The Sad Brain and Winter Blues: How to Cope with Depression and the Seasonal Low

00:00:03: Welcome to the Brain Health Mission Podcast, exploring how science, policy and everyday choices shape the health of your brain and what you can do to protect it.

00:00:15: Hello, and welcome back to the Brain Health Mission Podcast, the podcast where we explore the science, the strategies and the stories behind brain health in neurology.

00:00:27: I am your host, Dr.

00:00:29: Jarnal Medelfard Hof, neurologist and treasurer of the European Academy of Neurology.

00:00:35: In today's episode we will delve into a topic that affects millions worldwide.

00:00:42: Depression or dysthymia, particularly during the darker winter months.

00:00:47: We will explore the science behind the sad brain and especially the seasonal low in the winter months and we will discuss why depressive episodes and social isolation can impact our brain health.

00:01:03: And I'm so happy to be joined by a very special and competent guest, Professor Andrea Fiorilli, President of the European Psychiatric Association, who will share with us his insights on identifying depression, understanding its effects, and practical strategies for coping.

00:01:24: Welcome, Professor Fiorilli.

00:01:25: I hope I can say Andrea to you.

00:01:28: And thank you very much for joining us today.

00:01:31: Hello, everyone.

00:01:32: Thank you, Yana, for this kind invitation.

00:01:35: For me, it's a pleasure and a honor to participate in the Brain Health Mission podcast, and I'm also very pleased to see that something like a psychiatric disorder that is major depression and dysthymia are so relevant also for neurologists and for the European Academy of Neurology.

00:01:58: Yes, and before we go into that theme Andrea, we need to know a little bit about you.

00:02:04: Who are you?

00:02:05: Could you please introduce yourself and what is your field of interest in psychiatry and brain health?

00:02:11: Yes.

00:02:12: Thank you.

00:02:12: My name is Andre Ferillo.

00:02:14: I am currently professor of psychiatry in Italy, in Naples, which is in the southern part of the continent.

00:02:22: And this is important for what we will say later on.

00:02:26: I am also the current president of the European Psychiatric Association.

00:02:31: And one of my main interests from a clinical and research viewpoint is related to affective disorders, both in terms of pathogenesis and clinical course and outcome.

00:02:47: So I think that the issue of today is really important, both for the general population, for clinicians and for young trainees and medical doctors.

00:03:02: Thank you.

00:03:02: So happy to have you here.

00:03:03: Because as this podcast is being recorded, we are still in a very dark month of the year January, with significantly less sunlight than we have in summer, and therefore also perhaps less outdoor and social activity, and many people seem to experience changes in their moods and their energy levels.

00:03:25: And they also express them.

00:03:27: You can find notices all over in the media and so on about a seasonal low.

00:03:33: Is it just the myth that Darkness gives us less energy or is it for real?

00:03:41: Well, thank you for this question, which is, I think, extremely important in order to identify one of the, I would say, most frequent subtypes of major depression, that is the seasonal affective one.

00:03:56: Basically, this is among all affective disorders, probably one of the most biological ones, which is related to an imbalance of serotonin, but also of melatonin and orexin.

00:04:10: that are three hormones present in the brain that can affect energy mood.

00:04:19: concentration and so on and so forth.

00:04:22: Of course all psychiatric disorders also recognize psychosocial stressors and in this case we can identify that in particular in some countries the evening and also during the winter the reduced activities outside the house or the working hours can influence also mood and energy level and activities.

00:04:53: So this is also relevant for the treatment as we would say later on because lifestyle changes also have a role in the development of seasonal affective disorders.

00:05:08: So it's not only a matter of light, it's also the lack of light that causes us to be less active or to change our lifestyle that could contribute to feeling a little more low in the winter months.

00:05:22: Yeah, I mean the exact cause of this disorder is not fully understood.

00:05:29: What we can say now?

00:05:31: that there is an interplay between these biological factors that during winter, or I would say not real winter, but during darkness, these levels, particularly of serotonin or norepinephrine or melatonin, can be reduced.

