I'm Dr. Norman Rosenthal, Psychiatrist, Author and Scientist who first described Winter Depression (SAD). AMAA

Yes, my colleagues laughed, but I am not alone in being ridiculed for a novel idea. The German philosopher Schopenhauer put it best when he said: All truth passes through three stages. First, it is ridiculed. Second, it is violently opposed. Third, it is accepted as being self-evident.

"All great truths begin as blasphemies"

That's blasphemous!

What a great thread. Who could imagine that blasphemy could be so much fun?

Does listening to positive music/audio in your sleep help you keep a better mindset for when you was up and throughout the day?

No evidence for that. But listening while you are awake may be a wonderful mood booster

I understand that psychotic disorders aren't your main focus, but I've always wondered how to professionally differentiate between transgenderism and a psychotic belief structure? If that sounds ignorant and inflammatory, allow me to elaborate: For example, a man who was born a man, is biologically, anatomically and physiologically a man claims he is actually a woman, has always felt more like a woman and identifies as a woman. This guy is a transgender. Another man claims he is the second coming of Christ, or hell, he claims he's really a horse, has always felt more like a horse and identifies as a horse. This guy is psychotic. Why is the first man not psychotic and the second man transspecies? I know this sounds like an absurd question, but I'm a current medical student planning on entering psychiatry, I've spent several years working in some of the more prestigious psychiatric hospitals in Boston and Philadelphia and have never had the proper platform to ask this question. Thank you.

This is such a fascinating question and I don't believe I can do it justice in this format. However, it seems as though one's sexual identity and sexual preferences (same vs. other sex) are separately influenced, possibly by intrauterine hormones or by early experiences. So, one could see how you can get variations. There are clear cases of people feeling strongly that they are one or another gender from very early on. They can be psychologically healthy and well-adjusted. That cannot be said of someone who thinks he is a horse

It's obviously a comlex issue, for example I could imagine a scenario where a man who is attracted to other men and could just as easily be classified as homosexual finds some cognitive dissonance in this notion and feels more comfortable identifying himself as a women such that he now views himself as a straight female rather than a homosexual male. In this case he allows his sexual preference to determine his gender identity. My curiosity stemmed from having a patient who had a rather complex, delusional belief structure (believing he was a different ethnicity, from a different era, and of a different gender, among other things) and started me thinking why his other symptoms taken alone would qualify him as psychotic but the gender issue seems to get a pass and is classified as something else altogether when, at its core, its a claim based on internal stimuli with no external corroboration, which in most other circumstances, makes up the basis for a delusion or psychotic belief.

Fascinating discussion. Most gay guys -- especially these days -- are OK with being gay (not that there aren't issues) but most consider themselves men. So, if someone thinks of himself as a woman there is probably something else going on rather than a denial of being gay, which has a retro Freudian feel to it (not to say it's wrong). But what a fascinating line of reasoning. Your colleagues and supervisors must enjoy your inquiring mind

Maybe the transgender issue "seems to get a pass" because there exists a remedy. Whereas the hypothetical 'horse man' has no means of becoming a horse the way a "woman in a man's body" can be made a "woman."

Reminds me of a South Park episode where Kyle's dad has a "Dolphinplasty" where he is surgically transformed into a dolphin LOL

This raises the question of interracial transformation. Both sex and race are surgically correctable, so why are racial transformations so stigmatized?

I think we are working on having all races be accepted and valued, rather than investing energy in trying to change people from one race to another

But you typically see "psychotic" delusions manifest with other psychotic features, correct? In that context, wouldn't it be more likely that the delusions are symptomatic of the psychosis itself?

If you had a client that held a bizarre belief, but exhibited no other evidence of a psychotic illness, would you treat them with an antipsychotic?

It's an interesting question, but it seems like from a treatment perspective delusions should be looked at as possible symptoms that can aid in diagnostic decisions but are not an illness in themselves. Mental health is a spectrum, and I think we start to define things as falling under the umbrella of "illness" when there's an evident impact on functioning.

You make a good point. Sometimes delusions can be circumscribed to particular areas (like old ladies that believe people are breaking into their apartments to shift their dresses around in their closets) but I get what you are saying.

I realize that I'm accessing a very peripheral part of this discussion, but the delusion you just mentioned has a very significant personal impact on me.. could you please point me in the direction of more information on "old ladies that believe people are breaking into their apartments to shift their dresses around in their closets"? My mom suffers from an uncannily similar delusion, and it's been a pretty heavy strain on the family. I had no idea this was not an uncommon phenomenon.

