Seasonal Affective Disorder – prevent it now

The days are getting shorter, the nights are getting cooler. The trees are flecked with red and yellow, and there are parking spaces on Main Street in Vineyard Haven — fall has officially arrived on Martha’s Vineyard.

For many people, autumn is a time to savor the resplendent New England foliage, to become reacquainted with their favorite sweaters, and to look forward to cozy times by the fire.

But for people with Seasonal Affective Disorder (SAD), the change of season can bring on a sinking, ominous feeling that, left untreated, can spiral into a paralyzing winter depression.

“Seasonal Affective Disorder is a common syndrome,” Tom Bennett, psychologist at Martha’s Vineyard Community Services, said in an email to The Times. “Most people with SAD have Major Depressive Disorder, but up to 20 percent may have Bipolar Disorder.”

Depending on the severity of the depression, symptoms of SAD can include: fatigue, excessive sleeping, carbohydrate and sugar cravings, decreased sexual interest, lethargy, hopelessness, irritability, lack of concentration, social withdrawal, and suicidal thoughts.

New Englanders are particularly prone to the condition with the exceptionally apt acronym. Prevalence of SAD in the U.S. ranges from 1.4 percent in Florida, to 9.7 percent in New Hampshire, according to a study by the Uniformed Services University of the Health Sciences, in Bethesda, Maryland.

“There is a linear relationship between latitude and percentage of people with Seasonal Affective Disorder,” said Dr. Charles Silberstein, attending psychiatrist at Martha’s Vineyard Hospital. “It’s a straight line.”

Although there is no statistic for SAD on the Island, according to the Martha’s Vineyard Health Conditions and Status report, clinical depression here is roughly double the national average — as high as 17 percent, compared to 8 percent nationwide. A recent study by the Massachusetts Department of Public Health also found that the suicide rate on the Cape and Islands for people 15 to 24, and for middle-aged men, is double the state rate.

A long winter on a wind-whipped Island in the North Atlantic brings additional depressive triggers: it means more isolation as favorite restaurants and gathering places are shuttered and entire neighborhoods become ghost towns. It means businesses shutting down and employment drastically dropping off. It means stretches of cold, gray days that are only a few gradients lighter than night. For an Islander with SAD, just the prospect of winter can send them into the abyss, where they can stay until well after the Dairy Queen re-opens.

But there are proven techniques that can mitigate, and possibly fend off a seasonal slide.

Let there be light

The key trigger for SAD is daylight, or the lack thereof. As sunlight wanes, the body can produce less serotonin, which can trigger depression. Melatonin levels can also drop, which can have negative effects on sleep patterns and mood.

“Light therapy is a safe, effective preventative against Seasonal Affective Disorder,” Dr. Silberstein said. “Studies have shown that spending at least 20 minutes a day in front of a light box is extremely effective.”

Dr. Silberstein stresses that for those predisposed to SAD, the time to start light therapy is now. “It’s really important to start using the light box as soon as the days begin to shorten. If you wait until your mood changes, it’s harder to get out of it, the same as clinical depression,” he said.

Studies have shown that light therapy can also act quickly — people tend to respond within four to seven days to light therapy, as compared with antidepressants, which can take four to six weeks to kick in.

Morning is the optimum time for light therapy. It triggers serotonin production for the day ahead and it can also increase production of melatonin that night. Using a light box at night can be counter productive, however, because it reduces melatonin production the same way that computers and television do.

There is a multitude of SAD light boxes available in the Internet, ranging in price from $40 to well over $400. “Most of the price differences are due to stylistic reasons and portability,” Dr. Silberstein said. “You can get a perfectly fine light box for $40 or $50.”

The main consideration in a light box is that it has to be 10,000 lux, which is the equivalent of a bright sunny day. “A common misconception people have is that they have to stare at the light. That’s not the case,” said Dr. Silberstein. “They can read the newspaper, eat breakfast, or read a book. What is important is that the light hits your eyes. There’s a pathway from the retina pineal gland that produces melatonin, which is closely related to serotonin, which helps fight depression. You should be about 15 to 20 inches away from the light. There’s an exponential drop off in effectiveness as you move farther away from it.”

