Health Voices

The Winter Blues

• Yale PHC • Season 1 • Episode 3

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When friends or family feel down or worse at a particular time in the year, people wave them off and don’t recognize the actual health issue. However, seasonal depression is a legitimate mental health condition. 

At least 5% of Americans face this depression every year, but the majority of Americans don’t take it seriously and stigmatize the condition. 

With Dr. Paul Desan, an associate professor of psychiatry at the Yale School of Medicine and head of the Winter Depression Clinic, we discuss the importance of legitimizing seasonal depression.

We specifically talk about the what and how of seasonal depression, seasonal depression’s relationship with pandemics, treatments of seasonal depression, and summer depression.

[00:00-02:02]: Intro

[02:02-07:03]: History of Seasonal Depression

[07:04-13:59]: Risk factors and symptoms of seasonal depression  

[14:00-17:04]: Pandemics’ and Climate Relationship with seasonal depression

[17:04-27:50]: Treatments for seasonal depression and research about seasonal depression

[27:51-29:51]: Treatment and symptoms of summer depression

[29:51-32:39]: The future of seasonal depression

[32:40-34:02]: Government’s role in seasonal depression

[34:-03-37:42]: Conclusion

Link to Paul Desan Profile: https://medicine.yale.edu/profile/paul-desan/

Link to Article about Seasonal Depression that Desan is Featured in: 

https://www.nytimes.com/article/seasonal-depression-what-to-know.html


Email us at yalephcpodnews@gmail.com if you have any questions or want to be featured in an episode. Follow us on social media at https://www.instagram.com/yalephc/ and https://www.instagram.com/yphcpodcast/. And please subscribe to our show. 

Fareed Salmon:

Welcome to Health Voices, a podcast from the Yale Public Health Coalition where we discuss the breadth and depth of public health and how it actually impacts the individual in the New Haven area and beyond.

Frederick Rivas-Georgi:

My name is Salman and my name is Frederick Rivas-George.

Fareed Salmon:

And welcome to the second episode of Health Voices.

Frederick Rivas-Georgi:

In this episode we were inspired by the colder weather in shorter days that affect us here in New Haven, connecticut. In particular, we were quite interested in seasonal affective disorder.

Fareed Salmon:

Coming from the south, seasonal depression was an unheard phenomenon, as the days were longer and the weather was warmer. However, in the north, it seems like seasonal depression is a real thing.

Frederick Rivas-Georgi:

Seasonal affective disorder, according to the Cleveland Clinic, is a type of depression that is triggered by a change in seasons. There's a huge stigma around this disorder, even though it's a legitimate part of at least 5% of Americans' lives today.

Fareed Salmon:

That stigma- is based on ignorance, and so today we talk with Dr Paul Desan an associate professor of psychiatry at the Yale School of. Medicine and director of the Yale's Winter Depression Research Clinic, he's one of the biggest experts of seasonal depression and has informed multiple media outlets about this type of mental disease, including ABC. News CNN and the New York Times.

Frederick Rivas-Georgi:

We will talk about seasonal affective disorder symptoms and how to best protect yourself against this depression. We also learned that seasonal depression does not only occur in winter, as most people might expect. We talk about the importance of removing the stigma and the general disregard that many people might have for this, as well as avenues of research and government intervention in order to effectively deal with what is a real issue in public health today.

Fareed Salmon:

Let's dive into the episode. Professor Desan, welcome to the podcast. We know that you have a very brief schedule, so we really do appreciate you being here with us today to talk about seasonal depression.

Dr. Paul Desan:

Well, I'm very glad to talk to you about seasonal affective disorder from the public health perspective. I think many more people than as commonly understood have serious problems with the season. Now, if I told you 5% of people in the United States had a significant clinical problem and we had an easy treatment for it, you'd say it was really important that we be able to get the word out to those folk that we can identify and treat the problem that they're having. Maybe part of the confusion is it's normal for people to feel a little worse in the winter and consequently they may not take it seriously when someone says they have serious problems in the winter months.

Fareed Salmon:

And from a public health perspective that only increases the level of seasonal depression. Before we delve deep into the topic, I wanted to ask what was your role at the Oscole Medicine?

Dr. Paul Desan:

Well, I'm an associate professor of psychiatry and I'm also the director of the Winter Depression Research Clinic.