It is quite sad. I have seen this condition respond to medication -- sometimes really small doses. The medication can be given gently to help the person feel less upset and agitated without challenging the delusion, which rarely does any good

Nicely said.

"I'm a horse!"

Give that horse some oats!

Dr Rosenthal; I still have memories of Building 10 and the "motion/activity" detectors you used; and how they got smaller and smaller till they were just a silver metal box the size of a box of matches worn on the wrist! (And there was a minor amount of teasing at school from wearing those devices)

I do remember feeling a bit silly sitting under the full spectrum lights (and then the colored filters as well) for a few hours/day in the AM and PM when it was dark. But apparently it worked! (not that I thought it would as a kid at the time)

But thank you again for your research!!! (and the 10 year (I think) follow up after the research program as well)

Sincerely;

One of your very initial group of "Lab Rats". I'll have to tell my Mom about this (she's also a PhD in related fields, and does bio- and nurofeedback (still!))

Oh my! You take me back to some good old days. Thanks for the memories, whoever you are!

Well, I'm not about to break Dr./Patient (or in this case Researcher/Lab Rat) confidentiality on a public forum. But I was one of the younger ones in your initial group of 10~15 people (if I remember correctly, it was more then 2 decades ago, and I was in middle school at the time).

I remember the long lists of questions, and the weekly or more often visits to "read out" my activity meter (9th floor? near one of the corners? of the building, looking towards Ceder lane?), the plotted graphs of my motion over time to show how as light went down; so did my activity; and as the lights were used it went up; and then when the "correct" filters were used, it went up even more. I also remember that I liked the full spectrum lights to sit under much much more then the filtered spectrum ones. But the filtered ones were more effective. (and the cat really liked the full spectrum ones too... just like lying in a sunbeam)

Both my parents are PhD's in related fields, and I cant remember if mom was also doing research of some type at NIH or what, but you two did seem to know each other, at least professionally. (Possibly via Dr. Irv @ the Apothecary on Cedar?)

In any event; it's a rather nice little "check box" in my life history to know I was a (very small) part of helping the world to feel better in a measurable way. And I even got to know myself a lot better! (and I seem to have out-grown some percentage of my SAD symptoms... but I also know just what to do if they come back! A great feeling!)

And it's great to hear you are still doing well!!

Warmest Regards!

And warm regard to you Take care and thanks for helping make the world a better place

Have you ever dealt with the opposite effect? I get happy in the winter. Love the dark, love the cold. As spring approaches I start to get depressed. Just the thought of summer brings me down. Am I the only one?

Yes, I have seen LOTS of people with this problem. Most people with summer depression tend to eat LESS, sleep LESS and be MORE active during depressions -- this is the opposite of the winter type of SAD

If lack of light is the main problem in Winter SAD, what's the cause of Summer SAD?

Great question and sadly, we don't know; sometimes it seems like it's too much heat (and staying in air conditioned rooms helps); but sometimes my patients complain of too much light. One says "the light cuts through me like a knife". I listen to my patients and try to customize my treatment accordingly

Do you think there is an evolutionary advantage to changes in behavior seasonally? Could this, in theory, describe why SAD is so pervasive?

Yes, at some point in our history, it might have been advantageous to gain weight, eat more and slow down in winter, when there little food around. Nowadays, however, when food is available all year round, these very same behaviors are disadvantageous

Hi. I have a SAD lamp and using it in the mornings as prescribed. I know a number of other people with SAD lamps that leave them on all day. I've tried to explain how this defeats the purpose of the lamps, but to no avail.

Can you explain simply how to use a SAD lamp correctly and why?

Thanks.

It's OK to leave the SAD lamp on all day -- though not too close -- and certainly don't stare at it for any length of time One caveat: leaving it on in the office doesn't substitute for a good dose of morning light

I work in a pharmacy. During winter time we see a pretty big increase in antidepressant use (new prescriptions, higher doses, change of medication, etc.). Do you think it's pointless for so many people to be on antidepressants simply because of seasonal affective disorder? Do you think light therapy would be more efficient? If so, why don't more psychiatrists use this technique?

It's a great question as to why psychiatrists don't use light therapy more. They certainly should. I think a lot has to do with economics. Drug companies spend a lot of money to "educate" doctors to prescribe drugs. Don't get me wrong. I prescribe drugs -- but usually I prescribe light first for seasonal affective disorder

By prescribing light, do you mean telling them to go outside more often and open their shades, or are there certain types of light bulbs that help to counter the effects of seasonal affective disorder?

Great question There are many ways to get more light - going outdoors is one great method The only problem is that during the winter there is often not enough light outdoors, especially in the early morning when light therapy is most powerful So, mostly prescribing light also means suggesting artificial light fixtures

My mother tells me that going to the tanning booth helps her SAD, is there any evidence to support that?