00:05:51: due probably to a reduced activation of hypotalamus.

00:05:57: But in this, let's say, biological basis, of course, the relevance of psychosocial triggers can be counterbalanced also by our attitudes and lifestyle.

00:06:15: Just to let people know, basically we identify two main types of depression, the major and the minor, let's say.

00:06:23: Usually major depression recognizes worsening during the day, so during the light hours, while minor depression that is basically the anxious subtype usually recognize a worsening in the evening.

00:06:42: So for a certain period of time many people considered that seasonal affective depression could have been considered as a minor type of depression.

00:06:53: Now we know that this is an absolutely major depression that recognizes different pathways and for them also other biological interventions such as light therapy can be extremely effective, so not only antidepressants or psychosocial approaches.

00:07:16: I just spoke to a colleague recently and she said, oh, I love the winters.

00:07:20: I love the darkness.

00:07:22: I think this is so super.

00:07:24: So it seems that not all of us are affected by the changes in light in the winter.

00:07:32: Would you say that some people are more prone to have dysthymia to have a mood low in the winter months than others and is there something about them or us?

00:07:48: The research suggests to us that women are basically more affected by seasonal affective disorders compared to men.

00:07:58: So this is one issue and this is probably also related to the hormones.

00:08:05: So, for example, we can have in women different types of depression that is the perimenopausal depression or the... depression that can occur during pregnancy or postpartum or the postpartum depression.

00:08:25: Then we also have a latitude imbalance.

00:08:30: People living in the northern countries are more prone by this type of disorder.

00:08:37: And that is true that some people love darkness, but we can also say that probably darkness does not activate certain brain circuits that can lead more easily to the development of this type.

00:08:55: of the question.

00:08:57: And the third group of people who I mean we should consider at higher risk are those already suffering from other types of mental or behavioral disorders, in particular anxiety disorder or panic disorder or sleep disorder.

00:09:16: So these are people that during winter can have a higher risk of developing SAID.

00:09:27: So do I understand you correctly that if you have something already in your luggage.

00:09:31: I mean if you if you either like in a hormonal transitional phase or you're having sleeping problems and so on then you can be more vulnerable to the changes in light and the winter and so on.

00:09:44: That's

00:09:45: right.

00:09:45: Is that correct?

00:09:47: Yeah, that's correct.

00:09:49: I have a confession to make too, because I live in Norway and the winters here are pretty dark.

00:09:56: And especially without the snow where I live, it's quite gloomy.

00:10:01: And so I also sometimes feel less energetic and vivacious than I used to in the summer or autumn and spring, whatever.

00:10:11: And then I have a few tricks and I thought I'd share them with you and then you could see if they have a meaning to you.

00:10:20: I have a special daylight lamp that I used in the morning.

00:10:23: I got that recommended by a colleague by the way and I even gave my two adult sons one.

00:10:30: so I use it not to stare in but to have it beside me when I do my breakfast and the coffee things and you know.

00:10:37: And then I actively try to get a sneak of daylight every day.

00:10:42: I challenge myself to to go off the bus stop earlier or to walk to job or to take a lunch break, going a brisk walk.

00:10:51: And then I also try to be perhaps Even more physical active than I am in summer, I do it deliberately because, you know, when there is not cold and so on, it's easier to go out and run, but I still do these things as routines.

00:11:08: I give much more carefulness to them.

00:11:12: And I also use de-vitamin supplements.

00:11:14: So these are the four things that I do to sort of counteract the tiredness that I can feel in winter.

00:11:22: Does that seem okay to you?

00:11:24: Is that something that you also scientifically understand?

00:11:30: Yeah, I mean, you are right, you are not affected by seasonal affective depression, probably because you do all these things.

00:11:39: I mean, you are a woman, you live in the Northern Europe, so you have all these, let's say, risk factors, but since you can recognize them... you counteract them.

00:11:51: So one issue I think is extremely important is to not modify lifestyle behaviors compared to spring or summer.