Frederick Rivas-Georgi:

All right on that note. Well, thank you so much for joining us today. Dr Desan, to begin, would you please be able to describe and tell us about the history of research into seasonal affect disorder, and when did it really start to become understood as a public health issue?

Dr. Paul Desan:

Well, for several thousand years medical authorities have referred to the fact that depression is more common in the winter and mania more common in the summer. Now the modern start for understanding seasonal affective disorder begins with a psychiatrist named Norman Rosenthal and he's from South Africa and he was fine in the winter in South Africa but he came to work in Bethesda, maryland, at the National Institutes of Health. He noticed at that latitude, he got depressed in the winter and so he decided to start studying the phenomenon Now. At the time it was controversial to put an ad in the paper, but he did get consent. They put an ad in the local papers and they got an enormous response of people reporting that yes, the seasons did affect their mood. Most of the people reported their mood got worse in the fall, was at its absolute worst early winter, january, february and then got better as the calendar moved into the spring months.

Frederick Rivas-Georgi:

So it was a group of people that reported an opposite kind of depression feeling worse in the summer. So I mean this is a pretty big finding, I mean, given especially with how mental health was so stigmatized at the time that so many people would be openly saying that this was a real thing to them. How far was this research carried at the time, or did the mainstream scientific community pay it much heed? And how did it get then to your modern research today?

Dr. Paul Desan:

Well, I think his paper did create quite a stir and was well received, and it's a very impressive study. Now what he showed is that there's a group of people who have symptoms of change in appetite, weight, sleep, energy, health, esteem, etc. That in a technical, clinical sense, they have major depression. Psychiatrists have an official definition of what major depression is you have to have sufficiently severe disturbance in a number of different areas. So people with seasonal affective disorder. They meet criteria for an episode of depression every winter or nearly every winter, and they get better entirely every summer. Now anybody can have an episode of depression related to something that happens in their life, but for the most part these patients have a very stereotyped incidence that repeats identically each year, with depression in the winter and then full recovery in the summer.

Fareed Salmon:

And like see, that's, I guess, a very intriguing part of human depression, that… these, I guess, symptoms of seasonal depression only occur at specific times throughout the year. Now, why do you believe that on geography is such an important contribution to the levels of seasonal depression?

Dr. Paul Desan:

well, in an episode of depression we expect changes in a wide variety of parameters. In seasonal affective disorder there's a decreased mode of decreased enjoyment. There tends to be a bit less of the self-hatred, the suicidality that's more common in other variants of clinical depression. On the other hand, in seasonal affective disorder there tends to be a particularly marked effect on energy. Patients will report feeling fatigue, feeling difficulty getting going. Often withdrawing from activity is a special, especially social activities.

Dr. Paul Desan:

Now, another difference between seasonal affective disorder and non-seasonal depression is that people with seasonal affective disorder tend to report more frequently and increase in sleep. Insomnia is a common symptom of depression, but Patients with seasonal affective disorder frequently will tell us the opposite. They sleep more, they have hypersomnia. Similarly, people with seasonal affective disorder may tell us they have an increase in appetite, a craving for carbohydrates, starches, fatty foods to comfort foods, maybe an increase in weight, whereas in non-seasonal clinical depression it's more common to have a decrease in appetite and a loss of weight. So seasonal affective disorder is a kind of major depression, but it's a little different in the details of its flavor. It almost sounds like human beings are trying to hibernate. When they're far from the equator they seem to Want to sleep more, eat more and do less.

Fareed Salmon:

They're like a bear trying to hibernate very interesting how you talked about Seasonal depression only occurring in the north and not really happening in the south. Are there any other risk factors associated with depression, or is the geography aspect of it the only real factor that you'd consider is a risk?

Dr. Paul Desan:

There's an extremely important factor, and that is gender. Women are three times more likely than men to have seasonal affective disorder, and that persists Even when we do certain research in a way that compensates for the fact that men may be less likely to seek help or report problems. It's been consistently shown that women are more likely to have seasonal affective disorder. Moreover, women who have seasonal affective disorder are more likely to have premenstrual mood changes and vice versa, women who have Premenstrual mood changes are more likely to have seasonal affective disorder. Nobody understands why women are more vulnerable to seasonal changes. Now, when we hand out questionnaires to people at large, 90% of people report a change in at least one aspect of their life during the winter months changes in energy and Women, vigor, how they feel, changes in appetite, sleep, weight. So People are normally seasonal. The old textbooks would tell you that human beings were not seasonal animals. Well, human beings are seasonal animals. It does appear from that survey data that women have Greater seasonal variation. And how they feel?

