Seasonal Affective Disorder in Children and Adolescents

Seasonal Affective Disorder (SAD), known colloquially as seasonal depression and winter blues, has become more widely discussed in recent years. Despite this increase in awareness, the discussion about SAD, its symptoms, and how to deal with it primarily focuses on adults. Children and adolescents can also be affected by SAD, and while the presenting symptoms can be different, dealing with SAD is no less difficult for children.

The most recent version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) uses the following criteria to identify or diagnose depression with a seasonal pattern:

• Depression that begins during a specific season every year for at least two years
• Depression that ends during a specific season every year for at least two years
• No episodes of depression during the season in which you experience a normal mood for at least two years
• Many more seasons of depression than seasons without depression over the lifetime of your illness

When most people think of depression in general, they think of how it presents in adults: depressed mood, tearfulness, lack of pleasure in activities, low energy, feelings of worthlessness, etc. In children and adolescents, however, the symptoms of depression may look a little different.

For instance, rather than overt feelings of sadness or observed tearfulness, children and adolescents may be irritable or aggressive. Rather than being identified as fatigued, children or adolescents experiencing a depressive episode may be pegged as “lazy” by their parents or teachers. The diminished ability to think or concentrate or indecisiveness we see in adults with depression may be viewed as being off-task and disruptive at school in children and adolescents.

This misidentification of children and adolescents with SAD as being lazy, disruptive, or irritable may be even more common. If a child is displaying these symptoms year-round, parents and teachers may find it easier to identify depression as the underlying cause. On the other hand, a child who only displays these symptoms from November to March may be seen as a child who just doesn’t like school and isn’t putting in the effort.

Some studies suggest that between 1.7% and 5.5% of 9–19-year-old children may have SAD (Swedo et al, 1995), while others estimate that 10–20% of adult recurrent depression cases follow a seasonal pattern (Magnusson, 2000). What causes some people to develop symptoms of depression only during certain times of the year?

The specific cause of SAD has not been identified, but several factors are theorized to be at play, including one’s own biological clock (circadian rhythm), serotonin levels, and melatonin levels.

Circadian Rhythm

This theory posits that the decrease in the amount of sunlight in fall and winter may be the cause of fall/winter-onset SAD because the decrease in sunlight disrupts the body’s internal clock. A red flag for this in children and adolescents is sudden oversleeping in the fall and winter months with no such issues in the spring or summer.

Serotonin Levels

Reduced sunlight can cause a drop in serotonin production in the brain. Serotonin is a neurotransmitter associated with mood, and many studies have shown that reduced serotonin can lead to a depressed mood.

Melatonin Levels

This theory is related directly to the circadian rhythm theory, and it suggests that decreased light in the fall and winter disrupts the balance of melatonin in the body, leading to feelings of fatigue. Normally melatonin peaks at bedtime and reduces throughout the day, but a decrease in sunlight can disrupt this pattern, leading to more melatonin during the day.

The symptoms of SAD are particularly prevalent during the fall and winter months, when the days get shorter and the amount of sunshine each day decreases. For many children and adolescents, the sun may just be coming up as they are heading to school and starting to set once they get home. This can be a problem particularly for children and adolescents living furthest from the equator, in locations such as New England, Canada, and the United Kingdom.

What can you do if you suspect SAD may be the cause of your child’s irritability, fatigue, and poor concentration at school?

Get Them Moving

Exercise increases energy levels and leads to more restful sleep. For children and adolescents with SAD, exercise can help counter the effects of melatonin disruption, and several studies have shown that exercise boosts serotonin production.

Go Outside

Take advantage of what sunshine you can, especially on the weekends. Even if it’s cold, the sunshine will still help restore your child or adolescent’s circadian rhythm. Just remember that even if the sunshine is minimal, sunscreen is still a must (and don’t forget to bundle up)!

Eat Healthy

Many adults talk about craving comfort food when the days get short and the weather turns cold. Sometimes this leads to not-so-healthy choices. For your and your kid’s sake, focus on healthy eating during the fall and winter months. Eating fruits and vegetables that are in season will help you ensure that you get the hearty foods we are designed to crave during the cold months without turning to unhealthy alternatives. Proper fuel can do wonders for energy. Incorporating foods that are high in Omega-3 fatty acids is also a good way to help fight SAD. Some studies suggest that SAD is less common in those who consume more Omega-3 fatty acids, such as Icelandic people, who eat plenty of coldwater

Bring the Light to Them

If exercise, going outside, and eating healthy aren’t enough to combat the effects of SAD, light therapy may be a great non-pharmaceutical option. Light therapy consists of sitting close (usually within 18–24 inches) to a special light box for around 30 minutes a day, right after waking up. These boxes, which have become less expensive over the past decade, provide light intensity around 100 times brighter than usual home lighting and about one-fifth as intense as the light on a particularly sunny day. To get the positive effects, you need to have your eyes open, but don’t look directly at the light. This may be a great time for your children to finish up homework from the night before.

While light boxes can be a great option, it is important to consider several factors:

• Get a box designed to treat SAD. Not all light boxes are created equal
• Consider brightness; the brighter the box, the less time you’ll need in front of it, but a box that’s too bright will make sitting in front of it uncomfortable
• Light boxes to treat SAD should be designed to filter UV rays for your safety
• Some commercially available light boxes emit blue light, while most emit white light. The effectiveness and risk of each can vary, so do your research to find the one that is best for you
• Talk to your doctor. While light boxes are generally considered safe, some conditions make the use of a light box inappropriate. Always discuss your treatment plan with your doctor, and find out if he or she has recommendations

While SAD in children and adolescents can lead to fatigue, irritability, and an inability to concentrate, there are many ways to combat the winter blues