At this time of year, we hear a lot about Seasonal Affective Disorder (SAD) and its impact on adults, but children can also suffer from SAD and its symptoms, including depression, irritability and sleep disruption that occur only during the winter months. Laura Henrichs Cardella, MD, a UR Medicine psychiatrist who is board-certified in Psychiatry and Child and Adolescent Psychiatry, spoke to us about how parents can spot the symptoms of SAD in children and the treatment options that can help.
SAD in children and teens
What is Seasonal Affective Disorder (SAD)?
Seasonal Affective Disorder is a form of depression in which episodes of depression recur during the winter months and resolve completely during the spring and summer.
Can it affect children?
Yes it can, but it is more likely to start in adolescence. As with many mental health disorders affecting children and adolescents, there is still a need for more studies to further understand how SAD impacts youths.
How many children are estimated to have this condition?
One study suggests that the frequency of SAD in youths increases with age; it was diagnosed in 1.7 percent of sixth-graders, increasing in frequency up to 5.5 percent of high school seniors. In addition, in the high school groups, girls were more likely than boys to be affected, which is similar to typical depression.
What are the signs a child may have SAD?
The signs and symptoms of SAD are the same as signs of depression, but these symptoms will resolve in the summertime. Symptoms of depression in youth include prolonged (more than 2-week) periods of sadness, tearfulness, irritability, anger, or hostility. Depressed children may exhibit decreased interest in activities, boredom, or less enjoyment of previously favorite activities. They may express hopelessness, low self-esteem, and guilt. With Seasonal Affective Disorder, adolescents may feel the need to sleep more, have less energy, and eat more (especially craving carbohydrates). Additionally, children with depression may start to isolate themselves more from friends and family. They may be absent more from school and grades might start to slip. One of the most concerning symptoms of depression include thoughts or expressions of suicide or self-destructive behavior.
It is important to try to differentiate SAD from other causes of depressed or irritable mood, including non-seasonal major depression, adjusting to the stress of the school year, being cooped up inside during the winter months, as well as medical causes of depressed mood, like hypothyroidism or low vitamin D levels. In addition, an occasional sad mood, especially in response to a stressor, is expected and can be quite normal.
If a parent has SAD, is it more likely his or her child(ren) will have it?
Having a parent with SAD does increase the risk of SAD in children, but it is certainly not inevitable.
Are there other factors that make a child more prone to having SAD?
Risk factors for SAD include a history of depression, a family history of depression, living further from the equator, female gender, as well as a history of early life trauma or stress.
Will a child outgrow the problem or is it life-long?
While there is an increased risk of future episodes, there are certainly things that kids and parents can do to avoid future episodes.
Are there lifestyle changes that can make a difference?
There are many things parents can do to help their children through this. Help your child to understand what is happening, be open to talking about how she is feeling, and try to find quality time to spend together. It does not have to be anything more than sitting together. One of the best things parents can do to help their child is to validate, reflect, and empathize what she is feeling. (“It sounds like things have been really tough for you lately. It also sounds very frustrating. Thank you for telling me. We’re in this together.“) This will give her a space where it feels safe to share. Being a parent who listens, reflects and tries to understand is a wonderful gift you can give your child.
SAD can improve with proper self-care. As is the case with maintaining a healthy body and mind, getting the proper amount of sleep is very important. School-age children (6- to 12-year-olds) should get 9 to 11 hours of sleep and adolescents should get between 8 and 10 hours of sleep. Eating a well-balanced diet is also important. People with SAD crave carbohydrates, so it is important to include other forms of healthy nutrition and to avoid excess sugar.
Getting outside as much as possible during the winter months is also very important. It is thought that SAD may be caused by hormonal shifts that occur when light exposure decreases in the winter months. Outside exercise provides extra light exposure. This is like hitting two birds with one stone, because there is some evidence that mild to moderate exercise improves depression. Exercise can also help to reduce stress and improve sleep.
What medical treatments are available for children?
Light therapy is often recommended for treatment of SAD in adults, and a small study showed that bright light therapy is helpful for youths with Seasonal Affective Disorder. Light therapy involves using an artificial bright light device and sitting in front of it while doing other activities such as reading, writing or eating a meal. You should not look directly at the light, but at surfaces that the light illuminates. Early-morning sessions are recommended, lasting 30 to 120 minutes, depending on the intensity of the light. Bright light therapy has been associated with some minor side effects, such as headaches and eye strain. There is a potential risk when using it in the setting of bipolar disorder, as there is a small risk of mood switch. Those who have recurrent SAD have found that using the light therapy every morning during the winter months keeps them from developing symptoms of SAD.
If the depressed mood continues after lifestyle adjustments are made, a referral for psychotherapy would be the next step. Cognitive Behavioral Therapy and Interpersonal Psychotherapy have been found to be helpful for depression in youths. Occasionally, the addition of an antidepressant is recommended.
When should you consult a pediatrician about the problem?
If there are safety issues that you are made aware of, such as suicidal thoughts, it is imperative to contact your child’s primary care physician. If your child’s functioning is impacted, either at school, home, or with friends, it is also a good time to call. Certainly, if your child asks to talk with their doctor, making an appointment will send the message that
Dr. Laura Cardulla
you care and will help them through this.
Laura Henrichs Cardella, MD, is a UR Medicine psychiatrist who is board-certified in Psychiatry and Child and Adolescent Psychiatry