00:12:00: So if you do something, I mean of course if that is feasible, if you do something during the spring or summer you should try to do as well during the winter.

00:12:12: One other issue is let's say we call it light therapy but it is important to have almost always light on and there are particular lamps that can help us to improve our let's say functioning both in terms of psychosocial one but also in biological one.

00:12:35: A third issue is to have among lifestyle something like physical activity.

00:12:44: I know and I recognize that in some cases it can be very difficult to perform form it outside, but we can do it in-house, so this is also something that can help us.

00:12:56: to modify this biochemical imbalance.

00:13:00: And the fourth one is to help us with nutrients or supplements or also with eating.

00:13:07: But you know, in many cases, people during the winter tend to go to sleep earlier, to have dinner earlier.

00:13:17: So this is something that we should avoid, but we should try to... to keep our routine as it was.

00:13:25: And then if of course we know that we are already suffering from this type of disorder, mental disorder, but even or others that we are at higher risk, then I think what is extremely important is to make a proper diagnosis in order to prevent from a winter to another, because every episode can cause higher damage, let's say to the brain.

00:13:56: So to the listeners, keep up your routines.

00:13:59: That's what Professor Andrea is telling us.

00:14:01: Do not change.

00:14:03: Do not go to sleep earlier or eat very unhealthy food or stop exercising.

00:14:08: Try to be the same you in the winter that you are in the summer or spring.

00:14:14: I think that's a very good message.

00:14:17: Let's move a little away from the seasonal moods, I mean the seasonal affective disorders and more to a manifest depression.

00:14:28: because what is exactly a depression and what is the difference between like feeling a little low in January or November and having a manifest depression?

00:14:40: Yeah, I mean of course it may be let's say normal.

00:14:44: to feel low during during January particularly after New Year's Eve and with the start of New Year or during this very cold period of the year.

00:15:00: So this is something normal and I think that it's important that we should not pathologize everything.

00:15:05: So if you are feeling like that or you feel more tired or restless, that can be normal.

00:15:13: The seasonal affective depression has a particular, let's say, clinical characteristics.

00:15:20: First of all, it is a disorder that you have almost every year or every change.

00:15:29: of the season.

00:15:31: The most frequent pattern is winter depression, while I mean autumn and winter, while there is also another one with spring and summer depression, but that is definitely more rare.

00:15:48: So this is something that usually we can make a diagnosis at least after a couple of years, so not immediately.

00:15:55: Usually you get a diagnosis of major depression.

00:15:58: at the beginning.

00:15:59: A second issue is that usually this type of depression does not always as an onset with let's say low mood or anedonia or allogia or apathia.

00:16:14: But in some cases it happens with irritability, with sleep difficulties, with difficulties in concentration, with fatigue.

00:16:25: So these are let's say a typical depression, a typical symptoms of a major depression that occur usually during the same period of the year.

00:16:38: Basically, it starts with sub-threshold symptoms already in November or December and then as full-blown depression in January.

00:16:51: And if we are able to recognize this already from the onset, from the beginning, probably we can also intervene both in terms of biological or psychosocial interventions in order to prevent.

00:17:08: I

00:17:10: think what you're saying is very important that if it has happened before that should be a warning sign.

00:17:16: but are there other signs that the listeners should be aware of or should discuss with their clinician if they are feeling maybe I am depressed?

00:17:27: are there any signs that you would?

00:17:31: One of the main symptoms is a lack of pleasure of activities that usually you perform during the year and that you don't like anymore.

00:17:43: I mean, you can see the person without that reasoning, emotional reasoning and affective balance so that I can go out with friends but I don't find anything about it or even eating something that usually I like to eat.

00:18:07: So this is, let's say, anedonia.

00:18:09: Then I feel sad and, of course, sadness is one of the main symptoms.

00:18:16: one of the two, sadness or anedonia.

00:18:19: And then there are all accompanying symptoms.

00:18:23: And one of those particularly important here is insomnia.

00:18:28: So people tend to have sleep disorders during the night, but then they are sleepy along the day.

00:18:36: So this is something that usually can occur as a main symptom of major depression.