Dr. Silberstein said the light box has also been shown to alleviate conditions besides SAD, including PMS and the garden variety winter blahs.

Take a hike

“When I’m talking to people who seem to be getting blue as winter approaches, I push them to get walks every day, so they get light, and they exercise at the same time,” said Sumner Silverman of Vineyard Haven, a psychologist with 43 years experience who’s lived on the Island year-round since 2005. “Getting out in the sunlight sets the diurnal mechanism, which helps you sleep at night. And when you get out and walk, you can take in the scenery of this beautiful place where we live.”

“Exercise, exercise, exercise,” said Dr. Silberman. “I tell that to all my patients with depression. It makes a huge difference. The evidence is overwhelming.”

A quick look at the Calendar section of The Times shows a wide assortment of activities available to Islanders that can get the heart pumping and that can pump up the spirits. For someone wrestling with depression, getting out of the house can be a herculean effort, but the structure of a regular gathering can help get them out the door, and what is equally important, both experts said, is to be in the company of other people.

Step away from the carbs

A distinctive symptom of SAD is excessive, sometimes ravenous craving for sugar and carbohydrates, which can create a depressing cycle of weight gain and increased lethargy. “There’s a seasonal cycle that produces craving for fats and carbohydrates, which only makes sense going into winter,” said Mr. Silverman. “However, in modern times we don’t have to store fat for the winter famine. Binging on these foods can lead to deeper depression.”

Dr. Silberman recommends a diet high in Omega three fatty acids, and low on refined sugar, alcohol, refined flour, simple starches, and low in animal fat. “I’ve seen lots of people over the years who have told me that they feel altogether better when they change their diet.” he said.

“Folate and Vitamin B12 have been shown to help the body make more serotonin,” said Josh Levy of Vineyard Nutrition in an email to the Times. “You can find these vitamins in lentils, beets, oatmeal, eggs, low-fat dairy, wild salmon, and fortified breakfast cereals. Vitamin D can be tough to get from the sun during the New England winter months. To increase your intake of Vitamin D, try including low-fat milk, fortified soy milk, and eggs into your diet.”

Stinkin’ thinkin’

“Obviously there’s some people [with SAD]who will require medication and therapy,” said Mr. Silverman. “But for many of my patients, we focus on the attitudinal part. You can look at winter as being a bummer or look at it as a time that is very cozy. Winter can be a time to follow a passion that you didn’t have time for during the summer. Winter on the Island is two-edged sword. You only really become an Islander when you’ve spent a few winters here. There’s a bonding aspect to that which you don’t often get in a big city.”

Mr. Silverman also noted that winter is a period of festivals and celebrations. “It’s a time when good memories can be made and stored,” he said. “Social relationships tend to be much more intense in winter.”

A recent study at the University of Vermont concluded that Cognitive Behavioral Therapy (CBT) was even more effective than light therapy in dealing with SAD and the benefits lasted longer. CBT is a form of therapy where the depressed individual actively battles their depressive thoughts, in part by writing them down and then challenging them on paper — in a sense, reprogramming the brain over time. It takes rigor, and daily effort, which can be difficult for the depressed, but the results are striking. The seminal book “Feeling Good,” by David D. Burns, M.D., outlines the proven techniques of CBT.

Islanders who battle depression confront some uniquely difficult circumstances. However, they also have a uniquely strong support system available to them. “On the Island, treatment is available from the Martha’s Vineyard Community Services/Island Counseling Center, as well as mental health private practitioners and Primary Care Physicians,” Mr. Bennett said. “I have seen many cases over the years and know that SAD is a very treatable problem.”

Mr. Bennett also stressed that every Islander, regardless of their financial situation, can get help for SAD and depression. “People can come to ICC (Island Counseling Center) who are experiencing financial difficulty. Everyone in Massachusetts is mandated to get health insurance, so lack of financial means should never be an obstacle,” he said. “Our doors are open to everyone.”