“It is during our darkest moments that we must focus to see the light.” - Aristotle
During my preclinical years of medical school, it quickly became apparent that my productivity and overall mood plummeted in the winter. I always made excuses to myself: it’s just a stressful time of the year; if I just sleep more, it’ll get better. But eventually, I looked into seasonal affective disorder (SAD) and it seemed to be the perfect explanation.
UpToDate’s introduction on the topic starts, “The term seasonal affective disorder (SAD) describes episodes of major depression, mania, or hypomania that regularly occur during particular seasons. The most prevalent form of SAD is winter depression, marked by recurrent episodes of unipolar depression that begin in the fall or winter and if left untreated, generally remit in the following spring or summer.” I fell into the “most prevalent” category of SAD. As the seasons changed, my sleeping needs progressively increased. When I was awake, I felt like I couldn’t stop eating; sometimes it felt like eating was the only thing that could bring me joy. Trying to focus on coursework seemed like an impossible task. Many of my friends noticed the change, but when asked about what was going on, my only response was, “I don’t know.”
At some point, someone suggested that I try light therapy. I was skeptical, but after reading through a couple of papers (Terman, et al 1989 and Glickman, et al 2006) and Amazon reviews, I decided to try it. My first purchase was a relatively low cost light that could sit at my desk with me where I studied. I felt foolish at times sitting in front of this blinding light while I flipped through flashcards or Powerpoint presentations, but after using it consistently, I noticed a change in my mood.
After finishing up the preclinical years, I neglected my light therapy. As it became more and more difficult to wake up at 4 a.m. to pre-round on my patients, I decided to invest the money in the wake-up alarm clock. One huge advantage the wake up alarm clock had was ensure I didn’t accidentally sleep in (it’s so much harder to sleep with the lights on). I also found that the slow, gradual transition of light in the mornings made waking up at an ungodly hour much more palatable. It has been six years since I purchased my alarm clock and I still use it on a daily basis.
Another way I tried to stabilize my mood was through regular exercise. Just 20 minutes on an elliptical or recumbent bicycle was enough to get fresh ideas and thoughts flowing. In fact, most of my blog entry topics were conjured up during a workout and immediately executed post-workout. Unfortunately for most people (myself included), the motivation to exercise in the first place is often non-existent. Generally, if I got myself to the gym, I would reluctantly get onto an exercise machine. To reduce the number of barriers to working out, I always wore gym clothes under my scrubs, or brought a set with me to work. I also made it a habit to drive by the gym on my way home, which usually guilted me into going.
When I am feeling down, the last thing I want to do is socialize. But increasing isolation as the season progressed only worsened my mood. I’ve made it a point to plan outings with friends, or catch up over the phone with friends that live further away. I’ve also interacted with a lot of supportive individuals through various social media channels and find that the struggles of medical personnel are often shared.
Do you experience SAD? What have you done to combat it?
Amanda Xi, MD, MSE is currently a resident at Massachusetts General Hospital (MGH) in Boston, MA and upon graduation will be continuing at MGH as a Critical Care fellow. She is an active blogger at her self-titled website and also active on Twitter (@amandasxi), Facebook, Instagram (@amandaeleven), LinkedIn, and Doximity. She is also a 2018–2019 Doximity Author.
Image by Maksimilian / Shutterstock