00:18:45: There are other... physical symptoms in this case, so physical complaints or headache or dizziness that can be present during this type of depression that occurs in winter.

00:19:02: So these are typical and atypical symptoms.

00:19:06: Of course, there can be delusions, depressive delusions or thoughts or people can think that the life is over or that there is nothing to see and that the let's say also the spring or the summer are very far.

00:19:23: so it's like they their mind enter into a tunnel and they don't see the light.

00:19:30: That was a very good picture actually the tunnel without a light.

00:19:33: I think that's how many patients describe it because What you are saying is that it can be natural to feel a little gloomy in January after a fantastic Christmas or, you know, December is so full of events and in January is just full of work and all the new things.

00:19:54: But that is something completely different from having a depression and the depression is a serious... disease and we have to be so frank that we have to say that sometimes it's deadly and it's important to know that and it has consequences like you said not only for how you feel but also for how your brain works and therefore it's crucial that it's treated effectively.

00:20:21: The seasonal depression should be treated if it's recurrent but then you also have as you already mentioned we have depression securing to the other parts of the year and for other reasons or something like that.

00:20:33: And you are one of the main European experts in this field.

00:20:37: And if we go a little into treatment and to therapy, what is your opinion about the best treatment options for depression at the moment?

00:20:52: Because we have to say that there is treatment.

00:20:57: And that is also giving hope to those who are suffering from depression, but also those who have relatives and so on.

00:21:04: So I think as a neurologist I can say there is treatment, but you as an expert must tell me and the listeners what are the best treatment options.

00:21:13: Thank you.

00:21:14: The main message I would give also to our audience is that we don't have one treatment better than the other.

00:21:23: We don't have any more.

00:21:25: happiness pill.

00:21:27: We have different types of depression and for those different types of treatments.

00:21:33: So this is one issue that I think is important.

00:21:37: I mean, in the past, we came from the period where fluoxetine was good for everyone.

00:21:44: And if you take fluoxetine, you get smiling.

00:21:48: And this is not true.

00:21:49: I mean, major depression is a serious mental illness.

00:21:54: which has an origin in the brain and then has different types of depression.

00:22:00: So I would say it's different to treat depression in the young.

00:22:05: or in the elderly or in middle-aged persons, is different.

00:22:11: the depression in a woman or in a man is different if it's a first episode or is a recurrent illness or is a chronic disease.

00:22:23: So this is something that I mean it's important that we tell loudly everyone because this is a change and we are entering this precision psychiatry approach now that we should make a proper diagnosis.

00:22:38: In terms of seasonal affective disorder, the good news is that since it is one of the most biological mental disorders, it is even also one of the most treatable ones, but what is important is to make the correct diagnosis.

00:22:58: In that case, if a person knows that let's say in November or in December, he or she can enter into this phase of illness.

00:23:09: Preventive measure can be either lifestyle changes or having something like cognitive behavioral approach or even some psychiatric medications like mood stabilizers.

00:23:24: Because if you take a mood stabilizer, then probably you don't need to go through and antidepressant treatment.

00:23:32: If you are already, let's say in phase two or three, so the episode is already there, then you can benefit from an antidepressant.

00:23:45: Usually in that case we don't treat the illness for long periods, but you should take the medication for the time being you are depressed so usually we have three or four weeks of treatment can be sufficient in order to avoid that the illness can progress.

00:24:08: So here the framework is extremely relevant because we have very let's say closed therapeutic windows and that is important.

00:24:19: so for general population to recognize and for physicians to correct diagnosis the illness if we are able to intervene as early as possible in many cases medications are even not needed or mood stabilizer if the case is more serious than antidepressants.

00:24:44: I think that's a fantastic message.

00:24:46: First of all you're saying that we need to tailor the treatment.

00:24:51: that is not one suit one size suits all and i think that's super good.

00:24:56: that you need to see what is this patient the factors risk factors the the history and so on.

00:25:04: i think that's good.

00:25:05: and that you also say like we do for almost every disease nowadays, we say it's very unusual that one pill does it all.

