Depression during a bleak midwinter is serious

Publisher’s Note: This has been one of the hardest winters on the Island in memory. What’s made it uniquely difficult is a string of local tragedies that descended upon the Island at the start of the winter and that were followed by unusually frigid temperatures and a harsh set of winter storms. And now it can feel like this week’s blizzard, well, just buried us all.

Faced with digging out from under two feet of heavy snow for many days and spring nowhere in sight, we wanted to highlight what can be serious psychological conditions and physical challenges that can accompany bleak midwinters like this one. One condition is known as seasonal affective disorder, or SAD. 

We are fortunate on this Island to have access to mental health counseling for this malady, and at The Times we are fortunate to have the regular contributions of Dr. Charles Silberstein, medical director at the Island Counseling Center within Martha’s Vineyard Community Services, to help us understand it. We would like to offer excerpts from an essay by Silberstein from 10 years ago that feels as relevant as ever. Now as then, Silberstein wants our readers to remember that 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. And, he added, SAD is still very prevalent although there are successful treatments for it that seem to be improving in recent years. 

This week, Silberstein said, “I have been having great success with light visors. Some people just can’t sit still long enough for the light box. I recommend the Luminette 3. For full SAD, I usually recommend one hour per day of light therapy … I hope my previous writing will help people understand what they are going through and know treatment is always evolving, and that help is available.” 

By Charles Silberstein 

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 that 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 pops 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.

Dr. Charles Silberstein is a psychiatrist on staff at Martha’s Vineyard Hospital and at Island Counseling Center, where he is the medical director. He is board-certified in general, addiction, and geriatric psychiatry. He writes regularly about issues Islanders have with mental health.This essay was first published in The Times on Dec. 28, 2016, and excerpts are being reprinted with permission. You can read the full essay online here: https://www.mvtimes.com/2016/12/28/mind-deal-seasonal-depression/.

Mental health services on Martha’s Vineyard are primarily provided through Martha’s Vineyard Community Services (MVCS), offering counseling, psychiatric services, and specialized support for children, adults, and seniors. For immediate crises, the MVCS Island Intervention Center provides urgent, walk-in care and 24/7 support. 

Emergency Mental Health Crisis Services (24/7)

• Martha’s Vineyard Community Services Crisis Line: 508-693-7900.
• Massachusetts Behavioral Health Hotline: Call or text 877-382-1609.
• Crisis Intervention (MVCS): Provides triage, brief interventions, and assessments for urgent needs.

Martha’s Vineyard Hospital Emergency Room: For severe, immediate, or acute mental health emergencies.