Fareed Salmon:

and then you Talk about bearing symptoms of seasonal depression, like gaining an appetite and increase in sleep. I was wondering what are the biological causes of these symptoms for people that have some depression. Is it due to a lack of light or is it due to a different reason?

Dr. Paul Desan:

Well, it appears to be a light dark cycle that causes seasonal affective disorder. Even though we live in an environment with electric lights, you can show that the human body knows whether it's winter or summer and of course in the winter the sun comes up later and goes down earlier, and in the sun in the summer we have the opposite a longer photo period. The body seems to be able to transduce that photo period. Now Norman Rosenthal and his original description of seasonal affective disorder, published in this classic paper from 1984, showed that if you provide bright light in the morning and the evening and you extended the photo period, they would have volunteers who would participate in these pretty involved experiments Units at the National Institute of Health Campus. He was able to show that if you expose these patients to a winter like I'm sorry a summer like photo period, their seasonal affective disorder, got better in their mood, return to normal.

Frederick Rivas-Georgi:

So it's really quite fascinating then. So it seems that they're. The current research seems to indicate there's almost some sort of a evolutionary link, right, almost as if we're we're trying to hibernate, or could there be that we know of any possible genetic factors that may play a link, may play a role in mediating a seasonal affective disorder?

Dr. Paul Desan:

Well, one has to believe that mother nature knows what she's doing, that is to say, evolution works in such a fashion as to create a particular phenotype that is adaptive in some way. It does appear that for the most part, when people live far from the equator, they tend to shut down during the winter. There may be some difference between different genetic groups. Unfortunately that hasn't been studied as well as we'd like, but it's possible that certain Scandinavian groups may have less seasonal affective disorder than we might have expected. So the jury is still out. We need better research, but there may be a genetic contribution as well.

Frederick Rivas-Georgi:

Well, thank you so much for your very in-depth and fascinating discussion of the history and the symptoms behind SAD. We'd like to switch gears a little and talk about a broader aspect of SAD. As you know, the COVID-19 pandemic has become in its process of becoming an endemic disease and, as it's been shown, prior research has demonstrated that pandemics like COVID-19 appear to be positively correlated with SAD. So how did the COVID-19 pandemic influence SAD and how might other pandemics on, or perhaps public health crises on that sort of scale, correlate with SAD?

Dr. Paul Desan:

Well, you know, during the COVID years we had a clear increase in the number of patients seeking help for various forms of psychological distress. Well, people's lives were disrupted, people's income was disrupted, people were home rather than going outside, so on all kinds of different ways things were worse. Well, when it comes to human mood, it all adds up. I think. When someone is under special stresses, I'm sure that adds in and the seasonal change in mood is potentiated and is even more intense. So I think that could be a psychological effect from all of the increased stress that we all went through in those years.

Dr. Paul Desan:

Could also be a physiological effect. For example, before COVID, people got up in the morning, they drove to work. They're exposed to bright light. On the other hand, during the COVID years they're working from home, or maybe unemployed, not out of bed in the morning, exposed to less light. So there could have been a direct physiological effect. It's hard to separate all of these things, but you know, the fact that an environmental variable like light can have so much effect on us should make the public health specialists start to worry about the changes in climate that we're going to be seeing. To what extent does temperature affect the human organism. We already know there are studies about changes in temperature over days and weeks and peaks in the incidence of suicide and onset of depression and so forth. What we should learn from seasonal affective disorder is to take the natural environment seriously.

Frederick Rivas-Georgi:

Absolutely yes, and you preempted our next question. I mean, with the changing climate it'll be really up to see how changes in sunlight and weather patterns more generally will lead to the manifestations of SAD in the population. I suppose also changing gears as well. We've talked about the importance of light therapy and the importance of just having lights in preventing, as Rosenthal did in his fascinating experiment. Do we know of any other current therapies for those affected by seasonal affected disorder?