00:25:14: We usually have to do other things as well, and that's for depression.

00:25:18: And I also like the way you're saying that there is definitely something to be done.

00:25:23: You just need to diagnose it very thoroughly so that you can target the therapy.

00:25:31: I think that's a very positive message.

00:25:34: Yeah, Indiana.

00:25:35: You are completely right.

00:25:36: Tailoring for us now is becoming a correct way of working.

00:25:43: And while in the past we considered only to have one illness, major depression, now we know that we have different types of depression or major or minor or affective.

00:25:57: And the usual diagnostic manuals do not recognize these clinical heterogeneity of depression.

00:26:05: So every person is different and we need to tailor treatment.

00:26:11: Andrea, I think your message is very good that you are looking... to design more individually targeted therapies just like in cancer and other parts of medicine.

00:26:23: also psychiatry is going into that pathway and i think that's a very positive message and also that it might not be need to take medication all the time.

00:26:32: but you of course need to have a close connection to your treating for psychiatrists and so on.

00:26:40: And also that lifestyle has an influence here.

00:26:43: So I think that's a very, very nice and interesting message.

00:26:46: And then also, I'd like to challenge you a little bit.

00:26:50: What does the future have in store for the treatment of depression?

00:26:56: What make you most hopeful if you look forward?

00:27:02: regarding the treatment of depression and probably also prevention of depression?

00:27:09: Well, we have different considerations to make.

00:27:13: One is that the pipeline of several drug companies in terms of treatment of major depression is particularly rich now.

00:27:24: We already have entered the new era of psychiatric treatment that is the eschatamine, psilocybin and other psychostimulants that are very useful.

00:27:38: They are already used in clinical practice, some of them in some part of the world.

00:27:44: They are already available in some other.

00:27:46: They are now under negotiation, but that is something that can be very useful, particularly for the most severe forms of major depression for the suicidal.

00:27:59: once, but also for the so-called treatment-resistant depression.

00:28:04: Another field of interest is that about hormones.

00:28:10: For example, now we have treatment for postnatal depression or perimenopausal depression, and there are some treatments that can be already done in gene ecology, in obstetrics, and also in mental health practice.

00:28:28: And this is also another field, particularly for the female depression.

00:28:35: And then there is a third one that is mostly related to immunomodulation or to, let's say, the gut-brain axis.

00:28:46: And in that sense, we are already working with some new medications, which are very useful already.

00:28:55: for the gut, but can be also very interesting for major depression.

00:29:01: So this is in terms of new medications.

00:29:04: And as I said before, now we are in the pipeline for the next ten years, several medications under evaluation.

00:29:13: From the psychological and psychosocial aspects, again here, what is very important is to tailor or to adopt this approach for for major depression like we do with cancer in terms of staging of clinical staging.

00:29:31: so now we can use for example cognitive behavioral therapy or cognitive remediation approaches or even virtual reality treatments for let's say the phase one or phase two.

00:29:46: of depression or the milder forms of depression.

00:29:50: Lifestyle interventions are becoming even more evident of their efficacy, both for major depression but also for psychosis.

00:30:02: But again, what I think that is the most important here is that this treatment should be combined or augmented, so we can have this sequential approach.

00:30:15: I don't think that, as I said before, there is one treatment, both medication or psychotherapy, which is better than the other.

00:30:26: But there are different patients that can respond better to a treatment or to another according to a series of individual or contextual illness reliefs.

00:30:40: and the good clinician should be able to identify these factors and in that sense we can now definitely treat this depression illness.

00:30:53: I like the concept about the good clinician and I also think what you are... Picturing here is very, I think it's very interesting and I hope the listeners do as well.

00:31:04: And I got caught a little bit about in that brain-gut connection because there is a saying that you are what you eat, but maybe we could say that you feel what you eat.

00:31:16: So to be aware of how the guts and the microbiota influences the brain.

00:31:26: is very interesting.

00:31:28: Thank you for sharing that with us.

