For some children, the change in season brings with it a shift in mood. Is it a passing phase, or something more serious? Here’s what you need to know about depression, SAD, and your child.
Depression can be a serious problem for adults and children alike. Regardless of the season, shifts in a child’s mood and/or attitude are not something to ignore or dismiss. What appears to be a teenager’s newly developed bad attitude could actually be a case of depression or, in some instances, Seasonal Affective Disorder.
Seasonal Affective Disorder (SAD) — often referred to as “winter depression” — is a subtype of depression that follows a seasonal pattern. The most common form of SAD occurs in winter, although some people do experience symptoms during spring and summer.
While SAD is almost always talked about in terms of adults, children and adolescents are not necessarily immune. “SAD might exist among children, but it has not been well studied,” says Eve Spratt, M.D., MSCR, associate professor of pediatrics and psychiatry at the Medical University of South Carolina. “I am not aware of any evidence-based studies that have examined SAD rates or treatment in children.”
A Season’s Symptoms
SAD usually develops in a person’s early 20s, and the risk for the disorder decreases as you get older. SAD is diagnosed most often in young women, but men who have SAD may suffer more severe symptoms. People with a family history of SAD or those who live in northern latitudes where daylight hours during winter are shorter are at a higher risk for developing SAD.
As winter approaches, 10 to 20 percent of us begin to suffer mild symptoms of SAD. We are saddened by the shortening days, climb into bed earlier and resent waking up when the morning light grows dim. For 14 million Americans, these symptoms grow considerably worse as winter progresses.
People with SAD may crave comfort foods, including simple carbs such as pasta, breads, and sugar. With excess unhealthy calories and a lack of fresh fruits, vegetables, and whole grains, fatigue often sets in. They may become depressed and irritable. Eventually, they are no longer able to maintain their regular lifestyle. They may withdrawal socially and no longer enjoy things that used to be fun. It’s as if a person’s batteries have just run down. For parents, SAD can obviously have a sharp impact on the ability to be an effective parent.
Children and adolescents can also suffer these symptoms. They may experience feelings of low self-worth and hopelessness. Children with depression struggle to concentrate on their schoolwork. Their grades may drop, worsening feelings of low self-esteem. Symptoms that last more than two weeks are cause for concern.
Spring and summer SAD is characterized by anxiety, insomnia, irritability, and weight loss. The symptoms more closely resemble mania than depression.
No Known Cause
Researchers have not pinpointed what causes SAD. There is some evidence pointing to a disruption of a person’s “circadian rhythm” — the body’s natural cycle of sleeping and waking. As the days shorten, the decreasing amount of light can throw off the body’s natural clock, triggering depression. Sunlight also plays a role in the brain’s production of melatonin and serotonin. During winter, your body produces more melatonin (which encourages sleep) and less serotonin (which fights depression). Researchers do not know why some people are more susceptible to SAD than others.
“In general, SAD is a better-recognized disorder in adults because so many children’s mental health disorders emerge over time,” says Dr. Spratt. “Diagnosing SAD in a child is not easy, because determining the pattern of depression takes time. A doctor will typically attempt to determine whether a child is suffering from depression or anxiety first, then look at the pattern over time.”
In order to diagnose SAD, doctors need to perform a medical exam to rule out other possible causes of the symptoms, such as hypothyroidism, hypoglycemia, or mononucleosis. Doctors can administer questionnaires to determine mood and also to look for a seasonal pattern. “It’s difficult to diagnose children with depression in the first place, because it often presents as irritability, and they have a hard time understanding terms like ‘sad mood’ or ‘feeling blue,’” says Dr. Spratt. She points out that one of the most telling markers of depression in children is anhedonia — which means “absence of pleasure.” “So a good screening question to ask children is, ‘When was the last time you had a really good time?’”
Several effective treatments can help adult sufferers of SAD. Simply bringing more sunlight into your life can treat mild cases. Spend time outdoors everyday, even on cloudy days. Open window shades in your home. Exercise regularly and eat a healthy diet, one low in simple carbohydrates and high in vegetables, fruit, and whole grains.
Researchers at the New York State Psychiatric Institute at Columbia University suggest using a “dawn simulator,” which gradually turns on the bedroom light, tricking the body into thinking its an earlier sunrise.
People with SAD sometimes find that their symptoms go away when they travel in or move to more Southern latitudes. If possible, plan a mid-winter family vacation in a sunny climate.
As with adults, depression in children can be addressed effectively. “Depression is very treatable with medication and therapy,” says Dr. Spratt. “There are several evidence-based studies showing that cognitive behavioral therapy is effective in treating depression in kids.”
For severe cases of SAD in adults, several treatment options exist. The most common treatment is light therapy. Patients sit for up to three hours in front of strong light boxes or wear light visors, with UV rays filtered out. However, light therapy is not recommended for children, says Dr. Spratt. “I know of no evidence-based studies showing light therapy to work for children, and I have never recommended it for children,” she says.
When to Medicate?
Left untreated, SAD can lead to serious complications for adults, including suicidal behavior, problems at school and work, and substance abuse. If other treatments prove ineffective, prescription antidepressants may help regulate the balance of serotonin and other neurotransmitters that affect mood. Antidepressants, however, come with a “black box” warning about the risk of suicidal thoughts and behavior. Parents with children on antidepressants need to be vigilant in watching for agitation, anxiety, or insomnia and make sure they continue to see their physician on a regular basis.
Dr. Spratt points out that a recent analysis of 27 studies published in the Journal of the American Medical Association found that the benefits of using antidepressant medication to treat major depressive disorder outweighed the risks. But the benefits were more limited in younger patients. “In children younger than 12, only fluoxetine (Prozac) showed benefit over placebo,” she says.
Working Through It Together
Parents of children with depression should participate in their child’s treatment and recovery. Learn about the disorder and share what you learn with your child. Make sure your child completes his treatment everyday, no matter what form your doctor prescribes.
Plan low-key quality time together. Your child won’t have the energy for an arcade, but reading a book or playing a family board game can be fun. Encourage your child to get exercise and spend time outdoors. Plan daily walks together. Fix healthy meals for your family, and establish a set bedtime to ensure he gets enough sleep and the same amount of sleep every night.
Your fatigued child will probably need help with his homework. Take time to work through schoolwork together, and communicate your child’s situation to his teachers. Be patient with your child and reassure him that these issues will get better.
Whether noticing symptoms of SAD in yourself or depression in your child, take it seriously. Treating this disorder early and diligently can turn the dark days of winter into a pleasant time of togetherness for your family.
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This article was featured in Healthy Children Magazine. To view the full issue, click here.