Winter Blues 

When we “fall back” for daylight saving time this Sunday at 2 a.m., most Vermonters will enjoy an extra hour of sleep and then grouse about the earlier sunsets.

But for people like Burlington’s Sue Smith, the time change is a tick toward the dark depression that once left her nearly incapacitated. “I wanted to crawl into a corner,” says Smith (who agreed to speak with Seven Days using a pseudonym) about autumn’s light-dwindling days. “I lost my appetite, my interest in work and my ability to focus. I’d avoid reading the paper, watching the news — the gloomy weather and the gloomy life and stressful circumstances became even more gloomy and stressful.”

Smith suffers from seasonal affective disorder, or SAD, a condition once dismissed as the “winter blues” but now considered a form of severe depression. Thanks to Vermont’s climate and distance from the equator, the Green Mountain State has among the highest rates of Smith’s so-called “gloom.”

According to the University of Vermont’s Kelly Rohan, an associate professor of psychology and a leading researcher on SAD, about 1 percent of Floridians suffer from the disorder. In northern states, that number jumps to 9 or 10 percent of the population who are “depressed emotionally, losing interest in the things they normally enjoy, [having] difficulty concentrating, feeling guilty or worthless, or gaining or losing at least five pounds,” says Rohan.

There can be thoughts of death and suicide, too — and researchers still aren’t able to pinpoint why SAD happens. “One theory is that our body’s circadian rhythms may become delayed, but exactly how this leads to depression isn’t clear,” says Rohan. “Another theory is that maybe people with SAD are like circadian mammals who hibernate in winter.”

Some northern Vermonters are already using light therapy to help them emerge from the SAD cave. Now, on the heels of her seminal study published in the September issue of Behavior Therapy, Rohan is looking for local SAD sufferers to participate in a study on how resetting our minds through cognitive therapy can offset the resetting of the clock. “The general public is more aware of SAD [than before], and health and mental-health providers are more aware of it,” says Rohan. “But we’re looking at the long-term outcome ... how we can permanently change that maladaptive pattern of thinking and retreating.”

That retreat can happen at any point from the end of summer into January, says Rohan; typically, the worst months are January and February. For longtime Vermonter Tom Ayres, the malaise begins in August each year. “Labor Day is my least favorite holiday,” he says, “because it marks the entry into what I ruefully call ‘the dark side.’”

Ayres says he first noticed SAD symptoms in 1994, when he’d bolt awake in the middle of the night and couldn’t get back to sleep — a biorhythm interruption accompanied by drowsiness, lethargy and inertia. Instead of self-diagnosis and self-treatment — common practices among the public, says Rohan — Ayres consulted his doctor, who prescribed light therapy.

Exercise can help stave off SAD symptoms, as can improved eating habits and some nutritional supplements. But nothing, believe many SAD sufferers, beats basking in the artificial rays of a 10,000-lux light box.

Available since the 1960s, these boxes mimic natural outdoor light and have proved to be one of the most effective natural treatments for SAD. Some insurance companies will even cover them with a prescription. When Smith’s niece was diagnosed with SAD about 10 years ago, the Burlington resident realized the illness might run in the family, and she decided to seek treatment for her own symptoms. While she now takes an antidepressant and notes that “a one-week break in Puerto Rico can really charge the batteries,” Smith swears by the rays she receives from her newly adjusted windows and a light box.

“I feel like I’m managing it now,” says Smith, who goes for 20 to 30 minutes of light therapy daily. “I don’t feel like I’m hiding all winter. I can go out and do my regular activities.”

Ayres, meanwhile, depends on 45 minutes of exposure to his light box each day to ensure normal energy levels and sound sleep. “It’s pretty dramatic how finely tuned to the light my system seems to be, and how noticeable the symptoms are when I don’t get the light,” he says.

But light therapy remains a short-term fix for SAD on which patients become dependent, and that has led Rohan to examine an alternative — specifically, cognitive therapy. The study she just published in Behavior Therapy compares light therapy treatment with cognitive behavior therapy, a combination of the two and a wait-list control. Rohan and her team of researchers found that those who underwent cognitive group therapy for twice-weekly, 90-minute sessions over six weeks were “significantly less depressed at one year than the light therapy group.”

Meanwhile, the authors write, light therapy “appears to be best classified as a palliative treatment in that it tends to suppress SAD symptoms as long as it is continued throughout the typically symptomatic months, but it does not alter the course of the underlying disorder once it is discontinued.” While 36.7 percent of people treated with light therapy had a SAD recurrence one year later, only 7 percent of the cognitive behavior therapy group felt depression again, and at less severe levels.

In short, unplug the light box and you unplug the solution to SAD, but cognitive therapy rewires the whole system. “It changes the person,” Rohan says. “They are different in how they think about and cope with winter. They know how to fortify themselves against a relapse.”

Cognitive therapy is actually simpler than it sounds. “This is about getting people out,” says Rohan. “Literally, anything outside of hibernating — if you like outdoor exercise, great. But it could be indoor activities, anything that’s fun. Maybe you can become interested in the arts, painting, indoor gardening; ways to grow herbs and to coax bulbs to bloom if you have the patience. Social activities.”

Thanks to a $2 million, five-year grant from the National Institute of Mental Health, Rohan is planning to follow 160 adult participants over two years, comparing just light therapy and cognitive behavior therapy (without combination therapy). She calls it the “Cadillac” version of the trial, and hopes it will give Vermonters like Smith and Ayres a smoother ride through the dark days of winter.

Simply waiting and watching the clock isn’t an option for those at northern latitudes. As Rohan says of sufferers who don’t seek professional treatment for SAD, “It will be mid-March before you begin feeling better.”