Maybe mr Rosenthal will still answer your question, but from what I have found online, there seems to be only (but lots of) anecdotal evidence, nothing scientific. As someone who doesn't like tanning, but whose SAD does benefit greatly from session on a tanning bed now and again, my own experience confirms the anecdotal evidence.

Recent studies however, have shown that tanning might release the same kind of brain chemicals that many addictions do - and that this could be the reason tanning makes people 'feel good'. So it might help SAD, but through a different mechanism than everyone so far expected.

OK, guys and gals. Here's the scoop There are NO controlled studies of tanning for SAD There is anecdotal evidence-- and quite a lot of it Also, one controlled studies that show that regular folks that use tanning booths (not SAD folks) prefer lights with UV in them So, it seems to work BUT UV light causes aging skin and can even cause skin cancers including the potentially fatal melanoma SO I prefer regular visible light, unwrinkled skin and NO cancer But, the choice is yours And yes, UV light does cause certain skin cells to release beta-endorphin, an endogenous, opiate

What's your view on introversion? What tips would you give to someone that's deeply introverted, but still going into a social networking oriented career?

Some of my best friends are introverts. Introverts are among the most thoughtful people, the best listeners and the kindest people I know. It's just that they must reach out at least a bit so that others can appreciate their wonderful qualities

How are you doing today?

Thanks for asking I'm typing as fast as I can -- but otherwise fine

These electronic devices tend to interfere with one another. Try moving your light box a little further away from the computer and let me know how it goes

Hello, and good afternoon. I am an American who aspires to be a Psychiatrist like yourself. Any words of inspiration for the long and arduous journey?

-What are your thoughts and feelings on the current state of Psychiatry in regards to the slippery slope of diagnosing with "disorders" such as ADD? -What are your thoughts on the fascination people have with Psychopathy? There are A LOT of people who post "IamA Psycho/Sociopath AMA!" Do you believe people change their personalities to fit the Psychopath diagnosis? Have you seen it before?

Thanks for your time, I'm really stoked about this AMA!

For better or worse, we are stuck with diagnoses -- for insurance, FDA approval etc etc. I don't like to get too hung up on diagnoses. I think one reason we are fascinated by psychopaths is that most of us have a conscience, which holds us back (which is what a conscience is meant to do). Psychopaths lack a conscience, which seems to give them freedom to have sex with whomever they want, take what they want, con who they want etc etc. At some level, that may be something a lot of us would like to do, but don't. BUT psychopaths are not happy people. They don't have friends, love, loyalty, a real sense of accomplishment -- all the things that give us deep satisfaction in life. So, let's not be too quick to envy them their "freedoms"

Hey Dr. Rosenthal, I'm on track for a PhD in clinical psych, currently working at a university doing research on psychopathic prison inmates. Given your statements about psychopathy, I suggest checking out some of the recent work by Joseph Newman and Michael Koenigs. I think your knowledge of psychopathic symptoms is spot on, but you're making assumptions about etiology that imply emotional rather than cognitive deficits (the debate rages on). I only bring it up because I really think the theory behind this disorder needs to be made more public, rather than allowing mass media to influence our understanding of it.

Thanks for the awesome IAMA. Also, can I call you Dr. BROsenthal from now on? thanks!

Yes, you may call me BROsenthal Since my first name is Norman, it often gets misspelled as "Normal" Some have debated that I agree with you that psychopaths have varied and complex brain problems that may span the areas of cognition and emotion. Their cognitive problems sometimes make it impossible to understand the consequences of their actions -- or why people are so upset by what they do!

I would recommend that you focus on the journey. Not only the destination. The process of learning all the things you need to know to become a psychiatrist is so fascinating. I would not have wanted to short circuit it. Good luck, my friend

learn all the things!

That is HILARIOUS -- thanks for steering me that way

Would write a question but feeling pretty down. Believe your theory is correct.

rage give me sunlight

That is almost a haiku I LOVE it

This Friday I am going to sit down with a psychiatrist and more then likely get a PTSD diagnosis. Even though it doesn't surprise me getting the actual diagnosis in writing still scares the crap out of me. How would you suggest I prepare for getting the news and dealing with the immediate aftermath.

Edit - Totally blown away by all the support from reddit. Thanks for caring and sharing your experiences.

It seems like you have the news already -- you know the answer. Now that you will have an expert on your team, it should be on the way to getting better. You've taken the biggest step -- to reach out for help. Make sure you like the person you see == and feel that she or he understands you. Best of luck

How have you grown as a psychiatrist over your career?

