Seasonal Affective Disorder (SAD) in children and teens

[David Baxter PhD]

Seasonal Affective Disorder
July 21, 2004
KidsHealth.org

Maggie started off her junior year of high school with great energy. She had no trouble keeping up with her schoolwork and was involved in several after- school activities. But after the Thanksgiving break, she began to have trouble getting through her assigned reading and had to work harder to apply herself. She couldn't concentrate in class, and after school all she wanted to do was sleep. Her grades began to drop, and she rarely felt like socializing anymore. Even though Maggie was always punctual before, she began to have trouble getting up on time for school and was absent or late many days during the winter.

At first, Maggie's parents thought she was slacking off. They were upset with her, but they figured it was just a phase - especially because her energy finally seemed to return in the spring. But when the same thing happened the following November, and Maggie's mood and her grades plummeted again, they took Maggie to the doctor, who diagnosed her with a type of depression called seasonal affective disorder, or SAD.

What Is Seasonal Affective Disorder?
A form of depression that follows a seasonal pattern, seasonal affective disorder (SAD) appears at the same time each year and disappears at the same time each year. With SAD, a person typically experiences symptoms of depression as winter approaches and daylight hours become shorter. When spring returns and the days become longer again, a person with SAD experiences relief from their symptoms, returning to a normal mood and energy level.

What Are the Symptoms of SAD?
Like other forms of depression, the symptoms of SAD can be mild, severe, or anywhere in between. Milder symptoms interfere less with someone's ability to participate in everyday activities, but more severe symptoms can interfere much more.

The symptoms of SAD are the same as those of depression, but simply occur during a specific time of year. It's the seasonal pattern of SAD - the fact that symptoms occur only for a few months each winter (for at least 2 years in a row) but not during other seasons - that distinguishes SAD from other forms of depression.

Symptoms of SAD may include:

• Changes in mood - sadness, irritability, and/or feelings of hopelessness or worthlessness most of the time for at least 2 weeks; tendency to be more self-critical and more sensitive than usual to criticism; crying or getting upset more often or more easily
• Lack of enjoyment - loss of interest in things that are normally enjoyable; feeling like tasks can't be accomplished as well as before; feelings of dissatisfaction or guilt
• Low energy - unusual tiredness or unexplained fatigue
• Changes in sleep - sleeping much more than usual (which can make it difficult for children with SAD to get up and get ready for school in the morning)
• Changes in eating - craving simple carbohydrates (i.e., comfort foods and sugary foods); tendency to overeat (which could result in weight gain during the winter months)
• Difficulty concentrating - more trouble than usual completing assignments on time; lack of usual motivation (which can affect school performance and grades)
• Less time socializing - spending less time with friends, in social activities, or in extracurricular activities[/list:u]
  The problems caused by SAD, such as lower-than-usual grades or less energy for socializing with friends, can affect self-esteem and leave people feeling disappointed, isolated, and lonely - especially if they don't realize what's causing the changes in energy, mood, and motivation.
  
  What Causes SAD?
  It's believed that with SAD, depression is somehow triggered by the brain's response to decreased daylight exposure. How and why this happens isn't yet fully understood. Current theories about what causes SAD focus on the role of sunlight in the brain's production of certain key hormones that help regulate sleep-wake cycles, energy, and mood. Two naturally occurring chemicals in the body, melatonin and serotonin, are currently thought to be involved in SAD.
  
  Melatonin, which is linked to sleep, is produced in greater quantities when it's dark or when days are shorter. Increased production of melatonin can cause sleepiness and lethargy. Serotonin production increases with exposure to sunlight. Low levels of serotonin are associated with depression, so increasing the availability of serotonin helps to combat depression. Shorter days and longer hours of darkness in fall and winter may cause increased levels of melatonin and decreased levels of serotonin, the combination of which may create the biological conditions for depression.
  
  Who Gets SAD?
  About six in every 100 people (6%) experience SAD. Although SAD can affect children and young teens, it's most common in older teens and young adults, usually starting in the early twenties. Like other forms of depression, females are about four times more likely than males to develop SAD, as are people with relatives who have experienced depression. Individual biology, brain chemistry, family history, environment, and life experiences may also make certain individuals more prone to SAD and other forms of depression.
  
  The prevalence of SAD varies from region to region, and it's far more abundant among people who live in higher latitudes. For instance, one study found the rates of SAD were seven times higher among people in New Hampshire than in Florida, suggesting that the farther someone lives from the equator, the more likely they are to develop SAD. Interestingly, when people who get SAD travel to lower latitude areas during winter where there is more daylight, they don't experience their seasonal symptoms.
  
  However, most people don't experience seasonal depression, even if they live in areas where days are shorter during winter months. Why certain individuals are more likely to experience SAD isn't yet fully understood. It may be that certain people are more sensitive than others to the variations in light, and therefore may experience more dramatic shifts in hormone production depending on their exposure to light. Research into the cause and mechanisms involved in SAD continues, as does research into why some people are more likely than others to experience SAD.
  
  How Is SAD Treated?
  Treatment for SAD, which varies depending on the severity of the symptoms, includes:
  Increased Light Exposure - Because the symptoms of SAD are triggered by lack of exposure to light and tend to go away on their own when available light increases, treatment for SAD often involves increased exposure to light during winter months. For someone with mild symptoms, it may be enough to spend more time outside during the daylight hours, perhaps by exercising outdoors or taking a daily walk. Full spectrum (daylight) lightbulbs that fit in regular lamps can help bring a bit more daylight into your home in winter months and might help with mild symptoms.
  
