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 her
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, SAD appears
and disappears at the same times each year. People with SAD
typically experience symptoms of depression as winter approaches
and daylight hours become shorter. When spring returns and the days
become longer again, they experience relief from the symptoms and a
return to a normal mood and energy level.
Signs and Symptoms
Like other forms of depression, the symptoms of SAD can be mild,
severe, or anywhere in between. Milder symptoms minimally interfere
with someone's ability to participate in everyday activities,
while 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
kids 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 or extracurricular
activities
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 6 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 they 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 causes and mechanisms of
SAD continues, as does research into why some people are more
likely than others to experience SAD.
Treatment
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 (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 or weeks. 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 doctor. Like any treatment,
phototherapy should be used under a doctor's supervision.
Medication (Pharmacotherapy).
Medications, which might be used in combination with talk therapy
and light therapy, may be prescribed for a child or 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 doctor know about any other medications your child
takes, including over-the-counter or herbal medicines, which could
interfere with prescription medications.
Talk Therapy (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
Talk to your doctor if you suspect your child has SAD. Doctors
and mental health professionals make a diagnosis of SAD after a
careful evaluation and a checkup to ensure that symptoms aren't
due to a medical condition that needs treatment. Tiredness,
fatigue, changes in appetite and sleep, and low energy can be signs
of other medical problems, such as hypothyroidism, hypoglycemia, or
mononucleosis.
When symptoms of SAD first develop, it's not uncommon for
parents to attribute low motivation, energy, and interest to an
intentional poor attitude. Learning about SAD can help them
understand another possible reason for the changes, easing feelings
of blame or impatience with their child or teen.
Parents sometimes are unsure about how to discuss their concerns
and observations. The best approach is usually one that's
supportive and nonjudgmental. Try opening the discussion saying
something like, "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 - if so,
just recap the main points.
-
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 are important and 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 complete work. Explain that
concentration problems are part of SAD and that things will get
better again. Kids and teens with SAD may not realize this and
worry that they're incapable of doing the schoolwork. You may
also want to talk to the teachers and 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.
-
Establish a sleep routine.
Encourage your child to stick to a regular bedtime every day to
reap the mental health benefits of daytime light.
-
Take it seriously.
Don't put off evaluation if you suspect your child has SAD.
If diagnosed, your child should learn about the seasonal pattern
of the depression. Talk often about what's happening, and
offer reassurance that things will get better, even though that
may seem impossible right now.
Reviewed by:
D'Arcy Lyness, PhD
Date reviewed: February 2007
Note: All information is for educational purposes only. For specific medical advice,
diagnoses, and treatment, consult your doctor.
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