Dr. Paul Desan:

Well, the most important therapy for seasonal affective disorder is exposure to bright light, first thing in the morning. So there's been a number of experiments since Dr Rosenthal's initial work how to make light therapy simpler. He's exposing people to light for several hours in the morning, several hours in the evening. That's not practical for the average patient, but the research suggests that bright light is very powerful and it's most effective when administered early in the morning. So the consensus of experts who work on seasonal affective disorder we think would support an initial suggestion that someone with seasonal affective disorder should get 30 minutes of exposure to 10,000 lux of light before 8 am, 7 days a week. Now they may begin getting some benefit within a few days, but it might take a few weeks to get the full benefit.

Dr. Paul Desan:

The importance of bright light is that bright light seems to work more intensely than dim light. So 10,000 lux is like being outdoors in July in midday. It's quite bright. 10,000 lux for half an hour seems about the same as 5,000 lux for an hour seems about the same for 2,500 lux for 2 hours. Well, you want your patient to be able to do the therapy effectively, so we'd like them to sit in front of a proper device and get that level of bright light for a half an hour, 7 days a week.

Frederick Rivas-Georgi:

We've talked about the importance of having at least half an hour of a very bright amount of light in the day, but you talk about sitting in front of a device. What does that exactly entail for someone being treated for seasonal affective disorder?

Dr. Paul Desan:

In most research the device used for treatment is a metal box called a light box. It's about a foot and a half or two feet wide, with multiple fluorescent tubes, and the patient puts this on the table or counter in front of them. It's nice to have a little stand. Then you have a little more space on the counter, it's somewhat easier to be closer to it, and that's a research grade device. And the problem is that the government doesn't regulate this kind of light therapy at all. So if you go to Amazon, you can buy very good, high quality boxes that will make 10,000 lux at a comfortable distance, 15 or 20 inches over a space of a width of a foot foot and a half, and it's relatively easy to sit in front of a device like that at a comfortable distance, move your head back and forth a little bit. You want the patient to be able to do this on a practical basis for half an hour every morning, so you want them to be able to eat breakfast, look at their phone, read the paper, whatever they do in the morning.

Dr. Paul Desan:

The problem is, you go to Amazon, you're going to find some devices that are very good. You're going to find some devices that are just garbage. They're too dim and they're too small to really be a practical light treatment device for SAD. Now, if you hold your eyes six inches away, yeah, you might get 10,000 lux and you don't move your eye at all, but that's not a practical 10,000 lux light box. You'd like the government to regulate things. We did a very large research project involving subjects in the United States, canada and the Netherlands. I think we showed very good treatment efficacy for a light treatment device. We went to the FDA and the FDA said great, we'd approve this if you brought us a second trial to duplicate your results. Well, you know, we didn't have the kind of funding to do that.

Dr. Paul Desan:

When a drug company makes a drug that costs $150, $200 a month or more, and someone's going to take this month after month, years on end. They're talking about a billion dollars worth of sale. They can put millions into research. On the other hand, a light box you buy it once it lasts for decades. There's not the same level of money and that means that there's not the same level of detailed research that would impress the FDA. When you're a central regulator like the FDA, you want to set your standards high because you don't want to approve a drug or device that doesn't work or isn't safe. But, on the other hand, if you set your standards so high, you may not approve anything, and then anybody can go online, put up an ad and say I'm selling a 10,000 lux light box. That's the crisis that the American consumer is in now. They don't know which way to turn.

Frederick Rivas-Georgi:

Our.

Dr. Paul Desan:

Winter Depression Research Clinic. Website at.

Dr. Paul Desan:

Yale that does show the results of some of our research. This is research that's peer reviewed. Independent scientists have studied what we did and agreed that it's valid. We don't have any financial stake. What we did is obtain over two dozen types of light boxes and measure them with spectrophotometers and proper scientific methodology to rate. Did they meet the standards that experts in seasonal affective disorder think a device should meet as a treatment for seasonal affective disorder? We found only a handful of devices sold really are effective devices we would recommend.

Dr. Paul Desan:

Anyone who wants to see this can look at the Winter Depression Research Clinic at Yale. You can search that phrase and you'll get to our site and look at the tab how to obtain a light box. You can also go to the tinyurlcom slash SAD information all one word and that'll take you to our website. I think this is the first time that objective scientific measurements were made on a range of commercial products and I'm happy to say that a lot of clinicians seem to use our website as a guide to which commercial devices can produce an adequate intensity of light at a comfortable distance, over a reasonable side-to-side range, without being glaring or distinguished by hot spots or uncomfortable glare.

