The Q&A: Iram Kazimi

With each issue, Trib+Health brings you an interview with experts on issues related to health care. Here is this week's subject:

Iram Kazimi is an assistant professor and residency training director in the Department of Psychiatry and Behavioral Sciences at the University of Texas Health Science Center at Houston. She was named director of an inpatient unit at the Harris County Psychiatric Center. Kazimi’s research focuses on pediatric bipolar disorder. 

Editor's note: This interview has been edited for length and clarity.

Trib+Health: What exactly is seasonal affective disorder?

Iram Kazimi: Seasonal affective disorder is really a type of depression that’s related to changes in the seasons. The qualifier for it is that it usually begins and ends at about the same time of year, every year. 

It’s a disorder in and of itself but it can also present in people who have depression or even bipolar disorder. So that’s why it’s really important to identify what time of the year the mood is changing. 

The majority of people have seasonal affective disorder in the winter months, but there’s an uncommon subtype that actually happens in the summertime.  

Trib+Health: Why does something like this happen? How can people be so extremely affected by changing seasons?

Kazimi: There’s some theories as to why seasonal affective disorder happens. Most commonly they talk about changes in the melatonin, which is why it usually happens in the winter months. The brain chemistry changes a little bit and there starts to be a deficiency in the melatonin, so that can account for seasonal affective disorder. 

Trib+Health: How can someone know if they’re suffering from this disorder or if they’re just experiencing a mood swing with the weather? What are some symptoms? 

Kazimi: It’s not going to be just your regular blues. It’s going to be something more significant that’s really going to be interfering with your quality of life. There can be really different symptoms. 

Let’s talk about the more common subtype which is the type that occurs in the winter months. Feeling depressed most of the day, nearly every day, the depression progresses to the point where you start to feel hopeless or worthless.

You are having low energy, losing interest in activities that you’ve enjoyed, having trouble falling and staying asleep, experiencing changes in your appetite where you start feeling more hungry. You may start gaining weight, feeling easily agitated and irritable and have difficulty concentrating.

Trib+Health: So what makes this different than depression, the seasonal elements? Otherwise, are they fairly similar?

Kazimi: Absolutely. The seasonal element is what is the most important distinguishing feature. Usually it’s going to have to be at least two years of seasonal changes that are at the same time of the year and that’ll show if you’re going to be able to differentiate whether it’s just regular depression or whether it’s seasonal affective disorder. 

Just one year of having low mood and irritability is not going to mean that it’s seasonal affective disorder.

Trib+Health: What sort of people are predisposed to be affected by this? People with existing mental health issues, people who work in an office versus outside?

Kazimi: Anything that requires your sleeping patterns to be different than usual where you would be exposed to. Let’s say you’d be working at night and not working during the day so your exposure to normal sunlight is going to be a little bit different. That can predispose you. 

But there are some things intrinsically that can predispose people to seasonal affective disorder. For example, being female. It’s much more common in women than in men, but we know that men have more severe symptoms. Age can be a risk factor. We know that younger people have a higher risk of winter seasonal affective disorder and winter seasonal affective disorder is less likely to occur in older adults. 

We know that family history can be a predisposing factor and people with seasonal affective disorder are much more likely to have blood relatives with seasonal affective disorder. 

Living far away from the equator, that can be a predisposing factor as well. That’s because of decreased sunlight during the winter and longer days during the summer months. Not having the normal exposure to sunlight kind of affects the way melatonin is received by the brain.

Trib+Health: Is it common for people to seek treatment for this? It sounds like something an individual might try to regulate themselves. 

Kazimi: Well, often times what happens is people will blow it off with, “It’s just that time of year.” Really, the important thing is that if someone feels that, “It’s been at least two years and I’m noticing that I’m kind of feeling down around the same time.” It’s really important to get that evaluated by a professional to make sure that’s not what it is. There are really good treatments for it and the outcome is actually excellent if people get treatment for it. 

Trib+Health: How can you treat it?

Kazimi: The first kind of treatment for seasonal affective disorder is usually light therapy. So the doctor would prescribe a type of light box and one would sit close to that light box for about 30 minutes a day. It’s a very particular type of light box and would have to be something prescribed by a physician. 

The theory behind light therapy is that it mimics outdoor light and affects the way that the chemicals in the brain are released. So, usually, the box is done in the morning when you’re starting off your day. That’s one of the treatments for seasonal affective disorder. Medication can be also a part of the treatment, but it’s really important for your psychiatrist to know if you have bipolar disorder or major depressive disorder. We don’t want to give certain medications or even light therapy to people who actually have bipolar disorder and have seasonal affective disorder in the face of that. 

There’s psychotherapy, that is another type of treatment, or what we would traditionally call talk therapy. That can help with seasonal affective disorder as well. 

Trib+Health: What happens if it goes untreated? Is it a consistent severity or can it get progressively worse?

Kazimi: It can get worse and the danger is that it can progress to the point where people actually become suicidal. So that’s why it’s really important to identify it and treat it early. 

The great thing is, if we identify that someone has seasonal affective disorder, then usually what happens is, that time of year, we would start treating them. So let’s say someone usually has an onset of seasonal affective disorder starting in November or so. We would start treating them preemptively in October so that they don’t have that usual downswing in mood. 

Trib+Health: What are some common misconceptions people have about seasonal affective disorder?

Kazimi: Something people will think is that, “It’s just this time of year and it will go away and it won’t come back.” Some feelings might be that. It’s just the usual blues and they’re not picking up on things that actually qualify for full depression. So those are the major things.

The other risk would be that sometimes people get concerned about medication. Medications don’t have to be the only mainstay of treatment. Light therapy can be just as effective, talk therapy can be effective. If you have patients who are caught even earlier, then there are some lifestyle changes at home sometimes that can be really effective as well. 

Trib+Health: What are some of those changes?

Kazimi: Regulating sleep patterns, getting really good sleep, making sure they have a really good diet with adequate intake, making their environment is a little more friendly — opening their blinds, making sure they’re getting enough natural sunlight at home.

Getting outside, taking walks, being outside in the park, exercising regularly, because we do know that all those things can really help regulate the way that melatonin is decreasing in the brain. 

In exercise and maybe talking about things like yoga, medication, guided therapy or flash therapy, those are all alternative treatments that can really help. 

Trib+Health: What would determine if you would recommend somebody to pursue those kind of avenues instead of more traditional medical treatment?

Kazimi: If I know that someone has really severe major depression and that they have additional seasonal affective disorder, that might change my thinking in terms of maybe getting them to take medications preemptively because those are the people who are at higher risk.

And it’s the same thing with bipolar disorder. If I know someone has bipolar disorder, I’m definitely not going to recommend certain types of medications. I’m definitely not going to recommend light therapy because that can actually give them a manic episode. 

Trib+Health: I know you mentioned that this disorder could lead to suicidal thoughts, but could it lead someone to develop depression if they did not suffer form it before?

Kazimi: Certainly that is definitely a risk. People who don’t have major depression but have untreated seasonal affective disorder can certainly go on to develop long-term depression — what we would consider traditional depression. 

Trib+Health: How many people suffer from this?

Kazimi: We don’t have a good number, but it’s not that common. It’s definitely much more uncommon than regular depression.