  Light Therapy (or phototherapy) - Stronger symptoms may be treated with light therapy involving the use of a special stronger light that simulates daylight. A special light box or panel is placed on a tabletop or desk, and the person sits in front of the light for a short period of time every day (45 minutes a day or so, usually in the morning) with their eyes open, glancing - not staring - occasionally at the light (to work, the light has to be absorbed through the retinas). Symptoms tend to improve within a few days in some cases or within a few weeks in others. Generally, light therapy is used until enough sunlight is available outdoors. Some mild side effects of phototherapy might include headache or eyestrain.
  
  Lights that are used for SAD phototherapy must filter out harmful UV rays. Tanning beds or booths should not be used to alleviate symptoms of SAD. The ultraviolet rays emitted by tanning beds can damage skin and cause wrinkles, age spots, and even lead to skin cancer such as melanoma. Phototherapy should be used with caution if your child has: another type of depressive disorder, skin that's sensitive to light, or medical conditions that may make his or her eyes vulnerable to light damage. Be sure to discuss any of these situations with your child's doctor. Like any treatment, phototherapy should be used under the supervision of your child's doctor.
  
  Medication (or pharmacotherapy) - Medications, which might be used in combination with talk therapy and light therapy, may be prescribed for a child or a teen with SAD and should be monitored by a doctor. Antidepressant medications help to regulate the balance of serotonin and other neurotransmitters in the brain that affect mood and energy. Be sure to let your child's doctor know about any other medications he or she may be taking, including over-the-counter or herbal medicines, which could interfere with prescription medications.
  
  Talk Therapy (or psychotherapy) - Helping to ease the sense of isolation or loneliness, talk therapy focuses on revising the negative thoughts and feelings associated with depression. Talk therapy can also help people with SAD to learn about and understand their condition as well as learn what to do to prevent or minimize future bouts of seasonal depression.
  
  What Parents Can Do
  If you suspect your son or daughter has SAD, talk to your child's doctor about your concerns. Doctors and mental health professionals make a diagnosis of SAD after a careful evaluation. A medical checkup is also important r to make sure that symptoms aren't due to a medical condition that needs treatment. Tiredness, fatigue, and low energy could be signs of another medical condition such as hypothyroidism, hypoglycemia, or mononucleosis. Other medical conditions can cause extreme fatigue or changes in appetite and sleep.
  
  When symptoms of SAD first develop, a parent may mistakenly think that his or her child is slacking off or not trying. It's not uncommon for parents to attribute low motivation, energy, and interest to an intentional poor attitude. Learning about SAD can help parents understand another possible reason for the changes, easing feelings of blame or impatience with their child or teen.
  
  Parents are sometimes unsure of how to discuss their concerns and observations with their child or teen. The best approach is usually one that's supportive and non-judgmental. Opening the discussion (using your own words) in the following way may be helpful: "You haven't seemed yourself lately - you've been so sad and grouchy and tired, and you don't seem to be having much fun. It seems like you've been feeling kind of worn out and exhausted - like you just can't get enough sleep. So, I've made an appointment for you to get a checkup. I want to help you to feel better and get back to doing your best and enjoying yourself again."
  
  Here are a few things you can do if your child or teen has been diagnosed with SAD:
  • Participate in your child's treatment. Ask the doctor how you can best help your child.
  • Help your child understand SAD. Learn about the disorder and provide simple explanations. Remember, concentration might be difficult, so it's unlikely your child will want to read or study much about SAD - recap the main points for him or her if symptoms are strong.
  • Encourage your child to get plenty of exercise and to spend time outdoors. Take a daily walk together.
  • Find quality time. Spend a little extra time with your child - nothing special, just something low key that doesn't require much energy. Bring home a movie you might enjoy or share a snack together. Your company and caring is the key ingredient. It's helpful to provide personal contact and a sense of connection.
  • Be patient. Don't expect symptoms to go away immediately. Remember that low motivation, low energy, and low mood are part of SAD - it's unlikely that your child will respond cheerfully to your efforts to help.
  • Help with homework. You may have to temporarily provide hands-on assistance to help your child organize assignments or support your child in completing work. Let your child know that concentration problems are part of SAD and that things will get better again. Kids and teens with SAD may not realize this and may worry that they aren't capable of doing the schoolwork. You may also want to talk to your child's teacher - ask for extensions on assignments until things get better with treatment.
  • Help your child to eat right. Encourage your child to avoid loading up on simple carbohydrates and sugary snacks. Provide plenty of whole grains, vegetables, and fruits. (PsychLinks note: Foods containing onega-3 essential fatty acids (EFAs), which include fish, have also been shown to be helpful.)
  • Establish a sleep routine. Encourage your child to stick to a regular bedtime every day so they can reap the mental health benefits of daytime light.
  • Take it seriously. Don't put off evaluation if you suspect you child may be experiencing depression. If your child has SAD, help your child learn about the seasonal pattern of his or her depression. Talk with your child - and let your child talk about what he or she is experiencing. Reassure your child that things will get better, even though that may seem impossible right now.[/list:u]