Frederick Rivas-Georgi:

Well, given, then, that the government hasn't really been funding research as much and there's still a general lack of regulation, can we talk about how the insurance companies have reacted to the rise of interest in researching as well as treating seasonal affective disorder? Say, if I were interested in buying a light box, perhaps would the would our insurance companies moving towards taking this seriously as a real public health risk?

Dr. Paul Desan:

Well, some insurance companies will fund purchase of a light treatment device if you get the proper documentation from your doctor. It varies from company to company. You know an insurance company really should pay for light therapy because the alternate therapy is to take antidepressant medications. Now, antidepressant medications work well for seasonal affective disorder in some people. Our experience is most people want to try light first, but some people they just don't like the light therapy.

Dr. Paul Desan:

They don't find it very convenient, or the light therapy doesn't work that well for them, and so they end up taking an antidepressant medication. Well, in the long run that's going to cost the insurance company more, so we think it is forward-looking and a positive development that some insurance companies will cover purchase of a light treatment device.

Fareed Salmon:

You talked extensively about light therapy. Are there other more possible treatment options for lighted depression, or is light therapy the more dominant or recommended option?

Dr. Paul Desan:

Well, we think light therapy should be the first recommended option. The second option is antidepressant medications. Several antidepressants have been shown to work and in research studies and in the clinical experience of experts in this field. One kind of therapy I do want to emphasize it does not work and that's vitamin D. So it's a common misperception.

Dr. Paul Desan:

Vitamin D has been studied as a treatment for seasonal affective disorder. Not as much research as we'd like, but there isn't good evidence that it works, whereas when people get exposed to proper light they get better much quicker. They get better quickly. So we really think light is the right modality. Incidentally, of the light box that you use for treating seasonal affective disorder does not emit UV Radiation. It would be very dangerous to have a light box You're gonna look at emitting UV radiation. So we're quite certain the link box is not causing your body to make vitamin D. Vitamin D is made by ultraviolet light in the skin, but it's important on a public health level to understand that for the vast majority of patients, vitamin D likely has absolutely nothing to do with seasonal affective disorder.

Frederick Rivas-Georgi:

I Suppose. Then, on the topic of therapy therapy, of course, you know most people and most research has been done, particularly into its manifestation within winter, which, of course, is why you know the importance of get out, of Having a lot, receiving lots of light, is important, but for the, for the group of people that perhaps, as we mentioned earlier, might, might have summer or spring SAD, what possible treatment options exist for them? Of course, like light in those times of the year isn't a mess, isn't necessarily a hard thing to come by compared with winter.

Dr. Paul Desan:

You know there's not a lot of solid data so it's hard for us to give explicit treatment recommendations about the other group of patients who get summer SAD. Some people think that temperature is much more of a trigger factor, that it's not increased light in the summer but increased temperature in the summer. There have been some efforts to treat summer seasonal affective disorder with environmental interventions. So the obvious intervention is what people want to cool or Temperature and expose them to more darkness at the beginning, in the end of the photo period, and some of these initial studies have shown some effect. But I don't feel as confident giving people advice about summer seasonal affective disorder.

Fareed Salmon:

What are like the non-symptoms of you know uh summer depression?

Dr. Paul Desan:

Well, that's been what we studied. Summer depression is probably not quite as distinct. When we talked about winter seasonal affective disorder, we talked about Symptoms that are particularly marked in terms of lethargy, withdrawal, increased appetite, weight and sleep.

Frederick Rivas-Georgi:

This doesn't seem to happen to the same extent with summer seasonal affective disorder. You know, I suppose you know there's you, there's been a you know you've emphasized the fact that we just don't have, you know, talking about summer SAD, for example, we just don't have the research but, in general getting a more a look as SAD as a whole.

Frederick Rivas-Georgi:

I mean, where would you like to see the research go in the future? And, ian, are there Perhaps field studies which you think would be important, or perhaps should, should researchers also try to, you know, figure this out in a, you know, let's say, a wet lab environment? I mean, where do you, where do you see the research going in the next couple of years, or where would you like to see the research go?