I have fewer opinions than I used to have, I have become more humble and aware of what I don't know, more eager to understand and less quick to judge

What is your association with the rats of NIMH, specifically Nicodemus and Jenner?

Sadly I had no close relationships with the rats of NIMH It was my loss!

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Seasonal Affective Disorder

Do you think drug companies have affected the treatment of disease and disorders by pushing drugs that they sell? In that this type of overt "advertising" for their drugs causes doctors to overlook or ignore non-medicinal treatments or therapies which may be more effective and have less side effects?

Absolutely. So much of medicine in this country is driven by drug company advertisements -- direct to consumer. The overall goal is to push expensive drugs that are still on patent over cheaper, older drugs that have gone generic

How did you get into studying mood disorders?

I felt changes in moods with the seasons myself -- that's how I came to describe seasonal affective disorder -- and developed a treatment for it

Was it you who gave it that acronym? Does the person (maybe it's you) who gave it the acronym realize its irony?

Also thanks for taking the time to do the AMA!

Yes, I gave SAD it's name and the irony was not lost on me. You know, half of the problem in a name is getting people to remember it. So SAD it was, and SAD it has remained

You're right on time!

What is your opinion on clinical psychologists being able to prescribe psychotropic medications?

What do you think about nationalized health care?

What do you think about the new research being done on Ketamine and its effects on major depression?

Thanks!

Hi there

This is controversial. As someone who prescribes medication, I am glad to have a medical degree behind me. It can be scary -- especially when things don't work out the way you want them to.

The new research on Ketamine is very exciting. I hope it leads to drugs working on brain glutamate systems that provide more sustained benefits

I enjoyed reading both "Winter Blues" and "Transcendence". Do you have any new books on the horizon?

Thank you so much -- music to an author's ears My next book will be a memoir about lessons learned in my own life I appreciate your kind words

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I know of no data to support that -- and lots to the contrary. Many of my mood disorder patients do better when they get off it. And remember, what makes you feel better in the short term could easily make things worse in the long term. Think of all the other drugs that do that

Are there any fixes to mild SAD that you would suggest? I work out about 45 minutes to an hour 5 times a week, don't suffer from a lack of contact and have healthy relationships, but I'm just in overall worse moods during winter, to the point where working out becomes more of a chore. Is this just a grin and bear it sort of thing?

Where is the LIGHT THERAPY? Check out one of my blogs in which I describe how much light I personally need to function at my best every day? [http://normanrosenthal.com/blog/2012/01/seasonal-affective-disorder-light-therap/]

Thoughts on vitamin D deficiency? A lot of hype these days, obviously somewhat tied to exposure to light, or lack thereof during winter months.

The lucky thing about Vitamin D is that there are standard measurements for it (about 30-100 units), so you can get your Vit D level tested. Many of us have low Vit D because we don't get enough sunlight. Luckily it is easily supplemented. Remember to get Vitamin D3. Also, be careful not to take TOO much. Since it is a fat soluble vitamin, it gets stored in the body and can accumulate excessively

fairbanks alaska here, its been in the -40 range and colder for the past month along with little day light s well

being stuck inside most of the winter do you think internet social interaction ( chats,live streams etc ) is beneficial ?

and also " every day is a day closer to summer " :)

Yes, I've been to Fairbanks -- great place. The amazing thing about -40 degrees is that Fahrenheit and Centigrade is exactly the same -- which is FREEZING. I think social media would be vital at such times -- though you could also try bright light and Transcendental Meditation -- two of my favorite remedies

Do you think the "friendzone" is an actual thing? Or are redditors just looking for an excuse as to why they are single?

I"m getting educated here. I didn't really know exactly what Friendzone was. I think it could be very frustrating if one person wants a relationship to be sexual but the other one wants to keep it platonic. It's almost like staring at dessert that you can't eat -- it's bound to lead to frustration. I get the appeal. The one keeps hoping the other will change her/his mind. But it's usually a better bet to go for someone who can reciprocate what you want and can offer -- whether that is friendship or romance

I think that friendship is great wherever you find it. As I said, I have become less quick to judge. One needs to be careful of friends, however, until you know you can trust them. The Internet can easily give you an illusion that someone can be trusted, which may or may not be the case

can you tell us about the scariest encounter you've ever had with a patient/someone you were observing?

Yes. I got coshed on the head. But luckily all ended up well -- for me and for him

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Sadly, there is a question about the future of psychiatry. My son went into the field just 5 years or so ago, and is happy with his choice. I strongly advise psychiatrists against being just medicine dispensers. You miss out on all the joy of getting to know your patients and helping them personally. However, the economics are moving in the wrong direction. The training is very long. So you need to calculate the pros and cons carefully

Can you comment on the connection between circadian rhythm and mood disorders (bipolar in particular)?

