Islanders are almost twice as likely as residents in the rest of Massachusetts (or the U.S.) to suffer from depression — about 14 percent of the residents of Martha’s Vineyard struggle with it. Over the next several months, The Martha’s Vineyard Times will feature stories of Vineyarders with various types of mental illness.
At least once a month, Dr. Charles Silberstein, psychiatrist at Martha’s Vineyard Hospital, will write a column that directly addresses issues Islanders have with mental health. This is his first column.
Why do I always feel blue in the winter? I don’t want to go on an antidepressant. Do light boxes really work? How do I choose one? Is there anything else that I can do?
During the first hour of every evaluation, I ask whether seasonal mood changes occur. Often the answer is “no,” or even, “I like the dark days of winter.” And often, I hear this: “Doesn’t everyone feel lower in the winter?” Well, the answer is that about 20 percent of people will experience some seasonal blues. About 6 percent of us will experience more severe mood changes, or seasonal affective disorder (SAD). The American Psychiatric Association regards SAD as a variant of major depressive disorder and bipolar disorder. SAD occurs in about 1.4 percent of people in Florida, and about 9.9 percent in Alaska. Though there is some controversy about this, there appears to be a direct relationship between latitude and incidence of SAD; women are about four times as likely to get it. Being younger, having a mood disorder, and having a family history are all factors that increase the risk.
What causes it?
The exact mechanism is unknown, but it appears to be triggered by the decreased seasonal light. While cold weather, winter isolation, and underemployment no doubt contribute to the winter blues, they are not the cause of SAD. It appears that the excessive production of melatonin which occurs in dim light or darkness, as well as a different pattern of serotonin regulation, may be factors. People with SAD need much more light than others to inhibit the brain’s production of melatonin. And some people with SAD may have trouble making enough Vitamin D.
What to do?
I appreciate your preference not to go on medication. Medications all have side effects and unknown long-term consequences. While ultimately that may be necessary in more severe cases, starting with more natural treatments probably makes more sense. Here are my suggestions:
- Get a light box. Light is a powerful antidepressant. In a recent research study, light therapy was found to be as effective as Prozac at treating nonseasonal depression. If you search for “seasonal light box” at Amazon, a bunch pop up. The most important thing is that the box is 10,000 lux. Full-spectrum bulbs provide a nice light, but the important ingredient is light intensity. You will see blue and white lights. It is unclear if one is superior. Some people find the blue lights tend to be more stimulating. Beyond that, the choice is mostly stylistic. Some people want a small portable light, others might want a desk lamp. There is even a light visor that can work while people move around.
- Sit close to the light — 16 to 24 inches. There is an exponential dropoff in light intensity with distance from the light. Just think about how light fans out from its source. The closer you sit, the more intense and therefore effective the light is. Most people use it in the morning. Others use it twice a day. Some people find that it really helps evening energy when used late in the day. One word of caution: Bright light interferes with the production of melatonin — the sleep hormone. If you use it late in the day, it may interfere with sleep.
- Get your vitamin D level checked, and if it is low, take Vitamin D supplements.
- Get psychotherapy. Cognitive therapy has been studied for SAD, and it works. Other therapies have been studied for depression, and they are quite effective as well.
- Consider a negative air ionizer in your bedroom. Negatively charged particles in the sleep environment can help mood and SAD.
- Consider medication. Serotonin reuptake inhibitors like Zoloft, Celexa, Lexapro, Prozac, and a bunch of others are probably the most effective medication for SAD. Others, such as Wellbutrin and Provigil, may help as well. Medication can be safe, easy, and effective.
Here are some other suggestions that are less well studied but make common sense for anyone with the blues:
- Spend time with caring, comfortable, low-conflict friends and family. We are tribal animals, and benefit from being with others.
- Keep a neat and organized home and work space.
- Get enough sleep. (I will write about sleep in another column.)
- Exercise! Especially outdoors in daylight.
- Get enough omega-3 fatty acids in your diet. Eating fatty fish twice a week may suffice.
- Sex and love — giving and receiving — of course are also powerful and pleasurable mood enhancers.
Have an ill family member? Connect with help at Family to Family
Living with mental illness is difficult, and so is living with the mentally ill. Family to Family, a free program administered by the National Association for Mental Illness (NAMI), teaches people how to communicate with their mentally ill family members. The next program starts on the Vineyard on Jan. 12, 2017, and runs once a week for 12 weeks.
The Family to Family course was launched 25 years ago by Joyce Burland, a clinical psychologist in Florida whose sister had a mental disorder. According to a press release, Ms. Burland was sick and tired of hearing that bad parenting caused mental illness — she knew she and her sister had had loving parents.
A major goal of the course Ms. Burland went on to create is to remove the stigma that accompanies mental illness and to help people understand what is happening to their loved ones. It addresses the genetics of illness, and describes brain function and the areas affected by different disorders. The curriculum includes an introduction to the symptoms of the major illnesses and the medications used to treat them.
The teachers are also family members of people with mental illness; participants are encouraged to tell stories of their own experience. Families are often taken by surprise by the emergence of symptoms, which often occurs in a person’s late teens or early 20s. Often, people suffering from a mental illness refuse to acknowledge they have a problem. Family to Family aims to give people the skills they need to move a family member beyond this state of denial and support them in getting and help.
Participants form bonds, and exchange information.
“When you are in the class,” one parent graduate told The Times, “you see other people in a situation similar to the one you’re in. You feel like it’s you against the world, but not while you’re in that class. It brings [mental illness] out from behind closed curtains. It’s been around a long time; it’s time to talk about it. [The course] helped me a lot getting my son through school. I schooled the teachers from what I learned.”
One graduate reported benefiting from the breadth of the curriculum: “Learning about co-occurring disorders [a.k.a. dual diagnosis] interested me the most. We knew that substance abuse could be a form of self-medication for something about life that wasn’t going right. We did not know that 50 percent of the time, substance abuse went hand in hand with mental illness.”
To register for Family to Family, call Daryl at 508-627-5249 or Peggy at 508-693-5872.