Dr. Paul Desan:

well we know that the chemistry the brain changes during the winter. There's slower turnover. Serotonin, for example, which is a molecule that is in some ways is linked to human mode, obviously very complicated relationship. We haven't established what the chemistry of mood is in the brain. Despite decades of research. We still haven't established that is probably a complex network property rather than a simple level of any neurotransmitter.

Dr. Paul Desan:

So there has been work about how the pathways carry information from the eye to the limbic system, to the emotional parts of the brain. A Big breakthrough, for example, was that the rods and cones don't seem to be involved. There are brightness sensitive ganglion cells in the eye that project directly to the hypothalamus and other structures in the brain and it seems that these special projections have some kind of ability to influence our neurochemistry. This story is evolving so we'll have to get back to you on that. There's even some research that Dan Orrin and myself and others have contributed to that light may affect blood and compounds in the blood to create gaseous neurotransmitters like Nitrous oxide, and these may diffuse into the body circulation and, of course, the. The blood that comes out the back of the eye envelops the Carotid artery going up to the brain, so the brain may be Exactly the recipient of these signals, so it may be quite complex. The nature has different ways of sending signals to the brain. I'd love to see more research about how how Light has a connection with mood.

Fareed Salmon:

It's simply not established, it's very interesting how Gaseous neurotransmitters and the brain are topics of current research that is being conducted. In relation to that, what do you believe the government should be doing to address his own depression and how do you believe it should also address socio-economic disparities with seasonal depression?

Dr. Paul Desan:

well, the first concern that I have is that race and ethnicity has seldom been studied in research studies. It's hard to believe research studies Simply haven't paid enough attention. Now we do see African-American individuals living in northern latitudes presumably have a genetic origin near the equator but have quite strong seasonal affective disorder. So we know that seasonal affective disorder occurs in people of all races, but whether there are differences in the incidence of the pattern or the response to therapy we simply don't know. I think that the research establishment, the funding mechanisms from the government, are starting to insist that that's race and ethnicity of gender to, for that matter, be studied in an equitable fashion.

Fareed Salmon:

Yeah, taking into account all these different contributors to social determinants is very important indeed in upcoming research, I guess. To Round up on the interview today, I wanted to ask what is one thing that you want people to get from seasonal depression? There's like one thing People should get from this episode. What should it be?

Dr. Paul Desan:

Well, you know, I really want people to understand about seasonal affective disorder and its treatment. I think it's a major public health problem. I see people in the clinic who come in and say my life shuts down for months every winter and this occurs year after year and I've been to many doctors and nobody knows what to do about it. And we start the patient on a very simple, natural kind of therapy. Bright light first thing in the morning completely changes their life. So in very northerly latitudes like Sweden or Alaska, a lot of people know about this and you can buy a light treatment device in a drug store. Even buildings have bright rooms specifically so people can get more light in the morning. They put bright lights in bus stops so people can get light treatment first thing in the morning.

Dr. Paul Desan:

But in the United States seasonal affective disorder is not that common, even in northerly latitudes in the United States. So there isn't as much knowledge. And of course, a lot of people tend to say well, everybody feels a little worse in the winter. What's the big deal? Well, what I'm telling you is if you have significant changes in how you feel during the winter, it's not your imagination and if it's really affecting your life, you should seek treatment.

Frederick Rivas-Georgi:

No, thank you so much For your work, dr Desan, and for researchers like you, I think, tearing the veil, as it were, on these topics, there's a lot of stigma or, as you say, disregard for people who, oh, you know, you just need to, as you said, oh, everyone feels worse during the winter. But this is a real thing, and thank you for your work and your colleagues' work. This is absolutely should be taken as seriously as any other form of mental illness.

Dr. Paul Desan:

I'm always happy to get an invitation from journalists and other kinds of media content generators.

Frederick Rivas-Georgi:

I think we really have to get the word out about seasonal affective disorder and its treatment All right, so why don't you Thank you so much? You know you understand you're quite busy, thankfully, so I mean it's an immense privilege on our part to have been able to interview you. Thank you so much again. This is Frederick Rivas, georgie from Health Voices. Health Voices is a podcast produced by Spheri Salmon and Sahil Chabra with support from the Yale PhD Vice President, dylan Kim, and the entire PhD board. If you have any questions about the podcast or would like to be featured in an episode, please email us at YalePhcPodNews at gmailcom. That is, yalephcpodnews at gmailcom. Thanks again for listening today.