Is there a connection between the sleep-wake cycle and timing of mood shifts?

I've had a lot of issues with sleep since my teens (24 now) in the form of difficulty falling asleep/waking up at earlier hours, sleeping uninterrupted for 12+ hours and insomnia. I've wondered if this has anything to do with my diagnosis of "Mood Disorder NOS" (Due to rapid day to day cycling and absence of euphoric mania).

There are very important connections between mood disorders and daily (circadian) rhythms, but they are complex. Their importance lies in the therapeutic possibility of manipulating circadian rhythms in such a way that you can come right out of a depression and stay well. Look at an article by Joseph Wu on the subject of bipolar depression and sleep deprivation -- you will find it of interest.

I had an exgirlfriend with SAD and it really took a toll on our relationship over the years. Is there anything that a significant other can do to help?

Yes -- understand, encourage, support But the person with SAD needs to do the many, many things that can make such a HUGE difference I guess, as with all successful couples, sharing burdens as well as joys is a key to the success

Hi Dr. Rosenthal,

I'm an MS2, as is my girlfriend. She's thinking seriously about psychiatry as a career. In our limited personal experience with psychiatry, it seems like the profession has shifted towards medication management only - the quick 15 minute med-check visits without any cognitive behavioral or talk therapy.

My girlfriend would really like to incorporate more of a talk therapy approach in her practice in the future. Is this type of work still financially feasible? What would you recommend as far as training/residency?

Thanks!

I'm with your girlfriend on this one. Someone asked me just yesterday if I do 15 minute sessions and I said no. I would burn out too quickly if my patients became just "sessions." My practice would feel like the drive by at MacDonald's

I know this isn't related to SAD, but as a psychiatrist, could you confirm once and for all that ADHD and other perceived "imaginary" disorders are in fact very, very real?

It always is painful for me when people try to tell me that this thing I suffer from is just "bad parents trying to shut up their kids".

Are you listening out there Once and for all ADD and ADHD are REAL They can interfere with learning and relationships and other aspects of life They also come with a gift -- of seeing the world in a special way that contributes to society

I have night terrors and scream & talk in my sleep every night; I probably wake up at least 6 times every night. I have sleep walked a couple time, but not for years. I feel horrible for my husband who nicely wakes me up from my screaming; although I never remember him waking me. Suggestions? Would going to a sleep clinic be any benefit for me? Thanks!

Yes, definitely go to a sleep clinic and get properly diagnosed and treated. You should not be suffering so -- nor your husband, who sounds like a saint!

I've heard of you! I live in Yellowknife, NT, and SAD is a HUGE thing up here. All the cool kids have it. And all the cool kids take vitamin D to try and combat it.

I'm so glad it's cool. I have always worked to destigmatize SAD. That's why I told folks that I have it myself. And my wife and son have it too. I guess we're a SAD family. But pretty happy now that we ALL use light therapy. Recently I have added TM meditation to my exercise and light, so I am pretty happy all year round

Do you miss South Africa?

Yes, I do -- in many ways. What a beautiful country. I look forward to visiting again

Do you party?

Not really. I'm not much of a party animal

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There is some evidence that UV light helps mood in winter. I summarize this in my book Winter Blues. But as we all know, UV light also can be dangerous to the skin. Conventional light therapy units screen out UV light and are the safer more tried and tested way to go

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Thank you. Have you tried regular light therapy that does NOT use UV light?

Are children in the US being prescribed too much medication ( for their mental health ), too frequently? If yes, what should be done to lower the rate at which children are medicated?

It's hard to say -- because some children really need the meds, but i'm sure others don't. But when it comes to one group of meds -- that antipsychotics, I think too many are being used -- and they have quite severe side-effects

Hi there! I'm a lifelong Alaskan, and wow... thanks for your work!! It's hard living in the land of the midnight sun. (or the opposite, in the winter)

My pleasure. The days are getting longer. Here comes the sun!

Two topics:

(1) I saw from your web site that you treat people internationally. How does that work? What do you find easy or difficult about it? How do you have to change your approach (if at all) when working with people internationally?

(2) obviously without violating confidentiality, what was the most difficult / challenging case you have dealt with?

I have treated people via Skype or the phone. Obviously one has to know the person on the other end pretty well because it could be risky if you weren't very careful

I can't say what the most difficult case was -- it hasn't always been easy -- but as with anything else, experience helps. One of the most difficult thing is to avoid feeling responsible for all the troubles in the world. That can make you less helpful to others