Winter blues or something more serious?

Each winter you might notice a dip in your child's mood and a change in their behavior, and then witness them return to being themselves again once springtime hits. You might even experience these seasonal changes yourself.

Nicholas J. Westers, Psy.D., ABPP, clinical psychologist at Children's Health℠ and Associate Professor at UT Southwestern, says there is a condition that may be impacting your family's emotional health during the winter months.

"A lot of people express disappointment with the decreased amount of daylight during the winter months,” says Dr. Westers. "However, when that disappointment turns into other behaviors, it could be more than just the winter blues. It could be depression. And if it occurs around the same time every year, it could be seasonal affective disorder, or SAD.”

Seasonal affective disorder symptoms

SAD is a form of significant depression with a seasonal pattern, sometimes occurring during the summer months, but most often during the winter months (November through February).

Common symptoms of SAD include:

• Excessive sleepiness and difficulty waking up in the morning
• More than two weeks of significant sadness or irritability
• Increased social withdrawal and isolation
• Craving for carbohydrates
• Decrease in energy
• Weight gain

Seasonal affective disorder in children and adolescents

Although the typical age of onset is around 20 years old, even young children can experience SAD. SAD typically occurs less frequently in children and adolescents than in adults, but as many as 3-4% of children and adolescents may suffer from symptoms. Many adults with SAD report their first episode started when they were younger than 18.

Although women are significantly more likely to experience SAD than men, boys have slightly higher rates than girls during childhood. As children grow older, rates of SAD increase for both boys and girls, but once they hit puberty, adolescent girls are at greater risk of developing SAD and have higher rates than adolescent boys.

In addition to the symptoms listed above child and adolescent SAD typically includes sleeping more, having more difficulty waking up in the morning than usual, and performing poorly in school. Dr. Westers explains that unlike adults, children are often unaware of these seasonal changes and may act out behaviorally rather than verbally articulate their feelings.

SAD is more common in the north where there are fewer hours of sunlight in the winter than in the south (e.g., about 1% of people in Florida compared to about 9-10% in New Hampshire). Since SAD is rarer in the south, individuals might be less likely to recognize it or seek help.

What causes SAD?

There is still a lot to be learned about SAD, especially in children and adolescents. Even so, most research points to a disruption in the sleep-wake cycle where fewer hours of daylight cause an increase in the hormone melatonin, which typically peaks during darkness and helps promote sleep. The sleep-wake cycle gets out of sync with sunlight and darkness and increased daytime melatonin can contribute to depressive symptoms.

Furthermore, the brain chemical serotonin, which is typically associated with feelings of happiness, often declines during winter months. Decreased serotonin, coupled with an increase in melatonin and an out-of-sync sleep-wake cycle, can cause depression during the winter months.

What should I do if I think my child is experiencing SAD?

By definition, depression and SAD cause a disruption in day-to-day functioning. If your child is feeling more than just sad or stressed because of exams or the holiday season, and you notice them sleeping more, not being able to get up for school, getting lower grades than normal, withdrawing from friends and snapping back at you with more irritability and poorer mood than usual, you should consult a mental health professional.

If it was like this last year around this time (and maybe even the year before), your child could be suffering from SAD. If this is the first time this has happened, then it could be significant depression or even the beginning of SAD.

Treatment for children experiencing SAD

Parents can start by encouraging their children to play outside during daylight hours. Physical activity and exercising outdoors during the day might be enough to improve symptoms. If this does not seem to work, parents should consider the following treatment options:

1. Light therapy

One of the quickest ways to improve symptoms of SAD, even in as little as a few days, is using a light box. These can be purchased online or in some stores, and they can be used at home for as little as 30 minutes a day (preferably in the morning). However, once they stop being used, depressive symptoms can return just as quickly as they left.

2. Cognitive behavioral therapy (CBT)

Recent research on CBT for SAD with adults, which focuses on changing thoughts and behaviors to positively impact feelings and improve symptoms, has suggested that light therapy and CBT are each effective at addressing SAD, but that CBT had a better effect two years later.

3. Antidepressant medication

If light therapy or CBT do not seem to help, medication may help alleviate symptoms.

Additional resources

• Kids Health: Seasonal Affective Disorder
• Health Central: Seasonal Affective Disorder in Children
• American Academy of Pediatrics: Winter Blues and Seasonal Affective Disorder