aerobic and resistance training. We do a little bit of yoga, we meditate. We really embrace the winter in all its different aspects and collectively that’s what’s going to hold us through the winter with light therapy as the jewel in the crown.

Terry

43:14-43:25

Let’s talk a little bit about some of those individual aspects that add to the benefits of light therapy. I’m wondering if you would start with cognitive behavioral therapy.

Dr. Norman Rosenthal

43:27-45:57

Well, cognitive behavior therapy has been thoroughly explored by my colleague, Dr. Kelly Rohan up in Vermont. She’s done wonderful work, and what she’s found is that cognitive therapy was as good as light therapy in the first winter where they studied it. And then in the subsequent winter, cognitive behavior therapy actually prevented the recurrence of SAD better than the previous light therapy group. And it wasn’t actually a surprise to me because when we asked our patients in our seasonal affective disorder studies at the NIH, what was the most useful thing you learned from your participation in the program? I thought they would say light therapy, but instead they said, understanding the nature of our illness.

Because, you know, people are smart. And once they understand what causes what, they can think of all these inventive ways to overcome that cause and effect relationship. So Dr. Rohan shared a lot of her information on her studies with me, which I was able then to incorporate into my book. And she emphasizes the importance of behavior because SAD is an illness where your behavior contributes to the symptoms and you can modify it.

So the worst thing you can do with SAD is to, when you wake up in the morning, pull the covers over your head. Because that’s preventing you from seeing the light. Instead, if you got out of bed, looked out of the window, opened the curtains, put on your light box, you’re doing behaviorally all kinds of little things that are going to make a huge difference.

So the magical word about treating seasonal affective disorder, SAD, is combination. So if you combine with your light therapy, exercise, cognitive behavior therapy, a few winter vacations, maintain your social connections, and know and understand what are the factors that make you feel down and how can you reverse them, you will do a great job in managing your winter depression.

Joe

45:57-46:23

Thank you for that, Dr. Rosenthal. I guess it’s important for us to go back and review what is SAD, seasonal affective disorder. What are the symptoms? How would somebody know that they are vulnerable to maybe bad winter blues or, in fact, Seasonal Affective Disorder.

Dr. Norman Rosenthal

46:23-47:15

If you wonder, have I got Seasonal Affective Disorder? Look back. How do I feel normally at Christmas time, at Thanksgiving? Am I the life and soul of the party, or am I the one sitting in the corner because I’m feeling down? In fact, I don’t even want to go to the parties. I don’t want to celebrate. I don’t want to make all these things that a lot of people say is necessary for the holidays because I’m just not feeling myself. If you have that pattern, then you can say, do I need more sleep? Do I eat more? Do I gain weight? Do I withdraw from friends and family? Is it hard for me to get my work done? And this happens each year in the wintertime and it gets better in the spring and summer. Chances are you have seasonal affective disorder.

Joe

47:16-48:41

I’d like to share a message that we got from Teresa, and it’s a little different, and I wonder if she’s doing the right thing. So help us come up with an answer for Teresa. She says, “I really enjoy your program on KERA here in Texas. I profoundly suffer every winter from SAD, and it seems like everyone around me is unaffected. Things always seem more hopeful by February because I reside in the South. I’m always hopeful around March for the return of the light.”

“My whole life revolves around the natural, the only thing that makes me happy. I prefer to work in the winter and be off in the summer, which is rarely possible, though. When it’s a sunny day, I can’t stand to have to leave the house. I just want to sit and look out at the sun like I’m starved for those UV rays. On gloomy days, I prefer to go out for mundane activities.”

“I reside in the South, but sunny days still seem like rare gold to me. If it’s a sunny day, I love to stay home just staring out the window. The light means more than food, water, anything. If I had money, I’d book flights to the hemispheres according to the season. By that, I mean I would fly down to New Zealand in December while it’s summer there.”

So what advice do you have for Teresa?

Dr. Norman Rosenthal

48:42-50:16

The first thing I would say is that description is so beautiful because in one point in my writing, I quote the line, drink to me only with thine eyes and I will pledge with mine. The idea of drinking with the eyes is so profound to me because if you are one of those people who long for the light, you are like a thirsty man in the desert.

And when you come up with a little bit of water on your tongue, it feels so wonderful. The receptors of your tongue are responding to the water and feeling so joyful. And that’s how it is when you long for the light.

So I really think Teresa’s done a fantastic job of explaining it. Now, what’s happening with Teresa is that she is very, very sensitive to the light. And even far into the South, she misses it terribly in the winter and craves it in the summer.

So I’ve had some of those people who have actually moved down to the South. And even in the South, when there’s a lot of light for most people, they have still needed to use light therapy to supplement their natural light, even though it’s a sunny climate. So she just has the problem to a greater extent, and she needs to exercise these options that we’ve been describing to a greater degree than most people.

Terry

50:18-50:45

Dr. Rosenthal, I’m going to raise an issue that is somewhat controversial now. You introduced the concept of seasonal affective disorder decades ago, and most people accept it. But apparently, some of your colleagues are now questioning whether it is a real thing. Can you tell us about the research and your reaction to it?

Dr. Norman Rosenthal

50:47-54:17

Yeah, I know the research. What the researchers did was they looked at depression ratings in a large data set that was collected for various reasons, whether it was an insurance company or someone had these large data sets where they looked at parameters of various behaviors over the year and they looked at depression as one of them. And when they looked at that, they did not find a winter peak. It was all kind of flat.