00:31:30: But Andrea, in this podcast, we also go chasing myths about brain health.

00:31:36: And what is your favorite, or perhaps I should say most hated myth about depression?

00:31:44: Do you have any?

00:31:46: One of the most frequent misconceptions is that depression affects weak people.

00:31:54: So depression is an illness like all the others.

00:32:00: everyone can be affected during his or her life from major depression but as an illness is treatable, is curable and you should ask for help.

00:32:14: Another misconception is that people with depression don't want to go outside or to have a walk or to to meet friends.

00:32:25: This is not something to do with willingness, but it has to do with inability to do that.

00:32:32: It's like you would like to ask to a person with a broken leg to go out for a walk.

00:32:39: I mean, they would like to, but they cannot go.

00:32:41: So friends and caregivers and relatives should support.

00:32:48: depressed people by staying close to them, by providing physical emotional support, by taking an appointment with the doctors, but they don't have to feel guilty about their depression.

00:33:07: I think that was so important that you said.

00:33:10: So let's establish that very quickly.

00:33:13: It's nothing.

00:33:14: It's not a sign of weakness to be depressed.

00:33:17: It can happen to everybody just as eczema or any other disease that you can get.

00:33:22: It's not because you're especially weak as a person.

00:33:26: And also that it's important that those around you support you and encourage you, but that it's understood that it's a disease, which also, of course, gives you reduced level of functioning.

00:33:42: That was very, very nicely expressed.

00:33:47: Listeners, being depressed will affect how you can do your life.

00:33:53: And that must also be accepted by those around.

00:33:56: It's not because you don't want to, but it's because you do not feel able to.

00:34:03: And that can of course be encouraged, but it's not something you can control by your will.

00:34:07: But then let's share something.

00:34:10: which is fact-based, Andrea.

00:34:12: And I have a scientific article that I read and I thought I'd share it with you because there was this huge study in the UK in twenty twenty one where they gathered data from about five hundred thousand women and men between thirty seven and seventy three years old.

00:34:29: And the participants in this study reported that they spent about two point five hours outdoors each day.

00:34:37: and they then found the medical information on this group and the outcomes and so on.

00:34:42: And they found the researchers then found that each additional hour spent outside by the persons in natural light, it's important to say, was linked to a corresponding decrease in the risk of developing long-term depression.

00:34:59: And they also saw that those who were more outside than the usual two point five hours, which I actually think It's quite a lot in winter, but probably it was for the whole year.

00:35:11: They also reported higher improvements of mood and had a higher general feeling of happiness.

00:35:21: This makes any sense to you, Andrea, this clear relationship between the dose that you have from outdoor related to the occurrence of depression and also the way you feel.

00:35:38: Yes, I know this study very well and I think they made a tremendous effort in highlighting the importance of lifestyle in major depression, but also, as you were saying, about natural light.

00:35:58: people with major depression to keep up their routine, to work outside.

00:36:05: I mean, one of the factors explaining the increased incidence of major depression during and after the COVID-D-IX was that people were blocked in their house.

00:36:20: So this is now, and this study was during that period, this finding.

00:36:27: I think it should tell us that happiness is something that we should aim to, but it doesn't exist for everyone, unless for children.

00:36:40: But what we should try to feel and to stay as well as possible according to a series, of course, of personal or social or interrelational difficulties and the social and in that sense psychosocial aspects are extremely important.

00:37:03: Then of course it also depends on where you live.

00:37:06: For example, we are now living all together in these big cities and this is a risk factor for good mental health while those living in rural areas.

00:37:21: Probably because they breath a better, better air and environment, they feel less depressed.

00:37:32: People living in big cities in Europe like London or Milan or Paris have a high risk of developing major depression, but also of being compulsory admitted to a psychiatric ward.

00:37:46: So this is something that I think at the political level.

00:37:51: we should say together, neurologists and psychiatrists, because all these aspects influence brain aging, brain development, and I think that major depression and mental disorders are part of this aging.