But the problem was nobody really knew who these people were. I mean, were they people with summer depression? You know, they’re people who get depressed every summer. They’re people who get depressed every spring. They’re people who get depressed at all kinds of different times of the year. So you’ve got a very mixed database. And those people who get depressed in the autumn, you see, remember, winter depression, it’s not just winter. People are getting depressed already in September, some even as early as August, because the light is already waning in some parts of the country at that time.

So August, September, October, November, December, January, February, March, people with SAD could be affected in all of those months. So that’s half of their data. And the other half of the data, there may be summer depression, there may be all kinds of things. It’s a mixed data set where the signal has been camouflaged.

And in fact, until we looked at people longitudinally, the signal didn’t emerge. People found that they looked at hospitalizations for depression and most occurred in spring and fall. Well, most people with SAD don’t get hospitalized. It’s not that kind of depression. So when you’ve got a heterogeneous data set and you’re sampling people in this particular way, you are bound to miss a signal, whatever that signal happens to be. I’ve got colleagues who are working in similar areas where signals get camouflaged because of, like, let’s say you looked for PMS and you looked all over and you looked at it not by when people’s menstrual periods were, but when the seasons were. You wouldn’t necessarily find any link at all.

So it’s the methodology that led to a negative finding. And then the negative finding was very boldly interpreted as a complete revolution in scientific discovery, debunking 40 years of work, which I think was extremely… a very kind self-interpretation of the data by the researchers.

So I think that, yes, it’s a kind of man-bites-dog story as far as I’m concerned, and I don’t think it’s really been replicated. I don’t think much has happened with it, but it does stand out there as an interesting, controversial item that I think really doesn’t have any bearing on debunking what really is hundreds of papers.

Terry

54:18-54:35

Well, Dr. Rosenthal, before we conclude our conversation today, I wonder if you can tell us, are there things that people who suspect they might have SAD can do in the autumn to prevent the onset of symptoms?

Dr. Norman Rosenthal

54:36-54:50

That is an absolutely wonderful question. And I think we really need to have an autumn checklist. And so, may I read an autumn checklist over here?

Terry

54:50-54:51

Yes, please do.

Dr. Norman Rosenthal

54:51-56:11

Because I have one right here in my book, and it’s so important. Here is the checklist.

One: Ask yourself, One: Have I purchased a light box or boxes for the winter?

Two: Do I have at least one room in my home that is bright and inviting?

Three: Have I made plans for a winter vacation or two, in the sun?

Four: Is this a good time to check in with my doctor and put her or him on notice that I’m entering my season of risk?

Five: Have I notified those close to me that I may need a bit more support from them in the coming months?

Six: Have I put a physical fitness program in place? If you start an exercise program before winter hits in full force, it will be easier to continue when your energy and motivation flag.

Number seven: Have I evaluated my outlook to see whether it could be improved? For example, can I view winter at least in part as a challenge and an adventure rather than an unmitigated pain in the neck, as it so often feels?

And finally: How can I find beauty in this colorful season of autumn, resplendent with the fruits of summer?

Terry

56:12-56:18

Dr. Norman Rosenthal, thank you so very much for talking with us on The People’s Pharmacy today.

Dr. Norman Rosenthal

56:20-56:22

Thank you so much for having me as a guest.

Terry

56:23-57:07

You’ve been listening to Dr. Norman Rosenthal. He’s a psychiatrist and scientist who first described seasonal affective disorder in 1984 and pioneered light therapy as a treatment. Dr. Rosenthal is clinical professor of psychiatry at Georgetown University School of Medicine.

He’s the author of several books, including Winter Blues, Everything You Need to Know to Beat Seasonal Affective Disorder, and Transcendence, Healing and Transformation Through Transcendental Meditation. His most recent book is Defeating SAD (Seasonal Affective Disorder): A Guide to Health and Happiness Through All Seasons.

Joe

57:07-57:15

Lyn Siegel produced today’s show, Al Wodarski engineered. Dave Graedon edits our interviews. B.J. Leiderman composed our theme music.

Terry

57:15-57:23

This show is a co-production of North Carolina Public Radio, WUNC, with The People’s Pharmacy.

Terry

57:45-58:10

Today’s show is number 1,363. You can find it online at peoplespharmacy.com. That’s where you can share your comments about today’s interview. Tell us about your experience with SAD. Have you ever tried a light box? How well did it work for you? We’d like to hear about it. You can also reach us through email, radio at peoplespharmacy.com.

Joe

58:10-58:19

Our interviews are available through your favorite podcast provider. You’ll find the show on our website on Monday morning. At peoplespharmacy.com,

Terry

58:19-58:36

you can sign up for our free online newsletter. Get the latest news about important health stories. When you subscribe, you also have regular access to information about our weekly podcast, so you can find out ahead of time what topics we’ll be covering.

Joe

58:37-58:39

In Durham, North Carolina, I’m Joe Graedon.

Terry

58:39-59:20

And I’m Terry Graedon. Thank you for listening. Please join us again next week. Thank you for listening to the People’s Pharmacy Podcast. It’s an honor and a pleasure to bring you our award-winning program week in and week out. But producing and distributing this show as a free podcast takes time and costs money.

Joe

59:20-59:30

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Terry

59:30-59:35

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Joe

59:35-59:48

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