00:38:10: I think that's also very nicely said, that psychiatry and neurology and brain health are all aspects of the same thing and that we need to unite our forces in order to make the world better for good brain health, including psychiatric disorders and other disorders that can affect the brain, I think.

00:38:35: So it's like you say, it's not only the personal responsibility, but it's also a societal responsibility.

00:38:43: Andrea, this podcast is soon coming to an end, but we need to get a little personal here in the last minutes.

00:38:51: I just wondered if you sometimes feel gloomy in January or November, and if you do, or if you don't want to do, what do you do to prevent it?

00:39:05: And could you, in the last minutes, give our listeners some advice?

00:39:12: That could be easily implemented in today's life?

00:39:17: Well, luckily enough, I work in Naples, as I said in the beginning of this podcast, which is a city in the southern part of Italy.

00:39:28: So basically, we have the sun almost nine months.

00:39:32: career and the winter is very very short and not very cold.

00:39:37: so at least from this point of view I feel protected against this type of depression.

00:39:44: Having said that of course in some In periods I feel overwhelmed or stressed, so what I can suggest people is to try to keep a balance between duties, between, let's say, working hours, but also our personal life, and this balance can protect us against feeling... particularly stressed that in some certain period of the year can lead us to higher liability risk of developing major depression.

00:40:25: Of course, I have also lived for a period of my life in Northern Europe, particularly in the United Kingdom and in Scandinavia, and I can tell you that during the winter the risk of feeling depressed, these, let's say, very controversial feelings of depression.

00:40:46: In that case, what I tried to do was to keep my routine, to going out with friends, to phone people and to engage in physical activities, but also in healthy habits and taking some time for me in order to relax and listening music or going out to watch a movie.

00:41:13: Everything you like to do, then you should try to keep, but that also is very important.

00:41:20: That was great.

00:41:20: So to sum up... Keep your balance people and if you are not so fortunate as Professor Fiorilli to live in Naples then you should take his advice in trying to keep up a social lifestyle.

00:41:36: That's what you lack in sunlight.

00:41:38: You should try to get in social activity, being out with friends, being active.

00:41:44: Wouldn't that be something of the core message here Andrea?

00:41:48: Yes, be active, don't feel alone, don't feel isolated and try to reach your networks whenever you feel a little bit, you know, out of the blue.

00:42:02: And again, if you are feeling depressed, don't be scared.

00:42:08: There is nothing bad in you, but just ask for help.

00:42:15: and now the treatments are extended.

00:42:17: extremely effective.

00:42:19: but if they are done properly and also in the right moments.

00:42:29: So my key message would be a positive one.

00:42:35: It can be normal to feel, let's say, out of blue for a period.

00:42:41: that is normal and don't, don't, don't be scared about it.

00:42:44: But if you feel depressed, ask for help because now mental health professionals and all other professionals and medical doctors can help you to overcome this period.

00:42:58: That was beautifully said.

00:43:00: So, I think our job is done here, Andrea.

00:43:05: I hope the listeners enjoyed our conversation as much as I did.

00:43:10: I learned a lot from you.

00:43:12: Thank you so much, Professor Andrea Fiorillo, for this insightful discussion.

00:43:18: And thanks again to the listeners for joining us on the Brain Health Mission podcast.

00:43:23: If you or someone you love are experiencing symptoms like those we have talked about in this episode or feel depressed, promise us to contact professional help and confine in someone you trust.

00:43:34: As for Brain Health, if you enjoyed this episode, please follow us on your preferred podcast platform, share it with your network and stay tuned for more conversations on Brain Health.

00:43:49: You've been listening to the Brain Health Mission podcast, where science meets action for a healthier brain.

00:43:54: If you enjoyed today's episode, don't forget to follow us on Spotify or your favourite podcast app, so you never miss an update.

00:44:01: For more tools, tips and expert insights, head to brainhealthmission.org.

00:44:06: That's brainhealthmission.org.

00:44:08: A special thank you to our supporting partner Roche for supporting our mission.

00:44:13: Until next time, take care of your brain.

00:44:15: It's the only one you've got.